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J Am Coll Emerg Physicians Open ; 1(5): 757-765, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33145516


Objectives: In the 2016 Peace Accord with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate 14,000 ex-combatants into the healthcare system. However, FARC ex-combatants have faced significant challenges in receiving healthcare, and little is known about physicians' abilities to address this population's healthcare needs. Methods: An electronic questionnaire sent to the Colombian Emergency Medicine professional society and teaching hospitals assessed physicians' knowledge, attitudes, and experiences with the FARC ex-combatant reincorporation process. Results: Among 53 participants, most were male (60.4%), and ∼25% were affected by the FARC conflict (22.6%). Overall knowledge of FARC reincorporation was low, with nearly two-thirds of participants (61.6%) scoring in the lowest category. Attitudes around ex-combatants showed low bias. Few physicians received training about reincorporation (7.5%), but 83% indicated they would like such training. Twenty-two participants (41.5%) had identified a patient as an ex-combatant in the healthcare setting. Higher knowledge scores were significantly correlated with training about reincorporation (r = 0.354, n = 53, P = 0.015), and experience identifying patients as ex-combatants (r = 0.356, n = 47, P = 0.014). Conclusion: Findings suggested high interest in training and low knowledge of the reincorporation process. Most physicians had low bias, frequent experiences with ex-combatants, and cared for these patients when they self-identify. The emergency department (ED) serves as an entrance into healthcare for this population and a potential setting for interventions to improve care delivery, especially those related to mental healthcare. Future studies could evaluate effects of care delivery following training on ex-combatant healthcare reintegration.

Afr J Emerg Med ; 10(2): 68-73, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32612911


Background: Studies from high-income countries (HIC) support restrictive blood transfusion thresholds in medical patients. In low- and middle-income countries (LMIC), the etiologies of anemia and baseline health states differ greatly; optimal transfusion thresholds are unknown. This study evaluated the association of packed red blood cell (PRBC) transfusion with mortality outcomes across hemoglobin levels amongst emergency center (EC) patients presenting with medical pathology in Kigali, Rwanda. Methods: This retrospective cohort study was performed using a random sample of patients presenting to the EC at the University Teaching Hospital of Kigali. Patients ≥15 years of age, treated for medical emergencies during 2013-16, with EC hemoglobin measurements were included. The relationship between EC PRBC transfusion and patient mortality was evaluated using logistic regression, with stratified analyses performed at hemoglobin levels of 7 mg/dL and 5 mg/dL. Results: Of 3609 cases sampled, 1116 met inclusion. The median age was 42 years (IQR 29, 60) and 45.2% were female. Transfusion occurred in 12.1% of patients. Hematologic (24.4%) and gastrointestinal pathologies (20.7%) were the primary diagnoses of those transfused. Proportional mortality was higher amongst those receiving transfusions, although not statistically significant (23.7% vs 17.0%, p = 0.06). No significant difference in adjusted odds of overall mortality by PRBC transfusion was found. In stratified analysis, patients receiving EC transfusions with a hemoglobin >5.0 mg/dL, had 2.21 times the odds of mortality (95% CI 1.51-3.21) as compared to those ≤5.0 mg/dL. Conclusions: No association between PRBC transfusion and odds of mortality was observed amongst EC patients in this LMIC setting. An increased mortality association was found for patients receiving PRBC transfusions with an initial hemoglobin >5 mg/dL. Results suggest benefits from PRBC transfusion are limited as compared to HIC. Further research evaluating emergent transfusion thresholds for medical pathologies should be performed in LMICs to guide practice.

Injury ; 51(7): 1468-1476, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32409189


BACKGROUND: Worldwide, injuries account for approximately five million mortalities annually, with 90% occurring in low- and middle-income countries (LMICs). Although guidelines characterizing data for blood product transfusion in injury resuscitation have been established for high-income countries (HICs), no such information on use of blood products in LMICs exists. This systematic review evaluated the available literature on the use and associated outcomes of blood product transfusion therapies in LMICs for acute care of patients with injuries. METHODS: A systematic search of PubMed, EMBASE, Global Health, CINAHL and Cochrane databases through November 2018 was performed by a health sciences medical librarian. Prospective and cross-sectional reports of injured patients from LMICs involving data on blood product transfusion therapies were included. Two reviewers identified eligible records (κ=0.92); quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Report elements, patient characteristics, injury information, blood transfusion therapies provided and mortality outcomes were extracted and analyzed. RESULTS: Of 3411 records, 150 full-text reports were reviewed and 17 met inclusion criteria. Identified reports came from the World Health Organization regions of Africa, the Eastern Mediterranean, and South-East Asia. A total of 6535 patients were studied, with the majority from exclusively inpatient hospital settings (52.9%). Data on transfusion therapies demonstrated that packed red blood cells were given to 27.0% of patients, fresh frozen plasma to 13.8%, and unspecified product types to 50.1%. Among patients with blunt and penetrating injuries, 5.8% and 15.7% were treated with blood product transfusions, respectively. Four reports provided data on comparative mortality outcomes, of which two found higher mortality in blood transfusion-treated patients than in untreated patients at 17.4% and 30.4%. The overall quality of evidence was either low (52.9%) or very low (41.2%), with one report of moderate quality by GRADE criteria. CONCLUSION: There is a paucity of high-quality data to inform appropriate use of blood transfusion therapies in LMIC injury care. Studies were geographically limited and did not include sufficient data on types of therapies and specific injury patterns treated. Future research in more diverse LMIC settings with improved data collection methods is needed to inform injury care globally.

Transfusão de Sangue , Hemorragia/terapia , Ferimentos e Lesões/complicações , Doença Aguda , Países em Desenvolvimento , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ferimentos e Lesões/cirurgia
Perm J ; 24: 1-6, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33482932


INTRODUCTION: Differential standards in academic medicine based on gender have been described for self-promoting behavior. BACKGROUND: Objective: To explore differences in office display of professional and personal items between male and female academic physicians as a proxy for self-promotion. METHODS: A university hospital's faculty was invited to participate in a study on office setup. Participants were blinded to the study aim. Investigators evaluated offices to assess the number of professional and personal displays. De-identified data on participant characteristics and office physical characteristics were recorded. Correlations with the number of items displayed were analyzed by univariable and multivariable Poisson regression. RESULTS: Forty-eight physicians participated: 23 (47.9%) from emergency medicine, 9 (18.8%) from surgery, and 16 (33.3%) from internal medicine. The median number of professional displays was 5.0 for women (interquartile range [IQR] = 3.0-9.0) and 6.0 for men (IQR = 2.0-12.0). Controlling for specialty and academic rank, no significant difference existed in professional display rates by women (incidence rate ratio = 1.1, 95% confidence interval = 0.8-1.4). The median number of personal displays was 14.5 items for women (IQR = 8.0-25.0) and 6.0 items for men (IQR = 3.0-15.0), with a significantly different rate (incidence rate ratio = 1.4, 95% confidence interval = 1.2-1.7) when we controlled for specialty, generation, rank, and office characteristics. CONCLUSION: Women displayed more personal items than did men, with no difference in professional display rates. Future studies should examine this difference to understand its cause, which may be linked to differences in academic promotion between men and women.

R I Med J (2013) ; 102(7): 40-43, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31480819


INTRODUCTION: Colombia represents a country in transition, from decades of devastating civil war to a post-conflict era of peace building, to the recent management of the influx of thousands of Venezuelan migrants. Brown University, along with Colombian partners, are leading the way in an international, multi-institutional consortium with the goal of emergency medicine capacitation across Colombia. Program Implementations: Through these collaborative efforts, exchange programs for residents and faculty alike have been successfully established. A baseline assessment of emergency medicine education for medical students is underway. By the end of 2019, the Harvard Humanitarian Initiative (HHI) will launch an online tool in multiple languages, including Spanish, to help medical and nursing educators conduct systematic needs assessments of the way in which conflict has impacted medical and nursing schools. CONCLUSIONS: Successful avenues for collaboration and partnership are described between Brown Emergency physicians and Colombian collaborating universities. These programs help to build capacity in Colombia and also provide education and support for residents and faculty at Brown University. Current work will see these programs grow into the future.

Serviços Médicos de Emergência/organização & administração , Medicina de Emergência/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Hospitais Universitários/organização & administração , Médicos/organização & administração , Guerra , Colômbia/epidemiologia , Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/normas , Medicina de Emergência/normas , Acesso aos Serviços de Saúde/normas , Humanos , Cooperação Internacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Refugiados , Rhode Island/epidemiologia
Acad Emerg Med ; 26(3): 347-349, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29858543