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Zimmerman A, Minnig MC, Meela J, Tupetz A, Bettger JP, Nickenig Vissoci JR, Staton C. A systematic review and cross-sectional survey of rehabilitation resources for injury patients in the Kilimanjaro Region of Tanzania. Disabil Rehabil 2024; 46:1045-1052. [PMID: 36803149 PMCID: PMC10468893 DOI: 10.1080/09638288.2023.2179674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE An estimated 10 million people across Tanzania have a condition that would benefit from rehabilitative care. However, access to rehabilitation remains inadequate to meet the needs of Tanzania's population. The goal of this study was to identify and characterize rehabilitation resources available to injury patients in the Kilimanjaro region of Tanzania. METHODS We used two approaches to identify and characterize rehabilitation services. First, we conducted a systematic review of peer-reviewed and gray literature. Second, we administered a questionnaire to rehabilitation clinics identified through the systematic review as well as through staff at Kilimanjaro Christian Medical Centre. RESULTS Our systematic review identified eleven organizations offering rehabilitation services. Eight of these organizations responded to our questionnaire. Seven of the surveyed organizations provide care to patients with spinal cord injuries, short term disability, or permanent movement disorders. Six offer diagnostic and treatment procedures to injured and disabled patients. Six offer homecare support. Two require no payment. Only three accept health insurance. None offer financial support. CONCLUSIONS There is a sizable portfolio of health clinics offering rehabilitation services to injury patients in the Kilimanjaro region. However, there remains an ongoing need to connect more patients in the region to long-term rehabilitative care.IMPLICATIONS FOR REHABILITATIONInjury is a leading cause of death and disability worldwide and disproportionately affects populations in low- and middle-income countries (LMICs).Rehabilitation is an essential component of injury care, yet an estimated 50% of patients in LMICs who need rehabilitation do not receive it.This study offers insight into the availability and use of rehabilitative services in an LMIC with a substantial injury burden.
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Affiliation(s)
| | | | - Joseph Meela
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Anna Tupetz
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
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Serrão-Pinto T, Strand E, Rocha G, Sachett A, Saturnino J, Seabra de Farias A, Alencar A, Brito-Sousa JD, Tupetz A, Ramos F, Teixeira E, Staton C, Vissoci J, Gerardo CJ, Wen FH, Sachett J, Monteiro WM. Development and validation of a minimum requirements checklist for snakebite envenoming treatment in the Brazilian Amazonia. PLoS Negl Trop Dis 2024; 18:e0011921. [PMID: 38241387 PMCID: PMC10829989 DOI: 10.1371/journal.pntd.0011921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/31/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Currently, antivenoms are the only specific treatment available for snakebite envenoming. In Brazil, over 30% of patients cannot access antivenom within its critical care window. Researchers have therefore proposed decentralizing to community health centers to decrease time-to-care and improve morbidity and mortality. Currently, there is no evidence-based method to evaluate the capacity of health units for antivenom treatment, nor what the absolute minimum supplies and staff are necessary for safe and effective antivenom administration and clinical management. METHODS This study utilized a modified-Delphi approach to develop and validate a checklist to evaluate the minimum requirements for health units to adequately treat snakebite envenoming in the Amazon region of Brazil. The modified-Delphi approach consisted of four rounds: 1) iterative development of preliminary checklist by expert steering committee; 2) controlled feedback on preliminary checklist via expert judge survey; 3) two-phase nominal group technique with new expert judges to resolve pending items; and 4) checklist finalization and closing criteria by expert steering committee. The measure of agreement selected for this study was percent agreement defined a priori as ≥75%. RESULTS A valid, reliable, and feasible checklist was developed. The development process highlighted three key findings: (1) the definition of community health centers and its list of essential items by expert judges is consistent with the Brazilian Ministry of Health, WHO snakebite strategic plan, and a general snakebite capacity guideline in India (internal validity), (2) the list of essential items for antivenom administration and clinical management is feasible and aligns with the literature regarding clinical care (reliability), and (3) engagement of local experts is critical to developing and implementing an antivenom decentralization strategy (feasibility). CONCLUSION This study joins an international set of evidence advocating for decentralization, adding value in its definition of essential care items; identification of training needs across the care continuum; and demonstration of the validity, reliability, and feasibility provided by engaging local experts. Specific to Brazil, further added value comes in the potential use of the checklist for health unit accreditation as well as its applications to logistics and resource distribution. Future research priorities should apply this checklist to health units in the Amazon region of Brazil to determine which community health centers are or could be capable of receiving antivenom and translate this expert-driven checklist and approach to snakebite care in other settings or other diseases in low-resource settings.
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Affiliation(s)
- Thiago Serrão-Pinto
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Faculdade de Ciências Farmacêuticas, Universidade Federal do Amazonas, Manaus, Brazil
| | - Eleanor Strand
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Gisele Rocha
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - André Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Joseir Saturnino
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Altair Seabra de Farias
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Aline Alencar
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - José Diego Brito-Sousa
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Anna Tupetz
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Flávia Ramos
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Elizabeth Teixeira
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Catherine Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - João Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Charles J. Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Fan Hui Wen
- Instituto Butantan, São Paulo, São Paulo, Brazil
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Wuelton M. Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
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Prattipati S, Tarimo TG, Kweka GL, Mlangi JJ, Samuel D, Sakita FM, Tupetz A, Bettger JP, Thielman NM, Temu G, Hertz JT. Patient and provider perspectives on barriers to myocardial infarction care among persons with human immunodeficiency virus in Tanzania: A qualitative study. Int J STD AIDS 2024; 35:18-24. [PMID: 37703080 DOI: 10.1177/09564624231199507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION People with HIV (PLWH) have an increased risk myocardial infarction (MI), and evidence suggests that MI is under-diagnosed in Tanzania. However, little is known about barriers to MI care among PLWH in the region. METHODS In this qualitative study grounded in phenomenology, semi-structured interviews were conducted in northern Tanzania. Purposive sampling was used to recruit a diverse group of providers who care for PLWH and patients with HIV and electrocardiographic evidence of prior MI. Emergent themes were identified via inductive thematic analysis. RESULTS 24 physician and patient participants were interviewed. Most participants explained MI as caused by emotional shock and were unaware of the association between HIV and increased MI risk. Providers described poor provider training regarding MI, high out-of-pocket costs, and lack of diagnostic equipment and medications. Patients reported little engagement with and limited knowledge of cardiovascular care, despite high engagement with HIV care. Most provider and patient participants indicated that they would prefer to integrate cardiovascular care with routine HIV care. CONCLUSIONS PLWH face many barriers to MI care in Tanzania. There is a need for multifaceted interventions to educate providers and patients, improve access to MI diagnosis, and increase engagement with cardiovascular care among this population.
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Affiliation(s)
| | | | | | | | | | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Janet P Bettger
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA, USA
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gloria Temu
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
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Hosaka L, Tupetz A, Sakita FM, Shayo F, Staton C, Mmbaga BT, Joiner AP. A qualitative assessment of stakeholder perspectives on barriers and facilitators to emergency care delays in Northern Tanzania through the Three Delays. Afr J Emerg Med 2023; 13:191-198. [PMID: 37456586 PMCID: PMC10344688 DOI: 10.1016/j.afjem.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/09/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Emergency conditions cause a significant burden of death and disability, particularly in developing countries. Prehospital and Emergency Medical Services (EMS) are largely nonexistent throughout Tanzania and little is known about the community's barriers to accessing emergency care. The objective of this study was to better understand local community stakeholder perspectives on barriers, facilitators, and potential solutions surrounding emergency care in the Kilimanjaro region through the Three Delays Model framework. Methods A qualitative assessment of local stakeholders was conducted through semi-structured focus group discussions (FGDs) from February to June 2021 with five separate groups: hospital administrators, emergency hospital workers, police personnel, fire brigade personnel, and community health workers. FGDs were conducted in Kiswahili, audio recorded, and translated to English verbatim. Two research analysts separately coded the first two FGDs using both inductive and deductive thematic analysis. A final codebook was then created to analyze the remaining FGDs. Results A total of 24 participants were interviewed. Thematic analysis revealed that participants identified significant barriers within the Three Delays Model as well as identified an additional delay centered on community members and first aid provision. Perceived delays in the decision to seek care, the first delay, were financial constraints and the lack of community education on emergency conditions. Limited infrastructure and reduced transportation access were thought to contribute to the second delay. Potential barriers to receiving timely appropriate care, the third delay, included upfront payments required by hospitals and emergency department intake delays. Suggested solutions focused on increasing education and improving communication and infrastructure. Conclusion The findings outline barriers to accessing emergency care from a stakeholder perspective. These themes can support recommendations for further strengthening of the prehospital and emergency care system. Due to logistical constraints, emergency care workers interviewed were all from one hospital and patients were not included.
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Affiliation(s)
- Leah Hosaka
- University of Hawaii at Manoa School of Nursing, Honolulu, HI, United States
| | - Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Francis M. Sakita
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Durham, NC, United States
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Frida Shayo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Durham, NC, United States
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Durham, NC, United States
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Anjni Patel Joiner
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Durham, NC, United States
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
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Rocha TAH, Silva LL, Wen FH, Sachett J, Tupetz A, Staton CA, Monteiro WM, Vissoci JRN, Gerardo CJ. River dataset as a potential fluvial transportation network for healthcare access in the Amazon region. Sci Data 2023; 10:188. [PMID: 37024499 PMCID: PMC10078007 DOI: 10.1038/s41597-023-02085-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
Remote areas, such as the Amazon Forest, face unique geographical challenges of transportation-based access to health services. As transportation to healthcare in most of the Amazon Forest is only possible by rivers routes, any travel time and travel distance estimation is limited by the lack of data sources containing rivers as potential transportation routes. Therefore, we developed an approach to convert the geographical representation of roads and rivers in the Amazon into a combined, interoperable, and reusable dataset. To build the dataset, we processed and combined data from three data sources: OpenStreetMap, HydroSHEDS, and GloRiC. The resulting dataset can consider distance metrics using the combination of streets and rivers as a transportation route network for the Amazon Forest. The created dataset followed the guidelines and attributes defined by OpenStreetMap to leverage its reusability and interoperability possibilities. This new data source can be used by policymakers, health authorities, and researchers to perform time-to-care analysis in the International Amazon region.
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Affiliation(s)
- Thiago Augusto Hernandes Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America
| | - Lincoln Luís Silva
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America
- Post-Graduation Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, 87020-900, Brazil
| | - Fan Hui Wen
- Butantan Institute, São Paulo, São Paulo, 05503-900, Brazil
| | | | - Anna Tupetz
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America
| | - Catherine Ann Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America
| | - Wuelton Marcelo Monteiro
- State University of Amazonas, Manaus, Amazonas, 69750-000, Brazil
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America
| | - Charles John Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America.
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America.
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Eucker S, Tupetz A, Walker E, Frazier M, Knisely M, O'Regan A, TumSuden O, Glass O, Klasson C, Sununu C, Maxwell AM, Limkakeng A. Qualitative Analysis Of Study Participant Feedback On Emergency Department Acupuncture To Improve Trial Participation Experience. The Journal of Pain 2023. [DOI: 10.1016/j.jpain.2023.02.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Rodriguez RM, Nichol G, Eucker SA, Chang AM, O'Laughlin KN, Pauley A, Rising KL, Eswaran V, Morse D, Li C, Patel A, Duber HC, Arreguin M, Shughart L, Glidden D, Butler J, Kemball R, Chan V, Lara-Chavez C, Guth A, Olarewaju I, Morse SC, Patel A, Schaeffer K, Grau D, Arab A, Tupetz A, Walker E, Watts P, Shughart H, Yan B, Finkelstein S, Chen H, Daniels N, White J, Sarafian J, Howard L, Alali L, Agun G, Chan EA, Covington A, Klasson C. Effect of COVID-19 Vaccine Messaging Platforms in Emergency Departments on Vaccine Acceptance and Uptake: A Cluster Randomized Clinical Trial. JAMA Intern Med 2023; 183:115-123. [PMID: 36574256 PMCID: PMC9856883 DOI: 10.1001/jamainternmed.2022.5909] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Large segments of the US population's primary health care access occurs in emergency departments (EDs). These groups have disproportionately high COVID-19 vaccine hesitancy and lower vaccine uptake. OBJECTIVE To determine whether provision of COVID-19 vaccine messaging platforms in EDs increases COVID-19 vaccine acceptance and uptake in unvaccinated patients. DESIGN, SETTING, AND PARTICIPANTS This prospective cluster randomized clinical trial was conducted at 7 hospital EDs in 4 US cities from December 6, 2021, to July 28, 2022. Noncritically ill adult patients who had not previously received COVID-19 vaccines were enrolled. INTERVENTIONS A 3-pronged COVID-19 vaccine messaging platform (an English- or Spanish-language 4-minute video; a 1-page informational flyer; and a brief, scripted message from an ED physician or nurse) was delivered during patient waiting times. MAIN OUTCOMES AND MEASURES The 2 primary outcomes were (1) COVID-19 vaccine acceptance, assessed by survey responses in the ED, and (2) receipt of a COVID-19 vaccine within 30 days, ascertained by ED confirmation of vaccination, electronic health record review, and telephone follow-up. RESULTS Of the 496 participants enrolled (221 during intervention weeks and 275 during control weeks), the median (IQR) age was 39 (30-54) years, 205 (41.3%) were female, 193 (38.9%) were African American, 97 (19.6%) were Latinx, and 218 (44.0%) lacked primary care physicians. More intervention group participants, compared with control participants, stated that they would accept the vaccine in the ED (57 [25.8%] vs 33 [12.0%]; adjusted difference, 11.9 [95% CI, 4.5-19.3] percentage points; number needed to treat [NNT], 8 [95% CI, 5-22]). More intervention group participants than control participants received a COVID-19 vaccine within 30 days of their ED visit (44 [20.0%] vs 24 [8.7%]; adjusted difference, 7.9 [95% CI, 1.7-14.1] percentage points; NNT, 13 [95% CI, 7-60]). The intervention group had greater outcome effect sizes than the control group in participants who lacked a primary care physician (acceptance, 38 of 101 [37.6%] vs 16 of 117 [13.7%] [P for interaction = .004]; uptake, 31 of 101 [30.7%] vs 11 of 117 [9.4%] [P for interaction = .006]), as well as in Latinx persons (acceptance, 23 of 52 [44.2%] vs 5 of 48 [10.4%] [P for interaction = .004]; uptake, 22 of 52 [42.3%] vs 4 of 48 [8.3%] [P for interaction < .001]). CONCLUSIONS AND RELEVANCE Results of this cluster randomized clinical trial showed that with low NNT, implementation of COVID-19 vaccine messaging platforms in EDs leads to greater vaccine acceptance and uptake in unvaccinated ED patients. Broad implementation in EDs could lead to greater COVID-19 vaccine delivery to underserved populations whose primary health care access occurs in EDs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05142332.
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Affiliation(s)
- Robert M Rodriguez
- Department of Emergency Medicine, University of California, San Francisco
| | - Graham Nichol
- Center for Prehospital Emergency Care, Division of General Internal Medicine, Harborview Medical Center, University of Washington, Seattle
| | - Stephanie A Eucker
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Anna Marie Chang
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Alena Pauley
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vidya Eswaran
- Department of Emergency Medicine, University of California, San Francisco
| | - Dana Morse
- Department of Emergency Medicine, University of Washington, Seattle
| | - Cindy Li
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Ashini Patel
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Herbie C Duber
- Department of Emergency Medicine, University of Washington, Seattle
| | - Mireya Arreguin
- Department of Emergency Medicine, University of California, San Francisco
| | - Lindsey Shughart
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dave Glidden
- Department of Epidemiology & Biostatistics, University of California, San Francisco
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Gentsch AT, Butler J, O'Laughlin K, Eucker SA, Chang A, Duber H, Geyer RE, Guth A, Kanzaria HK, Pauley A, Rising KL, Chavez CL, Tupetz A, Rodriguez RM. Perspectives of COVID-19 vaccine-hesitant emergency department patients to inform messaging platforms to promote vaccine uptake. Acad Emerg Med 2023; 30:32-39. [PMID: 36310395 PMCID: PMC9874774 DOI: 10.1111/acem.14620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Efforts to promote COVID-19 vaccine acceptance must consider the critical role of the emergency department (ED) in providing health care to underserved patients. Focusing on patients who lacked primary care, we sought to elicit the perspectives of unvaccinated ED patients regarding COVID-19 vaccination concerns and potential approaches that might increase their vaccine acceptance. METHODS We conducted this qualitative interview study from August to November 2021 at four urban EDs in San Francisco, California; Seattle, Washington; Durham, North Carolina; and Philadelphia, Pennsylvania. We included ED patients who were ≥18 years old, fluent in English or Spanish, had not received a COVID-19 vaccine, and did not have primary care physicians or clinics. We excluded patients who were unable to complete an interview, in police custody, under suspicion of active COVID-19 illness, or presented with a psychiatric chief complaint. We enrolled until we reached thematic saturation in relevant domains. We analyzed interview transcripts with a content analysis approach focused on identifying concerns about COVID-19 vaccines and ideas regarding the promotion of vaccine acceptance and potential trusted messengers. RESULTS Of 65 patients enrolled, 28 (43%) identified as female, their median age was 36 years (interquartile range 29-49), and 12 (18%) interviews were conducted in Spanish. Primary concerns about COVID-19 vaccines included risk of complications, known and unknown side effects, and fear of contracting COVID-19 from vaccines. Trust played a major role for patients in deciding which sources to use for vaccine information and in engendering vaccine acceptance. Health care providers and family or friends were commonly cited as trusted messengers of information. CONCLUSIONS We characterized concerns about COVID-19 vaccines, uncovered themes that may promote vaccine acceptance, and identified trusted messengers-primarily health care professionals. These data may inform the development of nuanced COVID-19 vaccine messaging platforms to address COVID-19 vaccine hesitancy among underserved ED populations.
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Affiliation(s)
- Alexzandra T Gentsch
- Center for Connected Care, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jonathan Butler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Kelli O'Laughlin
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Stephanie A Eucker
- Department of Emergency Medicine, Duke University, Durham, North Carolina, USA
| | - AnnaMarie Chang
- Center for Connected Care, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Herbie Duber
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Rachel E Geyer
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Amanda Guth
- Center for Connected Care, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Hemal K Kanzaria
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Alena Pauley
- Department of Emergency Medicine, Duke University, Durham, North Carolina, USA
| | - Kristin L Rising
- Center for Connected Care, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Cecilia Lara Chavez
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Anna Tupetz
- Department of Emergency Medicine, Duke University, Durham, North Carolina, USA
| | - Robert M Rodriguez
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
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Strand E, Murta F, Tupetz A, Barcenas L, Phillips AJ, Farias AS, Santos AC, Rocha GDS, Staton CA, Ramos FR, Machado VA, Wen FH, Vissoci JR, Sachett J, Monteiro W, Gerardo CJ. Perspectives on snakebite envenoming care needs across different sociocultural contexts and health systems: A comparative qualitative analysis among US and Brazilian health providers. Toxicon X 2022; 17:100143. [PMID: 36578905 PMCID: PMC9791583 DOI: 10.1016/j.toxcx.2022.100143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
With the advancements in therapeutics and available treatment options, almost all deaths and permanent disabilities from snakebite envenoming (SBE) are preventable. The challenge lies in implementing these evidence-based treatments and practices across different settings and populations. This study aims to compare data on provider perceptions of SBE care across health systems and cultural contexts to inform potential implementation science approaches. We hypothesize different health systems and cultural contexts will influence specific perceived needs to provide adequate snakebite care within central tenets of care delivery (e.g., cost, access, human resources). We previously conducted exploratory descriptive studies in the US and Brazil in order to understand the experience, knowledge, and perceptions of health professionals treating SBE. In the US, in-depth interviews were performed with emergency physicians from January 2020 to March 2020. In BR, focus group discussions were conducted with health professionals from community health centers at the end of June 2021. The focus group discussions (BR) were originally analyzed through an inductive thematic analysis approach. We conducted a secondary qualitative analysis in which this codebook was then applied to the interviews (US) in a deductive content analysis. The analysis concluded in August 2022. Brazil participants were physicians (n=5) or nurses (n=20) from three municipalities in the State of Amazonas with an average of three years of professional experience. US participants were emergency physicians (n=16) with an average of 15 years of professional experience. Four main themes emerged: 1) barriers to adequate care on the patient and/or community side and 2) on the health system side, 3) perceived considerations for how to address SBE, and 4) identified needs for improving care. There were 25 subthemes within the four themes. These subthemes were largely the same across the Brazil and US data, but the rationale and content within each shared subtheme varied significantly. For example, the subtheme "role of health professionals in improving care" extended across Brazil and the US. Brazil emphasized the need for task-shifting and -sharing amongst health care disciplines, whereas the US suggested specialized approaches geared toward increasing access to toxicologists and other referral resources. Despite similar core barriers to adequate snakebite envenoming care and factors to consider when trying to improve care delivery, health professionals in different health systems and sociocultural contexts identified different needs. Accounting for, and understanding, these differences is crucial to the success of initiatives intended to strengthen snakebite envenoming care. Implementation science efforts, with explicit health professional input, should be applied to develop new and/or adapt existing evidence-based treatments and practices for SBE.
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Affiliation(s)
- Eleanor Strand
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Felipe Murta
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Anna Tupetz
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Loren Barcenas
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Ashley J. Phillips
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Altair Seabra Farias
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Alícia Cacau Santos
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Gisele dos Santos Rocha
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Catherine A. Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Flávia Regina Ramos
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Vinícius Azevedo Machado
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Fan Hui Wen
- Instituto Butantan, São Paulo, São Paulo, Brazil
| | - João R.N. Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Wuelton Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Corresponding author. Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Charles J. Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
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Beck TP, Tupetz A, Farias AS, Silva-Neto A, Rocha T, Smith ER, Murta F, Dourado FS, Cardoso D, Ramos TA, Sachett A, Pinto TS, Pucca MB, Sampaio V, Ramos F, Vissoci JN, Sachett J, Wen FH, Staton CA, Gerardo CJ, Monteiro W. Mapping of clinical management resources for snakebites and other animal envenomings in the Brazilian Amazon. Toxicon X 2022; 16:100137. [PMID: 36160931 PMCID: PMC9489497 DOI: 10.1016/j.toxcx.2022.100137] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Snakebite envenomings (SBEs) and other envenomings triggered by venomous animals (VAEs) represent a significant disease burden in Brazil, with 29,152 SBEs reported in 2021 alone with nearly half of those occurring in the remote Brazilian Amazon. In 2021, Brazil recorded 240,294 envenomings from snakes, scorpions, spiders, and caterpillars. Therefore, there is an unequal distribution of SBEs with high morbidity and mortality in the Brazilian Amazon. The severity of SBEs increases when patients require more than 6 h to access antivenom treatment, a common issue for the rural and indigenous populations. Understanding currently available resources and practices in Amazon remote areas of Brazil can serve to inform future interventions and guide health care policies. This study aims to develop a resource map of existing healthcare resources for the Brazilian Amazon's clinical management of VAEs with emphasis in SBEs, which will aid future strategic interventions. Data collection included a literature review, secondary data collected by government departments and organizational records, GIS mapping activities, and expert input. Our framework was guided by the three levels of healthcare service ecosystem analysis (macro, meso, and micro). Our resource map lays out a comprehensive overview of antivenom access, the distribution landscape, differences in patient transportation, and barriers to access healthcare that face populations in the Brazilian Amazon. In Brazil, there are financial, cultural, and logistical barriers to access antivenom. Despite antivenom manufacturing on a national scale, antivenom treatment is limited in rural areas. Indigenous and riverine populations are the most vulnerable to being deprived of proper treatment. We present a framework guided by the macro, meso, and micro levels of healthcare service. Antivenom treatment decentralization should be a priority of the health system in the Brazilian Amazon.
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Affiliation(s)
- Timothy P. Beck
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Anna Tupetz
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Altair Seabra Farias
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Alexandre Silva-Neto
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Thiago Rocha
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Emily R. Smith
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Felipe Murta
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Deugles Cardoso
- Zoonosis Department, Fundação de Vigilância Em Saúde Dra. Rosemary Costa Pinto, Manaus, Brazil
| | - Tatyana A. Ramos
- Zoonosis Department, Fundação de Vigilância Em Saúde Dra. Rosemary Costa Pinto, Manaus, Brazil
| | - André Sachett
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Thiago Serrão Pinto
- School of Pharmaceutical Sciences, Universidade Federal Do Amazonas, Manaus, Brazil
| | | | - Vanderson Sampaio
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Flavia Ramos
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - João Nickenig Vissoci
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Jacqueline Sachett
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Department of Teaching and Research, Fundação Alfredo da Matta, Manaus, Brazil
| | - Fan Hui Wen
- Butantan Institute, São Paulo, São Paulo, Brazil
| | - Catherine A. Staton
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Charles J. Gerardo
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Wuelton Monteiro
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Corresponding author. School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil.
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Tupetz A, Strand E, Hoque KI, Sultana M, Vissoci JRN, Staton C, Landry MD. Scarf Injury: a qualitative examination of the emergency response and acute care pathway from a unique mechanism of road traffic injury in Bangladesh. BMC Emerg Med 2022; 22:141. [PMID: 35922760 PMCID: PMC9351164 DOI: 10.1186/s12873-022-00698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background Road traffic injuries (RTI) are the leading cause of death worldwide in children over 5 and adults aged 18–29. Nonfatal RTIs result in 20–50 million annual injuries. In Bangladesh, a new mechanism of RTI has emerged over the past decade known as a ‘scarf injury.’ Scarf injuries occur when scarves, part of traditional female dress, are caught in the driveshaft of an autorickshaw. The mechanism of injury results in novel, strangulation-like cervical spine trauma. This study aimed to understand the immediate emergency response, acute care pathway, and subsequent functional and health outcomes for survivors of scarf injuries. Methods Key informant interviews were conducted with female scarf injury survivors (n = 12), caregivers (n = 6), and health care workers (n = 15). Themes and subthemes were identified via inductive content analysis, then applied to the three-delay model to examine specific breakdowns in pre-hospital care and provide a basis for future interventions. Findings Over half of the scarf injury patients were between the ages of 10 and 15. All but two were tetraplegic. Participants emphasized less than optimal patient outcomes were due to unawareness of scarf injuries and spinal cord injuries among the general public and health professionals; unsafe and inefficient bystander first aid and transportation; and high cost of acute health care. Conclusions Females in Bangladesh are at significant risk of sustaining serious and life-threatening trauma through scarf injuries in autorickshaws, further worsened through inadequate care along the trauma care pathway. Interventions designed to increase awareness and knowledge of basic SCI care at the community and provider level would likely improve health and functional outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00698-2.
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Affiliation(s)
- Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | - Eleanor Strand
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Mohsina Sultana
- Center for the Rehabilitation of the Paralyzed (CRP), Savar, Bangladesh.,Directorate of General Health Services (DGHS), Government of Mohakhali, Dhaka, Bangladesh
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | - Michel D Landry
- Western Norway University of Applied Sciences, Bergen, Norway. .,Virginia Commonwealth University, Richmond, VA, USA.
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12
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Seidenfeld J, Tupetz A, Fiorino C, Limkakeng A, Silva L, Staton C, Vissoci JRN, Purakal J. Experiences of COVID-19 infection in North Carolina: A qualitative analysis. PLoS One 2022; 17:e0269338. [PMID: 35653407 PMCID: PMC9162358 DOI: 10.1371/journal.pone.0269338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/18/2022] [Indexed: 11/02/2022] Open
Abstract
Background and aim
It has been demonstrated that marginalized populations across the U.S. have suffered a disproportionate burden of the coronavirus disease 2019 (COVID-19) pandemic, illustrating the role that social determinants of health play in health outcomes. To better understand how these vulnerable and high-risk populations have experienced the pandemic, we conducted a qualitative study to better understand their experiences from diagnosis through recovery.
Methods
We conducted a qualitative study of patients in a North Carolina healthcare system’s registry who tested positive for COVID-19 from March 2020 through February 2021, identified from population-dense outbreaks of COVID-19 (hotspots). We conducted semi-structured phone interviews in English or Spanish, based on patient preference, with trained bilingual study personnel. Each interview was evaluated using a combination of deductive and inductive content analysis to determine prevalent themes related to COVID-19 knowledge, diagnosis, disease experience, and long-term impacts.
Findings
The 10 patients interviewed from our COVID-19 hotspot clusters were of equal distribution by sex, predominantly Black (70%), aged 22–70 years (IQR 45–62 years), and more frequently publicly insured (50% Medicaid/Medicare, vs 30% uninsured, vs 20% private insurance). Major themes identified included prior knowledge of COVID-19 and patient perceptions of their personal risk, the testing process in numerous settings, the process of quarantining at home after a positive diagnosis, the experience of receiving medical care during their illness, and difficulties with long-term recovery.
Discussion
Our findings suggest areas for targeted interventions to reduce COVID-19 transmission in these high-risk communities, as well as improve the patient experience throughout the COVID-19 illness course.
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Affiliation(s)
- Justine Seidenfeld
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, United States of America
- * E-mail:
| | - Anna Tupetz
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Cassandra Fiorino
- Duke University School of Medicine, Durham, NC, United States of America
| | - Alexander Limkakeng
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Lincoln Silva
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Catherine Staton
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Joao R. N. Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - John Purakal
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States of America
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Tupetz A, Quirici M, Sultana M, Hoque KI, Stewart KA, Landry M. Exploring the intersection of critical disability studies, humanities and global health through a case study of scarf injuries in Bangladesh. Med Humanit 2022; 48:169-176. [PMID: 35501122 PMCID: PMC9185814 DOI: 10.1136/medhum-2021-012244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
This article puts critical disability studies and global health into conversation around the phenomenon of scarf injury in Bangladesh. Scarf injury occurs when a woman wearing a long, traditional scarf called an orna rides in a recently introduced autorickshaw with a design flaw that allows the orna to become entangled in the vehicle's driveshaft. Caught in the engine, the orna pulls the woman's neck into hyperextension, causing a debilitating high cervical spinal cord injury and quadriplegia. The circumstances of the scarf injury reveal the need for more critical cultural analysis than the fields of global health and rehabilitation typically offer. First, the fatal design flaw of the vehicle reflects different norms of gender and dress in China, where the vehicle is manufactured, versus Bangladesh, where the vehicle is purchased at a low price and assembled on-site-a situation that calls transnational capitalist modes of production and exchange into question. Second, the experiences of women with scarf injuries entail many challenges beyond the injury itself: the transition to life with disability following the rehabilitation period is made more difficult by negative perceptions of disability, lack of resources and accessible infrastructure, and cultural norms of gender and class in Bangladesh. Our cross-disciplinary conversation about women with scarf injuries, involving critical disability studies, global health and rehabilitation experts, exposes the shortcomings of each of these fields but also illustrates the urgent need for deeper and more purposeful collaborations. We, therefore, argue that the developing subfield of global health humanities should include purposeful integration of a humanities-based critical disability studies methodology.
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Affiliation(s)
- Anna Tupetz
- Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Marion Quirici
- Thompson Writing Program, Duke University, Durham, North Carolina, USA
| | - Mohsina Sultana
- Directorate of General Health Services (DGHS), Government of Mohakhali, Dhaka, Bangladesh
| | - Kazi Imdadul Hoque
- Physical Rehabilitation Program (PRP), International Committee of the Red Cross, Cox's Bazar, Bangladesh
| | | | - Michel Landry
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
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Hoff JJ, Zimmerman A, Tupetz A, Van Vleet L, Staton C, Joiner A. Shame and Guilt in EMS: A Qualitative Analysis of Culture and Attitudes in Prehospital Emergency Care. PREHOSP EMERG CARE 2022; 27:418-426. [PMID: 35522078 DOI: 10.1080/10903127.2022.2074178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Study ObjectivesThe shame reaction is a highly negative emotional reaction shown to have long-term deleterious effects on the mental health of clinicians. Prior studies have focused on in-hospital personnel, but very little is known about what drives shame reactions in emergency medical services (EMS), a field with very high rates of post-traumatic stress disorder, burnout, anxiety, and depression. The objective of this study was to describe emotions, processes, and resilience associated with self-identified adverse events in the work of prehospital clinicians.MethodsWe conducted a qualitative study using a modified critical incident technique. Participants were recruited from two EMS agencies in North Carolina: one urban and one rural. They provided an open-ended, written reflection in which they were asked to self-identify particular events in their EMS careers that felt emotionally difficult. In-person or video in-depth interviews about these events were then conducted in a semi-structured fashion using an iterative interview guide. The codebook was developed through a mix of inductive and deductive analysis strategies and discussed within the research team and a content expert for validation. Interviews were transcribed and data were analyzed following a thematic content analysis approach for types of cases identified as emotionally difficult, common emotional responses and coping mechanisms, and the lingering effects of these experiences on study subjects.ResultsEight interviews were conducted with EMS personnel: five from an urban agency and three from a rural agency. Participants commonly identified complex medical cases as being emotionally difficult, which led to the most robust shame reactions. Shame reactions were more common when EMS clinicians committed self-perceived errors in patient care, whereas guilt reactions were more common when patient outcomes seemed "inevitable" despite any intervention. Common themes related to coping mechanisms included both personal mechanisms, which tended to be less successful compared to interpersonal mechanisms, particularly when emotions were shared with colleagues. This reflected a perceived culture change within EMS in which sharing emotions with colleagues was seen as a departure from the "old school" where emotions tended to be kept to oneself. Feelings of inadequacy, low self-worth, and being "not good enough" were frequently identified as lingering emotions after difficult cases that were hard to move on from, corresponding to longstanding shame in these clinicians. Recovery and resilience varied but tended to be positively associated with a culture in which sharing with colleagues was encouraged, along with personal introspection on root causes for the sentinel event.ConclusionEMS clinicians often identify complex patient cases as those leading to emotions such as shame and guilt, with shame reactions being more common when a perceived error was committed. Coping mechanisms were varied, but individuals often relied on their co-workers in a sharing environment to adequately process their negative feelings, which was seen as a departure from past practices in EMS personnel. Our hope is that future studies will be able to use these findings to identify targets for intervention on negative mental health outcomes in EMS personnel.
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Affiliation(s)
- J J Hoff
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.,Department of Emergency Medicine, East Carolina University, Greenville, NC
| | - Armand Zimmerman
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Anna Tupetz
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Lee Van Vleet
- Duke Global Health Institute, Durham, NC.,Durham County Emergency Medical Services, Durham, NC
| | - Catherine Staton
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.,Duke Global Health Institute, Durham, NC
| | - Anjni Joiner
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.,Duke Global Health Institute, Durham, NC
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15
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Tupetz A, Barcenas LK, Phillips AJ, Vissoci JRN, Gerardo CJ. BITES study: A qualitative analysis among emergency medicine physicians on snake envenomation management practices. PLoS One 2022; 17:e0262215. [PMID: 34995326 PMCID: PMC8741014 DOI: 10.1371/journal.pone.0262215] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Antivenom is currently considered standard treatment across the full spectrum of severity for snake envenomation in the United States. Although safe and effective antivenoms exist, their use in clinical practice is not universal. OBJECTIVE This study explored physicians' perceptions of antivenom use and experience with snake envenomation treatment in order to identify factors that influence treatment decisions and willingness to administer. METHODS We conducted a qualitative study including in-depth interviews via online video conferencing with physicians practicing in emergency departments across the United States. Participants were selected based on purposive sampling methods. Data analysis followed inductive strategies, conducted by two researchers. The codebook and findings were discussed within the research team. FINDINGS Sixteen in-depth interviews with physicians from nine states across the US were conducted. The participants' specialties include emergency medicine (EM), pediatric EM, and toxicology. The experience of treating snakebites ranged from only didactic education to having treated over 100 cases. Emergent themes for this manuscript from the interview data included perceptions of antivenom, willingness to administer antivenom and influencing factors to antivenom usage. Overall, cost-related concerns were a major barrier to antivenom administration, especially in cases where the indications and effectiveness did not clearly outweigh the potential financial burden on the patient in non-life- or limb-threatening cases. The potential to decrease recovery time and long-term functional impairments was not commonly reported by participants as an indication for antivenom. In addition, level of exposure and perceived competence, based on prior education and clinical experience, further impacted the decision to treat. Resources such as Poison Center Call lines were well received and commonly used to guide the treatment plan. The need for better clinical guidelines and updated treatment algorithms with clinical and measurable indicators was stated to help the decision-making process, especially among those with low exposure to snake envenomation patients. CONCLUSIONS A major barrier to physician use of antivenom is a concern about cost, cost transparency and cost-benefit for the patients. Those concerns, in addition to the varying degrees of awareness of potential long-term benefits, further influence inconsistent clinical treatment practices.
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Affiliation(s)
- Anna Tupetz
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Loren K. Barcenas
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Ashley J. Phillips
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Charles J. Gerardo
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
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Joiner AP, Tupetz A, Peter TA, Raymond J, Macha VG, Vissoci JRN, Staton C. Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study. PLOS Glob Public Health 2022; 2:e0000277. [PMID: 36962378 PMCID: PMC10021180 DOI: 10.1371/journal.pgph.0000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 03/02/2022] [Indexed: 11/19/2022]
Abstract
Disproportionately high injury rates in Sub-Saharan Africa combined with limited access to care in both the acute injury phase and for injury patients requiring continued care after hospital discharge remains a challenge. We aimed to characterize barriers to transportation and access to care in a cohort of post-hospitalized injury patients in Moshi, Tanzania. This was a mixed-methods study of a prospective cohort of trauma registry patients presenting to Kilimanjaro Christian Medical Center between August 2018 and January 2020. We conducted standardized patient/family surveys and in-depth interviews at a 2-week follow up visit after hospital discharge, and focus groups with healthcare providers. Quantitative results were analyzed using descriptive statistics and multivariable logistic regression using R statistical software. Qualitative results were analyzed using thematic analysis through an iterative process using NVivo software. A total of 1,365 patients were enrolled in the trauma registry, with 169 patients followed up at 2 weeks. Over half of patients at follow-up, 101 (59.8%), reported challenges in traveling. The majority of patients were male (80.3%). Difficulty in traveling since injury was associated with female gender (aOR 5.85 [95% CI 1.20-33.59]) and a need for non-family members escorts for travel (aOR 7.10 [95% CI 1.43-41.66]). Those who reported assault or fall as the mechanism of injury as compared to road traffic injury and had health insurance were less likely to report challenges in traveling (aOR 0.19 [95% CI 0.03-0.90]), 0.11 [95% CI 0.01-0.61], 0.14 [95% 0.02-0.80]). Transportation barriers that emerged from qualitative data included inability to use regular means of transportation, financial challenges, physical barriers, rigid compliance to physician orders, access to healthcare, and social support barriers. Our findings demonstrate several areas to address transportation barriers for post-injury patients in Tanzania. Educational interventions such as clarification of doctors' orders of strict bedrest, provision of vouchers to support financial challenges and alternate means of transportation given physical barriers and reliance on social support may address some of these barriers.
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Affiliation(s)
- Anjni Patel Joiner
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Anna Tupetz
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | | | | | | | - João Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Catherine Staton
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
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Hoff J, Zimmerman A, Tupetz A, Staton C, Van Vleet L, Joiner A. 356EMF Shame and Error in EMS: A Qualitative Analysis of Culture and Attitudes in Prehospital Emergency Care. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Purakal J, Seidenfeld J, Tupetz A, Vissoci J, Silva L, Fiorino C, Phillips A, Limkakeng A, Staton C. 94EMF COVID-19 Infection Experiences and Social Determinants of Health in North Carolina: A Qualitative Analysis. Ann Emerg Med 2021. [PMCID: PMC8536271 DOI: 10.1016/j.annemergmed.2021.09.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Purakal J, Seidenfeld J, Tupetz A, Vissoci J, Silva L, Limkakeng A, Fiorino C, Phillips A, Staton C. 30EMF COVID-19 Infection Experiences and Social Determinants of Health in North Carolina: A Qualitative Analysis. Ann Emerg Med 2021. [PMCID: PMC8335433 DOI: 10.1016/j.annemergmed.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Purakal J, Silva L, Tupetz A, Seidenfeld J, Limkakeng A, Staton C, Vissoci J. 27EMF Social Determinants of Health and COVID-19 Infection in North Carolina: A Geospatial Analysis. Ann Emerg Med 2021. [PMCID: PMC8335497 DOI: 10.1016/j.annemergmed.2021.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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22
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Tupetz A, Friedman K, Zhao D, Liao H, Isenburg MV, Keating EM, Vissoci JRN, Staton CA. Prevention of childhood unintentional injuries in low- and middle-income countries: A systematic review. PLoS One 2020; 15:e0243464. [PMID: 33373371 PMCID: PMC7771986 DOI: 10.1371/journal.pone.0243464] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022] Open
Abstract
Injuries are a leading cause of death and disability among children. Numerous injury prevention strategies have been successful in high-income countries, but the majority of unintentional injuries happen to children living in low- and middle-income countries (LMICs). This project aims to delineate the childhood injury prevention initiatives in LMICs. For inclusion, peer-reviewed articles needed to address unintentional injury, include children <18, assess a prevention-related intervention, contain a control group, and be published after 1988. Two pairs of reviewers evaluated articles independently to determine study eligibility. 74 articles were included. 30 studies addressed road traffic injuries, 11 drowning, 8 burns, 3 falls, 8 poisonings, and 21 an unspecified injury type. The findings show positive effects on injury outcome measures following educational interventions, the need for longer follow-up periods after the intervention, the need for effectiveness trials for behavior change, and the need for an increase in injury prevention services in LMICs. This is the first systematic review to summarize the prevention initiatives for all types of childhood unintentional injuries in LMICs. Increased attention and funding are required to go beyond educational initiatives with self-reported measures and little follow-up time to robust interventions that will reduce the global burden of unintentional injuries among children.
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Affiliation(s)
- Anna Tupetz
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kaitlyn Friedman
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Duan Zhao
- Duke Kunshan University, Kunshan, Suzhou, Jiangsu, China
| | - Huipeng Liao
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Megan Von Isenburg
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Elizabeth M. Keating
- Division of Pediatric Emergency Medicine, Division of Public Health, University of Utah, Salt Lake City, Utah, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
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23
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Landry MD, Tupetz A, Jalovcic D, Sheppard P, Jesus TS, Raman SR. The Novel Coronavirus (COVID-19): Making a Connection between Infectious Disease Outbreaks and Rehabilitation. Physiother Can 2020; 72:325-327. [PMID: 35110802 PMCID: PMC8781500 DOI: 10.3138/ptc-2020-0019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Michel D. Landry
- Duke Global Health Institute
- Western Norway University of Applied Sciences, Bergen, Norway
| | - Anna Tupetz
- Department of Emergency Medicine, Duke University Health System, Durham, NC, USA
| | | | | | - Tiago S. Jesus
- WHO Collaborating Center on Health Workforce Policy and Planning, NOVA University of Lisbon, Lisbon
| | - Sudha R. Raman
- Department of Population Health Sciences, Duke University
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24
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Landry MD, Tupetz A, Jalovcic D, Sheppard P, Jesus TS, Raman SR. Le nouveau coronavirus (COVID-19) : un lien entre les éclosions de maladies infectieuses et la réadaptation. Physiother Can 2020; 72:327-329. [DOI: 10.3138/ptc-2020-0019-fr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Michel D. Landry
- Duke Global Health Institute
- Université des sciences appliquées de l’ouest de la Norvège, Bergen, Norvège
| | - Anna Tupetz
- Département de médecine d’urgence, Duke University Health System, Durham (Caroline du Nord) États-Unis
| | - Djenana Jalovcic
- Université des sciences appliquées de l’ouest de la Norvège, Bergen, Norvège
| | | | - Tiago S. Jesus
- Centre de collaboration de l’OMS pour la planification et les politiques sur les effectifs de santé, Université nouvelle de Lisbonne, Lisbonne, Portugal
| | - Sudha R. Raman
- Département des sciences de la santé en population, Duke University
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Tupetz A, Barcenas L, Phillips A, Vissoci J, Gerardo C. 145 Physician Perceptions Impacting Snake Envenomation Treatment. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Landry MD, Tupetz A. Disability and the Rohingya Displacement Crisis: A Humanitarian Priority. Arch Phys Med Rehabil 2018; 99:2122-2124. [PMID: 29969585 DOI: 10.1016/j.apmr.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Michel D Landry
- Doctor of Physical Therapy Division, Duke Global Health Institute, Duke University, Durham, NC.
| | - Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC
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