Initial Descriptive Study Research Articles

Human anthrax outbreak and associated factors in the horrific siege of Tigray, Ethiopia

ObjectivesTo investigate the magnitude of the anthrax outbreak and its associated factors during the war and the de facto siege of Tigray, Ethiopia. Design or methodsA case-control study design was applied after an initial descriptive cross-sectional study. Multiple logistic regression was used to identify factors associated with the outbreak. ResultsA total of 339 participants (113 cases and 226 controls) were enrolled with a mean age of 22 ( ± 17) and 35 ( ± 16) years for cases and control groups, respectively. Human anthrax attack and case fatality rates in selected districts of Tigray were estimated at 42.3 per 100,000 population and 5.4%, respectively. Cutaneous anthrax was identified as the most common case of anthrax, accounting for 141/149 total cases (94.6%). Age, consumption of raw meat of diseased animals, sharing of meat, presence of a diseased person among household members, disposal of diseased/dead animals, and contact with products of diseased/dead animals were associated with the outbreak. ConclusionA high rate of human anthrax attacks and fatal cases was recorded during the Tigray defacto blockade, with an epidemic curve. The defacto blockade of Tigray complicated the investigation and management of the outbreak.

Women's Experiences of Urinary Tract Infections and Impact on Life: An Exploratory Qualitative Study.

Despite high incidences of urinary tract infections (UTIs), little is known about how bothersome symptoms are and the effects on women's life and sexual activity, leaving a gap in our understanding of the physical and emotional effects of UTIs on women. This initial exploratory and descriptive study analyzes women's experiences of UTI and their perceived impact on quality of life. Qualitative interviews were undertaken with 23 women who had experienced at least 1 UTI, recruited from different settings-primary care, general gynecology clinics, urogynecology clinics, and online via social media. Data were analyzed thematically. Three themes described women's experiences of UTI: Women in all groups reported a wide range of physical symptoms and described the financial and psychological effects of UTIs. These effects seemed worse in women recruited via social media who also reported experiencing strong emotions and worries about close family members. Urinary tract infection support groups were considered useful, with women being grateful for consultations with alternative health practitioners and presuming safety of natural products. Having a UTI appeared to affect women in a variety of ways, ranging from having different physical symptoms to being psychologically affected by these symptoms, which affected their quality of life in different ways. This research contributes to the growing evidence on how UTIs affect women, specifically further expanding on the impact on women in a range of settings-in the community and different health care settings.

Golden culinary landscapes: A legacy of the palatial female vision in the face of hunger

This study analyzes the feminine culinary universe of Early Modernity in a society marked by food crises and socio-cultural change. To do so, it examines two handwritten recipe books dated between the 16th and 17th centuries. Both examples represent a specific typology of works that is typical of a domestic and private environment. A non-experimental investigation is carried out that consists of an initial descriptive study of the structure of the same. This is followed by a correlational analysis where the relationship between both compliled works is evaluated through the model of recipes, raw materials used, exposed culinary techniques and the final purpose of the food preparations. The results show the permanence of a Greco-Latin culture in the gastronomy of the time with the presence of a strong Moorish influence and a still scarce incidence of the American raw materials. It can be concluded that the formation of this type of Golden Age food pattern had great continuity with previous periods in terms of taste, the transmission of cooking knowledge and the memory of a very sweet and spicy palate.

National quality improvement indicators project: an initial descriptive study.

Anaesthesia Quality Improvement New Zealand developed a set of five quality improvement indicators pertaining to postoperative nausea and vomiting, pain, respiratory distress, hypothermia and a prolonged post-anaesthesia care unit stay. This study sought to assess the proportion of eligible institutions that were able to measure and provide data on these indicators, produce an initial national estimate of these, and a measure of variability in the quality improvement indicators across hospitals in New Zealand. All public hospitals that provide a representative to Anaesthesia Quality Improvement New Zealand were eligible for inclusion. Participating institutions were required to provide the number and proportion of patients with each of the five quality improvement indicators over a continuous 2-week period between 1 June 2019 and 25 October 2019. The overall percentage of patients and the median percentage with each outcome were calculated. A total of 79.2% of eligible hospitals participated. The median incidence of the indicators ranged from 1.67% for respiratory distress to 6.31% for prolonged post-anaesthesia care unit stay. The indicator with the largest interquartile range was hypothermia and the smallest was respiratory distress (13.48 and 2.29, respectively). A large variation was seen for prolonged post-anaesthesia care unit stay, hypothermia, pain and postoperative nausea and vomiting. The majority of eligible institutions were able to measure and provide data on the quality improvement indicators. There was a low rate of respiratory distress with low variability. A large amount of variability was observed in the other indicators. Future studies are needed to explore the nature of this variability.

Clinical Quality Measure Exchange is Not Easy.

The Trial of Aggregate Data Exchange for Maintenance of Certification and Raising Quality was a randomized controlled trial which first had to test whether quality reporting could be a by-product of clinical care. We report on the initial descriptive study of the capacity for and quality of exchange of whole-panel, standardized quality measures from health systems. Family physicians were recruited from 4 health systems with mature quality measurement programs and agreed to submit standardized, physician-level quality measures for consenting physicians. Identified measure or transfer errors were captured and evaluated for root-cause problems. The health systems varied considerably by patient demographics and payer mix. From the 4 systems, 256 family physicians elected to participate. Of 19 measures negotiated for use, 5 were used by all systems. There were more than 15 types of identified errors including breaks in data delivery, changes in measures, and nonsensical measure results. Only 1 system had no identified errors. The secure transfer of standardized, physician-level quality measures from 4 health systems with mature measure processes proved difficult. There were many errors that required human intervention and manual repair, precluding full automation. This study reconfirms an important problem, namely, that despite widespread health information technology adoption and federal meaningful use policies, we remain far from goals to make clinical quality reporting a reliable by-product of care.

Treatment of acute cholecystitis in high-risk surgical patients.

Acute cholecystitis (AC) is the most common biliary stone disease complication. While there is consensus regarding cholecystectomy for AC, gallbladder drainage is indicated in elderly or high-risk surgical patients. We systematically reviewed available evidence in the field of EUS-guided gallbladder drainage (EUS-GBD) for AC in high-risk surgical patients. The studies were classified according to their level of evidence (LE) according to the Oxford Centre for Evidence Based Medicine classification. Literature search retrieved 175 manuscripts; most of them were expert opinions (LE V, N.=53) or case-series (LE IV, N.=29). There was no meta-analysis of RCT (LE Ia), while two randomized controlled trials (LE Ib) demonstrated that EUS-GBD was superior to percutaneous transhepatic-GBD (PT-GBD) regarding long-term outcomes (adverse events, recurrent cholecystitis, and reintervention). Several meta-analyses of cohort studies (LE IIa, N.=11) were designed to compare the three available drainage strategies (endoscopic, echoendoscopic and percutaneous) and to assess the pooled risk of adverse events. Comparison between surgery and EUS-GBD was done in a single retrospective study with a propensity score analysis (LE III). The outcomes of conversion from PT-GBD to EUS-GBD were covered by few retrospective studies (LE III). Several manuscripts (N.=69) were published on EUS-GBD as a rescue strategy in case of malignant biliary obstruction. The levels of evidence of EUS-GBD in the literature have evolved from initial descriptive studies to recent randomized controlled trials and meta-analysis of cohort studies. While several articles addressed the comparison among different techniques for GBD, in our opinion some topics and questions have not been adequately investigated. are still debated.

The intangible heritage in the historical and current cuisine: Multidisciplinary didactic proposal for the teaching and learning of culinary ethnobotany

This study analyzes the development and implementation of a didactic proposal whose final objective is the elaboration by the students of an ethnobotanical research work. This study values the use of local vegetable species in fully updated recipes. For this purpose, there is a sample of 59 students who are studying Gastronomy of Spain I, in the 2 nd year of their Degree in Gastronomy and Culinary Arts. On this matter, we carry out non-experimental research that consists of an initial descriptive univariate study on a questionnaire of previous ideas, and a correlational study. On the research front, we analyze the relationship between the previous ideas and the characteristics of the sample, and between the evaluation of the teaching staff and the co-evaluation of the research work developed. The results show great interest by students in this type of internship, which has achieved a 100% pass rate and an average mark of 7.66. In addition, it establishes a negative correlation between teacher evaluation and co-evaluation. The conclusion is that the training of this type of student in ethnobotany could give an innovative impulse to avant-garde cuisine, while contributing to the enhancement and conservation of local plant biodiversity.

Iterative value models generation in the engineering design process

Value models are increasingly discussed today as a means to frontload conceptual design activities in engineering design, with the final goal of reducing cost and rework associated with sub-optimal decisions made from a system perspective. However, there is no shared agreement in the research community about what a value model exactly is, how many types of value models are there, their input–output relationships and their usage along the engineering design process timeline. Emerging from five case studies conducted in the aerospace and in the construction equipment industry, this paper describes how to tailor the development of value models in the engineering design process. The initial descriptive study findings are summarized in the form of seven lessons learned that shall be taken into account when designing value models for design decision support. From these lessons, the paper proposes a six-step framework that considers the need to update the nature and definition of value models as far as new information becomes available, moving from initial estimations based on expert judgment to detailed quantitative analysis.

Protocol for a program of research from the Aging, Community and Health Research Unit

Background:The goal of the Aging, Community and Health Research Unit (ACHRU) is to promote optimal aging at home for older adults with multimorbidity (≥2 chronic conditions) and to support their family/friend caregivers. This protocol paper reports the rationale and plan for this patient-oriented, cross-jurisdictional research program.Objectives:The objectives of the ACHRU research program are (i) to codesign integrated and person-centered interventions with older adults, family/friend caregivers, and providers; (ii) to examine the feasibility of newly designed interventions; (iii) to determine the intervention effectiveness on Triple Aim outcomes: health, patient/caregiver experience, and cost; (iv) to examine intervention context and implementation barriers and facilitators; (v) to use diverse integrated knowledge translation (IKT) strategies to engage knowledge users to support scalability and sustainability of effective interventions; and (vi) to build patient-oriented research capacity.Design:The research program was informed by the Knowledge-to-Action Framework and the Complexity Model. Six individual studies were conceptualized as integrated pieces of work. The results of the three initial descriptive studies will inform and be followed by three pragmatic randomized controlled trials. IKT and capacity building activities will be embedded in all six studies and tailored to the unique focus of each study.Conclusions:This research program will inform the development of effective and scalable person-centered interventions that are sustainable through interagency and intersectoral partnerships with community-based agencies, policy makers, and other health and social service agencies. Implementation of these interventions has the potential to transform health-care services and systems and improve the quality of life for older adults with multimorbidity and their caregivers.Trial registration:NCT02428387 (study 4), NCT02158741 (study 5), and NCT02209285 (study 6).

A PSS maturity self-assessment tool

The ongoing discussion about digital transformation in combination with new digital services is increasing uncertainties in companies on how to proceed regarding their strategic development of new products, services as well as integrated offers. The main challenges for companies has been stated in several industrial workshops and projects. They comprise the assessment of the current situation, identifying the business value of digital transformation as well as the necessary capabilities needed regarding the implementation of a target vision. Based on the results of a literature analysis as well as initial prescriptive and descriptive study a revised PSS maturity model has been developed for assessing the status of a company reflecting on four dimensions: value proposition, business processes, customer and sustainability. The approach is complemented with an online self-assessment tool and generic action recommendations. The methodology has been applied and evaluated with a case company. The qualitative results indicate a good user acceptance and a very good ease of use as well as an improvable feedback regarding the action recommendations.

The clinical impact of ultrasound contrast agents in EUS: asystematic review according to the levels of evidence.

The use of contrast-harmonic EUS (CH-EUS) in routine clinical practice is increasing rapidly but is not yet standardized. We present the levels of evidence (LEs) found in the literature to put its clinical outcomes in the appropriate perspective. We conducted a systematic review of the available English-language articles. The LEs were stratified according to the Oxford Centre for Evidence-Based Medicine guidelines. Overall, 210 articles were included and presented according to different pathologic conditions. For pancreatic solid neoplasms, the pooled sensitivity and specificity in the diagnosis of pancreatic carcinoma were very high (LE 1); quantitative analysis and guidance of FNA were reported as investigational research (LE 2-3). For pancreatic cystic lesions, the identification of neoplastic solid components as hyperenhanced lesions represented a promising application of CH-EUS (LE 2). For lymph nodes, CH-EUS increased the diagnostic yield of B-mode EUS for the detection of malignancy (LE 2). For submucosal tumors, CH-EUS seemed useful for differential diagnosis and risk stratification (LE 2-3). For other applications, differential diagnosis of gallbladder and vascular abnormalities by CH-EUS were reported (LE 2-3). The LEs of CH-EUS in the literature have evolved from the initial descriptive studies to multicenter and prospective trials, and even meta-analyses. The differential diagnosis between benign and malignant lesions is the main field of application of CH-EUS. With regard to pancreatic solid neoplasms, the concomitant use of both CH-EUS and EUS-FNA may have additive value in increasing the overall accuracy by overcoming the false-negative results associated with each individual technique. Other applications are promising but still investigational.

Education and simulation training of pediatric intensive care unit nurses to care for open heart surgery patients.

Providing appropriate education for nurses working in the pediatric intensive care unit (PICU) to develop and update the skill sets and knowledge required to care for infants and children with congenital heart disease (CHD) is a challenge. We provide care to children with a variety of congenital heart defects that require medical care and surgical corrections. In the extreme circumstance, we provide extracorporeal membrane oxygenation to those children who require extracardiac support postoperatively. Our program deals with a mean of about 150 cases annually that require surgical correction, in addition to the medically managed patients with CHD. The hospital-based simulation center opened in 2010. It provides high-fidelity simulation to enhance current medical and nursing education. Patient scenarios are created on the basis of real patient cases, maintaining the realistic details of the disease and injury processes essential to provide the pertinent learning points of each case. Shortly after the simulation center opened, the PICU educator inquired about the process to provide PICU nurses an opportunity to learn about pediatric open heart surgery patients at the simulation center. The inherent challenge within our PICU is that we have 32 nurses with various skills sets and experiences who must be able to provide care for all patients within our unit, including children with CHD. At that time, 7 PICU nurses were ready to learn how to provide nursing care to children who have undergone open heart surgery. This state of readiness is detailed later. A classroom format was used to present the material, which addressed identification of defects, along with medical and nursing management. This classroom training was followed by a 4-hour simulation session, wherein these nurses participated in 2 patient scenarios. Clinical objectives (Table 1) were reviewed and reinforced to define what needed to be learned and to ensure that learning occurred. Following this simulation training, each nurse was assigned to admit a pediatric open heart patient with an experienced nurse present to reinforce the prior learning.

In vivo Monitoring of Cerebral Hemodynamics in the Immature Rat: Effects of Hypoxia-Ischemia and Hypothermia

Background: Neonatal hypoxic-ischemic (HI) encephalopathy occurs in 1-4 per 1,000 live term births and can cause devastating neurodevelopmental disabilities. Currently, therapeutic hypothermia (TH) is the only treatment with proven efficacy. Since TH is associated with decreased cerebral metabolism and cerebral blood flow (CBF), it is important to assess CBF at the bedside. Diffuse correlation spectroscopy (DCS) has emerged as a promising optical modality to noninvasively assess an index of CBF (CBF_i) in both humans and animals. In this initial descriptive study, we employ DCS to monitor the evolution of CBF_i following HI with or without TH in immature rats. We investigate potential relationships between CBF and subsequent cerebral damage. Methods: HI was induced on postnatal day 10 or 11 rat pups by right common carotid artery ligation followed by 60-70 min hypoxia (8% oxygen). After HI, the pups recovered for 4 h under hypothermia (HI-TH group, n = 23) or normothermia (HI-N group, n = 23). Bilateral measurements of hemispheric CBF_i were made with DCS in unanesthetized animals at baseline, before HI, and 0, 1, 2, 3, 4, 5, and 24 h after HI. The animals were sacrificed at either 1 or 4 weeks, and brain injury was scored on an ordinal scale of 0-5 (0 = no injury). Results: Carotid ligation caused moderate bilateral decreases in CBF_i. Following HI, an initial hyperemia was observed that was more prominent in the contralateral hemisphere. After initiation of TH, CBF_i dropped significantly below baseline levels and remained reduced for the duration of TH. In contrast, CBF_i in the HI-N group was not significantly decreased from baseline levels. Reductions in CBF_i after 4 h of TH were not associated with reduced damage at 1 or 4 weeks. However, elevated ipsilateral CBF_i and ipsilateral-to-contralateral CBF_i ratios at 24 h were associated with worse outcome at 1 week after HI. Conclusions: Both HI and TH alter CBF_i, with significant differences in CBF_i between hypothermic and normothermic groups after HI. CBF_i may be a useful biomarker of subsequent cerebral damage.

Glass Production in the Early Byzantine Period (4th–7th Century) at Gadara (Umm Qais), Jordan, Area W, 2011 Season of Excavation

Studies of ancient glass production in northern Jordan are rare. During the 2011 season of excavation at ancient Gadara (Umm Qais), a large number of fragmentary glass objects were found, along with a group of chunks and molten glass fragments. These finds may indicate the existence of a glass secondary workshop at the site during the Byzantine period (4th–7th centuries AD. This paper focuses on the glass objects and the chunks and molten glass fragments discovered at the site. An initial descriptive and comparative study of the objects is followed by a discussion of the glass production and workshops that are already known in the region. A sample of twenty-five diagnostic fragments dated between the 4th and the 7th centuries AD was selected for study, of which nine were analysed chemically using the Atomic Absorption method. The results suggest that glass objects were locally produced at Gadara.

Improving practice in community-based settings: a randomized trial of supervision – study protocol

BackgroundEvidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Methods/DesignThe study has two phases. We will conduct an initial descriptive study (Phase I) of supervision practices within public mental health in Washington State followed by a randomized controlled trial of gold standard supervision strategies (Phase II), with randomization at the clinician level (i.e., supervisors provide both conditions). Study participants will be 35 supervisors and 130 clinicians in community mental health centers. We will enroll one child per clinician in Phase I (N = 130) and three children per clinician in Phase II (N = 390). We use a multi-level mixed within- and between-subjects longitudinal design. Audio recordings of supervision and therapy sessions will be collected and coded throughout both phases. Child outcome data will be collected at the beginning of treatment and at three and six months into treatment.DiscussionThis study will provide insight into how supervisors can optimally support clinicians delivering evidence-based treatments. Phase I will provide descriptive information, currently unavailable in the literature, about commonly used supervision strategies in community mental health. The Phase II randomized controlled trial of gold standard supervision strategies is, to our knowledge, the first experimental study of gold standard supervision strategies in community mental health and will yield needed information about how to leverage supervision to improve clinician fidelity and client outcomes.Trial registrationClinicalTrials.gov NCT01800266

Serratus plane block: a novel ultrasound-guided thoracic wall nerve block

We present a novel ultrasound-guided regional anaesthetic technique that may achieve complete paraesthesia of the hemithorax. This technique may be a viable alternative to current regional anaesthetic techniques such as thoracic paravertebral and central neuraxial blockade, which can be technically more challenging and have a higher potential side-effect profile. We performed the serratus block at two different levels in the midaxillary line on four female volunteers. We recorded the degree of paraesthesia obtained and performed fat-suppression magnetic resonance imaging and three-dimensional reconstructions of the spread of local anaesthetic in the serratus plane. All volunteers reported an effective block that provided long-lasting paraesthesia (750-840 min). There were no side-effects noted in this initial descriptive study. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for the serratus plane block to provide analgesia following surgery on the thoracic wall. We suggest that this novel approach appears to be safe, effective, and easy to perform, and is associated with a low risk of side-effects.

Perforation and mortality after cleansing enema for acute constipation are not rare but are preventable

ObjectivesConstipation is a common complaint, frequently treated with cleansing enema. Enemas can be very effective but may cause serious adverse events, such as perforation or metabolic derangement. Our aim was to evaluate the outcome of the use of cleansing enema for acute constipation and to assess adverse events within 30 days of therapy.MethodsWe performed a two-phase study: an initial retrospective and descriptive study in 2010, followed by a prospective study after intervention, in 2011. According to the results of the first phase we established guidelines for the treatment of constipation in the Emergency Department and then used these in the second phase.ResultsThere were 269 and 286 cases of severe constipation in the first and second periods of the study, respectively. In the first study period, only Fleet® Enema was used, and in the second, this was changed to Easy Go enema (free of sodium phosphate). There was a 19.2% decrease in the total use of enema, in the second period of the study (P < 0.0001). Adverse events and especially, the perforation rate and the 30-day mortality in patients with constipation decreased significantly in the second phase: 3 (1.4%) versus 0 (P = 0.0001) and 8 (3.9%) versus 2 (0.7%) (P = 0.0001), for perforation and death in the first and second period of the study, respectively.ConclusionEnema for the treatment of acute constipation is not without adverse events, especially in the elderly, and should be applied carefully. Perforation, hyperphosphatemia (after Fleet Enema), and sepsis may cause death in up to 4% of cases. Guidelines for the treatment of acute constipation and for enema administration are urgently needed.

WITHDRAWN: Existing Infrastructure for the Delivery of Emergency Care in Post-Conflict Rwanda: an Initial Descriptive Study

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/S2211-419X(12)00102-4 . The duplicate article has therefore been withdrawn.

Establishing an emergency department syndromic surveillance system to support the London 2012 Olympic and Paralympic Games

BackgroundThe London 2012 Olympic and Paralympic Games is a mass gathering event that will present a major public health challenge. The Health Protection Agency, in collaboration with the College of...

Existing infrastructure for the delivery of emergency care in post-conflict Rwanda: An initial descriptive study

Rwanda’s EM infrastructure has progressed since 1994. EM providers were interviewed about ongoing challenges. These include: resources, training, and pre-ER care. Rwanda is a landlocked East-African country that was the site of the 1994 genocide, during which much of its health infrastructure was destroyed. It remains one of the poorest and least developed countries in the world. In the last two decades, there have been significant efforts to rebuild its healthcare system. No study has since examined Rwanda’s emergency medicine (EM) infrastructure. To perform an initial descriptive study of EM infrastructure in post-conflict Rwanda. We employed two methods. The first was 160 h of direct observation at six healthcare sites in the capital city of Kigali leading to a descriptive understanding of Rwanda’s EM infrastructure. The second method utilized face-to-face narrative interviews based on a 5-item open-ended questionnaire with a convenience sample of 54 healthcare workers. A relatively basic EM infrastructure was found to exist. Emergency care is available to all, though timely access and demand for payment are barriers to care. Emergency care is delivered at all levels, from local community health centres to district hospitals to national referral centres. The majority of physicians working in the Emergency Departments (EDs) are general practitioners, and only one hospital provides specialised training at the BLS level to EM practitioners. Prehospital care is almost entirely missing. The three most commonly cited problems facing EM infrastructure in Rwanda were lack of resources (94% of respondents), need for specialised EM training (89%), and absence of prehospital care (74%). All except one worker surveyed (98%) were satisfied with the progress Rwanda has made to improve EM in the last 10 years. Despite ongoing challenges, the infrastructure for the delivery of emergency care is much improved since 1994, and Rwanda’s continuing progress can serve as a model for EM development in other developing and/or post-conflict countries in Africa. Le Rwanda est un pays enclavé d’Afrique de l’Est, lieu du génocide de 1994, au cours duquel la majeure partie de ses infrastructures sanitaires a été détruite. Il demeure l’un des pays les plus pauvres et les moins développés du monde. Au cours des deux dernières décennies, des efforts importants ont été entrepris afin de reconstruire son système de soins. Aucune étude ne s’est depuis penchée sur les infrastructures de médecine d’urgence (MU) du Rwanda. Réaliser une première étude descriptive des infrastructures de MU dans le Rwanda d’après-conflit. Nous avons employé deux méthodes. La première a consisté en 160 heures d’observation directe dans six lieux d’administration de soins de la capitale, Kigali, permettant une compréhension détaillée des infrastructures de MU au Rwanda. La seconde consistait en des entretiens narratifs en face à face s’appuyant sur un questionnaire de cinq questions ouvertes avec un échantillon de commodités de 54 membres du personnel soignant. Il a été constaté que des infrastructures de MU basiques existaient. Les soins d’urgence sont disponibles pour tous, bien qu’un accès opportun et une demande de paiement constituent des barrières aux soins. Les soins d’urgence sont fournis à tous les niveaux, des centres de santé communautaires locaux aux hôpitaux de district en passant par les centres hospitaliers nationaux. La majorité des médecins travaillant dans les Services d’urgence (SE) sont des généralistes, et un seul hôpital propose aux généralistes de MU une formation spécialisée en premiers soins de réanimation. Les soins pré-hospitaliers n’existent quasiment pas. Les trois problèmes auxquels sont confrontées les infrastructures de MU les plus souvent cités sont le manque de ressources (94% des sondés), la nécessité d’une formation en MU spécialisée (89%) et l’absence de soins pré-hospitaliers (74%). Toutes les personnes interrogées, à l’exception d’une (98%), étaient satisfaites des progrès réalisés par le Rwanda pour améliorer la MU au cours des dix dernières années. En dépit des défis actuels, les infrastructures nécessaires à la fourniture de soins d’urgence se sont beaucoup améliorées depuis 1994, et les progrès continus du Rwanda peuvent servir de modèle à un développement de la MU dans d’autres pays en voie de développement et/ou en situation d’après-conflit en Afrique.