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Flaherty KE, Klarman MB, Zakariah AN, Mahama MN, Osei-Ampofo M, Nelson EJ, Becker TK. Evaluating the prerequisites for adapting a paediatric nighttime telemedicine and medication delivery service to a setting with high malarial burden: A cross-sectional pre-implementation study. Trop Med Int Health 2023; 28:763-770. [PMID: 37536706 DOI: 10.1111/tmi.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVE We sought to evaluate the prerequisites (demand, interest, feasibility) for adapting a paediatric nighttime telemedicine and medication delivery service (TMDS) to Ghana. METHODS A cross-sectional survey of households and associated healthcare providers was conducted in urban and rural Ghana. Households were identified through randomised geospatial sampling; households with at least one child <10 years were enrolled. Household surveys collected information relating to demographics, household resources, standardised case scenarios, recent paediatric health events, satisfaction with healthcare access, and interest in TMDS intervention models. Providers were identified by households and enrolled. Provider surveys collected provider type, hours of operation, services, and opinions of a TMDS model. RESULTS A total of 511 (263 urban, 248 rural) households and 18 providers (10 urban, 8 rural) were surveyed. A total of 262 health events involving children <10 years were reported, of which 47% occurred at night. Care was sought for >70% of health events presenting at night; however, care-seeking was delayed until morning or later for >75% of these events; 54% of households expressed dissatisfaction with their current access to paediatric care at night; 99% of households expressed that a nighttime TMDS service for children would be directly useful to their families. Correspondingly, 17 of 18 providers stated that a TMDS was needed in their community; >99% of households had access to a cellular phone. All households expressed willingness to use their phones to call a TMDS and allow a TMDS provider into their homes at night. Willingness to pay and provider-recommended price points varied by setting. CONCLUSIONS Prerequisites for adapting a TMDS to Ghana were met. A nighttime paediatric TMDS service was found to be needed, appealing, and feasible in Ghana. These data motivate the adaptation of a TMDS to urban and rural Ghana.
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Affiliation(s)
- Katelyn E Flaherty
- Section of Global Health, Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Molly B Klarman
- Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Ahmed N Zakariah
- Section of Global Health, Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- National Ambulance Service, Ministry of Health, Accra, Ghana
| | | | | | - Eric J Nelson
- Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Torben K Becker
- Section of Global Health, Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for African Studies, Colleges of Liberal Arts & Sciences, University of Florida, Gainesville, Florida, USA
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Mesic A, Damsere-Derry J, Gyedu A, Mock C, Larley J, Opoku I, Wuaku DH, Kitali A, Osei-Ampofo M, Donkor P, Stewart B. Generating consensus on road safety issues and priorities in Ghana: A modified Delphi approach. Injury 2023; 54:110765. [PMID: 37193635 DOI: 10.1016/j.injury.2023.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/31/2023] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Implementation of evidence-based approaches to reduce the substantial health, social, and financial burdens of road traffic injuries and deaths in Ghana and other low-and-middle-income countries (LMICs) is vitally important. Consensus from national stakeholders can provide insight into what evidence to generate and which interventions to prioritize for road safety. The main objective of this study was to elicit expert views on the barriers to reaching international and national road safety targets, the gaps in national-level research, implementation, and evaluation, and the future action priorities. MATERIALS AND METHODS We used an iterative three-round modified Delphi process to generate consensus among Ghanaian road safety stakeholders. We defined consensus as 70% or more stakeholders selecting a specific response in the survey. We defined partial consensus (termed "majority") as 50% or more stakeholders selecting a particular response. RESULTS Twenty-three stakeholders from different sectors participated. Experts generated consensus on barriers to road safety goals, including the poor regulation of commercial and public transport vehicles and limited use of technology to monitor and enforce traffic behaviors and laws. Stakeholders agreed that the impact of increasing motorcycle (2- and 3-wheel) use on road traffic injury burden is poorly understood and that it is a priority to evaluate road-user risk factors such as speed, helmet use, driving skills, and distracted driving. One emerging area was the impact of unattended/disabled vehicles along roadways. There was consensus on the need for additional research, implementation, and evaluation efforts of several interventions, including focused treatment of hazardous spots, driver training, road safety education as part of academic curricula, promotion of community involvement in first aid, development of strategically positioned trauma centers, and towing of disabled vehicles. CONCLUSION This modified Delphi process with stakeholders from Ghana generated consensus on road safety research, implementation, and evaluation priorities.
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Affiliation(s)
- Aldina Mesic
- Department of Global Health, University of Washington, Seattle, Washington, USA.
| | | | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Department of Global Health, University of Washington, Seattle, Washington, USA; Department of Surgery, University of Washington, Seattle, Washington, USA; Harborview Injury Prevention and Research Center, Seattle, Washington, USA
| | | | - Irene Opoku
- Building and Road Research Institute, Kumasi, Ghana
| | | | | | | | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA; Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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3
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Awini AB, Opoku DA, Ayisi-Boateng NK, Osarfo J, Sulemana A, Yankson IK, Osei-Ampofo M, Zackaria AN, Newton S. Prevalence and determinants of occupational injuries among emergency medical technicians in Northern Ghana. PLoS One 2023; 18:e0284943. [PMID: 37098096 PMCID: PMC10129006 DOI: 10.1371/journal.pone.0284943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Emergency Medical Technicians (EMTs) are the primary providers of prehospital emergency medical services. The operations of EMTs increase their risks of being exposed to occupational injuries. However, there is a paucity of data on the prevalence of occupational injuries among EMTs in sub-Saharan Africa. This study, therefore, sought to estimate the prevalence and determinants of occupational injuries among EMTs in the northern part of Ghana. METHODS A cross-sectional study was conducted among 154 randomly recruited EMTs in the northern part of Ghana. A pre-tested structured questionnaire was used to collect data on participants' demographic characteristics, facility-related factors, personal protective equipment use, and occupational injuries. Binary and multivariate logistic regression analyses with a backward stepwise approach were used to examine the determinants of occupational injuries among EMTs. RESULTS In the 12 months preceding data collection, the prevalence of occupational injuries among EMTs was 38.6%. Bruises (51.8%), and sprains/strains (14.3%) were the major types of injuries reported among the EMTs. The key determinants of occupational injury among EMTs were male sex (AOR: 3.39, 95%CI: 1.41-8.17), an absence of a health and safety committee at the workplace (AOR: 3.92, 95%CI: 1.63-9.43), absence of health and safety policy at the workplace (AOR: 2.76, 95%CI: 1.26-6.04) and dissatisfaction with health and safety measures at the workplace (AOR: 2.51, 95%CI: 1.10-5.71). CONCLUSION In the twelve months before to the data collection for this study, the prevalence of occupational injuries among EMTs of the Ghana National Ambulance Service was high. The creation of health and safety committees, the creation of health and safety rules, and the strengthening of current health and safety procedures for EMTs are all possible ways to lessen this.
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Affiliation(s)
- Ali Baba Awini
- Ghana National Ambulance Service, Upper East Region, Ghana
| | - Douglas Aninng Opoku
- Department of Occupational and Environmental Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Allen Clinic, Family Healthcare Services, Kumasi, Ghana
| | - Nana Kwame Ayisi-Boateng
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Osarfo
- Department of Community Medicine, School of Medicine, University of Health and Allied Health Science, Ho, Ghana
| | - Alhassan Sulemana
- Department of Environmental Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Kofi Yankson
- Council for Scientific and Industrial Research-Building and Road Research Institute, Kumasi, Ghana
| | - Maxwell Osei-Ampofo
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Sam Newton
- Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Garbern SC, Hyuha G, González Marqués C, Baig N, Chan JL, Dutta S, Gulamhussein MA, López Terán GP, Manji HK, Mdundo WK, Moresky RT, Mussa RY, Noste EE, Nyirenda M, Osei-Ampofo M, Rajeev S, Sawe HR, Simbila AN, Thilakasiri MCK, Turgeon N, Wachira BW, Yang RS, Yussuf A, Zhang R, Zyer A, Rees CA. Authorship representation in global emergency medicine: a bibliometric analysis from 2016 to 2020. BMJ Glob Health 2022; 7:bmjgh-2022-009538. [PMID: 35760436 PMCID: PMC9237874 DOI: 10.1136/bmjgh-2022-009538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field. Methods We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors’ affiliations and funding sources. We compared the proportion of authors affiliated with each income bracket using Χ2 analysis. We conducted logistic regression to identify factors associated with first or last authorship affiliated with the study country. Results There were 14 113 authors in 1751 articles. Nearly half (45.5%) of the articles reported work conducted in lower middle-income countries (MICs), 23.6% in upper MICs, 22.5% in low-income countries (LICs). Authors affiliated with HICs were most represented (40.7%); 26.4% were affiliated with lower MICs, 17.4% with upper MICs, 10.3% with LICs and 5.1% with mixed affiliations. Among single-country studies, those without any local authors (8.7%) were most common among those conducted in LICs (14.4%). Only 31.0% of first authors and 21.3% of last authors were affiliated with LIC study countries. Studies in upper MICs (adjusted OR (aOR) 3.6, 95% CI 2.46 to 5.26) and those funded by the study country (aOR 2.94, 95% CI 2.05 to 4.20) had greater odds of having a local first author. Conclusions There were significant disparities in authorship representation. Authors affiliated with HICs more commonly occupied the most prominent authorship positions. Recognising and addressing power imbalances in international, collaborative emergency medicine (EM) research is warranted. Innovative methods are needed to increase funding opportunities and other support for EM researchers in LMICs, particularly in LICs.
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Affiliation(s)
- Stephanie Chow Garbern
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Gimbo Hyuha
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Catalina González Marqués
- Division of Global Emergency Medicine and Humanitarian Studies, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Noor Baig
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Jennifer L Chan
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois, USA.,CrisisReady, Boston, Massachusetts, USA
| | - Sanjukta Dutta
- Department of Emergency Medicine, Fortis Hospital, Kolkata, India
| | - Masuma A Gulamhussein
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Gloria Paulina López Terán
- Servicio de Emergencia, Hospital Santa Inés de Ambato, Ambato, Ecuador.,Servicio de Emergencia, Hospital General Ambato, Ambato, Ecuador
| | - Hussein Karim Manji
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.,Accident and Emergency Department, Aga Khan Hospital, Dar es Salaam, United Republic of Tanzania
| | - Winnie K Mdundo
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Rachel T Moresky
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.,Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA
| | - Raya Yusuph Mussa
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Erin E Noste
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
| | - Mulinda Nyirenda
- Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, Ministry of Health - Malawi, Blantyre, Malawi.,Emergency Medicine Unit, Department of Internal Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Maxwell Osei-Ampofo
- Emergency Medical Services, Ghana National Ambulance Service, Accra, Ghana.,Department of Internal Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Sindhya Rajeev
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Alphonce Nsabi Simbila
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | | | - Nikkole Turgeon
- University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Benjamin W Wachira
- Accident & Emergency Department, The Aga Khan University, Nairobi, Kenya
| | - Rebecca S Yang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amne Yussuf
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Raina Zhang
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alishia Zyer
- Bryant University, Smithfield, Rhode Island, USA
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Gyedu A, Goodman SK, Quansah R, Osei-Ampofo M, Donkor P, Mock C. Assessing the appropriateness of blood transfusion among injured patients at a Ghanaian tertiary hospital: Time for clarity on the use of a scarce resource. Injury 2021; 52:1164-1169. [PMID: 33558023 PMCID: PMC8107114 DOI: 10.1016/j.injury.2021.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/31/2020] [Accepted: 01/15/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hemorrhage is an important cause of preventable injury-related death. Many low- and middle-income country (LMIC) patients do not have timely access to safe blood. We sought to determine the degree of appropriateness of blood transfusion among patients with injuries requiring surgical intervention at presentation to a tertiary hospital in Ghana. METHODS We performed a retrospective review of such patients presenting to Komfo Anokye Teaching Hospital (KATH), from January 2015 to December 2016. Patients' hemoglobin levels at presentation were determined as the first record of hemoglobin after presentation and their receipt of blood transfusion was determined by explicit documentation in the chart. We defined appropriate blood transfusion practice as patients receiving transfusion when hemoglobin was equal or below a threshold, or patients not being transfused when hemoglobin was above the threshold. We considered both restrictive (hemoglobin ≤7 g/dL) and liberal (hemoglobin ≤10 g/dL) transfusion thresholds. RESULTS There were 1,408 patients who presented to KATH with injuries that met inclusion criteria. Two hundred and ninety two (292) patients were excluded because of missing hemoglobin information. Four hundred and fifty eight (458;41%) patients received blood transfusion. Transfused patients had a higher mean age (38 vs 35 years) and were less likely to be male (62% vs 71%). Transfused patients underwent more external fixation procedures (28% vs 19%), trauma amputations (5% vs 1%) and trauma laparotomies (3% vs 1%). At a restrictive transfusion threshold (hemoglobin ≤7 g/dL), 20% of patients who needed a transfusion did not receive one and 39% of patients who did not need a transfusion received one. At a liberal threshold (hemoglobin ≤10 g/dL), 33% of patients who needed a transfusion did not receive one and 30% of patients who did not need a transfusion received one. Blood transfusion practice was inappropriate in 31%-39% of all patients. CONCLUSION Our data suggest that clearer guidelines for blood transfusion among emergency surgery patients are needed in Ghana and similar LMICs to avoid inappropriate use of blood as a scarce resource.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | | | - Robert Quansah
- Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Maxwell Osei-Ampofo
- Department of Medicine; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Peter Donkor
- Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA, Global Injury Control Section, Harborview Injury Prevention and Research Center.
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Orkin AM, Venugopal J, Curran JD, Fortune MK, McArthur A, Mew E, Ritchie SD, Drennan IR, Exley A, Jamieson R, Johnson DE, MacPherson A, Martiniuk A, McDonald N, Osei-Ampofo M, Wegier P, Van de Velde S, VanderBurgh D. Emergency care with lay responders in underserved populations: a systematic review. Bull World Health Organ 2021; 99:514-528H. [PMID: 34248224 PMCID: PMC8243031 DOI: 10.2471/blt.20.270249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the individual and community health effects of task shifting for emergency care in low-resource settings and underserved populations worldwide. Methods We systematically searched 13 databases and additional grey literature for studies published between 1984 and 2019. Eligible studies involved emergency care training for laypeople in underserved or low-resource populations, and any quantitative assessment of effects on the health of individuals or communities. We conducted duplicate assessments of study eligibility, data abstraction and quality. We synthesized findings in narrative and tabular format. Findings Of 19 308 papers retrieved, 34 studies met the inclusion criteria from low- and middle-income countries (21 studies) and underserved populations in high-income countries (13 studies). Targeted emergency conditions included trauma, burns, cardiac arrest, opioid poisoning, malaria, paediatric communicable diseases and malnutrition. Trainees included the general public, non-health-care professionals, volunteers and close contacts of at-risk populations, all trained through in-class, peer and multimodal education and public awareness campaigns. Important clinical and policy outcomes included improvements in community capacity to manage emergencies (14 studies), patient outcomes (13 studies) and community health (seven studies). While substantial effects were observed for programmes to address paediatric malaria, trauma and opioid poisoning, most studies reported modest effect sizes and two reported null results. Most studies were of weak (24 studies) or moderate quality (nine studies). Conclusion First aid education and task shifting to laypeople for emergency care may reduce patient morbidity and mortality and build community capacity to manage health emergencies for a variety of emergency conditions in underserved and low-resource settings.
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Affiliation(s)
- Aaron M Orkin
- Department of Family and Community Medicine, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada
| | | | | | - Melanie K Fortune
- Division of Clinical Sciences, Northern Ontario School of Medicine, Timmins, Canada
| | | | - Emma Mew
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Ian R Drennan
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Adam Exley
- Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Canada
| | | | - David E Johnson
- Wilderness Medical Associates International, Portland, United States of America
| | - Andrew MacPherson
- Department of Emergency Medicine, University of British Columbia, Victoria, Canada
| | - Alexandra Martiniuk
- Faculty of Medicine School of Public Health, University of Sydney, Sydney, Australia
| | | | - Maxwell Osei-Ampofo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Stijn Van de Velde
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - David VanderBurgh
- Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Canada
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Simon EL, Osei-Ampofo M, Wachira BW, Kwan J. Getting accepted - Successful writing for scientific publication: a Research Primer for low- and middle-income countries. Afr J Emerg Med 2020; 10:S154-S157. [PMID: 33304800 PMCID: PMC7718457 DOI: 10.1016/j.afjem.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 11/09/2022] Open
Abstract
Clear and precise writing is a vital skill for healthcare providers and those involved in global emergency care research. It allows one to publish in scientific literature and present oral and written summaries of their work. However, writing skills for publishing are rarely part of the curriculum in the healthcare education system. This review gives you a step-by-step guide on how to successfully write for scientific publication following the IMRaD principle (Introduction, Methods, Results, and Discussion) with every part supporting the key message. There are specific benefits of writing for publication that justify the extra work involved. Any lessons learned about improving global emergency care delivery can be useful to emergency clinicians. The end result can lead to changing others' practice and pave the way for further research.
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Konadu-Yeboah D, Kwasi K, Donkor P, Gudugbe S, Sampen O, Okleme A, Boakye FN, Osei-Ampofo M, Okrah H, Mock C. Preventable Trauma Deaths and Corrective Actions to Prevent Them: A 10-Year Comparative Study at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. World J Surg 2020; 44:3643-3650. [PMID: 32661695 PMCID: PMC7529993 DOI: 10.1007/s00268-020-05683-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the rate of preventable trauma deaths in an African hospital, identify the potential effect of improvements in trauma care over the past decade and identify deficiencies in care that still need to be addressed. METHODS A multidisciplinary panel assessed pre-hospital, hospital, and postmortem data on 89 consecutive in-hospital trauma deaths over 5 months in 2017 at the Komfo Anokye Teaching Hospital. The panel judged the preventability of each death. For definitely and potentially preventable deaths, the panel identified deficiencies in care. RESULTS Thirteen percent (13%) of trauma deaths were definitely preventable, 47% potentially preventable, and 39% non-preventable. In comparison with a panel review in 2007, there was no change in total preventable deaths, but there had been a modest decrease in definitely preventable deaths (25% in 2007 to 13% in 2017, p = 0.07) There was a notable change in the pattern of deficiency (p = 0.001) with decreases in pre-hospital delay (19% of all trauma deaths in 2007 to 3% in 2017) and inadequate resuscitation (17 to 8%), but an increase in delay in treatment at the hospital (23 to 40%). CONCLUSIONS Over the past decade, there have been improvements in pre-hospital transport and in-hospital resuscitation. However, the preventable death rate remains unacceptably high and there are still deficiencies to address. This study also demonstrates that preventable death panel reviews are a feasible method of trauma quality improvement in the low- and middle-income country setting.
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Affiliation(s)
- Dominic Konadu-Yeboah
- Directorate of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kusi Kwasi
- Directorate of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Senyo Gudugbe
- Directorate of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ossei Sampen
- Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Augustus Okleme
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Maxwell Osei-Ampofo
- Directorate of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Helena Okrah
- Department of Anaesthesia, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA.
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9
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Flaherty KE, Zakariah AN, Vescio VA, Osei-Ampofo M, Mahama MN, Agongo V, Becker TK. The state of emergency medical technician education in Ghana. Afr J Emerg Med 2020; 10:107-110. [PMID: 32923318 PMCID: PMC7474231 DOI: 10.1016/j.afjem.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/17/2019] [Accepted: 01/29/2020] [Indexed: 12/05/2022] Open
Abstract
Objective The National Ambulance Service (NAS) provides emergency medical services throughout Ghana and trains emergency medical technicians (EMTs) at the NAS Prehospital Emergency Care Training School (PECTS). Currently the majority of EMT training occurs primarily in a traditional didactic format. Students and faculty were interviewed to better understand their views of the current curriculum. Additionally, any barriers to integration of simulation-based learning were assessed. Following the interviews, the faculty was trained to conduct obstetric and neonatal simulations. The faculty was then observed introducing the simulations to the EMT students. Methods A standardized list of questions developed in consultation with an education expert was used to elicit student and faculty expression of opinion. Interviews were conducted in-person in small group settings. Training sessions were conducted in-person in large group settings. Results Students and faculty alike expressed pride in their work and 14/25 groups felt that teaching efforts were high. However, students verbalized concern involving their lack of rest (12/18) and the high volume of lectures per day (11/18). Both students and faculty felt limited by the lack of simulation tools (17/25), library resources (14/25), internet access (17/25), and infrastructure (20/25). All groups felt favorably towards the integration of simulation-based learning (25/25). Conclusion The faculty and students of PECTS support the transition from a curriculum based on traditional didactic learning to one based on simulation learning.
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Affiliation(s)
| | | | - Vicki A. Vescio
- School of Teaching and Learning, University of Florida, Gainesville, FL, USA
| | - Maxwell Osei-Ampofo
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Vitus Agongo
- National Ambulance Service, Ministry of Health, Accra, Ghana
| | - Torben K. Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
- Corresponding author.
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Mould-Millman NK, Dixon J, Burkholder TW, Sefa N, Patel H, Yaffee AQ, Osisanya A, Oyewumi T, Botchey I, Osei-Ampofo M, Sawe H, Lemery J, Cushing T, Wallis LA. Fifteen years of emergency medicine literature in Africa: A scoping review. Afr J Emerg Med 2019; 9:45-52. [PMID: 30873352 PMCID: PMC6400014 DOI: 10.1016/j.afjem.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/15/2018] [Accepted: 01/04/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Emergency medicine (EM) throughout Africa exists in various stages of development. The number and types of scientific EM literature can serve as a proxy indicator of EM regional development and activity. The goal of this scoping review is a preliminary assessment of potential size and scope of available African EM literature published over 15 years. METHODS We searched five indexed international databases as well as non-indexed grey literature from 1999-2014 using key search terms including "Africa", "emergency medicine", "emergency medical services", and "disaster." Two trained physician reviewers independently assessed whether each article met one or more of five inclusion criteria, and discordant results were adjudicated by a senior reviewer. Articles were categorised by subject and country of origin. Publication number per country was normalised by 1,000,000 population. RESULTS Of 6091 identified articles, 633 (10.4%) were included. African publications increased 10-fold from 1999 to 2013 (9 to 94 articles, respectively). Western Africa had the highest number (212, 33.5%) per region. South Africa had the largest number of articles per country (171, 27.0%) followed by Nigeria, Kenya, and Ghana. 537 (84.8%) articles pertained to facility-based EM, 188 (29.7%) to out-of-hospital emergency medicine, and 109 (17.2%) to disaster medicine. Predominant content areas were epidemiology (374, 59.1%), EM systems (321, 50.7%) and clinical care (262, 41.4%). The most common study design was observational (479, 75.7%), with only 28 (4.4%) interventional studies. All-comers (382, 59.9%) and children (91, 14.1%) were the most commonly studied patient populations. Undifferentiated (313, 49.4%) and traumatic (180, 28.4%) complaints were most common. CONCLUSION Our review revealed a considerable increase in the growth of African EM literature from 1999 to 2014. Overwhelmingly, articles were observational, studied all-comers, and focused on undifferentiated complaints. The articles discovered in this scoping review are reflective of the relatively immature and growing state of African EM.
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Affiliation(s)
- Nee-Kofi Mould-Millman
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, USA
- Corresponding author.
| | - Julia Dixon
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, USA
| | - Taylor W. Burkholder
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Nana Sefa
- Beaumont Health System, Royal Oak, MI, USA
| | - Hiren Patel
- Harvard Medical School/Massachusetts General Hospital, Department of Emergency Medicine, MA, USA
| | - Anna Q. Yaffee
- Emory University, Department of Emergency Medicine, Atlanta, GA, USA
| | | | - Tolulope Oyewumi
- University of Colorado, School of Public Health, Department of Epidemiology, Aurora, CO, USA
| | | | - Maxwell Osei-Ampofo
- Komfo Anokye Teaching Hospital, Emergency Medicine Directorate, Kumasi, Ghana
| | - Hendry Sawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jay Lemery
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, USA
| | - Tracy Cushing
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, USA
| | - Lee A. Wallis
- University of Cape Town, Division of Emergency Medicine, Observatory, Cape Town, South Africa
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Osei-Ampofo M, Aidoo A, Antwi-Kusi A, Joan Ofungwu O, Kotey SNK, Siaw-Frimpong M, Chiedozie O, Tafoya MJ, Becker TK. Respiratory failure requiring mechanical ventilation in critically ill adults in Ghana: A prospective observational study. Afr J Emerg Med 2018; 8:155-157. [PMID: 30534520 PMCID: PMC6277501 DOI: 10.1016/j.afjem.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/15/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Respiratory failure is commonly seen in African emergency centres and intensive care units, but little is known about the need for intubation and mechanical ventilation. METHODS From April to October 2017, we recorded the number of patients intubated and ventilated in the emergency centre and intensive care unit at Komfo Anokye Teaching Hospital in Kumasi, Ghana on a daily basis. We assessed patients for presence of acute respiratory distress syndrome (ARDS) using the Kigali Modification of the Berlin ARDS criteria. ARDS patients were re-assessed daily. RESULTS During the study period, 102 patients were intubated, of which 82 were assessed by the study team. The remaining 20 patients died before they could be assessed. Two (2.4%) patients were identified as having ARDS, and both died. Neither was treated with prone positioning or chemical paralysis. It is possible that many of the patients who died before an assessment suffered from ARDS, considering its associated high mortality, and thus the true incidence of ARDS may have been higher. CONCLUSION Respiratory failure requiring intubation and mechanical ventilation is common in patients presenting to the emergency centre or intensive care unit at an academic tertiary care centre in Ghana. The true incidence of ARDS was likely underestimated by our study.
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Osei-Ampofo M, Tafoya MJ, Tafoya CA, Oteng RA, Ali H, Becker TK. Skill and knowledge retention after training in cardiopulmonary ultrasound in Ghana: an impact assessment of bedside ultrasound training in a resource-limited setting. Emerg Med J 2018; 35:704-707. [PMID: 30154142 DOI: 10.1136/emermed-2018-207716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Brief training courses in bedside ultrasound are commonly done by visiting faculty in low-income and middle-income countries, and positive short-term effects have been reported. Long-term outcomes are poorly understood. We held a training course on a cardiopulmonary ultrasound (CPUS) protocol over two separate 10-day periods in 2016. In 2017, 9-11 months after the initial training, we assessed skill and knowledge retention as well as perceived impact on local practice. METHODS A written test using six clinical vignettes and an observed structured clinical examination were used to assess theoretical knowledge and practical skills. Additionally, in-person interviews and a written survey were completed with the physicians who had participated in the initial training. RESULTS All 20 participants passed the written and clinical examination. The median follow-up test score was 10 out of 12, compared with a median score of 12 on a test completed immediately after the initial training. Physicians identified the ability to narrow their differential diagnosis and to initiate critical interventions earlier than without ultrasound as a key benefit of the CPUS training. They rated the cardiac, abdominal and inferior vena cava components of the CPUS protocol as most relevant to their everyday practice. CONCLUSION Long-term ultrasound knowledge and skill retention was high after a brief and intensive training intervention at an academic tertiary hospital in Ghana. Clinicians reported improvements in patient care and local practice patterns.
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Affiliation(s)
- Maxwell Osei-Ampofo
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Matthew J Tafoya
- Department of Emergency Medicine, Highland Hospital, Oakland, California, USA
| | - Chelsea A Tafoya
- Department of Emergency Medicine, Highland Hospital, Oakland, California, USA
| | - Rockefeller A Oteng
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Hassan Ali
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
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Becker TK, Tafoya CA, Osei-Ampofo M, Tafoya MJ, Kessler RA, Theyyunni N, Yakubu HA, Opuni D, Clauw DJ, Cranford JA, Oppong CK, Oteng RA. Cardiopulmonary ultrasound for critically ill adults improves diagnostic accuracy in a resource-limited setting: the AFRICA trial. Trop Med Int Health 2017; 22:1599-1608. [PMID: 29072885 DOI: 10.1111/tmi.12992] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effects of a cardiopulmonary ultrasound (CPUS) examination on diagnostic accuracy for critically ill patients in a resource-limited setting. METHODS Approximately half of the emergency medicine resident physicians at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, were trained in a CPUS protocol. Adult patients triaged to the resuscitation area of the emergency department (ED) were enrolled if they exhibited signs or symptoms of shock or respiratory distress. Patients were assigned to the intervention group if their treating physician had completed the CPUS training. The physician's initial diagnostic impression was recorded immediately after the history and physical examination in the control group, and after an added CPUS examination in the intervention group. This was compared to a standardised final diagnosis derived from post hoc chart review of the patient's care at 24 h by two blinded, independent reviewers using a clearly defined and systematic process. Secondary outcomes were 24-h mortality and use of IV fluids, diuretics, vasopressors and bronchodilators. RESULTS Of 890 patients presenting during the study period, 502 were assessed for eligibility, and 180 patients were enrolled. Diagnostic accuracy was higher for patients who received the CPUS examination (71.9% vs. 57.1%, Δ 14.8% [CI 0.5%, 28.4%]). This effect was particularly pronounced for patients with a 'cardiac' diagnosis, such as cardiogenic shock, congestive heart failure or acute valvular disease (94.7% vs. 40.0%, Δ 54.7% [CI 8.9%, 86.4%]). Secondary outcomes were not different between groups. CONCLUSIONS In an urban ED in Ghana, a CPUS examination improved the accuracy of the treating physician's initial diagnostic impression. There were no differences in 24-h mortality and a number of patient care interventions.
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Affiliation(s)
- Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Chelsea A Tafoya
- Department of Emergency Medicine, Highland Hospital, Oakland, CA, USA
| | - Maxwell Osei-Ampofo
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Matthew J Tafoya
- Department of Emergency Medicine, Highland Hospital, Oakland, CA, USA
| | - Ross A Kessler
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nikhil Theyyunni
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Hussein A Yakubu
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Daniel Opuni
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Daniel J Clauw
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - James A Cranford
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Chris K Oppong
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Rockefeller A Oteng
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
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Tafoya C, Tafoya M, Becker T, Oteng R, Kessler R, Cranford J, Yakubu H, Opuni D, Clauw D, Theyyunni N, Osei-Ampofo M. 396 Ultrasound-Guided Resuscitation of Critically Ill Patients Presenting to the Emergency Department in a Resource-Limited Setting. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Becker TK, Hansoti B, Bartels S, Hayward AS, Hexom BJ, Lunney KM, Marsh RH, Osei-Ampofo M, Trehan I, Chang J, Levine AC. Global Emergency Medicine: A Review of the Literature From 2016. Acad Emerg Med 2017; 24:1150-1160. [PMID: 28474823 DOI: 10.1111/acem.13216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. METHODS This year 13,890 articles written in four languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. RESULTS A total of 716 articles met our inclusion criteria and underwent full review. Fifty-nine percent were categorized as emergency care in resource-limited settings, 17% as EM development, and 24% as disaster and humanitarian response. Nineteen articles received scores of 18.5 or higher out of a maximum score of 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed Cohen's kappa of 0.441. CONCLUSIONS In 2016, the total number of articles identified by our search continued to increase. The proportion of articles in each of the three categories remained stable. Studies and reviews with a focus on infectious diseases, pediatrics, and the use of ultrasound in resource-limited settings represented the majority of articles selected for final review.
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Affiliation(s)
- Torben K. Becker
- Department of Critical Care Medicine; University of Pittsburgh Medical Center; Pittsburgh PA
| | - Bhakti Hansoti
- Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Susan Bartels
- Department of Emergency Medicine; Queen's University; Kingston Ontario Canada
- Harvard Humanitarian Initiative; Cambridge MA
| | | | - Braden J. Hexom
- Department of Emergency Medicine; Rush University Medical Center; Chicago IL
| | - Kevin M. Lunney
- TheMedical Corps, US Navy, and the Navy Trauma Training Center; Los Angeles County and University of Southern California; Los Angeles CA
| | - Regan H. Marsh
- Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
- Partners In Health; Boston MA
| | - Maxwell Osei-Ampofo
- Emergency Medicine Directorate; Komfo Anokye Teaching Hospital, and Kwame Nkrumah University of Science and Technology; Kumasi Ghana
| | - Indi Trehan
- Partners In Health; Harper Liberia
- Department of Pediatrics and Institute for Public Health; Washington University in St. Louis; St. Louis MO
- Department of Paediatrics and Child Health; University of Malawi; Blantyre Malawi
| | | | - Adam C. Levine
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
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Ekremet K, Osei-Ampofo M, Nkansah RS, Offei KO, Antwi-Donkor K, Ekremet PA. Ujuzi (Practical Pearl/ Perle Pratique). Afr J Emerg Med 2016; 6:154-155. [PMID: 30456084 PMCID: PMC6234153 DOI: 10.1016/j.afjem.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/20/2014] [Indexed: 11/28/2022] Open
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Gyedu A, Agbedinu K, Dalwai M, Osei-Ampofo M, Nakua EK, Oteng R, Stewart B. Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care. Pan Afr Med J 2016; 24:294. [PMID: 28154649 PMCID: PMC5267868 DOI: 10.11604/pamj.2016.24.294.8728] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 06/02/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction The incidence of emergency conditions is increasing worldwide, particularly in low- and middle-income countries (LMICs). However, triage and emergency care training has not been prioritized in LMICs. We aimed to assess the reliability and validity of the South African Triage Scale (SATS) when used by providers not specifically trained in SATS, as well as to compare triage capabilities between senior medical students and senior house officers to examine the effectiveness of our curriculum for house officer training with regards to triage. Methods Sixty each of senior medical students and senior house officers who had not undergone specific triage or SATS training were asked to triage 25 previously validated emergency vignettes using the SATS. Estimates of reliability and validity were calculated. Additionally, over- and under-triage, as well as triage performance between the medical students and house officers was assessed against a reference standard. Results Fifty-nine senior medical students (98% response rate) and 43 senior house officers (72% response rate) completed the survey (84% response rate overall). A total of 2,550 triage assignments were included in the analysis (59 medical student and 43 house officer triage assignments for 25 vignettes each; 1,475 and 1,075 triage assignments, respectively). Inter-rater reliability was moderate (quadratically weighted κ 0.59 and 0.60 for medical students and house officers, respectively). Triage using SATS performed by these groups had low sensitivity (medical students: 54%, 95% CI 49–59; house officers: 55%, 95% CI 48–60) and moderate specificity (medical students: 84%, 95% CI 82 - 89; house officers: 84%, 95% CI 82 - 97). Both groups under-triaged most ‘emergency’ level vignette patients (i.e. SATS Red; 80 and 82% for medical students and house officers, respectively). There was no difference between the groups for any metric. Conclusion Although the SATS has proven utility in a number of different settings in LMICs, its success relies on its use by trained providers. Given the large and growing burden of emergency conditions, training current and future emergency care providers in triage is imperative.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kwabena Agbedinu
- Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Mohammed Dalwai
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Maxwell Osei-Ampofo
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Emmanuel Kweku Nakua
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rockefeller Oteng
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Barclay Stewart
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Surgery, University of Washington, Seattle, WA, USA; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa
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Osei-Ampofo M, Flynn-O’Brien KT, Owusu-Dabo E, Otupiri E, Oduro G, Donkor P, Mock C, Ebel BE. Injury patterns and health outcomes among pregnant women seeking emergency medical care in Kumasi, Ghana: Challenges and opportunities to improve care. Afr J Emerg Med 2016; 6:87-93. [PMID: 30456072 PMCID: PMC6233248 DOI: 10.1016/j.afjem.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/08/2015] [Accepted: 01/04/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In high-income countries, injury is the most common cause of non-obstetric death among pregnant women. However, the injury risk during pregnancy has not been well characterized for many developing countries including Ghana. Our study described maternal and fetal outcomes after injury at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, and identified associations between the prevalence of poor outcomes and maternal risk factors. METHODS We conducted a cross-sectional study to identify pregnant women treated for injury over a 12-month period at KATH in Kumasi, Ghana. Descriptive statistics were used to characterize the population. We identified the association between poor outcomes and maternal risk factors using multivariable Poisson regression. RESULTS There were 134 women with documented pregnancy who sought emergency care for injury (1.1% of all injured women). The leading injury mechanisms were motor vehicle collision (23%), poisoning (21%), and fall (19%). Assault was implicated in 3% of the injuries. Eleven women (8%) died from their injuries. The prevalence of poor fetal outcomes: fetal death, distress or premature birth, was high (61.9%). One in four infants was delivered prematurely following maternal injury. After adjusting for maternal and injury characteristics, poor fetal outcomes were associated with pedestrian injury (adjusted prevalence ratio (aPR) 2.5, 95% CI 1.5-4.6), and injury to the thoraco-abdominal region (aPR 2.1, 95% CI 1.4-3.3). CONCLUSIONS Injury is an important cause of maternal morbidity and poor fetal outcomes. Poisoning, often in an attempt to terminate pregnancy, was a common occurrence among pregnant women treated for injury in Kumasi. Future work should address modifiable risk factors related to traffic safety, prevention of intimate partner violence, and prevention of unintended pregnancies.
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Affiliation(s)
- Maxwell Osei-Ampofo
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Katherine T. Flynn-O’Brien
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, United States
- Department of Surgery, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research, Kumasi, Ghana
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Easmon Otupiri
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - George Oduro
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Peter Donkor
- Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Dept. of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, United States
- Department of Surgery, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Beth E. Ebel
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Seattle Children’s Hospital, Seattle, WA, United States
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Nkansah S, Osei-Ampofo M, Ekremet K, Offei O, Antwi-Donkor K, Oteng R, Oduro G. Ujuzi (Practical Pearl/Perle Pratique). Afr J Emerg Med 2015. [DOI: 10.1016/j.afjem.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Osei-Ampofo M, Cheskes S, Byers A, Drennan IR, Buick JE, Verbeek PR. A Novel Approach to Improve Time to First Shock in Prehospital STEMI Complicated by Ventricular Fibrillation. PREHOSP EMERG CARE 2015; 20:278-82. [PMID: 26517201 DOI: 10.3109/10903127.2015.1076100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Lethal cardiac arrhythmias such as ventricular fibrillation and pulseless ventricular tachycardia (VF/pVT) complicate up to 6% of all out-of-hospital STEMIs. Typically, paramedics respond to this by applying defibrillation pads and delivering a shock as soon as possible. A recently introduced "pads-on" protocol directed paramedics to apply defibrillation pads to all STEMI patients (regardless of clinical stability) with the aim of decreasing time to first shock. In this article we present two cases of prehospital STEMI complicated by VF to illustrate times to first shock for the two different protocols. One case each of a STEMI complicated by VF before implementation of the pads-on protocol and after the implementation of the protocol is presented. An important difference in the time to first shock is noted between the two patients with STEMI complicated by VF. While it took 2 min 43 s for the pads-off patient to be defibrillated, only 27 s elapsed before the pads-on patient was defibrillated. These two cases demonstrate that the application of defibrillation pads immediately following the diagnosis of prehospital STEMI has the potential to decrease the time to shock in patients suffering VF/pVT.
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Mould-Millman NK, Oteng R, Zakariah A, Osei-Ampofo M, Oduro G, Barsan W, Donkor P, Kowalenko T. Assessment of Emergency Medical Services in the Ashanti Region of Ghana. Ghana Med J 2015; 49:125-135. [PMID: 26693186 PMCID: PMC4676599 DOI: 10.4314/gmj.v49i3.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND We aimed to assess the structure, function and performance of Ashanti Region's emergency medical services system in the context of the regional need for prehospital emergency care. DESIGN A mixed-methods approach was employed, using retrospective collection of quantitative data and prospectively gathered qualitative data. Setting - pertinent data were collected from Ghanaian and international sources; interviews and technical assessments were performed primarily in the Ashanti Region of Ghana. PARTICIPANTS All stakeholders relevant to emergency medical services in the Ashanti Region of Ghana were assessed; there was a special focus on National Ambulance Service (NAS) and Ashanti Region healthcare personnel. INTERVENTION This was an observational study using qualitative and quantitative assessment techniques. MAIN OUTCOME MEASURES The structure, function and performance of the Ashanti emergency medical services system, guided by a relevant technical assessment framework. RESULTS NAS is the premier and only true prehospital agency in the Ashanti Region. NAS has developed almost every essential aspect of an EMS system necessary to achieve its mission within a low-resource setting. NAS continues to increase its number of response units to address the overwhelming Ashanti region demand, especially primary calls. Deficient areas in need of development are governance, reliable revenue, public access, community integration, clinical care guidelines, research and quality assurance processes. CONCLUSIONS The Ashanti Region has a growing and thriving emergency medical services system. Although many essential areas for development were identified, NAS is well poised to meet the regional demand for prehospital emergency care and transport.
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Affiliation(s)
- N K Mould-Millman
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, USA
| | - R Oteng
- University of Michigan, Department of Emergency Medicine, Ann Arbor, USA
| | - A Zakariah
- National Ambulance Service, Republic of Ghana Ministry of Health, Accra, Ghana
| | - M Osei-Ampofo
- Komfo Anokye Teaching Hospital, Accident and Emergency Centre, Kumasi, Ghana
| | - G Oduro
- Komfo Anokye Teaching Hospital, Accident and Emergency Centre, Kumasi, Ghana
| | - W Barsan
- University of Michigan, Department of Emergency Medicine, Ann Arbor, USA
| | - P Donkor
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - T Kowalenko
- Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, USA
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22
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Becker TK, Bartels S, Hansoti B, Jacquet GA, Lunney K, Marsh R, Osei-Ampofo M, Lam C, Levine AC. Global emergency medicine: a review of the literature from 2014. Acad Emerg Med 2015. [PMID: 26223901 DOI: 10.1111/acem.12733] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a worldwide audience of academics and clinical practitioners. METHODS This year 6,376 articles written in six languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. A total of 477 articles were deemed appropriate by at least one reviewer and approved by the editor for formal scoring of overall quality and importance. RESULTS Of the 477 articles that met our predetermined inclusion criteria, 63% were categorized as emergency care in resource-limited settings, 13% as EM development, and 23% as disaster and humanitarian response. Twenty-five articles received scores of 17.5 or higher and were selected for formal summary and critique. Inter-rater reliability for two reviewers using our scoring system was good, with an intraclass correlation coefficient of 0.657 (95% confidence interval = 0.589 to 0.713). Studies and reviews focusing on infectious diseases, trauma, and the diagnosis and treatment of diseases common in resource-limited settings represented the majority of articles selected for final review. CONCLUSIONS In 2014, there were fewer total articles, but a slightly higher absolute number of articles screening in for formal scoring, when compared to the 2013 review. The number of EM development articles decreased, while the number of disaster and humanitarian response articles increased. As in prior years, the majority of articles focused on infectious diseases and trauma.
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Affiliation(s)
- Torben K. Becker
- Department of Emergency Medicine; University of Michigan; Ann Arbor MI
| | - Susan Bartels
- Department of Emergency Medicine; Queen's University; Kingston Ontario Canada
- Harvard Humanitarian Initiative; Cambridge MA
| | - Bhakti Hansoti
- Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Gabrielle A. Jacquet
- Department of Emergency Medicine; Boston University School of Medicine; Boston MA
- Boston University Center for Global Health and Development; Boston MA
| | - Kevin Lunney
- Medical Corps; US Navy, Department of Emergency Medicine; Navy Hospital Camp Lejeune; Camp Lejeune NC
| | - Regan Marsh
- Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
- Partners In Health; Boston MA
| | - Maxwell Osei-Ampofo
- Accident & Emergency Department; Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and Technology; Kumasi Ghana
| | - Christopher Lam
- Warren Alpert Medical School of Brown University; Providence RI
| | - Adam C. Levine
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
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23
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Offei O, Osei-Ampofo M, Ekremet K, Yakubu A, Nkansah S, Oteng R, Oduro G. Ujuzi (Practical Pearl/Perle Pratique). Afr J Emerg Med 2015. [DOI: 10.1016/j.afjem.2014.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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24
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MacDonald RD, Osei-Ampofo M. Articles that may change your practice: the benefits of helicopter emergency medical services in trauma. Air Med J 2015; 34:134-136. [PMID: 25934237 DOI: 10.1016/j.amj.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/10/2015] [Indexed: 06/04/2023]
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25
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26
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Osei-Ampofo M, Forson P, Offei K, Osei-Kwame D. Ujuzi (Practical Pearl/Perle Pratique). Afr J Emerg Med 2015. [DOI: 10.1016/j.afjem.2014.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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27
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Forson P, Osei-Ampofo M, Ofori-Boadu L, Safo A, Oteng R, Oduro G, Donkor P. Ujuzi (Practical Pearl/Perle Pratique). Afr J Emerg Med 2014. [DOI: 10.1016/j.afjem.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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28
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Runyon MS, Sawe HR, Levine AC, Pousson A, House DR, Agrawal P, Osei-Ampofo M, Weiner SG, Douglass K. Clinical and translational research in global health and emergency care: a research agenda. Acad Emerg Med 2013; 20:1272-7. [PMID: 24341582 DOI: 10.1111/acem.12268] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/27/2022]
Abstract
As policy-makers increasingly recognize emergency care to be a global health priority, the need for high-quality clinical and translational research in this area continues to grow. As part of the proceedings of the 2013 Academic Emergency Medicine consensus conference, this article discusses the importance of: 1) including clinical and translational research in the initial emergency care development plan, 2) defining the burden of acute disease and the barriers to conducting research in resource-limited settings, 3) assessing the appropriateness and effectiveness of local and global acute care guidelines within the local context, 4) studying the local research infrastructure needs to understand the best methods to build a sustainable research infrastructure, and 5) studying the long-term effects of clinical research programs on health care systems.
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Affiliation(s)
- Michael S. Runyon
- The Department of Emergency Medicine; Carolinas Medical Center; Charlotte NC
| | - Hendry R. Sawe
- The Department of Emergency Medicine; Muhimbili University of Health and Allied Sciences; Dar Es Salaam Tanzania
| | - Adam C. Levine
- The Department of Emergency Medicine; Brown University; Providence RI
| | - Amelia Pousson
- The Department of Emergency Medicine; George Washington University; Washington DC
| | - Darlene R. House
- The Department of Emergency Medicine; Indiana University; Indianapolis IN
| | - Pooja Agrawal
- The Department of Emergency Medicine; Yale School of Medicine; New Haven CT
| | - Maxwell Osei-Ampofo
- The Emergency Medicine Department; Komfo Anokye Teaching Hospital; Kumasi Ghana
| | - Scott G. Weiner
- The Department of Emergency Medicine; Tufts University School of Medicine; Boston MA
| | - Katherine Douglass
- The Department of Emergency Medicine; George Washington University; Washington DC
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29
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Forson P, Osei-Ampofo M, Ofori-Boadu L, Bonney J, Acheampong E, Oteng R, Donkor P, Oduro G. Ujuzi. Afr J Emerg Med 2013. [DOI: 10.1016/j.afjem.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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30
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Osei-Ampofo M, Osei-Kwame D, Ofori-Boadu L, Oteng R, Oduro G. Ujuzi. Afr J Emerg Med 2013. [DOI: 10.1016/j.afjem.2012.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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