Medical Simulation Training on Trauma-Informed Care in the Emergency Department

Learning Objectives: To describe a novel simulation training developed to teach Trauma-Informed Care principles and applications for patient care in Emergency Medicine. To present results from pre- and post-surveys about effectiveness of simulations to learn and apply Trauma-Informed Care in acute-care settings.Introduction/Background: Emergency Medicine physicians often care for patients experiencing direct sequelae from traumatic events including abuse, discrimination, and violence. Trauma-Informed Care (TIC) is a framework that recognizes the prevalence of trauma, promotes patient empowerment, and aims to minimize retraumatization. Limited curriculum on TIC in acute-care settings exists despite its widespread utility, with medical simulations (SIM) presenting a novel educational opportunity for this aim.Educational Objectives: Describe principles of TIC and its importance in clinical practice. Present strategies for performing TIC-guided history taking and physical exams. Discuss situations when trauma screenings are indicated for patient safety and care. Facilitate the practice of TIC in acute-care settings.Curricular Design: An SIM workshop reproducing relevant clinical encounters was developed for medical students to practice implementing TIC in the Emergency Department (ED). Students attended a didactic on TIC fundamentals and its applications in clinical care. Small groups then interacted with three SIM cases caring for patients with urgent medical needs and pertinent history related to intimate partner violence, transgender health, and discrimination in the healthcare system.Impact/Effectiveness: Application of TIC principles is essential to providing patient-centered care in the ED. A pilot group of 12 students participated in these SIM sessions. The workshop was well-received, as 100% of participants found simulation training “Very” or “Extremely Useful” in preparing to apply TIC in patient interactions, compared to 42% prior to the session (p<0.05). Students also developed relevant skills, as 42% of students felt “Very” or “Extremely Confident” in using appropriate TIC language during physical exams, compared to 0% initially (p<0.05). Overall, this novel intervention represents a feasible and effective session for teaching TIC skills in Emergency Medicine

Redressing COVID-19 vaccine inequity amidst booster doses: charting a bold path for global health solidarity, together

BACKGROUND: With large swathes of the world's population-majority clustered in low- and middle-income countries-still yet to receive the minimum of two doses of the COVID-19 vaccine; The need to address the failures of international solidarity to equitably distribute COVID-19 vaccines is now more urgent than ever to help curb the pandemic and prevent future variants. However, many high-income countries have adopted a "me first" approach, proceeding to offer COVID-19 booster doses to their entire populations, including those at least risk of severe illness, whilst the rest of the world is left unvaccinated or partially vaccinated with one dose for even their most vulnerable communities. MAIN BODY: COVID-19 vaccine inequity places the health of the global population at risk and exacerbates socio-economic repercussions, especially in low- and middle-income countries. Initiatives launched to combat vaccine inequity such as the Fair Allocation Framework for the COVID-19 Vaccines (COVAX) have been unsuccessful as several governments, primarily from high-income countries, have scaled down their contributions to the initiative. Furthermore, COVAX has not seriously engaged with the Access to COVID-19 Tools (ACT) Health Systems Connector, as was originally intended, leading to crucial health systems components critical to vaccine delivery to be overlooked. Several strategies can be employed to help achieve the desired global immunization goals, such as Intellectual Property waivers, increased donations, and activation of new COVID-19 vaccine manufacturing hubs. In addition, continued advocacy for vaccine equity by all involved and affected stakeholders, as well as critical amendments to existing or upcoming legislation and funding mechanisms will help address the shortcomings of current inequitable vaccine distribution. CONCLUSIONS: Global solidarity and collective action through pandemic governance mechanisms are urgently needed to ensure vaccine equity. These interventions are vital to rapidly mitigate ongoing health and humanitarian crises and ultimately curb the pandemic, sooner rather than later

Critical Breaths in Transit: A Review of Non-invasive Ventilation (NIV) for Neonatal and Pediatric Patients During Transportation.

Respiratory illnesses are a leading cause of death for children worldwide, with the majority of these cases occurring from preterm birth complications or acute respiratory infections. Appropriate respiratory intervention must be provided quickly to lower the chances of death or permanent harm. As a result, respiratory support given in prehospital and interfacility transport can substantially improve health outcomes for these patients, particularly in areas where transportation time to appropriate facilities is lengthy. Existing literature supports the use of non-invasive ventilation (NIV), such as nasal or bilevel continuous positive airway pressure, as a safe form of respiratory support for children under 18 years old in certain transportation settings. This mini review summarizes the literature on pediatric NIV in transport and highlights significant gaps that future researchers should address. In particular, we identify the need to: solidify clinical guidelines for the selection of eligible pediatric patients for transport on NIV; explore the range of factors influencing successful NIV implementation during transportation; and apply appropriate best practices in low and middle income countries

Words matter: political and gender analysis of speeches made by heads of government during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has put a spotlight on political leadership around the world. Differences in how leaders address the pandemic through public messages have practical implications for building trust and an effective response within a country. METHODS: We analysed the speeches made by 20 heads of government around the world (Bangladesh, Belgium, Bolivia, Brazil, Dominican Republic, Finland, France, Germany, India, Indonesia, New Zealand, Niger, Norway, Russia, South Africa, Scotland, Sint Maarten, United Kingdom, United States and Taiwan) to highlight the differences between men and women leaders in discussing COVID-19. We used an inductive analytical approach, coding speeches for specific themes based on language and content. FINDINGS: Five primary themes emerged across a total of 122 speeches on COVID-19, made by heads of government: economics and financial relief, social welfare and vulnerable populations, nationalism, responsibility and paternalism, and emotional appeals. While all leaders described the economic impact of the pandemic, women spoke more frequently about the impact on the individual scale. Women leaders were also more often found describing a wider range of social welfare services, including: mental health, substance abuse and domestic violence. Both men and women from lower-resource settings described detailed financial relief and social welfare support that would impact the majority of their populations. While 17 of the 20 leaders used war metaphors to describe COVID-19 and the response, men largely used these with greater volume and frequency. CONCLUSION: While this analysis does not attempt to answer whether men or women are more effective leaders in responding to the COVID-19 pandemic, it does provide insight into the rhetorical tools and types of language used by different leaders during a national and international crisis. This analysis provides additional evidence on the differences in political leaders' messages and priorities to inspire citizens' adhesion to the social contract in the adoption of response and recovery measures. However, it does not consider the influence of contexts, such as the public audience, on leaders' strategic communication approaches

Optimizing Pandemic Preparedness and Response Through Health Information Systems: Lessons Learned From Ebola to COVID-19.

Strengthening health systems and maintaining essential service delivery during health emergencies response is critical for early detection and diagnosis, prompt treatment, and effective control of pandemics, including the novel coronavirus disease 2019 (COVID-19). Health information systems (HIS) developed during recent Ebola outbreaks in West Africa and the Democratic Republic of the Congo (DRC) provided opportunities to collect, analyze, and distribute data to inform both day-to-day and long-term policy decisions on outbreak preparedness. As COVID-19 continues to sweep across the globe, HIS and related technological advancements remain vital for effective and sustained data sharing, contact tracing, mapping and monitoring, community risk sensitization and engagement, preventive education, and timely preparedness and response activities. In reviewing literature of how HIS could have further supported mitigation of these Ebola outbreaks and the ongoing COVID-19 pandemic, 3 key areas were identified: governance and coordination, health systems infrastructure and resources, and community engagement. In this concept study, we outline scalable HIS lessons from recent Ebola outbreaks and early COVID-19 responses along these 3 domains, synthesizing recommendations to offer clear, evidence-based approaches on how to leverage HIS to strengthen the current pandemic response and foster community health systems resilience moving forward

The global fatty liver disease Sustainable Development Goal country score for 195 countries and territories

Background and Aims: Fatty liver disease is highly prevalent, resulting in overarching wellbeing and economic costs. Addressing it requires comprehensive and coordinated multisectoral action. We developed a fatty liver disease Sustainable Development Goal (SDG) country score to provide insights into country-level preparedness to address fatty liver disease through a whole-of-society lens. Approach and Results: We developed 2 fatty liver disease-SDG score sets. The first included 6 indicators (child wasting, child overweight, noncommunicable disease mortality, a universal health coverage service coverage index, health worker density, and education attainment), covering 195 countries and territories between 1990 and 2017. The second included the aforementioned indicators plus an urban green space indicator, covering 60 countries and territories for which 2017 data were available. To develop the fatty liver disease-SDG score, indicators were categorized as "positive"or "negative"and scaled from 0 to 100. Higher scores indicate better preparedness levels. Fatty liver disease-SDG scores varied between countries and territories (n = 195), from 14.6 (95% uncertainty interval: 8.9 to 19.4) in Niger to 93.5 (91.6 to 95.3) in Japan; 18 countries and territories scored &gt; 85. Regionally, the high-income super-region had the highest score at 88.8 (87.3 to 90.1) in 2017, whereas south Asia had the lowest score at 44.1 (42.4 to 45.8). Between 1990 and 2017, the fatty liver disease-SDG score increased in all super-regions, with the greatest increase in south Asia, but decreased in 8 countries and territories. Conclusions: The fatty liver disease-SDG score provides a strategic advocacy tool at the national and global levels for the liver health field and noncommunicable disease advocates, highlighting the multisectoral collaborations needed to address fatty liver disease, and noncommunicable diseases overall.</p

The global fatty liver disease Sustainable Development Goal country score for 195 countries and territories

Background and Aims: Fatty liver disease is highly prevalent, resulting in overarching wellbeing and economic costs. Addressing it requires comprehensive and coordinated multisectoral action. We developed a fatty liver disease Sustainable Development Goal (SDG) country score to provide insights into country-level preparedness to address fatty liver disease through a whole-of-society lens. // Approach and Results: We developed 2 fatty liver disease–SDG score sets. The first included 6 indicators (child wasting, child overweight, noncommunicable disease mortality, a universal health coverage service coverage index, health worker density, and education attainment), covering 195 countries and territories between 1990 and 2017. The second included the aforementioned indicators plus an urban green space indicator, covering 60 countries and territories for which 2017 data were available. To develop the fatty liver disease–SDG score, indicators were categorized as “positive” or “negative” and scaled from 0 to 100. Higher scores indicate better preparedness levels. Fatty liver disease–SDG scores varied between countries and territories (n = 195), from 14.6 (95% uncertainty interval: 8.9 to 19.4) in Niger to 93.5 (91.6 to 95.3) in Japan; 18 countries and territories scored > 85. Regionally, the high-income super-region had the highest score at 88.8 (87.3 to 90.1) in 2017, whereas south Asia had the lowest score at 44.1 (42.4 to 45.8). Between 1990 and 2017, the fatty liver disease–SDG score increased in all super-regions, with the greatest increase in south Asia, but decreased in 8 countries and territories. // Conclusions: The fatty liver disease–SDG score provides a strategic advocacy tool at the national and global levels for the liver health field and noncommunicable disease advocates, highlighting the multisectoral collaborations needed to address fatty liver disease, and noncommunicable diseases overall

Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource settings: A scoping review.

BACKGROUND: Continuous positive airway pressure (CPAP) is the gold standard of care in providing non-invasive positive pressure support to neonates in respiratory distress in high-resource settings. While safety has been demonstrated in low-resource settings, there is a lack of knowledge on the barriers and facilitators to proper implementation. OBJECTIVE: To identify and describe the barriers, facilitators, and priorities for future implementation of CPAP for neonates and infants in low-resource settings. METHODS: A systematic search (database inception to March 6, 2020) was performed on MEDLINE, Embase, Web of Science, CINAHL, Global Health, and the WHO Global Index Medicus using PRISMA-ScR guidelines. Original research articles pertaining to implementation of CPAP devices in low-resource settings, provider or parent perspectives and experiences with CPAP, cost-benefit analyses, and cost-effectiveness studies were included. Inductive content analysis was conducted. FINDINGS: 1385 article were screened and 54 studies across 19 countries met inclusion criteria. Six major themes emerged: device attributes, patient experiences, parent experiences, provider experiences, barriers, and facilitators. Nasal trauma was the most commonly reported complication. Barriers included unreliable electricity and lack of bioengineering support. Facilitators included training, mentorship and empowerment of healthcare providers. Device design, supply chain infrastructure, and training models were imperative to the adoption and sustainability of CPAP. CONCLUSION: Sustainable implementation of CPAP in low resource settings requires easy-to-use devices, ready access to consumables, and holistic, user-driven training. Further research is necessary on standardizing metrics, interventions that support optimal provider performance, and conditions needed for successful long-term health system integration

Systematic review of electronic health records to manage chronic conditions among displaced populations.

OBJECTIVES: The objective of this study was to assess the impact of electronic health records (EHRs) on health outcomes and care of displaced people with chronic health conditions and determine barriers and facilitators to EHR implementation in displaced populations. DESIGN: A systematic review protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Systematic Reviews. DATA SOURCES: MEDLINE, Embase, PsycINFO, CINAHL, Health Technology Assessment, Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was searched from inception to 12 April 2021. ELIGIBILITY CRITERIA FOR SELECTED STUDIES: Inclusion criteria were original research articles, case reports and descriptions of EHR implementation in populations of displaced people, refugees or asylum seekers with related chronic diseases. Grey literature, reviews and research articles unrelated to chronic diseases or the care of refugees or asylum populations were excluded. Studies were assessed for risk of bias using a modified Cochrane, Newcastle-Ottawa and Joanna Briggs Institute tools. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data from each study using Covidence. Due to heterogeneity across study design and specific outcomes, a meta-analysis was not possible. An inductive thematic analysis was conducted using NVivo V.12 (QSR International, Melbourne, Australia). An inductive analysis was used in order to uncover patterns and themes in the experiences, general outcomes and perceptions of EHR implementation. RESULTS: A total of 32 studies across nine countries were included: 14 in refugee camps/settlements and 18 in asylum countries. Our analysis suggested that EHRs improve health outcomes for chronic diseases by increasing provider adherence to guidelines or treatment algorithms, monitoring of disease indicators, patient counselling and patient adherence. In asylum countries, EHRs resource allocation to direct clinical care and public health services, as well as screening efforts. EHR implementation was facilitated by their adaptability and ability to integrate into management systems. However, barriers to EHR development, deployment and data analysis were identified in refugee settings. CONCLUSION: Our results suggest that well-designed and integrated EHRs can be a powerful tool to improve healthcare systems and chronic disease outcomes in refugee settings. However, attention should be paid to the common barriers and facilitating actions that we have identified such as utilising a user-centred design. By implementing adaptable EHR solutions, health systems can be strengthened, providers better supported and the health of refugees improved

Neptunism and transformism:Robert Jameson and other evolutionary theorists in early nineteenth-century Scotland

This paper sheds new light on the prevalence of evolutionary ideas in Scotland in the early nineteenth century and establish what connections existed between the espousal of evolutionary theories and adherence to the directional history of the earth proposed by Abraham Gottlob Werner and his Scottish disciples. A possible connection between Wernerian geology and theories of the transmutation of species in Edinburgh in the period when Charles Darwin was a medical student in the city was suggested in an important 1991 paper by James Secord. This study aims to deepen our knowledge of this important episode in the history of evolutionary ideas and explore the relationship between these geological and evolutionary discourses. To do this it focuses on the circle of natural historians around Robert Jameson, Wernerian geologist and professor of natural history at the University of Edinburgh from 1804 to 1854. From the evidence gathered here there emerges a clear confirmation that the Wernerian model of geohistory facilitated the acceptance of evolutionary explanations of the history of life in early nineteenth-century Scotland. As Edinburgh was at this time the most important center of medical education in the English-speaking world, this almost certainly influenced the reception and development of evolutionary ideas in the decades that followed.</p