African Journal of Emergency Medicine最新文献_第3页

Global Health research abstracts: November ‘25 全球健康研究摘要：25年11月

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-20 DOI: 10.1016/j.afjem.2025.100921

引用次数: 0

Acute paediatric pain management: A survey of doctors’ knowledge, attitudes and reported practices at regional hospitals in KwaZulu-Natal, South Africa 急性儿科疼痛管理：对南非夸祖鲁-纳塔尔省区域医院医生的知识、态度和报告做法的调查

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-09-04 DOI: 10.1016/j.afjem.2025.100897

Shannon Pillay, Bavani Naicker, Kamlin Ekambaram

Background

Despite advances in both pharmacological and non-pharmacological pain management, children remain vulnerable to oligoanalgesia. Understanding clinical practices and barriers encountered by treating clinicians is essential to inform targeted interventions. This study aimed to examine knowledge, attitudes and reported practices of doctors managing acute paediatric pain in rural regional hospitals in KwaZulu-Natal, South Africa.

Methods

An electronic survey was distributed between January and February 2024 to doctors working in the departments of Emergency Medicine, Paediatrics, Surgery, and Orthopaedics at three regional hospitals. The survey included both closed- and open-ended questions addressing analgesic choices, awareness of clinical protocols, and perceived barriers to effective pain management. Descriptive statistics were used to summarise overall trends. Post hoc subgroup analyses were conducted using Chi-square and Fisher’s exact tests. Odds ratios were calculated to describe significant associations.

Results

Of 165 clinicians approached, 131 responded (response rate: 80%). Over half (55.7%) reported inadequate training for paediatric pain management, and only 42% were aware of departmental protocols. Paracetamol was the most commonly used analgesic agent. Key barriers included time constraints, limited drug access, and departmental culture. Awareness of departmental paediatric pain protocols was highest (82,9%) in Paediatrics (χ², p<0.001). Paediatric doctors reported significantly greater use of non-pharmacological methods across multiple conditions and procedures. Emergency Medicine respondents more frequently reported opioids for severe abdominal pain (OR=4.24, p<0.001, 95% CI 1.96-9.14). Barriers varied by discipline. Paediatrics cited difficulties with pain assessment, while Orthopaedics primarily reported time and staffing constraints.

Conclusion

Paediatric pain remains common yet inadequately addressed in Southern Africa. This study identifies insufficient training, poor access to analgesia, and departmental practices as key barriers. Context-specific, cost-effective, multimodal strategies and tailored education are needed to improve care. Sustainable progress requires cultural change, better training, and interdisciplinary collaboration to ensure equitable pain management.

尽管在药物和非药物疼痛管理方面都取得了进展，但儿童仍然容易受到少效镇痛的影响。了解临床实践和治疗临床医生遇到的障碍对于告知有针对性的干预措施至关重要。本研究旨在检查知识，态度和报告的医生在夸祖鲁-纳塔尔省农村地区医院管理急性儿科疼痛的做法，南非。方法于2024年1 - 2月对3家地区医院急诊科、儿科、外科和骨科的医生进行电子调查。该调查包括封闭和开放式问题，涉及止痛药的选择，临床协议的认识，以及有效疼痛管理的感知障碍。描述性统计用于总结总体趋势。事后亚组分析采用卡方检验和Fisher精确检验。计算比值比来描述显著相关性。结果165名临床医生中，131名有反应（有效率：80%）。超过一半（55.7%）的人报告儿科疼痛管理培训不足，只有42%的人知道部门协议。对乙酰氨基酚是最常用的镇痛药。主要障碍包括时间限制、药物获取受限和部门文化。儿科对科室儿科疼痛方案的知晓率最高（82.9%）（χ²，p<0.001）。儿科医生报告说，在多种情况和程序中，非药物方法的使用明显增加。急诊医学受访者更频繁地报告阿片类药物治疗严重腹痛（OR=4.24, p<0.001, 95% CI 1.96-9.14）。障碍因学科而异。儿科提到疼痛评估的困难，而骨科主要报告时间和人员限制。结论：在南部非洲，儿童疼痛仍然很常见，但尚未得到充分解决。本研究确定培训不足、难以获得镇痛药和部门实践是主要障碍。需要针对具体情况、具有成本效益的多模式战略和量身定制的教育来改善护理。可持续发展需要文化变革、更好的培训和跨学科合作，以确保公平的疼痛管理。

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引用次数: 0

Assessing the relationship between armed conflict and infectious disease incidence in Six Sub-Saharan Countries: Implications for Emergency Departments in conflict areas 评估撒哈拉以南六个国家武装冲突与传染病发病率之间的关系：对冲突地区急诊科的影响

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-09-26 DOI: 10.1016/j.afjem.2025.100911

Andrew Holzman , Daniel Olinga , Jacob Busingye , Douglas Rappaport

Introduction

This study aimed to update and expand on prior ecological analyses by examining within-country and cross-national correlations between conflict deaths and infectious disease incidence in six neighboring sub-Saharan African countries.

Methods

We analyzed six countries including Uganda, Rwanda, the Democratic Republic of the Congo, Central African Republic, South Sudan, and Burundi using conflict death data from the Uppsala Conflict Data Program and disease incidence data from the World Health Organization databases. Data were analyzed for the maximum period covered in the UCDP for each country, in general from 1990 to the present. Seven diseases were examined: malaria, tuberculosis, human immunodeficiency virus, tetanus, pertussis, measles, and yellow fever. We assembled matrices of regressions between conflict deaths and disease incidence within and across countries. The approach of this study was hypothesis-generating, with the intent to flag associations worthy of further consideration.

Results

Within-country analyses identified strong positive associations in Burundi (e.g., tuberculosis: R² = 0.81, p<0.001; tetanus: R² = 0.59, p<0.001) and Uganda (e.g., tuberculosis: R² = 0.56, p<0.001; malaria: R² = 0.42, p<0.001). Weaker but statistically significant correlations were also observed with measles in Uganda (R² = 0.13, p = 0.04) and Burundi (R² = 0.29, p = 0.001). Cross-nationally, we observed strong correlations between conflict deaths in Burundi and tuberculosis incidence in Uganda (R² = 0.86, p<0.001) and conflict deaths in South Sudan and malaria in the Democratic Republic of the Congo (R² = 0.64, p<0.001).

Conclusion

We confirm prior reports of malaria incidence association with armed conflict while introducing potential new associations involving tetanus and measles. Our hypothesis-generating approach supports further research. Emergency physicians and health systems in conflict-affected and adjacent regions should anticipate shifts in disease burden and consider preparedness strategies.

本研究旨在通过检查六个邻近的撒哈拉以南非洲国家冲突死亡与传染病发病率之间的国内和跨国相关性，更新和扩展先前的生态分析。方法采用乌普萨拉冲突数据计划中的冲突死亡数据和世界卫生组织数据库中的疾病发病率数据，对乌干达、卢旺达、刚果民主共和国、中非共和国、南苏丹和布隆迪等6个国家进行了分析。对每个国家统一发展方案所涵盖的最长时期的数据进行了分析，总的来说是从1990年到现在。检查了七种疾病：疟疾、肺结核、人类免疫缺陷病毒、破伤风、百日咳、麻疹和黄热病。我们收集了国家内部和国家间冲突死亡与疾病发病率之间的回归矩阵。本研究的方法是假设生成，目的是标记值得进一步考虑的关联。结果国内分析确定了布隆迪（例如，结核病：R²= 0.81,p<0.001；破伤风：R²= 0.59,p<0.001）和乌干达（例如，结核病：R²= 0.56,p<0.001；疟疾：R²= 0.42,p<0.001）的强正相关。乌干达（R²= 0.13,p = 0.04）和布隆迪（R²= 0.29,p = 0.001）与麻疹的相关性也较弱，但有统计学意义。在跨国研究中，我们观察到布隆迪的冲突死亡人数与乌干达的结核病发病率（R²= 0.86,p<0.001）以及南苏丹的冲突死亡人数与刚果民主共和国的疟疾发病率（R²= 0.64,p<0.001）之间存在很强的相关性。结论：我们证实了先前关于疟疾发病率与武装冲突相关的报道，同时引入了破伤风和麻疹的潜在新关联。我们的假设生成方法支持进一步的研究。受冲突影响地区和邻近地区的急诊医生和卫生系统应预测疾病负担的变化，并考虑防范战略。

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引用次数: 0

Global Health research abstracts: July ‘25 全球健康研究摘要：25年7月

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-20 DOI: 10.1016/j.afjem.2025.100924

引用次数: 0

Incidence of mortality and predictors among patients with shock managed in the emergency room of a tertiary hospital in Ethiopia 埃塞俄比亚一家三级医院急诊室中休克患者的死亡率和预测因素

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-15 DOI: 10.1016/j.afjem.2025.100917

Kalsidagn Girma Asfaw , Abel Getachew Adugna , Nahom Mesfin Mekonen , Merahi Kefyalew Merahi , Segni Kejela , Fekadesilassie Henok Moges , Tigist Workneh Leulseged

Introduction

Shock is a common emergency condition which can lead to organ failure and death if not diagnosed and managed timely. Despite its huge global impact, data is scarce in resource-limited settings, including Ethiopia, which hinders the provision of quality care for improved outcomes. Hence, this study aimed to determine the incidence of death and predictors among adult patients with shock managed at the Emergency Department of St. Paul’s Hospital Millennium Medical College in Ethiopia.

Methods

A retrospective chart review study was conducted among eligible patients managed at the hospital between October 1, 2021 and May 20, 2022. Mortality was estimated with incidence density using person day (PD) of observation. To identify predictors of mortality, a generalized linear model using poisson regression model with robust standard errors fitted, where adjusted relative risk (ARR) with 95 % CI was used to interpret results.

Result

During the study period, a total of 196 patients were identified for assessment, of which 18 with incomplete records were excluded, resulting in 178 eligible patients for inclusion. The majority of participants were 40 or older (69.7 %) and female (51.1 %), presenting with symptoms lasting less than one week (68.5 %) and had at least one comorbid illness (70.8 %). The incidence of death was 16.5 deaths per 100 PD (95 % CI = 13.1 to 20.9). While triage to orange was associated with a decreased risk of death, high shock index, septic shock diagnosis, vasopressor use, and organ failure were associated with increased risk of death.

Conclusion

The incidence of mortality among shock patients was found to be considerable. To optimize patient care and improve outcomes, it is important to remain vigilant in the proper triage and early diagnosis of shock using more sensitive tools for prompt identification of high-risk cases, as well as to provide timely, prioritized and effective interventions.

休克是一种常见的紧急情况，如果不及时诊断和处理，可能导致器官衰竭和死亡。尽管它在全球产生了巨大影响，但在包括埃塞俄比亚在内的资源有限的环境中，数据很少，这阻碍了为改善结果提供高质量的护理。因此，本研究旨在确定埃塞俄比亚圣保罗医院千年医学院急诊科管理的成年休克患者的死亡率和预测因素。方法对该医院于2021年10月1日至2022年5月20日收治的符合条件的患者进行回顾性图表回顾研究。死亡率用观察的人日（PD）随发病率密度估计。为了确定死亡率的预测因子，采用具有稳健标准误差的泊松回归模型拟合了一个广义线性模型，其中使用95% CI的校正相对危险度（ARR）来解释结果。结果研究期间共纳入196例患者，排除记录不完整的18例，纳入178例患者。大多数参与者年龄在40岁或以上（69.7%），女性（51.1%），症状持续时间少于一周（68.5%），至少有一种合并症（70.8%）。死亡发生率为16.5 / 100 PD （95% CI = 13.1 ~ 20.9）。虽然橙色分类与死亡风险降低有关，但高休克指数、脓毒性休克诊断、血管加压药的使用和器官衰竭与死亡风险增加有关。结论休克患者的死亡率相当高。为了优化患者护理和改善预后，重要的是要保持警惕，使用更敏感的工具对休克进行适当的分类和早期诊断，以及时识别高风险病例，并提供及时、优先和有效的干预措施。

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引用次数: 0

Artificial intelligence in clinical toxicology in Africa: Emerging applications and barriers 人工智能在非洲临床毒理学：新兴应用和障碍

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-09-02 DOI: 10.1016/j.afjem.2025.100901

Mikiyas G. Teferi, Biruk T. Mengistie, Helina K. Teklehaimanot, Chernet T. Mengistie, Fitsum A. Gemechu, Michael A. Negussie, Tilahun J. Jufara, Getaw W. Hassen

Artificial intelligence (AI) has a supplementary role in clinical toxicology in Africa, addressing key challenges such as delayed diagnoses, limited expertise, and inadequate healthcare infrastructure. This method has the potential to increase diagnostic accuracy, optimize treatment strategies, and advance research on toxic substance exposure and poisoning cases. AI-driven tools, including machine learning algorithms and decision-support systems, enhance the early detection and risk assessment of toxicities. AI-powered predictive models facilitate precision medicine by designing treatment plans for individual patient profiles. Integrating this in telemedicine expands access to toxicology expertise, particularly in resource-limited settings. Additionally, AI accelerates research by analyzing large datasets, identifying trends, and predicting toxicological risks, thus contributing to public health interventions. Despite these advancements, challenges such as data poverty, ethical issues, and restrictive policies hinder its full potential in African healthcare. These gaps can be bridged through policy reforms, capacity-building initiatives, and robust AI frameworks, which will be crucial in maximizing AI benefits for clinical toxicology. This narrative review highlights the emerging applications of AI in Africa, emphasizing the need for collaborative efforts to ensure equitable and effective implementation. However, its adoption is limited by financial constraints, scarce datasets, weak infrastructure, and ethical concerns.

人工智能（AI）在非洲的临床毒理学中发挥着补充作用，解决了诊断延误、专业知识有限和卫生保健基础设施不足等关键挑战。这种方法有可能提高诊断准确性，优化治疗策略，并推进有毒物质暴露和中毒病例的研究。人工智能驱动的工具，包括机器学习算法和决策支持系统，加强了毒性的早期发现和风险评估。人工智能预测模型通过为个体患者设计治疗方案来促进精准医疗。将其与远程医疗相结合，扩大了获取毒理学专业知识的机会，特别是在资源有限的情况下。此外，人工智能通过分析大型数据集、确定趋势和预测毒理学风险来加速研究，从而促进公共卫生干预。尽管取得了这些进步，但数据贫困、伦理问题和限制性政策等挑战阻碍了其在非洲医疗保健领域的充分潜力。这些差距可以通过政策改革、能力建设举措和健全的人工智能框架来弥补，这对于最大限度地提高人工智能对临床毒理学的益处至关重要。本述评重点介绍了人工智能在非洲的新应用，强调需要合作努力，以确保公平和有效地实施。然而，它的采用受到资金限制、数据集稀缺、基础设施薄弱和道德问题的限制。

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引用次数: 0

Global Health research abstracts: September ‘25 全球健康研究摘要：25年9月

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-20 DOI: 10.1016/j.afjem.2025.100923

引用次数: 0

Global Health research abstracts: October ‘25 全球健康研究摘要：25年10月

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-20 DOI: 10.1016/j.afjem.2025.100922

引用次数: 0

Improving emergency care capacity with the WHO-ICRC Basic Emergency Care (BEC) course 通过世卫组织-红十字国际委员会基本紧急护理课程提高紧急护理能力

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-09-09 DOI: 10.1016/j.afjem.2025.100892

Boris Arnaud Nteungue Kouomogne , Bissouma-Ledjou Tania , Chanceline Bilounga Ndongo , Alvine Choula Noulala , Hyppolite Kalambay Ntembwa , Pierre Claver Kariyo , Baonga Ba Pouth , Douba Epée , Bitang Louis Joss , Bertolt Brecht Kouam Nteungue , Dieudonnée Reine Ndougou , Mochache Trufosa , Simon Tumusiime , Ambomo Sylvie Myriam , Lauren Lai King , Annet Ngabirano Alenyo , Antoinette Naidoo , Linda Endale Esso , Yap Boum , Habimana Phanuel , Lee Wallis

Background

Globally, the demand for acute care is surging, disproportionately burdening low- and middle-income countries. Training for healthcare providers can play a pivotal role in reducing related mortality and improving overall health and well-being, particularly in sub-Saharan Africa. Despite the potential for impact, the World Health Organization- International Committee of the Red Cross (WHO-ICRC) Basic Emergency Care (BEC) course is yet to be fully rolled out in Francophone African nations such as Cameroon, Djibouti, Haiti, Morocco, and Tunisia. In this paper, we describe the introduction of this training in these countries.

Methods

This study utilized pre- and post-course surveys to gauge change in knowledge and confidence in delivering acute care. A comprehensive 4-day French BEC course and a concise 1-day Training of Trainer (ToT) course were delivered in Yaounde, Cameroon, in early 2023. Participants undertook surveys pre- and post-training, offering insights into their acute care knowledge, skills, and self-assurance.

Results

The courses were attended by 50 participants. The post-course evaluation highlighted a marked improvement in scores, showcasing a median score elevation from 72% pre-course to 88% post-course (p < 0.001). Participants’ self-confidence in handling acute care scenarios doubled. Universal acclaim was received for the quality of training materials, courses, and facilitation methodology, with nearly half feeling no amendment was necessary in the course design. However, 30% felt a longer duration should be dedicated to the practical/skills components of the course.

Conclusions

The WHO-ICRC BEC course significantly enhanced the acute care knowledge, skills, and self-confidence of participants from these five countries, laying a solid foundation for future training sessions. Provisional trainers are now proficient in expanding such training within their regions. Evaluating patient outcomes post-training presents significant challenges, highlighting a crucial area for future research and scrutiny.

在全球范围内，对急症护理的需求正在激增，给低收入和中等收入国家造成了不成比例的负担。对保健提供者的培训可在降低相关死亡率和改善整体健康和福祉方面发挥关键作用，特别是在撒哈拉以南非洲。尽管具有潜在的影响，但世界卫生组织-红十字国际委员会（WHO-ICRC）的基本急救（BEC）课程尚未在喀麦隆、吉布提、海地、摩洛哥和突尼斯等非洲法语国家全面推行。在本文中，我们描述了这种培训在这些国家的介绍。方法本研究采用课程前和课程后的调查来衡量在提供急性护理的知识和信心的变化。2023年初，在喀麦隆雅温得举办了为期4天的法语BEC综合课程和为期1天的简明培训师培训（ToT）课程。参与者在培训前和培训后进行了调查，提供了对他们的急症护理知识、技能和自信的见解。结果50人参加了课程。课程后评估突出了分数的显著提高，显示中位分数从课程前的72%提高到课程后的88% （p < 0.001）。参与者在处理紧急护理情况时的自信心增加了一倍。培训材料、课程和促进方法的质量受到普遍好评，近一半的人认为课程设计不需要修改。然而，30%的人认为应该将更长的时间用于课程的实践/技能部分。世卫组织-红十字国际委员会BEC课程显著提高了这五个国家参与者的急症护理知识、技能和自信心，为今后的培训奠定了坚实的基础。临时训练员现在精通在其区域内扩大这种训练。评估患者培训后的结果提出了重大挑战，突出了未来研究和审查的关键领域。

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引用次数: 0

Paediatric procedural sedation and or analgesia in the emergency unit; A descriptive study of practice at a Ugandan Referral Hospital 儿科急诊科的程序性镇静和/或镇痛；对乌干达一家转诊医院实践的描述性研究

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-26 DOI: 10.1016/j.afjem.2025.100929

Anna Meridah Kaguna , John Mark Mayanja Kasumba , Mary Ellen Lyon , Jonathan Byasi , Celine Jacobs , Rachael Parke

Background

Paediatric Procedural Sedation and/ or Analgesia (PPSA) is the recommended standard of practice for children undergoing painful and distressing procedures outside the operating room; however, global practice may vary. In Sub-Saharan Africa, data on the practice of PPSA is lacking. This study aimed to determine the current practice and outcomes of PPSA in the Emergency unit of Mulago National Referral Hospital to inform future standardisation of care.

Methods

We conducted a descriptive study from 1st October to 31st December 2023 in the surgical section of the emergency unit of Mulago National Referral Hospital. Data was collected using specifically designed and pretested observational checklists, documenting demographics, pre-procedure assessment and preparation, intra-procedural and post-procedural care, average sedation scores attained, pain control and adverse events observed. Data was coded using EPI-Data and analysed to describe PPSA practice and outcomes.

Results

We recruited 183 children undergoing procedures at the surgical section of the emergency unit. Majority were male, 104(56.8 %), and the median age (IQR) was 8 (4–12)years. Most procedures performed were orthopaedic, 149(81.4 %). Only 15(8.2 %) children got both sedation and analgesia, 4(2.2 %) got sedation only while 164(89.6 %) got analgesia only. Propofol was the most used sedative, while lignocaine with paracetamol was the most used analgesia. Most children, 92(50.3 %), had pain scores ≥8, and adverse events occurred in 6(3.3 %), all of whom belonged to the sedation and analgesia group. Anaesthetic officers were the primary providers in 75 % of the sedation-only cases and 46.7 % of the sedation and analgesia group.

Conclusion

PPSA practice in this Emergency setting deviates from recommended standards with limited monitoring and inadequate pain control. The clustering of adverse events among children receiving both sedation and analgesia underscores safety risks. Safer sedative choices, clear provider roles, local guidelines, and targeted training are needed to improve the safety and quality of PPSA.

背景：儿科手术镇静和/或镇痛（PPSA）是在手术室外接受疼痛和痛苦手术的儿童的推荐实践标准；然而，全球的做法可能有所不同。在撒哈拉以南非洲，缺乏关于PPSA做法的数据。本研究旨在确定目前在穆拉戈国家转诊医院急诊科实施PPSA的做法和结果，为未来的护理标准化提供信息。方法于2023年10月1日至12月31日在穆拉戈国家转诊医院急诊科外科进行描述性研究。使用专门设计和预先测试的观察性检查表收集数据，记录人口统计学、术前评估和准备、术中和术后护理、获得的平均镇静评分、疼痛控制和观察到的不良事件。使用EPI-Data对数据进行编码，并对其进行分析，以描述PPSA的实践和结果。结果我们招募了183名在急诊科外科接受手术的儿童。多数为男性，104例（56.8%），中位年龄（IQR）为8（4-12）岁。大多数手术是矫形手术，149例（81.4%）。同时镇静和镇痛15例（8.2%），单纯镇静4例（2.2%），单纯镇痛164例（89.6%）。异丙酚是最常用的镇静剂，而利多卡因与扑热息痛是最常用的镇痛药。92例（50.3%）患儿疼痛评分≥8分，6例（3.3%）患儿发生不良事件，均属于镇静镇痛组。麻醉人员是75%的单纯镇静组和46.7%的镇静镇痛组的主要提供者。结论急诊ppsa的做法偏离了推荐的标准，监测有限，疼痛控制不足。同时接受镇静和镇痛的儿童不良事件的聚集性强调了安全风险。需要更安全的镇静剂选择、明确的提供者角色、当地指南和有针对性的培训来提高PPSA的安全性和质量。

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引用次数: 0