Summary
The aim of this study was to objectively measure demand for critical care services in a southern African tertiary referral centre. We carried out a point prevalence study of medical and surgical admissions over a 48‐h period at the University Teaching Hospital, Lusaka, recording the following: age; sex; diagnosis; Human Immunodeficiency Virus (HIV) status and National Early Warning Score. One‐hundred and twenty medical and surgical admissions were studied. Fifty‐four patients (45%) had objective evidence of a requirement for critical care review and potential or probable admission to an intensive care unit, according to the Royal College of Physicians (UK) guidelines. A greater than expected HIV rate was also noted; 53 of 75 tested patients (71%). When applied to the estimated 17,496 annual acute admissions, this would equate to 7873 patients requiring critical care input annually at this hospital alone. In contrast to this demand, we identified 109 critical care beds nationally, and only eight at this institution.
Purpose A new postgraduate anesthesiology residency program has been founded as a North-South partnership between the United Kingdom (UK) and Zambia. The project aims to train physician anesthesiologists in Lusaka in an attempt to address the high perioperative mortality associated with anesthesia as well as to provide better professional support for clinical officer anesthesiologists. Principle findings We present a detailed description of our experiences in establishing a new global health partnership and reflect on the outcomes of the first year of the training program. The formal healthcare partnership between the UK and Zambian governments began in 2009.
We aimed to assess effectiveness of simulation for teaching medical students critical care medicine and to assess which simulation methods were most useful. We searched AMED, EMBASE, MEDLINE, Education Resources Information Centre, British Education Index, Australian Education Index, and bibliographies and citations, in July 2013. Randomized controlled trials comparing effectiveness of simulation with another educational intervention, or no teaching, for teaching medical students critical care medicine were included. Assessments for inclusion, quality, and data extraction were duplicated and results were synthesized using meta-analysis.We included 22 randomized control trials (n = 1325). Fifteen studies comparing simulation with other teaching found simulation to be more effective [standardized mean difference (SMD) = 0.84; 95% confidence interval (CI) = 0.43 to 1.24; P < 0.001; I = 89%]. High-fidelity simulation was more effective than low-fidelity simulation, and subgrouping supported high-fidelity simulation being more effective than other methods. Simulation improved skill acquisition (SMD = 1.01; 95% CI = 0.49 to 1.53) but was no better than other teaching in knowledge acquisition (SMD = 0.41; 95% CI = -0.09 to 0.91).
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