African Journal of Emergency Medicine最新文献

{"title":"Barriers and facilitators to providing facility-based emergency care in Addis Ababa, Ethiopia: A mixed methods study","authors":"Demelash Ataro Ambushe ,&nbsp;Lee A Wallis ,&nbsp;Willem Stassen","doi":"10.1016/j.afjem.2025.100894","DOIUrl":"10.1016/j.afjem.2025.100894","url":null,"abstract":"<div><h3>Background</h3><div>Illness and injury that may be impacted by emergency care account for over half of all deaths in low- and middle-income countries. However, studies show that Emergency Units in these countries face numerous barriers to facility-based emergency care. Yet, data on the barriers to facility-based emergency care in Ethiopia and some reasons for these barriers have not been established, and this study aimed to bridge this gap.</div></div><div><h3>Methods</h3><div>The study followed an explanatory, sequential mixed-methods design. In phase one, a cross-sectional evaluation of five hospitals was done using WHO's Hospital Emergency Unit Assessment Tool (HEAT). A purposive sampling technique was used to select the hospitals, and a convenience sampling technique was used to determine the participants. Quantitative data were analysed descriptively. In phase two, in-depth key informant interviews were done. Qualitative data were analysed using content analysis. Finally, the integration of the results from the two phases was done.</div></div><div><h3>Results</h3><div>We surveyed 38 participants in phase one and interviewed 15 in phase two. The most apparent findings to emerge from the quantitative phase of the study were the participants from across the hospitals reported the absence of equipment (<em>n</em> = 119) and stock out of supplies (<em>n</em> = 47) as the two most common barriers. Similarly, the most common reasons reported for not performing diagnostic services across all facilities were absent equipment (<em>n</em> = 128) and stock out of supplies (<em>n</em> = 99). The most important barriers identified from the qualitative phase of the study included a shortage or lack of resources, and inadequate management of resources. The facilitators identified for the procedures they could perform were the availability of essential resources, including trained human resources, good management practices, and coordination among the staff.</div></div><div><h3>Conclusion</h3><div>Overall, the tertiary hospitals in Addis Ababa reported they could perform the majority of the diagnostic and therapeutic procedures in the emergency units despite the interruption of some of the services. Some of the services' complete absence or interruptions were due to several barriers. Both existing literature and the findings of this study indicate the EUs of Ethiopian hospitals need further investment to improve resource availability and proper management of available resources.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100894"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute non-traumatic abdominal pain presenting to emergency unit of a university teaching hospital in Rwanda.","authors":"Faustin Turamyimana, Jean Paul Dushime, Appolinaire Manirafasha, Deninson Martin Kyle, Doris Lorette Uwamahoro, Francois Regis Twagirumukiza, Pascal Mugemangango, Seraphina Negash, Anna Dobbins","doi":"10.1016/j.afjem.2025.100895","DOIUrl":"10.1016/j.afjem.2025.100895","url":null,"abstract":"<p><strong>Background: </strong>Emergency Department consultation for non-traumatic abdominal pain is one of the common reasons for presentation; accounting for 5.76-20 % of all Emergency Department consultations. Research about non-traumatic abdominal pain is limited in Rwanda and East Africa. This study aims to understand the clinical profile and outcomes of non-traumatic abdominal pain at the largest tertiary hospital in Rwanda.</p><p><strong>Methodology: </strong>A prospective cohort study of patients presenting with non-traumatic abdominal pain was undertaken.</p><p><strong>Results: </strong>During the 5-month study, two hundred sixty-one patients were enrolled in the study. The mean age was 39.7 years and male patients accounted for 57.5 % of the cohort. Nearly half of the cohort were triaged as a high priority (11.1 % red, 31.8 % orange), and 42.9 % were hemodynamically unstable at or shortly after presentation. More than half of the patients (57 %) had surgical conditions, including 40.2 % who underwent surgery and 17.6 % who were treated conservatively. The most common diagnoses were intestinal obstruction (25.7 % of all cases) and hollow viscus perforation (18.8 %). Mortality was 11.1 %, and the mean hospital length of stay was 9.1 days. Predicting factors for death outcome (p-value<0.05) were advanced age, altered mental status, jaundice at presentation, peritonitis, known malignancy, and acute kidney injury.</p><p><strong>Conclusion: </strong>Abdominal pain is a common presenting problem, accounting for approximately 1 in 10 patients presenting to a tertiary care centre in Rwanda, with 2 in 5 patients requiring operative interventions. Identification of potential risk factors for mortality requires a multidisciplinary approach to decrease mortality and morbidity.</p>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"100895"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876058","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":"Adrenaline vs noradrenaline: Equity, context, and the realities of best practice.","authors":"Clint Hendrikse","doi":"10.1016/j.afjem.2025.100891","DOIUrl":"10.1016/j.afjem.2025.100891","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"100891"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12351318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876059","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":"Global health research abstracts: February ‘25","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2025.02.004","DOIUrl":"10.1016/j.afjem.2025.02.004","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 2","pages":"Pages 574-576"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687701","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":"Factors associated with mortality among patients with penetrating non-compressible torso hemorrhage in South Africa: A retrospective cohort study","authors":"Smitha Bhaumik ,&nbsp;Adane F. Wogu ,&nbsp;Lani Finck ,&nbsp;Maria Jamison ,&nbsp;Mengli Xiao ,&nbsp;Julia Finn ,&nbsp;Hendrick Lategan ,&nbsp;Janette Verster ,&nbsp;Shaheem de Vries ,&nbsp;Craig Wylie ,&nbsp;Lesley Hodson ,&nbsp;Mohammet Mayet ,&nbsp;Leigh Wagner ,&nbsp;L'Oreal Snyders ,&nbsp;Karlien Doubell ,&nbsp;Elaine Erasmus ,&nbsp;George Oosthuizen ,&nbsp;Christiaan Rees ,&nbsp;Steven G Schauer ,&nbsp;Julia Dixon ,&nbsp;Nee-Kofi Mould-Millman","doi":"10.1016/j.afjem.2025.02.002","DOIUrl":"10.1016/j.afjem.2025.02.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Non-compressible torso haemorrhage (NCTH), resulting from penetrating trauma to the chest, abdomen, or pelvis, places patients at high risk of death. The objectives of this study are to characterize the injury profile of patients with penetrating NCTH who receive care within a tiered public trauma system in South Africa and to identify factors associated with mortality.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of clinical data collected from Sept-2021 through Dec-2023 across 6 hospitals, 4 ambulance bases, and 2 mortuaries in the Western Cape Province that form a cohesive trauma referral pathway. The study included patients age ≥18 years with penetrating NCTH who arrived at the hospital within 3 h and received blood products within 6 h of injury. NCTH was defined as Abbreviated Injury Scale (AIS) ≥ 2 to chest, abdomen or pelvis, with a systolic blood pressure ≤ 100 mm Hg. Data were analysed using multivariable logistic regression and Cox proportional hazards modelling.</div></div><div><h3>Results</h3><div>There were 202 patients with penetrating NCTH; median age was 29 years, 94 % male, injured by stab wounds (66 %) and gunshot wounds (31 %). Most patients (85 %) sustained injuries to the chest, 33 % to the abdomen, and 1.5 % to the bony pelvis. In a multivariable logistic regression model, elevated Triage Early Warning Score (TEWS ≥7) (OR 4.45, 95 % CI 1.58–13.90), elevated New Injury Severity Score (NISS &gt;25) (OR 4.35, 95 % CI 1.45–16.30), anatomic injury to the abdomen/pelvis (OR 2.76, 95 % CI 1.03–7.74), and receipt of acute airway intervention (OR 4.97, 95 % CI 1.94–13.20) were significantly associated with 7-day in-hospital mortality.</div></div><div><h3>Conclusion</h3><div>Among patients with penetrating injuries to the torso, high triage scores, high injury severity, early airway interventions, and penetrating abdominal trauma were associated with elevated mortality risk.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 2","pages":"Pages 613-620"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global health research abstracts: April ‘25","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2025.03.001","DOIUrl":"10.1016/j.afjem.2025.03.001","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 2","pages":"Pages 589-591"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760276","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 effect of smartphones and mobile apps in Egyptian Emergency Departments: A cross-sectional study","authors":"Mohamed Hassan ,&nbsp;Roeya Aboelnasr ,&nbsp;Aya Farag Attia Elsebaey ,&nbsp;Sherif Shawky Elabd ,&nbsp;Alaa H. Ewida ,&nbsp;Waleed M. Taha","doi":"10.1016/j.afjem.2025.02.001","DOIUrl":"10.1016/j.afjem.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of mobile devices in healthcare environments has steeply increased the creation of medical software applications, or apps, for these platforms. It can enhance the provided healthcare services.</div></div><div><h3>Aim</h3><div>This study aimed to assess the prevalence of smartphone use among health care professionals (HCPs) in Egypt and detect the possible benefits and challenges identified by HCPs in the emergency department associated with the use of smartphones and mobile apps.</div></div><div><h3>Methods</h3><div>A cross-sectional 23-question structured survey-based study was conducted and distributed electronically via GoogleForms. The survey targeted all healthcare professionals working in emergency departments in Egypt either from University hospitals or the Ministry of Health.</div></div><div><h3>Results</h3><div>Among 130 responders, almost 89 % were physicians, while the rest were nurses. In addition, 53.1 % had one to four years of experience. Our study revealed that 62.3 % of the responders used medical apps daily with 61.5 % using smartphones during their work shifts. Though, about 81.5 % demonstrated limited or no availability of necessary technology infrastructure in ED. Furthermore, peer-reviewed evidence use was detected among 80 % of the responders using Google and other search engines for health-related information, and about 23 % of them used WikiEM and Wikipedia. Nevertheless, Medscape, MedCalc, and Up-to-date were among the most used medical apps with 69.2 %, 44.6 %, and 33.1 % respectively. Most of the responders were confident that smartphones could improve patient safety. In addition, satisfaction with current mobile apps was detected by more than 60 %, and most of the HCPs agreed that smartphones and mobile apps are crucial for future emergency healthcare delivery.</div></div><div><h3>Conclusion</h3><div>The use of smartphone apps in Egyptian ED is critical and is widespread among health providers; however, proper training on peer-reviewed resources can serve in improving medical health services.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 2","pages":"Pages 584-588"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704855","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 evolving role of paramedicine educators: A scoping review","authors":"Judy Sheahan ,&nbsp;Richelle Duffy ,&nbsp;Charmaine Cunningham","doi":"10.1016/j.afjem.2025.04.001","DOIUrl":"10.1016/j.afjem.2025.04.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Growing responsibility and changes to paramedicine and prehospital care have led to rapid developments in paramedicine education. Despite educational requirements at increasingly advanced levels, it remains unclear how academia has responded to these changes and if they're developing the requisite skills and knowledge.</div></div><div><h3>Methods</h3><div>A scoping review was undertaken to understand the present role of paramedicine educators and how they've adapted to the evolution of paramedicine education worldwide. Data searches were performed across eight electronic databases, six paramedicine journals, grey literature, and included sources reference lists.</div></div><div><h3>Results</h3><div>The four-staged search strategy revealed 1,738 sources, of which 32 remained for final synthesis. In general, there was a lack of contemporary research examining the role of the paramedicine educator despite changes to Higher Education provision and function of paramedics. Noteworthy was the absence of articles from Africa, South America, and major parts of Europe, highlighting the need for development in these regions. There is a lack of clear role descriptions or definitions for paramedicine educators. Inconsistencies were highlighted in entry criteria and progression routes across paramedicine academia globally, emphasising the importance of support for transitioning and established paramedicine educators.</div></div><div><h3>Discussion</h3><div>These findings have important implications for Higher Education. Professional demands are on the rise, creating a need to introduce clearly defined roles for paramedicine educators to provide clarity in expectations and increase confidence. The changing landscape of care provision in paramedicine from the historic emergency care focussed model to a more autonomous and inclusive sphere of out-of-hospital care, provides an ideal opportunity to progress and shape the identity of the paramedicine educator.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 2","pages":"Pages 595-601"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Health research abstracts: March ‘25","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2025.02.005","DOIUrl":"10.1016/j.afjem.2025.02.005","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 2","pages":"Pages 571-573"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143576997","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":"Acute trauma care training in undergraduate medical education programs in Uganda; A cross-sectional survey of final year medical students","authors":"Nankabirwa Victoria ,&nbsp;Guma Isaac ,&nbsp;Kabunga Jonathan ,&nbsp;Bigogo H Charles ,&nbsp;Navume Deborah Esther ,&nbsp;Mwanje T Kintu ,&nbsp;Nakiwere Elizabeth ,&nbsp;Chelimo Gerald ,&nbsp;Lemi Edward Nelson ,&nbsp;Kanyike A Marvin ,&nbsp;Francis M. Mwaka ,&nbsp;Law J Tyler ,&nbsp;Annet N. Alenyo ,&nbsp;Bulamba Fred","doi":"10.1016/j.afjem.2025.01.003","DOIUrl":"10.1016/j.afjem.2025.01.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma is one of the leading causes of death and long-term disability globally. In sub-Saharan Africa, the number of specialist emergency care personnel is inadequate and task shifting is common. We aimed to assess the variation in knowledge on acute trauma care, and self-perceived confidence in performing lifesaving skills amongst final year medical students in Uganda.</div></div><div><h3>Methods</h3><div>We conducted a multi-institutional, cross-sectional survey among final year medical students who had just completed their training from eight medical schools in Uganda. We assessed knowledge using a 25 standardized multiple-choice question test adopted from a previous study, and self-reported confidence in perfuming lifesaving skills, scored on a 5-Point Likert scale.</div></div><div><h3>Results</h3><div>Some 246 (88.5 %) participants responded to the survey and 241 provided complete data. The mean knowledge score was 58.9 % (SD; 12.4) with a mean variation ratio of 0.36 (SD; 0.17). The mean self-perceived confidence score of the participants was 3.8 (SD; 1.0) with relatively high scores in interpretation of radiological investigations (mean 4.2, SD; 0.9) and patient assessment (mean 4.1, SD; 0.9), and lower scores in management of different categories of trauma patients (mean 3.8, SD; 1.0) and performing life-saving procedures (mean 3.5, SD; 0.9). Only three institutions had emergency medicine physicians, with one at each institution, and 146 (60.6 %) of participants received no dedicated trauma training.</div></div><div><h3>Conclusion</h3><div>Final year medical students exiting training in Uganda had variable knowledge in acute trauma care and intermediate self-perceived confidence in performing lifesaving skills. Training programs need to standardize and strengthen acute trauma training and provide specialists and resources essential for trauma training at undergraduate level.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 2","pages":"Pages 602-606"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}