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Global Emergency Care

Lauren E Kelly, Michele P Dyson, Nancy J Butcher, Robert Balshaw, Alex John London, Christine J Neilson, Anne Junker, Salaheddin M Mahmud, S Michelle Driedger, Xikui Wang
BACKGROUND: Although children have historically been excluded from clinical trials (CTs), many require medicines tested and approved in CTs, forcing health care providers to treat their pediatric patients based on extrapolated data. Unfortunately, traditional randomized CTs can be slow and resource-intensive, and they often require multi-center collaboration. However, an adaptive design (AD) framework for CTs could be used to increase the efficiency of pediatric CTs by incorporating prospectively planned modifications to CT methods without undermining the integrity or validity of the study...
October 19, 2018: Trials
Terri Scott, Shelley L Brown
OBJECTIVE: Debate ensues regarding female-specific risk and strength factors among adolescent offenders. Using meta-analysis, we examined whether risk and strength factors predicted recidivism differentially between male and female youth. METHOD: Database searches identified 22 studies, representing 50,601 justice-involved youth (11,952 females and 38,649 males) and a total of 584 effect sizes. RESULTS: For the global risk domains, there is some evidence for gender neutrality (i...
November 2018: Journal of Consulting and Clinical Psychology
Thomas F O'Brien, Adam Clark, Rob Peters, John Stelling
OBJECTIVES: Surveillance of antimicrobial resistance can now be automated to analyze the reports of microbiology laboratories continually without operator assistance It can also be made comprehensive to monitor all the reports of all the world's microbiology laboratories. METHODS AND RESULTS: As illustrated through examples provided in this work, each clinical report can be scanned automatically by algorithms to suspect emerging problems and prompt sampling to confirm such problems, now increasingly by nucleotide sequencing...
October 13, 2018: Journal of Global Antimicrobial Resistance
Frank X Scheuermeyer, Eric Grafstein, Jane Buxton, Keith Ahamad, Mark Lysyshyn, Stan DeVlaming, Gerrit Prinsloo, Christopher Van Veen, Andrew Kestler, Reka Gustafson
Opioid overdoses (OD) cause substantial morbidity and mortality globally, and current emergency management is typically limited to supportive care, with variable emphasis on harm reduction and addictions treatment. Our urban setting has a high concentration of patients with presumed fentanyl OD, which places a burden on both pre-hospital and emergency department (ED) resources. From December 13, 2016, to March 1, 2017, we placed a modified trailer away from an ED but near the center of the expected area of high OD and accepted low-risk patients with presumed fentanyl OD...
October 15, 2018: Journal of Urban Health: Bulletin of the New York Academy of Medicine
Catherine Arsenault, Keely Jordan, Dennis Lee, Girmaye Dinsa, Fatuma Manzi, Tanya Marchant, Margaret E Kruk
BACKGROUND: Emerging data show that many low-income and middle-income country (LMIC) health systems struggle to consistently provide good-quality care. Although monitoring of inequalities in access to health services has been the focus of major international efforts, inequalities in health-care quality have not been systematically examined. METHODS: Using the most recent (2007-16) Demographic and Health Surveys and Multiple Indicator Cluster Surveys in 91 LMICs, we described antenatal care quality based on receipt of three essential services (blood pressure monitoring and urine and blood testing) among women who had at least one visit with a skilled antenatal-care provider...
November 2018: Lancet Global Health
İpek Özmen, Elif Yıldırım, Murat Öztürk, Birsen Ocaklı, Reyhan Yıldız, Rüya Aydın, Meral Karakış, Özgür Yılmaz, Emine Aksoy
OBJECTIVES: Chronic respiratory diseases exert a global health burden with high health care costs, morbidity, and mortality. The aim of the present study was to investigate the effect of pulmonary rehabilitation (PR) on emergency admission and hospitalization rates of patients with chronic respiratory disease. MATERIALS AND METHODS: In this retrospective cohort study, hospitalization rates and emergency admissions of patients before (December 2014-December 2015) and after PR (January 2015-December 2016) were investigated...
September 13, 2018: Turkish Thoracic Journal
Jeyaraj D Pandian, Seana L Gall, Mahesh P Kate, Gisele S Silva, Rufus O Akinyemi, Bruce I Ovbiagele, Pablo M Lavados, Dorcas B C Gandhi, Amanda G Thrift
Along with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). Our focus includes global strategies and campaigns, and measurements of the effectiveness of worldwide preventive interventions, with an emphasis on low-income and middle-income countries...
October 6, 2018: Lancet
Sheena M Eagan
Often known as ' global health diplomacy ' , the provision of medical care to accomplish strategic objectives, advance public diplomacy goals and enhance soft power is increasingly emphasised in international affairs and military policies. Despite this emergent trend, there has been little critical analysis and examination of the ethics of military actors engaging in this type of work. This type of mission represents the most common form of military medical deployment within the International Security Assistance Force in Afghanistan and is now explicitly emphasised in many militaries' defence doctrine...
October 12, 2018: Journal of the Royal Army Medical Corps
Rachel Koch, Lina Roa, Jordan Pyda, Monica Kerrigan, Ernest Barthélemy, John G Meara
BACKGROUND: The Bill and Melinda Gates Foundation has made unparalleled contributions to global health and human development by bringing together generous funding, strategic partnerships, and innovative leadership. For the last twenty years, the Gates Foundation has supported the expansion of programs that directly address the fundamental barriers to the advancement of marginalized communities around the globe, with a transformative focus on innovations to combat communicable diseases and to ensure maternal and child health...
October 10, 2018: Surgery
Chrishan J Nalliah, Prashanthan Sanders, Jonathan M Kalman
PURPOSE OF REVIEW: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in humans, affecting more than 33 million people globally. Its association with complex, resource intensive medical conditions such as stroke, heart failure and dementia have had profound impacts across existing health care structures. The global prevalence of AF has enjoyed significant growth despite significant improvement in our armamentarium for arrhythmia treatment. RECENT FINDINGS: Efforts aimed at curtailing the incidence, prevalence, or progression of AF have prompted re-evaluation of traditional frameworks for understanding and managing this debilitating disease...
October 12, 2018: Current Cardiology Reports
Angela Vassallo, Kelley M Boston
Infectionprevention is a rapidly changing field with regulatory requirements and emerging global public health threats. Infection preventionists (IPs) must use advanced epidemiologic skills for health care-associated infection investigation and prevention. A potential talent pool for IPs is the Master of Public Health graduate. Those hiring IPs should consider master of public health graduates as candidates who can help drive the future of this profession.
October 9, 2018: American Journal of Infection Control
Ya-Lin Ko, Jyun-Wei Wang, Hui-Mei Hsu, Chia-Hung Kao, Chun-Yi Lin
AIM: Acute pancreatitis is associated with significant morbidity and mortality. In the United States, more than 3,00,000 patients are admitted and about 20,000 die from acute pancreatitis per year. In Taiwan, the incidence rate of acute pancreatitis is 0.03% and the mortality rate among severe acute pancreatitis is 16.3%. The aim of the study was to evaluate the impact of the global budgeting system on health service utilization, health care expenditures, and quality of care among patients with acute pancreatitis in Taiwan...
October 2018: Medicine (Baltimore)
M H F Sakeena, Alexandra A Bennett, Andrew J McLachlan
BACKGROUND: Antimicrobial resistance (AMR) is a global challenge. Developing countries are more vulnerable to the consequences of AMR than developed nations because of complex issues pertaining to the nature their health care systems. Inappropriate antimicrobial drug use and the unrestricted availability of antimicrobial agents in community pharmacies in developing countries can contribute to emergence of resistant microbes. The aim of this systematic review is to explore the availability of antimicrobial agents without a doctor's prescription in developing countries and to investigate factors that contribute to inappropriate antimicrobial supply in developing countries...
October 9, 2018: International Journal of Antimicrobial Agents
Joanna M Cain, Lynette Denny
Women's cancer rates are increasing in low- and middle-income countries, with presentations that are often far advanced requiring intense symptom management, thus advancing the urgent need to address palliative care. Most resource settings have some options available to assist women with advanced gynecologic cancer, and a combination of leveraging these and expanding on emerging models for palliative care could lessen suffering and improve care for women with gynecologic cancers globally. Providing palliative care for women with cancer is constrained by resources (human and physical), lack of equipment, lack of access, and policy absence or barriers...
October 2018: International Journal of Gynaecology and Obstetrics
Nicola Luigi Bragazzi, Andrea Aparo von Flüe, Ugo Luigi Aparo
We have reached the awareness that diseases, far from being simple altered health states, are characterized by intrinsic emerging and adaptive properties, requiring an interdisciplinary, global and systemic approach, oriented towards integration and coordination, rather than an atomic and disintegrated logic. A new approach is needed, "systems medicine", defined as an interdisciplinary field of study that looks at the systems of the human body as part of an integrated whole, incorporating biochemical, physiological, and environment interactions...
September 2018: Recenti Progressi in Medicina
Hwan Il Kim, Sunghoon Park
Sepsis is a life-threatening condition caused by infection and represents a substantial global health burden. Recent epidemiological studies showed that sepsis mortality rates have decreased, but that the incidence has continued to increase. Although a mortality benefit from early-goal directed therapy (EGDT) in patients with severe sepsis or septic shock was reported in 2001, three subsequent multicenter randomized studies showed no benefits of EGDT versus usual care. Nonetheless, the early administration of antibiotics and intravenous fluids is considered crucial for the treatment of sepsis...
September 28, 2018: Tuberculosis and Respiratory Diseases
Vincent Couture, Régen Drouin, Jean-Marie Moutquin, Patricia Monnier, Chantal Bouffard
Cross-border reproductive care (CBRC) can be defined as the movement from one jurisdiction to another for medically assisted reproduction (MAR). CBRC raises many ethical concerns that have been addressed extensively. However, the conclusions are still based on scarce evidence even considering the global scale of CBRC. Empirical ethics appears as a way to foster this ethical reflection on CBRC while attuning it with the experiences of its main actors. To better understand the 'in and out' situation of CBRC in Canada, we conducted an ethnographic study taking a 'critically applied ethics' approach...
October 9, 2018: Journal of Medical Ethics
Sara Gasparini, Ettore Beghi, Edoardo Ferlazzo, Massimiliano Beghi, Vincenzo Belcastro, Klaus P Biermann, Gabriella Bottini, Giuseppe Capovilla, Rosa A Cervellione, Vittoria Cianci, Giangennaro Coppola, Cesare M Cornaggia, Pasquale De Fazio, Salvatore De Masi, Giovambattista De Sarro, Maurizio Elia, Giuseppe Erba, Lucia Fusco, Antonio Gambardella, Valentina Gentile, Anna T Giallonardo, Renzo Guerrini, Francesca Ingravallo, Alfonso Iudice, Angelo Labate, Ersilia Lucenteforte, Adriana Magaudda, Laura Mumoli, Costanza Papagno, Giovanni B Pesce, Eugenio Pucci, Pietrantonio Ricci, Antonino Romeo, Rui Quintas, Chiara Sueri, Giovanna Vitaliti, Riccardo Zoia, Umberto Aguglia
BACKGROUND: The International League Against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic nonepileptic seizures (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized, and management might differ according to the age groups. OBJECTIVE: To reach an expert and stakeholder consensus on PNES management. METHODS: A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed...
October 9, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Klara Junker, Gustavo Bravo Ruiz, Alexander Lorenz, Louise Walker, Neil A R Gow, Jürgen Wendland
Candida auris has recently emerged as a multi-drug resistant fungal pathogen that poses a serious global health threat, especially for patients in hospital intensive care units (ICUs). C. auris can colonize human skin and can spread by physical contact or contaminated surfaces and equipment. Here, we show that the mycoparasitic yeast Saccharomycopsis schoenii efficiently kills both sensitive and multi-drug resistant isolates of C. auris belonging to the same clade, as well as clinical isolates of other pathogenic species of the Candida genus suggesting novel approaches for biocontrol...
October 8, 2018: Scientific Reports
Olga Zvonareva, Willemien van Bergen, Nadezhda Kabanets, Aleksander Alliluyev, Olga Filinyuk
Tuberculosis (TB) remains a major global public health problem that has become a crisis fuelled by HIV and the increasing occurrence of antimicrobial resistance. What has been termed the biosocial nature of TB challenges effective control of the disease. Yet, biosocial interactions involved in the persistence of TB in diverse settings are difficult to systematically account for. The recently developed framework of syndemics provides a way to capture how complex health problems result from the interactions between diseases such as HIV and TB, and harmful social conditions such as unemployment, malnutrition and substance abuse...
October 9, 2018: Journal of Biosocial Science
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