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BACKGROUND Between 2008 and 2011, Rwanda introduced integrated community case management (iCCM) of childhood illness nationwide. Community health workers in each of Rwanda's nearly 15,000 villages were trained in iCCM and equipped for empirical diagnosis and treatment of pneumonia, diarrhea, and malaria; for malnutrition surveillance; and for comprehensive(More)
BACKGROUND Dehydration due to acute gastroenteritis is one of the leading causes of mortality in children worldwide. The World Health Organization (WHO) scale, the Gorelick scale, and the Clinical Dehydration Scale (CDS) were created to estimate percentage dehydration in children with gastroenteritis based on clinical signs. Of these, only the CDS has been(More)
INTRODUCTION Morbidity and mortality due to acute but treatable conditions remain high in the developing world, as many significant barriers exist to providing emergency medical care. This study investigates these barriers in a rural region of Ethiopia. HYPOTHESIS The limited capacity of frontline healthcare workers to diagnose and treat acute medical and(More)
OBJECTIVE To prospectively validate three popular clinical dehydration scales and overall physician gestalt in children with vomiting or diarrhea relative to the criterion standard of percent weight change with rehydration. METHODS We prospectively enrolled a non-consecutive cohort of children ≤ 18 years of age with an acute episode of diarrhea or(More)
As portability and durability improve, bedside, clinician-performed ultrasound is seeing increasing use in rural, underdeveloped parts of the world. Physicians, nurses and medical officers have demonstrated the ability to perform and interpret a large variety of ultrasound exams, and a growing body of literature supports the use of point-of-care ultrasound(More)
STUDY OBJECTIVES The Institute of Medicine (IOM) has called for the elimination of resident work shifts exceeding 16 hours without sleep. We sought to comprehensively evaluate the effects of eliminating or reducing shifts over 16 hours. DESIGN AND OUTCOME MEASURES We performed a systematic review of published and unpublished studies (1950-2008) to(More)
OBJECTIVES The objective of this study was to determine the test characteristics for two different ultrasound (US) measures of severe dehydration in children (aorta to inferior vena cava [IVC] ratio and IVC inspiratory collapse) and one clinical measure of severe dehydration (the World Health Organization [WHO] dehydration scale). METHODS The authors(More)
To determine what patient characteristics are associated with prolonged emergency department (ED) length-of-stay (LOS) for surgical critical care patients, the charts of 169 patients admitted from the ED directly to the operating room (OR) or intensive care unit (ICU) during a 6-week period in 1993 were reviewed. The ED record was reviewed for documentation(More)
BACKGROUND Global health experts identify emergency obstetric care (EmOC) as the most important intervention to improve maternal survival in low- and middle-income countries. In Zambia, 1 in 27 women will die of maternal causes, yet the level of availability of EmOC is not known at the provincial level. AIMS Our goal was to develop a tool to measure the(More)
The field of international emergency medicine has grown rapidly over the past several decades, with an increase in the number of interested individuals and in the range of topics included under its rubric. One of the greatest obstacles, however, faced by international emergency medicine researchers and practitioners alike remains the lack of a high-quality,(More)