Browsing by Author "Bruijns, Stevan R"
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- ItemOpen AccessA critical realist study into the emergence and absence of academic success among Bachelor of Emergency Medical Care students(2018) Sobuwa, Simpiwe; Bruijns, Stevan R; Lord, BillThis critical realist thesis explores academic success in the four-year Bachelor of Emergency Medical Care degree in South Africa. The Bachelor of Emergency Medical Care degree is a relatively new degree that is offered at four universities in South Africa. In view of the existing shortage of paramedics both in South Africa and on the African continent, an understanding of the factors that play a role in academic success may lead to an increase in the number of emergency care providers. Accordingly, this study was conceptualised to explore the reasons why academic success is either evident or absent among Bachelor of Emergency Medical Care students. The study utilised a sequential, explanatory, mixed methods research design. The quantitative phase consisted of an online survey that was disseminated to Bachelor of Emergency Medical Care students in South Africa with the aim of gaining an insight into their socio-cultural history. Continuous and categorical variables were described using basic descriptive statistics. The Pearson’s chi-square and Fisher’s exact test were used to test associations between the various survey variables and repeating a year. A p-value of less than 0.05 was considered to be statistically significant. During the qualitative phase focus groups were held with students while semi-structured interviews were conducted with lecturing staff members. The aim of the qualitative approach was to explore the causal powers and generative mechanisms that give rise to or enable the emergence or absence of academic success among Bachelor of Emergency Medical Care students. Thematic analysis was used to analyse results from the focus groups and semistructured interviews. A critical realist concept of the laminated system was also used to explore the themes that emerged. A total of 176 participants from an available sample of 408 students responded to the survey. Not repeating a year was significantly associated with two important variables, namely, the possession of a pre-existing emergency care qualification and not being a white student. The results revealed that the following interactive generative mechanisms played a role in the lack of academic success, namely, biological, socioeconomic, socio-cultural, normative, psychosocial and psychological factors while the following interactive generative mechanisms facilitated the emergence of academic success – psychological, psycho-social, normative and socioeconomic factors.
- ItemOpen AccessA descriptive study of the use of cardiac point of care ultrasound (PoCUS) in public emergency centres in Cape Town(2021) Ganas, Ushira; Malan, Jacques J; Bruijns, Stevan RBackground Cardiac point of care ultrasound (PoCUS) has evolved into an important diagnostic tool in the daily practice of emergency medicine. Its use has been advocated internationally, but its limitations have also been emphasised. The indications for cardiac PoCUS vary somewhat in different parts of the world, and training programs may also differ. We set out to describe the self-reported indications and imaging windows used at a selection of secondary-level, public hospital emergency centres in Cape Town. Methods A descriptive study with prospective data collection from the emergency centres of Mitchells Plain District, Victoria and New Somerset Hospitals was used. Data were collected over a three-month period, by all formally consented providers who have completed a basic emergency ultrasound course, using a purpose-designed data collection tool for all cardiac PoCUS scans. The study was approved the University of Cape Town's Human Research Ethics Committee (581/2017). Results We recruited 15 PoCUS providers who recorded 267 data entries over the 3-month study period. Seventeen surveys were excluded leaving 250 for analysis. The most common indication for cardiac PoCUS was electrocardiogram abnormalities,27% (n= 112); dyspnoea,25% (n= 102); chest pain,16%(n=65); cardiomegaly on chest xray,12%(n=51); new murmur,6%(n=23); and chest trauma,5%(n=22). Other indications made up the remaining 10%(n=40). Parasternal long and short axis were the predominantly used views. Conclusion The results of the study suggest that cardiac PoCUS is used for a wide range of indications which are recommended in training guidelines. However, some indications are outliers but may be useful in low-middle income settings. Further research needs to be done to ascertain the extent of the use of cardiac PoCUS, and possibly the need for a more comprehensive training program with adequate training in these clinical conditions, to ensure safe practice.
- ItemOpen AccessDissemination patterns of scientific abstracts presented at the first and second African Conferences of Emergency Medicine(2021) Abrams, Marlin; van Hoving, Daniël J; Bruijns, Stevan RIntroduction:Evidence based medicine is the standard of modern health care practices. Ongoing biomedical research is needed to expand existing knowledge and improve quality of care, but it needs to reach clinicians to drive change. Journal articles and conference presentations are dissemination tools. The aim of the study was to establish the publication rate of scientific abstracts presented at the first and second African Conference of Emergency Medicine. The secondary objectives were establishing nonpublication dissemination and the factors associated with publication and non-publication. Determining non-publication dissemination patterns and the factors associated with reasons for publishing or non-publication were also investigated. Methods:Presenters of the 129 scientific abstracts from the first and second African Conference of Emergency Medicine were invited to participate in an online survey. The survey was followed by a manual literature search to identify published manuscripts of authors that did not complete the survey, to determine the most accurate publication rate. Results:Thirty-one presenters responded (24%), of which 18 published in a peer-reviewed journal. An additional 25 publications were identified by the literature search. The overall publication rate was 33.3% (26.9% from 2012 and 40.3% from 2014). Oral presentations were more likely to be published (p=0.09). Sixteen manuscripts (37.2%) were published in the African Journal of Emergency Medicine. Presentations at local academic meetings were the most used platform beyond publication (43%). The main reason to publish was to add to the body of knowledge (100%), while lack of time (57%) was the major obstacle for not publishing.Conclusion:The overall publication rate for the first and second Africa Conferences of Emergency Medicine iscomparable to other non-African Emergency Medicine conferences. The increasing publication trendbetween conferences might reflect the development of regional research capacity. EmergencyMedicine providers in Africa need to be encouraged to participate in high quality, locally relevant research and to distribute those findings through accessible formats.
- ItemOpen AccessEvaluation of the diagnostic and management accuracy of closed fractures of forearm and wrist using validated vignettes as a reference standard by emergency centre clinicians in the Cape Town metropole(2020) Goncalves, Melisanda; Cloete, Philip G; Bruijns, Stevan RIntroduction Reduction of forearm and wrist fractures is a common practice in the Emergency Centre (EC). EC doctors must be familiar with the appropriate management thereof. The standard treatment of a fracture involves reduction and immobilization. This study aims to describe the diagnostic and management accuracy of EC clinicians using validated vignettes (also used as the reference standard) of adult patients with closed fractures of the forearm or wrist. Methods This is a prospective, cross-sectional study in the form of an electronic questionnaire to address the study aim. A set of vignettes were created and then validated to serve as the control for the study participants. The study was open to emergency medicine consultants, emergency medicine trainees/registrars, medical officers, and community service medical officers employed at a secondary-level public hospital EC in the Cape Town metropole. Comparison is made by the number and proportions of correct and incorrect answers using the vignette reference standard. Data were analysed using ChiSquare (X2). Results For the diagnosis of forearm and wrist fractures, EC clinicians present 86,8% (1309/1508) correct responses (p=0.68) and, for the course of action, 78% (278/354) correct responses (p=0.09). For the overall management of the fractures (diagnostic and course of action), EC clinicians answered correctly to 84,9% (1585/1866) and incorrectly to 15,1% (281/1866), although the difference by each EC clinician group.was not significant (p=0.72). Conclusion In Western Cape, EC doctors appear to fare better than reported in the literature. However, this can not be shown definitively with this dataset. Regular training is necessary for all clinicians working in EC to improve their skills in managing forearm and wrist fractures, including the interpretation of X-ray imaging. Clear and good notes in the patient folder, top-quality X-ray images, good EC work environment, and improvement between doctors communication are other sets of requirements important to help to avoid errors in fracture management.
- ItemOpen AccessStrengthening prehospital clinical practice guideline implementation in South Africa: a qualitative case study(2020-04-24) McCaul, Michael; Young, Taryn; Bruijns, Stevan R; Clarke, MikeBackground Methods on developing new (de novo) clinical practice guidelines (CPGs) have received substantial attention. However, research into alternative methods of CPG development using existing CPG documents (CPG adaptation) — a specific issue for guideline development groups in low- and middle-income countries — is sparse. There are only a few examples showcasing the pragmatic application of such alternative approaches in settings with time and budget constraints, especially in the prehospital setting. This paper aims to describe and strengthen the methods of developing prehospital CPGs using alternative guideline development methods through a case study design. Methods We qualitatively explored a CPG development project conducted in 2016 for prehospital providers in South Africa as a case study. Key stakeholders, involved in various processes of the guideline project, were purposefully sampled. Data were collected from one focus group and six in-depth interviews and analysed using thematic analysis. Overarching themes and sub-themes were inductively developed and categorised as challenges and recommendations and further transformed into action points. Results Key challenges revolved around guideline implementation as opposed to development. These included the unavoidable effect of interest and beliefs on implementing recommendations, the local evidence void, a shifting implementation context, and opposing end-user needs. Guideline development and implementation strengthening priority actions included: i) developing a national end-user document; ii) aligning recommendations with local practice; iii) communicating a clear and consistent message; iv) addressing controversial recommendations; v) managing the impact of interests, beliefs and intellectual conflicts; and vi) transparently reporting implementation decisions. Conclusion The cornerstone of a successful guideline development process is the translation and implementation of CPG recommendations into clinical practice. We highlight key priority actions for prehospital guideline development teams with limited resources to strengthen guideline development, dissemination, and implementation by drawing from lessons learnt from a prehospital guideline project conducted in South Africa.
- ItemOpen AccessThe availability of acute care resources to treat major trauma in different income settings: a self-reported survey of acute care providers(2019) Alibhai, Alyshah Zulfikar; Bruijns, Stevan R; Hendrikse, ClintIntroduction: Injury and violence is a neglected global health problem, despite being largely predictable and therefor preventable. This study aimed to indirectly describe and compare the availability of resources to manage major trauma between high income, and low- to middle-income countries, as self-reported by delegates at the 2016 International Conference on Emergency Medicine held in Cape Town, South Africa. Materials and methods: A survey was distributed to delegates at the International Conference on Emergency Medicine 2016, Cape Town to achieve the study aim. The survey instrument was based on the 2016 NICE guidelines for the management of patients with major trauma. It captured responses from participants working in both pre- and in hospital settings. Responses were grouped according to income group (either high income, or low- to middle-income) based on the responding delegate’s nationality (using the World Bank definition for income group). A Fisher’s Exact test was conducted to compare delegate responses Results: The survey was distributed and opened by 980 delegates, of whom 392 (40%) responded. A total of 206 (53%) respondents were from high-income countries and 186 (47%) were from low- to middle-income countries. Responders of this self-reported survey described a significant discrepancy between the resources and services available to high income countries s and low- to middle-income countries to adequately care for major trauma patients both pre- and in-hospital. Shortages ranged from consumables to analgesia, imaging to specialist services, pre-hospital to in-hospital. Discussion: Resource restriction is a major concern in the care for major trauma patients in low- to middle-income countries. Current accepted reference standards does not take the resource restrictions that apply to the vast majority of the world’s injured patients into account. More research is required to describe the problem of resource restrictions in low to middle-income countries, and then working out how to overcome it.