Pattern and outcomes of admissions to the Medical Acute Care Unit of a tertiary teaching hospital in South Africa

A research report submitted to the University of the Witwatersrand, in fulfilment for the requirements of the degree of Master of Medicine in the branch of Internal Medicine. Johannesburg 2018.Background A Medical Acute Care Unit (MACU) was established at Chris Hani Baragwanath Academic Hospital (CHBAH) to provide comprehensive medical specialist care to the patients presenting with acute medical emergencies. Improved standards of health care delivery systems at the MACU may result in shorter hospital stay, better outcomes and less mortality. Objectives The objective of the study was to describe the demographics, diagnoses, pattern of diseases and the outcomes, including mortality of patients admitted to the MACU at the Chris Hani Baragwanath Academic Hospital (CHBAH). Methods A record review of 200 patients admitted to the MACU at CHBAH was performed from March 2015 to August 2015. The records were analysed for patient demographics, diagnosis at admission and duration of stay in MACU. The outcome was defined as transfer to the medical ward, Intensive Care Unit (ICU) or discharged home. The main causes of mortality were also recorded. Results Of the 200 patients, 59% were females. The mean age of the patients was 46 ± 17.2 years and the mean duration of stay at the MACU was 1.45 ± 1.25 days. Noncommunicable diseases accounted for 76% of admissions. The most frequently diagnosed conditions included: diabetic ketoacidosis acidosis (DKA) and hyperosmolar non-ketotic (HONK) (17.5%), non-accidental self-poisoning (16%), hypertensive emergencies (9.5%), decompensated cardiac failure (8%) and ischemic v heart disease (7%). Infectious diseases comprised 14% of the diagnoses of which pneumonias were the most common (5%). Most patients (77.5%) were transferred to medical wards, 12% to ICU, while 10% demised at the MACU. The main causes of death included sepsis (25%), DKA/HONK (20%), non-accidental self-poisoning (10%) and cardiac failure (10%). Conclusion Non-communicable diseases particularly diabetic emergencies were the main causes of admission to the MACU at CHBAH. During the study period, high rates of case improvement, patient discharge, shorter hospital stay, and less mortality were observed. The main cause of mortality was sepsis related.LG201

Investigating Elementary Principals\u27 Science Beliefs and Knowledge and its Relationship to Students\u27 Science Outcomes

The aim of this quantitative study was to investigate elementary principals\u27 beliefs about reformed science teaching and learning, science subject matter knowledge, and how these factors relate to fourth grade students\u27 superior science outcomes. Online survey methodology was used for data collection and included a demographic questionnaire and two survey instruments: the K-4 Physical Science Misconceptions Oriented Science Assessment Resources for Teachers (MOSART) and the Beliefs About Reformed Science Teaching and Learning (BARSTL). Hierarchical multiple regression analysis was used to assess the separate and collective contributions of background variables such as principals\u27 personal and school characteristics, principals\u27 science teaching and learning beliefs, and principals\u27 science knowledge on students\u27 superior science outcomes. Mediation analysis was also used to explore whether principals\u27 science knowledge mediated the relationship between their beliefs about science teaching and learning and students\u27 science outcomes. Findings indicated that principals\u27 science beliefs and knowledge do not contribute to predicting students\u27 superior science scores. Fifty-two percent of the variance in percentage of students with superior science scores was explained by school characteristics with free or reduced price lunch and school type as the only significant individual predictors. Furthermore, principals\u27 science knowledge did not mediate the relationship between their science beliefs and students\u27 science outcomes. There was no statistically significant variation among the variables. The data failed to support the proposed mediation model of the study. Implications for future research are discussed

Global and local road traffic injury epidemiology in children and adolescents

Background: Every year around the globe, more than 800,000 children and adolescents under the age of 20 die due to injuries from any cause. Globally, low-and middle-income countries bear a disproportionate 95% of the burden of all childhood injury mortality. There is a paucity of data on all injuries in children and road traffic injuries by type of road users among adolescents particularly from low and middle-income countries. The aim of this thesis is to increase the knowledge on the epidemiology of injuries in children 1-4 years and road traffic injuries in adolescents 10-19 years by type of road users in high-income, upper and lower- middle-income and low-income countries with a focus in Pakistan. Methods: The studies I and II have an ecological study design and used the database by global burden of disease study for the year 2010 and 1990-2019 respectively. The setting for the studies III and IV is Karachi, city of a lower-middle-income country, Pakistan. The study III is a survey of adolescents about their independent mobility and road traffic injuries and the data for study IV are motorcycle injuries from hospitals. Results: The highest injury rate was 94 per 100,000 in low-income countries of Sub-Saharan Africa and the lowest injury rate was 6 per 100,000 in the high-income countries of Eastern Europe/Central Asia (Study I). The reduction in mortality rates of adolescents’ road traffic injuries is more prominent in high-income countries than any other income level from 1990 to 2019. For instance, the mortality reduction in pedestrians 15-19 years in HICs was IRR 0.94 (95% CI 0.90 to 0.98) (Study II). Adolescents who had parental permission to cross main roads alone (adjusted odds ratio 1.39; 95% confidence interval 1.04 to 1.86) and who participated in one or more activities outside the home alone on the previous weekend (adjusted odds ratio 2.61; 95% confidence interval 1.42 to 5.13) had higher odds of road traffic injuries (Study III). Motorcyclists aged 13-17 years (adjusted odds ratio 1.25; 95% confidence interval 1.11, 1.42) and 18-19 years (adjusted odds ratio 1.26; 95% confidence interval 1.10, 1.43) had higher odds of severe injury compared to aged 20-24 years (Study IV). Conclusions: Child injury mortality is unevenly distributed across income level, to the detriment of low-income countries. There are decreasing trends in mortality for all types of road users in adolescents from 1990 to 2019 at all income levels but high-income countries have a larger decrease in mortality rates for all types of road users as compared with any other income level. Adolescents in Karachi who were allowed to cross main roads alone and who had weekend activities on their own were associated with road traffic injuries. In addition, adolescents aged 13-17 and 18-19 years were associated with higher odds of severe road traffic injuries compared to motorcyclists aged 20-24 years in Karachi, Pakistan

Licensing effect in consumer choice

Many real world choices require consumers to make decisions after other choices or judgments. We show that prior choices, which activate and boost the self-concept, are likely to subsequently license more self-indulgent choices. We propose that licensing can operate through an expression of intent to be virtuous, which reduces negative self-attributions associated with the purchase of relative luxuries. Five studies are conducted to illustrate our proposed licensing effect of expressing an initial virtuous intent on subsequent decision to be more indulgent. Consistent with our theory, the preference for an indulgent option diminishes if the licensing decision can be attributed to an external motivation. We also report a mediation analysis in support of our theoretical explanation that the licensing effect operates by providing a temporary boost in relevant self-concept. 2 Imagine a person who is making a choice between two items, one of which is a relative luxury or indulgence. Is this person more or less likely to buy something more self-indulgent if she previously expressed an unrelated altruistic intent? Most choice research focuses on the decision rules by which consumers choose among a set of alternatives, independent of the manner in which they arrive at the choice. In contrast to this focus on single shot decisions

Importance of clinical toxicology teaching and its impact in improving

Objective: To assess the impact of a one-day clinical toxicology workshop in improving knowledge.Methods: A one-day clinical toxicology workshop was conducted as a pre-conference workshop of the Annual Emergency Medicine Conference at the Aga Khan University Hospital, Karachi, in April 2012. The course was composed of poisoning-related common clinical scenarios. The pre-test and post-test understanding was used to assess the impact of the course in improving knowledge. The participants also evaluated the workshop as a whole thorough written evaluation forms. SPSS 19 was ued for statistical analysis of the data.Result: There were 22 participants in the course. The pre-test mean score was 31.6±15.1% (95% CI; 24-40; n=19) compared to the post-test the mean score of 56.0±10.8% (95% CI; 47- 61; n=17). The positive difference was also statistically significant (pConclusion: Short training in clinical toxicology improved knowledge of the participants

Importance of clinical toxicology teaching and its impact in improving knowledge: sharing experience from a workshop

Objective: To assess the impact of a one-day clinical toxicology workshop in improving knowledge.Methods: A one-day clinical toxicology workshop was conducted as a pre-conference workshop of the Annual Emergency Medicine Conference at the Aga Khan University Hospital, Karachi, in April 2012. The course was composed of poisoning-related common clinical scenarios. The pre-test and post-test understanding was used to assess the impact of the course in improving knowledge. The participants also evaluated the workshop as a whole thorough written evaluation forms. SPSS 19 was ued for statistical analysis of the data.RESULT: There were 22 participants in the course. The pre-test mean score was 31.6 +/- 15.1% (95% CI; 24-40; n = 19) compared to the post-test the mean score of 56.0 +/- 10.8% (95% CI; 47- 61; n = 17). The positive difference was also statistically significant (p \u3c 0.001). The overall workshop was evaluated as excellent by 08 (47.46%) and very good by 10 (52.63%) participants.CONCLUSION: Short training in clinical toxicology improved knowledge of the participants

Pediatric congenital heart diseases: Patterns of presentation to the emergency department of a tertiary care hospital

Objective: To observe presentation of Pediatric congenital cardiac defects to the Emergency Department (ED) of a tertiary care hospital in Pakistan.Methods: This is a retrospective chart review of patients under the age of 16 years with congenital cardiac defects presenting to the Emergency Department of Aga Khan University Hospital over a period of eighteen months, from January 2012 to June 2013. Study population was divided into two groups; first group constituted children with undiagnosed congenital cardiac defects, whereas second group constituted children with diagnosed congenial cardiac defects presented to ED. In previously diagnose cases each visit was counted as a separate encounter.Results: Out of 133 children, 44 (33.5%) were diagnosed congenital cardiac disease for the first time (Group-1) in ED, while 89 (66.5%) children were diagnosed cases of congenital heart disease (Group-2). Among Group-1; main reasons for ED visits were cyanosis, cardiac failure, murmur evaluation and cardiogenic shock where as in Group-2; main presentations were cardiac failure, hyper cyanotic spells, gastroenteritis, lower respiratory tract infection, and post-operative issues. There were total 13 deaths.Conclusion: High index of suspicion is necessary for early diagnosis and management of children with congenital heart disease in the pediatric emergency department

Application of geographical information system (GIS) for mapping road traffic injuries using existing source of data in Karachi, Pakistan--a pilot study

OBJECTIVE: To assess the feasibility of using Geographical Information System for mapping of road traffic injuries with an existing data source in a developing country. METHODS: The study was a retrospectives case series of road traffic injury cases registered with the medico-legal office located in the three major trauma centers in Karachi for the period of January 1, 2004 till December 31st, 2004. Spatial data analysis was performed using ARCVIEW 3.1. RESULTS: Out of 3650 of all road traffic injury, only 3% had locations detailed and accurate enough allowing mapping on a GIS map in the first attempt. Even after using detailed town maps and field exercises more than a quarter cases (n=1088; 30%) of road traffic injuries (RTIs) could not be properly located. We identified 25 areas of one kilometer or less in Karachi accounting for 27% of all RTIs. Five corridors of road measuring 27.7 km accounted for 590 (23%) of all RTIs with known locations. CONCLUSIONS: Existing sources of data from the medico-legal system in Karachi failed to provide exact information on crash site. Such datasets can however be used to define high risk areas/neighbourhoods

Causation between Consumption, Export, Import, and Economic Growth of Oman

To examine the causation between consumption, export, import, and economic growth for the Sultanate of Oman using yearly time series data collected from the World Bank for 2000-2018. Further, it was tested by basic statistics, the Bound test with the ARDL model, and the Granger-causality tests. The findings of the Bound test analysis indicate the presence of both long-run and short-run associations among competing variables. The ARDL Model result reflects that imports have both short-run and long-run effects, supported by the Granger Causality tests by indicating the presence of unidirectional causality import to economic growth and import to consumption. The outcome of the study revealed that import is essential for economic growth as imports can absorb foreign technology in the domestic economy that can boost the export and further act as an engine of growth. How to Cite:Khan, U., Khan, A. M., Alam, M. D., & Alkatheery,N. (2022). Causation Between Consumption, Export, Import & Economic Growth of Oman. Etikonomi, 21(1), 67-78. https://doi.org/10.15408/etk.v21i1.20034

Comparison of predictive protocols in chest pain patients in a tertiary care hospital in Karachi, Pakistan

Background: The most challenging aspect in evaluation of a patient presenting with chest pain in the Emergency Department (ED) is diagnosis of acute cardiac ischemia (ACI). Various decisions aids have been developed to aid the ED physician in the diagnosis of chest pain. Three different predictive protocols – the Goldman protocol, ACI-TIPI, and the Troponin protocol are used in predicting the occurrence of ACI. None of these decision aids have been tested in the Pakistani population, where risk factors and prevalence of CAD are much different than what is seen in other regions of the world.Aims: The aim of this study was to compare how three different predictive protocols for ACI fared in the Pakistani population.Methods:This retrospective case series included a consecutive sample of 212 patients who presented to the ED with symptoms of chest pain or its equivalent. Patient data was collected and retrospectively analyzed with each predictive protocol to analyze sensitivity, specificity, PPV, and NPV of each protocol.Results: 63% of patients were diagnosed with ACI. The sensitivities of the Goldman, ACI-TIPI, and Troponin protocols were 94%, 98%, and 38% respectively. The specificities of the Goldman, ACI-TIPI, and Troponin protocols were 14%, 29%, and 95% respectively. Conclusion: Sensitivities from a small sample size show promise in the use of predictive protocols for chest pain in the Pakistani population. However, prospective studies on a larger level need to be conducted to validate these findings