1 10 12 https://repository.horizon.ac.id/files/original/651ec9bd8271b09d483ddb96998ff978.pdf a463b49ba03018f9a56a9f25a04a8113 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol. 10 issue 3 2020 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol.10 issue.3 2020 African Journal of Emergency Medicine An assessment of Nurses' knowledge, attitude and practice of emergency care related to road traffic accident victims at three selected hospitals in Rwanda Subject The topic of the resource Knowledge Attitude Practice Nurses Emergency Management Road Traffic Accident Description An account of the resource Introduction: Quality emergency nursing care is an important variable in reducing death and disability due to road traffic accidents (RTA), yet little is known about emergency nursing care within the Rwandan context. This study aims to describe the knowledge, attitude and practice (KAP) of nurses of the emergency care of RTA patients. Method: We employed a cross sectional design to survey the full cohort of nurses working in Accident and Emergency (A&E) units in three selected Rwandan hospitals (N = 51). Results: This study revealed that the knowledge and practice of nurses is either high or very high and the majority of them (73.657%) had a positive attitude towards emergency management of RTA patients. Being trained before working in A&E units was associated with a significant increase in the likelihood of being at the level of practice which is (1) very high (OR = 5.35, 95%, CI = 5.20–5.50), (2) high (OR = 1.60, 95%, CI = 1.17–2.19) (3), moderate (OR = 5.35,95%, CI = 4.15–6.88) and (4) low (OR = 1.33,95%, CI = 1.33–133) and it decreased more than 99.9% the likelihood of being at low level of practice in all levels. Discussion: The study showed that training had a significant effect on practice and this is supported by previous studies. Training interventions to improve the management of RTA patients by nurses working in A&E should be regularly audited to ensure ongoing quality of care. Creator An entity primarily responsible for making the resource Claudine Nshutiyukuri, Busisiwe Rosemary Bhengu, Darius Gishoma Source A related resource from which the described resource is derived https://doi.org/10.1016/j.afjem.2020.03.003 Date A point or period of time associated with an event in the lifecycle of the resource 31 March 2020 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Jurnal Internasional Keperawatan Knowledge Attitude Practice Nurses Emergency Management Road Traffic Accident https://repository.horizon.ac.id/files/original/cf99a43375232700245c7758638db462.pdf b22cb98dfc450390741347a6f4b449ed Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol. 10 issue 3 2020 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol.10 issue.3 2020 African Journal of Emergency Medicine Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact Subject The topic of the resource Focused cardiac ultrasound Training Capacity building Low and middle-income Description An account of the resource Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agree- ment between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training pro- gramme locally. Methods: This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were as- sessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen's kappa > 0.6 indicative of good inter-rater agreement. Results: Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties. Conclusions: Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives. Creator An entity primarily responsible for making the resource Wangari Waweru-Siika, Anders Barasa, Benjamin Wachir, David Nekyon, Barbara Karau, Fatimah Juma, Grace Wanjiku, Harun Otieno, Gerald S. Bloomfield, Erik Sloth Source A related resource from which the described resource is derived https://doi.org/10.1016/j.afjem.2020.04.011 Date A point or period of time associated with an event in the lifecycle of the resource 28 April 2020 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Focused cardiac ultrasound Training Capacity building Low and middle-income Jurnal Internasional Keperawatan https://repository.horizon.ac.id/files/original/bb218216857f0a43291d5e0bd899107d.pdf 92b53b117abc3edf6d9b7357d5505c5e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol. 10 issue 3 2020 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol.10 issue.3 2020 African Journal of Emergency Medicine Colchicine overdose: A South African experience, a case report Subject The topic of the resource Overdose Colchicine Multi-organ failure Description An account of the resource Introduction: Colchicine overdose is uncommon but is associated with a high mortality rate. It has a narrow therapeutic index and has been described to have a 100% mortality with ingestion of > 0.8 mg/kg (Finkelstein et al., 2010; Herran-Monge et al., 2013; Aghabiklooei et al., 2014; Erden et al., 2013). Case report: This is a case report of a 19-year-old male who ingested 0.4 mg/kg of colchicine in a suicide attempt. He developed multiorgan dysfunction. He was managed supportively, and the dysfunction resolved. Discussion: The clinical presentation and management should be familiar to all those who work in acute care in order to be able to identify and treat it timeously thus preventing morbidity and mortality. Treatment is largely supportive. To the best of our knowledge this is the first case of colchicine overdose described in Sub-Saharan Africa. Creator An entity primarily responsible for making the resource Jenna Essam, Saul Grossberg, Adam Mahomed Source A related resource from which the described resource is derived https://doi.org/10.1016/j.afjem.2019.12.005 Date A point or period of time associated with an event in the lifecycle of the resource 31 December 2019 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Jurnal Internasional Keperawatan Overdose Colchicine Multi-organ failure https://repository.horizon.ac.id/files/original/c7f701f2ef225ee5d373ccc172392414.pdf d8a53340aa2a9ccd8b2152e607e6bedf Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol. 10 issue 3 2020 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol.10 issue.3 2020 African Journal of Emergency Medicine Could lung ultrasound be used instead of auscultation? Subject The topic of the resource The covid-19 era poses significant and unprecedented challenges for re-organisation of care, redistribution of resources and rationing of services Description An account of the resource The covid-19 era poses significant and unprecedented challenges for re-organisation of care, redistribution of resources and rationing of services [1,2]. A review of patients' clinical characteristics showed a high prevalence of respiratory symptoms and respiratory failure which require full assessment [3]. However, the role for auscultation is not proven and may be a very risky strategy as the risk of cross infection with taking a stethoscope from a patient to the next is very tangible [4,5]. A recent editorial in the African Journal of Emergency medicine suggested Severity Scoring Tool for low resourced settings and men- tioned auscultation [6]. The stethoscope and auscultation have limited usefulness in the assessment of respiratory failure. Crackles on auscultation have a sen- sitivity of 19–67% and a specificity of 36–96%, with a positive like- lihood ratio of 2.3 and a negative likelihood ration of 0.8 [7]. Thus, their use in ruling pneumonia in or out is limited as their presence or absence only slightly changes the initial diagnosis (poor inter observer reliability, 72% agreement, kappa value 0.41) [7]. One might argue on the value of detecting wheeze on auscultation. The Centers for Disease Control and Prevention (CDC) does not mention wheeze as a symptom of Covid-19 [8]. Furthermore, Xu et al. did not describe wheeze as a finding in 62 patients with Covid-19 [9] and as such wheeze does not seem to be present in such patients. Hence, in the current pandemic, is there a role for other diagnostic or investigative modalities such as lung ultrasound? Lung ultrasonography in acute respiratory failure has been de- scribed for over a decade. A 2008 single centre study of bedside lung ultrasound examination protocol showed an accuracy of 90.5% in di- agnosing the cause of acute respiratory failure in critically ill patients. The methods were standardised and reproducible [8]. This has been since incorporated in consensus guidelines [10]. As such, it has been debated as to whether lung ultrasound can have a role to play in the diagnostic pathway for Covid-19. Point of care ultrasound machines can be small, portable and cleaned in between patients [11,12]. Huang et al. performed lung ultrasound on 19 non-critical Covid-19 patients and found them to have specific characteristics (large number of B lines, subpleural pulmonary consolidation and poor blood flow) which were mainly visible in the posterior and inferior areas [13]. Ultrasound missed lesions that were completely intrapulmonary and apical and some of the analysis is only in abstract form. Care must be applied to the analysis of this as this is a pre-print, and not peer-reviewed. Peng et al. found similar findings using a similar 12 zone method but the article lacks details about the clinical characteristics of the patients [14]. Poggiali et al. found strong correlation between similar ultra- sound findings and strong correlation between ultrasound and CT scan findings [15]. Creator An entity primarily responsible for making the resource Commentary Source A related resource from which the described resource is derived https://doi.org/10.1016/j.afjem.2020.04.007 Date A point or period of time associated with an event in the lifecycle of the resource 26 April 2020 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Jurnal Internasional Keperawatan redistribution of resources and rationing of services The covid-19 era poses significant and unprecedented challenges for re-organisation of care https://repository.horizon.ac.id/files/original/2de07ee84f38fcf649ed6edca46e6680.pdf 8800f38008d80bcb99ad7ebf090c996e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol. 10 issue 3 2020 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol.10 issue.3 2020 African Journal of Emergency Medicine Emergency department management of traumatic brain injuries: A resource tiered review Subject The topic of the resource Traumatic brain injury trauma Emergency management Head injury TBI Description An account of the resource Introduction: Traumatic brain injury is a leading cause of death and disability globally with an estimated African incidence of approximately 8 million cases annually. A person suffering from a TBI is often aged 20–30, con- tributing to sustained disability and large negative economic impacts of TBI. Effective emergency care has the potential to decrease morbidity from this multisystem trauma. Objectives: Identify and summarize key recommendations for emergency care of patients with traumatic brain injuries using a resource tiered framework. Methods: A literature review was conducted on clinical care of brain-injured patients in resource-limited set- tings, with a focus on the first 48 h of injury. Using the AfJEM resource tiered review and PRISMA guidelines, articles were identified and used to describe best practice care and management of the brain-injured patient in resource-limited settings. Key recommendations: Optimal management of the brain-injured patient begins with early and appropriate triage. A complete history and physical can identify high-risk patients who present with mild or moderate TBI. Clinical decision rules can aid in the identification of low-risk patients who require no neuroimaging or only a brief period of observation. The management of the severely brain-injured patient requires a systematic ap- proach focused on the avoidance of secondary injury, including hypotension, hypoxia, and hypoglycaemia. Most interventions to prevent secondary injury can be implemented at all facility levels. Urgent neuroimaging is recommended for patients with severe TBI followed by consultation with a neurosurgeon and transfer to an intensive care unit. The high incidence and poor outcomes of traumatic brain injury in Africa make this subject an important focus for future research and intervention to further guide optimal clinical care. Creator An entity primarily responsible for making the resource Julia Dixon, Grant Comstock, Jennifer Whitfield, David Richards, Taylor W. Burkholder, Noel Leifer, Nee-Kofi Mould-Millman, Emilie J. Calvello Hynes Source A related resource from which the described resource is derived https://doi.org/10.1016/j.afjem.2020.05.006 Date A point or period of time associated with an event in the lifecycle of the resource 20 May 2020 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Jurnal Internasional Keperawatan Traumatic brain injury trauma Emergency management Head injury TBI https://repository.horizon.ac.id/files/original/f43f73cef8af85889d1690a95bbd1df8.pdf 9ccdc4bb61c08df38f9fbb526602b830 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol. 10 issue 3 2020 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol.10 issue.3 2020 African Journal of Emergency Medicine Injury patterns of patients presenting to a non-governmental hospital inWestern Uganda Subject The topic of the resource Trauma registry Uganda Global health Injury epidemiology Road traffic injury Description An account of the resource Introduction: Injury is a leading cause of morbidity and mortality globally and disproportionately affects low- income countries. While most injury data comes from tertiary care centers in urban settings, the purpose of this study was to describe the characteristics and severity of injury in rural Uganda and the associated treatment patterns and delays in care. Methods: This is a retrospective cohort study of a trauma registry that was implemented at Masindi-Kitara Medical Center (MKMC), a rural hospital in Western Uganda. Demographic information, injury characteristics, modified Kampala Trauma Scores (M-KTS), and treatment modalities over a 12 month period were retro- spectively collected from paper-based registry forms completed for all injury patients presenting to MKMC. Results: A total of 350 patients were entered into the trauma registry. Most patients were male (71.2%) with a median age of 26.5 years. Motorcycle crashes were the most prevalent mechanism of injury (42.3%) with the majority being unhelmeted (83.3%). Soft tissue injury was the most common diagnosis (44.9%). Patients were frequently treated in the outpatient department and then discharged (54.8%). Patients requiring admission or transfer (M-KTS = 11.57 or 11.67) tended to have a lower M-KTS than discharged patients (M-KTS = 12.75). Analgesics (74.6%) and antibiotics (52.9%) were the most common treatments administered. For those patients requiring admission (29.4%), only one in-hospital death was documented. Thirty-nine percent of patients re- ported a delay in seeking care, most frequently due to lack of transportation (31.5%) with a median time of delay of 11 h. Conclusion: Road traffic injuries were the leading cause of injury in Masindi, with a high proportion of injuries associated with unhelmeted motorcycle crashes. Future opportunities to prevent injury and improve care may be seen through improved prehospital care, enforcement of helmet laws, increased access to neurosurgical services, and enactment of hospital quality improvement measures. Creator An entity primarily responsible for making the resource Heather A. Brown, Joshua Skaggs, Caroline Brady, Vincent Tumusiime, Austin S. White Source A related resource from which the described resource is derived https://doi.org/10.1016/j.afjem.2020.02.001 Date A point or period of time associated with an event in the lifecycle of the resource 4 February 2020 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource indonesia Type The nature or genre of the resource text Jurnal Internasional Keperawatan rauma registry Uganda Global health Injury epidemiology Road traffic injury https://repository.horizon.ac.id/files/original/5654c18acc40b017fde9912ccea4810d.pdf f6d989bb620b2d7d94316b7239451bc1 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol. 10 issue 3 2020 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol.10 issue.3 2020 African Journal of Emergency Medicine Non-operative management of blunt abdominal solid organ trauma in adult patients Subject The topic of the resource Blunt abdominal trauma Operative Non-operative management Solid organs Description An account of the resource Introduction: Despite agreement in the literature that “stable” blunt trauma patients may be managed con- servatively, in Egypt many such patients receive operative management. This paper presents the results of a pragmatic, prospective, observational study to evaluate outcomes of non-operative (NOP) versus operative (OP) management of blunt abdominal solid organ trauma in hemodynamically stable adults admitted to Tanta University Emergency Hospital (TUH) in Egypt. Methods: A prospective observational study enrolled adult blunt abdominal trauma patients with solid organ injury at TUH over a 3-year period (June 2014–June 2017). Inclusion criteria were age ≥18 yr, mean arterial pressure > 65 mm Hg, heart rate < 110 bpm, hematocrit ≥7 mg/dl, and abdominal organ injury diagnosed by ultrasound or computed tomography (CT). Excluded patients were those with pelvis and femur fractures; pa- tients with penetrating abdominal trauma; predominate burn injuries, children and pregnant women. All pa- tients were assigned to non-operative or operative management based on clinician preference. Outcomes of interest were 30-day mortality, blood transfusion volume, and length of stay. Descriptive statistics and χ2 were used to compare outcomes. Results: During the study period, 4254 trauma patients presented to TUH. Of these, 790 had blunt abdominal trauma and 111 (14.1%) met inclusion criteria. Injury severity scores for each group were comparable (24 ± 10 – NOP vs. 28 ± 11 – OP, p = 0.126). NOP received less transfused blood (213.41 ± 360.3 ml [NOP] vs.1155.17 ± 380.4 ml [OP] (p < 0.0001)) but had a longer length of stay (8.29 ± 2.8 [NOP] vs. 6.45 ± 1.97 days [OP] (p = 0.012)). There was no difference in mortality between groups (p = 0.091). Conclusion: Our study demonstrated that non-operative management in Egypt of blunt abdominal trauma was safe and resulted in fewer procedures, fewer units of blood transfused, and no increase in mortality. Longer length of stay for non-operative patients might reflect treating physician caution in their management. Creator An entity primarily responsible for making the resource Wesam Ibrahim, Gamal Mousa, Jon Mark Hirshon, Mohamed El-Shinawi, Hani Mowafi Source A related resource from which the described resource is derived https://doi.org/10.1016/j.afjem.2020.02.002 Date A point or period of time associated with an event in the lifecycle of the resource 17 February 2020 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Blunt abdominal trauma Operative Non-operative management Solid organs Jurnal Internasional Keperawatan https://repository.horizon.ac.id/files/original/a2f2c0e0053fa88b7efae95dba6835a4.pdf e768f49ccfd5518f94b739299a44bbd0 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol. 10 issue 3 2020 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol.10 issue.3 2020 African Journal of Emergency Medicine Paediatric Emergency Department preparedness in Nigeria: A prospective cross-sectional study Subject The topic of the resource Paediatric Emergency Department Paediatric emergency medicine Paediatric emergency care Emergency care preparedness Emergency medicine Paediatrics Description An account of the resource Introduction: Paediatric emergency medicine (PEM) is poorly developed in low and middle-income countries. The magnitude of challenges facing Paediatric Emergency Departments (PEDs) in Nigeria has not been well described. This study aimed to assess paediatric emergency care preparedness across PEDs in Nigeria. Methods: This was a prospective cross-sectional study that utilized a self-administered questionnaire and a check list to assess three key domains (managerial, medication and equipment) in tertiary care PED facilities that were recruited across Nigeria. Preparedness scores and other institutional attributes were compared between zones and regions. Results: Thirty-four tertiary-level PEDs across Nigeria were included. The mean number of patient visits over the 30-day period prior to data collection was 253.2 ( ± 261.2). The mean (SD) managerial, medication and equipment performance scores of the included PEDs were 42.9% ( ± 14.3%), 50.7% ( ± 22.3%) and 43.9% ( ± 11.8%) respectively. The mean (SD) total performance score was 46.9% ( ± 15.3%). Only 13 PEDs had a total performance score of > 50%. There was a statistically significant higher mean equipment score (p = 0.029) in the Southern region (47.6 ± 3.1) compared to the Northern region (38.9 ± 2.3) of the country. Conclusions: This study reports a global but remediable deficiency in emergency care preparedness amongst PEDs in tertiary care facilities in Nigeria. This study highlights the need for training of PED managers in basic and advanced life support and for the improvement in medication and equipment procurement across Nigeria. Creator An entity primarily responsible for making the resource Callistus O.A. Enyuma, Muhammed Moolla, Feroza Motara, Gbenga Olorunfemi, Heike Geduld, Abdullah E. Laher Source A related resource from which the described resource is derived https://doi.org/10.1016/j.afjem.2020.05.010 Date A point or period of time associated with an event in the lifecycle of the resource 26 May 2020 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Jurnal Internasional Keperawatan Paediatric Emergency Department Paediatric emergency medicine Paediatric emergency care Emergency care preparedness Emergency medicine Paediatrics https://repository.horizon.ac.id/files/original/1c37c732165b31f547f02e435dd4f648.pdf d11dcd2ddc1a3b79af61677650961a45 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol. 10 issue 3 2020 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol.10 issue.3 2020 African Journal of Emergency Medicine Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti Subject The topic of the resource Emergency medicine Emergency department Observation unit Haiti Stroke Description An account of the resource Introduction: In many low-income countries, Emergency Medicine is underdeveloped and faces many opera- tional challenges including emergency department (ED) overcrowding and prolonged patient length of stays (LOS). In high-resource settings, protocolized ED observation unit (EDOU) care reduces LOS while preserving care quality. EDOUs are untested in low-income countries. We evaluate the effect protocolized EDOU care for ischemic stroke on the quality and efficiency of care in Haiti. Methods: We performed a prospective cohort study of protocolized observation care for ischemic stroke at a Haitian academic hospital between January 2014 and September 2015. We compared patients cared for in the EDOU using the ischemic stroke protocol (study group) to eligible patients cared for before protocol im- plementation (baseline group), as well as to eligible patients treated after protocol introduction but managed without the EDOU protocol (contemporary reference group). We analysed three quality of care measures: aspirin administration, physical therapy consultation, and swallow evaluation. We also analysed ED and hospital LOS as measures of efficiency. Results: Patients receiving protocolized EDOU care achieved higher care quality compared to the baseline group, with higher rates of aspirin administration (91% v. 17%, p < 0.001), physical therapy consultation (50% v. 9.6%, p < 0.001), and swallow evaluation (36% v. 3.7%, p < 0.001). We observed similar improvements in the study group compared to the contemporary reference group. Most patients (92%) were managed entirely in the ED or EDOU. LOS for non-admitted patients was longer in the study group than the baseline group (28 v. 19 h, p = 0.023). Conclusion: Protocolized EDOU care for patients with ischemic stroke in Haiti improved performance on key quality measures but increased LOS, likely due to more interventions. Future studies should examine the aspects of EDOU care are most effective at promoting higher care quality, and if similar results are achievable in patients with other conditions. Creator An entity primarily responsible for making the resource Shada A. Rouhani, Regan H. Marsh, Linda Rimpel, Kathryn Anderson, Malena Outhay, Marie Cassandre Edmond, Keegan A. Checkett, Aaron L. Berkowitz, Gene F. Kwan, Christopher W. Baugh, Jeremiah D. Schuur Source A related resource from which the described resource is derived https://doi.org/10.1016/j.afjem.2020.05.007 Date A point or period of time associated with an event in the lifecycle of the resource 20 May 2020 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Emergency medicine Emergency department Observation unit Haiti Stroke Jurnal Internasional Keperawatan https://repository.horizon.ac.id/files/original/81ddf292b04071afc5ca93b61df81ce2.pdf 35c4a4ab61a4b9025c7176cf07ebd579 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol. 10 issue 3 2020 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Jurnal Internasional Afrika vol.10 issue.3 2020 African Journal of Emergency Medicine Providing end-of-life care in the emergency department: Early experience from Médecins Sans Frontières during the Covid-19 pandemic Subject The topic of the resource SARS-CoV-2 (Covid-19) Description An account of the resource While most infections attributable to SARS-CoV-2 (Covid-19) are mild, a considerable percentage of affected people require hospitalisa- tion and critical care. In European and North American centres, the mortality rate amongst individuals that are hospitalised, particularly those requiring mechanical ventilation, is high [1–3]. Earlier identification of impending severe disease is imperative to reducing mortality from CoVid-19 [4]. Health authorities and others responding to the epidemic should prioritise activities that support this life-saving approach, which includes improving access to health care for persons that are most susceptible to develop critical illness. However, as evidenced in Europe and the USA, maintaining access to health care and prioritising care for the most vulnerable during an epidemic are com- plex. While resource allocation related to shortages of critical equip- ment has been heavily emphasized in reports coming from European and North American settings, in African contexts these shortages are more pronounced, and high-complexity care is non-existent in nu- merous regions. Given underlying issues of access to care in many lo- cations, patients frequently present to African emergency services in an advanced stage of disease suffering from organ failure that cannot be reversed. While the emergency department is not typically an environment associated with the provision of palliative care, we anticipate that the gravity of presentation of certain CoVid-19 patients, particularly those with underlying comorbidities, means that some will be more appro- priately treated with informed, symptom-based end-of-life care than aggressive resuscitation. The decision process regarding resource allo- cation is outside the scope of this paper, but the scale of this pandemic highlights the necessity to implement ethical and compassionate pal- liative care in settings where it has not previously been considered. Médecins Sans Frontières (MSF) has combined research and field- based experience to develop a guidance document for clinicians with limited experience in the provision of palliative care, including those working in emergency services. In this paper we describe how evidence- based palliative care protocols can be adapted to less-resourced con- texts at the necessary scale for a rapidly spreading epidemic whilst still respecting the physical and emotional needs of critically unwell in- dividuals and their families. Creator An entity primarily responsible for making the resource Guest Editorial Source A related resource from which the described resource is derived https://doi.org/10.1016/j.afjem.2020.05.012 Date A point or period of time associated with an event in the lifecycle of the resource 01 June 2020 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Jurnal Internasional Keperawatan