Pub Date : 2024-08-06DOI: 10.1016/j.afjem.2024.07.002
Introduction
Inadequate patient handover is linked to numerous medical errors and lapses in communication between hospital healthcare providers and prehospital healthcare providers. Undergraduate healthcare curricula may limit programme-specific education on patient handover and shift learning to informal learning opportunities. This study aimed to investigate the outcomes of qualified healthcare provider (HCPs) educational programmes to determine the adequacy of handover practices, the source of their training, and their interprofessional acceptance of these practices.
Methods
A multi-method study design was used – a document analysis of HCP programme outcomes and a two-section questionnaire. The questionnaire was sent to HCPs to determine the impact of patient handover practices on current healthcare systems and their opinion on whether the training on handovers is sufficient.
Results
HCPs indicated little educational interaction regarding patient handover. Most participants felt handover education relied predominantly on informal training. With their existing knowledge, many HCPs revealed that they were comfortable in handing over a patient. Little interprofessional confidence regarding patient handover information indicates minimal interprofessional collaboration toward standardised approaches for patient handover.
Conclusion
This study indicates a lack of standardised handover procedures, which leads to HCP self-interpretations. There is low trust between HCPs regarding information received. The study highlights the need for standardised handover training in healthcare curricula to improve patient safety and interprofessional collaboration.
{"title":"The transition of patient care: Exploring the outcomes of prehospital to hospital patient handover practices and healthcare provider education","authors":"","doi":"10.1016/j.afjem.2024.07.002","DOIUrl":"10.1016/j.afjem.2024.07.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Inadequate patient handover is linked to numerous medical errors and lapses in communication between hospital healthcare providers and prehospital healthcare providers. Undergraduate healthcare curricula may limit programme-specific education on patient handover and shift learning to informal learning opportunities. This study aimed to investigate the outcomes of qualified healthcare provider (HCPs) educational programmes to determine the adequacy of handover practices, the source of their training, and their interprofessional acceptance of these practices.</p></div><div><h3>Methods</h3><p>A multi-method study design was used – a document analysis of HCP programme outcomes and a two-section questionnaire. The questionnaire was sent to HCPs to determine the impact of patient handover practices on current healthcare systems and their opinion on whether the training on handovers is sufficient.</p></div><div><h3>Results</h3><p>HCPs indicated little educational interaction regarding patient handover. Most participants felt handover education relied predominantly on informal training. With their existing knowledge, many HCPs revealed that they were comfortable in handing over a patient. Little interprofessional confidence regarding patient handover information indicates minimal interprofessional collaboration toward standardised approaches for patient handover.</p></div><div><h3>Conclusion</h3><p>This study indicates a lack of standardised handover procedures, which leads to HCP self-interpretations. There is low trust between HCPs regarding information received. The study highlights the need for standardised handover training in healthcare curricula to improve patient safety and interprofessional collaboration.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000284/pdfft?md5=9b03bbe60af221bf5f5dc74f32d29e4d&pid=1-s2.0-S2211419X24000284-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141962690","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}
Pub Date : 2024-07-17DOI: 10.1016/j.afjem.2024.07.001
Introduction
The introduction of emergency nursing in Africa has resulted in the establishment of several training schools across the continent. This has translated into a growing body of emergency care research being carried out by nurses; however, the breadth and extent of evidence remains unclear. The aim of the review was to map and collate the available literature on emergency nursing research in WHO Afro-region states.
Methods
The review adopted the methodology of the Joanna Briggs Institute (JBI) scoping reviews. The review protocol was registered on 27 June 2022 (osf.io/5wz3x). The Population (nurse), Concept (emergency nursing research), Context (WHO Afro-region) (PCC) elements guided the development of the inclusion and exclusion criteria. Papers were searched across seven electronic data bases and two search engines using a three-search strategy. The screening was performed initially on the abstract and title and lastly on full text. The reporting for the review was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).
Results
One hundred and thirteen papers were included in the review. Publication of emergency nursing research occurred from 2000 to 2022. The year 2017 and 2019 recorded the highest number of publications (n = 14). The country with the most publications was South Africa (n=50). Emergency nursing research used predominantly quantitative methodologies (n=58). The professional groups involved in research were nurses (n=69) as well as nurses and doctors (n=26). The identified papers focused primarily on emergency nursing education (n=23) and epidemiology (n=24).
Conclusion
There is a notable increase in the number of publications on emergency nursing research in WHO Afro-region states, however from only 11 countries. Since most of the research is still at descriptive level, there is need to encourage emergency nursing research on interventions and measuring outcomes and impact in the emergency care system.
导言非洲引入急诊护理后,在整个非洲大陆建立了多所培训学校。护士们也因此开展了越来越多的急救护理研究;然而,证据的广度和程度仍不明确。本综述旨在对世界卫生组织非洲地区国家现有的急救护理研究文献进行梳理和整理。审查协议于 2022 年 6 月 27 日注册(osf.io/5wz3x)。在制定纳入和排除标准时,以人群(护士)、概念(急救护理研究)、背景(世界卫生组织非洲地区)(PCC)要素为指导。采用三种检索策略在七个电子数据库和两个搜索引擎中对论文进行了检索。首先对摘要和标题进行筛选,最后对全文进行筛选。综述报告以《系统综述和 Meta 分析首选报告项目》(Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews,PRISMA-ScR)为指导。急诊护理研究的发表时间为 2000 年至 2022 年。2017 年和 2019 年发表的论文数量最多(n = 14)。发表论文最多的国家是南非(n=50)。急救护理研究主要使用定量方法(n=58)。参与研究的专业群体包括护士(n=69)以及护士和医生(n=26)。所发现的论文主要集中在急救护理教育(23 篇)和流行病学(24 篇)方面。由于大多数研究仍停留在描述层面,因此有必要鼓励急诊护理研究干预措施,并衡量急诊护理系统的成果和影响。
{"title":"Mapping the evidence of emergency nursing research in who Afro-region states: A Scoping Review","authors":"","doi":"10.1016/j.afjem.2024.07.001","DOIUrl":"10.1016/j.afjem.2024.07.001","url":null,"abstract":"<div><h3>Introduction</h3><p>The introduction of emergency nursing in Africa has resulted in the establishment of several training schools across the continent. This has translated into a growing body of emergency care research being carried out by nurses; however, the breadth and extent of evidence remains unclear. The aim of the review was to map and collate the available literature on emergency nursing research in WHO Afro-region states.</p></div><div><h3>Methods</h3><p>The review adopted the methodology of the Joanna Briggs Institute (JBI) scoping reviews. The review protocol was registered on 27 June 2022 (osf.io/5wz3x). The Population (nurse), Concept (emergency nursing research), Context (WHO Afro-region) (PCC) elements guided the development of the inclusion and exclusion criteria. Papers were searched across seven electronic data bases and two search engines using a three-search strategy. The screening was performed initially on the abstract and title and lastly on full text. The reporting for the review was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).</p></div><div><h3>Results</h3><p>One hundred and thirteen papers were included in the review. Publication of emergency nursing research occurred from 2000 to 2022. The year 2017 and 2019 recorded the highest number of publications (n = 14). The country with the most publications was South Africa (n=50). Emergency nursing research used predominantly quantitative methodologies (n=58). The professional groups involved in research were nurses (n=69) as well as nurses and doctors (n=26). The identified papers focused primarily on emergency nursing education (n=23) and epidemiology (n=24).</p></div><div><h3>Conclusion</h3><p>There is a notable increase in the number of publications on emergency nursing research in WHO Afro-region states, however from only 11 countries. Since most of the research is still at descriptive level, there is need to encourage emergency nursing research on interventions and measuring outcomes and impact in the emergency care system.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000272/pdfft?md5=85f015021276895ac2d607fc01e5c83c&pid=1-s2.0-S2211419X24000272-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636509","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}
Pub Date : 2024-07-16DOI: 10.1016/j.afjem.2024.06.005
Objective
Supplemental oxygen therapy is suppling oxygen at quantities higher than those found in the atmosphere (>21 %) and is mostly prescribed for hypoxic patients. To avoid hypoxemia, hypercapnia, and oxygen poisoning, nurses closely monitor patients receiving oxygen therapy. There are considerable gaps in nurses' practice of oxygen therapy. Patients who receive inappropriate oxygen therapy may have negative effects, and it has financial repercussions for both individuals and nations. The aim of this study was to assess oxygen therapy practices and associated factors influencing oxygen administration among nurses in an Ethiopian Regional Hospital.
Method
From March 1 to March 30, 2019, a cross-sectional institutional study using quantitative methods was performed amongst nurses working at a referral hospital in northwestern Ethiopia. Data was gathered using structured self-administered questionnaires.
Result
In this study, 147 participants (91.3 %) were found to have inadequate practice with oxygen therapy. Nurses' lack of knowledge about carbon monoxide, adult patients' typical breathing rates, cardiopulmonary function, and devices (face mask, nasal cannula, oxygen concentrators, pulse oximeter and others) that are difficult for patients to accept were found to be factors associated with oxygen administration practice.
Conclusion
The findings of this study showed that nurses' use of oxygen administration was subpar. The institutional factors, knowledge gaps, and attitudes of nurses were identified as the determinants affecting oxygen administration practice. Nurses would do better to read up on oxygen administration, interact with one another and undertake further training.
{"title":"Oxygen therapy practice and associated factors among nurses working at an Ethiopian Referral Hospital","authors":"","doi":"10.1016/j.afjem.2024.06.005","DOIUrl":"10.1016/j.afjem.2024.06.005","url":null,"abstract":"<div><h3>Objective</h3><p>Supplemental oxygen therapy is suppling oxygen at quantities higher than those found in the atmosphere (>21 %) and is mostly prescribed for hypoxic patients. To avoid hypoxemia, hypercapnia, and oxygen poisoning, nurses closely monitor patients receiving oxygen therapy. There are considerable gaps in nurses' practice of oxygen therapy. Patients who receive inappropriate oxygen therapy may have negative effects, and it has financial repercussions for both individuals and nations. The aim of this study was to assess oxygen therapy practices and associated factors influencing oxygen administration among nurses in an Ethiopian Regional Hospital.</p></div><div><h3>Method</h3><p>From March 1 to March 30, 2019, a cross-sectional institutional study using quantitative methods was performed amongst nurses working at a referral hospital in northwestern Ethiopia. Data was gathered using structured self-administered questionnaires.</p></div><div><h3>Result</h3><p>In this study, 147 participants (91.3 %) were found to have inadequate practice with oxygen therapy. Nurses' lack of knowledge about carbon monoxide, adult patients' typical breathing rates, cardiopulmonary function, and devices (face mask, nasal cannula, oxygen concentrators, pulse oximeter and others) that are difficult for patients to accept were found to be factors associated with oxygen administration practice.</p></div><div><h3>Conclusion</h3><p>The findings of this study showed that nurses' use of oxygen administration was subpar. The institutional factors, knowledge gaps, and attitudes of nurses were identified as the determinants affecting oxygen administration practice. Nurses would do better to read up on oxygen administration, interact with one another and undertake further training.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000223/pdfft?md5=04a34d0410bfa0f0afa92e899b016912&pid=1-s2.0-S2211419X24000223-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141622455","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}
Pub Date : 2024-07-05DOI: 10.1016/j.afjem.2024.06.003
Daniel Gams Massi , Adonis Herman Kedonkwo Mbogne , Verla Vincent Siysi , Junette Arlette Metogo Mbengono , Annick Mélanie Magnerou , Eric Gueumekane Bila Lamou , Victor Sini , Paul Cédric Mbonda Chimi , Jacques Doumbe , Callixte Kuate Tegueu , Mapoure Njankouo Yacouba
Introduction
Coma is a medical emergency, and optimal management, especially in a resource-poor setting, depends on knowledge of its aetiology and predictors of outcome. This study aimed to provide hospital-based data on the prevalence, etiology, and outcome of non traumatic coma (NTC) in adults at a tertiary level in Cameroon.
Methods
A three year retrospective cohort study of medical records of patients aged 18 years and above, who presented in coma of non-traumatic origin at a Cameroon emergency department (ED) was conducted. Data related to sociodemographic, clinical findings, investigations, etiology of the coma, and outcomes were collected.
Results
A total of 408 patients were recruited, 214 (52.5 %) were males. The mean age was 55.9 ± 16.6 years. NTC accounted for 2.2 % of all consultations at the ED during the period of study. Stroke (29.6 %), infections (19.8 %), and metabolic disorders (12.6 %) were the most frequent cause of NTC. Etiology was unknown in 23.3 % of our participants. The in-hospital mortality was 66.4 %. Duration of hospitalization ≤ 3 days, GCS 〈 6, serum creatinine level 〉 13 mg/L, and administration of adrenergic drugs were predictors of mortality. Overall survival rate was 44.3 % after 5 days of admission.
Conclusion
Non-traumatic coma had various aetiologies. Stroke accounted for almost one third of cases. About three out of five patients died in hospital. Deep coma, high serum creatinine level, short hospital stay and administration of adrenergic medications were independent predictors of mortality.
{"title":"Outcome of non-traumatic coma in a tertiary referral hospital in Cameroon","authors":"Daniel Gams Massi , Adonis Herman Kedonkwo Mbogne , Verla Vincent Siysi , Junette Arlette Metogo Mbengono , Annick Mélanie Magnerou , Eric Gueumekane Bila Lamou , Victor Sini , Paul Cédric Mbonda Chimi , Jacques Doumbe , Callixte Kuate Tegueu , Mapoure Njankouo Yacouba","doi":"10.1016/j.afjem.2024.06.003","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.06.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Coma is a medical emergency, and optimal management, especially in a resource-poor setting, depends on knowledge of its aetiology and predictors of outcome. This study aimed to provide hospital-based data on the prevalence, etiology, and outcome of non traumatic coma (NTC) in adults at a tertiary level in Cameroon.</p></div><div><h3>Methods</h3><p>A three year retrospective cohort study of medical records of patients aged 18 years and above, who presented in coma of non-traumatic origin at a Cameroon emergency department (ED) was conducted. Data related to sociodemographic, clinical findings, investigations, etiology of the coma, and outcomes were collected.</p></div><div><h3>Results</h3><p>A total of 408 patients were recruited, 214 (52.5 %) were males. The mean age was 55.9 ± 16.6 years. NTC accounted for 2.2 % of all consultations at the ED during the period of study. Stroke (29.6 %), infections (19.8 %), and metabolic disorders (12.6 %) were the most frequent cause of NTC. Etiology was unknown in 23.3 % of our participants. The in-hospital mortality was 66.4 %. Duration of hospitalization ≤ 3 days, GCS 〈 6, serum creatinine level 〉 13 mg/L, and administration of adrenergic drugs were predictors of mortality. Overall survival rate was 44.3 % after 5 days of admission.</p></div><div><h3>Conclusion</h3><p>Non-traumatic coma had various aetiologies. Stroke accounted for almost one third of cases. About three out of five patients died in hospital. Deep coma, high serum creatinine level, short hospital stay and administration of adrenergic medications were independent predictors of mortality.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000211/pdfft?md5=74f0efa9c38f5e4d01872709a75947df&pid=1-s2.0-S2211419X24000211-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541605","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}
Pub Date : 2024-07-05DOI: 10.1016/j.afjem.2024.06.008
Ahmed N. Zakariah , Edmund Boateng , Christiana Achena , Foster Ansong-Bridjan , Charles Mock
Introduction
Emergency medical services (EMS) are minimally developed in many African countries. We sought to document the achievements and challenges faced by the National Ambulance Service (NAS) of Ghana during its 20-year nationwide expansion, and to understand how well it is providing access to previously unserved, remoter areas.
Methods
Data routinely collected by NAS from 2004 to 2023 were analyzed, including structure and capacity (number of stations, ambulances, employees) and utilization and process of care (number of patients served, demographics, medical conditions, response site). Per population indicators of capacity and utilization were compared across Ghana's 16 regions.
Results
From 64 emergency medical technicians (EMTs) and nine ambulances in 2004, NAS has grown to 3,473 EMTs and 356 ambulances. From covering three cities in 2004, NAS now has at least one station in each of Ghana's 261 districts. From transporting 205 patients in 2004, NAS transported 38,393 patients in 2022. There have been interruptions due to financial restrictions, with numbers of patients transported per year in 2017–2019 decreasing by over 50% from the prior peak (n = 20,236 in 2014). In 2022, there were 1.13 ambulances per 100,000 people and 0.33 transports/100,000/day. Most (81.3%) transports are inter-facility transfers. Among Ghana's 16 regions, there is moderate variation in utilization from 0.16 to 0.50 transports/100,000/day. However, the three lowest-income, remoter regions currently have utilizations of 0.16, 0.30, and 0.37 transports/100,000/day, mostly near the National average of 0.33.
Conclusion
Despite periodic limitations due to finances, the NAS has expanded to cover all of Ghana's 261 districts and has largely achieved geographic equity. Sustainability has been aided by having a training school directly under NAS's control, assuring a steady supply of EMTs. Challenges include assuring financial stability and increasing utilization for emergencies at the scene, in addition to the current high utilization for inter-facility transfer.
{"title":"The National Ambulance Service of Ghana: Changes in capacity and utilization over 20 years","authors":"Ahmed N. Zakariah , Edmund Boateng , Christiana Achena , Foster Ansong-Bridjan , Charles Mock","doi":"10.1016/j.afjem.2024.06.008","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.06.008","url":null,"abstract":"<div><h3>Introduction</h3><p>Emergency medical services (EMS) are minimally developed in many African countries. We sought to document the achievements and challenges faced by the National Ambulance Service (NAS) of Ghana during its 20-year nationwide expansion, and to understand how well it is providing access to previously unserved, remoter areas.</p></div><div><h3>Methods</h3><p>Data routinely collected by NAS from 2004 to 2023 were analyzed, including structure and capacity (number of stations, ambulances, employees) and utilization and process of care (number of patients served, demographics, medical conditions, response site). Per population indicators of capacity and utilization were compared across Ghana's 16 regions.</p></div><div><h3>Results</h3><p>From 64 emergency medical technicians (EMTs) and nine ambulances in 2004, NAS has grown to 3,473 EMTs and 356 ambulances. From covering three cities in 2004, NAS now has at least one station in each of Ghana's 261 districts. From transporting 205 patients in 2004, NAS transported 38,393 patients in 2022. There have been interruptions due to financial restrictions, with numbers of patients transported per year in 2017–2019 decreasing by over 50% from the prior peak (<em>n</em> = 20,236 in 2014). In 2022, there were 1.13 ambulances per 100,000 people and 0.33 transports/100,000/day. Most (81.3%) transports are inter-facility transfers. Among Ghana's 16 regions, there is moderate variation in utilization from 0.16 to 0.50 transports/100,000/day. However, the three lowest-income, remoter regions currently have utilizations of 0.16, 0.30, and 0.37 transports/100,000/day, mostly near the National average of 0.33.</p></div><div><h3>Conclusion</h3><p>Despite periodic limitations due to finances, the NAS has expanded to cover all of Ghana's 261 districts and has largely achieved geographic equity. Sustainability has been aided by having a training school directly under NAS's control, assuring a steady supply of EMTs. Challenges include assuring financial stability and increasing utilization for emergencies at the scene, in addition to the current high utilization for inter-facility transfer.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000260/pdfft?md5=af05056337f023485e2db89f16edd6bd&pid=1-s2.0-S2211419X24000260-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541597","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}
Pub Date : 2024-07-01DOI: 10.1016/j.afjem.2024.03.001
O. Akinlade, Adebisi A. Adeyeye, Brandon L. Ellsworth, Christopher W. Reynolds, Chiamaka Eneh, A. Olufadeji
{"title":"Exploring trauma surgeons' views on trauma care in Nigeria: A qualitative study","authors":"O. Akinlade, Adebisi A. Adeyeye, Brandon L. Ellsworth, Christopher W. Reynolds, Chiamaka Eneh, A. Olufadeji","doi":"10.1016/j.afjem.2024.03.001","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.03.001","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-28DOI: 10.1016/j.afjem.2024.06.007
Chadi Rahmani , Ayoub Belhadj , Younes Aissaoui
Introduction
Blood lactate is a marker of tissue hypoxia while capillary refill time (CRT) is a surrogate of tissue perfusion. Measuring these parameters is recommended for assessing circulatory status and guiding resuscitation. However, blood lactate is not widely available in African emergency departments. Additionally, CRT assessment faces challenges related to its precision and reproducibility. This study aims to evaluate the accuracy of visual CRT(V-CRT) compared to plethysmographic CRT (P-CRT) in predicting lactate levels among septic patients.
Methods
This prospective observational study enrolled consecutive patients with sepsis or septic shock over a 6-month period from a tertiary hospital in Marrakech, Morroco. V-CRT and P-CRT were evaluated upon admission, and simultaneous measurements of arterial lactate levels were obtained. The precision of V-CRT and P-CRT in predicting arterial lactate was assessed using ROC curve analysis.
Results
Forty-three patients aged of 64±15 years, of whom 70 % were male, were included in the study. Of these, 23 patients (53 %) had sepsis, and 20 patients (47 %) experienced septic shock. Both V-CRT and P-CRT demonstrated statistically significant correlations with arterial lactate, with correlation coefficients of 0.529 (p < 0.0001) and 0.517 (p = 0.001), respectively. ROC curve analysis revealed that V-CRT exhibited satisfactory accuracy in predicting arterial lactate levels >2 mmol/l, with an area under the curve (AUC) of 0.8 (95 % CI=0.65 – 0.93; p < 0.0001). The prediction ability of P-CRT was lower than V-CRT with an AUC of 0.73 (95 % CI: 0.57–0.89; p = 0.043). The optimal thresholds were determined as 3.4 s for V-CRT (sensitivity = 90 %, specificity = 58 %) and 4.1 s for P-CRT (sensitivity = 85 %, specificity = 62 %).
Conclusion
These findings suggest that the plethysmographic evaluation did not improve the accuracy of CRT for predicting lactate level. However, V-CRT may still serve as a viable surrogate for lactate in septic patients in low-income settings.
{"title":"Can plethysmographic capillary refill time predict lactate during sepsis? An observational study from Morocco","authors":"Chadi Rahmani , Ayoub Belhadj , Younes Aissaoui","doi":"10.1016/j.afjem.2024.06.007","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.06.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Blood lactate is a marker of tissue hypoxia while capillary refill time (CRT) is a surrogate of tissue perfusion. Measuring these parameters is recommended for assessing circulatory status and guiding resuscitation. However, blood lactate is not widely available in African emergency departments. Additionally, CRT assessment faces challenges related to its precision and reproducibility. This study aims to evaluate the accuracy of visual CRT(V-CRT) compared to plethysmographic CRT (P-CRT) in predicting lactate levels among septic patients.</p></div><div><h3>Methods</h3><p>This prospective observational study enrolled consecutive patients with sepsis or septic shock over a 6-month period from a tertiary hospital in Marrakech, Morroco. V-CRT and P-CRT were evaluated upon admission, and simultaneous measurements of arterial lactate levels were obtained. The precision of V-CRT and P-CRT in predicting arterial lactate was assessed using ROC curve analysis.</p></div><div><h3>Results</h3><p>Forty-three patients aged of 64±15 years, of whom 70 % were male, were included in the study. Of these, 23 patients (53 %) had sepsis, and 20 patients (47 %) experienced septic shock. Both V-CRT and P-CRT demonstrated statistically significant correlations with arterial lactate, with correlation coefficients of 0.529 (<em>p</em> < 0.0001) and 0.517 (<em>p</em> = 0.001), respectively. ROC curve analysis revealed that V-CRT exhibited satisfactory accuracy in predicting arterial lactate levels >2 mmol/l, with an area under the curve (AUC) of 0.8 (95 % CI=0.65 – 0.93; <em>p</em> < 0.0001). The prediction ability of P-CRT was lower than V-CRT with an AUC of 0.73 (95 % CI: 0.57–0.89; <em>p</em> = 0.043). The optimal thresholds were determined as 3.4 s for V-CRT (sensitivity = 90 %, specificity = 58 %) and 4.1 s for P-CRT (sensitivity = 85 %, specificity = 62 %).</p></div><div><h3>Conclusion</h3><p>These findings suggest that the plethysmographic evaluation did not improve the accuracy of CRT for predicting lactate level. However, V-CRT may still serve as a viable surrogate for lactate in septic patients in low-income settings.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000259/pdfft?md5=fcd9789e6d8afb55389ff5cdb5e67803&pid=1-s2.0-S2211419X24000259-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141484600","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}
Pain management is crucial for improving patients' quality of care. Persistent pain has been linked to higher depression, anxiety, and work-related difficulties. This study aimed to enhance the time to pain relief in the emergency department through triage nurse-initiated analgesia. It evaluated the impact of nurse-led analgesia on patient satisfaction compared to standard pain management at Tikur Anbessa Specialized Hospital and Kidus Paulos Specialized Hospital. Additionally, it compared the time to analgesia between the two hospitals and assessed the effect of nurse-led analgesia on reducing the length of stay for patients with pain.
Methods
Using a quasi-experimental design, the study included an intervention group and a control group. Data was collected using an open data kit, and after ensuring data completeness, it was exported to SPSS and Excel for analysis. To assess the effectiveness of the intervention, the time to analgesia was compared between the intervention and control groups using an independent samples t-test. This statistical test allowed for a comparison of the mean time to analgesia between the two groups.
Patient satisfaction scores were also compared between the intervention and control groups using the Mann-Whitney U test. Kaplan-Meier curves were employed to compare the time to analgesia between the intervention and control groups within both settings. A point bi-serial correlation analysis was performed to examine the association between the length of stay and the intervention of nurse-led analgesia in both hospital settings.
Result and discussion
The study enrolled 179 participants, with a median age of 34 years (range: 9–80) and 67% female. The most common events leading to pain were medical conditions (21%), followed by trauma/quarrel/war, fall accidents, and underlying diseases (15%, 13%, and 13%, respectively). There was a significant correlation between the degree of pain on arrival and time to analgesia. Additionally, a significant correlation (p < 0.01) was found between time to analgesia and patient satisfaction.
Conclusion and recommendation
Implementing a nurse-led analgesia protocol in the emergency department is crucial for reducing time to analgesia and improving patient satisfaction. It is recommended to scale up this approach to other healthcare facilities by incorporating it into the nursing practice guidelines of the country.
导言疼痛管理对于提高患者的护理质量至关重要。持续疼痛与抑郁、焦虑和工作困难等因素有关。本研究旨在通过由分诊护士发起的镇痛,缩短急诊科的疼痛缓解时间。研究评估了在蒂库尔安贝萨专科医院和基度斯保罗斯专科医院,与标准疼痛管理相比,护士引导镇痛对患者满意度的影响。此外,该研究还比较了两家医院的镇痛时间,并评估了护士主导镇痛对缩短疼痛患者住院时间的影响。使用开放数据工具包收集数据,在确保数据完整性后,将数据导出到 SPSS 和 Excel 中进行分析。为了评估干预措施的效果,采用独立样本 t 检验法比较了干预组和对照组的镇痛时间。患者满意度评分也通过曼-惠特尼 U 检验在干预组和对照组之间进行了比较。采用 Kaplan-Meier 曲线比较干预组和对照组在两种情况下的镇痛时间。进行了点双序列相关性分析,以研究两种医院环境中住院时间与护士主导镇痛干预之间的关联。导致疼痛的最常见原因是内科疾病(21%),其次是外伤/枪伤/战争、跌倒意外和潜在疾病(分别为 15%、13% 和 13%)。到达时的疼痛程度与镇痛时间之间存在明显的相关性。结论和建议在急诊科实施护士主导的镇痛方案对于缩短镇痛时间和提高患者满意度至关重要。建议将此方法纳入国家护理实践指南,推广到其他医疗机构。
{"title":"Improving the time to pain relief in the emergency department through triage nurse-initiated analgesia - a quasi-experimental study from Ethiopia","authors":"Merahi Kefyalew , Negussie Deyassa , Uqubay Gidey , Maligna Temesgen , Maraki Mehari","doi":"10.1016/j.afjem.2024.06.004","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.06.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Pain management is crucial for improving patients' quality of care. Persistent pain has been linked to higher depression, anxiety, and work-related difficulties. This study aimed to enhance the time to pain relief in the emergency department through triage nurse-initiated analgesia. It evaluated the impact of nurse-led analgesia on patient satisfaction compared to standard pain management at Tikur Anbessa Specialized Hospital and Kidus Paulos Specialized Hospital. Additionally, it compared the time to analgesia between the two hospitals and assessed the effect of nurse-led analgesia on reducing the length of stay for patients with pain.</p></div><div><h3>Methods</h3><p>Using a quasi-experimental design, the study included an intervention group and a control group. Data was collected using an open data kit, and after ensuring data completeness, it was exported to SPSS and Excel for analysis. To assess the effectiveness of the intervention, the time to analgesia was compared between the intervention and control groups using an independent samples <em>t</em>-test. This statistical test allowed for a comparison of the mean time to analgesia between the two groups.</p><p>Patient satisfaction scores were also compared between the intervention and control groups using the Mann-Whitney U test. Kaplan-Meier curves were employed to compare the time to analgesia between the intervention and control groups within both settings. A point bi-serial correlation analysis was performed to examine the association between the length of stay and the intervention of nurse-led analgesia in both hospital settings.</p></div><div><h3>Result and discussion</h3><p>The study enrolled 179 participants, with a median age of 34 years (range: 9–80) and 67% female. The most common events leading to pain were medical conditions (21%), followed by trauma/quarrel/war, fall accidents, and underlying diseases (15%, 13%, and 13%, respectively). There was a significant correlation between the degree of pain on arrival and time to analgesia. Additionally, a significant correlation (<em>p</em> < 0.01) was found between time to analgesia and patient satisfaction.</p></div><div><h3>Conclusion and recommendation</h3><p>Implementing a nurse-led analgesia protocol in the emergency department is crucial for reducing time to analgesia and improving patient satisfaction. It is recommended to scale up this approach to other healthcare facilities by incorporating it into the nursing practice guidelines of the country.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000235/pdfft?md5=3dd5d5c34af986a469d0e6de23258cfa&pid=1-s2.0-S2211419X24000235-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141484599","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}
Focused cardiac ultrasound (FoCUS) has emerged as a valuable tool in emergency and critical care medicine, allowing for rapid assessment of cardiac function and structure at the bedside. This rapid diagnostic technique holds particular promise in resource-limited settings like Ethiopia, where access to standard echocardiography may be limited and delayed. However, the accuracy of FoCUS interpretation is highly dependent on the operator's skills and expertise. To inform the design of effective interventions, the study aimed to assess the accuracy of FoCUS interpretation and associated factors among senior Emergency Medicine residents at two large referral teaching hospitals in Ethiopia.
Methods
A cross-sectional study was conducted from October to December 2023 among 80 residents at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College. To assess diagnostic accuracy, 15 pre-selected cardiac ultrasound videos (normal and pathological cases) were selected from American College of Emergency Physicians website and the PoCUS Atlas, and accurate interpretation was defined as correctly answering at least 12 out of 15 readings. A binary logistic regression model was fitted to identify significant factors at the 5% level of significance, where significant results were interpreted using adjusted odds ratio (AOR) with 95% confidence interval (CI).
Result
The overall accuracy in interpreting FoCUS findings was 47.5% (95% CI: 38.8–60.0%), with highest for collapsing Inferior Vena Cava (91.3%) and standstill (90.0%), and lowest for Regional Wall Motion Abnormality of Left Ventricle (46.3%). Residents who received training (AOR=4.14, 95%CI:1.32–13.04, p = 0.015), perceived themselves as skilled (AOR=4.81, 95%CI=1.06–21.82, p = 0.042), and felt confident in acquiring and interpretation (AOR=3.16, 95%CI=1.01–9.82, p = 0.047) demonstrated significantly higher accuracy.
Conclusion
The study identified a low overall accuracy in FoCUS interpretation, with accuracy improving with training and better perceived skill and confidence. Training programs with simulation, continuous education, and mentorship are crucial to enhance these critical skills.
{"title":"Accuracy of focused cardiac ultrasound interpretation among emergency and critical care medicine residents in Ethiopia: A multi-center cross-sectional study","authors":"Nahom Mesfin Mekonen , Temesgen Beyene Abicho , Kalsidagn Girma Asfaw , Tigist Workneh Leulseged , Nebiat Adane Mera , Yegeta Wondafrash Habte , Fekadesilassie Henok Moges , Yidnekachew Asrat Birhan , Meron Tesfaye , Birhanu Tesfaye","doi":"10.1016/j.afjem.2024.06.002","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.06.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Focused cardiac ultrasound (FoCUS) has emerged as a valuable tool in emergency and critical care medicine, allowing for rapid assessment of cardiac function and structure at the bedside. This rapid diagnostic technique holds particular promise in resource-limited settings like Ethiopia, where access to standard echocardiography may be limited and delayed. However, the accuracy of FoCUS interpretation is highly dependent on the operator's skills and expertise. To inform the design of effective interventions, the study aimed to assess the accuracy of FoCUS interpretation and associated factors among senior Emergency Medicine residents at two large referral teaching hospitals in Ethiopia.</p></div><div><h3>Methods</h3><p>A cross-sectional study was conducted from October to December 2023 among 80 residents at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College. To assess diagnostic accuracy, 15 pre-selected cardiac ultrasound videos (normal and pathological cases) were selected from American College of Emergency Physicians website and the PoCUS Atlas, and accurate interpretation was defined as correctly answering at least 12 out of 15 readings. A binary logistic regression model was fitted to identify significant factors at the 5% level of significance, where significant results were interpreted using adjusted odds ratio (AOR) with 95% confidence interval (CI).</p></div><div><h3>Result</h3><p>The overall accuracy in interpreting FoCUS findings was 47.5% (95% CI: 38.8–60.0%), with highest for collapsing Inferior Vena Cava (91.3%) and standstill (90.0%), and lowest for Regional Wall Motion Abnormality of Left Ventricle (46.3%). Residents who received training (AOR=4.14, 95%CI:1.32–13.04, <em>p</em> = 0.015), perceived themselves as skilled (AOR=4.81, 95%CI=1.06–21.82, <em>p</em> = 0.042), and felt confident in acquiring and interpretation (AOR=3.16, 95%CI=1.01–9.82, <em>p</em> = 0.047) demonstrated significantly higher accuracy.</p></div><div><h3>Conclusion</h3><p>The study identified a low overall accuracy in FoCUS interpretation, with accuracy improving with training and better perceived skill and confidence. Training programs with simulation, continuous education, and mentorship are crucial to enhance these critical skills.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X2400020X/pdfft?md5=c042bcae5b455ddfd93a6d11e42c4b3a&pid=1-s2.0-S2211419X2400020X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141429418","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}
Pub Date : 2024-06-19DOI: 10.1016/j.afjem.2024.06.001
Jandre Henning , Lucy Hindle
Introduction
Accurate management of endotracheal tube cuff pressure is essential to prevent patient morbidity and mortality. Due to increased length of stay of critically ill patients in emergency departments, it has become an increasingly important skill among Emergency Department nurses.
Methods
This prospective longitudinal interventional study was performed among registered nurses at the emergency departments in a Johannesburg Academic Hospital. The study aimed to determine their current knowledge and practical skills on endotracheal tube cuff manometry and assess the effectiveness of a training program. The training program was provided once, in the form of a narrated PowerPoint presentation developed by the researchers and involved theoretical and practical components. The participants' theoretical knowledge and practical skills were measured by using questionnaires and skill assessments. The theoretical and practical scores were compared pre- and post-training.
Results
Of the 63 registered nurses employed in the emergency departments, 95 % (60) participated in this study. 86 % reported having never received any formal training on endotracheal tube cuff manometry. Only 38.9 % used cuff manometry as standard practice and only 12.8 % checked it at appropriate 12-hourly intervals. The pre-training median score on theory was 4.5 (IQR=3.0) and improved to 7.0 (IQR=3.0) post-training. The maximum achievable score was 11 with a pre-training average of 41.8 % and post-training of 64.5 % (p = 0.001).
The practical pre-training median score was 1.0 (IQR=8.0) and improved to 12.0 (IQR=2.0) post-training. The maximum achievable score was 12 with a pre-training average of 29.1 % and a post-training average of 93.3 % (p = 0.001).
Conclusion
This study showed inadequate knowledge and skills on endotracheal cuff pressure manometry among registered nurses in the emergency department. It also correlates with other evidence that supports the need for ongoing training programs. Our training program led to significant improvement among participants in both knowledge and practical skills. This training program was well received by participants and deemed to be practice changing. The recommendation after this study will be for South African emergency units to consider using this study and training material as a guide for annual in-service training.
{"title":"The knowledge and skills of emergency department registered nursing staff at an academic hospital in South Africa, on endotracheal tube cuff manometry, before and after a training session","authors":"Jandre Henning , Lucy Hindle","doi":"10.1016/j.afjem.2024.06.001","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.06.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Accurate management of endotracheal tube cuff pressure is essential to prevent patient morbidity and mortality. Due to increased length of stay of critically ill patients in emergency departments, it has become an increasingly important skill among Emergency Department nurses.</p></div><div><h3>Methods</h3><p>This prospective longitudinal interventional study was performed among registered nurses at the emergency departments in a Johannesburg Academic Hospital. The study aimed to determine their current knowledge and practical skills on endotracheal tube cuff manometry and assess the effectiveness of a training program. The training program was provided once, in the form of a narrated PowerPoint presentation developed by the researchers and involved theoretical and practical components. The participants' theoretical knowledge and practical skills were measured by using questionnaires and skill assessments. The theoretical and practical scores were compared pre- and post-training.</p></div><div><h3>Results</h3><p>Of the 63 registered nurses employed in the emergency departments, 95 % (60) participated in this study. 86 % reported having never received any formal training on endotracheal tube cuff manometry. Only 38.9 % used cuff manometry as standard practice and only 12.8 % checked it at appropriate 12-hourly intervals. The pre-training median score on theory was 4.5 (IQR=3.0) and improved to 7.0 (IQR=3.0) post-training. The maximum achievable score was 11 with a pre-training average of 41.8 % and post-training of 64.5 % (<em>p</em> = 0.001).</p><p>The practical pre-training median score was 1.0 (IQR=8.0) and improved to 12.0 (IQR=2.0) post-training. The maximum achievable score was 12 with a pre-training average of 29.1 % and a post-training average of 93.3 % (<em>p</em> = 0.001).</p></div><div><h3>Conclusion</h3><p>This study showed inadequate knowledge and skills on endotracheal cuff pressure manometry among registered nurses in the emergency department. It also correlates with other evidence that supports the need for ongoing training programs. Our training program led to significant improvement among participants in both knowledge and practical skills. This training program was well received by participants and deemed to be practice changing. The recommendation after this study will be for South African emergency units to consider using this study and training material as a guide for annual in-service training.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000193/pdfft?md5=3a32fe81fb2f6b5dbdc9301981fa5325&pid=1-s2.0-S2211419X24000193-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141429419","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}