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Brozat JF, Haverkamp M, Hohlstein P, Adams JK, Wirtz TH, Klingel HR, Hürtgen S, Hamesch K, Bruns T, Trautwein C, Jhaisha SA, Koch A. An old foe on peculiar paths: severe falciparum malaria in a Syrian refugee, possibly infected during migrant smuggling from Türkiye to Germany. Infection 2023; 51:1583-1586. [PMID: 37223876 PMCID: PMC10206553 DOI: 10.1007/s15010-023-02042-7] [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: 02/14/2023] [Accepted: 04/20/2023] [Indexed: 05/25/2023]
Abstract
Infectious diseases and their imperative awareness gain major relevance through global warming and multi-continent refugee crises. Here, we demonstrate the challenges of malaria diagnosis, disease course, and treatment, including post-artesunate hemolysis in a Syrian refugee with severe falciparum malaria, most probably infected during migrant smuggling from Türkiye to Germany.
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Affiliation(s)
- Jonathan F Brozat
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, University Hospital RWTH Aachen, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Miriam Haverkamp
- Department of Infection Control and Infectious Diseases, University Hospital RWTH Aachen, RWTH Aachen, Aachen, Germany
| | - Philipp Hohlstein
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, University Hospital RWTH Aachen, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jule K Adams
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, University Hospital RWTH Aachen, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Theresa H Wirtz
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, University Hospital RWTH Aachen, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Hanna R Klingel
- Laboratory Diagnostic Center, University Hospital RWTH Aachen, RWTH Aachen, Aachen, Germany
| | - Susanne Hürtgen
- Department of Gastroenterology, Rhein-Maas Hospital, Würselen, Germany
| | - Karim Hamesch
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, University Hospital RWTH Aachen, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Tony Bruns
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, University Hospital RWTH Aachen, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christian Trautwein
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, University Hospital RWTH Aachen, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Samira Abu Jhaisha
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, University Hospital RWTH Aachen, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Alexander Koch
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, University Hospital RWTH Aachen, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Marx G, Greiner W, Juhra C, Elkenkamp S, Gensorowsky D, Lemmen SW, Englbrecht J, Dohmen S, Gottschalk A, Haverkamp M, Hempen A, Flügel-Bleienheuft C, Bause D, Schulze-Steinen H, Rademacher S, Kistermann J, Hoch S, Beckmann HJ, Lanckohr C, Lowitsch V, Peine A, Juzek-Kuepper F, Benstoem C, Sperling K, Deisz R. An innovative telemedical network to improve infectious disease management in critically ill patients and outpatients: a stepped-wedge, cluster randomized controlled trial (TELnet@NRW). J Med Internet Res 2022; 24:e34098. [PMID: 35103604 PMCID: PMC8928042 DOI: 10.2196/34098] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/10/2022] [Accepted: 01/22/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Evidence-based infectious disease and intensive care management is more relevant than ever. Medical expertise in the two disciplines is often geographically limited to university institutions. In addition, the interconnection between inpatient and outpatient care is often insufficient (e.g., no shared electronic health record, no digital transfer of patient findings). OBJECTIVE To establish and evaluate a telemedical inpatient-outpatient network based on expert teleconsultations to increase treatment quality in intensive care medicine and infectious diseases. METHODS We performed a multicentre, stepped-wedge cluster randomised trial (Feb 2017 - Jan 2020) to establish a telemedicine inpatient-outpatient network among university hospitals, hospitals, and outpatient physicians in North Rhine Westphalia, Germany. Patients ≥ 18 years of age in the intensive care unit (ICU) or consulting with a physician in the outpatient setting were eligible. We provided expert knowledge from intensivists and infectious disease specialists through advanced training courses and expert teleconsultations with 24/7/365 availability on demand resp. once per week to enhance treatment quality. The primary outcome was adherence to the ten Choosing Wisely® recommendations for infectious disease management. Guideline adherence was analysed using binary logistic regression models. RESULTS Overall, 159,424 patients (10,585 inpatients, 148,839 outpatients) from 17 hospitals and 103 outpatient physicians were included. There was a significant increase in guideline adherence in the management of Staphylococcus aureus infections (OR 4.00 [95% CI 1.83, 9.20], P<.01) and in sepsis management in critically ill patients (OR 6.82 [95% CI 1.27, 56.61], P=.04). There was a statistically non-significant decrease in sepsis related mortality from 28.8% (19/66) in the control group to 23.8% (50/210) in the intervention group. Furthermore, the extension of treatment with prophylactic antibiotics after surgery was significantly less likely (OR 9.37 [95% CI 1.52, 111.47], P=.04). Patients treated by outpatient physicians, who were regularly taking part in expert teleconsultations, were also more likely to be treated according to guideline recommendations regarding antibiotic therapy for uncomplicated upper respiratory tract infections (OR 1.34 [95% CI 1.16, 1.56], P<.01) and asymptomatic bacteriuria (OR 9.31 [95% CI 3.79, 25.94], P<.01). For the other recommendations, we found no significant effects, or we had too few observations to generate models. Key limitations of our study include selection effects due to the applied on-site triage of patients as well as the limited possibilities to control for secular effects. CONCLUSIONS Telemedicine facilitates a direct round-the-clock interaction over broad distances between intensivists or infectious disease experts and physicians who care for patients in hospitals without ready access to these experts. Expert teleconsultations increase guideline adherence and treatment quality in infectious disease and intensive care management creating added value for critically ill patients. CLINICALTRIAL ClinicalTrials.gov, NCT03137589, https://clinicaltrials.gov/ct2/show/NCT03137589.
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Affiliation(s)
- Gernot Marx
- University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen, DE
| | | | | | | | | | | | | | - Sandra Dohmen
- University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen, DE
| | | | | | - Annette Hempen
- Physician Network, Medizin und Mehr eG (MuM), Buende, DE
| | | | | | | | | | | | - Stefan Hoch
- Physician Network, Gesundheitsnetz Köln-Süd (GKS) e.V., Cologne, DE
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Paffenholz P, Peine A, Hellmich M, Paffenholz SV, Martin L, Luedde M, Haverkamp M, Roderburg C, Marx G, Heidenreich A, Trautwein C, Luedde T, Loosen SH. Perception of the 2020 SARS-CoV-2 pandemic among medical professionals in Germany: results from a nationwide online survey. Emerg Microbes Infect 2020; 9:1590-1599. [PMID: 32573350 PMCID: PMC7473195 DOI: 10.1080/22221751.2020.1785951] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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] [Indexed: 01/08/2023]
Abstract
Background: The COVID-19 pandemic represents an unprecedented global challenge and implicates a wide range of burden on medical professionals. Here, we evaluated the perception of the COVID-19 pandemic among medical professionals in Germany. Methods: A total of n = 2827 medical professionals participated in an online survey between 27 March and 11 April. Results: While most participants stated that Germany was well prepared and rated the measures taken by their employer as positive, subgroup analyses revealed decisive differences. The preventive measures were rated significantly worse by nurses compared to doctors (p < 0.001) and by participants from ambulatory healthcare centres compared to participants from maximum-care hospitals (p < 0.001). Importantly, shortage of protective medical equipment was reported more commonly in the ambulatory sector (p < 0.001) and in East German federal states (p = 0.004). Moreover, the majority of health care professionals (72.4%) reported significant restrictions of daily work routine. Finally, over 60% of medical professionals had concerns regarding their own health, which were more pronounced among female participants (p = 0.024). Conclusion: This survey may indicate starting points on how medical professionals could be supported in carrying out their important activities during the ongoing and future healthcare challenges.
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Affiliation(s)
- Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Arne Peine
- Department of Intensive Care Medicine and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Hellmich
- Faculty of Medicine, Institute for Medical Statistics and Computational Biology (IMSB), University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stella V Paffenholz
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Louis V. Gerstner Jr. Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lukas Martin
- Department of Intensive Care Medicine and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Miriam Haverkamp
- Department of Infection Control and Infectious Diseases, University Hospital RWTH Aachen, Aachen, Germany
| | - Christoph Roderburg
- Department of Gastroenterology/Hepatology, Charité University Medicine Berlin, Berlin, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Christian Trautwein
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom Luedde
- Division of Gastroenterology, Hepatology and Hepatobiliary Oncology, University Hospital RWTH Aachen, Aachen, Germany.,Clinic for Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Sven H Loosen
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany.,Clinic for Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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4
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Juzek-Küpper MF, Fussen R, Haverkamp M, Lemmen S. Antibiotic Stewardship in der Intensivmedizin. Dtsch Med Wochenschr 2018; 143:1525-1531. [PMID: 30336505 DOI: 10.1055/s-0042-109253] [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: 10/28/2022]
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Vehreschild MJGT, Haverkamp M, Biehl LM, Lemmen S, Fätkenheuer G. Vancomycin-resistant enterococci (VRE): a reason to isolate? Infection 2018; 47:7-11. [PMID: 30178076 DOI: 10.1007/s15010-018-1202-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Abstract
In recent years, an increase in invasive VRE infections has been reported worldwide, including Germany. The most common gene encoding resistance to glycopeptides is VanA, but predominant VanB clones are emerging. Although neither the incidence rates nor the exact routes of nosocomial transmission of VRE are well established, screening and strict infection control measures, e.g. single room contact isolation, use of personal protective clothing by hospital staff and intensified surface disinfection for colonized individuals, are implemented in many hospitals. At the same time, the impact of VRE infection on mortality remains unclear, with current evidence being weak and contradictory. In this short review, we aim to give an overview on the current basis of evidence on the clinical effectiveness of infection control measures intended to prevent transmission of VRE and to put these findings into a larger perspective that takes further factors, e.g. VRE-associated mortality and impact on patient care, into account.
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Affiliation(s)
- Maria J G T Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, 50924, Cologne, Germany
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Bonn-Cologne, Germany
| | - Miriam Haverkamp
- Zentralbereich für Krankenhaushygiene und Infektiologie, Uniklinik Aachen, Aachen, Germany
| | - Lena M Biehl
- Department I of Internal Medicine, University Hospital of Cologne, 50924, Cologne, Germany
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Bonn-Cologne, Germany
| | - Sebastian Lemmen
- Zentralbereich für Krankenhaushygiene und Infektiologie, Uniklinik Aachen, Aachen, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, University Hospital of Cologne, 50924, Cologne, Germany.
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Bonn-Cologne, Germany.
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6
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Peluso MJ, Tapela N, Langeveldt J, Williams ME, Mochankana K, Motseosi K, Ricci B, Rodman A, Haverkamp C, Haverkamp M, Maoto R, Luckett R, Prozesky D, Nkomazana O, Barak T. Building Health System Capacity through Medical Education: A Targeted Needs Assessment to Guide Development of a Structured Internal Medicine Curriculum for Medical Interns in Botswana. Ann Glob Health 2018; 84:151-159. [PMID: 30873812 PMCID: PMC6748212 DOI: 10.29024/aogh.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Medical internship is the final year of training before independent practice for most doctors in Botswana. Internship training in Botswana faces challenges including variability in participants’ level of knowledge and skill related to their completion of medical school in a variety of settings (both foreign and domestic), lack of planned curricular content, and limited time for structured educational activities. Data on trainees’ opinions regarding the content and delivery of graduate medical education in settings like Botswana are limited, which makes it difficult to revise programs in a learner-centered way. Objective: To understand the perceptions and experiences of a group of medical interns in Botswana, in order to inform a large curriculum initiative. Methods: We conducted a targeted needs assessment using structured interviews at one district hospital. The interview script included demographic, quantitative, and free- response questions. Fourteen interns were asked their opinions about the content and format of structured educational activities, and provided feedback on the preferred characteristics of a new curriculum. Descriptive statistics were calculated. Findings: In the current curriculum, training workshops were the highest-scored teaching format, although most interns preferred lectures overall. Specialists were rated as the most useful teachers, and other interns and medical officers were rated as average. Interns felt they had adequate exposure to content such as HIV and tuberculosis, but inadequate exposure to areas including medical emergencies, non-communicable diseases, pain management, procedural skills, X-ray and EKG interpretation, disclosing medical information, and identifying career goals. For the new curriculum, interns preferred a structured case discussion format, and a focus on clinical reasoning and procedural skills. Conclusions: This needs assessment identified several foci for development, including a shift toward interactive sessions focused on skill development, the need to empower interns and medical officers to improve teaching skills, and the value of shifting curricular content to mirror the epidemiologic transition occurring in Botswana. Interns’ input is being used to initiate a large curriculum intervention that will be piloted and scaled nationally over the next several years. Our results underscore the value of seeking the opinion of trainees, both to aid educators in building programs that serve them and in empowering them to direct their education toward their needs and goals.
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Affiliation(s)
- Michael J Peluso
- Botswana-Harvard Partnership, Gaborone, Botswana, ZA.,Department of Medicine and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, US.,Harvard Medical School, Boston, MA, US
| | - Neo Tapela
- Botswana-Harvard Partnership, Gaborone, Botswana, ZA.,Department of Medicine and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, US.,Harvard Medical School, Boston, MA, US.,Botswana Ministry of Health, Gaborone, Botswana, ZA
| | | | - Margaret E Williams
- Botswana-Harvard Partnership, Gaborone, Botswana, ZA.,Harvard Medical School, Boston, MA, US.,Department of Medicine, Scottish Livingstone Hospital, Molepolole, Botswana, ZA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, US.,The Ohio State University Wexner Medical Center, Columbus, OH, US
| | | | | | - Brian Ricci
- Botswana-Harvard Partnership, Gaborone, Botswana, ZA.,Department of Medicine, Oregon Health and Science University, Portland, OR, US
| | - Adam Rodman
- Botswana-Harvard Partnership, Gaborone, Botswana, ZA.,Harvard Medical School, Boston, MA, US.,Department of Medicine, Scottish Livingstone Hospital, Molepolole, Botswana, ZA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, US.,Department of Medicine, Oregon Health and Science University, Portland, OR, US
| | | | - Miriam Haverkamp
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana, ZA.,Botswana-UPenn Partnership, Gaborone, Botswana, ZA
| | | | - Rebecca Luckett
- Botswana-Harvard Partnership, Gaborone, Botswana, ZA.,Harvard Medical School, Boston, MA, US.,Department of Obstetrics and Gynecology, Scottish Livingstone Hospital, Molepolole, Botswana, ZA.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, US
| | - Detlef Prozesky
- Department of Medical Education, University of Botswana, Gaborone, Botswana, ZA
| | - Oathokwa Nkomazana
- Harvard Medical School, Boston, MA, US.,Faculty of Medicine, University of Botswana, Gaborone, Botswana, ZA
| | - Tomer Barak
- Botswana-Harvard Partnership, Gaborone, Botswana, ZA.,Harvard Medical School, Boston, MA, US.,Department of Medicine, Scottish Livingstone Hospital, Molepolole, Botswana, ZA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, US.,Medical Internship Training Programme, Gaborone, Botswana, ZA
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7
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Peluso MJ, Luckett R, Mantzor S, Bedada AG, Saleeb P, Haverkamp M, Mosepele M, Haverkamp C, Maoto R, Prozesky D, Tapela N, Nkomazana O, Barak T. Correction to: Strengthening medical training programmes by focusing on professional transitions: a national bridging programme to prepare medical school graduates for their role as medical interns in Botswana. BMC Med Educ 2018; 18:56. [PMID: 29587735 PMCID: PMC5872549 DOI: 10.1186/s12909-018-1169-3] [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] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
Forllowing publication of the original article [1], the first author reported that there was a typographical error in the name of one of his co-authors. The correct spelling is Alemayehu Bedada, not Alemayhu Bedada.
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Affiliation(s)
- Michael J Peluso
- Botswana-Harvard Partnership, Gaborone, Botswana.
- Department of Medicine and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, USA.
| | - Rebecca Luckett
- Botswana-Harvard Partnership, Gaborone, Botswana
- Harvard Medical School, Boston, USA
- Department of Obstetrics and Gynecology, Scottish Livingstone Hospital, Molepolole, Botswana
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Savara Mantzor
- Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Paediatrics, Princess Marina Hospital, Gaborone, Botswana
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Alemayehu G Bedada
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Paul Saleeb
- University of Maryland, College Park, MD, USA
- Botswana-University of Maryland School of Medicine Health Initiative, Gaborone, Botswana
| | - Miriam Haverkamp
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Mosepele Mosepele
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Rosa Maoto
- Medical Internship Training Programme, Gaborone, Botswana
| | - Detlef Prozesky
- Medical Internship Training Programme, Gaborone, Botswana
- Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - Neo Tapela
- Botswana-Harvard Partnership, Gaborone, Botswana
- Department of Medicine and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, USA
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
- Botswana Ministry of Health, Gaborone, Botswana
| | - Oathokwa Nkomazana
- Medical Internship Training Programme, Gaborone, Botswana
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Tomer Barak
- Botswana-Harvard Partnership, Gaborone, Botswana
- Harvard Medical School, Boston, USA
- Medical Internship Training Programme, Gaborone, Botswana
- Department of Medicine, Scottish Livingstone Hospital, Molepolole, Botswana
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
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8
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Peluso MJ, Luckett R, Mantzor S, Bedada AG, Saleeb P, Haverkamp M, Mosepele M, Haverkamp C, Maoto R, Prozesky D, Tapela N, Nkomazana O, Barak T. Strengthening medical training programmes by focusing on professional transitions: a national bridging programme to prepare medical school graduates for their role as medical interns in Botswana. BMC Med Educ 2017; 17:261. [PMID: 29268729 PMCID: PMC5740920 DOI: 10.1186/s12909-017-1102-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 12/12/2017] [Indexed: 05/30/2023]
Abstract
BACKGROUND The improvement of existing medical training programmes in resource-constrained settings is seen as key to addressing the challenge of retaining medical graduates trained at considerable cost both in-country and abroad. In Botswana, the establishment of the national Medical Internship Training Programme (MIT) in 2014 was a first step in efforts to promote retention through the expansion and standardization of internship training, but MIT faces a major challenge related to variability between incoming trainees due to factors such as their completion of undergraduate medical training in different settings. To address this challenge, in August 2016 we piloted a bridging programme for foreign and locally trained medical graduates that aimed to facilitate their transition into internship training. This study aimed to describe the programme and evaluate its impact on the participants' self-rated perceptions of their knowledge, experience, clinical skills, and familiarity with Botswana's healthcare system. METHODS We conducted a national, intensive, two-week programme designed to facilitate the transition from medical student to intern and to prepare all incoming interns for their work in Botswana's health system. Participants included all interns entering in August 2016. Formats included lectures, workshops, simulations, discussions, and reflection-oriented activities. The Kellogg Foundation Outcomes Logic Model was used to evaluate the programme, and participants self-rated their knowledge, skills, and attitudes across each of the programme objectives on paired questionnaires before and after participation. RESULTS 48/54 participants (89%) provided paired data. Participants reported a high degree of satisfaction with the programme (mean 4.2/5). Self-rated preparedness improved after participation (mean 3.2 versus 3.7, p < 0.001), as did confidence across 18/19 knowledge/skill domains, suggesting that participants felt that the programme prepared them for their internship training. Exploratory analysis revealed that 20/25 participants (80%) reporting either no effect or a negative effect following participation had rated themselves "extremely" or "quite" prepared beforehand, suggesting the programme grounded expectations for interns who initially were overconfident. In contrast, no interns who had initially rated themselves "moderately" or "somewhat" prepared reported a decline in their self-rated sense of preparedness. Interns commented on the benefits of learning about roles/responsibilities, interacting with clinicians from Botswana's healthcare sectors, and the sense of community the programme engendered. CONCLUSIONS This programme was feasible to implement and was well-received by participants. Overall, participants perceived an enhancement of their knowledge, skills, and expectations about their role in Botswana's health system after completion of the programme. Our results are likely to be of interest to educators dedicated to training, professional transitions, and career pathways in similar settings in the region and beyond.
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Affiliation(s)
- Michael J. Peluso
- Botswana-Harvard Partnership, Gaborone, Botswana
- Department of Medicine and Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, USA
| | - Rebecca Luckett
- Botswana-Harvard Partnership, Gaborone, Botswana
- Harvard Medical School, Boston, USA
- Department of Obstetrics and Gynecology, Scottish Livingstone Hospital, Molepolole, Botswana
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Savara Mantzor
- Children’s Hospital of Philadelphia, Philadelphia, USA
- Department of Paediatrics, Princess Marina Hospital, Gaborone, Botswana
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Alemayhu G. Bedada
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Paul Saleeb
- University of Maryland, College Park, MD USA
- Botswana-University of Maryland School of Medicine Health Initiative, Gaborone, Botswana
| | - Miriam Haverkamp
- Botswana-UPenn Partnership, Gaborone, Botswana
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Mosepele Mosepele
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Rosa Maoto
- Medical Internship Training Programme, Gaborone, Botswana
| | - Detlef Prozesky
- Medical Internship Training Programme, Gaborone, Botswana
- Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - Neo Tapela
- Botswana-Harvard Partnership, Gaborone, Botswana
- Department of Medicine and Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, USA
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
- Botswana Ministry of Health, Gaborone, Botswana
| | - Oathokwa Nkomazana
- Medical Internship Training Programme, Gaborone, Botswana
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Tomer Barak
- Botswana-Harvard Partnership, Gaborone, Botswana
- Harvard Medical School, Boston, USA
- Medical Internship Training Programme, Gaborone, Botswana
- Department of Medicine, Scottish Livingstone Hospital, Molepolole, Botswana
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
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9
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Peluso M, Haverkamp C, Tapela N, Maoto R, Bedada A, Mantzor S, Luckett R, Saleeb P, Haverkamp M, Mosepele M, Prozesky D, Nkomazana O, Barak T. Stronger Training Programs for Better Transitions and Improved Retention:
The Experience of a Bridging Program to Facilitate the Transition from
Medical School to Internship Training in Botswana. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.049] [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: 11/26/2022] Open
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10
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Peluso M, Langeveldt J, Mochankana K, Haverkamp M, Williams M, Rodman A, Ricci B, Maoto R, Prozesky D, Nkomazana O, Luckett R, Tapela N, Barak T. Assessing the Impact of Standardized Educational Curriculum Modules on
Medical Interns’ Preparedness for Independent Practice in Botswana. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.288] [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: 10/19/2022] Open
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11
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Solano-Aguilar G, Molokin A, Botelho C, Fiorino AM, Vinyard B, Li R, Chen C, Urban J, Dawson H, Andreyeva I, Haverkamp M, Hibberd PL. Transcriptomic Profile of Whole Blood Cells from Elderly Subjects Fed Probiotic Bacteria Lactobacillus rhamnosus GG ATCC 53103 (LGG) in a Phase I Open Label Study. PLoS One 2016; 11:e0147426. [PMID: 26859761 PMCID: PMC4747532 DOI: 10.1371/journal.pone.0147426] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 12/31/2015] [Indexed: 02/07/2023] Open
Abstract
We examined gene expression of whole blood cells (WBC) from 11 healthy elderly volunteers participating on a Phase I open label study before and after oral treatment with Lactobacillus rhamnosus GG-ATCC 53103 (LGG)) using RNA-sequencing (RNA-Seq). Elderly patients (65–80 yrs) completed a clinical assessment for health status and had blood drawn for cellular RNA extraction at study admission (Baseline), after 28 days of daily LGG treatment (Day 28) and at the end of the study (Day 56) after LGG treatment had been suspended for 28 days. Treatment compliance was verified by measuring LGG-DNA copy levels detected in host fecal samples. Normalized gene expression levels in WBC RNA were analyzed using a paired design built within three analysis platforms (edgeR, DESeq2 and TSPM) commonly used for gene count data analysis. From the 25,990 transcripts detected, 95 differentially expressed genes (DEGs) were detected in common by all analysis platforms with a nominal significant difference in gene expression at Day 28 following LGG treatment (FDR<0.1; 77 decreased and 18 increased). With a more stringent significance threshold (FDR<0.05), only two genes (FCER2 and LY86), were down-regulated more than 1.5 fold and met the criteria for differential expression across two analysis platforms. The remaining 93 genes were only detected at this threshold level with DESeq2 platform. Data analysis for biological interpretation of DEGs with an absolute fold change of 1.5 revealed down-regulation of overlapping genes involved with Cellular movement, Cell to cell signaling interactions, Immune cell trafficking and Inflammatory response. These data provide evidence for LGG-induced transcriptional modulation in healthy elderly volunteers because pre-treatment transcription levels were restored at 28 days after LGG treatment was stopped. To gain insight into the signaling pathways affected in response to LGG treatment, DEG were mapped using biological pathways and genomic data mining packages to indicate significant biological relevance. Trial Registration: ClinicalTrials.gov NCT01274598
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Affiliation(s)
- Gloria Solano-Aguilar
- Diet, Genomics, and Immunology Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland, United States of America
- * E-mail:
| | - Aleksey Molokin
- Diet, Genomics, and Immunology Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland, United States of America
| | - Christine Botelho
- Division of Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Anne-Maria Fiorino
- Division of Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Bryan Vinyard
- Statistics Group, Northeast Area, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland, United States of America
| | - Robert Li
- Animal Genomics and Improvement Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland, United States of America
| | - Celine Chen
- Diet, Genomics, and Immunology Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland, United States of America
| | - Joseph Urban
- Diet, Genomics, and Immunology Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland, United States of America
| | - Harry Dawson
- Diet, Genomics, and Immunology Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland, United States of America
| | - Irina Andreyeva
- Division of Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Miriam Haverkamp
- Division of Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Patricia L. Hibberd
- Division of Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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12
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Russo G, Paganotti GM, Soeria-Atmadja S, Haverkamp M, Ramogola-Masire D, Vullo V, Gustafsson LL. Pharmacogenetics of non-nucleoside reverse transcriptase inhibitors (NNRTIs) in resource-limited settings: Influence on antiretroviral therapy response and concomitant anti-tubercular, antimalarial and contraceptive treatments. Infect Genet Evol 2015; 37:192-207. [PMID: 26602158 DOI: 10.1016/j.meegid.2015.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 01/11/2023]
Abstract
The burden of human immunodeficiency virus (HIV) is mainly concentrated to resources-limited countries where the response to available antiretroviral therapy is often limited by the occurrence of toxicity or by the emergence of HIV drug resistance. Efavirenz and nevirapine are the antiretroviral drugs most prescribed in resources-limited countries as part of antiretroviral combination therapy. Their metabolism and conjugation are largely influenced by enzymatic genetic polymorphisms. The genetic variability of their metabolism could be associated to different metabolic phenotypes causing reduced patients' adherence because of toxicity or drug-drug interactions with concomitant therapies. The purpose of this review is to summarize published evidence on pharmacogenetic and pharmacokinetic aspects related to efavirenz and nevirapine, the influence of concomitant anti-tubercular, anti-malarial or contraceptive treatments, and the impact of human genetic variation and drug-drug interaction on the virologic and immunologic response to antiretroviral therapy in resources-limited countries.
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Affiliation(s)
- Gianluca Russo
- Department of Public Health and Infectious Diseases, University "La Sapienza", P.le Aldo Moro 5, 00185 Rome, Italy
| | - Giacomo Maria Paganotti
- Botswana-University of Pennsylvania Partnership, P.O. Box AC 157 ACH, Gaborone, Botswana; Medical Education Partnership Laboratory, c/o Faculty of Medicine, University of Botswana, Pvt Bag 00713, Gaborone, Botswana.
| | - Sandra Soeria-Atmadja
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, B57, SE-141 86, Stockholm, Sweden
| | - Miriam Haverkamp
- Botswana-University of Pennsylvania Partnership, P.O. Box AC 157 ACH, Gaborone, Botswana
| | - Doreen Ramogola-Masire
- Botswana-University of Pennsylvania Partnership, P.O. Box AC 157 ACH, Gaborone, Botswana
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, University "La Sapienza", P.le Aldo Moro 5, 00185 Rome, Italy
| | - Lars Lennart Gustafsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden
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13
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Molefi M, Chofle AA, Molloy SF, Kalluvya S, Changalucha JM, Cainelli F, Leeme T, Lekwape N, Goldberg DW, Haverkamp M, Bisson GP, Perfect JR, Letang E, Fenner L, Meintjes G, Burton R, Makadzange T, Ndhlovu CE, Hope W, Harrison TS, Jarvis JN. AMBITION-cm: intermittent high dose AmBisome on a high dose fluconazole backbone for cryptococcal meningitis induction therapy in sub-Saharan Africa: study protocol for a randomized controlled trial. Trials 2015; 16:276. [PMID: 26081985 PMCID: PMC4479349 DOI: 10.1186/s13063-015-0799-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 06/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cryptococcal meningitis (CM) is a leading cause of mortality among HIV-infected individuals in Africa. Poor outcomes from conventional antifungal therapies, unavailability of flucytosine, and difficulties administering 14 days of amphotericin B are key drivers of this mortality. Novel treatment regimes are needed. This study examines whether short-course high-dose liposomal amphotericin B (AmBisome), given with high dose fluconazole, is non-inferior (in terms of microbiological and clinical endpoints) to standard-dose 14-day courses of AmBisome plus high dose fluconazole for treatment of HIV-associated CM. METHODOLOGY/DESIGN This is an adaptive open-label phase II/III randomised non-inferiority trial comparing alternative short course AmBisome regimens. Step 1 (phase II) will compare four treatment arms in 160 adult patients (≥ 18 years old) with a first episode of HIV-associated CM, using early fungicidal activity (EFA) as the primary outcome: 1) AmBisome 10 mg/kg day one (single dose); 2) AmBisome 10 mg/kg day one and AmBisome 5 mg/kg day three (two doses); 3) AmBisome 10 mg/kg day one, and AmBisome 5 mg/kg days three and seven (three doses); and 4) AmBisome 3 mg/kg/d for 14 days (control); all given with fluconazole 1200 mg daily for 14 days. STEP 2 (phase III) will enrol 300 participants and compare two treatment arms using all-cause mortality within 70 days as the primary outcome: 1) the shortest course AmBisome regimen found to be non-inferior in terms of EFA to the 14-day control arm in STEP 1, and 2) AmBisome 3 mg/kg/d for 14 days (control), both given with fluconazole 1200 mg daily for 14 days. STEP 2 analysis will include all patients from STEP 1 and STEP 2 taking the STEP 2 regimens. All patients will be followed for ten weeks, and mortality and safety data recorded. All patients will receive consolidation therapy with fluconazole 400-800 mg daily and ART in accordance with local guidelines. The primary analysis (for both STEP 1 and STEP 2) will be intention-to-treat. TRIAL REGISTRATION ISRCTN10248064. Date of Registration: 22 January 2014.
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Affiliation(s)
- Mooketsi Molefi
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, P.O.Box 1357 ABG, Gaborone, Botswana.
- Botswana-Upenn Partnership, Gaborone, Botswana.
| | - Awilly A Chofle
- Bugando Medical Centre, Mwanza, Tanzania.
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania.
| | - Síle F Molloy
- Research Centre for Infection and Immunity, St. George's University of London, London, UK.
| | | | - John M Changalucha
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania.
| | - Francesca Cainelli
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, P.O.Box 1357 ABG, Gaborone, Botswana.
| | | | | | | | - Miriam Haverkamp
- Botswana-Upenn Partnership, Gaborone, Botswana.
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | - Gregory P Bisson
- Botswana-Upenn Partnership, Gaborone, Botswana.
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | - John R Perfect
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Emili Letang
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania.
- ISGLOBAL, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
| | - Lukas Fenner
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Graeme Meintjes
- Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa.
- Department of Medicine, Imperial College London, London, UK.
| | - Rosie Burton
- Department of Medicine, Khayelitsha Hospital, Khayelitsha, Cape Town, South Africa.
| | - Tariro Makadzange
- Ragon Institute of MGH, MIT, Harvard Cambridge, MA, USA.
- Department of Medicine, University of Zimbabwe College of Health Sciences, Parirenyatwa Hospital, Harare, Zimbabwe.
| | - Chiratidzo E Ndhlovu
- Department of Medicine, University of Zimbabwe College of Health Sciences, Parirenyatwa Hospital, Harare, Zimbabwe.
| | - William Hope
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
| | - Thomas S Harrison
- Research Centre for Infection and Immunity, St. George's University of London, London, UK.
| | - Joseph N Jarvis
- Botswana-Upenn Partnership, Gaborone, Botswana.
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Solano‐Aguilar G, Molokin A, Botelho C, Fiorino A, Vinyard B, Urban J, Haverkamp M, Hibberd P. Lactobacillus rhamnosus
GG ATCC 53103 (LGG) as an Immune Adjuvant for Influenza Vaccination in the Elderly. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.593.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Aleksey Molokin
- Beltsville Human Nutrition Research Center USDA‐ARSBeltsvilleMarylandUnited States
| | - Christine Botelho
- Division of Global HealthDepartment of Pediatrics Massachusetts General HospitalBostonMassachusettsUnited States
| | - Anne‐Maria Fiorino
- Division of Global HealthDepartment of Pediatrics Massachusetts General HospitalBostonMassachusettsUnited States
| | - Bryan Vinyard
- Biometrical Consulting ServiceUSDA‐ARSBelstvilleMarylandUnited States
| | - Joseph Urban
- Beltsville Human Nutrition Research Center USDA‐ARSBeltsvilleMarylandUnited States
| | - Miriam Haverkamp
- Division of Global HealthDepartment of Pediatrics Massachusetts General HospitalBostonMassachusettsUnited States
| | - Patricia Hibberd
- Division of Global HealthDepartment of Pediatrics Massachusetts General HospitalBostonMassachusettsUnited States
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15
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Hibberd PL, Kleimola L, Fiorino AM, Botelho C, Haverkamp M, Andreyeva I, Poutsiaka D, Fraser C, Solano-Aguilar G, Snydman DR. No evidence of harms of probiotic Lactobacillus rhamnosus GG ATCC 53103 in healthy elderly-a phase I open label study to assess safety, tolerability and cytokine responses. PLoS One 2014; 9:e113456. [PMID: 25438151 PMCID: PMC4249962 DOI: 10.1371/journal.pone.0113456] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 07/28/2014] [Accepted: 10/25/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although Lactobacillus rhamnosus GG ATCC 53103 (LGG) has been consumed by 2 to 5 million people daily since the mid 1990s, there are few clinical trials describing potential harms of LGG, particularly in the elderly. OBJECTIVES The primary objective of this open label clinical trial is to assess the safety and tolerability of 1×1010 colony forming units (CFU) of LGG administered orally twice daily to elderly volunteers for 28 days. The secondary objectives were to evaluate the effects of LGG on the gastrointestinal microbiome, host immune response and plasma cytokines. METHODS Fifteen elderly volunteers, aged 66-80 years received LGG capsules containing 1×1010 CFU, twice daily for 28 days and were followed through day 56. Volunteers completed a daily diary, a telephone call on study days 3, 7 and 14 and study visits in the Clinical Research Center at baseline, day 28 and day 56 to determine whether adverse events had occurred. Assessments included prompted and open-ended questions. RESULTS There were no serious adverse events. The 15 volunteers had a total of 47 events (range 1-7 per volunteer), 39 (83%) of which were rated as mild and 40% of which were considered related to consuming LGG. Thirty-one (70%) of the events were expected, prompted symptoms while 16 were unexpected events. The most common adverse events were gastrointestinal (bloating, gas, and nausea), 27 rated as mild and 3 rated as moderate. In the exploratory analysis, the pro-inflammatory cytokine interleukin 8 decreased during LGG consumption, returning towards baseline one month after discontinuing LGG (p = 0.038) while there was no difference in other pro- or anti-inflammatory plasma cytokines. CONCLUSIONS Lactobacillus rhamnosus GG ATCC 53103 is safe and well tolerated in healthy adults aged 65 years and older. TRIAL REGISTRATION ClinicalTrials.gov NCT 01274598.
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Affiliation(s)
- Patricia L. Hibberd
- Division of Global Health, Massachusetts General Hospital for Children, Boston, MA, United States of America
- * E-mail:
| | - Lauren Kleimola
- Division of Global Health, Massachusetts General Hospital for Children, Boston, MA, United States of America
| | - Anne-Maria Fiorino
- Division of Global Health, Massachusetts General Hospital for Children, Boston, MA, United States of America
| | - Christine Botelho
- Division of Global Health, Massachusetts General Hospital for Children, Boston, MA, United States of America
| | - Miriam Haverkamp
- Division of Global Health, Massachusetts General Hospital for Children, Boston, MA, United States of America
| | - Irina Andreyeva
- Division of Global Health, Massachusetts General Hospital for Children, Boston, MA, United States of America
| | - Debra Poutsiaka
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, United States of America
| | - Claire Fraser
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Gloria Solano-Aguilar
- United States Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, Diet, Genomics, and Immunology Laboratory, Beltsville, MD, United States of America
| | - David R. Snydman
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, United States of America
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16
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Madzimbamuto FD, Ray SC, Mogobe KD, Ramogola-Masire D, Phillips R, Haverkamp M, Mokotedi M, Motana M. A root-cause analysis of maternal deaths in Botswana: towards developing a culture of patient safety and quality improvement. BMC Pregnancy Childbirth 2014; 14:231. [PMID: 25030702 PMCID: PMC4223720 DOI: 10.1186/1471-2393-14-231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 07/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background In 2007, 95% of women in Botswana delivered in health facilities with 73% attending at least 4 antenatal care visits. HIV-prevalence in pregnant women was 28.7%. The maternal mortality ratio in 2010 was 163 deaths per 100 000 live births versus the government target of 130 for that year, indicating that the Millennium Development Goal 5 was unlikely to be met. A root-cause analysis was carried out with the aim of determining the underlying causes of maternal deaths reported in 2010, to categorise contributory factors and to prioritise appropriate interventions based on the identified causes, to prevent further deaths. Methods Case-notes for maternal deaths were reviewed by a panel of five clinicians, initially independently then discussed together to achieve consensus on assigning contributory factors, cause of death and whether each death was avoidable or not at presentation to hospital. Factors contributing to maternal deaths were categorised into organisational/management, personnel, technology/equipment/supplies, environment and barriers to accessing healthcare. Results Fifty-six case notes were available for review from 82 deaths notified in 2010, with 0–4 contributory factors in 19 deaths, 5–9 in 27deaths and 9–14 in nine. The cause of death in one case was not ascertainable since the notes were incomplete. The high number of contributory factors demonstrates poor quality of care even where deaths were not avoidable: 14/23 (61%) of direct deaths were considered avoidable compared to 12/32 (38%) indirect deaths. Highest ranking categories were: failure to recognise seriousness of patients’ condition (71% of cases); lack of knowledge (67%); failure to follow recommended practice (53%); lack of or failure to implement policies, protocols and guidelines (44%); and poor organisational arrangements (35%). Half the deaths had some barrier to accessing health services. Conclusions Root-cause analysis demonstrates the interactions between patients, health professionals and health system in generating adverse outcomes for patients. The lessons provided indicate where training of undergraduate and postgraduate medical, midwifery and nursing students need to be intensified, with emphasis on evidence-based practice and adherence to protocols. Action plans and interventions aimed at changing the circumstances that led to maternal deaths can be implemented and re-evaluated.
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17
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Verma K, Haverkamp M, Kayembe M, Musimar Z. Chylothorax associated with non-endemic Kaposi’s sarcoma. South Afr J HIV Med 2013. [DOI: 10.4102/sajhivmed.v14i3.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Chylothorax is a rare cause of pleural effusion, seen in approximately 2% of cases. In HIV-positive patients with Kaposi’s sarcoma (KS), the development of chylothorax presents as a diagnostic challenge with an aggressive course and poor, often lethal outcome. In this clinical scenario, the aetiology of chylothorax may include infections and malignancy, while pleural fluid examination and computed tomography of the mediastinum may fail to establish a cause. We present a case of KS-associated non-traumatic chylothorax resulting in death, and a review of available literature on this condition.
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18
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Sunamura M, Ter Hoeve N, van den Berg-Emons HJG, Haverkamp M, Redekop K, Geleijnse ML, Stam HJ, Boersma E, van Domburg RT. OPTImal CArdiac REhabilitation (OPTICARE) following Acute Coronary Syndromes: Rationale and design of a randomised, controlled trial to investigate the benefits of expanded educational and behavioural intervention programs. Neth Heart J 2013; 21:324-30. [PMID: 23700038 PMCID: PMC3722380 DOI: 10.1007/s12471-013-0422-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The majority of cardiac rehabilitation (CR) referrals consist of patients who have survived an acute coronary syndrome (ACS). Although major changes have been implemented in ACS treatment since the 1980s, which highly influenced mortality and morbidity, CR programs have barely changed and only few data are available on the optimal CR format in these patients. We postulated that standard CR programs followed by relatively brief maintenance programs and booster sessions, including behavioural techniques and focusing on incorporating lifestyle changes into daily life, can improve long-term adherence to lifestyle modifications. These strategies might result in improved (cardiac) mortality and morbidity in a cost-effective fashion. In the OPTImal CArdiac REhabilitation (OPTICARE) trial we will assess the effects of two advanced and extended CR programs that are designed to stimulate permanent adaption of a heart-healthy lifestyle, compared with current standard CR, in ACS patients. We will study the effects in terms of cardiac risk profile, levels of daily physical activity, quality of life and health care consumption.
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Affiliation(s)
- M Sunamura
- Capri Cardiac Rehabilitation Rotterdam, Parklaan 38, 3016 BC Rotterdam, the Netherlands,
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Abstract
There is a paucity of research demonstrating how HIV-funded services in Africa have improved equity and access to non-HIV services for both HIV-infected and uninfected patients. In this short communication, we describe the impact of an airborne outreach program to provide HIV services to high-HIV burden health facilities in rural Botswana. The analysis demonstrates how this HIV-funded program enhanced access to essential subspecialist services at several rural health facilities across Botswana.
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Affiliation(s)
- Michael J. A. Reid
- Botswana UPenn Partnership, Gaborone, Botswana
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Miriam Haverkamp
- Botswana UPenn Partnership, Gaborone, Botswana
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Brianna L. Kirk
- Baylor College of Medicine, International Pediatric AIDS Initiative, Houston, TX, USA
- Botswana-Baylor Children's Clinical Center of Excellence, Gaborone, Botswana
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20
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Solano‐Aguilar GI, Molokin A, Botelho C, Fiorino A, Chen C, Urban J, Dawson H, Haverkamp M, Wang L, Hibberd P. Measurement of the whole blood transcriptomic signatures in healthy elderly subjects fed the probiotic bacteria
Lactobacillus rhamnosus
GG ATCC 53103 (LGG). FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.1079.64] [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: 11/11/2022]
Affiliation(s)
| | - Aleksey Molokin
- Beltsville Human Nutrition Research Center, ARS‐USDABeltsvilleMD
| | - Christine Botelho
- Division of Global HealthMassachusetts General Hospital for ChildrenBostonMA
| | - Anne‐Maria Fiorino
- Division of Global HealthMassachusetts General Hospital for ChildrenBostonMA
| | - Celine Chen
- Beltsville Human Nutrition Research Center, ARS‐USDABeltsvilleMD
| | - Joseph Urban
- Beltsville Human Nutrition Research Center, ARS‐USDABeltsvilleMD
| | - Harry Dawson
- Beltsville Human Nutrition Research Center, ARS‐USDABeltsvilleMD
| | - Miriam Haverkamp
- Division of Global HealthMassachusetts General Hospital for ChildrenBostonMA
| | - Linda Wang
- Division of Global HealthMassachusetts General Hospital for ChildrenBostonMA
| | - Patricia Hibberd
- Division of Global HealthMassachusetts General Hospital for ChildrenBostonMA
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Abstract
The question as to whether shock-type whole-body vibration causes increasingly acute strain was investigated. Random vibrations were superimposed with shocks differing in amplitude and in number per unit of time in a systematic manner. The weighted root mean square (rms) acceleration was kept constant in all over the varied experiments. A total of 17 men were exposed to vibration from an electrohydraulic simulator. The following strain criteria were used: biodynamic behavior of the trunk and the head, electrical activity of the muscles of the back and the neck, subjective sensation, skin temperature in the lumbar area and visual and tracking performance. It was found that increasing shock amplitude and, in some experiments, also increasing numbers of shocks led to increasingly acute effects that varied, depending on the kind of shock used. New methods should be developed for the assessment of transient vibration that are better than the existing standards.
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Affiliation(s)
- H Dupuis
- Institut für Arbeits- und Sozialmedizin, Johannes Gutenberg-Universität, Mainz, Federal Republic of Germany
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