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Hospital Re-admission, Length of Stay, and Chief Complaints of Patients Experiencing Housing Instability
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Schistosoma haematobium Infection in Ethiopian Children: Evaluating Praziquantel Efficacy, Nutritional Effects, and Diagnosis Using FlukeCatcher
Get PDFUrogenital schistosomiasis continues to impact the wellbeing of hundreds of millions of people worldwide and remains a significant public health challenge across Ethiopia. Despite existing knowledge on the disease, there remain significant unanswered questions with regard to its treatment and diagnosis. This dissertation evaluated the efficacy of praziquantel at treating urogenital schistosomiasis, improving nutritional parameters among children and the performance of FlukeCatcher at detecting and determining the intensity of infection. In effecting this, a total of 977 children aged 5 through 15 from the Afar and Gambella regions of Ethiopia were screened for S. haematobium infection using urine filtration microscopy and followed for one month. S. haematobium infection and nutritional status of the children were assessed at baseline and one month after treatment. Nutritional status was determined using height, weight and mid-upper arm circumference measurements. The samples collected from children in the Afar region at baseline were also examined for S. haematobium egg using FlukeCatcher. Children infected with S. haematobiumat baseline were treated with 40 mg/kg of praziquantel. Results indicated a significant reduction in infection rates post-treatment, with an 86% overall cure rate and a 97% overall egg reduction rate. Infection with urogenital schistosomiasis was strongly associated with underweight at baseline (aOR: 1.76, 95% CI: 1.63 – 1.90). Nutritional status did not notably improve within one month of treatment among children who received praziquantel therapy. Using the combined results based on FlukeCather and UFM as a reference, FlukeCatcher demonstrated a sensitivity of 84% whilst standard urine filtration microscopy had a sensitivity of 65%. FlukeCatcher, however, had a very poor ability to properly categorise infection intensity. This study concludes that praziquantel at a dose of 40 mg/kg remains highly effective in treating S. haematobium infection, but does not have a significant short-term effect at reversing disease-related malnutrition. Furthermore, FlukeCatcher is superior at diagnosing the infection compared to standard urine filtration microscopy, but has a poor ability to characterise infection intensity. These findings have significant implications for public health strategies, emphasising the need for deeper research into these topics and the deployment of more holistic approaches to combatting schistosomiasis in Ethiopia
Evaluating Surge Capacity in the Emergency Department: A Comprehensive Literature Review on Preparedness and Response Frameworks
Get PDFMedical surge capacity in emergency departments is influenced by four critical factors: staff, stuff, space, and systems. Understanding these factors and the interplay between them is critical. Emergency departments are increasingly encountering issues with overcrowding, patient boarding, and medical surge events causing interruptions in care and depleting critical resources. Coordination of medical surge is challenging during normal operations but is intensified during times of crisis. This comprehensive literature review seeks to better understand the current state of the literature surrounding surge preparedness and response in emergency departments across the United States, identify gaps in the current literature, and ultimately recommend avenues for further investigation to enhance medical surge in the emergency department setting and improve community public health.
This comprehensive literature review investigates a variety of topics related to emergency department surge capacity through a systematic review of current research. The review will focus on preparedness and response frameworks, which encompass the identification of surges and the strategic distribution of resources. This analysis seeks to evaluate current recommendations for surge capacity preparedness and response in the emergency department setting, identify metrics for early surge detection, and better understand tools used to effectively manage emergency department resources. This review seeks to help portray the current state of emergency department medical surge literature, identify gaps in current knowledge, and recommend best practices to increase medical surge capabilities in the emergency department setting.
A detailed protocol with established search strategies as well as inclusion and exclusion criteria will be employed for this comprehensive literature review to select a comprehensive collection of relevant studies without bias. The articles included for review will be organized systematically and analyzed for main themes, trends, and knowledge gaps about factors influencing surge capacity. A quality analysis for each of the articles included in this review will be performed and documented. This comprehensive literature review seeks to identify methods that enhance emergency department surge preparedness and response.
The findings of this comprehensive literature review aim to provide a foundational understanding of the factors affecting medical surge capabilities in the emergency department setting. Ultimately, this review seeks to guide areas for further investigation to fill identified knowledge and evidence gaps in the literature. In addition, this review seeks to recognize current recommendations for increasing medical surge capacities in the emergency department setting. This comprehensive literature review surrounds a topic critical not only to emergency department operations but also to community public health
Severe Acute Malnutrtion Among Children Under Five in South Sudan
Get PDFSevere acute malnutrition (SAM) is a life-threatening condition characterized by severe wasting. The World Health Organization defines SAM as a low weight-for-height Z-score (WHZ) less than -3 standard deviation (SD) from the median growth standard or the presence of edema of both feet and/or mid-upper arm circumference (MUAC) less than 115mm. SAM is a significant public health concern affecting children under five in developing countries, with South Sudan being one of the most severely affected regions. Persistent food insecurity, weak healthcare systems, and ongoing conflict contribute to the high SAM prevalence in the region, where political, religious, and social divisions, along with scarce resources, exacerbate the humanitarian crisis. Despite global efforts to combat SAM, its prevalence remains above emergency thresholds in South Sudan. Addressing structural barriers is crucial for reducing the impact of SAM. This systematic literature review, guided by the Population, Intervention, Comparison, and Outcome (PICO) framework, aimed to analyze the prevalence, causes, and interventions for SAM in children under five years of age in South Sudan. Specifically, this research focused on children under five, evaluating practical interventions, comparing effective versus ineffective strategies, and assessing the intervention outcome. Utilizing the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), this study ensured a structured approach to literature selection, data extraction, and synthesis, proposing evidence-based strategies to enhance SAM treatment and prevention efforts in South Sudan
Palliative Care Education to Heart Failure Patients
Get PDFPurpose: This project aims to increase heart failure patients\u27 knowledge of the benefits of palliative care for improved quality of life, advance understanding of the difference between palliative and hospice care, promote attendance at heart chat classes, and increase referrals to outpatient palliative care clinics.
Methods: This quality improvement project used a one-group, descriptive, exploratory design with pre-and post-testing. The study was conducted on a cardiac unit at a large urban medical center, involving heart failure patients. A tailored educational pamphlet and heart chat class were provided to promote understanding and attendance, along with pre-and post-tests to measure changes in knowledge and perceptions.
Results: Evaluating heart failure patients’ comprehension and perception of palliative care versus hospice care through pre-and post-testing showed a significant difference in knowledge. Of the ten participants, the pre-test median was 5.00 (mean 4.40, SD 1.51), while the post-test median was 5.50 (mean 5.50, SD 0.53), p=.026. Implementing a system-level change through a comprehensive educational pamphlet to promote palliative care referrals and attendance of heart chat classes resulted in mixed outcomes. The palliative heart chat class attendance significantly increased from 6 of 29 patients to 10 of 18, p = .01. However, the palliative care referral rate did not show a significant difference, decreasing from 7 of 29 patients to 2 of 18, p = .27.
Conclusion: This project shows that an educational intervention significantly improved heart failure patients\u27 understanding of palliative care, as evidenced by higher post-test scores. While the educational pamphlet and classes improved patient knowledge and attendance, additional measures may be necessary to influence referral rates
A Comparative Analysis of Preventable Deaths and Healthcare Accessibility: The U.S. Healthcare System vs. Canada, the United Kingdom, and Australia
Get PDFThe United States continues to struggle to improve healthcare performance and patient outcomes in comparison with other developed nations. This study examines access to primary care services and preventable deaths by comparing the performance of the United States, Australia, Canada, and the United Kingdom. (Blumenthal et al., 2024). A comprehensive scoping literature review method was applied to examine the health systems of three countries\u27 public health structures to better understand the factors that may influence the US health system performance in accessing primary care services and decreasing preventable deaths. Understanding the structures that lead to the outcomes can help provide a framework for identifying the foundational changes that may be needed to improve the health outcomes in the United States
Active Shooter and Radiological Contamination Full-Scale Exercise
No full textPlanning and conducting exercises in rural settings highlights the unique features and challenges of emergency preparedness in rural America. Exercise designers must employ creative solutions to plan for player/controller contingencies, limited resources, and patient management across large geographical areas. This paper outlines the process by which a full-scale mass casualty exercise was conducted in a small Wyoming town. It analyzes some of the major problems encountered in rural exercise development and the solutions employed. The focus is on the success and failures of the exercise design based on direct observation/participation, hotwash forms, the after-action review, and direct feedback from participants. Specific techniques for facilitating hospital, emergency medical services, and law enforcement participation are discussed in depth. This analysis is significant because it can help meet the growing demand for more rural-centered training and preparedness approaches
Week 96 Results of Bictegravir/Emtricitabine/Tenofovir Alafenamide for HIV Treatment in People With Substance Use Disorders
Get PDFBACKGROUND: The BASE study (NCT03998176), a phase 4, 48-week (W), single-arm, prospective trial, revealed that the use of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in people with HIV and substance use disorders (PWH/SUD) was safe and effective without emergent antiretroviral resistance despite incomplete adherence. Here, we present the W96 results.
METHODS: A retrospective analysis of all participants enrolled in the BASE study was completed from W48 to W96. End points of interest at W96 included the proportion of participants with viral suppression (VS; HIV RNA \u3c 50 copies/mL [c/mL]), incidence of protocol-defined virologic failure (PDVF; 2 consecutive ≥400 c/mL), safety, adherence (percentage of days covered [PDC]), retention in care, and prevalence of ongoing substance use.
RESULTS: All enrolled BASE participants (n = 43) were included in the W96 analysis. At W48, 21 participants (49%) had achieved VS (intent-to-treat [ITT]). Thirty-six (84%) participants completed W96, with 19 achieving an HIV RNA \u3c 50 copies/mL (ITT, 44%; per-protocol, 54%). Seven participants (19%) met PDVF; genotyping was performed on 2, with no evidence of treatment-emergent antiretroviral resistance noted. No safety signals were identified or attributed to B/F/TAF. Adherence to B/F/TAF decreased 18% after W48 (mean PDC: W0-W48, 72%; W48-W96, 54%;
CONCLUSIONS: At W96, the proportion of PWH/SUD achieving VS with B/F/TAF decreased to 44%, along with an adherence decrease of 18%, with no evidence of treatment-emergent HIV drug resistance occurring
The State of Abortion Training in Medical School and Family Medicine Residency Curricula: A Scoping Literature Review
No full textThis project aims to assess how abortion education has been integrated into medical training over the past decade, with a particular focus on understanding its current state in medical schools and family medicine residencies, including those offering specialized programs affiliated with RHEDI (Reproductive Health Education in Family Medicine) and TEACH (Training in Early Abortion for Comprehensive Healthcare). Given the ever-evolving legal landscape following the June 4th, 2022 Supreme Court case of Dobbs v. Jackson Women’s Health Organization, this review explores how both federal- and state-level legal restrictions impact access to abortion training and attempts to identify gaps in both didactic and clinical education. A scoping literature review was conducted to determine the state and quality of abortion training in medical school curricula and family medicine residency programs in the United States. The findings in this review provide insights into how these current gaps may affect future physicians’ abilities to provide comprehensive reproductive healthcare, particularly in states with restrictive abortion laws. This review will also contribute to ongoing public health efforts to improve reproductive healthcare education and ensure equitable access to safe abortion services. Additionally, these findings highlight the need for further research to evaluate the long-term effects of abortion training restrictions on physician competency and patient outcomes, as well as to explore potential strategies for expanding educational opportunities despite legal and institutional barriers
