Browsing by Author "Khan, Waseela"

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    Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital
    (2023) Mbanga, Kedibone; Khan, Waseela
    Introduction: Paracetamol is frequently ingested for intentional self-poisoning. N-acetylcysteine (NAC) is administered to patients at risk of developing hepatotoxicity and was historically administered using a three-bag intravenous regimen. A change towards a two-bag NAC regimen was initiated at Khayelitsha Hospital. The aim of the study was to describe the clinical outcomes in patients with a history of paracetamol ingestion who were treated with the two-bag NAC regimen. A descriptive comparison to a historical cohort of patients treated with the three-bag NAC regimen was also made. Methods: A retrospective chart review was conducted to assess a 6-month clinical audit. Summary statistics were used to describe all variables. Results: Overall, 57 patients were included (mean age 26 years, 83% female). The median ingested dose (10 g) was similar between the regimens. An empiric indication occurred more in patients receiving the two-bag regimen (84.0% versus 50.0%). The median paracetamol level (231 umol/L) and the proportion of confirmed paracetamol toxicity (32%) were less in the two-bag regimen. A delay in initiating the first NAC infusion occurred in 22 (38.6%) patients. Forty adverse effects were recorded in 22 (38.6%) patients and a higher proportion occurred in the two-bag regime (44.0% vs. 34.4%). Nausea and vomiting occurred frequently (n=30, 52.7%), which were comparable for both regimens. The prevalence of hepatotoxicity after receiving NAC was 8.8% (n=5). Conclusion: A large number of patients were empirically started on NAC with a higher incidence of adverse reactions in the two-bag NAC than in the three-bag NAC regimen in contrast to existing evidence. However, there was a reduction in treatment delay in the two-bag NAC regimen compared to the three-bag NAC regimen.
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    Curriculum renewal in acute care: a South African based study for returning Cuban-trained students
    (2025) Khan, Waseela; Jansen, Marvin; Cilliers, Francois
    Background: Emergency Care plays an integral role in Universal Health Coverage (UHC), yet several limitations have been identified in Low- and Middle-Income Countries (LMIC), one of which is the lack of dedicated, integrated curricula. In 1996 the Nelson Mandela Fidel Castro (NMFC) student program was developed in response to societal health needs for equitable health care in rural and under-served areas, affirmative action, and the low doctor-to-population ratios nationally. Cuban medical education is Primary Health Care focussed and not aligned with Acute Care competencies. This study explores the NMFC students' needs, the barriers to learning, and the role of transition in this process, as a first integral step in curriculum renewal in Acute Care. Methods: A qualitative approach of focus group interviews with 18 UCT NMFC students and semi-structured interviews with preceptors was conducted. Data was then analysed thematically and with the lens of the chosen theoretical framework framed by Transition theory and Situated Learning theory. Results: The findings indicate that skills and simulation-based teaching methodologies are favoured. A structured orientation within an Acute Care transition program and supervised and integrated workplace supervision is needed. Barriers to student learning include time, a perceived sense of ‘othering,' and educational ‘differences' to Cuban training. NMFC students were identified for their willingness to learn. Preceptors further identified a lack of dedicated time for Acute Care and a lack of resources as barriers to facilitation. Conclusions: As socially responsible educators we must be considerate of student needs and respond with a robust curriculum. The challenge is designing a curriculum in Acute Care that addresses the specific learning needs of a group of designated adult learners from previously disadvantaged backgrounds, transitioning between institutions with different educational outcomes, in the care of undifferentiated critically ill patients, within the short timeframes in resource-constrained educational and health institutions. Recommendations include the addition of a robust transition program to integrate, orientate and scaffold Acute Care knowledge and skills deficits. The curriculum must include skills and simulation-based methodologies for ‘hands-on' practice, opportunities for self-directed learning, and situated learning within supportive communities of practice.
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    Initiating the development of a South African curriculum for education in Neonatal Critical Care Transfers
    (2022) Williams, West; Stassen, Willem; Theron, Elzarie; Khan, Waseela
    Background Owing to limited neonatal care resources, the transfer of neonates to district and tertiary facilities is inevitable in a Low- and Middle-Income Country (LMIC) such as South Africa. The lack of neonatal transport is one of the top ten avoidable causes of under-5 mortality. In South Africa, these transfers are mostly conducted by Advanced Life Support (ALS) Providers with limited neonatal specific education. The transfer of neonates by teams with limited neonatal knowledge can lead to high adverse event rates. Dedicated Critical Care Retrieval Services (CCRS) teams have providers with additional education in neonatal critical care transfers and have shown a lower risk of adverse events in developed settings. Given the limited neonatal education of ALS providers that conduct transfers and the lack of dedicated CCRS teams in South Africa, it is the aim of this study to initiate the development of a neonatal critical care transfer curriculum. Methods A general and targeted needs assessment was conducted through semi-structured interviews with experts in the field and a focus group discussion with a learner group. The voice recordings were transcribed verbatim and data were analysed inductively, using content analysis to the manifest level. Results Six experts in neonatal critical care transfers participated in semi-structured interviews with a mean duration of 59 minutes (51-68min). Following transcription and analysis, 372 codes were extracted. Seven learners that involved in neonatal transfers in South Africa participated in a semi-structured focus group discussion with a duration of 91 minutes. The audio recording was transcribed and analysed with 97 codes extracted. The main categories were: Current status of neonatal CCR in South Africa; Learning and education in neonatal CCR; and proposed curriculum structure. The proposed curriculum structure described 13 broad course outcomes to be delivered as a blended postgraduate programme. Participants noted that funding, employer buy-in and internet resources would be required. The targeted student group should be all ALS providers with a change in their scope of practice on completion. Conclusion This study described the specific needs of prehospital learners as it pertains to the teaching, learning and assessment (TLA) of a curriculum in neonatal critical care transfers. It also described some of the limitations in the current and past education systems in neonatal critical care transfers. This study provides broad course outcomes and the results can be used to inform the next steps in curriculum development for education in neonatal critical care transfers.
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    The development of consensus-based pre-hospital core competencies and outcomes as a component of specialist emergency physician training - a South African-based study
    (2025) Vlok, Neville; Khan, Waseela; Stassen, Willem
    BACKGROUND: South African Emergency Medicine registrars undertake between one and three-month pre-hospital work placements as a component of the specialist training programme. Anecdotally, the experiences of trainees nationally vary substantially which may be attributed to the lack of a curriculum to guide expected graduate outcomes, teaching, learning or assessment in Pre-Hospital Emergency Medicine (PHEM). Although efforts are underway to renew the EM curriculum in SA by the College of Emergency Medicine (CEM), this is the first body of research dedicated towards a pre-hospital curriculum for South African EM specialist training. AIM: To seek consensus on expected graduate level pre-hospital core competencies and generate broad learning outcomes for the SA EM specialist training curriculum. METHODS: A modified nominal group technique (NGT) was used to derive PHEM competencies and outcomes for specialist trainees. A scoping review of the literature informed the NGT by extrapolating global pre-hospital competencies and outcomes for registrars. Fourteen experts in either pre-hospital education and/or practice and specialist EM physicians were purposively recruited. A summary of core competencies and outcomes were presented to the panel over two virtual sessions. PHEM core competencies and broad-level outcomes were generated through consensus and context-specific gaps in the international literature were addressed and suggestions also presented for consensus. RESULTS The panel concluded that the WHO Emergency Care Systems Framework (ECSF) was appropriate to organise competencies and outcomes. The consensus process yielded 6 core competencies and 36 broad-level outcomes; eleven outcomes for scene response, 21 for transport and 4 for facility. CONCLUSION: The consensus process allowed researchers to design a curriculum framework for a PHEM module which can inform the specialist training curriculum for the CEM SA. Aviation for Health Care Provider and Hospital Major Incident Medical Management and Support courses potentially address specific outcomes. Self-directed and experiential learning have been highlighted as crucial teaching-learning methodologies, and opportunities identified for transprofessional collaboration. The results reported here could be used in the next steps of curriculum development.