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Journal Cover African Journal of Emergency Medicine
  [SJR: 0.2]   [H-I: 3]   [3 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2211-419X
   Published by Elsevier Homepage  [2969 journals]
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: Available online 16 August 2016
      Source:African Journal of Emergency Medicine
      Author(s): Emmanuel Kwasi Acheampong



      PubDate: 2016-08-20T10:39:13Z
       
  • Developing metrics for emergency care research in low- and middle-income
           countries

    • Abstract: Publication date: Available online 12 August 2016
      Source:African Journal of Emergency Medicine
      Author(s): Samer Abujaber, Cindy Y. Chang, Teri A. Reynolds, Hani Mowafi, Ziad Obermeyer
      Introduction There is little research on emergency care delivery in low- and middle-income countries (LMICs). To facilitate future research, we aimed to assess the set of key metrics currently used by researchers in these settings and to propose a set of standard metrics to facilitate future research. Methods Systematic literature review of 43,109 published reports on general emergency care from 139 LMICs. Studies describing care for subsets of emergency conditions, subsets of populations, and data aggregated across multiple facilities were excluded. All facility- and patient-level statistics reported in these studies were recorded and the most commonly used metrics were identified. Results We identified 195 studies on emergency care delivery in LMICs. There was little uniformity in either patient- or facility-level metrics reported. Patient demographics were inconsistently reported: only 33% noted average age and 63% the gender breakdown. The upper age boundary used for paediatric data varied widely, from 5 to 20years of age. Emergency centre capacity was reported using a variety of metrics including annual patient volume (n =175, 90%); bed count (n =60, 31%), number of rooms (n =48, 25%); frequently none of these metrics were reported (n =16, 8%). Many characteristics essential to describe capabilities and performance of emergency care were not reported, including use and type of triage; level of provider training; admission rate; time to evaluation; and length of EC stay. Conclusion We found considerable heterogeneity in reporting practices for studies of emergency care in LMICs. Standardised metrics could facilitate future analysis and interpretation of such studies, and expand the ability to generalise and compare findings across emergency care settings.


      PubDate: 2016-08-15T10:01:39Z
       
  • Seeking health care from a general hospital in Uganda following a fracture
           or a dislocation

    • Abstract: Publication date: Available online 25 July 2016
      Source:African Journal of Emergency Medicine
      Author(s): Isaac Kajja, Cees Th. Smit Sibinga
      Introduction Selecting a treatment approach and a facility to get treated from, poses a challenge in musculoskeletal injuries in Africa. The study aimed at determining demographic and injury characteristics of patients with musculoskeletal injuries and how these impact the time and reason for presenting to a general hospital in Uganda. Methods An observational study was carried out at Entebbe general hospital on patients presenting with musculoskeletal injuries between 1 November 2014 and 28 February 2015. The patient demographics, injury characteristics, duration of injury to presentation for treatment and reason for seeking treatment from this hospital were noted. Results A total of 101 patients were recruited. Of these, 95 had fractures while six had dislocations. Patients took an average of 96h before presenting for care, females taking significantly longer than males (191.2 and 58.6h respectively, p =0.005). The fractured segment of bone significantly influenced the patients’ choice for care at this hospital (p =0.02). Discussion Entebbe General Hospital serves a young and unemployed population for musculoskeletal injuries. These patients present late for care, especially females. Patients base their choice for care from this hospital on the character of the injury.


      PubDate: 2016-07-26T00:41:59Z
       
  • Bedside ultrasound as a simple non-invasive method of assessing
           intracranial pressure in limited resource setting

    • Abstract: Publication date: Available online 22 July 2016
      Source:African Journal of Emergency Medicine
      Author(s): Ayalew Zewdie, Haymanot Tesema, Abenezer Tirsit Aklilu, Tsegazeab Laeke Teklemariam, Tigist Zewdu, Yordanos Ashagre, Yemsrach Bizuneh, Aklilu Azazh, Getaw Worku Hassen
      Introduction Increased intracranial pressure is usually measured with invasive methods that are not practical in resource-limited countries. However, bedside ultrasound, a non-invasive method, measures the optic nerve sheath diameter and could be a safe and accurate alternative to measure intracranial pressure, even in children. Case report We report a case of a 15-year old patient who presented with severe headache, projectile vomiting, and neck pain for two months. The bedside ultrasound showed a 10mm optic nerve sheath diameter and a Computed Tomography scan of her brain revealed obstructive hydrocephalus secondary to a mass in the fourth ventricle. After intervening, we were able to monitor the decrease in her optic nerve sheath diameter with ultrasound. Conclusion Performing invasive procedures continues to be a challenge in the resource limited setting. However, bedside ultrasound can be a useful tool in emergency centres for early detection and monitoring of intracranial pressure.


      PubDate: 2016-07-26T00:41:59Z
       
  • The clinical profile and acute care of patients with traumatic spinal cord
           injury at a tertiary care emergency centre in Addis Ababa, Ethiopia

    • Abstract: Publication date: Available online 22 July 2016
      Source:African Journal of Emergency Medicine
      Author(s): Finot Debebe, Assefu Woldetsadik, Adam D. Laytin, Aklilu Azazh, James Maskalyk
      Introduction Traumatic spinal cord injuries can have catastrophic physical, psychological, and social consequences, particularly in low resource settings. Since many of these injuries result in irreversible damages, it is essential to understand risk factors for them and focus on primary prevention strategies. The objectives of this study are to describe the demographics, injury characteristics, and management of traumatic spinal cord injury victims presenting to the Adult Emergency Centre of Tikur Anbessa Specialised Hospital in Addis Ababa, the tertiary referral centre for emergency care in Ethiopia. Methods A prospective cross sectional survey was conducted from October 2013 to March 2014 in the Adult Emergency Centre of Tikur Anbessa Specialised Hospital. Patients were identified at triage and followed through admission to discharge from the emergency centre. Results Eighty-four patients with traumatic spinal cord injuries were identified. The mean age was 33years and 86% were male. The most common mechanisms of injury were motor vehicle collisions (37%), falls (31%), and farming injuries (11%). The cervical spine (48%) was the most commonly injured region and 41% were complete spinal cord injuries. Most patients (77%) did not receive any prehospital care or medical care at other facilities prior to arrival in the Emergency Centre. Conclusion In our context, traumatic spinal cord injuries predominantly affect young men, and the majority of victims suffer severe injuries with little chance of recovery. Attention to occupational and road traffic safety is essential to mitigate the personal and societal burdens of traumatic spinal cord injuries. It is also imperative to focus on improving prehospital care and rehabilitation services for traumatic spinal cord injury victims.


      PubDate: 2016-07-26T00:41:59Z
       
  • Conservative management of gunshot oesophageal injuries: A report of two
           consecutive exceptional cases

    • Abstract: Publication date: Available online 29 June 2016
      Source:African Journal of Emergency Medicine
      Author(s): Francesco Virdis, Sharfuddin Chowdhury, Andrew John Nicol, Pradeep Harkison Navsaria
      Introduction Oesophageal trauma carries high mortality and morbidity. For penetrating intrathoracic oesophageal injury, surgical repair has been the standard for decades to avoid its devastating consequences. Case report Both patients presented with a thoracoabdominal gunshot wound and retained intraabdominal missile. Although there were no visible signs of perforation on oesophagoscopy or contrast swallow, the presence of an intraluminal bullet highly suggested a thoracic oesophageal injury. Discussion Non-operative management of intrathoracic oesophageal perforation is controversial. Small perforations or contained leaks diagnosed within 24–48h in a stable patient with no mediastinitis or empyema can be managed non-operatively with antibiotics and nasogastric feeds. These two case reports support the notion of selective non-operative management of asymptomatic patients with penetrating injury to the oesophagus.


      PubDate: 2016-07-20T00:03:30Z
       
  • Message in a bottle. The use of chest radiography for diagnosis of
           pericardial effusion

    • Abstract: Publication date: Available online 29 June 2016
      Source:African Journal of Emergency Medicine
      Author(s): James Foley, Lai Pun Tong, Navin Ramphul
      Introduction The diagnosis of pericardial effusion may be elusive, and only diagnosed with echocardiography. Case reports Here we report the cases of two patients who presented to the emergency centre (EC) with dyspnoea, and their chest X-rays (CXR) revealed the “water bottle sign”, which is the typical appearance of the cardiac silhouette that is present when there is a large pericardial effusion. Discussion This clinched the diagnosis of pericardial effusion, where the diagnosis may have otherwise been delayed. We discuss these cases, and the relevant literature and discuss the benefits of standard chest radiography in aiding in the diagnosis of pericardial effusion.


      PubDate: 2016-07-20T00:03:30Z
       
  • In this issue…

    • Abstract: Publication date: June 2016
      Source:African Journal of Emergency Medicine, Volume 6, Issue 2
      Author(s): Stevan R. Bruijns



      PubDate: 2016-07-20T00:03:30Z
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: June 2016
      Source:African Journal of Emergency Medicine, Volume 6, Issue 2
      Author(s): P.K. Forson, M. Osei-Ampofo, E.K. Acheampong, R. Oteng, P. Donkor, G. Oduro



      PubDate: 2016-07-20T00:03:30Z
       
  • Economic development and road traffic fatalities in two neighbouring
           African nations

    • Abstract: Publication date: Available online 31 May 2016
      Source:African Journal of Emergency Medicine
      Author(s): Douglas J. Wiebe, Sunanda Ray, Titus Maswabi, Christina Kgathi, Charles C. Branas
      Introduction The rapid growth of Botswana’s economy since independence in 1966 has brought more tarred roads and vehicles, accompanied by an escalating road crash fatality rate. We tested the hypothesis that motor vehicle crash fatality increases resulted from, rather than just corresponded with, annual gross domestic product (GDP) increases. Data from Zambia, adjacent to Botswana, were used for comparison. Methods Annual social and economic indicators and motor vehicle crash fatality rates in Botswana and Zambia were accessed from 1960 to 2012 and analysed using vector autoregressive analysis and Granger causality tests. Results In Botswana, annual changes in per capita GDP predicted annual changes in motor vehicle crash fatality rates (p =0.042). The opposite was not observed; annual changes in motor vehicle crash fatality rates did not predict annual GDP changes. These findings suggest that GDP growth in a given year caused additional road traffic fatalities in Botswana and that, on average, every billion dollar increase in GDP produced an increase in the rate of road traffic fatalities. In Zambia, annual GDP changes predicted annual fatality rate changes three years later (p =0.029), but annual changes in road crash fatality rates also predicted annual increases in per capita GDP (p =0.026) three years later, suggesting a correlation between trends, but not a causal effect of GDP. Conclusion Road crash fatalities increased in recent decades in both Zambia and Botswana. But the rapid economic development in Botswana over this time period appears to have driven proportionate road traffic fatality increases. There are opportunities for newly emerging economies such as Zambia, Angola, and others to learn from the Botswana experience. Evidence-based investments in road safety interventions should be concomitant with economic development.


      PubDate: 2016-06-02T17:18:43Z
       
  • African oral and poster abstracts from the 2016 International Conference
           on Emergency Medicine Conference

    • Abstract: Publication date: Available online 13 May 2016
      Source:African Journal of Emergency Medicine




      PubDate: 2016-05-17T15:38:04Z
       
  • Sub-Saharan African hospitals have a unique opportunity to address
           intentional injury to children

    • Abstract: Publication date: Available online 13 May 2016
      Source:African Journal of Emergency Medicine
      Author(s): Jared R. Gallaher, Elizabeth Molyneux, Anthony G. Charles



      PubDate: 2016-05-17T15:38:04Z
       
  • Pre-hospital clinical practice guidelines – Where are we now'

    • Abstract: Publication date: Available online 13 May 2016
      Source:African Journal of Emergency Medicine
      Author(s): Michael McCaul, Karen Grimmer



      PubDate: 2016-05-17T15:38:04Z
       
  • Global research highlights

    • Abstract: Publication date: Available online 13 May 2016
      Source:African Journal of Emergency Medicine




      PubDate: 2016-05-17T15:38:04Z
       
  • Uchunguzi (Journal Watch/Montre de Journal)

    • Abstract: Publication date: Available online 13 May 2016
      Source:African Journal of Emergency Medicine
      Author(s): Benjamin W. Wachira



      PubDate: 2016-05-17T15:38:04Z
       
  • 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
       
 
 
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