African Journal of Emergency Medicine最新文献

Introduction

Methods

Results

Conclusion

Background

Purpose

Methods

Results

Conclusions

Background

Methods

Findings

Conclusion

Introduction

Methods

Results

Conclusion

Introduction

Suicidal behaviour is a public health emergency, causing an estimated one million deaths globally each year. The impact of the COVID-19 pandemic on suicidal behaviour is not fully understood. This study aimed to describe the impact of the COVID-19 pandemic on presentations with suicidal behaviour at a tertiary hospital in the Eastern Cape, South Africa.

Method

This study was a retrospective cross-sectional analysis of patients with fatal and nonfatal suicidal behaviour who presented to Frere Hospital Emergency Centre in the Eastern Cape, South Africa. The analysis included three study periods: August to October 2019 (pre-COVID-19), August to October 2020 (wave 1), and August to October 2021(wave 3).

Results

A total of 16 419 patients presented to the Frere Hospital Emergency Centre during the study period, with 6 204 in 2019, 4 909 in 2020, and 5 306 in 2021. These correspond to the research periods from August to October for each successive year. The overall prevalence of suicidal behaviour was 1.6 % but decreased marginally during the pandemic (1.8 % in 2019 vs. 1.4 % in 2021) – contrary to what occurred in high-income countries. The prevalence demonstrated a clinically insignificant stepwise decline as the pandemic progressed and was inversely associated with the number of daily new COVID-19 cases nationally. A significant increase in the emergency centre's total length of stay was however observed during the COVID-19 period (143 vs. 80 min, p < 0.001). The high proportion (66 %) of patients with suicidal behaviour requiring admissions increased further during the COVID-19 study period, placing an additional burden on inpatient disciplines. The proportion of social worker consultations increased significantly during the COVID-19 period (65% vs. 44 %, p<.05).

Conclusion

The COVID-19 pandemic marginally reduced the prevalence of presentations with suicidal behaviour to the Emergency Centre, contrary to what was observed in high-income countries.

Introduction

Vocational learning has been critical in shaping South Africa's workforce, especially for paramedicine. The introduction of the National Qualification Framework (NQF) in 1995 phased out previous short course learning systems and redesigned qualifications within the framework. While recognition of prior learning is well advocated in the NQF, the predominant focus is undergraduate studies. The leap from vocational to Higher Education can be significant, especially for non-seasoned learners, and additional support may be required to ensure a successful transition. This study describes the support needs of vocational paramedics transitioning to post-graduate education.

Methods

The study used a two-phase sequential design to achieve the aims. The first phase was conducted in 2021 and involved an analysis of grades followed by semi-structured interviews to obtain qualitative insights. The second phase, conducted in 2022, focused exclusively on collecting quantitative data to validate and expand upon the initial findings from phase one.

Results

Analysis of the academic results over two years between Recognition of Prior Learning (RPL) and non-RPL candidates showed a difference of 4 % in the aggregated mark. This indicates that the RPL candidates have the academic acumen to succeed in a post-graduate diploma education program. Interview analysis revealed the support requirements were not academic but rather technological and institutional, with navigation of the university's learning management system being a common challenge. Hesitancy to access formal support services was noted as a university barrier.

Conclusion

This study highlights the academic ability of students from vocational backgrounds to succeed in post-graduate programs. These learners demonstrated strong academic performance despite entering higher education through a non-traditional pathway. Whilst advocating for consideration and refinement of the role of RPL within the NQF, this research suggests a re-evaluation of current support systems for vocational learners transitioning to post-graduate studies.

Background

Little is known regarding the effectiveness of pain protocols and guideline use in Emergency Departments (ED) in Sub-Saharan Africa. Therefore, to shed light on this research gap, this study had the following objectives: 1) to evaluate if the implementation of the Essential Pain Management (EPM) course combined with mentorship to use the World Health Organization (WHO) pain ladder-based protocol improves the quality of pain management among trauma patients at the ED of two teaching hospitals in Rwanda; and 2) to determine barriers to implementing the WHO pain ladder-based protocol among trauma patients in the same settings.

Methods

This was a pre- and post-intervention study. The intervention was 1-day essential pain management training for ED clinical staff followed by 1 week mentorship on the use of the WHO pain ladder-based protocol.

Results

We enrolled 261 patients (47.5% pre versus 52.5% post intervention), most of them were aged between 21 and 40 (60% pre versus 33% post intervention), and male (76% pre versus 73% post intervention). The quality of pain management at the ED improved as shown by the decrease of the number of patients with undocumented pain scores from 58% to 24% after the intervention (p-value > 0.001) and the increase of the number of patients with mild pain from 37% to 62% (p-value > 0.001). In addition, patients who were satisfied with the quality of pain management increased significantly from 42% before the intervention to 80% (p-value > 0.001). Barriers to the implementation of the WHO pain ladder-based protocol were identified related to staff (i.e. inadequate experience), to the hospital (i.e. poor documentation), and to patients (i.e. reluctance to report pain).

Conclusion

The implementation of the EPM course along with mentorship to use the WHO pain ladder-based protocol significantly improved the quality of pain management for trauma patients in EDs of both referral hospitals. Despite this, some barriers remain unfixed such as inadequate staff experience, poor documentation, and patient's reluctance to report pain. Appropriate interventions should be implemented to address the identified barriers and ensure adequate pain management for patients admitted at EDs in public hospitals in Rwanda.

Introduction

In Dar es Salaam, Tanzania, death from road traffic crashes (RTC) occurs at roughly double the global rate. In this study, we sought to understand the locations and types of vehicles involved in RTC in Dar es Salaam encountered by a cohort of motorcycle taxi drivers previously trained in first aid.

Methods

This was a quasi-non-randomized interventional study, cohort subtype, with three-month follow-up. Some 186 motorcycle taxi drivers were selected by convenience sampling from 16 heavily populated, central wards and trained in a basic hemorrhage control course. Participants reported the location and types of vehicles involved in RTCs they encountered and intervened upon through performing bleeding control interventions. Surveys were designed on KoboToolbox and administered via phone call at monthly intervals over a three-month period. The main outcome measures were the location of crash encounters and types of vehicles involved.

Results

In all 62 unique participants (33.3 %) encountered and provided bleeding control interventions to 83 injured individuals following 69 RTC in at least 31 distinct city wards, despite training only having occurred in 16 wards. Eight crash locations were not recorded. Crashes in distant wards typically contained major roads. Most commonly, crashes involved a motorcycle without the involvement of another vehicle (n=20), followed by motorcycle vs. car/three-wheeled vehicle (n=15), motorcycle vs. bus/van (n=10), motorcycle vs. motorcycle (n=9), motorcycle vs. pedestrian (n=7), pedestrian vs. bus/van (n=2), pedestrian vs. car/three-wheeled vehicle (n=1), motorcycle vs. bicycle (n=1), multi vehicle (n=1), and other (n=3).

Conclusions

Motorcycle taxi drivers trained in hemorrhage control frequently encounter and intervene upon RTC in wards where they are based as well as in distant locations, commonly in wards containing major roads. Expanding first aid training for motorcycle taxi drivers could improve timely access to emergency care for RTC victims. Since most crashes involved motorcycles, road safety training should be integrated into future courses.