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                <text>Jurnal Internasional Afrika vol. 13 issue 2 2023&#13;
African Journal of Emergency Medicine&#13;
Acute organophosphorus toxicity in a regional hospital in Johannesburg, South Africa: A retrospective chart review</text>
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                <text>Organophosphorus toxicity Atropinisation dose Atropine toxicity Emergency department Cholinesterase levels</text>
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                <text>Introduction: Intentional and accidental organophosphorus exposures pose a significant healthcare-related bur- den on South African communities. This study will review the demographics, characteristics and clinical course of patients presenting with features of acute organophosphorus toxicity to a regional Emergency Centre in Jo- hannesburg, South Africa. Methods: This was a retrospective chart review of all patients treated for possible acute organophosphorus toxicity from January 2020 to August 2021. Results: A total of 205 patients were identified of which 134 patients were included in the study. The median age was 26 years with a male predominance (male = 56%, female = 44%). 109 patients (81.3%) survived, 18 pa- tients (13.4%) demised and the outcome of 7 patients (5.2%) was unknown. The median hospital length of stay was 8 days, (IQR = 5-13 days), and the longest hospital stay was 37 days in ICU. Atropinisation dose was signif- icantly higher for intubated patients (median = 140.0mg; IQR = 90mg-219.5mg) compared to patients who were not intubated (median = 60mg; IQR = 20.5mg-120mg, p &lt; 0.05). The length of stay was significantly higher for intubated patients (median = 11 days; IQR = 7-15 days) compared to patients who were not intubated (median = 5 days; IQR = 3-8 days, p &lt; 0.00). There was a moderate positive correlation between atropinisation dose and length of stay (Correlation coefficient = 0.37, p &lt; 0.00). There was a moderate negative correlation between atropinisa- tion dose and cholinesterase level (Correlation coefficient = - 0.39, p &lt; 0.00). Of those reported to have adverse effects 78.6%, were related to atropine toxicity. Conclusion: Our study shows a high mortality rate secondary to organophosphorus toxicity. Significant exposures and thus higher doses of atropine were associated with increased length of stay and need for intubation. We found a high incidence of atropine-related adverse effects. More studies are needed to further establish the balance between the therapeutic and adverse effects of high-dose atropine as a treatment modality for organophosphorus toxicity.</text>
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                <text>Vanessa Khonje&#13;
a ,&#13;
∗ , Jedd Hart&#13;
a ,&#13;
b , Jakus Venter&#13;
a ,&#13;
b , Saisha Deonarain&#13;
a , Saul Grossberg</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 2 2023&#13;
African Journal of Emergency Medicine&#13;
An evaluation of basic life support training among medical students in Southwest Nigeria: A web-based study</text>
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                <text>Lifesaving skills Medical proficiency Emergency medicine BLS training Medical students</text>
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                <text>Background: Basic Life Support (BLS) is considered a lifesaving measure and sound knowledge is expected among health professionals. Studies conducted among medical doctors and students in many developing countries show deficiencies in knowledge and practice of essential BLS skills. This study assessed the awareness, knowledge, perception, practice, accessibility and barriers to BLS training amongst medical students in South-Western Nigeria, exposing skill gaps and training challenges to inform appropriate solutions. Methods: This was a cross-sectional descriptive e-survey involving 2 nd –6 th year medical students enrolled in 12 regional medical schools. Overall, 553 responses were received over a 3-month period from November 2020 to January 2021 and analyzed using IBM-SPSS 26. Results: Of the 553 respondents, 79.2% were aware of BLS however only 160 (29%) respondents had good knowledge of BLS principles. Increasing age, higher level of study, prior BLS training and being enrolled in College of Medicine, University of Lagos (CMUL) were significantly associated with a higher knowledge score ( p &lt; 0.05). Majority (99.5%) considered BLS training necessary however, only 51.3% had prior training. Increased level of study correlated with prior BLS training ( p &lt; 0.05) alongside higher BLS uptake by respondents from CMUL (26.7%) and College of Medicine, University of Ibadan (20.9%) compared to respondents from other schools ( p &lt; 0.05). Only 35.4% had ever done Cardiopulmonary Resuscitation. Most respondents reported no confidence in performing BLS (67.1%) or in using an Automated External Defibrillator (85.7%). Unavailability of training opportunities in state (35%), town (42%) and cost (27%) were major barriers to BLS training identified. Conclusion: Despite a high level of awareness of BLS training, knowledge of BLS principles and its practice is poor among Nigerian medical students, reflecting a need to integrate stand-alone/structured BLS trainings into the medical curriculum to increase participation and accessibility by medical students</text>
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                <text>Simileoluwa O. Onabanjo&#13;
a ,&#13;
∗ , Faith O. IBU&#13;
a , Adebisi A. Adeyeye&#13;
a , Babatunde A. Akodu&#13;
b , Oyinoluwa G Adaramola&#13;
a , Akinboade O. Popoola</text>
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                  <text>Jurnal Internasional Afrika vol. 13 issue 2 2023</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 2 2023&#13;
African Journal of Emergency Medicine&#13;
Comparative study of National Emergency X-Radiography Utilization Study (NEXUS) chest algorithm and extended focused assessment with sonography for trauma (E-FAST) in the early detection of blunt chest injuries in polytrauma patients</text>
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                <text>Pneumothorax Hemothorax E-FAST NEXUS Blunt chest trauma</text>
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                <text>Introduction: Chest imaging plays a prominent role in the assessment of patients with blunt trauma. Selection of the right approach at the right time is fundamental in the management of patients with blunt chest trauma .&#13;
[1] A reliable, economic, bedside, and rapidly accomplished screening test can be pivotal.&#13;
[2] Objective: The aim of this study was to compare the accuracy of extended- focused assessment with sonography for trauma (E-FAST) to that of the National Emergency X-Radiography Utilisation Study (NEXUS) chest algorithm in detecting blunt chest injuries. Methods: This descriptive cross-sectional study included 50 polytrauma patients with blunt chest trauma from the emergency centre of Suez Canal University Hospital. E-FAST and computed tomography (CT) were conducted, followed by reporting of NEXUS criteria for all patients. Blinding of the E-FAST performer and CT reporter were confirmed. The results of both the NEXUS algorithm and E-FAST were compared with CT chest results. Results: The NEXUS algorithm had 100% sensitivity and 15.3% specificity, and E-FAST had 70% sensitivity and 96.7% specificity, in the detection of pneumothorax. In the detection of hemothorax, the sensitivity and specificity of the NEXUS algorithm were 90% and 7.5%, respectively, whereas E-FAST had a lower sensitivity of 80% and a higher specificity of 97.5%. Conclusion: E-FAST is highly specific for the detection of hemothorax, pneumothorax, and chest injuries compared with the NEXUS chest algorithm, which demonstrated the lowest specificity. However, the NEXUS chest algorithm showed a higher sensitivity than E-FAST and hence can be used effectively to rule out thoracic injury.</text>
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                <text>Yasmin Z. Attia&#13;
a ,&#13;
∗ , Nashwa M. Abd Elgeleel&#13;
a , Hazem M. El-Hariri&#13;
b , Gouda M. Ellabban&#13;
c , Maged El-SETOUHY&#13;
d ,&#13;
e ,&#13;
i , Jon Mark Hirshon&#13;
f , Adel H Elbaih&#13;
a ,&#13;
# , Mohamed El-Shinawi</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 2 2023&#13;
African Journal of Emergency Medicine&#13;
Diagnostic Performance of Point of Care Ultrasound Compared to Chest X-Ray in Patients with Hypoxia at a Teaching Hospital Emergency Department in Uganda</text>
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                <text>Background: Hypoxia is a common presentation in the Emergency Department (ED) worldwide. It affects 9-12% of hospitalized adults in Sub-Saharan Africa. Timely diagnosis of the multiple causes such as pneumonia, heart failure among others is challenging. Chest X-Ray (CXR), one of the most utilized imaging modalities has many limitations, and the gold standard (Computed Tomography scan) is inaccessible. Point of care ultrasound (PoCUS) is more available and increasingly being used, however little is known of its performance in resource limited EDs. The study aimed to assess the diagnostic performance of PoCUS compared with CXR in identifying the causes of hypoxia in the medical ED. Methods: 49 adults presenting with hypoxia (SP02 ≤ 88%) in the medical ED were evaluated. Ultrasound of the lungs and heart (PoCUS) was done, then CXR obtained. Lung ultrasound (LUS) was compared with CXR (first reference standard). Chest X-Ray and PoCUS were each compared to the physician diagnosis (second reference standard) to determine agreement using an acceptable disagreement cut-offof 15%. Results: 31% more abnormalities were identified by LUS than CXR. Lung ultrasound findings agreed with CXR in 86% of the participants with moderate reliability ( ĸ = 0.75). There was no significant difference between the actual findings of the two tests (X 2 = 2, p 0.1). Using the second reference, 82% of the CXRs were similar with weak reliability ( ĸ = 0.5) compared to 98% of PoCUS findings with strong reliability ( ĸ = 0.9). Compared to PoCUS, CXRs significantly differed from the physician diagnosis (X 2 = 0.85, p 0.38 vs X 2 = 8.5, p 0.004 respectively). Conclusion: Overall, PoCUS was not inferior to CXR when compared to final physician diagnosis in identifying causes of hypoxia, and LUS and CXR had comparable performance. Significantly more abnormalities were iden- tified on PoCUS and it demonstrated better agreement and strong reliability with the physician diagnosis than CXR. We recommend PoCUS use in patients with hypoxia attending resource limited in- and pre-hospital settings</text>
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                <text>Prisca Mary Kizito&#13;
a ,&#13;
c ,&#13;
∗ , Kenneth Daniel Bagonza&#13;
a ,&#13;
c , Justine Athieno Odakha&#13;
a ,&#13;
c , Linda Grace Nalugya&#13;
a ,&#13;
c , Pius Opejo&#13;
a ,&#13;
c , Anthony Muyingo&#13;
b ,&#13;
c , Harry Chen&#13;
a ,&#13;
c , Derek Harborne</text>
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        <name>Jurnal Internasional Keperawatan</name>
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        <name>Ultrasound Chest X-Ray Hypoxia Emergency Department (ED) Ugan</name>
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                  <text>Jurnal Internasional Afrika vol. 13 issue 2 2023</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 2 2023&#13;
African Journal of Emergency Medicine&#13;
Effectiveness of handover practices between emergency department and intensive care unit nurses</text>
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                <text>Background: Nurses from the emergency department (ED) and the intensive care unit (ICU) must interact during the handover procedure. Factors such as unit boundaries, the interaction between different specialities, patient acuities, and treatment adjustments generate specific negotiating and teamwork problems during the transition of patients from ED to ICU. Objective: This study aimed to describe the opinions of nurses regarding the effectiveness of handover practices between nurses in the ED and ICU in a major academic hospital in Gauteng province, South Africa. Method: An analytical cross-sectional survey design was used. Data were collected using a 16-item handover evaluation tool. It comprises two sections (1) biographical details and (2) 16 statements about handover quality divided into five constructs, namely information transfer, shared understanding, working atmosphere, overall handover quality, and circumstances of handover. Data analysis was done utilising descriptive and non-parametric statistics. Results: The majority (51.8%; n = 115) of the handovers occurred during the day. Out of 171 nurses, there were specialist practice emergency (19.2%; n = 33) and intensive care (28.0%; n = 48) nurses. There was statistical significance in information transfer between the ED and ICU nurses. (Me = 4.0, p &lt; 0.05), compared to ICU nurses (Me = 3.0). Nurse specialist and non-specialist nurses’ handovers differed statistically significantly on 12 of the 16 items on the rating scale, compared to 10 for non-specialist nurses’ handovers. Conclusion: The study showed that ED and ICU nurses have significantly different requirements and expectations for handover procedures. In addition to completed documentation, subtle interpretations of the information pro- vided and received also impact the need. The ED and ICU nurses would need to agree on the contents of a struc- tured handover framework because different specialities and departments have varied expectations to achieve an effective handover.</text>
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                <text>Tebogo T. Mamalelala&#13;
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b ,&#13;
∗ , Meghan Botes&#13;
b , William Holzemer</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 2 2023&#13;
African Journal of Emergency Medicine&#13;
Global health research abstracts: March ‘23</text>
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                <text>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal.&#13;
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                  <text>Jurnal Internasional Afrika vol. 13 issue 2 2023</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 2 2023&#13;
African Journal of Emergency Medicine&#13;
Injury patterns in patients with severe traumatic brain injuries from motor crashes admitted to Mulago hospital accidents &amp; emergency unit</text>
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                <text>Background: The global burden of Road Traffic Crashes (RTC) is increasing. Uganda has one of the highest rates of RTCs in Sub-Sahara. Victims of RTCs sustain varying degrees of injuries depending on factors including the velocity at time of impact, protective gear; and if it was a motorcycle–motorcycle or motorcycle–vehicle crash. High speed collisions can result in severe forms of injuries and polytrauma. Some injuries are undetected. Methods: A cross sectional study was carried at Mulago Hospital Accidents &amp; Emergency Unit, between November 2021 and February 2022; on all adult patients ( ≥ 18 years) with severe head injury from motor road traffic crashes. The study looked at injury patterns and assessed the relationship of polytrauma in patients with severe head injury to the mechanism of injury (motorcycles versus vehicles). Data were extracted from patient charts using a validated data abstraction tool and complete head to toe physical examination was carried out and injuries recorded. Data were analysed to determine the relationship of polytrauma in patients with severe head injury to the mechanism of injury. Results: The participants were predominantly males with a population median age of 32 (25-39). The commonest modes of transportation of patients to the hospital were Police Pickup trucks (40%) and ambulance (36.1%). Among motorcycle RTCs, (19.2%) wore helmets; 21.2% had protective gear; with injury identified mainly in; the limbs (84.8%), neck (76.8%), chest (39.4%), and abdomen (26.3%). Patients from vehicle RTCs were 19% more likely to have polytrauma compared to patients from motorcycle RTCs. Conclusions: This study showed that patients who sustain severe traumatic brain injuries from vehicle crashes have an increased likelihood of having multiple injuries, compared to patients from motorcycle RTCs. For motorcycle users, injuries mostly affect the limbs. At particular risk are motorcyclists who do not wear helmets and protective coveralls.</text>
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                <text>Joseph Kalanzi&#13;
a ,&#13;
∗ , Lee Wallis&#13;
b , Mary Nabukenya&#13;
a , Erasmus Okello&#13;
a , Doreen Okong&#13;
a , Stella Namirembe</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                <text>peri irawan</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 2 2023&#13;
African Journal of Emergency Medicine&#13;
Leveraging tele-mentoring and remote learning to strengthen the emergency care capacity of health workers in Uganda</text>
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                <text>Emergency medicine ECHO Telemedicine</text>
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                <text>Background: A robust emergency care system is a cost-effective method of reducing preventable death and dis- ability, especially in low-and middle-income countries. To scale emergency care expertise across the country, the Uganda Ministry of Health and Seed Global Health established the Emergency Medical Services (EMS) ECHO program. We describe the process of establishing the program in a resource-limited setting, best practices, and lessons learned in Uganda. Methods: Investigators conducted a mixed-methods evaluation to assess the initial 4 months’ implementation of the EMS ECHO. We conducted pre/post-program assessments of healthcare worker knowledge, self-efficacy, and professional’s satisfaction with the program. The analysis compared the differences between pre/post-test scores descriptively. Results: The EMS ECHO was initiated in November 2021. A phased curriculum was developed with the initial phase focusing on the ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) approach to the emer- gency patient. This phase reached 2,030 health workers cumulatively across 200 health facilities. The majority of the participants were medical doctors ( n = 751, 37%), and nurses ( n = 568, 28%). Majority of participants (95%) rated the sessions as informative. On whether the ECHO sessions diminished professional isolation, 66% agreed or strongly agreed. Conclusions: Similar to other ECHO program evaluation results, Uganda’s EMS ECHO program improved knowl- edge, skills, and the development of a virtual community of practice thereby diminishing professional isolation. It also demonstrates that through a planned stepwise process, virtual learning and telementorship can be used efficiently to improve healthcare worker knowledge,skills and multiply the limited number of emergency care experts available in the country.</text>
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                <text>Irene Atuhairwe&#13;
a ,&#13;
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