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                  <text> Jurnal Internasional Afrika vol. 12 issue 3 2022</text>
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                <text>Jurnal Internasional Aprika  vol.12 issue 3 2022&#13;
African Journal of Emergency Medicine&#13;
A descriptive analysis of the casemix presenting to a tertiary hospital emergency centre in East London, South Africa</text>
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                <text>Emergency centre Casemix South Africa East London Eastern Cape</text>
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                <text>Introduction: Emergency centres are most often the point of entry to the healthcare system for patients presenting with emergencies. Even though emergency medicine has developed rapidly in certain regions of South Africa, it is yet to flourish in the Eastern Cape. A paucity of data exists with regards to the demographic and disease profile of patients presenting to Eastern Cape emergency centres. This study describes the casemix presenting to a tertiary hospital emergency centre in East London in the Eastern Cape. Methods: A retrospective descriptive study was conducted of all patients presenting to Frere Hospital emergency centre from 1st of August 2019 to 31 st of October 2019. Data were manually collected from the emergency centre paper-based register for the study period and included: patient demographics, geographical location, triage category, presenting complaint, disposition, and process times. Descriptive statistics were used to describe all variables. Results: A total of 6 204 patients presented during the study period. The median age was 31 years, with a male predominance of 56%. Lower acuity triage categories (green and yellow) represented 67% of all cases. Trauma comprised 56% of all presentations, with assault being the most prevalent mechanism of injury in the adult population (n = 1 460, 48%). Sundays (18%) and Mondays (20%) had the highest patient caseload. The majority of patients were discharged home (n = 4 257, 69%) of which 79% had lower acuity triage categories. The majority of patients lived within a 20 km radius of Frere Hospital (n = 4 689, 77%). Conclusion: This descriptive study provides essential data that could guide further development of emergency care systems within the Eastern Cape. A high trauma burden, comprising predominantly of lower acuity presentations are described. Social and economic determinants of violence must be addressed and multisectoral interventions are required to reduce the high burden of trauma</text>
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                <text>Luan Taljaard, Roshen Maharaj , Clint Hendrikse</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                <text>Peri Irawan</text>
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        <name>Emergency centre Casemix South Africa East London Eastern Cape</name>
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                  <text> Jurnal Internasional Afrika vol. 12 issue 3 2022</text>
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                <text>Jurnal Internasional Aprika  vol.12 issue 3 2022&#13;
African Journal of Emergency Medicine&#13;
A descriptive study of trauma patients transported by helicopter emergency medical services to a level one trauma centre&#13;
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                <text>HEMS Trauma Outcome Pre-hospital care South Africa</text>
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                <text>Background: KwaZulu-Natal, the largest land mass province that is densely populated in SA has vast distances to referral centres and time to definitive treatment is key in trauma care. Helicopter Emergency Medical Service (HEMS) is still an invaluable prehospital asset for the transport of time sensitive trauma. This study reviews the impact of HEMS in the management of trauma at Inkosi Albert Luthuli hospital (IALCH) which is the only public accredited level one trauma centre in the province. Methods: A retrospective descriptive study of polytrauma patients transported by HEMS in KZN to IALCH over a three-year period from 01 January 2014 to 31 December 2016. Data was collected around patient demographics, transfer details and patient outcomes. Results: Over the three-year period, 117 HEMS transfers were reviewed, with the majority being male (90.6%). Just 26% of HEMS transfers were direct from the scene, with the balance being interhospital transfers largely from distant regional hospitals around the province. Some 60% of injuries were caused by vehicle crashes, and 31% by intentional injury. Mortality was 30% which is reflective of the high severity of injury of the cohort. The injury severity scores (ISS) (median 26 overall) of those who died was higher (median 38) ( P - = .0002), and there were more interventions before and during transfer such as thoracostomy, ventilation and immobilization. Overall, 88% required admission to ICU at IACLH. Conclusions: HEMS in the KwaZulu Natal province was mainly used for long-distance transfer of major trauma patients which is an appropriate use of this essential service, given the single major trauma centre in the province. The majority of patients that were transported by HEMS had severe injury, which was also associated with increased mortality outcomes. Rational use of this essential but expensive resource will require clear policy around the role of HEMS and call out criteria in each setting.</text>
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                <text>Marwala Simon Pule , Peter Hodkinson , Timothy Hardcastle</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                  <text> Jurnal Internasional Afrika vol. 12 issue 3 2022</text>
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                <text>Jurnal Internasional Aprika  vol.12 issue 3 2022&#13;
African Journal of Emergency Medicine&#13;
A prospective, internal validation of an emergency patient triage tool for use in a low resource setting</text>
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                <text>Triage low resource setting predictive scores Emergency department</text>
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                <text>Aim: Assess the performance of a simple triage disposition score based on mental status, mobility and either oxygen saturation or respiratory rate by three principal metrics: 24 h mortality, the need for hospital admission and the urgency ranking of patient presentations. Method: Prospective observational non-interventional study of consecutive patients presenting to the emergency and outpatient departments of a low-resource sub-Saharan hospital Results: Out of 14,585 consecutive patients arriving to hospital 1,804 (12.4%) were admitted and 39 died (0.3%) within 24 hours. No patients with normal mental status or a stable independent gait died within 24 h, and 95% of those who did had an oxygen saturation &lt; 94%. The c statistic of the score for death within 24 hours was &gt; 0.95 and not significantly changed if respiratory rate replaced oxygen saturation as a score component, or mental status was assessed subjectively or objectively. However, an objective measure of mental status significantly reduced the c statistic for hospital admission from 0.970 SE 0.003 to 0.956 SE 0.004, p 0.002. The score attributed a higher acuity rating than the South African Triage System urgency ranking of presentations to 11.1% of patients and a lower acuity rating to 1.3%. However, 53% of the patients given a higher acuity rating were subsequently admitted to hospital and 6.1% of them died. Conclusion: The score identified patients who subsequently required hospital admission and who were likely to die within 24 hours</text>
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                <text>Brian Kikomeko , George Mutiibwa , Pauline Nabatanzi  , Alfred Lumala, John Kellett, on behalf of the Kitovu Hospital Study Group</text>
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                  <text> Jurnal Internasional Afrika vol. 12 issue 3 2022</text>
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                <text>Jurnal Internasional Aprika  vol.12 issue 3 2022&#13;
African Journal of Emergency Medicine&#13;
After-hour trauma-radiograph interpretation in the emergency centre of a District Hospital&#13;
&#13;
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                <text>Plain films X-rays Trauma imaging Fracture detection Missed fracture</text>
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                <text>Introduction: Plain radiographs remain a first-line trauma investigation. Most trauma radiographs worldwide are reported by junior doctors. This study assesses the accuracy of after-hour acute trauma radiograph reporting by emergency centre (EC) doctors in an African district hospital. Methods: An institutional review board approved retrospective descriptive study over two consecutive weekends in February 2020. The radiologist report on the admission radiographs of adult trauma patients was compared with the initial EC interpretation. The accuracy, sensitivity, specificity, positive predictive value (PPV) and neg- ative predictive value (NPV) for EC interpretation were calculated with 95% confidence intervals (95%CI). The association between reporting accuracy and anatomical region, mechanism of injury, time of investigation, and the number of abnormalities per radiograph was assessed. Results: 140 radiographs were included, of which 49 (35%) were abnormal. EC doctors recorded (95%CI) 77% (69-84%) accuracy, 38% (25-54%) sensitivity, 97% (91-99%) specificity, 86% (65-95%) PPV and 76% (71-80%) NPV. Performance was associated with the anatomical region (p = 0.02), mechanism of injury (p = &lt; 0.01) time of day (p = 0.04) and the number of abnormalities on the film (p = &lt; 0.01). The highest sensitivity was achieved in reports of the appendicular skeleton (42%) and in the setting of simple blunt trauma (62%). Overall accuracy was in line with the range (44%-99%) reported in the international literature. Discussion: Accurate reporting of acute trauma radiographs is challenging. Key factors impact performance. Further training of junior doctors in this area of clinical practice is recommended. Future work should focus on assessing the impact of such training on reporting performance.</text>
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                  <text> Jurnal Internasional Afrika vol. 12 issue 3 2022</text>
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                <text>Jurnal Internasional Aprika  vol.12 issue 3 2022&#13;
African Journal of Emergency Medicine&#13;
Analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource-limited setting</text>
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                <text>Machete cut open fracture wound infection risk factor</text>
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                <text>Background: Machete cut fracture is a unique subset of open fracture. The sharp force of a wielded machete that cleanly divides soft tissue envelope with minimal or no contusion results in an open fracture wound that is relatively less prone to infection. However, in resource-limited settings, the wound infection rate after machete cut fracture is relatively high. This study aimed to determine the risk factors for wound infection after extremity machete cut fractures in a Nigerian setting. Methods: We undertook a retrospective analysis of the patients who were seen in the Emergency room of two tertiary hospitals in Nigeria with a machete cut extremity fracture from 2009 to 2018. The association of wound infection with population and wound characteristics as well as intervention related factors were evaluated. Sta- tistical significant factors for wound infection in the Univariable analysis were entered into a Multivariable re- gression analysis to evaluate the risk of each factor when adjusted to other factors. Results: There were 113 machete-cut fractured bones in 67 eligible patients and wound infection was a complica- tion in 45 (39.8%) of the cases (95%CI 30.3 –49.7%).The factors significantly associated with high wound infec- tion rate were smoking, haematocrit &lt; 30%, fractures sustained outdoors, lower extremity fractures, a wound size of &gt; 5cm in length, injury-to-hospital arrival interval &gt; 6hrs. Multivariable regression analysis identified wound size &gt; 5 cm (aOR 14.142, 95%CI (2.716 - 73.636); p = 0.002), injury-to- hospital arrival interval later than 6hrs (aOR 4.410, 95% CI (1.003-19.394); p = 0.050) and administration of antibiotics later than 3hrs of injury (aOR 5.736, 95%CI (aOR1.362 - 24.151; p = 0.017) as independent risk factors for wound infection. Conclusion: Wound infection after open fractures caused by machetecut is more likely to occur in patients that present later than six hours after injury, wounds more than 5cm in length and delayed antibiotic administration. Appropriate treatment protocols can be instituted with this knowledge.</text>
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                <text>Njoku Isaac Omoke,  Christian Chukwuemeka Madubueze , Francis Ndubuisi Ahaotu , Chinedu Gregory Nwigwe , Anthony Anakweze Anagor , Peace Ifeoma Amaraegbulam , Agama Nnachi Egwu , Omolade Ayoola Lasebikan</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                  <text> Jurnal Internasional Afrika vol. 12 issue 3 2022</text>
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              <elementText elementTextId="20167">
                <text>Jurnal Internasional Aprika  vol.12 issue 3 2022&#13;
African Journal of Emergency Medicine&#13;
Analysis of the demographic characteristics and clinical profile of acute ischemic strokes admitted to the emergency centre in the Somalia population</text>
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          <element elementId="49">
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                <text>Acute Ischemic stroke Emergency department Somalia Sub-Saharan Africa</text>
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                <text>Background: Stroke is a leading cause of death and chronic disability worldwide. In Sub-Saharan Africa (SSA), which includes Somalia, stroke represents a significant part of the chronic disease burden. However, there is relatively little data on risk factors, demographics, and clinical profiles. This study aimed to define the etiological, demographic characteristics, classification of stroke and functional status of patients with acute ischemic stroke (AIS) admitted to the emergency centre, and to create projections to evaluate the incidence and genetic aspects of stroke. Methods: The study population consisted of patients who applied to the emergency centre between 1 May 2017 and 1 May 2021 and were diagnosed with acute ischemic stroke (AIS). Patient demographics, season of onset, risk factors, laboratory data, imaging results, infarct location, AIS subtype and treatment outcomes were collected, and compared. Results: A total of 3,968 patients diagnosed with ischemia stroke were included in the study. The mean age was 51.12 ± 16.43 years, and we reported male predominance (65.7%). While hypertension, hyperlipidaemia, Diabetes mellitus (DM) were more frequent among the risk factors, smoking history and alcohol consumption history were very low. HIV-infected ischemic stroke was detected at a high rate (20.9%) and was common in a relatively young age group (31.8 ± 14.3). Large-artery atherosclerosis (LAA) subtype was detected with a high rate of 67.7%. The most common clot localization was in Supratentorial location (74.3%), and according to OSCP classification, partial anterior circulation infarcts (PACI) subtype (56.3%) was the most common. And these results were again different from other studies. Discussion: While the incidence of stroke and especially HIV-associated youthful ischemic stroke continues to increase rapidly in developing countries such as Somalia, with the addition of inadequate primary health care services, stroke has become a major public health problem in African countries regarding its costs at social, psychological, and economic levels.</text>
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                <text>Ebubekir Arslan , Osman Cetinkaya</text>
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            <elementTextContainer>
              <elementText elementTextId="20171">
                <text>www.elsevier.com/locate/afjem</text>
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                <text>PERI IRAWAN</text>
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        <name>Acute Ischemic stroke Emergency department Somalia Sub-Saharan Africa</name>
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                  <text> Jurnal Internasional Afrika vol. 12 issue 3 2022</text>
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                <text>Jurnal Internasional Aprika  vol.12 issue 3 2022&#13;
African Journal of Emergency Medicine&#13;
Bedside colorimetric reagent dipstick in the diagnosis of meningitis in low–and middle–income countries: A prospective, international blinded comparison with laboratory analysis</text>
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              <elementText elementTextId="20243">
                <text>Meningitis Reagent dipstick Bedside diagnosis Resource-limited Global health</text>
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                <text>Background: Colorimetric reagent dipstick (CRD) for leukocyte esterase (LE) has shown potential for diagnosing and ruling out bacterial meningitis. Potential advantages over traditional cerebrospinal fluid (CSF) analysis in- clude the small quantity of CSF required, rapid results, and easy interpretation. Our study aimed to determine whether clinicians in LMICs could accurately diagnose bacterial meningitis using CRD at the bedside. Methods: A convenience sample of 143 patients requiring lumbar puncture for possible meningitis were enrolled from 1 October 2018 to 31 December 2019 at three hospitals, one each in rural Burundi, the Democratic Republic of Congo, and Kenya. CSF was analyzed using CRD followed by traditional laboratory-based analysis by techni- cians blinded to bedside results. Results were analyzed for concordance rates, sensitivity/specificity, positive and negative predictive values and impact on clinical decision-making. Results: One hundred and one patients were included in the analysis. The prevalence of bacterial meningitis in the convenience sample was 35% (35/101) as defined by microscopy or positive Gram stain. Using a threshold of “any positivity ”for LE on the CRD, bedside testing correctly identified 33/35 cases (sensitivity 94.3%) and had a NPV of 92%. When only a clearly positive ( ≥ “+ ”for LE) CRD criterion was used, sensitivity and NPV were 77.1% and 86.2%, respectively. Conclusion: Despite considerable promise, in our study, color reagent dipstick analysis of CSF did not perform well enough to rule out meningitis or screen samples for the need for microscopy. The development of a CSF-specific dipstick should be considered.</text>
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                <text>Carlan Bruce Wendler,  Ladislas Mashimango , Temoi Remi  , Patrick LaRochelle , Elliot Kang, B. Jason Brotherton</text>
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                <text>11 April 2022</text>
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                  <text> Jurnal Internasional Afrika vol. 12 issue 3 2022</text>
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              <elementText elementTextId="20253">
                <text>Jurnal Internasional Aprika  vol.12 issue 3 2022&#13;
African Journal of Emergency Medicine&#13;
Community ‐acquired pneumonia and its predictors of mortality in rural southwestern Nigeria: A ‐five year retrospective observational study</text>
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          <element elementId="49">
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            <elementTextContainer>
              <elementText elementTextId="20254">
                <text>Community-acquired pneumonia Predictors Mortality Rural Nigeria</text>
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          <element elementId="41">
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            <description>An account of the resource</description>
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              <elementText elementTextId="20255">
                <text>Introduction: The predictors of community-acquired pneumonia (CAP) mortality are important outcome measures in epidemiological studies and clinical trials. There is an observed paucity of data regarding the predictors of mortality of CAP in Nigeria. Few studies from the urban centres have been reported in the literature, with none from the rural centres. The objective of this study is to ascertain the clinical presentations, risk factors, and predictors of mortality among patients admitted for CAP in rural Southwestern Nigeria. Methods: A retrospective observational study using a data form and a standardised questionnaire reviewed the 176 patients admitted to Southwestern Nigeria hospital between January 2015 and December 2019. The data were analysed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Results: A total of 176 patients were studied. Their mean age was 53.3 ± 16.8 years. There were more males, 112 (63.6%), than females. The most common clinical presentations were cough, fever and sputum expectoration. The case fatality rate was 9.1% and its predictors were older aged patients [Adjusted Odds Ration (AOR), 4.135: 95% Confidence Interval (CI) (1.389-12.315); p = 0.005], hypoxia [AOR, 11.118: 95% CI (2.607-47.405); p &lt; 0.001], tobacco smoking [AOR, 3.632: 95% CI (1.459-9.039); p = 0.008], chronic obstructive pulmonary disease (COPD) [AOR, 10.111: 95%CI (2.370-43.139); p &lt; 0.001], and human immunodeficiency virus (HIV) [AOR, 9.444: 95% CI (4.304-20.725), p &lt; 0.001]. Conclusion: The case -fatality rate was 9.1%, and its predictors were older age patients, patients with hypoxia, tobacco smoking, COPD, and HIV. This study strengthens the argument on the higher prevalence of CAP and its mortality in rural Southwestern Nigeria. The findings may provide an impetus for prospective research on these outcomes.</text>
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                <text>Azeez Oyemomi IBRAHIM, Olabode Muftau SHABI, Shuaib Kayode AREMU , Emmanuel Olusegun OMOSANYA , Fasanmi Tolulope KOLAWOLE , Adewumi Oluwaserimi AJETUNMOBI </text>
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                  <text> Jurnal Internasional Afrika vol. 12 issue 3 2022</text>
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                <text>Jurnal Internasional Aprika  vol.12 issue 3 2022&#13;
African Journal of Emergency Medicine&#13;
Comparison of inferior vena cava collapsibility and central venous pressure in assessing volume status in shocked patients</text>
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                <text>Introduction: Determination of intravascular volume status in patients admitted to the emergency centre is critical. Physical signs of hypovolaemic, distributive, cardiogenic, and obstructive shock frequently overlap, making an accurate diagnosis of shock state difficult. This is problematic because fluid loading is considered the first step in haemodynamically unstable patients’ resuscitation. Yet, multiple studies have shown that only approximately 50% of haemodynamically unstable patients in the intensive care unit and operating theatre respond to a fluid challenge. This study aims to provide an accurate estimation of intravascular volume status using bedside noninvasive methods as an essential part of the assessment of volume status in shocked patients. Methodology: This is a cross-sectional analytical study conducted on 102 shocked patients presented to the emer- gency centre. IV fluid boluses were standardized to be administered at 500 mL every 30 min over 120 min, as clinically indicated. Concurrent measurements of inferior vena cava collapsibility index (IVC-ci) were performed shortly before the initiation of IV bolus (i.e., time 0), and then at 30, 90, and 120 min, we measured both venous collapsibility index (CI) and central venous pressure (CVP). At each session, we recorded patient demographics, fluid responsiveness, and vital sign assessments. Results: We discovered that IVC-ci at cut-offpoint 40 has a sensitivity of 93.3% and specificity of 70.7% with an AUC of 0.908 and a good 95% CI (0.84–0.975), implying that IVC-ci of 40% or higher can indicate fluid responsiveness in shocked patients. CVP, despite having a good sensitivity of 88.6%, high specificity of 100%, and a significant p-value, is not a reliable detector of fluid responsiveness due to its small AUC value and low 95% CI. Conclusion: IVC-ci could be a good tool with moderate reliability for detecting fluid responsiveness because it is a less invasive and fast method</text>
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                <text>Monira T Ismail, Afaf A. El-iraky , Emad El-Din A. Ibrahim , Tarek H. El.Kammash  , Ahmed E. Abou-Zied</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                <text>Jurnal Internasional Aprika  vol.12 issue 3 2022&#13;
African Journal of Emergency Medicine&#13;
Development of a checklist for auditing completion of patient report forms: A Delphi study</text>
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                <text>Introduction: Medical records are an integral part of patient care. Information loss during the handover from Emergency Care Providers to hospital staffis common and has a significant impact on patient care. Information loss can be prevented with medical documentation that is accurate, complete and contains the relevant infor- mation regarding patient management. Patient report Forms (PRF’s) are used by Emergency Care Providers to record the details of their patient care and they form part of the patients’ medical records. Quality assuring of PRF’s is required to determine if the required information has been recorded on the PRF. Checklists are one the means of quality assuring PRF, by comparing the points on the checklist to the content of the PRF. Methods: An three-round Delphi survey was conducted with experts to determine the relevant information (data elements) required for the completion of a PRF including any additional South African –specific elements. Results: Thirty-two experts participated in the Delphi survey, which identified 166 data elements for the check list and this was refined to a final 133 elements after collation by the researchers. A proposed checklist was developed. Discussion: The Delphi process is a useful technique to develop a checklist. A checklist consisting of 133 total possible data elements to quality assure PRFs was designed. Further research regarding the use and reliability of the checklist is required</text>
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