Background Ghana’s first Emergency Medicine residency and nursing training programs were initiated in 2009 and 2010, respectively, at Komfo Anokye Teaching Hospital in the city of Kumasi in association with Kwame Nkrumah University of Science and Technology and the Universities of Michigan and Utah. In addition, the National Ambulance Service was commissioned initially in 2004 and has developed to include both prehospital transport services in all regions of the country and Emergency Medical Technician training. Over a decade of domestic and international partnership has focused on making improvements in emergency care at a variety of institutional levels, culminating in the establishment of comprehensive emergency care training programs. Objective We describe the history and status of novel post-graduate emergency physician, nurse and prehospital provider training programs as well as the prospect of creating a board certification process and formal continuing education program for practicing emergency physicians. Discussion Significant strides have been made in the development of emergency care and training in Ghana over the last decade, resulting in the first group of Specialist level EM physicians as of late 2012, as well as development of accredited emergency nursing curricula and continued expansion of a national EMS. Conclusion This work represents a significant move toward in-country development of sustainable, interdisciplinary, team-based emergency provider training programs designed to retain skilled healthcare workers in Ghana and may serve as a model for similar developing nations.
Lower back pain is common, with up to 8% of the adult population in the United States reporting at least one episode of acute back pain within the last year. This is associated with considerable burden to the health care system. The majority of patients who experience back pain have no clear etiology for their symptoms; although symptoms tend to improve within 4 to 6 weeks, they also tend to recur. This review covers the pathophysiology, diagnosis and treatment, and disposition and outcomes of acute lower back pain. Figures show magnetic resonance images of L4/L5 disk herniation, spinal neoplasm, and epidural abscess; schematics of cauda equina syndrome associated with central disk herniation and disk herniation causing unilateral radicular symptoms due to nerve root compression; and dermatomal symptoms associated with L4-S1 nerve root compromise. Tables list red flag signs and symptoms of acute back pain, emergent causes of acute back pain, Waddell signs suggestive of nonorganic back pain, neurologic examination findings associated with L1-S1 nerve roots, pros and cons of treatment options for musculoskeletal and radicular back pain, and indications for surgery for patients with spinal epidural abscess and vertebral osteomyelitis. This review contains 5 highly rendered figures, 6 tables, and 98 references.
Neck and back pain are common reasons for seeking evaluation and treatment in the emergency department. Within both systems there exist several time-sensitive diagnoses that the emergency provider should be familiar with in order to prevent significant morbidity and mortality. In this article we provide a general overview of these complaints by discussing problems in a systems-based fashion as well as discussing the initial evaluation, work-up, and treatment options for these diagnoses.
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