Identification of Current Best Practices for Short-term Medical Mission Trips and Adherence to Current Common Principles and Guidelines

Background: Recent reviews of published guidelines for conducting short-term medical missions (STMM) identify significant concerns about the lack of adherence and of formal regulations concurrent with the increasing number of individuals and organizations participating in STMM. Method: A descriptive survey methodology was used. A 44-item survey that identifies current practices utilized by healthcare providers (HCP) who have participated in STMM was used based on the literature and prior research, and distributed electronically to HCP participating in STTM to identify current best practices and compare findings with the most recent recommendations for short-term global health activities. A focus on current operational practices was surveyed and analyzed to develop operational recommendations for the ethical and safe care provided during STMM. Results: Eighty-seven surveys were included in the final analysis, with 33% (N=29) serving as coordinators for the trip. The majority of the respondents were female (67%) and the primary roles represented were: MD (N=17; 20%), nurse practitioner (N=20; 23%), and registered nurse (N=18; 21%). A majority (N=48; 67%) traveled to South America or Latin America, with 38% (N=33) having participated in four or more STMM. Language proficiency was reported as deficient (N=35; 40%) along with little or no knowledge of the basic culture (N=39; 45%). Additional data were collected on trip preparation, clinic operations, and outcomes follow up. Conclusions: Using a convenience sample, the results of the survey provide information on the current best practices utilized by HCP who have participated in STMM and compare the findings to assess for adherence with the most recent recommendations for short-term global health activities. There was variation in the degree to which HCP were knowledgeable about specific aspects related to knowledge of local culture, language proficiency, and adherence to recommended practices for STMM. Additional research on STMM is needed, along with further exploration of how evidence based practices for STMM can be implemented to improve access and safety to the care provided while in the host country.

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Extent, nature and consequences of performing outside scope of training in global health

Globalization and Health ◽

10.1186/s12992-019-0506-6 ◽

2019 ◽

Vol 15 (1) ◽

Cited By ~ 3

Author(s):

Ashti Doobay-Persaud ◽

Jessica Evert ◽

Matthew DeCamp ◽

Charlesnika T. Evans ◽

Kathryn H. Jacobsen ◽

...

Keyword(s):

Global Health ◽

Health Professionals ◽

Online Survey ◽

Moral Distress ◽

Human Resources For Health ◽

Final Analysis ◽

Ethical Challenges ◽

Short Term ◽

Middle Income ◽

Emergency Situations

Abstract Background Globalization has made it possible for global health professionals and trainees to participate in short-term training and professional experiences in a variety of clinical- and non-clinical activities across borders. Consequently, greater numbers of healthcare professionals and trainees from high-income countries (HICs) are working or volunteering abroad and participating in short-term experiences in low- and middle-income countries (LMICs). How effective these activities are in advancing global health and in addressing the crisis of human resources for health remains controversial. What is known, however, is that during these short-term experiences in global health (STEGH), health professionals and those in training often face substantive ethical challenges. A common dilemma described is that of acting outside of one’s scope of training. However, the frequency, nature, circumstances, and consequences of performing outside scope of training (POST) have not been well-explored or quantified. Methods The authors conducted an online survey of HIC health professionals and trainees working or volunteering in LMICs about their experiences with POST, within the last 5 years. Results A total of 223 survey responses were included in the final analysis. Half (49%) of respondents reported having been asked to perform outside their scope of training; of these, 61% reported POST. Trainees were nearly twice as likely as licensed professionals to report POST. Common reasons cited for POST were a mismatch of skills with host expectations, suboptimal supervision at host sites, inadequate preparation to decline POST, a perceived lack of alternative options and emergency situations. Many of the respondents who reported POST expressed moral distress that persisted over time. Conclusions Given that POST is ethically problematic and legally impermissible, the high rates of being asked, and deciding to do so, were notable. Based on these findings, the authors suggest that additional efforts are needed to reduce the incidence of POST during STEGH, including pre-departure training to navigate dilemmas concerning POST, clear communication regarding expectations, and greater attention to the moral distress experienced by those contending with POST.

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Evaluation of Perception and Correct Tourniquet Use among EMS Personnel and Healthcare Providers in Latin-American: A Search for Barriers for the Implementation of the Stop the Bleed Campaign in a Global Health Setting

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.08.632 ◽

2020 ◽

Vol 231 (4) ◽

pp. e236

Author(s):

Juan Jose Melendez ◽

Edison Angamarca ◽

Juliana Ordonez ◽

Monica Guzman ◽

Juan Pablo Herrera ◽

...

Keyword(s):

Global Health ◽

Latin American ◽

Healthcare Providers

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Dyslipidaemia and mortality in COVID-19 patients - a meta-analysis

QJM ◽

10.1093/qjmed/hcab071 ◽

2021 ◽

Author(s):

Marco Zuin ◽

Gianluca Rigatelli ◽

Claudio Bilato ◽

Carlo Cervellati ◽

Giovanni Zuliani ◽

...

Keyword(s):

Random Effects ◽

Mortality Risk ◽

Meta Analysis ◽

Random Effect ◽

Final Analysis ◽

Short Term ◽

Random Effects Models ◽

Pooled Prevalence ◽

Statistical Heterogeneity ◽

Trim And Fill

Abstract Objective The prevalence and prognostic implications of pre-existing dyslipidaemia in patients infected by the SARS-CoV-2 remain unclear. To perform a systematic review and meta-analysis of prevalence and mortality risk in COVID-19 patients with pre-existing dyslipidaemia. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to January 31, 2021, reporting data on dyslipidaemia among COVID-19 survivors and non-survivors. The pooled prevalence of dyslipidaemia was calculated using a random effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random effects models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic. Results Eighteen studies, enrolling 74.132 COVID-19 patients [mean age 70.6 years], met the inclusion criteria and were included in the final analysis. The pooled prevalence of dyslipidaemia was 17.5% of cases (95% CI: 12.3-24.3%, p < 0.0001), with high heterogeneity (I2=98.7%). Pre-existing dyslipidaemia was significantly associated with higher risk of short-term death (OR: 1.69, 95% CI: 1.19-2.41, p = 0.003), with high heterogeneity (I2=88.7%). Due to publication bias, according to the Trim-and-Fill method, the corrected random-effect ORs resulted 1.61, 95% CI 1.13-2.28, p < 0.0001 (one studies trimmed). Conclusions Dyslipidaemia represents a major comorbidity in about 18% of COVID-19 patients but it is associated with a 60% increase of short-term mortality risk.

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A short-term evaluation of a prototype disposable Oscillating Positive Expiratory Pressure (OPEP) device in a cohort of children with cystic fibrosis

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01525-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kevin J. O’Sullivan ◽

Valerie Power ◽

Barry Linnane ◽

Deirdre McGrath ◽

Magdalena Mulligan ◽

...

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Clinical Investigation ◽

Mean Difference ◽

Short Term ◽

Intervention Participant ◽

Post Intervention ◽

Convenience Sample ◽

Disposable Device ◽

Positive Expiratory Pressure

Abstract Background Oscillating Positive Expiratory Pressure (OPEP) devices are important adjuncts to airway clearance therapy in patients with cystic fibrosis (CF). Current devices are typically reusable and require daily, or often more frequent, cleaning to prevent risk of infection by acting as reservoirs of potentially pathogenic organisms. In response, a daily disposable OPEP device, the UL-OPEP, was developed to mitigate the risk of contamination and eliminate the burdensome need for cleaning devices. Methods A convenience sample of 36 participants, all current OPEP device users, was recruited from a paediatric CF service. For one month, participants replaced their current OPEP device with a novel daily disposable device. Assessment included pre- and post-intervention lung function by spirometry, as well as Lung Clearance Index. Quality of life was assessed using the Cystic Fibrosis Questionnaire – Revised, while user experience was evaluated with a post-study survey. Results 31 participants completed the study: 18 males; median age 10 years, range 4–16 years. Lung function (mean difference ± SD, %FEV1 = 1.69 ± 11.93; %FVC = 0.58 ± 10.04; FEV1: FVC = 0.01 ± 0.09), LCI (mean difference ± SD, 0.08 ± 1.13), six-minute walk test, and CFQ-R were unchanged post-intervention. Participant-reported experiences of the device were predominantly positive. Conclusions The disposable OPEP device maintained patients’ lung function during short term use (≤ 1 month), and was the subject of positive feedback regarding functionality while reducing the risk of airway contamination associated with ineffective cleaning. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).

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Best Practices in Specialized Amyloidosis Centers in the United States: A Survey of Cardiologists, Nurses, Patients, and Patient Advocates

Clinical Medicine Insights Cardiology ◽

10.1177/11795468211015230 ◽

2021 ◽

Vol 15 ◽

pp. 117954682110152

Author(s):

Jose Nativi-Nicolau ◽

Nitasha Sarswat ◽

Johana Fajardo ◽

Muriel Finkel ◽

Younos Abdulsattar ◽

...

Keyword(s):

Best Practices ◽

Patient Care ◽

Nurse Practitioners ◽

Healthcare Providers ◽

Multidisciplinary Care ◽

The United States ◽

Comprehensive Care ◽

Patient Support ◽

Patient Support Group ◽

Patient Advocates

Background: Because transthyretin amyloid cardiomyopathy (ATTR-CM) poses unique diagnostic and therapeutic challenges, referral of patients with known or suspected disease to specialized amyloidosis centers is recommended. These centers have developed strategic practices to provide multidisciplinary comprehensive care, but their best practices have not yet been well studied as a group. Methods: A qualitative survey was conducted by telephone/email from October 2019 to February 2020 among eligible healthcare providers with experience in the management of ATTR-CM at US amyloidosis centers, patients with ATTR-CM treated at amyloidosis centers, and patient advocates from amyloidosis patient support groups. Results: Fifteen cardiologists and 9 nurse practitioners/nurses from 15 selected amyloidosis centers participated in the survey, with 16 patients and 4 patient advocates. Among participating healthcare providers, the most frequently cited center best practices were diagnostic capability, multidisciplinary care, and time spent on patient care; the greatest challenges involved coordination of patient care. Patients described the “ideal” amyloidosis program as one that provides physicians with expertise in ATTR-CM, sufficient time with patients, comprehensive patient care, and opportunities to participate in research/clinical trials. The majority of centers host patient support group meetings, and patient advocacy groups provide support for centers with physician/patient education and research. Conclusions: Amyloidosis centers offer comprehensive care based on staff expertise in ATTR-CM, a multidisciplinary approach, advanced diagnostics, and time dedicated to patient care and education. Raising awareness of amyloidosis centers’ best practices among healthcare providers can reinforce the benefits of early referral and comprehensive care for patients with ATTR-CM.

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Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting

SAGE Open ◽

10.1177/2158244016677747 ◽

2016 ◽

Vol 6 (4) ◽

pp. 215824401667774 ◽

Cited By ~ 1

Author(s):

Benjamin Woodward ◽

Reba Umberger

Keyword(s):

Best Practices ◽

Healthcare Providers ◽

Bloodstream Infections ◽

Central Line ◽

Mandatory Reporting ◽

Future Research ◽

Common Source ◽

Healthcare Associated Infection ◽

Extrinsic Factors ◽

The Impact

Central line-associated bloodstream infections (CLABSI) are a very common source of healthcare-associated infection (HAI). Incidence of CLABSI has been significantly reduced through the efforts of nurses, healthcare providers, and infection preventionists. Extrinsic factors such as recently enacted legislation and mandatory reporting have not been closely examined in relation to changes in rates of HAI. The following review will examine evidence-based practices related to CLABSI and how they are reported, as well as how the Affordable Care Act, mandatory reporting, and pay-for-performance programs have affected these best practices related to CLABSI prevention. There is a disconnect in the methods and guidelines for reporting CLABSI between these programs, specifically among local monitoring agencies and the various federal oversight organizations. Future research will focus on addressing the gap in what defines a CLABSI and whether or not these programs to incentivize hospital to reduce CLABSI rates are effective.

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Ethical Obligations in Short-Term Global Health Clinical Experiences: The Devil Is in the Details

Annals of Internal Medicine ◽

10.7326/m18-0566 ◽

2018 ◽

Vol 168 (9) ◽

pp. 672-673 ◽

Cited By ~ 3

Author(s):

Carey Farquhar ◽

Ruth W. Nduati ◽

Judith N. Wasserheit

Keyword(s):

Global Health ◽

Clinical Experiences ◽

Short Term ◽

The Devil ◽

Ethical Obligations

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Human Factors Considerations for Patients: A Cursory Review of Telehealth Guidelines

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181321651340 ◽

2021 ◽

Vol 65 (1) ◽

pp. 943-947

Author(s):

Sarah A. Powers ◽

Kimberly N. Perry ◽

Amanda J. Ashdown ◽

Matthew Pacailler ◽

Mark W. Scerbo

Keyword(s):

Best Practices ◽

Human Factors ◽

Healthcare Providers ◽

Evidence Based ◽

Environmental Requirements ◽

Laws And Policies

During the COVID-19 pandemic, changes to telehealth laws and policies enabled more patients to meet with their healthcare providers remotely. The rapid implementation of telehealth has resulted in providers and patients interacting remotely with few existing standards or guidelines. Additionally, a cursory search of telehealth guidelines for patients revealed overly broad recommendations related to technology, security, and environmental requirements. Although researchers have recommended some human factors considerations for guidelines, these recommendations were rarely implemented in the guidelines we reviewed. Therefore, human factors professionals can contribute further by implementing best practices for telehealth appointments to create evidence-based standardized guidelines. Some initial areas to focus on include accessibility for patients, overcoming typical telehealth barriers, and addressing a wider diversity of patients.

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Admission Hemoglobin Is Prognostic for In-Hospital Mortality in Oldest-Old Patients with Acute Ischemic Stroke

Gerontology ◽

10.1159/000514678 ◽

2021 ◽

pp. 1-8

Author(s):

Mingquan Li ◽

Xiaoyun Liu ◽

Liumin Wang ◽

Lei Shu ◽

Liqin Luan ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Hospital Stay ◽

Acute Ischemic Stroke ◽

Oldest Old ◽

Final Analysis ◽

Short Term ◽

Old Patients ◽

Short Term Mortality ◽

Tertiary Hospitals

Introduction: Anemia is a common condition encountered in acute ischemic stroke, and only a few pieces of evidence has been produced suggesting its possible association with short-term mortality have been produced. The study sought to assess whether admission anemia status had any impact on short-term clinical outcome among oldest-old patients with acute ischemic stroke. Materials and Methods: A retrospective review of Electronic Medical Recording System was performed in 2 tertiary hospitals. Data, from the oldest-old patients aged > = 80 years consecutively admitted with a diagnosis of acute ischemic stroke between January 1, 2015, and December 31, 2019, were analyzed. Admission hemoglobin was used as indicator for anemia and severity. Univariate and multivariate regression analyses were used to compare in-hospital mortality and length of in-hospital stay in different anemia statuses and normal hemoglobin patients. Results: A total of 705 acute ischemic stroke patients were admitted, and 572 were included in the final analysis. Of included patients, 240 of them were anemic and 332 nonanemic patients. A statistical difference between the 2 groups was found in in-hospital mortality (p < 0.001). After adjustment for baseline characteristics, the odds ratio value of anemia for mortality were 3.91 (95% confidence intervals (CI) 1.60–9.61, p = 0.003) and 7.15 (95% CI: 1.46–34.90, p = 0.015) in moderate and severely anemic patients, respectively. Similarly, length of in-hospital stay was longer in anemic patients (21.64 ± 6.17 days) than in nonanemic patients (19.08 ± 5.48 days, p < 0.001). Conclusions: Increased severity of anemia may be an independent risk factor for increased in-hospital mortality and longer length of stay in oldest-old patients with acute ischemic stroke.

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