MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Toxicology / Environmental Injury

J01 OUTCOMES FOLLOWING BRODIFACOUM EXPOSURE REPORTED IN THE TOXIC REGISTRY (2010-2013) B. Hatten 1, J. Westphalen 2, R. Vohra 3, L. Tormoehlen 4, P. Wax 5, J. Brent 1, On Behalf Of Toxic 6 1 Section Of Medical Toxicology, Department Of Emergency Medicine, University Of Colorado School Of Medicine, Aurora, Co, Usa, 2 Denver Health Residency In Emergency Medicine, Denver Health Medical Center, Denver, Co, Usa, 3 Emergency Medicine, Ucsf-Fresno, Fresno, Ca, Usa, 4 Departments Of Neurology And Emergency Medicine, Indiana University, Indianapolis, In, Usa, 5 Department Of Emergency Medicine, University Of Texas-Southwestern, Dallas, Tx, Usa, 6 Toxicology Investigators Consortium, American College Of Medical Toxicology Background: Since 2010, the Toxicology Investigators Consortium(ToxIC) Registry records all clinical consults seen by an international multi-center network of medical toxicologists in a standardized fashion. In recent years, the United States Department of Defense, Food and Drug Administration, Department of Health and Human Services, and Centers for Disease Control have developed lists of chemicals that are considered potential threat agents. Brodifacoum is one of the agents of interest. Methods: The Registry was queried from 2010-2013 for cases entered with an exposure to brodifacoum. Cases recorded as no or chronic exposure, no signs/symptoms, and signs/symptoms unlikely toxin-related were excluded. Sites reporting brodifacoum exposures were contacted for a case abstraction of the medical record. Results: 21 cases of brodifacoum exposure from 13 sites were identified. 10 cases from 5 sites were abstracted and available for analysis. 5/10 were female and 9/10 were adult patients. 7/10 had psychiatric comorbidities. All were admitted to the hospital with a mean length of stay of 3.9 days(range: 2-11 days). 2/10 required intubation. The median initial prothrombin time reported was 94.3 sec(range 13 sec to >200 sec). Dose of exposure was inconsistently reported. Treatment in all cases was initiated based on abnormal coagulation studies and presumed exposure. Only 1 case underwent brodifacoum confirmatory testing. 8/10 experienced spontaneous bleeding and 3 of these experienced bleeding in a noncompressible site. 1 death was reported in a case of prenatal maternal ingestion resulting in a postnatal intraventricular hemorrhage in the neonate. 6/10 cases were treated with fresh frozen plasma(median 3 units: range 1-20 units) and 1/10 was treated with Factor IX concentrate. 2/10 were treated with IV vitamin K. All surviving patients were discharged on an oral vitamin K regimen with a median daily dose of 100mg(range 10-300mg). 1 was treated with daily dosing, 4 were treated with 2x daily dosing, and 4 with 3x daily dosing. Conclusions: Coagulation abnormalities and spontaneous bleeding are common following brodifacoum exposure. In hospital treatment is variable but often includes fresh frozen plasma. High dose oral vitamin K was the mainstay of the discharge regimen.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Social role of emergency medicine

J02 IMPACT OF A MULTIDISCIPLINARY ASSESSMENT TEAM ON THE EFFECTIVENESS OF PATIENTS’ DISCHARGES FROM EMERGENCY DEPARTMENT AND ITS EFFECT ON THE QUALITY PATIENTS’ EXPERIENCE A. Habib 1, A. Jalil 1, G. Nurani 1 1 Doncaster Royal Infirmary, Doncaster, United Kingdom Background: Until recently, it was usual for patients to be discharged from the emergency department once their presenting physical conditions were satisfactorily treated. With an increasingly aging population with multiple and complex co morbidities, the psychological and social aspects of a patient’s presentation have become equally important factors to be considered prior to a safe and effective discharge. The importance of a full assessment of a patient’s physical, mental, social and psychological needs, was identified, before a patient could be safely discharged, and to prevent further harm to the patient. A dedicated team of professionals, which comprised of a Physiotherapist, social care worker and an old age mental health worker were responsible for a complete assessment of all patients considered medically fit for discharge but with such complex needs identified. Aims: Our aim was to evaluate the impact of the multidisciplinary team (also called RAPT- Rapid assessment and physiotherapy team) on the effectiveness and safety of discharges from our Emergency Department and patient’s experience.

Methods: We reviewed records of a series of 50 patients, who were referred to the RAPT team in CDU (Clinical Decision Unit) after initial assessment and treatment in the department of Emergency Medicine. 1. Readmission rate within 30 days with social reasons as a measure of effectiveness of discharge. 2. Patients were asked to fill in a survey form to evaluate their satisfaction after being assessed by RAP Team in CDU.

Results: C Conclusions: The attendance at an emergency department with medical problems can be used as an opportunity to carry out a detailed and thorough assessment of the physical, psychological and social needs of appropriate patients. A dedicated multidisciplinary team of trained health care professionals may be used as a rapid and comprehensive service to address these needs and ensure a safe and effective discharge by implementing appropriate action plans and collaborating with family or/and intermediate care, GP and social services.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Hematological and oncological disorders

J03 CARDIOTOXICITY FROM ANTINEOPLASTIC INTERVENTIONS IN THIS MODERN ERA OF MEDICINE: A CANCER PERSPECTIVE A. Miller 1 1 Ut Md Anderson Cancer Center, Houston, Usa Background: Cancer and cardiovascular disease (CVD) are the most common causes of mortality and morbidity worldwide. Antineoplastic chemo- and radiation therapies contribute to cardiotoxicity that manifests as CVD in the emergency department. As the life span of these populations increases, so does the possibility that the emergency physician (EP) will encounter these cancer survivors with these cardiotoxicities. <FILE IMAGE='191_20150530174111.jpg'>

Methods: We provide details of these cardiotoxic agents including their associated manifestations and postulated mechanisms of action. Results: A. Arrhythmias associated with chemotherapies (Table 1) include QT prolongation leading to ventricular arrhythmias and bradycardia and heart block are associated with paclitaxel and thalidomide. B. Ischemic Heart Disease including unstable angina (UA) and acute coronary syndrome (ACS) are associated with the agents listed in Table 2. C. Heart Failure (HF) associated with the agents listed in Table 3 may be dose-dependent and involve redox cycling and the generation of reactive oxygen species (ROS). Cardiomyocyte-specific deletion of Top2b (encoding topoisomerase-IIb) protects cardiomyocytes. D. Venous Thromboembolism (VTE) is associated with i. Cisplatin; ii. Vorinostat; iii. Thalidomide; iv. Lenalidomide; and v. Erlotinib; VTE risk is highest in metastatic disease, those with central venous catheters and comorbidities including immobility, HF, atrial fibrillation, dehydration, and concurrent chemotherapy. E. Hypertension (HTN) and cancer is common (37%) and is associated with agents listed in Table 4. Antiangiogenic therapy-related HTN is thought to be related to VEGF inhibition that decreases nitric oxide production in the wall of the arterioles and other resistant vessels promoting vasoconstriction, increased peripheral vascular resistance and blood pressure. F. Cardiovascular effects of radiotherapy can i. directly damage heart muscle; ii. injure vessels supplying the heart muscle with blood; iii. cause pericardial inflammation; and iv. valve damage. Risk is compounded by the interactions of radiation and concurrent anthracyclines and tyrosine kinase inhibitors, and conventional cardiovascular risk factors i.e., smoking and hypertension.

Conclusions: As we become more proficient in treating malignancy, recognition by the EP of the most relevant cardiotoxic effects of chemo- and radiation therapy becomes increasingly important.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Administration, Health Policy, and Legislation

J04 REVALIDATION IN THE UK- AN APPRAISERS ROLE O. Ghazanfar 1 1 Medsu, London, United Kingdom Background: Revalidation became legislation in the UK from Dec 2012 This requires all practicing doctors in the United Kingdom to hold a licence to practice. Annually an appraisal has to be done by a credentialled appraiser who is trained in the enhanced appraisal process.This looks at the doctors entire scope of work We will try to explain the process of appraisal in the UK,how it applies to individual doctors and how it can be replicated in other Western healthcare sytems We also try to elaborate on the role of the appraiser

Methods: Appraisal data for the last 2 years Lessons learnt What could be improved What works well

Results: Majority of doctors get revalidated in the UK

Conclusions: Revalidation works to improve the confidence of the general population in the medical profession

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Patient Flow / Throughput Management

J05 ASSESSMENT OF PATIENTS’ SATISFACTION AFTER INSTAURING A TRIAGE UNIT M.A. Hadj Ali 1, L. Boukadida 2, A. Zorgati 3, R. Kaddechi 4, F. Ben Mabrouk 5, T. Jeffel 6, R. Boukef 7 1 Sahloul Hospital, Emergency Department, Sousse, Tunisia Background: The triage is known to improve morbidity and mortality by prioritizing the support in emergency departments. Currently the quality of care is evaluated by different quality indicators such as consultants’ satisfaction. However, few local studies have evaluated this tool before and after instauring triage unit in our emergency departments. Methods: This is a comparative prospective study over 08 months during which there has been introduction of the triage unit. It included 100 patients of all adults over 18 years consulting for various emergency complaints. After consent they were interviewed as they left for a questionnaire. The questionnaire dealt with several items including the perceived waiting time, the quality of reception, information of the patient, the quality of the doctor-patient contact and satisfaction with overall care. Results: we identified two consulting groups (50 patients in each one) before and after triage. The two groups were comparable in terms of sex ratio, age and treated disease (heart disease, urology, and trauma) .The main results were 3: Perception of the waiting delay before medical contact as long is 77% versus 35% before triage versus after triage. Patients were satisfied with the information given about their pathology and the global healthcare (70% in the group after triage versus 28% in the group before triage). The difference was mainly significant for these results. Conclusions: Patient satisfaction is linked to several factors. The organization plays a mean role. Triage offers a fast enough patient-doctor contact and this is determinant for patient’s satisfaction. Communication between medical staff and patients is important too to promote global health care in emergency departments and should be more improved.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Patient Flow / Throughput Management

J06 I AM YOUR PATIENT…. DESIGNATION OF PATIENT TO SPECIFIC TEAMS IN ED A. Habib 1, F. Khan 1 1 Doncaster Royal Infirmary, Doncaster, United Kingdom Background: Objectives & background: Long waiting time is a critical and serious issue faces by all Emergency Departments across the country. To minimize this waiting time before being seen by a Health Care Professional, we developed a system called ”Push System” Every Patient presented to the department will have a designated team of health care professionals to look after them.

Methods: Methods: Every patient came through Ambulance is seen by Staff Nurse immediately. After initial assessment patient is assigned to one of the three teams in ED called Red, Yellow and Blue Team. Each team consist of 2 Middle Grade Doctors, 2 SHOs, 2 Nurses and1 HCA Walk in patients are directed to Unplanned Care Centre, where after High Level Triage they are assigned to 1- ENPs 2- GP Unplanned care 3- ED Doctor Unplanned care

Results: Results: 4 Hours target has improved from 85% to 96%, resulting in reduction of the departmental breeches from 10% to 3%.

Conclusions: Conclusion: Allocation of patients to a Team in ED (PUSH SYSTEM) has resulted in out standing improvement in performance and patient experience.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Toxicology / Environmental Injury

J07 OUTCOMES FOLLOWING CYANIDE EXPOSURE REPORTED IN THE TOXIC REGISTRY (2010-2013) B. Hatten 1, J. Westphalen 2, B. Judge 3, T. Wiegand 4, S. Rhyee 5, R. Vohra 6, P. Wax 7, J. Brent 1, On Behalf Of Toxic 8 1 Section Of Medical Toxicology, Department Of Emergency Medicine, University Of Colorado School Of Medicine, Aurora, Co, Usa, 2 Denver Health Residency In Emergency Medicine, Denver Health Medical Center, Denver, Co, Usa, 3 Grand Rapids Medical Education Partners, Michigan State University, Grand Rapids, Mi, Usa, 4 Emergency Medicine, Urmc And Strong Memorial Hospital, Rochester, Ny, Usa, 5 Division Of Medical Toxicology, University Of Massachusetts Medical School, Umass Memorial Medical Center, Worcester, Ma, Usa, 6 Emergency Medicine, Ucsf-Fresno, Fresno, Ca, Usa, 7 Department Of Emergency Medicine, University Of Texas-Southwestern, Dallas, Tx, Usa, 8 Toxicology Investigators Consortium, American College Of Medical Toxicology Background: Since 2010, the Toxicology Investigators Consortium(ToxIC) Registry records all clinical consults seen by an international multi-center network of medical toxicologists in a standardized fashion. The United States Department of Defense, Food and Drug Administration, Department of Health and Human Services, and Centers for Disease Control have developed lists of potential chemical threat agents. Cyanide is one such agent. Methods: The Registry was queried from 2010-2013 for cases entered with an exposure to cyanide. Cases recorded as no/chronic exposure, no signs/symptoms, and signs/symptoms unlikely toxin-related were excluded. Sites reporting cyanide exposure or treatment with a cyanide antidote were contacted for abstraction of the case record. Results: 35 cases from 14 sites were identified. 17 cases from 6 sites were abstracted. 9/17 patients were female. 2/17 were <6 years, 11/17 were 19-65 years, and 4/17 were >65 years. Median time to presentation was <1 hour. 12/17 presented following smoke inhalation, 4/17 following intentional ingestion of a cyanide-containing product, and 1/17 following a nitroprusside infusion. 7/17 exhibited an initial Glasgow Coma Score of 3. 3 additional cases decompensated with a score of 3 in hospital. Of the 8 smoke inhalation patients with a measured carboxyhemoglobin, 4 were elevated >10%. Median initial pH was 7.3(range:<6.8-7.6), median initial lactate was 7.8mmol/L(range:1.0-22.2 mmol/L), and median initial bicarbonate was 16mEq/L(range:6-29mEq/L). Cyanide testing was performed in 7 cases with 6 revealing a measurable blood cyanide level(median:32.7 mcg/dl; range:7.1-1300mcg/dl). There was 1 death in the emergency department, 12 intensive care unit admissions, and 4 floor admissions. 13/16 admitted patients survived to discharge. The overall survival rate was 76%(95%CI:50-93%). 2/4 deaths occurred in those >65 years. The median hospital length of stay was 17 days(range:2-65 days). 12/17 patients were intubated. 10/17 received vasopressor therapy. 13/17 received cyanide antidote: 2/13 treated with nitrite/thiosulfate alone, 9/13 treated with hydroxocobalamin alone, and 2/13 treated with both antidotes. Conclusions: The majority of cyanide exposure cases seen by medical toxicologists are due to smoke inhalation. Cyanide antidotes are frequently employed, with hydroxocobalamin most common. Most patients survive but are critically ill and consume many hospital resources.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Toxicology / Environmental Injury

J08 BETA-BLOCKERS INTOXICATION: PREDICTORS OF HOSPITALIZATION IN INTENSIVE CARE UNIT H. Ghazali 1, W. Ben Hmida, W. Bousselmi, S. Souissi, S. Chiboub, A. Yahmadi, A. Azouzi, N. Ngach 1 Regional Hospital, Emergency Department, Ben Arous, Tunisia Background: Objective: Identify predictive factors of hospitalization in intensive care unit in beta- blockers poisoning. Methods: Prospective and observational study. Inclusion of symptomatic beta-blockers poisoned patients admitted consecutively between 2010 and 2015 to emergency department. Diagnosis of beta-blockers poisoning was made based on history, clinical findings, electrocardiographic and laboratory confirmation, if available. Collection of data from the medical observation: demographics, co-morbidities, clinical findings, complications and final outcomes. Multiple logistic regression method was used to identify the predictive factors of hospitalization in intensive care unit. Results: Inclusion of 26 patients. Mean age : 37 ± 21 years. Sex ratio = 0, 44. Co-morbidities n (%): hypertension 10(38), diabetes 3 (11), coronary insufficiency 3 (11), psychiatric history 5(19), suicide attempts history 4 (15) and renal failure 1 (4). The intoxication was voluntary in 18 patients and polydrug in 20 patients. The most incriminating beta- blockers were: acebutolol (11; 42%), atenolol (2,7; 7%), proparanolol (1;4%) and metoprolol (1; 4%). Ten patients (38%) were hospitalized in intensive care unit with 3 patients (11%) intubated. Univariate analysis identified: psychiatric history, suicide attempts history, voluntary intoxication, polydrug intoxication, systolic blood pressure <90mmHg and the presence of membrane stabilizing activity on the electrocardiogram as significantly associated with intensive care unit hospitalization. In multiple logistic regression suicide attempts history (odds ratio adjusted= 6,1; p = 0.01 , 95% confidence interval 1.02 to 25,4) and systolic blood pressure < 90mmHg (odds ratio adjusted =5,47;p=0,01;95% confidence interval 1,46 to 20,5) were independent predictors of hospitalization in intensive care unit. Conclusions: This study showed that suicide attempt history and systolic blood pressure <90mmHg are independently associated with hospitalization in intensive care unit in beta-blockers poisoning patients.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: International Emergency Medicine

J09 ACEP INTERNATIONAL AMBASSADOR PROGRAM: A NEW APPROACH FOR THE DEVELOPMENT GLOBAL EMERGENCY MEDICINE N. Bustamante 1, C. Arbelaez 1 1 Brigham And Women's Hospital - Department Of Emergency Medicine, Boston, Usa Background: The ACEP International Ambassador Program was established to bring together international member experts who provide advice and information on issues pertaining to the progress and status of emergency medicine globally. ACEP members are elected as country specific ambassadors actively collaborate with local emergency medicine leaders and organizations in their assigned countries for the development of Emergency Medicine. During the ACEP Scientific Assembly, the program organizes a one-day conference. By bringing the Ambassadors together within the communicative environment of facilitated dialogue, the main objective is to reach beyond the immediate one-day event.

Methods: ACEP International Ambassador Program brings together a large community of emergency medicine physicians, fellows, and residents in order to identify key aspects to advancing emergency medicine globally and has focused on standardization, certification, and educational development. During the 2014 ACEP International Ambassador Conference, 35 members representing 78 countries, discussed goals and strategies of the group based on regions, and educational mission and needs for ambassadors, residency programs, the country, region, and globally. <FILE IMAGE='255_20150603012429.jpg'>

Results: The key conference findings included the need for emergency medicine to find firm footing of its identity, internationally, by standardizing the curriculum used to establish and develop emergency medicine programs; the need to organize an international approval board or system of certification to allow Emergency Medicine the ability to gain credibility with international medical systems and governments; and the importance of simulation-based training and improving access to mid-level providers. An iterative and tiered resource educational toolkit was made available online to help educate, engage, and promote the development of emergency medicine. Conclusions: The ACEP International Ambassador Program is a novel approach for the development of global emergency medicine and can be useful model for other specialties doing international development in medical education.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Substance abuse

J10 DO ELECTRONIC REPORTING SYSTEMS THAT TRACK CONTROLLED SUBSTANCES DECREASE VISTS FOR DENTAL PAIN? B. Adkins 1, W. Hickerson, S. Stearley, P. Stein, M. Wilson 1 University Of Kentucky College Of Medicine, Lexington, Ky, Usa, 2 University Of Kentucky College Of Medicine, Lexington, Ky, Usa, 3 University Of Kentucky College Of Medicine, Lexington, Ky, Usa, 4 University Of Kentucky College Of Dentistry, Lexington, Ky, Usa, 5 University Of Kentucky College Of Nursing, Lexington, Ky, Usa Background: Visits in dental pain and dental caries often result in the prescription of opiate pain killers. The misuse and abuse of prescription drugs is the fastest growing drug problem in the United States. Kentucky is often cited as one of the top ten states for non-medical use of prescription drugs. The Kentucky All Schedule Prescription Electronic Reporting System (KASPER) tracks controlled substance prescriptions dispensed within the state. The use of KASPER for prescribing most scheduled drugs, including all opiate medications, became mandatory on July 20 2012. We hypothesize that visits to the ED for dental pain decreased after KASPER implementation. <FILE IMAGE='22_20150318165150.jpg'>

Methods: The study was performed in an urban level 1 trauma center and academic medical institution. 8 ICD9 codes and correlating diagnoses relating to dental pain were gathered over a 42 month period from July 2010 through December 2013. The results were compared to the implementation of KASPER in July 2012. Results: There was a decrease in dental pain related presentations to the ED in 2013 after the implementation of KASPER in 2012. There were 473 visits related to dental pain in 2011, 538 visits in 2012, and 380 visits in 2013. The month of July 2012 saw the most visits related to dental pain, thereafter the number of visits steadily declined. The total number of ED visits increased from 48,058 in 20102011 to 67,384 in 20122013 (July to June). Conclusions: The implantation of KASPER appears to have influenced the number of ED visits related to dental pain at our institution. While total volume increased by nearly 20,000 visits from 2010 to 2013, the number of dental pain related visits declined. Weaknesses of this study include a small number of data points (42 months), the lack of statistical analysis, and possible confounding factors that may have discouraged dental pain related visits.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Cardiovascular / Non-CPR/Non-Resuscitation

J11 GRAVITY R. Skulec 1, J. Callerova 1, J. Knor 1, P. Merhaut 1, K. Kucera 1, V. Cerny 2,3,4,5 1 Emergency Medical Service Of The Central Bohemian Region, Kladno, Czech Republic, 2 Department Of Anesthesiology, Perioperative Medicine And Intensive Care J.E. Purkinje University, Masaryk Hospital, Usti Nad Labem, Czech Republic, 3 Department Of Research And Development, Hradec Kralove, Czech Republic, 4 Department Of Anesthesiology And Intensive Care, Hradec Kralove, Czech Republic, 5 Department Of Anesthesia, Pain Management And Perioperative Medicine, Dalhousie University, Halifax, Canada Background: Effect of the interaction between the Earth and Moon on health condition has been the subject of mystical speculation, but also serious research. Researchers mostly concentrated on the impact of lunar phases, almost always with the negative result. However, key influence of the moon on the geosphere is mediated by gravitational interaction, not by changing lunar phases. Therefore, we decided to evaluate possible association between a frequency of episodes of cardiogenic pulmonary edema (CPE) treated by Emergency Medical Service (EMS) of the Central Bohemian Region, Czech republic and intensity of gravitational interaction between the Earth and Moon. Methods: We extracted all dispatches to CPE cases from local database of EMS for the period from 1.1.2013 to 31.12.2014. For each episode of CPE, gravitational interaction between the Moon and Earth was calculated using the formula H=G*m1*m2/d2. Entire file of CPE episodes was divided equally into five subsets of the same duration, according to the intensity of the gravitational interaction. The number of CPE episodes was compared among the subsets. We also compared the number of events ASS in moments of apogee and perigee ± 36 days during the whole period. Results: During the reported period there were 1634 episodes of CPE. The gravitational interaction between the Earth and Moon in the observed period ranged from 1.775e+26 N to 2.275e+26 N. In the subset when the moon was farthest from the Earth and gravitational interaction was <1.875e + 26 N, as much as 546 episodes of CPE was observed, significantly more than in any of other four subsets (from 232 to 297 episodes, p <0.01). In all periods of apogee we identified a trend toward a higher number of CPE events than in periods of perigee (334 vs. 266, p = 0.310). Conclusions: We observed substantialy higher incidence of CPE episodes in the field when gravitational interaction between the Earth and Moon was the least intensive than in other periods od synodic month during the reporting period in defined geographical region. We will attempt to interprete this phenomenon.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Cardiovascular / Non-CPR/Non-Resuscitation

J12 VALUE OF SPIROERGOMETRY FOR DIAGNOSIS OF EARLY HEART FAILURE IN PATIENTS WITH METABOLIC SYNDROME. M. Balciunas 1, J. Celutkiene 1, J. Badariene 1, A.M. Jakstaite 2, A. Laucevicius 1 1 Vilnius University Clinic Of Heart Disease, Vilnius, Lithuania, 2 Vilnius University Medical Faculty, Vilnius, Lithuania Background: Persons with metabolic syndrome are at higher risk of cardiovascular disease compared with those without the syndrome. Peak oxygen uptake (peakVO2) has been shown to be predictor of morbidity and mortality in patients with heart failure (HF). Our goal was to determine the value of spiroergometry for early diagnosis of HF in patients with metabolic syndrome (MS).

Methods: The retrospective investigation of 1927 patients was performed in Vilnius University Heart Disease Clinic through the period of 2010/01/04-2015/03/19. Into final analysis we enrolled 155 patients having 3 out of 5 criteria of metabolic syndrome (Circumference of the waist >=102 cm for men and >=88 cm for women; Triglyceride>=1.7 mmol/l; High-density lipoprotein (HDL) cholesterol<1.03 mmol/l for men and <1.29 mmol/l for women; Arterial blood pressure (ABP)>=130/85 mmHg and blood Glucose level >=5.6 mmol/l). The peak of VO2 <90% of predicted and/or BNP>35 pmol/l were criteria of HF. Left ventricular hypertrophy (LVH) was diagnosed if mass index (MMI) was >=95 g/m² for women and >=115 g/m² for men and/or relative wall thickness (RWT) >=0.42 and diastolic dysfunction - E/E‘ mean >8. Data were analyzed using SPSS 22.0 and P values<=0.05 were considered significant.

Results: The mean patients age was 57.43±9.22 years. 52.9% of investigatives were men and 47.1% women. BNP >35 pmol/l was found in 57.42% of patients with the mean value of 152.99 ± 258.87. Peak VO2<90% of predicted was 59.3% (mean of 81.33 ± 22.30%). 69.57% of investigatives had peak VO2<90% and BNP >35 pmol/l concomitantly. Correlation between peak VO2 and BNP was r=-0.347, p<0.01. E/E‘ mean >8 was measured in 82.88% and 72.9% of patients had LV hypertrophy (mean value of MMI and RWT were 117.70±35.1 g/m2 and 0.38±0.08 respectively). Statistically significant correlation between peak VO2 except that with triglyceride was found with HDL cholesterol (r=0.22, p<0.01), circumference of the waist (r=0.32, p<0.01), arterial blood pressure (r=0.19, p=0.02), glucose level (r=-0.28, p<0.01).

Conclusions: Our study found significant correlation between peak VO2 and criteria of MS that could suggest of Spiroergometry as useful tool for early diagnosis of HF in patients with metabolic syndrome.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Cardiovascular / Non-CPR/Non-Resuscitation

J13 PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN ST-ELEVATION MYOCARDIAL INFARCTION COMPLICATED WITH ACUTE HEART FAILURE: PREDICTORS AND LONG-TERM OUTCOME I. Zivkovic 1, V. Pavlovic 1, D. Milasinovic 1, Z. Mehmedbegovic 1, A.D. Ristic 1,2, D. Matic 1, L. Jovanovic 1, V. Dedovic 1, I. Milinkovic 1, D. Simeunovic 1,2, V. Vukcevic 1,2, G. Stankovic 1,2, P.M. Seferovic 1,2 1 Department Of Cardiology, Clinical Center Of Serbia, Belgrade, Serbia, 2 School Of Medicine, University Of Belgrade, Belgrade, Serbia Background: Acute heart failure (AHF) in ST-elevation myocardial infarction (STEMI) is a frequently encountered complication with adverse clinical outcome. The aim of this study was to determine independent predictors and outcome of AHF in subset of patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

Methods: The retrospective analysis of 1941 consecutive STEMI patients undergoing primary PCI in a high-volume catheterization laboratory was performed. AHF was defined as presence of Killip class II-IV at admission. Multivariable regression was used to identify AHF predictors while Cox regression model was applied to determine the risk of five-year mortality.

Results: AHF developed in 299 (15.4%) STEMI patients who underwent primary PCI. Patients with AHF had significantly higher mortality after 30 days (4.8% vs. 22.4%, p<0.001) and after one year (9% vs. 33.8%, p<0.001). During median follow-up of 4.7 years (IQR 4.1y–5.1y), mortality rate remained significantly higher in AHF patients (16% vs. 43.5%, p<0.001). The following independent predictors of AHF were identified: left ventricle ejection fraction <40% (OR 2.89, CI95% 1.94-4.29, p<0.001), age (OR pre 1 year increment 1.03, CI95% 1.01-1.05, p=0.001), renal dysfunction (glomerular filtration rate <60 ml/min/1.73m2, Cockcroft-Gault formula) (OR 1.68, CI95% 1.05-2.68, p=0.032), diabetes (OR 1.78, CI95% 1.22-2.61, p=0.003), creatine kinase (OR per 100 U/L 1.02, CI95% 1.01-1.03, p<0.001) and anterior myocardial infarction (OR 2.04, CI95% 1.04-4.00, p=0.038). When adjusted for baseline clinical and procedural features, AHF tended to independently predict 30 day mortality (HR 1.53, CI95% 0.96-2.43, p=0.073) and five-year mortality (HR 1.3, CI95% 0.98-1.75, p=0.068).

Conclusions: AHF complicating STEMI treated with primary PCI was associated with higher short-term (4-fold) and higher (3-fold) long-term mortality. Most important predictors to develop AHF in STEMI treated with primary PCI are increasing age, diabetes, renal impairment and extensive myocardial injury.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: International Emergency Medicine

J14 AFTERHOURS PATIENT CARE IN AN OUTPATIENT CLINIC IN RURAL HAITI: FILLING THE GAP WITH NON-NATIONAL STAFF B. Nicholson 1, H. Dhindsa 2, J. Lovelady 2 1 Boston Medical Center - Department Of Emergency Medicine, Boston, Usa, 2 Virginia Commonwealth University - Department Of Emergency Medicine, Richmond, Usa Background: Haitian national medical staff provided medical care in a rural clinic in central Haiti Monday through Friday between 8:00 and 3:00 PM with an international group of medical volunteers supplementing the facilities staff. Outside of normal operating hours, an American registered nurse, paramedic, and a Finnish physician provided medical care as needed. This review sought to identify the epidemiology of chief complaints brought by patients to an outpatient clinic outside of the normal clinic hours and how non-national staff can fill the gap in a post-disaster medical environment.

Methods: Prospective observational review of a consecutive series of all patients who sought medical care outside of normal hours of operation at an outpatient clinic in Titanyen, Haiti between 11/22/2010 and 12/14/2010. Observations focused on the chief complaint.

Results: During the twenty-three day period, a total of eight patients sought treatment outside of normal clinic hours. One patient returned two days in a row for continued treatment of traumatic wounds requiring delayed closure resulting in a total of nine separate patient encounters. A pediatric male with suspected cerebral malaria presenting with a fever required immediate transfer to a pediatric hospital. An adult male with suspected skull and facial fractures was also emergently transferred to a hospital in Port-au-Prince. Five of the eight cases had traumatic injuries. Furthermore, five patients sought treatment during a period of severe political unrest when the Haitian staff was unable to safely travel to and staff the clinic.

Conclusions: The post-disaster environment in Haiti continues to have a role for on-site non-national staff to provide medical care both outside normal clinic hours and during periods of political unrest in which the national staff may be unable to travel to and staff the clinic. This supplemental staffing model may provide more consistent medical coverage in rural Haitian clinics. Supplemental staffing is an additional benefit teams providing emergency medicine education can provide afterhours and should supplement teaching efforts.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Trauma

J15 TRANEXAMIC ACID OVER USE IN MAJOR TRAUMA PATIENTS M. Majeed 1, F. Khan 1, O. Ullah Zafar 1 1 University Hospital Birmingham, Birmingham, United Kingdom Background: Primary fibrinolysis is integral in the pathogenesis of the acute coagulopathy of trauma ACOT. Impaired clotting after injury initially was thought to be caused by iatrogenic causes (hypothermia, acidosis, hemodilution), which are sequelae of resuscitation. Impaired thrombin production occurs secondary to hypothermia and acidosis. TXA has been available for more than 20 years. In November 2009, the FDA approved the oral form of TXA to treat menorrhagia. The 1gram TXA vial costs 1.50£. All other uses of TXA, including trauma use, are considered ‘‘off-label’’ uses. Objective: To find out how appropriately we are using TXA in major trauma cases.

Methods: We did the retrospective analysis of 200 major trauma patients presenting during the month of June 2014 at University hospitals Birmingham, where we see more than 2000 major trauma alerts per year. Results: We had total 113 major trauma patients patients, 73 were male and 27 were female with a mean age of 56years. Out of 113 patients only 6 patients (0.05%) had SBP <90. Among the 107 patients 17 patients (15%) had SBP > 90 and pulse rate <100. All these 17 patients received TXA.

Conclusions: TXA had greatest impact on reduction of death caused by bleeding in the severe shock group (SBP 75 mm Hg) (14.9% vs. 18.4%; RR, 0.81; 95% CI, 0.69Y0.95). TXA given between 1 hour and 3 hours after injury also reduced the risk of death caused by bleeding (4.8% vs. 6.1%; RR, 0.79; 95% CI, 0.64Y0.97; p = 0.03). In our results we have inappropriately given TXA to 15% of the patients. This is just from 1 major trauma center where were we see over 2000 major trauma patients per year. Now about rest of the major trauma centers in the whole of England we are talking about thousands of patients each year unnecessarily receiving TXA. One ampule of TXA costs 1.50£ and multiplied by thousands we are essentially talking about thousands of pounds spent unnecessarily each year. We believe we need to follow robust criteria to give TXA as shown in previous studies.

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Trauma

J16 FINANCIAL IMPACT OF GUN VIOLENCE AT ONE URBAN HOSPITAL C. Babcock 1, R. Voelker 1, M. Pena 1 1 St. John Hospital An Medical Center, Detroit, Usa Background: Gun violence is expensive with one estimate of 174 Billion in the US in 2010. Objectives: To estimate the societal, community, and hospital costs from gun violence in one urban ED without a firearm prevention program.

Methods: All firearm related ED visits were extracted from our electronic charting system (EMAP) from year 2013 at a large (115,000 ED visits/year) urban teaching hospital. Variables extracted included patient ID and ED disposition (Discharge, admitted, died in ED). A chart review of patients admitted was performed to determine hospital discharge status (dead/alive). National estimates per victim from the literature (which included separate estimates for costs for work loss, medical care, mental health, emergency transport, police, criminal justice, insurance claims processing, employer cost, and quality of life costs) were used to calculate the societal costs (including QALY costs), community costs (Not including QALY but including other costs), and hospital costs (including only medical costs. Different cost estimates were used for ED discharged, admitted but survived, and fatally injured patients. Using insurance status information (proportion uninsured) and assuming no collections from uninsured, the uncompensated hospital costs were estimated.

Results: There were 358 gun related ED visits, 39% (139/358) discharged from the ED, 7% (25/358) died in the ED, and 54% (195/358) admitted. Of the admitted patients, 6% (12/195) died (mortality rate of 10% (37/358). The total societal costs for these patients was $283,515,515. Not including the cost of pain and suffering the Community cost was 105,409,333. The total hospital cost was estimated at 14,299,891. The uncompensated hospital cost was estimated at 5,941959.

Conclusions: There were 358 gun related ED visits with 39% (139/358) discharged from the ED, 7% (25/358) died in the ED, and 54% (195/358) admitted. Of the admitted patients, 6% (12/195) died yielding a total mortality rate of 10% (37/358). The total societal costs for these patients was $283,515,515. Not including the cost of pain and suffering (ie quality of life) the Community cost was 105,409,333. The total hospital cost was estimated at 14,299,891. The uncompensated hospital cost was estimated at 5,941959.

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Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Geriatrics

J17 ELDERLY FRAGILE AND DIABETES: ONE-YEAR EXPERIENCE IN SUB INTENSIVE CARE UNIT A. Tavanti 1, G. Colombo 1, G. Aguglia 1, G. Carlotti 1, L. Del Vecchio 1, F. Pace 1, G. Ricciuto 1, M. Schiano 1, M. Schito 1, M. Vitto 1, E. Guglielmelli 1 1 Uoc Medicina D'urgenza Osp. San Camillo, Roma, Italy Background: In acute care hospitals can be selected a patient population of elderly fragile requiring a better management than normally provided in a regular ward, with necessity of particular therapeutic and nursing interventions, also because an adequate glycemic control may represent a critical tool in the better outcome of hospitalized patients.

Methods: We evaluated the management of diabetic elderly patients with high complexity, related also to presence of several renal failure and obesity, admitted to our Sub Intensive Care Unit (SICU) during 2014. Results: In 2014 were hospitalized 79 patients, 36 (45,6%) with NIDDM, 34 (43,0%) with IDDM, 9 (11,4%) with hyperglycemia; 36 M -45.6% - and 43 F- 54.4%, mean age 74.3, mean SAPS II 36.4, median hospital stay 4 days; we observed an incidence of severe renal failure (GFR below 30 ml/min) of 30,4% and obesity (BMI>35) of 24,1%: 40 patients (50.6%) with ARF (70,0% COPD exacerbation, 27.5% pneumonia and 2.5% pulmonary embolism); 16 patients (20,3%) with cardiopathy (31.3% myocardial infarction); 8 patients (10,1%) with sepsis (37,5% MOF); 6 patients (7,6%) with acute bleeding (66,7% with an upper gastrointestinal bleeding); 4 patients (5,1%) with neurological disease, 4 patients with metabolic disorders (5,1%) and the last one (1,3%) with surgical disease (acute lower limb ischemia). Only 7,6% of patients needed a management in ICU (33,3% in obese population). In the obese population (24.1%), with diabetes and renal failure, COPD exacerbation was observed with a rate of 26,3%. According to guidelines in this group was performed an usual medical therapy and non-invasive ventilation (NIV), with an increase in the values of PH (normal range) and improvement in PaO2 / FiO2 (>200), while to achieve a better glycemic control an insulin therapy was started.

Conclusions: A therapeutic approach with insulin may represent the gold standard with glycemic target between 140 - 180 mg/dl. In the COPD exacerbation the use of the combined approach of medical therapy, with special attention to the glycemic control, nursing and NIV, when performed by a well-trained physicians and nurses team in SICU, would be effective, improving survival.

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Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Cardiovascular / Non-CPR/Non-Resuscitation

J18 INFLUENCE OF METABOLIC SYNDROME ON ACUTE HEART FAILURE CLINICAL PRESENTATION I. Potocnjak 1, S. Dokoza Teresak 1, B. Radulovic 2, M. Trbusic 1,3, G. Pregartner 4, V. Degoricija* 1,3, S. Frank* 5 1 University Hospital Center Sisters Of Charity, Zagreb, Croatia, 2 University Hospital Centre Zagreb, Zagreb, Croatia, 3 University Of Zagreb School Of Medicine, Zagreb, Croatia, 4 Medical University Of Graz, Institute For Medical Informatics, Statistics Und Documentation, Graz, Austria, 5 Medical University Of Graz, Institute Of Molecular Biology And Biochemistry, Center Of Molecular Medicine, Graz, Austria Background: Metabolic syndrome (MS) is important concomitant disease in acute heart failure (AHF) thus its effect on HF clinical presentation is crucial field of investigation. Various classifications of acute HF are utilized in intensive cardiac care units. The aim of this study was to investigate influence of MS on clinical presentation of AHF defined by European Society of Cardiology (ESC) Guidelines for the diagnosis and treatment of acute and chronic heart failure.

Methods: Study was performed as observational, prospective study on hospitalised AHF patients (pts.). Subjects were recruited from the Emergency Department, from November 2013 to February 2015. Participants were divided in two groups depending on coexistence of MS and clinical presentation of AHF. Pts. were compared according to clinical presentation of AHF, including the following: worsening of decompensated chronic HF, pulmonary oedema, hypertensive HF, cardiogenic shock, isolated right HF and acute coronary syndrome (ACS) and HF. Pts. were treated by standard protocol for AHF treatment by ESC Guidelines. Study was approved by local Ethics committee and performed according to Good Clinical Practice and Helsinki Declaration principles.

Results: Complete analysis included data for 152 pts. 55.92% of pts. with AHF had MS. In total 51.3% of pts. had worsening of chronic HF, 15.1% had ACS and HF, 14.5% had hypertensive AHF, 13.2% had pulmonary edema, 4.6% had isolated right side HF, and 1.3% had cardiogenic shock. There was no statistically significant difference between groups with and without MS (p=0.178). According to time of onset 69.1% of pts. had worsening of chronic HF, and rest of them de novo, as well without difference in MS comorbidity (p=0.380). Our study showed that ejection fraction was reduced for 57.6%, without difference in coexistence in MS comorbidity (p=0.866). Conclusions: Results of this study showed that MS is serious concomitant parameter in AHF pts. However, it was not proven that it can influence clinical presentation of AHF. Pts. suffering from AHF should be treated individualy and dependently on their clinical presentation. MS as frequent disease has to be accentuated, diagnosed and treated. *equally contributing senior authors and project leaders

MEMC - GREAT

Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Neurologic / Psychiatric

J19 RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR ADMINISTRATION IN PATIENTS WITH CEREBROVASCULAR ACCIDENT; A CASE SERIES A. Baratloo 1, A. Rouhipour 2, F. Rahmati 1, S. Safari 1, H. Delavar Kasmaei 3, M. Motamedi 1 1 Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran, 2 Pediatric Department, Valiasr Hospital, Ghazvin Medical University, Abyek, Iran, 3 Neurology Department, Shohadaye Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran Background: Cerebrovascular accident (CVA), as a debilitating neurological impairment, is one of the most common causes of death in adults. The current study aimed to evaluate the effectiveness, feasibility, outcome, and safety of intravenous recombinant tissue plasminogen activator (IV rt-PA) administration in patients with acute ischemic cerebrovascular accident (CVA).

Methods: All CVA patients referred three hours after onset of symptoms to the emergency department (ED) of Shohadaye Tajrish Hospital, Tehran, Iran, from February 2012 to March 2014 were included. The following data were collected using specific check list: demographic data, chief complaint, signs and symptoms, medical history, risk factors, focused neurologic examination, and the National Institutes of Health CVA Scale (NIHSS). Then, all patients received 0.9 mg/kg of rt-PA as a bolus intravenous dose and intravenous infusion under close monitoring in the ED. Outcomes were categorized as good (complete reversal of focal neurologic deficit), not bad (partial reversal of focal neurologic deficit), death, and unknown (missed follow up). Data were analyzed by STATA software version 11.

Results: Fifteen patients with the mean age of 56.7 ± 18.9 years included in the study (male 66.7%). The most common chief complaints were left side hemiplegia (46.67%), right side hemiplegia (40%), and decreased level of consciousness (13.33%), respectively. The most common affected vascular territory was medial cerebral artery (MCA) (86.67%). There was no significant relationship between age (P = 0.06), gender (P = 0.08), NIHSS score (P = 0.07), location of infarct (P > 0.99) and mean time from admission to beginning the drug administration (P = 0.55) with the outcomes. The outcome in 26.7% of the patients was favorable and death (two of four) happened due to intra cranial hemorrhage (ICH) as rt-PA side effects.

Conclusions: It seems that intravenous rt-PA administered three hours after CVA is bemeficial in patients with CVA and by reducing the early evaluation time and brain imaging can overcome the CVA complications. However, any conclusion from this study is limited by the small population under study.

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Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Cardiovascular / CPR / Resuscitation

J20 POTASSIUM CARDIOPLEGIA DURING CPR FOR PORCINE VF ARREST: A BLINDED RANDOMIZED CONTROLLED TRIAL K. Marill 1, D. Salcido 1, M. Sundermann 1, A. Koller 1, J. Menegazzi 1 1 University Of Pittsburgh Medical Center - Department Of Emergency Medicine, Pittsburgh, Usa Background: Potassium cardioplegia-induced transient asystole may conserve myocardial energy and improve outcome in ventricular fibrillation (VF) arrest. We hypothesized potassium infusion during VF arrest would lead to an increase in intra-arrest amplitude spectrum area (AMSA) prior to defibrillation, and improved hemodynamic parameters in those animals that attained return of spontaneous circulation(ROSC).

Methods: Twelve swine were randomized to KCl or placebo in a randomized controlled trial, and 10 were included in an amended protocol. After initiation of monitoring, induction of anesthesia, and instrumentation of the aorta and right atrium, VF was electrically induced. After 4 minutes, 1.5 meq/kg KCl or placebo was infused in blinded fashion in a peripheral ear vein and mechanical chest compressions and ventilations were begun. Defibrillation was performed 10 minutes post VF induction, as appropriate. Animals without ROSC received continued resuscitation per Advanced Cardiac Life Support(ACLS) guidelines for 10 more minutes. Animals that achieved ROSC were monitored for 30 more minutes. The primary outcome, change in AMSA from just before study drug infusion to 5 minutes post infusion, was compared using nonparametric statistics.

Results: Six animals were randomized to KCl and 4 to Placebo. KCl infusion induced approximately 1 minute of transient asystole at the dosage used. The mean change in normalized AMSA was -0.24 in the KCl and 0.21 in the Placebo group, with a median difference of -0.50(95%CI -0.79 to -0.09), p=0.038, favoring Placebo. Five of 6(83%) animals in the KCl group and 2 of 4(50%) in the Placebo group developed an organized, though not necessarily, perfusing rhythm with the difference in proportion 33%(95% CI -33 to 86). One of 6(17%) animals in the KCl and 2 of 4(50%) in the Placebo group achieved ROSC with the difference in proportion -33%(95%CI -93 to 33). Hemodynamics were not quantitatively compared post ROSC due to limited survivors. One animal in each group required norepinephrine infusion.

Conclusions: Normalized AMSA, the primary trial outcome, was significantly lower compared to placebo after single agent potassium cardioplegia in this porcine model of VF arrest. Secondary measurements including ROSC demonstrated mixed trends and no clear benefit.

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Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Paediatrics

J21 REDUCING CERVICAL SPINE IMAGING IN PEDIATRIC TRAUMA PATIENTS <11 YEARS OF AGE C. Zeretzke 1, S. Alwood, P. Mcmahon, S. Herskovitz 1 University Of Florida, Gainesville, Usa, 2 Our Lady Of The Lake Regional Medical Center, Baton Rouge, Usa Background: Children are sensitive to the effects of radiation and are at increased risk when compared to adults. Cervical Spine Injury occurs in less than 1% of children who present with trauma. Evaluation exposes children to unnecessary use of CT scans. By implementation of a cervical spine protocol, we proposed a 20% decrease in the number of pediatric trauma patients undergoing CT imaging.

Methods: A retrospective review was used to identify patients less than 11 years of age presenting from March 2013 to December 2014. Clinical clearance was recommended if the following criteria were met: GCS was 15, the patient was able to communicate at a developmentally appropriate level, there was no neck pain, no neurological deficit, no intoxication, and no distracting injuries. If criteria were not met then X-rays of the cervical spine were recommended.

Results: There were 43 trauma patients less than age 11 in March through December 2013 and there were 32 Level I or Level II trauma patients less than age 11 in 2014. The two samples were not significantly different regarding mean age (t (73) = 1.27, p > .05), distribution of sex (x2 (1) = 1.59, p>.05), and distribution of activation level, (x2 (1) = 0.41, p>.05). If the patient’s GCS score was less than 15 or there were positive findings, imaging was required. 16% (n=7) of 43 met the protocol’s criteria for clinical clearance of the cervical spine while 19% (n=6) of the sample of 32 met the same criteria. There was an increase of 35.7% in patients meeting criteria for clinical clearance, and a 24% decrease in the number of patients undergoing CT scans.

Conclusions: Cervical spine injuries are rare among young children, and radiation effects can be very harmful. Techniques to limit the radiation exposure in the trauma unit were explored by implementation of a cervical spine protocol. Clinical clearance of the cervical spine increased by 35.7% and CT scans decreased by more than 20% during the post-protocol phase as compared to the pre-protocol phase among patients who met criteria for clinical clearance.

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Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Ophthalmology

J22 COMPARING ATTITUDE, KNOWLEDGE AND PRACTICE ABOUT EYE CARE IN IRAINIAN AND ARABIC SPEAKING DIABETIC RETINOPATHY PATIENTS. S. Shahed 1, A. M 2, F. A 1 1 Shiraz Nursing University, Shiraz, Iran, 2 Emergency Medicine And Disaster Management Research And Development Center Of Fars, Shiraz, Iran Background: Diabetic retinopathy is the most acute reason of blindness in aged people. assessing eye care in this field is one of the nursing duties, so this study was done to compare the attitude, knowledge and practice of eye care in Irany and Arabic speaking diabetic retinopathy patients who refer to Shiraz Khodadust Eye Center.

Methods: A cross-sectional study was done in 2014 at Khodadust eye center of Iran. Both Irany(n:50) and Arabic speaking (n:50) diabetic patients were interviewed by on hand sampling. After completing informed consent, a closed ended questionare with 15 questions were used to collect data about their attitude, knowledge and practice of eye care in diabetic retinopathy. Cranach's alpha show reliability for the questionnaire (0.76-0.88-0.85).

Results: Data analysis indicated that in Irany patients of 50 participants, excellent grade for knowledge about diagnosis and eye care was for 83%, excellent grade about eye care was found in27% and excellent level of practice for eye checkups and treatment acceptance was for 41%. This result for Arabic speaking patients was prospectively 44%, 17% and 34%. Independent t-test showed a significant difference (P:0.03) for knowledge in two groups.

Conclusions: Studying about the challenges of eye care deficiencies in Arabic regions in compare to Iran must be considered for problem solving. Need in applying a practical education nursing program to prevent eye crises in diabetic retinopathy patients for increasing attitude and skill in eye care is sensible.