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 Table of Contents  
CONFERENCE ABSTRACTS AND REPORTS
Year : 2019  |  Volume : 5  |  Issue : 3  |  Page : 198-239

The Fourth Annual Academic International Medicine Congress (AIM 2019) in Philadelphia, Pennsylvania, July 26–28, 2019: Advancing Global Leadership to Promote Health Equity


On behalf of the AIM 2019 Congress Steering Committee, Philadelphia; ACAIM Publications and Awards Committees,The American College of Academic International Medicine, Bethlehem, Pennsylvania, USA

Date of Submission19-Nov-2019
Date of Decision25-Nov-2019
Date of Acceptance06-Dec-2019
Date of Web Publication24-Dec-2019

Correspondence Address:
Stanislaw P Stawicki
Department of Research and Innovation, St. Luke's University Health Network, EW2 Research Administration, 801 Ostrum Street, Bethlehem, Pennsylvania 18015
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_61_19

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  Abstract 


The Academic International Medicine (AIM) Congress is the official annual meeting of the American College of Academic International Medicine (ACAIM), a United States-based organization dedicated specifically to connecting academic physicians from diverse areas of expertise toward the common goals of sustainable global medical outreach and multinational clinical research and education. ACAIM's primary focus is to promote AIM and to establish a platform for individuals and entities to work collectively to create a foundation for efficient, effective, and sustainable resource sharing. World-renowned experts and speakers from the AIM community attended and participated in the Fourth Annual Congress (AIM 2019) held in Philadelphia, Pennsylvania, from July 26 to July 28, 2019. The conference theme Advancing Global Leadership to Promote Health Equity showcased efforts of the AIM community to generate and utilize objective data to achieve global impact. This year's Congress saw an overall increase in attendance compared to 2018. Pre-conference activities incorporated a Global Leadership Certification Course. In addition, the Congress featured the Third Annual Scientific Forum as a platform for exchanging scientific knowledge among scholars. Here, we present an overview of this major academic event, including the listing of podium presentations from the 2019 Scientific Forum.
The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, Systems-based practice, Interpersonal and communication skills, Professionalism.

Keywords: Academic International Medicine 2019, Academic International Medicine World Congress, American College of Academic International Medicine, scientific abstracts, scientific forum


How to cite this article:
Garg SM, Garg M, Paladino L, Jeanmonod D, Jeanmonod R, McDonald MP, Nanda S, Opara IN, Miller A, Papadimos TJ, Peck G, Sifri ZC, Stawicki SP, Swaroop M, Thakker K, Yaffe AQ, Galwankar SC, Bloem C, Arquilla B, Anderson HL. The Fourth Annual Academic International Medicine Congress (AIM 2019) in Philadelphia, Pennsylvania, July 26–28, 2019: Advancing Global Leadership to Promote Health Equity. Int J Acad Med 2019;5:198-239

How to cite this URL:
Garg SM, Garg M, Paladino L, Jeanmonod D, Jeanmonod R, McDonald MP, Nanda S, Opara IN, Miller A, Papadimos TJ, Peck G, Sifri ZC, Stawicki SP, Swaroop M, Thakker K, Yaffe AQ, Galwankar SC, Bloem C, Arquilla B, Anderson HL. The Fourth Annual Academic International Medicine Congress (AIM 2019) in Philadelphia, Pennsylvania, July 26–28, 2019: Advancing Global Leadership to Promote Health Equity. Int J Acad Med [serial online] 2019 [cited 2020 Sep 23];5:198-239. Available from: http://www.ijam-web.org/text.asp?2019/5/3/198/273935

[TAG:2]Introduction[/TAG:2]

The Fourth Academic International Medicine Congress (AIM 2019) titled Advancing Global Leadership to Promote Health Equity (the AIM Congress) was held at the Lewis Katz School of Medicine of Temple University (LKSOM) in Philadelphia, Pennsylvania, between July 26, and July 28, 2019. Conference faculty and attendees included physicians and AIM experts representing over 40 academic medical institutions and organizations from around the world. This 3-day conference was organized by the American College of Academic International Medicine (ACAIM, www.acaim.org), with the generous assistance from the leadership and medical staff of LKSOM. AIM 2019 encompassed both clinical and nonclinical activities that broadly constitute a combination of international medical outreach, education and research, as well as global health. One of the hallmarks of ACAIM is its dedication to multidisciplinary pursuits with membership inclusive of all medical and surgical trainees and practitioners without regard to specialty or geographic location of collaborating international medical programs (IMPs).

Topics discussed during the AIM Congress included global academic leadership, undergraduate and graduate medical education (GME) and international rotations, AIM educational leadership, translational science in the global context, optimization of bidirectional exchanges, refugee care, longevity and sustainability of international projects, clinical care innovations and associated international applications, narrative medicine, and many others. In addition, pre-Congress activities featured the Global Leadership Certificate Course by Dr. Michael Frisina. The participating faculty listing is available under the “Congress Program and Map” tab at http://acaim.org/home/aim_2019. Additional details, including multiple photographs and other multimedia links from the Congress, can be found on Twitter at https://twitter.com/acaiminfo and Facebook at https://www.facebook.com/1acaim.

Medical and surgical specialties represented at the Congress included anesthesiology, cardiology, cardiothoracic surgery, critical care, emergency medicine, general surgery, geriatric medicine, infectious diseases, internal medicine, nephrology, orthopedics, obstetrics and gynecology, occupational health, pediatrics, primary care/family medicine, psychiatry, pulmonology, and traumatology/critical care. In addition, various allied health professions were represented including emergency care, medical education, nursing, public health, and social work experts. The 3-day conference featured a combination of joint plenary sessions and multitrack specialty sessions Figure 1, as detailed in the following sections.
Figure 1: Sample of conference activities: [Top left] Volunteers at the Academic International Medicine 2019 registration desk - Gabriela Lopez, Ashlee Torturro, and Lauren D'Andrea; [Top right] Dr. Pia Daniel and Dr. Manish Garg recognize Dr. Anoop Raman after his talk on Global Project Leadership; [Bottom left] Dr. Bill Novick gives his talk on international health diplomacy; [Bottom center] Dr. Galwankar receives the American College of Academic International Medicine Founder and Legacy Award; [Bottom right] Dr. Sona Garg and Dr. Ziad Sifri with Dr. Harsh Sule and Dr. Vennila Padmanaban

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[TAG:2]Day 1: Friday, July 26, 2019[/TAG:2]

The premeeting activities began on Friday morning, with the Global Leadership Certification Course delivered masterfully by Michael Frisina, Ph.D. This continuing medical education (CME)-certified activity provided attendees with the fundamentals of a behavior-based system of mindful leadership, complete assessments of individual behavior patterns and communication styles, personalized burnout-wellness continuum, as well as upper-/lower-brain dynamic awareness. The focus on leadership continued into the afternoon, with Dr. John M. Daly giving the Annual President's Address on how to engage Medical School Deans in AIM-related activities. This is the continuation of a discussion ACAIM has previously introduced [1],[2],[3],[4],[5] on academic engagement and its value in international medicine, a topic to which ACAIM is committed. The address was followed by an informative presentation by Dr. Cameron Page on how to set up GME compliant international rotations.

After reconvening following the lunch break, Mr. Seeling of GemX outlined the multilateral exchange model to facilitate international educational collaborations. This was followed by Dr. William Burdick speaking on how to foster the development of global educational leaders. The afternoon session continued with Dr. Christopher Austin who presented on the importance of translational science for optimization of international impact in biomedical sciences. The CME program concluded with Dr. Anoop Raman giving a presentation on how innovations in clinical care move bilaterally between the Global South and Global North. The evening concluded with a Story Slam!during which Congress participants and faculty presented personal narratives and reflections to a filled main auditorium. Dr. Lisa Moreno-Walton, the first female President-Elect of the American Academy of Emergency Medicine, won the coveted Story Slam! Champion title, with her story of perseverance, grit, and determination, despite multiple challenges.

[TAG:2]Day 2: Saturday, July 27, 2019[/TAG:2]

The 2nd day of the conference started with a networking breakfast in the LKSOM main lobby. The opening ceremony was launched by the ACAIM President, Dr. Manish Garg, and featured presentations on Diplomacy for Health Equity (Dr. Emmanuel Makasa), Diversity and Inclusion (Dr. Lisa Moreno-Walton), Sacrifices Made by AIM Professionals Practicing in Conflict Areas (Dr. Carlos Pilasi Menichetti), and Medical Diplomacy [Dr. William Novick, Figure 1.

Next, Congress attendees partitioned into two tracks: (1) “How to” Guide for International Medicine and (2) Health Equity. Track 1 began with sessions entitled How to Engage the Global Community (Dr. Esperanza Martinez) and the Past Presidents' Lecture titled Advancing Your Community Globally (Dr. Robert Gore). Dr. Howard Friedman then continued with an important talk on how to evaluate US-based AIM projects. During this talk, he provided concrete steps to outline objective measures for project success to justify ongoing funding and support. Dr. Veronica Tucci then lectured on Navigating Countertransference in Medical Decision-Making, during which she challenged the audience to recognize and face their own implicit biases. The late afternoon session began with Dr. Christine Butts speaking on key challenges facing International US-based programs. Dr. Susan Torrey then followed with a lecture titled, How to Create Bidirectionality in AIM. A discussion on logistics associated with the management of programs abroad was then led by Mr. Jason Friesen. The session concluded with Dr. Andrew Miller speaking on how to successfully and effectively mentor in AIM. He outlined an organized framework on how best to provide feedback to learners.

Within the Health Equity track, Dr. Christine Butts and Dr. Nicole Kaban gave an informative lecture on AIM Ultrasound Applications. They highlighted the portability and applicability of this technology in many patient care scenarios. This was followed by Dr. Shama Patel speaking on Global Emergency Care Ethics. Dr. Christina Pardo then spoke on the Sustainable Village and Learning Community Project based in Haiti. Dr. Alyssa Green next outlined the essentials of refugee care. Dr. Esther Han and Dr. Veronica Ades presented on Obstetrics and Gynecology in the international context. Finally, Dr. Anna Yaffee spoke on optimal ways to adapt education in low-resource settings. Panel discussants from the Women in International Medicine session are recognized in Figure 2.
Figure 2: [Top left] Women in Academic International Medicine Panel: Dr. Christina Pardo, Dr. Anjali Niyogi, Dr. Zoe Maher, Dr. Susan Torrey, Dr. Annelies DeWulf; [Top right] How to Engage the Global Community: Dr. Mamta Swaroop, Dr. Esperanza Martinez, Dr. Manish Garg; [Bottom left] Harnessing Translational Science for Maximal Impact: Dr. Vikas Kapil, Dr. Christopher Austin, Dr. Manish Garg; [Bottom right] Medical Student Abstract Award Winner: Dr. Manish Garg, Carly Williams, Dr. Bonnie Arquilla

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[TAG:2]Inaugural Meeting of the Accreditation Council for International Medical Programs[/TAG:2]

The Accreditation Council for International Medical Programs (ACIMP) was established to promote the accreditation and harmonization of IMPs as defined by ACAIM.[3],[5] More specifically, ACIMP was established to promote domestic/global collaborations and coordination of international medicine efforts, providing a clearinghouse function for other institutions and organizations. Finally, ACIMP was established to educate, publish, and assist policymaking in the area of international medicine, focusing specifically on accreditation and related issues. Key stakeholders were invited and the initial bylaws and constitution were reviewed. ACIMP will create strategic partnerships, establish working groups (standards, site evaluation, and bylaws), and create an effective governance structure to promote organizational mission.

With representatives from multiple stakeholder institutions convened, plans were drafted to develop a set of policies, procedures, toolkits, and instruments; create key workgroups and taskforces; and set up regular work meetings.

A mission statement outlining the need for an Accreditation Council to promote standards and regulations, as well as the role of ACIMP in maintaining high quality across international medical programs will be published within the next year.

[TAG:2]The Gala at the Philadelphia College of Physicians: Faim Recognitions[/TAG:2]

A Gala event hosted at the College of Physicians in Philadelphia was held in the evening on July 27, 2019. The College of Physicians is one of the oldest professional medical organizations in the country founded in 1787. Guests were able to tour the Mutter Museum filled with interesting medical artifacts and discoveries. They were then welcomed to the garden for appetizers and enjoyed a formal dinner followed by an awards presentation ceremony Figure 3. The following new fellows of AIM were inaugurated by the President of ACAIM, Dr. Manish Garg: Dr. Donald Jeanmonod, Dr. Lorenzo Paladino, Dr. Ziad Sifri, and Dr. Silvana Teixeira Dal Ponte. The evening concluded with a Founder and Legacy Award for Dr. Sagar Galwankar in recognition of his vision and passion for ACAIM Figure 1.
Figure 3: Academic International Medicine 2019 Gala attendees in the garden of the Philadelphia College of Physicians

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[TAG:2]Day 3: Sunday, July 28, 2019[/TAG:2]

Day 3 of the Congress began with a Keynote Speech by Dr. Juan Asensio, titled Lessons from the Past to Prepare Our Future. Dr. Asensio provided an excellent overview of surgical advancements that have occurred as a result of combat operations over the last century. Dr. Vikas Kapil then followed with a talk on the Centers for Disease Control and Prevention role in global health security Figure 2. His presentation was followed by an informational session that provided an opportunity for AIM programs from around the country to present and share their unique experiences with other experts in this area.

Dr. Manish Garg opened this informational session by presenting on the Global Health Program at LKSOM in Philadelphia, Pennsylvania. Dr. Adele Schneider then presented on the Einstein Medical Center (Philadelphia) program and her work in Chuuk (Federated States of Micronesia). This was followed by Dr. Ziad Sifri's presentation on AIM programs at Rutgers New Jersey Medical School in Newark, New Jersey. Dr. Danny Mai spoke about the Kaiser-Permanente/VN Hope initiative. The program at Northwell Health was then presented by Dr. Rafael Barrera.

The session continued with a presentation by Dr. Marian P. McDonald and Dr. Richard P. Sharpe on Global Medicine and Surgery Programs at St. Luke's University Health Network, Eastern Pennsylvania, and Western New Jersey. Dr. Mamta Swaroop then provided an overview of Global Medicine & Surgery at Northwestern University, Chicago, Illinois. The SUNY Downstate program was then presented by Dr. Christina Bloem, followed by a summary of the Wayne State University Global Health Alliance and Global Urban Health Equity program by Dr. Kristiana Kaufmann and Dr. Ijeoma Nnodim Opara.

[TAG:2]Academic International Medicine 2019 Scientific Forum[/TAG:2]

The AIM 2019 Scientific Forum featured 49 abstract presentations. This year, medical student participation was further highlighted by the Medical Student Abstract Session on July 27, 2019, during which 40 clinical research projects and cases were presented. A Resident Abstract Competition on July 28th was moderated by Drs. Richard Sinert, Lorenzo Paladino, Donald Jeanmonod, and Harry L. Anderson III. Podium presentations featured a broad range of topics, including aeromedical transportation safety, global drug shortages, medical education, postgraduate specialty certifications, geographic and population-specific diseases, international outreach, and program logistics. The program featured both international and domestic presenters. Scientific competition judges awarded Ms. Carly Williams with “Best Student Presentation” Figure 2 for her work on prehospital care in Cambodia. Finally, the “Best Scientific Presentation” was given to Dr. Vennila Padmanaban for her work on the global impact of bleeding control courses utilizing “train-the-trainer” initiatives Figure 1.

[TAG:2]Summary[/TAG:2]

Building on the success of AIM 2018 in Brooklyn, New York, the AIM 2019 Congress was the most attended ACAIM event to-date. In addition to the high-quality didactic program, the 2019 Scientific Forum featured the largest number, and best quality, of abstracts in the history of AIM annual meetings. Changes on the ACAIM leadership team included the Presidential transition from Dr. Manish Garg to Dr. Christina Bloem Figure 4, Dr. Annelies De Wulf becoming President-Elect, and finally the election of Dr. Pia Daniel to the Organization's Vice-President. Dr. Ron Maio became ACAIM's Secretary, while Dr. Harry L. Anderson III continues as the Treasurer. Next year's AIM Congress will take place on August 28–30, 2020, at Rutgers University in New Brunswick, New Jersey. We hope to see you there!
Figure 4: Formal transition of American College of Academic International Medicine Presidency from Dr. Manish Garg to Dr. Christina Bloem

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Acknowledgments

We would like to acknowledge the support of the following individuals: Dr. Ron Maio, Dr. Jessica Paulson, Dr. Ricardo Izurieta, Dr. Michelle Kallis, Dr. Abbas Khan, and Dr. Richard Sinert. Your dedication and leadership were critical to the success of the AIM 2019 Congress. Thank you!

Ethical conduct of research

All of the abstracts and case reports listed below were required to follow applicable EQUATOR Network (http://www.equator-network.org/) guidelines prior to acceptance for presentation at the AIM 2019 Scientific Forum. This includes approval by Institutional Review Board / Ethics Committee and patient consent declaration for case reports or series.


  References Top


  1. Saeed M, Swaroop M, Hansoti B, Anderson HL, Arquilla B, Firstenberg MS, et al. The 2nd Annual Academic International Medicine Congress (AIM 2017) connecting health with care in clearwater Beach, Florida, July 28-30, 2017: Event highlights and scientific forum abstracts. Int J Acad Med 2017;3:295.
  2. Anderson HL 3rd, Arquilla B, Firstenberg MS, Garg M, Galwankar SC, Gracias VH, et al. Mission statement of the American College of Academic International Medicine. Int J Crit Illn Inj Sci 2017;7:3-7.
  3. Peck GL, Garg M, Arquilla B, Gracias VH, Anderson Iii HL, Miller AC, et al. The American College of Academic International Medicine 2017 Consensus Statement on International Medical Programs: Establishing a system of objective valuation and quantitative metrics to facilitate the recognition and incorporation of academic international medical efforts into existing promotion and tenure paradigms. Int J Crit Illn Inj Sci 2017;7:201-11.
  4. Arquilla B, Bloem C, Izurieta R, Jeanmonod D, Jeanmonod RK, Nanda S, et al. The Third Annual Academic International Medicine World Congress (AIM 2018)”translating evidence into global innovation” in Brooklyn, New York, July 27-29, 2018: Event highlights and scientific forum abstracts. Int J Acad Med 2018;4:310.
  5. Garg M, Peck GL, Arquilla B, Miller AC, Soghoian SE, Anderson Iii HL, et al. A comprehensive framework for international medical programs: A 2017 consensus statement from the American College of Academic International Medicine. Int J Crit Illn Inj Sci 2017;7:188-200.


[TAG:2]Abstracts from the Third Annual Academic International Medicine 2019 Scientific Forum[/TAG:2]

[TAG:2]Abstract Number 1[/TAG:2]

Growth and Distribution of Postgraduate Academic Emergency Medicine Residency Programs in India

M. Ayyan, V. Rohan1

Emergency Medicine Association of India,1 Department of Emergency Medicine, Pariyaram Medical College, Kannur, Kerala, India

Background: Medical education and healthcare system in India are controlled by the Ministry of Health and Family Welfare. The Medical Council of India (MCI), the National Board of Examinations (NBE), and institutes of national importance are the only autonomous bodies who control and conduct postgraduate courses. Birth of academic emergency medicine (EM) as a recognized specialty in India took place in 2009 when the MCI added EM as the 30th broad specialty. By 2010 postgraduate residency programs in EM, MD (EM) were initiated which paved the way for academic EM development in India. This was followed by the adoption of DNB (EM) program by the NBE in 2013. This article describes, in detail, the growth of EM residencies both in time and space in India.

Methods: The data pertinent to previous and present distributions of residency positions were derived from the MCI and NBE website database. Quantitative data were analyzed using Microsoft Excel, and qualitative data were analyzed using thematic analysis.

Results: At present, there are 77 training programs for EM in India. Only 29 (37.7 %) of them are university-based, attached to a medical college; the remainder are stand-alone programs situated in private hospitals. They are predominantly in the more urbanized parts of the country, especially in the southern and western parts of India. Through 2009–2012, there were only two available training sites in academic medical centers in India. Beginning in 2012 and for the next 6 years, a remarkable increase took place such that by 2017, more than 77 hospitals had set up residency programs in EM.

Discussion: Academic EM in India is growing exponentially, and after almost a decade since inception, there are around 578 EM residents in training and about 350 government of India recognized EM specialists practicing in India.

[TAG:2]Abstract Number 2[/TAG:2]

Novel Introduction of Global Health as a Dimension of a Preclinical Health Disparities Curriculum

R. Asri, A. M. Mozeika, S. Y. Cerasiello, M. L. Dalla Piazza, H. Sule, Z. C. Sifri

New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, New Jersey, USA

Background: Recent trends within patient-centered medical education have emphasized the social determinants of health as part of holistic undergraduate medical education. Typically, this educational thread reflects on the equitable delivery of care; however, the notion of health equities comprises several other dimensions that are gradually being incorporated into curricula. Another newly emerging priority in undergraduate medical education is global health (GH), but its implementation is difficult to assess since most coursework does not focus exclusively on GH topics. The implications of GH pervade throughout healthcare, and thus, their principles should be introduced as a means of providing equitable care. We present a novel strategy whereby a GH educational session was incorporated into an existing curriculum on the social determinants of health that targets all preclinical medical students as a way to introduce them to GH topics while also sensitizing them to broad concepts around equitable care.

Methods: In the setting of a system-based preclinical curriculum, 180 students enrolled in a mandatory, longitudinal, 2-year course titled, “Health Equity and Social Justice,” participated in a 2-h didactic session on Global Health and Global Surgery. The session was conducted by institutional faculty and addressed broad themes, such as key definitions, the global burden of disease and surgery, and ethics of GH. Students completed an end-of-course evaluation to provide feedback regarding the impact and utility of the session, with a free-text comment section.

Results: Overall, 74% of student survey respondents reported self-determined improvement of knowledge to a “great” or “considerable degree” following the session. More than half (53%) of the respondents agreed to a “great” or “considerable degree” on the benefit of additional GH training. Student feedback commented positively on the unbiased presentation of the topic and suggested avenues for further education and implementation.

Discussion: Preclinical medical students note the utility of early exposure to GH principles, especially in the context of health equities. Incorporating GH and global surgery topics into existing coursework creates an avenue to present this information without a formal curriculum. Future iterations of the session will include more timely information on direct student involvement and impact.

[TAG:2]Abstract Number 3[/TAG:2]

Early Impact of Community Bleeding Control Training: Nursing Students “Stop the Bleed” in Rural Sierra Leone

U. Barrie, S. Jalloh, V. Padmanaban, B. Brad Chernock, H. Koroma, Z. C. Sifri

New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, New Jersey, USA

Background: Bleeding Control (B-Con) courses have strengthened bystander awareness and response to life-threatening hemorrhage in the United States. B-Con courses are not readily accessible in low-and-middle-income countries (LMICs), particularly in rural settings where the injury burden is substantial. A pilot group of nursing students in rural Sierra Leone underwent B-Con training. The goal of this study was to examine the trainee's attitudes toward the course, confidence, and any opportunity to use B-Con skills after training.

Methods: In December 2018, the hour-long B-Con V1 course was taught to 121 nursing students in Krio at the rural Kabala Nursing School during a short-term surgical mission. A month later, participants were invited to complete an 11-question anonymous survey addressing self-reported confidence and satisfaction with the B-Con course. Encounters with life-threatening hemorrhage and application of B-Con techniques were also assessed.

Results: Of 121 eligible participants, 82 (70%) completed the survey. All participants were female; age range 19 to 40 years (mean = 26, standard deviation ±4). 98% reported strong agreement with the statement, “I feel confident with the knowledge and skills that I learned”. Overall, 75% of the participants reported witnessing at least one life-threatening bleeding event after the class. Of participants who witnessed bleeding, 97% used B-Con skills inclusive of direct pressure (55%), wound packing (31%), and tourniquet application (10%), while 4% reported using “other” techniques. 98% successfully “stopped the bleed” and thus enabled transfer to the hospital after intervention. 98% of the participants recommended the B-Con course to other community members.

Conclusion: Nursing students in rural Sierra Leone reported high confidence with knowledge and techniques attained after completing the B-Con course. In just 1-month postinstruction, 75% encountered at least one life-threatening injury. Of these respondents, 95% reported successful hemostasis. Teaching B-Con to nursing students in a rural setting led to frequent and successful B-con technique use. With significant prevalence of injury burden in LMICs, there is a widespread need for dissemination of prehospital intervention techniques, particularly to healthcare workers in rural areas.

[TAG:2]Abstract Number 4[/TAG:2]

Disaster Simulation: Evaluating Processes for Allocation of Limited Beds

M. Behrens, P. Daniel, P. Roblin, B. Arquilla

Department of Emergency Medicine, SUNY Downstate Medical School, Brooklyn, New York, USA

Background: In the event of a mass casualty incident (MCI), a large number of patients may require hospital transfer to a limited number of specialized beds (burn, neurosurgical, trauma, and pediatric). This process must ensure that limited available resources are appropriately distributed to the patients who will benefit most. There are two options: to allow each facility to manage this process on their own (decentralized) or to have one group oversee this process for a whole city (centralized). The focus of this study is to compare decentralized versus centralized allocation of limited, specialized beds.

Methods: A tabletop exercise conducted at SUNY Downstate evaluated the secondary transfer of victims in an MCI utilizing both centralized and decentralized processes to allocate available beds for transfer. A five-scale Likert questionnaire assessed the participants perceived usefulness (strongly agree, agree, neutral, disagree, and strongly disagree) of centralization of patient transfers Figure 1. Results were measured as percentage of participants' response to each option of the Likert scale.
Figure 1: Survey tool used in the current study

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Results: Questions 1–3 assessed participants' preference for a centralized process for transferring patients and were averaged: 34.13% strongly agree, 42.86% agree, 16.67% neutral, 2.38% disagree, and 3.17% strongly disagree Figure 2 and Figure 3. Questions 6 and 7 assessed participant's preference for a decentralized process of transfer and were averaged: 7.14% strongly agree, 33.33% agree, 25.00% neutral, 19.05% disagree, and 7.14% strongly disagree Figure 4. Question 5 assessed participant's preference for Fire Department of New York being the agency responsible for centralization: 14.29% strongly agree, 16.67% agree, 21.43% neutral, 30.95% disagree, and 16.67% strongly disagree Figure 5.
Figure 2: Summary of primary study results

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Figure 3: Bar graph showing respondent preference for centralization of transfers

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Figure 4: Bar graph showing respondent preference for decentralization of transfers

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Figure 5: Bar graph showing responder preference on whether the Fire Department of New York (FDNY) should manage transfers

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Discussion: There was a moderate-to-strong preference for a centralized process for transferring patients over a decentralized one during an MCI Figure 3 and Figure 4. In the setting of New York City, the role of network affiliation further complicates the process of centralizing the allocation of beds, with networks potentially losing patients to other organizations. Participants failed to reach a consensus over which agency or organization should be responsible for the central prioritization of patients.

[TAG:2]Abstract Number 5[/TAG:2]

Epidemiology of Injuries and Outcomes among Emergency Department Trauma Patients Presenting to an Urban Teaching Hospital in Rwanda

S. Bilal, J. P. Nzabandora1, Z. A. Mutabazi2, N. Karim 3, C. Gonzalez Marques1, J. D. Nyinawankusi4, J. C. Byiringiro1, G. Mbanjumucyo1, A. C. Levine1, A. R. Aluisio3

Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital, New York City,3 Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA,1 Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda,2 University of Rwanda College of Medicine and Health Sciences,4 Service d'Aide Médicale Urgente, Kigali, Rwanda

Background: Injuries result in high morbidity and mortality in Sub-Saharan countries like Rwanda. An initial step to addressing injury-related health burdens is to understand the patterns and causes of injury. This study describes the epidemiology of injuries and outcomes at the University Teaching Hospital-Kigali (UTH-K), the primary trauma receiving center of the country.

Methods: A hospital database was queried to identify a random sample of emergency department (ED) trauma patients presenting during August 2015–July 2016. Nontrauma patients were excluded. Data collected included demographics, clinical presentation, mechanism of injury (MOI), injury type, and ED disposition. Descriptive statics were used to explore the characteristics of the population.

Results: From 22,117 cases presenting to the UTH-K ED, a random sample of 786 trauma patients were studied. The median age was 28 (interquartile range: 6–50) and 69.4% were male. Road traffic accidents (RTAs) were the most common MOI at 49.4% followed by falls (23.9%) and penetrating trauma (10.9%). The most frequent types of injuries were fractures (46.2%). The most common anatomical region of injury was craniofacial (36.3%). Lower and upper limb injuries constituted 35.8% and 27.1% of anatomical regions injured, respectively. Spinal and pelvic injuries accounted for similar percentages of injuries at 7.4% and 7.5%, respectively. Among trauma patients, ED blood product transfusions were given to 3.9% of patients and 31.4% received crystalloids. Among trauma patients sampled, 68.2% required hospital admission, with 23.3% to the orthopedic service and 19.2% to the surgical service.

Discussion: Blunt trauma accounted for the majority of presentations, and RTAs were the predominant MOI. Approximately two-thirds of patients required hospital admission, while one-third required resuscitation with either crystalloids or blood products. These findings suggest that the trauma population in the setting studied has substantial injury burdens and further study of treatment interventions could provide positive impacts in injured populations at UTH-K.

[TAG:2]Abstract Number 6[/TAG:2]

MojTermin: Not Just a Scheduling Program

D. Bogdanovski, A. Stamenova

New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, New Jersey, USA

Introduction: The Republic of Macedonia is a relatively small country with an estimated population of 2 million as of 2017. One of the greatest challenges faced by the Institute of Public Health is the inability to generate high-power studies due to the relatively low volume of patients seen in the healthcare system, unfortunately slowing the process of collecting clinical evidence to improve practice. In 2014, the Macedonian Healthcare System launched a platform called MojTermin for the purpose of making and tracking appointments and record keeping. This centralized bank of information has the potential to identify adverse events and hospital readmissions. By utilizing MojTermin in this way, large-scale outcomes research may be conducted to enhance evidence-based practice in Macedonia.

Methods: Chart review and clinician interviews were the methods utilized.

Results: MojTermin generates a record every time public healthcare is accessed in Macedonia, including the patient's primary diagnosis and the services and procedures rendered. At present, it is being used to populate databases of diabetic and cancer patients. The system allows clinicians to record risk factors and comorbidities although they are occasionally omitted – most notably patient smoking status.

Conclusions: Admission records in MojTermin are complete and accurate for all patients at public hospitals. These data can be utilized and implemented within a surveillance system to generate meaningful epidemiologic information to identify specific areas of interest. Such a system would address the difficulties the Institute of Public Health has faced in collecting evidence to inform clinical practice.

[TAG:2]Abstract Number 7[/TAG:2]

Antibiotic Resistance in Developing Countries: A Meta-Analysis of Surgical Site Infections

A. Chokshi, V. Padmanaban, P. Ladha, H. Horng, Z. C. Sifri

New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, New Jersey, USA

Background: Surgical site infections (SSIs) are the most common nosocomial infections among surgical patients and require antibiotic therapy. With increasing trends of antibiotic resistance globally, it is important to determine the extent of antibiotic resistance among SSIs in developing countries. While studies have analyzed local resistance rates, none have computed the overall resistance rates for SSIs. The goal of this meta-analysis was to determine the overall antibiotic resistance prevalence among SSIs in developing countries and to identify which commonly used antibiotics have higher resistance rates, guiding clinical decision-making.

Methods: PubMed was used to identify primary research articles published from January 2011 to January 2019. Search terms included “surgical site infections,” “SSI,” “antibiotic resistance,” “antimicrobial resistance,” “superbugs,” “multidrug-resistant organisms,” “developing countries.” Inclusion criteria comprised papers in English focusing on developing countries as per the World Bank Classification, including antibiotic susceptibility profiles of SSI isolates, and had extractable/usable data. Exclusion criteria included case studies/reports and papers focusing on nosocomial infections other than SSIs. Data were collected for each of the most commonly tested antibiotics against the SSI isolates. The overall antibiotic resistance prevalence and resistance rates of common antibiotics were computed.

Results: Literature review yielded 60 papers. Twelve matched the above criteria and were included in the final analysis. The total sample size of SSI isolates tested in all papers was 9251. The overall antibiotic resistance prevalence was 57%. Ampicillin had the highest resistance rate of 88%, followed by cotrimoxazole (68%), tetracycline (68%), ceftazidime (64%), erythromycin (60%), cefotaxime (58%), amoxicillin/clavulanic acid (55.5%), ciprofloxacin (49%), clindamycin (49%), gentamicin (46%), and chloramphenicol (43%). The lowest resistance rate was for vancomycin (5%) and imipenem (5%) Figure 1. The most common organisms in the isolates were Staphylococcus aureus (304),  Escherichia More Details coli (117), and Klebsiella pneumoniae (111).
Figure 1: Resistance rates of various commonly used antibiotics

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Discussion: This meta-analysis demonstrates that 57% of the SSI isolates are resistant to one or more antibiotic. Significantly, high levels of resistance exist to commonly-used antibiotics such as ampicillin, cephalosporins, and ciprofloxacin. In contrast, vancomycin and imipenem have significantly lower resistance rates. S. aureus was the most common organism found in the SSI isolates. These findings can guide physician antibiotic prescribing practices in developing countries.

[TAG:2]Abstract Number 8[/TAG:2]

Utility of Aggregating Hazard and Vulnerability Analyses for Multiple Hospitals in the Same Geographical Region

S. Desai, P. Daniel, B. Arquilla

Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA

Background: A hazard vulnerability assessment (HVA) is performed by healthcare facilities to assess which hazards a facility is most vulnerable to. Facilities in the same geographic region perform HVAs independently, despite the impact of each other's vulnerabilities on each other. The aim of this study is to investigate the utility of aggregating facilities' HVAs into a combined, geographically based HVA. We propose that an aggregated HVA is superior to an institutional HVA, and due to its accessibility, this method can be applied globally to resource-poor regions.

Methods: Fourteen hospitals within a 9-mile radius in Brooklyn, USA, completed independent HVAs. Descriptive statistics were used to describe aggregated results of the HVAs. Bed capacities were calculated as a sum across facilities and as a percentage of total beds across facilities. Capabilities were calculated as a percentage of total facilities having an asset. Hazards were ranked based on the average score of each hazard across the facilities.

Results: The total bed capacity was 5060 total beds with 2135 adult (40%), 168 pediatric (11%), 314 obstetrics (6%), 15 neurosurgical intensive care unit (ICU), and zero burn beds Figure 1 and Figure 2. Assessment of capabilities showed 31% have a Level 1 trauma designation, 54% have HAZMAT teams, 57% have transfer centers, 50% have pediatric surgeons, 50% have trauma surgeons, and 43% have pediatric critical care specialists Figure 3, Figure 4, Figure 5. The average rankings of hazards showed the top three hazards for the borough to be hurricanes, inclement weather, and communication/telephone failure Figure 6.
Figure 1: Bed capacity: Results of combined hazard vulnerability assessment

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Figure 2: Bar graph showing 2019 bed category capacity for the Brooklyn Coalition acute care facilities

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Figure 3: Percentage of facilities with specialty staffing

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Figure 4: Bar graph showing percentage of acute care facilities with affiliated clinic

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Figure 5: Bar graph showing 2019 capabilities of teh Brooklyn Coalition's acute care facilities

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Figure 6: Bar graph showing top 10 hazards identified for the Brooklyn Coalition

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Discussion: Combining the HVAs of multiple healthcare facilities allows for a more global assessment of the resources and vulnerabilities of a geographic region that cannot be captured by individual healthcare facilities. Gaps in percent of bed capacity versus percent population in Brooklyn were identified, such as in pediatrics Figure 7. Identification of borough-wide gaps in burn units, neurosurgical ICUs, dialysis, and trauma services provides a more thorough overview of the community's vulnerabilities compared to looking at individual facilities. Facilities need to account for the borough's top hazards along with their individual facilities' hazards to best meet the needs of their area.
Figure 7: Bar graph showing gaps in bed capacity for the Brooklyn Coalition, population under 18 years of age

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[TAG:2]Abstract Number 9[/TAG:2]

Safe Acid Technology: Applications as a Cold Sterilant in Resource-Limited International Surgical Settings

L. DiPasquale, C. Capicotto, B. Lam

Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA

Background: Sterility in a surgical setting is critical for reducing risk of postoperative infection. Achieving the same sterile conditions seen in operating rooms in the US can be challenging in low/middle-income countries (LMICs) with resource limitations. Most US hospitals dedicate entire departments to sterilizing surgical instruments and cleaning clinical environments. In LMICs, outside of well-funded metropolitan centers, these resources are largely unavailable. As a result, less than ideal sterilization techniques are often employed, leading to higher rates of infection and poorer operative outcomes. “Safe acid” technology (SAT) represents a potential solution for achieving sterile conditions in low-resource settings as it has unique antimicrobial properties that are nontoxic to human tissues.

Methods: SAT formulations were tested against single species microbes for standardized durations. The log reduction of species was quantified for SAT formulations of varying pH levels. SAT anti-biofilm testing was administered using a single species (Pseudomonas aeruginosa) biofilm grown in the CDC reactor according to ASTM E2871-12 on polycarbonate coupons. After establishing biofilms, the polycarbonate coupons were exposed to SAT formulations for multiple exposure times and in varying concentrations. SAT safety testing was completed using a single SAT formulation using the EPA's toxic 6-pack criteria that assess an agent's toxicity against skin, oral, respiratory, and ocular exposures.

Results: SAT single species testing proved effective in eliminating microbes (bacteria, viruses, and fungi) on contact, achieving a 7 log reduction of the organism in <90 s of contact time. SAT biofilm testing demonstrated log reductions in biofilm between 3.61 and 4.82 compared to biofilm accumulated on control coupons of log 8.6. safety testing using the EPA's toxic 6-pack criteria demonstrated SAT's non-toxicity. In all six categories, SAT achieved the highest level, Category IV – Harmless designation.

Discussion: Having successfully demonstrated the dual properties of potent antimicrobial action while proving harmless to human skin and mucosa, SAT presents clinicians in LMICs with a powerful tool for improving operative safety. This technology is proposed for use as a cold sterilant for surgical instrumentation sterilization, surgical site skin preparation, and wound irrigation.

[TAG:2]Abstract Number 10[/TAG:2]

Community Health Worker Recognition and Referral of Surgical Diseases: Pilot Study Results of a Pictorial Guide

S. Gualy1,2, C. Herrera1,2, C. Warden, J. Barnum3, 4, 5, B. Colman4, 5, N. Betanco, J. W. Swanson1, 2, 6

Perelman School of Medicine, University of Pennsylvania,1 Division of Plastic Surgery, Children's Hospital of Philadelphia,2 Center for Global Health, University of Pennsylvania,6 Penn Global Surgery Group, Philadelphia, PA,3 Operation Smile International, Virginia Beach, VA, USA,4 Operation Smile Honduras, Tegucigalpa, Honduras,5 Operation Smile Nicaragua, Managua, Nicaragua

Background: Access to surgical care is a pressing challenge, particularly for vulnerable populations. Community health workers (CHWs) increasingly function in pivotal roles in primary care but remain disconnected from surgical care in most environments. This study examined the degree to which CHW understanding of surgical conditions could be improved through use of a pictorially-based manual.

Methods: A manual and associated situational problem-solving questionnaire instrument was developed and contextualized through focus groups in Central America Figure 1 and Figure 2, Table 1. A baseline assessment was obtained. In the program implementation, cohorts of formal and informal CHWs were introduced and trained to use the manual through a short curriculum. Assessment was repeated in program implementation, first with access to relevant manual content only and then subsequently after a relevant teaching session. Participants were also quantitatively and qualitatively surveyed about manual scheme and usability, as well as perceived utility.
Figure 1: Section organization of each manual page

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Figure 2: Sample Page in the Manual – Eye Trauma

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Table 1: The Manual for the People – Table of contents (in the appendix)

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Results: 100 subjects (67% female) participated in baseline assessment, and 403 subjects (68% female) were assessed through the program implementation Table 2. Baseline problem-solving averaged 11.8 (standard deviation [SD] 2.46) out of a possible 20 points. Mean score increased to 15.4 (SD 3.10) when participants had access to relevant surgical manual content and again to 15.9 (SD 3.09, P < 0.0001) following participation with an instructive curriculum. Participant score while utilizing the manual correlated with amount of education completed (r = 0.26), but baseline score did not. High readability (389, 96%) and high self-reported CHW willingness for use (398, 96%) were noted. Key results are shown in Table 3, Table 4, Table 5 and Figure 3.
Table 2: Demographics of each group with statistical comparison of the two groups by age, education, and gender with associated P-values

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Table 3: Description of the n=403 group divided into “Some Medical Training” and “No Medical training” with associated P-value, showing that there was no significant difference between these two groups. This allowed the comparison to the baseline (n=100) with no medical training. (in the appendix)

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Table 4: Mean scores by education for the three groups

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Table 5: Question analysis for all 3 groups and statistical comparison between mean scores per questions for each group

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Figure 3: Statistical comparison of mean scores by education between the three groups with associated P values noted

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Discussion: Baseline familiarity with surgically-treatable conditions appears modest among rural Central American populations and improves with access to a contextualized, pictorial manual focused on recognizing and appropriately referring surgical conditions.

[TAG:2]Abstract Number 11[/TAG:2]

Assessment of General Surgery Residents' Perception of Feedback

A. Gupta, C. Villegas, A. Watkins, C. Foglia1, J. Rucinski1, R. Winchell, P. Barie, M. Narayan

Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine,1New York-Presbyterian–Queens and Brooklyn Methodist Campuses, New York, USA

Background: Feedback (FB) regarding perioperative care from attending is essential in general surgery residents' (GSR) training. We hypothesized that FB would be distributed unevenly across preoperative (PrO), intraoperative (IO), and postoperative (PO) phases.

Methods: Quantitative, cross-sectional, Likert scale anonymous surveys were distributed to 115 GSRs at various training levels in three teaching hospitals (university:community 1:2). 25 questions considered frequency and perceived quality of FB in PrO, IO, and PO settings.

Results: Among 115 GSRs surveyed, 83 (72%) responded. While 93% reported receiving some FB within the past year, 46% reported receiving FB ≤20% of the time. A majority (58%) found FB to be helpful ≥80% of the time. 77% and 64% of GSRs reported receiving PrO and PO FB, respectively, only ≤20% of the time. 52% of GSRs also believed that FB was lacking in all three areas. Most GSRs wanted designated time for PrO planning FB (82%) and PO FB (87%), respectively. 78% GSRs reported that FB from chief/senior residents was equally or more valuable than that from attending surgeons. 78% reported that attending explicitly stated that they were providing FB only ≤20% of the time. A sub-analysis based on gender and GSR level was not statistically different.

Conclusion: FB during GSR training varies across operative settings. Data show particularly low FB outside of the operating room (OR). Most GSRs surveyed preferred a structured format and designated times for debriefing and evaluation of performance. Detailed understanding will undoubtedly influence future reforms.

[TAG:2]Abstract Number 12[/TAG:2]

Fostering Outreach and Resident Education through Global Surgery: The Northwell Health Experience in Ecuador

M. P. Kallis, N. L. Denning, V. A. Moon 1, H. F. McMullen 1, R. Barrera2, G. Coppa 1

Feinstein Institute for Medical Research at Northwell Health,1 Donald and Barbara Zucker School of Medicine at Hofstra/Northwell,2 Long Island Jewish Medical Center at Northwell Health, Long Island, New York, USA

Introduction: The Northwell Health Surgical Service Line medical mission to Ecuador began in an effort to provide high-quality and socially conscious healthcare to this developing nation. Beyond providing advanced surgical care to patients, it was also the objective of the mission to provide an educational experience for both Northwell trainees, as well as local surgeons within Ecuador through a long-term international partnership.

Methods: Northwell Health 2019 surgical mission to Quito, Ecuador, was established in partnership with Hospital Padre Carollo, Fundacion Tierra Nueva, and the Ecuadorian Ministry of Public Health.

Results: Thirty team members were selected from across the Northwell Health system, as well as other medical personnel from the greater New York area Table 1. Specialties included general surgery, plastic surgery, oral and maxillofacial surgery, anesthesiology, and critical care. A total of 32 surgical cases were completed over the course of the mission, the majority of which were craniofacial operations in the pediatric population Table 2. Northwell surgeons assisted and proctored the bariatric surgical cases conducted by local surgeons Table 2. At least one local surgeon or medical student was present for all cases for teaching purposes.
Table 1: Team characteristics

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Table 2: Surgical services

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Conclusions: Global surgery missions represent unique opportunities to provide necessary healthcare to developing nations and populations in need, while simultaneously providing an important academic benefit to both mission trainees and surgical residents, as well as local surgeons and medical staff within the host nation. The Northwell Health experience in Ecuador highlights the feasibility with which such programs can be initiated and the profound humanitarian and academic benefits that occur as a result.

[TAG:2]Abstract Number 13[/TAG:2]

Creating the Global and Urban Health and Equity Scholars Program using the Consortium of Universities for Global Health Toolkit

K. Kaufmann, J. Van Laere, K. Anderson, V. A. Kumar, A. Cortis, L. Allenspach 1, J. Snell2, I. Nnodim Opara3

Departments of Emergency Medicine and 2 Pediatric Anesthesia, Global Health Alliance,3 Department of Medicine and Pediatrics, Wayne State University,1 Department of Pulmonary Transplant, Henry Ford Hospital System, Detroit, Michigan, USA

Background: The Global and Urban Health and Equity (GLUE) curriculum was created to meet the growing need of medical students, residents, and fellows across all specialties who desired global health education and experiences. For this curriculum, we turned to the Consortium of Universities for Global Health (CUGH) toolkit to provide standardization and structure to global health educational and professional development programs. By utilizing this toolkit, we have been able to create a successful, informative, and transformative course which is free and open to the students and residents affiliated with Wayne State University.

Methods: After an initial literature review, the CUGH toolkit was chosen as the framework for the GLUE curriculum utilizing the core 11 domains of the basic operational–practitioner-oriented level along with five additional practitioner-specific domains chosen by our core faculty and mapped to the ACGME competencies. The GLUE course meets once per month August–May over a 2-year span. Each session consists of an online assignment that incorporates the readings, videos, and questions from the toolkit in addition to an in-class session with topic overview, guest speaker real-life examples, and small group work sessions. The scholars also have required quarterly community engagement and a capstone project either locally or internationally. Students are graded monthly on their homework assignments, attendance/participation, quarterly involvement, and capstone. The course was evaluated using an international learning guidelines survey and a class survey designed by our office of teaching.

Results: After 2 years, the GLUE program currently has 58 registered scholars and we graduated our first cohort of 27 scholars. These scholars are 25% senior medical students, 25% residents in training, 10% public health students, and 40% allied health professionals including nurses, physician assistants, and physicians. The course mid-term evaluation had overwhelmingly positive feedback from scholars. In fact, the main point of contention was only to request more time for small group activities. Key study outcomes - comparing entry and exit learner performance - are outlined in Table 1 and Figure 1.
Table 1: Global health toolkit questionnaire

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Figure 1: Mean scores for each question/statement, listed at entry / exit phases

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Discussion: The CUGH toolkit is a fantastic framework for which to build a global health curriculum. Using a format and timeframe that worked in our institution, we were able to implement a best-practice curriculum in the course of 1 year.

[TAG:2]Abstract Number 14[/TAG:2]

Assessment of Tuberculosis Treatment Implementation in the Democratic People's Republic of Korea: An Interview-Based Investigation

E. S. Kim, A. Y. Im1, H. Sule, H. Y. Shin1

Rutgers New Jersey Medical School, Newark, New Jersey, USA,1Institute for Health and Unification Studies, Seoul National University School of Medicine, Seoul, South Korea

Background: The state of tuberculosis (TB) management in North Korea is poorly understood due to challenges in obtaining information and data. We assess North Korean implementation of TB treatment practices by comparing public TB reports with interviews of former North Korean TB patients.

Methods: Public data were extracted from Global Fund's Democratic People's Republic of Korea (DPRK) TB Grant Performance Report (October–December 2013). Selected were interviews of eight North Korean confirmed TB patients who were treated with anti-TB medications between 2000 and 2014 in North Korea, conducted by the Korea Foundation for International Health and the Institute for Health and Unification Studies at Seoul National University School of Medicine.

Results: Global fund's assessment of directly observed treatment, short course (DOTS) provision shows that, of all new smear-positive TB cases registered, 90.3% were successfully treated (22,532/24,597), while only 1.84% were cases with drug resistant TB which started treatment but were lost to follow-up at 6 months. Comparatively, interviews indicate none of the eight patients received inpatient or outpatient DOTS and 3/8 (37.5%) were lost to follow-up. The interviewed patients' average duration of treatment was 5.9 months, with a range of 4–12 months. In addition, global fund's report also indicates 100% of units reported no stock-outs of anti-TB medications. Comparatively, interviews showed only 4/8 (50%) patients received TB medication at a health facility, while 5/8 (62.5%) patients had to purchase all or part of it on the black market.

Conclusion: Our findings demonstrate a gap between reported performance markers and actual treatment delivery in North Korea, highlighting the necessity of further needs-assessment, accurate monitoring and evaluation, and identification of drug-resistance mechanisms in the country.

[TAG:2]Abstract Number 15[/TAG:2]

Real-Time Audiovisual Feedback during Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest: A Review

A. C. Miller, N. East1, D. Gertsch, M. S. Dyson Jr., A. Vahedian-Azimi2

Department of Emergency Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine,1East Carolina University Brody School of Medicine, Greenville, NC, USA,2 Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran

Objective: In-hospital cardiac arrest (IHCA) is common and carries high patient morbidity and mortality. Cardiopulmonary resuscitation with effective chest compression remains the cornerstone of acute management. Evidence suggests that compressions administered in real-time may be suboptimal. Real-time audiovisual feedback (AVF) may aid resuscitation efforts by improving compression quality.

Methods: Scholarly databases (n = 20) and relevant bibliographies were searched as were clinical trial registries and relevant conference proceedings to limit publication bias Figure 1. Studies were not limited by date, language, or publication status. Inclusion criteria were (1) clinical randomized controlled trial (RCT), (2) patients age ≥18 years, and (3) IHCA. Eligible comparison groups included chest compression delivered with either the standard manual technique or the assistance of a different AVF device.
Figure 1: Risk of bias graph (a) and summary (b). “+” signifies low risk; “?” signifies uncertain risk; “-” signifies high risk

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Results: We identified four clinical RCTs (3 published and 1 unpublished) that met inclusion criteria Table 1. No ongoing trials were identified in Clinicaltrials.gov, WHO ICTRP, or ANZCTR. One RCT assessed the Ambu CardioPump (Ambu Inc., Columbia, MD, USA), whereas three assessed (Inotech, Nubberg, Germany). No clinical RCTs compared AVF devices head-to-head. Three RCTs were multicenter. One RCT reported improved guideline adherence with AVF. Three of four RCTs reported improved sustained return of spontaneous circulation (ROSC, 1 reported no change). One study reported improved survival to intensive care unit (ICU) discharge. One of two studies reported improved survival to hospital discharge (1 reported no change). One study reported improved neurologic outcomes with AVF. The incidence of rib (but not sternum) fractures was improved with AVF.
Table 1: Clinical randomized controlled trials

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Conclusion: While we cannot draw a firm conclusion on the efficacy or benefit of free-standing compression AVF devices for IHCA, the existing evidence indicates improved rates of sustained ROSC. Survival to ICU discharge, hospital discharge, and neurologic outcomes may also be improved; however, evidence is sparse. Additional clinical study is needed to assess the utility of free-standing compression AVF devices in patients with IHCA.

[TAG:2]Abstract Number 16[/TAG:2]

Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Meta-Analysis and Systematic Review

A. C. Miller, M. R. Lawson 1, B. Pfeffer 1, A. M. Khan, K. A. Sewell 2, A. R. King3

The Morzak Collaborative,1 Department of Emergency Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, 2 William E. Laupus Health Sciences Library, East Carolina University,3 Department of Emergency Medicine and Toxicology, Vidant Medical Center, Greenville, NC, USA

Background: Nontraumatic headaches comprise up to 4% of all emergency department (ED) visits. Current practice is moving toward multimodal analgesia regimens that limit narcotic use.

Objective: The objective of this project is to address the following research question: In patients with vasogenic headaches (target population) does intravenous magnesium sulfate (intervention) compared to placebo, conventional therapy, dopamine antagonist, non-steroidal anti-inflammatory drug (NSAID), corticosteroid, an ergot, or a triptan (comparisons) improve analgesia, recurrence rates at 24 h, nausea and vomiting, or adverse medication effects (outcomes)?

Search Methods: A structured search was performed of Cochrane CENTRAL, CINAHL, CHKD-CNKI, CSJD-VIP, DOAJ, Embase, IEEE-Xplorer, KCI, LILACS, Magiran, PsycInfo, PubMed, RSCI, SciELO, Scopus, SID, TÜBİTAK ULAKBİM, and Web of Science. Relevant bibliographies were also searched. Searches were not limited by date, language, or publication status. To limit publication bias, clinical trial registries were searched (ClinicalTrials.gov, WHO ICTRP, ANZCTR). Relevant conference proceedings were searched. Studies were not limited by date, language, or publication status. Studies eligible for inclusion were prospective randomized clinical trials enrolling patients (age ≥18 years) with nontraumatic vasogenic headaches in the ED or an outpatient acute care treatment center. Magnesium sulfate must have been administered intravenously. Comparison groups included placebo or conventional therapy, dopamine antagonist, NSAID, corticosteroid, ergot, or triptans.

Main Results: We identified 4018 references. Seven randomized controlled trails (545 participants) met inclusion criteria: migraine headaches (n = 6) and benign nontraumatic headaches (n = 1). Pain intensity was improved in the magnesium sulfate versus comparators at 60–120 min, but not at earlier time points. Fifty percent pain reduction was not improved with magnesium sulfate. Complete pain relief with greater with magnesium treatment in 1 of 2 studies and improved in the aura subgroup of the other. Magnesium treatment may not reduce the need for rescue medication. Overall adverse effects appear unchanged; however, nausea may be less with magnesium treatment.

Conclusion: Based on available evidence, we cannot draw a firm conclusion on the efficacy or benefit of intravenous magnesium sulfate in the treatment of acute vasogenic headaches. However, preliminary evidence suggests benefits in pain intensity beyond 1 h, aura duration, and nausea.

[TAG:2]Abstract Number 17[/TAG:2]

Maternal Common Mental Disorder Prevalence and Stigma in the Gurage Region of Ethiopia

S. Monaghan, F. Ayele, G. L. Darmstadt

Stanford King Center on Global Development, Stanford University School of Medicine, Stanford, California, USA

Background: Unipolar depression (as opposed to bipolar depression) is twice as prevalent in women than in men, and an estimated 20% of postpartum women in developing countries suffer from common mental disorder (CMD), which encompasses both depression and anxiety. This report evaluates the mental health of newly postpartum women in the Yetebon Community in the Gurage Region of Ethiopia as well as the attitude of the staff toward mental illness.

Methods: A survey was conducted among 118 women aged 18–45 years who had given birth in the last 3 months in the Yetebon kebele and came for postnatal vaccinations in the Glenn C. Olsen Memorial Primary Hospital, the only one in the community. The questionnaire used was the (SRQ-20) developed by the World Health Organization – a CMD screening instrument that includes 20 yes/no questions on depression, anxiety, and somatic symptoms experienced in the last 30 days. It was translated to Amharic by a local community member and given by the maternal nurses as a part of a routine vaccination administration appointment. For data collection and determination of probable mental disorder, a cutoff score of 5/6 (≤5 “yes” responses = noncase, ≥6 “yes” responses = case) was used. The survey instrument is shown in Table 1.
Table 1: Specific SRQ-20 survey questions with accompanying affirmative ("yes") responses

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Results: Among the 120 women surveyed, 18% had probable CMD using the 5/6 cutoff and 2% admitted to suicidal thoughts. There were also significant observational data on the existence of stigma using multiple definitions of what constitutes stigma. Key study results are shown in Figure 1.
Figure 1: Bar graph demonstrating key study results, organized by CMD indicator category with corresponding frequencies of occurrence

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Discussion: Poor mental health as well as stigma against such diagnoses exists in the Yetebon community and probably other rural areas of Ethiopia. Since there is currently no recognition of these disorders nor immediate access to treatment in the surrounding area, this study shows that it is important that training is given to hospital staff in rural areas as well as access to psychiatric services to improve the mental health of mothers, and therefore, the overall health of children based on multiple studies showing the impact of maternal depression on child development.

[TAG:2]Abstract Number 18[/TAG:2]

Global Impact of Bleeding Control Courses via “Train-the-Trainer” Initiatives

V. Padmanaban, S. Jalloh 1, L. Lopez2, H. Sule 3, C. Gill 4, C. Rozario5, Z. C. Sifri

Departments of Surgery,2 Physical Medicine and Rehabilitation and 3 Emergency Medicine, Rutgers New Jersey Medical School, Newark,4 Centro de Salud Carabamba–Ministerio de Salud, Carabamba, Julcán, Peru,5 Office of Global Health, Rutgers–Robert Wood Johnson Medical School, New Brunswick, NJ, USA,1 College of Medicine and Allied Health Sciences, Freetown, Sierra Leone

Introduction: The American College of Surgeons' bleeding control (B-Con) skills course has the potential for lifesaving application in low-to-middle income countries (LMICs) with maturing prehospital trauma systems. Periodic course offerings by visiting instructors preclude ongoing and effective skills training. “Train-the-trainer” is an established educational model whereby local personnel with teaching potential are trained to administer the content. The goal of this study was to measure the efficacy of “train-the-trainer” initiatives for B-con in LMICs and to quantify the impact via measuring subsequent LMIC trainees.

Methods: B-Con instructors participated in short-term medical and surgical trips to the Ivory Coast, Liberia, Peru, Ghana, Bangladesh, and Sierra Leone from December 2017 to January 2019. During each trip, official B-Con instructor courses were administered to local healthcare professionals that were identified as potential educators in their local communities. All new instructors were observed teaching hands-on skills proficiency and upon successful demonstration were provided trainer course materials and certificates, so they could conduct independent training sessions. Data inclusive of country location, total number of courses, instructors trained, and number of subsequent trainees were collected from December 2017 to April 2019.

Results: Over a 1-year period, eight index instructor courses were conducted over seven short-term trips to six countries Figure 1. A total of 29 LMIC healthcare professionals were successfully trained as B-Con instructors. During the study period, LMIC instructors led an additional 16 courses and 302 new trainees underwent B-Con certification.
Figure 1: Bar graph showing key descriptive characteristics of the B-Con program between December 2017 - April 2019.

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Conclusions: Over 16 months, 29 LMIC instructors taught B-Con techniques to 302 new trainees in six countries. The “train-the-trainer” model was found to be an effective and sustainable way to provide targeted skills training via short courses that have a high proven impact. Future studies should evaluate barriers to implementation and long-term sustainability encountered by LMIC instructors so that B-Con educational efforts can be enhanced.

[TAG:2]Abstract Number 19[/TAG:2]

Emergency Ultrasound Use in Fort Liberte Emergency Department

J. Paulson, C. Bloem

Department of Emergency Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York, USA

Background: Fort Liberte Hospital is the referral hospital for Northeast Haiti, treating critically ill and injured patients from all over the region. The emergency medical care provided is limited by lack of sufficient resources and medical training. The hospital has an ultrasound machine, and some providers have received previous training, but this tool is being used very infrequently in patient care. This project aims to assess the barriers to ultrasound use in the Fort Liberte Hospital Emergency Department.

Methods: Surveys were given to six of the nine providers who completed the training given in 2016 to evaluate skill and comfort level with ultrasound. Verbal consent was obtained via local translator. Questions included how comfortable the provider feels using the machine, how often the provider uses it, the most common ultrasound studies done, and what barriers exist that hinders its use. The project received local ethics approval by the Ministry of Health of Northeast Haiti and the Director of Fort Liberte Hospital.

Results: Majority of subjects interviewed reported feeling “very” comfortable using the ultrasound machine, but only half reported using it daily or more, with those using it less stating they do not have time or do not feel it is useful in patient care. Obstetric sonography is overwhelmingly the most common study done, with half of those interviewed reporting this as the only study they ever do. While most stated they would use it more if they had more training, one-third would not use it more citing that there is no time.

Discussion/Conclusions: This survey demonstrates that barriers to ultrasound use include lack of provider training and limited access to a functioning ultrasound machine. Some of these logistical barriers may be overcome by working with hospital administration to improve access to the machine. The majority of the challenges, however, relate to proficiency, practice, and oversight, suggesting that future areas for collaboration might include a more regular presence by skilled ultrasound users to provide real-time training and practice opportunities.

[TAG:2]Abstract Number 20[/TAG:2]

Getting Lean in the Emergency Department: Experience from a Developing Country Tertiary Care Hospital

C. Pedroso, E. Ferranti, G. Guerra Andrioli, J. C. Batista Santana, J. P. Kessner Prates Jr., M. L. Machado, M. Pescador de Camargo, R. Nicolaidis, S. Teixeira Dal Ponte

Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

Introduction: Lean is the “set of concepts, principles, and tools used to create and deliver the most value from the point of view of the client, consuming minimal resources and utilizing fully the knowledge and skills of the people in charge to carry out the work.” In Brazil, “lean in emergencies” is a project of the Ministry of Health aiming to reduce overcrowding of emergency departments (EDs) in public hospitals and philanthropic care organizations.

Objective: To present the initial results obtained through the implementation of lean methodology in the ED of a tertiary care public hospital in Brazil.

Results: In comparison to March 2018, the total number of daily patient arrivals remained the same in March 2019. The average number of patients in the ED decreased from 91 to 63. The average length of stay reduced from 42 to 25 h.

Conclusion: The implementation of lean methodology brought results that provided higher quality services to our ED patients.

[TAG:2]Abstract Number 21[/TAG:2]

Evaluating Patients using Mission Services in the Dominican Republic

J. Rehrig, C. Boni1, R. Moore2

University of New England College of Osteopathic Medicine, Biddeford, Maine,2University of Maryland, College Park, Maryland, USA,1 Waves of Health Non-Profit Organization, Rutherford, New Jersey, USA

Background: Medical mission trips have become a popular form of volunteer work for medical professionals, yet little data are published regarding the impact these trips have. Wave of Health (WOH), a non-profit healthcare organization, partner with local services abroad to send healthcare professionals to the Dominican Republic. We hypothesized that patients using WOH as their main healthcare source were more likely to lack access to care and medications elsewhere compared to those who did not use mission care as their primary source.

Methods: Seventy patients at random were verbally asked questions about their healthcare. In the interview, qualitative and quantitative data were gathered regarding the patient's healthcare point of contact, medications, and health conditions.

Results: 51 (72%) patients attended WOH before as their main point of contact for medical needs. The majority 38 (54%) said that public clinics were their alternative for medical care, though many added that the public clinics “never have any medication.” 43 (61%) patients reported needing to see a doctor at some point but were unable. Of those unable to seek care, 27 (63%) said that cost was the main reason while 10 (23%) credited lack of time and limited transport to their lack of access. 46.51% of patients who lacked access to a physician said that they took less medicine to avoid running out (P < 0.05).

Discussion: WOH is the primary mean of healthcare for the majority of patients who attend our clinics. Patients often do not receive healthcare in their community due to factors such as cost, time, and transportation. When further discussing alternatives for healthcare with Dominican staff and patients, it appears that public facilities often do not have the resources necessary to adequately treat patients. Further analysis of local healthcare alternatives and insufficient resources will allow medical mission trips such as WOH to better, and more accurately, provide patients with the care they need.

[TAG:2]Abstract Number 22[/TAG:2]

Northwell Health/Universidad San Francisco de Quito International Emergency Training Program in Quito and Galapagos, Ecuador

J. Rosa, G. Farina1, D. Gonzalez2, M. Kaufman3, G. Coppa4, R. Barrera2,4

Long Island Jewish Medical Center, Northwell Health,1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell,2 Fire Department, City of New York,4 Division of General Surgery, Long Island Jewish Medical Center, Northwell Health and North Shore University Hospital, Long Island, New York, USA,3 Envision Physician Services, Nashville, Tennessee, USA

Introduction: The Northwell Health/Universidad San Francisco de Quito, International Emergency Training Program, had a mission to provide disaster and emergency management education to front line medical staff and firefighters in San Cristobal, located at Galapagos, Ecuador. San Cristobal is the second most populated island of the archipelago, with a population of approximately 6000. The only hospital on the island, Oskar Jandl, a 34-bed facility, is considered the main regional hospital throughout the province of Galapagos.

Methods: In an effort to enhance and improve disaster and emergency management on the island and at the facility, in January 2019, a cadre of physicians and a nurse traveled to Galapagos to collaborate with local doctors, nurses, pharmacists, and firefighters. Over 2 days, we conducted mass casualty disaster drills, triage lectures, and practice breakout sessions as well as a Stop the Bleed lecture and hands-on tourniquet application practice. Other lectures included burn management, fluid resuscitation, altered mental status, pediatric respiratory distress, intraosseous access, and skills stations. Pretests were conducted to assess baseline knowledge and understanding of the material to be discussed.

Results: Team members were selected with emergency/disaster response and critical care experience from a clinical and academic background to provide training. Ten local physicians with specialties, including emergency medicine, general medicine, anesthesia, and radiology as well as six nurses, and one pharmacist underwent training. The local fire department took part in the 2-day training program with 12 paid and volunteer firefighters present.

Conclusions: The Northwell Health/Universidad San Francisco de Quito, International Emergency Training Program, provides necessary education to first responders and medical personnel in developing nations and underserved regions. Such training programs can be invaluable to the populations in these areas. Posttest data reveal an increase in knowledge and retention of the material. We have been invited back to provide more education to the local medical/nursing staff. Future plans include further training and development of local firefighters to meet certified first responder criteria and improve communication and collaboration between first responders and hospital personnel.

[TAG:2]Abstract Number 23[/TAG:2]

A Long-Term Surgical Medical Mission Trip Highlighting the Ethical Obligations of Global Clinical Experiences

L. Santoriello, D. Aronowitz, I. Palacios, G. Farina, G. Coppa1, R. Barrera1

Donald and Barbara Zucker School of Medicine at Hofstra/Northwell,1Northwell Health and North Shore University Hospital, Long Island, New York, USA

Background: The American College of Physicians recently released a position paper detailing physicians' ethical obligations when participating in short-term volunteer global health trips, emphasizing the importance of focusing on the health and well-being of the host country's community while acknowledging the benefits afforded to mission participants. With the need for access to safe prehospital, surgical, and anesthetic services continuing to be a growing public health concern, sustainable quality health care in the underserved areas is of utmost importance. While several short-term surgical mission trips have attempted to fill this need, the sustainability of their efforts remains a challenge once such missions have completed. However, longitudinal medical mission trips, such as the comprehensive programs performed by Medical Missions for Children (MMFC) and the Global Health Initiate of the Surgical Service Line of Northwell Health, fully encompass the five positions set forth by DeCamp and his team.

Discussion/Conclusion: By partnering with local hospitals and operating with the support of the local public health ministry, MMFC's missions serve as an opportunity to both train and empower local physicians/nurses, as well as provide training to US-based physician residents who are part of our mission teams, integrating the staff and trainees of both the Northwell and Universidad San Francisco de Quito medical programs in the process. The program has been further expanded to train the country's first responders with the help of emergency physicians from Northwell as well. This process creates a model of self-sufficiency within each host country and affords the opportunity to train the next generation of medical providers, while simultaneously introducing them to the world of community medical service.

[TAG:2]Abstract Number 24[/TAG:2]

Assessing the Ability to Provide Direct Medical Treatment to Refugees of the Venezuelan Crisis with Limited Pharmacological Resources

F. F. Schmitzberger, L. E. Mamer 1, R. T. Bryan 1

Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,1 Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA

Background: The humanitarian crisis in Venezuela led to a considerable influx of refugees into Colombia, overwhelming local resources. The Cúcuta border region has been receiving the majority of refugees. During a 6-day medical civic action effort, five clinicians provided treatment to 726 patients. The objective of this study was to evaluate the efficacy of a severely limited pharmacy in addressing the medical needs of a refugee population.

Methods: Based on prior experience, a limited pharmacy of 21 medications (28 when including different formulations/routes) Figure 1 were selected and included, among other items, antibiotics, analgesics, antidiarrheal, and anthelmintic medications. These items were based on local availability and some substitutions were required. During the medical relief action, anonymized medical records were kept that included reported symptoms, diagnoses, and treatments provided. Postdeployment, two physicians independently assessed adequacy of medications and noted possible pharmacologic shortfalls.
Figure 1: Limited formulary available in the area of operations

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Results: Reviewer agreement was substantial (per Landis and Koch), with Cohen's Kappa being recorded as 0.67. In total, 726 patients were seen. In 44 cases (6.1% of total), at least one of the reviewers saw a lack of proper pharmacologic treatment capability; in 22 cases (3.0%), both reviewers concurred. The most commonly untreated diseases are diabetes (9%), malnutrition (9%), anxiety (7%), and congestive heart failure (CHF) (7%) Figure 2. 41 (5.6%) of all patients were referred, and 31 (4.3%) required minor surgical procedures. Most prescribed other medications were analgesics/non-steroidal analgesics (NSAIDs) (25.8%), vitamins (23.7%), anthelmintic (11.9%), and antibiotics (11.9%).
Figure 2: Medically untreated conditions that were left untreated or had to be referred

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Discussion/Conclusion: Austere medical care requires foreknowledge of epidemiology within a given area of operations. Maximizing resources and impact requires establishing a focused formulary (fiscally responsible, easy to transport, adequate shelf-life). Based on experience and local availability, our preliminary investigation of local epidemiology established a formulary that provided limited pharmacologic treatment to roughly 93% of patients. These did however include patients with surgical needs or more complex needs that required referral. Untreated diseases are a mix of diseases of prior affluence (such as type II diabetes) and poverty (such as malnutrition). Sharing of civil action data and lessons learned will allow for improved pharmacologic efficacy while reducing risk and resource utilization.

[TAG:2]Abstract Number 25[/TAG:2]

Balancing Security Variables with Host Country Expectations in a Resource-Limited Refugee Medical Civic Action

F. F. Schmitzberger, R. T. Bryan 1

Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania,1 Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA

Background: Security concerns along the Venezuelan Colombian border region of Norta de Santander directly impact medical civic actions in support of refugees. Colombian resources are being overwhelmed by the influx of Venezuelan refugees, creating a need for external support, to include nongovernmental organizations. Colombia's Norte de Santander border “frontier” is a permeable low-intensity conflict zone with scant innate government resources. To maximize resource utilization, the host nation placed an expectation of patients to be seen per day on Refugee Relief International.

Methods: Retrospective analysis of a medical civic action project was performed, examining five clinicians treating patients over 6 days. One clinician acted as a pharmacist, one is a surgeon, and three provided general medical care. All are experienced in global health and conflict medicine; none were native speakers but were assigned a translator each. Referrals were available for high-risk infectious disease/obstetrics (OB) and select severe cases. Diagnostics were limited to urine point-of-care (POC) testing. Surgical care was limited to procedures under local anesthesia. We analyzed demographics, number of patients registered to be seen, number of patients seen, and number of patients discharged per day and correlated statistics to documented threats per clinic day and clinic hours lost. After discussion, adjusted host nation expectations were 100 patient's day 1 and 200 patients per day thereafter. Patients were tracked by the use of anonymized index cards.

Results: A total of 726 patients were registered in 6 days: day-1 110, day-2 22, day-3 178, day-4 165, day-5 136, and day-6 115. A threat requiring cessation of clinic occurred day 2, 2 h after arrival at the site Figure 1.
Figure 1: Patients seen per day with host expectations. Day 2 shows a significant drop in patients seen due to a security threat requiring termination of operations after 2 h

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Discussion: Refugees are overwhelming Colombian medical resources, putting political pressure on regional leadership. Host nation expectations of 200 patients/day were not met. Local realities limited clinic-time, patient-flow, patient referral, and transfers. An emergent security threat reduced patients seen per day from an otherwise average of 141–22. Security realities challenge host nation expectations, operational planning, and patient satisfaction, resulting in reduced efficacy. To reduce risk and improve efficacy, we recommend an open-source standardized reporting repository to define risk tolerance, observed threat, and efficacy.

[TAG:2]Abstract Number 26[/TAG:2]

Elevated Incidence of Microphthalmia in Chuuk, Federated States of Micronesia: A Genetic Study by a US Team Headquartered in Philadelphia

A. Schneider, A. Yomai1, A. V. Levin 2, J. Capasso3, S. Kopinsky 2, D. McNear 2, T. Glaser 4

Jefferson Medical College, Philadelphia, Pennsylvania,2 The Einstein Anophthalmia/Microphthalmia Clinical and Research Center and Registry,3 Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital,4 Department of Cell Biology and Human Anatomy, Davis School of Medicine, University of California, CA, USA,1 Chuuk Department of Health Services, Federal States of Micronesia

Background: Chuuk is one of the four states in the Federated States of Micronesia (FSM), in the Southern Pacific, near Guam. The Chuuk lagoon is a large archipelago, with mountainous islands surrounded by a string of smaller islets on a barrier reef Figure 1. Health services for the children with microphthalmia and anophthalmia (A/M) in Chuuk are provided by the Children with Special Healthcare Needs program, part of Maternal and Child Health which provides primarily “heath education” for families. Special clinics depend on the child's medical needs. A/M is a rare birth defect with a complex etiology. The incidence of A/M is elevated 4–5 fold in Chuuk State, FSM, affecting 14 per 10,000 births (Yomai et al., 2010) compared to the worldwide average of 3/10,000 (Shah et al., 2011). The elevated incidence of A/M and population structure in Chuuk is consistent with a genetic founder effect. Moreover, Vitamin A deficiency (VAD), a known maternal risk factor for A/M, is endemic in Chuuk, suggesting a potential gene x environment interaction.
Figure 1: Chuuk Lagoon

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Methods: To investigate the etiology of A/M in this population, we held clinics in Chuuk during April 2017. The study is approved by the Western IRB and consent was obtained in Chuukese by local professionals. Our team performed eye and medical examinations and obtained family history data and genomic DNA from 25 probands with suspected A/M and their parents from seven different islands. Our team worked very closely with the Chuukese professionals who acted as translators in the clinic.

Results: Five probands from one island were found to have Leber's congenital amaurosis with enophthalmos and a homozygous inactivating mutation in CRB1 (c.3134delT). The remaining 20 probands (8 male, 12 female) were determined to have colobomatous microphthalmia. The majority of mothers with affected children reported night-blindness during pregnancy, consistent with VAD. Serum retinol and retinol-binding protein (RBP) levels were moderately or severely reduced to 78% (14 of 18 mothers tested).

Discussion: DNA studies including whole genome sequencing did not identity one consistent variant shared among all probands. These data exclude a single recessive founder mutation and suggest a polygenic basis for A/M in Chuuk, with maternal VAD as a likely contributing factor.

[TAG:2]Abstract Number 27[/TAG:2]

Evaluating Medical Need in Puerto Rico 6 and 18 Months after Hurricane Maria

L. Serwatka, P. Gutierrez, J. Zirnheld, J. Corcoran, M. Garg1

Lewis Katz School of Medicine at Temple University,1Department of Emergency Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA

Background: The Temple Emergency Action Corps (TEAC) is a student-run disaster organization that coordinates an annual service-learning trip. In March 2018, TEAC traveled to Puerto Rico (PR) to provide medical care and mental health support 6 months after Hurricane Maria. In March 2019, TEAC returned to PR to provide additional care to vulnerable towns identified in 2018. Our authors hypothesized that affected regions in PR would require continued medical and mental health support 18 months posthurricane.

Methods: Clinics were hosted in Humacao, Patillas, and Vieques, hurricane-afflicted towns selected by degree of need. Intake forms included a review of systems (ROS) section for pre-existing conditions and a validated mental health screening tool (PHQ9). Similar forms were used 6- and 18-month postdisaster to ensure accurate comparisons. A retrospective IRB-exempt chart review was conducted.

Results: Forms were obtained from 223 patients and 287 unique visits with providers Figure 1. 65.3% of the patients were female and 56.2% reported seeing their primary care physician (PCP) ≥ three times annually. Cardiology was the most popular requested specialty (22.5% of visits) and radio was the most effective clinic advertising method (43.6%). Electricity, water, and pharmacy access had been restored for >98% of patients. However, 15.8% of patients were depressed and 9.5% were suicidal. Females were more likely to be depressed (19.7% vs. 8.2%) and had significantly higher PHQ9 scores than males (female x̄= 5.45, male x̄ = 3.36, P < 0.0005). Depressed individuals also had significantly more reported ROS (depressed x̄ = 9.1, nondepressed x̄ = 5.4, P = 0.0058). Key study results are summarized in Figure 2 and Figure 3.
Figure 1: Proportion of visits with different specialties at 6 (a) and 18 months (b) posthurricane

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Figure 2: Patients seen at Temple Emergency Action Corps clinics

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Figure 3: Depression (PHQ9 ≥10) and suicide risk 6- and 18-month posthurricane. Suicide risk measured with the Ask Suicide-Screening Questions <0 at 6 months and with the PHQ9 at 18 months

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Discussion: While there is immense value in coordinating a medical response to a location with an emergent need, returning to that location after the acute need has subsided requires changing the scope and planning of the mission to serve the changing needs of the population. Approximately 18 months after Hurricane Maria, infrastructure and access to general care have largely been restored. However, mental health needs remain, and medical specialists are in high demand. A focus on delivering diverse specialty care in the months immediately following a disaster may ameliorate the risk that these acute specialty issues transform into chronic health problems.

Acknowledgments: We would like to acknowledge The Greenfield Foundation and TEAC.


  References Top


  1. King CA Horwitz A, Czyz E, Lindsay R. Suicide Risk screening in healthcare settings: Identifying males and females at risk. J Clin Psychol Med Settings 2017;24:8-20.
  2. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-13.


[TAG:2]Abstract Number 28[/TAG:2]

Global Health: A Successful Learning Experience

W. Tambo, R. Barrera1, G. Coppa1, G. Farina1, M. Bahamonde, M. Grunauer, I. Palacios

Universidad San Francisco de Quito, Escuela de Medicina, Quito, Ecuador,1 School Medicine at Hofstra/Northwell, New York, USA

Introduction: Donald and Barbara Zucker School of Medicine at Hofstra/Northwell University and Universidad San Francisco de Quito (USFQ) have created a partnership to provide Global Health (GH) learning and research opportunities for students and faculty. Ecuador offers a variety of public health scenarios in both rural and urban settings where foreign students participate in activities, including clerkships, clinical rotations, community health projects, and research. In turn, Northwell Health System introduces Ecuadorian students to different areas of medicine within the context of the American education system.

Methods: Good standing students (GPA 3.2 and above) can apply to GH program; these opportunities are available to Northwell and USFQ. Hofstra/Northwell students are located in a community setting where they become participating members in the work of the Ministry of Health. USFQ students take part in a clerkship program. Students from the two universities receive evaluation at the end of such rotation.

Results: Hofstra/Northwell students have improved their Spanish skills and have learned about the culture(s) present in Ecuador and the structure of the Ecuadorian health system. USFQ students have been able to improve their English medical skills and better understand the USA residency program. Both USFQ and Northwell have identified a basic hospital where both research and clinical activities are developed and administered. An institutional strengthening plan for the basic hospital has been designed by the two universities and is in the implementation phase.

Conclusion: The GH program not only offers a unique opportunity to share in medical knowledge but also provides a participatory experience of language and culture. The partnership continues to identify new ways to collaborate. GH program remains unique in that it allows for a foreign, two-way medical exchange, in which students learn within and contribute to the Public Health System of Ecuador and high-quality medical system of the U. S. Through the GH program, we hope to promote a broader and deeper vision of the possibilities in public health work and healthcare by creating a new generation of medical professionals with expanded competencies and cultural immersion.

[TAG:2]Abstract Number 29[/TAG:2]

Community Needs Assessment 2019 – Bangalore, India

K. Thakker, T. Bhuiya, C. Anania, E. Cioè-Peña

The Northwell Center for Global Health India Team, Long Island, New York

Background: Health disparities in India are seen within the southern state of Karnataka. A community needs assessment is a systematic approach of identifying populations' unsatisfied needs and determining what changes can be made. The Northwell Center for Global Health's team worked alongside a local private boarding school called Shanti Bhavan to conduct a needs assessment using CDC's Community Assessment for Public Health Emergency Response tool.

Methods: A community-based cross-sectional survey design was implemented in ten rural villages in Karnataka, India, during the month of February 2019. The target population for this study included people who earned less than US$2/day. Systematic random cluster sampling was used in this study. The survey instrument consisted of a survey questionnaire and tracking form. Results were entered into Epi Info 7 database for descriptive analysis.

Results: 197 of 359 households consented to participate in the survey (54.9%). The total population residing in the 197 houses surveyed was 1023 individuals. Proper housing structure was the most common need (27.7%) followed by access to transportation (16.1%) and then access to healthcare (15.2%). Agitated behavior, sad mood, and frequent worries were the most experienced behavioral health concerns with 47.7%, 41.6%, and 41.1% prevalence, respectively. Chronic diseases (i.e., high blood pressure, diabetes, asthma) were prevalent in 35 of the households (9.7%). The major disease concern in relation to mosquito-borne illness was dengue (36.0%). Access to healthcare was an issue in 44 of the 197 households (12.3%) with lack of money or healthcare costs being the most common problems.

Discussion: Contrary to expectations, there were no expressed needs for basic necessities such as food, water, and medication. This may be due to state programs such as the Karnataka Rural Water Supply and Sanitation Project and Public Distribution System or a limitation of the format of our survey. Respondents were most concerned with dengue but are also at risk for other vector diseases such as malaria and chikungunya, highlighting the need to spread awareness and safety measures. Mental health needs, largely unmet in poorer communities, represented a significant burden of disease.

Acknowledgments: Northwell CGH India Team members were as follows: Sara Ali, MD; Tanzim Bhuiya, MPH; Jonathan Blau, MD; Eric Cioe Pena, MD MPH FACEP; Maria Cioe Pena, PhD; Amy Cooper, MD; Shazmin Gangji, MS PA-C; Tasfia Hoque, DO; Hafza Sharieff, MD; Janelle Singh, MBBS; Arya Soman, MD; Krima Thakkar, MPH; Daniel Ying, DO; John Young, MD, MPP, PhD. The Center for Global Health organized this needs assessment. A special thanks to Daniel Y Kim, MBA PMP and Shari Jardine, MPH, MS at the Northwell Health Center for Global Health.

[TAG:2]Abstract Number 30[/TAG:2]

A Negative Inspiratory Force Threshold of Negative Inspiratory Force Threshold of ≤−25 cmH2O Best Discriminates Extubation Readiness in Chronic Obstructive Pulmonary Disease Patients: A Prospective Observational Study

A. Vahedian-Azimi, F. R. Bashar1, M. N. Boushra, J. W. Quinn2, A. M. Khan, A. C. Miller3,4

Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran,1 Department of Anesthesia and Critical Care, Hamadan University of Medical Sciences, Hamadan, Iran,2 Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, Greenville, NC,3 Department of Emergency Medicine, Vident Medical Center, East Carolina University Brody School of Medicine,4 The MORZAK Collaborative, USA

Objectives: Negative inspiratory force (NIF) is a tool used by some clinicians to help identify patients ready for liberation from mechanical ventilation (MV). However, the utility of the traditional threshold of ≤−30 cmH2O may be suboptimal for patients with chronic obstructive pulmonary disease (COPD). This study aims to define the optimal predictive NIF threshold for COPD patients on MV.

Methods: A prospective-observational multicenter study was conducted in the intensive care units (ICUs) of eight academic medical centers. All patients had COPD and were intubated for hypercapnic respiratory failure. The study was approved by institutional review boards at Baqiyatallah University of the Medical Sciences (340/5/5904) and Shahid Beheshti University of the Medical Sciences (SBMU1/REC/1393/89). All aspects of the study adhere to the Strengthening the Reporting of Observational Studies in Epidemiology Statement: guidelines for reporting observational studies. Consent was required and covered both study participation and publication of findings. The process of weaning from MV was conducted according to the defined hospital protocol. NIF was measured after 120 min of spontaneous breathing trial (SBT). The sensitivity, specificity, positive and negative predictive value (PPV, NPV), and positive and negative likelihood ratios (LR+, LR−) were calculated, and the diagnostic accuracy was also recorded.

Results: Ninety COPD patients (39 males, 51 females) were included. Of these, 43 patients (47.8%) were successfully extubated whereas 47 patients (52.2%) failed SBT or required re-intubation (P = 0.654). The threshold value of ≤−25 cmH2O offered the optimal performance to predict extubation success: area under the receiver operating characteristic 0.836, sensitivity 95.0%, specificity 86.0%, PPV 84.4%, NPV 95.6%, LR+ 6.79, LR− 0.06, and the diagnostic accuracy 90.7%.

Conclusions: In mechanically ventilated COPD patients with hypercapnic respiratory failure, the NIF threshold of ≤−25 cmH2O was a moderate-to-good predictor for successful ventilator liberation and outperforms the traditional threshold of ≤−30 cmH2O.

[TAG:2]Abstract Number 31[/TAG:2]

Prehospital Care in Cambodia: Can We Break Down Barriers with Bystander Interventions?

C. L. Williams, J. Sincavage, C. Im1, S. Stock, M. Swaroop

Department of Surgery, Northwestern University School of Medicine, Chicago, Illinois, USA,1World Mate Emergency Hospital, Battambang, Cambodia

Background: With the recent passing of the World Health Assembly resolution 72.31 on emergency care, the unmet need for prompt and safe trauma healthcare is evident on a global platform. A paucity of quantitative and qualitative data in low-and middle-income countries impedes their development of a functioning trauma system. This study aimed to characterize the burden of traumatic disease, viewpoints on prehospital interventions, and barriers to accessing surgical care in Battambang, Cambodia.

Methods: Using both modified survey and deployment technique, the Surgeons Overseas Assessment of Surgical Need population-based survey was implemented at World Mate Emergency Hospital (WMEH) and two associated clinics in Battambang. Patients and family members were interviewed for demographics, transportation information, injury histories in six anatomical regions, and experience with the local trauma system.

Results: In total, 126 individuals from 107 households were analyzed with a median age of 45 years (interquartile range 31–61). The majority of participants were male (50.8%) and from Battambang province (63.6%), with agriculture being the most common occupation (35.7%). The study population consisted of 38.9% WMEH patients, 23.8% clinic patients, and 37.3% relatives. Four of the 118 (3.4%) noninpatient participants had an unmet surgical need. Of the 123 reported medical conditions, 102 (59%) were injury-related, with 49% of injuries due to road traffic incidents (RTIs). Fifty-nine percent of participants (74/126) believed there was a public ambulance in their province, yet only 27% (20/74) knew how to call it. On average, participants witnessed 2.4 RTIs in the past 6 months, with 78.6% (99/126) expressing willingness to assist as a bystander. Transit time across all modes of transport increased by 21.8% (P < 0.0001) and ability to afford transportation decreased by 19.2% (P = 0.0025) between primary and tertiary facilities. Key study results are summarized in Table 1, Table 2, Table 3, Table 4.
Table 1: Demographics

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Table 2: Transportation to healthcare facilities

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Table 3: Medical conditions, injuries, n (%)

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Table 4: Individual trauma experience

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Discussion/Conclusion: There is a significant burden of injury and variable awareness of ambulance availability with low utilization in Battambang. The willingness of respondents to assist those affected by trauma suggests that layperson first-responder courses may be effective in reducing prehospital morbidity and mortality in the region. Effective interventions to improve prompt and safe trauma care need further study to understand the barriers to injury prevention and adequate, community-sensitive prehospital response.

[TAG:2]Abstract Number 32[/TAG:2]

Global Burden of Rheumatic Heart Disease and the Shortage of Penicillin

V. Yellapu, I. Perez-Figueroa1, S. DeTurk2, Q. Malik 3, S. Longo4, S. Nanda3

Departments of Research and Innovation and 1 Pathology, St. Luke's University Health Network,2 Department of Family Medicine, St. Luke's Warren Campus, Phillipsburg, New Jersey,3 St. Luke's Heart and Vascular Center, Bethlehem,4 Department of Family Medicine, St. Luke's Richard A. Anderson Campus, Easton, Pennsylvania, USA

Introduction: Rheumatic heart disease (RHD) is a sequela of a simple Group A streptococcal that has not been treated adequately. It is estimated that in 2017, the global incidence of RHD was 1.3 million new cases up from 1.2 million cases in 2007. While most developed countries have access to screening and treatments, many countries are struggling with the global shortage of penicillin. Our study looks to identify if the availability and the cost of penicillin have a correlation to the prevalence of RHD.

Methods: Data from the Global Health Data Exchange (GHDx) were queried for incidence, prevalence, deaths, and disability years between 2010 and 2017. We identified the 25/195 countries with the highest incidence, prevalence, and deaths due to RHD. We then identified the availability of penicillin. We used the WHO, CDC, and international government agency websites to identify the costs of penicillin.

Results: Using the GHDx, we identified n = 195 countries in the world with reported data on RHD. We looked at the 25 countries that had the highest overall incidence. Of these countries, 11/25 reported shortage of antibiotics, 4/25 reported no shortage, and 5/25 had no report at all. The median price of penicillin is between $0.13 and $0.28. Figure 1 shows the incidence of rheumatic heart disease (RHD) around the world. Figure 2 shows mortality attributable to RHD.
Figure 1: The above map shows the incidence of rheumatic heart disease worldwide with darker colors representing higher incidence

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Figure 2: Deaths causes by rheumatic heart disease with the darker colors representing higher rates

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Discussion: The management of Group A Strep (GAS) infection is a simple shot of benzathine penicillin G (BPG) which can prevent the development of RHD at a rate of 80%. Our results show that with decreased availability of penicillin, there is increased use of other antibiotics, which may not effectively treat the infection and lead to rheumatic fever or latent rheumatic heart disease. A solution we propose is for governments of these countries to incentivize pharmaceutical companies to produce antibiotics such as BPG. This will allow for a better supply chain and can prevent deaths from RHD. With the increased incidence of RHD and decreased supply of BPG, it is critical to identify solutions to curb unnecessary fatalities from RHD.

[TAG:2]Abstract Number 33[/TAG:2]

Aeromedical Transport Incidents: Local Impacts on Global Dimensions

V. Yellapu, T. Wojda1, L. Strohm1, S. Shahabzada1, J. Wilson 2, S. P. Stawicki

Department of Research and Innovation, St. Luke's University Health Network, Bethlehem,1 Department of Family Medicine, St. Luke's Warren Hospital, Phillipsburg, New Jersey,2 Department of Emergency Medicine, St. Luke's University Richard A. Anderson Campus, Easton, Pennsylvania, USA

Introduction: Over the past decade, The National Transportation Safety Board (NTSB) has established stringent requirements for air medical transport (AMT) to prevent accidents. However, due to the unpredictable and critical nature of AMT, fatal and nonfatal occurrences are bound to happen. This study looks at updated data since 2015 to provide additional insight into the factors potentially associated with fatal and nonfatal AMT incidents (AMTIs). We hypothesized that weather/visual conditions, postcrash fire, and time of day are all correlated with the risk of AMTI with “injury or fatality.”
Figure 1: A bar graph representing total aeromedical accidents by year

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Methods: Various specialty databases such as Aviation International Database, Aviation Safety Network, NTSB, and other internet resources were queried for AMTI between January 1, 2015, and April 31, 2019. Univariate analyses of the collected sample were then performed for association between “fatal crash or injury” (FCOI) and weather/visual conditions, aircraft type/make, pilot error, equipment failure, postincident fire, time of day, weekend (Friday–Sunday) versus weekday (Monday–Thursday), season of the year, presence of patient on board. Variables reaching significance level of P < 0.20 were included in multivariate analysis.

Results: We identified 25 accidents between 2015 and 2019. After these results were combined with previously published (2003-2014) data, a total of 81 AMTIs from five continents and 15 different countries were available for further analyses. Helicopters were involved in 68/81 AMTI, with 13/81 fixed-wing incidents. There was no association between aircraft make/model and FCOI. In univariate analyses, time of incident (7 pm–6 am) and post-incident fire reached statistical significance sufficient for multivariate analysis. Factors independently associated with FCOI included postincident fire (odds ratio [O.R.] 14, 95% confidence interval [CI] 1.74–112.66) and time of incident (O.R. 3.5, 95% CI 1.07–11.45). Weather conditions and darkness/impaired visibility were not independently associated with FCOI.

Discussion: The current study supports previous observation that postcrash fire is independently associated with FCOI. However, our data do not support previous observations that suggest weather conditions and darkness/impaired visibility to be predictive of fatal AMTI. In addition, this report demonstrates that flights between the hours of 7 pm and 6 am may be associated with greater odds of FCOI. Global efforts aimed at identification, remediation, and active prevention of AMTI are warranted and should be embraced given the global increase in aeromedical transport.

[TAG:2]Abstract Number 34[/TAG:2]

Significantly higher prevalence of hypertension, type 2 diabetes, and obesity in the rural poor in the Philippines

G. Zandrow, S. Malkani 1

University of Massachusetts Medical School, Worcester, Massachusetts,1Temple University Hospital, Philadelphia, Pennsylvania, USA

Background: The Philippines has a high prevalence of lifestyle and nutritional diseases. According to the Filipino Government's latest data (NNS), 31% of adults are overweight or obese, 22.3% are hypertensive (HTN), 5.4% have type 2 diabetes mellitus (DM), 4.1% have an impaired fasting glucose (IFG) with a fasting blood sugar (FBS) >110 mg/dL (World Health Organization [WHO] cutoff), and 12.8% have IFG with FBS > 100 mg/dL (Philippine Unite Diabetes [PUD] cutoff). In the poorest quartile of children, there is a 29.8% prevalence of stunting, 44.8% are underweight, and 9.5% are wasted.[1]. The average household makes 267,000 PHP (~$5200) a year and spends 215,000 PHP (~$4200), or 80.5% of their income, on all expenses.[2]

Objective: To determine if these national figures accurately represent the burden of disease of the rural poor.

Methods: Five economically disadvantaged villages were surveyed via repeated visits at their respective community center. Height and weight were obtained by a tape measure and electronic bathroom scale. Body mass indexes (BMIs) were analyzed using the Asian BMI standard. FBSs were obtained from consenting adults who had fasted for >8 h. Blood pressure was measured via OMEON (OMRON Healthcare, Kyoto, Japan) Fourth-Generation Cuff using standard guideline for resting before the measurement. Those with elevated readings had repeat measurements 3–5 days later. The head of the household provided data on household economics.

Results: 216 adults were measured, and the average age was 50 years old (standard deviation [SD] 14.4), with predominantly female (78%). A total of 106 children were measured, with average age of 73 months (SD 41) and 54% male. 34% of adults were overweight, 35% were obese, combining to 69% (P < 0.0001, confidence interval [CI] 62.3–75.1). 48% had high blood pressure (P < 0.0001, CI 41.2–55.9). 22% had diabetes (n = 51) (P < 0.0001, CI 11.6–46.8). 24% had IFG by the WHO standard FBS >110 mg/dL (P < 0.0001, CI 13.1–38.0) or 28% via the PUD standard of FBS >100 mg/dL (P = 0.001, CI 16.3–44.3). 106 children were measured demonstrating 10% severely wasted, 12% underweight, 25% severely stunted, and 15% stunted. Each household had an average of 6 persons – 3.5 adults and 2.5 children. Households earned 137,603 PHP (~2680) annually, spent 85,866 PHP (~1675) on food accounting for 65% of their total income.

Conclusion: The adult rural poor are disproportionately affected by lifestyle diseases. Our data show that 69% of adults were overweight or obese (34% and 35%, respectively), doubling the combined 31% overweight plus obese statistic reported by the NNS. 48% of this sample has HTN, again doubling the national average of 22.3%. The DM prevalence is 400% of that reported by the national data although these data likely suffer from selection bias and are limited by inability to verify their fasting status beyond patient report, and only single finger-stick glucose was used, whereas recommendations suggest repeating abnormal tests. The statistics on childhood malnutrition were similar to the national data. The vast majority of household income is diverted toward food expenses.


  References Top


  1. Food and Nutrition Research Institute of the Department of Science and Technology. The 8th National Nutrition Survey. The Food and Nutrition Research Institute of the Department of Science and Technology; 2014.
  2. Bersales L. 2015 Family Income and Expenditure Survey. Philippines Statistics Authority; 31 July, 2018. Available from: https://psa.gov.ph/survey/annual-poverty-indicator. [Last accessed on 2019 Nov 26].


[TAG:2]Abstract Synopsis 1[/TAG:2]

Misdiagnosis of Neuroborreliosis

R. Anmolsingh, D. W. Kannangara1

Departments of Geriatrics and 1 Infectious Diseases, St Luke's University Health Network, Bethlehem, PA, USA

Background: Lyme borreliosis (LB) is a multisystem disease with a global distribution involving all continents, except Australia with no confirmed local cases. It is the most common vector-borne disease in North America and Europe, with human cases reported in Asia (China, Japan, India, Malaysia, and Taiwan), Kenya in Africa; and Uruguay and Brazil in South America. LB has varied manifestations that mimic common diseases. Here, we report two cases of LB that were misdiagnosed and the etiology not established for over a week.

Method/Results: Case 1 was a young female seen by the family doctor for pain radiating down the back of right leg. She was diagnosed to have sciatica and was sent home with a prescription of prednisone. The patient also had pain radiating from the right orbit backward on the scalp, photophobia, and low-grade fever. An erythema migrans rash on the right thigh was overlooked. Her symptoms got worse requiring hospital admission. She responded to intravenous ceftriaxone followed by oral doxycycline. Case 2 was a young woman who was camping in the woods and admitted to the hospital with severe lower extremity weakness and multiple infected “mosquito bites.” She admitted to seeing many birds but not deer. She did not recall any tick bites. She was presumed to have either a spinal epidural abscess or West Nile virus infection. Magnetic resonance imaging of the spine was negative. West Nile serology was negative. She had a positive blood culture for methicillin-susceptible Staphylococcus aureus from infected “mosquito bites.” She was treated with oxacillin and discharged with a prescription for doxycycline. After the discharge, Lyme IgM was reported positive.

Discussion/Conclusion: Both cases presented with radiculopathy, the most common manifestation of neuroborreliosis. In Norway, 71% of Lyme cases present with neuroborreliosis. The disease affects all parts of the nervous system (brain, spinal cord, cranial nerves, peripheral nerves, meninges, and cerebrospinal fluid). There is considerable variation in the manifestations, depending on the geography and the Borrelia species. US physicians are mostly familiar with Bell's palsy and miss other manifestations. The purpose of this report is to alert physicians in Lyme-endemic areas to be vigilant on presentations that mimic other conditions.

[TAG:2]Abstract Synopsis 2[/TAG:2]

Munchausen Syndrome by Proxy “Polle Syndrome” Variant in a Young Adult with 12 New Organisms in Blood Cultures 17 Days after Admission to the Hospital with a Clue to the Etiology

R. Anmolsingh, D. W. Kannangara1

Department of Geriatrics, St Luke's University Health Network, Bethlehem, Pennsylvania,1Department of Infectious Diseases, St Luke's University Warren Campus, Phillipsburg, New Jersey, USA

Background: Munchausen syndrome by proxy (MSBP) is when a parent or caregiver of a child or elderly deliberately inflicts an illness. We report a case where visitor(s) injected contaminated material into a patient's intravenous (iv) line. Most polymicrobial bloodstream infections (PBIs) involve two with up to five organisms during an episode. Our patient had eight organisms on day 17 and four organisms on day 21. We report PBI with 12 organisms including two fungi in a patient hospitalized for 17 days. The organisms gave clues as to the etiology. We present the significance of the findings and preventive measures.

Methods: A 30-year-old male iv drug user (IVDU), following the drainage of methicillin-susceptible Staphylococcus aureus (MSSA) spinal epidural abscess, T1–T4 was treated with iv cefazolin. One blood culture had MSSA on day 2 but culture-negative on day 3. BC grew Klebsiella oxytoca, Delftia acidovorans, Chryseobacterium sp., Citrobacter freundii, Acinetobacter sp., Candida albicans, Candida parapsilosis, and Stenotrophomonas maltophilia on day 17 and alpha Streptococcus, Chryseobacterium indologenes, Commamonas sp., and Lactobacillus sp. on day 21. He left against advice and was readmitted on day 35 but eloped from the hospital. BC on day 35 had no growth.

Results: The most common bacteria in IVDUs are S. aureus, Streptococci, and Pseudomonas aeruginosa in spine infections. Our patient had bacteria found in the environment and contaminated hands. Lactobacilli are present in gastrointestinal and genitourinary flora and hands of females. Unusual environmental bacteria (Commamonas, Chryseobacterium, and Delftia) have been reported in PBI and C. albicans, S. maltophilia, and alpha Streptococci in Munchausen syndrome by proxy (MSBP). Six bacteria in our patient were reported over 4 years in a 23-year-old female with Munchausen syndrome. PBI with 12 organisms has never been reported. Deliberately inflicted bacteremia is rare.

Special Note: The patient's intravenous line was likely injected by the drug user's relative. In healthy individuals, most environmental organisms do not cause invasive infections. As far as we know, the patient made a reasonable recovery. The presence of Lactobacillus in one culture points to a single, highly specific source. IVDU patients should be closely monitored in hospital, to avoid drugs being introduced from outside.

[TAG:2]Abstract Synopsis 3[/TAG:2]

Stenotrophomonas maltophilia Urinary Infections: A Geriatric Malady

R. Anmolsingh, D. Pandya, D.W. Kannangara

Department of Geriatrics, St Luke's University Health Network, Bethlehem, PA,1Department of Infectious Diseases, St Luke's Health Network, Warren Campus, Phillipsburg, NJ, USA

Background: Stenotrophomonas maltophilia (SM) is known for antibiotic resistance, association with carbapenem use, biofilm formation, infections in immunocompromised patients, cystic fibrosis, burn wounds, chronic infections, and foreign materials. Not much is reported in the literature on the role of this organism in urinary infections.

Method: We reviewed the charts of 317 patients with SM-positive cultures from different sites, admitted to our hospital network. There were 54 positive urine cultures from 52 patients (52/317) during 3 years. We evaluated the age, sex, clinical presentation, comorbidities, association with foreign materials, prior antibiotic use, polymicrobial infections (PMIs), invasive potential, drug susceptibilities, and mortality.

Results: There were 39 males and 13 females. All except two were above age 50 and the youngest 43. Thirty-seven were above age 70 and 10 above age 90. None had a positive blood culture for SM. Thirty-four had some form of drainage tube: suprapubic catheter, Foley catheter, or nephrostomy. One underwent intermittent catheterization. One had a condom catheter. All except three had comorbidities (cancer 15, benign prostatic hyperplasia (BPH) 13, dementia 4, multiple sclerosis 2, paraplegia 2, tethered spinal cord 1, bladder neck contracture 1, mental developmental delay 1). Forty-two infections were polymicrobial. The most common in PMI were Enterococcus faecalis (11), Pseudomonas aeruginosa (9), Escherichia coli (9), and Candida species (6). Only two patients had more than one culture positive for SM. Fifty-one isolates were tested for susceptibilities. All but one were susceptible to trimethoprim/sulfamethoxazole. Six were resistant and 45 susceptible to levofloxacin. Twelve were intermediate and 4 resistant to ticarcillin/clavulanic acid. One was intermediate to ceftazidime and 12 resistant. There were 10 deaths during the study period mostly due underlying disease and not directly attributable to SM. There was no significant correlation with prior antibiotic use.

Discussion: SM urinary infections were associated with elderly. Most infections were in males. Almost all had comorbidities. Majority were associated with some forms of drainage device, mostly suprapubic tubes. PMIs were frequent. The most common bacteria in PMI were E. faecalis, E. coli, P. aeruginosa, and Candida. There were no blood infections, suggesting lack of invasiveness. Recurrences were uncommon.

[TAG:2]Abstract Synopsis 4[/TAG:2]

Establishing a Peer-Instructed Cardiopulmonary Resuscitation Certification Program for Medical Students

D. A. Brown, M. D. Creager, M. Zapcic, M. Garg

Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA

Introduction: Early cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrests more than doubles 30-day survival rate, and individuals trained in CPR are 3.4 times more likely to perform bystander CPR outside the hospital. Yet, medical students often do not receive CPR training until before beginning 3rd-year clinical rotations.

Methods: Medical students at the Lewis Katz School of Medicine (LKSOM) at Temple University created a peer-instructed CPR program with the goal of certifying all LKSOM classes of medical students in high-quality CPR. Of 52 1st-year LKSOM medical students polled, 98% expressed interest in becoming CPR certified, with 62% willing to become instructors. From that class, 12 students were selected through an equitable application process to certify further classes as CPR instructors.

Results: The program certifies medical students in high-quality CPR beginning in their 1st year while providing leadership and teaching experience to the student instructors. The program is a cost-effective alternative to employing a private company. The previous cost of training was $14,181 (or $87 per student) while the cost of this program is $5004 to start, with an annual recurrent cost of $2785 (saving $9177 the inaugural year and $11,396 every subsequent year).

Conclusion: This program trains all medical classes in high-quality CPR. Medical student instructors gain valuable leadership experience. Moreover, the program decreases overall CPR education expenditures. Overall, we were able to increase the number of students trained in CPR, thus enhancing the awareness of the importance of early CPR and the potential timeliness of an appropriate intervention by our trainees.

[TAG:2]Abstract Synopsis 5[/TAG:2]

The Immigrant Experience

E. Brzana, E. Hall, C. Renninger, A. Shergill, S. Malik, M. Sammon

Department of Emergency Medicine, Temple University Medical Center, Philadelphia, Pennsylvania, USA

Introduction: We present the Immigrant Experience as a novel teaching modality aiming to provide medical students with a greater depth of understanding regarding immigration and the challenges faced by immigrants.

Methods: Our team introduced the Immigrant Experience with a presentation detailing different facets of the immigration experience, including push factors, migration hardships, and legal factors of the journey. We also included a first-person account of care for migrants in an active combat zone. The students participated in an activity in which they were assigned the role of a refugee migrating to the US. Participants were asked to make decisions based on the hardships presented and the perilous scenarios that simulated. The activity allowed participants to emotionally connect to the decisions refugees make.

Results: Student participants submitted a pre- and post-survey evaluating their understanding of the immigrant experience and their likelihood to provide healthcare abroad Figure 1 and Figure 2. Students reported much greater understanding of both the immigrant experience and familiarity with the terms immigrant, migrant, asylum seeker, refugee, and internally displaced person. Furthermore, every student indicated that they would consider providing healthcare abroad, in contrast to the 9% that reported they were unlikely to do so before the activity.
Figure 1: Presurvey results

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Figure 2: Postsurvey results

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Conclusions: We conclude that the Immigrant Experience is an immersive teaching method that effectively exposes medical students to the topic of immigration. Students reported a greater understanding of the immigrant experience, enhanced knowledge of common terms describing immigration, and increased willingness to provide healthcare abroad.

[TAG:2]Abstract Synopsis 6[/TAG:2]

Knowledge, Attitudes, and Beliefs of Adolescents about Sexual Health and Behavior in Huye, Rwanda

S. Charles, R. Dorey, L. Drobatz

Thomas Jefferson University, Philadelphia, Pennsylvania, USA

Background: Pregnancy and its associated complication is the leading cause of death for women aged 15–19 years, worldwide. Teenage pregnancy is correlated with increased health complications, death, poverty, and societal stigma. Pregnancy in Rwanda has been documented at rates of 7% among teen women. The objectives of this research study include assessing the attitudes, knowledge, and beliefs of adolescents in the Huye District of Rwanda regarding sexual health and behavior. We hypothesize that gaps in sexual health knowledge may exist and that differing beliefs among male and female adolescents affect adolescent sexual decision-making, and therefore, teenage pregnancy prevalence.

Methods: This study recruited men and women aged 15–25 years from secondary schools in the Huye District in Rwanda. A total of 270 students completed a survey adapted from the Kaiser Family Foundation on adolescent sexual health, and a total of 26 students participated in four gender-specific focus groups. The study was conducted by medical students from Thomas Jefferson University partnering with the Rwanda Village Community Promoters, a student-run health organization involving students from the University of Rwanda.

Results: This study demonstrates that Rwandan adolescents have some understanding of birth control methods, but cultural stigma may prevent access and efficacious use of these methods. With that being said, there are still many misconceptions that Rwandan teens have about birth control and various other sexual health issues. In addition, most teens reported that their sexual health education mostly comes from school and family, yet a large number of these teens do not feel comfortable discussing these issues with their families. Finally, sexual health concerns and pressures teens face vary by gender and are influenced by societal gender roles and expectations.

Discussion: To address gaps in the sexual health knowledge of adolescents and the taboos surrounding sexual health discussion in the community, which further perpetuates myths and misinformation, Jefferson and University of Rwanda students plan to implement more targeted sexual health education programming in secondary schools in Huye, Rwanda.

[TAG:2]Abstract Synopsis 7[/TAG:2]

The Association between Mental Health Status and Cancer Prevention Screenings

C. Edirisuriya, A. Leader

Thomas Jefferson University, Philadelphia, Pennsylvania, USA

Background: Among those with a diagnosed mental health condition in the United States, the uptake of preventative health services, such as cancer screening, is remarkably low. Women with depressive or anxiety disorders have rates of breast and cervical cancer screening that fall below the national average, putting them at greater risk for being diagnosed with late-stage disease. Within the homeless population, depression is negatively associated with colon-rectal cancer (CRC) screening. Cancer patients with schizophrenia are three times more likely to die than those without schizophrenia. This research assessed disparities in breast, colorectal, and cervical cancer screening rates among those living in Southeastern Pennsylvania (PA) who do and do not have a diagnosed mental health condition.

Methods: We used data from Southeastern PA Community Health Data Base collected in 2014–2015. The project utilized cancer screening variables (i.e., the time since the individual's last  Pap smear More Details, mammogram, and sigmoidoscopy/colonoscopy) and calculated adherence to national guidelines to examine differences between those with and without a mental health condition, i.e., depression, anxiety, and schizophrenia. Analyses consisted of population counts, P values, and Pearson Chi-square statistics.

Results: Sixteen percent of the Southeastern PA population was diagnosed with a mental health condition. Within the five counties of Southeastern PA, no significant statistical differences between those with and without a diagnosed mental illness and their cancer screening adherence rates were observed. However, when restricting the analysis to Philadelphia County, those with a diagnosed mental health condition were significantly less likely to have been screened for breast, cervical, or prostate cancer. More granular details are provides in Table 1 and Table 2.
Table 1: Screening adherence by cancer type

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Table 2: Philadelphia county population counts

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Discussion: It is evident that there are health challenges that the mental health community must endure in Philadelphia County. These results imply that the level of care and treatment outside of Philadelphia may allow the mental health community to overcome inequities and be screened. There may be greater stability and more frequent access to primary care physicians in nonmetropolitan counties. Therefore, patients are more likely to adhere to cancer screening protocol. The analysis of this research can help direct the next steps that preventative healthcare should take for those suffering from mental illness, especially in Philadelphia.

Special Notes: We were invited to submit this abstract by Thomas Jefferson University, Population Health Research Department.

[TAG:2]Abstract Synopsis 8[/TAG:2]

Initial Assessment of the Temple Emergency Action Corps THRIVE Medical-Student-Run Clinic

L. A. Goldberg, N. Mokhashi, J. Corcoran, P. Delrosario, M. Hotz, E. Jennings, K. Kwon, J. Swiatek, M. Garg1

Lewis Katz School of Medicine at Temple University,1 Department of Emergency Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA

Introduction: The Temple Emergency Action Corps THRIVE clinic is Temple's first medical-student-run free clinic. THRIVE seeks to expand the capacity for health in the North Philadelphia community by working with individuals in the following areas: knowledge, self-efficacy, motivation, health, and accessibility of care. Through these areas, THRIVE aims to protect, sustain, and promote the health of patients. THRIVE operates out of 1 day at a time, a shelter located in North Philadelphia. The semi-transient resident population allows THRIVE to effectively serve as a bridge clinic providing some continuity of care to residents, while also allowing continuous influx of new patients.

Methods: This was a retrospective review.
Figure 1: Patient, student, and faculty involvement in THRIVE Clinic. There have been a total of 264 visits, with 159 of these being new patient visits. 127 students (M1–M4) and 12 faculty members have volunteered in the clinic to-date

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Figure 2: Involvement of the 1st-year class in THRIVE Clinic. 70 of 197 1st-year students (36%) have volunteered in the clinic to-date

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Figure 3: Breakdown of student involvement in THRIVE Clinic by year

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Figure 4: Breakdown of hours committed to THRIVE by students and faculty

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Figure 5: Estimated monetary value of THRIVE Clinic services. An average between a routine adult visit and sick visit ($165/visit) was used to generate the value of 264 primary care visits. Each health and wellness packet is estimated at $13.12 and each vaccine at $68.25

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Figure 6: Services offered and specialties represented at THRIVE Clinic

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Results: A total of 159 patients have been seen in 264 visits. Student effort exceeds 1500 h and 36% of the 1st-year class has volunteered.

Conclusions: In the first 6 months of operations, THRIVE has demonstrated enormous potential in both healthcare delivery and medical student education. The clinic has provided acute, minor care and connected individuals with outside resources through referrals, education, and knowledge. THRIVE has partnered with the city of Philadelphia in vaccine administration. Finally, over 100 medical students have served the North Philadelphia community and had an opportunity to learn from one another, precepting physicians, and community members. THRIVE is a powerful tool to educate and engage future generations of health professionals, providing students the opportunity to learn from the resiliency and lived experiences of patients. THRIVE clinic has made a sustainable impact in our community.

Acknowledgments: We would like to acknowledge Margot Savoy MD, David O'Gurek MD, Tara Jennings MD, Rachel Jennings MD, David Link MD, Dianne Butera, Micki Miller, The Greenfield Foundation, Chinaemelum Akpunonu, Roshni Bhat, Carolina Caban, Sydney Ehrman, Jacklyn Huhn, Alexa Leib, Sophia Mercadante, Chase Renninger, Meera Solanki, and Theresa Webster.

[TAG:2]Refereces[/TAG:2]

  1. Cost & Quality Tools. MyBlue. Available from: http://myblue.bluecrossma.com/tools-resources/find-care/estimate-costs. [Last accessed on 2019 Nov 27].
  2. VFC | Current CDC Vaccine Price List | CDC. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html. [Last accessed on 2019 Nov 27].


[TAG:2]Abstract Synopsis 9[/TAG:2]

Temple Emergency Action Corps as a Model for Multi-Faceted Medical Student Groups

N. Mokhashi, L. A. Goldberg, L. Serwatka, M. Simons, D. Guillory, E. Jennings, M. Garg1

Lewis Katz School of Medicine at Temple University;1 Department of Emergency Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA

Introduction: Temple Emergency Action Corps (TEAC) is a medical-student-run group at the Lewis Katz School of Medicine created in 2005 in response to medical needs after Hurricane Katrina. TEAC has evolved today to have two main goals: outreach and education. There are five branches that support these goals: An International Service-Learning Trip, THRIVE Clinic, TEAC Funding, TEAC I/II Electives, and cardiopulmonary resuscitation (CPR)/disaster response, with a total of 25 regular board members. TEAC pursues outreach internationally with a service-learning trip to a location affected by crisis, and locally, by facilitating a weekly student-run free clinic at a shelter in North Philadelphia. In addition, TEAC funding provides subsidization to local and international student projects that represent TEAC's core values. Electives I/II and CPR/disaster response programs provide education to medical students through disaster preparedness workshops and CPR training.

Methods: Each branch collected relevant statistics of program participation and impact which guided data review.

Results: Through disaster response and TEAC I/II electives, 120 medical students have been trained in relevant knowledge and technical skills. Furthermore, 381 students have been trained in CPR/basic life support (BLS). Services offered on the Service-Learning Trip and in THRIVE Clinic include preventative screening/medicine, health and wellness kits, acute care, and diagnostic evaluations. Nearly 3400 h of student and faculty effort has been devoted to the goals of TEAC. Detailed results of this study are shown in Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6.
Figure 1: Student, faculty, and patient experiences through Temple Emergency Action Corps

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Figure 2: Experiences through Temple Emergency Action Corps Branches broken down by students, faculty, and patients. Service-Learning Trip student involvement includes 30 medical students from Puerto Rico and 17 Lewis Katz School of Medicine students. Faculty on the service trip included 3 Lewis Katz School of Medicine physicians and 15 physicians from Puerto Rico. In the cardiopulmonary resuscitation program, greater than 99% of the M1 and M2 classes have been cardiopulmonary resuscitation-certified through Temple Emergency Action Corps

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Figure 3: Breakdown of 3372 total hours devoted by each Temple Emergency Action Corps branch

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Figure 4: Estimated Monetary Value of Temple Emergency Action Corps Initiatives. An average between a routine adult visit and sick visit ($165/visit) was used to generate the value of primary care visits. For the THRIVE clinic, additional value was estimated for each health and wellness packet at $13.12 and each vaccine at $68.25. Cardiopulmonary resuscitation training estimate was based on cost of one-time supplies, instructor training, and certification cards

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Figure 5: Involvement of the student body (M1–M4) in Temple Emergency Action Corps Initiatives. 421 out of 780 medical school students (54%) have engaged in Temple Emergency Action Corps initiatives to-date

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Figure 6: Services offered and specialties represented at THRIVE Clinic and in Puerto Rico on the Service-Learning Trip. Skills reinforced through Temple Emergency Action Corps Electives I/II and cardiopulmonary resuscitation/Disaster Response Programs

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Conclusions: A medical-student-run group focused on local and international emergency response through outreach and education can have a meaningful impact on the health and preparedness of communities. The model of this group can serve to help future medical students establish similar programs around the country.

Acknowledgments: We would like to acknowledge C. Akpunonu, R. Bhat, C. Caban, P. Delrosario, S. Ehrman, M. Girgis, M. Grunat, P. Gutierrez, E. Hall, M. Hotz, J. Huhn, R. Jenkins, K. Kwon, A. Leib, S. Mercadante, C. Renninger, M. Solanki, T. Webster, J. Zirnheld, D. Brown, J. Corcoran, M. Creager, T. Jennings, R. Jennings, N. Kus, D. Link, J. Swiatek, D. Butera, M. Miller, M. LaRussa, the Greenfield Foundation.


  References Top


  1. Cost & Quality Tools. MyBlue. Available from: http://myblue.bluecrossma.com/tools-resources/find-care/estimate-costs. [Last accessed on 2019 Nov 27].
  2. li>VFC | Current CDC Vaccine Price List | CDC. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html. [Last accessed on 2019 Nov 27].


[TAG:2]Abstract Synopsis 10[/TAG:2]

Portuguese-Speaking Patients: Domestic and International Outreach

T. Ndlovu, N. Silva

Rutgers New Jersey Medical School, Newark, New Jersey, USA

Introduction: As healthcare providers, it is imperative that we obtain information on the health and socioeconomic needs of our target populations. Hospitals have a responsibility to be integrated within their surrounding communities. The Ironbound community of Newark is a culturally rich area, with one of the highest Portuguese-speaking immigrant populations in the country. This population consists of documented and undocumented immigrants who have little access to healthcare and are challenged by language and cultural barriers. We strived to address these aforementioned challenges through both local and international outreach.

Methods: We engaged the community via local initiatives and organized service-learning trips to Brazil to further medical students' understanding of the Brazilian culture and healthcare system.

Results: Our outreach in the Ironbound community called Ironbound Initiative has recruited over 50 students to take vital signs, provide health education, and offer preventative cancer screening to the community for over 2 years. Our relationship with the community has encouraged this population to utilize healthcare resources at University Hospital. Two medical rotation trips to Santarém, Brazil, have demonstrated students' increase in cultural, language, and healthcare system awareness after the experience.

Conclusions: A multi-faceted approach toward addressing the healthcare needs of Portuguese-speaking populations in Newark is flourishing and expanding. More medical students are educated about this patient population, and more community members are receiving culturally sensitive care.

[TAG:2]Abstract Synopsis 11[/TAG:2]

Partnering with Leaders in Global Communities

Jenny Schadt

Temple University School of Medicine, Philadelphia, Pennsylvania, USA

Synopsis: The presenter was ?an intern with the Uganda Village Project, a public health nongovernmental organization in Iganga, Uganda. Global health professionals need to recognize that the members of the communities they are working in are global health leaders as well and that their help is necessary for achieving success in health initiatives. Only by partnering with village leaders, our neighbors, and even children, were we able to together design the most community-effective initiatives and empower the community to be a part of improving their own health.

[TAG:2]Abstract Synopsis 12[/TAG:2]

Physician Assistant Emergency Medicine Global Health Fellowship: A Unique Education Opportunity

K. Towns, S. Gangji, E. Cioe-Pena

Center for Global Health, Northwell Health/Staten Island University Hospital, New York, USA

Summary: Emergency medicine is a broad discipline that gives practitioners the skills and knowledge to take care of critical patients while also addressing the needs of the community. Historically, the physician assistant (PA) profession was created to address the healthcare disparities in primary and rural care and is currently in a unique position to bridge the gap of physician and healthcare shortages that affect developing healthcare systems around the world. The PA profession was designed to be cost-effective and flexible enough to address these shortages. The Staten Island University Hospital Emergency Department PA/Global Health Fellowship is the next step in developing the first generation of PAs formally trained and focused on the realities of global health. The 2-year fellowship includes 18 months of mentorship at Staten Island University Hospital Emergency Department followed by 6 months devoted to global health work. A master's degree in public health is also obtained through the University of London. This fellowship provides an excellent foundation in developing the skill set needed for high-quality clinical practice and understanding the global health community. The fellows will not only gain the well-rounded clinical skills needed to deliver the best care in high-income countries and low/middle-income countries, but they will also be able to take leadership roles, establish relationships with other international organizations, educate others, and become involved in policy.

[TAG:2]Abstract Synopsis 13[/TAG:2]

Disparities in International Health, International Health Security

D. W. Wassef, V. Padmanaban, U. Barrie, A. Gupta, S. Jalloh, A. Benneh, Z. C. Sifri

Rutgers New Jersey Medical School, Newark, New Jersey, USA

Background: Humanitarian nongovernmental organizations (NGOs) conduct short-term surgical missions (STSMs) to provide surgical care with concurrent goals of training and capacity building. While NGOs rely on partnerships with low-and-middle-income country (LMIC) hospital leaders to conduct STSMs, little is reported regarding viewpoints of local healthcare workers (HCWs) about volunteer preparedness, mission goals, effectiveness, and motivations. The primary objective of this study is to examine if West African HCW viewpoints align with STSM priorities and services rendered.

Materials and Methods: The International Surgical Health Initiative (ISHI) is a volunteer-run NGO that provides annual general surgeries to Tetteh Quarshie Memorial Hospital (TQMH) in Mampong, Ghana, and Kabala Government Hospital (KGH) in Kabala, Sierra Leone. An anonymous, qualitative 23-part survey was administered to host medical staff inclusive of physicians/physician extender designation and nonphysicians to determine agreement with statements regarding STSM volunteer services on a Likert scale. Verbal consent was issued at the time of survey administration. Survey results were segregated by staff designation of “physicians/physicians extenders,” inclusive of “community health officers,” and “nurses” and compared.

Results: There were 44 survey respondents with 25 from TQMH and 19 from KGH. Ten respondents identified as physicians or community health officers (CHOs), while 35 identified as nurses Table 1. All cohorts agreed that the specific needs of the host practices are met by ISHI host volunteers, that volunteers were competent, and that ISHI missions were successful in achieving their intended goals. Nurses more frequently believed that ISHI volunteers were motivated exclusively by personal gain in addition to more altruistic goals. All HCWs agreed that future STSMs should emphasize on capacity building and supply donations.
Table 1: Percentage of host survey respondents who report “strongly agree” to selected survey statements

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Discussion: This pilot study demonstrates that overall, West African HCW perceptions align with STSM primary goals of volunteer-run NGO. Identified differences between intended and perceived goals practices and motivations should be minimized by culturally sensitive, open communication with the host team to improve STSM impact. STSMs rely on partnerships with LMIC HCWs and alignment of priorities with host communities. HCW opinion about goals of future mission should be elicited, appropriately refocused, and endorsed to the local team to close the feedback loop.







 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17]



 

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