African Journal of Emergency Medicine最新文献

{"title":"The use of non-invasive ventilation by emergency doctors in Johannesburg Academic Hospitals, South Africa – assessing knowledge, attitudes and practices","authors":"Dr Holly Bird,&nbsp;Dr Craig Beringer,&nbsp;Dr Pano Parris","doi":"10.1016/j.afjem.2023.11.002","DOIUrl":"https://doi.org/10.1016/j.afjem.2023.11.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Non-invasive ventilation (NIV) is an alternative ventilatory method to endotracheal intubation and invasive ventilation in patients presenting in acute respiratory failure. Appropriate and timely application of NIV has shown benefits over invasive ventilation. In recent years, there has been an increase in the use of NIV for varying pathologies in response to limited resources.</p><p>Emergency department doctors’ knowledge of NIV, as well as their attitude towards its use can have significant effects on the success of NIV. The aim of this study was to assess emergency doctors’ use of NIV in the South African setting.</p></div><div><h3>Methods</h3><p>This was a multi-centre prospective cross-sectional study that was conducted across three academic emergency departments in Johannesburg, South Africa. Doctors of various grades were included in the study and their responses were analysed according to their level of experience and their job description.</p></div><div><h3>Results</h3><p>The mean knowledge score of the participants was shown to increase with an increase in job designation (<em>p</em> &lt; 0.001). The doctors’ attitude towards NIV was more positive in those with higher knowledge scores (<em>p</em> &lt; 0.001). Participants with previous critical care experience versus those without was associated with a higher average knowledge score (77% vs. 69 %, <em>p</em> = 0.009) as was formal NIV training versus those without (77% vs. 69 %, <em>p</em> = 0.01). The COVID-19 pandemic increased confidence in the use of NIV in 61 % of participants. The majority (69 %) of participants did not use a checklist when administering NIV. Only 53 % used a guideline when initiating a patient on NIV and just 26 % used a locally produced protocol.</p></div><div><h3>Conclusion</h3><p>Increased clinical experience, critical care exposure and formal NIV training corresponded with higher knowledge scores. Formal NIV training programs, the implementation of a checklist and the development of locally produced protocols are recommended to improve knowledge, attitudes and NIV practice that is in-keeping with international standards.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X23000587/pdfft?md5=512158b034657a1a122c7ba45493de27&pid=1-s2.0-S2211419X23000587-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91993359","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":"Ketamine as adjunctive or monotherapy for post-intubation sedation in patients with trauma on mechanical ventilation: A rapid review","authors":"C Hendrikse ,&nbsp;V Ngah ,&nbsp;II Kallon ,&nbsp;T D Leong ,&nbsp;M McCaul","doi":"10.1016/j.afjem.2023.10.002","DOIUrl":"https://doi.org/10.1016/j.afjem.2023.10.002","url":null,"abstract":"<div><h3>Background</h3><p>The effectiveness of ketamine as adjunctive or monotherapy for post-intubation sedation in adults with trauma on mechanical ventilation is unclear.</p></div><div><h3>Methods</h3><p>A rapid review of systematic reviews of randomized controlled trials, then randomized controlled trials or observational studies was conducted searching three electronic databases (PubMed, Embase, Cochrane Library) and one clinical trial registry on June 1, 2022. We used a prespecified protocol following Cochrane rapid review methods.</p></div><div><h3>Results</h3><p>We identified eight systematic reviews of randomized controlled trials and observational studies. Among the included reviews, only the most relevant, up to date, highest quality-assessed reviews and reviews that reported on critical outcomes were considered. Adjunctive ketamine showed a morphine sparing effect (MD −13.19 µmg kg^–1 h^–1, 95 % CI −22.10 to −4.28, moderate certainty of evidence, 6 RCTs), but no to little effect on midazolam sparing effect (MD 0.75 µmg kg^–1 h^–1, 95 % CI −1.11 to 2.61, low certainty of evidence, 6 RCTs) or duration of mechanical ventilation in days (MD −0.17 days, 95 % CI −3.03 to 2.69, moderate certainty of evidence, 3 RCTs).</p><p>Adjunctive ketamine therapy may reduce mortality (OR 0.88, 95 % CI 0.54 to 1.43, <em>P</em> = 0.60, very low certainty of evidence, 5 RCTs, <em>n</em> = 3076 patients) resulting in 30 fewer deaths per 1000, ranging from 132 fewer to 87 more, but the evidence is very uncertain. Ketamine results in little to no difference in length of ICU stay (MD 0.04 days, 95 % CI −0.12 to 0.20, high certainty of evidence, 5 RCTs <em>n</em> = 390 patients) or length of hospital stay (MD −0.53 days, 95 % CI −1.36 to 0.30, high certainty of evidence, 5 RCTs, <em>n</em> = 277 patients).</p><p>Monotherapy may have a positive effect on respiratory and haemodynamic outcomes, however the evidence is very uncertain.</p></div><div><h3>Conclusion</h3><p>Adjunctive ketamine for post-intubation analgosedation results in a moderate meaningful net benefit but there is uncertainty for benefit and harms as monotherapy.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X23000538/pdfft?md5=51d109993fca655fc6467b51f6994749&pid=1-s2.0-S2211419X23000538-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92096533","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":"Strengthening emergency care provision in a non-emergency physician run emergency department – Experience from the Eastern Cape, South Africa","authors":"L Taljaard ,&nbsp;C Hendrikse","doi":"10.1016/j.afjem.2023.10.004","DOIUrl":"https://doi.org/10.1016/j.afjem.2023.10.004","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X23000526/pdfft?md5=acb7f5e75ef092cd21710402f1321fd7&pid=1-s2.0-S2211419X23000526-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91686388","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 knowledge level of nurses managing critically-ill and injured patients in Ashanti Region of Ghana","authors":"AK Karikari ,&nbsp;D Amedjake ,&nbsp;J Antwi ,&nbsp;P Agyei-Baffour ,&nbsp;C Mock ,&nbsp;AK Edusei ,&nbsp;P Donkor","doi":"10.1016/j.afjem.2023.10.003","DOIUrl":"https://doi.org/10.1016/j.afjem.2023.10.003","url":null,"abstract":"<div><h3>Background</h3><p>Shortages in the right cadres of human resources to manage health emergencies remain an acute problem especially in low- and middle-income countries. Efforts to address this challenge are dependent on the knowledge and competency of emergency nurses. We sought to determine the knowledge level of nurses in emergency management in the Ashanti Region of Ghana.</p></div><div><h3>Methods</h3><p>We used a cross-sectional, quantitative approach to evaluate knowledge about emergency care among 408 nurses working in wards and emergency units in 11 randomly selected district hospitals (6 public and 5 faith-based). Participants were purposively selected and examined on knowledge level using a structured questionnaire. The inclusion criteria were different cadres of nurses who had spent at least 6 months in the selected hospitals.</p></div><div><h3>Results</h3><p>Four hundred and eight nurses participated. Most were general nurses (73.1 %) or mid-wives (14.4 %), with few specialised in emergency nursing (3.9 %) or critical care nursing (1.6 %). Mean percentage correct on an objective 20 question test on emergency care was 59.8 %. Few (35.6 %) nurses felt that they had adequate knowledge to manage emergencies. Around half (52.5 %) had received training in managing critically ill and injured patients through continuing professional development and 46.6 % felt prepared to work at emergency units. But few (34.7 %) reported having adequate logistics to manage emergencies and fewer (32.2 %) had time off to access training opportunities. Predictors of reporting adequate knowledge to manage emergencies included: having received training in managing critically ill and injured patients (<em>p</em>&lt;.002), feeling prepared to work at emergency units (<em>p</em>&lt;.001), and having adequate logistics to manage emergencies (<em>p</em>&lt;.001).</p></div><div><h3>Conclusion</h3><p>Most nurses did not feel that they had adequate knowledge to manage emergencies. This study has identified increased availability of continuing professional development on emergency care for nurses as a priority in Ghana.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X23000551/pdfft?md5=1b93cc0ccd03ec3d7506b7398e5098d8&pid=1-s2.0-S2211419X23000551-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91993104","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":"Essential human and material resources for emergency care in the district hospitals of Burundi","authors":"Thierry Giriteka ,&nbsp;Doña Patricia Bulakali ,&nbsp;Carlan Bruce Wendler","doi":"10.1016/j.afjem.2023.09.005","DOIUrl":"10.1016/j.afjem.2023.09.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Burundi, like many African nations, faces challenges in providing accessible emergency care. The aim of this study was to assess the type of staff training, accessibility to imaging, and availability of essential equipment in the district hospitals of Burundi in order to inform strategic planning for healthcare delivery.</p></div><div><h3>Methods</h3><p>In June 2022 an online survey was sent to each district hospital of the country. Complete responses were analysed and, where appropriate, significance determined by chi-square analysis, with <em>p</em>&lt;0.05 considered significant.</p></div><div><h3>Results</h3><p>Forty of 45 district hospitals completed the survey, of which 35 were rural (matching national demographics). The majority of district hospitals (21/40) had ready access to ≥4/5 critical drugs while few (5/40) were equipped with ≥4/5 key material. One quarter had 24/7 physician coverage and X-ray available. Only 3 had continuous access to ultrasound studies despite most district hospitals having ultrasound machines. Trained emergency room staff were almost totally absent from the field, with only 6 nurses, 4 generalists, and 1 specialist reported across 9 sites. Even a single EM-trained staff member was significantly correlated with being better equipped for emergencies (<em>p</em>&lt;0.01).</p></div><div><h3>Conclusion</h3><p>Burundi needs a strategic investment in emergency preparedness and care. Policy initiatives and technology purchases have demonstrated reasonable penetration down to the district hospital level, however, trained personnel are essential to develop sustainable emergency capacity.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10582767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683737","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 variables predictive of ambulance non-conveyance of patients in the Western Cape, South Africa","authors":"Faisal Binks ,&nbsp;Anneli Hardy ,&nbsp;Lee A Wallis ,&nbsp;Willem Stassen","doi":"10.1016/j.afjem.2023.09.006","DOIUrl":"10.1016/j.afjem.2023.09.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Emergency medical service (EMS) resources are limited and should be reserved for incidents of appropriate acuity. Over-triage in dispatching of EMS resources is a global problem. Analysing patients that are not transported to hospital is valuable in contributing to decision-making models/algorithms to better inform dispatching of resources. The aim is to determine variables associated with patients receiving an emergency response but result in non-conveyance to hospital.</p></div><div><h3>Methods</h3><p>A retrospective cross-sectional study was performed on data for the period October 2018 to September 2019. EMS records were reviewed for instances where a patient received an emergency response but the patient was not transported to hospital. Data were subjected to univariate and multivariate regression analysis to determine variables predictive of non-transport to hospital.</p></div><div><h3>Results</h3><p>A total of 245 954 responses were analysed, 240 730 (97.88 %) were patients that were transported to hospital and 5 224 (2.12 %) were not transported. Of all patients that received an emergency response, 203 450 (82.72 %) patients did not receive any medical interventions. Notable variables predictive of non-transport were green (OR 4.33 (95 % CI: 3.55–5.28; p&lt;0.01)) and yellow on-scene (OR 1.95 (95 % CI: 1.60–2.37; p&lt;0.01).</p><p>Incident types most predictive of non-transport were electrocutions (OR 4.55 (95 % CI: 1.36–15.23; p=0.014)), diabetes (OR 2.978 (95 % CI: 2.10–3.68; p&lt;0.01)), motor vehicle accidents (OR 1.92 (95 % CI: 1.51–2.43; p&lt;0.01)), and unresponsive patients (OR 1.98 (95 % CI: 1.54–2.55; p&lt;0.01)). The highest treatment predictors for non-transport of patients were nebulisation (OR 1.45 (95 % CI: 1.21–1.74; p&lt;0.01)) and the administration of glucose (OR 4.47 (95 % CI: 3.11–6.41; p&lt;0.01)).</p></div><div><h3>Conclusion</h3><p>This study provided factors that predict ambulance non-conveyance to hospital. The prediction of patients not transported to hospital may aid in the development of dispatch algorithms that reduce over-triage of patients, on-scene discharge protocols, and treat and refer guidelines in EMS.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10551619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41139918","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 value of shock index, modified shock index and age shock index to predict mortality and hospitalisation in a district level emergency centre","authors":"Patrick Aleka,&nbsp;Candice Van Koningsbruggen,&nbsp;Clint Hendrikse","doi":"10.1016/j.afjem.2023.09.007","DOIUrl":"10.1016/j.afjem.2023.09.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Triage is the most important step in patients’ journey through an Emergency Centre (EC) and directly impacts time to critical actions. Triage tools, like the South African Triage Scale, are however not designed to predict patient outcomes. The shock index (SI), modified shock index (MSI) and age shock index (ASI) are clinical markers derived from vital signs and correlate with tissue perfusion in critically ill patients. This study aimed to assess the value of SI, MSI and ASI to predict mortality and the need for hospitalisation in all adult patients presenting to a district level emergency centre in South Africa.</p></div><div><h3>Methods</h3><p>This diagnostic study was performed as a retrospective observational study, using data from an existing electronic registry at a district level hospital emergency centre over a period of 24 months. All adult patients who presented to Mitchells Plain Hospital were eligible for inclusion. Sensitivity, specificity and likelihood ratios were calculated for each variable as a predictor of mortality and hospitalisation with pre-determined thresholds.</p></div><div><h3>Results</h3><p>During the study period of 24 months, a total of 61 329 patients ≥ 18 years old presented to the EC with 60 599 included in the final sample. A red SATS triage category (+LR = 7.2) and SI ≥1.3 (+LR = 4.9) were the only two predictors with any significant clinical value. The same two markers performed well for both patients with and without trauma and specifically for patients who died while under the care of the emergency centre.</p></div><div><h3>Discussion</h3><p>The study demonstrated that patients with a SI≥1.3 at triage have a significantly higher likelihood to die or require hospitalisation, whether the presenting complaint is trauma related or not, especially to predict mortality while under the care of the EC. Incorporating this marker as a triage alert could expedite the identification of patients requiring time critical interventions and improve patient throughput in the emergency centre.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/62/0a/main.PMC10562169.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41216481","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 understandability and quality of telephone-guided bystander cardiopulmonary resuscitation in the Western Cape province of South Africa: A manikin-based study","authors":"Leonel P De Caires,&nbsp;Katya Evans,&nbsp;Willem Stassen","doi":"10.1016/j.afjem.2023.09.008","DOIUrl":"10.1016/j.afjem.2023.09.008","url":null,"abstract":"<div><h3>Background</h3><p>The incidence of cardiovascular disease is on the increase in Africa and with it, an increase in the incidence of out-of-hospital cardiac arrest (OHCA). OHCA carries a high mortality, especially in low-resource settings. Interventions to treat OHCA, such as mass cardiopulmonary resuscitation (CPR) training campaigns are costly. One cost-effective and scalable intervention is telephone-guided bystander CPR (tCPR). Little data exists regarding the quality of tCPR. This study aimed to determine quality of tCPR in untrained members of the public. Participants were also asked to provide their views on the understandability of the tCPR instructions.</p></div><div><h3>Methods</h3><p>This study followed a prospective, simulation-based observational study design. Adult laypeople who have not had previous CPR training were recruited at public CPR training events and asked to perform CPR on a manikin. Quality was assessed in terms of hand placement, compression rate, compression depth, chest recoil, and chest exposure. tCPR instructions were provided by a trained medical provider, via loudspeaker. Participants were also asked to complete a short questionnaire afterwards, detailing the understandability of the tCPR instructions. Data were analysed descriptively and compared to recommended quality guidance.</p></div><div><h3>Results</h3><p>Fifty participants were enrolled. Hand placement was accurate in 74 % (<em>n</em> = 37) of participants, while compression depth and chest recoil only had compliance in 20 % (<em>n</em> = 10) and 24 % (<em>n</em> = 12) of participants, respectively. The mean compression rate was within guidelines in just under half (48 %, <em>n</em> = 24) of all participants. Only 20 (40 %) participants exposed the manikin's chest. Only 46 % (<em>n</em> = 23) of participants felt that the overall descriptions offered during the tCPR guidance were understandable, while 80 % (<em>n</em> = 40) and 36 % (<em>n</em> = 18) felt that the instructions on hand placement and compression rate were understandable, respectively. Lastly, 94 % (<em>n</em> = 47) of participants agreed that they would be more likely to perform bystander CPR if they were provided with tCPR.</p></div><div><h3>Conclusion</h3><p>The quality of CPR performed by laypersons is generally suboptimal and this may affect patient outcomes. There is an urgent need to develop more understandable tCPR algorithms that may encourage bystanders to start CPR and optimise its quality.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10542001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41155215","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":"Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study","authors":"Ken Diango ,&nbsp;Eric Mafuta ,&nbsp;Lee A. Wallis ,&nbsp;Charmaine Cunningham ,&nbsp;Peter Hodkinson","doi":"10.1016/j.afjem.2023.09.001","DOIUrl":"10.1016/j.afjem.2023.09.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Prehospital care in many low- and middle-income countries is underdeveloped and needs strengthening for improved outcomes. Where formal prehospital care systems are under development, integration of a layperson first responder programme may help improve access for those in need. The World Health Organization recently developed the Community First Aid Responder (CFAR) learning program in support of this system, providing that it may require adaptation to be contextually suitable and sustainably implemented at country level. This study assesses a pilot WHO CFAR course in Kinshasa, Democratic Republic of Congo, to inform future rollouts and related research.</p></div><div><h3>Methods</h3><p>We conducted a 3-day in-person pilot CFAR training with 42 purposively selected community health workers. Data collection involved quantitative and qualitative phases. The first consisted of structured pre- and post-training surveys, and a course evaluation by participants. The second consisted of two focus group discussions involving purposively selected community health workers in one group, and a convenience sample of course instructors and organisers in the other. Perceptions regarding course content, perceived knowledge acquisition and self-confidence gain were analysed using descriptive statistics for the quantitative data and content analysis for qualitative data.</p></div><div><h3>Results</h3><p>Course participants were predominantly male (76.3 %) with a median age of 42 years and most (80.5 %) had no prior first aid training. Most were satisfied that the learning objectives were reached, the logistics were adequate, and that the content and teaching language were appropriately tailored to local context. The majority (94.7 %) found the 3-day duration insufficient. There was a significant self-confidence gain regarding first aid skills (average 17.9 % in pre- to 95.3 % in post-training, <em>p</em> &lt; 0.001). Favourable opinions on the course structure, content, logistics and teaching methods were noted.</p></div><div><h3>Conclusion</h3><p>A CFAR course pilot was successfully conducted in Kinshasa. The course is appropriate for context and well received by participants. It can form a key component of developing prehospital care systems in resource-constrained settings.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10542602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160956","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":"Emergency laparotomy for peritonitis in the elderly: A Multicentre observational study of outcomes in Sub-Saharan Africa","authors":"Aloysius Ugwu-Olisa Ogbuanya ,&nbsp;Nonyelum Benedett Ugwu ,&nbsp;Vincent C Enemuo ,&nbsp;Ugochukwu U Nnadozie ,&nbsp;Uche Emmanuel Eni ,&nbsp;Richard L Ewah ,&nbsp;Uzoamaka E Ajuluchuku ,&nbsp;Daniel A Umezurike ,&nbsp;Livinus N Onah","doi":"10.1016/j.afjem.2023.08.005","DOIUrl":"10.1016/j.afjem.2023.08.005","url":null,"abstract":"<div><h3>Background</h3><p>Globally, interest in surgical diseases in the elderly was rekindled recently mainly due to a surge in the aging population and their increased susceptibility to infections. In sub-Saharan Africa, infective diseases are major causes of high morbidity and mortality especially in elderly cohorts, hence this study was set to evaluate current status of this scourge in the elderly in our environment.</p></div><div><h3>Aim</h3><p>To document the aetiologic factors and analyze the impact of selected clinical and perioperative indices on mortality and morbidity rates of peritonitis in the elderly.</p></div><div><h3>Methods</h3><p>This was a multicenter prospective study involving elderly patients aged 65years and above managed between October 2015 and September 2021 in Southeast Nigeria.</p></div><div><h3>Results</h3><p>Of the 236 elderly patients examined, approximately two-third (150, 63.6%) were aged 65–74years. The rest were aged ≥ 75years. There were 142(60.2%) males and 94(39.8%) females. Perforated peptic ulcer (89,37.7%) was the most common cause of peritonitis followed by ruptured appendix (59, 25.0%), then typhoid perforation (44,18.6%). However, typhoid perforation was the deadliest with a crude mortality rate of 40.9%. Overall, morbidity and mortality rates were 33.8% and 28.5% respectively. The main independent predictors of mortality were peritonitis arising from typhoid perforation (<em>p</em> = 0.036), late presentation (<em>p</em> = 0.004), district location of hospital (<em>p</em> = 0.011) and intestinal resection (<em>p</em> = 0.003).</p></div><div><h3>Conclusion</h3><p>Generalized peritonitis is a cause of significant morbidity and mortality in the elderly patients in our environment. Perforated peptic ulcer was the most common cause, but typhoid perforation remains the deadliest. Late presentation, district hospital setting and bowel resection were associated with elevated mortality.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10542594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160896","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}