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&#13;
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                <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
African Journal of Emergency Medicine&#13;
Access to acute care resources in various income settings to treat new-onset stroke: A survey of acute care providers</text>
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                <text>Emergency&#13;
Low resource&#13;
Access&#13;
Stroke&#13;
Cerebrovascular accident</text>
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                <text>Introduction: Stroke affects 15 million people annually and is responsible for 5 million deaths per annum&#13;
globally. In contrast to the trend in low- and middle-income countries (LMICs), stroke mortality is on the decline&#13;
in high-income countries (HICs). Even though the availability of resources varies considerably by geographic&#13;
region and across LMICs and HICs, evidence suggests that material resources in LMICs to implement recommendations&#13;
from international guidelines are largely unmet. This study describes and compares the availability&#13;
of resources to treat new-onset stroke in countries based on the World Bank’s gross national incomes,&#13;
using recommendations of the American Heart Association and the American Stroke Association 2013 update.&#13;
Methods: A self-reported cross-sectional survey was conducted of delegates that attended the April 2016&#13;
International Conference on Emergency Medicine using the web-based e-Survey client, Survey Monkey Inc. The&#13;
survey assessed both pre-hospital and in-hospital settings and was piloted before implementation.&#13;
Results: The survey was distributed and opened by 955 delegates and 382 (40%) responded. Respondents from&#13;
LMICs reported significantly less access to a prehospital service (p &lt; 0.001) or a national emergency number&#13;
(p &lt; 0.001). Access to specialist neurology services (p &lt; 0.001) and radiology services (p &lt; 0.001) were also&#13;
significantly lower in LMICs.&#13;
Conclusion: The striking finding from this study was that there was essentially very little difference between the&#13;
responses between LMIC and HIC respondents with a few notable exceptions. The findings also propose a universal&#13;
lack of adherence to the 2013 AHA/ASA stroke management guideline by both groups, in contrast to the&#13;
good reported knowledge thereof. Carefully planned qualitative research is needed to identify the barriers to&#13;
achieving the 2013 AHA/ACA recommendations.</text>
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                <text>Ramadhan Chunga, Stevan R. Bruijns, Clint Hendrikse</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                <text>4 January 2019</text>
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                <text>peri irawan</text>
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        <name>Jurnal Internasional Keperawatan</name>
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&#13;
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                <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
African Journal of Emergency Medicine&#13;
Cochrane, evidence-based medicine and associated factors: A cross-sectional study of the experiences and knowledge of Ethiopian specialists in training</text>
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                <text>Cochrane&#13;
Evidence-based medicine&#13;
Resident doctors&#13;
Residency training program&#13;
Ethiopia</text>
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                <text>Introduction: Evidence-based healthcare is a core competency for practicing healthcare practitioners and those in&#13;
speciality training. In sub-Saharan Africa, little is known about the teaching of evidence-based medicine (EBM)&#13;
in residency program. This survey evaluated the experiences and knowledge of Cochrane, EBM and associated&#13;
factors among Ethiopian specialists in training.&#13;
Methods: A convenient sample of trainee specialists completed a pretested self-administered survey. The majority&#13;
(93%) were ≤30 years old, males (63%) and 41% in paediatrics speciality. The associations of categorical&#13;
variables with EBM knowledge was assessed by Fisher’s exact or Chi-Square tests. Covariates contributing to&#13;
EBM knowledge were identified using multivariate logistic regression analysis.&#13;
Results: Eighty-three trainees participated in the survey (response rate 88.2%). About 75% have heard about&#13;
Cochrane but no one recognized Cochrane South Africa. Only 25% of the trainees knew the Cochrane Library but&#13;
none used it in clinical practice. Most (78%) have heard of EBM, 15% had attended EBM course, 96% wanted to&#13;
attend EBM course and 81% had positive attitudes to EBM. Trainees EBM knowledge was associated with&#13;
awareness of Cochrane [Adjusted odds ratio (AOR)=8.5, 95% Confidence interval (CI) 1.3–54.6, P=0.02],&#13;
EBM (AOR=51.2, 95% CI 2.7–960.8, P=0.009), and being in third year training (AOR=28.4, 95% CI&#13;
1.9–427.2, P=0.02). The promotion of EBM in residency hospital (AOR=22.2, 95% CI 2.2–223.8, P=0.008)&#13;
and being aware of Cochrane (AOR=4.8, 95% CI 1.1–21.7, P=0.04) were predictors of positive attitude.&#13;
Familiarity with Cochrane Library was influenced by EBM knowledge (AOR=6.6, 95% CI 1.4–31.5, P=0.02)&#13;
and perceived organization barrier to accessing the resource (AOR=3.2, 95% CI 1.03–10.1, P=0.04).&#13;
Conclusion: Ethiopian trainee specialists lacked formal EBM training, awareness and use of the Cochrane Library.&#13;
To improve the healthcare quality and patient outcomes, EBM education should be integrated into residency&#13;
curricula.</text>
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            <name>Creator</name>
            <description>An entity primarily responsible for making the resource</description>
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              <elementText elementTextId="23971">
                <text>Omar Abdulwadud, Aklilu Azazh, Amha Mekasha, Tigist Bacha Heye, Balkachew Nigatu, Finote Debebe, Haimanot Geremew Emiru</text>
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              <elementText elementTextId="23972">
                <text>www.elsevier.com/locate/afjem</text>
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                <text>afem</text>
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            <description>An entity responsible for making contributions to the resource</description>
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                <text>peri irawan</text>
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                <text>english</text>
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        <name>Cochrane Evidence-based medicine Resident doctors Residency training program Ethiopia</name>
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        <name>Jurnal Internasional Keperawatan</name>
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                  <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
&#13;
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            <description>A name given to the resource</description>
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                <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
African Journal of Emergency Medicine&#13;
Dissemination patterns of scientific abstracts presented at the first and second African Conference of Emergency Medicine </text>
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          <element elementId="49">
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                <text>Conference&#13;
Africa&#13;
Publication&#13;
Barriers&#13;
Dissemination</text>
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            <description>An account of the resource</description>
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                <text>Introduction: Evidence based medicine is the standard of modern health care practices. Ongoing biomedical&#13;
research is needed to expand existing knowledge and improve quality of care, but it needs to reach clinicians to&#13;
drive change. Journal articles and conference presentations are dissemination tools. The aim of the study was to&#13;
establish the publication rate of scientific abstracts presented at the first and second African Conference of&#13;
Emergency Medicine. The secondary objectives were establishing non-publication dissemination and the factors&#13;
associated with publication and non-publication. Determining non-publication dissemination patterns and the&#13;
factors associated with reasons for publishing or non-publication were also investigated.&#13;
Methods: Presenters of the 129 scientific abstracts from the first and second African Conference of Emergency&#13;
Medicine were invited to participate in an online survey. The survey was followed by a manual literature search&#13;
to identify published manuscripts of authors that did not complete the survey, to determine the most accurate&#13;
publication rate.&#13;
Results: Thirty-one presenters responded (24%), of which 18 published in a peer-reviewed journal. An additional&#13;
25 publications were identified by the literature search. The overall publication rate was 33.3% (26.9% from&#13;
2012 and 40.3% from 2014). Oral presentations were more likely to be published (p=0.09). Sixteen manuscripts&#13;
(37.2%) were published in the African Journal of Emergency Medicine. Presentations at local academic&#13;
meetings were the most used platform beyond publication (43%). The main reason to publish was to add to the&#13;
body of knowledge (100%), while lack of time (57%) was the major obstacle for not publishing.&#13;
Conclusion: The overall publication rate for the first and second Africa Conferences of Emergency Medicine is&#13;
comparable to other non-African Emergency Medicine conferences. The increasing publication trend between&#13;
conferences might reflect the development of regional research capacity. Emergency Medicine providers in&#13;
Africa need to be encouraged to participate in high quality, locally relevant research and to distribute those&#13;
findings through accessible formats.</text>
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            <description>An entity primarily responsible for making the resource</description>
            <elementTextContainer>
              <elementText elementTextId="23982">
                <text>Marlin Abrams, Stevan R. Bruijns, Daniël J. van Hoving</text>
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            <description>A related resource from which the described resource is derived</description>
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              <elementText elementTextId="23983">
                <text>www.elsevier.com/locate/afjem</text>
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            <description>A point or period of time associated with an event in the lifecycle of the resource</description>
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                <text>16 January 2019</text>
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          <element elementId="37">
            <name>Contributor</name>
            <description>An entity responsible for making contributions to the resource</description>
            <elementTextContainer>
              <elementText elementTextId="23985">
                <text>peri irawan</text>
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            <elementTextContainer>
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                <text>english</text>
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        <name>Conference Africa Publication Barriers Dissemination</name>
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        <name>Jurnal Internasional Keperawatan</name>
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                <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
African Journal of Emergency Medicine&#13;
Pre-hospital intercostal chest drains in South Africa: A modified Delphi study </text>
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          <element elementId="49">
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                <text>Pre-hospital&#13;
Intercostal chest drain&#13;
Pneumothorax&#13;
Haemothorax</text>
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            <description>An account of the resource</description>
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                <text>Introduction: Trauma is one of the most common causes of death in low- and middle-income countries, with&#13;
thoracic injury accounting for 20–25% of these deaths worldwide. The current management of a life-threatening&#13;
pre-hospital pneumothorax is with a needle chest decompression, however, definitive care for a pneumothorax&#13;
and/or haemothorax is still the insertion of an intercostal chest drain. The aim of this study was to seek expert&#13;
opinion and consensus on the placement of ICDs in the pre-hospital emergency care setting in South Africa.&#13;
Methods: A three-round modified Delphi study was undertaken with an expert panel drawn from local emergency&#13;
care experts consisting of physicians and emergency medical service practitioners. Participants supplied&#13;
opinion statements in round 1 under headings derived from common emerging themes found in the literature.&#13;
During round 2 participants used a 9-point Likert scale to rate their consensus on each statement and in round 3&#13;
they were able to change their position based on the earlier panel distributions. A consensus percentage of 60%&#13;
was set within a narrow margin of ‘strongly agree’ or ‘strongly disagree’.&#13;
Results: A total of 22 experts took part as panel members. There were 123 opinion statements produced from&#13;
round 1, of which 21 (17%) reached consensus in round 2. At the end of round 3 another four statements reached&#13;
consensus, bringing the total up to 25 (20%).&#13;
Conclusion: Definitive care of a life-threating pneumothorax and/or haemothorax must be sought emergently.&#13;
The insertion of an ICD, under select conditions, may be required in the pre-hospital setting in South Africa</text>
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                <text>Enrico Dippenaar, Lee Wallis</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                <text>peri irawan</text>
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      <tag tagId="2017">
        <name>Jurnal Internasional Keperawatan</name>
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        <name>Pre-hospital Intercostal chest drain Pneumothorax Haemothorax</name>
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                  <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
&#13;
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                <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
African Journal of Emergency Medicine&#13;
Prognostic performance of ECG abnormalities compared to vital signs in acutely ill patients in a resource-poor hospital in Uganda </text>
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                <text>Acute illness&#13;
Early warning scores&#13;
Risk stratification&#13;
ECG&#13;
Prolonged QTc&#13;
Left ventricular hypertrophy</text>
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                <text>patients admitted to low resource hospitals in sub-Saharan Africa.&#13;
Methods: We undertook an observational study of acutely ill medical patients admitted to a low-resource hospital&#13;
in Uganda. Vital signs were used to calculate the National Early Warning Score (NEWS), and all ECGs were&#13;
assessed using Tan et al.’s scoring system as described in Clin Cardiol 2009;32:82–86.&#13;
Results: There were 1361 ECGs performed, covering 68% of all acutely ill medical patients admitted to the hospital&#13;
during the study. The most common ECG abnormality was a prolonged QTc interval (42% of all patients) and left&#13;
ventricular hypertrophy (13.5%). Compared to the 519 patients (38%) with no Tan score abnormality, the 842&#13;
(62%) patients with one or more abnormalities were more likely to die in hospital (OR=2.82; CI95%=1.50–5.36)&#13;
and within 30 days of discharge (OR=2.46; CI95%=1.50–4.08). There was no relationship between age and&#13;
mortality; however, after adjustment by logistic regression, any NEWS ≥1 on admission, a Tan score of ≥1, and&#13;
male sex all remained clinically significant predictors of both in-hospital and 30-day mortality.&#13;
Discussion: The majority of acutely ill medical patients admitted in a low-resource hospital in sub-Saharan Africa&#13;
had ECG abnormalities, of which prolonged QTc and left ventricular hypertrophy were most common. Those&#13;
with any Tan score abnormality were twice as likely to die as those without an abnormality</text>
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                <text>Teopista Namujwiga, Immaculate Nakitende, John Kellett, Martin Opio, Alfred Lumala, on behalf of the Kitovu Hospital Study Group</text>
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                <text>www.elsevier.com/locate/afjem</text>
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        <name>Acute illness Early warning scores Risk stratification ECG Prolonged QTc Left ventricular hypertrophy</name>
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      <tag tagId="2017">
        <name>Jurnal Internasional Keperawatan</name>
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                  <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
&#13;
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                <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
African Journal of Emergency Medicine&#13;
The cost of time: A randomised, controlled trial to assess the economic impact of upfront, point-of-care blood tests in the Emergency Centre </text>
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                <text>Emergency department&#13;
Point-of-care systems&#13;
Point-of-care testing&#13;
Economic analysis</text>
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                <text>Introduction: Time and cost constraints abound in the Emergency Centre (EC). These resource-constraints are&#13;
further magnified in low- and middle-income countries (LMIC). Almost half of all patients presenting to the EC&#13;
require laboratory tests. Unfortunately, access to laboratory services in LMIC is commonly inadequate. Point-of-&#13;
Care (POC) tests may assist to avert this shortcoming. The aims of this study were to evaluate the cost effectiveness&#13;
of upfront POC blood tests performed prior to doctor assessment compared to the standard EC workflow.&#13;
Methods: A secondary analysis was performed on data from a prospective, randomised, controlled trial where&#13;
patients with abdominal/chest symptoms or generalised body pain/weakness followed either the normal EC&#13;
workflow pathway or one of two enhanced workflow pathways with POC tests (i-STAT with and without a&#13;
complete blood count (CBC)) prior to doctor evaluation. The incremental cost effectiveness ratio (ICER) was used&#13;
to perform the cost effectiveness analysis.&#13;
Results: There were 248 patients enrolled in the study. The use of the two upfront, POC test pathways significantly&#13;
exceeded the primary outcome measure of a 20% reduction in treatment time. In the i-STAT+CBC&#13;
group, the 31 min. time-saving translated into cost-saving of US$14.96 per patient (IECR 0.27) whereas the&#13;
21 min. time-saving in the i-STAT only group only had an additional net cost of US$3.11 per patient (IECR 0.90).&#13;
Conclusion: Upfront, POC blood tests can be utilised in the resource-constrained EC to manage patients more&#13;
efficiently by saving time. This time-saving can, in fact, be more cost effective than traditional EC workflow&#13;
making it an economically viable option for implementation in LMIC.</text>
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              <elementText elementTextId="24035">
                <text>Lara Nicole Goldstein, Mike Wells, Craig Vincent-Lambert</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                <text>16 January 2019</text>
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              <elementText elementTextId="24039">
                <text>peri irawan</text>
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        <name>Emergency department Point-of-care systems Point-of-care testing Economic analysis</name>
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        <name>Jurnal Internasional Keperawatan</name>
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                  <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
&#13;
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                <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
African Journal of Emergency Medicine&#13;
The variables perceived to be important during patient handover by South African prehospital care providers</text>
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                <text>Handover&#13;
Handoff&#13;
Prehospital&#13;
Emergency centre</text>
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                <text>Introduction: High-acuity patients are typically transported directly to the emergency centre via ambulance by&#13;
trained prehospital care providers. As such, the emergency centre becomes the first of many physical transition&#13;
points for patients, where a change of care provider (or handover) takes place. The aim of this study was to&#13;
describe the variables perceived to be important during patient handover by a cohort of South African prehospital&#13;
care providers.&#13;
Methods: A purpose-designed questionnaire was used to gather data related to prehospital emergency care&#13;
provider opinions on the importance of certain patient variables.&#13;
Results: We collected 175 completed questionnaires from 75 (43%) BAA, 49 (28%) ANA, 15 (9%) ECT, 16 (9%)&#13;
ANT and 20 (11%) ECP respondents. Within the ten handover variables perceived to be most important for&#13;
inclusion in emergency centre handover, five were related to vital signs. Blood pressure was ranked most important,&#13;
followed by type of major injuries, anatomical location of major injuries, pulse rate, respiration rate and&#13;
patient history. These were followed by Glasgow Coma Score, injuries sustained, patient priority, oxygen saturations&#13;
and patient allergies.&#13;
Conclusion: This study has provided some interesting results related to which handover elements prehospital&#13;
care providers consider as most important to include in handover. More research is required to correlate these&#13;
findings with the opinions of emergency centre staff.</text>
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                <text>Andrew William Makkink, Christopher Owen Alexander Stein, Stevan Raynier Bruijns, Sean Gottschalk</text>
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                <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
African Journal of Emergency Medicine&#13;
Traumatic ocular lens dislocation</text>
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Ultrasound&#13;
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                <text>Introduction: Ocular lens dislocation is a relatively rare and difficult to diagnose disorder. Computed tomography&#13;
often confirms the diagnosis, however may be unavailable in resource limited settings. Bedside ultrasound offers&#13;
an alternative method of diagnosis which is rapid, inexpensive, and relatively easy.&#13;
Case: A 59-year-old man presented with a complaint of decreased vision in his right eye after being assaulted.&#13;
Exam was remarkable for decreased visual acuity and increased intraocular pressure. Maxillofacial and brain CT&#13;
as well as bedside ultrasound demonstrated a posteriorly dislocated ocular lens. The patient’s intraocular&#13;
pressures were medically managed and he was discharged with close follow-up with ophthalmology.&#13;
Conclusion: Ocular lens dislocation may be easily diagnosed with ultrasound. Direction of lens dislocation dictates&#13;
management, however posterior dislocations may be amenable to outpatient management</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>Ocular lens dislocation Traumatic lens dislocation Ultrasound POCUS</name>
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                  <text>Jurnal Internasional Afrika vol. 9 issue 2 2019&#13;
&#13;
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African Journal of Emergency Medicine&#13;
Triage live lecture versus triage video podcast in pre-hospital students’ education </text>
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Lecture&#13;
Podcast&#13;
Pre-hospital&#13;
Education&#13;
Emergency</text>
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                <text>Introduction: Triage is the process of determining the priority of patients’ treatments based on the severity of&#13;
their conditions. The aim of the present study was to survey the effect of triage video podcasting on the&#13;
knowledge and performance of pre-hospital students.&#13;
Methods: Sixty pre-hospital students were randomly divided into two groups of a 30-subject control group and a&#13;
30-subject intervention group. A pre-test was administered among all students. Afterwards, for the first group,&#13;
triage education was offered through lectures using PowerPoint, while for the second group, audio and video&#13;
podcasts tailored for this training program were employed. Right after the training as well as one month later,&#13;
post-tests were run for both groups, and the results were analysed using an independent t-test and covariance.&#13;
Results: No significant difference was observed between the effects of both types of education on knowledge and&#13;
performance, either immediately, or one month after training.&#13;
Discussion: We suggest that video podcasts are ready to replace traditional teaching methods in triage</text>
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                <text>Hamidreza Aghababaeian, Ladan Araghi Ahvazi, Ahmad Moosavi, Sadegh Ahmadi Mazhin, Noorollah Tahery, Mohsen Nouri, Maryam Kiarsi, Leila Kalani</text>
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