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The practical dissemination of new knowledge is not given adequate attention despite large investment in undertaking high-quality research and the desire for evidence-based practice. It is important that those involved in knowledge translation and continuing medical education understand the fundamental principles of effective presentations, whether at scientific conferences, workshops or group teaching sessions. The switch to remote presentations has made this a more challenging endeavour. We describe established presentation techniques that improve knowledge translation and how to use them in both face-to-face and remote settings.
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Educación Médica Continua , Ciencia Traslacional Biomédica , HumanosRESUMEN
BACKGROUND: Uganda continues to depend on a health system without a well-defined emergency response system. This is in the face of the rising cases of out-of-hospital cardiac arrest contributed largely to the high incidence of road traffic accidents. Non-communicable diseases are also on the rise further increasing the incidence of cardiac arrest. Medical students are key players in the bid to strengthen the health system which warrants an assessment of their knowledge and attitude towards BLS inclusion in their study curriculum. METHODS: A descriptive cross-sectional study was conducted in 2021 among undergraduate medical students across eight public and private universities in Uganda. An online-based questionnaire was developed using Google forms and distributed via identified WhatsApp groups. Chi-square or Fisher's exact test and logistic regression were performed in STATA 15 to assess the association between knowledge of BLS and demographics. P < 0.05 was considered statistically significant. RESULTS: Out of the total 354 entries obtained, 351 were analyzed after eligibility screening. Of these, (n = 250, 71.2%) were male less than 25 years (n = 273, 77.8%). Less than half (n = 150, 42.7%) participants had undergone formal BLS training. Less than a third of participants (n = 103, 29.3%) had good knowledge (≥ 50%) with an overall score of 42.3 ± 12.4%. Age (p = 0.045), level of academic progress (p = 0.001), and prior BLS training (p = 0.033) were associated with good knowledge. Participants with prior training were more likely to have more BLS knowledge (aOR: 1.7, 95% CI: 1.1-2.7, p = 0.009). The majority (n = 348, 99.1%) believed that BLS was necessary and would wish (n = 343, 97.7%) to have it included in their curriculum. CONCLUSIONS: Undergraduate medical students have poor BLS knowledge but understand its importance. Institutions need to adopt practical teaching methods such as clinical exposures, field experience in collaboration with local implementers, and participating in community health promotion campaigns.
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Reanimación Cardiopulmonar , Estudiantes de Medicina , Reanimación Cardiopulmonar/educación , Estudios Transversales , Curriculum , Humanos , Masculino , UgandaRESUMEN
BACKGROUND: There is a high mortality of burns especially in low- and middle-income countries which already have less developed healthcare systems. Besides, little is known about nursing students' knowledge and practices towards the need to monitor fluid requirements in admitted burns patients. OBJECTIVE: To assess the knowledge and practices of nursing students regarding monitoring fluid requirements for hospitalised paediatrics and adult burn patients on the surgical ward at Mbarara regional referral hospital. METHODS: We conducted an online descriptive cross-sectional study among clinical nursing students at Mbarara University of Science and Technology (MUST) during September and November 2021. We assessed knowledge and practices using an adapted questionnaire. Summary statistics were then used to describe the data. RESULTS: Thirty-seven nursing students (64.9% response rate) participated in our survey. Twenty one (56.8%) were female and had a modal age range of 20-24 years. Nineteen (51.4%) of the students were BNC (Bachelor of Nursing Completion) students, with the rest being BNS (Bachelor of Nursing). More than 75% of students correctly answered each of two out of the ten questions. More than three quarters of the students reported having done each of six out of the eleven practices surveyed. CONCLUSION: Nursing students had poor knowledge and fair satisfactory practices regarding monitoring of the fluid requirements in burns patients. More similar studies are needed to survey more nursing students on this topic and to henceforth evaluate the need for periodic re-trainings and reassessment of clinical skills of nursing students.
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PURPOSE OF REVIEW: Concern regarding appendicitis is a common reason for presentation to the paediatric emergency department. We review recent progress in the use of biomarkers, imaging and clinical scoring systems in improving diagnostic accuracy in suspected appendicitis in children. RECENT FINDINGS: Use of ultrasound, often performed at the bedside, is becoming more widespread with a parallel reduction in computed tomography (CT) use. Protocols for image acquisition and interpretation have been shown to improve diagnostic accuracy. Novel biomarkers have been explored and clinical diagnostic algorithms refined but none have achieved the level of diagnostic accuracy required. SUMMARY: Appendicitis remains a clinical diagnosis. Point of care ultrasound is increasingly available and offers higher diagnostic accuracy than several routinely performed laboratory investigations. Recent publications provide support for increased use of clinician performed ultrasound, increased use of MRI, less use of CT, less emphasis on basic laboratory investigation and a renewed respect for the value of serial examination, particularly early in the course of illness.
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Apendicitis , Servicio de Urgencia en Hospital , Apendicitis/diagnóstico por imagen , Niño , Humanos , Sistemas de Atención de Punto , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
The high-risk, high-stress and high-stakes environment of out-of-hospital or emergency department paediatric resuscitation is prone to human error, and medication errors are common. This could be contributing to the difference in survival rate of resuscitation in the out-of-hospital versus inpatient setting. Medication for children during resuscitation requires estimation of the child's weight and calculation of the corresponding drug dose. Whilst both of these steps can lead to error, calculation errors (including 10-fold errors) are much more common and harmful than weight errors. Previous solutions aim to optimise each stage of the medication dosing process. Currently, Australian guidelines suggest using the highly inaccurate original advanced paediatric life support formula, weight = 2 × (age + 4), to dose medications in these settings. This means age is converted to weight, which is then converted to dose. There is no evidence that this is causing harm to patients. Therefore, it could be suggested that age could safely be converted straight to dose according to preset doses. This eliminates the need for any weight estimation or dose calculation, thus reducing the potential for error and harm.
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Relación Dosis-Respuesta a Droga , Errores de Medicación/prevención & control , Resucitación/normas , Australia , Niño , Preescolar , Servicio de Urgencia en Hospital , Humanos , Lactante , Recién NacidoRESUMEN
AIM: Children frequently ingest coins (generally with minimal reported side effects); however, the ingestion of other items has been subject to less academic study. Parental concern regarding ingestion applies across a range of materials. In this study, we aimed to determine typical transit times for another commonly swallowed object: a Lego figurine head. METHODS: Six paediatric health-care professionals were recruited to swallow a Lego head. Previous gastrointestinal surgery, inability to ingest foreign objects and aversion to searching through faecal matter were all exclusion criteria. Pre-ingestion bowel habit was standardised by the Stool Hardness and Transit (SHAT) score. Participants ingested a Lego head, and the time taken for the object to be found in the participants stool was recorded. The primary outcome was the Found and Retrieved Time (FART) score. RESULTS: The FART score averaged 1.71 days. There was some evidence that females may be more accomplished at searching through their stools than males, but this could not be statistically validated. CONCLUSIONS: A toy object quickly passes through adult subjects with no complications. This will reassure parents, and the authors advocate that no parent should be expected to search through their child's faeces to prove object retrieval.
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Heces , Cuerpos Extraños , Adulto , Niño , Preescolar , Deglución , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE OF REVIEW: Over the last 2 years, algorithms for the optimal management of status epilepticus have changed, as the medical community has recognized the need to terminate seizures in status in a timely manner. Recent research has evaluated the different choices of benzodiazepine and has given consideration to second-line treatment options. RECENT FINDINGS: There has been a move to examine alternatives to phenytoin (such as levetiracetam and lacosamide) as second-line agents. Valproate should be used cautiously in view of the potential side effects. Three ongoing trials [Established Staus Epilepticus Treatment Trial (ESETT), Convulsive Status Epilepticus Paediatric Trial (ConSEPT), and emergency treatment with levetiracetam or phenytoin in status epilepticus in children (EcLiPSE)] are comparing the efficacy of levetiracetam and phenytoin. SUMMARY: Benzodiazepines remain the first-line agent of choice, although there is ongoing discussion about the mode of administration and the best drug to choose. The results of ESETT, ConSEPT, and EcLiPSE will affect our future management of status, as we give consideration to levetiracetam as an alternative to phenytoin. Other medications such as lacosamide may emerge in future algorithms too.
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Anticonvulsivantes/uso terapéutico , Estado Epiléptico/tratamiento farmacológico , Algoritmos , Niño , Toma de Decisiones Clínicas , Tratamiento de Urgencia/métodos , Humanos , Sistemas de Atención de Punto , Estado Epiléptico/diagnósticoRESUMEN
OBJECTIVES: To determine the incidence of patients presenting to a major metropolitan hospital after experiencing syncope at church, and to compare their outcomes with those of patients experiencing syncope at other locations. DESIGN, SETTING AND PARTICIPANTS: A retrospective matched cohort study in which patients presenting with church syncope between July 2009 and June 2013 were compared with controls (patients presenting after syncope experienced elsewhere) matched by 5-year age group and San Francisco Syncope Score. MAIN OUTCOME MEASURES: Admission to hospital was the primary outcome measure. Mortality, intensive care unit or coronary care unit admission, and length of stay in hospital were secondary outcome measures. RESULTS: There were 31 cases of church syncope during the study period, which were matched to 62 controls. The hospital admission rate among patients who experienced syncope in church was significantly lower than among controls (22.6% v 46.8%; P = 0.02). After adjusting for other variables significantly associated with admission to hospital, the church as a location for syncope was no longer significantly associated with hospital admission (odds ratio, 0.4; 95% CI, 0.1-1.1; P = 0.06). CONCLUSIONS: The number of patients presenting to hospital after church syncope was low; most had benign diagnoses and were discharged home from the emergency department. While syncope at church was associated with a lower rate of hospital admission, the church did not appear to offer any additional sanctuary when clinical risk profiles were taken into consideration.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Religión , Síncope/epidemiología , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Incidencia , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Análisis por Apareamiento , Análisis Multivariante , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Síncope/etiología , Síncope/terapia , Victoria/epidemiologíaRESUMEN
The SARS-CoV-2 coronavirus (COVID-19) pandemic is in constant evolution, much like the virus, and we must learn to adapt our undergraduate education and learning strategies to enable students to complete their studies. This narrative review focuses on what is currently known about the face-to-face and e-learning strategies of undergraduate medical students in resource-limited settings during the COVID-19 pandemic. The majority of studies, involving health professional students, took place in 2020. Few involved educators. Students have faced challenges with the transition to remote learning, for which a couple of interventions have been devised. Bridging the gap in access and utilisation of remote learning might have required more time, however, the COVID-19 pandemic has accelerated the learning curve and the transition from in-person to online learning.
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OBJECTIVES: Paediatric forearm fractures are common. Anecdotally, there is a trend towards ED reduction of selected fractures under procedural sedation. We aimed to determine the rate of subsequent operative intervention for fracture re-displacement. METHODS: Retrospective observational study of children with a forearm/wrist fracture undergoing fracture reduction in ED. Outcome of interest was operative intervention for fracture re-displacement within 6 weeks. RESULTS: Among 176 patients studied, operative intervention occurred in nine patients (5.1%, 95% confidence interval 2.7-9.4%). CONCLUSION: Reduction of paediatric forearm fractures under procedural sedation by ED clinicians is increasingly common and results in a low rate of subsequent operative intervention.
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Traumatismos del Antebrazo , Fracturas del Radio , Fracturas del Cúbito , Niño , Humanos , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugía , Antebrazo , Traumatismos del Antebrazo/cirugía , Servicio de Urgencia en Hospital , Estudios RetrospectivosRESUMEN
Introduction: Emergency medicine (EM) is a new specialty in Uganda. There is no current formal EM undergraduate curriculum. The Mbarara University of Science and Technology Emergency Medicine Interest Group (MUST-EMIG) was established to bridge this gap. This survey was done to assess the contributions of MUST-EMIG. Objectives of the study were to: discover students' reasons for joining the MUST-EMIG; assess whether interest in learning emergency medicine was affected by participation in MUST-EMIG; evaluate plans to pursue emergency medicine as a specialty before and after joining MUST-EMIG; determine whether MUST-EMIG affected students' perception of emergency medicine's importance in Uganda's health care system; and elicit feedback from students on their experience as members of MUST-EMIG. Methods: The MUST-EMIG executive developed a membership survey which was reviewed by MUST-EMIG's faculty advisor for suitability. Members of MUST-EMIG were voluntarily asked to participate in the online survey. Results of the survey were summarized using descriptive statistics and thematic analysis. Results: 49 responses (46.7% response rate) were collected and analyzed. Participants included 29 (59.2%) male and 20 (40.8%) female medical students. The majority of participants were fourth year students 22 (44.9%). 44 (89.8%) students joined MUST-EMIG to learn how to handle medical emergencies, and expressed a desire of at least 6/10 to learn more about emergency medicine after utilizing opportunities provided by MUST-EMIG. Overall, students had a good experience with MUST-EMIG. They reported that our interest group had provided them networking, unique learning, and leadership opportunities. Having an EMIG significantly affects students' desire to pursue a career in emergency medicine and their perception of the relevance of emergency medicine. Discussion: An EMIG helps develop interest of medical students in emergency medicine. Students passionate about emergency medicine need to be supported to help them preserve and further develop this passion.
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OBJECTIVE: Clean-catch urine (CCU) samples are frequently contaminated. Our aim was to determine if cleaning with 0.1% chlorhexidine before CCU is a safe and feasible method to reduce contamination. METHODS: Prospective interventional pilot study. Children 1-24 months underwent perigenital skin cleaning with 0.1% chlorhexidine. Primary outcome was contamination rate, and secondary outcomes were parent and clinician satisfaction with the procedure. RESULTS: Twelve of 54 urine samples were contaminated (22%, 95% CI 13-35). Over 90% of parents and clinicians were either 'satisfied' or 'very satisfied'. No adverse events were recorded. CONCLUSION: Cleaning with chlorhexidine solution before CCU is safe and feasible.
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Clorhexidina , Infecciones Urinarias , Niño , Clorhexidina/farmacología , Clorhexidina/uso terapéutico , Humanos , Lactante , Proyectos Piloto , Estudios Prospectivos , Toma de Muestras de Orina/métodosRESUMEN
Introduction Educational podcasts are increasingly being utilized by health professionals for continuing education, but how they are being used remains poorly understood. Given their extensive reach, they represent a phenomenal opportunity for researchers to engage in knowledge translation of their scholarly works. The design, study, and effectiveness of these resources should be informed by a deeper understanding of their pragmatic usage. We aimed to prospectively determine the pragmatic, real-world listening habits of health professionals. Methods We performed a prospective observational study of a broad, interprofessional sample of participants (medical students, residents, physicians, nurses, physician assistants, and paramedics) recruited through a multimodal social media (Twitter and Facebook) campaign. Recruitment materials included an infographic and study website. Participants listened to eight podcasts and described their use of each in subsequent questionnaires. Results A total of 393 participants enrolled in the study, and 241 completed the survey for all eight podcasts. Listening behaviors were consistent across the podcasts with the majority selecting a normal speed of playback and engaging in concomitant activities such as driving. One-third of participants paused the podcasts due to interruption. Conclusion We describe the prospective use of medical podcasts by a cohort of health professionals. This work should inform the role of podcasts in the communication of medical research.
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There has been an increased focus on diversity and inclusion in medicine in recent years-the field of medicine still has a long way to go to reach gender equity. We assess how paediatrics is performing by examining the role gender plays in our specialty; and we propose some practical solutions to reach an equitable state. Achieving gender equity is not a simple or easy option and will require an ongoing commitment from all facets of the profession.
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Equidad de Género , Pediatras , Australia , Femenino , Humanos , Masculino , Medicina Estatal , Reino Unido , Estados UnidosRESUMEN
BACKGROUND: Burnout is common among university students and may adversely affect academic performance. Little is known about the true burden of this preventable malady among university students in low-and-middle-income countries (LMICs). OBJECTIVES: This study aimed to systematically estimate the prevalence of burnout among university students in LMICs. METHODS: We searched PubMed, Google Scholar, CINAHL, Web of Science, African Journals Online, and Embase from the inception of each database until February 2021. Original studies were included. No study design or language restrictions were applied. A random-effects meta-analysis was performed using STATA version 16.0. Heterogeneity and publication bias were assessed using Q-statistics and funnel plots, respectively. RESULTS: Fifty-five unique articles, including a total of 27,940 (Female: 16,215, 58.0%) university students from 24 LMICs were included. The Maslach Burnout Inventory (MBI) was used in 43 studies (78.2%). The pooled prevalence of burnout was 12.1% (95% Confidence Interval (CI) 11.9-12.3; I2 = 99.7%, Q = 21,464.1, p = < 0.001). The pooled prevalence of emotional exhaustion (feelings of energy depletion), cynicism (negativism), and reduced professional efficacy were, 27.8% (95% CI 27.4-28.3; I2 = 98.17%. p = <0.001), 32.6 (95% CI: 32.0-33.1; I2: 99.5%; p = < 0.001), and 29.9% (95% CI: 28.8-30.9; I2: 98.1%; p = < 0.001), respectively. CONCLUSION: Nearly one-third of university students in LMICs experience burnout. More studies are needed to understand the causes of burnout in this key population. There is a need to validate freely available tools for use in these countries.
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Agotamiento Profesional/epidemiología , Países en Desarrollo , Renta , Estudiantes , Universidades , Rendimiento Académico , Adolescente , Adulto , COVID-19/psicología , Emociones , Femenino , Humanos , Masculino , Prevalencia , Adulto JovenRESUMEN
Previous research has examined the utilisation of musical cues to improve the performance of cardiopulmonary resuscitation (CPR) delivered in training environments. We postulated a musical cue that is both contemporary and transcends cultures may improve CPR performance. Our aim was to establish whether chest compressions are performed with improved rate and depth if a song of a fixed beat (PinkFong's 'Baby Shark' with a tempo of 115 beats per minute (bpm) and 15 beats in each verse) is played to a healthcare professional immediately before undertaking CPR compared to whale noises (a non-metronomic rhythm). 58 Participants of a paediatric conference (majority doctors) were randomly assigned to listen to a minute of Baby Shark (28) or whale song (30) and then undertake a minute of CPR. There was no significant difference in the mean compression rate between the Baby Shark and control groups, with the groups achieving 121 and 125 bpm, respectively (p=0.18). In relation to compression depth within the target zone, the Baby Shark group had more compressions completed within the target zone (55%) than the control group (39%) although this difference was not significant (p=0.08). Listening to Baby Shark prior to undertaking simulated CPR does not improve overall performance, but there is a potential tendency to improve adequate compression depth which may be beneficial in training exercises.
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OBJECTIVE: For seriously ill children, weight is often required to direct critical interventions. As it is not always feasible to measure weight in emergencies, age-based weight prediction formulae may be used as an alternative. The Best Guess formulae, derived in Australia, have been shown to be among the most accurate age-based methods in Australian children. They were validated in 2010. The present study aims to re-validate the Best Guess formulae and compare their performance to the previous validation cohort. METHODS: A prospective observational study was conducted in the paediatric ED of a community teaching hospital. It included a convenience sample of children aged 1 month to 10 years who presented between July 2018 and April 2019. Seriously ill children were excluded. Data collected included measured weight, height, gender, age and ethnic group. The outcomes of interest were predictive performance of Best Guess formulae and comparison of predictive accuracy with a 2005 cohort from the same ED. RESULTS: A total of 961 patients were included; 42% girls, median age 3 years. The sample was ethnically diverse. Mean percent difference in weight was -3.3% with the formulae usually over-estimating weight. Overall, agreement within 10% was 41.8%; agreement within 20% was 72.6%. Predictive accuracy was not significantly different between the cohorts. CONCLUSION: The Best Guess method has not reduced in accuracy as a weight estimation method in emergent situations in this Australian cohort, despite a tendency to slightly over-estimate children's weight. Further study is needed to test the Best Guess method's accuracy in ethnic subgroups.
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Antropometría/métodos , Peso Corporal , Servicio de Urgencia en Hospital , Australia , Niño , Preescolar , Femenino , Hospitales de Enseñanza , Humanos , Lactante , Masculino , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
INTRODUCTION: Podcasts are increasingly being used for medical education. Studies have found that the assessment of the quality of online resources can be challenging. We sought to determine the reliability of gestalt quality assessment of education podcasts in emergency medicine. METHODS: An international, interprofessional sample of raters was recruited through social media, direct contact, and the extended personal network of the study team. Each participant listened to eight podcasts (selected to include a variety of accents, number of speakers, and topics) and rated the quality of that podcast on a seven-point Likert scale. Phi coefficients were calculated within each group and overall. Decision studies were conducted using a phi of 0.8. RESULTS: A total of 240 collaborators completed all eight surveys and were included in the analysis. Attendings, medical students, and physician assistants had the lowest individual-level variance and thus the lowest number of required raters to reliably evaluate quality (phi >0.80). Overall, 20 raters were required to reliably evaluate the quality of emergency medicine podcasts. DISCUSSION: Gestalt ratings of quality from approximately 20 health professionals are required to reliably assess the quality of a podcast. This finding should inform future work focused on developing and validating tools to support the evaluation of quality in these resources.
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Educación Médica/métodos , Medicina de Emergencia/educación , Difusión por la Web como Asunto/normas , Análisis de Varianza , Educación Médica/normas , Educación Médica/estadística & datos numéricos , Evaluación Educacional , Medicina de Emergencia/tendencias , Humanos , Reproducibilidad de los Resultados , Saskatchewan , Encuestas y Cuestionarios , Difusión por la Web como Asunto/estadística & datos numéricosRESUMEN
OBJECTIVES: Podcasts are increasingly being used for medical education. A deeper understanding of usage patterns would inform both producers and researchers of medical podcasts. We aimed to determine how and why podcasts are used by emergency medicine and critical care clinicians. METHODS: An international interprofessional sample (medical students, residents, physicians, nurses, physician assistants, and paramedics) was recruited through direct contact and a multimodal social media (Twitter and Facebook) campaign. Each participant completed a survey outlining how and why they utilize medical podcasts. Recruitment materials included an infographic and study website. RESULTS: 390 participants from 33 countries and 4 professions (medicine, nursing, paramedicine, physician assistant) completed the survey. Participants most frequently listened to medical podcasts to review new literature (75.8%), learn core material (75.1%), and refresh memory (71.8%). The majority (62.6%) were aware of the ability to listen at increased speeds, but most (76.9%) listened at 1.0 x (normal) speed. All but 25 (6.4%) participants concurrently performed other tasks while listening. Driving (72.3%), exercising (39.7%), and completing chores (39.2%) were the most common. A minority of participants used active learning techniques such as pausing, rewinding, and replaying segments of the podcast. Very few listened to podcasts multiple times. CONCLUSIONS: An international cohort of emergency clinicians use medical podcasts predominantly for learning. Their listening habits (rarely employing active learning strategies and frequently performing concurrent tasks) may not support this goal. Further exploration of the impact of these activities on learning from podcasts is warranted.