Nurse-led implementation of ETAT plus is associated with reduced mortality in a children's hospital in Freetown, Sierra Leone

BACKGROUND: In the wake of the Ebola virus disease (EVD) epidemic in Sierra Leone, secondary care facilities faced an increase in admissions with few members of medical staff available to assess and treat patients. This led to long waiting times in hospital outpatient departments. The study was undertaken in the outpatient department of Ola During Children’s Hospital (the tertiary paediatric hospital for Sierra Leone) in the period immediately following the EVD epidemic of 2014–2015. AIMS: This retrospective analysis of operational programme data aimed to assess whether a quality-improvement approach and task-sharing between medical and nursing staff improved the quality of triage and the timeliness of care. METHODS: All staff working in the outpatient department were offered a 4-week training course, followed by on-the-job supervision and support for 6 months. Nurses who successfully completed the course were given responsibility for the initial assessment of sick patients and for prescribing and giving initial treatment. Data were collected at three points: before intervention and at 3 and 6 months after initiation of the intervention. All children presenting to the hospital for medical attention between 0800 and 1400 Monday to Friday were included. Triage assessment by the outpatient nurse was compared to that made by a clinically experienced observer, and the time taken for each child to be triaged, assessed and given initial treatment was recorded. RESULTS:Between months 0 and 6 of the intervention, detection of emergency signs by the triage nurse improved from 30% to 100%, and detection of priority signs improved from 34% to 100%. For children presenting with emergency signs, the median time between triage and full assessment improved from 57 minutes before intervention to 17 minutes at 3 months and 5 minutes at 6 months (p < 0.0005). For the same group, median time between triage and first antibiotic or antimalarial treatment improved from 220 minutes before intervention to 40 minutes at 3 months and 18 minutes at 6 months (p = 0.006). CONCLUSION: The results indicate that, with appropriate training and support, extending the emergency assessment and treatment of sick children to nursing staff in West African hospitals may improve the accuracy of triage and the time to assessment and treatment of children presenting with signs of serious illness

Glucose metabolism abnormalities among pediatric acute lymphoblastic leukemia survivors: Assessment and relation to body mass index and waist to hip ratio

AbstractBackgroundAs survival rates of pediatric acute lymphoblastic leukemia (ALL) improve, attention is turning to side and late effects of therapy including glucose metabolism abnormalities.ObjectiveTo asses the presence of abnormal glucose metabolism in pediatric ALL survivors and its possible relation to body mass index (BMI), waist to hip ratio and treatment related factors.Subjects and methodsRetrospective study with a prospective follow-up of 12 ALL survivors who had been off chemotherapy for >9months was done. Fifteen healthy sex and age matched children were involved as controls. Body mass index (BMI) waist to hip ratio (WHR), and Oral glucose tolerance test (OGTT) were performed with assessment of glycated hemoglobin (Hb A1C) and insulin sensitivity indices.ResultsAt study time the mean BMI, WHR, all components of the OGTT (except the 2h post load glucose), all indices of insulin sensitivity and the mean Hb A1C% were significantly higher compared to those of the controls. Two survivors (16.6%) developed transient hyperglycemia during therapy, one (8.3%) had pre-diabetes, seven (58.3%) had a risk level of Hb A1C but no one had diabetes mellitus (DM) or insulin resistance (IR). At study time the two survivors with transient hyperglycemia during therapy had a significantly high WHR compared to the remainders. WHR of the survivors at study time correlated significantly with fasting plasma glucose and area of insulin under the curve (AUC). The 2h post-prandial plasma glucose correlated with the duration after therapy completion.ConclusionsWHR may play a better role than BMI in the prediction of insulin resistance in those patients. Hb A1C may increase earlier than other indices of glucose tolerance

An approach for simulating regional migration patterns

In this paper, GERTS III is presented as a possible approach for simulating regional migration patterns. Fourteen years of aggregate Canadian census data were compiled and a mathematical model was constructed to describe the patterns of inter-regional migration viewed as a discrete time Markov process. A GERTS III network was developed to analyze and describe this process. Measures of population mobility, degree of mobility and retention were derived. The implications for policy makers are highlighted.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24487/1/0000763.pd

Potential Role of New Anthropometric Parameters in Childhood Obesity with or Without Metabolic Syndrome

BACKGROUND: Obese children and adolescents are more prone to have metabolic syndrome (MS).MS is a cluster of cardiovascular risk factors associated with insulin resistance. Body round index [BRI], visceral adiposity index [VAI] and a body shape index [ABSI] are among the new obesity anthropometric parameters. AIM: To evaluate the new markers for obesity in children and their possible association with other laboratory and clinical variables of MS. METHODS: Eighty nine obese children and 40 controls aged 10-18 years were recruited. Full history taking, thorough clinical examination, anthropometric and biochemical features were performed in the studied groups. Subcutaneous fat thickness (SFT) and visceral fat thickness (VFT) were estimated by ultrasonography. RESULTS: Obese children, exhibited significantly higher values in all anthropometric measurements (P &lt; 0.001). Diastolic and systolic blood pressure were significantly higher (P &lt; 0.001) in the obese group. ABSI, BRI and VAI have been found to be significantly higher in obese subjects (P &lt; 0.001), with no significant gender difference. BMI, WHtR, WC/HR, SBP, DBP, subcutaneous fat thickness and visceral fat thickness, Liver Span, ABSI, BRI, VAI and HOMA_IR were significantly higher among children with MS than those without MS. Positive significant correlations of VAI with BMI, WC/Ht, WC/Hip, SBP, DBP, SFT, VFT, Liver size and HOMA-IR (r = 0.384, 0.239, 0.268, 0.329, 0.516, 0.320, 0.254, 0.251, and 0.278 respectively) are shown. The area under the ROC curve (AUC) of BMI, VAI, ABSI, BRI for predicting MS was 0.802 (0.701-0.902), 0.737 (0.33-0.841), 0.737 (0.620-0.855), 0.816 (0.698-0.934). CONCLUSION: We suggest using the VAI and WHtR indexes, as they are better predictor of MS

Breaking Borders: How Barriers to Global Mobility Hinder International Partnerships in Academic Medicine

This article describes the authors' personal experiences of collaborating across international borders in academic research. International collaboration in academic medicine is one of the most important ways by which research and innovation develop globally. However, the intersections among colonialism, academic medicine, and global health research have created a neocolonial narrative that perpetuates inequalities in global health partnerships. The authors critically examine the visa process as an example of a racist practice to show how the challenges of blocked mobility increase inequality and thwart research endeavors. Visas are used to limit mobility across certain borders, and this limitation hinders international collaborations in academic medicine. The authors discuss the concept of social closure and how limits to global mobility for scholars from low- and middle-income countries perpetuate a cycle of dependence on scholars who have virtually barrier-free global mobility-these scholars being mainly from high-income countries. Given the current sociopolitical milieu of increasing border controls and fears of illegal immigration, the authors' experiences expose what is at stake for academic medicine when the political sphere, focused on tightening border security, and the medical realm, striving to build international research collaborations, intersect. Creating more equitable global partnerships in research requires a shift from the current paradigm that dominates most international partnerships and causes injury to African scholars