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Tuyishime E, Irakoze A, Seneza C, Fan B, Mvukiyehe JP, Kwizera J, Rosenberg N, Evans FM. The initiative for medical equity and global health (IMEGH) resuscitation training program: A model for resuscitation training courses in Africa. Afr J Emerg Med 2024; 14:33-37. [PMID: 38268932 PMCID: PMC10805636 DOI: 10.1016/j.afjem.2023.12.003] [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: 09/04/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024] Open
Abstract
In high-income countries, outcomes following in hospital cardiac arrest have improved over the last two decades due to the introduction of rapid response teams, cardiac arrest teams, and advanced resuscitation training. However, in low-income countries, such as Rwanda, outcomes are still poor. This is due to multiple factors including lack of adequate resuscitation training, few trainers, and lack of equipment. To address this issue, the Initiative for Medical Equity and Global Health Equity (IMEGH), a training organization founded in 2018 by 5 local anesthesiologists has regularly taught resuscitation courses such as Basic Life Support, Advanced Cardiac Life Support, and Pediatric Advanced Life Support in hospitals throughout Rwanda. The aims of the organization include developing a sustainable model to offer context relevant resuscitation training courses, building a cadre of local instructors to teach on the courses, as well as engaging funding partners to help support the effort. From October 2018 until September 2022, 31 courses were run in 11 hospitals across Rwanda training 1,060 healthcare providers (mainly of non-physician anesthetists, nurses, midwives, and general practitioners). Ongoing challenges include lack of local protocols, inability to tracking resuscitation outcomes, and continued inaccessibility by many healthcare providers. Despite these challenges, the IMEGH program is an example of a successful context-relevant model and has potential to inform the design of resuscitation programs in other similar settings. This article describes the development of the IMEGH program, accomplishments as well as lessons learned, challenges, and next steps for expansion.
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Affiliation(s)
- Eugene Tuyishime
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department of Anesthesia and Perioperative Medicine, Western University, Canada
| | - Alain Irakoze
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department Anesthesia and Critical Care, King Faisal Hospital, Kigali, Rwanda
| | - Celestin Seneza
- Department Anesthesia and Critical Care, Kibagabaga District Hospital, Kigali, Rwanda
| | - Bernice Fan
- School of Nursing, University of Virginia, USA
| | - Jean Paul Mvukiyehe
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department Anesthesia and Critical Care, King Faisal Hospital, Kigali, Rwanda
| | - Jackson Kwizera
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department Anesthesia and Critical Care, King Faisal Hospital, Kigali, Rwanda
| | - Noah Rosenberg
- Department of Emergency Medicine, University of Botswana, Gaborone, Botswana
| | - Faye M Evans
- Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
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Shakir M, Altaf A, Irshad HA, Hussain N, Pirzada S, Tariq M, Trillo-Ordonez Y, Enam SA. Factors Delaying the Continuum of Care for the Management of Traumatic Brain Injury in Low- and Middle-Income Countries: A Systematic Review. World Neurosurg 2023; 180:169-193.e3. [PMID: 37689356 DOI: 10.1016/j.wneu.2023.09.007] [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: 07/15/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Considering the disproportionate burden of delayed traumatic brain injury (TBI) management in low- and middle-income countries (LMICs), there is pressing demand for investigations. Therefore, our study aims to evaluate factors delaying the continuum of care for the management of TBIs in LMICs. METHODS A systematic review was conducted with PubMed, Scopus, Google Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Observational studies with TBI patients in LMIC were included. The factors affecting management of TBI were extracted and analyzed descriptively. RESULTS A total of 55 articles were included consisting of 60,603 TBI cases from 18 LMICs. Road traffic accidents (58.7%) were the most common cause of injury. Among included studies, factors contributing to prehospital delays included a poor referral system and lack of an organized system of referral (14%), long travel distances (11%), inadequacy of emergency medical services (16.6%), and self-treatment practices (2.38%). For in-hospital delays, factors such as lack of trained physicians (10%), improper triage systems (20%), and absence of imaging protocols (10%), lack of in-house computed tomography scanners (35%), malfunctioning computed tomography scanners (10%), and a lack of invasive monitoring of intracranial pressure (5%), limited theater space (28%), lack of in-house neurosurgical facilities (28%), absence of in-house neurosurgeons (28%), and financial constraints (14%) were identified. CONCLUSIONS Several factors, both before and during hospitalization contribute to delays in the management of TBIs in LMICs. Strategically addressing these factors can help overcome delays and improve TBI management in LMICs.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Ahmed Altaf
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Nowal Hussain
- Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sonia Pirzada
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Mahnoor Tariq
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Yesel Trillo-Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Tuyishime E, Mossenson A, Livingston P, Irakoze A, Seneza C, Ndekezi JK, Skelton T. Resuscitation team training in Rwanda: A mixed method study exploring the combination of the VAST course with Advanced Cardiac Life Support training. Resusc Plus 2023; 15:100415. [PMID: 37363124 PMCID: PMC10285628 DOI: 10.1016/j.resplu.2023.100415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction The influence of non-technical skills training on resuscitation performance in low-resource settings is unknown. This study investigates combining the Vital Anaesthesia Simulation Training Course with Advanced Cardiac Life Support training on resuscitation performance in Rwanda. Methods Participants in this mixed method study are members of resuscitation teams in three district hospitals in Rwanda. The intervention was participation in a 2-day Advanced Cardiac Life Support course followed by the 3-day Vital Anaesthesia Simulation Training Course. Quantitative primary endpoints were time to initiation of cardiopulmonary resuscitation, time to epinephrine administration, and time to defibrillation. Qualitative data on workplace implementation were gathered during focus groups held 3-months post-intervention. Results Forty-seven participants were recruited. Quantitative data showed a statistically significant decrease in time to cardiopulmonary resuscitation, epinephrine administration, and defibrillation from pre- to post-Advanced Cardiac Life Support, with times of [43.3 (49.7) seconds] versus [16.5 (20) sec], p = <0.001; [137.3 (108.9) sec] versus [51.3 (37.9)], p = <0.001; and [218.5 (105.8) sec] versus [110.8 (87.1) sec], p = <0.001; respectively. These improvements were maintained following the Vital Anaesthesia Simulation Training Course, and at 3-month retention testing. Qualitative analysis highlighted five key themes: ability to initiate cardiopulmonary resuscitation; team coordination for task allocation; empowerment; desire for training and mentorship; and advocacy for system improvement. Conclusion A modified 2-day Advanced Cardiac Life Support course improved resuscitation time indicators with retention 3-months later. Combining the Vital Anaesthesia Simulation Training Course and Advanced Cardiac Life Support led to better team coordination, empowerment to act, and advocacy for system improvement. This pairing of courses has promise for improving Advanced Cardiac Life Support skills amongst healthcare workers in low-resource settings.ClinicalTrials.gov Identifier: NCT05278884.
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Affiliation(s)
- Eugene Tuyishime
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department Anesthesia and Critical Care, University of Botswana, Botswana
- Department of Anesthesia and Perioperative Medicine, Western University, Ontario, Canada
| | - Adam Mossenson
- Department of Anaesthesia, SJOG Public and Private Hospital, Perth, Western Australia
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Nova Scotia, Canada
- Curtin University, Perth, Western Australia, Australia
| | - Patricia Livingston
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Nova Scotia, Canada
| | - Alain Irakoze
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
| | | | | | - Teresa Skelton
- Department of Anesthesia and Pain Medicine, the Hospital for Sick Children, University of Toronto, Canada
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Shrestha R, Indrasena BSH, Subedi P, Lamsal D, Moulton C, Aylott J. Evaluation of junior doctors' retention of knowledge and skills after simulation training in shockable rhythm cardiac arrest in a low-resource setting in Nepal. Resusc Plus 2023; 15:100448. [PMID: 37649875 PMCID: PMC10463246 DOI: 10.1016/j.resplu.2023.100448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Aims To test junior doctors' abilities to retain advanced life support psychomotor skills and theoretical knowledge in management of shockable rhythm cardiac arrest. Methods A repeated measure pre-post study design was used with 43 junior doctors, recruited after notifying them with robust method of attraction through flyers, brochures, email and phone calls. Written and performance tests, initial pre-test, immediate post-training, 30-days post-training and 60-days post-training, using simulation-based scenarios with a low-fidelity manikin were used with recording performance of ALS. Instrumentation Resuscitation Council UK ALS algorithms and guidelines1 were used in a simulated testing environment. Results There was a highly significant improvement in knowledge immediately after training (p < 0.00), with a net gain of marks from a mean value of 63.2% before training to 87.7% after training by 24.5% (95% CI 19.4, 29.6).There was a gradual decline of retained knowledge with time from immediate post-training over, 30-days and 60-days post-training (p < 0.00). The simulation pre-training assessments and immediate post-training assessments results were statistically significant (p < .00). The mean difference was 44.1% (95% CI 50.11, 38.10). There was a statistically significant decline of the competency with time (p < .00). Unlike for the knowledge test, the drop was significant on the 30th day (p < .00) with a mean difference of -10.5% (95% CI -13.55, -7.40). Conclusion The training of junior doctors in shockable rhythm cardiac arrest in a low resource setting, improved knowledge and skills in the participants after training. However, retention of knowledge declined at 30 days and more significantly after 60 days and retention of skill was declined more significantly at 30 days.
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Affiliation(s)
- Rojina Shrestha
- Department of Emergency Medicine, Chitwan Medical College Teaching Hospital, Chitwan, Nepal
| | - Buddhike Sri Harsha Indrasena
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK
- Department of General Surgery, Provincial General Hospital, Badulla, Sri Lanka
| | - Prakash Subedi
- Department of Emergency Medicine, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
- Institute of Medicine, QiMET Medical Institute (QMI), QiMET International Ltd., Sheffield, UK
| | - Dayaram Lamsal
- Department of Emergency Medicine, Chitwan Medical College Teaching Hospital and QIMET Nepal, Chitwan, Nepal
| | - Chris Moulton
- Department of Emergency Medicine, Royal Bolton Hospital, Bolton, UK
| | - Jill Aylott
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK
- Institute of Medicine, QiMET Medical Institute (QMI), QiMET International Ltd., Sheffield, UK
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