Establishing a Self-sustaining Emergency Medicine Point-of-Care Ultrasound Curriculum in an Academic Teaching Hospital in Ethiopia.

Background: Point-of-care ultrasound (POCUS) training has become a standard component of Canadian emergency medicine (EM) residency programs. In resource-limited contexts, including Ethiopia, there is a critical shortage of local clinicians who can perform and teach POCUS. Our aim was to establish an introductory POCUS rotation within the EM residency program at Addis Ababa University (AAU) through The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). Methods: Through stakeholder engagement, the authors completed a quality improvement initiative and conducted a survey of AAU EM faculty and residents to understand which POCUS scans should be included in a core residency POCUS curriculum, "POCUS1". Results: 17 residents completed the POCUS1 program and 16 residents completed the written survey. Focused assessment with sonography for trauma, inferior vena cava, and lung (pneumothorax, pleural effusions, and interstitial syndrome) were identified as core introductory topics. Seventeen residents completed the initial POCUS1 program. Three program graduates were supported to become "POCUS1 Master Instructors" to continue the program during the SARS-CoV-2 global pandemic. Conclusion: The authors identified the highest yield POCUS scans through a written survey, successfully introduced a sustainable core POCUS curriculum at AAU for EM residents, and graduated three master instructors for curriculum continuation. We outline the structure and materials for implementation of POCUS programs for EM trainees and staff in similar low- and middle-income countries.

Traumatic pneumothorax mapping using computed tomography to assess optimal area to scan with POCUS.

INTRODUCTION: It is traditionally taught that the location to place an ultrasound probe to detect a pneumothorax with point-of-care ultrasound (POCUS) is the anterior chest, given the theory that air will collect at the least dependent area in the supine patient. There is a wide variety of scanning protocols with varying accuracy and completeness. We sought to assess the optimal area to scan for diagnosing pneumothorax by mapping the location of traumatic pneumothorax on computed tomography (CT). METHODS: Patients were selected after a retrospective cohort of adult patients who presented to a regional trauma center with a pneumothorax diagnosed on CT. Data were extracted using a standardized data collection tool, and 20% of charts were reviewed by two reviewers. Predefined zones were used to map the areas of pneumothoraces. Theoretical sensitivity and 95% confidence intervals (CIs) are reported. RESULTS: A total of 203 traumatic pneumothoraces were reviewed from 2006 to 2016. The majority of the pneumothoraces were found in an area defined by the para-sternal border and the mid-clavicular line from the inferior aspect of the clavicle to the physiologic lung point (liver on the right, heart on the left). The theoretical sensitivity for pneumothorax of scanning this area was 91.6% (95% CI, 86.9-95%). CONCLUSION: This study suggests any POCUS scanning protocol for traumatic pneumothorax should include an area from the inferior border of the clavicle at the parasternal border down to the liver or cardiac lung points and then the mid clavicular line down to the liver or cardiac lung points.

Management of incontinence-associated dermatitis patients using a skin protectant in acute care: a case series.

OBJECTIVE: Incontinence-associated dermatitis (IAD) is a common type of irritant contact dermatitis. It is categorised by persistent erythema and can be associated with denudation and/or colonisation and infection. IAD is challenging to treat and affects 3.4-50% of patients. This case series evaluates a novel, elastomeric, advanced skin protectant (3M Cavilon Advanced Skin Protectant) in a UK acute health-care setting, for the management of IAD in patients suffering from moisture-associated skin damage (MASD) in the sacral/genital area. METHOD: The patient's skin was assessed by clinicians using the GLOBIAD classification tool at the point of recruitment and to monitor progress throughout the study period. The product was applied as a single layer in accordance with the instructions for use. Patients, when able, were asked to assess their own pain level using the Wong-Baker FACES pain scale. Photographs were taken as part of the ongoing assessment. RESULTS: The skin protectant was used on average every 2.28 days. Of the 18 IAD patients recruited, 79% (n=11) were classified as IAD-free, based on the GLOBIAD categorisation tool, by the end of the evaluation period. Skin deterioration during the evaluation period was seen in one patient (6%), and of the patients able to complete pain assessments, 55% (n=6) reported a reduction in pain. CONCLUSION: These results suggest that the elastomeric skin protectant, applied every three days, plays a role in the improvement of IAD. The skin protectant adheres to wet and weeping partial-thickness wounds and may aid IAD management. Reducing application to every third day supports a change in practice which may offer benefits to patients and caregivers.

Using heel protectors for the prevention of hospital-acquired pressure ulcers.

Pressure ulcers are a frequent, but often preventable, occurrence among patients in acute care facilities, and the heel is one of the anatomical locations most commonly affected. Multiple clinical guidelines recommend the use of robust assessments to identify at-risk patients and the application of heel protection devices to reduce the likelihood of developing heel pressure ulcers. A quality improvement initiative involving robust skin-assessment practices, staff education, and the use of heel protection devices was analysed retrospectively to evaluate the efficacy of current practice interventions. These analyses revealed that the incidence of heel pressure ulcers was inversely correlated with the number of heel protectors used at two large acute NHS teaching hospitals in inner London, and that the consistent and early use of heel protectors improved patient outcomes and reduced costs of care.

The use of smart technology to deliver efficient and effective pressure-damage education.

This article outlines an innovative joint working strategy, as well as a partnership project, between two NHS Foundation Trusts-a community trust and industry partner-to develop a mobile training app to deliver pressure ulcer prevention and management for clinical staff. The aim of the innovation was to enable a new way of delivering education to large numbers of staff by moving away from traditional classroom-based training. The process included development of the app, along with testing and implementation, followed by a review of the qualitative data after the app's implementation. The review takes into account the key outcomes that have had an impact on this method of delivering education, its challenges and how it has been received by clinical staff and patients.

Initial clinical experiences with a new, portable, single-use negative pressure wound therapy device.

Since the introduction of negative pressure wound therapy in combination with reticulated open cell foam (NPWT/ROCF) in 1997, the clinical and economic benefits of this therapy have been showed in several randomised-controlled studies. This article describes the clinical application of a new portable NPWT unit. The V.A.C.Via™ Therapy System (KCI USA, Inc., San Antonio, TX) offers continuous negative pressure and dynamic pressure control for wound treatment of low exudating (<80 ml/day), small-to-medium size wounds, grafts and flaps in all care settings, including homecare. We describe four cases in which this new device was successfully used.

Reducing avoidable pressure ulcers: an online clinical ordering system.

Healthcare practitioners face diverse challenges presented by an ageing population, reducing funds, public demand for better health care, and a zero tolerance to avoidable healthcare-acquired injuries, such as pressure ulcers. To support the reduction in avoidable pressure ulcers European Pressure Ulcer Advisory Panel and National Institute for Health and Clinical Excellence guidelines recommend patient repositioning, the provision of either an active or reactive pressure-redistributing support surface and, for some, complete and permanent off-loading of the tissue. Guy's and St. Thomas's NHS Foundation Trust recognised that an evidence-based prevention strategy was required to reduce the incidence of pressure ulcers in line with the Harm Free Care initiative. As part of the prevention strategy, eTRACE was implemented, an online clinical ordering system that uses the patient's clinical risk assessment in conjunction with the Trust's clinical protocols to recommend appropriate equipment selection. Additionally the system supports the organisational and national reporting/management requirements. This article will review the clinical and economic evidence to support the introduction of eTRACE and how this system has contributed to the Trust's agenda in reducing avoidable pressure ulcers.

The use of amelogenin protein in the treatment of hard-to-heal wounds.

The management of hard-to-heal or chronic wounds places a high economic burden on healthcare services. This problem is exacerbated by the increasing age of the general population, an increasing diabetes population and a high prevalence of such wounds in the elderly, patients with diabetes and those with venous insufficiency. Standard treatments for such wounds, such as compression therapy in venous leg ulcers, debridement and wound care for diabetic foot ulcers, can still leave a significant population with non-healing wounds, resulting in extended hospital stays and reduced quality of life. The use of amelogenin (Xelma, Mölnlycke Health Care) for the treatment of a variety of chronic wounds has been assessed in both case studies and larger clinical trials with encouraging findings. This article examines the findings of studies relating to amelogenin in the treatment of hard-to-heal wounds.

The use of medical grade honey in clinical practice.

In the current healthcare environment, clinicians are increasingly under pressure to use wound care products that are cost-effective. This includes products that can be used in a variety of wounds to achieve different outcomes, depending on the wound-bed requirements. Medical grade honey has emerged as a product that can achieve a variety of outcomes within the wound and is safe and easy to use. This article reviews the use of a medical grade honey (Medihoney) in various clinical applications, with a view to placement on the wound care formulary in both primary and secondary care. It provides an in-depth account of case studies featured in a poster presentation at the 2008 European Wound Management Association meeting in Lisbon, Portugal.

Medihoney: a complete wound bed preparation product.

In recent years, honey has emerged as a versatile product that can be applied to many different types of wound to achieve a variety of outcomes, depending on the requirements of the clinician and patient. However, there is still some confusion about how specific honeys work, their antibacterial potency, and what effects this has on wounds treated with honey products. This article reviews the need for ongoing use of honey in wound care. It focuses on Medihoney, a medically certified honey licensed for professional wound care, and presents an update of the clinical data supporting its use.