The use of low-cost simulation in a resource-constrained teaching environment

BACKGROUND. To improve the management of chest trauma at the University of Botswana, Gaborone, Botswana, we incorporated simulation into a theorybased chest trauma module by developing procedural guides, checklists and low-cost simulation. OBJECTIVES. To assess the suitability of low-cost simulation-based training and its impact on students’ proficiency, as well as its general acceptability. METHODS. A total of 39 medical students who completed their surgical rotation and 20 intern doctors in their first clinical rotation participated. A checklist was used in a pre- and post-test design to assess procedural proficiency, and a rating system categorised scores. Thirteen content-based items assessed the students’ knowledge relating to the diagnosis and management of a chest injury and one item assessed their ability to perform the procedure correctly. A questionnaire was administered after the second assessment to evaluate the acceptability of the training module. Findings were summarised by median, proportion and range, and pre- and post-test outcomes were compared by Student’s paired t-test. RESULTS. Pre- and post-test assessment scores differed significantly (median (range) 11.3 (4.5 - 21.0) and 19.5 (15.5 - 23.0), respectively (p<0.001)). The proportions of participants’ scores categorised as ‘full proficiency’ rose from 7% to 42%, and ‘reasonable proficiency’ from 30% to 60%, while both ‘some proficiency’ and ‘poor proficiency’ decreased from 50% and 20% to 0%. Most (93%) participants ‘strongly agreed’ that the training module was acceptable. CONCLUSION. Our results demonstrate the suitability of low-cost simulation for training and assessment in resource-constrained settings

Non-communicable diseases in antiretroviral therapy recipients in Kagera Tanzania: A cross-sectional study

Introduction: The aim of this study was to describe the extent of  self-reported non-communicable diseases (NCDs) among highly activeantiretroviral therapy (HAART) recipients in Kagera region in Tanzania and their effect on health-related quality of life (HRQOL). This study was conducted 2 years after HAART administration was started in Kagera region. Methods: The SF-36 questionnaire was used to collect the HRQOLdata of 329 HAART recipients. Questions on the NCDs, socio-demographic characteristics and treatment information were validated and added tothe SF-36. Bivariate analyses involving socio-demographic characteristics and SF-36 scores of the recipients were performed. Multiple logisticregression was employed to compute adjusted odds ratios for different explanatory variables on physical functioning and mental health scores.Results: Respondents who reported having 1 or more NCDs were 57.8% of all the respondents. Arthritis was the commonest NCD (57.8%).Respondents with the NCDs were more likely to have HRQOL scores below the mean of the general Tanzanian population. The populationattributable fraction (PAF) for the NCDs on physical functioning was 0.28 and on mental health was 0.22. Conclusion: Self-reported NCDs were prevalent among the HAART recipients in Kagera region. They accounted for 28% of the physical  functioning scores and 22% of the mental health scores that were below the mean of the general Tanzanian population. Therefore, the integration of NCD care is important in the management of HIV/AIDS

Asthma Prevalence, Knowledge, and Perceptions among Secondary School Pupils in Rural and Urban Costal Districts in Tanzania.

Asthma is a common chronic disease of childhood that is associated with significant morbidity and mortality. We aimed to estimate the prevalence of asthma among secondary school pupils in urban and rural areas of coast districts of Tanzania. The study also aimed to describe pupils' perception towards asthma, and to assess their knowledge on symptoms, triggers, and treatment of asthma. A total of 610 pupils from Ilala district and 619 pupils from Bagamoyo district formed the urban and rural groups, respectively. Using a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, a history of "diagnosed" asthma or the presence of a wheeze in the previous 12 months was obtained from all the studied pupils, along with documentation of their perceptions regarding asthma. Pupils without asthma or wheeze in the prior 12 months were subsequently selected and underwent a free running exercise testing. A >= 20% decrease in the post-exercise Peak Expiratory Flow Rate (PEFR) values was the criterion for diagnosing exercise-induced asthma. The mean age of participants was 16.8 (+/-1.8) years. The prevalence of wheeze in the past 12 months was 12.1% in Bagamoyo district and 23.1% in Ilala district (p < 0.001). Self-reported asthma was found in 17.6% and 6.4% of pupils in Ilala and Bagamoyo districts, respectively (p < 0.001). The prevalence of exercise-induced asthma was 2.4% in Bagamoyo, and 26.3% in Ilala (P < 0.002). In both districts, most information on asthma came from parents, and there was variation in symptoms and triggers of asthma reported by the pupils. Non-asthmatic pupils feared sleeping, playing, and eating with their asthmatic peers. The prevalence rates of self-reported asthma, wheezing in the past 12 months, and exercise-induced asthma were significantly higher among urban than rural pupils. Although bronchial asthma is a common disease, pupils' perceptions about asthma were associated with fear of contact with their asthmatic peers in both rural and urban schools

Phlegmasia cerulea dolens in a long distance driver

Phlegmasia cerulea dolens (PCDs) is a rare and serious complication of massive deep venous thrombosis of the lower extremities, which has a high mortality rate. It is characterized by the sudden onset of severe leg pain, massive edema, cyanosis, venous gangrene, compartment syndrome and arterial compromise, often followed by pulmonary embolism and death. We report one case of a long distance driver who presented with PCDs, complicated by fatal pulmonary embolism.Key words: Compartment syndrome, deep vein thrombosis, phlegmasia cerulea dolen

The use of low-cost simulation in a resource-constrained teaching environment

Background. To improve the management of chest trauma at the University of  Botswana, Gaborone, Botswana, we incorporated simulation into a theorybased chest trauma module by developing procedural guides, checklists and low-cost simulation.Objectives. To assess the suitability of low-cost simulation-based training and its impact on students’ proficiency, as well as its general acceptability.Methods. A total of 39 medical students who completed their surgical rotation and 20 intern doctors in their first clinical rotation participated. A checklist was used in a pre- and post-test design to assess procedural proficiency, and a rating system categorised scores. Thirteen content-based items assessed the students’  knowledge relating to the diagnosis and management of a chest injury and one item assessed their ability to perform the procedure correctly. A questionnaire was administered after the second assessment to evaluate the acceptability of the  training module. Findings were summarised by median, proportion and range, and pre- and post-test outcomes were compared by Student’s paired t-test.Results. Pre- and post-test assessment scores differed significantly (median  (range) 11.3 (4.5 - 21.0) and 19.5 (15.5 - 23.0), respectively (p&lt;0.001)). The proportions of participants’ scores categorised as ‘full proficiency’ rose from 7% to 42%, and ‘reasonable proficiency’ from 30% to 60%, while both ‘some proficiency’ and ‘poor proficiency’ decreased from 50% and 20% to 0%. Most (93%)   participants ‘strongly agreed’ that the training module was acceptable.Conclusion. Our results demonstrate the suitability of low-cost simulation for  training and assessment in resource-constrained settings

Organised trauma systems and designated trauma centres for improving outcomes in injured patients

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of organised trauma systems and designated trauma centres for improving outcomes in injured patients, specifically patient outcomes and adverse effects or harms.Published versio