Attitudes and Practices of Lumbar Puncture among Students, Interns, and Residents of the Pediatric Department of the Mohammed VI University Hospital Center of Oujda, Morocco

Introduction: Even though lumbar puncture (LP) represents an important tool in the diagnosis of certain neurological diseases, this procedure is little practiced by our students. We aimed to evaluate the attitudes and practices of students, interns, and residents about LP, and to assess their feelings about how this procedure is taught. Materials and Methods: We conducted a cross-sectional study of 160 participants, using an anonymous questionnaire, to evaluate the attitudes and practices of students, interns and residents in the pediatrics department concerning lumbar puncture. Results: Half of the participants had never performed LP, usually because of the risk involved or lack of confidence, while 20% had performed it more than 4 times. None of the participants had learned to perform the procedure through simulation sessions, while (42%) had learned it under the supervision of a senior physician and had not been able to perform it successfully the first time. Most participants inform the patient about the procedure before performing it. Only 44% of participants acknowledged that LP can be performed under local anesthetic. The sitting position (60%) was by far the most commonly used. Most LPs were performed for diagnostic purposes. Most participants stated that the pediatric ward and the pediatric emergency department are among the departments that perform LP most frequently, and that they would be interested in taking part in simulated lumbar puncture sessions in children in the future. Conclusion: The results of our study show that LP is perceived by students as a risky procedure that is difficult to perform. Teachers should reconsider how this technical procedure is taught, by integrating simulation on mannequins into student training.

A discrete event simulation model for waiting time management in an emergency department:A case study in an Egyptian hospital

This paper presents a discrete event simulation model to help improving healthcare service provided by an emergency department at a private hospital at Zagazig,Egypt.We construct a patient flow division model by dividing patients according to their severity level.Although patients division and routing have significant evidence in improving health service in terms of waiting times and Length of Stay(LoS),there is a lack in a detailed system evaluation and implementation under this configuration.Based on system observation and health care provider’s interviews,a comprehensive and clear picture of the system has been drawn along with a conceptual model showing different patient flows through the studied system.A discrete event simulation model of the Emergency Department is built using collected data.Different operational scenarios were tested against the baseline scenario to study the impact of patient flow division,including different staff capacities and different patient magnitudes.Results indicate that waiting times and length of patient stay can be significantly improved under the proposed7 system configuration.