Malaria treatment-seeking behaviour and recovery from malaria in a highland area of Kenya

<p>Abstract</p> <p>Background</p> <p>Malaria epidemics in highland areas of Kenya cause significant morbidity and mortality.</p> <p>Methods</p> <p>To assess treatment-seeking behaviour for malaria in these areas, a questionnaire was administered to 117 randomly selected households in the highland area of Kipsamoite, Kenya. Self-reported episodes of malaria occurred in 100 adults and 66 children.</p> <p>Results</p> <p>The most frequent initial sources of treatment for malaria in adults and children were medical facilities (66.0% and 66.7%) and local shops (19.0% and 30.3%). Adults and children who initially visited a medical facility for treatment were significantly more likely to recover and require no further treatment than those who initially went to a local shop (adults, 84.9% v. 36.8%, <it>P </it>< 0.0001, and children, 79.6% v. 40.0%, <it>P </it>= 0.002, respectively). Individuals who attended medical facilities recalled receiving anti-malarial medication significantly more frequently than those who visited shops (adults, 100% vs. 29.4%, and children, 100% v. 5.0%, respectively, both <it>P </it>< 0.0001).</p> <p>Conclusion</p> <p>A significant proportion of this highland population chooses local shops for initial malaria treatment and receives inappropriate medication at these localshops, reslting in delay of effective treatment. Shopkeeper education has the potential to be a component of prevention or containment strategies for malaria epidemics in highland areas.</p

Shared Decision Making for the Emergency Provider: Engaging Patients When Seconds Count

IntroductionPhysicians need to be able to communicate the myriad of management options clearly to patients and engage them in their health care decisions, even in the fast-paced environment of the emergency department. Shared decision making (SDM) is an effective communication strategy for physicians to share diagnostic uncertainty, avoid potentially harmful tests, and solicit patients' preferences for their care. Role-playing with just-in-time feedback is an effective method to learn and practice SDM before having these conversations with patients.MethodsThis flipped classroom workshop featured precourse materials and an in-class session incorporating a short lecture outlining a framework for SDM, followed by role-playing through patient scenarios. Learners took turns playing the physician or patient role and received feedback on their communication skills while in the physician role. A faculty examiner subsequently assessed skill attainment using a simulated patient encounter and checklist of critical actions.ResultsThe workshop was an interactive and effective way to teach SDM to 28 PGY 1 and PGY 2 emergency medicine residents. Two months after attending the workshop, over 75% of the first-year residents were able to complete all the elements of the SDM process in a simulated patient encounter; four residents required no prompting by the examiner.DiscussionA communications workshop that incorporates role-playing with different patient encounters is an interactive way to teach SDM for the emergency setting. Residents early in their clinical training can benefit from learning and practicing SDM in a simulated setting

Intolerance of error and culture of blame drive medical excess.

Jerome R Hoffman: and Hemal K Kanzaria: argue that efforts to reduce overdiagnosis and overtreatment should focus on changing professional and public attitudes towards medical error and uncertainty

Adie’s Tonic Pupil

West J Emerg Med. 2012;13(6):54

Adie’s Tonic Pupil

n/a images in emergency medicin

Emergency Department Death Rates Dropped By Nearly 50&nbsp;Percent, 1997-2011.

Between 1997 and 2011, there was a nearly 50&nbsp;percent reduction in US emergency department mortality rates for adults. This trend likely has many causes, related to advances in palliative, prehospital, and emergency care