Emergency Medicine

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Browsing Emergency Medicine by browse.metadata.advisor "Hendrikse, Clint"

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    Describing and comparing the availability of acute care resources to treat new onset stroke in different income settings : a self-reported survey of acute care providers at the 2016 international conference on emergency medicine
    (Stellenbosch : Stellenbosch University, 2019-12) Chunga, Ramadhan Mohamed; Allgaier, Rachel; Hendrikse, Clint; Bruijns, Stevan R.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine.
    ENGLISH SUMMARY : Introduction: Stroke affects 15 million people annually and is responsible for 5 million deaths per annum globally. In contrast to the trend in low- and middle-income countries (LMICs), stroke mortality is on the decline in high-income countries (HICs). Even though the availability of resources varies considerably by geographic region and across LMICs and HICs, evidence suggests that material resources in LMICs to implement recommendations from international guidelines are largely unmet. This study describes and compares the availability of resources to treat new-onset stroke in countries based on the World Bank’s gross national incomes, using recommendations of the American Heart Association and the American Stroke Association 2013 update. Methods: A self-reported cross-sectional survey was conducted of delegates that attended the April 2016 International Conference on Emergency Medicine using the web-based e-Survey client, Survey Monkey Inc. The survey assessed both pre-hospital and in-hospital settings and was piloted before implementation. Results: The survey was distributed and opened by 955 delegates and 382 (40%) responded. Respondents from LMICs reported significantly less access to a prehospital service (p<0.001) or a national emergency number (p<0.001). Access to specialist neurology services (p<0.001) and radiology services (p<0.001) were also significantly lower in LMICs. Conclusions: The striking finding from this study was that there was essentially very little difference between the responses between LMIC and HIC respondents with a few notable exceptions. The findings also propose a universal lack of adherence to the 2013 AHA/ASA stroke management guideline by both groups, in contrast to the good reported knowledge thereof. Carefully planned qualitative research is needed to identify the barriers to achieving the 2013 AHA/ASA recommendations.
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    A qualitative exploration of the language and expression of pain in a Cape Town emergency centre
    (Stellenbosch : Stellenbosch University, 2020-12) Kajee, Muhammad Shaheen; Geduld, Heike; Hendrikse, Clint; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Emergency Medicine.
    ENGLISH SUMMARY : Background: Oligoanalgesia is increasingly being identified as an issue affecting emergency centres universally, especially in low- and middle-income countries where a lack of culturally specific pain scales compound the issue. Despite successful translation of pain scales into different languages, differing cultures and dialects often lead to the pain experience being inappropriately categorised and communicated. This study aimed to explore the language and the expression of pain in adult patients who required tube thoracostomies for penetrating chest trauma, at a district level hospital. Methods: The study was conducted at a district level hospital in Cape Town. An explorative qualitative study design was used, using a single stage semi-structured English language interview. All adults who had a thoracostomy tube inserted for penetrating chest trauma were eligible for inclusion. Audio recordings were transcribed, and thematic content analysis of interview data was performed. 22 participants were interviewed (All male, ages 18-45). All participants could speak English at least as a second language. Results: Participants had difficulty expressing pain using language and often used non-verbal means; expressing a limitation of functioning and a need for additional analgesia were common mechanisms to express severity of pain; expression of intensity pain was often conveyed by categorising pain as tolerable or intolerable with the latter associated with hopelessness and defeat. The actual language used was simple, and commonly used colloquialisms unique to the setting. Barriers to communication between patient and doctor related to use and interpretation of pain scales and the poor relationship between doctor and patient. Conclusion: This study emphasises the inadequacy of currently accepted pain assessment methods in this setting in terms of use and interpretation. It highlights the need for culturally appropriate tools and training of doctors in communication related to pain.