“Resuscitate and Push”:End-of-Life Care Experiences of Healthcare Staff in the Emergency Department – A Hermeneutic Phenomenological Study

Objective: Care in the emergency department focuses significantly on delivering lifesaving/ life-sustaining clinical actions, often with limited attention to health-related suffering even at the end-of-life. How healthcare staff experience and navigate through the end-of-life phase remains minimally explored. Thus, this study aimed to uncover the lived experiences of emergency department staff at the end-of-life. Methods: van Manen’s hermeneutic phenomenological approach was used. Nineteen healthcare staff were purposively recruited and interviewed. Interviews were audio-taped, transcribed verbatim, and thematic categories formulated. The existential lifeworld themes (corporeality, relationality, spatiality, and temporality) were used as heuristic guides for reflecting and organizing the lived experiences of participants. Results: The overarching category, ‘resuscitate and push’, was captured as corporeality (resisting death and dying); relationality (connectedness to the body of the patient; and lacking support for family and self); spatiality (navigating through a liminal space and lack of privacy for patients); and temporality (having limited to no time for end-of-life care and grieving). The end-of-life space was unpleasant. Although participants experienced helplessness and feelings of failure, support systems to help them to navigate through these emotions were lacking. Grief was experienced covertly and concealed by the entry of a new patient. Conclusion: End-of-life in the emergency department is poorly defined. In addition to shifting from the traditional emergency care model to support the streamlining of palliative care in the department, staff will require support with navigating through the liminal space, managing their grief, and developing a better working relationship with patients/ families

Burns in the middle belt of Ghana: A systematic review

Background: Burns are a major global public health issue affecting persons of all ages. Various studies have indicated that developing countries share a greater burden of the injury. Despite this fact, Ghana as a developing country lacks a burn repository and that makes it difficult to clearly understand the bigger picture of the injury. To this end, this study aimed to systematically review primary studies of burn occurrence in the country. Methodology: A comprehensive literature search was undertaken using PubMed, ScienceDirect, Google Scholar, MEDLINE and EMBASE. The keywords used were “burns, epidemiology, Ghana, injury, flame burn, scald burn, electric burn, chemical burn, contact burn and explosion”. Additional articles were identified by reviewing reference lists. The local journals such as the Postgraduate Medical Journal of Ghana were searched for the articles not indexed in PubMed or EMBASE. MOOSE guidelines were followed in executing this review. At the end of the selection process, seven papers remained and included in the study. Findings: Findings from this review identified that more males than females were involved in burn injuries. Persons within the paediatric age group (particularly those under 10 years of age) were particularly susceptible to burns. This notwithstanding it was noted that there is an increasing occurrence of burns among persons in the working class group (15 years–59 years). Scald was the most common injury among the paediatric age group whilst flame burn was most common among the adult population. The home was noted to be the commonest place for burn occurrence though some disasters at fuel filling stations were recorded. The occurrence of burn was associated with various burned surface area and from the studies reviewed it was noted that higher total burned surface area (TBSA) may be linked to increasing mortality rates. Length of hospitalisation ranged from less than 10 days to 760 days. Epilepsy was reported by one study as a pre-morbid condition. Conclusion: Burns represent a significant public health problem in Ghana and there is a need for the design of more effective intervention to reduce the occurrence of the injury. A larger scale research is imperative to investigate burns epidemiology from a national perspective. Keywords: Burns, Middle belt of Ghana, Epidemiology, Systematic revie

Assessment of the phytochemical composition and antimicrobial properties of Tapinanthus bangwensis leaves hosted by the branches of Persea americana

Abstract Background Medicinal plants represent a valuable source for new effective and safe antimicrobial drugs making them an alternative therapy. Existing antimicrobial agents are costly and mostly associated with possible side effects. The aim of the present study therefore, was to assess the antimicrobial property and phytochemical composition of hydroethanolic extract of Tapinanthus bangwensis leaves and its fractions. Method T. bangwensis leaves (harvested from its host plant, Persea americana) was extracted by cold maceration with 70% ethanol and further fractionated with different organic solvents using the solvent partitioning method to obtain the crude extract, petroleum ether, chloroform, ethyl acetate and the resulting aqueous fractions. The phytochemical constituents of the extracts were screened and quantified. Also, the TLC of the extracts were analyzed to serve as a fingerprint. Using the agar diffusion and broth dilution methods, the antimicrobial properties of the extracts were assessed. Results The study showed that the hydroethanolic (70%) crude extract of T. bangwensis leaves and its fractions contain phenolic compounds, flavonoids, saponins, phytosterols and reducing sugars. The phytoconstituents were well extracted into the ethyl acetate fraction than the other fractions evidenced in the high levels (p < 0.0001) of saponins (66.47 ± 1.72% w/w), phenolic compounds (77.75 ± 1.06 mg/100 mg GAE) and flavonoids (44.34 ± 0.06 mg/100 mg QE) contents. From the antimicrobial studies, all the microorganisms tested exhibited varying degrees of susceptibility to the extracts with MIC values between 0.78 to 12.5 mg/mL. The crude extract of T. bangwensis leaves, its ethyl acetate and chloroform fractions also exhibited lethal antimicrobial activity with MLC between 6.25 to 50 mg/mL. Conclusion The crude extract of T. bangwensis leaves and its fractions demonstrated antimicrobial properties against Escherichia coli, Staphylococcus aureus, Staphylococcus saprophyticus and Candida albicans, thereby representing a potential source of natural antimicrobial agent. Further study is required to identify and isolate antimicrobial compounds from the plant for the development of the natural bioactive antimicrobial agents