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1.
Afr Health Sci ; 19(2): 1910-1923, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656474

RESUMO

Background: There is a high prevalence of paediatric emergency cases in less developed countries. However, prolonged hospital stay at emergency units may further overstretch the facilities. Objective: To assess the patterns of presentations, services offered and predictors of a prolonged stay at the Children Emergency Room of a tertiary hospital in Southern Nigeria. Methods: This prospective cross-sectional, study was conducted at the University of Calabar Teaching Hospital, Nigeria from 1st January-31st December 2014. Socio-demographic and clinical characteristics of consecutively recruited children (n=633) were recorded in a proforma. Binary logistic regression was conducted to determine predictors of prolonged stay (>72 hours). Result: The median age of participants was 2 (1 - 4.6) years. Three-fifths of children were admitted at off-hours and the commonest symptom was fever (73.9%). About 16.4% (95%CI:13.6% - 19.4%, n= 103/633) of the children had prolonged stay while those with sepsis had the longest mean stay (65.5±72.1 hours). Children admitted on account of Sickle cell disease (OR:11.2, 95%CI:1.3-95.1, P-value = 0.03), Malaria (OR:10.7, 95%CI:1.4-82.5, P-value = 0.02) or sepsis (OR:10.5, 95%CI:1.3 - 82.7, P-value = 0.03) had higher odds of prolonged hospital stay. There was no significant difference in hospital stay among children admitted by the consultant as compared to other health personnel (P-value = 0.08). Conclusion: Prevention and proper management of Sickle cell disease and malaria reduces paediatric hospital stay in our environment. Paediatric emergency medicine should be re-organized to cater for high volume of off-hour admissions.


Assuntos
Emergências/epidemiologia , Hospitais de Ensino/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Anemia Falciforme/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Febre/epidemiologia , Mortalidade Hospitalar , Humanos , Lactente , Malária/epidemiologia , Masculino , Nigéria/epidemiologia , Estudos Prospectivos , Sepse/epidemiologia , Fatores Socioeconômicos , Fatores de Tempo
2.
Acad Emerg Med ; 26(10): 1186-1196, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31313411

RESUMO

OBJECTIVES: The Global Emergency Medicine Literature Review (GEMLR) conducts a systematic annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most rigorously conducted and widely relevant research in global EM. METHODS: An electronic search of PubMed, a comprehensive retrieval of articles from specific journals, and search of the gray literature were conducted. Title and abstracts retrieved by these searches were screened by a total of 22 reviewers based on their relevance to the field of global EM, across the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). All articles that were deemed relevant by at least one reviewer, their editor, and the managing editor underwent formal scoring of overall methodologic quality and importance to global EM. Two independent reviewers scored all articles; editors provided a third score in cases of widely discrepant scores. RESULTS: A total of 19,102 articles were identified by the searches and, after screening and removal of duplicates, a total of 517 articles underwent full review. Twenty-five percent were categorized as DHR, 61% as ECRLS, and 15% as EMD. Inter-rater reliability testing between the reviewers revealed a Cohen's kappa score of 0.213 when considering the complete score or 0.426 when excluding the more subjective half of the score. A total of 25 articles scored higher than 17.5 of 20; these were selected for a full summary and critique. CONCLUSIONS: In 2018, the total number of articles relevant to global EM that were identified by our search continued to increase. Studies and reviews focusing on pediatric infections, several new and traditionally underrepresented topics, and landscape reviews that may help guide clinical care in new settings represented the majority of top-scoring articles. A shortage of articles related to the development of EM as a specialty was identified.

3.
J Infect Public Health ; 12(6): 794-798, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31006636

RESUMO

BACKGROUND: Global health emergencies, such as from diseases like dengue fever, can lead to rapid surges in visits to emergency departments. The objective of our study was to evaluate the impact of dengue on factors that could impact emergency department flow, including patient volume and staffing, on Indian emergency departments. METHODS: This was a prospective cohort study of Indian emergency providers. Respondents were queried via online survey about a number of domains including practice environment, use of rapid testing, changes in ED volume and ED staffing adjustments occurring during dengue season. Data was analyzed using multivariate analysis. RESULTS: We had a total of 210 respondents to our online survey. Less than half of respondents reported that their institutions used rapid point of care testing. When asked how dengue impacted ED flow, the most common response was that dengue increased the total number of ED visits (84%). Despite this increase, only about 32% of respondents reported that their institutions increased hospital staffing. In multivariate analysis, respondents at hospitals that experienced ED visit surges over 40% of baseline were more likely to also report that their institutions also increased staffing during this time (OR 3.28, 95% CI 1.44-7.46). CONCLUSIONS: Our study shows that despite increases in visits during dengue season, ED providers noted that their EDs did not respond with staffing increases. More research is needed to better understand how emergency departments can adjust to dengue to provide optimal care for patients in India.

4.
Acad Emerg Med ; 25(11): 1287-1298, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29791967

RESUMO

OBJECTIVES: The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. METHODS: This year, 17,722 articles written in three languages were identified by our electronic search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. Another two reviewers searched the gray literature, yielding an additional 11 articles. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. RESULTS: A total of 848 articles met our inclusion criteria and underwent full review. Sixty-three percent were categorized as emergency care in resource-limited settings, 23% as disaster and humanitarian response, and 14% as EM development. Twenty-one articles received scores of 18.5 or higher out of a maximum score 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed a Cohen's kappa of 0.344. CONCLUSIONS: In 2017, the total number of articles identified by our search continued to increase. Studies and reviews with a focus on infectious diseases, pediatrics, and trauma represented the majority of top-scoring articles.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Medicina de Emergência/estatística & dados numéricos , Saúde Global , Humanos , Internacionalidade
5.
Emerg (Tehran) ; 5(1): e70, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29201952

RESUMO

Introduction: Focused training in transthoracic echocardiography enables emergency physicians (EPs) to accurately estimate the left ventricular function. This study aimed to evaluate the efficacy of a brief training program utilizing standardized echocardiography video clips in this regard. Methods: A before and after design was used to determine the efficacy of a 1 hour echocardiography training program using PowerPoint presentation and standardized echocardiography video clips illustrating normal and abnormal left ventricular ejection fraction (LVEF) as well as video clips emphasizing the measurement of mitral valve E-point septal separation (EPSS). Pre- and post-test evaluation used unique video clips and asked trainees to estimate LVEF and EPSS based on the viewed video clips. Results: 21 EPs with no prior experience with the echocardiographic technical methods completed this study. The EPs had very limited prior echocardiographic training. The mean score on the categorization of LVEF estimation improved from 4.9 (95% CI: 4.1-5.6) to 7.6 (95%CI: 7-8.3) out of a possible 10 score (p<0.0001). Categorization of EPSS improved from 4.1 (95% CI: 3.1-5.1) to 8.1 (95% CI: 7.6- 8.7) after education (p<0.0001). Conclusions: The results of this study demonstrate a statistically significant improvement of EPs' ability to categorize left ventricular function as normal or depressed, after a short lecture utilizing a commercially available DVD of standardized echocardiography clips.

8.
J Emerg Med ; 49(5): 746-54, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26095219

RESUMO

BACKGROUND: Emergency medicine (EM) is a recently recognized specialty in India, still in its infancy. Local training programs are developing, but remain very limited. Private, for-profit hospitals are an important provider of graduate medical education (GME) in India, and are partnering with United States (US) universities in EM to expand training opportunities. OBJECTIVE: Our aim was to describe current private-sector programs affiliated with a US university providing postgraduate EM training in India, the evolution and structure of these programs, and successes and challenges of program implementation. DISCUSSION: Programs have been established in seven cities in India in partnership with a US academic institution. Full-time trainees have required didactics, clinical rotations, research, and annual examinations. Faculty members affiliated with the US institution visit each program monthly. Regular evaluations have informed program modifications, and a local faculty development program has been implemented. Currently, 240 trainees are enrolled in the EM postgraduate program, and 141 physicians have graduated. A pilot survey conducted in 2012 revealed that 93% of graduates are currently practicing EM, 82% of those in India; 71% are involved in teaching, and 32% in research. Further investigation into programmatic impacts is necessary. Challenges include issues of formal program recognition both in India and abroad. CONCLUSIONS: This unique partnership is playing a major early role in EM GME in India. Future steps include official program recognition, expanded numbers of training sites, and a gradual transition of training and education to local faculty. Similar partnership programs may be effective in other settings outside of India.


Assuntos
Educação de Pós-Graduação em Medicina/organização & administração , Medicina de Emergência/educação , Medicina de Emergência/organização & administração , Hospitais Privados , Internato e Residência/organização & administração , Faculdades de Medicina , Pesquisa Biomédica , Avaliação Educacional , Medicina de Emergência/normas , Docentes de Medicina/organização & administração , Necessidades e Demandas de Serviços de Saúde , Humanos , Índia , Cooperação Internacional , Intercâmbio Educacional Internacional , Internato e Residência/métodos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estados Unidos
9.
Acad Emerg Med ; 20(12): 1216-23, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24341576

RESUMO

The past 40 years have seen expanded development of emergency medicine (EM) postgraduate residency training programs worldwide. An important part of this educational experience is the ability of resident trainees to participate in experiences abroad. However, little is known about how these experiences shape trainees and the populations they serve. During the 2013 Academic Emergency Medicine consensus conference, a group of educators met to define and outline current trends in graduate medical education (GME) emergency care research. The authors discuss future research questions bridging the gap of GME and global health.


Assuntos
Educação de Pós-Graduação em Medicina/tendências , Medicina de Emergência/educação , Saúde Global , Pesquisa , Consenso , Conferências de Consenso como Assunto , Currículo , Humanos , Internato e Residência
10.
Acad Emerg Med ; 20(12): 1233-40, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24341578

RESUMO

Global emergency medicine (EM) is a rapidly growing field within EM, as evidenced by the increasing number of trainees and clinicians pursuing additional experiences in global health and emergency care. In particular, many trainees now desire opportunities at the postgraduate level by way of global EM fellowship programs. Despite this growing popularity, little is known of the effects of postgraduate training in global health and emergency care on learners and patients in the United States and abroad. During the 2013 Academic Emergency Medicine consensus conference on global health and emergency care, a group of leading educators at the postgraduate medical education level convened to generate a research agenda of pressing questions to be answered in this area. The consensus-based research agenda is presented in this article.


Assuntos
Educação de Pós-Graduação em Medicina/tendências , Medicina de Emergência/educação , Saúde Global , Pesquisa , Consenso , Currículo , Humanos , Estados Unidos
11.
Acad Emerg Med ; 20(12): 1272-7, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24341582

RESUMO

As policy-makers increasingly recognize emergency care to be a global health priority, the need for high-quality clinical and translational research in this area continues to grow. As part of the proceedings of the 2013 Academic Emergency Medicine consensus conference, this article discusses the importance of: 1) including clinical and translational research in the initial emergency care development plan, 2) defining the burden of acute disease and the barriers to conducting research in resource-limited settings, 3) assessing the appropriateness and effectiveness of local and global acute care guidelines within the local context, 4) studying the local research infrastructure needs to understand the best methods to build a sustainable research infrastructure, and 5) studying the long-term effects of clinical research programs on health care systems.


Assuntos
Medicina de Emergência , Saúde Global , Pesquisa sobre Serviços de Saúde , Pesquisa , Pesquisa Médica Translacional , Conferências de Consenso como Assunto , Prioridades em Saúde , Humanos
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