Funding US Centers for Disease Control and

Funding US Centers for Disease Control and Prevention, US President\'s Malaria Initiative, Doris Duke Charitable Foundation, and Alpha Omega Alpha Honor Society. Declaration of interests
Abstract Background Injuries are the cause of almost 6 million deaths every year, with 15–20% of these associated with alcohol use. However, the frequency of alcohol-associated injury varies widely between countries, but is unknown in Ghana. In this cross-sectional chart review, we aimed to measure the frequency of alcohol-associated injury in adults who presented to an emergency department in Kumasi, Ghana. Methods We reviewed the records of consecutive injured patients 18 years or older who presented to the Komfo Anokye Teaching Hospital (KATH) emergency department for care within 8 h of injury. We excluded patients who had blood in their buy Zalcitabine that interfered with alcohol testing, minor injuries that resulted in referral to a separate outpatient clinic, and patients who died before admission. We recorded alcohol test results, and patient and injury characteristics. Findings Between November, 2014, and April, 2015, 2 488 injured adults presented to the emergency department and we included 1085 (43%) in this study. Median pre-hospital time was 2 h (IQR 1–4h); Median age was 33 years (IQR 26–42 years), 756 (70%) of patients included in the study were men, and 557 (51%) were involved in road traffic incidents. 35% (n=382) of the study population tested positive for alcohol. We noted high rates of alcohol positivity in certain sub-groups such as men (756 total; 42% positive), those aged 25–44 years (626; 40%), drivers (156; 42%), pedestrians (204; 42%), people who had been assaulted (166; 49%), the seriously injured (311; 40%); and patients who died in the emergency department (15; 53%). Interpretation The frequency of alcohol-associated injury was 35% in patients in this Ghanaian tertiary hospital emergency department. Our findings support the practice of routine alcohol testing of injured patients in the KATH emergency department and have implications for health policy, emergency department based interventions, and acute care. Funding Grant R25TW009345 from US National Institutes of Health and Fogarty International Center. Declaration of interests
Abstract Background The burden of complex orthopaedic trauma in low-income and middle-income countries (LMICs) is exacerbated by soft tissue injuries, which can often lead to amputation. The purpose of this study was to create and evaluate the Surgical Management and Reconstruction Training (SMART) course to help orthopaedic surgeons from LMICs manage soft tissue defects and reduce the rate of amputation. Methods In this prospective observational study, orthopaedic surgeons from LMICs were recruited to attend a 2-day SMART course in San Francisco, CA, USA. We administered a survey to participants before the course to assess the burden of soft tissue injury and rates of amputation at their respective sites of practice. We repeated this survey immediately and 1 year post-course to evaluate the quality of instructional materials and the effect of the course in reducing the burden of amputation, respectively. A Likert scale from 1 (poor) to 5 (excellent) was used to assess 14 instructional criteria. Findings 51 practising orthopaedic surgeons from 25 LMICs attended the SMART course. Before the course, participants cumulatively reported 970 amputations per year as a result of soft tissue defects. Mean Likert scores from the survey of participants\' rating of the quality and effectiveness of training materials was at least 4·4 for all instructional criteria. Of the 34 (66·7%) orthopaedic surgeons who completed the survey at 1 year follow up, all reported that Micrococcal nuclease had performed flaps, learned at the course, to treat soft tissue defects. Of the 594 flaps performed by participants 1 year after the course, 554 (93·3%) were reported to have been successful and respondents estimated that flap procedures prevented 116 amputations. At 1 year follow up, almost all (33 [97%]) respondents reported that they had taught flap reconstruction technique to either colleagues or residents, and they estimated that 28 other surgeons undertook flap reconstruction as a result of information dissemination.