"We Want to Know What They Are Saying" -- A Multiagency Collaborative Effort to Address Parent Language Barriers and Disproportionate Minority Contact

Describes Vera's collaborative work to provide a multilingual information resource to help parents understand their role in the juvenile justice system. Outlines lessons learned on addressing language access issues for minorities in contact with the law

Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia

Total Sanitation and Sanitation Marketing (TSSM) is the Indonesian component of World Bank Water and Sanitation Program's Scaling Up Rural Sanitation initiative. The approach consists of raising awareness of the problems of open defecation; marketing sanitation products; and supporting policies, financing, training, and regulations that are conducive to these efforts. Therefore, desired outcomes of the program include changes in perception of the consequences of poor sanitation, toilet construction and access to improved sanitation, reduction in open defecation, and child health outcomes. This impact evaluation assesses these results using a randomized controlled trial (RCT), and unlike many RCTs that are carried out on pilot programs, it looks at an intervention that has been implemented at scale and led by the government under real-world conditions, providing more reliable estimates. TSSM is associated with sanitation improvements overall, particularly among wealthier households that had no sanitation prior to the intervention

How to Formulate a Clinical Question and Effectively Search for the Answer

This small group, case-based exercise is geared towards medical students on their pediatric clerkship. The goal of this session is to teach students how to re-frame their clinical questions into a format that allows for more effective and efficient searching of the literature. I provide this session once a month as a part of the Third-year medical student core lecture series during their inpatient pediatrics rotation. My co-facilitator is a medical librarian. We initially used a lecture format in which we reviewed use of advanced PubMed features with very little interaction from the learners. Based on feedback and evaluations, we decided to overhaul the design of our session to allow the students a more active and engaged role. Additionally, we were able to secure our institution’s computer training room, which allows each learner to have their own computer for the session. I created the cases based on my previous experience with questions that students and residents commonly have during their pediatric inpatient month. Each scenario is focused on inpatient pediatric diagnoses as the session is scheduled during their inpatient rotation. Any resemblance to real-life cases is by chance only. Since the change in our format, we have seen a significant increase in learner satisfaction with the activity. Below is a compilation of evaluation scores since initiation of this new format. Summary of Evaluations 10/11 to 4/12 (6 sessions): N=55 Overall Teaching Effectiveness: 4.9 out of 5 [Likert Scale: 1=poor (\u3c10%); 2=fair (11-25%); 3=good (26-75%); 4= excellent (76-90%); and 5=outstanding (\u3e90%)] Selected Comments: What did you like best? “Group activity, interactive” “Active participation and practical EBM skills” “The interactive component—you learn much more doing the search yourself” When were you most engaged? “Small group work, when I was actually doing the search” “Interactive case scenarios” “Discussion of everyone’s case and the tips given by the teachers” What would you change? “Allow more time” “Present searching tips first” “Nothing” Additional comments “Very helpful” “Great discussion of various sources” “Very engaging and effective teaching format” AAMC MedEdPORTAL publication ID 9213. Link to original

Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs—those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks—to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient–provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured highneed adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their need

Parolees' physical closeness to health service providers: a study of California parolees.

We studied a sample of parolees and health service providers in the state of California in 2005-2006 to examine the relative physical closeness to health providers (and the potential demand of these providers) of parolees based on their demographic and prior offending characteristics. Although African-American and Latino parolees have more health providers nearby, these providers have considerably more potential demand. The health providers near long-term prisoners and sex offenders have more potential demand. The results suggest inequity in access to services, as minority parolees and those with greater needs may live near more impacted providers. The results also suggest some differences in access based on rural, suburban, or urban location

A Prospective, Randomized Trial in the Emergency Department of Suggestive Audio-Therapy under Deep Sedation for Smoking Cessation

Objectives: In a sample of patients undergoing procedural deep sedation in the emergency department (ED), we conducted a prospective, randomized, single-blinded trial of audio-therapy for smoking cessation. Methods: We asked subjects about their smoking, including desire to quit (0-10 numerical scale) and number of cigarettes smoked per day. Subjects were randomized to either a control tape (music alone) or a tape with repeated smoking-cessation messages over music. Tapes were started with first doses of sedation and stopped with patient arousal. Telephone follow-up occurred between two weeks and three months to assess the number of cigarettes smoked per day. Study endpoints were self-reported complete cessation and decrease of half or more in total cigarettes smoked per day. Results: One hundred eleven patients were enrolled in the study, 54 to intervention and 57 to control. Mean desire to quit was 7.15 ± 2.6 and mean cigarettes per day was 17.5 ± 12.1. We successfully contacted 69 (62%) patients. Twenty-seven percent of intervention and 26% of control patients quit (mean difference = 1%; 95% CI: –22.0% to 18.8%). Thirty-seven percent of intervention and 51% of control patients decreased smoking by half or more (mean difference = 14.6%; 95% CI: –8.7% to 35.6%). Conclusion: Suggestive audio-therapy delivered during deep sedation in the ED did not significantly decrease self-reported smoking behavior

Associated Factors and Outcomes of Acute Kidney Injury in COVID-19 Patients in Kenya.

Background; Corona Virus Disease 2019 (COVID-19), an infection caused by the SARS-CoV-2 virus, has been the largest global pandemic since the turn of the 21st century. With emerging research on this novel virus, studies from the African continent have been few. Corona Virus Disease 2019 has been shown to affect various organs including the lungs, gut, nervous system, and the kidneys. Acute kidney injury (AKI) is an independent risk factor for mortality and increases the health care burden for patients with persistent kidney dysfunction and maintenance dialysis. Sub-Saharan Africa has a high number of poorly controlled chronic illnesses, economic inequalities, and health system strains that may contribute to higher cases of kidney injury in patients with COVID-19 disease. Objectives: The objective of this study was to determine the incidence, associated factors, and outcomes of AKI in patients hospitalized with COVID-19 in Kenya. Methods: This retrospective cohort study included 1366 patients with confirmed COVID-19 illness hospitalized at the Aga Khan University Hospital in Nairobi, Kenya, between April 1, 2020 and October 31, 2021. Data were collected on age, sex, the severity of COVID-19 illness, existing pregnancy and comorbid conditions including human immunodeficiency virus (HIV), diabetes mellitus, hypertension, and functioning kidney transplant patients. Univariate analysis was carried out to determine the association of clinical and demographic factors with AKI. To determine independent associations with AKI incidence, a logistic regression model was used and the relationship was reported as odds ratios (ORs) with a 95% confidence interval (CI). The outcomes of AKI including the in-hospital mortality rate, renal recovery rate at hospital discharge, and the duration of hospital stay were reported and stratified based on the stage of AKI. Results: The median age of study patients was 56 years (interquartile range [IQR] = 45-68 years), with 67% of them being male (914 of 1366). The AKI incidence rate was 21.6% (n = 295). Patients with AKI were older (median age = 64 years vs 54 years; P \u3c .001), majority male (79% of men with AKI vs 63.6% without AKI; P \u3c .001), and likely to have a critical COVID-19 (OR = 8.03, 95% CI = 5.56-11.60; P \u3c .001). Diabetes and hypertension, with an adjusted OR of 1.75 (95% CI = 1.34-2.30; P \u3c .001) and 1.68 (95% CI = 1.27-2.23; P \u3c .001), respectively, were associated with AKI occurrence in COVID-19. Human immunodeficiency virus, pregnancy, and a history of renal transplant were not significantly associated with increased AKI risk in this study. Patients with AKI had significantly higher odds of mortality, and this effect was proportional to the stage of AKI (OR = 11.35, 95% CI = 7.56-17.03; P \u3c .001). 95% of patients with stage 1 AKI had complete renal recovery vs 33% of patients with stage 3 AKI. Of the patients with stage 3 AKI (n = 64), 10 underwent hemodialysis, with 1 recovery in renal function and 3 patients requiring ongoing dialysis after discharge. Conclusions: This study was conducted at a single private tertiary-level health care facility in Kenya and only up to the time of hospital discharge. It is one of the first large studies from sub-Saharan Africa looking at the associated factors and outcomes of AKI in COVID-19 and forms a foundation for further analysis on the long-term consequences of COVID-19 on the kidneys. A major limitation of the study is the lack of baseline pre-admission creatinine values for most patients; thus, the impact of chronic kidney disease/baseline creatinine values on the incidence of AKI could not be established

Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys

Background: Pathology and laboratory medicine diagnostics and diagnostic imaging are crucial to achieving universal health coverage. We analysed Service Provision Assessments (SPAs) from ten low-income and middle-income countries to benchmark diagnostic availability. Methods: Diagnostic availabilities were determined for Bangladesh, Haiti, Malawi, Namibia, Nepal, Kenya, Rwanda, Senegal, Tanzania, and Uganda, with multiple timepoints for Haiti, Kenya, Senegal, and Tanzania. A smaller set of diagnostics were included in the analysis for primary care facilities compared with those expected at hospitals, with 16 evaluated in total. Surveys spanned 2004–18, including 8512 surveyed facilities. Country-specific facility types were mapped to basic primary care, advanced primary care, or hospital tiers. We calculated percentages of facilities offering each diagnostic, accounting for facility weights, stratifying by tier, and for some analyses, region. The tier-level estimate of diagnostic availability was defined as the median of all diagnostic-specific availabilities at each tier, and country-level estimates were the median of all diagnostic-specific availabilities of each of the tiers. Associations of country-level diagnostic availability with country income as well as (within-country) region-level availability with region-specific population densities were determined by multivariable linear regression, controlling for appropriate covariates including tier. Findings: Median availability of diagnostics was 19·1% in basic primary care facilities, 49·2% in advanced primary care facilities, and 68·4% in hospitals. Availability varied considerably between diagnostics, ranging from 1·2% (ultrasound) to 76·7% (malaria) in primary care (basic and advanced) and from 6·1% (CT scan) to 91·6% (malaria) in hospitals. Availability also varied between countries, from 14·9% (Bangladesh) to 89·6% (Namibia). Availability correlated positively with log(income) at both primary care tiers but not the hospital tier, and positively with regionspecific population density at the basic primary care tier only. Interpretation: Major gaps in diagnostic availability exist in many low-income and middle-income countries, particularly in primary care facilities. These results can serve as a benchmark to gauge progress towards implementing guidelines such as the WHO Essential Diagnostics List and Priority Medical Devices initiatives