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Mancini V, Borellini M, Belardi P, Colucci MC, Kadinde EY, Mwibuka C, Maziku D, Parisi P, Di Napoli A. Factors associated with hospitalization in a pediatric population of rural Tanzania: findings from a retrospective cohort study. Ital J Pediatr 2024; 50:53. [PMID: 38500138 PMCID: PMC10949679 DOI: 10.1186/s13052-024-01622-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/24/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Despite pediatric acute illnesses being leading causes of death and disability among children, acute and critical care services are not universally available in low-middle income countries, such as Tanzania, even if in this country significant progress has been made in child survival, over the last 20 years. In these countries, the hospital emergency departments may represent the only or the main point of access to health-care services. Thus, the hospitalization rates may reflect both the health system organization and the patients' health status. The purpose of the study is to describe the characteristics of clinical presentations to a pediatric Outpatient Department (OPD) in Tanzania and to identify the predictive factors for hospitalization. METHODS Retrospective cohort study based on 4,324 accesses in the OPD at Tosamaganga Voluntary Agency Hospital (Tanzania). Data were collected for all 2,810 children (aged 0-13) who accessed the OPD services, within the period 1 January - 30 September 2022. The association between the hospitalization (main outcome) and potential confounding covariates (demographic, socio-contextual and clinical factors) was evaluated using univariate and multivariate logistic regression models. RESULTS Five hundred three (11.6%) of OPD accesses were hospitalized and 17 (0.4%) died during hospitalization. A higher (p < 0.001) risk of hospitalization was observed for children without health insurance (OR = 3.26), coming from more distant districts (OR = 2.83), not visited by a pediatric trained staff (OR = 3.58), and who accessed for the following conditions: burn/wound (OR = 70.63), cardiovascular (OR = 27.36), constitutional/malnutrition (OR = 62.71), fever (OR = 9.79), gastrointestinal (OR = 8.01), respiratory (OR = 12.86), ingestion/inhalation (OR = 17.00), injury (OR = 6.84). CONCLUSIONS The higher risk of hospitalization for children without health insurance, and living far from the district capital underline the necessity to promote the implementation of primary care, particularly in small villages, and the establishment of an efficient emergency call and transport system. The observation of lower hospitalization risk for children attended by a pediatric trained staff confirm the necessity of preventing admissions for conditions that could be managed in other health settings, if timely evaluated.
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Affiliation(s)
- Vincenzo Mancini
- Chair of Pediatrics, NESMOS department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
- Doctors with Africa CUAMM, Iringa, Tanzania
| | | | | | - Maria Carolina Colucci
- Chair of Pediatrics, NESMOS department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
| | | | | | | | - Pasquale Parisi
- Chair of Pediatrics, NESMOS department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
| | - Anteo Di Napoli
- Epidemiolgy Unit, National Institute for Health Migration and Poverty (INMP), Via di San Gallicano, 25a - 00153, Rome, Italy.
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Michaeli N, De Luca G, Gitau M, Myers J, Ojuka D, Ouma D, Wieland T, Wanjiku G. Evaluation of the World Health Organization-International Committee of the Red Cross Basic Emergency Care course for senior medical students. Int J Emerg Med 2023; 16:29. [PMID: 37085780 PMCID: PMC10120185 DOI: 10.1186/s12245-023-00487-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 02/12/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND The Basic Emergency Care: Approach to the acutely ill and injured course was developed to train health care providers to recognize, stabilize, and treat critically ill patients in resource-limited settings. This study evaluates the Basic Emergency Care course as a tool for improving the emergency medicine knowledge and skills of medical students in a lower-middle income country. METHODS This prospective study was conducted with senior medical students at the University of Nairobi School of Medicine in October 2021. Participants' knowledge was assessed with multiple choice pre- and post-course examinations. Pre- and post-course surveys assessed participants' confidence in managing acutely ill and injured patients using a 4-point Likert scale. RESULTS A total of 30 students from the graduating medical school class participated in the study. Post-course examination scores (mean 94.5%, range 80-100%) showed a significant improvement (p < 0.05) compared to pre-course examination scores (mean 82%, range 64-96%). Participants' comfort and confidence in providing emergency care and performing critical emergency skills significantly increased (p < 0.05) between the pre- and post-course surveys. CONCLUSION These findings suggest that the Basic Emergency Care course is effective in providing senior medical students with basic emergency medicine knowledge and increasing their confidence to identify and address life-threatening conditions prior to their intern year.
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Affiliation(s)
- Nichole Michaeli
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick St., Providence, RI, 02903, USA.
| | - Giovanna De Luca
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick St., Providence, RI, 02903, USA
| | - Mary Gitau
- P.C.E.A. Chogoria Hospital, Chogoria, Kenya
| | - Justin Myers
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel Ojuka
- Department of Surgery, University Of Nairobi, College of Health Science, Nairobi, Kenya
| | | | - Travis Wieland
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
| | - Grace Wanjiku
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick St., Providence, RI, 02903, USA
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Jaffry Z, Sabawo M, Harrison WJ, Schade AT. Using a consensus meeting to enhance fracture care education in low income countries. BMC MEDICAL EDUCATION 2023; 23:111. [PMID: 36793036 PMCID: PMC9930265 DOI: 10.1186/s12909-023-04077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND A key strategy to building surgical capacity in low income countries involves training care providers, particularly in the interventions highlighted by the Lancet Commission for Global Surgery, including the management of open fractures. This is a common injury, especially in areas with a high incidence of road traffic incidents. The aim of this study was to use a nominal group consensus method to design a course on open fracture management for clinical officers in Malawi. METHODS The nominal group meeting was held over two days, including clinical officers and surgeons from Malawi and the UK with various levels of expertise in the fields of global surgery, orthopaedics and education. The group was posed with questions on course content, delivery and evaluation. Each participant was encouraged to suggest an answer and the advantages and disadvantages of each suggestion were discussed before voting through an anonymous online platform. Voting included use of a Likert scale or ranking available options. Ethical approval for this process was obtained from the College of Medicine Research and Ethics Committee Malawi and the Liverpool School of Tropical Medicine. RESULTS All suggested course topics received an average score of greater than 8 out of 10 on a Likert scale and were included in the final programme. Videos was the highest ranking option as a method for delivering pre-course material. The highest ranking methods for each course topic included lectures, videos and practicals. When asked what practical skill should be tested at the end of the course, the highest ranking option was "initial assessment". CONCLUSION This work outlines how a consensus meeting can be used to design an educational intervention to improve patient care and outcomes. Through combining the perspectives of both the trainer and trainee, the course aligns both agendas so that it is relevant and sustainable.
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Affiliation(s)
| | | | - William J Harrison
- Countess of Chester Hospital NHS Trust, London, UK
- AO Alliance Africa, Davos, Switzerland
| | - Alexander T Schade
- Malawi- Liverpool Wellcome Trust, Blantyre, Malawi.
- Liverpool School of Tropical Medicine, Liverpool, UK.
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Bebbington E, Poole R, Kumar SP, Krayer A, Krishna M, Taylor P, Hawton K, Raman R, Kakola M, Srinivasarangan M, Robinson C. Establishing Self-Harm Registers: The Role of Process Mapping to Improve Quality of Surveillance Data Globally. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2647. [PMID: 36768009 PMCID: PMC9915364 DOI: 10.3390/ijerph20032647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Self-harm registers (SHRs) are an essential means of monitoring rates of self-harm and evaluating preventative interventions, but few SHRs exist in countries with the highest burden of suicides and self-harm. Current international guidance on establishing SHRs recommends data collection from emergency departments, but this does not adequately consider differences in the provision of emergency care globally. We aim to demonstrate that process mapping can be used prior to the implementation of an SHR to understand differing hospital systems. This information can be used to determine the method by which patients meeting the SHR inclusion criteria can be most reliably identified, and how to mitigate hospital processes that may introduce selection bias into these data. We illustrate this by sharing in detail the experiences from a government hospital and non-profit hospital in south India. We followed a five-phase process mapping approach developed for healthcare settings during 2019-2020. Emergency care provided in the government hospital was accessed through casualty department triage. The non-profit hospital had an emergency department. Both hospitals had open access outpatient departments. SHR inclusion criteria overlapped with conditions requiring Indian medicolegal registration. Medicolegal registers are the most likely single point to record patients meeting the SHR inclusion criteria from multiple emergency care areas in India (e.g., emergency department/casualty, outpatients, other hospital areas), but should be cross-checked against registers of presentations to the emergency department/casualty to capture less-sick patients and misclassified cases. Process mapping is an easily reproducible method that can be used prior to the implementation of an SHR to understand differing hospital systems. This information is pivotal to choosing which hospital record systems should be used for identifying patients and to proactively reduce bias in SHR data. The method is equally applicable in low-, middle- and high-income countries.
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Affiliation(s)
- Emily Bebbington
- Wrexham Academic Unit, Centre for Mental Health and Society, Bangor University, Wrexham LL13 7YP, UK
- Department of Emergency Medicine, Ysbyty Gwynedd, Bangor LL57 2PW, UK
| | - Rob Poole
- Wrexham Academic Unit, Centre for Mental Health and Society, Bangor University, Wrexham LL13 7YP, UK
| | - Sudeep Pradeep Kumar
- South Asia Self-Harm Initiative, JSS Hospital, Mysuru 570 004, India
- Department of Clinical Psychology, JSS Hospital, Mysuru 570 004, India
| | - Anne Krayer
- Wrexham Academic Unit, Centre for Mental Health and Society, Bangor University, Wrexham LL13 7YP, UK
| | - Murali Krishna
- Wrexham Academic Unit, Centre for Mental Health and Society, Bangor University, Wrexham LL13 7YP, UK
- South Asia Self-Harm Initiative, JSS Hospital, Mysuru 570 004, India
| | - Peter Taylor
- Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Rajesh Raman
- Department of Psychiatry, JSS Hospital, Mysuru 570 004, India
| | - Mohan Kakola
- Department of Plastic Surgery and Burns, Krishna Rajendra Hospital, Mysuru 570 001, India
| | | | - Catherine Robinson
- Social Care and Society, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
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Abstract
This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient—these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single “best” care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country’s current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient’s geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources.
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Kemmler CB, Saleem SG, Ali S, Samad L, Haider KF, Jamal MI, Aziz T, Maroof Q, Dadabhoy FZ, Yasin Z, Rybarczyk MM. A 1-year training program in emergency medicine for physicians in Karachi, Pakistan: Evaluation of learner and program outcomes. AEM EDUCATION AND TRAINING 2021; 5:e10625. [PMID: 34222755 PMCID: PMC8241570 DOI: 10.1002/aet2.10625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Pakistan has an underdeveloped and overburdened emergency care system, with most emergency departments (EDs) staffed by physicians not formally trained in emergency medicine (EM). As of January 2020, only nine Pakistani institutions were providing formal EM specialty training; therefore, a training program of shorter duration is needed in the interim. METHODS The Certification Program in Emergency Medicine (CPEM) is a 1-year training program in EM consisting of two arms: CPEM-Clinical (CPEM-C), which includes physicians from The Indus Hospital (TIH) ED, and CPEM-Didactic (CPEM-D), including physicians from EDs across Karachi. Both groups participate in weekly conferences, including didactics, small-group discussions, workshops, and journal clubs. CPEM-C learners also receive clinical mentorship from visiting international and TIH EM faculty. Both groups were assessed with preprogram, midterm, and final examinations as well as on clinical skills. Additionally, both groups provided regular feedback on program content and administration. RESULTS Twenty-five of the 32 initially enrolled learners completed the program in June 2019. Scores on a matched set of 50 questions administered in the pretest and final examination improved by an average of 15.1% (p < 0.005) for CPEM-C learners and 8.5% (p < 0.0005) for CPEM-D learners, with 93% of learners showing improvement. Clinical evaluations of CPEM-C and CPEM-D learners during the first and fourth quarters showed an average improvement of 1.1 out of 5 (p < 0.05) and 1.2 out of 9 (p < 0.0005) points, respectively. Learner evaluations of the program were overall positive. CONCLUSIONS CPEM demonstrated significant improvement in test scores and clinical evaluations in both program arms. Evaluations also suggested that the program was well received. These data, along with CPEM's ability to train physicians from multiple institutions using low-cost, innovative educational strategies, suggest that it may be an effective, transferable mechanism for the expedited development of EM in Pakistan and countries where EM is developing as a specialty.
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Affiliation(s)
- Charles B. Kemmler
- Department of Emergency MedicinePrisma HealthUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
| | | | - Saima Ali
- Department of Emergency MedicineThe Indus HospitalKarachiPakistan
| | - Lubna Samad
- Center for Essential Surgical and Acute CareIndus Health NetworkKarachiPakistan
- Department of Pediatric SurgeryThe Indus HospitalKarachiPakistan
| | - Kaniz F. Haider
- Center for Essential Surgical and Acute CareIndus Health NetworkKarachiPakistan
| | | | - Tariq Aziz
- Department of Emergency MedicineThe Indus HospitalKarachiPakistan
| | | | - Farah Z. Dadabhoy
- Department of Emergency MedicineMassachusetts General Hospital and Brigham and Women’s HospitalBostonMassachusettsUSA
| | | | - Megan M. Rybarczyk
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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7
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Pandiselvam S, Jena NN, Ghatak‐Roy A, Dreyer N, Naik N, Blanchard J, Davey K. Prevalence of undiagnosed HIV, hepatitis B, and hepatitis C among patients in an Indian emergency department. J Am Coll Emerg Physicians Open 2021; 2:e12328. [PMID: 33521780 PMCID: PMC7819266 DOI: 10.1002/emp2.12328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES HIV, hepatitis B, and hepatitis C remain significant causes of morbidity and mortality in low resource settings. Emergency department (ED)-based screening has proven effective in decreasing the spread of undiagnosed disease, although such programs are rare in low-middle income countries. METHODS A prospective, cross sectional study of all adult patients presenting to the ED in a 600-bed teaching hospital in Tamil Nadu, India. This study used an opt-in strategy in which patients were offered testing at the end of their ED visit. Costs of testing were paid out of pocket by patients. Patients with known HIV, hepatitis B, or hepatitis C were excluded from the study. RESULTS During the study period 26,465 patients presented to the ED, and 18,286 patients consented to participate (68.9%). Among the 18,286 patients tested, 174 were positive for either HIV (39, 0.21%), hepatitis C (52, 0.28%), or hepatitis B (83, 0.45%). Three patients tested positive for both HIV and hepatitis C, and 1 patient tested positive for both HIV and hepatitis B. A total of 69.2% of patients with HIV, 61.2% of patients with hepatitis B, and 83% of patients with hepatitis C presented for reasons unrelated to their underlying diagnosis. CONCLUSION Although limited to only 1 hospital in southern India, this study represents the largest ED-based screening program for HIV, hepatitis B, and hepatitis C ever conducted in India or any other low-middle income countries. The majority of patients presented for reasons unrelated to their underlying diagnosis. Future research is needed on implementation strategies, cost feasibility, and linkage to care.
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Affiliation(s)
- Sathishkumar Pandiselvam
- Meenakshi Mission Hospital and Research CenterInstitute of Emergency MedicineMaduraiTamil NaduIndia
| | - Narendra N. Jena
- Meenakshi Mission Hospital and Research CenterInstitute of Emergency MedicineMaduraiTamil NaduIndia
| | - Aditi Ghatak‐Roy
- Department of Emergency MedicineGeorge Washington UniversityWashington DCUSA
| | - Nicholas Dreyer
- Department of Emergency MedicineGeorge Washington UniversityWashington DCUSA
| | - Nehal Naik
- Department of Emergency MedicineGeorge Washington UniversityWashington DCUSA
| | - Janice Blanchard
- Department of Emergency MedicineGeorge Washington UniversityWashington DCUSA
| | - Kevin Davey
- Department of Emergency MedicineGeorge Washington UniversityWashington DCUSA
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Moretti K, Uwamahoro DL, Naganathan S, Uwamahoro C, Karim N, Nkeshimana M, Aluisio AR. Emergency medicine matters: epidemiology of medical pathology and changes in patient outcomes after implementation of a post-graduate training program at a Tertiary Teaching Hospital in Kigali, Rwanda. Int J Emerg Med 2021; 14:9. [PMID: 33478387 PMCID: PMC7819192 DOI: 10.1186/s12245-021-00331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background Emergency care is a new but growing specialty across Africa where medical conditions have been estimated to account for 92% of all disability-adjusted life years. This study describes the epidemiology of medical emergencies and the impact of formalized emergency care training on patient outcomes for medical conditions in Rwanda. Methods A retrospective cohort study was performed using a database of randomly sampled patients presenting to the emergency center (EC) at the University Teaching Hospital of Kigali. All patients, > 15 years of age treated for medical emergencies pre- and post-implementation of an Emergency Medicine (EM) residency training program were eligible for inclusion. Patient characteristics and final diagnosis were described by time period (January 2013–September 2013 versus September 2015–June 2016). Univariate chi-squared analysis was performed for diagnoses, EC interventions, and all cause EC and inpatient mortality stratified by time period. Results A random sample of 1704 met inclusion with 929 patients in the pre-residency time period and 775 patients in the post-implementation period. Demographics, triage vital signs, and shock index were not different between time periods. Most frequent diagnoses included gastrointestinal, infectious disease, and neurologic pathology. Differences by time period in EC management included antibiotic use (37.2% vs. 42.2%, p = 0.04), vasopressor use (1.9% vs. 0.5%, p = 0.01), IV crystalloid fluid (IVF) use (55.5% vs. 47.6%, p = 0.001) and mean IVF administration (2057 ml vs. 2526 ml, p < 0.001). EC specific mortality fell from 10.0 to 1.4% (p < 0.0001) across time periods. Conclusions Mortality rates fell across top medical diagnoses after implementation of an EM residency program. Changes in resuscitation care may explain, in part, this mortality decrease. This study demonstrates that committing to emergency care can potentially have large effects on reducing mortality.
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Affiliation(s)
- Katelyn Moretti
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, USA.
| | - Doris Lorette Uwamahoro
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Sonya Naganathan
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, USA
| | - Chantal Uwamahoro
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Naz Karim
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, USA
| | - Menales Nkeshimana
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Adam R Aluisio
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, USA
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Feasibility and integration of an intensive emergency pediatric care curriculum in Armenia. Int J Emerg Med 2021; 14:1. [PMID: 33407068 PMCID: PMC7789778 DOI: 10.1186/s12245-020-00320-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Emergency pediatric care curriculum (EPCC) was developed to address the need for pediatric rapid assessment and resuscitation skills among out-of-hospital emergency providers in Armenia. This study was designed to evaluate the effectiveness of EPCC in increasing physicians’ knowledge when instruction transitioned to local instructors. We hypothesize that (1) EPCC will have a positive impact on post-test knowledge, (2) this effect will be maintained when local trainers teach the course, and (3) curriculum will satisfy participants. Methods This is a quasi-experimental, pre-test/post-test study over a 4-year period from October 2014‑November 2017. Train-the-trainer model was used. Primary outcomes are immediate knowledge acquisition each year and comparison of knowledge acquisition between two cohorts based on North American vs local instructors. Descriptive statistics was used to summarize results. Pre-post change and differences across years were analyzed using repeated measures mixed models. Results Test scores improved from pretest mean of 51% (95% CI 49.6 to 53.0%) to post-test mean of 78% (95% CI 77.0 to 79.6%, p < 0.001). Average increase from pre- to post-test each year was 27% (95% CI 25.3 to 28.7%). Improvement was sustained when local instructors taught the course (p = 0.74). There was no difference in improvement when experience in critical care, EMS, and other specialties were compared (p = 0.23). Participants reported satisfaction and wanted the course repeated. In 2017, EPCC was integrated within the Emergency Medicine residency program in Armenia. Discussion This program was effective at impacting immediate knowledge as well as participant satisfaction and intentions to change practice. This knowledge acquisition and reported satisfaction remained constant even when the instruction was transitioned to the local instructors after 2 years. Through a partnership between the USA and Armenia, we provided OH-EPs in Armenia with an intensive educational experience to attain knowledge and skills necessary to manage acutely ill or injured children in the out-of-hospital setting. Conclusions EPCC resulted in significant improvement in knowledge and was well received by participants. This is a viable and sustainable model to train providers who have otherwise not had formal education in this field.
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Cox M, Masunge J, Geduld H. A successful hybrid emergency medicine postgraduate partnership in Southern Africa. Afr J Emerg Med 2020; 10:S56-S59. [PMID: 33318903 PMCID: PMC7723910 DOI: 10.1016/j.afjem.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/05/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022] Open
Abstract
Emergency Medicine (EM) development is established worldwide and fast developing in Sub-Saharan Africa. Medical specialty development requires multiple human resources and logistics which are frequently not available in LMICs. This article describes an innovative hybrid EM specialization program in Botswana that involved partnership with a neighbouring country in Sub-Saharan Africa. Many initial problems challenged its development, but significant local and regional support led to success. Botswana graduated its first three EM specialists in 2018 and now has an ongoing and sustainable EM program. This regional partnership resulted in numerous academic, research and clinical EM developments for Botswana and SA. UB-UCT EM training Partnership Model is a novel and sustainable cross- African collaboration with significant benefits for both health systems as well as for the individual trainees. This hybrid arrangement should be considered by other LMICs looking for EM specialty training and development.
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Affiliation(s)
- Megan Cox
- University of Sydney, Faculty of Medicine and Health, Australia
- University of Botswana, Faculty of Medicine, Botswana
- Corresponding authors.
| | | | - Heike Geduld
- University of Cape Town, Division of Emergency Medicine, South Africa
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11
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Brugnolaro V, Fovino LN, Calgaro S, Putoto G, Muhelo AR, Gregori D, Azzolina D, Bressan S, Da Dalt L. Pediatric emergency care in a low-income country: Characteristics and outcomes of presentations to a tertiary-care emergency department in Mozambique. PLoS One 2020; 15:e0241209. [PMID: 33147242 PMCID: PMC7641453 DOI: 10.1371/journal.pone.0241209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/10/2020] [Indexed: 12/27/2022] Open
Abstract
Background An effective pediatric emergency care (PEC) system is key to reduce pediatric mortality in low-income countries. While data on pediatric emergencies from these countries can drive the development and adjustment of such a system, they are very scant, especially from Africa. We aimed to describe the characteristics and outcomes of presentations to a tertiary-care Pediatric Emergency Department (PED) in Mozambique. Methods We retrospectively reviewed PED presentations to the "Hospital Central da Beira" between April 2017 and March 2018. Multivariable logistic regression was used to identify predictors of hospitalization and death. Results We retrieved 24,844 presentations. The median age was 3 years (IQR 1-7 years), and 92% lived in the urban area. Complaints were injury-related in 33% of cases and medical in 67%. Data on presenting complaints (retrieved from hospital paper-based registries) were available for 14,204 (57.2%) records. Of these, respiratory diseases (29.3%), fever (26.7%), and gastrointestinal disorders (14.2%) were the most common. Overall, 4,997 (20.1%) encounters resulted in hospitalization. Mortality in the PED was 1.6% (62% ≤4 hours from arrival) and was the highest in neonates (16%; 89% ≤4 hours from arrival). A younger age, especially younger than 28 days, living in the extra-urban area and being referred to the PED by a health care provider were all significantly associated with both hospitalization and death in the PED at the multivariable analysis. Conclusions Injuries were a common presentation to a referral PED in Mozambique. Hospitalization rate and mortality in the PED were high, with neonates being the most vulnerable. Optimization of data registration will be key to obtain more accurate data to learn from and guide the development of PEC in Mozambique. Our data can help build an effective PEC system tailored to the local needs.
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Affiliation(s)
- Valentina Brugnolaro
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
- * E-mail:
| | - Laura Nai Fovino
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Serena Calgaro
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | | | | | - Dario Gregori
- Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Danila Azzolina
- Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Silvia Bressan
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
- Pediatric Emergency Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Liviana Da Dalt
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
- Pediatric Emergency Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
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12
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Mwachofi A, Fadul NA, Dortche C, Collins C. Cost-effectiveness of HIV screening in emergency departments: a systematic review. AIDS Care 2020; 33:1243-1254. [PMID: 32933322 DOI: 10.1080/09540121.2020.1817299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In 2016 worldwide, 1.8 million people were newly infected with HIV. About 36.7 million had HIV but 14 million were unaware, did not seek treatment and were likely to infect others. Undiagnosed HIV infection is a major contributor to transmission. Therefore, screening is critical to prevention. Although CDC recommends routine screening in the emergency department (ED), implementation is not universal or sustained. Cost-effectiveness of ED-based screening could enhance implementation. We address the question: Is HIV screening in the ED cost-effective? Using the Joanna Briggs Institute guidelines, we conducted a systematic review of economic evaluations of ED-based HIV screening. We found 311 studies with 12 duplicates. We excluded 276 studies that did not conduct economic evaluations and another three for lack of quantitative data, leaving 20 articles for the full review. We reviewed cost-effectiveness ratios (CER), incremental cost-effectiveness ratios (ICER), and average costs per diagnosis, quality-adjusted life years, averted transmissions and per patient linked to care. CER and ICER were below CDC thresholds indicating that HIV screening in the ED is cost-effective. Therefore, ED-based HIV screening should be widely implemented, supported and sustained as a cost-effective tool for combating HIV/AIDS.
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Affiliation(s)
- Ari Mwachofi
- Public Health Department, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Nada A Fadul
- Division of Infectious Diseases, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - Ciarra Dortche
- Public Health Department, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Casey Collins
- Public Health Department, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Ravaghi H, Nasiri A, Takbiri A, Heidari S. Status, role, and performance of emergency medicine specialists in Iran: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:224. [PMID: 33062757 PMCID: PMC7530415 DOI: 10.4103/jehp.jehp_276_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 11/14/2018] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The performance of the emergency department (ED) as one of the main parts of hospitals, have a great impact on the performance of the whole-hospital. In Iran, the official education program of this discipline was started in 2001 and has expanded in most medical universities. Given the unprecedentedness of emergency medicine (EM), there are limited studies about this specialty. Thus, this study aims to explore the status, role, and performance of Iranian EM specialists. MATERIALS AND METHODS This qualitative study was conducted using content analysis of 19 semi-structured interviews with EM specialists and key informant. Purposive sampling was conducted, and some teaching and nonstate hospitals in different geographic regions of Tehran city were selected. Conducting interviews continued until reaching the data saturation. Thematic analysis was employed. Extracted themes were reviewed and confirmed by some of the participants. RESULTS The study results were categorized within five main themes; included the role of ED from EM specialists' viewpoint, EM specialists' viewpoint on their discipline, performance of EM specialists (including medical, managerial, and economic performance), and role of EM specialists in patient satisfaction; and opportunities and challenges of EM specialists. CONCLUSION Overall, the study findings highlighted the effectiveness and positive medical, managerial and economic impacts of EM in Iran, inside and beyond hospitals. However, the study addressed significant opportunities some solvable challenges in educational, professional and economic domains, and interdisciplinary relationships. Further studies are recommended for comprehensive exploring viewpoint of other disciplines and stakeholders.
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Affiliation(s)
- Hamid Ravaghi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Nasiri
- Department of Health in Emergencies and Disasters, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Takbiri
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Heidari
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
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Rybarczyk MM, Ludmer N, Broccoli MC, Kivlehan SM, Niescierenko M, Bisanzo M, Checkett KA, Rouhani SA, Tenner AG, Geduld H, Reynolds T. Emergency Medicine Training Programs in Low- and Middle-Income Countries: A Systematic Review. Ann Glob Health 2020; 86:60. [PMID: 32587810 PMCID: PMC7304456 DOI: 10.5334/aogh.2681] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Despite the growing interest in the development of emergency care systems and emergency medicine (EM) as a specialty globally, there still exists a significant gap between the need for and the provision of emergency care by specialty trained providers. Many efforts to date to expand the practice of EM have focused on programs developed through partnerships between higher- and lower-resource settings. Objective To systematically review the literature to evaluate the composition of EM training programs in low- and middle-income countries (LMICs) developed through partnerships. Methods An electronic search was conducted using four databases for manuscripts on EM training programs - defined as structured education and/or training in the methods, procedures, and techniques of acute or emergency care - developed through partnerships. The search produced 7702 results. Using a priori inclusion and exclusion criteria, 94 manuscripts were included. After scoring these manuscripts, a more in-depth examination of 26 of the high-scoring manuscripts was conducted. Findings Fifteen highlight programs with a focus on specific EM content (i.e. ultrasound) and 11 cover EM programs with broader scopes. All outline programs with diverse curricula and varied educational and evaluative methods spanning from short courses to full residency programs, and they target learners from medical students and nurses to mid-level providers and physicians. Challenges of EM program development through partnerships include local adaptation of international materials; addressing the local culture(s) of learning, assessment, and practice; evaluation of impact; sustainability; and funding. Conclusions Overall, this review describes a diverse group of programs that have been or are currently being implemented through partnerships. Additionally, it highlights several areas for program development, including addressing other topic areas within EM beyond trauma and ultrasound and evaluating outcomes beyond the level of the learner. These steps to develop effective programs will further the advancement of EM as a specialty and enhance the development of effective emergency care systems globally.
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Affiliation(s)
- Megan M. Rybarczyk
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Nicholas Ludmer
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, US
| | | | - Sean M. Kivlehan
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Michelle Niescierenko
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, US
| | - Mark Bisanzo
- Division of Emergency Medicine, Department of Surgery, University of Vermont, US
| | - Keegan A. Checkett
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, US
| | - Shada A. Rouhani
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Andrea G. Tenner
- Department of Emergency Medicine, University of California, San Francisco, US
| | - Heike Geduld
- University of Cape Town/Stellenbosch University, College of Emergency Medicine of South Africa, ZA
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Impact of emergency medicine training implementation on mortality outcomes in Kigali, Rwanda: An interrupted time-series study. Afr J Emerg Med 2019; 9:14-20. [PMID: 30873346 PMCID: PMC6400013 DOI: 10.1016/j.afjem.2018.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/04/2018] [Accepted: 10/04/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Although emergency medicine (EM) training programmes have begun to be introduced in low- and middle-income countries (LMICs), minimal data exist on their effects on patient-centered outcomes in such settings. This study evaluated the impact of EM training and associated systems implementation on mortality among patients treated at the University Teaching Hospital-Kigali (UTH-K). METHODS At UTH-K an EM post-graduate diploma programme was initiated in October 2013, followed by a residency-training programme in August 2015. Prior to October 2013, care was provided exclusively by general practice physicians (GPs); subsequently, care has been provided through mutually exclusive shifts allocated between GPs and EM trainees. Patients seeking Emergency Centre (EC) care during November 2012-October 2013 (pre-training) and August 2015-July 2016 (post-training) were eligible for inclusion. Data were abstracted from a random sample of records using a structured protocol. The primary outcomes were EC and overall hospital mortality. Mortality prevalence and risk differences (RD) were compared pre- and post-training. Magnitudes of effects were quantified using regression models to yield adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS From 43,213 encounters, 3609 cases were assessed. The median age was 32 years with a male predominance (60.7%). Pre-training EC mortality was 6.3% (95% CI 5.3-7.5%), while post-training EC mortality was 1.2% (95% CI 0.7-1.8%), constituting a significant decrease in adjusted analysis (aOR = 0.07, 95% CI 0.03-0.17; p < 0.001). Pre-training overall hospital mortality was 12.2% (95% CI 10.9-13.8%). Post-training overall hospital mortality was 8.2% (95% CI 6.9-9.6%), resulting in a 43% reduction in mortality likelihood (aOR = 0.57, 95% CI 0.36-0.94; p = 0.016). DISCUSSION In the studied population, EM training and systems implementation was associated with significant mortality reductions demonstrating the potential patient-centered benefits of EM development in resource-limited settings.
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Abstract
OBJECTIVES Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury. METHODS We undertook a multi-step consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final in-person consensus process. RESULTS The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential, and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (e.g. district hospitals), and an additional 78 for advanced facilities (e.g. tertiary centres). CONCLUSION The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation, and will be a useful tool for practical expansion of emergency care delivery in Africa.
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Broccoli MC, Pigoga JL, Nyirenda M, Wallis L, Calvello Hynes EJ. Essential medicines for emergency care in Africa. Emerg Med J 2018; 35:412-419. [PMID: 29627770 DOI: 10.1136/emermed-2017-207396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/02/2018] [Accepted: 03/14/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury. METHODS We undertook a multistep consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final inperson consensus process. RESULTS The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML, but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (eg, district hospitals) and an additional 78 for advanced facilities (eg, tertiary centres). CONCLUSION The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation and will be a useful tool for practical expansion of emergency care delivery in Africa.
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Affiliation(s)
- Morgan C Broccoli
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts, USA
| | - Jennifer L Pigoga
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mulinda Nyirenda
- Queen Elizabeth Central Hospital, Ministry of Health and University of Malawi College of Medicine, Blantyre, Malawi
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Emilie J Calvello Hynes
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Rouhani SA, Israel K, Leandre F, Pierre S, Bollman B, Marsh RH. Addressing the immediate need for emergency providers in resource-limited settings: the model of a six-month emergency medicine curriculum in Haiti. Int J Emerg Med 2018; 11:22. [PMID: 29626265 PMCID: PMC5889369 DOI: 10.1186/s12245-018-0182-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/23/2018] [Indexed: 11/04/2022] Open
Abstract
Background In many resource-limited settings, emergency medicine (EM) is underdeveloped and formal EM training limited. Residencies and fellowships are an ideal long-term solution but cannot meet immediate needs for emergency providers, while short-term programs are often too limited in content. We describe a third method successfully implemented in Haiti: a medium-duration certificate program to meet the immediate need for emergency specialists. Methods In conjunction with the Haitian Ministry of Health and National Medical School, we developed and implemented a novel, 6-month EM certificate program to build human resources for health and emergency care capacity. The program consisted of didactic and supervised clinical components, covering core content in EM. Didactics included lectures, simulations, hands-on skill-sessions, and journal clubs. Supervised clinical time reinforced concepts and taught an EM approach to patient care. Results Fourteen physicians from around Haiti successfully completed the program; all improved from their pre-test to post-test. At the end of the program and 9-month post-program evaluations, participants rated the program highly, and most felt they used their new knowledge daily. Participants found clinical supervision and simulation particularly useful. Key components to our program’s success included collaboration with the Ministry of Health and National Medical School, supervised clinical time, and the continual presence of a course director. The program could be improved by a more flexible curriculum and by grouping participants by baseline knowledge levels. Conclusion Medium-duration certificate programs offer a viable option for addressing immediate human resource gaps in emergency care, and our program offers a model for implementation in resource-limited settings. Similar options should be considered for other emerging specialties in resource-limited settings.
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Affiliation(s)
- Shada A Rouhani
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,Hôpital Universitaire de Mirebalais, Route Départmentale 11, Mirebalais, Haiti. .,Partners In Health, 800 Boylston Street, Suite 300, Boston, MA, 02199, USA.
| | - Kerling Israel
- Hôpital Universitaire de Mirebalais, Route Départmentale 11, Mirebalais, Haiti.,Zanmi Lasante, 18a Route De Santo, Croix Des Bouquets, Port Au Prince, Haiti
| | - Fernet Leandre
- Zanmi Lasante, 18a Route De Santo, Croix Des Bouquets, Port Au Prince, Haiti
| | - Sosthène Pierre
- Faculte de Medecine et de Pharmacie de l'Universite d'Etat d'Haiti, 89 Rue Oswald Durand, Port-au-Prince, Haiti
| | - Brennan Bollman
- Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA, 70112, USA
| | - Regan H Marsh
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Partners In Health, 800 Boylston Street, Suite 300, Boston, MA, 02199, USA
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Burkholder TW, Bellows JW, King RA. Free Open Access Medical Education (FOAM) in Emergency Medicine: The Global Distribution of Users in 2016. West J Emerg Med 2018; 19:600-605. [PMID: 29760862 PMCID: PMC5942031 DOI: 10.5811/westjem.2018.3.36825] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/28/2018] [Accepted: 03/05/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Free open-access medical education (FOAM) is a collection of interactive online medical education resources-free and accessible to students, physicians and other learners. This novel approach to medical education has the potential to reach learners across the globe; however, the extent of its global uptake is unknown. Methods This descriptive report evaluates the 2016 web analytics data from a convenience sample of FOAM blogs and websites with a focus on emergency medicine (EM) and critical care. The number of times a site was accessed, or "sessions", was categorized by country of access, cross-referenced with World Bank data for population and income level, and then analyzed using simple descriptive statistics and geographic mapping. Results We analyzed 12 FOAM blogs published from six countries, with a total reported volume of approximately 18.7 million sessions worldwide in 2016. High-income countries accounted for 73.7% of population-weighted FOAM blog and website sessions in 2016, while upper-middle income countries, lower-middle income countries and low-income countries accounted for 17.5%, 8.5% and 0.3%, respectively. Conclusion FOAM, while largely used in high-income countries, is used in low- and middle-income countries as well. The potential to provide free, online training resources for EM in places where formal training is limited is significant and thus is prime for further investigation.
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Affiliation(s)
- Taylor W Burkholder
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Jennifer W Bellows
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, Colorado.,Denver Health & Hospital Authority, Department of Emergency Medicine, Denver, Colorado
| | - Renee A King
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, Colorado
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High-Fidelity Realistic Acute Medical Simulation and SBAR Training at a Tertiary Hospital in Blantyre, Malawi. Simul Healthc 2018; 13:139-145. [PMID: 29373386 DOI: 10.1097/sih.0000000000000287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abdelwahab R, Yang H, Teka HG. A quality improvement study of the emergency centre triage in a tertiary teaching hospital in northern Ethiopia. Afr J Emerg Med 2017; 7:160-166. [PMID: 30456132 PMCID: PMC6234140 DOI: 10.1016/j.afjem.2017.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/08/2017] [Accepted: 05/29/2017] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION An effective emergency triage system should prioritize both trauma and non-trauma patients according to level of acuity, while also addressing local disease burden and resource availability. In March 2012, an adapted version of the South African Triage Scale was introduced in the emergency centre (EC) of Ayder Comprehensive Specialized Hospital in northern Ethiopia. METHODS This quality improvement study was conducted to evaluate the implementation of nurse-led emergency triage in a large Ethiopian teaching hospital using the Donabedian model. A 45% random sample was selected from all adult emergency patients during the study period, May 10th to May 25th 2015. Patient charts were collected and retrospectively reviewed. Presence and proper completion of the triage form were appraised. Triage level was abstracted and compared with patient outcome (dichotomized as "admitted to hospital or died" and "discharged alive from emergency centre") to quantify over- and under-triage triage. RESULTS From 251 randomly selected patients, 107 (42.6%) charts were retrieved. From these, only 45/107 (42.1%) contained the triage form filled within the chart. None of the triage forms were filled out completely. From 13 (28.9%) admitted or deceased patients, the under-triage rate was 30.7% and from 32 (71.1%) patients discharged alive from the EC the over-triage rate was 21.9%. DISCUSSION The under-triage rate observed in this study exceeds the recommended threshold of 5% and is a serious patient safety concern. However, under-triage may have been magnified by irregularities in the hospital admission process. Haphazard medical record handling, poor documentation, erroneous triage decisions, and poor rapport between nurses and physicians were the main process-related challenges that must be addressed through intensive training and improved human resource management approaches to enhance the quality of triage in the emergency centre.
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Affiliation(s)
| | - Hannah Yang
- Mekelle University College of Health Sciences, PO Box 1871, Mekelle, Tigray, Ethiopia
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
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Hansoti B, Kelen GD, Quinn TC, Whalen MM, DesRosiers TT, Reynolds SJ, Redd A, Rothman RE. A systematic review of emergency department based HIV testing and linkage to care initiatives in low resource settings. PLoS One 2017; 12:e0187443. [PMID: 29095899 PMCID: PMC5667894 DOI: 10.1371/journal.pone.0187443] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/19/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Only 45% of people currently living with HIV infection in sub-Saharan Africa are aware of their HIV status. Unmet testing needs may be addressed by utilizing the Emergency Department (ED) as an innovative testing venue in low and middle-income countries (LMICs). The purpose of this review is to examine the burden of HIV infection described in EDs in LMICs, with a focus on summarizing the implementation of various ED-based HIV testing strategies. METHODOLOGY AND RESULTS We performed a systematic review of Pubmed, Embase, Scopus, Web of Science and the Cochrane Library on June 12, 2016. A three-concept search was employed with emergency medicine (e.g., Emergency department, emergency medical services), HIV/AIDS (e.g., human immunodeficiency virus, acquired immunodeficiency syndrome), and LMIC terms (e.g., developing country, under developed countries, specific country names). The search returned 2026 unique articles. Of these, thirteen met inclusion criteria and were included in the final review. There was a large variation in the reported prevalence of HIV infection in the ED population ranging from to 2.14% in India to 43.3% in Uganda. The proportion HIV positive patients with previously undiagnosed infection ranged from 90% to 65.22%. CONCLUSION In the United States ED-based HIV testing strategies have been front and center at curbing the HIV epidemic. The limited number of ED-based studies we observed in this study may represent the paucity of HIV testing in this venue in LMICs. All of the studies in this review demonstrated a high prevalence of HIV infection in the ED and an extraordinarily high percentage of previously undiagnosed HIV infection. Although the numbers of published reports are few, these diverse studies imply that in HIV endemic low resource settings EDs carry a large burden of undiagnosed HIV infections and may offer a unique testing venue.
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Affiliation(s)
- Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Gabor D. Kelen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Thomas C. Quinn
- Division of Intramural Research, NIAID/NIH, Baltimore, Maryland, United States of America
| | - Madeleine M. Whalen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Taylor T DesRosiers
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Steven J. Reynolds
- Division of Intramural Research, NIAID/NIH, Baltimore, Maryland, United States of America
| | - Andrew Redd
- Division of Intramural Research, NIAID/NIH, Baltimore, Maryland, United States of America
| | - Richard E. Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Sustainable Resuscitation Ultrasound Education in a Low-Resource Environment: The Kumasi Experience. J Emerg Med 2017; 52:723-730. [PMID: 28284769 DOI: 10.1016/j.jemermed.2017.01.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/28/2017] [Accepted: 01/31/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Point-of-care-ultrasound (POCUS) is an increasingly important tool for emergency physicians and has become a standard component of emergency medicine residency training in high-income countries. Cardiopulmonary ultrasound (CPUS) is emerging as an effective way to quickly and accurately assess patients who present to the emergency department with shock and dyspnea. Use of POCUS, including CPUS, is also becoming more prevalent in low- and middle-income countries (LMICs); however, formal ultrasound training for emergency medicine resident physicians in these settings is not widely available. OBJECTIVES To evaluate the feasibility of integrating a high-intensity ultrasound training program into the formal curriculum for emergency medicine resident physicians in an LMIC. METHODS We conducted a pilot ultrasound training program focusing on CPUS for 20 emergency medicine resident physicians in Kumasi, Ghana, which consisted of didactic sessions and hands-on practice. Competency was assessed by comparing pretest and posttest scores and with an Objective Structured Clinical Examination (OSCE) performed after the final training session. RESULTS The mean score on the pretest was 61%, and after training, the posttest score was 96%. All residents obtained passing scores above 70% on the OSCE. CONCLUSION A high-intensity ultrasound training program can be successfully integrated into an emergency medicine training curriculum in an LMIC.
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Latifi R, Gunn JKL, Stroster JA, Zaimi E, Olldashi F, Dogjani A, Kerci M, Draçini X, Kuçani J, Shatri Z, Kociraj A, Boci A, Donaldson RI. The readiness of emergency and trauma care in low- and middle-income countries: a cross-sectional descriptive study of 42 public hospitals in Albania. Int J Emerg Med 2016; 9:26. [PMID: 27718129 PMCID: PMC5055520 DOI: 10.1186/s12245-016-0124-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 09/02/2016] [Indexed: 11/16/2022] Open
Abstract
Background Traumatic injuries have become a substantial but neglected epidemic in low- and middle-income countries (LMICs), but emergency rooms (ERs) in these countries are often staffed with healthcare providers who have minimal emergency training and experience. The aim of this paper was to describe the specialized training, available interventions, and the patient management strategies in the ERs in Albanian public hospitals. Methods A cross-sectional descriptive study of 42 ERs in the Republic of Albania between September 5, 2014, and December 29, 2014 was performed. Assessment subcategories included the following: (1) specialized training and/or certifications possessed by healthcare providers, (2) interventions performed in the ER, and (3) patient management strategies. Results Across the 42 ERs surveyed, less than half (37.1–42.5 %) of physicians and one third of nurses (7.1–26.0 %) working in the ERs received specialized trauma training. About half (47.9–57.1 %) of the ER physicians and one fifth of the nurses (18.3–22.9 %) possessed basic life support certification. This survey demonstrated some significant differences in the emergency medical care provided between primary, secondary, and tertiary hospitals across Albania (the significance level was set at 0.05). Specifically, these differences involved spinal immobilization (p = 0.01), FAST scan (p = 0.04), splinting (p = 0.01), closed reduction of displaced fractures (p = 0.02), and nurses performing cardiopulmonary resuscitation (CPR) (p = 0.01). Between 50.0 and 71.4 % of the facilities cited a combined lack of training and supplies as the reason for not offering interventions such as rapid sequence induction, needle thoracotomy, chest tube insertion, and thrombolysis. Mass casualty triage was utilized among 39.1 % primary hospitals, 41.7 % of secondary, and 28.6 % of tertiary. Conclusions The emergency services in Albania are currently staffed with inadequately trained personnel, who lack the equipment and protocols to meet the needs of the population.
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Affiliation(s)
- Rifat Latifi
- Department of Surgery, Westchester Medical Center Health, 100 Woods Road, Valhalla, New York, 10595, USA. .,International Virtual e-Hospital (IVeH) Foundation, Hope, USA.
| | - Jayleen K L Gunn
- International Virtual e-Hospital (IVeH) Foundation, Hope, USA.,Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, 85721, USA
| | - John A Stroster
- Department of Surgery, Westchester Medical Center Health, 100 Woods Road, Valhalla, New York, 10595, USA
| | | | - Fatos Olldashi
- Department of Neurosurgery, University Hospital of Trauma, Tirana, Albania
| | | | - Mihal Kerci
- Anesthesiology and Intensive Care, University Hospital of Trauma, Tirana, Albania
| | - Xheladin Draçini
- Faculty of Medicine & Surgery, University of Tirana, Tirana, Albania
| | - Julian Kuçani
- International Virtual e-Hospital (IVeH) Foundation, Hope, USA
| | - Zhaneta Shatri
- The United States Agency for International Development (USAID)/Albania, Tirana, Albania
| | - Agim Kociraj
- The United States Agency for International Development (USAID)/Albania, Tirana, Albania
| | - Arian Boci
- International Virtual e-Hospital (IVeH) Foundation, Hope, USA
| | - Ross I Donaldson
- Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
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Thomassen O, Mann C, Mbwana JS, Brattebo G. Emergency medicine in Zanzibar: the effect of system changes in the emergency department. Int J Emerg Med 2015; 8:22. [PMID: 26191085 PMCID: PMC4501336 DOI: 10.1186/s12245-015-0072-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022] Open
Abstract
Background Mnazi Mmoja Hospital is a tertiary hospital in Zanzibar serving a population of 1.2 million. The emergency department was overcrowded and understaffed and the hospital management initiated a quality improvement project. The aim of this article is to describe the approach, methods and main results of this quality improvement process. Methods The Plan-Do-Study-Act (PDSA) method was used in a five-circle process. In addition, a consensus-based approach was performed to identify areas of improvement. Results Over a period of 6 months, regular staff meetings were implemented, a registration system was developed and implemented, the numbers of patients with simple problems were reduced, a simple triage tool was developed and implemented and an emergency room was established. Conclusions Change and improvement in health care are achievable despite limited financial resources if a comprehensive, robust and simple system is used. Involvement of all stakeholders from the start, identification and use of change agents, regular feedback and a focus on human resources rather than equipment have been key factors for the success of this project.
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Affiliation(s)
- Oyvind Thomassen
- Department of Anaesthesiology and Intensive care, Haukeland University Hospital, Bergen, Norway
| | - Clifford Mann
- Emergency Department Musgrove Park Hospital, Taunton, England UK
| | | | - Guttorm Brattebo
- Department of Anaesthesiology and Intensive care, Haukeland University Hospital, Bergen, Norway
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Stolz LA, Muruganandan KM, Bisanzo MC, Sebikali MJ, Dreifuss BA, Hammerstedt HS, Nelson SW, Nayabale I, Adhikari S, Shah SP. Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department. Trop Med Int Health 2015; 20:1067-72. [PMID: 25808431 DOI: 10.1111/tmi.12511] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the outcomes and curriculum components of an educational programme to train non-physician clinicians working in a rural, Ugandan emergency department in the use of POC ultrasound. METHODS The use of point-of-care ultrasound was taught to emergency care providers through lectures, bedsides teaching and hands-on practical sessions. Lectures were tailored to care providers' knowledge base and available therapeutic means. Every ultrasound examination performed by these providers was recorded over 4.5 years. Findings of these examinations were categorised as positive, negative, indeterminate or procedural. Other radiologic studies ordered over this same time period were also recorded. RESULTS A total of 22,639 patients were evaluated in the emergency department by emergency care providers, and 2185 point-of-care ultrasound examinations were performed on 1886 patients. Most commonly used were the focused assessment with sonography in trauma examination (53.3%) and echocardiography (16.4%). Point-of-care ultrasound studies were performed more frequently than radiology department-performed studies. Positive findings were documented in 46% of all examinations. CONCLUSIONS We describe a novel curriculum for point-of-care ultrasound education of non-physician emergency practitioners in a resource-limited setting. These non-physician clinicians integrated ultrasound into clinical practice and utilised this imaging modality more frequently than traditional radiology department imaging with a large proportion of positive findings.
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Affiliation(s)
- Lori A Stolz
- The University of Arizona, Tucson, AZ, USA.,Global Emergency Care Collaborative
| | | | - Mark C Bisanzo
- Global Emergency Care Collaborative.,University of Massachusetts, Worcester, MA, USA
| | - Mugisha J Sebikali
- Department of Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bradley A Dreifuss
- The University of Arizona, Tucson, AZ, USA.,Global Emergency Care Collaborative
| | | | - Sara W Nelson
- Global Emergency Care Collaborative.,Maine Medical Center, Portland, ME, USA
| | - Irene Nayabale
- Global Emergency Care Collaborative.,Nyakibale Hospital, Rukungiri, Uganda
| | | | - Sachita P Shah
- Global Emergency Care Collaborative.,University of Washington School of Medicine, Seattle, WA, USA
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Hammerstedt H, Maling S, Kasyaba R, Dreifuss B, Chamberlain S, Nelson S, Bisanzo M, Ezati I. Addressing World Health Assembly Resolution 60.22: A Pilot Project to Create Access to Acute Care Services in Uganda. Ann Emerg Med 2014; 64:461-8. [DOI: 10.1016/j.annemergmed.2014.01.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 01/27/2014] [Accepted: 01/29/2014] [Indexed: 11/25/2022]
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