A. Werne

H. Mamillapalli

K. Dieckhaus

N.D. Stein

Annals of Global Health

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74 I n n o v a t i o n s /New Te chn o l o g i e s / Imp r o v em en t S c i e n c eOutcomes & Evaluation: Our efforts to evaluate the impact of thesePVCs and Expert Panels are ongoing. We have established four PVCsand are currently reaching over 6,000 US-based health care pro-fessionals. Preliminary survey findings and member interviews showincreased knowledge and ability to implement certain evidence-basedtools. In order for USCI to reach sustainability, we have identified anumber of areas where we must adapt both our approach andplatform functionality to better engage our new, US-based audience.Challenges include: members’ access to an already overwhelmingamount of information and updates from existing connections onestablished social networks such as Twitter and Facebook; less need fornew virtual connections to colleagues; a desire for short-term engage-ments, such as videos and webinars, over text-based discussions; andan expectation of more personalized notifications and a specializedmobile application.Going Forward: GHDonline is currently experimenting with videoExpert Panels and Twitter chats to provide alternative engagementopportunities for this US-based audience. We are also implementinga responsive web design to improve PVC usability on mobile devices,and we are improving the underlying information architecture thatpowers navigation on GHDonline to more clearly tailor content tothe needs of community members and highlight the benefits ofjoining our PVCs.Funding: The US Communities Initiative is supported by a grantfrom the Agency for Healthcare Research and Quality (AHRQ), adivision of the US Department of Health and Human Services.Abstract #: 01ITIS009A simplified, stature-based method for dosingantiepileptic therapy in children presenting with statusepilepticusK. Dieckhaus1, H. Mamillapalli2, A. Werne2, N.D. Stein3; 1University ofConnecticut Health Center, Farmington, CT/US, 2University of Con-necticut School of Medicine, Farmington, CT/US, 3Hospital for SpecialCare, New Britain, CT/USBackground: Seizure disorders in children are a frequent presen-tation in under-resourced healthcare settings. Appropriate dosing ofmedication can be challenging, as dosing is based on weight, whichcan be difficult to obtain in emergent situations. The Seizure Tape isa flexible tape measure that provides the clinician with appropriateclinical decision guidance for seizure management including stan-dard dosing of antiepileptic therapy for children. By measuringheight only, the tape provides an immediate recommendation ofdosing for common antiepileptic medications based on expectedweights of the child using WHO standard growth curves, avoidingthe need to weigh a child or estimate a weight in the emergentsetting. Previous work in Kisoro District, Uganda, has demonstrateda high prevalence of underweight children, as measured by weight-for-age, in this district. This project evaluated the accuracy of theseizure tape in providing an appropriate recommended dose ofantiepileptic medications for a cohort of Ugandan children inKisoro, Uganda.Methods: After appropriate IRB and local approval, height (cm),weight (kg), and age (mo) were collected on 167 children age thpercentile of weight-for-age. Dosing recommendations within 30% ofthe standard weight-based ranges were considered acceptable.Findings: The stature-based dosing method accurately recommendeddosing of lorazepam in 87.8%, diazepam in 91.5%, midazolam in92.0%, phenytoin in 90.9%, and phenobarbital in 93.9% of children.Doses 30% of ideal were suggested in 11.6%, 7.3%, 7.4%, 7.9% and5.5% respectively. Child underweight status strongly predicted dosingby >30% above the maximum ideal range for all medications (p <0.001 for each), with nearly all height-based suggestions leading todoses>30% above ideal occurring in children with low weight-for-age.Interpretation: The seizure tape provides a quick clinical referencefor managing pediatric status epilepticus in resource-limited settings.Using a stature-based simplified dosing guide accurately dosed anti-epileptic therapy in 87.8%e93.9% of children. For significantly un-derweight children with low weight-for-age as determined by clinicalexam at presentation, the clinician may wish to decrease the suggesteddose to compensate for smaller body mass.Funding: None.Abstract #: 01ITIS010Novel use of a medical database smart phone applicationimproves clinical learning experience during a globalhealth rotation in Tena, EcuadorM. Dieckmann, B. Hodge; University of Louisville School of Medicine,Louisville, KY/USBackground: Two seemingly conflicting trends are emerging amongmedical students: they are high-tech learners [1] and they consistently seekout global health electives in low resource areas [2, 3]. PEMSoft Portable isan evidence-based electronic resource that can function on the nativememory of a smart phone or tablet. We hypothesized that using PEMSoftPortable would improve the perceived clinical learning experience ofmedical students on a global health rotation in Tena, Ecuador.Methods: Sixteen medical students participated in running 8 ruralclinics over a 2 week period in the area surrounding Tena, Ecuador,where they helped provide primary care services to over 1100 patientsof all ages. Internet access was not available during clinics. Studentsserved as their own controls by performing clinical work withoutaccess to PEMSoft Portable for the first 4 days of clinic and then usingPEMSoft Portable for the last 4 days of clinic. Pre-rotation, daily, mid-rotation, and post surveys were conducted to understand studentperceptions regarding the utility of the application for learning andproviding care. Data from the surveys was compiled into an Exceldocument and analyzed for trends.Findings: Compiled data from the daily shift surveys revealed that92% of the time the medical students thought PEMSoft Portableimproved their clinical understanding of the Patient/Condition on aday-to-day basis. The data from the post surveys showed that 87.5% ofthe subjects said they would definitely recommend PEMSoft Portableto a friend planning a global health elective. Finally, 100% of themedical students believed that PEMSoft Portable improved theiroverall clinical learning experience.Interpretation: It is clear from the data that the medical studentsbelieved that using PEMSoft Portable improved their clinicallearning experience. These results suggest this may be a way toimprove the clinical learning experience of students while rotating inareas where internet access is limited. While this study had a smallsample size, it still demonstrates that students find a portable pointof care referencing tool enhances their learning in clinical settings.Further studies should be done to examine if there are differentresults for different levels of medical school training, length orlocation of global health experience, or types of health care deliveredwhile working abroad.Funding: EBSCO Health (ipswich, MA) gifted the PEMSoftPortable to KidsCareEverywhere, a California nonprofit charity, whothen donated PEMSoft Portable for this project.Abstract #: 01ITIS011

A simplified, stature-based method for dosing antiepileptic therapy in children presenting with status epilepticus

http://www.annalsofglobalhealth.org/articles/10.1016/j.aogh.2015.02.675/galley/1693/download/

A simplified, stature-based method for dosing antiepileptic therapy in children presenting with status epilepticus

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