African Journal of Emergency Medicine最新文献

Introduction

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.

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.

Objective

To make a cross-cultural adaptation of the National Early Warning Score 2 (NEWS 2) from English to Angolan Portuguese.

Methods

A methodological research of cross-cultural adaptation was conducted, involving sequential stages of forward translation, translation synthesis, back-translation, and the application of the Delphi Panel methodology for analyzing semantic, idiomatic, experiential, and conceptual equivalence between the translated and the original versions. This process culminated in the development of a pre-final version, which subsequently underwent testing in a cohort of nurses (n = 37). The Intraclass Correlation Coefficient was calculated to assess inter-rater reliability of ratings. Cronbach's alpha was used for evaluating the internal consistency and reliability within the items of the NEWS 2 score.

Results

The cross-cultural adaptation process allowed us to prepare the final version of this tool. The data collected during the testing phase facilitated the examination of inter-rater reliability of ratings and the internal consistency and reliability within the items of the NEWS2 score. The Intraclass Correlation Coefficient observed at this step was 0.992. The Cronbach's alpha was 0.993.

Conclusion

The cross-cultural adaptation of the NEWS 2 scoring system to Angolan Portuguese was successful, providing healthcare professionals in Angola with the means to effectively use the tool.

Introduction

Despite stroke being a leading cause of death and disability in sub-Saharan Africa, stroke awareness remains a major hurdle to early stroke response and care in the region. To improve stroke awareness, we endeavoured to borrow a leaf from initiatives in high-income countries, beginning with the translation and dissemination of the acronym, FAST (Face, Arms, Speech, Time) to Swahili.

Methods

We formed a translation group consisting of two stroke physicians, one nurse and two professional translators, all native Swahili speakers. Forward translation of the original document from English to Swahili was done by one Swahili translator; followed by a backward translation by another translator. Clinician reviews and cognitive reviews were then done, and a final translation was developed.

Results

We developed the acronym UPESI, a Swahili translation of the word, FAST. The acronym stands for Uso kupooza upande mmoja; Pooza mkono/mguu (au kupoteza hisia); ugumu ku-Eleza/kuongea; SImu upesi translating to face drooping, arm/leg paralysis, difficulty in speaking/explaining and fast to the phone.

Conclusion

The result of this process is a Swahili translation of the FAST tool for stroke awareness campaigns. The translation will improve communication during stroke campaigns and increase awareness of stroke.

Introduction

Emergency departments are the primary entry point for emergencies in the public healthcare system. Resource constraints burden a large proportion of the public hospital emergency departments, which includes limited access to radiological services. Emergency point-of-care ultrasound provides a tool capable of bridging this gap. The Eastern Cape is yet to describe the utilisation of emergency point-of-care ultrasound in any of its emergency departments.

Methods

Frere Hospital initiated a clinical audit to assess the utilisation of emergency point-of-care ultrasound in its emergency department in 2022. This study was a retrospective review of the audit between 01 November 2022 until 28 February 2023. Data from the handwritten register regarding patient's presenting complaints and provisional diagnoses was also captured during the study period to draw comparisons between burden of disease and use of emergency point-of-care ultrasound.

Results

A total of 9501 patients attended Frere Hospital's emergency department over the study period with 492 emergency point-of-care ultrasounds performed (overall utilisation rate 5.2 %). The five credentialed emergency point-of-care ultrasound providers performed the majority (n = 360, 73.2 %) of the applications, compared to 132 (26.8 %) performed by the seven non-credentialed providers. The extended focused abdominal sonography in trauma (eFAST) was the most frequently performed application (n = 140, 28.5 %).

Conclusion

Emergency point-of-care ultrasound is underutilised in Frere Hospital's emergency department. The varied casemix requires upskilling of clinicians in emergency point-of-care ultrasound to suit the burden of disease experienced in the department. Ongoing emergency point-of-care ultrasound training, credentialing and research is important to ensure appropriate and quality emergency point-of-care ultrasound utilisation.

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.

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.

Introduction

Frequent reassessment of injured patients is an important component of trauma and emergency care. How frequently such reassessment is done in African hospitals has been minimally addressed. We sought to address this gap, as well as to assess the effectiveness of a standardized trauma intake form (TIF) to improve assessment and reassessment rates.

Methods

We undertook a stepped-wedge cluster randomized trial with research assistants observing trauma care before and after introducing the TIF at emergency units of eight non-tertiary Ghanaian hospitals for 17.5 months. Differences in seven key performance indicators (KPIs) of assessment and reassessment were evaluated using generalized linear mixed regression. KPIs included: respiratory rate, heart rate, blood pressure, level of consciousness, mobility, temperature, and oxygen saturation.

Results

Management of 4077 patients was observed: 2067 before TIF initiation and 2010 after. In the before period, completion of KPIs of initial assessment ranged from 55% (oxygen saturation) to 88% (level of consciousness). KPIs for reassessment for patients still in the EU after 30 min (n = 1945, in before period) were much lower than for initial assessment, ranging from 10% (respiratory rate and oxygen saturation) to 13% (level of consciousness). The TIF did not significantly improve performance of any KPI of assessment or reassessment. Similar patterns pertained for the subgroup of seriously injured patients (Injury Severity Score ≥9).

Conclusion

At non-tertiary hospitals in Ghana, performance of KPIs of initial assessment were mostly adequate, but with room for improvement. Performance of KPIs for reassessment were very low, even for seriously injured patients. The intervention (trauma intake form) did not impact reassessment rates, despite previously having been shown to impact many other KPIs of trauma care. Potential avenues to pursue to improve reassessment rates include other quality improvement efforts and increased emphasis on reassessment in training courses.

Background

The experiences of trauma patients referred from Ghanaian non-tertiary hospitals for definitive care at higher levels is not well-known. Understanding the motivations of injured patients who do not attend their referral for definitive management may inform interventions to improve injury outcomes.

Methods

This study is a follow-up survey of participants of a larger study involving initial management of injured patients presenting to 8 non-tertiary hospitals in Ghana from October 2020 to March 2022. Injured patients referred to higher levels of care were surveyed by phone using a structured questionnaire and patients who could not be reached were excluded. The main outcome was referral non-attendance and differences between patients who attended the referral and those who did not were determined with chi squared tests. Variables with intergroup differences were included in a multivariable logistic regression. Open-ended survey responses were analyzed using thematic content analysis.

Results

Of 335 referred patients surveyed, 17 % did not attend the referral. Factors associated with referral non-attendance included being male (Adjusted odds ratio (AOR)=2.70, p = 0.013), sustaining a fracture (AOR=2.83, p = 0.003), and having less severe injury (AOR 2.84, p = 0.017). Primary drivers of referral non-attendance included financial problems (59 %), family influence (45 %), and lack of transportation (20 %). The majority of patients (77 %) not attending the referral sought treatment from traditional healers, citing lower cost, faster service, and a perception of equivalent outcomes. Reported facilitators of referral attendance included positive hospital staff experiences and treatment while barriers included higher hospital costs, lack of bed space, and poor interhospital communication.

Conclusions

An important proportion of injured patients in Ghana do not attend referrals for definitive management, with many seeking care from traditional healers. Our study identified possible targets for interventions aimed at maintaining the continuum of hospital-based care for injured patients in order to improve outcomes.

Introduction

The phenomenon that has been described as Financial Medicine has been occurring within the South African Healthcare sector for at least the last decade. Despite the ongoing effect of this phenomenon, there is no organised body of knowledge or formulated working definitions to guide knowledge sharing and theorisation within this research focus area. The practice of Financial Medicine exerts a deleterious effect on the South African prehospital healthcare system, and represents an area in dire need of focused research efforts. Establishing appropriate working definitions and associated taxonomy is an important first step in supporting further research efforts into this aspect of South African prehospital healthcare systems.

Methods

A qualitative research methodology following a constructivist grounded theory design was used. Participants voluntarily consented to be enrolled into one-on-one in-depth interviews, and were selected using purposive and theoretical sampling techniques. Data was subjected to validated coding procedures and analysed using the constant comparative analysis approach, analytical diagramming, and supported by researcher theoretical sensitivity.

Results

A working definition for Financial Medicine is provided. Six new terms are introduced, with associated working definitions, namely Financial Medicine Practices, Treatment-based profiteering, Cost-of-care-aversion, Personal-gain-at-patient-expense, Money-racketeering-in-healthcare, and Impoverishing-healthcare-earning.

Conclusion

The working definitions and suggested taxonomy presented in this article are the first step in formally conceptualising and theorising the phenomenon of Financial Medicine, in order to support further research and collaboration in this space.