African Journal of Emergency Medicine最新文献

{"title":"Impact of COVID-19 pandemic on the utilization of emergency medical services in Nairobi, Kenya","authors":"Maurine Mumo Mutua ,&nbsp;Benjamin Wachira ,&nbsp;Nancy Chege ,&nbsp;Sammy Simiyu ,&nbsp;Moses Masika","doi":"10.1016/j.afjem.2024.10.220","DOIUrl":"10.1016/j.afjem.2024.10.220","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency medical services (EMS) are vital for providing immediate medical or trauma care to patients and stabilizing them for transportation to hospitals. Following the confirmation of the first case of coronavirus disease 2019 (COVID-19) in Kenya on March 13th, 2020, the government announced several measures to curb its spread, including movement restrictions and the use of ambulance services for confirmed or suspected COVID-19 patients. This study aimed to determine the utilization of EMS in Kenya the year before and one year into the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>This retrospective study collected data on all calls received from two dispatch centers in Nairobi City County from March 2019 to February 2021, encompassing the period both before and during the COVID-19 pandemic. Data collected was analyzed based on the number of calls, sex, call timing and call type.</div></div><div><h3>Results</h3><div>The two dispatch centers received 3,477 calls during the study period. The total number of calls made during the first year of the pandemic was 1,376, compared to 2,014 the year before, a decrease of 31.7%. The proportion of trauma-related calls increased from 15% (293/2014) to 22% (303/1376) while the proportion of nighttime calls increased from 20% (410/2014) to 35% (479/1376) during the pandemic.</div></div><div><h3>Conclusion</h3><div>EMS utilization decreased during the pandemic, and trauma calls increased. While most calls were made during the day, there was a notable increase in calls made during night shifts.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 273-276"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573067","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}

{"title":"The impact of the COVID-19 pandemic on presentations with suicidal behaviour in a tertiary hospital Emergency Centre in the Eastern Cape, South Africa–A cross-sectional analysis","authors":"Johnré Retief Els ,&nbsp;Luan Taljaard ,&nbsp;Clint Hendrikse","doi":"10.1016/j.afjem.2024.08.005","DOIUrl":"10.1016/j.afjem.2024.08.005","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Method</h3><p>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).</p></div><div><h3>Results</h3><p>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, <em>p</em> &lt; 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 %, <em>p</em>&lt;.05).</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 268-272"},"PeriodicalIF":1.4,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X2400034X/pdfft?md5=1b1fe98a16db754170fb404a560b8393&pid=1-s2.0-S2211419X2400034X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270731","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}

{"title":"From vocational to graduation: A mixed methods study of support needs for vocational learners pursuing post-graduate education in South Africa","authors":"Debbi Groome ,&nbsp;Charmaine Cunningham","doi":"10.1016/j.afjem.2024.08.008","DOIUrl":"10.1016/j.afjem.2024.08.008","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 263-267"},"PeriodicalIF":1.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000375/pdfft?md5=b71e68c05425b4b6ad69fa372f77c950&pid=1-s2.0-S2211419X24000375-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142172808","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}

{"title":"Improving pain management for trauma patients at two Rwandan emergency departments","authors":"Jean Pierre Hagenimana ,&nbsp;Paulin Ruhato Banguti ,&nbsp;Rebecca Lynn Churchill Anderson ,&nbsp;Jean de Dieu Tuyishime ,&nbsp;Gaston Nyirigira ,&nbsp;Eugene Tuyishime","doi":"10.1016/j.afjem.2024.08.009","DOIUrl":"10.1016/j.afjem.2024.08.009","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 &gt; 0.001) and the increase of the number of patients with mild pain from 37% to 62% (p-value &gt; 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 &gt; 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).</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 258-262"},"PeriodicalIF":1.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000387/pdfft?md5=602c8e513a76185e9c5f0722f5ace2d0&pid=1-s2.0-S2211419X24000387-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142166773","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}

{"title":"Descriptive analysis of road traffic crashes encountered by Tanzanian motorcycle taxi drivers trained in first aid","authors":"J.H. Drake ,&nbsp;G. Kiwango ,&nbsp;D. Kitapondya ,&nbsp;F. Mashili ,&nbsp;S.M. Kivlehan","doi":"10.1016/j.afjem.2024.08.002","DOIUrl":"10.1016/j.afjem.2024.08.002","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 (<em>n</em>=20), followed by motorcycle vs. car/three-wheeled vehicle (<em>n</em>=15), motorcycle vs. bus/van (<em>n</em>=10), motorcycle vs. motorcycle (<em>n</em>=9), motorcycle vs. pedestrian (<em>n</em>=7), pedestrian vs. bus/van (<em>n</em>=2), pedestrian vs. car/three-wheeled vehicle (<em>n</em>=1), motorcycle vs. bicycle (<em>n</em>=1), multi vehicle (<em>n</em>=1), and other (<em>n</em>=3).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 246-251"},"PeriodicalIF":1.4,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000314/pdfft?md5=b8ebff8362b48c276d6d5f1b6e4d4d51&pid=1-s2.0-S2211419X24000314-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142150695","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}

{"title":"Workplace violence in three public sector emergency departments, Gauteng, South Africa: A cross-sectional survey","authors":"Mahlako Nkadimeng,&nbsp;Andreas Engelbrecht,&nbsp;Suma Rajan","doi":"10.1016/j.afjem.2024.08.006","DOIUrl":"10.1016/j.afjem.2024.08.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Workplace violence against healthcareworkers in Emergency Departments (EDs) is a global concern. The purpose of this study was to determine the prevalence and types of workplace violence in EDs.</p></div><div><h3>Methods</h3><p>a cross-sectional survey was conducted in three public sector hospital EDs in Gauteng, South Africa. A self-administered, standardised online questionnaire developed by the World Health organization was used to collect data between March and November 2022. A total of 65 healthcareworkers which consisted of nurses (24) and doctors (41) participated in the study.</p></div><div><h3>Results</h3><p>The prevalence of workplace violence was 73.8 % with verbal abuse being the most common type at 66 %. Eighty-two percent of the victims did not report the incident. Poor communication and lack of mutual respect among staff and healthcare users contributed to both physical and non-physical workplace violence.</p></div><div><h3>Conclusion</h3><p>Workplace violence appears to be a common occurrence in EDs in the hospitals surveyed in Gauteng. It is regarded as a typical incident by respondents, and it is underreported. It has a direct negative impact on healthcareworkers and their working environment and indirectly on patients. Urgent attention from all stakeholders is needed to minimize the prevalence of these incidents.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 252-257"},"PeriodicalIF":1.4,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000363/pdfft?md5=dbe8b2d996c8beb112bc1dbaf69c0b1f&pid=1-s2.0-S2211419X24000363-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142150697","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}

{"title":"Healthcare professionals perceptions towards the determinants of effective emergency health care services in public health centres of Addis Ababa, Ethiopia","authors":"Genanew Kassie Getahun ,&nbsp;Abraham Shewamare ,&nbsp;Wondimu Ayele Andabob ,&nbsp;Ewnetu Mulugeta Duressa ,&nbsp;Molla Yigzaw Birhanu","doi":"10.1016/j.afjem.2024.08.003","DOIUrl":"10.1016/j.afjem.2024.08.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Emergency healthcare services enable early detection and life-saving interventions for time-sensitive acute injuries and illnesses. The aim of this paper was to assess health care professional's perception towards determinants of effective emergency healthcare services in public health centers of Addis Ababa, Ethiopia, in 2023.</p></div><div><h3>Methods</h3><p>A facility-based cross-sectional study was conducted at public health centers in Addis Ababa with a sample of 422 study participants. Study participants were selected using simple random sampling techniques. To identify factors associated with the outcome variable, bi-variable and multi-variable logistic regression analyses were conducted. Variables having a <em>p</em>-value less than 0.05 in multi-variable logistic regression analysis were declared determinants of positive perception towards emergency medical services effectiveness.</p></div><div><h3>Results</h3><p>Among the study participants, 76.3 % (95 % CI: 72.3, 80.6) had a positive perception towards the public health centers effectiveness in providing emergency healthcare services. Moreover, training (AOR: 4.05; 95 % CI: 1.97, 8.32), ICT service implementation (AOR: 6.55; 95 % CI: 3.37, 12.73), resource availability in the emergency department (AOR: 5.07; 95 % CI: 2.51, 10.25), and management support (AOR: 3.22; 95 % CI: 1.66, 6.25) were determinant factors associated with the perception of effectiveness in emergency medical care services.</p></div><div><h3>Conclusion</h3><p>Nearly three-fourths of healthcare providers in Addis Ababa perceived that the emergency healthcare services were effective. Furthermore, training on patient service delivery, ICT service implementation, availability of resources in emergency departments, and management support were independent determinants of positive perception towards effective emergency healthcare services.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 240-245"},"PeriodicalIF":1.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000326/pdfft?md5=fcc9ac0f04eba1714448e3c952047bc9&pid=1-s2.0-S2211419X24000326-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122314","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}

{"title":"South African palliative care provider perspectives on emergency medical services in palliative situations","authors":"Caleb Hanson Gage ,&nbsp;Liz Gwyther ,&nbsp;Willem Stassen","doi":"10.1016/j.afjem.2024.08.007","DOIUrl":"10.1016/j.afjem.2024.08.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Due to the frequent intersection of Emergency Medical Services (EMS) with palliative situations and the increasing global need for palliative care, there has been increased recognition of the need for palliative care integration with EMS. However, EMS and palliative care systems remain segregated in many Low-to-Middle Income Country contexts, as in South Africa (SA). The aim of this study was to gather perspectives of palliative care providers in SA concerning EMS in palliative situations.</p></div><div><h3>Methods</h3><p>A qualitative design employing individual semi-structured interviews was implemented. Ten interviews with experienced doctors and nurses holding post-graduate palliative medicine qualifications were conducted. Verbatim transcriptions of interviews were subjected to content analysis with an inductive-dominant approach to develop codes and categories.</p></div><div><h3>Results</h3><p>Four categories were developed: (1) Disposition towards EMS, (2) Perceived EMS challenges, (3) Positive EMS impact across patients’ palliative care journeys and (4) Methods of EMS and palliative care system integration. Participants maintained an overall positive view of EMS and palliative care integration, noting the beneficial impact of EMS and suggesting various methods of integration, while also highlighting challenges and concerns.</p></div><div><h3>Conclusion</h3><p>EMS and palliative care integration would be mutually beneficial to both systems while benefiting patient well-being and the broader healthcare system. Potentially low-cost, high-impact interventions suggested by participants, such as palliative care cards for patients and enhancing EMS and palliative care system communication, represent efficacious and judicious use of limited resources within the SA context. Pilot studies investigating these suggestions should be conducted.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 231-239"},"PeriodicalIF":1.4,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000351/pdfft?md5=a781652c341501224e96c646aaed1f57&pid=1-s2.0-S2211419X24000351-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099512","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}

{"title":"Undergraduate acute care clinical competencies for managing acute care cases in adult patients within a South African in-hospital environment: A modified Delphi Study","authors":"Marvin Jeffrey Jansen ,&nbsp;Nadia Hartman ,&nbsp;David Grant","doi":"10.1016/j.afjem.2024.08.004","DOIUrl":"10.1016/j.afjem.2024.08.004","url":null,"abstract":"<div><h3>Introduction</h3><p>With the increase of global population, there has been an increased demand for acute care services both locally and globally. In the absence of an acute care competency-based curriculum in South Africa, this study sought to identify the core competencies required by undergraduate medical students to safely manage adult patients within an acute care setting in a South African hospital environment.</p></div><div><h3>Methodology</h3><p>The modified Delphi study comprised of three rounds. The traditional Delphi method, which uses the same participants across various rounds, was modified by using different stakeholders across the three rounds. Emergency Medicine (EM) specialist trainees (registrars) generated competencies in round one, which were provided to a multi-disciplinary team with expertise in undergraduate curriculum development in round two, using a 5-point Likert scale for rating their agreement-disagreement. Round three entailed inviting the round one contributors to anonymously comment, via online survey, on the competencies generated in round two.</p></div><div><h3>Results</h3><p>A total of 34 EM registrars participated during round one and 7 curriculum development experts participated during round two. A total of 120 competencies were identified from the 3-round Delphi study; of these 103 (85.8%) were reached by “Strong Agreement”; 16 (13.3%) reached by “Agreement”; and 1 (0.8%) was undecided.</p></div><div><h3>Discussion</h3><p>The results of the modified Delphi study contributed to developing a comprehensive list of undergraduate acute care clinical competencies set in a South African context. The value of engaging with medical practitioners at the forefront of delivering acute care in a South African healthcare environment who are exposed on a daily basis to the healthcare needs of society, became evident. The findings of this study highlight and reinforce the importance of contextual relevance during the curriculum development process.</p></div><div><h3>Conclusion</h3><p>The modified Delphi method, based on three iterative rounds and feedback from experts, was effective in reaching consensus on the competencies required by undergraduate medical students to manage acute care adult patients safely within a South African hospital environment.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 3","pages":"Pages 231-236"},"PeriodicalIF":1.4,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000338/pdfft?md5=63618025b2b1f6da0e5f6e0324953606&pid=1-s2.0-S2211419X24000338-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083917","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}

{"title":"Characteristics of paediatric injuries as predictors of 24-hour disposition from the Emergency Department of a teaching hospital in Southwestern Uganda","authors":"Daniel Olinga ,&nbsp;Felix Oyania ,&nbsp;Kenneth Bagonza ,&nbsp;Justine Athieno Odakha ,&nbsp;Mabiala Constant Balu ,&nbsp;William Mwanje ,&nbsp;Andrew Flanery ,&nbsp;Ambrose Okello ,&nbsp;Evelyn Mwende Musau ,&nbsp;Prisca Mary Kizito","doi":"10.1016/j.afjem.2024.08.001","DOIUrl":"10.1016/j.afjem.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><p>Paediatric injuries are among the leading causes of morbidity and mortality globally, especially in low- and middle-income countries. We aimed to characterize paediatric injuries as predictors of disposition from Mbarara Regional Referral Hospital Emergency Department (ED) Southwestern Uganda.</p></div><div><h3>Methods</h3><p>This was a prospective cohort study done from 12th December 2022 to 31st March 2023. We described the characteristics of injuries sustained by children and evaluated the predictors of 24-hour disposition from the ED using logistic regression.</p></div><div><h3>Results</h3><p>Of the 160 children followed up, 64.4% were male with a median age of 7 years, brought in with road traffic accidents (RTAs) (40.6%) and falls (35.6%) as the commonest mechanism of injury. Over half of the patients were triaged as yellow (urgent); polytrauma and head injuries were the top injury patterns. The majority (45.6%) of the children were admitted to the inpatient surgical ward. Only 1.9% and 5.0% ended up in intensive care unit (ICU) and died (to mortuary), respectively. The median time to disposition was 8 h and 14% stayed in the ED beyond 24-hours. Patients who needed more intensive initial treatment, including additional medications or interventions, were significantly more likely to be admitted to the ward (AOR= 5.3, 95%CI: 2.0-13.0, p &lt;0.01).</p></div><div><h3>Conclusion</h3><p>Paediatric injuries were caused mainly by RTAs and presenting with polytrauma and head injuries. Most patients were disposed of to the inpatient surgical ward within 24 h with severe KTS and initial management being strongest predictors of admission. These findings can be used to tailor quick risk stratification and decision-making tools and improve ED disposition of paediatric injuries in Low- and Middle- income countries.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 3","pages":"Pages 224-230"},"PeriodicalIF":1.4,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000302/pdfft?md5=dd27c7b76a8800578bdc149c47e259fd&pid=1-s2.0-S2211419X24000302-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142058005","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}