bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methods for evaluating effectiveness and cost‐effectiveness of a Skilled Care Initiative in rural Burkina Faso
Authors: Hounton Sennen , Sombié Issiaka , Meda Nicolas , Bassane Brahima , Byass Peter , Stanton Cynthia , De Brouwere Vincent 
Published: August 2010

SummaryIntroduction  This paper aims to describe the design, methods and approaches used to assess the effectiveness and cost‐effectiveness of the Skilled Care Initiative in reducing pregnancy‐related and perinatal mortality in Ouargaye district, Burkina Faso.Methods  The evaluation used a quasi‐experimental design, mixed methods and a composite of tools to compare mortality and severe morbidity (near‐miss) of women in reproductive age, perinatal mortality, facility functionality, perceived quality of care, utilisation of maternal health services, and costs borne by families and the health care system for maternal health care in Ouargaye and Diapaga districts. Structured questionnaires and interview guides were developed, pre‐tested and piloted prior to the main survey. The evaluation was carried out from January to July 2006. A household census was used to retrospectively assess pregnancy‐related and perinatal mortality over the previous 5 years, and causes of pregnancy‐related death were identified using a newly developed and tested probabilistic model for interpreting verbal autopsy data. Data were directly entered into Personal Digital Assistant devices at the point of interview. Analyses included univariate and multivariate regressions and incremental cost‐effectiveness ratios.Results  A population census covering over half a million people, three qualitative surveys and facility surveys in 47 health centres have been carried out.Conclusion  A partnership with key stakeholders and the use of mixed methods proved feasible for evaluating complex safe motherhood strategies, and the use of hand‐held computers proved possible for direct data capture, even in this remote rural environment.
The epidemiology of pregnancy outcomes in rural Burkina Faso
Authors: Bell Jacqueline S. , Ouédraogo Moctar , Ganaba Rasmane , Sombié Issiaka , Byass Peter , Baggaley Rebecca F. , Filippi Véronique , Fitzmaurice Ann E. , Graham Wendy J. 
Published: August 2010

SummaryObjectives  To describe levels and causes of pregnancy‐related mortality and selected outcomes after pregnancy (OAP) in two districts of Burkina Faso.Methods  A household census was conducted in the two study districts, recording household deaths to women aged 12–49 years from 2001 to 2006. Questions on pregnancy outcomes in the last 5 years for resident women of reproductive age were included, and an additional method – direct sisterhood – was added in part of the area. Adult female deaths were followed‐up with verbal autopsies (VA) with household members. A probabilistic model for interpreting VA data (InterVA‐M) was used to determine distributions of probable causes of death. An OAP survey was conducted among all women with an experience of pregnancy during the prior 12 months. It aimed to document physical and psychological disabilities, economic and social consequences and discomfort that women may suffer as a result of a pregnancy.Results  The maternal mortality ratio (MMR) was 441 per 100 000 live births (95% CI: 397, 485), significantly higher in Diapaga [519 per 100 000 (95% CI: 454, 584)] than Ouargaye [353 per 100 000 (95% CI: 295, 411)]. MMRs were associated with wealth quintile, age and distance from a health facility. The causes of death showed higher than expected rates of sepsis (30%) and lower rates of haemorrhage (7%). A substantial proportion of all women had difficulty performing day‐to‐day tasks as a consequence of pregnancy. Women who had experienced stillbirths or Caesarean sections reported symptom‐related indicators of poor physical health more frequently than women reporting uncomplicated deliveries, and were also more likely to be depressed.Conclusions  Expectations on the levels and causes of pregnancy‐related mortality in Burkina Faso may need to be re‐examined, and this could have programmatic implications; for example high levels of sepsis could prompt renewed efforts to reach women with skilled attendance at delivery and follow‐up during the postpartum period. Further documentation of how complication‐induced disabilities affect women and their families is needed. For mortality and morbidity outcomes, demonstrating variation between study districts is important to empower local decision makers with evidence of need at a subnational level.
HIV serological screening in a population of pregnant women in the Republic of Congo: suitability of different assays
Authors: Bruzzone Bianca , Bisio Francesca , Ventura Agostina , Nigro Nicola , Miguel Landry M. , Mayinda Mboungou Franck A. , Nzagou Abdon C. , Mayembo Patrice , Uberti Filippo , De Maria Andrea , Icardi Giancarlo , Viscoli Claudio 
Published: August 2010

SummaryDifferent strategies can be applied for the screening of HIV infection, depending on the local seroprevalence. Within a WHO type III strategy, we compared the results of two different second‐line methods for HIV screening of a population of pregnant women in the Republic of Congo. Sera from 3614 consecutive pregnant women were tested for HIV with Genescreen Plus Ag/Ab EIA assay; positive specimens were retested with two different second‐line methods. (Determine HIV‐1/2 rapid test and Vironostika HIV Ag/Ab specific EIA assay). Discordant samples were tested with HIV‐1/2 Western Blot and, if necessary, HIV RNA molecular assay. Of the 3614 sera, 221 were positive with Genscreen. Among them, 21 and 10 tested negative with Vironostika and Determine, respectively. A 100% correspondence with 3rd line confirmation test results was found in Genscreen positive/Vironostika negative samples, whereas a 5.5% overestimation of HIV seroprevalence was observed when Determine, instead of Vironostika, was used as second‐line test. The choice of appropriate assays in adequate sequence, within the correct WHO strategy, is pivotal to minimize the risk of overtreatment of HIV infection.
Violence in society: fact or fiction?
Authors: FULDE GORDIAN W O , CUTHBERT MARJORIE , KELLY ROBYN 
Published: August 2010

ABSTRACTFive hundred and twelve of the patients who presented to an inner city emergency department over a six month period with injuries sustained as a result of another's violence were studied. This demonstrated that the emergency department can play a significant role in the collection of data on violence.Until now Australian data on violence have come mainly from police files. However, 57% of the victims questioned in this study had not reported the attacks to the police.The data obtained have been analysed to provide information on recurring and preventable factors in the incidence of violence. A majority of victims had consumed drugs (54% alcohol, 5% other), and 33% of assailants were influenced by alcohol (39% unknown). Street violence was experienced in 78% of cases, but female victims were more likely to have been victims of violence in their own home, and usually knew the assailant. Only 9% of injuries were caused by a knife or other sharp instrument, the most common “weapon” was the assailant's fist. The usual site of injury was the head and neck (54%). Young single males were the most frequent victims.
A descriptive study of 100 emergency department patients with abdominal pain
Authors: HENRY SIOBHAN 
Published: August 2010

ABSTRACTOne hundred consecutive patients with abdominal pain attending the Department of Emergency Medicine of the Royal Hobart Hospital were studied.There was a bimodal age distribution, with peaks in the 10–30 and 60–80 year groups. Admitted patients were likely to be older, and were more likely to present in working hours.When compared with later diagnosis, the emergency department diagnosis was “correct” in 75% of cases. No patient admitted with “unspecified abdominal pain” was later diagnosed more definitively.The findings suggest that one may be reasonably confident of a diagnosis made in the emergency department in patients with abdominal pain.
Rapidly progressive and overwhelming meningococcal septicaemia in a 14 year old girl
Authors: HOLMES JOHN L , PEAKE PAUL W 
Published: August 2010

ABSTRACTSepticaemia due to Neisseria meningitidis may be overwhelming and has a high mortality, especially in children. A case is described of rapidly fulminating mening‐ococcal septicaemia without meningitis in a previously well 14 year old girl who died within hours of the onset of illness. Clinical features of meningococcal septicaemia, the pathology, and the principles of management are described. The recent introduction of monoclonal IgM antitoxin may play a significant role in the future management of this condition.
Lumbar puncture in the emergency department is useful and safe
Authors: DUNJEY STEVEN J , DANCOCKS ANGELA C , MAGUIRE JOHN E , JELINEK GEORGE A 
Published: August 2010

ABSTRACTA 12 month retrospective study was carried out by the Department of Emergency Medicine at Fremantle Hospital to evaluate lumbar puncture in the Emergency Department.Sixty‐four patients underwent lumbar puncture in the study period. The main indication was suspicion of central nervous system (CNS) infection.Fifty‐three percent of patients had an abnormal cerebrospinal fluid. Diagnoses in order of frequency were viral meningitis, subarachnoid haemorrhage, bacterial meningitis, and viral encephalitis, confirming the importance of this investigation in the diagnosis of CNS infection.No side effects were recorded.With appropriate selection criteria and supervision, lumbar puncture is a safe, simple and valuable investigation in the emergency department.
The examination process in emergency medicine
Authors: Walpole Bryan , GAUDRY P L 
Published: August 2010

ABSTRACTThe Australasian College for Emergency Medicine has held examinations since 1985. The Primary Examination is an examination in Anatomy, Pathology, Physiology and Pharmacology taken after medical registration. The Fellowship Examination is a certifying examination in emergency medicine taken in the fifth year of a 5 year advanced training programme. In this review the format and results of the examinations held during 1985 to 1991 are compared with the examinations in emergency medicine held by the American Board of Emergency Medicine, The Royal College of Physicians and Surgeons of Canada and The Royal College of Surgeons of Edinburgh and The Royal College of Physicians of Edinburgh.
Emergency acne: a case of acne fulminans with erythema nodosum and respiratory failure
Authors: RICHARDSON DREW B 
Published: August 2010

ABSTRACTAcne fulminans is a rare and severe form of acne with systemic involvement. A young female presented to the Emergency Department with acne and erythema nodosum and subsequently developed respiratory failure. Although systemic symptoms may be marked, acne fulminans is not normally associated with illness of this severity.
Facial and scalp injuries
Authors: FONG SAI YAN 
Published: August 2010

ABSTRACTThe aim of this study was to define the aetiology, demographic detail, pattern or attendance and outcome of patients with facial or scalp injury (FSI) attending the Department of Emergency Medicine at the Royal Hobart Hospital over one month. A total or 168 patients (120 male, 48 female) were recruited. Seventy two percent were less than 30 years old and 6% were over 60 years. Injuries from assaults, accidents, falls and sports were more common in males than in females. Most patients presented “out of hours” with victims of assault coming in frequently between 2200 and 0300 hours. One hundred and four patients were discharged home, half being followed up in outpatient clinic. Only ten were admitted, six because of their FSI. This study shows that most FSIs are managed in the emergency department.
Neuropathy from household electric shock
Authors: FATOVICH DANIEL M 
Published: August 2010

ABSTRACTWhile neuropathy following electric shock has been well documented, this complication has always been associated with coexisting soft tissue injury. Two cases are reported of neuropathy following accidental household electric shock to the hand in which there was no associated soft tissue injury. These resulted in pain and disability for up to six months. Emergency physicians should be aware of the potential for this injury and that it has a good prognosis.
Envenomation by a death adder (Acanthophis antarcticus) in Perth
Authors: JELINEK GEORGE A , WAMBEEK NICHOLAS 
Published: August 2010

Objective: Recently it has been recommended that a combination of brown snake and tiger snake antivenom be given to a patient envenomed by an unidentified snake in Perth, except when the bite occurred in the areas where the death adder is prevalent.We present the first reported case of envenomation by a death adder (Acanthophis antarcticus) in Perth, with a view to examining the appropriateness of that recommendation.Clinical features: A 36 year old woman, bitten in a suburb of Perth where death adders are not usually seen, presented with progressive paralysis.Intervention and outcome: Rapid and complete recovery immediately after one ampoule of death adder antivenom confirmed the diagnosis of death adder envenomation.Conclusion: The recommendation is appropriate. Death adder envenomation is in effect “the exception that proves the rule”. Vigilance for this rare envenomation is necessary.
Pneumoperitoneum following cardiopulmonary resuscitation
Authors: SMITH P B , McDONALD G 
Published: August 2010

ABSTRACTA case of pneumoperitoneum complicating cardiopulmonary resuscitation in a 54 year old man is presented. With clinical evidence of evolving peritonism, he underwent laparotomy, but no visceral rupture was discovered. A search of the literature reveals at least 12 cases of pneumoperitoneum following cardiopulmonary resuscitation, the majority from lesser curve gastric rupture, with several cases showing no evident rent at laparotomy or autopsy. To assist critical management decisions, especially with respect to performing laparotomy, several authors have proposed investigations and algorithms to separate those with visceral rupture from those without. These are evaluated, and in the context of the case presented, considered neither highly specific nor sensitive.
Value of the urine dipstick test for leukocytes in screening for urinary tract infection
Authors: YEUNG KAI‐CHO , WONG TAI‐WAI 
Published: August 2010

ABSTRACTA prospective study to assess the value of white cell detection in the urine as a screening test for urinary tract infection was carried out in an emergency department.Commercially available dipsticks were used to detect urinary leukocytes.A total of 105 adult female patients were entered into the study. The criterion for patient selection was the presence of urinary symptoms.All urine samples were cultured. The presence of pure growth of a single organism with a colony count of greater than 105CFU per millilitre was taken as proof of urinary tract infection and was compared with the dipstick result.A good negative predictive value was found in this study.Dipstick testing for urinary leukocytes may be useful in ruling out a urinary tract infection in emergency departments.
The structure, process and outcome of emergency medicine training
Authors: GAUDRY P L 
Published: August 2010

ABSTRACTA study was conducted of 85 graduates of the Australasian College for Emergency Medicine to determine their perceptions of the quality of their graduate training and the status of their current practice. Participants were asked to use a scale of 1 to 5 (with 1 being a low or very poor rating, 5 being a high or very good rating) to rate their satisfaction with the structure of their training, the adequacy of the learning environment during training and the adequacy of their training relative to the emergency medicine curriculum. A response rate of 94% was achieved. Training in emergency departments (EDs) rated 4.0. Training in off‐service rotations rated 3.6. The learning environment during training rated 3.8. The scope of educational experiences, access to teaching and research resources, and the quality and quantity of supervision by non‐emergency physician specialists rated the lowest. The adequacy of their training relative to the curriculum rated 3.5, with a number of clinical areas including paediatrics, administrative aspects of emergency medicine and emergency medical systems, rated among the lowest. These perceptions in the context of the current practice of most graduates will help highlight the aspects of training that need further monitoring and improvement.
A change in road trauma attendances associated with a major campaign to lower the road toll
Authors: ROGERS I R , ABRAMSON M 
Published: August 2010

ABSTRACTObjective: To document the patterns of hospital attendances due to road trauma before and after a campaign, which commenced in Victoria in late 1989, to reduce the road toll.Design: A retrospective review of the medical records of all patients presenting to an emergency department as a result of road trauma during June/July of 1989 and the corresponding period in 1990.Setting: Emergency department of a secondary level hospital in the outer eastern suburbs of Melbourne.Patients: Four hundred and twenty five patients presenting during June/July 1989 and 307 patients during June/July 1990.Main results: In the period following the new road toll initiatives, road trauma attendances and admissions dropped significantly. With respect to demographic data and measures of injury type and severity the two groups were similar.Conclusion: The savings to the community and health care system reflected in the observed changes should provide support for continuing campaigns to reduce the incidence of road trauma in Australia.
Undergraduate teaching of emergency medicine in Australasia
Authors: KELLY ANNE‐MAREE 
Published: August 2010

ABSTRACTStudy objective: To describe current undergraduate teaching of emergency medicine in Australasia and analyse the structural features of this teaching.Design: Cross sectional mail survey.Setting and participants: Fellows of the Australasian College for Emergency Medicine.Intervention: Questionnaires were sent requesting details of undergraduate teaching of emergency medicine at Fellows' parent institutions.Measurements and results: Australasia has 30 undergraduate programs in emergency medicine. Teaching is occurring across the clinical years with concentrations in years 4 and 6. Seventy‐seven percent of programs employ a combination of structured and opportunistic learning experiences. Contact hours per student vary greatly, averaging 13 hours structured and 41 hours unstructured contact. Content of programs is highly variable. Input into assessment of programs is suboptimal. Program distribution across Australasia is uneven.Recommendations: An undergraduate strategy and learning objective guidelines for emergency medicine should be developed. Pressure must be placed on medical schools for the inclusion of emergency medicine in curricula with appropriate input into student assessment. Emergency physicians should be encouraged to develop skills in education.
The safety of oxygen‐driven nebulisers in patients with chronic hypoxaemia and hypercapnia
Authors: CAMERON PETER , COLERIDGE JOHN , EPSTEIN JOSEPH , TEICHTAHL HARRY 
Published: August 2010

ABSTRACTThere is potential to cause deterioration due to hypoxia in patients with acute exacerbation of obstructive airways disease with the indiscriminate use of aerosol bronchodilators delivered by air‐driven nebulisers without supplemental oxygen. Traditionally, air‐driven nebulisers have been reserved for the treatment of chronically hypoxic and hypercapnic patients with an exacerbation of chronic obstructive pulmonary disease (COPD). The purpose of this pilot study was to assess the safety of oxygen‐driven nebulisers (6 L/min) in the treatment of COPD patients.Sixteen patients received bronchodilator via an oxygen‐driven nebuliser for 30 minutes. No patient deteriorated clinically and in all the PaO2 rose significantly (mean baseline 43.7 ± 6.3 mmHg (± SD) post nebuliser 108.8 ± 30.4 mmHg). There was an insignificant rise in PaC02 from 59.7 ± 9.1 mmHg to 66.4 ± 15.3 mmHg and this was not important clinically.On the basis of this pilot study, we suggest that aerosol bronchodilators may be safely delivered by oxygen‐driven nebulisers in chronically hypoxic and hypercapnic COPD patients. A larger scale formal trial is indicated to compare oxygen‐driven versus air‐driven nebulisers in COPD.
Melioidosis presenting to the emergency department
Authors: HODGE JONATHON V 
Published: August 2010

ABSTRACTMelioidosis is a well recognised disease in the tropics. During the wet season of 1990/91, of 14 patients with melioidosis presenting the Townsville General Hospital, three were identified as presenting through the Emergency Department. These cases demonstrated the necessity for emergency physicians in the tropics to be vigilant for the disease.
Caustic ingestion still causes death and disability
Authors: EDWARDS ROBERT J , HANSON RALPH M , KILHAM HENRY A 
Published: August 2010

ABSTRACTObjective: To review the experience over five years of a major paediatric referral centre with caustic ingestion.Design, setting and patients: A retrospective review was performed of 25 consecutive children with caustic ingestion who were managed at the Royal Alexandra Hospital for Children, Camperdown between June 1983 and December 1988.Results: Sodium hydroxide (NaOH or lye) was the commonest caustic ingested. The remainder ingested various products used for household cleaning. All ingestions were accidental with a peak incidence between the ages of 12 to 36 months. Eighty percent of patients recovered without complications. One patient died and another patient made a full recovery after a Bilroth 1 gastrectomy for gastric burns. Four children developed recurrent strictures requiring repeated oesophageal dilatations for persistent dysphagia.Conclusion: Caustic ingestion is still a cause of death and significant morbidity in children. A review of the literature shows that clinical findings do not reliably predict endoscopic findings and that there is little evidence in controlled human studies of the value of corticosteroids in reducing caustic injury to the oesophagus.
Prehospital defibrillation in Geelong
Authors: JACKSON TREVOR , CAMERON PETER 
Published: August 2010

ABSTRACTIntroduction: In 1988, a defibrillation/CPR protocol was phased in over 12 months for the management of ventricular fibrillation (VF) by ambulance officers, in the Geelong region of Victoria. This study reviews the three years following its inception.Study objective: To determine the success of this intervention in terms of survivors to hospital discharge, and compare this to the previous Australian and international literature.Methods: A retrospective case analysis of the initial three years from June 1988‐June 1991. Ambulance case sheets and hospital records were studied for all patients where the protocol was exercised.Results: Of 125 cases studied, 46 were excluded. Fourteen (18%) of the 79 patients included survived to hospital discharge.Conclusion: The results compare favourably with previously published reports, and reaffirm early defibrillation as the key intervention in the management of VF.
Analysis of 24 cases of bullrout envenomation
Authors: FITZGERALD GERARD J 
Published: August 2010

ABSTRACTNotesthes robusta (bullrout) is a spined freshwater fish found in the rivers, creeks and estuaries of the east coast of Australia.Its sting causes intense pain at the site of envenomation. The symptoms may be successfully treated by immersion of the affected part in hot water and infiltration with local anaesthetic.This is a review of 24 cases of presumed bullrout envenomation presenting to the Emergency Department of Ipswich General Hospital. The characteristic and pathognomonic presentation is described and the response to treatment demonstrated.