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Journal Cover African Journal of Emergency Medicine
  [SJR: 0.2]   [H-I: 3]   [2 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2211-419X
   Published by Elsevier Homepage  [2805 journals]
  • Tapping into a vital resource: Understanding the motivators and barriers
           to blood donation in Sub-Saharan Africa

    • Abstract: Publication date: Available online 8 April 2016
      Source:African Journal of Emergency Medicine
      Author(s): Tanja Z. Zanin, Denise P. Hersey, David C. Cone, Pooja Agrawal
      Introduction Sub-Saharan Africa (SSA) has a need for blood and blood products that exceeds current availability. This unmet demand is evidenced by persistently high mortality rates associated with potentially reversible conditions such as haemorrhage and anaemia. This study reviews current literature on blood donation in SSA to identify common local motivators and deterrents to blood donation and highlights specific interventions that have successfully increased the number of blood donors in this region. Methods The authors searched the health literature to identify original studies conducted in SSA that addressed blood donation motivators and deterrents. Data were then extracted from each study to determine how often each study identified specific motivators and deterrents. Results Pro-social motivation, such as altruism and the desire to have a positive effect on the community, is the most frequently noted reason for people in SSA countries to donate blood. Negative attitudes and misconceptions towards blood donation, in addition to perceived negative health effects caused by donation, are the two most frequently mentioned reasons that dissuade individuals from donating blood. Conclusion Due to paucity of research on this topic, our understanding of blood donor behaviour in SSA is limited. Local traditions and cultures intimately shape individuals’ proclivity towards the donation process. In order to change the attitudes and behaviours of many potential donors in SSA it is important to address the deterrents to blood donation, as many represent misconceptions or culture-specific beliefs that may be the ultimate driving force dictating donor behaviour.


      PubDate: 2016-04-08T23:57:06Z
       
  • Bedside ultrasound training at Muhimbili National Hospital in Dar es
           Salaam, Tanzania and Hospital San Carlos in Chiapas, Mexico

    • Abstract: Publication date: Available online 7 April 2016
      Source:African Journal of Emergency Medicine
      Author(s): Teri A. Reynolds, Jeanne Noble, Gehres Paschal, Hendry Robert Sawe, Aparajita Sohoni, Sachita Shah, Bret Nicks, Victor Mwafongo, John Stein
      Introduction In resource-rich settings, bedside ultrasound has rapidly evolved to be a crucial part of emergency centre practice and a growing part of critical care practice. This portable and affordable technology may be even more valuable in resource-limited environments where other imaging modalities are inaccessible, but the optimal amount of training required to achieve competency in bedside ultrasound is largely unknown. We sought to evaluate the feasibility of implementation of a mixed-modality bedside ultrasound training course for emergency and generalist acute care physicians in limited resource settings, and to provide a description of our core course components, including specific performance goals, to facilitate implementation of similar initiatives. Methods We conducted a standardised training course at two distinct sites—one large, urban tertiary hospital in Tanzania with a dedicated Emergency Centre, and one small, rural, hospital in southern Mexico with a general, acute intake area. We report on pre-training ultrasound use at both sites, as well as pre- and post-training views on most useful indications. Results Overall, participants were very satisfied with the course, although approximately one-third of the providers at both sites would have preferred more hands-on training. All participants passed a standardised exam requiring image acquisition and interpretation. Discussion Introducing bedside ultrasound training in two distinct resource-limited settings was feasible and well-received. After a brief intensive period of training, participants successfully passed a comprehensive examination, including demonstration of standardised image acquisition and accurate interpretation of normal and abnormal studies.


      PubDate: 2016-04-08T23:57:06Z
       
  • Professional needs of young Emergency Medicine specialists in Africa:
           Results of a South Africa, Ethiopia, Tanzania, and Ghana survey

    • Abstract: Publication date: Available online 7 April 2016
      Source:African Journal of Emergency Medicine
      Author(s): Crystal Bae, Heike Geduld, Lee A. Wallis, De Villiers Smit, Teri Reynolds
      Introduction Emergency Medicine (EM) residency programmes are new to Africa and exist in only a handful of countries. There has been no follow up on faculty development needs nor training of these graduates since they completed their programmes. The African Federation for Emergency Medicine (AFEM) aims to explore the needs of recent EM graduates with respect to the need for resources, mentorship, and teaching in order to develop a focused African faculty development intervention. Methods As part of the AFEM annual survey, all those who have graduated since 2012 from a Sub-Saharan African EM residency programme were approached. These included Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania, Addis Ababa University (AAU) in Ethiopia, Komfo Anokye Teaching Hospital (KATH) in Ghana, the University of Cape Town (UCT) in South Africa, the University of Pretoria (UP) in South Africa, the University of Witswatersrand (Wits) in South Africa, and the University of KwaZulu-Natal (UKZN) in South Africa. Results The 47 respondents rated themselves as most confident medical experts in knowledge, procedural skills, and communication. Overall graduates felt least equipped as scholars and managers, and requested more educational materials. They reported that the best way for AFEM to support them is through emergency care advocacy and support for their advocacy activities and that their most critical development need is for leadership development, including providing training materials. Conclusion Recent graduates report that the best ways for AFEM to help new EM graduates is to continue advocacy programmes and the development of leadership and mentorship programmes. However, there is also a demand from these graduates for educational materials, especially online.


      PubDate: 2016-04-08T23:57:06Z
       
  • Added value of graded compression ultrasound to the Alvarado score in
           cases of right iliac fossa pain

    • Abstract: Publication date: Available online 7 April 2016
      Source:African Journal of Emergency Medicine
      Author(s): Mohamed Samir, Mohamed Hefzy, Mohamed Gaber, Khaled Moghazy
      Introduction Acute appendicitis is one of the most common emergencies treated by the general surgeon. Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality, and surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. The aim of this study was to evaluate the sensitivity and specificity of the Alvarado score combined with ultrasounds of the abdomen and pelvis in cases of right iliac fossa pain with suspected acute appendicitis. Methods 100 patients admitted to the Department of Surgery at Alexandria Main University Hospital in 2013 complaining of right iliac fossa pain with suspected acute appendicitis were studied prospectively. The demographic information, histopathology, physical examination, laboratory data, Alvarado score, sonography report and histopathological reports of these patients were gathered. The treating surgeon made decisions for surgery or conservative management without any intervention from the research team. Results A combination of methods showed that Alvarado alone was 100% sensitive in excluding appendicitis at scores below five and was highly specific at scores above eight (91.9%) with no added value when combining it with ultrasound in those scores. On the other hand, ultrasound was beneficial only in patients with Alvarado scores between five and eight for detecting appendicitis and not excluding it (increasing specificity to 100% and not affecting sensitivity). Conclusion Ultrasound is a good adjuvant examination in cases with Alvarado scores between five and eight in order to diagnose appendicitis. Negative ultrasound results do not exclude appendicitis and further assessment by other modalities should be performed.


      PubDate: 2016-04-07T23:52:35Z
       
  • A pilot training program for point-of-care ultrasound in Kenya

    • Abstract: Publication date: Available online 6 April 2016
      Source:African Journal of Emergency Medicine
      Author(s): Greg Bell, Benjamin Wachira, Gerene Denning
      Introduction Ultrasound is an effective and affordable clinical diagnostic tool highly attractive for use in low and middle income countries (LMICs), but access to training programs in these countries is limited. The objective of our study was to develop and pilot a program for healthcare providers in Kenya in the use of point-of-care ultrasound. Methods Trainees were recruited in district hospitals for participation in three all-day workshops held every 3–5months from September 2013 through November 2014. Prior to the initial workshop, trainees were asked to study a training manual, and a knowledge test was administered. Ultrasound-credentialed emergency physicians provided brief didactic lessons then hands-on training for eFAST and obstetric training. This was followed by an observed assessment of scanning image quality (IM) and diagnostic interpretation (IN). Results Eighty-one trainees enrolled in four initial training sessions and 30 attended at least one refresher session. Among those trainees who attended refresher sessions, there was an increase in the proportion passing both the knowledge and practical tests at the follow-up, as compared to the initial session. Overall, mean practical skill scores also trended toward an increase over time, with a significantly higher mean score in November (2.64+0.38, p =0.02) as compared to March (2.26+0.54), p <0.05. Pre-workshop preparation evolved over time with the goal of maximizing trainee readiness for the hands-on course. A strong correlation was observed between knowledge and practical skill scores illustrating the importance of pre-workshop training. Conclusions Our pilot workshop showed promise in promoting knowledge and practical skills among participants, as well as increasing use in patient care. Results also suggest that refresher training may provide additional benefits for some participants. These findings provide a strong rationale for expanding the training program and for measuring its clinical impact.


      PubDate: 2016-04-07T23:52:35Z
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: Available online 26 March 2016
      Source:African Journal of Emergency Medicine
      Author(s): Johanna Catharina Botha



      PubDate: 2016-03-30T23:18:34Z
       
  • In this issue…

    • Abstract: Publication date: March 2016
      Source:African Journal of Emergency Medicine, Volume 6, Issue 1
      Author(s): Stevan R. Bruijns



      PubDate: 2016-03-20T22:11:45Z
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: March 2016
      Source:African Journal of Emergency Medicine, Volume 6, Issue 1
      Author(s): P.K. Forson, M. Osei-Ampofo, Momade Eszter, J. Sylverken, R. Oteng, P. Donkor, G. Oduro



      PubDate: 2016-03-20T22:11:45Z
       
  • Injury patterns and health outcomes among pregnant women seeking emergency
           medical care in Kumasi, Ghana: Challenges and opportunities to improve
           care

    • Abstract: Publication date: Available online 22 February 2016
      Source:African Journal of Emergency Medicine
      Author(s): Maxwell Osei-Ampofo, Katherine T. Flynn-O’Brien, Ellis Owusu-Dabo, Easmon Otupiri, George Oduro, Peter Donkor, Charles Mock, Beth E. Ebel
      Introduction In high-income countries, injury is the most common cause of non-obstetric death among pregnant women. However, the injury risk during pregnancy has not been well characterized for many developing countries including Ghana. Our study described maternal and fetal outcomes after injury at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, and identified associations between the prevalence of poor outcomes and maternal risk factors. Methods We conducted a cross-sectional study to identify pregnant women treated for injury over a 12-month period at KATH in Kumasi, Ghana. Descriptive statistics were used to characterize the population. We identified the association between poor outcomes and maternal risk factors using multivariable Poisson regression. Results There were 134 women with documented pregnancy who sought emergency care for injury (1.1% of all injured women). The leading injury mechanisms were motor vehicle collision (23%), poisoning (21%), and fall (19%). Assault was implicated in 3% of the injuries. Eleven women (8%) died from their injuries. The prevalence of poor fetal outcomes: fetal death, distress or premature birth, was high (61.9%). One in four infants was delivered prematurely following maternal injury. After adjusting for maternal and injury characteristics, poor fetal outcomes were associated with pedestrian injury (adjusted prevalence ratio (aPR) 2.5, 95% CI 1.5–4.6), and injury to the thoraco-abdominal region (aPR 2.1, 95% CI 1.4–3.3). Conclusions Injury is an important cause of maternal morbidity and poor fetal outcomes. Poisoning, often in an attempt to terminate pregnancy, was a common occurrence among pregnant women treated for injury in Kumasi. Future work should address modifiable risk factors related to traffic safety, prevention of intimate partner violence, and prevention of unintended pregnancies.


      PubDate: 2016-02-22T20:32:09Z
       
  • Uchunguzi (Journal Watch/Montre de Journal)

    • Abstract: Publication date: Available online 5 February 2016
      Source:African Journal of Emergency Medicine
      Author(s): Benjamin W. Wachira



      PubDate: 2016-02-12T19:56:36Z
       
  • Time to standardise levels of care amongst Out-of-Hospital Emergency Care
           providers in Africa

    • Abstract: Publication date: Available online 4 February 2016
      Source:African Journal of Emergency Medicine
      Author(s): N.K. Mould-Millman, C. Stein, L.A. Wallis
      The African Federation for Emergency Medicine’s Out-of-Hospital Emergency Care (OHEC) Committee convened 15 experts from various OHEC systems in Africa to participate in a consensus process to define levels of care within which providers in African OHEC systems should safely and effectively function. The expert panel concluded that four provider levels were relevant for African OHEC systems: (i) first aid, (ii) basic life support, (iii) intermediate life support, and (iv) advanced life support. Definitions for each provider level were also created to aid standardisation of providers across Africa and to help advance the practice of OHEC.


      PubDate: 2016-02-12T19:56:36Z
       
  • The clinical practice of emergency medicine in Mahajanga, Madagascar

    • Abstract: Publication date: Available online 4 February 2016
      Source:African Journal of Emergency Medicine
      Author(s): Vijay C. Kannan, Georges Ramalanjaona, Clara N. Andriamalala, Teri A. Reynolds
      Introduction Little is documented concerning the clinical practice of emergency care in low- and middle-income countries. The lack of structural models presents serious obstacles to the development of effective emergency care services. This study provides such a model by describing the clinical practice at the emergency centre of the Centre Hôpitalier Universitaire de Mahajanga in Madagascar. Methods This was a retrospective chart review of all adult patients presenting to the emergency centre from September to November 2012. Archived chart data were extracted into a computer database. Data included: age, sex, date, diagnostic investigations, procedures, medications, and diagnosis. Results 727 charts were reviewed, averaging eight patients per day. The three most frequent pathologies observed were trauma, gastrointestinal, and infectious disease. A total of 392 received diagnostic investigations. These were chiefly complete blood counts (n =218), blood glucose (n =155) and ECG (n =92). Chest X-rays (n =83), extremity X-rays (n =55) and skull/face X-rays (n =44) comprised the most common imaging. Ultrasounds were primarily abdominal (n =9), renal/genitourinary (n =6), and obstetric (n =2). Therapeutic interventions were performed in 564 patients, most commonly intravenous access (n =452) and wound/orthopaedic care (n =185). Medications were administered to 568 patients, mostly anti-inflammatory/analgesics (n =463) and antibiotics (n =287). Conclusion This is the first descriptive study of the clinical practice of emergency medicine in Mahajanga, Madagascar. It provides both the Malagasy and international medical communities with an objective analysis of the practice of emergency care in Madagascar from both diagnostic and therapeutic standpoints. Emergency care here focuses on the management of traumatic injury and infectious disease. The diagnostic imaging, pharmacologic and procedural therapeutic interventions reflect the burdens placed upon this institution by these diseases. We hope this study will provide guidance for the further development of Malagasy-specific emergency care systems.


      PubDate: 2016-02-12T19:56:36Z
       
  • Global research highlights

    • Abstract: Publication date: Available online 18 January 2016
      Source:African Journal of Emergency Medicine




      PubDate: 2016-01-20T19:36:01Z
       
  • Typhoid intestinal perforation: Point-of-care ultrasound as a diagnostic
           tool in a rural Ugandan Hospital

    • Abstract: Publication date: Available online 4 January 2016
      Source:African Journal of Emergency Medicine
      Author(s): Jordan Chanler-Berat, Alfunsi Birungi, Brad Dreifuss, Ronald Mbiine
      Introduction Point-of-care ultrasound (POCUS) in resource-limited areas has demonstrated utility in the hands of physicians and may be useful for non-physician providers to learn as well. Case Report An 11year old male presented with abdominal pain and diffuse abdominal tenderness to a remote Emergency Centre (EC). An Emergency Care Practitioner, a non-physician emergency care provider with limited ultrasound training, used bedside ultrasonography and alerted the on-call surgeon of complex intraperitoneal fluid representing perforated typhoid, which expedited the patient’s care. Discussion There is scant literature involving cases of non-physician use of POCUS, particularly in the emergency care setting. This case demonstrates the potential benefits of training these providers in POCUS.


      PubDate: 2016-01-05T17:51:41Z
       
  • A promising poison information centre model for Africa

    • Abstract: Publication date: Available online 5 January 2016
      Source:African Journal of Emergency Medicine
      Author(s): Carine Marks, Niel van Hoving, Nick Edwards, Christopher Kanema, David Kapindula, Tom Menge, Caesar Nyadedzor, Clare Roberts, Dexter Tagwireyi, Joanna Tempowski
      Introduction The burden of poisoning exposures in Africa is a significant public health concern, yet only ten African countries have poisons information centres. The establishment of poisons centres was subsequently identified as a priority. This article focuses on workshop discussions with international multi-sector stakeholders in Eastern Africa regarding the possibility of a sub-regional poisons centre serving multiple countries. Methods The project was led by an independent consultant under the guidance of an international steering group. Steering group members provided input at international multi-stakeholder meetings and during monthly teleconferences. Results Participants of the stakeholder meetings agreed that the establishment of a sub-regional poisons centre in Eastern Africa was necessary and feasible. Virtual collaboration is possible due to recent technological developments, and the overall suggestion was for countries to establish their own poisons centres and to network and coordinate these centres through a network hub. Conclusion A number of benefits might result from such a poisons centre network hub, including: (1) Improved cooperation between countries on poisoning problems; (2) Harmonisation and strengthening of research and surveillance; (3) Common standards and best practices e.g. regulating chemicals, data management, and staff training; and (4) Greater bargaining power to secure resources. Further investigation is needed to identify the most suitable location for the network hub, the activities it should fulfil, and the availability of specialists in poisons information who could become members of the hub.


      PubDate: 2016-01-05T17:51:41Z
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: December 2015
      Source:African Journal of Emergency Medicine, Volume 5, Issue 4
      Author(s): S.R. Nkansah, M. Osei-Ampofo, K. Ekremet, O.K. Offei, K. Antwi-Donkor, R. Oteng, G. Oduro



      PubDate: 2015-12-12T00:16:03Z
       
  • In Africa

    • Abstract: Publication date: December 2015
      Source:African Journal of Emergency Medicine, Volume 5, Issue 4
      Author(s): Ellen Weber



      PubDate: 2015-12-12T00:16:03Z
       
  • Free Open Access Medical Education resource knowledge and utilisation
           amongst Emergency Medicine trainees: A survey in four countries

    • Abstract: Publication date: Available online 11 December 2015
      Source:African Journal of Emergency Medicine
      Author(s): Natalie Thurtle, Colin Banks, Megan Cox, Tilley Pain, Jeremy Furyk
      Introduction Free Open Access Medical Education encompasses a broad array of free online resources and discussion fora. The aim of this paper was to describe whether Emergency Medicine trainees in different contexts know about Free Open Access Medical Education, and whether or not they know about its different platforms, which ones they use, and what the major barriers to regular usage are. Methods A convenience sample was surveyed on awareness and use of Free Open Access Medical Education blogs, podcasts, websites and Twitter at three institutions (in Australia, Botswana and Papua New Guinea) and one deanery (United Kingdom) between June 2013 and June 2014 using an online survey tool or via hand-distributed survey. Results 44 trainees responded: four from Botswana, seven from Papua New Guinea, ten from the United Kingdom and 23 from Australia. 82% were aware of blogs, 80% of websites, 75% of podcasts and 61% of Twitter as resources in Emergency Medicine. Awareness and use of specific resources were lower in Botswana and Papua New Guinea. For blogs, podcasts and websites, trainees who had looked at a resource at least once were neutral or agreed that it was relevant. For Twitter, some trainees found it difficult to navigate or not relevant. Lack of awareness of resources rather than lack of internet access was the main barrier to use. Conclusion The Emergency Medicine trainees in both developed and low resource settings studied were aware that Free Open Access Medical Education resources exist, but trainees in lower income settings were generally less aware of specific resources. Lack of internet and device access was not a barrier to use in this group.


      PubDate: 2015-12-12T00:16:03Z
       
  • Agar ultrasound phantoms for low-cost training without refrigeration

    • Abstract: Publication date: Available online 27 November 2015
      Source:African Journal of Emergency Medicine
      Author(s): Matthew Earle, Giuliano De Portu, Elizabeth DeVos
      Introduction Ultrasound is a technique that can be utilised to augment procedures to increase their safety and efficacy, but requires that health professionals be trained to use this imaging modality before it can be implemented. With the extremely high cost of manufactured phantoms, homemade alternatives are popular substitutes. Gelatine is commonly used as a matrix to suspend analogues and mimic tissue, but other substrates like ground meat can also be used. Both of these substrates require refrigeration and are subject to spoiling. Our research was designed to evaluate whether agar models would be superior to traditional Gelatine models in their sustainability and whether they would produce ultrasound images adequate for training. Methods Agar models of varying formulas (percent agar by weight with certain additives varied) were tested for acceptable fidelity to real tissue, ultrasound image quality, and durability compared to gelatine models and human tissue. Results A five percent by-mass agar model augmented with small amounts of suspended wheat flour presented as a model that could generate an ultrasound image that remarkably resembled that of real tissue. This agar model does not require refrigeration, is resistant to spoiling and desiccation, mimics tissue texture well, is durable enough to withstand high-volume training, and can be recycled to make new models. Conclusion Agar phantoms are easy to make, do not require refrigeration, and have multiple distinct advantages over gelatine models for ultrasound training in austere conditions.


      PubDate: 2015-12-02T02:22:04Z
       
  • Endotracheal tube cuff pressures and tube position in critically injured
           patients on arrival at a referral centre: Avoidable harm'

    • Abstract: Publication date: Available online 21 November 2015
      Source:African Journal of Emergency Medicine
      Author(s): Timothy C. Hardcastle, Michael Faurie, David J.J. Muckart
      Introduction The consequences of excessive endotracheal tube (ETT) cuff pressure are known and have long-term effects; however less attention is placed upon cuff pressure and tube position pre-hospital and in emergency centre. The aim of this study was to evaluate the ETT cuff pressure and tube position on arrival of all patients admitted to the Trauma Unit at Inkosi Albert Luthuli Central Hospital, both from scene and inter-hospital transfers to determine the median cuff-pressure and if there were differences between the two groups. Methods Data from Trauma Unit patients are entered into a prospective; UKZN approved (BE207-09) Trauma Database. Data on 65 admissions between April and December 2014 were reviewed to determine the arrival cuff pressure and tube position. Data captured included patient age, cuff pressure, where and who intubated the patient, and time since intubation to cuff pressure check. Data were analysed by descriptive statistics and Student’s t-test for continuous data. Results Most patients had sustained motor vehicle related trauma, with a male predominance. Equal numbers were intubated pre-hospital versus the in-hospital group. Eighty percent of ETT’s were placed in the correct anatomical location, however only 23% of cuff pressures were found to be within the safe pressure limits. ETT cuff pressures were excessive in the pre-hospital ALS group more often than the facility-intubation group (p =0.042). There were fatal complications related to supra-glottic intubations resulting in aspiration pneumonia, highlighting the need for X-ray confirmation of tube position. Conclusion Most patients, whether intubated on-scene or at hospital have ETT cuff pressures that are excessive, with the potential for ischaemic necrosis of the tracheal mucosa. ETT cuff manometry should be standard of care for all prehospital and in-hospital intubations where the tube will remain in situ for any prolonged period of time. Before inter-facility transfer ETT position should be confirmed radiologically.


      PubDate: 2015-11-27T01:19:43Z
       
  • Global research highlights

    • Abstract: Publication date: Available online 6 November 2015
      Source:African Journal of Emergency Medicine




      PubDate: 2015-11-11T23:00:04Z
       
  • In this issue

    • Abstract: Publication date: Available online 28 October 2015
      Source:African Journal of Emergency Medicine
      Author(s): Stevan R. Bruijns



      PubDate: 2015-11-06T11:28:41Z
       
  • The Sendai Framework and emergency care

    • Abstract: Publication date: Available online 20 October 2015
      Source:African Journal of Emergency Medicine
      Author(s): Paul Y. Kim, Hendry R. Sawe, Lee A. Wallis



      PubDate: 2015-11-06T11:28:41Z
       
  • Developing a reference standard for assessing paediatric triage scales in
           resource poor settings

    • Abstract: Publication date: Available online 19 October 2015
      Source:African Journal of Emergency Medicine
      Author(s): Mohammed Dalwai, Katie Tayler-Smith, Michele Twomey, Lee Wallis
      Introduction One of the main challenges for emergency healthcare services in low to middle income countries (LMICs) is limited capacity to deal with heavy emergency caseloads. The process of triage is one mechanism for mitigating this challenge. Methods In a two-round consensus building process (the Delphi process), a panel of emergency centre (EC) experts were asked to independently triage 50 clinical vignettes using one of four acuity levels: emergency (patient to be seen immediately), very urgent (patient to be seen within 10min), urgent (patient to be seen within 60min), or routine (patient to be seen within four hours). The vignettes were based on real paediatric EC cases in South Africa. Vignettes that reached a minimum of 80% group consensus for acuity ratings on either round one or two were included in the final set of reference vignettes. Results Of the 50 vignettes presented to 11 EC experts, in the first round, 80% group consensus on acuity ratings was obtained for 10 (20%) of the vignettes. In the second round, 80% consensus was reached for 30 of the 40 remaining vignettes. Thus, overall, 40 (80%) of the vignettes reached a minimum group consensus of 80% (emergency n =4; very urgent n =8; urgent n =12; routine n =16). Conclusion This study demonstrates how context-specific reference vignettes can be developed to provide a cheap, effective, and feasible means by which to evaluate paediatric triage systems in LMICs.


      PubDate: 2015-11-06T11:28:41Z
       
  • Uchunguzi (Journal Watch/Montre de Journal)

    • Abstract: Publication date: Available online 17 October 2015
      Source:African Journal of Emergency Medicine
      Author(s): Benjamin W. Wachira



      PubDate: 2015-11-06T11:28:41Z
       
  • The state of emergency care in Democratic Republic of Congo

    • Abstract: Publication date: Available online 21 September 2015
      Source:African Journal of Emergency Medicine
      Author(s): Luc Malemo Kalisya, Margaret Salmon, Kitoga Manwa, Mundenga Mutendi Muller, Ken Diago, Rene Zaidi, Sarah Wendel, Teri Ann Reynolds
      The Democratic Republic of Congo (DRC) is the second largest country on the African continent with a population of over 70million. It is also a major crossroad through Africa as it borders nine countries. Unfortunately, the DRC has experienced recurrent political and social instability throughout its history and active fighting is still prevalent today. At least two decades of conflict have devastated the civilian population and collapsed healthcare infrastructure. Life expectancy is low and government expenditure on health per capita remains one of the lowest in the world. Emergency Medicine has not been established as a specialty in the DRC. While the vast majority of hospitals have emergency rooms or salle des urgences, this designation has no agreed upon format and is rarely staffed by doctors or nurses trained in emergency care. Presenting complaints include general and obstetric surgical emergencies as well as respiratory and diarrhoeal illnesses. Most patients present late, in advanced stages of disease or with extreme morbidity, so mortality is high. Epidemics include HIV, cholera, measles, meningitis and other diarrhoeal and respiratory illnesses. Lack of training, lack of equipment and fee-for-service are cited as barriers to care. Pre-hospital care is also not an established specialty. New initiatives to improve emergency care include training Congolese physicians in emergency medicine residencies and medic ranger training within national parks.


      PubDate: 2015-09-22T22:23:34Z
       
  • Availability of resources for emergency care at a second-level hospital in
           Ghana: A mixed methods assessment

    • Abstract: Publication date: Available online 4 September 2015
      Source:African Journal of Emergency Medicine
      Author(s): Kennedy B. Japiong, Godfried Asiamah, Ellis Owusu-Dabo, Peter Donkor, Barclay Stewart, Beth E. Ebel, Charles N. Mock
      Introduction Emergency care is an essential component of health systems, particularly in low- and middle-income countries. We sought to assess the availability of resources to provide emergency care at a second-level hospital in Ghana. By doing so, deficits that could guide development of targeted intervention strategies to improve emergency care could be identified. Methods A qualitative and quantitative assessment of capacity for care of emergency patients was performed at the Emergency Centre of the Police Hospital, a second-level hospital in Accra, Ghana. Direct inspection and job-specific survey of clinical, orderly, administrative and ambulance staff was performed. Responses to quantitative questions were described. Qualitative responses were examined by content analysis. Results Assessment revealed marked deficiencies in many essential items and services. However, several successes were identified, such as laboratory capacity. Among the unavailable essential items, some were of low-cost, such as basic airway supplies, chest tubes and several emergency medications. Themes from staff responses when asked how to improve emergency care included: provide periodic training, increase bed numbers in the emergency unit, ensure availability of essential items and make personal protective equipment available for all staff caring for patients. Conclusion This study identified opportunities to improve the care of patients with emergency conditions at the Police Hospital in Ghana. Low-cost improvements in training, organization and planning could improve item and service availability, such as: developing a continuing education curriculum for staff in all areas of the emergency centre; holding in-service training on existing protocols for triage and emergency care; adding checklists to guide appropriate triage and safe transfer of patients; and perform a root cause analysis of item non-availability to develop targeted interventions.


      PubDate: 2015-09-08T11:28:38Z
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: September 2015
      Source:African Journal of Emergency Medicine, Volume 5, Issue 3
      Author(s): Sanjay Meena, Pankaj Sharma, Shreesh Kumar Gangary, Ashok Kumar Dawar, Buddhadev Chowdhury



      PubDate: 2015-09-03T14:47:58Z
       
  • Sepsis, severe sepsis, and septic shock: A review of the literature

    • Abstract: Publication date: September 2015
      Source:African Journal of Emergency Medicine, Volume 5, Issue 3
      Author(s): Keegan Tupchong, Alex Koyfman, Mark Foran
      Sepsis represents a continuum of illness due to systemic inflammation caused by an infection that requires prompt recognition and treatment. While sepsis is a significant cause of death worldwide, its mortality is believed to be disproportionately high in low- and middle-income countries (LMICs). Since 1992, its definition has become standardized, and beginning in 2002, an international collaboration has produced a set of consensus guidelines on the optimal management of septic patients. Based on new evidence, significant updates have been made since then. It is known that application of a bundled approach to patient care with the use of specific resuscitation endpoints to guide therapy leads to significant reductions in mortality from sepsis. However, it is also recognized that the implementation of such interventions in LMICs is extremely challenging. Consequently, a body of literature on practical guidelines for sepsis in developing countries has emerged. This article provides a review of the evidence for the best practice of sepsis management, with recommendations for resource-limited settings.


      PubDate: 2015-09-03T14:47:58Z
       
  • Developing emergency medical dispatch systems in Africa –
           Recommendations of the African Federation for Emergency
           Medicine/International Academies of Emergency Dispatch Working Group

    • Abstract: Publication date: Available online 29 July 2015
      Source:African Journal of Emergency Medicine
      Author(s): Nee-Kofi Mould-Millman, Shaheem de Vries, Christopher Stein, Muhumpu Kafwamfwa, Julia Dixon, Arthur Yancey, Busha Laba, Jerry Overton, Ron McDaniel, Lee A. Wallis
      Emergency medical dispatch (EMD) systems are a crucial component of effective Emergency Medical Service (EMS) systems. They provide a means of public access to emergency care information and out-of-hospital emergency care resources and expertise. EMD systems also link various components of EMS, thereby improving efficiency and performance. As EMS systems are rapidly developing across many parts of Africa, EMD systems which are context appropriate are in great need, but are mostly absent despite the wide availability of telecommunications technology. To facilitate the development of EMD systems appropriate for the African setting, the African Federation for Emergency Medicine (AFEM) and the International Academies of Emergency Dispatch (IAED) convened a working group in November 2014 to provide conceptual, technical, and innovative recommendations for contextually appropriate EMD systems for African settings. It is hoped that these recommendations will augment efficiency, effectiveness, and standardisation within and among African EMD systems, thereby improving health outcomes for sufferers of acute illness or injury.


      PubDate: 2015-07-30T20:51:56Z
       
  • Uchunguzi (Journal Watch/Montre de Journal)

    • Abstract: Publication date: Available online 13 July 2015
      Source:African Journal of Emergency Medicine
      Author(s): Benjamin W. Wachira



      PubDate: 2015-07-15T14:12:27Z
       
  • Electronic Medical Records in low to middle income countries: The case of
           Khayelitsha Hospital, South Africa

    • Abstract: Publication date: Available online 8 July 2015
      Source:African Journal of Emergency Medicine
      Author(s): Emmanuel C. Ohuabunwa , Jared Sun , Karen Jean Jubanyik , Lee A. Wallis
      Introduction Electronic Medical Records (EMRs) have shown benefit for clinical, organisational, and societal outcomes. In low-to-middle-income countries, the desire for EMRs will continue to rise as increasing trauma and infectious disease rates necessitate adequate record keeping for effective follow-up. 114 nations are currently working on national EMRs, with some using both a full EMR (Clinicom) and a paper-based system scanned to an online Enterprise Content Management (ECM) database. Methods The authors sought to evaluate the ability and completeness of the EMR at Khayelitsha Hospital (KH) to capture all Emergency Centre (EC) encounters classified as trauma. Based on the high trauma rates in the Khayelitsha area and equally high referral rates from KH to higher-level trauma centres, an assumption was made that its rates would mirror nationwide estimates of 40% of EC visits. Records from July 2012 to June 2013 were examined. Results 3488 patients visited the EC in the month of July 2012. 10% were noted as trauma on Clinicom and within their records were multiple sections with missing information. The remaining months of Aug 2012–June 2013 had an average trauma load of 8%. On further investigation, stacks of un-scanned patient folders were identified in the records department, contributing to the unavailability of records from January 2013 to the time of study (June 2013) on ECM. Conclusion The results highlight difficulties with implementing a dual record system, as neither the full EMR nor ECM was able to accurately capture the estimated trauma load. Hospitals looking to employ such a system should ensure that sufficient funds are in place for adequate support, from supervision and training of staff to investment in infrastructure for efficient transfer of information. In the long run, efforts should be made to convert to a complete EMR to avoid the many pitfalls associated with handling paper records.


      PubDate: 2015-07-11T13:52:11Z
       
  • In this issue…

    • Abstract: Publication date: Available online 6 July 2015
      Source:African Journal of Emergency Medicine
      Author(s): Stevan R. Bruijns



      PubDate: 2015-07-11T13:52:11Z
       
  • Investigation and management of foreign body ingestion in children at a
           major paediatric trauma unit in South Africa

    • Abstract: Publication date: Available online 9 July 2015
      Source:African Journal of Emergency Medicine
      Author(s): C.D. Delport , P.W. Hodkinson , B. Cheema
      Introduction Foreign body (FB) ingestion is a common paediatric presentation to emergency centres in South Africa (SA). There are no guidelines for the management of FB ingestion in children in SA. This study describes the presentation, investigation, and management of FB ingestion at a tertiary paediatric trauma unit in SA. Methods A retrospective chart review was conducted on all children presenting to Red Cross War Memorial Children’s Hospital Trauma Unit with a history of FB ingestion. Data were gathered from referral letters and hospital records, including any radiographs performed. Results 146 patients were included with a median age of 32months. Of these, 90% were asymptomatic at presentation. The main types of FB ingested were: 62% metallic, 14% non-metallic, and 15% food. In the metallic group, the most common FB was a coin, ingested by 45% of children. Radiographs were performed in 94% of patients, with a total of 202 radiographs performed on 137 children. The FB was identified by radiographic means in 68% of cases (39% in the oesophagus and 34% in the stomach) and removed endoscopically in 41 patients. Following endoscopy there were minor complications in 7 patients, all of which were managed conservatively. Conclusion The age distribution and types of FBs ingested are comparable to other published studies, though the investigation and management of FBs varied widely. Most patients with FB ingestion had several radiographs performed, exposing them to potentially harmful radiation. The use of a hand-held metal detector in emergency centres could reduce the number of radiographs performed. Guidelines for the investigation and management of FB ingestions in children in SA are necessary.


      PubDate: 2015-07-11T13:52:11Z
       
  • Neurological disorders in the emergency centre of the Douala General
           Hospital, Cameroon: A cross-sectional study

    • Abstract: Publication date: Available online 9 July 2015
      Source:African Journal of Emergency Medicine
      Author(s): Y.N. Mapoure , J.S. Ongono , C. Nkouonlack , G. Beyiha , A.S. Mouelle , H.N. Luma
      Introduction The aim of this study was to determine the prevalence, aetiologies and outcome of neurological disorders at the emergency centre (EC) of the Douala General Hospital (DGH). Patients and methods A cross-sectional study was carried out from 1st January to 30th April 2014, at the EC of the DGH, in Cameroon. We included all patients above 15years of age who presented with isolated or associated neurological complaints. Data collected for each patient were: socio-demographic, clinical and laboratory characteristics, time lapse before management and the prognosis. Patients with no definitive diagnosis made in the EC, had their files reviewed on the wards by the investigators for the final diagnosis and/or aetiology. Results Of 1844 patients who were consulted in the EC over the study period, 502 of them presented with neurological disorders (27.2%). The mean age was 44.4±17.8years with 53.6% males. The common symptoms were headache (47.8%), loss of consciousness (19.5%), lumbar pain (11%), hemiparesis (8.4%), and seizure (7%). Non-traumatic neurological disorders were common (86.1%). The common aetiologies were malaria (16.9%), stroke (13.5%), primary headaches (13.1%), head injury (12.9%) and metabolic encephalopathy (12.4%). Mean time lapse to be consulted by a general practitioner was 23.1±20.7min and 2.1±1.3h for neurologist’s consultation. The time lapse to receive initial medical care was 26.3±30.6min. The mean duration to have an imaging result was 1.3±0.9h and 3.1±1.7h for laboratory tests. The in-hospital mortality rate of neurological disorders was 15.1%. Conclusion Neurological disorders are common in the emergency centre of the DGH. Aetiologies are diverse and in-hospital mortality is high. This highlights the need to organize neurologist calls at the EC and/or to improve the human resources capacity through regular training and evaluation.


      PubDate: 2015-07-11T13:52:11Z
       
  • Transfusion in emergency trauma: A puzzle for the African surgeon

    • Abstract: Publication date: Available online 2 July 2015
      Source:African Journal of Emergency Medicine
      Author(s): Isaac Kajja



      PubDate: 2015-07-05T13:37:05Z
       
  • An online learning programme improves traumatic brain injury guideline
           adherence in a South African Helicopter Emergency Medical Service

    • Abstract: Publication date: Available online 24 June 2015
      Source:African Journal of Emergency Medicine
      Author(s): Willem Stassen , Craig Wylie , Robyn Holgate
      Introduction It is difficult to initiate clinical quality improvement projects through continuous education in the prehospital environment due to the very nature of their mobile workplace and unpredictable presence in a specific location. This study reviews the impact of an online learning platform and the effect it had on the clinical quality of care offered to patients with traumatic brain injury (TBI) during Helicopter Emergency Medical Services (HEMS) operations. Methods A prospective improvement project was initiated to improve the clinical care for patients with TBI. A clinical monitoring tool, based on the prehospital care guidelines of the Brain Trauma Foundation was designed to assess the clinical quality of TBI patient care. The clinical indicators measured included initial Glasgow Coma Score, motor function, pupil size and reactivity, hypotension, hypoxaemia, carbon dioxide levels, temperature control, and patient position. A four month baseline monitoring was completed to determine the level of adherence to the guidelines, and subsequently an online, free access lecture series was presented to the HEMS operational staff. The clinical monitoring tool was applied during this time and afterwards to review adherence to guidelines. Results A total of 71 cases of TBI were seen during the period of assessment and 64.8% of HEMS crew participated in the online training programme. A change in the average adherence to the clinical guidelines improved from 66.9% to 75.7% (p =0.033) from the baseline monitoring period, to the period immediately after the online training. Conclusion Free and open online learning platforms can be implemented at little to no cost and can be accessed anywhere. This initiative has shown benefit in ensuring best care for critically ill TBI HEMS patients.


      PubDate: 2015-06-26T04:15:26Z
       
  • In this issue…

    • Abstract: Publication date: June 2015
      Source:African Journal of Emergency Medicine, Volume 5, Issue 2
      Author(s): Stevan R. Bruijns



      PubDate: 2015-06-01T10:19:36Z
       
  • Libyan armed conflict 2011: Mortality, injury and population displacement

    • Abstract: Publication date: Available online 26 May 2015
      Source:African Journal of Emergency Medicine
      Author(s): Mohamed A. Daw , Abdallah El-Bouzedi , Aghnaya A. Dau
      Background Armed conflicts can negatively affect health services and cause injuries and death. The recent Arab uprising has been associated with considerable damage to infrastructure and loss of human lives. The aim of this study was to determine mortality, injuries and population displacement that occurred during the recent Libyan armed conflict. Methods A systematic cross-sectional field survey and non-structured search was carried out over fourteen provinces in six Libyan regions, representing the primary sites of the armed conflict between February 2011 and February 2012. Thirty-five percent of the total area of Libya and 62.4% of the Libyan population were involved in the study. The mortality and injury rates were determined and the number of displaced people was calculated during the conflict period. Results A total of 21,490 (0.5%) persons were killed, 19,700 (0.47%) injured and 435,000 (10.33%) displaced. The overall mortality rate was found to be 5.1 per 1000 per year (95% CI 4.1–7.4) and injury rate was found to be 4.7 per 1000 per year (95% CI 3.9–7.2) but varied by both region and time, reaching peak rates by July–August 2011. Conclusion The Libyan armed conflict resulted in great human loss and social damage mirrored by high rates of mortality, injury and human displacement. Such parameters peaked as the conflict escalated and differed according to the Libyan regions and provinces involved. National and international efforts should be combined to overcome the consequences of these conflicts.


      PubDate: 2015-05-27T10:16:44Z
       
  • A cross-sectional analysis of the short-term outcomes of patients
           receiving prehospital treatment for symptomatic hypoglycaemia in Cape Town
           

    • Abstract: Publication date: Available online 23 May 2015
      Source:African Journal of Emergency Medicine
      Author(s): Mohamed Ridhaa Booley , Tyson Welzel
      Introduction There has been a growing prevalence of patients with chronic medical conditions in South Africa, diabetes mellitus being one of them. Acute symptomatic hypoglycaemia (SH) refers to decreased level of plasma glucose <3.5mmol/L accompanied by an altered level of consciousness. Pre-hospital management of such episodes includes reversal by oral and/or intravenous glucose administration, or intramuscular glucagon administration. Post-reversal, patients may refuse transport to hospital, which may result in recurrent episodes of acute SH. The aim of this study was to retrospectively determine the outcomes of adult SH patients who were treated and discharged pre-hospital. Methods A retrospective cross-sectional study design was used. Patient report forms from patients with SH managed in the pre-hospital setting between May 2012 and September 2012 in the greater Cape Town area were extracted from the Emergency Medical Services (EMS) database. A follow-up survey using a closed-ended questionnaire was administered to these same patients within seven days post-reversal to evaluate the efficacy of pre-hospital discharge of SH patients. Results A total of 110 eligible patients were identified and telephonically interviewed. It was found that 21 (19%) of cases had subsequently died. Of the 89 remaining cases, 30 (34%) reactivated EMS within seven days of discharge, independent of SH being the chief complaint. In total, 48 (54%) had recurrent episodes of SH within seven days of discharge by EMS. In 47 (53%) of cases discharged by EMS, no follow-up instructions were provided to mitigate recurrent SH episodes or complications. Conclusion More than half of patients who received pre-hospital treatment and discharge for SH had recurrent symptoms post-reversal by EMS staff, with a third needing to reactivate EMS. This would suggest that the current strategy of dealing with such cases needs careful re-evaluation to improve the quality of management of this patient population.


      PubDate: 2015-05-27T10:16:44Z
       
  • Buccal, intranasal or intravenous lorazepam for the treatment of acute
           convulsions in children in Malawi: An open randomized trial Le
           lorazépam par voie orale, intranasale ou intraveineuse pour le
           traitement des convulsions aiguës chez l’enfant au Malawi:
           étude ouverte randomisée

    • Abstract: Publication date: Available online 18 April 2015
      Source:African Journal of Emergency Medicine
      Author(s): Samantha Lissauer , Julia Kenny , Oliver Jefferis , Tom Wingfield , Anne Miller , George Chagaluka , Linda Kalilani-Phiri , Elizabeth Molyneux
      Introduction Acute convulsions in children are a common emergency worldwide. Benzodiazepines are the recommended first line treatment. Intravenous lorazepam is inexpensive, long acting and the first line drug in resource-rich settings. However, comparable efficacy by other routes of administration is unknown. We wished to compare the efficacy of lorazepam by the buccal, intranasal or intravenous route in the treatment of acute seizures in Malawian children. Methods A prospective, open-label, randomised, non-inferiority trial was performed in children aged 2months to 14years presenting to the Queen Elizabeth Central Hospital in Blantyre, Malawi with acute seizures lasting longer than 5min. Children were randomly assigned to receive lorazepam, 0.1mg/kg, by the buccal, intranasal or intravenous route. The primary endpoint was seizure cessation within 10min of drug administration. Results There were 761 seizures analysed, with 252 patients in the buccal, 245 in the intranasal and 264 in the intravenous groups. Intravenous lorazepam stopped seizures within 10min in 83%, intranasal lorazepam in 57% (RR 2.46, CI 1.82–3.34), and the buccal route in 46% (RR 3.14, CI 2.35–4.20; p =0.001) of children. There were no significant cardio-respiratory events and no difference in mortality or neurological deficits. The study was halted after an interim analysis showed that the primary endpoint had exceeded the protocol-stopping rule. Conclusions Intravenous lorazepam effectively treats most childhood seizures in this setting. Intranasal and buccal routes are less effective but may be useful in pre-hospital care or when intravenous access cannot be obtained. Further studies comparing intranasal lorazepam to other benzodiazepines, or alternative doses by a non-intravenous route are warranted.


      PubDate: 2015-04-18T21:53:38Z
       
  • Assisting the setting up of an emergency service in rural Africa

    • Abstract: Publication date: Available online 18 April 2015
      Source:African Journal of Emergency Medicine
      Author(s): H.R. Guly , K. Robinson , N. Burke



      PubDate: 2015-04-18T21:53:38Z
       
  • Procedural sedation and analgesia: Auditing the practice at Steve Biko
           Academic Hospital Emergency Centre from May to October 2014

    • Abstract: Publication date: Available online 17 April 2015
      Source:African Journal of Emergency Medicine
      Author(s): C.C. Meyer , A. Engelbrecht
      Introduction Procedural sedation and analgesia (PSA) is a vital skill for physicians working in an emergency centre (EC). For doctors working in the African setting, dealing with high patient loads and limited theatre availability, knowledge and proficiency in PSA is a highly valuable and necessary skill. The aim of this study was to audit the practice of PSA in the EC of Steve Biko Academic Hospital. Methods This was a cross-sectional descriptive audit. Procedures conducted under PSA were identified. An audit of clinical notes and interview with staff was conducted. Data were analysed using the STAT 12 package. The results were presented as adherence statistics with reference to the PSA guidelines of the Emergency Medicine Society of South Africa (EMSSA). Results This audit indicated that documentation of informed consent prior to PSA was poor in this hospital’s EC. No evidence of informed consent was found in any audited cases. Adherence to the other aspects of PSA was also fairly average (below 50% in most). The mean adherence scores for these components were as follows: pre-procedure preparation and equipment check 46.19% (95% CI 36.62–55.76), documented patient pre-evaluation 50.99% (46.78–55.18), monitoring during procedure 39.22% (34.68–43.75), post procedure monitoring 37.99% (32.78–43.20), and overall documentation of procedure 40.69% (37.85–43.52). Analysis of adherence to the guidelines between different ranks of doctors demonstrated that the registrars in EM were, in general, more compliant. Conclusions This audit identified documentation of informed consent as a major shortcoming in the practice of PSA in this EC. There is also room for improvement in most of the other aspects that were assessed. As part of the clinical audit cycle, the results of this study will be used to initiate changes to increase adherence to the guidelines.


      PubDate: 2015-04-18T21:53:38Z
       
  • An audit of consent practices and perceptions of lumbar puncture, Botswana
           inpatient setting experience

    • Abstract: Publication date: Available online 18 March 2015
      Source:African Journal of Emergency Medicine
      Author(s): M.B. King , G.M. Rwegerera
      Introduction The epidemic of HIV/AIDS in sub-Saharan Africa has led to significant increases in the burden of meningitis, especially cryptococcal meningitis. Morbidity and mortality resulting from meningitis occur partly due to delays in performing lumbar punctures both for diagnostic and therapeutic purposes. This study was conducted with the primary objective of exploring the attitudes and concerns that patients have with regard to lumbar puncture, and also to assess current consenting practices of doctors with regard to lumbar puncture. Methods A descriptive cross-sectional study was conducted in medical wards of Princess Marina Hospital, a tertiary hospital in Gaborone, Botswana. Data were collected by means of a questionnaire-based survey involving patients or their next of kin, and doctors. Other relevant information was obtained from patient charts. Data collection involved 12 patients and 23 doctors. Results Of the 12 patients interviewed, four stated that the reasons for doing lumbar puncture (LP) were explained to them. One respondent stated that LP risks were mentioned, while two stated that they were given the option to refuse LP. Most patients’ possible reasons for refusal of LP was attributed to fear of pain. Five (42.7%) patients/next of kin had never heard of LP before, and most of the interviewed patients associated the procedure with death and paralysis, while none associated with meningitis or HIV. Twenty-two (95.7%) of 23 doctors stated that they routinely consent patients for LP, 11 (47.8%) mentioned risks, and nine (39.1%) stated that the patient has the option to decline the procedure. Only 26% of doctors routinely used local anaesthesia while 22% routinely asked for written consent. Conclusion Contrasting responses between doctors and patients indicates a need for standard consenting practices among doctors. Also, patients’ attitudes and receptiveness to lumbar punctures can be improved through education on lumbar puncture indications, benefits, and risks.


      PubDate: 2015-03-31T17:11:03Z
       
  • In-service training of physician assistants in acute care in Ghana:
           Challenges, successes, and lessons learned

    • Abstract: Publication date: Available online 5 March 2015
      Source:African Journal of Emergency Medicine
      Author(s): Anjali Niyogi , Barbra Villona , Beth L. Rubenstein , Stephanie J. Hubbard , Frank Baiden , Rachel T. Moresky
      Introduction To meet the greater demand for skilled personnel in Emergency Medicine (EM) in Ghana, the authors developed an in-service course in basic acute care for Physician Assistants (PAs) working in district hospitals. Methods An initial training of trainer course was held for twenty-two PAs. From this initial group, ten were selected as Senior Trainers. Following a refresher course, Senior Trainers facilitated an in-service training and refresher course for other PAs from their regions. The course was organised into modules consisting of didactic lectures and interactive small group sessions. Assessment included testing, observation, case review, and simulations. Results All groups showed improvement in knowledge. The majority learned information sequentially, inconsistently used physical examinations for diagnosis, and rarely reassessed following interventions. Practical skills were more easily acquired than clinical decision-making skills. The case discussions and simulations were the most helpful learning tools. Symptom-based algorithms were useful for daily practice. Conclusion The greatest successes of this programme were providing the participants with greater confidence in basic life-saving skills and increasing their knowledge of and advocacy for EM. For continued success of this programme, a formal course with greater emphasis on filling Senior Trainer knowledge gaps, increased coordination with administrative authorities, and specific measurable clinical outcomes are needed.


      PubDate: 2015-03-10T17:01:25Z
       
  • Fascia iliaca compartment block in dislocated hip reduction

    • Abstract: Publication date: Available online 28 February 2015
      Source:African Journal of Emergency Medicine
      Author(s): Umit Kaldirim , Figen Dural , Salim Kemal Tuncer , Ibrahim Arziman , Yusuf Emrah Eyi
      Introduction Femoral dislocation constitutes an orthopaedic emergency. For pain control in these cases, apart from procedural sedation, a regional block can be applied. Case report A 26-year old male was brought to the emergency centre after being struck by a motor vehicle. Dislocation of the left femur was determined on direct radiograph. It was decided to apply a fascia iliaca compartment block instead of procedural sedation due to the risk of side effects. After sufficient anaesthesia was provided, the dislocation was successfully reduced on the first attempt with the Allis technique. Conclusion The fascia iliaca compartment block (FICB) can be performed easily and successfully under ultrasound guidance. The pain associated with femoral dislocation is decreased and the reduction procedure can be achieved successfully. In many cases, FICB is easy to apply and carries a low risk of side effects.


      PubDate: 2015-03-05T16:46:41Z
       
  • An unusual tourist. A case of a body packer’s death in Botswana

    • Abstract: Publication date: Available online 27 February 2015
      Source:African Journal of Emergency Medicine
      Author(s): Megan Cox , Mukendi Kayembe
      Introduction Death as a result of body packing syndrome is not well described within Africa (including Botswana) and therefore not commonly considered in a differential diagnosis. We describe a fatal presentation of a toxicological emergency related to body packing that was initially mistaken for an infective cause. Case report A 43-year-old Tanzanian male presented to the Princess Marina Hospital Emergency Centre with acute vomiting and bloody diarrhoea. He started with massive haematemesis and deteriorated quickly into cardiac arrest with attempts to resuscitate him proving futile. The main concern was for haemorrhagic fever but this was disproven on post mortem when 66 wrapped packages were found in his intestines. Discussion Patients involved in drug trafficking can present to any emergency centre. The acute presentation may mimic other, more prevalent conditions. In the event of death, an understanding of local legal and public health procedures is necessary to ensure a structured investigation.


      PubDate: 2015-02-28T16:45:49Z
       
  • In search of an effective teaching approach for skill acquisition and
           retention: Teaching manual defibrillation to junior medical students

    • Abstract: Publication date: Available online 30 December 2014
      Source:African Journal of Emergency Medicine
      Author(s): Elize Archer , Daniël J. van Hoving , Adele de Villiers
      Introduction Although overloaded curricula, the increasing student to educator ratio, limited resources, insufficient curriculum alignment and the unpredictable clinical learning environment contribute to the decay of clinical skill competency, the problem of poor skill retention often lies in inadequate skill acquisition which is associated with the quality of the instruction. The aim of the study was to investigate the influence of three different instructional approaches on the acquisition and retention of skills in order to determine which method would be best suited for teaching in simulation in a resource-constrained environment. Methods A randomised controlled trial design was used to compare the efficacy of the traditional, Peyton’s four-stage, and a modified five-step method. Regarding the latter, George and Doto’s five-step method was altered to include peer teaching and feedback with a tutor in a supervisory role. Groups of first year students were taught ‘manual defibrillation’. Subsequent to the teaching session as well as at two months later, students’ skills were tested. Additional qualitative data regarding students’ perceptions of the different teaching strategies they were exposed to were obtained by means of questionnaires. Results None of the three instructional approaches proved to be superior in acquisition or retention. Previous studies reported similar findings. The lack of differentiation between the three teaching methods might be attributed to the fact that all three methods included practice with feedback in one form or another. Numerous studies have identified these as critical components leading to effective learning in a simulation-based learning environment. Conclusion Considering that the three instructional approaches were similar in terms of skill acquisition and retention, incorporating peer teaching and feedback is a feasible strategy in a resource-limited environment.


      PubDate: 2015-01-02T09:57:30Z
       
  • Surgical outcomes for perforated peptic ulcer: A prospective case series
           at an academic hospital in Monrovia, Liberia

    • Abstract: Publication date: Available online 31 December 2014
      Source:African Journal of Emergency Medicine
      Author(s): J. Fallah Moses , Christopher D. Hughes , Pratik B. Patel , Tiffany E. Chao , Solomane A. Konneh , Torsou Y. Jallabah , Michael Kiiza Kikubaire , John G. Meara , Lars E. Hagander
      Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant, and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes. Methods This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia, Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality. Results Median age was 33years and 85% were males. A majority of the patients (70%) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35%. Median length of stay among survivors was 16days, and death occurred at median 1day after admission. Long symptom duration and age >30years of age were significantly associated with in-hospital mortality on univariate (β =2.60 [0.18–5.03], p =0.035) and multivariate testing (β =2.95 [0.02–5.88], p =0.049). Conclusion Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series, surgical treatment for perforated peptic ulcer disease carried a high mortality, and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries.


      PubDate: 2015-01-02T09:57:30Z
       
 
 
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