Development of a Prehospital Care Rotation for Emergency Medicine Residents in Haiti

2021 ◽  
pp. 1-5
Author(s):  
Sean M. Kivlehan ◽  
Lourdes Rachelle Faikha Colinet ◽  
Cassandre Edmond ◽  
Hank Song ◽  
Chen Wei ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Emergency Care ◽  
Low Income ◽  
Prehospital Care ◽  
Low Income Countries ◽  
Middle Income ◽  
Emergency Care Systems ◽  
Emergency Care System ◽  
Physician Engagement ◽  
Care Systems

Abstract Background: Prehospital care is a key component of an emergency care system. Prehospital providers initiate patient care in the field and transition it to the emergency department. Emergency Medicine (EM) specialist training programs are growing rapidly in low- and middle-income countries (LMICs), and future emergency physicians will oversee emergency care systems. Despite this, no standardized prehospital care curriculum exists for physicians in these settings. This report describes the development of a prehospital rotation for an EM residency program in Central Haiti. Methods: Using a conceptual framework, existing prehospital curricula from high-income countries (HICs) were reviewed and adapted to the Haitian context. Didactics covering prehospital care from LMICs were also reviewed and adapted. Regional stakeholders were identified and engaged in the curriculum development. Results: A one-week long, 40-hour curriculum was developed which included didactic, clinical, evaluation, and assessment components. All senior residents completed the rotation in the first year. Feedback was positive from residents, field sites, and students. Conclusions: A standardized prehospital rotation for EM residents in Haiti was successfully implemented and well-received. This model of adaptation and local engagement can be applied to other residency programs in low-income countries to increase physician engagement in prehospital care.

scholarly journals Advancing research on emergency care systems in low-income and middle-income countries: ensuring high-quality care delivery systems

2019 ◽  
Vol 4 (Suppl 6) ◽  
pp. e001265 ◽  
Author(s):  
Rachel T Moresky ◽  
Junaid Razzak ◽  
Teri Reynolds ◽  
Lee A Wallis ◽  
Benjamin W Wachira ◽  
...  
Keyword(s):  
Health Systems ◽  
Emergency Care ◽  
Low Income ◽  
Communicable Diseases ◽  
Middle Income ◽  
Care Research ◽  
Middle Income Countries ◽  
Emergency Care Systems ◽  
Care Systems ◽  
Research Questions

Emergency care systems (ECS) address a wide range of acute conditions, including emergent conditions from communicable diseases, non-communicable diseases, pregnancy and injury. Together, ECS represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). It is estimated that up to 54% of annual deaths in LMICs could be addressed by improved prehospital and facility-based emergency care. Research is needed to identify strategies for enhancing ECS to optimise prevention and treatment of conditions presenting in this context, yet significant gaps persist in defining critical research questions for ECS studies in LMICs. The Collaborative on Enhancing Emergency Care Research in LMICs seeks to promote research that improves immediate and long-term outcomes for clients and populations with emergent conditions. The objective of this paper is to describe systems approaches and research strategies for ECS in LMICs, elucidate priority research questions and methodology, and present a selection of studies addressing the operational, implementation, policy and health systems domains of health systems research as an approach to studying ECS. Finally, we briefly discuss limitations and the next steps in developing ECS-oriented interventions and research.

scholarly journals Perspectives on the current state of Nigeria’s emergency care system among participants of an emergency medicine symposium: a qualitative appraisal

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e043869
Author(s):  
Agnes Usoro ◽  
Benjamin Aiwonodagbon ◽  
Jonathan Strong ◽  
Sean Kivlehan ◽  
Babatunde A Akodu ◽  
...  
Keyword(s):  
Health System ◽  
Emergency Care ◽  
Care Delivery ◽  
Prehospital Care ◽  
Current State ◽  
Emergency Care Systems ◽  
Emergency Care System ◽  
Care Systems ◽  
Health System Governance ◽  
Care System

IntroductionEmergency care systems provide timely and relevant care to the acutely ill and injured. Published commentaries have characterised deficiencies in the Nigerian emergency care system and offered potential solutions but have not included the perspectives of the Nigerian public. A more inclusive approach that includes feedback from the public may help improve the Nigerian emergency care system through better understanding of the needs, values and expectations of the community.MethodsParticipants of an emergency medicine symposium participated in focus group discussions that were randomly divided into small groups led by two trained facilitators. These facilitators asked open-ended, semistructured questions to lead discussions in the English language. Participant responses were audio-recorded and transcribed verbatim into transcripts. Two independent investigators employed conventional content analysis to code the transcripts until thematic saturation was achieved.ResultsThree descriptive themes emerged characterising the current state of Nigeria’s emergency care system as it relates to prehospital care delivery, hospital care delivery and health system governance: rudimentary, vulnerable and disconnected. At the prehospital level, concepts revolved around emergency recognition and response, ambulance and frontline providers, and cultural norms. At the hospital level, concepts centred around the health workforce, clinical competency, hospital capacity and the burden of financial hardship. At the health system level, concepts concentrated on healthcare access and healthcare financing. Opportunities for emergency care system improvement at each component level were identified and explored.ConclusionsThe participants in this study identified shortcomings and opportunities to improve prehospital care, hospital care and health system governance. The results of this study may help healthcare professionals, policy makers and community leaders identify gaps in the emergency care system and offer solutions in harmony with the needs, values and expectations of the community. If successful, these community-informed interventions may serve as a model to improve emergency care systems throughout Africa.

scholarly journals Emergency Medicine Education at a Medical Institute in Nepal: Breaking the Frontiers

2020 ◽  
Vol 18 (1) ◽  
pp. 120-125
Author(s):  
Harish Chandra Neupane ◽  
Niki Shrestha ◽  
Daya Ram Lamsal
Keyword(s):  
Emergency Medicine ◽  
Training Program ◽  
Emergency Care ◽  
Medical Institute ◽  
International Emergency Medicine ◽  
Medical College ◽  
Emergency Care Systems ◽  
Care Systems ◽  
The Uk ◽  
Medical Leadership

Emergency medicine, globally, is a developing specialty. The President of International Federation for Emergency Medicine penned down in a 2007 editorial that emergency medicine is rapidly becoming a global specialty. There are an increasing number of countries which are exploring ways to further build emergency medicine. The Hybrid International Emergency Medicine Training Program is the first collaborative international Emergency Medicine training developed in the UK. A Memorandum of Understanding has been signed among Doncaster& Bassetlaw Teaching Hospital,, UK, International Centre for Emergency Medicine UK, International Academy of Medical Leadership, UK and Chitwan Medical College, Nepal.The HIEM program has been executed by CMC from November 15, 2018. As per the MOU, the International Training Registrars of HIEM Program will undergo 1st& 4rth Year of training at CMC, Nepal and the 2nd year and 3rd year of training at DBTH, UK. The HIEM Training Program is the first of its kind in the country; HIEM is the first post graduate emergency medicine program in Nepal which also has an international recognition and is unique in the sense that the programme is integrated with training in leadership and management.The HIEM Training Program is recognized by Royal College of Emergency Medicine, UK. CMC has committed to improving emergency care in Nepal by pioneering the HIEM Training Program. We are committed to fulfilling our moral and social responsibility to improve emergency care systems in the country through building up of a cadre of adequately trained Emergency Physicians.Keywords: Emergencies; emergency care; emergency medicine; Nepal

scholarly journals Advancing research on the economic value of emergency care

2019 ◽  
Vol 4 (Suppl 6) ◽  
pp. e001768 ◽  
Author(s):  
Nicholas Risko ◽  
Amit Chandra ◽  
Taylor W Burkholder ◽  
Lee A Wallis ◽  
Teri Reynolds ◽  
...  
Keyword(s):  
Emergency Care ◽  
Low Income ◽  
Economic Value ◽  
Health Financing ◽  
Cost Effective ◽  
Future Research ◽  
Health Coverage ◽  
Middle Income ◽  
Catastrophic Health Expenditures ◽  
Emergency Care System

Emergency care and the emergency care system encompass an array of time-sensitive interventions to address acute illness and injury. Research has begun to clarify the enormous economic burden of acute disease, particularly in low-income and middle-income countries, but little is known about the cost-effectiveness of emergency care interventions and the performance of health financing mechanisms to protect populations against catastrophic health expenditures. We summarise existing knowledge on the economic value of emergency care in low resource settings, including interventions indicated to be highly cost-effective, linkages between emergency care financing and universal health coverage, and priority areas for future research.

scholarly journals Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

2021 ◽  
Vol 18 (5) ◽  
pp. 2439
Author(s):  
Brendon Stubbs ◽  
Kamran Siddiqi ◽  
Helen Elsey ◽  
Najma Siddiqi ◽  
Ruimin Ma ◽  
...  
Keyword(s):  
Health Survey ◽  
Low Income ◽  
World Health ◽  
Low Income Countries ◽  
Multivariable Logistic Regression Analysis ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

scholarly journals Factors associated with the disbursements of development assistance for health in low-income and middle-income countries, 2002–2017

2021 ◽  
Vol 6 (4) ◽  
pp. e004858
Author(s):  
Modhurima Moitra ◽  
Ian Cogswell ◽  
Emilie Maddison ◽  
Kyle Simpson ◽  
Hayley Stutzman ◽  
...  
Keyword(s):  
Low Income ◽  
Development Assistance ◽  
Health Spending ◽  
Recipient Country ◽  
Health Systems Strengthening ◽  
Low Income Countries ◽  
Middle Income ◽  
Development Assistance For Health ◽  
Country Characteristics ◽  
Health Accounts

IntroductionIn 2017, development assistance for health (DAH) comprised 5.3% of total health spending in low-income countries. Despite the key role DAH plays in global health-spending, little is known about the characteristics of assistance that may be associated with committed assistance that is actually disbursed. In this analysis, we examine associations between these characteristics and disbursement of committed assistance.MethodsWe extracted data from the Creditor Reporting System of the Organization for Economic Co-operation and Development, Institute for Health Metrics and Evaluation, and the WHO National Health Accounts database. Factors examined were off-budget assistance, administrative assistance, publicly sourced assistance and assistance to health systems strengthening. Recipient-country characteristics examined were perceived level of corruption, civil fragility and gross domestic product per capita (GDPpc). We used linear regression methods for panel of data to assess the proportion of committed aid that was disbursed for a given country-year, for each data source.ResultsFactors that were associated with a higher disbursement rates include off-budget aid (p<0.001), lower administrative expenses (p<0.01), lower perceived corruption in recipient country (p<0.001), lower fragility in recipient country (p<0.05) and higher GDPpc (p<0.05).ConclusionSubstantial gaps remain between commitments and disbursements. Characteristics of assistance (administrative, publicly sourced) and indicators of government transparency and fragility are also important drivers associated with disbursement of DAH. There remains a continued need for better aid flow reporting standards and clarity around aid types for better measurement of DAH.

scholarly journals Breast Cancer in Low- and Middle-Income Countries: An Emerging and Challenging Epidemic

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Arafat Tfayli ◽  
Sally Temraz ◽  
Rachel Abou Mrad ◽  
Ali Shamseddine
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Low Income ◽  
Therapeutic Interventions ◽  
Low Income Countries ◽  
Middle Income ◽  
Major Health ◽  
Middle Income Countries ◽  
Low And Middle Income

Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.

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