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Dodd, Will. "Pediatric Emergency Medicine." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/8915.
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Smith, Casey. "History of Emergency Medicine." The University of Arizona, 2018. http://hdl.handle.net/10150/626595.
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Kilroy, D. A. "Discursive practices in contemporary emergency medicine." Thesis, Manchester Metropolitan University, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.543249.
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Carley, Simon. "Technology enhanced learning in emergency medicine." Thesis, Manchester Metropolitan University, 2018. http://e-space.mmu.ac.uk/621509/.
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Education is integral to the practice and delivery of Emergency Medicine in the UK. The staffing structures, the complexity of the workload and the need to deliver a service 24-hours a day require a high-quality learning environment. This thesis describes my work in using web-based technologies to enhance the learning experience of emergency medicine trainees and consultants. It describes three overlapping themes of innovation. Theme 1 describes the development of the BestBets approach to evidence-based medicine in emergency care. The papers and websites presented describe how the principles of evidence-based medicine were adapted, developed and published to provide a practical and pragmatic approach suitable for the acute care environment. Theme 2 describes how Virtual Learning Environments provided a solution to the challenges of teaching and learning with a chronologically and geographically distributed workforce. Theme 3 describes how I have used the latest social media technologies to enhance learning on a global scale. It describes how local learning can be shared amongst a diverse range of learners using social media tools. This theme charts how my projects on the St. Emlyn's platform have advocated for the Free Open Access Medical Education movement. It also describes how I have created a symbiotic relationship between modern and traditional publishing mechanisms to promote the academic outputs of local and international publishing collaborations. In this thesis I describe the narrative of educational development alongside and in some cases in the mutual support of technological innovation. I reflect on the strengths and weaknesses of the learning narrative and also on the methodological approach to the analysis of the three main themes. Central to my work is how I have developed my skills to now lead the social media projects for the St. Emlyn's group and in the establishment of my recognition as a leader in the area of technologically enhanced emergency medical education.
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Boyle, Adrian Alexander. "Domestic violence among emergency medicine patients." Thesis, University of Cambridge, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.612113.
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Waterbrook, Anna, Gail Pritchard, Allison Lane, et al. "Development of a novel sports medicine rotation for emergency medicine residents." DOVE MEDICAL PRESS LTD, 2016. http://hdl.handle.net/10150/615113.
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Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students' and residents' musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM) does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC) and University Campus (UC). The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the total number of dislocation reductions performed by each graduating resident at both programs over the last 5 years. While all residents in both programs exceeded the ten dislocation reductions required for graduation, residents on the sports medicine rotation had a statistically significant higher rate of satisfaction of their educational experience when compared to the traditional orthopedics rotation. All SC residents successfully completed their sports medicine rotation, had completed postrotation evaluations by attending physicians, and had no duty hour violations while on sports medicine. In our experience, a sports medicine rotation is an effective alternative to the traditional orthopedics rotation for EM residents.
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Fitzgerald, Katherine. "The psychological health of emergency medicine consultants." Thesis, University of Exeter, 2014. http://hdl.handle.net/10871/15560.
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Objective—To explore the experience of psychological distress and wellbeing in emergency medicine (EM) consultants. Methods— A qualitative, Interpretative Phenomenological Analysis (IPA) study based on interviews with EM consultants working in emergency departments (EDs) across South West England. 18 EM consultants were interviewed, representing a response rate of 54.55% across 5 EDs. The mean (SD) age of participants was 43.17 (5.8) years. All participants worked full-time as EM consultants, with the average years-in-role being 7.64 (5.76). The personal meanings that participants attached to their experiences were inductively analysed and explored alongside their perceived psychological health. Results— The analysis formed three super-ordinate themes: systemic pressures, physical and mental strain, and managing the challenges. Pressures within the ED and healthcare system contributed to participants feeling undervalued and unsatisfied when working in an increasingly uncontrollable environment. Participants described working intensely to meet systemic demands, which inadvertently contributed to a diminishing sense of achievement and self-worth. Consultants perceived their experience of physical and emotional strain as unsustainable, as it negatively impacted: functioning at work, relationships, personal wellbeing and the EM profession. Sustainability was promoted by the presence of social support and through evolving with the consultant role. Conclusions— EM consultants experience considerable physical and mental strain. This strain is dynamically related to consultants' experiences of diminishing self-worth and satisfaction, alongside current socio-political demands on EM services. Recognising the psychological experience and needs of EM consultants through promoting a sustainable EM consultant role could have wide-reaching benefits for the delivery of emergency care and physician wellbeing.
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Broccoli, Morgan Carol. "Community-based perceptions of emergency care in communities lacking formalised emergency medicine systems." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15459.
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Kenya and Zambia face an increasing burden of emergent disease, with a high incidence of communicable diseases, increasing prevalence of non-communicable diseases and traumatic injuries. However, neither country has an integrated emergency care system that provides community access to high-quality emergency services. There has been recent interest in strengthening the emergency care systems in these countries, but before any interventions are implemented, an assessment of the current need for emergency care must be conducted, as the burden of acute disease and barriers to accessing emergency care in Zambia and Kenya remain largely undocumented. Aims and Objectives: The aim of this project was to ascertain community-based perceptions of the critical interventions necessary to improve access to emergency care in Zambia and Kenya, with the following objectives: 1. Determine the current pattern of out-of-hospital emergency care delivery at the community level. 2. Identify the communities’ experiences with emergency conditions and the barriers they face when trying to access care. 3. Discover community-generated solutions to the paucity of emergency care in urban and rural settings. Methods: Semi-structured focus groups were piloted in Zambia with 200 participants. Results were analysed with subsequent tool refinement for Kenya. Data were collected via focus groups with 600 urban and rural community members in cities and rural villages in the 8 Kenyan provinces. Thematic analysis of community member focus groups identified frequency of emergencies, perceptions of emergency care, perceived barriers to emergency care, and ideas for potential interventions. Results: Analysis of the focus group data identified several common themes. Community members in Zambia and Kenya experience a wide range of medical emergencies, and they rely on family members, neighbours, and Good Samaritans for assistance. These community members frequently provide assistance with transportation to medical facilities, and also attempt some basic first aid. These communities are already assisting one another during emergencies, and are willing to help in the future. Participants in this study also identified several barriers to emergency care : a lack of community education, absent or non-functional communication systems, insufficient transportation, no triage system, a lack of healthcare providers trained in emergency care, and inadequate equipment and supplies. Conclusions: Community members in Zambia and Kenya experience a wide range of medical emergencies. There is substantial reliance on family members and neighbours for assistance, commonly with transportation. Creating community education initiatives, identifying novel transportation solutions, implementing triage in healthcare facilities, and improving receiving facility care were community-identified solutions to barriers to emergency care.
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De, Man Martin. "Emergency medicine registrars' attitudes towards youth violence prevention interventions in Cape Town emergency centres." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25044.
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Background: The City of Cape Town, South Africa, has a large youth violence problem with the highest percentage of non-natural deaths per age group in Cape Town occurring between 15 and 24 years of age. Many authorities suggest that youth violence is preventable and there is a fast growing international knowledge base on how emergency centres (ECs) and EC personnel can contribute to youth violence prevention (YVP). In order to utilise this opportunity most effectively, it is important to understand the challenges faced by EC staff, their perceptions of youth violence, and their willingness to engage in YVP interventions in the EC. There is currently no known EC-based YVP intervention in South Africa. Objectives: This study explored the perceptions and attitudes of Cape Town emergency medicine doctors on youth violence, their role in YVP and how it applies to their practice in the EC. Methods: Semi-structured focus groups, each with 3-5 Cape Town emergency medicine (EM) registrars, were conducted, using five basis questions for discussion to elicit participants' perceptions of and attitudes towards YVP. Data saturation was reached after three focus groups. Thematic analysis as described by Braun and Clarke was carried out on the focus group data sets. Results: The three focus groups were all diverse in terms of race, gender, and level of training. In terms of the "Extent of the problem" themes around acceptability and increased burden were explored."Youth Violence Prevention in the EC" focused on the need for a champion, role of the emergency doctor vs. other stakeholders and sustainability issues. Conclusions: EM registrars in Cape Town have a very limited knowledge of YVP in general and specific to the EC. They are faced with immense challenges that relate to patient load, violence directed to EC personnel, and a sense of despair or despondence in terms of ability to effect change. Concerns about the possible implementation of YVP interventions were sustained funding and sustainability in general. These and other factors influenced attitudes towards EC initiated YVP. Notwithstanding challenges, this study has shown an overwhelmingly positive attitude of EM registrars towards the concept of YVP intervention in the EC, and them being the champion or co-champion of it. Recommendations: It is recommended that EM registrars in their training time should receive theoretical and practical training on YVP which can lead to increased awareness of YVP issue, the need to know resources in the community, and in the future will make it easier to implement a pilot intervention project in a selected EC. Further research is needed on a relevant screening tool to identify high risk patients in local ECs.
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Asher, Shellie L., Kenneth V. Iserson, and Lisa H. Merck. "Society for Academic Emergency Medicine Statement on Plagiarism." WILEY, 2017. http://hdl.handle.net/10150/626119.
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The integrity of the research enterprise is of the utmost importance for the advancement of safe and effective medical practice for patients and for maintaining the public trust in health care. Academic societies and editors of journals are key participants in guarding scientific integrity. Avoiding and preventing plagiarism helps to preserve the scientific integrity of professional presentations and publications. The Society for Academic Emergency Medicine (SAEM) Ethics Committee discusses current issues in scientific publishing integrity and provides a guideline to avoid plagiarism in SAEM presentations and publications.
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Sobuwa, Simpiwe. "A critical realist study into the emergence and absence of academic success among Bachelor of Emergency Medical Care students." Doctoral thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29475.
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This critical realist thesis explores academic success in the four-year Bachelor of Emergency Medical Care degree in South Africa. The Bachelor of Emergency Medical Care degree is a relatively new degree that is offered at four universities in South Africa. In view of the existing shortage of paramedics both in South Africa and on the African continent, an understanding of the factors that play a role in academic success may lead to an increase in the number of emergency care providers. Accordingly, this study was conceptualised to explore the reasons why academic success is either evident or absent among Bachelor of Emergency Medical Care students. The study utilised a sequential, explanatory, mixed methods research design. The quantitative phase consisted of an online survey that was disseminated to Bachelor of Emergency Medical Care students in South Africa with the aim of gaining an insight into their socio-cultural history. Continuous and categorical variables were described using basic descriptive statistics. The Pearson’s chi-square and Fisher’s exact test were used to test associations between the various survey variables and repeating a year. A p-value of less than 0.05 was considered to be statistically significant. During the qualitative phase focus groups were held with students while semi-structured interviews were conducted with lecturing staff members. The aim of the qualitative approach was to explore the causal powers and generative mechanisms that give rise to or enable the emergence or absence of academic success among Bachelor of Emergency Medical Care students. Thematic analysis was used to analyse results from the focus groups and semistructured interviews. A critical realist concept of the laminated system was also used to explore the themes that emerged. A total of 176 participants from an available sample of 408 students responded to the survey. Not repeating a year was significantly associated with two important variables, namely, the possession of a pre-existing emergency care qualification and not being a white student. The results revealed that the following interactive generative mechanisms played a role in the lack of academic success, namely, biological, socioeconomic, socio-cultural, normative, psychosocial and psychological factors while the following interactive generative mechanisms facilitated the emergence of academic success – psychological, psycho-social, normative and socioeconomic factors.
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Cohen, Kirsten Lesley. "An analysis of the clinical practice of emergency medicine in emergency centres in the Western Cape." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/10276.
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Includes abstract.<br>Includes bibliographical references.<br>To determine whether the current South African Emergency Medicine Curriculum is appropriate for the burden of disease seen by registrars in Cape Town Emergency Centres, a cross- sectional retrospective audit of 1283 clinical presentations from three secondary level ECs in Cape Town was done. The type of clinical presentations, investigations done and procedures per- formed were analysed. Basic descriptives are presented. The curriculum did not cover all the clinical conditions, procedures and investigations encountered by EM registrars in Cape Town. There were also multiple categories in the curriculum that were not encountered in EM practice at all. The investigations section correlated particularly poorly with the skills needed for the burden of disease seen in ECs in Cape Town. The curriculum should be redrafted guided by a practice analysis of EM.
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Morris, Gary. "Non-emergency Use of Emergency Medicine Services According to Insurance Status in an Urban Population." Thesis, The University of Arizona, 2012. http://hdl.handle.net/10150/221347.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.<br>Non-emergent use of Emergency Department (ED) resources has been targeted in political discourse as a potential for cost savings. The general consensus anecdotally is that there is a considerable amount of non-emergent ED use locally. The purpose of this study is to describe non-emergent use of the ED at Maricopa Medical Center and the association of non-emergent use with insurance and demographic variables. Computer-stored data about ED visits during the years 2008-2009 were provided by ASU’s Center for Health Information and visits were classified using an algorithm developed initially by Billings et al at the NYU Center for Health and Public Policy Research that uses International Classification of Diseases-9th edition Clinical Modification (ICD-9-CM) codes. The ICD-9-codes for each visit to the ED are obtained and the Billings algorithm is used to determine a percentage of likelihood that the visit was emergent or not after identifying visits that cannot be classified clearly as either emergent or non-emergent. After classifying ED visits, a statistical analysis was done to evaluate the association of demographic and insurance status variables with non-emergent use of the ED for all visits and for visits that were not due to injury, psychiatric conditions, alcohol or drugs.
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We find that 47% of the visits were classified as non-emergent. Furthermore, of these non-emergent visits the rate of non-emergent use by insured patients is 34% compared to 54% rate for self-pay/charity patients and 50% rate for AHCCCS/Medicaid patients. Clearly there is a large volume of non-emergent use at MMC and a correlation exists between not having insurance and using the ED non-emergently at a higher rate compared to the insured population. All patient populations however did have a large number of non-emergent visits. Non-emergent ED use is then thought to be a valid target for health care policy discussion and a need exists for evaluating what the economic impact of these visits may be.
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Chung, Shun-hang Joseph. "Performance of emergency medicine (EM) ward in Tuen Mun hospital." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41709779.
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Graham, Anna Louise. "Improving teenagers' understanding of emergency contraception." Thesis, University of Bristol, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251126.
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De, Jager J. L. C. "Does emergency medicine training improve ECG interpretation skills in South Africa?" Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/11847.
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Includes abstract.<br>Includes bibliographical references (leaves 35-37).<br>The aim of this study is to assess whether ECG interpretation improves with advancing years of Emergency Medicine training in South Africa, and to compare the results with similar international studies. A prospective cross-sectional study of Emergency Medicine registrars and recently qualified emergency physicians was conducted between August 2008 and February 2009 during training sessions at various universities through South Africa. Subjects completed a survey about level of training and experience, previous ECG training and their impression of the current training program and how it could be improved. They were then asked to interpret 10 clinically important ECGs. The trainees in their first and second years of emergency medicine training were compared to their more senior counterparts (third to fifth years).
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Smith, Leanne. "Modelling Emergency Medical Services." Thesis, Cardiff University, 2013. http://orca.cf.ac.uk/47743/.
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Emergency Medical Services (EMS) play a pivotal role in any healthcare organisation. Response and turnaround time targets are always of great concern for the Welsh Ambulance NHS Trust (WAST). In particular, the more rural areas in South East Wales consistently perform poorly with respect to Government set response standards, whilst delayed transfer of care to Emergency Departments (EDs) is a problem publicised extensively in recent years. Many Trusts, including WAST, are additionally moving towards clinical outcome based performance measures, allowing an alternative system-evaluation approach to the traditional response threshold led strategies, resulting in a more patient centred system. Three main investigative parts form this thesis, culminating in a suite of operational and strategic decision support tools to aid EMS managers. Firstly, four novel allocation model methods are developed to provide vehicle allocations to existing stations whilst maximising patient survival. A detailed simulation model then evaluates clinical outcomes given a survival based (compared to response target based) allocation, determining also the impact of the fleet, its location and a variety of system changes of interest to WAST (through ‘what-if?’ style experimentation) on entire system performance. Additionally, a developed travel time matrix generator tool, enabling the calculation and/or prediction of journey times between all pairs of locations from route distances is utilised within the aforementioned models. The conclusions of the experimentation and investigative processes suggest system improvements can in fact come from better allocating vehicles across the region, by reducing turnaround times at hospital facilities and, in application to South East Wales, through alternative operational policies without the need to increase resources. As an example, a comparable degree of improvement in patient survival is witnessed for a simulation scenario where the fleet capacity is increased by 10% in contrast to a scenario in which ideal turnaround times (within the target) occur.
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Stander, Charnelle. "Prehospital emergency care provider’s understanding of their responsibilities towards a mental health care user, during a behavioural emergency." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31266.
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Background: Prehospital emergency care providers in South Africa are regularly called to assist with the management of mental healthcare users. The Mental Health Care Act no 17 of 2002 regulates mental healthcare in South Africa but makes no reference to the roles and responsibilities of prehospital emergency care providers in the provision of mental healthcare, rather giving the South African Police Services authority over the wellbeing of a mental healthcare user outside the hospital setting. Aims: To investigate what prehospital emergency care providers understand their responsibilities are towards a mental healthcare user and the community during the management of a behavioural emergency. Setting: Prehospital emergency care providers from the three main levels of care, currently operational within the boundaries of Pretoria. Methods: A grounded theory qualitative study design was chosen using semi-structured focus groups for each level of prehospital emergency care; Basic Life Support, Intermediate Life Support and Advanced Life Support. Data from each focus group was collected through audio recordings, transcribed and analysed using a framework approach. Results: A total of 19 prehospital emergency care providers from all three main levels of care participated in the focus group discussions (4 BLS, 6 ILS and 9 ALS). Four main themes were identified: Perceptions of behavioural emergencies, responsibilities, understanding of legislation and barriers experienced. Conclusion: Participants placed high value on their moral and medical responsibilities towards a mental healthcare user and would like to have the backing of legislation to fulfil their role. There is a desire for better education, skill development and awareness of mental healthcare in the prehospital emergency care setting.
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Säfwenberg, Urban. "Presenting complaint and mortality in non-surgical emergency medicine patients." Doctoral thesis, Uppsala University, Department of Medical Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8583.
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<p>In 1995 and 2000 a total of 29 886 non surgical ED visits at Uppsala University Hospital were registered. Presenting complaint, admittance to a ward, length of stay, in-hospital mortality, discharge diagnoses, 30-day and long-term mortality were registered. The presenting complaints were sorted into 33 presenting complaint groups (PCGs). </p><p>For different PCGs there was different in-hospital fatality rate. Compared to the largest PCG, chest pain, the gender and age adjusted OR was 2.12 (95% CI 1.01 – 4.44) for the miscellaneous complaint group and 2.04 (95 % CI 1.35 – 3.08) for the stroke–like symptom group. Within a given PCG the in-hospital mortality could vary depending on discharge diagnoses. By relating PCG and long term mortality to the expected mortality in the population, the Standardized Mortality Ratio (SMR) could be calculated. The SMR was found to be highest in seizure 2.62 (95 % CI 2.13 – 3.22), intoxication 2.51 (95% CI 2.11-2.98) and symptoms of asthma 1.8 (1.65 – 2.06). For the same discharge diagnoses the long term mortality could differ considerably depending on PCG at ED arrival (p<0.001). </p><p>Between 1995 and 2000 there was a 30 % increase in ED visits at the non surgical ED. PCGs representing lesser severe conditions had increased. Demographic changes could account for 45 % of the increment and the remaining increase could be ascribed to change in visiting pattern. </p><p>In the 2000 cohort 41.0 % of all visits were performed by re-visitors. The number of revisits and five-year mortality had an inversed u-shaped relationship were patients with three re-visits within the same year had an increased mortality compared to patients with more or less visits. </p><p>Conclusion: It is possible to define presenting complaint groups (PCGs) that are robust and consistent over time and useful as a tool for epidemiological studies in the ED.</p>
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鍾舜恆 and Shun-hang Joseph Chung. "Performance of emergency medicine (EM) ward in Tuen Mun hospital." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41709779.
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Campano, Erik. "Artificially Intelligent Black Boxes in Emergency Medicine : An Ethical Analysis." Thesis, Umeå universitet, Institutionen för psykologi, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-160696.
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Det blir allt vanligare att föreslå att icke-transparant artificiell intelligens, s.k. black boxes, används inom akutmedicinen. I denna uppsats används etisk analys för att härleda sju riktlinjer för utveckling och användning av black boxes i akutmedicin. Analysen är grundad på sju variationer av ett tankeexperiment som involverar en läkare, en black box och en patient med bröstsmärta på en akutavdelning. Grundläggande begrepp, inklusive artificiell intelligens, black boxes, metoder för transparens, akutmedicin och etisk analys behandlas detaljerat. Tre viktiga områden av etisk vikt identifieras: samtycke; kultur, agentskap och privatliv; och skyldigheter. Dessa områden ger upphov till de sju variationerna. För varje variation urskiljs en viktig etisk fråga som identifieras och analyseras. En riktlinje formuleras och dess etiska rimlighet testas utifrån konsekventialistiska och deontologiska metoder. Tillämpningen av riktlinjerna på medicin i allmänhet, och angelägenheten av fortsatt etiska analys av black boxes och artificiell intelligens inom akutmedicin klargörs.<br>Artificially intelligent black boxes are increasingly being proposed for emergency medicine settings; this paper uses ethical analysis to develop seven practical guidelines for emergency medicine black box creation and use. The analysis is built around seven variations of a thought experiment involving a doctor, a black box, and a patient presenting chest pain in an emergency department. Foundational concepts, including artificial intelligence, black boxes, transparency methods, emergency medicine, and ethical analysis are expanded upon. Three major areas of ethical concern are identified, namely consent; culture, agency, and privacy; and fault. These areas give rise to the seven variations. For each, a key ethical question it illustrates is identified and analyzed. A practical guideline is then stated, and its ethical acceptability tested using consequentialist and deontological approaches. The applicability of the guidelines to medicine more generally, and the urgency of continued ethical analysis of black box artificial intelligence in emergency medicine, are clarified.
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Van, Koningsbruggen Candice Ann. "Attrition amongst Emergency Medicine Registrars in the Western Cape: an exploration of contributing factors." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29677.
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Background. Attrition of registrars impedes the development of Emergency Medicine (EM) in South Africa and Africa, which negatively affects health systems strengthening. Factors relating to attrition of registrars in the EM training program in the Western Cape had not previously been explored. Understanding these factors will enable the development of a framework to be used to conduct formal exit interviews. This exit interview will allow the Division to continually document and address factors related to attrition. Objectives. To explore the factors contributing towards attrition amongst EM Registrars in the Western Cape, to enable a framework for a formal exit interview to be developed. Methods. An explorative qualitative study was conducted using semi-structured interviews. Data was analysed using NVivo software and thematic qualitative analysis. Results. Seven participants were interviewed (5 female and 2 male; ages 28-33). They joined the EM training program at different times (2005-2013) and their time spent in the program varied (8 months to 20 months). Despite their diverse histories, they voiced similar concerns regarding the training program (i.e. lack of support, unsociable hours), regarding relationships (i.e. motherhood, family time), and also with regards to self (i.e. burnout, work-life balance). Conclusion. This study highlights the need for a formal exit interview to address attrition in the Division of EM. The framework for the exit interview should encompass factors related to self, relationships and the training program.
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Bae, Crystal. "Emergency care assessment tool for health facilities." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20990.
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Includes bibliographical references<br>To date, health facilities in Africa have not had an objective measurement tool for evaluating essential emergency service provision. One major obstacle is the lack of consensus on a standardized evaluation framework, applicable across a variety of resource settings. The African Federation for Emergency Medicine has developed an assessment tool, specifically for low- and middle-income countries, via consensus process that assesses provision of key medical interventions. These interventions are referred to as essential emergency signal functions. A signal function represents the culmination of knowledge of interventions, supplies, and infrastructure capable for the management of an emergent condition. These are evaluated for the six specific clinical syndromes, regardless of aetiology, that occur prior to death: respiratory failure, shock, altered mental status, severe pain, trauma, and maternal health. These clinical syndromes are referred to as sentinel conditions. This study used the items deemed "essential", developed by consensus of 130 experts at the African Federation for Emergency Medicine Consensus Conference 2013, to develop a tool, the Emergency Care Assessment Tool (ECAT), incorporating these using signal functions for the specific emergency sentinel conditions. The tool was administered in a variety of settings to allow for the necessary refinement and context modifications before and after administering in each country. Four countries were chosen: Cameroon, Uganda, Egypt, and Botswana, to represent West/Central, East, North, and Southern Africa respectively. To enhance effectiveness, ECAT was used in varying facility levels with different health care providers in each country. This pilot precedes validation studies and future expansive roll out throughout the region.
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Wong, Chi-pang, and 黃志鵬. "The impact of the establishment of emergency medicine ward at accident& emergency department on hospital admission." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45174416.
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Abrams, Marlin. "Dissemination patterns of scientific abstracts presented at the first and second African Conferences of Emergency Medicine." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33617.
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Introduction:Evidence based medicine is the standard of modern health care practices. Ongoing biomedical research is needed to expand existing knowledge and improve quality of care, but it needs to reach clinicians to drive change. Journal articles and conference presentations are dissemination tools. The aim of the study was to establish the publication rate of scientific abstracts presented at the first and second African Conference of Emergency Medicine. The secondary objectives were establishing nonpublication dissemination and the factors associated with publication and non-publication. Determining non-publication dissemination patterns and the factors associated with reasons for publishing or non-publication were also investigated. Methods:Presenters of the 129 scientific abstracts from the first and second African Conference of Emergency Medicine were invited to participate in an online survey. The survey was followed by a manual literature search to identify published manuscripts of authors that did not complete the survey, to determine the most accurate publication rate. Results:Thirty-one presenters responded (24%), of which 18 published in a peer-reviewed journal. An additional 25 publications were identified by the literature search. The overall publication rate was 33.3% (26.9% from 2012 and 40.3% from 2014). Oral presentations were more likely to be published (p=0.09). Sixteen manuscripts (37.2%) were published in the African Journal of Emergency Medicine. Presentations at local academic meetings were the most used platform beyond publication (43%). The main reason to publish was to add to the body of knowledge (100%), while lack of time (57%) was the major obstacle for not publishing.Conclusion:The overall publication rate for the first and second Africa Conferences of Emergency Medicine iscomparable to other non-African Emergency Medicine conferences. The increasing publication trendbetween conferences might reflect the development of regional research capacity. EmergencyMedicine providers in Africa need to be encouraged to participate in high quality, locally relevant research and to distribute those findings through accessible formats.
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Kalla, Moosa. "Emergency medicine physician and registrars knowledge of mechanical ventilation in Cape Town South Africa by Moosa Kalla." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2863.
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Includes abstract.<br>Includes bibliographical references.<br>The aim of this study is: to determine whether Emergency Physicians have knowledge to optimally mechanically ventilate the intubated patient.
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Louw, Pauline. "Effective use of defibrillators in the Emergency Centre." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/2865.
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Mtombeni, Sithembile. "Identifying Procedural Core Competencies for Undergraduate Emergency Medicine Education at the University of Zimbabwe College of Health Sciences." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29670.
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Introduction: Low and middle-income countries account for over 90% of worldwide morbidity and mortality associated with injuries. While insufficient resources preclude appropriate care, suboptimal clinical skills, are a universal setback. Major curricula gaps have been identified as underlying this situation. In Africa, most training efforts are targeted at postgraduate level, relegating undergraduate Emergency Medicine (EM) education to a less formal undertaking. This study set out to delineate a list of locally appropriate undergraduate EM procedural core competencies for the University of Zimbabwe College of Health Sciences (UZCHS), through a consensus building process. Methods: A three-stage modified online Delphi survey was used to gain consensus among expert medical trainers at UZCHS, between July and August 2017. Opinion was sought on a five-point Likert scale, regarding agreement with items for inclusion on the procedural core competency list. The original survey list of 105 competencies was generated from literature. The second round included suggestions from panelists. The study was ethically cleared by the University of Cape Town, UZCHS and the Medical Research council of Zimbabwe. Results: 19 expert medical teachers, representing seven clinical departments responded to the survey, with 15 completing all rounds. 79% had more than 5 years’ experience in teaching and assessment of emergency procedures. Of these, 50% had at least 10 years’ experience. The experts reached consensus (75% selecting agree or strongly agree) on 64 competencies (61%), on the first round. The second round yielded consensus on a further 33 items. Only one additional item reached consensus in the final round. A final list of 98 core procedural competencies was generated by three Delphi rounds. Qualitative comments are summarised per emerging themes. Conclusions: A locally appropriate list of undergraduate procedural core competencies, was established. This process can serve as guidance for curriculum projects in Zimbabwe and similar settings.
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Hansson, Jeanette, Anna Mattsson, and Malin Olausson. "Receving women in the accident and emergency department who have been abused by their male partner – an empirical nursing study." Thesis, Kristianstad University College, Department of Health Sciences, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-3382.
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<p>Introduction:Violence towards women is an extensive and important problem in the society. Confronting women who are assulted by their male partner is a demanding task for the nurses.The aim of the study:The aim of this empirical study was to illustrate the experiences of nurses in the meeting with women exposed to violence by their male partner.Method:This is a qualitative interview study including nine female nurses. The material recieved from the interviews was analysed with help of content analysis. Categories were formed named Comunication, feelings, Ability to recognize the women, Lack of time, Need of support and further education. An application to the ethical council at the University of Kristianstad were remitted and approved. Result:The difficulties in the caring of assulted women were emerged as: The lack of time and the difficulties in recognicing the assulted women. These problems caused strong emotional feelings like inability to help, anger and frustration.Conclusion:The writers think that the attitude in the society have to change, in order to get the economical resurses needed to support the nurses with further education and feed back.</p>
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Magnusson, Anne. "Parental experiences when children are undergoing emergency surgery/Föräldrars upplevelser i samband med att deras barn genomgår en akut operation." Thesis, Kristianstad University College, Department of Health Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-3582.
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<p>When a child is hospitalized, it is usually more than one person who needs attention – i.e. the child as well as its parents. The emergency ward environment and surgery rooms are unfamiliar and the parents feel anxious, insecure and uncertain about how to act. They are expected to participate in the child’s care, cope with their own anxiety and simultaneously convey a sense of security and stability to the child. The purpose of this study was to investigate parents' experiences related to this situation. Data was collected by interviewing thirteen consecutively sampled parents. Qualitative content analysis showed that parents' previous experiences created expectations, which in turn influenced their perceptions of the present episode. Participation was perceived as an offer and/or a requirement from parents as well as from the staff. For parents, it sometimes meant an additional effort since it demanded their involvement in caring for the child/in the child’s care. They experienced that their presence could be a threat as well as an asset for the hospital staff. The parents described that the level of accessibility, participation, relief, shared responsibility and adequate information determined the level of perceived security and safety toward medicine and hospital staff. Since every caring experience creates expectations, it means that every caring contact could be seen as an investment in future security.</p>
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McAlpine, Nicola Anita. "The Perceptions of Emergency Medicine Physicians and Trainees Regarding Family Presence During Adult Patient Resuscitation in South African Public Sector Emergency Centres." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/31098.
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Introduction
The benefits of family presence during adult resuscitation (FPDR) are well documented in the literature. However, despite apparent value, FPDR is not always practised. The purpose of this study was to evaluate the perceptions of Emergency Medicine physicians and specialist trainees regarding FPDR in South African public sector Emergency Centres.
Method
A descriptive study was undertaken, using an electronic survey which consisted of both open and closed-end questions. The Survey was distributed via email to 157 Emergency Medicine physicians and specialist trainees in South Africa. The data was collected and subjected to descriptive statistical analysis.
Results
Most South African Emergency Medicine physicians and trainees did not feel that FPDR interrupted patient care; did not feel it hindered the teams’ productivity; and did not believe it increases complaints about the quality of patient care. Despite this, practice of FPDR was found to be uncommon. Knowledge regarding FPDR guidelines was poor.
Discussion
The views of South African Emergency Medicine physicians and specialist trainees regarding FPDR is in keeping with other pro-FPDR countries. However, these views do not seem to translate into practice. FPDR education and development of local guidelines are recommended.
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Fleming, Julian. "An evaluation of blood cultures in the emergency centre." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10436.
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Includes bibliographical references.<br>The aim of this study is to determine whether routine blood cultures performed in a secondary level hospital Emergency Centre affect the choice of antibiotic used in treating patients with bacterial infections. A secondary aim is to determine if staff in the EC are aware of correct procedures for drawing blood cultures, and whether their practice reflects this. This will be a retrospective analysis of all blood cultures done in GF Jooste hospital over a 12 month period (1 April 2008 - 31 March 2009). The EC sees approximately 45 000 patients per year, and approximately 300 blood cultures are performed every month. Inclusion criteria: Age 18 or greater; Blood culture performed by EC staff in EC; Recorded blood culture result by laboratory; Patient in hospital when results received. The data will be analysed and presented as simple descriptive statistics.
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Oosthuizen, Almero Hendrik. "Correlating emergency centre referral diagnoses with final discharge diagnoses." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/2869.
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Geraty, Sian. "Adverse event registry analysis of an EMS system in a low resource setting: a descriptive study." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29292.
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Introduction Out of hospital emergency medical service patients present unique challenges and ample opportunities for medical error to occur. Identifying medical error is important for mitigating future risk and improving patient safety. Hypothesis/problem Our study describes the adverse event registry of an emergency medical service system in a low resource setting over a six-year period. Methods The Western Cape Emergency Medical Services Adverse Event Registry were reviewed for the period 1 January 2010 to 31 December 2015. From these, all cases classified as an adverse event or near miss were extracted for in depth review. Demographics, type of error, and types of recommendations implemented are reported. Results Altogether 106 (69%) adverse events and 47 (31%) near misses were reported over the six-year period. The mean age of patients was 31 years (standard deviation ±24.8). Of these 65 (42%) cases were adult medical patients, 31 (20%) adult trauma patients, 15 (10%) obstetric patients and 42 (27%) paediatric patients. The caseload was observed to increase over the six-year period, whilst system medical errors decreased and individual medical errors increased over the same period. Conclusion In this low resource emergency medical service system, individual medical errors increased and system medical errors decreased as more recommendations derived from adverse events caused by the system errors were implemented. This created a greater need for individual and group training of EMS clinical providers. We recommend further research in order to adequate describe the reason for the increase individual medical error, as well as to find more effective means of detecting adverse events and near misses in this population.
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Hansoti, Bhakti. "Prioritization of critically unwell children in low resource primary healthcare centres in Cape Town, South Africa." Doctoral thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25008.
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Background: Every day, sick children die from time sensitive preventable illnesses. Due to an inadequate number of trained healthcare workers and high volumes of children presenting to Primary Healthcare Centres (PHC), waiting times remain high and often result in significant delays for critically ill children. Delays in the recognition of critically unwell children are a key contributing factor to avoidable childhood mortality in Cape Town, South Africa. Methodology: A stepped implementation approach was undertaken to develop and evaluate a context-appropriate prioritization tool to identify and expedite the care of critically ill children PHC in Cape Town, South Africa. Aim 1: To conduct a systematic review of paediatric triage and prioritization tools for low resource settings in order to evaluate the evidence supporting the use of these tools. Aim 2: To perform an exploratory study, to identify barriers to optimal care for critically ill children in the pre-hospital setting in Cape Town, South Africa. Aim 3: To develop an implementable context-appropriate tool to identify and expedite the care of critically ill children in PHC in the City of Cape Town, South Africa. Aim 4: Evaluate the reliability of this tool compared to established triage tools currently used in this setting. Aim 5: Evaluate the impact of implementing this tool, on waiting times for children presenting for care to PHC. Aim 6: Evaluate the effectiveness of this tool post real-world implementation in identifying and expediting the care for critically ill children. Findings: Post real world implementation SCREEN was able to significantly reduce waiting times in PHC for critically ill children. Compared to pre-SCREEN implementation, post-SCREEN the proportion of critically ill children who saw a PN within 10 minutes increased tenfold from 6.4% (pre-SCREEN) to 64% (post-SCREEN) (p<0.001). SCREEN is also able to accurately identify critically ill children, in an audit of 827 patient-charts SCREEN had a sensitivity of 94.2% and a specificity of 88.1% when compared to IMCI. Interpretation: The SCREEN program when implemented in a real-world setting has shown that it can effectively identify and expedite the care of critically ill children in PHC.
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Bam, Zina. "An exploratory survey: experiences and perceptions of community members who have accessed pre-hospital Emergency Medical Service in Langa, Cape Town." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31165.
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Background: Calling an ambulance is the first line for citizens in dealing with many healthcare emergencies. It is crucial for the caller to convey correct information regarding the patient’s emergency and on-scene location to the emergency services, resulting in prompt dispatch of correct emergency resources to the exact location. Although there is a good deal of focus on emergency medicine time parameters and outcomes, little is known about the experiences, perceptions and satisfaction level from those who have accessed pre-hospital Emergency Medical Services. Methods: A telephonic survey was conducted on individuals who had recently called for an ambulance, from the urban township of Langa, Cape Town. Surveys were conducted in the caller’s home language, using a standardized tool for collecting quantitative data around the call process, caller satisfaction, outcomes of the call, and issues experienced. Results: During June 2018, 50 callers completed the survey (69% response rate). Most callers (88%) used a personal mobile phone, and 83% called predominantly for medical problems in the daytime. Callers accessed the service by dialling a variety of emergency phone numbers. Callers were largely satisfied with the call (66%), and there were fewer language mismatches than expected. A need for better communication regarding ambulance status and over the phone medical advice was identified. A substantial number of inconsistencies were reported between callers’ outcomes and those from emergency communication centre which require further analysis. These inconsistencies, pointed into gaps within the emergency communication centre’s collecting and database system Conclusion: The study provided the first insight into pre-hospital emergency caller experiences and perceptions, highlighting important aspects perhaps not revealed through other metrics. Measurement of caller satisfaction can be a useful quality improvement tool, and would seem feasible without substantial resources. Further investigation into data capturing system and identification of call outcomes are recommended.
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Callachan, Edward. "Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes." Doctoral thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25168.
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Introduction: Acute coronary syndromes, including ST-elevation myocardial infarction (STEMI), are a leading cause of morbidity and mortality worldwide. Existing research shows that prehospital care provided by emergency medical services (EMS) can significantly improve outcomes. However, EMS remains grossly underutilised in Abu Dhabi despite a well-established presence. Objectives: In this three-part quantitative, observational study, we sought to (1) assess physicians' perceptions of, and recommendations for, utilization and improvement of EMS, (2) assess patients' awareness of EMS, mode of transport use in decision to seek care and reasons for their decision, and (3) establish if in the current study setting, mode of transport used has implications for in hospital adverse events, as well as short and long term clinical outcomes. The goal was to investigate both physicians' and patients' perceptions of prehospital STEMI care, as well as to assess the clinical correlates of the mode of transport in a patient's decision to seek care. Methods: We conducted the study in three phases. Phase 1: At four government-operated hospitals in Abu Dhabi, we administered surveys to a convenience sample of physicians involved in care of patients with acute coronary syndromes to measure (a) likelihood of recommending EMS, (b) satisfaction with EMS, (c) likelihood of using EMS for self or family, and (d) recommendations for prehospital care of acute coronary syndromes. Phase 2: We gathered mode of transport data from a purposive, non-random sample of 587 consecutive patients with STEMI over an 18-month period and conducted structured follow-up interviews to assess their perceptions of EMS. We conducted analysis to determine whether mode of transport was related to demographic variables. Phase 3: We collected medical records from patient participants and conducted structured follow-up interviews at 1, 6 and 12 months post discharge. We conducted chi square difference testing to determine the relationships among mode of transport, treatment times, and short- and long-term clinical outcomes. Variables included treatment times and associated outcomes. Results: Physician participants (n = 106) were most supportive of prehospital 12-lead ECG for STEMI, but indicated low satisfaction with existing EMS services in Abu Dhabi. Among STEMI patient participants (n = 587), EMS was underutilized in Abu Dhabi; over half (55%) of patients did not know the phone number to contact EMS, and only 14.7% used EMS in their decision to seek care. EMS-transported patients were more likely to receive timely treatment (door-todiagnostic ECG time, door-to-balloon time) and had lower incidence of mortality compared to privately-transported patients. Conclusions: These findings suggest a need to raise public awareness of EMS and its importance for coronary symptoms in Abu Dhabi. Broader application of prehospital ECG, including prehospital activation of cardiac catheterization labs, bypassing non-interventional cardiology centres, and admission directly to facilities that provide these services without initial admission to the emergency department, could help improve physicians' perceptions of EMS and outcomes for patients with STEMI.
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Hodkinson, Peter William. "Developing a patient-centred care pathway for paediatric critical care in the Western Cape." Doctoral thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/17259.
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Includes bibliographical references<br>Background: Emergency care of critically ill or injured children requires prompt identification, high quality treatment and rapid referral. This study examines the critical care pathways in a health system to identify preventable care failures by evaluating the entire pathway to care, the quality of care at each step along the referral pathway, and the impact on patient outcomes. Methods: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation until paediatric intensive care unit admission or emergency centre death, using a modified confidential enquiry process of expert panel review and caregiver interview. Outcomes were expert panel assessment of quality of care, avoidability of death or PICU admission and severity at PICU admission, identification of modifiable factors, adherence to consensus standards of care, as well as time delays and objective measures of severity and outcome. Results: The study enrolled 282 children: 85% medical and 15% trauma cases (252 emergency admissions, and 30 children who died at referring health facilities). Global quality of care was graded poor in 57(20%) of all cases and 141(50%) had at least one major impact modifiable factor. Key modifiable factors related to access and identification of the critically ill, assessment of severity, inadequate resuscitation, delays in decision making and referral, and access to paediatric intensive care. Standards compliance increased with increasing level of healthcare facility, as did caregiver satisfaction. Children presented primarily to primary health care (54%), largely after hours (65%), and were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 74% of children, indicating room for improvement. Conclusions and Relevance: The study presents a novel methodology, examining the quality of paediatric critical care across a health system in a middle income country. The findings highlight the complexity of the care pathway and focus attention on specific issues, many amenable to suggested interventions that could reduce mortality and morbidity, and optimize scarce critical care resources; as well as demonstrating the importance of continuity and quality of care throughout the referral pathway.
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Gangaram, Padarath. "An investigation into recruitment, retention and motivation of advanced life support practitioners in South Africa." Doctoral thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25289.
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Background: Internationally, emergency medical services (EMS) are experiencing problems with recruiting, retaining and motivating advanced life support (ALS) practitioners. The persistent shortage of ALS practitioners in South Africa (SA) poses a challenge to the effective delivery of prehospital emergency medical care. The global demand for SA trained ALS practitioners is steadily increasing. SA EMS organisations are struggling to compete for these practitioners with the international market. The SA EMS industry currently has no effective approach to decrease the loss of ALS practitioners. This research study was therefore conceptualized to investigate factors that influence ALS practitioner recruitment, retention and motivation in an effort to enhance them. Methods: This study followed a sequential, explanatory, mixed method design. The two phase study was non-experimental and descriptive in nature. The quantitative phase was comprised of ALS practitioners (n=1309) and EMS managers (n=60) completing questionnaires. The qualitative phase of the study involved data gathering through focus group (n=7) discussions with ALS practitioners and semi-structured interviews with EMS managers (n=6). Quantitative data was analysed with Statistical Package for the Social Sciences (SPSS). Inferential techniques included the use of correlations and chi squared test values which were interpreted using p-values. Results: The study identified 19 recruitment, 25 retention and 16 motivation factors that influence ALS practitioners. Cumulatively, these factors revolved around the ALS practitioners' work environment, professional development and employment package. Strong recruitment factors that were identified include: ALS practitioner remuneration, skilled EMS management and organisation culture. Similarly, strong ALS practitioner retention factors that were identified include: skilled EMS management, remuneration, resources, availability of health and wellness programmes, recognition of practitioners, working conditions and safety and security. Strong ALS practitioner motivation factors included: remuneration, skilled EMS management and resources. Conclusion: More ALS practitioner training institutions are required to improve the number of these practitioners. EMS organisations must improve the work environment, employment package and professional development opportunities for ALS practitioners. Such practices will encourage ALS practitioner recruitment, retention and motivation.
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Bruijns, Stevan Raynier. "From anxiety to haemorrhage : describing the physiological effects that confound the prognostic inferences of vital signs in injury." Doctoral thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2855.
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Govender, Pregalathan. "The development and testing of a training intervention designed to improve the acquisition and retention of CPR knowledge and skills in ambulance paramedics." Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20835.
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Despite several therapeutic advances in cardio-pulmonary resuscitation (CPR), there has been little overall improvement in the out-of-hospital, cardiac arrest (OHCA) survival rates. Reports indicate that, although the incidence and outcome of OHCA vary across the globe, the median reported rates of survival at hospital discharge have remained below 10% for the 30 years preceding this study. One of the factors associated with this low survival rate is the deficient quality of the CPR provided during an OHCA by paramedics. Despite revised training standards, structured CPR training programmes and industry-regulated CPR refresher training schedules, paramedic-delivered CPR (pdCPR) during OHCAs is reported to be both inadequate and rarely in line with established resuscitation guidelines. International resuscitation bodies such as the International Liaison Committee on Resuscitation (ILCOR) postulate the need for tailored CPR training interventions in order to improve CPR performance. The aim of this study was to investigate the impact of a tailored pdCPR training intervention on pdCPR performance. The study was conducted in four phases and, using a mixed-method, multiphase design the study developed, implemented and evaluated the impact of a pdCPR training intervention which had been designed and tailored to improve the acquisition and retention of knowledge and skills by ambulance paramedics (AP). The primary outcome measure used in the study was the achievement of a competent rating which reflected the ability of the AP in question to perform high-quality, effective CPR as determined and evaluated by a 26 measure CPR Rapid Evaluation Tool predicated on variables derived from the globally accepted Cardiff list. Each of the 26 measures represented a treatment element within a pdCPR care bundle and which had been shown to contribute to successful resuscitation.
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Vassallo, James M. A. "Major incident triage: development and validation of a modified primary triage tool." Doctoral thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29232.
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Introduction
A key principle in the effective management of a major incident is triage, prioritising patients on the basis of their clinical acuity. However, existing methods of primary major incident triage demonstrate poor performance at identifying the Priority One patient in need of a life-saving intervention. The aim of this thesis was to derive an improved triage tool.
Methods
The first part of the thesis defined what constitutes a life-saving intervention. Then using a retrospective military cohort, the optimum physiological thresholds for identifying the need for life-saving intervention were determined; the combination of which was used to define the Modified Physiological Triage Tool (MPTT). The MPTT was validated using a large civilian trauma database and a prospective military cohort. Subsequently, to describe the safety profile of the MPTT, an analysis of the implications of under-triage was undertaken. Finally, pragmatic changes were made to the MPTT (MPTT-24) - in order to provide a more useable method of primary triage. Statistical analysis was conducted using sensitivities and specificities, with triage tool performance compared using a McNemar test.
Results
32 interventions were considered life-saving and the optimum physiological thresholds to identify these were a GCS <14, 12 < RR <22 and a HR < 100. Within both the military and civilian populations, the MPTT outperformed all existing methods of triage with the greatest sensitivity and lowest rates of under-triage, but at the expense of over-triage. Applying pragmatic changes, the MPTT-24 had comparable performance to the MPTT and continued to outperform existing methods.
Conclusion
The priority of primary major incident triage is to identify patients in need of life-saving intervention and to minimise under-triage. Fulfilling these priorities, the MPTT-24 outperforms existing methods of triage and its use is recommended as an alternative to existing methods of primary major incident triage. The MPTT-24 also offers a theoretical reduction in time required to triage and uses a simplified conscious level assessment, thus allowing it to be used by less experienced providers.
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Dippenaar, Enrico. "Standardisation and validation of a triage system in a private hospital group in the United Arab Emirates." Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/23397.
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Introduction: Upon inspection and evaluation of the Mediclinic Middle East emergency centres in the United Arab Emirates, inconsistencies related to triage were found. Of note, it was found that the use of various international triage systems within and between the emergency centres may have caused potentially harmful patient conditions. The aim of this thesis was to study the reliability and validity of existing triage systems within Mediclinic Middle East, and then to use these systems as a starting point to design, standardise and validate a single, locally appropriate triage system. This single triage system should be able to accurately and safely assign triage priority to adults and children within all of Mediclinic Middle East emergency centres. Methods: A System Development Life Cycle process intended for business and healthcare service improvement was expanded upon through an action research design. Quantitative and qualitative components were used in a five-part study that was conducted by pursuing the iterative activities set by an action research approach to establish the following: the emergency centre patient demographic and application of triage, the reliability and validity of the existing triage systems, a determination of the most appropriate triage system for use in this local environment and development of a best-fit novel triage system, establishment of validation criteria for the novel triage system, and determination of reliability and validity of the novel triage system within Mediclinic Middle East emergency centres. Results: Low-acuity illness profiles predominated the patient demographic; high acuity cases were substantially smaller in number. The emergency centres used a combination of existing international triage systems; this was found to be inappropriate for this environment. Poor reliability and validity performance of the existing triage systems led to the development of a novel, four-level triage system. This novel triage system incorporates early warning scores through vital sign parameters, and clinical descriptors. The novel triage system proved to be substantially more reliable and valid than the existing triage systems within the Mediclinic Middle East emergency centres. Conclusion: Through an initial systems analysis, it became clear that the Mediclinic Middle East emergency centres blindly implemented an array of international triage systems. Using an action research approach, a novel triage system that is both reliable and valid within this local environment was developed. The triage system is fit to be implemented throughout all the Mediclinic Middle East emergency centres and may be transposed to similar emergency centre settings elsewhere.
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Sun, Jared. "Using community members to assist life-threatening emergencies in violent, developing areas." Doctoral thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/2876.
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Gage, Caleb Hanson. "The thoughts and opinions of advanced life support providers in the South African private emergency medical services sector concerning pre-hospital palliative care." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32216.
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The World Health Organisation (WHO) defines palliative care as 'an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.' 1 This includes a wide variety of situations such as chronic illness and end-of-life care. 2 Palliative care is usually performed in-hospital. However, emergency medical services (EMS) often encounter patients requiring palliative care as these patients may have acute exacerbations of illness, progress towards end-of-life or require transport to a medical facility. 3-9 Thus, there is a role for palliative care in the pre-hospital setting. EMS providers are uniquely positioned to deliver this care in the pre-hospital setting as they are often the first point of medical contact. 10 This has great potential benefit for patient comfort, early identification and relief of suffering and earlier referral to hospice care. 10, 11 Despite this unique position there is an overall lack of guidance within EMS systems to manage palliative patients. 5, 6, 10 In the United States of America (USA), for example, only 5-6% of EMS systems have protocols for palliative care. 6, 10 In addition, there is no specific pre-hospital emergency care curricula on the subject, resulting in a lack of education and training for EMS providers. 3-5, 12, 13 This may stem from the historical focus of EMS training which primarily involves immediate measures to preserve life or limb until definitive care is reached. 11 This focus has resulted in an EMS ethos of 'saving lives.' 5, 12 Palliative care, on the other hand, is not focussed on 'saving lives', but rather the prevention and relief of suffering. 1 Therefore, palliative care may seem to conflict with emergency care, placing EMS providers in difficult situations when confronted with palliative care patients. 8, 12, 14 South Africa itself faces what has been termed a “quadruple burden of disease” due to communicable diseases such as HIV/AIDS, high maternal and paediatric mortality rates, non-communicable disease as well as injury. 15 The large number of patients suffering from these diseases and the life-limiting complications thereof, results in increased need for palliative care in the country as noted by the South African Minister of Health. 16 Access to health care for patients suffering from these diseases is a further challenge in the Sub-Saharan African setting. 17, 18, 19 In South Africa, EMS are often contacted 3 by those without access to transport to provide this service. 20 Thus, South African EMS providers may frequently encounter not only high acuity emergency patients, but many ill HIV/AIDS, cancer and other chronically ill patients requiring palliative care who are unable to access healthcare via alternative means. 21 European studies have found that approximately 3-5% of all pre-hospital calls involve palliative care situations. 2, 22, 23 With the quadruple burden of disease and limited access in the South African setting, this percentage is likely higher as these factors result in increased frequency of contact between EMS providers and patients requiring palliative care. Although EMS providers in South Africa manage palliative patients in the prehospital setting, to our knowledge, no research has been produced in the (South) African setting regarding prehospital palliative care. Outside of Africa literature has been produced but is limited. This literature review discusses paramedic perceptions of prehospital palliative care, prehospital palliative care patient management and legislation concerning prehospital palliative care. Finally, expert opinion pieces and recommendations are reviewed.
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Mohamed, Zunaid. "Text Reminders in Pyrexial Paediatric Patients (TRIPPP): a randomized controlled pilot study." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32285.
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Transitions in care – including at the point of discharge from a hospital - may potentially place patients in a position of increased risk and vulnerability.(1) This is recognised to be of particular concern for paediatric patients, compounded by the fact that no widely accepted or used standards of care for paediatric discharge exist. Current research and quality improvement efforts to optimize care transitions in children are considered an essential contributor to reducing post hospitalization morbidity and improving family centred care. (2)(3) Care transitions are also considered especially challenging during the discharge process from the Emergency Centre. Effective patient education and follow-up arrangements may be compromised in the frequently fast paced, high patient volume environment often characterised by interruptions and distractions thus increasing the risk of medical error. This is further complicated by shift working healthcare providers who are required to treat unfamiliar patients of varying clinical acuity who present for care.(1)(4)(5)
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Kalanzi, Joseph. "An analysis of health facility preparedness for major incidents in Kampala." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/21188.
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Background & Objectives: Major incidents occur commonly in Uganda, but little is known about either local hazards which risk causing major incidents, or health system preparedness for such events. Understanding risk and current preparedness is the first step in improving response. Methods: We undertook a cross - sectional study across four teaching hospitals in Kampala (Mulago National Referral Hospital, Nsambya Hospital, Mengo Hospital and Lubaga Hospital). A local geographic area Hazard Vulnerability Analysis (HVA) f or each site was combined with a key informant questionnaire and standardized facility checklist within the hospitals. Data collected included status of major incident committees, operational major incident plans and facility major incident operation centres, bed capacity, equipment and supplies and staffing. The HVA assessed the human impact, impact on property and on business of the hazards as well as measures for mitigation (preparedness, internal response and external response) in place at the hospitals. Results: Only one of the four hospitals was found to have had an operational major incident plan. The designated coordinator for major incidents across all facilities was mostly a general surgeon; no funds were specifically allocated for planning .All hospitals have procedures for triage, resuscitation, stabilization and treatment. None of the facilities had officially designated a major incident committee. All the facilities had sufficient supplies for daily use but none had specifically stock piled any reserves for major incidents. All hospitals were staffed by at least a medical officer, clinical officers, nurses and a specialist with procedures for mobilizing extra staff s for major incidents. Some staffs had received some emergency care training in courses namely basic life support, advanced trauma life support, primary trauma care and emergency triage and treatment but no team had received training in major incident response. Only one hospital carried out annual simulation exercises. Incidents involving human hazards specifically bomb threats, road crash mass casualty incidents, civil disorder and epidemics posed the highest risk to all four hospitals and yet preparation and response measures were inadequate. Conclusion: Hospitals in Kampala face a wide range of hazards and frequent major incidents but despite this they remain under - prepared to respond. Large gaps were identified in as far as staffing, equipment and infrastructure.
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Mahomed, Zeyn. "Emergency department patients' perception of care: do doctors understand their patients?" Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11526.
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Includes abstract.<br>Includes bibliographical references (leaves 42-55).<br>The aim of my study is to directly compare the patient’s perceptions of care received in the emergency department to that of the attending physician’s. The aim is to give us better insight into how the patient experiences their care, with a view to improving the level of care offered. The study elucidates the emphasis a patient places on aspects of their care such as empathy, communication, waiting times, etc. The study was conducted at GF Jooste Emergency Department over a period of eight weeks. Patients voluntarily, and with full anonymity, filled in a short questionnaire. The attending physician did the same. Questionnaires were collected and data fed into a database, analyzed and the results interpreted.
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Du, Toit Rene. "Risk adjusted mortality rates : Do they differ if bases on administrative data (hospital standardised mortality ratio) versus a physiological predictive model (APACHE IV ®)?" Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15478.
Full textAbstract:
Background: The measurement of, and reporting on clinical outcomes, is an integral part of clinical governance but no consensus has been reached about which measures to use and the validity thereof. Objective: To compare an administrative predictive model (Hospital Standardised Mortality Ratio [HSMR]) with a physiological predictive model (APACHE ®IV) to determine the correlation in the predicted risk adjusted mortality rates. To determine whether stratifying the patients into low (<10%), medium (<50%) or high (>80%) risk bands will lead to more accurate comparisons. Design: Prospective cohort study Setting: 63 critical care units in 34 private acute care facilities across South Africa Methods: Both HSMR and APACHE ®IV are calculated routinely in all participating facilities and the research study will use the data generated. An additional audit process will be implemented to determine and ensure the integrity of the data. Ethics: The healthcare facilities have standard processes in place to ensure confidentiality and the statistician analysing the data is employed by the healthcare group and bound to a confidentiality agreement. Ethics approval has also been obtained by the University of Cape Town ethic committee before the approval of the research proposal.
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Jansen, Marvin Jeffrey. "A qualitative study on 6th year medical students' perceptions of and self-reported competence in clinical practice after receiving resuscitation-based simulation training." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20408.
Full textAbstract:
Background: Despite practicing resuscitation skills in a simulation environment, medical students often express anxiety about having to participate in patient resuscitation in the clinical environment. This fear can lead to an unwillingness to initiate or participate in resuscitations, and a decreased confidence in their skills. Exploring the perceptions of final year medical students can provide valuable insight for improving the current simulation programme at the University of Cape Town. Aim: The aim of the study is to explore 6th year medical students' perceptions and self-reported competence for clinical practice after receiving Resuscitation-Based Simulation training.