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Value of Research/evidence based treatment.

Posted on by ask
Abdus Salam Khan, MD FACP
June, 2018

Emergency departments across the world provide care to vast spectrum of diseases and conditions. The teamwork required to provide the care needs to be safe care delivery especially to the most sick. As the pace of activity in the emergency department is quite high and too many decisions are made in too short span of time, it becomes more prudent to have a mechanism to ensure safety. To an outside person what seems like a chaos is all routine work to the ED staff.

As the custodian of the emergency care we all strive to be safe yet efficient, and achieving this balance is always important. Creating evidence based pathway driven care has a time tested and proven worth. All treatments that have shown benefit should be utilized and all modalities shown harm should be avoided.

These evidences come from meticulous reporting by the treating physicians, in terms of case reports, observational studies and the clinical trials. The collected data and body of information proves worthiness as well as provide treatment guidelines for the physicians. The value of research is thus in the worthiness of this body of evidence or information. If the research data is not good enough then the results will not be better by any chance. This leads to categorization of the research material into high quality and low quality evidence. Similarly according to relevance it will be highly relevant or irrelevant research. Different institutions create this system and people understand how to look at the research and what to take from it. The bottomline is how to use the research at the bedside in a meaningful way. This whole practice of medicine is called evidence based medicine (EBM). It should be at the core of our clinical practice. It comprises of the ability to trackdown in meticulous fashion and then critically evaluate the body of research and come up with the ways to update the practice of medicine.

It is always difficult to bring research to the bedside and do it is a safer and effective ways. We have to keep ourselves updated and then pick those features that have proven value and which are relevant. The institutions have this role to get into habit of developing strategies to stay on top. Review articles, bestbets, Cochrane review and clinical debates in journals are some of the ways the thought leaders bring academic or clinical research to the bedside.

As treating physicians we also have the duty to help in creating this evidence by participating in ways of documenting our practices and outcomes. Through case reports and prospective as well as retrospective studies, we let the other physicians know what has worked in our practice and what has not. Meticulous and correct data collection is one of the ways to keep our patients safe.

Last thing is the way we practice EBM. As explained above we utilize the uptodate evidence, and then we should involve the most important component of our practice, which is the patient himself. The preference of the patient and his or her customs and values should be carefully matched with the evidence and then the physician uses his/her experience to lump everything together. The treating physician has the greatest role in safeguarding the patients interest at the same time instituting the best treatment option available through keeping him/her uptodate regarding the treatment options.

Our patients rely on us for the best opinion, and we should reciprocate by practicing EBM (evidence based medicine).

I can be reached at askhan65@yahoo.com.

Poison Control Center

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Abdus Salam Khan, MD FACP
May, 2018

Doctors working in emergency department across the world see patients with drug overdose or poisonings and at times feel inadequate in properly managing those patients. They sort out books or call colleagues to get a hint of what could be the safe way of managing these patients.  Where can they turn if all they come across such situations. In the industrialized world, they call there poison control centers.

What is poison. Poison is a substance with an inherent property that tends to destroy life or impair health. And the science of dealing with the effects, antidotes, detection and control of poisons is called toxicology.

A poison control center is the medical facility that is able to provide immediate, free, and expert treatment advice and assistance over the telephone in cases of exposure to poisonous and hazardous substance.

The world started realizing the value of providing right information at right time to the treating staff. In Europe special poison units were started in 1940’s. First such center was initiated in North America in 1950s. Since then numerous centers are there, but mostly in industrialized countries. The task of these centers were well defined and limited to poison and injury information and care.

In Pakistan National Poison and Drug information center was initiated in 2012 in JPMC as Public sector. The JPMC service is run by one doctor, one nurse and one Pharmacist in a shift pattern. There is another public sector poison center in Faisalabad. Now there are two private sector poison information services providing information, one in AKUH( Aga Khan University Hospital) and other by Pharma company by the name of Pharmassist.

Functions of PCC (Poison Control Center):

It is a specialized unit providing information regarding poisoning to the whole community. It acts to provide toxicological information and advice and manages poisoning cases depending on the capability. With proper data collection, it can provide analytical input as well as Pharmacovigilence. The center can also be very instrumental in providing training in prevention and treatment of poisoning. There is also a good role in contingency planning and responding to chemical disaster.

Need for the PCC (Poison control Center):

Because of the poisoning case load there is a need for early and right treatment of exposed patient. It includes providing right information to patients or their relatives with toxic or poison substance exposure. The data collected serves as Toxicovigilence for the whole community. These information given in right time and through good and sound information service can avoid expensive treatments by going to emergency departments unnecessarily.

PCC(Poison Control Center) or DPIC (Drug and Poison information center) can be initiated and run by either a hospital or university, or it can also be part of the public health service.

Conclusion:

Poison control centers provide excellent service to the population. Poison control centers are needed for the surveillance, and recognition of the pattern of poisoning in society. A drug information service is necessary component of any health care system, as it tends to provide necessary information to the general public to keep them safe.

 

I can be reached at askhan65@yahoo.com.

A New ERA in Emergency Medicine in Pakistan

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Abdus Salam Khan, MD FACP
April, 2018
 

Pakistan has turned another corner in its journey of Emergency Medicine. Our collective efforts to bring Emergency Medicine to forefront got a boost with creation of society to represent the Emergency Medicine in Pakistan.

When we talk about the efforts done in the field of Emergency Medicine, it used to be due to individual or institutional effects . We felt the need for a combined and collective voice for Emergency Medicine. Our efforts materialized in the form of PSEM (Pakistan Society Of EM).

The society like any other society will create a common platform to talk about every aspect of EM. This will serve the great purpose of uniting our energies to bring everyone to same page, and thus be very effective.

The society is open to all, and that means Doctors, Nurses, Paramedics, Technicians, Managers and all interested in bringing Emergency care in Pakistan to a decent level. In the background of plenty of work done by our colleagues, it is relatively easy to move forward, yet enormity of task requires right attitude and right decision making.

I still remember early days, when I joined Shifa Emergency Department in 2009 and came in touch with SEPP (Society Of Emergency Physicians Pakistan). At that time we were very few people, no recognized program for training and people in most Emergency Department were clueless regarding this specialty. Our small team was spearheaded by Dr. Junaid Razak. Agha Khan University had already started a residency training which was not recognized by CPSP. We started having meetings and the combined efforts resulted in the recognition of program.

Fast forward to 2018 and we have more than 10 supervisors, more than 50 trainees and two trainees passed FRCP EM exam and serving in Pakistan. We felt the need of society back than in 2005 and since then in some shape and form we tried to work under the banner of society, so that the efforts can be seen as one geared towards whole Pakistan. What we see in future is very promising expansion of Emergency Medicine filed in Pakistan. Increasing number of institutions for the training is expected and so will see increased number of trainees. With the activation of Society we will create links with international bodies like IFEM and RCEM. We also need to work on our level care provision and improve the quality. Society is expected to play role of a helper in all activities related to emergency care.

Working to emergency Department here in Pakistan for past 9 years, I feel energized to see formation of a body that is dedicated to Emergency Medicine.

This way people who are decision makers at all level can be brought into conversation regarding improving emergency care. We will work on defining level of care, competence, level of staffing including nurses and paramedics and also the pathway and procedure for the care delivery in all emergency settings. There are plenty of resources available and the best available resource is our human capital. Although untrained yet experienced enough that they should be given a fair chance of expanding their capability and competence and coming to the fold of emergency medicine. It would be a very cost effective way of improving emergency care quickly.

We are also experiencing a slow flux of physicians back to the country. These physicians have worked in the developed setups and attained the level of competence to develop and enhance the system here. Its a perfect timing to enhance our efforts and channelize it to have maximal impact.

We do understand the political situation of the country and instability that has various causes, yet we feel the extreme urge to quickly develop the emergency management system to provide basic emergency care for the vast majority of citizens without incurring huge cost to the system. This would happen by training human capital through training and teambuilding.

PSEM with its penetration in almost all provinces is in perfect position to spearhead this efforts through help from all our international partners and collaborators.

I can be reached at askhan65@yahoo.com.