Browsing by Author "Matthews, Ryan"

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    A description of practices of analgesia administration by advanced life support paramedics in the City of Cape Town
    (2016) Matthews, Ryan; Smith, Wayne
    Introduction: Emergency Medical Services (EMS) are ideally placed to provide relief of acute pain and discomfort. EMS frequently follow locally prescribed guidelines and have a variety of qualifications each with differing capabilities and scopes of practice. The objectives of this study are to describe prehospital pain management practices by EMS in the Western Cape, South Africa. Methods: A retrospective descriptive survey was undertaken of analgesic drug administration by advanced life support (ALS) paramedics. Patient care records (PCRs) generated in t he City of Cape Town during an 11 month period containing administrations of Morphine, Ketamine, Nitrates and 50% Nitrous Oxide/Oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. Results: A total of 530 PCRs were included (N=530). Morphine was administered in 70% (95% CI 66 - 74, n=371) of cases, Nitrates in 37 %(95% CI 33 - 41, n=197) and Ketamine in 1.7% (95% CI 1 - 3, n=9) of cases. A total of 5mg or less of Morphine was administered in 75% (95% CI 70 - 79, n=278), with the mean dose being 4mg (IQR 3 - 6). Single doses were administered in 72.2% (95% CI, 67 - 77, n=268) of Morphine administrations, 56% (95% CI, 21 - 86, n=5) of Ketamine administrations and 82% (95% CI, 76 - 87, n=161) of Nitrate administrations. Chest pain was the reason for pain management in 43% (n=226) of cases. ALS providers have a median experience level of 2 years (IQR2 - 4). Conclusion: ALS providers in the Western Cape appear to use low doses of Morphine, with most analgesia administered as a single dose. Chest pain is an important reason for drug administration in acute prehospital pain. Paramedics do not appear to be using a weight based nor a titration based strategy.
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    Investigating the influence of thermomechanical variables on ridging in aisi 430 stainless steel
    (2001) Matthews, Ryan; Knutsen, Robert D
    The phenomenon of ridging is known to occur in most ferritic stainless steels and is manifested during deformation of sheet material. It results in the formation of a corrugated profile with ridges always elongated in the rolling direction of the sheet and are typically around 1 mm in wavelength. The formation of a ridged profile, while not having a detrimental effect of the mechanical properties, results in the product having an unatractive surface finish. Thus there is a drive to find a thermomechanical process to minimise the severity of ridging in the final sheet product. In this regard, the purpose of this investigation was to establish the influence of three thermomechanical (TMP) variables on the ridging severity. The samples in this investigation represented: two zones of the initial starting structure, with equiaxed of solunar grains; four hot rolling finish temperatures (HRFT), 700°C, 800°C, 900°C and 1000°C; and two colling methods after hot rolling, quench and slow cool versus slow cool. Each sample completed the TMP cycle, was elongated to 20% strain and the topography on the surface measured and compared.
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    Shaping the undergraduate pain management curriculum in prehospital emergency care education: toward a curriculum and competency framework for South Africa
    (2025) Matthews, Ryan; Hodkinson, Peter; Naidoo, Navindhra
    Introduction: Managing patients' pain is a common necessity in Prehospital Emergency Care. Research evidence suggests that pain and nociception are not optimally managed by Emergency Medical Services. One reason for this suboptimal management may be education that is misaligned with clinical and contextual needs. The knowledge gap is that Prehospital Emergency Care has not systematically developed evidence-informed competencies for pain management. Aim: This research aimed to develop a competency framework and provide recommendations for curriculum implementation to shape and guide the design of contextually relevant pain management curricula in South African Prehospital Emergency Care education. Methods: Subsequent to a narrative analysis of pain discourse, the research employed a scoping review of therapies to identify quality and therapeutic possibilities as evidentiary basis for competencies. Semi-structured interviews with educators explored contemporary education practice and documented knowledge broker perspectives on educational needs through thematic analysis. The initial competency framework was inductively derived from the above analyses. Content analysis of contemporary curriculum documents mapped key graduate attributes and identified deficient or absent learning intentions and related success criteria. An expert consensus panel provided critical input into the draft competency framework and made recommendations toward curriculum implementation. Findings: Contemporary curricula are fragmented and misaligned with pain assessment and management needs. Seven competency domains (given expression to by specific competency statements) should guide curriculum development: 1. Clinical Pain Praxis, 2. Foundational Sciences, 3. Practitioner Wellness and Safety, 4. Communication and Collaboration, 5. Duty of Care and Predisposition for Caring, 6. Ethical Practice, and 7. Scholarship. The expert panel made ten recommendations for implementing the framework in curricula, including the use of a ‘spiral' curriculum, focusing on the multidimensional nature of pain, and building relationships with clinical mentors. Conclusion: The novel output of the study is an evidence-based competency framework, compatible with micro credentialing or for local adaptation and progressive inclusion into emergency care curricula. This framework redresses the practice difficulties experienced by key stakeholders and enables higher education institutions and professional regulators to comprehensively and inclusively guide education providers in the noble pursuit of quality and equity in pain assessment and management across the lifespan and across clinical acuity and pain causation.