OpenUCT :: Browsing by Author "Geduld, Heike"

Browsing by Author "Geduld, Heike"

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Open Access
Assessment of routine laboratory screening of adult psychiatric patients presenting to an emergency centre in Cape Town
(2011) Crede, Andrea; Geduld, Heike; Wallis, Lee
Our study suggests that routine laboratory screening provides no additional information to that obtained from a thorough history and clinical examination in patients at high risk of having an underlying medical cause of presenting psychotic symptoms.
Open Access
Attrition amongst Emergency Medicine Registrars in the Western Cape: an exploration of contributing factors
(2018) Van Koningsbruggen, Candice Ann; Geduld, Heike; Hendrikse, Clint
Background. Attrition of registrars impedes the development of Emergency Medicine (EM) in South Africa and Africa, which negatively affects health systems strengthening. Factors relating to attrition of registrars in the EM training program in the Western Cape had not previously been explored. Understanding these factors will enable the development of a framework to be used to conduct formal exit interviews. This exit interview will allow the Division to continually document and address factors related to attrition. Objectives. To explore the factors contributing towards attrition amongst EM Registrars in the Western Cape, to enable a framework for a formal exit interview to be developed. Methods. An explorative qualitative study was conducted using semi-structured interviews. Data was analysed using NVivo software and thematic qualitative analysis. Results. Seven participants were interviewed (5 female and 2 male; ages 28-33). They joined the EM training program at different times (2005-2013) and their time spent in the program varied (8 months to 20 months). Despite their diverse histories, they voiced similar concerns regarding the training program (i.e. lack of support, unsociable hours), regarding relationships (i.e. motherhood, family time), and also with regards to self (i.e. burnout, work-life balance). Conclusion. This study highlights the need for a formal exit interview to address attrition in the Division of EM. The framework for the exit interview should encompass factors related to self, relationships and the training program.
Open Access
Emergency medicine registrars' attitudes towards youth violence prevention interventions in Cape Town emergency centres
(2017) De Man, Martin; Ward, Catherine; Geduld, Heike
Background: The City of Cape Town, South Africa, has a large youth violence problem with the highest percentage of non-natural deaths per age group in Cape Town occurring between 15 and 24 years of age. Many authorities suggest that youth violence is preventable and there is a fast growing international knowledge base on how emergency centres (ECs) and EC personnel can contribute to youth violence prevention (YVP). In order to utilise this opportunity most effectively, it is important to understand the challenges faced by EC staff, their perceptions of youth violence, and their willingness to engage in YVP interventions in the EC. There is currently no known EC-based YVP intervention in South Africa. Objectives: This study explored the perceptions and attitudes of Cape Town emergency medicine doctors on youth violence, their role in YVP and how it applies to their practice in the EC. Methods: Semi-structured focus groups, each with 3-5 Cape Town emergency medicine (EM) registrars, were conducted, using five basis questions for discussion to elicit participants' perceptions of and attitudes towards YVP. Data saturation was reached after three focus groups. Thematic analysis as described by Braun and Clarke was carried out on the focus group data sets. Results: The three focus groups were all diverse in terms of race, gender, and level of training. In terms of the "Extent of the problem" themes around acceptability and increased burden were explored."Youth Violence Prevention in the EC" focused on the need for a champion, role of the emergency doctor vs. other stakeholders and sustainability issues. Conclusions: EM registrars in Cape Town have a very limited knowledge of YVP in general and specific to the EC. They are faced with immense challenges that relate to patient load, violence directed to EC personnel, and a sense of despair or despondence in terms of ability to effect change. Concerns about the possible implementation of YVP interventions were sustained funding and sustainability in general. These and other factors influenced attitudes towards EC initiated YVP. Notwithstanding challenges, this study has shown an overwhelmingly positive attitude of EM registrars towards the concept of YVP intervention in the EC, and them being the champion or co-champion of it. Recommendations: It is recommended that EM registrars in their training time should receive theoretical and practical training on YVP which can lead to increased awareness of YVP issue, the need to know resources in the community, and in the future will make it easier to implement a pilot intervention project in a selected EC. Further research is needed on a relevant screening tool to identify high risk patients in local ECs.
Open Access
Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): results of research prioritisation setting exercise
(2020-08-31) Lecky, Fiona E; Reynolds, Teri; Otesile, Olubukola; Hollis, Sara; Turner, Janette; Fuller, Gordon; Sammy, Ian; Williams-Johnson, Jean; Geduld, Heike; Tenner, Andrea G; French, Simone; Govia, Ishtar; Balen, Julie; Goodacre, Steve; Marahatta, Sujan B; DeVries, Shaheem; Sawe, Hendry R; El-Shinawi, Mohamed; Mfinanga, Juma; Rubiano, Andrés M; Chebbi, Henda; Do Shin, Sang; Ferrer, Jose M E; Haddadi, Mashyaneh; Firew, Tsion; Taubert, Kathryn; Lee, Andrew; Convocar, Pauline; Jamaluddin, Sabariah; Kotecha, Shahzmah; Yaqeen, Emad A; Wells, Katie; Wallis, Lee
Abstract Background More than half of deaths in low- and middle-income countries (LMICs) result from conditions that could be treated with emergency care - an integral component of universal health coverage (UHC) - through timely access to lifesaving interventions. Methods The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt, Nepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and Phillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the strengthening of emergency care systems in limited-resource settings. Results The RPS proposed seven priority research questions addressing: identification of context-relevant emergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential quality improvement via registries; characteristics of people seeking emergency care; best practices for staff training and retention; and cost effectiveness of critical care – all within LMICs. Conclusions Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research Network project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for strengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the current evidence supporting the identified priorities.
Open Access
Identifying Procedural Core Competencies for Undergraduate Emergency Medicine Education at the University of Zimbabwe College of Health Sciences
(2018) Mtombeni, Sithembile; Geduld, Heike; Chidzonga, Midion M
Introduction: Low and middle-income countries account for over 90% of worldwide morbidity and mortality associated with injuries. While insufficient resources preclude appropriate care, suboptimal clinical skills, are a universal setback. Major curricula gaps have been identified as underlying this situation. In Africa, most training efforts are targeted at postgraduate level, relegating undergraduate Emergency Medicine (EM) education to a less formal undertaking. This study set out to delineate a list of locally appropriate undergraduate EM procedural core competencies for the University of Zimbabwe College of Health Sciences (UZCHS), through a consensus building process. Methods: A three-stage modified online Delphi survey was used to gain consensus among expert medical trainers at UZCHS, between July and August 2017. Opinion was sought on a five-point Likert scale, regarding agreement with items for inclusion on the procedural core competency list. The original survey list of 105 competencies was generated from literature. The second round included suggestions from panelists. The study was ethically cleared by the University of Cape Town, UZCHS and the Medical Research council of Zimbabwe. Results: 19 expert medical teachers, representing seven clinical departments responded to the survey, with 15 completing all rounds. 79% had more than 5 years’ experience in teaching and assessment of emergency procedures. Of these, 50% had at least 10 years’ experience. The experts reached consensus (75% selecting agree or strongly agree) on 64 competencies (61%), on the first round. The second round yielded consensus on a further 33 items. Only one additional item reached consensus in the final round. A final list of 98 core procedural competencies was generated by three Delphi rounds. Qualitative comments are summarised per emerging themes. Conclusions: A locally appropriate list of undergraduate procedural core competencies, was established. This process can serve as guidance for curriculum projects in Zimbabwe and similar settings.
Open Access
Prehospital care providers' decision to transport the patient with a suicide attempt refusing care in the Cape Town Metropole, Western Cape: A survey based on the Mental Healthcare Act of 2002
(2015) Evans, Katya; Geduld, Heike; Stassen, Willem
Anecdotally incidents of inappropriate refusal of treatment or transportation by patients referred to hospital under the Mental Healthcare Act of 2002 have been noted. There is little documented about the knowledge and understanding of prehospital providers of the mental healthcare act, their responsibilities and the issues around patient competence and refusal of care. The transportation of patients presenting with a suicide attempt who have not yet been formally assessed for involuntary admission poses a particular problem. Aim: To determine the knowledge of prehospital providers with respect to the transport of patients presenting with suicide attempts and the mental health act and to describe their management of cases where these patients may refuse treatment. Methods: A cross-sectional survey and including open ended questions of 100 prehospital providers in the Western Cape both public and private. The questionnaire will include knowledge testing, vignettes describing patient management and open-ended questions regarding their opinions on suicidal patients. Simple descriptive statistics will be used for the knowledge test. Qualitative data will be coded using a grounded theory approach. Discussion: The findings of the study will be used to determine provider knowledge and attitudes regarding the prehospital management of patients presenting with suicide attempts. Recommendations will be made for provincial EMS guidelines and the results will be disseminated in an article for publication.
Open Access
A qualitative study on 6th year medical students' perceptions of and self-reported competence in clinical practice after receiving resuscitation-based simulation training
(2016) Jansen, Marvin Jeffrey; Weiss, Rachel; Geduld, Heike
Background: Despite practicing resuscitation skills in a simulation environment, medical students often express anxiety about having to participate in patient resuscitation in the clinical environment. This fear can lead to an unwillingness to initiate or participate in resuscitations, and a decreased confidence in their skills. Exploring the perceptions of final year medical students can provide valuable insight for improving the current simulation programme at the University of Cape Town. Aim: The aim of the study is to explore 6th year medical students' perceptions and self-reported competence for clinical practice after receiving Resuscitation-Based Simulation training.
Open Access
A review of the door to needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town
(2011) Maharaj, Roshen Chathram; Geduld, Heike
The aim of this study is to determine the current door to needle time for administration of fibrinolytics in acute myocardial infarction in Emergency Centres in the Cape Metropole. This study will also aim to identify the factors contributing to the delay.
Open Access
South African paramedic perspectives on prehospital palliative care
(2020-10-08) Gage, Caleb H; Geduld, Heike; Stassen, Willem
Abstract Background Palliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice. Methods A qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings. Results Four categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist. Conclusion Challenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.
Open Access
The Perceptions of Emergency Medicine Physicians and Trainees Regarding Family Presence During Adult Patient Resuscitation in South African Public Sector Emergency Centres
(2018) McAlpine, Nicola Anita; Rajbaran, Joshna; Geduld, Heike
Introduction The benefits of family presence during adult resuscitation (FPDR) are well documented in the literature. However, despite apparent value, FPDR is not always practised. The purpose of this study was to evaluate the perceptions of Emergency Medicine physicians and specialist trainees regarding FPDR in South African public sector Emergency Centres. Method A descriptive study was undertaken, using an electronic survey which consisted of both open and closed-end questions. The Survey was distributed via email to 157 Emergency Medicine physicians and specialist trainees in South Africa. The data was collected and subjected to descriptive statistical analysis. Results Most South African Emergency Medicine physicians and trainees did not feel that FPDR interrupted patient care; did not feel it hindered the teams’ productivity; and did not believe it increases complaints about the quality of patient care. Despite this, practice of FPDR was found to be uncommon. Knowledge regarding FPDR guidelines was poor. Discussion The views of South African Emergency Medicine physicians and specialist trainees regarding FPDR is in keeping with other pro-FPDR countries. However, these views do not seem to translate into practice. FPDR education and development of local guidelines are recommended.
Open Access
The thoughts and opinions of advanced life support providers in the South African private emergency medical services sector concerning pre-hospital palliative care
(2020) Gage, Caleb Hanson; Geduld, Heike; Stassen, Willem
The World Health Organisation (WHO) defines palliative care as 'an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.' 1 This includes a wide variety of situations such as chronic illness and end-of-life care. 2 Palliative care is usually performed in-hospital. However, emergency medical services (EMS) often encounter patients requiring palliative care as these patients may have acute exacerbations of illness, progress towards end-of-life or require transport to a medical facility. 3-9 Thus, there is a role for palliative care in the pre-hospital setting. EMS providers are uniquely positioned to deliver this care in the pre-hospital setting as they are often the first point of medical contact. 10 This has great potential benefit for patient comfort, early identification and relief of suffering and earlier referral to hospice care. 10, 11 Despite this unique position there is an overall lack of guidance within EMS systems to manage palliative patients. 5, 6, 10 In the United States of America (USA), for example, only 5-6% of EMS systems have protocols for palliative care. 6, 10 In addition, there is no specific pre-hospital emergency care curricula on the subject, resulting in a lack of education and training for EMS providers. 3-5, 12, 13 This may stem from the historical focus of EMS training which primarily involves immediate measures to preserve life or limb until definitive care is reached. 11 This focus has resulted in an EMS ethos of 'saving lives.' 5, 12 Palliative care, on the other hand, is not focussed on 'saving lives', but rather the prevention and relief of suffering. 1 Therefore, palliative care may seem to conflict with emergency care, placing EMS providers in difficult situations when confronted with palliative care patients. 8, 12, 14 South Africa itself faces what has been termed a “quadruple burden of disease” due to communicable diseases such as HIV/AIDS, high maternal and paediatric mortality rates, non-communicable disease as well as injury. 15 The large number of patients suffering from these diseases and the life-limiting complications thereof, results in increased need for palliative care in the country as noted by the South African Minister of Health. 16 Access to health care for patients suffering from these diseases is a further challenge in the Sub-Saharan African setting. 17, 18, 19 In South Africa, EMS are often contacted 3 by those without access to transport to provide this service. 20 Thus, South African EMS providers may frequently encounter not only high acuity emergency patients, but many ill HIV/AIDS, cancer and other chronically ill patients requiring palliative care who are unable to access healthcare via alternative means. 21 European studies have found that approximately 3-5% of all pre-hospital calls involve palliative care situations. 2, 22, 23 With the quadruple burden of disease and limited access in the South African setting, this percentage is likely higher as these factors result in increased frequency of contact between EMS providers and patients requiring palliative care. Although EMS providers in South Africa manage palliative patients in the prehospital setting, to our knowledge, no research has been produced in the (South) African setting regarding prehospital palliative care. Outside of Africa literature has been produced but is limited. This literature review discusses paramedic perceptions of prehospital palliative care, prehospital palliative care patient management and legislation concerning prehospital palliative care. Finally, expert opinion pieces and recommendations are reviewed.
Open Access
Towards developing a consensus assessment framework for global emergency medicine fellowships
(2019-11-11) Jahn, Haiko K; Kwan, James; O’Reilly, Gerard; Geduld, Heike; Douglass, Katherine; Tenner, Andrea; Wallis, Lee; Tupesis, Janis; Mowafi, Hani O
Abstract Background The number of Global Emergency Medicine (GEM) Fellowship training programs are increasing worldwide. Despite the increasing number of GEM fellowships, there is not an agreed upon approach for assessment of GEM trainees. Main body In order to study the lack of standardized assessment in GEM fellowship training, a working group was established between the International EM Fellowship Consortium (IEMFC) and the International Federation for Emergency Medicine (IFEM). A needs assessment survey of IEMFC members and a review were undertaken to identify assessment tools currently in use by GEM fellowship programs; what relevant frameworks exist; and common elements used by programs with a wide diversity of emphases. A consensus framework was developed through iterative working group discussions. Thirty-two of 40 GEM fellowships responded (80% response). There is variability in the use and format of formal assessment between programs. Thirty programs reported training GEM fellows in the last 3 years (94%). Eighteen (56%) reported only informal assessments of trainees. Twenty-seven (84%) reported regular meetings for assessment of trainees. Eleven (34%) reported use of a structured assessment of any sort for GEM fellows and, of these, only 2 (18%) used validated instruments modified from general EM residency assessment tools. Only 3 (27%) programs reported incorporation of formal written feedback from partners in other countries. Using these results along with a review of the available assessment tools in GEM the working group developed a set of principles to guide GEM fellowship assessments along with a sample assessment for use by GEM fellowship programs seeking to create their own customized assessments. Conclusion There are currently no widely used assessment frameworks for GEM fellowship training. The working group made recommendations for developing standardized assessments aligned with competencies defined by the programs, that characterize goals and objectives of training, and document progress of trainees towards achieving those goals. Frameworks used should include perspectives of multiple stakeholders including partners in other countries where trainees conduct field work. Future work may evaluate the usability, validity and reliability of assessment frameworks in GEM fellowship training.
Open Access
Validation of weight estimation by age and length based methods in the South African population
(2008) Geduld, Heike; Wallis, Lee A
Paediatric resuscitation can be a stressful event for many clinicians. It is compounded by the need to calculate accurate drug dosages and equipment sizes for many interventions. These calculations are most often based on weight, which is a difficult parameter to obtain. It is rare that one is able to weigh a child before a resuscitation. There are many different methods available for weight estimation. Most of these are formulae based on age but length based tools are often used. Most of these formulae were derived in developed world populations and have become inaccurate due to the changing weights and heights of children. The aim of this study was to evaluate 4 weight estimation methods (APLS, Luscombe and Owens, Best Guess and Broselow® Tape) to determine which are accurate for weight estimation in South African Children. These 4 formulae were also used to calculate the doses of adrenaline (0.1 m/kg of 1: 10000), Fluid bolus (20ml/kg) and First Shock defibrillation dose (2J/Kg) to determine which were clinically useful. A database of 3233 children between 1 and 12 years seen at Red Cross Hospital· Trauma Unit in Cape Town during 2002 was used. Measured weight was compared to estimated weights from all 4 methods and Intervention doses calculated from measured weight was compared to doses from weight estimation methods. APLS formula and the Broselow® Tape showed the best correlation with measured weight. Mean percent error- 6.4% for APLS for 1-10 year olds and -10% error for Broselow® tape in children <145cm length. Both the Best Guess and Luscombe and Owens formulae tended to overestimate weight (+13.4% and +17.6 % respectively). The Broselow tape was most accurate for dosages of all interventions but little difference existed between methods. The APLS and Broselow® tape are most accurate in estimating weight in the South African population, even though they have a tendency to underestimate weight.
Open Access
Workplace violence against emergency medicine registrars and consultants, and their experience of job safety and satisfaction
(2021) Midgley, Alexandra; Saunders, Colleen; Jooste, Willem; Geduld, Heike
Background: Studies have shown that healthcare workers in Emergency Units (EUs) are at a high risk of both physical and non-physical workplace violence. While several international studies have focused on the experience of workplace violence by Emergency Medicine (EM) specialist physicians, there is a paucity of data regarding that of EM physicians in training. Objectives: This study aimed to determine the amount of workplace violence (and the subtypes thereof) perpetrated against Western Cape EM registrars and consultants, and their perceived level of, and identified barriers to and facilitators of, job safety and satisfaction. Methods: This cross-sectional study relied upon responses to a survey, electronically disseminated over a 6-week period, in May/June 2018, amongst Western Cape public sector EM registrars and consultants. The primary outcome was the incidence of workplace violence experienced. The secondary outcomes were the sub-types of workplace violence perpetrated, as well as the perceived level of job safety and satisfaction, and identified barriers thereto and facilitators thereof. Results: In total, 66% of respondents had experienced at least one act of physical violence while working in Western Cape EUs, specifically by patients. Regarding non-physical violence, 90.6% of respondents had experienced at least one act of verbal harassment, 84.9% of verbal threat, and 45.3% of sexual harassment. The rates of both physical and non-physical workplace violence (especially sexual harassment), perpetrated by patients specifically, were found to be higher in female than in male respondents. Apart from acts of verbal harassment, which were perpetrated equally by patients and visitors, all other acts of physical and nonphysical workplace violence were perpetrated at a higher rate by patients than visitors. The rates of both physical and non-physical workplace violence, perpetrated by patients specifically, were found to be higher in EM consultants than in EM registrars. The factors most commonly indicated by respondents as contributory to workplace violence were patient and/or visitor alcohol use, drug use and psychiatric illness. Other factors commonly indicated were long waiting times and unmet expectations, and resultant patient and/or visitor frustration. Conclusion: Workplace violence against EM registrars and consultants is a significant problem in Western Cape EUs. The information gained during this study will be useful in improving safety and security policies at an EU (and hospital) level. It may even be applicable at a provincial (or national) level in changing legislation, in order to reduce, and ultimately prevent, workplace violence in the EU.

Browsing by Author "Geduld, Heike"

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