Understanding presentations of children with fever to a Sydney emergency department

Background: Fever is a common childhood illness resulting in a potentially high number of presentations to local Emergency Departments (ED). This paper describes the characteristics of these presentations of children, including initial and subsequent diagnosis, disposition from ED and seasonal variations, to inform nursing and other health professionals working within these departments. Methods: The study was conducted at a metropolitan hospital in Sydney, using existing data collected by emergency staff. Data for a 12-month period were extracted from the existing database of all ED presentations. Results: This study demonstrated that the age of the majority of febrile child presentations varied between 13 months and 24 months (53%), and the number of ED visits doubled during the winter months (33%). Most of the child presentations to ED in this study were not urgent (68%). Viral illness, upper respiratory tract infections, and urinary tract infections accounted for 14.9 % of all the ED presentations, with most being discharged to home. Conclusion: This study confirms the continuing pattern of inappropriate presentations to EDs of children with fever. Public education campaigns are needed to reduce these presentations

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

A factorial randomised controlled trial of a health literacy modified children's fever education program for parents attending emergency

Background: Fever in children is one of the primary reasons for parents/carers to become concerned for their child’s health, and to consequently seek medical assistance. Considered to be one of the most frequent complaints in children’s diseases, fever is usually reported to Emergency Departments (ED) and primary healthcare centres. While fever management education can improve the knowledge and practices of parents/carers, there was no education program that specifically caters for parents/carers who have limited health literacy. This study sought to address this gap by developing a health literacy modified fever education program suitable for parents/carers with varying health literacy levels. Aims: The aims of this thesis were to explore fever management presentations within local EDs, and to develop, implement and evaluate the effectiveness of a health literacy modified fever education program for parents/carers. It was envisaged that informed parents/carers would reduce their inappropriate use of emergency services for children with fever. Methods: This thesis was composed of three major phases: Phase 1 related to the development the educational intervention; Phase 2 explored ED presentations of children to the study site; and finally Phase 3 was the conduct of a factorial randomised controlled trial testing the effectiveness of the education intervention in a sample of parents/carers with limited and functional health literacy attending emergency. The setting for Phase 2 and 3 was Campbelltown Hospital, South Western Sydney. In Phase 1 the principles of design of health literacy interventions—defining the scope of health information, using pictorial images and plain language, assessing the readability level using established tools, and confirming the content— were utilised. This was followed by secondary analysis of ED presentations for children with fever (N=1581) which highlighted the frequency and seasonal variation in presentation of febrile children during a twelve-month period (January to December 2011), and the non-urgent nature of most presentations (68%). Finally, a factorial randomised controlled trial (F-RCT) was conducted within Campbelltown Hospital ED. One hundred and fifty-five parents/carers of febrile children aged between six months and five years of age participated in the presurvey (98.1% response rate). Participants’ level of health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine Short Form. All participants were randomly allocated to one of four groups: intervention or control with limited or functional health literacy. The intervention group received a health literacy modified fever education program (brochure and DVD), while the control group received the existing Fever Fact Sheet and DVD currently in use. F-RCT Results: A total of forty-six parents/carers participated in the follow-up survey. There were no differences between the intervention and the control groups in their baseline demographics. The planned contrasts analysis revealed that there was no statistically significant difference between the four groups (parents/carers with limited health literacy intervention group, parents/carers with functional health literacy intervention group, and parents/carers with limited health literacy control group, parents/carers with functional health literacy control group), in any of the outcome measures (p ˃ 0.05). Two group analyses (control and intervention) showed improvement in participants’ fever knowledge (mean difference =1.03, 0.2), anticipated fever management practices (mean difference = 1.07, 0.75), and a reduction in the number of visits to the ED (mean difference = -1.57, -1.15) respectively. However, participants in the control group (who received the Fever Fact Sheet) demonstrated a statistically significant improvement in fever knowledge and anticipated fever management practices, and a reduction in the number of visits to the ED/primary care facilities (p < 0.05). No statistically significant difference was found in the intervention group. Conclusion: Providing parents/carers with tailored, appropriate educational interventions improves their fever knowledge and anticipated fever management practices, and thus reduces unnecessary ED/primary care presentations. The Fever Fact Sheet was found to be effective. Further testing of the health literacy modified fever education program, using instruments with improved reliability, within a larger sample of parents/carers with limited health literacy is recommended. Design techniques used in the development of this health literacy modified intervention are supported. Further qualitative research into why parents/carers with children experiencing low grade fevers, continue to attend ED even when well-informed, is recommended

Mathematical analysis of fractional order alcoholism model

In this manuscript, we are going to study a novel model of the dynamics of alcohol consumption under induced complications. The mentioned model is considered under the concept of conformable fractional order derivative (CFOD). Currently, most of real-world problems are considered under fractional order derivatives because of their stable and global behavior. First, we will investigate the model for qualitative theory including existence and uniqueness of solution and Ulam-Hyers stability. For qualitative theory, we will use fixed point theory. In addition, we use a numerical method to find the approximate solution of the proposed model. In the final part of the paper, we give a detailed discussion of its numerical results and its graphical presentation

The Volterra-Lyapunov matrix theory and nonstandard finite difference scheme to study a dynamical system

A compartmental model is considered to study the transmission dynamics of COVID-19. The proposed model is investigated for different results by using Volterra-Lyapunov (V-L) matrix theory. In this regard, first we presented a modified form of SEIR model by incorporating three new compartments C (protected), D (death due to corona) and Q (quarantined). Both equilibrium points are computed together with basic reproductive number. In addition, local stability of both equilibrium points for our proposed model is examined by assuming that wearing of mask, testing of the unaware infected individuals and medical care of the individuals that got infected should constantly be maintained. Hence, subsequently by combining the V-L stable matrix theory with the traditional methodology of constructing the Lyapunov functions, a procedure for the global stability analysis of COVID-19 is presented. Furthermore, based on LaSalle and Lipschitz invariance principle, the global stability of disease free equilibrium point is also examined. The technique we introduced in this paper will provide the more profound comprehension to understand the basic structure of COVID-19. Moreover, for numerical interpretation of our proposed model non-standard finite difference (NSFD) scheme is utilized for simulations. Different graphical illustrations are provided to understand the transmission dynamics

A fractional approach to solar heating model using extended ODE system

In contrast to fossil fuels, the sun has more than enough energy to supply the entire world's energy needs. The sole constraint on solar energy as a renewable resource is our capacity to efficiently and economically convert it to electricity. In this work, we take advantage of the fractional derivative, we introduce the dynamics of the solar heating model. We incorporated the Atangana-Baleanu derivative (ABC) in our analysis. Then the solutions of our fractional system are investigated for existence and uniqueness. In order to visualize the fractional order model solution, we used a novel and trendy numerical method to represent the dynamics of different parameters of the nonlinear ordinary differential equation system. It is shown that the proposed ODE models are valid and efficient for fractional order data for a functioning solar heating system

Numerical Approximations for the Solutions of Fourth Order Time Fractional Evolution Problems Using a Novel Spline Technique

Developing mathematical models of fractional order for physical phenomena and constructing numerical solutions for these models are crucial issues in mathematics, physics, and engineering. Higher order temporal fractional evolution problems (EPs) with Caputo’s derivative (CD) are numerically solved using a sextic polynomial spline technique (SPST). These equations are frequently applied in a wide variety of real-world applications, such as strain gradient elasticity, phase separation in binary mixtures, and modelling of thin beams and plates, all of which are key parts of mechanical engineering. The SPST can be used for space discretization, whereas the backward Euler formula can be used for time discretization. For the temporal discretization, the method’s convergence and stability are assessed. To show the accuracy and applicability of the proposed technique, numerical simulations are employed

An innovative fever management education program for parents, caregivers, and emergency nurses

Parents frequently present to the emergency department (ED) concerned about their child's fever. Fever management education programs have been found to improve parents' knowledge of managing fever, although no education program was identified that specifically considered parents with lower functional health literacy. This article describes the development of an easily understood children's fever management education program for parents with varying levels of health literacy. A review of existing literature and guidelines was conducted. Pictorial images and written material constrained to fifth-grade level of readability were used. Academics and ED experts confirmed the content of this evidence-based program. The education program, a combination of Digital Video Disc (DVD) and a brochure in relation to child fever management, is currently being trailed at an ED in Sydney and is appropriate for EDs or primary care settings. Tailoring education programs with plain and simple language is potentially beneficial to all parents (or caregivers) presenting to the ED with children experiencing fever. This program will provide nurses with a simple and clear fever management brochure or DVD to give to parents or caregivers with varying levels of health literacy. We envisage that this program will be continuously televised within local EDs and available for parents or caregivers to view online

Measuring health literacy in emergency departments

Background: Literacy and health literacy are important concepts that are related to how important health care messages are understood by patients. Emergency nurses are engaged in health promotion and require an understanding of the patient’s health literacy. To assist emergency nurses in assessing a patient’s level of health literacy a series of valid and reliable health literacy measurement tools have been presented. The aim of this paper is to nominate one of these tools to be used by emergency nurses in testing individual and group levels of health literacy. Methods: Databases searched included Scopus, Science direct, PubMed, PsycINFO and Educational Resources Information Center (ERIC). Included articles were published between 1990 and 2011, English language only, and articles that discussed word recognition tools and tools that take five minutes or less to administer resulting in sixteen articles. Results: The Rapid Estimate of Adult Literacy in Medicine-Short Format (REALM-SF) has been used successfully within an emergency setting to identify patients’ level of health literacy and to supply appropriate health information. This tool was found by nursing staff to be easily administered, and more acceptable when used in private areas. However, further research within varying age groups is recommended. Conclusion: Most of the available tools are related to each other and have the ability to measure varying levels of health literacy. The REALM-SF is a simple quick approach to measuring health literacy in busy clinical settings. Emergency nurses require training in administering these tests in a non-threatening and accurate manner