African Journal of Emergency Medicine最新文献

{"title":"Out of hospital emergency care in Nigeria: A narrative review","authors":"Taofiq Olusegun Oyedokun ,&nbsp;Emre Mehrab Islam ,&nbsp;Nkemakolam Obinna Eke ,&nbsp;Oladayo Oladipo ,&nbsp;Olurotimi Olaolu Akinola ,&nbsp;Olufunmilayo Salami","doi":"10.1016/j.afjem.2023.06.001","DOIUrl":"10.1016/j.afjem.2023.06.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Out of Hospital Emergency Care (OHEC) in Nigeria, the most populous country with the highest GDP in Africa, is considered inadequate. A better understanding of the current state of OHEC is essential to address the country's unique challenges and offer potential solutions.</p></div><div><h3>Objectives</h3><p>This paper sought to identify gaps, barriers, and facilitators in implementing an OHEC model in Nigeria and provide recommendations for improvement.</p></div><div><h3>Methods</h3><p>We searched MEDLINE (PubMed), Embase (OVID), CINAHL (EBSCO), and Google Scholar, using combinations of “emergency medical care” (‘FRC,’ ‘PHC,’ and ‘EMS’) OR prehospital care OR emergency training' AND 'Nigeria.' We included papers that described OHEC in Nigeria and were published in English. Of the initial 73 papers, those that met our inclusion criteria and those obtained after examination of reference lists comprised the 20 papers that contributed to our final review. Two authors independently reviewed all the papers, extracted data relevant to our objectives and performed a content analysis. All authors reviewed, discussed, and refined the proposed recommendations.</p></div><div><h3>Key recommendations</h3><p>For OHEC to meet the needs of Nigerians and achieve international standards, the following challenges need to be addressed: harmful cultural practices, inadequate training of citizens in the provision of first aid or of professionals that provide prehospital care, lack of proper infrastructure, poor communication, absent policy, and poor funding. Based on the available literature, this paper proposes key recommendations to improve OHEC with the hope of improving the standards of living. The federal government should provide general oversight, but this will require political will on the part of the country's leadership and the provision of adequate funding.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9805296","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":"Pediatric procedural sedation in African clinical settings: A mixed methods study of African providers’ sedation practices","authors":"Megan L. Schultz ,&nbsp;Andrew Melby ,&nbsp;Rebecca Gray ,&nbsp;Faye M. Evans ,&nbsp;Sarah Benett ,&nbsp;Michelle L. Niescierenko","doi":"10.1016/j.afjem.2023.06.005","DOIUrl":"10.1016/j.afjem.2023.06.005","url":null,"abstract":"<div><h3>Background</h3><p>Little is known about the practice of pediatric procedural sedation in Africa, despite being incredibly useful to the emergency care of children. This study describes the clinical experiences of African medical providers who use pediatric procedural sedation, including clinical indications, medications, adverse events, training, clinical guideline use, and comfort level. The goals of this study are to describe pediatric sedation practices in resource-limited settings in Africa and identify potential barriers to the provision of safe pediatric sedation.</p></div><div><h3>Methods</h3><p>This mixed methods study describes the pediatric procedural sedation practices of African providers using semi-structured interviews. Purposive sampling was used to identify key informants working in African resource-limited settings across a broad geographic, economic, and professional range. Quantitative data about provider background and sedation practices were collected concurrently with qualitative data about perceived barriers to pediatric procedural sedation and suggestions to improve the practice of pediatric sedation in their settings. All interviews were transcribed, coded, and analyzed for major themes.</p></div><div><h3>Results</h3><p>Thirty-eight key informants participated, representing 19 countries and the specialties of Anesthesia, Surgery, Pediatrics, Critical Care, Emergency Medicine, and General Practice. The most common indication for pediatric sedation was imaging (42%), the most common medication used was ketamine (92%), and hypoxia was the most common adverse event (61%). Despite 92% of key informants stating that pediatric procedural sedation was critical to their practice, only half reported feeling adequately trained. The three major qualitative themes regarding barriers to safe pediatric sedation in their settings were: lack of resources, lack of education, and lack of standardization across sites and providers.</p></div><div><h3>Conclusions</h3><p>The results of this study suggest that training specialized pediatric sedation teams, creating portable “pediatric sedation kits,” and producing locally relevant pediatric sedation guidelines may help reduce current barriers to the provision of safe pediatric sedation in resource-limited African settings.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/eb/main.PMC10491935.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10222496","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":"An investigation into the use of Full-body Low Dose X-rays Imaging system in South Africa: Radiographer's perspective","authors":"Muchui Julius Thambura","doi":"10.1016/j.afjem.2023.05.009","DOIUrl":"10.1016/j.afjem.2023.05.009","url":null,"abstract":"<div><h3>Introduction</h3><p>A low dose x-rays alias Lodox© statscan was originally developed in South Africa to detect smuggled diamonds in the mines. Later, hospital trauma units began to use it as a screening tool for gross pathology on trauma patients. This imaging system became popular because of its use of low radiation doses and its ability to perform anterior posterior (head to toe image) image in under 13 seconds. Anecdotal evidence confirms that patients were referred for additional regional images on conventional x-ray systems after Lodox imaging. Thus, patients were subjected to additional ionising radiation, long waiting times as well as additional charges for secondary radiological examinations.</p></div><div><h3>Objective</h3><p>This research aimed at investigating the extent to which Lodox was used in trauma units (n=28) in South Africa.</p></div><div><h3>Method</h3><p>In this descriptive cross-sectional research. researcher invited one radiographer from each of the 28 hospitals in South Africa that were using Lodox.</p></div><div><h3>Results</h3><p>Out of twenty radiographers who responded, it was found that most hospitals were referring patients for additional conventional x-ray images (Figure 1); for example, for chest x-rays. This was done despite the patient having undergone radiological procedures and examinations by the Lodox imaging system that was similar to those performed by conventional x-ray systems.</p></div><div><h3>Conclusion</h3><p>Lodox was used for a successful diagnosis Thus, researcher recommends an imaging protocol for Lodox to be developed for guiding the referral of patients after the Lodox scanning has been performed.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10491940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10219112","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":"Description and analysis of the emergency obstetric interfacility ambulance transfers (IFTs) to Kawempe National Referral Hospital in Uganda","authors":"Okong Doreen Alaleit ,&nbsp;Jonathan Kajjimu ,&nbsp;Kalanzi Joseph ,&nbsp;Magara Stella Namirembe ,&nbsp;Peter K. Agaba ,&nbsp;Andrew Kintu","doi":"10.1016/j.afjem.2023.06.003","DOIUrl":"10.1016/j.afjem.2023.06.003","url":null,"abstract":"<div><h3>Introduction</h3><p>In Uganda, 2% of women die from maternal causes with a mortality rate of 336 maternal deaths per 100,000 live births. According to the World Health Organization Uganda is one of the top three contributors to maternal mortality in sub-Saharan Africa. Uganda has parallel weak ambulance systems, government, and non-government-owned, that transport obstetric emergencies to higher-level facilities. These two operations lack standards of medical care and inter-facility transfer (IFT) protocols to direct care. Limited studies exist which assess the state of Emergency Care Services in Uganda and none has been performed to assess the ambulance referral services utilized to address obstetric emergencies.</p></div><div><h3>Objective</h3><p>The present study was performed to describe the ambulance transfer processes of obstetric emergencies by analyzing cases arriving at Kawempe National Referral Hospital (KNRH) from outlying health facilities</p></div><div><h3>Methods</h3><p>The study was based at KNRH in Kampala, Uganda. It was a descriptive and analytic cross-sectional study. Trained research assistants enrolled participating patients who met the inclusion criteria consecutively on arrival by ambulance at the hospital. Utilizing a questionnaire, quantitative data was collected from the ambulance driver, the sending facility referral form, and the receiving hospital's ambulance log book for each case. The sample size was 215.</p></div><div><h3>Results</h3><p>The median age was 27 years and the majority of patients were referred because of hypertensive disorders (34.9%), obstructed labor (26.5%) and hemorrhage (20.9%). The median total response time for transfer of obstetric emergencies was 50 min, from ambulance activation until the mother was received at KNRH. Differences were identified between government and non-government-owned ambulances in regards to the method of activation, medical escort staffing, number of vital signs recorded, and ambulance onboard medical care. Ambulances parked at the facility took the shortest transfer time and EMT-supported ambulances had the greatest number of vital signs taken<strong>.</strong></p></div><div><h3>Conclusions</h3><p>Recommendations are to develop an integrated ambulance system for both government and non-government ambulances with standards especially in regards to standardized scripted call-center calls analysis, dispatch activation time, response-to-patient time, and trained ambulance professional staffing and medical care whenever in patient transport mode.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10240556","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":"Disaster response readiness assessment of public hospitals in Addis Ababa City, Addis Ababa, Ethiopia","authors":"Yared Boru Firissa ,&nbsp;Menbeu Sultan ,&nbsp;Mahdi Abdelwahab ,&nbsp;Fitsum Kifle Belachew","doi":"10.1016/j.afjem.2023.06.004","DOIUrl":"10.1016/j.afjem.2023.06.004","url":null,"abstract":"<div><p><strong>Introduction:</strong> Due to its diverse geography, climate, and political instability, Ethiopia is one of the countries most affected by disasters. However, there is a lack of evidence-based assessments of disaster preparedness, especially in Addis Ababa, where most tertiary-level referral hospitals are located. This study aims to evaluate disaster readiness in public hospitals in Addis Ababa using WHO standards, focusing on hospital characteristics, disaster plans, infrastructure, and human resources availability. Ultimately, the findings are expected to provide actionable recommendations for improving disaster preparedness in public hospitals in the city.</p><p><strong>Methods:</strong> A cross-sectional study design was utilized using quantitative and qualitative methods to assess disaster response readiness among public hospitals in Addis Ababa, the capital city of Ethiopia.</p><p><strong>Results:</strong> This study assessed ten public referral hospitals in Addis Ababa. In the last two years, all but one of the ten public referral hospitals in Addis Ababa have experienced a disaster. Road traffic accidents are responsible for half of all disasters. While 50% of the hospitals have trauma-specific plans, there are no disaster-specific guidelines for the remaining hospital. Moreover, all facilities and ambulances lack communication networks to receive assistance during disasters. A total of 88.8% of emergency and disaster facility level representatives (n=18) stated that their emergency care areas need improvement to be able to manage patients during disasters more effectively. While seven hospitals (70%) have separate disaster medication and equipment storage, only three (43%) are regularly restocked. Furthermore, nearly half of the respondents (44%) reported that their hospital does not have a functional disaster management team, and 61% are unprepared to handle a disaster. Lastly, 33% of the respondents mentioned the Ministry of Health and hospital leaders' commitment as an enabling factor to improve future disaster response readiness.</p><p><strong>Conclusion:</strong> Public referral hospitals in Addis Ababa have significant gaps in disaster management preparedness and response. A comprehensive disaster response plan, including staff training, regular restocking of medication and equipment, and functional communication networks, should be implemented in every public referral hospital. It is imperative that all stakeholders work together, including local government authorities, emergency response teams, and community members, to ensure hospitals are well-equipped to deal with disasters.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10491934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10219108","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":"Epidemiology and outcomes of geriatric trauma patients consulting at the center hospitalier universitaire de Kigali emergency department","authors":"Martin Sabigaba ,&nbsp;Ling Jing ,&nbsp;Gabin Mbanjumucyo ,&nbsp;Lise Mumporeze ,&nbsp;Aly Beeman ,&nbsp;Kyle D. Martin","doi":"10.1016/j.afjem.2023.08.001","DOIUrl":"10.1016/j.afjem.2023.08.001","url":null,"abstract":"<div><h3>Background</h3><p>Life expectancy in low- and middle-income countries (LMIC) continues to rise, resulting in a growing geriatric population. In Rwanda, a sub-Saharan LMIC, traumatic injuries are a common cause of mortality and morbidity. However, little is known about the frequency and type of traumatic injuries among geriatric populations in Rwanda.</p></div><div><h3>Objective</h3><p>We explored the epidemiology and outcomes of trauma for geriatric patients presenting to the emergency department (ED) of the center Hospitalier Universitaire de Kigali (CHUK) in Rwanda.</p></div><div><h3>Methods</h3><p>This prospective cross-sectional study was conducted from July 2019 to January 2020 at the ED of CHUK. Trauma patients aged 65 and above and alive at the time of evaluation were eligible for inclusion. Demographic characteristics were collected along with triage category, mechanism of injury, transfer status, transport method to CHUK, time spent at the ED, complications, and mortality predictors.</p></div><div><h3>Results</h3><p>For the 100 patients enrolled, the most common injury mechanism was falls (63%), followed by road traffic accidents (28%). The majority of patients spent less than 48 h in the ED (63%). The mortality rate was 14%, with most deaths resulting from injury-related complications. Triage category, Kampala Trauma Score, and Glasgow Coma Scale were significant predictors of mortality, with p-values of 0.002, &lt;0.001, and &lt;0.001, respectively.</p></div><div><h3>Conclusions</h3><p>The epidemiology of geriatric trauma found in this study can inform public health and clinical guidelines. Interventions targeting falls and road traffic accidents would target the most common geriatric trauma mechanisms, and clinical protocols that take into account predictors of mortality could improve outcomes and increase life expectancy for this population.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10470277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10152675","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":"Injury patterns in patients with severe traumatic brain injuries from motor crashes admitted to Mulago hospital accidents & emergency unit","authors":"Joseph Kalanzi ,&nbsp;Lee Wallis ,&nbsp;Mary Nabukenya ,&nbsp;Erasmus Okello ,&nbsp;Doreen Okong ,&nbsp;Stella Namirembe","doi":"10.1016/j.afjem.2023.03.003","DOIUrl":"10.1016/j.afjem.2023.03.003","url":null,"abstract":"<div><h3>Background</h3><p>The global burden of Road Traffic Crashes (RTC) is increasing. Uganda has one of the highest rates of RTCs in Sub-Sahara. Victims of RTCs sustain varying degrees of injuries depending on factors including the velocity at time of impact, protective gear; and if it was a motorcycle–motorcycle or motorcycle–vehicle crash. High speed collisions can result in severe forms of injuries and polytrauma. Some injuries are undetected.</p></div><div><h3>Methods</h3><p>A cross sectional study was carried at Mulago Hospital Accidents &amp; Emergency Unit, between November 2021 and February 2022; on all adult patients (≥18 years) with severe head injury from motor road traffic crashes. The study looked at injury patterns and assessed the relationship of polytrauma in patients with severe head injury to the mechanism of injury (motorcycles versus vehicles). Data were extracted from patient charts using a validated data abstraction tool and complete head to toe physical examination was carried out and injuries recorded. Data were analysed to determine the relationship of polytrauma in patients with severe head injury to the mechanism of injury.</p></div><div><h3>Results</h3><p>The participants were predominantly males with a population median age of 32 (25-39). The commonest modes of transportation of patients to the hospital were Police Pickup trucks (40%) and ambulance (36.1%). Among motorcycle RTCs, (19.2%) wore helmets; 21.2% had protective gear; with injury identified mainly in; the limbs (84.8%), neck (76.8%), chest (39.4%), and abdomen (26.3%). Patients from vehicle RTCs were 19% more likely to have polytrauma compared to patients from motorcycle RTCs.</p></div><div><h3>Conclusions</h3><p>This study showed that patients who sustain severe traumatic brain injuries from vehicle crashes have an increased likelihood of having multiple injuries, compared to patients from motorcycle RTCs. For motorcycle users, injuries mostly affect the limbs. At particular risk are motorcyclists who do not wear helmets and protective coveralls.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10149386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9416278","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":"Pattern of admissions and outcome in the children emergency department of a tertiary health institution in Southwestern Nigeria: A four-year review","authors":"Tosin Anthony Agbesanwa ,&nbsp;Adefunke Olarinre Babatola ,&nbsp;Odunayo Adebukola Fatunla ,&nbsp;Azeez Ibrahim ,&nbsp;Felix O Aina ,&nbsp;Ezra Olatunde Ogundare ,&nbsp;Adewuyi Temidayo Adeniyi ,&nbsp;Funmilayo Egbedi ,&nbsp;Tinu Olubamiwa ,&nbsp;Bolanle Olanipekun ,&nbsp;Oladele Simeon Olatunya","doi":"10.1016/j.afjem.2023.02.001","DOIUrl":"10.1016/j.afjem.2023.02.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Pediatrics and adolescents are susceptible to illnesses that often necessitate emergency attention. Morbidity and mortality from illnesses in these ages have attracted much interest globally, particularly in Africa. Knowledge of pattern and outcomes of admissions may guide policy and interventions especially in resource constrained settings. The study aimed to determine the pattern of admissions, outcomes and seasonal variations of conditions that presented at the children emergency of a tertiary health institution over a four-year period.</p></div><div><h3>Methods</h3><p>A retrospective descriptive study of children emergency admissions from January 2016 to December 2019. Information obtained included age, diagnosis, month and year of admission, and outcome. Descriptive statistics were used to describe the demographic characteristics and Chi-squared test to assess their associations with the diagnoses made.</p></div><div><h3>Results</h3><p>There were 3,223 admissions. There were more males (1866; 57.9%) and more toddlers (1181; 36.6%). The highest number of admissions were observed in the year 2018 (951; 29.6%) and during the wet season (1962; 60.9%). There was an overall mortality rate of 7%; complicated malaria, gastroenteritis and meningitis were the leading causes of death. Malaria (χ2 = 135.522, p value &lt; 0.001), and gastroenteritis (χ2 = 130.883, p value &lt; 0.001) were predominant among the toddlers while sepsis (χ2 = 71.530, p value &lt; 0.001) and pneumonia (χ2 = 133.739, p value &lt; 0.001) were more among the infants. Typhoid enteritis (χ2 = 26.629, p value &lt; 0.001) and HIV (χ2 = 16.419, p value = 0.012) were commoner among the early adolescents.</p></div><div><h3>Conclusion</h3><p>The major causes of death in the study area are preventable with more of these amongst the children under the age of 5 years. There are seasonal and age-related patterns to admissions and the need for policy formulations and emergency preparations to be tailored towards these observed patterns through the year</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3c/71/main.PMC9970896.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10826947","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":"Diagnostic Performance of Point of Care Ultrasound Compared to Chest X-Ray in Patients with Hypoxia at a Teaching Hospital Emergency Department in Uganda","authors":"Prisca Mary Kizito ,&nbsp;Kenneth Daniel Bagonza ,&nbsp;Justine Athieno Odakha ,&nbsp;Linda Grace Nalugya ,&nbsp;Pius Opejo ,&nbsp;Anthony Muyingo ,&nbsp;Harry Chen ,&nbsp;Derek Harborne","doi":"10.1016/j.afjem.2023.02.004","DOIUrl":"10.1016/j.afjem.2023.02.004","url":null,"abstract":"<div><h3>Background</h3><p>Hypoxia is a common presentation in the Emergency Department (ED) worldwide. It affects 9-12% of hospitalized adults in Sub-Saharan Africa. Timely diagnosis of the multiple causes such as pneumonia, heart failure among others is challenging. Chest X-Ray (CXR), one of the most utilized imaging modalities has many limitations, and the gold standard (Computed Tomography scan) is inaccessible. Point of care ultrasound (PoCUS) is more available and increasingly being used, however little is known of its performance in resource limited EDs. The study aimed to assess the diagnostic performance of PoCUS compared with CXR in identifying the causes of hypoxia in the medical ED.</p></div><div><h3>Methods</h3><p>49 adults presenting with hypoxia (SP02 ≤ 88%) in the medical ED were evaluated. Ultrasound of the lungs and heart (PoCUS) was done, then CXR obtained. Lung ultrasound (LUS) was compared with CXR (first reference standard). Chest X-Ray and PoCUS were each compared to the physician diagnosis (second reference standard) to determine agreement using an acceptable disagreement cut-off of 15%.</p></div><div><h3>Results</h3><p>31% more abnormalities were identified by LUS than CXR. Lung ultrasound findings agreed with CXR in 86% of the participants with moderate reliability (ĸ=0.75). There was no significant difference between the actual findings of the two tests (X²= 2, p 0.1). Using the second reference, 82% of the CXRs were similar with weak reliability (ĸ=0.5) compared to 98% of PoCUS findings with strong reliability (ĸ=0.9). Compared to PoCUS, CXRs significantly differed from the physician diagnosis (X²= 0.85, p 0.38 vs X²= 8.5, p 0.004 respectively).</p></div><div><h3>Conclusion</h3><p>Overall, PoCUS was not inferior to CXR when compared to final physician diagnosis in identifying causes of hypoxia, and LUS and CXR had comparable performance. Significantly more abnormalities were identified on PoCUS and it demonstrated better agreement and strong reliability with the physician diagnosis than CXR. We recommend PoCUS use in patients with hypoxia attending resource limited in- and pre-hospital settings.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10019986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9499445","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":"Effectiveness of handover practices between emergency department and intensive care unit nurses","authors":"Tebogo T. Mamalelala ,&nbsp;Shelley Schmollgruber ,&nbsp;Meghan Botes ,&nbsp;William Holzemer","doi":"10.1016/j.afjem.2023.03.001","DOIUrl":"10.1016/j.afjem.2023.03.001","url":null,"abstract":"<div><h3>Background</h3><p>Nurses from the emergency department (ED) and the intensive care unit (ICU) must interact during the handover procedure. Factors such as unit boundaries, the interaction between different specialities, patient acuities, and treatment adjustments generate specific negotiating and teamwork problems during the transition of patients from ED to ICU.</p></div><div><h3>Objective</h3><p>This study aimed to describe the opinions of nurses regarding the effectiveness of handover practices between nurses in the ED and ICU in a major academic hospital in Gauteng province, South Africa.</p></div><div><h3>Method</h3><p>An analytical cross-sectional survey design was used. Data were collected using a 16-item handover evaluation tool. It comprises two sections (1) biographical details and (2) 16 statements about handover quality divided into five constructs, namely information transfer, shared understanding, working atmosphere, overall handover quality, and circumstances of handover. Data analysis was done utilising descriptive and non-parametric statistics.</p></div><div><h3>Results</h3><p>The majority (51.8%; n = 115) of the handovers occurred during the day. Out of 171 nurses, there were specialist practice emergency (19.2%; n = 33) and intensive care (28.0%; n = 48) nurses. There was statistical significance in information transfer between the ED and ICU nurses. (Me = 4.0, p &lt; 0.05), compared to ICU nurses (Me = 3.0). Nurse specialist and non-specialist nurses' handovers differed statistically significantly on 12 of the 16 items on the rating scale, compared to 10 for non-specialist nurses' handovers.</p></div><div><h3>Conclusion</h3><p>The study showed that ED and ICU nurses have significantly different requirements and expectations for handover procedures. In addition to completed documentation, subtle interpretations of the information provided and received also impact the need. The ED and ICU nurses would need to agree on the contents of a structured handover framework because different specialities and departments have varied expectations to achieve an effective handover.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10033719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9560628","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}