A review of the door to needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town

The aim of this study is to determine the current door to needle time for administration of fibrinolytics in acute myocardial infarction in Emergency Centres in the Cape Metropole. This study will also aim to identify the factors contributing to the delay

Practicing medicine on the high seas: a review of South African doctors’ careers in cruise ship medicine

Background: There has been an increase in the number of South African doctors working in the field of maritime medicine on board cruise ships. Despite this, there is a paucity of literature available addressing the epidemiology, level of expertise and continued medical education (CME) activities of cruise ship medicine. We aim to describe the demographics, qualifications and level of experience of South African doctors embarking on a career as a cruise ship doctor and assess ongoing CME and the future careers of doctors post cruise ship medicine. Materials and methods: A survey was distributed to doctors either currently employed or previously employed as a cruise ship doctor from July 2012 to June 2017. The data obtained was used to describe the characteristics of South African doctors working in the field of cruise ship medicine. Results: Of the 65 respondents, 61.5% were female. The majority of doctors were aged between 25 and 40 years. All South African doctors held a Bachelor of Medicine and Bachelor of Surgery degree, or equivalent, as a primary medical qualification and 46% held a Diploma in Primary Emergency Care prior to working at sea. The majority of doctors obtained certification in Basic Life Support, Advanced Cardiac Life Support, Paediatric Advanced Life Support and Advanced Trauma Life Support prior to joining cruise ship medicine. A wide range of courses and diplomas were undertaken by these doctors whilst working at sea. The majority of doctors opted for short to medium term contracts before returning to South Africa to pursue a land-based career, often by enrolling in postgraduate specialist training programmes. Conclusions: Maritime medicine is an emerging field of emergency medicine in South Africa and requires a high standard of competence. A robust CME programme exists whilst working at sea. Most South African doctors return to South Africa to pursue a land based career, alleviating the potential concern that South Africa is permanently losing doctors to cruise ship medicine

Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town

Objectives. To determine the current door-to-needle time for the administration of fibrinolytics for acute myocardial infarction (AMI) in emergency centres (ECs) at three hospitals in Cape Town, and to compare it with the American Heart Association/American College of Cardiology (AHA/ACC) recommendation of 30 minutes as a marker of quality of care. Methods. A retrospective review of case notes from January 2008 to July 2010 of all patients receiving thrombolytics for AMI in the ECs of three Cape Town hospitals. The total door-to-needle time was calculated and patient demographics and presentation, physician qualification, clinical symptomology and reasons for delays in thromobolytic administration were analysed. Results. A total of 372 patients with acute ST elevation myocardial infarction (STEMI) were identified; 161 patients were eligible for the study. The median door-to-needle time achieved was 54 minutes (range 13 - 553 mins). A door-to-needle time of 30 minutes or less was achieved in 33 (20.5%) patients; 51.3% of the patients arrived by ambulance; 34% of patients had a pre-hospital 12-lead ECG; and 88.8% had typical symptoms of myocardial infarction. Medical officers administered thrombolytics to 44.7% of the patients. The predominant infarct location on ECG was inferior (55.9%). Conclusion. A significant number of patients were not thrombolysed within 30 minutes of presentation. The lack of senior doctors, difficulty interpreting ECGs, atypical presentations and EC system delays prolonged the door-to-needle time in this study

The impact of HIV knowledge and attitudes on HIV testing acceptance among patients in an emergency department in the Eastern Cape, South Africa

Background: Transmission of HIV in South Africa continues to be high due to a large proportion of individuals living with undiagnosed HIV. Uptake of HIV testing is influenced by a multitude of factors including the patient’s knowledge and beliefs about HIV. Methods: This study sought to quantify the impact of knowledge and attitudes on HIV testing acceptance in an emergency department by co-administering a validated HIV knowledge and attitudes survey to patients who were subsequently offered HIV testing. Results: During the study period 223 patients were interviewed and offered HIV testing. Individuals reporting more negative overall attitudes (p = 0.006), higher levels of stigma to HIV testing (p < 0.001), and individuals who believed their test was confidential (p < 0.001) were more likely to accept an HIV test. Conclusions: Interventions focused on improving patient perceptions around testing confidentiality will likely have the greatest impact on testing acceptance in the emergency department

The impact of HIV knowledge and attitudes on HIV testing acceptance among patients in an emergency department in the Eastern Cape, South Africa

Background: Transmission of HIV in South Africa continues to be high due to a large proportion of individuals living with undiagnosed HIV. Uptake of HIV testing is influenced by a multitude of factors including the patient’s knowledge and beliefs about HIV. Methods: This study sought to quantify the impact of knowledge and attitudes on HIV testing acceptance in an emergency department by co-administering a validated HIV knowledge and attitudes survey to patients who were subsequently offered HIV testing. Results: During the study period 223 patients were interviewed and offered HIV testing. Individuals reporting more negative overall attitudes (p = 0.006), higher levels of stigma to HIV testing (p < 0.001), and individuals who believed their test was confidential (p < 0.001) were more likely to accept an HIV test. Conclusions: Interventions focused on improving patient perceptions around testing confidentiality will likely have the greatest impact on testing acceptance in the emergency department

Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town

OBJECTIVES: To determine the current door-to-needle time for the administration of fibrinolytics for acute myocardial infarction (AMI) in emergency centres (ECs) at three hospitals in Cape Town, and to compare it with the American Heart Association/American College of Cardiology (AHA/ACC) recommendation of 30 minutes as a marker of quality of care. METHODS: A retrospective review of case notes from January 2008 to July 2010 of all patients receiving thrombolytics for AMI in the ECs of three Cape Town hospitals. The total door-to-needle time was calculated and patient demographics and presentation, physician qualification, clinical symptomology and reasons for delays in thromobolytic administration were analysed. RESULTS: A total of 372 patients with acute ST elevation myocardial infarction (STEMI) were identified; 161 patients were eligible for the study. The median door-to-needle time achieved was 54 minutes (range 13 - 553 mins). A door-to-needle time of 30 minutes or less was achieved in 33 (20.5%) patients; 51.3% of the patients arrived by ambulance; 34% of patients had a pre-hospital 12-lead ECG; and 88.8% had typical symptoms of myocardial infarction. Medical officers administered thrombolytics to 44.7% of the patients. The predominant infarct location on ECG was inferior (55.9%). CONCLUSION: A significant number of patients were not thrombolysed within 30 minutes of presentation. The lack of senior doctors, difficulty interpreting ECGs, atypical presentations and EC system delays prolonged the door-to-needle time in this study

Developing an Emergency Medicine assessment tool for medical interns within the South African context – A Modified Delphi Study

Introduction: Emergency Medicine is a relatively new specialty in South Africa. Limited data is available regarding junior doctors’ competence in managing emergencies, however previous surveys have identified limited teaching and supervision of junior doctors in Emergency Medicine. Currently there is no formal standardised assessment tool to assess an intern's Emergency Medicine competence. The aim of the study was to, through expert opinion and consensus, develop an Emergency Medicine assessment tool to identify a level of appropriate Emergency Medicine knowledge at the end of internship. Methods: The Modified Delphi Methodology was used to create an assessment tool via interaction with a panel of experts and took place over 4 rounds via an online survey platform. The initial round identified the high-priority topics within each intern domain. A questionnaire was created based on these topics and was presented to the panel for consensus during the following round/s. Rounds continued until each question met consensus of 75 %. Results: A total of 35 panellists consented to participate, representing 6 provinces. The majority were Emergency Medicine specialists. High-priority topics included acute respiratory distress, polytrauma, dehydration and shock in children, airway management, and the agitated patient. A 40-question, multiple choice questionnaire was created with all questions reaching consensus. Conclusion: This study highlighted the core high-priority Emergency Medicine topics that interns should be exposed to during their internship and created a questionnaire aimed at evaluating them. The study findings provide a novel contribution to identifying gaps in Emergency Medicine knowledge during intern training, allowing for potential interventions to be implemented to improve intern EM training. The addition of a clinical skills component and increasing the question database is suggested to further develop this tool. Larger iterative studies involving the HPCSA, and health education experts provide avenues for future research