Masters Degrees (Emergency Medicine)
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- ItemMapping research outputs to previously defined research priorities in an emergency care academic community of practice in South Africa(Stellenbosch : Stellenbosch University, 2022-12) Meyer, Kirby; Geduld, Heike; Saunders, Colleen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine.Background: Developing emergency care systems in Africa requires high quality contextual evidence to guide local policies. We sought to map research outputs from the divisions of emergency medicine at the University of Cape Town (UCT) and Stellenbosch University (SU) between 2015-2020 to the list published by van Hoving et al (2015) following a modified Delphi study identifying research priorities in South African emergency medicine. Methodology: This study utilised an evidence mapping approach to map a database of research outputs from UCT and SU Divisions of Emergency Medicine between 2015 and 2020. The Google Scholar, Scopus and the Web of Science databases were searched for research outputs with authors affiliated to either Division. Research outputs were mapped against the proposed research priorities outlined by van Hoving et al (2015). Results: During the study period, 276 publications and 107 dissertations/theses were produced by the Divisions of Emergency Medicine at UCT and SU. In total, 42% of the dissertations/theses had been published in a journal at the time of this study. Only 7% of the research publications mapped to the research priorities identified in the 2015 study in both research statement and study design, while 4% of the publications mapped to the priority list in research statement alone. Only 8,4% of the dissertations/theses mapped to the previously identified research priorities in both research statement and study design and only one mapped to the list by research statement alone. Common themes identified in the research outputs were (i) Prehospital emergency care, (ii) clinical emergency care, (iii) general systems and safety management, (iv) education and training, (v) research and (vi) policies and frameworks. Conclusion: Few of the research outputs in our database mapped to the proposed research priorities list. This evidence map allows for identification of ongoing knowledge gaps and will inform future agenda setting.
- ItemThe diagnostic utility of abdominal ultrasound in adult patients presenting with non-traumatic abdominal pain to the emergency centre of Khayelitsha Hospital(Stellenbosch : Stellenbosch University, 2022-12) Dausab, Gaudencia Florence; van Hoving, Daniel; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine.ENGLISH SUMMARY: Introduction: Patients with non-trauma related acute abdominal pain often presents to emergency centres. Ultrasound is frequently used to augment the clinical diagnosis but is still a scarce imaging modality in resource-limited settings. The aim of the study was to evaluate the utility of abdominal ultrasound in diagnosing adult patients with non-trauma related abdominal pain presenting to the emergency centre of an entry-level hospital in Cape Town. A secondary objective was to determine the agreement between the initial clinical impression, sonographic diagnosis, and the final discharge diagnosis. Methods: A retrospective chart review was conducted of adults (≥18-years) with acute nontrauma related abdominal pain and required an abdominal ultrasound ordered by emergency centre staff for a 6-month period (01 January 2019 – 30 June 2019). All ultrasound studies which assess the abdomen or part thereof were included. Patients with no ultrasound performed, obstetric-only ultrasounds, missing ultrasound report, or missing clinical records were excluded from analysis. Summary statistics were used to describe all variables. Results: A total of 88 patients were analysed of which 64 (72.7%) had an abnormal abdominal ultrasound examination. An urgent ultrasound diagnosis was identified in 34 (53.1%) patients. The median age was 36 years, predominantly female (70.5%), and most patients (85.1%) were triaged as routine or urgent. The predominant associated symptom reported was nausea and vomiting (20.5%). Most abnormal ultrasounds (28.1%) fell within the general surgical category. Fair agreement (κ=0.3) occurred between the ultrasound indication and the ultrasound diagnosis. Conclusion: Abdominal ultrasounds ordered by emergency centre staff were frequently abnormal and aided in the identification of an urgent diagnosis in half of these patients. It highlights the undocumented burden of non-trauma related abdominal pain in this low-tomiddle- income resource setting although no independent predictors of sonographic pathology were identifiable.
- ItemCross-sectional study of paediatric case mix presenting to an emergency centre in Cape Town, South Africa, during COVID-19(Stellenbosch : Stellenbosch University, 2021-12) Akuaake, Lembi Magano; Van Hoving, Daniel J.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine.ENGLISH SUMMARY : Objective: To describe and compare the effect of level 5 lockdown measures on the workload and case mix of paediatric patients presenting to a district- level emergency centre in Cape Town, South Africa. Methods: Paediatric patients (<13 years) presenting to Mitchells Plain Hospital were included. The level 5 lockdown period (27 March 2020–30 April 2020) was compared with similar 5- week periods immediately before (21 February 2020–26 March 2020) and after the lockdown (1 May 2020–4 June 2020), and to similar time periods during 2018 and 2019. Patient demographics, characteristics, International Statistical Classi"cation of Diseases and Related Health Problems, 10th Revision (ICD-10) diagnosis, disposition and process times were collected from an electronic patient tracking and registration database. The X2 test and the independent samples median test were used for comparisons. Results: Emergency centre visits during the lockdown period (n=592) decreased by 58% compared with 2019 (n=1413) and by 56% compared with the 2020 prelockdown period (n=1342). The proportion of under 1 year olds increased by 10.4% (p<0.001), with a 7.4% increase in self- referrals (p<0.001) and a 6.9% reduction in referrals from clinics (p<0.001). Proportionally more children were referred to inpatient disciplines (5.6%, p=0.001) and to a higher level of care (3.9%, p=0.004). Signi"cant reductions occurred in respiratory diseases (66.9%, p<0.001), injuries (36.1%, p<0.001) and infectious diseases (34.1%, p<0.001). All process times were signi"cantly different between the various study periods. Conclusion: Signi"cantly less children presented to the emergency centre since the implementation of the COVID-19 lockdown, with marked reductions in respiratory and infectious- related diseases and in injuries.
- ItemA quantative study on the perception of international medical students and doctors on an emergency medicine elective in Cape Town(Stellenbosch : Stellenbosch University, 2021-12) Buizer, Angenita Midee; Van Hoving, Daniel J.; Lahri, Sa'ad; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine.ENGLISH SUMMARY : Background: International health electives are a popular component of medical students and doctors training, as it has unique learning opportunities both professionally and personally. Emergency medicine has become a growing global speciality, amid opportunities to complete an international health elective either during registrar training or as a medical student/doctor. Objective: To determine international medical students and doctors' perceptions of an Emergency Medicine elective in two South African hospitals within the Cape Town Metropolitan region. Methods: An anonymous online questionnaire was sent to participants that completed the Emergency medicine elective from 2016 to 2019 at Tygerberg- and Khayelitsha Hospital. Responses were scored on a 5 point Likert scale (strongly disagree to strongly agree) for both perceived personal and professional development, 5 point rating scale for mentorship and a 10 point rating scale for the overall perception of the elective. Results are presented as percentages or median (25th – 75th percentile). Results: Of all participants, 104 responded to the survey (18.8%). Participants were mainly from highincome countries of which the U.K. (20.4%), U.S.A.(17.5%), and Canada(17.5%) formed the larger part. The median (25th-75th percentile) age of participants was 28 (25-31) years; 50 (48.5%) were undergraduate students and 43 (41.7%) postgraduate students. Agreement for perceived personal development was 4.0 (3.67-4.38) at Tygerberg hospital and 4.75 (4.13-5.00) at Khayelitsha hospital. Agreement for perceived professional development was 3.69 (3.23-4.05) and 4.27(3.87-4.68), respectively. Overall, participants rated the elective highly and would recommend the elective to future participants. Conclusion: An international emergency medicine elective in South Africa were deemed valuable and resulted in personal and professional development.
- ItemEmergency clinician output in a district hospital emergency centre : a cross-sectional analysis(Stellenbosch : Stellenbosch University, 2021-12) Hoffe, Mary Elizabeth; McCaul, Michael; Hendrickse, Clint; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Emergency Medicine.ENGLISH SUMMARY : Introduction: Appropriate and efficient staffing is a cornerstone of emergency centre performance. There is however a paucity of literature describing clinician output in low- and middle-income countries with current staffing models based on anecdotal evidence. This study aimed to assess clinician output at a district level emergency centre, and how it varied depending on shift, clinician, and workload factors. Methods: We conducted a retrospective cross-sectional study using an existing electronic patient registry, to determine the patients consulted per hour (PPH) during each clinician shift and how this is affected by various clinician, shift, and workload factors. Data was collected over three non-contiguous randomly selected four-week cycles from Mitchells Plain Hospital's electronic patient registry. Associations between PPH and various factors were assessed using the ANOVA and post-hoc adjustments where appropriate. The correlation between PPH and workload metrics was calculated with the Pearson’s Rank correlation test. Statistical significance was defined as p<0.05. Results: A total of 1 289 clinician shifts were analysed with an overall PPH of 0.7. A significant association between PPH and shift type (p 0.021), clinician category (p<0.001) and cumulative shifts (p<0.001) were shown. There was a decline in clinician output during a shift and output was significantly decreased by the number of boarders in the emergency centre but increased with higher numbers of patients waiting at the start of the shift. Conclusion: This study describes a relatively low clinician output as compared to evidence from high-income countries and has highlighted several associations with various shift, clinician, and workload factors. The results from this study will form the basis of quality improvement interventions to improve patient throughput and will inform staff scheduling and surge planning strategies.