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Teri A Reynolds - One of the best experts on this subject based on the ideXlab platform.

  • results from a world health organization pilot of the basic Emergency Care course in sub saharan africa
    PLOS ONE, 2019
    Co-Authors: Andrea G Tenner, Hendry R Sawe, Stas Amato, Joseph Kalanzi, Muhumpu Kafwamfwa, Heike Geduld, Nikki Roddie, Teri A Reynolds
    Abstract:

    BACKGROUND Frontline providers around the world deliver Emergency Care daily, often without prior dedicated training. In response to multiple country requests for open-access, basic Emergency Care training materials, the World Health Organization (WHO), in collaboration with the International Committee of the Red Cross (ICRC) and the International Federation for Emergency Medicine (IFEM), undertook development of a course for health Care providers-Basic Emergency Care: Approach to the acutely ill and injured (BEC). As part of course development, pilots were performed in Uganda, the United Republic of Tanzania, and Zambia to evaluate course feasibility and appropriateness. Here we describe participant and facilitator feedback and pre- and post-course exam performance. METHODS A mixed methods research design incorporated pre- and post-course surveys as well as participant examination results to assess the feasibility and utility of the course, and knowledge transfer. Quantitative data were analyzed using Stata, and simple descriptive statistics were used to describe participant demographics. Survey data were coded and grouped by themes and analyzed using ATLAS.ti. RESULTS Post-course test scores showed significant improvement (p-value < 0.05) as compared to pre-course. Pre- and post-course questionnaires demonstrated significantly increased confidence in managing Emergency conditions. Participant-reported course strengths included course appropriateness, structure, language level and delivery methods. Suggested changes included expanding the 4-day duration of the course. CONCLUSION This pilot demonstrates that a low-fidelity, open-access course taught by local instructors can be successful in knowledge transfer. The BEC course was well-received and deemed context-relevant by pilot facilitators and participants in three East African countries. Further studies are needed to evaluate this course's impact on clinical practice and patient outcomes.

  • reconceptualizing the role of Emergency Care in the context of global healthCare delivery
    Health Policy and Planning, 2019
    Co-Authors: Lee A Wallis, Teri A Reynolds, Lucas C Carlson, Emilie Calvello J Hynes
    Abstract:

    : Since the adoption of the Sustainable Development Goals in 2015, innovation in global healthCare delivery has been recognized as a vital avenue for strengthening health systems and overcoming present implementation bottlenecks. In the recent rapid development of the science of global health-Care delivery, Emergency Care-a critical element of the health system-has been widely overlooked. Emergency Care plays a vital role in the health system through providing immediately responsive Care and serving as one of the main entry points for those with symptomatic disease. We present a new perspective on Emergency Care's role in the health system within the context of global health-Care delivery, and argue that, if properly integrated, Emergency Care has the potential to add significant value across the healthCare continuum. Capitalizing on Emergency Care as a shared delivery infrastructure presents opportunities to increase efficiency not only in treatment of time-sensitive conditions, but also for secondary prevention through its capacity to promote early disease detection and enhance coordination of Care. We propose an integrated Emergency Care delivery value chain, demonstrating Emergency Care's critical position as a point of access to the greater health system and its key connections to longitudinal Care delivery, which remain under-developed in low- and middle-income country health systems. As Emergency Care systems are created within emerging and established health systems, this role can be more effectively leveraged by policy makers and healthCare leaders globally to promote progress towards the Sustainable Development Goals.

  • operationalising Emergency Care delivery in sub saharan africa consensus based recommendations for healthCare facilities
    Emergency Medicine Journal, 2016
    Co-Authors: Emilie J B Calvello, Andrea G Tenner, Morgan C Broccoli, Alexander P Skog, Andrew Muck, Janis P Tupesis, Petra Brysiewicz, Sisay Teklu, Lee A Wallis, Teri A Reynolds
    Abstract:

    A major barrier to successful integration of acute Care into health systems is the lack of consensus on the essential components of Emergency Care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of Emergency Care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on Emergency Care delivery at health facilities. Using the well-established approach developed in the WHO9s Monitoring Emergency Obstetric Care , the workgroup identified the essential services delivered—signal functions—associated with each Emergency Care sentinel condition. Levels of Emergency Care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing Emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery.

  • the state of Emergency Care in democratic republic of congo
    African Journal of Emergency Medicine, 2015
    Co-Authors: Luc Malemo Kalisya, Margaret Salmon, Kitoga Manwa, Mundenga Mutendi Muller, Ken Diango, Rene Zaidi, Sarah K Wendel, Teri A Reynolds
    Abstract:

    The Democratic Republic of Congo (DRC) is the second largest country on the African continent with a population of over 70million. It is also a major crossroad through Africa as it borders nine countries. Unfortunately, the DRC has experienced recurrent political and social instability throughout its history and active fighting is still prevalent today. At least two decades of conflict have devastated the civilian population and collapsed healthCare infrastructure. Life expectancy is low and government expenditure on health per capita remains one of the lowest in the world. Emergency Medicine has not been established as a specialty in the DRC. While the vast majority of hospitals have Emergency rooms or salle des urgences , this designation has no agreed upon format and is rarely staffed by doctors or nurses trained in Emergency Care. Presenting complaints include general and obstetric surgical emergencies as well as respiratory and diarrhoeal illnesses. Most patients present late, in advanced stages of disease or with extreme morbidity, so mortality is high. Epidemics include HIV, cholera, measles, meningitis and other diarrhoeal and respiratory illnesses. Lack of training, lack of equipment and fee-for-service are cited as barriers to Care. Pre-hospital Care is also not an established specialty. New initiatives to improve Emergency Care include training Congolese physicians in Emergency medicine residencies and medic ranger training within national parks.

  • research priorities for data collection and management within global acute and Emergency Care systems
    Academic Emergency Medicine, 2013
    Co-Authors: Teri A Reynolds, Mark Bisanzo, Daniel A Dworkis, Bhakti Hansoti, Ziad Obermeyer, Phil Seidenberg, Mark Hauswald, Hani Mowafi
    Abstract:

    Barriers to global Emergency Care development include a critical lack of data in several areas, including limited documentation of the acute disease burden, lack of agreement on essential components of acute Care systems, and a lack of consensus on key analytic elements, such as diagnostic classification schemes and regionally appropriate metrics for impact evaluation. These data gaps obscure the profound health effects of lack of Emergency Care access in low- and middle-income countries (LMICs). As part of the Academic Emergency Medicine consensus conference "Global Health and Emergency Care: A Research Agenda," a breakout group sought to develop a priority research agenda for data collection and management within global Emergency Care systems.

Henriette A Moll - One of the best experts on this subject based on the ideXlab platform.

  • validity of the manchester triage system in Emergency Care a prospective observational study
    PLOS ONE, 2017
    Co-Authors: Joany M Zachariasse, Nienke Seiger, Pleunie P M Rood, Claudio F Alves, Paulo B De Freitas, Frank J Smit, Gert R Roukema, Henriette A Moll
    Abstract:

    textabstractObjectives To determine the validity of the Manchester Triage System (MTS) in Emergency Care for the general population of patients attending the Emergency department, for children and elderly, and for commonly used MTS flowcharts and discriminators across three different Emergency Care settings. Methods This was a prospective observational study in three European Emergency departments. All consecutive patients attending the Emergency department during a 1-year study period (2010-2012) were included. Validity of the MTS was assessed by comparing MTS urgency as determined by triage nurses with patient urgency according to a predefined 3-category reference standard as proxy for true patient urgency. Results 288,663 patients were included in the analysis. Sensitivity of the MTS in the three hospitals ranged from 0.47 (95%CI 0.44-0.49) to 0.87 (95%CI 0.85-0.90), and specificity from 0.84 (95%CI 0.84-0.84) to 0.94 (95%CI 0.94-0.94) for the triage of adult patients. In children, sensitivity ranged from 0.65 (95%CI 0.61-0.70) to 0.83 (95%CI 0.79-0.87), and specificity from 0.83 (95%CI 0.82-0.83) to 0.89 (95%CI 0.88-0.90). The diagnostic odds ratio ranged from 13.5 (95%CI 12.1-15.0) to 35.3 (95%CI 28.4-43.9) in adults and from 9.8 (95%CI 6.7-14.5) to 23.8 (95%CI 17.7-32.0) in children, and was lowest in the youngest patients in 2 out of 3 settings and in the oldest patients in all settings. Performance varied considerably between the different Emergency departments. Conclusions Validity of the MTS in Emergency Care is moderate to good, with lowest performance in the young and elderly patients. Future studies on the validity of triage systems should be restricted to large, multicenter studies to define modifications and improve generalizability of the findings.

  • validity of telephone and physical triage in Emergency Care the netherlands triage system
    Family Practice, 2011
    Co-Authors: Yvette Van Ierland, Mirjam Van Veen, Linda Huibers, Paul Giesen, Henriette A Moll
    Abstract:

    Background Due to Emergency Care overcrowding, right Care at the right place and time is necessary. Uniform triage of patients contacting different Emergency Care settings will improve quality of Care and communication between health Care providers. Objective Validation of the computer-based Netherlands Triage System (NTS) developed for physical triage at Emergency departments (EDs) and telephone triage at general practitioner cooperatives (GPCs). Methods Prospective observational study with patients attending the ED of a university-affiliated hospital (September 2008 to November 2008) or contacting an urban GPC (December 2008 to February 2009). For validation of the NTS, we defined surrogate urgency markers as best proxies for true urgency. For physical triage (ED): resource use, hospitalization and follow-up. For telephone triage (GPC): referral to ED, self-Care advice after telephone consultation or GP advice after physical consultation. Associations between NTS urgency levels and surrogate urgency markers were evaluated using chi-square tests for trend. Results We included nearly 10 000 patients. For physical triage at ED, NTS urgency levels were associated with resource use, hospitalization and follow-up. For telephone triage at GPC, trends towards more ED referrals in high NTS urgency levels and more self-Care advices after telephone consultation in lower NTS urgency levels were found. The association between NTS urgency classification and GP advice was less explicit. Similar results were found for children; however, we found no association between NTS urgency level and GP advice. Conclusions Physically and telephone-assigned NTS urgency levels were associated with majority of surrogate urgency markers. The NTS as single triage system for physical and telephone triage seems feasible.

  • manchester triage system in paediatric Emergency Care prospective observational study
    BMJ, 2008
    Co-Authors: M Van Veen, Ewout W Steyerberg, Madelon Ruige, Alfred H J Van Meurs, Jolt Roukema, Henriette A Moll
    Abstract:

    Objective To validate use of the Manchester triage system in paediatric Emergency Care. Design Prospective observational study. Setting Emergency departments of a university hospital and a teaching hospital in the Netherlands, 2006-7. Participants 17 600 children (aged Intervention Nurses triaged 16 735/17 600 patients (95%) using a computerised Manchester triage system, which calculated urgency levels from the selection of discriminators embedded in flowcharts for presenting problems. Nurses over-ruled the urgency level in 1714 (10%) children, who were excluded from analysis. Complete data for the reference standard were unavailable in 1467 (9%) children leaving 13 554 patients for analysis. Main outcome measures Urgency according to the Manchester triage system compared with a predefined and independently assessed reference standard for five urgency levels. This reference standard was based on a combination of vital signs at presentation, potentially life threatening conditions, diagnostic resources, therapeutic interventions, and follow-up. Sensitivity, specificity, and likelihood ratios for high urgency (immediate and very urgent) and 95% confidence intervals for subgroups based on age, use of flowcharts, and discriminators. Results The Manchester urgency level agreed with the reference standard in 4582 of 13 554 (34%) children; 7311 (54%) were over-triaged and 1661 (12%) under-triaged. The likelihood ratio was 3.0 (95% confidence interval 2.8 to 3.2) for high urgency and 0.5 (0.4 to 0.5) for low urgency; though the likelihood ratios were lower for those presenting with a medical problem (2.3 (2.2 to 2.5) v 12.0 (7.8 to 18.0) for trauma) and in younger children (2.4 (1.9 to 2.9) at 0-3 months v 5.4 (4.5 to 6.5) at 8-16 years). Conclusions The Manchester triage system has moderate validity in paediatric Emergency Care. It errs on the safe side, with much more over-triage than under-triage compared with an independent reference standard for urgency. Triage of patients with a medical problem or in younger children is particularly difficult.

Owais Raza - One of the best experts on this subject based on the ideXlab platform.

  • weaknesses and capacities affecting the prehospital Emergency Care for victims of road traffic incidents in the greater kampala metropolitan area a cross sectional study
    Prehospital and Disaster Medicine, 2019
    Co-Authors: Joseph Kimuli Balikuddembe, Ali Ardalan, Davoud Khorasanizavareh, Amir Nejati, Owais Raza
    Abstract:

    Introduction: Prehospital Emergency Care is a vital and integral component of health systems, particularly in resource-constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities, and trauma caused by road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the prehospital Emergency Care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA). Methods: A cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims’ pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions, respectively. Data were descriptively analyzed, and a principal component analysis was employed to identify the most influential weaknesses and capacities affecting the prehospital Emergency Care for the victims of RTI in the GKMA. Results: From 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 20164. key weaknesses and 5 key capacities were identified to affect the prehospital Emergency Care for RTI victims in the GKMA. Although some strengths exist, (e.g., ambulance facilitation, EMS structuring, and coordination), the key weaknesses affecting the pre-hospital Care for victims were noted to relate to the absence of predefined EMS systems, particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment, insufficient skills/training of the first responders, inadequate EMS resources, and avoidable delays to respond and transport RTI victims to medical facilities. Discussion: Though some strengths exist, the weaknesses affecting prehospital Care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.

  • weaknesses and capacities affecting the prehospital Emergency Care for victims of road traffic incidents in the greater kampala metropolitan area a cross sectional study
    BMC Emergency Medicine, 2017
    Co-Authors: Joseph Kimuli Balikuddembe, Ali Ardalan, Davoud Khorasanizavareh, Amir Nejati, Owais Raza
    Abstract:

    Pre-hospital Emergency Care is a vital and integral component of health systems particularly in the resource constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities and trauma caused by the road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the pre-hospital Emergency Care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA). A cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims’ pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions respectively. Data was descriptively analyzed, and after the principal component analysis was employed to identify the most influential weaknesses and capacities affecting the pre-hospital Emergency Care for the victims of RTI in the GKMA. From 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 2016, 4 and 5 key weaknesses and capacities respectively were identified to affect the pre-hospital Emergency Care for RTI victims in the GKMA. Although some strengths exist like ambulance facilitation, EMS structuring, coordination and others), the key weaknesses affecting the pre-hospital Care for victims were noted to relate to absence of predefined EMS systems particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment; insufficient skills/training of the first responders; inadequate EMS resources; and avoidable delays to respond and transport RTI victims to medical facilities. Though some strengths exist, the weaknesses affecting prehospital Care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.

Jeremy S Brown - One of the best experts on this subject based on the ideXlab platform.

  • the Emergency Care of patients with cancer setting the research agenda
    Annals of Emergency Medicine, 2016
    Co-Authors: Jeremy S Brown, Ziad Obermeyer, Corita R Grudzen, Demetrios N Kyriacou, Tammie E Quest, Donna Rivera, Susan Stone, Jason D Wright, Nonniekaye Shelburne
    Abstract:

    To identify research priorities and appropriate resources and to establish the infrastructure required to address the Emergency Care of patients with cancer, the National Institutes of Health's National Cancer Institute and the Office of Emergency Care Research sponsored a one-day workshop, "Cancer and Emergency Medicine: Setting the Research Agenda," in March 2015 in Bethesda, MD. Participants included leading researchers and clinicians in the fields of oncology, Emergency medicine, and palliative Care, and representatives from the National Institutes of Health. Attendees were charged with identifying research opportunities and priorities to advance the understanding of the Emergency Care of cancer patients. Recommendations were made in 4 areas: the collection of epidemiologic data, Care of the patient with febrile neutropenia, acute events such as dyspnea, and palliative Care in the Emergency department setting.

  • national institutes of health support for clinical Emergency Care research 2011 to 2014
    Annals of Emergency Medicine, 2016
    Co-Authors: Jeremy S Brown
    Abstract:

    Study objective I report on the results of a portfolio analysis of National Institutes of Health (NIH) support for clinical Emergency Care research. Methods A targeted query was created with data-mining techniques that accessed the NIH database for 2011 to 2014. The search was constructed to have a clinical focus; animal and bench research projects, as well as Career development grants, were excluded. The search results were manually reviewed for appropriateness and then analyzed. Results Six-hundred eighty-eight applications were analyzed. During the study period, the number of new Emergency Care projects submitted to NIH increased from 62 in 2011 to 153 in 2014. A total of 112 new applications were funded for $100 million, with an overall success rate of 23%. The total amount of support for both new and existing projects during the 4-year study period was $263 million. One third of the funded principal investigators were Emergency medicine faculty, and their success rate for R01 funding was twice the NIH average. Conclusion Emergency Care research makes up 0.7% of NIH spending on new research project grants. The success rate is high for Emergency medicine principal investigators conducting clinical work. The overall success rate for Emergency medicine R01s is similar to that of other clinical specialties.

Robert W Neumar - One of the best experts on this subject based on the ideXlab platform.

  • facilitating Emergency Care research networks integration into the clinical translational and science award ctsa infrastructure
    Academic Emergency Medicine, 2009
    Co-Authors: Judd E Hollander, Mark D Courtney, Glen N Gaulton, Roger J Lewis, Robert A Lowe, Mark O Becker, Robert W Neumar
    Abstract:

    Emergency Care research (ECR) does not fit neatly into the traditional National Institutes of Health (NIH) funding model, because Emergency research involves undifferentiated disease presentations involving multiple disciplines and time-sensitive interventions. A task force of Emergency Care researchers and other stakeholders was convened to discuss the present and future state of clinical research networks. Integration of ECR with the Clinical Translational and Science Award (CTSA) program through a multidisciplinary Emergency Care research network (ECRN) would obviate the duplication of research efforts by disease-specific or institute-specific multicenter networks and reduce startup and maintenance costs. Strategies to enhance integration must include the training of Emergency physician investigators in biostatistical and epidemiologic methods, as well as educating collaborative investigators in Emergency Care–related methodologies. Thus, an ECRN would be of great benefit to CTSA awardees and applicants and should be considered a priority.

  • unique characteristics of Emergency Care research scope populations and infrastructure
    Academic Emergency Medicine, 2009
    Co-Authors: Mark D Courtney, Robert W Neumar, Arjun K Venkatesh, Amy H Kaji, Charles B Cairns, Eric J Lavonas, Lynne D Richardson
    Abstract:

    The National Institutes of Health (NIH) Clinical and Translational Science Awards (CTSA) program and the 2006 Institute of Medicine (IOM) Report on the future of Emergency Care highlight the need for coordinated Emergency Care research (ECR) to improve the outcomes of acutely ill or injured patients. In response, the Society for Academic Emergency Medicine (SAEM) and the American College of Emergency Physicians (ACEP) sponsored the Emergency Care Research Network (ECRN) Conference in Washington, DC, on May 28, 2008. The conference objectives were to identify the unique nature of ECR and the infrastructure needed to support ECR networks and to understand the optimal role of Emergency medicine (EM) and other acute Care specialties in research networks. Prior to the conference, participants responded to questions addressing the relevant issues that would form the basis of breakout session discussions; two of these breakout questions are summarized in this report: 1) what makes EM research unique? and 2) what are the critical components needed to establish and maintain networked ECR? Emergency Care research was defined as “the systematic examination of patient Care that is expected to be continuously available to diverse populations presenting with undifferentiated symptoms of acute illness, or acutely decompensated chronic illness, and whose outcomes depend on timely diagnosis and treatment.” The chain of ECR may extend beyond the physical Emergency department (ED) in both place and time and integrate prehospital Care, as well as short- and long-term outcome determination. ECR may extend beyond individual patients and have as the focus of investigation the actual system of Emergency Care delivery itself and its effects on the community with respect to access to Care, use of resources, and cost. Infrastructure determinants of research network success identified by conference participants included multidisciplinary collaboration, accurate long-term outcome determination, novel information technology, intellectual infrastructure, and wider network relationships that extend beyond the ED.

  • the zerhouni challenge defining the fundamental hypothesis of Emergency Care research
    Academic Emergency Medicine, 2007
    Co-Authors: Robert W Neumar
    Abstract:

    What is your hypothesis? This is almost always the first question I ask graduate students when they enter my office to propose a new research project. It is also the first thing I look for when reviewing a research grant or original research manuscript. The hypothesis is fundamental to modern scientific inquiry. Without one, it is impossible to judge the potential impact of a proposed line of investigation. Why, then, was I surprised, and somewhat unprepared, when the same question was asked by the director of the National Institutes of Health (NIH), Dr. Elias Zerhouni? What makes Dr. Zerhouni’s question compelling is that it wasn’t directed at a specific research grant or manuscript: it was directed at an entire field of investigation, the field of Emergency Care research. On January 25, 2007, a group of Emergency Medicine investigators, including Chuck Cairns, Jim Hoekstra, Judd Hollander, Roger Lewis, Sandy Schneider, and me, met with Dr. Zerhouni at the NIH to discuss the future of Emergency Care research. After numerous conference calls and e-mail exchanges, we were prepared to highlight the synergy between the recent reports of the Institute of Medicine (IOM) Committee on the Future of Emergency Care in the United States Health System and the NIH roadmap initiative to “reengineer the clinical research enterprise” in the United States. Dr. Zerhouni listened attentively to a wellorchestrated proposal that was primarily focused on integrating Emergency Care research and research training into the new Clinical Translational Science Award program. 7,8 Although he acknowledged the importance of building our research infrastructure, he asked us to consider the “why” as much as the “how.” He challenged us to define and prioritize Emergency Care research. What areas of scientific investigation are unique to Emergency Care, best studied by Emergency Care investigators, and inadequately explored by other groups of scientists? He asked us to state the unique fundamental hypothesis of Emergency Care research. Before he even finished articulating the question, my mind was racing to recall the text of the IOM reports, 1-3 the American College of Emergency Physicians (ACEP) Research Committee report submitted to the IOM, 9 and even the original 1995