Female Genital Mutilation. Information for Health-Care Professionals Working in Ireland.

AkiDwA, the African and Migrant Women’s Network in Ireland, developed this resource as part of a project funded by the Office of the Minister for Integration, examining the health-care needs of women who have undergone female genital mutilation (FGM) in their countries of origin and who now reside in Ireland. As the project developed in 2008, it became apparent that there were few resources for health-care professionals working in Ireland encountering these women, who may have very specific and urgent health-care needs. As a result of successful collaboration between the Royal College of Surgeons in Ireland’s MSc Women\u27s Health course director and students, and the coordinator of the Migrant Women\u27s Health Services Project in AkiDwA, key information on FGM and related health-care needs was researched and developed. Irish FGM-prevalence statistics were collated during 2008 and are also contained in this resource. It is envisaged that this resource will be useful to a range of health-care professionals in a broad spectrum of possible settings. The removable image sheet is designed to be used with a patient or client to illustrate FGM typologies and FGM prevalence across Africa. This resource would not have been completed without the active participation and assistance of the AkiDwA FGM Health Forum members (listed below), the board and staff of AkiDwA, the significant contribution from the RCSI, and the courageous women who have endured FGM and are seeking supports and services in Ireland

A tabletop exercise approach to global disaster preparedness: insights from Nepal’s first international conference on disaster preparedness and management

Considering recent earthquakes and the COVID-19 pandemic, disaster preparedness has come to the forefront of the public health agenda in Nepal. To strengthen the developing health system, many initiatives are being implemented at different levels of society to build resiliency, one of which is through training and education. The first International Conference on Disaster Preparedness and Management convened in Dhulikhel, Nepal on December 1–3, 2023. It brought together international teaching faculty to help deliver didactic and simulation-based sessions on various topics pertaining to disaster preparedness and management for over 140 Nepali healthcare professionals. This paper focuses on the tabletop exercise-based longitudinal workshop portion of the conference on disaster leadership and communication, delivered by United States-based faculty. It delves into the educational program and curriculum, delivery method, Nepali organizer and US facilitator reflections, and provides recommendations for such future conferences, and adaptation to other settings

Hemoperitoneum among Pediatric Abdominal Trauma Patients Visiting in Emergency Department of a Tertiary Care Centre: A Descriptive Cross-sectional study

Introduction: Pediatric abdominal trauma presents a major challenge for first-line responders in the Emergency Department for assessment and management. The Focused assessment sonography for trauma is a readily available, easy-to-use, and affordable tool for detecting hemoperitoneum during the initial assessment of trauma in the Emergency Department for adult traumatic patients. The aim of this study was to find the prevalence of hemoperitoneum among pediatric abdominal trauma patients visiting the Emergency Department of tertiary care centre through Focused assessment with sonography for trauma examination technique. Methods: This was a descriptive cross-sectional study conducted in the Emergency Department of a tertiary care hospital from 7 April 2019 to 7 April 2020. Among 413 pediatric trauma patients, 93 children (1 to 17 years) admitted to the Emergency Department who underwent focused assessment with sonography for trauma examination were included in the study. Ethical approval was obtained from the Institutional Review Committee (Approval number: 111/19). Convenience sampling was used. Point estimate and 90% Confidence Interval were calculated. Results: Among 93 children receiving focused assessment with sonography for trauma imaging in the Emergency Department with a history of blunt abdominal trauma, the prevalence of hemoperitoneum was 18 (19.34%) (12.61-26.09, 90% Confidence Interval). Conclusions: The prevalence of hemoperitoneum was similar to other studies conducted in a similar setting

Emergency medical dispatcher training as a strategy to improve pre-hospital care in low- and middle-income countries: the case study of Nepal

Abstract Background Low- and middle-income countries (LMICs) often face significant challenges related to providing effective pre-hospital care services. Barriers to providing care include lack of financial resources, poor road infrastructure, lack of trained first responders and ambulance staff, and issues regarding coordination/communication between different entities involved in Emergency Medical Services. Prior initiatives to characterize and improve the state of pre-hospital care in LMICs have largely focused on improving access to high-quality ambulance services by providing training programs to community first responders and ambulance staff on how to recognize and manage key emergency conditions. In this article, we discuss an alternative strategy for improving pre-hospital care: the creation of a context-specific Emergency Medical Dispatcher (EMD) training curriculum and program. Methods We describe the current pre-hospital care setting in Nepal, the process of creating and piloting the Nepal-specific EMD training manual, and the early impact of its implementation. Results The 30-h EMD training was designed, piloted, and revised in collaboration with the three largest EMS organizations in Nepal. The training is now required for all dispatchers at the Dhulikhel Hospital Dispatch Center, one of the largest ambulance dispatch networks in Nepal. Dispatchers are trained in the following knowledge and skill areas: telecommunication guidelines, triaging and documentation procedures, delivery of Basic Life Support instructions to callers, other medical and trauma-condition specific instructions, and limited resource management. The short-term positive impacts of the training’s implementation include improved documentation procedures, better prioritization of ambulance resources, delivery of Basic Life Support instructions to callers, and improved communication between dispatch, responders, and healthcare facilities. Conclusions Context-specific Emergency Medical Dispatch training programs, which aim to optimize the emergency resources available in resource-limited settings, present a promising low-cost, high-impact interventional strategy to strengthen the pre-hospital care systems in low- and middle-income countries. </jats:sec

Emergency Medicine Education and Research in Nepal: Challenges and Opportunities

Emergency medicine (EM) is a young but prestigious medical discipline worldwide.1 However, in Nepal, it is in preliminary phase.2 EM is not only restricted to urban emergency departments but also a multifaceted discipline.3 Several EM training modules are currently practiced fragmented with different curriculum and duration.4,5 Pre-hospital emergency medical services (EMS), hospitals, trauma centres, and public health are working in silos and most of them devoid of proper emergency facility.2 This brought us to the realization of an urgent need of bringing all the stakeholders together in a symposium like this. The symposium was arranged into four different sessions as listed below: • To familiarize with the history and current state of EM from Global Emergency Medicine perspective. • To highlight the different clinical experiences and advancements in EM in Nepal. • To emphasize the importance and possibilities in EM education and research in Nepal. • To discuss the roadmap to develop and establish EM as a recognized medical speciality in Nepal. The overall objectives of the symposium were to discuss the challenges faced by current Emergency Medicine providers and identify the opportunities for the future development and recognition in Nepal. The most important current task for Nepal’s emergency physicians of advocating for policies, programs, and funding to support further development of the specialty was realized. Rural and urban emergency service providers from academic and non-academic institutions, governmental/non-governmental organizations and international medical institutions attended the symposium. General Practice (GP) residents, medical officers, medical students, interns and paramedics were among active participants

Prevalence of Dyspnea among Patients Attending the Emergency Department of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Dyspnea is a common presenting complaint in the emergency department worldwide and a diagnostic challenge for emergency physicians. Our study aims to find the prevalence of dyspnea among patients attending emergency department in our hospital.&#x0D; Methods: A descriptive cross-sectional study was conducted in the emergency department of Dhulikhel hospital from May 2019 to July 2019 after ethical approval from the institutional review committee. Total 1200 samples were collected by consecutive sampling method. All patients were triaged in the emergency department as a part of regular protocol. The participants were included in the study after obtaining an informed consent from the patient or caretaker (if the patient were not able to provide it). Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. The statistical analysis was done using R version 3.5.3 (2019-03-11).&#x0D; Results: The prevalence of dyspnea among patients attending emergency department of a tertiary care hospital was 107 (8.9%) (4.6%-13.2%) at 95% confidence interval. The patients triaged into red, orange and yellow categories were 14 (13.1%), 50 (46.7%) and 43 (40.2%) respectively. Median age was 64 years and 74 (69%) were ≥60 years. Sixty-seven (62.6%) were females and 40 (37.4%) were males. Forty-four (41.1%) arrived by ambulance. Most commonly associated symptoms were cough and fever 59 (51.1%) and 44 (41.1%) respectively. &#x0D; Conclusions: The prevalence of dyspnea among patients attending emergency department of our hospital is higher compared to that of other studies. This warrants structured and prompt management of dyspnea for quality improvement.</jats:p

Retrospective analysis of trauma patients transported by dispatch monitored type B ambulances to Dhulikhel Hospital, Kavre, Nepal, 2019–2023

Abstract Background Timely emergency medical services (EMS) are particularly important among trauma patients, as inefficient EMS systems can result in potentially avoidable death before reaching a hospital. The Dhulikhel Hospital Dispatch Center coordinates and monitors a growing network of ambulances, including seven Type B ambulances staffed with a trained prehospital care provider and medical equipment. This study evaluates the prehospital care and outcomes of trauma patients transported by Type B ambulances to Dhulikhel Hospital’s Emergency Department, as monitored by the Dispatch Center. Methods Data were collected via a retrospective chart review of Dispatch Center records, including patient demographics, injury mechanisms, prehospital care, and outcomes. Patients were included if they experienced physical trauma and were transported by a Type B ambulance to Dhulikhel Hospital’s Emergency Department between 2019 and 2023. Results Between 2019 and 2023, 224 trauma patients were transported to the hospital and received prehospital care services from Type B ambulances monitored by the Dispatch Center. Most patients were male (59%), and nearly half were aged 18–44 (49%). The median total transport time for Dhulikhel Hospital-owned Type B ambulances was 40 min. Type B ambulances reached patients across 24 municipalities (88% in Kavrepalanchowk and Sindupalchowk districts). Falls (55%) and road traffic accidents (30%) were the most common injury mechanisms, followed by physical assault (7%). Falls were significantly associated with female, pediatric, and geriatric patients (p < 0.05), while road traffic accidents predominated among males, particularly in adults aged 25–34 years (p < 0.05). Approximately one-third of patients admitted to the hospital after evaluation in the emergency department experienced multiple injuries, and the most prevalent diagnosis of admitted cases were extremity fractures (52%). Conclusion Trauma cases accounted for 15% (227/1541) of all patients who received transport and prehospital care services from a Type B ambulance monitored by the Dispatch Center between 2019 and 2023. This study demonstrates the critical role of Type B ambulances and an integrated dispatch center in advancing timely and efficient prehospital care for trauma patients in Nepal

Synthesis, characterization and As(III) scavenging behaviours of mango peel waste loaded with Zr(IV) ion from contaminated water

Raw mango peel (RMP) was first saponified to yield saponified mango peel (SMP), which was then loaded with Zr(IV) ions to form a biosorbent for As(III) scavenging.The biosorption behaviors and mechanisms of As(III) scavenging using RMP and Zr(IV)-loaded saponified mango peel (Zr(IV)-SMP) were investigated batchwise. The As(III) scavenging efficiency of RMP increased from 20.13 % to 87.32 % after Zr(IV) loading. Optimum contact time of 6 h has been investigated for As(III) scavenging by Zr(IV)-SMP, and the data on kinetics is well fitted to the pseudo-second-order (PSO) model. Similarly, isotherm data of Zr(IV)-SMP fitted well to the Langmuir isotherm model with the maximum As(III) scavenging potential of 45.52 mg/g. Chloride (Cl−) and nitrate (NO3−) have negligible influence on As(III) scavenging, but sulphate (SO42−) interferes significantly. The exhausted Zr(IV)-SMP could be easily regenerated by treating with 2MNaOH. A mechanistic study indicates that As(III) scavenging is primarily contributed to electrostatic interaction and ligand exchange, which is confirmed from both instrumental and chemical characterizations techniques. Tubewell underground water polluted with a trace amount of arsenic (98.63 μg/L) could be successfully lowered down to the WHO standard (10 μg/L) by applying a small amount of Zr(IV)-SMP. Therefore, the Zr(IV)-SMP investigated in this work can be a low-cost, environmentally benign, and promising alternative for scavenging trace levels of arsenic from contaminated water