Browsing by Author "Geduld, Heike"

Now showing 1 - 8 of 8
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    Assessment of routine laboratory screening of adult psychiatric patients presenting to an emergency centre in Cape Town
    (Health and Medical Publishing Group (HMPG), 2011-12) Crede, Andreas; Geduld, Heike; Wallis, Lee
    Managing mental health patients forms part of the workload in emergency centres (ECs) throughout the Western Cape (WC), which has an estimated overall lifetime prevalence of mental health disorders of 39.4%. The Mental Health Care Act of 2002 requires that patients presenting with a mental health disorder and requiring involuntary or assisted admission be admitted to a designated hospital for 72 hours for assessment and treatment. Their entry point in most cases is via the EC, which places additional strain on emergency facilities. The high incidence of mental health disorders in adolescence, when many adult mental health conditions begin, is expected to increase because of increasing social stressors such as poverty, displacement and conflict in low-income areas.3 We can therefore expect an increasing human and financial resources burden on health care facilities.
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    An educational pathway and teaching materials for first aid training of children in sub-Saharan Africa based on the best available evidence
    (BMC (part of Springer Nature), 2020-06-03) De Buck, Emmy; Laermans, Jorien; Vanhove, Anne-Catherine; Dockx, Kim; Vandekerckhove, Philippe; Geduld, Heike
    Background: First aid training is a cost-effective way to decrease the burden of disease and injury in low- and middle-income countries (LMIC). Since evidence from Western countries has shown that children are able to learn first aid, first aid training of children in LMIC may be a promising way forward. Hence, our project aim was to develop contextualized materials to train sub-Saharan African children in first aid, based on the best available evidence. Methods: Systematic literature searches were conducted to identify studies on first aid education to children up to 18 years old (research question one), and studies investigating different teaching approaches (broader than first aid) in LMIC (research question two). A multidisciplinary expert panel translated the evidence to the context of sub- Saharan Africa, and evidence and expert input were used to develop teaching materials. Results: For question one, we identified 58 studies, measuring the effect of training children in resuscitation, first aid for skin wounds, poisoning etc. For question two, two systematic reviews were included from which we selected 36 studies, revealing the effectiveness of several pedagogical methods, such as problem-solving instruction and small-group instruction. However, the certainty of the evidence was low to very low. Hence expert input was necessary to formulate training objectives and age ranges based on “good practice” whenever the quantity or quality of the evidence was limited. The experts also placed the available evidence against the African context. Conclusions: The above approach resulted in an educational pathway (i.e. a scheme with educational goals concerning first aid for different age groups), a list of recommended educational approaches, and first aid teaching materials for children, based on the best available evidence and adapted to the African context.
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    Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs) : results of research prioritisation setting exercise
    (BMC (part of Springer Nature), 2020-08-31) Lecky, Fiona E.; Reynolds, Teri; Otesile, Olubukola; Hollis, Sara; Turner, Janette; Fuller, Gordon; Sammy, Ian; Williams-Johnson, Jean; Geduld, Heike; Tenner, Andrea G.; French, Simone; Govia, Ishtar; Balen, Julie; Goodacre, Steve; Marahatta, Sujan B.; DeVries, Shaheem; Sawe, Hendry R.; El-Shinawi, Mohamed; Mfinanga, Juma; Rubiano, Andres M.; Chebbi, Henda; Do Shin, Sang; Ferrer, Jose Maria E.; Haddadi, Mashyaneh; Firew, Tsion; Taubert, Kathryn; Lee, Andrew; Convocar, Pauline; Jamaluddin, Sabariah; Kotecha, Shahzmah; Yaqeen, Emad Abu; Wells, Katie; Wallis, Lee
    Background: More than half of deaths in low- and middle-income countries (LMICs) result from conditions that could be treated with emergency care - an integral component of universal health coverage (UHC) - through timely access to lifesaving interventions. Methods: The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt, Nepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and Phillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the strengthening of emergency care systems in limited-resource settings. Results: The RPS proposed seven priority research questions addressing: identification of context-relevant emergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential quality improvement via registries; characteristics of people seeking emergency care; best practices for staff training and retention; and cost effectiveness of critical care – all within LMICs. Conclusions: Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research Network project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for strengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the current evidence supporting the identified priorities.
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    A living WHO guideline on drugs for covid-19
    (2022-09) Agarwal, Arnav; Rochwerg, Bram; Lamontagne, François; Siemieniuk, Reed AC; Agoritsas, Thomas; Askie, Lisa; Lytvyn, Lyubov; Leo, Yee-Sin; Macdonald, Helen; Zeng, Linan; Amin, Wagdy; Barragan, Fabian A Jaimes; Bausch, Frederique J.; Burhan, Erlina; Calfee, Carolyn S.; Cecconi, Maurizio; Chanda, Duncan; Dat, Vu Quoc; De Sutter, An; Du, Bin; Freedman, Stephen; Geduld, Heike; Gee, Patrick; Gotte, Matthias; Harley, Nerina; Hashmi, Madiha; Hunt, Beverley; Jehan, Fyezah; Kabra, Sushil K.; Kanda, Seema; Kim, Yae-Jean; Kissoon, Niranjan; Krishna, Sanjeev; Kuppalli, Krutika; Kwizera, Arthur; Castro-Rial, Marta Lado; Lisboa, Thiago; Lodha, Rakesh; Mahaka, Imelda; Manai, Hela; Mino, Greta; Nsutebu, Emmanuel; Preller, Jacobus; Pshenichnaya, Natalia; Qadir, Nida; Relan, Pryanka; Sabzwari, Saniya; Sarin, Rohit; Shankar-Hari, Manu; Sharland, Michael; Shen, Yinzhong; Ranganathan, Shalini S.; Souza, Joao P.; Stegemann, Miriam; Swanstrom, Ronald; Ugarte, Sebastian; Uyeki, Tim; Venkatapuram, Sridhar; Vuyiseka, Dubula; Wijewickrama, Ananda; Tran, Lien; Zeraatkar, Dena; Bartoszko, Jessica J.; Ge, Long; Brignardello-Petersen, Romina; Owen, Andrew; Guyatt, Gordon; Diaz, Janet; Kawano-Dourado, Leticia; Jacobs, Michael; Vandvik, Per Olav
    This living guideline by Arnav Agarwal and colleagues (BMJ 2020;370:m3379, doi:10.1136/bmj.m3379) was last updated on 22 April 2022, but the infographic contained two dosing errors: the dose of ritonavir with renal failure should have read 100 mg, not 50 mg; and the suggested regimen for remdesivir should have been 3 days, not 5-10 days. The infographic has now been corrected.
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    Patterns of on-scene and healthcare system trauma deaths in the Western Cape of South Africa. World
    (John Wiley & Sons Ltd, 2024-02) Finn, Julia ; Dixon, Julia M. ; Moreira, Fabio ; Herbst, Celeste ; Bhaumik, Smitha ; Fleischer, Chelsie L. ; Stassen, Willem ; Beaty, Brenda ; Denise, Lourens, ; Verster, Janette ; Fosdick, Bailey ; Lategan, Hendrick J. ; de Vries, Shaheem ; Uren, Grace ; Wylie, Craig ; Steyn, Elmin ; Geduld, Heike ; Mould‐Millman, Nee‐Kofi
    ABSTRACT: Background Injuries account for 8% or 4.4 million deaths annually worldwide, with 90% of injury deaths occurring in low- and middle-income countries. Inter-personal violence and road traffic injuries account for most injury deaths in South Africa, with rates among the highest globally. Understanding the location, timing, and factors of trauma deaths can identify opportunities to strengthen care. Methods This is a retrospective cross-sectional secondary analysis of trauma deaths from 2021 to 2022 in the Western Cape of South Africa. Healthcare system trauma deaths were identified from a multicenter study paired with a dataset for on-scene (i.e., prior to ambulance or hospital) trauma deaths in the same jurisdictions. We describe locations, timing, injury factors, and cause of death. We assess associations between those factors. Results There were 2418 deaths, predominantly young men, with most (2274, 94.0%) occurring on-scene. The most frequent mechanism of injury for all deaths was firearms (32.6%), followed by road traffic collisions (17.8%). On-scene deaths (33.2%) were significantly more likely to be injured by firearms compared to healthcare system deaths (23.6%) (p-value <0.01). Most healthcare system deaths within 4–24 h of injury occurred in a hospital emergency center. Among healthcare system decedents, half died in the emergency unit. Conclusions We identified a large burden of deaths from interpersonal violence and road traffic collisions, mostly on-scene. In addition to primary prevention, shortening delays to care can improve mortality outcomes especially for deaths occurring within 4–24 h in emergency centers.
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    Remdesivir for severe covid-19: a clinical practice guideline
    (2020-11) Rochwerg, Bram; Agarwal, Arnav; Zeng, Linan; Leo, Yee-Sin; Appiah, John Adabie; Agoritsas, Thomas; Bartoszko, Jessica; Brignardello-Petersen, Romina; Ergan, Begum; Ge, Long; Geduld, Heike; Gershengorn, Hayley B.; Manai, Hela; Huang, Minhua; Lamontagne, François; Kanda, Seema; Kawano-Dourado, Leticia; Kurian, Linda; Kwizera, Arthur; Murthy, Srinivas; Qadir, Nida; Siemieniuk, Reed; Silvestre, Maria Asuncion; Vandvik, Per Olav; Ye, Zhikang; Zeraatkar, Dena; Guyatt, Gordon
    Clinical question What is the role of remdesivir in the treatment of severe covid-19? This guideline was triggered by the ACTT-1 trial published in the New England Journal of Medicine on 22 May 2020. Current practice Remdesivir has received worldwide attention as a potentially effective treatment for severe covid-19. After rapid market approval in the US, remdesivir is already being used in clinical practice. Recommendations The guideline panel makes a weak recommendation for the use of remdesivir in severe covid-19 while recommending continuation of active enrolment of patients into ongoing randomised controlled trials examining remdesivir. How this guideline was created An international panel of patients, clinicians, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The recommendations are based on a linked systematic review and network meta-analysis. The panel considered an individual patient perspective and allowed contextual factors (such as resources) to be taken into account for countries and healthcare systems. The evidence The linked systematic review (published 31 Jul 2020) identified two randomised trials with 1300 participants, showing low certainty evidence that remdesivir may be effective in reducing time to clinical improvement and may decrease mortality in patients with severe covid-19. Remdesivir probably has no important effect on need for invasive mechanical ventilation. Remdesivir may have little or no effect on hospital length of stay. Understanding the recommendation Most patients with severe covid-19 would likely choose treatment with remdesivir given the potential reduction in time to clinical improvement. However, given the low certainty evidence for critical outcomes and the fact that different perspectives, values, and preferences may alter decisions regarding remdesivir, the panel issued a weak recommendation with strong support for continued recruitment in randomised trials.
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    South African paramedic perspectives on prehospital palliative care
    (BMC (part of Springer Nature), 2020-10-08) Gage, Caleb Hanson; Geduld, Heike; Stassen, Willem
    Background: Palliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice. Methods: A qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings. Results: Four categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist. Conclusion: Challenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.
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    Towards developing a consensus assessment framework for global emergency medicine fellowships
    (BMC (part of Springer Nature), 2019-11-11) Jahn, Haiko Kurt; Kwan, James; O’Reilly, Gerard; Geduld, Heike; Douglass, Katherine; Tenner, Andrea; Wallis, Lee; Tupesis, Janis; Mowafi, Hani O.
    Background: The number of Global Emergency Medicine (GEM) Fellowship training programs are increasing worldwide. Despite the increasing number of GEM fellowships, there is not an agreed upon approach for assessment of GEM trainees. Main body: In order to study the lack of standardized assessment in GEM fellowship training, a working group was established between the International EM Fellowship Consortium (IEMFC) and the International Federation for Emergency Medicine (IFEM). A needs assessment survey of IEMFC members and a review were undertaken to identify assessment tools currently in use by GEM fellowship programs; what relevant frameworks exist; and common elements used by programs with a wide diversity of emphases. A consensus framework was developed through iterative working group discussions. Thirty-two of 40 GEM fellowships responded (80% response). There is variability in the use and format of formal assessment between programs. Thirty programs reported training GEM fellows in the last 3 years (94%). Eighteen (56%) reported only informal assessments of trainees. Twenty-seven (84%) reported regular meetings for assessment of trainees. Eleven (34%) reported use of a structured assessment of any sort for GEM fellows and, of these, only 2 (18%) used validated instruments modified from general EM residency assessment tools. Only 3 (27%) programs reported incorporation of formal written feedback from partners in other countries. Using these results along with a review of the available assessment tools in GEM the working group developed a set of principles to guide GEM fellowship assessments along with a sample assessment for use by GEM fellowship programs seeking to create their own customized assessments. Conclusion: There are currently no widely used assessment frameworks for GEM fellowship training. The working group made recommendations for developing standardized assessments aligned with competencies defined by the programs, that characterize goals and objectives of training, and document progress of trainees towards achieving those goals. Frameworks used should include perspectives of multiple stakeholders including partners in other countries where trainees conduct field work. Future work may evaluate the usability, validity and reliability of assessment frameworks in GEM fellowship training. Keywords: Global emergency medicine, Global health, Assessment, Curriculum, Evaluation, Medical education, Postgraduate medical education, Fellowships