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Patients Perspective on the Non-Urgent Use of the Emergency Department in Kenya

Thesis Info

Author

Matifary, Carolyne Robai

Department

Family Medicine (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2019

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728056691

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Background: Globally, there is an increasing demand for emergency department (ED) care in many countries accompanied by the dire need to optimize scant resources. Sub Saharan Africa (SSA) is facing a rapid surge in the prevalence of non-communicable diseases (NCDs) compounded by an already prevailing significant problem of communicable diseases and injuries. This has led to increased demand for emergency care expertise owing to acute complications of all these conditions. The impact includes ED overcrowding, increased healthcare costs, extended waiting periods and overstretched essential services. To mitigate this, it is imperative that EDs be utilized appropriately to continue providing quality emergency medical care services. Objectives: The objectives of the study were to establish why patients visit the ED in a tertiary hospital for non-urgent care, whether they understood the role of the ED and their perception of the urgency of their presenting medical conditions. Methodology: An exploratory qualitative study was conducted. In-depth interviews were conducted among patients triaged as non-urgent using an interview guide. Interviews were audio recorded, transcribed verbatim and analyzed thematically using NVivo 12 software. Results: Thematic saturation was reached after interviewing a total of 24 patients. The results showed that several factors contributed to the non-urgent use of the ED: lack of awareness on alternative places to seek care, familiarity with the ED, closure of other departments after hours and on weekends and teamwork by ED staff. Most of the patients understood that the ED was a place where patients needing urgent medical attention with life threatening conditions were attended to and such patients were not required to queue. Majority of the patients felt their conditions were life threatening. Conclusion: Several reasons were identified in this study as to why patients with non-urgent medical conditions sought care in the ED. This was despite a majority of the patients being able to correctly define the role of the ED. There is need to continuously educate patients on which conditions are appropriate to be seen in the ED and provide mechanisms of referring patients with non-urgent conditions to alternative sites of care.
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صحافت

صحافت
یار صحافت عین عبادت کریئے جے کر سچ دے نال
جان دکھاں وچ پا صحافی بنندے ہین غریب دی ڈھال

جدوں ایہہ خبراں ڈھونڈن ویندے غم اندوہ نیں جردے
ماڑیاں تے مظلوماں اُتے ہتھ شفقت دا دھردے
جابر ظالم حاکم اگے ڈٹ جاندے نہ ڈردے
خوف ذرا نہ کھاندے ویکھو کردے صدق مقال

شہر محلے کوچہ کوچہ ہر جا ویکھو جاندے
ظالم لوگ غریباں تائیں حدوں ودھ ستاندے
مرہم زخم غریباں دے تے ہین صحافی لاندے
حق دی گل نیں کردے نالے رہندے حق دے نال

دفتراں اَتے کچہریاں وچ، کدی پھردے رہن بزاراں
سجریاں تازیاں خبراں ڈھونڈ کے چھاپن وچ اخباراں
چنگیاں مندیاں خبراں پڑھ کے پرچن دل ہزاراں
پنچھیاں وانگ توکل رب تے رہندے نیں خوشحال

یار صحافی چنگے نیں، ایہہ بولن بول رسیلہ
دکھیاں تے دکھیاراں دا ایہہ بن دے ہین وسیلہ
راہ ڈکن ایہہ اَگوں بھانویں ہووے شیر مریلہ
جس دے نال ایہہ دل تھیں ٹردے دکھڑے دیندے ٹال

اللہ سوہنے رزق انہاندا لکھیا کس بہانے
مالک روزی ہر نوں دیندا ، بھولے تے مستانے
کر مزدوری تے کھا چوری، کہہ گئے مرد ربانے
منگو یار دعاواں سب نوں لبھے رزق حلال

قادریؔ جی اخبار دی خدمت عزت بہت بناندی
عزت، شہرت ، دولت تائیں غربت شان گنواندی
اللہ سوہنا راضی تھیوے جتھے پیش نہ جاندی
خوفِ خدا تھیں روندیاں نوں تے بخشے گا ذوالجلال

توظيف وسائل الاتصال الحديثة في تعليم اللغة العربية

The Arabic language is the language of the Holy Quran, which has become an immortal language because of the immortality of the Holy Quran as it says: "Surely We have revealed the Reminder and We will most surely be its guardian." It is one of the most widely spoken languages in the world, especially since the language is the means of communication among the peoples of the world. Communication and technological techniques in learning and teaching the Arabic language taking into account the elements of the educational process (student, teacher and curriculum), according to the requirements of the age, and the development of the mechanisms of teaching the Arabic language with modern technologies that keep up with the times and developments. The aim of the research is to explain the impact of modern means of communication on the teaching of the Arabic language according to several axes: definition of the language, definition of the language in Arabic and the strategy of its publication, the definition of the modern means of communication and their types in the teaching of the Arabic language. The analytical approach will be used in this study. The researcher concluded at the end of this study to prove that the Arabic language faces many challenges in light of the great progress of the modern means of communication and technical progress; and that there are many obstacles in the use of educational technology in the teaching of the Arabic language, which prevents the achievement of the objectives of education. Solutions to this problem are, thus, suggested so as to improve the Arabic language and maintain its position among the languages of the world.

Analysis of Genetics Markers Associated With Kidney Transplantation Outcome

Allograft rejection remains a major hurdle in successful transplantation despite improved immunosuppressive drugs and clinical care. The molecular changes in the renal allograft that lead to graft rejection need to be investigated. In the present work, polymorphisms in chemokine receptors and urinary chemokine levels were investigated for association with rejection. This study includes; (a) gene polymorphisms of chemokine receptors of CCR2 and CCR5 (CCR2V64I and CCR5-59029G>A and CCR5Δ32), (b) urinary levels of interferon induced protein-10 (IP-10), (c) urinary levels of monokine induced by interferon-gamma (MIG) and (d) urinary levels of monocyte chemotactic protein-1 (MCP-1). This is the first study on chemokine receptor polymorphisms and the urinary chemokine levels (IP-10, MIG and MCP-1) in cohorts of Pakistani renal transplant patients. The project was approved by the Institutional Ethical Review Committee and informed consent was taken from all the participants. Briefly, the gene polymorphisms CCR2V64I, CCR5-59029G>A and CCR5Δ32 were investigated in 606 renal transplant patients and their donors by amplified fragments length polymorphisms (RFLP). The results showed that the G/G genotype of CCR2V64I was associated with a high frequency of allograft rejection (P=0.009). The Kaplan-Meier curve also indicated a significant reduction in the overall time to rejection-free allograft survival for patients with the G/G genotype of CCR2V64I as compared to the A/A or G/A genotype (59.2±1.4 vs. 68±2.6 weeks, P=0.008) showing that individuals with the A allele, either in the homozygous or heterozygous state, have a greater chance to accept the graft. ix Human IP-10 is classified as the CXC chemokine sub-family. A total of 206 urine samples of (a) rejection (n=96), (b) non-rejection (n=22) and (c) controls (n=88) were quantified for IP-10 by enzyme-linked immunosorbent assay (ELISA) for association with rejection. The results showed statistically significant differences in the urinary IP-10 levels between the rejection vs. non-rejection groups (P=0.004). The Receiver operating characteristic curve (ROC) of IP-10 showed area under the curve (AUC) of 0.70±0.06 with 72% sensitivity and 64% specificity, at a cut-off value of 27pg/ml. Human MIG also belongs to the CXC chemokine sub-family. A total of 266 urine samples from (a) rejection (n=108), (b) non-rejection (n=70), (c) stable grafts (n=42) and (d) control groups (n=46) were quantified for MIG and analyzed for association with rejection. The results indicated that although urinary MIG levels were higher in patients with rejection the association was not statistically significant (P>0.05). The ROC curve also showed AUC of 0.54±0.04 with low sensitivity (46%) and specificity (55%) at cut-off value of 6pg/ml. Human MCP-1 belongs to the CC chemokine sub-family. A total of 409 urine samples of (a) rejection (n=165), (b) non-rejection (n=93), (c) stable grafts (n=42) and (d) controls (n=109) were quantified for urinary level of MCP-1 by ELISA. The results showed that MCP-1 levels were different between the rejection and other groups (P<0.05). The ROC curve illustrated the area under curve of 0.83±0.04 with a sensitivity and specificity of 84% and 74% respectively, at a cut-off value of 214pg/ml. In conclusion, this work shows the usefulness of chemokine receptor CCR2V64I polymorphism as a marker for the increased possibility of an x immune response against an allograft. Urinary levels of MCP-1, the ligand of CCR2, and IP-10 were increased and show good correlation with rejection. While urinary MIG did not show any association with rejection. These findings may help in developing new therapeutic strategies in renal transplantation based on patient genetic makeup. Additionally, non-invasive screening tests based on urinary levels of IP-10 and MCP-1 would help in the assessment of the immune status of the graft