Management of Pediatric Cavum Cysts: A Scoping Review and a Single Institution Case Series.

INTRODUCTION: Pediatric cavum cysts are a rare yet complicated pathology to manage. The literature is scarce, primarily consisting of case series, and lacking a consensus regarding clear management. In this scoping review, we aimed to compile existing information in the literature regarding the management of pediatric cavum cysts across the last 10 years. We also present our management of 19 patients, the largest case series to date, highlighting knowledge gaps surrounding the management of this salient pathology. METHODS: A literature search using PubMed and SCOPUS was conducted using the following search terms: (pediatric) AND (Cavum septum pellucidum) OR (cavum vergae) OR (cavum velum interpositum) AND (management). Eligibility criteria included peer-reviewed publication published in the last 10 years, pediatric population, cavum cyst, and English language. A retrospective search was conducted for all pediatric cavum cysts between 2013 and 2023 at our institution. Clinical and radiographic characteristics as well as intervention and outcome data were collected for both the scoping review and our cases. RESULTS: 330 total articles were populated using our search. 12 articles met our inclusion criteria. 41.7% (n = 5) of the articles were case series, 33.3% (n = 4) were case reports, 8.3% (n = 1) was a technical article, 8.3% (n = 1) was a systematic review, and 8.3% (n = 1) was a case questionnaire. Resolution of symptoms was noted in all articles of our scoping review, regardless of treatment modality. The average age in our case series was 9.84 years old and average age at diagnosis was 5.53 years old. 6 patients (31.6%) were female and 13 patients (68.4%) were male. 2 out of the 19 patients (10.5%) were surgically treated. CONCLUSION: There is no clear consensus on the management of cavum cysts. A prospective, multicenter study is needed to create standardized pediatric cyst management guidelines. The current thought is that surgical intervention should be saved for those patients with obstructive hydrocephalus and signs of intracranial hypertension.

Ebola Patient Virus Cycle Threshold and Risk of Household Transmission of Ebola Virus.

BACKGROUND: Identifying risk factors for household transmission of Ebola virus (EBOV) is important to guide preventive measures during Ebola outbreaks. METHODS: We enrolled all confirmed persons with EBOV disease who were the first case patient in a household from December 2014 to April 2015 in Freetown, Sierra Leone, and their household contacts. Index patients and contacts were interviewed, and contacts were followed up for 21 days to identify secondary cases. Epidemiologic data were linked to EBOV real-time reverse-transcription polymerase chain reaction cycle threshold (Ct) data from initial diagnostic specimens obtained from enrolled index case patients. RESULTS: Ct data were available for 106 (71%) of 150 enrolled index patients. Of the Ct results, 85 (80%) were from blood specimens from live patients and 21 (20%) from oral swab specimens from deceased patients. The median Ct values for blood and swab specimens were 21.0 and 24.0, respectively (P = .007). In multivariable analysis, a Ct value from blood specimens in the lowest quintile was an independent predictor of both increased risk of household transmission (P = .009) and higher secondary attack rate among household contacts (P = .03), after adjustment for epidemiologic factors. CONCLUSIONS: Our findings suggest the potential to use Ct values from acute EBOV diagnostic specimens for index patients as an early predictor of high-risk households and high-risk groups of contacts to help prioritize EBOV disease investigation and control efforts.

Transmission dynamics of Ebola virus disease and intervention effectiveness in Sierra Leone.

Sierra Leone is the most severely affected country by an unprecedented outbreak of Ebola virus disease (EVD) in West Africa. Although successfully contained, the transmission dynamics of EVD and the impact of interventions in the country remain unclear. We established a database of confirmed and suspected EVD cases from May 2014 to September 2015 in Sierra Leone and mapped the spatiotemporal distribution of cases at the chiefdom level. A Poisson transmission model revealed that the transmissibility at the chiefdom level, estimated as the average number of secondary infections caused by a patient per week, was reduced by 43% [95% confidence interval (CI): 30%, 52%] after October 2014, when the strategic plan of the United Nations Mission for Emergency Ebola Response was initiated, and by 65% (95% CI: 57%, 71%) after the end of December 2014, when 100% case isolation and safe burials were essentially achieved, both compared with before October 2014. Population density, proximity to Ebola treatment centers, cropland coverage, and atmospheric temperature were associated with EVD transmission. The household secondary attack rate (SAR) was estimated to be 0.059 (95% CI: 0.050, 0.070) for the overall outbreak. The household SAR was reduced by 82%, from 0.093 to 0.017, after the nationwide campaign to achieve 100% case isolation and safe burials had been conducted. This study provides a complete overview of the transmission dynamics of the 2014-2015 EVD outbreak in Sierra Leone at both chiefdom and household levels. The interventions implemented in Sierra Leone seem effective in containing the epidemic, particularly in interrupting household transmission.

Household Transmission of Ebola Virus: Risks and Preventive Factors, Freetown, Sierra Leone, 2015.

Background: Knowing risk factors for household transmission of Ebola virus is important to guide preventive measures during Ebola outbreaks. Methods: We enrolled all confirmed persons with Ebola who were the first case in a household, December 2014-April 2015, in Freetown, Sierra Leone, and their household contacts. Cases and contacts were interviewed, contacts followed prospectively through the 21-day incubation period, and secondary cases confirmed by laboratory testing. Results: We enrolled 150 index Ebola cases and 838 contacts; 83 (9.9%) contacts developed Ebola during 21-day follow-up. In multivariable analysis, risk factors for transmission included index case death in the household, Ebola symptoms but no reported fever, age <20 years, more days with wet symptoms; and providing care to the index case (P < .01 for each). Protective factors included avoiding the index case after illness onset and a piped household drinking water source (P < .01 for each). Conclusions: To reduce Ebola transmission, communities should rapidly identify and follow-up all household contacts; isolate those with Ebola symptoms, including those without reported fever; and consider closer monitoring of contacts who provided care to cases. Households could consider efforts to minimize risk by designating one care provider for ill persons with all others avoiding the suspected case.

HPV-associated oropharyngeal squamous cell carcinoma.

Human papillomavirus (HPV) can infect the tonsillar tissues of the oropharynx and is associated with oropharyngeal squamous cell carcinoma. This article provides an overview to guide primary care providers in screening patients for oropharyngeal cancer and making appropriate referrals. The article also reviews available HPV vaccines and immunization adherence rates.

Risk factors for Ebola virus disease among household care providers, Sierra Leone, 2015.

BACKGROUND: Household contacts who provide care to an Ebola virus disease (EVD) case have a 3-fold higher risk of EVD compared with contacts who do not provide care. METHODS: We enrolled persons with confirmed EVD from December 2014 to April 2015 in Freetown, Sierra Leone, and their household contacts. Index cases and contacts were interviewed, and contacts were followed for 21 days to identify secondary cases. Epidemiological data were analysed to describe household care and to identify risk factors for developing EVD. RESULTS: Of 838 contacts in 147 households, 156 (17%) self-reported providing care to the index case; 56 households had no care provider, 52 a single care provider and 39 multiple care providers. The median care provider age was 29 years, 68% were female and 32% were the index case's spouse. Care providers were more likely to report physical contact, contact with body fluids or sharing clothing, bed linens or utensils with an index case, compared with non-care providers (P <0.01). EVD risk among non-care providers was greater when the number of care providers in the household increased (odds ratio: 1.61; 95% confidence interval: 1.1, 2.4). In multivariable analysis, factors associated with care provider EVD risk included no piped water access and absence of index case fever, and protective factors included age <20 years and avoiding the index case. CONCLUSIONS: Limiting the number of care providers in a household could reduce the risk of EVD transmission to both care providers and non-care providers. Strategies to protect care providers from EVD exposure are needed.

Association of community engagement with vaccination confidence and uptake: A cross-sectional survey in Sierra Leone, 2019.

Background: The 2014-2016 Ebola epidemic disrupted childhood immunization in Sierra Leone, Liberia, and Guinea. After the epidemic, the Government of Sierra Leone prioritized community engagement to increase vaccination confidence and uptake. To support these efforts, we examined potential drivers of vaccination confidence and uptake in Sierra Leone. Methods: We conducted a population-based household survey with primary caregivers of children in a birth cohort of 12 to 23 months in four districts with low vaccination coverage in Sierra Leone in 2019. Modified Poisson regression modeling with robust variance estimation was used to examine if perceived community engagement in planning the immunization program in the community was associated with vaccination confidence and having a fully vaccinated child. Results: The sample comprised 621 age-eligible children and their caregivers (91% response rate). Half of the caregivers (52%) reported that it usually takes too long to get to the vaccination site, and 36% perceived that health workers expect money for vaccination services that are supposed to be given at no charge. When mothers were the decision-makers of the children's vaccination, 80% of the children were fully vaccinated versus 69% when fathers were the decision-makers and 56% when other relatives were the decision-makers. Caregivers with high confidence in vaccination were more likely to have fully vaccinated children compared to caregivers with low confidence (78% versus 53%). For example, caregivers who thought vaccines are 'very much' safe were more likely to have fully vaccinated children than those who thought vaccines are 'somewhat' safe (76% versus 48%). Overall, 53% of caregivers perceived high level of community engagement, 41% perceived medium level of engagement, and 6% perceived low level of engagement. Perceiving high community engagement was associated with expressing high vaccination confidence (adjusted prevalence ratio (aPR) = 2.60; 95% confidence interval (CI) = 1.67-4.04) and having a fully vaccinated child (aPR = 1.67; 95% CI = 1.18-2.38). Conclusions: In these four low coverage districts in Sierra Leone, the perceived level of community engagement was strongly associated with vaccination confidence among caregivers and vaccination uptake among children. We have provided exploratory cross-sectional evidence to inform future longitudinal assessments to further investigate the potential causal effect of community engagement on vaccination confidence and uptake.

Issues of concern to emergency physicians in pre-retirement years: a survey.

BACKGROUND: Many members of the American College of Emergency Physicians are now over the age of 50. Little is known regarding age-specific issues that may impact the careers of emergency physicians in the latter stages of their professional lives. OBJECTIVES: To determine issues of concern regarding aging and retirement among a cohort of emergency physicians in pre-retirement years. METHODS: A survey of a randomized sample of 1000 American College of Emergency Physicians members over the age of 55 years was conducted with two separate mailings in the fall of 2006 and winter of 2007. The survey instrument consisted of 30 questions relating primarily to issues of health, finances, and the ability to practice emergency medicine. Four open-ended questions were included at the end of the survey, relating to means of promoting career longevity. RESULTS: There were 802 usable responses received (response rate 80%). The average respondent was 57 years old and worked 30 clinical and 12 non-clinical h per week. The average estimated time to complete retirement was 7.8 years. Respondents generally viewed themselves as competent clinicians with improved ability to relate to patients and staff and little decline in procedural skills. However, a substantial proportion reported age-related concerns. Seventy-four percent reported less ability to recover from night shifts, 44% reported a higher level of emotional exhaustion at end of shift, 40% reported less ability to manage heavy patient volume, 36% reported less ability to handle stress of emergency medicine, 28% reported health limitations on ability to practice, 28% reported memory somewhat or considerably worse, and 25% reported less ability to incorporate new modalities of diagnosis and treatment. With regard to retirement-related issues, 42% reported concerns about adequate financial preparations and 44% reported concerns regarding loss of identity upon retirement. The practice modifications most commonly reported to impact career longevity were the reduction or elimination of night shifts, a reduction in the number of hours per shift, and an increase in physician and support staffing. CONCLUSIONS: Respondents to this survey generally viewed themselves as competent, empathic practitioners. Yet a substantial percentage acknowledged at least some degree of cognitive or physical decline. The results suggest a role for the national organizations in emergency medicine in endorsing practice modifications that promote career longevity and clinical competence among its senior members.

Report of the Task Force on Residency Training Information (2009-2010), American Board of Emergency Medicine.

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents in those programs. We present the 2010 annual report on the status of US emergency medicine training programs.

Community knowledge, perceptions and practices around COVID-19 in Sierra Leone: a nationwide, cross-sectional survey.

OBJECTIVES: To assess the public's knowledge, attitudes and practices about the novel coronavirus in Sierra Leone to inform an evidence-based communication strategy around COVID-19. DESIGN: Nationwide, cross-sectional Knowledge, Attitudes and Practices survey. SETTING: 56 randomly selected communities in all 14 districts in Sierra Leone. PARTICIPANTS: 1253 adults aged 18 years and older of which 52% were men. MAIN OUTCOME MEASURES: We calculated proportions of core indicators (awareness, knowledge, risk perception, practices). A composite variable for knowledge (based on seven variables) was created, and categorised into low (0-2 correct), medium (3-4) and high (5-7). Predictors of knowledge were analysed with multilevel ordinal regression models. Associations between information sources, knowledge and two practices (washing hands with soap and avoiding crowds) were analysed using multilevel logistic regression models. RESULTS: We found that 75% of the respondents felt at moderate or great risk of contracting coronavirus. A majority (70%) of women did not know you can survive COVID-19, compared with 61% of men. 60% of men and 54% of women had already taken action to avoid infection with the coronavirus, mostly washing hands with soap and water (87%). Radio (73%) was the most used source for COVID-19 information, followed by social media (39%). Having a medium or high level of knowledge was associated with higher odds of washing hands with soap (medium knowledge: adjusted OR (AOR) 2.1, 95% CI 1.0 to 4.4; high knowledge: AOR 4.6, 95% CI 2.1 to 10.2) and avoiding crowds (medium knowledge: AOR 2.0, 95% CI 1.1 to 3.6; high knowledge: AOR 2.3, 95% CI 1.2 to 4.3). CONCLUSIONS: This study shows that in the context of COVID-19 in Sierra Leone, there is a strong association between knowledge and practices. Because the knowledge gap differs between genders, regions, educational levels and age, it is important that messages are specifically targeted to these core audiences.

Report of the Task Force on Residency Training Information (2008-2009), American Board of Emergency Medicine.

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents in those programs. We present the 2009 annual report on the status of US emergency medicine residency programs.

Report of the Task Force on Residency Training Information (2007-2008), American Board of Emergency Medicine.

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the eleventh annual report on the status of US emergency medicine residency programs.

Report of the Task Force on Residency Training Information (2006-2007), American Board of Emergency Medicine.

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the tenth annual report on the status of US emergency medicine residency programs.

Report of the Task Force on Residency Training Information (2005-2006), American Board of Emergency Medicine.

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the ninth annual report on the status of US emergency medicine residency programs.

Report of the Task Force on Residency Training Information (2004-2005), American Board of Emergency Medicine.

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the eighth annual report on the status of US emergency medicine residency programs.

Report of the Task Force on Residency Training Information (2003-2004), American Board of Emergency Medicine.

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the seventh annual report on the status of US emergency medicine residency programs.

Application of the medical knowledge general competency to emergency medicine.

In February 1999, the Accreditation Council for Graduate Medical Education (ACGME) identified six general competencies as the basic educational goals required by all training programs for their residents. This places emphasis on educational outcome assessment in residency programs and in the accreditation process. A concomitant goal is to have increasingly valid, reliable assessments of the ability of a resident physician to provide safe, evidenced-based, humanistic medical care to their patients. To better define these competencies for the specialty of emergency medicine (EM), the Council of Emergency Medicine Residency Directors (CORD-EM) held a consensus conference in March 2002. This article reports the results of the Consensus Group for the core competency area of medical knowledge. This competency is already being well addressed in residency programs, but there has been inadequate documentation of a resident's knowledge base. The Consensus Group focused on many assessment methods to determine those having the best potential for use in EM programs. Assessment methods felt to be most appropriate for assessment of the medical knowledge base of a resident are presented, as are practical suggestions for incorporating these into EM programs.

Results from a practice-based lipid clinic model in achieving low density lipoprotein cholesterol goals.

OBJECTIVE: Lipid clinic models that combine diet and drug therapy have shown significantly better hyperlipidemia management than usual care. The objective is to demonstrate that such a model can be established and utilized in a primary care practice, replicating the results obtained in specialty clinic settings. DESIGN: This study evaluated a "lipid clinic" model for cholesterol management in a primary care setting. SETTING/PARTICIPANTS: Men and women for both the study and control groups were selected from those with abnormal lipid profiles determined during the course of routine healthcare in community internal medicine group practices. INTERVENTION: Control subjects are those selected by chart review from the practices of four general internists. These physicians treated their patients according to "usual practice". Study subjects are those from another general internal medicine practice who volunteered to enroll in that practice-based "lipid clinic". MEASUREMENT & RESULTS: This program demonstrated significant reductions in total and low density lipoprotein cholesterol in patients with coronary heart disease, diabetes mellitus, and patients without coronary heart disease defined as high and low risk. It used a specialty clinic-based intervention that included diet, medication, and follow-up by nurses and physicians. Almost 90% of all patients were on appropriate drug therapy and achieved therapeutic goals. CONCLUSION: We believe that a primary care practice-based, lipid clinic model employing physician involvement, diet, maximal drug therapy and patient tracking can result in superior achievement of treatment goals.