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Nashwan AJ, Shaban MM, Kamugisha JB. Bridging the gap: How investing in advanced practice nurses could transform emergency care in Africa. Int Nurs Rev 2024; 71:285-290. [PMID: 38613148 DOI: 10.1111/inr.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/23/2024] [Indexed: 04/14/2024]
Abstract
AIM This paper aims to highlight the vital importance of investing in advanced practice nursing (APN) for enhancing emergency care throughout Africa. BACKGROUND APN's role is increasingly recognized as pivotal in optimizing healthcare, particularly in emergency settings in Africa. It offers improved patient care quality and strengthens the healthcare workforce. SOURCES OF EVIDENCE Evidence is drawn from successful implementations of APN in various healthcare environments. This includes the development of APN-specific curricula and training, mentorship initiatives, clinical supervision, and defining advanced nursing roles within healthcare organizations. Investing in APNs in emergency care in Africa can lead to improved quality and access to care, cost-effectiveness, enhanced patient outcomes and satisfaction, and opportunities for professional development and career advancement in the healthcare workforce. DISCUSSION Despite facing barriers in implementation, APN in emergency care presents innovative solutions. Investing in APN can help healthcare entities and policymakers surmount these challenges, providing specialized patient care and improving health outcomes. The discussion emphasizes the benefits such as enhanced access to care, reduced healthcare costs, and improved patient outcomes, alongside bolstering the healthcare workforce. CONCLUSION The necessity and benefits of investing in APN for emergency care in Africa are clear. It is crucial for improving healthcare delivery and outcomes. IMPLICATIONS FOR NURSING PRACTICE APN investment leads to a more competent and efficient nursing workforce, capable of addressing complex emergencies and improving patient care. IMPLICATIONS FOR NURSING POLICY AND HEALTH/SOCIAL POLICY The paper advocates for policies that support APN development and integration into the healthcare system, emphasizing the need for research to assess APN's long-term impact and establish best practices for its implementation in emergency care across Africa.
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Affiliation(s)
- Abdulqadir J Nashwan
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- Department of Nursing, Hamad Medical Corporation, Doha, Qatar
| | - Marwa M Shaban
- Community Health Nursing Department, Faculty of Nursing, Cairo University, Giza, Egypt
| | - John Bosco Kamugisha
- Global Emergency Care, Masaka, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
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Smit L, Redfern A, Murray S, Lishman J, van der Zalm MM, van Zyl G, Verhagen LM, de Vos C, Rabie H, Dyk A, Claassen M, Taljaard J, Aucamp M, Dramowski A. SARS-CoV-2 in children and their accompanying caregivers: Implications for testing strategies in resource limited hospitals. Afr J Emerg Med 2022; 12:177-182. [PMID: 35496826 PMCID: PMC9035358 DOI: 10.1016/j.afjem.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/01/2022] Open
Abstract
Background Identification of SARS-CoV-2 infected individuals is imperative to prevent hospital transmission, but symptom-based screening may fail to identify asymptomatic/mildly symptomatic infectious children and their caregivers. Methods A COVID-19 period prevalence study was conducted between 13 and 26 August 2020 at Tygerberg Hospital, testing all children and their accompanying asymptomatic caregivers after initial symptom screening. One nasopharyngeal swab was submitted for SARS-CoV-2 using real-time reverse-transcription polymerase chain reaction (rRT-PCR). An additional Respiratory Viral 16-multiplex rRT-PCR test was simultaneously done in children presenting with symptoms compatible with possible SARS-CoV-2 infection. Results SARS-Co-V 2 RT-PCR tests from 196 children and 116 caregivers were included in the analysis. The SARS-CoV-2 period prevalence in children was 5.6% (11/196) versus 15.5% (18/116) in asymptomatic caregivers (p<0.01). Presenting symptoms did not correlate with SARS-CoV-2 test positivity; children without typical symptoms of SARS-CoV-2 were more likely to be positive than those with typical symptoms (10.2% [10/99] vs 1% [1/97]; p<0.01). Children with typical symptoms (97/196; 49.5%) mainly presented with acute respiratory (68/97; 70.1%), fever (17/97; 17.5%), or gastro-intestinal complaints (12/97; 12.4%); Human Rhinovirus (23/81; 28.4%) and Respiratory Syncytial Virus (18/81; 22.2%) were frequently identified in this group. Children-caregiver pairs' SARS-CoV-2 tests were discordant in 83.3%; 15/18 infected caregivers' children tested negative. Symptom-based COVID-19 screening alone would have missed 90% of the positive children and 100% of asymptomatic but positive caregivers. Conclusion Given the poor correlation between SARS-CoV-2 symptoms and RT-PCR test positivity, universal testing of children and their accompanying caregivers should be considered for emergency and inpatient paediatric admissions during high COVID-19 community transmission periods. Universal PPE and optimising ventilation is likely the most effective way to control transmission of respiratory viral infections, including SARS-CoV-2, where universal testing is not feasible. In these settings, repeated point prevalence studies may be useful to inform local testing and cohorting strategies.
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McRae MP, Rajsri KS, Alcorn TM, McDevitt JT. Smart Diagnostics: Combining Artificial Intelligence and In Vitro Diagnostics. SENSORS (BASEL, SWITZERLAND) 2022; 22:6355. [PMID: 36080827 PMCID: PMC9459970 DOI: 10.3390/s22176355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
We are beginning a new era of Smart Diagnostics-integrated biosensors powered by recent innovations in embedded electronics, cloud computing, and artificial intelligence (AI). Universal and AI-based in vitro diagnostics (IVDs) have the potential to exponentially improve healthcare decision making in the coming years. This perspective covers current trends and challenges in translating Smart Diagnostics. We identify essential elements of Smart Diagnostics platforms through the lens of a clinically validated platform for digitizing biology and its ability to learn disease signatures. This platform for biochemical analyses uses a compact instrument to perform multiclass and multiplex measurements using fully integrated microfluidic cartridges compatible with the point of care. Image analysis digitizes biology by transforming fluorescence signals into inputs for learning disease/health signatures. The result is an intuitive Score reported to the patients and/or providers. This AI-linked universal diagnostic system has been validated through a series of large clinical studies and used to identify signatures for early disease detection and disease severity in several applications, including cardiovascular diseases, COVID-19, and oral cancer. The utility of this Smart Diagnostics platform may extend to multiple cell-based oncology tests via cross-reactive biomarkers spanning oral, colorectal, lung, bladder, esophageal, and cervical cancers, and is well-positioned to improve patient care, management, and outcomes through deployment of this resilient and scalable technology. Lastly, we provide a future perspective on the direction and trajectory of Smart Diagnostics and the transformative effects they will have on health care.
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Affiliation(s)
- Michael P. McRae
- Department of Molecular Pathobiology, Division of Biomaterials, Bioengineering Institute, New York University College of Dentistry, 433 First Ave. Rm 822, New York, NY 10010, USA
| | - Kritika S. Rajsri
- Department of Molecular Pathobiology, Division of Biomaterials, Bioengineering Institute, New York University College of Dentistry, 433 First Ave. Rm 822, New York, NY 10010, USA
- Department of Pathology, Vilcek Institute, New York University School of Medicine, 160 E 34th St, New York, NY 10016, USA
| | - Timothy M. Alcorn
- Latham BioPharm Group, 6810 Deerpath Rd Suite 405, Elkridge, MD 21075, USA
| | - John T. McDevitt
- Department of Molecular Pathobiology, Division of Biomaterials, Bioengineering Institute, New York University College of Dentistry, 433 First Ave. Rm 822, New York, NY 10010, USA
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McManus NM, Offman R, Oetman JD. Emergency Department Management of COVID-19: An Evidence-Based Approach. West J Emerg Med 2020; 21:32-44. [PMID: 33052814 PMCID: PMC7673887 DOI: 10.5811/westjem.2020.8.48288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus, SARs-CoV-2, causes a clinical disease known as COVID-19. Since being declared a global pandemic, a significant amount of literature has been produced and guidelines are rapidly changing as more light is shed on this subject. Decisions regarding disposition must be made with attention to comorbidities. Multiple comorbidities portend a worse prognosis. Many clinical decision tools have been postulated; however, as of now, none have been validated. Laboratory testing available to the emergency physician is nonspecific but does show promise in helping prognosticate and risk stratify. Radiographic testing can also aid in the process. Escalating oxygen therapy seems to be a safe and effective therapy; delaying intubation for only the most severe cases in which respiratory muscle fatigue or mental status demands this. Despite thrombotic concerns in COVID-19, the benefit of anticoagulation in the emergency department (ED) seems to be minimal. Data regarding adjunctive therapies such as steroids and nonsteroidal anti-inflammatories are variable with no concrete recommendations, although steroids may decrease mortality in those patients developing acute respiratory distress syndrome. With current guidelines in mind, we propose a succinct flow sheet for both the escalation of oxygen therapy as well as ED management and disposition of these patients.
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Affiliation(s)
- Nicholas M McManus
- Mercy Health - Muskegon, Department of Emergency Medicine. Muskegon, Michigan; Michigan State University College of Osteopathic Medicine, Department of Osteopathic Medical Specialties, East Lansing, Michigan
| | - Ryan Offman
- Mercy Health - Muskegon, Department of Emergency Medicine. Muskegon, Michigan; Michigan State University College of Osteopathic Medicine, Department of Osteopathic Medical Specialties, East Lansing, Michigan
| | - Jason D Oetman
- Mercy Health - Muskegon, Department of Emergency Medicine. Muskegon, Michigan; Michigan State University College of Osteopathic Medicine, Department of Osteopathic Medical Specialties, East Lansing, Michigan
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Salunke AA, Pathak SK, Dhanwate A, Warikoo V, Nandy K, Mendhe H, Kottakota V, Shinde RM, Patil SA, Petiwala T, Pandya S. A proposed ABCD scoring system for patient's self assessment and at emergency department with symptoms of COVID-19. Diabetes Metab Syndr 2020; 14:1495-1501. [PMID: 32795741 PMCID: PMC7399652 DOI: 10.1016/j.dsx.2020.07.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | | | - Anant Dhanwate
- Department of Anatomy, Government Medical College(GMC), Akola, Maharashtra, India
| | - Vikas Warikoo
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Kunal Nandy
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Harshal Mendhe
- Department of Preventive and Social Medicine, Government Medical College, Rajnandgaon, Chhattisgarh, India
| | - Viswanth Kottakota
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Rahul Madhukar Shinde
- Department of Skin and Venereal Disease, ACPM Medical College, Dhule, Maharashtra, India
| | - Shubham Ashok Patil
- Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | | | - Shashank Pandya
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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McRae MP, Dapkins IP, Sharif I, Anderman J, Fenyo D, Sinokrot O, Kang SK, Christodoulides NJ, Vurmaz D, Simmons GW, Alcorn TM, Daoura MJ, Gisburne S, Zar D, McDevitt JT. Managing COVID-19 With a Clinical Decision Support Tool in a Community Health Network: Algorithm Development and Validation. J Med Internet Res 2020; 22:e22033. [PMID: 32750010 PMCID: PMC7446714 DOI: 10.2196/22033] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has resulted in significant morbidity and mortality; large numbers of patients require intensive care, which is placing strain on health care systems worldwide. There is an urgent need for a COVID-19 disease severity assessment that can assist in patient triage and resource allocation for patients at risk for severe disease. OBJECTIVE The goal of this study was to develop, validate, and scale a clinical decision support system and mobile app to assist in COVID-19 severity assessment, management, and care. METHODS Model training data from 701 patients with COVID-19 were collected across practices within the Family Health Centers network at New York University Langone Health. A two-tiered model was developed. Tier 1 uses easily available, nonlaboratory data to help determine whether biomarker-based testing and/or hospitalization is necessary. Tier 2 predicts the probability of mortality using biomarker measurements (C-reactive protein, procalcitonin, D-dimer) and age. Both the Tier 1 and Tier 2 models were validated using two external datasets from hospitals in Wuhan, China, comprising 160 and 375 patients, respectively. RESULTS All biomarkers were measured at significantly higher levels in patients who died vs those who were not hospitalized or discharged (P<.001). The Tier 1 and Tier 2 internal validations had areas under the curve (AUCs) of 0.79 (95% CI 0.74-0.84) and 0.95 (95% CI 0.92-0.98), respectively. The Tier 1 and Tier 2 external validations had AUCs of 0.79 (95% CI 0.74-0.84) and 0.97 (95% CI 0.95-0.99), respectively. CONCLUSIONS Our results demonstrate the validity of the clinical decision support system and mobile app, which are now ready to assist health care providers in making evidence-based decisions when managing COVID-19 patient care. The deployment of these new capabilities has potential for immediate impact in community clinics and sites, where application of these tools could lead to improvements in patient outcomes and cost containment.
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Affiliation(s)
- Michael P McRae
- Department of Biomaterials, Bioengineering Institute, New York University College of Dentistry, New York, NY, United States
| | - Isaac P Dapkins
- Department of Population Health and Internal Medicine, Family Health Centers at NYU Langone, New York University School of Medicine, New York, NY, United States
| | - Iman Sharif
- Departments of Pediatrics and Population Health, Family Health Centers at NYU Langone, New York University School of Medicine, New York, NY, United States
| | - Judd Anderman
- Family Health Centers at NYU Langone, New York, NY, United States
| | - David Fenyo
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY, United States
| | - Odai Sinokrot
- Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Stella K Kang
- Department of Radiology, New York University School of Medicine, New York, NY, United States
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Nicolaos J Christodoulides
- Department of Biomaterials, Bioengineering Institute, New York University College of Dentistry, New York, NY, United States
| | - Deniz Vurmaz
- Department of Chemical and Biomolecular Engineering, NYU Tandon School of Engineering, New York University, New York, NY, United States
| | - Glennon W Simmons
- Department of Biomaterials, Bioengineering Institute, New York University College of Dentistry, New York, NY, United States
| | | | | | | | | | - John T McDevitt
- Department of Biomaterials, Bioengineering Institute, New York University College of Dentistry, New York, NY, United States
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