Haitian State Hospital Orthopedic Grand Rounds Series: A Virtual Curriculum to Address Global Surgery Needs

Background: Orthopedic Relief Services International (ORSI), in partnership with the Foundation for Orthopedic Trauma and the department of Orthopedic Surgery of La Paix University Hospital in Haiti, has developed a year-round Orthopedic Grand Round series. This series is moderated by Haitian faculty, features presentations by American orthopedic surgeons, and is broadcast to major state hospitals in Haiti for residents and attendings. Objective: To introduce clinical concepts and increase knowledge in an area that is medically underserved, especially in the field of orthopedics, through lectures that tailor to the educational needs of Haiti. Methods: Topics for lecture series are requested by Haitian attending orthopedic surgeons and residents in collaboration with American orthopedic surgeons to meet the educational needs of the residents in Haiti. These lectures reflect the case mix typically seen at state hospitals in Haiti and consider the infrastructural capacity of participating centers. Grand rounds are held an average of twice per month for an hour each, encompassing an educational lesson followed by an open forum for questions and case discussion. Feedback is taken from Haitian residents to ensure the sessions are beneficial to their learning. Findings and Conclusions: To date 95 sessions hosted by 32 lecturers have been completed over Zoom between the US and Haiti. The fourth year of the lecture series is currently ongoing with an expansion of topics. In an underserved medical area such as Haiti, programs that educate local surgeons are crucial to continuing the growth and development of the medical community. Programs like this have the potential to contribute to the educational infrastructure of countries in need, regardless of the specialty. The model of this program can be used to produce similar curricula in various specialties and areas around the world

Near-Peer Emergency Medicine for Medical Students in Port-au-Prince, Haiti: An Example of Rethinking Global Health Interventions in Developing Countries

Background: During a 3-year time frame, a partnership between medical trainees in Haiti and the United States was forged with the objective of implementing an emergency response skills curriculum at a medical school in Port-au-Prince. The effort sought to assess the validity of a near-peer, bidirectional, cross-cultural teaching format as both a global health experience for medical students and as an effective component of improving medical education and emergency response infrastructure in developing countries such as Haiti. Method: Medical students and emergency medicine (EM) residents from a North American medical school designed and taught a module on emergency response skills in PAP and certified medical students in basic cardiac life support (BLS) over 2 consecutive years. Five-point Likert scale self-efficacy (SE) surveys and multiple-choice fund of knowledge (FOK) assessments were distributed pre- and postmodule each year and analyzed with paired 't'tests and longitudinal follow-up of the first cohort. Narrative evaluations from participants were collected to gather feedback for improving the module. Findings: Challenges included bridging language barriers, maintaining continuity between cohorts, and adapting to unexpected schedule changes. Overall, 115 students were certified in BLS with significant postcurriculum improvements in SE scores (2.75 ± 0.93 in 2013 and 2.82 ± 1.06 in 2014; 'P' < 0.001) and FOK scores (22% ± 15% in 2013 and 41% ± 16% in 2014; 'P' < 0.001). Of 24 Haitian students surveyed at 1-year follow-up from the 2013 cohort, 7 (29.3%) reported using taught skills in real-life situations since completing the module. The US group was invited to repeat the project for a third year. Conclusions: Near-peer, cross-cultural academic exchange is an effective method of medical student–centered emergency training in Haiti. Limitations such as successfully implementing sustainability measures, addressing cultural differences, and coordinating between groups persist. This scalable, reproducible, and mutually beneficial collaboration between North American and Haitian medical trainees is a valid conduit for building Haiti's emergency response infrastructure and promoting global health

Exploration of Global Health Careers Across the Medical Fields

BackgroundDespite expansion of interest among American medical students in global health (GH), academic medical centers face multiple obstacles to the development of structured GH curricula and career guidance. To meet these demands we sought to provide a systematic analysis of the accounts of GH experts.MethodsWe developed a collaborative, interview-based, qualitative analysis of GH experiences across six career-related themes that are relevant to medical students interested in GH: justification, medical education, economics, research prospects, law and ethics, and work-life balance. Seven GH faculty members were interviewed for 30-90 minutes using sample questions as guidelines. We applied a grounded theory approach to analyze the interview transcripts to discover an emerging theory pertinent to GH trainees.FindingsRegarding 'justification,' 4 respondents defined GH as work with the underserved irrespective of geographic location; 5 respondents found sustainability imperative; and all respondents believe GH creates better physicians. Respondents identified many physician competencies developed through GH 'medical education,' with 5 respondents agreeing that work with underserved populations has transformative potential. Concerning 'economics', 3 respondents acknowledged GH's popularity among trainees, resulting in increased training opportunities, and 2 respondents emphasized an associated deficiency in program quality. All respondents described career models across specialties. Four respondents noted funding challenges when discussing 'research prospects'. Within the theme of 'laws and ethics', 4 respondents perceived inadequate accountability, and 6 respondents identified ways to create accountability. Finally, 6 respondents recognized family demands can compromise one's GH career and thus 'work-life balance'.ConclusionDespite diverse perspectives on the meaning and sustainability of GH work, this analysis provides a nascent framework that may inform curricular development for GH trainees. Suggestions are offered for elaborating this framework to fully exploit the transformative potential of GH training in medical education

Role of cellular immunity in Immune Reconstitution Inflammatory Syndrome (IRIS) in patient co infected HIV/TB under treatment of anti tuberculosis and antiretroviral in Cambodia

Syndrome inflammatoire lié à la reconstitution immunitaire chez le patient coinfecté par le VIH et la tuberculose est une complication du traitement par des antirétroviraux, appelé TB-IRIS. Ce syndrome est souvent rencontré dans les pays en voie de développement. Son diagnostic se pose essentiellement sur la présentation clinique et nécessiter de se différentier des autres pathologies. Son évolution est souvent favorable ou sous corticoïde mais certaine forme est sévère et/ou mortelle. L'étude de leur mécanisme permettra d'identifier de marqueur prédictif, applicable à leur diagnostic précoce et à l'amélioration de leur prise en charge. Alors, nous avons proposés d'étudier le rôle de cellule NK et le rôle de lymphocyte T dans l'essai clinique de CAMELIA au Cambodge. Le résultat a montré l'élévation de la capacité de dégranulation de cellule NK est associé à la survenu de TB-IRIS et il peut être un marqueur prédictif. De plus, l'hyperactivation de cellule T effectrice et la diminution de cellule T régulatrice sont aussi observées. Le rôle de cellule T régulatrice n'est pas encore préciser. Le mécanisme régulateur de ce phénomène doit être ultérieurement exploré.Inflammatory syndrome associated with immune reconstitution in patients coinfected with HIV and TB is one complication of antiretroviral treatment, called TB-IRIS. This syndrome more often encountered in developing countries. Diagnosis of this syndrome is mainly based of clinical presentation and needs to differentiate from other diseases. Their evolution is usually favorable or under corticosteroids, but some cases are severe and / or fatal. The study of their mechanism could lead to identify predictive markers, applicable to their early diagnosis and improved their management. Thus, we proposed to study the role of NK cell and T cell in the CAMELIA clinical trials which have conducted in Cambodia. The result showed that higher increase of NK cell degranulation capacity was associated with the occurrence of TB-IRIS and it could be a predictive marker. Furthermore, the hyperactivation of effector T cell and decrease of regulatory T cell were also observed. The implication of the regulatory T cell in this syndrome was not clear yet. The regulatory mechanism of this phenomenon should be further exploredMONTPELLIER-BU Pharmacie (341722105) / SudocSudocFranceF

level of patient education and proximal humerus fractures: a predictor and screening method

AbstractPurpose:To identify risk factors of functional outcome following proximal humerus open reduction and internal fixation.Methods: Patients treated for proximal humerus fractures with open reduction and internal fixation were enrolled in a prospective data registry. Patients were evaluated for function using the Disability of the Arm, Shoulder and Hand score for 12 months and as available beyond 12 months. Univariate analyses were conducted to identify variables associated with functional outcome. Significant variables were included in a multivariate regression predicting functional outcome.Results: Demographics and minimum of 12 month follow-up were available for 129 patients (75%). Multiple regression demonstrated postoperative complication (B=8.515 p=0.045), education level (B=-6.269,p&lt;0.0005), age (B=0.241,p=0.049) and Charlson Comorbidity Index (B=6.578, p=0.001) were all significant predictors of functional outcome.Conclusion:Orthopaedic surgeons can use education level, comorbidities, age, and postoperative complication information to screen patients for worse outcomes, establish expectations, and guide care

NSQIP 30-day outcome measures for below-knee amputations by ICD-10 diagnoses

Background: The indications for Below-Knee Amputation (BKA) are expansive and etiologic subgroups are not well defined. This analysis uses primary ICD-10 diagnosis codes to stratify patients undergoing BKA, and examines differences in subgroup characteristics and 30-day outcomes. Methods: We performed a retrospective analysis of patients in the NSQIP database who underwent BKA between 2015 and 2020. Approximately 80% of the 12,157 NSQIP BKA entries with primary ICD-10 diagnosis codes were stratified to diabetic (n = 3,363), vascular (n = 3,632), or infectious (n = 2,743) etiological subgroups. Results: Patients with vascular etiologies were older, more likely to be female, underweight, ASA classification of four, and active tobacco users than patients in the other groups. Across all groups, there were incidences of 37.5% for 30-day inpatient complications, 7.0% for Clavien-Dindo Grade IV 30-day complications, 10.2% for 30-day readmission, and 4.2% for 30-day mortality. On bivariate analysis, infectious patients had the highest incidences of inpatient complications (38.6%, p = 0.030) and Clavien-Dindo Grade IV complications (7.8%, p = 0.055). Patients in the vascular group had the highest rates of readmission (12.7%, p<0.001) and mortality (4.9%, p = 0.006). In multivariate analysis, infectious etiology was an independent risk factor for 30-day mortality with an odds ratio of 1.48 (1.11–19.6, p = 0.007). Conclusions: Despite significant clinical overlap of diabetic, vascular, and infectious etiologies of BKA, this study demonstrates that these patients can be grouped by primary ICD-10 code with statistically significant differences in patient characteristics and 30-day outcomes. Further delineation by etiology could focus clinical and research efforts

Metabolic Syndrome Increases Risk of Readmission and Complications in Operative Fixation of Pilon Fractures

Background Studies demonstrate that metabolic syndrome (MetS) negatively impacts surgical outcomes. This study sought to identify how metabolic syndrome affects outcomes after open reduction and internal fixation (ORIF) of traumatic pilon fractures. Methods Patients who underwent ORIF for pilon fractures from 2012 to 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with MetS were compared to non-MetS patients for rates of adverse events, prolonged stay, readmission, discharge location, and operative time in the 30-day postoperative period. All statistical analyses were conducted using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Paired student t-tests were used to assess continuous variables. Pearson\u27s Chi-square and odds ratios were used for categorical variables. Results A total of 1,915 patients met this study\u27s inclusion criteria, and 127 MetS patients were identified in the cohort. The MetS cohort was older (62.7 vs 49.5 years old, p-value \u3c0.01), with a greater proportion of female patients (59.1% vs 50.2%, p=0.054). MetS patients experienced significantly higher rates of infectious complications (7.9% vs 3.9% OR 2.75 (CI 1.36-5.53), p=0.008), major adverse events (11% vs 4.3%, OR 2.79 (CI 1.53-5.09) p=0.002), and readmissions. MetS patients also had longer lengths of stay (7 days vs 3.8 days, p-value\u3c0.001), and were more likely to be discharged to a non-home location (51.2% vs 19.5%, p-value\u3c0.01, OR 4.32 (CI=3.0-6.24) p\u3c0.001). Conclusion Patients with MetS have an increased risk of 30-day major complications, infection, readmissions, discharge to a non-home location, and prolonged operative time, and therefore warrant additional consideration for perioperative monitoring

Review of applied and tested control possibilities for energy flexibility in buildings

This report, one of the deliverables for the IEA Annex 67 on Energy Flexible Buildings, provides a comprehensive review of control methodologies to provide energy flexibility in buildings. The reviewed methodologies range from classical rule-based control to model predictive control and reinforcement learning based control. The objective of the report is to help practitioners formulate their optimal control problems according to the framework which best suits their problem.status: Published onlin

Carbapenem use in French hospitals: A nationwide survey at the patient level.

International audienceThe objective of this study was to evaluate the characteristics of carbapenem use in French healthcare settings in order to guide future actions. Healthcare facilities voluntarily participated in a nationwide cross-sectional survey in 2011. Medical data and reasons for carbapenem treatment (CPR) and discontinuation were recorded for all patients treated with carbapenems. A total of 2338 patients were recorded by 207 facilities. The median duration of CPR was 8 days, and 31.4% of patients received CPR for >10 days. An antibiotic consultant was involved in the initial choice of CPR in 36.8% of cases. CPR was chosen on an empirical (EP) basis for 1229 patients (52.6%), mainly because of severe sepsis (48.6%) or a perceived risk of bacterial resistance (33.7%). Among EP patients, de-escalation was more frequent in the case of intervention of an antibiotic consultant (35.1%) than without intervention (22.9%) (P<0.01). Among the 1109 patients receiving CPR initially based on bacteriological results, 607 (54.7%) had ESBL-producing Enterobacteriaceae and 397 (35.8%) had Gram-negative bacilli susceptible to at least one β-lactam other than carbapenems or to fluoroquinolones. Among the latter, de-escalation was performed in 59 cases (14.9%). The intervention of an antibiotic consultant did not favour de-escalation in this group. In conclusion, carbapenems are frequently used for treating suspected or confirmed multidrug-resistant bacteria, and overall CPR duration is long. De-escalation is frequently not implemented despite isolates being susceptible to other drugs. More frequent antibiotic consultant intervention may help to decrease carbapenem use in the case of EP treatment