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Pattern of admissions and outcome in the children emergency department of a tertiary health institution in Southwestern Nigeria: A four-year review 尼日利亚西南部一所高等卫生机构儿童急诊科的入院模式和结果:四年回顾
IF 1.3 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2023-06-01 DOI: 10.1016/j.afjem.2023.02.001
Tosin Anthony Agbesanwa , Adefunke Olarinre Babatola , Odunayo Adebukola Fatunla , Azeez Ibrahim , Felix O Aina , Ezra Olatunde Ogundare , Adewuyi Temidayo Adeniyi , Funmilayo Egbedi , Tinu Olubamiwa , Bolanle Olanipekun , Oladele Simeon Olatunya

Introduction

Pediatrics and adolescents are susceptible to illnesses that often necessitate emergency attention. Morbidity and mortality from illnesses in these ages have attracted much interest globally, particularly in Africa. Knowledge of pattern and outcomes of admissions may guide policy and interventions especially in resource constrained settings. The study aimed to determine the pattern of admissions, outcomes and seasonal variations of conditions that presented at the children emergency of a tertiary health institution over a four-year period.

Methods

A retrospective descriptive study of children emergency admissions from January 2016 to December 2019. Information obtained included age, diagnosis, month and year of admission, and outcome. Descriptive statistics were used to describe the demographic characteristics and Chi-squared test to assess their associations with the diagnoses made.

Results

There were 3,223 admissions. There were more males (1866; 57.9%) and more toddlers (1181; 36.6%). The highest number of admissions were observed in the year 2018 (951; 29.6%) and during the wet season (1962; 60.9%). There was an overall mortality rate of 7%; complicated malaria, gastroenteritis and meningitis were the leading causes of death. Malaria (χ2 = 135.522, p value < 0.001), and gastroenteritis (χ2 = 130.883, p value < 0.001) were predominant among the toddlers while sepsis (χ2 = 71.530, p value < 0.001) and pneumonia (χ2 = 133.739, p value < 0.001) were more among the infants. Typhoid enteritis (χ2 = 26.629, p value < 0.001) and HIV (χ2 = 16.419, p value = 0.012) were commoner among the early adolescents.

Conclusion

The major causes of death in the study area are preventable with more of these amongst the children under the age of 5 years. There are seasonal and age-related patterns to admissions and the need for policy formulations and emergency preparations to be tailored towards these observed patterns through the year

引言儿科和青少年容易患上需要紧急护理的疾病。这些年龄段疾病的发病率和死亡率在全球范围内引起了极大的兴趣,尤其是在非洲。对招生模式和结果的了解可以指导政策和干预措施,尤其是在资源有限的情况下。这项研究旨在确定四年来高等卫生机构儿童急诊的入院模式、结果和季节性变化。方法对2016年1月至2019年12月儿童急诊入院情况进行回顾性描述性研究。获得的信息包括年龄、诊断、入院月份和年份以及结果。描述性统计学用于描述人口统计学特征,卡方检验用于评估其与诊断的相关性。结果住院3223例。男性较多(1866人;57.9%),学步儿童较多(1181人;36.6%)。2018年(951人;29.6%)和雨季(1962年;60.9%)入院人数最多。总体死亡率为7%;复杂的疟疾、肠胃炎和脑膜炎是导致死亡的主要原因。疟疾(χ2=135.522,p值<;0.001)和肠胃炎(χ2=130.883,p值<;0.001)在幼儿中占主导地位,而败血症(χ2=71.530,p值<;0.001。伤寒性肠炎(χ2=26.629,p值<;0.001)和艾滋病毒(χ2=16.419,p值=0.012)在早期青少年中更为常见。结论研究地区的主要死亡原因是可以预防的,其中5岁以下儿童死亡的原因更多。入院有季节性和年龄相关的模式,需要根据全年观察到的这些模式制定政策和应急准备
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引用次数: 0
Diagnostic Performance of Point of Care Ultrasound Compared to Chest X-Ray in Patients with Hypoxia at a Teaching Hospital Emergency Department in Uganda 乌干达一家教学医院急诊科的点超声与胸部x线对缺氧患者的诊断效果比较
IF 1.3 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2023-06-01 DOI: 10.1016/j.afjem.2023.02.004
Prisca Mary Kizito , Kenneth Daniel Bagonza , Justine Athieno Odakha , Linda Grace Nalugya , Pius Opejo , Anthony Muyingo , Harry Chen , Derek Harborne

Background

Hypoxia is a common presentation in the Emergency Department (ED) worldwide. It affects 9-12% of hospitalized adults in Sub-Saharan Africa. Timely diagnosis of the multiple causes such as pneumonia, heart failure among others is challenging. Chest X-Ray (CXR), one of the most utilized imaging modalities has many limitations, and the gold standard (Computed Tomography scan) is inaccessible. Point of care ultrasound (PoCUS) is more available and increasingly being used, however little is known of its performance in resource limited EDs. The study aimed to assess the diagnostic performance of PoCUS compared with CXR in identifying the causes of hypoxia in the medical ED.

Methods

49 adults presenting with hypoxia (SP02 ≤ 88%) in the medical ED were evaluated. Ultrasound of the lungs and heart (PoCUS) was done, then CXR obtained. Lung ultrasound (LUS) was compared with CXR (first reference standard). Chest X-Ray and PoCUS were each compared to the physician diagnosis (second reference standard) to determine agreement using an acceptable disagreement cut-off of 15%.

Results

31% more abnormalities were identified by LUS than CXR. Lung ultrasound findings agreed with CXR in 86% of the participants with moderate reliability (ĸ=0.75). There was no significant difference between the actual findings of the two tests (X2= 2, p 0.1). Using the second reference, 82% of the CXRs were similar with weak reliability (ĸ=0.5) compared to 98% of PoCUS findings with strong reliability (ĸ=0.9). Compared to PoCUS, CXRs significantly differed from the physician diagnosis (X2= 0.85, p 0.38 vs X2= 8.5, p 0.004 respectively).

Conclusion

Overall, PoCUS was not inferior to CXR when compared to final physician diagnosis in identifying causes of hypoxia, and LUS and CXR had comparable performance. Significantly more abnormalities were identified on PoCUS and it demonstrated better agreement and strong reliability with the physician diagnosis than CXR. We recommend PoCUS use in patients with hypoxia attending resource limited in- and pre-hospital settings.

背景缺氧是世界各地急诊科常见的表现。它影响了撒哈拉以南非洲9-12%的住院成年人。及时诊断肺炎、心力衰竭等多种原因是一项挑战。胸部X射线(CXR)是最常用的成像方式之一,有许多局限性,金标准(计算机断层扫描)是无法实现的。护理点超声(PoCUS)在资源有限的ED中的应用越来越多,但人们对其性能知之甚少。本研究旨在评估PoCUS与CXR在确定医学ED缺氧原因方面的诊断性能。方法对49名在医学ED中出现缺氧(SP02≤88%)的成人进行评估。对肺和心脏进行超声检查(PoCUS),然后获得CXR。将肺部超声(LUS)与CXR(第一参考标准)进行比较。将胸部X光和PoCUS分别与医生诊断(第二参考标准)进行比较,以确定一致性,可接受的不一致截止值为15%。结果LUS比CXR多31%的异常。86%的参与者的肺部超声检查结果与CXR一致,具有中等可靠性(ĸ=0.75)。两项测试的实际结果之间没有显著差异(X2=2,p 0.1)。使用第二个参考,82%的CXR相似,具有弱可靠性(312;=0.5),而PoCUS检查结果的98%具有强可靠性(3.12;=0.9)。与PoCUS相比,CXR与医生诊断有显著差异(X2=0.85,p 0.38 vs X2=8.5,p 0.004)。结论总体而言,与最终医生诊断相比,PoCUS在识别缺氧原因方面并不劣于CXR,LUS和CXR具有可比的性能。PoCUS上发现的异常明显更多,与CXR相比,它与医生诊断的一致性更好,可靠性更强。我们建议在资源有限的院内和院前环境中使用PoCUS治疗缺氧患者。
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引用次数: 2
Effectiveness of handover practices between emergency department and intensive care unit nurses 急诊科和重症监护室护士交接的有效性
IF 1.3 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2023-06-01 DOI: 10.1016/j.afjem.2023.03.001
Tebogo T. Mamalelala , Shelley Schmollgruber , Meghan Botes , William Holzemer

Background

Nurses from the emergency department (ED) and the intensive care unit (ICU) must interact during the handover procedure. Factors such as unit boundaries, the interaction between different specialities, patient acuities, and treatment adjustments generate specific negotiating and teamwork problems during the transition of patients from ED to ICU.

Objective

This study aimed to describe the opinions of nurses regarding the effectiveness of handover practices between nurses in the ED and ICU in a major academic hospital in Gauteng province, South Africa.

Method

An analytical cross-sectional survey design was used. Data were collected using a 16-item handover evaluation tool. It comprises two sections (1) biographical details and (2) 16 statements about handover quality divided into five constructs, namely information transfer, shared understanding, working atmosphere, overall handover quality, and circumstances of handover. Data analysis was done utilising descriptive and non-parametric statistics.

Results

The majority (51.8%; n = 115) of the handovers occurred during the day. Out of 171 nurses, there were specialist practice emergency (19.2%; n = 33) and intensive care (28.0%; n = 48) nurses. There was statistical significance in information transfer between the ED and ICU nurses. (Me = 4.0, p < 0.05), compared to ICU nurses (Me = 3.0). Nurse specialist and non-specialist nurses' handovers differed statistically significantly on 12 of the 16 items on the rating scale, compared to 10 for non-specialist nurses' handovers.

Conclusion

The study showed that ED and ICU nurses have significantly different requirements and expectations for handover procedures. In addition to completed documentation, subtle interpretations of the information provided and received also impact the need. The ED and ICU nurses would need to agree on the contents of a structured handover framework because different specialities and departments have varied expectations to achieve an effective handover.

背景急诊科(ED)和重症监护室(ICU)的护士在交接过程中必须互动。诸如单位边界、不同专业之间的互动、患者敏锐性、,在患者从急诊室过渡到重症监护室的过程中,治疗调整会产生特定的谈判和团队合作问题。目的本研究旨在描述护士对南非豪登省一家大型学术医院急诊室和重症监护室护士之间交接做法的有效性的看法。方法采用分析性横断面调查设计。使用16项移交评估工具收集数据。它包括两个部分(1)传记细节和(2)关于移交质量的16个陈述,分为五个结构,即信息传递、共享理解、工作氛围、总体移交质量和移交情况。数据分析采用描述性和非参数统计方法。结果大多数(51.8%;n=115)移交发生在白天。在171名护士中,有专科急诊(19.2%;n=33)和重症监护(28.0%;n=48)护士。急诊科和ICU护士之间的信息传递具有统计学意义。(Me=4.0,p<;0.05),而ICU护士(Me=3.0)。在评定量表的16个项目中,护士-专科护士和非专科护士的交接在12个项目上存在统计学显著差异,而非专科护士交接的项目为10个。结论急诊科和ICU护士对交接程序的要求和期望存在显著差异。除了完整的文件外,对所提供和收到的信息的微妙解释也会影响需求。急诊科和重症监护室护士需要就结构化移交框架的内容达成一致,因为不同的专业和部门对实现有效移交有不同的期望。
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引用次数: 0
Leveraging tele-mentoring and remote learning to strengthen the emergency care capacity of health workers in Uganda 利用远程指导和远程学习,加强乌干达卫生工作者的紧急护理能力
IF 1.3 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2023-06-01 DOI: 10.1016/j.afjem.2023.04.001
Irene Atuhairwe , Annet Alenyo Ngabirano , Bonaventure Ahaisibwe , Allan Nsubuga , Andrew Marvin Kanyike , Raymond Bernard Kihumuro , Thomas Balizzakiwa , Helen Ewing , Randall Ellis , Leigh Forbush , Oumo Joseph , Marion Jane Nakyeyune , John Baptist Waniaye

Background

A robust emergency care system is a cost-effective method of reducing preventable death and disability, especially in low-and middle-income countries. To scale emergency care expertise across the country, the Uganda Ministry of Health and Seed Global Health established the Emergency Medical Services (EMS) ECHO program. We describe the process of establishing the program in a resource-limited setting, best practices, and lessons learned in Uganda.

Methods

Investigators conducted a mixed-methods evaluation to assess the initial 4 months’ implementation of the EMS ECHO. We conducted pre/post-program assessments of healthcare worker knowledge, self-efficacy, and professional's satisfaction with the program. The analysis compared the differences between pre/post-test scores descriptively.

Results

The EMS ECHO was initiated in November 2021. A phased curriculum was developed with the initial phase focusing on the ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) approach to the emergency patient. This phase reached 2,030 health workers cumulatively across 200 health facilities. The majority of the participants were medical doctors (n = 751, 37%), and nurses (n = 568, 28%). Majority of participants (95%) rated the sessions as informative. On whether the ECHO sessions diminished professional isolation, 66% agreed or strongly agreed.

Conclusions

Similar to other ECHO program evaluation results, Uganda's EMS ECHO program improved knowledge, skills, and the development of a virtual community of practice thereby diminishing professional isolation. It also demonstrates that through a planned stepwise process, virtual learning and telementorship can be used efficiently to improve healthcare worker knowledge,skills and multiply the limited number of emergency care experts available in the country.

背景健全的急救系统是减少可预防死亡和残疾的一种成本效益高的方法,尤其是在中低收入国家。为了在全国范围内扩大急救专业知识,乌干达卫生和种子全球卫生部制定了紧急医疗服务(EMS)ECHO计划。我们描述了在资源有限的环境中建立该计划的过程、最佳实践和乌干达的经验教训。方法调查人员进行了混合方法评估,以评估EMS ECHO最初4个月的实施情况。我们对医护人员的知识、自我效能感和专业人员对该项目的满意度进行了项目前/项目后评估。该分析描述性地比较了测试前/测试后分数之间的差异。结果EMS ECHO于2021年11月启动。制定了一个分阶段的课程,最初阶段侧重于急救患者的ABCDE(气道、呼吸、循环、残疾和暴露)方法。这一阶段共有2030名卫生工作者,分布在200个卫生设施中。大多数参与者是医生(n=751,37%)和护士(n=568,28%)。大多数参与者(95%)认为会议内容丰富。关于ECHO会议是否减少了职业隔离,66%的人表示同意或强烈同意。结论与其他ECHO项目评估结果类似,乌干达的EMS ECHO项目提高了知识、技能和虚拟实践社区的发展,从而减少了职业孤立。它还表明,通过有计划的逐步过程,可以有效地利用虚拟学习和远程指导来提高医护人员的知识和技能,并使该国有限的急救专家数量成倍增加。
{"title":"Leveraging tele-mentoring and remote learning to strengthen the emergency care capacity of health workers in Uganda","authors":"Irene Atuhairwe ,&nbsp;Annet Alenyo Ngabirano ,&nbsp;Bonaventure Ahaisibwe ,&nbsp;Allan Nsubuga ,&nbsp;Andrew Marvin Kanyike ,&nbsp;Raymond Bernard Kihumuro ,&nbsp;Thomas Balizzakiwa ,&nbsp;Helen Ewing ,&nbsp;Randall Ellis ,&nbsp;Leigh Forbush ,&nbsp;Oumo Joseph ,&nbsp;Marion Jane Nakyeyune ,&nbsp;John Baptist Waniaye","doi":"10.1016/j.afjem.2023.04.001","DOIUrl":"10.1016/j.afjem.2023.04.001","url":null,"abstract":"<div><h3>Background</h3><p>A robust emergency care system is a cost-effective method of reducing preventable death and disability, especially in low-and middle-income countries. To scale emergency care expertise across the country, the Uganda Ministry of Health and Seed Global Health established the Emergency Medical Services (EMS) ECHO program. We describe the process of establishing the program in a resource-limited setting, best practices, and lessons learned in Uganda.</p></div><div><h3>Methods</h3><p>Investigators conducted a mixed-methods evaluation to assess the initial 4 months’ implementation of the EMS ECHO. We conducted pre/post-program assessments of healthcare worker knowledge, self-efficacy, and professional's satisfaction with the program. The analysis compared the differences between pre/post-test scores descriptively.</p></div><div><h3>Results</h3><p>The EMS ECHO was initiated in November 2021. A phased curriculum was developed with the initial phase focusing on the ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) approach to the emergency patient. This phase reached 2,030 health workers cumulatively across 200 health facilities. The majority of the participants were medical doctors (<em>n</em> = 751, 37%), and nurses (<em>n</em> = 568, 28%). Majority of participants (95%) rated the sessions as informative. On whether the ECHO sessions diminished professional isolation, 66% agreed or strongly agreed.</p></div><div><h3>Conclusions</h3><p>Similar to other ECHO program evaluation results, Uganda's EMS ECHO program improved knowledge, skills, and the development of a virtual community of practice thereby diminishing professional isolation. It also demonstrates that through a planned stepwise process, virtual learning and telementorship can be used efficiently to improve healthcare worker knowledge,skills and multiply the limited number of emergency care experts available in the country.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 2","pages":"Pages 86-93"},"PeriodicalIF":1.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10130342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9746674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Global health research abstracts: March ‘23 全球健康研究摘要:23年3月
IF 1.3 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2023-06-01 DOI: 10.1016/j.afjem.2023.03.004
Dr. Jonathan Kajjimu

The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.

《非洲急诊医学杂志》与其他几家区域急诊医学杂志合作,出版了各自期刊的摘要。摘要不一定与开放获取论文相关联,但是,所有摘要都可以在不订阅的情况下访问。
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引用次数: 0
Global Health research abstracts: January ‘22 全球健康研究摘要:22年1月
IF 1.3 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2023-06-01 DOI: 10.1016/j.afjem.2023.01.005
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引用次数: 0
Weight estimation in two groups of Ghanaian children with chronic diseases using Broselow, Mercy, PAWPER XL and PAWPER XL-MAC tapes 使用Broselow, Mercy, PAWPER XL和PAWPER XL- mac磁带对两组加纳慢性疾病儿童进行体重估计
IF 1.3 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2023-06-01 DOI: 10.1016/j.afjem.2023.04.003
Rafiuk Cosmos Yakubu , Vivian Paintsil , Samuel Blay Nguah

Introduction

The performance of various weight estimation methods in children with sickle cell disease (SCD) and heart disease (HD) has not been studied. We aimed to determine and compare the accuracies of the Broselow, Mercy, PAWPER XL and PAWPER XL-MAC tapes in Ghanaian children with no known chronic diseases (controls), SCD and HD.

Methods

We prospectively recruited 631 children (199 with HD, 209 SCD and 223 controls) from the Komfo Anokye Teaching Hospital (KATH). Their weights were estimated using the Broselow, Mercy, PAWPER XL and PAWPER XL-MAC tapes. These estimated weights were compared to measured weight using mean percentage error (MPE), the proportion of weight estimates within ±10% (P10) and ±20% (P20) of measured weight. Bland-Altman limits of agreement (LOA) were determined to assess the precision of weight estimation and agreement with measured weight.

Results

The PAWPER XL, Mercy and PAWPER XL-MAC were the most accurate in all groups of children studied. All methods except the Broselow tape (BT), which performed best in the control group, had their best performance among children with SCD with negligible critical error rates (proportion of children with weight estimates > 20% of their actual weight). The P20 in the various groups of children using the BT were 88.36%, 80.21% and 51.10% respectively in the control, SCD and HD groups. The Mercy, PAWPER XL and PAWPER XL MAC tapes were generally above 90% in all groups.

Discussion

The Mercy, PAWPER XL and PAWPER XL-MAC tapes performed significantly better than the BT in all groups of children studied. These methods of weight estimation performed best in children with SCD with very little critical error.

引言各种体重估计方法在镰状细胞病(SCD)和心脏病(HD)儿童中的表现尚未得到研究。我们旨在确定和比较Broselow、Mercy、PAWPER XL和PAWPER XL-MAC胶带在没有已知慢性病(对照)、SCD和HD的加纳儿童中的准确性。方法我们前瞻性地从Komfo Anokye教学医院(KATH)招募了631名儿童(199名HD儿童、209名SCD儿童和223名对照)。使用Broselow、Mercy、PAWPER XL和PAWPER XL-MAC胶带估算它们的重量。使用平均百分比误差(MPE)将这些估计重量与测量重量进行比较,重量估计在测量重量的±10%(P10)和±20%(P20)范围内。确定Bland-Altman一致性限度(LOA),以评估重量估计的准确性以及与测量重量的一致性。结果PAWPER XL、Mercy和PAWPER XL-MAC在所研究的所有儿童组中是最准确的。除了在对照组中表现最好的Broselow胶带(BT)外,所有方法在SCD儿童中表现最好,临界错误率可忽略不计(体重估计值大于实际体重20%的儿童比例)。使用BT的各组儿童的P20在对照组、SCD组和HD组中分别为88.36%、80.21%和51.10%。Mercy、PAWPERXL和PAWPER-XL MAC磁带在所有组中普遍高于90%。讨论在所有研究的儿童组中,Mercy、PAWPER XL和PAWPER XL-MAC胶带的表现都明显优于BT。这些体重估计方法在SCD儿童中表现最好,临界误差很小。
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引用次数: 0
The views and experiences of candidates and graduates from a South African emergency medicine doctoral programme 南非急诊医学博士课程的候选人和毕业生的观点和经验
IF 1.3 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2023-06-01 DOI: 10.1016/j.afjem.2023.03.005
Craig W , Khan W , Rambharose S , Stassen W

Introduction

With the emergency medicine speciality in its nascency in Africa, EM doctoral programmes will need to be developed to facilitate the establishment of an evidence base that is responsive to the African populace. This study aimed to understand the thoughts, experiences, and opinions of current and past candidates of a South African EM PhD programme.

Methods

Descriptive, qualitative, semi-structured interviews were used to gather data on PhD EM candidates and graduates.

Findings

Four candidates, and four graduates were interviewed. Four categories emerged from the data 1) interviewees had various motivations for starting a PhD in EM, 2) candidate expectations and learning needs were not always aligned with reality, and the challenges and opportunities for success in the PhD programme are related both 3) intrinsically (candidate) and 4) extrinsically (system).

Discussion

Many of the barriers noted by the participants can be related to the nascency of the EM in Africa. Participants felt underprepared for their doctorate in terms of their baseline research literacy and skill. Candidates did not receive the level of student-supervisor engagement they desired. Candidates who are also clinicians faced both academic challenges and a resource-limited healthcare system. Pre-doctoral training may upskill prospective candidates in research literacy before they officially register. Distance-learning can be sub-optimal in terms of social interaction and collaboration. A well-curriculated, competency-based programme with clear outcomes, structured teaching-learning opportunities, intentional academic support throughout the programme, can mitigate the above. Protected academic time, promotion criteria which acknowledges academic contributions, financial incentives and more joint positions between universities and clinical services are potential solutions for clinician researcher challenges. An African PhD EM programme should produce graduates who are independent researchers, skilled in academic supervision and who are impactful to African needs when contributing to the African EM knowledge economy.

引言随着急诊医学专业在非洲的兴起,需要开发EM博士课程,以促进建立一个对非洲民众有反应的证据库。本研究旨在了解南非EM博士项目现任和前任候选人的想法、经历和意见。方法采用描述性、定性、半结构化的访谈方法,收集EM博士研究生和毕业生的相关数据。四名候选人和四名毕业生接受了面试。数据中出现了四类:1)受访者开始攻读EM博士学位的动机多种多样;2)候选人的期望和学习需求并不总是与现实一致,在博士课程中取得成功的挑战和机会既有内在的(候选人),也有外在的(系统)。讨论参与者指出的许多障碍可能与EM在非洲的种族有关。参与者对他们的基础研究知识和技能感到准备不足。考生没有得到他们想要的学生导师参与度。同时也是临床医生的候选人面临着学术挑战和资源有限的医疗系统。在正式注册之前,博士前培训可能会提高潜在候选人的研究素养。就社交互动和协作而言,远程学习可能是次优的。一个课程安排良好、基于能力的课程,有明确的结果、结构化的教学机会、整个课程中有意的学术支持,可以缓解上述情况。受保护的学术时间、承认学术贡献的晋升标准、经济激励以及大学和临床服务机构之间更多的联合职位是临床医生研究人员挑战的潜在解决方案。非洲新兴市场博士课程应培养出独立研究人员、精通学术监督、在为非洲新兴市场知识经济做出贡献时对非洲需求有影响力的毕业生。
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引用次数: 1
Man-O-War simulator: a Low-cost manikin for training on chest tube management Man-O-War模拟器:一种用于胸管管理训练的低成本人体模型
IF 1.3 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2023-06-01 DOI: 10.1016/j.afjem.2023.01.004
Abdennour Nasri , Mouna Jerbi , Rim Karray , Haifa Snoussi , Amal Samet , Aziza Talbi , Hana Ksentini , Imen Rejeb , Olfa Chakroun-Walha , Noureddine Rekik

Simulation-based medical education is becoming a cornerstone in health education. Simulators are commonly expensive and not available in developing countries.

We propose a very low-cost simulator that any educator can realize. We describe here the steps to follow to develop this proposed simulator.

基于模拟的医学教育正在成为健康教育的基石。模拟器通常价格昂贵,发展中国家没有。我们提出了一个任何教育工作者都可以实现的非常低成本的模拟器。我们在这里描述了开发该拟议模拟器的步骤。
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引用次数: 0
Acute organophosphorus toxicity in a regional hospital in Johannesburg, South Africa: A retrospective chart review 南非约翰内斯堡一家地区医院的急性有机磷中毒:回顾性图表审查
IF 1.3 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2023-06-01 DOI: 10.1016/j.afjem.2023.04.002
Vanessa Khonje , Jedd Hart , Jakus Venter , Saisha Deonarain , Saul Grossberg

Introduction

Intentional and accidental organophosphorus exposures pose a significant healthcare-related burden on South African communities. This study will review the demographics, characteristics and clinical course of patients presenting with features of acute organophosphorus toxicity to a regional Emergency Centre in Johannesburg, South Africa.

Methods

This was a retrospective chart review of all patients treated for possible acute organophosphorus toxicity from January 2020 to August 2021.

Results

A total of 205 patients were identified of which 134 patients were included in the study. The median age was 26 years with a male predominance (male= 56%, female=44%). 109 patients (81.3%) survived, 18 patients (13.4%) demised and the outcome of 7 patients (5.2%) was unknown. The median hospital length of stay was 8 days, (IQR= 5-13 days), and the longest hospital stay was 37 days in ICU. Atropinisation dose was significantly higher for intubated patients (median=140.0mg; IQR=90mg-219.5mg) compared to patients who were not intubated (median=60mg; IQR=20.5mg-120mg, p < 0.05). The length of stay was significantly higher for intubated patients (median=11 days; IQR=7-15 days) compared to patients who were not intubated (median=5 days; IQR=3-8 days, p < 0.00). There was a moderate positive correlation between atropinisation dose and length of stay (Correlation coefficient = 0.37, p < 0.00). There was a moderate negative correlation between atropinisation dose and cholinesterase level (Correlation coefficient= - 0.39, p < 0.00). Of those reported to have adverse effects 78.6%, were related to atropine toxicity.

Conclusion

Our study shows a high mortality rate secondary to organophosphorus toxicity. Significant exposures and thus higher doses of atropine were associated with increased length of stay and need for intubation. We found a high incidence of atropine-related adverse effects. More studies are needed to further establish the balance between the therapeutic and adverse effects of high-dose atropine as a treatment modality for organophosphorus toxicity.

引言故意和意外接触有机磷对南非社区造成了重大的医疗保健相关负担。本研究将回顾约翰内斯堡地区急救中心出现急性有机磷中毒特征的患者的人口统计学、特征和临床过程,南非。方法这是对2020年1月至2021年8月期间接受可能急性有机磷中毒治疗的所有患者的回顾性图表回顾。结果共确定205名患者,其中134名患者纳入研究。中位年龄为26岁,以男性为主(男性=56%,女性=44%)。109名患者(81.3%)存活,18名患者(13.4%)出院,7名患者(5.2%)的结局未知。中位住院时间为8天(IQR=5-13天),最长住院时间为37天。插管患者的阿托品剂量(中位数=140.0mg;IQR=90mg-219.5mg)明显高于未插管患者(中位数=60mg;IQR=20.5mg-120mg,p<;0.05)阿托品剂量与停留时间呈中度正相关(相关系数=0.37,p<;0.00)。阿托品剂量与胆碱酯酶水平呈中度负相关(相关性系数=-0.39,p<;0.00),报告有副作用的患者中,78.6%与阿托品毒性有关。结论本研究显示有机磷中毒死亡率较高。阿托品的大量暴露和更高剂量与住院时间和插管需求的增加有关。我们发现阿托品相关不良反应的发生率很高。需要更多的研究来进一步建立大剂量阿托品作为有机磷中毒治疗模式的治疗和不良反应之间的平衡。
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African Journal of Emergency Medicine
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