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Kaswa R. An approach to the management of acute poisoning in emergency settings. S Afr Fam Pract (2004) 2024; 66:e1-e5. [PMID: 38572878 PMCID: PMC10913156 DOI: 10.4102/safp.v66i1.5841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/01/2023] [Accepted: 12/17/2023] [Indexed: 04/05/2024] Open
Abstract
The impact of poisoning can differ significantly depending on the specific substance consumed. Identifying toxic substances in a patient is crucial to obtaining a thorough medical history. Frontline healthcare providers in the emergency department often handle patients presenting with poisoning. Their clinical presentation can vary depending on their dose, duration of exposure, and pre-existing medical conditions. Initially, poisoning management entails administering supportive care such as absorption and enhancing the elimination of poison with charcoal and antidote administration after identifying the poisoning substances. This article aims to provide a basic overview of the concepts involved in evaluating and managing these individuals.
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Affiliation(s)
- Ramprakash Kaswa
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa; and Department of Health, Mthatha Regional Hospital, Mthatha.
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Chen M, Wang X, Wang Y, Ren L, Jiang H, Xia L, Zhang L, Dong C. The characteristics of suicide attempters in Chinese patients: Comparison of adolescents, youths, middle-aged and elderly. J Forensic Leg Med 2024; 102:102658. [PMID: 38382217 DOI: 10.1016/j.jflm.2024.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/12/2023] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Potential risk factors for suicide differ by age group. Therefore, this study aims to investigate the characteristics of patients with suicide attempts according to age group and any the relevant risk factors. METHODS This study retrospectively reviewed the medical records of attempted suicide patients who were admitted to the emergency departments (ED) of the First Affiliated Hospital of Wenzhou Medical University between January 1, 2017, and December 31, 2021. Demographic information and clinical characteristics were collected. The participants were divided into four age groups and the characteristics of each group were compared. RESULTS A total of 834 participants were included in this study. Suicide attempts were more prevalent in females, and the gender difference decreased with age. Having religious belief and less educated suicide attempts were concentrated in the elderly groups. Adolescents suicide attempts were more likely to occur in the spring, autumn and during non-office hours. Mental disorders were the major motivation for suicide among adolescents, and interpersonal and social problems were more prevalent among youths. Psychiatric medication was the leading suicidal substances among adolescents, while pesticides and herbicides were more prevalent in adults. The history of psychiatric diagnosis was more common in adolescents, while the history of somatic disorder was more prevalent in the elderly. CONCLUSION This study confirmed differences in the demographic and clinical characteristics of patients in different age groups. Therefore, it is necessary to construct individualized intervention strategies for each age group based on the characteristics of the patients in order to reduce suicide.
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Affiliation(s)
- Meijia Chen
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Xinlu Wang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yuxin Wang
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China
| | - Liya Ren
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China
| | - Hao Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China
| | - Lin Xia
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Liping Zhang
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
| | - Chaoqun Dong
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China.
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Cowans C, Love A, Tangiisuran B, Jacob SA. Uncovering the Hidden Burden of Pharmaceutical Poisoning in High-Income and Low-Middle-Income Countries: A Scoping Review. PHARMACY 2023; 11:184. [PMID: 38133459 PMCID: PMC10747954 DOI: 10.3390/pharmacy11060184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/28/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Pharmaceutical poisoning is a significant global public health concern, causing approximately 190,000 deaths annually. This scoping review aims to comprehensively map the available literature on pharmaceutical poisoning and compare patterns between high-income countries (HICs) and low-middle-income countries (LMICs). A systematic search was performed across the following databases: Embase, PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL. Studies included were from 1 January 2011 to 31 December 2020, in English, with full text available. Seventy-nine articles were included in the study; 21 were from LMICs and 58 were from HICs. Toxic exposure was largely intentional (77%) in LMICs and accidental (68%) in HICs. Drugs acting on the nervous system were responsible for 95% of toxicities worldwide with analgesics accounting for the largest subtherapeutic group in both LMICs (40%) and HICs (58%). Notable statistics were that HICs accounted for 99% of opioid overdoses, and LMICs accounted for 19% of anti-epileptic-induced toxicities. Overall, the medical outcomes due to poisonings were generally worse in LMICs. The review provides possible interventions to target specific geographic locations, based on the trends identified, to reduce the burden worldwide. Many gaps within the literature were recognised, calling for more robust analytical research.
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Affiliation(s)
- Claire Cowans
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow G4 0RE, UK; (C.C.); (A.L.)
| | - Anya Love
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow G4 0RE, UK; (C.C.); (A.L.)
| | - Balamurugan Tangiisuran
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia;
| | - Sabrina Anne Jacob
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow G4 0RE, UK; (C.C.); (A.L.)
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor, Malaysia
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Taljaard L, Maharaj R, Hendrikse C. A descriptive analysis of the casemix presenting to a tertiary hospital emergency centre in East London, South Africa. Afr J Emerg Med 2022; 12:252-258. [PMID: 35795815 PMCID: PMC9249588 DOI: 10.1016/j.afjem.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/05/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
Quality emergency health care is not a reality in many low- and middle-income countries. Emergency Centre casemix description is essential for effective service delivery planning and resource allocation. A high trauma burden is described, which is in keeping with South Africa's quadruple burden of disease. This descriptive study provides essential data that could guide further development of emergency care systems within the Eastern Cape.
Introduction Emergency centres are most often the point of entry to the healthcare system for patients presenting with emergencies. Even though emergency medicine has developed rapidly in certain regions of South Africa, it is yet to flourish in the Eastern Cape. A paucity of data exists with regards to the demographic and disease profile of patients presenting to Eastern Cape emergency centres. This study describes the casemix presenting to a tertiary hospital emergency centre in East London in the Eastern Cape. Methods A retrospective descriptive study was conducted of all patients presenting to Frere Hospital emergency centre from 1st of August 2019 to 31st of October 2019. Data were manually collected from the emergency centre paper-based register for the study period and included: patient demographics, geographical location, triage category, presenting complaint, disposition, and process times. Descriptive statistics were used to describe all variables. Results A total of 6 204 patients presented during the study period. The median age was 31 years, with a male predominance of 56%. Lower acuity triage categories (green and yellow) represented 67% of all cases. Trauma comprised 56% of all presentations, with assault being the most prevalent mechanism of injury in the adult population (n = 1 460, 48%). Sundays (18%) and Mondays (20%) had the highest patient caseload. The majority of patients were discharged home (n = 4 257, 69%) of which 79% had lower acuity triage categories. The majority of patients lived within a 20 km radius of Frere Hospital (n = 4 689, 77%). Conclusion This descriptive study provides essential data that could guide further development of emergency care systems within the Eastern Cape. A high trauma burden, comprising predominantly of lower acuity presentations are described. Social and economic determinants of violence must be addressed and multisectoral interventions are required to reduce the high burden of trauma.
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Affiliation(s)
- Luan Taljaard
- University of Cape Town Faculty of Health Sciences, Division of Emergency Medicine, Cape Town, Western Cape, ZA, South Africa
- Frere Hospital Emergency Department, East London, South Africa
- Corresponding author at:
| | - Roshen Maharaj
- Livingstone Hospital Emergency Department, Gqeberha (Port Elizabeth), South Africa
| | - Clint Hendrikse
- University of Cape Town Faculty of Health Sciences, Division of Emergency Medicine, Cape Town, Western Cape, ZA, South Africa
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Alshaya OA, Alhamed A, Althewaibi S, Fetyani L, Alshehri S, Alnashmi F, Alharbi S, Alrashed M, Alqifari SF, Alshaya AI. Calcium Channel Blocker Toxicity: A Practical Approach. J Multidiscip Healthc 2022; 15:1851-1862. [PMID: 36065348 PMCID: PMC9440664 DOI: 10.2147/jmdh.s374887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Calcium channel blockers (CCBs) are widely prescribed medications for various clinical indications in adults and children. They are available in both immediate and long-acting formulations and are generally classified into dihydropyridines and nondihydropyridines, with nondihydropyridines having more cardioselectivity. CCB toxicity is common given the widespread use which leads to serious adverse clinical outcomes, especially in children. Severe CCB toxicities may present with life-threatening bradycardia, hypotension, hyperglycemia, and renal insufficiency. Dihydropyridine toxicity, however, may present with reflex tachycardia instead of bradycardia. Initial patient evaluation and assessment are crucial to identify the severity of CCB toxicity and design the best management strategy. There are different strategies to overcome CCB toxicity that requires precise dosing and close monitoring in various patient populations. These strategies may include large volumes of IV fluids, calcium salts, high insulin euglycemia therapy (HIET), and vasopressors. We hereby summarize the evidence behind the management of CCB toxicity and present a practical guide for clinicians to overcome this common drug toxicity.
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Affiliation(s)
- Omar A Alshaya
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pharmaceutical Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Correspondence: Omar A Alshaya, Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh, 11481, Saudi Arabia, Email
| | - Arwa Alhamed
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sara Althewaibi
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Lolwa Fetyani
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shaden Alshehri
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fai Alnashmi
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shmeylan Alharbi
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pharmaceutical Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alrashed
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pharmaceutical Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmacy Department, Northwest Medical Center, Tucson, AZ, USA
| | - Saleh F Alqifari
- Department of Pharmacy Practice, College of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Abdulrahman I Alshaya
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pharmaceutical Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Shadman KA, Edmonson MB, Coller RJ, Sklansky DJ, Nacht CL, Zhao Q, Kelly MM. US Hospital Stays in Children and Adolescents With Acetaminophen Poisoning. Hosp Pediatr 2022; 12:e60-e67. [PMID: 35048104 DOI: 10.1542/hpeds.2021-005816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Acetaminophen poisoning occurs in all age groups; however, hospital-based outcomes of children with these poisonings were not well characterized. Our objectives were to describe the incidence, characteristics, and outcomes of hospital stays in children with acetaminophen poisoning and evaluate the contribution of intentionality. METHODS We used the 2016 Kids' Inpatient Database and validated International Classification of Diseases, 10th Revision diagnostic codes to identify hospitalizations of children aged 0 to 19 years for acetaminophen poisoning. We used standard survey methods to generate weighted population estimates and describe characteristics and outcomes, both overall and stratified by intentionality. RESULTS There were 9935 (95% confidence interval [CI], 9252-10 619) discharges from acute care hospitals for acetaminophen poisoning in U.S. children aged 0 to 19 years during 2016, corresponding to a population rate of 12.1 (95% CI, 11.3-12.9) hospitalizations per 100 000 children. Most hospitalizations for both intentional and unintentional acetaminophen poisoning occurred in females, with a strongly age-related sex distribution. Median length of stay was 2 days (interquartile range, 1-4 days); however, nearly half of discharges were subsequently transferred to another type of facility (eg, psychiatric hospital). Median hospital charges for acute care were $14 379 (interquartile range, $9162-$23 114), totaling $204.7 million (95% CI, $187.4-$221.9) in aggregate. Of 31 632 hospital discharges associated with self-harm medication poisoning in children aged 0 to 19 years, acetaminophen was the single most commonly implicated agent. CONCLUSIONS Acetaminophen poisoning was the most common cause of U.S. hospital stays associated with medication self-harm poisoning. More effective acetaminophen poisoning prevention strategies are needed, which may reduce the burden of this common adolescent malady.
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Affiliation(s)
| | | | | | | | | | - Qianqian Zhao
- Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health
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An analysis of 1344 consecutive acute intoxication cases admitted to an academic emergency medicine department in Turkey. North Clin Istanb 2021; 8:377-384. [PMID: 34585073 PMCID: PMC8430352 DOI: 10.14744/nci.2020.98957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/25/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE: One of the major causes of emergency department (ED) visits is acute poisoning. Acute intoxications occur soon after either single or multiple exposures to toxic substances, and they started to be a more serious problem in developing countries. The objective of this study was to investigate the local patterns of acute intoxications, as well as clinical and sociodemographic characteristics of patients with acute poisoning, admitted to our hospital’s ED. METHODS: This single-center, retrospective study was conducted using medical records of consecutive patients admitted to the ED between January 2016 and December 2017. RESULTS: A total of 1344 patients were included in the statistical analysis. Of these, 673 (50.1%) were female. Mean (±SD) age was 32.2 (±12.0), ranging between 17 and 84 years. The highest number of poisoning cases was observed in summer, especially in July (10.0%) and August (11.8%), whereas lowest number of admissions related to poisoning occurred during winter in November (5.1%) and December (5.2%). Among admitted cases, many were suicide attempts (55.7%) followed by non-intentional (accidental) ingestion of non-pharmaceutical (n=553, 41.2%) and pharmaceutical agents (n=42, 3.1%). Single agents were the most common cause of acute intoxications (63.2%) rather than multidrug intoxications. Most frequently observed causes of poisonings were recreational substances (30.0%) and agents exposed by inhalation (13.2%). INR, lactate, and pH levels at admission were significant predictors of 7-day mortality without a significant paired difference between each other. The AUCs for each were 0.89 (SE 0.04; p<0.0001), 0.84 (SE 0.10; p=0.0007), and 0.79 (SE 0.11; p=0.0102), respectively. CONCLUSION: We conclude that recreational substances and medicinal drug intoxications were the leading cause of acute poisonings in our region, occurring mostly during the summer.
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Swarts L, Lahri S, van Hoving DJ. The burden of HIV and tuberculosis on the resuscitation area of an urban district-level hospital in Cape Town. Afr J Emerg Med 2021; 11:165-170. [PMID: 33680739 PMCID: PMC7910156 DOI: 10.1016/j.afjem.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/23/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Many patients present to emergency centres with HIV and tuberculosis related emergencies. Little is known about the influence of HIV and tuberculosis on the resuscitation areas of district-level hospitals. The primary objective was to determine the burden of non-trauma patients with HIV and/or tuberculosis presenting to the resuscitation area of Khayelitsha Hospital, Cape Town. METHODS A retrospective analysis was performed on a prospectively collected observational database. A randomly selected 12-week sample of data from the resuscitation area was used. Trauma and paediatric (<13 years) cases were excluded. Patient demographics, HIV and tuberculosis status, disease category, investigations and procedures undertaken, disposition and in-hospital mortality were assessed. HIV and tuberculosis status were determined by laboratory confirmation or from clinical records. Descriptive statistics are presented and comparisons were done using the χ2-test or independent t-test. RESULTS A total of 370 patients were included. HIV prevalence was 38.4% (n = 142; unknown n = 78, 21.1%), tuberculosis prevalence 13.5% (n = 50; unknown n = 233, 63%), and HIV/tuberculosis co-infection 10.8% (n = 40). HIV and tuberculosis were more likely in younger patients (both p < 0.01) and more females were HIV-positive (p < 0.01). Patients with tuberculosis spend 93 min longer in the resuscitation area than those without (p = 0.02). The acuity of patients did not differ by HIV or tuberculosis status.Infectious-related diseases and diseases of the digestive system occurred significantly more in the HIV-positive group, and endocrine-related diseases and diseases of the nervous system in HIV-negative patients.HIV-positive patients received more abdominal ultrasound examinations (p < 0.01), blood cultures (p < 0.01) and intravenous antibiotics (p < 0.01). In-hospital mortality was 17% and was not influenced by HIV status (p = 0.36) or tuberculosis status (p = 0.29). CONCLUSION This study highlights the burden of HIV and tuberculosis on the resuscitation area of a district level hospital. Neither HIV nor tuberculosis status were associated with in-hospital mortality.
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Affiliation(s)
- Lynne Swarts
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Sa'ad Lahri
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Daniël J. van Hoving
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
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Ekambaram K, Lamprecht H, Lalloo V, Caruso N, Engelbrecht A, Jooste W. An electronic survey of preferred podcast format and content requirements among trainee emergency medicine specialists in four Southern African universities. Afr J Emerg Med 2021; 11:3-9. [PMID: 33318911 PMCID: PMC7724151 DOI: 10.1016/j.afjem.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Global usage of educational Emergency Medicine (EM) podcasts is popular and ever-increasing. This study aims to explore the desired content, format and delivery characteristics of a potential educational, context-specific Southern African EM podcast, by investigating current podcast usages, trends and preferences among Southern African EM registrars of varying seniority. METHODS We developed an electronic survey - using a combination of existing literature, context-specific specialist-training guidance, and input from local experts - exploring preferred podcast characteristics among EM registrars from four Southern African universities. RESULTS The study's response rate was 75%, with 24 of the 39 respondents being junior registrars. Ninety-four percent (94%) of respondents used EM podcasts as an educational medium: 64% predominantly using podcasts to supplement a personal EM study program. The primary mode of accessing podcasts was via personal mobile devices (84%). Additionally, respondents preferred a shorter podcast duration (5-15 min), favoured multimedia podcasts (56%) and showed an apparent aversion toward recorded faculty lectures (5%). Eighty-two percent (82%) of respondents preferred context-specific podcast content, with popular topics including toxicology (95%), cardiovascular emergencies (79%) and medico-legal matters (74%). Just-in-Time learning proved an unpopular learning strategy in our study population, despite its substantial educational value. CONCLUSION Podcast-usage proved to be near-ubiquitous among the studied Southern African EM registrars. Quintessentially, future context-specific podcast design should cater for mobile device-use, shorter duration podcasts, more video content, context-specific topics, and content optimised for both Just-in-Time learning.
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Affiliation(s)
- K. Ekambaram
- Division of Emergency Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H. Lamprecht
- Division of Emergency Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - V. Lalloo
- Division of Emergency Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - N. Caruso
- Division of Emergency Medicine, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - A. Engelbrecht
- Division of Emergency Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - W. Jooste
- New Somerset Hospital, Cape Town, South Africa
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Marks C, Louw A, Couper I. Core competencies required by toxicology graduates in order to function effectively in a Poisons Information Centre: A Delphi study. Afr J Emerg Med 2020; 10:173-180. [PMID: 33299745 PMCID: PMC7700984 DOI: 10.1016/j.afjem.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The availability of trained Medical Toxicologists in developing countries is limited and education in Medical Toxicology remains inadequate. The lack of toxicology services contributes to a knowledge gap in the management of poisonings. A need existed to investigate the core competencies required by toxicology graduates to effectively operate in a Poisons Information Centre. The aim of this study was to obtain consensus from an expert group of health care workers on these core competencies. This was done by making use of the Delphi technique. METHODOLOGY The Delphi survey started with a set of carefully selected questions drawn from various sources including a literature review and exploration of existing curricula. To capture the collective opinion of experts in South Africa, Africa and also globally, three different groups were invited to participate in the study. To build and manage the questionnaire, the secure Research Electronic Data Capture (REDCap) web platform was used. RESULTS A total of 134 competencies were selected for the three rounds and in the end consensus was reached on 118 (88%) items. Panel members agreed that 113 (96%) of these items should be incorporated in a Medical Toxicology curriculum and five (4%) should be excluded. DISCUSSION All participants agreed that effective communication is an essential skill for toxicology graduates. The curriculum can address this problem by including effective pedagogy to enhance oral and written communication skills.Feedback from panellists indicated that the questionnaires were country-specific and not necessarily representative of all geographical locations. This is an example of the 'battle of curriculum design' where the context in which the curriculum will be used, will determine the content. CONCLUSION The Delphi method, based on three iterative rounds and feedback from experts, was effective in reaching consensus on the learning outcomes of a Medical Toxicology curriculum. The study results will ultimately improve education in Medical Toxicology.
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Affiliation(s)
- C.J. Marks
- Centre for Health Professions Education, Stellenbosch University, South Africa
- Division of Clinical Pharmacology, Stellenbosch University, Cape Town, South Africa
| | - A.J.N. Louw
- Centre for Health Professions Education, Stellenbosch University, South Africa
| | - I. Couper
- Centre for Health Professions Education, Stellenbosch University, South Africa
- Ukwanda Centre for Rural Health, Stellenboch University, South Africa
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Benedict MA, Mofolo N, Adefuye AO. The economic burden of deliberate self-poisoning: insight from a tertiary hospital in the Free State Province, South Africa. Pan Afr Med J 2020; 36:35. [PMID: 32774611 PMCID: PMC7388622 DOI: 10.11604/pamj.2020.36.35.22346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/14/2020] [Indexed: 11/11/2022] Open
Abstract
Suicide rate in South Africa is contentiously rated among the top ten highest in the world. Deliberate self-poisoning (DSP) remains one of the common methods for suicide. The management of DSP often impose a significant economic burden on health services with a growing loss of resources. However, studies on the financial implications associated with the management of DSP cases in South Africa are scarce and no known study has investigated the financial implication of managing DSP in a resource strained health system as obtained in the Free State Department of Health (FSDoH). This present study investigated the financial implication of managing DSP in a state regional hospital in the Free State province and proffer efficient ways of utilizing limited available resources in DSP management. This was a descriptive, retrospective cross-sectional study in which clinical records of 212 DSP cases which presented during an 18-month period at the emergency department of a state regional hospital were reviewed. The incidence of DSP was higher among individuals who are females (66% females vs 34% males), unemployed (65.6%) in the age group 20-29 years (44.8%). DSP management cost an average of R50, 000 per month. Wasteful expenditures such as blanket requests for laboratory investigation accounted for 19% of the cost. These findings agree with prior studies that have reported that managing DSP could pose a huge direct financial burden on hospital expenditure and health service delivery. If future cost containment and quality of care are to be achieved in the Free State province, efforts must be made by healthcare personnel to combat wasteful and unnecessary expenditure during patient management. We hope that recommendations proffered by this current study will alleviate the financial burden of DSP management in the province.
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Affiliation(s)
- Matthew Abiodun Benedict
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Nathaniel Mofolo
- School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Anthonio Oladele Adefuye
- Division of Health Sciences Education, Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Riebensahm C, Ka D, Sow A, Semmo N, Wandeler G. A closer look at the spectrum of drug-induced liver injury in sub-Saharan Africa. Expert Rev Clin Pharmacol 2019; 12:875-883. [PMID: 31269818 DOI: 10.1080/17512433.2019.1638251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introduction: Drug-induced liver injury (DILI) has become the most frequent cause of acute liver failure in high-income countries. However, little is known about the determinants of DILI in sub-Saharan Africa (SSA), where the prescription of antimicrobials and the use of potentially hepatotoxic traditional medicine are common. Areas covered: Based on an extensive literature search, we summarize current data available on the epidemiology and risk factors of DILI in SSA. We discuss the most likely causes of DILI in the region, including antimicrobial therapies and traditional medicine. We also highlight research gaps as well as barriers to diagnosis and management of the condition, and explore ways to address these important challenges. Expert opinion: DILI is underestimated in SSA and several factors challenge its early diagnosis, including lack of information on the causes of DILI in the region, sub-optimal knowledge about the condition among clinicians, and structural difficulties faced by health care systems. In order to better prevent the occurrence of DILI and its complications, it is crucial to enhance awareness among health care providers and patients, adapt drug prescription habits and regulations, and improve current knowledge on the main risk factors for DILI, including host genetic and environmental determinants.
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Affiliation(s)
- Carlotta Riebensahm
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Daye Ka
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland.,Department of Infectious Diseases, Hôpital Fann , Dakar , Senegal
| | - Abdoul Sow
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland.,Division of Gastroenterology and Hepatology, Hôpital Principal , Dakar , Senegal
| | - Nasser Semmo
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Hôpital Fann , Dakar , Senegal.,Department of Infectious Diseases, Bern University Hospital, University of Bern , Bern , Switzerland
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