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Frechette R, Colas N, Augustin M, Edema N, Pyram G, Louis S, Crevecoeur CE, Mathurin C, Louigne R, Patel B, Humphreys M, Chapital A, Martin M, Ayoub Q, Hottinger D, McCurdy MT, Tran Q, Skupski R, Zimmer D, Walsh M. Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project. Glob Health Action 2023; 16:2180867. [PMID: 36856725 PMCID: PMC9980030 DOI: 10.1080/16549716.2023.2180867] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
In response to the 2010 earthquake and subsequent cholera epidemic, St Luke's Medical Center was established in Port-au-Prince, Haiti. Here, we describe its inception and evolution to include an intensive care unit and two operating rooms, as well as the staffing, training and experiential learning activities, which helped St Luke's become a sustainable surgical resource. We describe a three-phase model for establishing a sustainable surgical centre in Haiti (build facility and acquire equipment; train staff and perform surgeries; provide continued education and expansion including regular specialist trips) and we report a progressive increase in the number and complexity of cases performed by all-Haitian staff from 2012 to 2022. The results are generalised in the context of the 'delay framework' to global health along with a discussion of the application of this three-phase model to resource-limited environments. We conclude with a brief description of the formation of a remote surgical centre in Port-Salut, an unforeseen benefit of local competence and independence. Establishing sustainable and collaborative surgery centres operated by local staff accelerates the ability of resource-limited countries to meet high surgical burdens.
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Affiliation(s)
- Richard Frechette
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Nathalie Colas
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Marc Augustin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Nathalie Edema
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Gerson Pyram
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Stanley Louis
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Carl Eric Crevecoeur
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Carmeline Mathurin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Raphael Louigne
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Bhavesh Patel
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Mitchell Humphreys
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Alyssa Chapital
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Mallory Martin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Qamarissa Ayoub
- Bamiyan Maternal and Child Health Project and the Andeshgah Library, Kabul, Afghanistan
| | - Daniel Hottinger
- Department of Anesthesia, Metropolitan Anesthesia Network, LLP, Plymouth, MN, USA
| | - Michael T McCurdy
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Quincy Tran
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Richard Skupski
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Department of Anesthesia, Memorial Hospital Beacon Medical Group of South Bend, South Bend, IN, USA
| | - Donald Zimmer
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Department of Emergency Medicine, Memorial Hospital Beacon Medical Group of South Bend, South Bend, IN, USA
| | - Mark Walsh
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, USA
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Dainton C, Chu CH. A qualitative narrative review of protocols for women's health on short-term medical missions in Latin America and the Caribbean. Int Health 2022; 14:434-441. [PMID: 32080707 PMCID: PMC9248057 DOI: 10.1093/inthealth/ihz109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 08/16/2019] [Accepted: 12/02/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Women's health conditions are commonly encountered on short-term medical missions (STMMs) in Latin America and the Caribbean. There have been no previous attempts to describe women's health protocols used by volunteer clinicians. This qualitative study aimed to describe areas of agreement between unpublished women's health protocols from different North American STMM organizations and assess their concordance with published WHO guidelines. METHODS A systematic web search was used to identify North American STMM sending organizations. Clinical protocols were downloaded from their websites and organizations were contacted to request protocols that were not published online. The protocols obtained were summarized, analysed thematically and compared to existing WHO guidelines. RESULTS Of 225 organizations contacted, 112 (49.8%) responded and 31 of these (27.7%) had clinical protocols, of which 20 were obtained and analysed. Nine (45%) discussed sexually transmitted infections, six (30%) discussed pelvic inflammatory disease, two (10%) discussed prenatal care and two (10%) discussed menstrual disorders. None were the product of systematic literature searches and most were not referenced. CONCLUSIONS To avoid ineffective treatment and related harms to women, volunteer clinicians would benefit from the adaptation and distribution of guidelines for STMMs that are based on existing WHO guidance and acceptable to clinicians, patients and organizations.
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Affiliation(s)
- Christopher Dainton
- Grand River Hospital, 835 King St. West, Kitchener, ON N2G 1G3, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 10-B Victoria Street South, 3rd Floor Kitchener, ON N2G 1C3, Canada
- Medical Service Trip, 1002-8 The Esplanade, Toronto, ON M5E0A6, Canada
| | - Charlene H Chu
- Medical Service Trip, 1002-8 The Esplanade, Toronto, ON M5E0A6, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St Suite 130, Toronto, ON M5T 1P8, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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3
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Vernon G. Dr E W Price, the discoverer of podoconiosis. J Med Biogr 2022; 30:2-5. [PMID: 31735101 DOI: 10.1177/0967772019888406] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A straightforward biography of Dr E W Price, the discoverer of podoconiosis, a medical missionary who was also the first to elucidate plantar ulcers in leprosy.
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Dailor EM. A History of Development of Medical Missions and Catholic Evangelization in Sub-Saharan Africa From the Early Twentieth Century to the Present: Tracing Some Representative Founders and Orders in the Context of the Twentieth Century Church. Linacre Q 2021; 88:381-390. [PMID: 34949883 DOI: 10.1177/00243639211024578] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the care of the sick has been a charism of Catholic community since the beginning, and hospitals as we know them have developed since the fourth century, religious orders began to develop hospitals as part of their mission work during the colonial expansion of the seventeenth century. These early efforts, however, were primarily a response to the needs of the colonists as well as recognition that the poor who were sick required care in these regions. It can be argued that medical missions developed during the twentieth century as a response to the outreach of Protestants as well as the exposure of physicians to the needs in mission territories, and that their advancement and success impacted the attitudes of the popes and bishops of the twentieth century. This article examines several individuals and organizations who have contributed to the development of medical missions in Africa in modern times and trace the approach of the Church toward medical missions by exploring missionary religious orders, especially women's religious orders, and papal and council documents. It primarily considers the role of medical missions in areas that had only a limited Catholic presence prior to nineteenth and twentieth centuries, and where Catholic health care and the local Catholic Church essentially developed together, and considers ways in which the growth of medical missions and the thinking of the Church developed together.
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Dainton C, Gorman C, Cherniak W, Lopez L, Chu CH. Reliability of the Service Trip Audit Tool to assess the quality of short-term medical missions. Int Health 2021; 13:606-614. [PMID: 32176774 PMCID: PMC8643480 DOI: 10.1093/inthealth/ihaa006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/30/2019] [Revised: 12/27/2019] [Accepted: 01/22/2020] [Indexed: 11/28/2022] Open
Abstract
Background We aimed to assess the adherence of short-term medical missions (STMMs) operating in Latin America and the Caribbean (LAC) to key best practices using the Service Trip Audit Tool (STAT) and to calculate the inter-rater reliability of the data points. This tool was based on a previously published inventory of 18 STMM best practices. Methods Programme administrators and recent volunteers from 335 North American organizations offering STMMs in LAC were invited to complete the STAT anonymously online. Adherence to each of 18 best practices was reported as either ‘yes’, ‘no’ or ‘not sure’. Fleiss’ κ was used to assess inter-rater agreement of the responses. Results A total of 194 individuals from 102 organizations completed the STAT (response rate 30.4%; 102/335 organizations) between 12 July and 7 August 2017. Reported adherence was >80% for 9 of 18 best practices. For 37 non-governmental organizations (NGOs) with multiple raters, inter-rater agreement was moderate to substantial (κ>0.4) for 12 of 18 best practices. Conclusions This is the first study to evaluate adherence to STMM best practices. Such an objective evaluation will be valuable to governments, volunteers and NGO donors who have an interest in identifying high-quality partners. Assessment and monitoring of STMMs through self-audit may be foundational steps towards quality improvement.
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Affiliation(s)
| | - Christina Gorman
- Department of Public Health Sciences, University of Toronto, 155 College Street Toronto, ON M5T 3M7 Canada
| | - William Cherniak
- Department of Family and Community Medicine, Division of Emergency Medicine, Markham Stouffville Hospital, 381 Church St, Markham, ON L3P 7P3, Canada.,Bridge to Health Medical and Dental, 491 Lawrence Avenue West Suite 301 M5M 1C7, Toronto, ON
| | - Lorena Lopez
- Universidad Privada Antenor Orrego, Avenida América Sur 3145, Trujillo 13008, Peru
| | - Charlene H Chu
- Department of Public Health Sciences, University of Toronto, 155 College Street Toronto, ON M5T 3M7 Canada.,Lawrence S. Bloomberg Faculty of Nursing, 155 College St, Toronto, ON M5T 1P8, Canada
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Rovers J, Andreski M, Becker M, Gray J. Short-term medical service trips: what is the cost of patient care and student training? Int Health 2021; 13:594-597. [PMID: 31821446 PMCID: PMC8643441 DOI: 10.1093/inthealth/ihz110] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/27/2019] [Accepted: 11/06/2019] [Indexed: 11/23/2022] Open
Abstract
Background Evaluations of the costs and effects of medical service trips (MSTs) are increasingly necessary. Estimates of costs can inform decision making to determine if participation is likely to be a wise use of resources. Methods This study estimates the costs and effects of a 1-week MST for 20 health professions students and seven providers to the Dominican Republic. Costs were defined as direct costs for students and providers and opportunity costs for providers. Effects were defined as the cost to treat one patient and the cost to train one student. Students were surveyed about their costs before and after the MST. Most provider costs were assumed to be the same as those of the students. Results The mean direct cost per student was US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}2066 for providers. Total opportunity costs for seven providers was US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}19 869. The total cost for the trip was US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}69 612 to treat 464 patients. With and without provider opportunity costs, the cost to treat one patient was US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}150 and US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}107, and the cost to train one student was US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}3481 and US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}2487, respectively. Conclusions Short-term MSTs may be more expensive than previously thought. The cost to treat one patient was similar to a medical office visit in the USA.
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Affiliation(s)
- John Rovers
- Department of Pharmaceutical and Administrative Sciences, College of Pharmacy and Health Sciences, Drake University, 2507 University Avenue, Des Moines, IA 50311, USA
| | - Michael Andreski
- Department of Pharmaceutical and Administrative Sciences, College of Pharmacy and Health Sciences, Drake University, 2507 University Avenue, Des Moines, IA 50311, USA
| | - Michelle Becker
- Department of Pharmaceutical and Administrative Sciences, College of Pharmacy and Health Sciences, Drake University, 2507 University Avenue, Des Moines, IA 50311, USA
| | - Jeffrey Gray
- Department of Global Health College of Medicine, Des Moines University, Des Moines, IA 50312, USA
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Tran Y, Jarrett J, Gardner S, Fernando J, Milliron M, Hong L. Long-Term Impact of Interprofessional Medical Mission Service Trips in Sierra Leone. Front Med (Lausanne) 2021; 8:742406. [PMID: 34646846 PMCID: PMC8502852 DOI: 10.3389/fmed.2021.742406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/16/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the impact of capacity-building short-term mission service trips to Sierra Leone on local health education and perspectives. Methods: This was a prospective, mixed-methods study. During three mission trips between June 2017 and December 2019, health professional students taught multiple locally selected patient care-related topics. Local staff completed knowledge questionnaires and were surveyed or interviewed on mission service impact along with the cultural competence of missionaries. Mission team members completed the Intercultural Effectiveness Scale (IES) and surveys to determine their cultural competence. Results: After initial education, 90% passed the knowledge questionnaire with at least a 50% and the correct response rate was 57.9 vs. 66.7% after 6 months and 2.5 years, respectively (p = 0.40). Local staff ranked education/training as most valuable (84%) and highly desired (53%). Mean IES score and survey responses of both missionaries and local staff rated mission team cultural competence as average. Conclusions: Education-focused mission trips in Sierra Leone seem to have long-lasting benefits and a positive impact on local staff, though improved intercultural competence is needed.
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Affiliation(s)
- Yen Tran
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, United States
| | - Jennie Jarrett
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Scott Gardner
- Department of Physician Assistants, Kettering College, Kettering, OH, United States
| | - James Fernando
- Adventist Health System Waterloo Hospital, Waterloo, Sierra Leone
| | - Mark Milliron
- Department of Physician Assistant Sciences, Loma Linda University, Loma Linda, CA, United States
| | - Lisa Hong
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, United States
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Jenkinson AO, Fell M, Eshete M, Patel V, Demissie Y, Abate F, McGurk M. The impact of complex facial surgery provided on a short-term surgical mission. Int J Oral Maxillofac Surg 2021; 50:1649-1652. [PMID: 34059404 DOI: 10.1016/j.ijom.2021.05.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/27/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
The long-term consequences of performing facial surgery on patients living in rural Ethiopia are largely unknown. A review of 36 patients who had been treated on a short-term surgical mission (STSM) in the previous 2 years was conducted to evaluate the outcomes of the surgical interventions performed. There was a significant reduction in social isolation following a surgical intervention. Improvements in postoperative self-reported changes were found for facial appearance, facial function, and quality of life. Positive outcomes can be achieved when surgical treatment is performed on a STSM.
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Affiliation(s)
| | - M Fell
- Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust, Bristol, UK
| | - M Eshete
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Department of Plastic and Reconstructive Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
| | - V Patel
- Oral Surgery Department, Guy's Hospital, Guy's and St Thomas' Foundation Trust, London, UK
| | - Y Demissie
- Department of Plastic and Reconstructive Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - F Abate
- Department of Plastic and Reconstructive Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - M McGurk
- Department of Oral and Maxillofacial Surgery, University College London Hospitals NHS Foundation Trust, London, UK
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Kinnison B. Nicaraguan Homeowner Showing Gratitude for Concrete Flooring as Part of a Public Health Mission Trip. HCA Healthc J Med 2020; 1:113-114. [PMID: 37425242 PMCID: PMC10324780 DOI: 10.36518/2689-0216.1047] [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] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Description I'm Bree Kinnison, a fourth-year medical student and aspiring psychiatrist. When I'm not studying, I enjoy painting using acrylics. This painting depicts a very fond memory of mine. After completing the medical portion of our mission trip in Nicaragua, we began our public health portion. Along with fellow students, I laid concrete flooring in this woman's house. For all 76 years of her life, she had never experienced anything other than a dirt floor in her home. Traditional dirt flooring in Nicaraguan homes is responsible for many preventable illnesses. When shown the final product, she reached out and hugged the first person she could get ahold of. She began crying and thanking God for placing us in her life. We were equally grateful for this life-changing experience.
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Crockett CJ, Zeigler LN, Kynes JM, Lawson KC, Figueroa LI, Hayes CB, Samen CDK, McQueen KA. A prospective observational study of postoperative follow-ups and outcomes at a nonprofit, internationally supported pediatric surgery center in Guatemala. Paediatr Anaesth 2020; 30:469-479. [PMID: 31976589 DOI: 10.1111/pan.13830] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Global surgical access is unequally distributed, with the greatest surgical burden in low- and middle-income countries, where surgical care is often supplemented by nongovernmental organizations. Quality data from organizations providing this care are rarely collected or reported. The Moore Pediatric Surgery Center in Guatemala City, Guatemala, is unique in that it offers a permanently staffed, freestanding pediatric surgical center. Visiting surgical teams supplement the local permanent staff by providing a broad range of pediatric subspecialty surgical and anesthesia care. AIM The aim of this study was to collect and report the incidence of completed postoperative follow-up visits and outcome measures at this nonprofit, internationally supported surgery center. METHODS De-identified demographic and postoperative outcome data were collected from each routinely scheduled, one-week pediatric surgical mission trip and incorporated into an electronic data collection system. Emphasis was placed on identification of completed postoperative visits and associated perioperative complications. After 27 months of data collection, results were analyzed to identify and quantify trends in patient follow-ups and postoperative outcomes. RESULTS Over 27 months, 1639 pediatric surgical procedures were performed and included in data analysis. The percentage of completed postoperative day-1 follow-up visits was 99.1%, and seven complications were identified out of these 1624 cases (postoperative complication rate of 0.4%). The percentage of completed first postoperative visits after discharge was 93.3%, and 67 complications were identified out of these 1530 cases (postoperative complication rate of 4.4%). CONCLUSION Our data show a high rate of postoperative follow-up visits completed and low perioperative complication rates similar to those of high-income countries. Our data suggest that The Moore Surgery Center model of care offers an alternative to the short-term visiting surgical model by incorporating the local system and allows for improved follow-up, outcomes analysis, and high quality of care.
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Affiliation(s)
- Christy J Crockett
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura N Zeigler
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James M Kynes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katheryne C Lawson
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Caleb B Hayes
- Pathology Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Christelle D K Samen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A McQueen
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
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11
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Smith MT, Monahan MP, Nelson P, Moruzzi M, DeLucenay AJ, Birnie CR. Elevated blood pressure in the developing world: a role for clinical pharmacists. Int J Pharm Pract 2017; 26:334-340. [PMID: 28925056 DOI: 10.1111/ijpp.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/01/2016] [Accepted: 08/14/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the prevalence and patient knowledge of elevated blood pressure amongst a cross-section of patients in underserved communities in three selected low-income countries worldwide: El Salvador, India and Kenya. METHODS Mobile medical clinics were established as part of medical mission trips in El Salvador, India and Kenya. Willing male and female patients, at least 25 years of age, who presented at each clinic were screened for elevated blood pressure, including 332 patients in El Salvador, 847 patients in India and 160 patients in Kenya. Patients were classified into Stage I or II elevated blood pressure based on modified JNCVII guidelines. A questionnaire was completed regarding their knowledge about the existence and management of their disease state. KEY FINDINGS Of the 1339 patients screened, 368 presented with elevated blood pressure (27%). Of these patients, 147 had been previously informed of hypertension or an elevated blood pressure (39.9%), 28 reported receiving antihypertensive medication (7.6%) and 24 reported awareness of non-pharmaceutical treatment options (6.5%). In Kenya, 81 patients were screened in a rural setting and 79 in an urban setting. Patients demonstrating controlled blood pressure were 63 (78%) and 38 (48%), respectively, demonstrating a significant difference between the rural versus urban settings (P = 0.00359). CONCLUSIONS All regions demonstrated similar trends in the prevalence of elevated blood pressure, highlighting the need for increased disease state education in these regions.
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Affiliation(s)
- Michael T Smith
- Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY, USA.,Springfield Medical Care Systems Springfield, VT, USA
| | - Megan P Monahan
- Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY, USA.,Brattleboro Memorial, Hospital Brattleboro, VT, USA
| | - Paige Nelson
- Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY, USA
| | - Matthew Moruzzi
- Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY, USA
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Punchak M, Lazareff JA. Cost-effectiveness of short-term neurosurgical missions relative to other surgical specialties. Surg Neurol Int 2017; 8:37. [PMID: 28458951 PMCID: PMC5369257 DOI: 10.4103/sni.sni_199_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 05/12/2016] [Accepted: 01/25/2017] [Indexed: 01/24/2023] Open
Abstract
Background: Short-term surgical relief efforts have helped close some gaps in the provision of surgical care in remote settings. We reviewed the published literature on short-term surgical missions to compare their cost-effectiveness across subspecialties. Methods: PubMed was searched using the algorithm [“cost-effectiveness” AND “surgery” AND (“mission” OR “volunteer”)]. Articles detailing the cost-effectiveness of short-term surgical missions in low and middle-income countries (LMIC) were included. Only direct mission costs were considered, and all costs were converted into 2014 USD. Results: Eight articles, representing 27 missions in 9 LMIC countries during 2006–2014, met our inclusion criteria. Latin America was the most frequently visited region. Per capita costs ranged from $259 for cleft lip/cleft palate (CL/CP) missions to $2900 for a neurosurgery mission. Mission effectiveness ranged from 3 disability adjusted life years (DALYs) averted per patient for orthopedic surgery missions to 8.12 DALYs averted per patient for a neurosurgery mission. CL/CP and general surgery missions were the most cost-effective, averaging $80/DALY and $87/DALY, respectively. The neurosurgical, orthopedic, and hand surgery missions averaged the highest costs/DALY averted, with the cost-effectiveness being $357/DALY, $435/DALY, and $445/DALY, respectively. All analyzed missions were very cost effective. Conclusion: To date, this is the first study to assess the cost-effectiveness of short-term surgical missions across surgical specialties. Neurosurgical missions avert the largest number of healthy life years compared to other specialties, and thus, could yield a greater long-term benefit to resource-poor communities. We recommend that further studies be carried out to assess the impact of surgical missions in low-resource settings.
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Affiliation(s)
- Maria Punchak
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jorge A Lazareff
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Abstract
BACKGROUND North American clinicians are increasingly participating in medical service trips (MSTs) that provide primary healthcare in Latin America and the Caribbean. Literature reviews have shown that the existence and use of evidence-based guidelines by these groups are limited, which presents potential for harm. OBJECTIVE This paper proposes a 5-step methodology to develop protocols for diagnosis and treatment of conditions encountered by MST clinicians. METHODS We reviewed the 2010 American College of Physicians guidance statement on guidelines development and developed our own adaptation. Ancestry search of the American College of Physicians statement identified specific publications that provided additional detail on key steps in the guideline development process, with additional focus given to evidence, equity, and local adaptation considerations. FINDINGS Our adaptation produced a 5-step process for developing locally optimized protocols for diagnosis and treatment of common conditions seen in MSTs. For specified conditions, this process includes: 1) a focused environmental scan of current practices based on grey literature protocols from MST sending organizations; 2) a review of relevant practice guidelines; 3) a literature review assessing the epidemiology, diagnosis, and treatment of the specified condition; 4) an eDelphi process with experts representing MST and Latin American and the Caribbean partner organizations assessing identified guidelines; and 5) external peer review and summary. CONCLUSIONS This protocol will enable the creation of practice guidelines that are based on best available evidence, local knowledge, and equitable considerations. The development of guidelines using this process could optimize the conduct of MSTs, while prioritizing input from local community partners.
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Affiliation(s)
- Christopher Dainton
- Department of Emergency Medicine, Grand River Hospital, Kitchener, Ontario, Canada.
| | - Charlene H Chu
- Lawrence S. Bloomberg Faculty of Nursing, Institute of Aging, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Henry Lin
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
| | - William Cherniak
- Department of Family and Community Medicine, University of Toronto and Bridge to Health Medical and Dental, Toronto, Ontario, Canada
| | - Lawrence C Loh
- Clinical Public Health Division, Office of Global Public Health Education and Training, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Rozier MD, Lasker JN, Compton B. Short-term volunteer health trips: aligning host community preferences and organizer practices. Glob Health Action 2017; 10:1267957. [PMID: 28218547 PMCID: PMC5328364 DOI: 10.1080/16549716.2017.1267957] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/27/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Short-term medical missions (STMMs) are quite common and largely understood to be a response to health needs in low-income countries. Yet most information about STMM practices is anecdotal. Even less is known about the preferences of in-country host communities regarding STMMs. OBJECTIVE We aimed to gather enough quantitative and qualitative information from both STMM organizers and host community staff to compare dominant practices of organizers as well as preferences of host community staff. We use these data to discover differences between practices and preferences and suggest ways in which STMMs can be more responsive to the communities they serve. METHODS Researchers gathered online survey responses from 334 STMM organizers and conducted interviews to determine existing practices. Similar methods were used to collect 49 online survey responses from, and conduct 75 interviews with, host community staff. RESULTS Organizer practices and host community staff preferences are different in several areas. Organizers admit to minimal screening and preparation of volunteers whereas host staff have clear ideas of topics that should be covered in preparation, including culture and basic language skills. Organizers prioritize provision of clinical care during trips whereas host staff prioritize capacity building. Practices and preferences also differ in relation to the length of STMMs, the nature of the partnership itself, and the type of assessment and evaluation that is needed. CONCLUSIONS The large amount of data gathered for this study allows us to confidently say that organizer practices are often not aligned with host community staff preferences. Several concrete changes can be made to STMMs to bring practices more in line with the desires of the communities they serve.
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Affiliation(s)
- Michael D. Rozier
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Judith N. Lasker
- Department of Sociology and Anthropology, Lehigh University, Bethlehem, PA, USA
| | - Bruce Compton
- International Outreach, Catholic Health Association, St. Louis, MO, USA
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Abstract
In this paper, we present findings from a qualitative study that gathered Nicaraguans' perceptions of short-term foreign medical missions, towards deepening the understanding of what Nicaraguans value or find limited in the work of such foreign missions operating in their country. Fifty-two interviews were conducted with patients, relatives of patients, Nicaraguan physicians and nurses who partnered with or observed missions at work, 'beneficiary' community leaders, and individuals who were unable or unwilling to access mission-provided healthcare. Factors underlying participants' positive and more critical accounts of foreign primary and surgical missions are described and analysed. Empirical investigation on how, whether or not, or on what bases short-term medical missions (STMs) have been perceived as beneficial, harmful, or otherwise by those on the receiving end of these efforts is limited. This study aims to contribute to the evidence base for reflecting on the ethical performance of trans-national STMs.
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Affiliation(s)
- Elysée Nouvet
- a Department of Clinical Epidemiology and Biostatistics , McMaster University , Hamilton , ON , Canada
| | - Elizabeth Chan
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Lisa J Schwartz
- a Department of Clinical Epidemiology and Biostatistics , McMaster University , Hamilton , ON , Canada
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Roche S, Hall-Clifford R. Making surgical missions a joint operation: NGO experiences of visiting surgical teams and the formal health care system in Guatemala. Glob Public Health 2016; 10:1201-14. [PMID: 25734638 DOI: 10.1080/17441692.2015.1011189] [Citation(s) in RCA: 8] [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] [Indexed: 10/23/2022]
Abstract
Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical missions (STMMs) hosted by local non-governmental organizations (NGOs) and staffed by foreign visiting medical teams (VMTs). The purpose of this study was to explore the perspectives of individuals based in NGOs involved in the coordination of surgical missions to better understand how these missions articulate with the larger Guatemalan health care system. During the summers of 2011 and 2013, in-depth interviews were conducted with 25 representatives from 11 different Guatemalan NGOs with experience with surgical missions. Transcripts were analysed for major themes using an inductive qualitative data analysis process. NGOs made use of the formal health care system but were limited by several factors, including cost, issues of trust and current ministry of health policy. Participants viewed the government health care system as a potential resource and expressed a desire for more collaboration. The current practices of STMMs are not conducive to health system strengthening. The role of STMMs must be defined and widely understood by all stakeholders in order to improve patient safety and effectively utilise health resources. Priority should be placed on aligning the work of VMTs with that of the larger health care system.
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Affiliation(s)
- Stephanie Roche
- a Department of Global Health , Boston University , Boston , MA , USA
| | - Rachel Hall-Clifford
- b Department of Anthropology , Agnes Scott College , Decatur , GA , USA.,c Department of Public Health , Agnes Scott College , Decatur , GA , USA
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Kydd AR, Patel D, Schwarz J, Joseph D, Mitchell G, Thomas S, Strasswimmer JM. Umbilical endometriosis mistaken for a keloid in a premenopausal woman of Caribbean descent. JAAD Case Rep 2016; 2:219-21. [PMID: 27294186 PMCID: PMC4890078 DOI: 10.1016/j.jdcr.2016.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Andre R Kydd
- Florida Atlantic University, Boca Raton, Florida
| | - Drumil Patel
- Dermatology Medical Missions, Delray Beach, Florida
| | | | | | | | | | - John M Strasswimmer
- Florida Atlantic University, Boca Raton, Florida; Dermatology Medical Missions, Delray Beach, Florida
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Chuang C, Khatri SH, Gill MS, Trehan N, Masineni S, Chikkam V, Farah GG, Khan A, Levine DL. Medical and pharmacy student concerns about participating on international service-learning trips. BMC Med Educ 2015; 15:232. [PMID: 26699122 PMCID: PMC4690328 DOI: 10.1186/s12909-015-0519-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/16/2015] [Indexed: 05/30/2023]
Abstract
BACKGROUND International Service Learning Trips (ISLT) provide health professional students the opportunity to provide healthcare, under the direction of trained faculty, to underserved populations in developing countries. Despite recent increases in international service learning trips, there is scant literature addressing concerns students have prior to attending such trips. This study focuses on identifying concerns before and after attending an ISLT and their impact on students. METHODS A survey comprised of closed and open-ended questions was developed to elucidate student concerns prior to attending an ISLT and experiences which might influence concerns. A five-point Likert-scale (extremely concerned = 1, minimally concerned = 5) was used to rate apprehension and satisfaction. Paired t-test was used to compare pre- and post-trip concerns; Chi-Square test was used to compare groups. RESULTS Thirty-five students (27 medical, 8 pharmacy) attended ISLTs in December 2013. All completed pre and post-trip surveys. Significant decreases were seen in concerns related to cultural barriers (4.14 vs 4.46, P = .047), disease/epidemics (3.34 vs 4.60, P < .001), natural disasters (3.94 vs 4.94, P < .001), terrorism (4.34 vs 4.94, P < .001), travel (3.86 vs 4.51, P < .001) monetary issues (3.80 vs 4.60, P < .001), hospitality (3.94 vs 4.74, P = .001) and food (3.83 vs 4.60, P < .001). Language and group dynamics remained concerns post-trip. On open-ended questions, students described benefits of attending an ISLT. CONCLUSIONS Students had multiple concerns prior to attending an ISLT. Most decreased upon return. Addressing concerns has the potential to decrease student apprehension. The results of this study highlight the benefits of providing ISLTs and supporting development of a curriculum incorporating trip-related concerns.
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Affiliation(s)
- Chih Chuang
- Department of Medical Education, Wayne State University, 320 East Canfield, Detroit, MI, 48201, USA.
| | - Siddique H Khatri
- Department of Internal Medicine, Wayne State University, 4201 St. Antoine, University Health Center 2E, Detroit, MI, 48201, USA.
| | | | - Naveen Trehan
- Department of Internal Medicine, Wayne State University, 4201 St. Antoine, University Health Center 2E, Detroit, MI, 48201, USA.
| | - Silpa Masineni
- Department of Internal Medicine, Wayne State University, 4201 St. Antoine, University Health Center 2E, Detroit, MI, 48201, USA.
| | - Vineela Chikkam
- Department of Internal Medicine, Wayne State University, 4201 St. Antoine, University Health Center 2E, Detroit, MI, 48201, USA.
| | | | - Amber Khan
- Department of Internal Medicine, Wayne State University, 4201 St. Antoine, University Health Center 2E, Detroit, MI, 48201, USA.
| | - Diane L Levine
- Department of Internal Medicine, Wayne State University, 4201 St. Antoine, University Health Center 2E, Detroit, MI, 48201, USA.
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Caldron PH, Impens A, Pavlova M, Groot W. A systematic review of social, economic and diplomatic aspects of short-term medical missions. BMC Health Serv Res 2015; 15:380. [PMID: 26373298 PMCID: PMC4572642 DOI: 10.1186/s12913-015-0980-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 07/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short-term medical missions (STMMs) represent a grass-roots form of aid, transferring medical services rather than funds or equipment. The objective of this paper is to review empirical studies on social, economic and diplomatic aspects of STMMs. METHODS A systematic literature review was conducted by searching PubMed and EBSCOhost for articles published from 1947-2014 about medical missions to lower and middle income countries (LMICs). Publications focused on military, disaster and dental service trips were excluded. A data extraction process was used to identify publications relevant to our objective stated above. RESULTS PubMed and EBSCOhost searches provided 4138 and 3262 articles respectively for review. Most articles that provide useful information have appeared in the current millennium and are found in focused surgical journals. Little attention is paid to aspects of volunteerism, altruism and philanthropy related to STMM activity in the literature reviewed (1 article). Evidence of professionalization remains scarce, although elements including guidelines and tactical instructions have been emerging (27 articles). Information on costs (10 articles) and commentary on the relevance of market forces (1 article) are limited. Analyses of spill-over effects, i.e., changing attitudes of physicians or their communities towards aid, and characterizations of STMMs as meaningful foreign aid or strategic diplomacy are few (4 articles). CONCLUSIONS The literature on key social, economic and diplomatic aspects of STMMs and their consequences is sparse. Guidelines, tactical instructions and attempts at outcome measures are emerging that may better professionalize the otherwise unregulated activity. A broader discussion of these key aspects may lead to improved accountability and intercultural professionalism to accompany medical professionalism in STMM activity.
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Affiliation(s)
- Paul H Caldron
- Maastricht Graduate School of Governance, University of Maastricht, Maastricht, Netherlands.
| | - Ann Impens
- Midwestern University Institute for Healthcare Innovation, Downers Grove, Illinois, USA.
| | - Milena Pavlova
- Department of Health Services Research; CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
| | - Wim Groot
- Department of Health Services Research; CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
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Abstract
Participation in short-term global health programmes for low-income countries is increasing amongst practising clinicians and trainees from high-income countries. However, few studies explicitly examine the perceptions of programme recipients. In July 2012, we conducted semi-structured interviews with a purposive sample of 47 adults receiving care from Medical Ministry International, an international non-governmental organisation providing short-term medical programmes in the Dominican Republic. Thirty interviews met criteria for inclusion. Transcripts were independently coded using a descriptive approach. After thematic saturation, 20 interviews were included in the final analysis. Nine major themes were identified: misidentification, access, identified needs, social determinants, faith, language, student involvement, areas for improvement and respect. Recipients were reluctant to discuss programme improvement directly and frequently misidentified the researcher as a caregiver, suggesting a need to separate clearly programme evaluation from care provision. They viewed student involvement positively in a setting where supervision is emphasised, suggesting a potential to develop measures of supervision's adequacy. Finally, recipients' perceptions of respect as an important but intangible programme element encourage broadening the ethical discourse around short-term programmes beyond only tangible goods and services. Our findings support the usefulness of qualitative methods for short-term programme evaluation and generate important hypotheses for future research.
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Affiliation(s)
- Matthew DeCamp
- a Berman Institute of Bioethics and Division of General Internal Medicine , Johns Hopkins University , Baltimore , MD , USA
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21
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Abstract
OBJECTIVE To design and implement a Medical Outreach Experience elective course and assess its impact on students' level of confidence in organizing future medical outreach trips, providing population-specific pharmaceutical care, and achieving learning outcomes. DESIGN A 2-credit hour elective course was designed for second- and third-year pharmacy students. The course was structured to include 3 sections over 1 semester, a 10-week training and preparation phase, followed by a weeklong international outreach experience and post-outreach reflection. ASSESSMENT Student achievement of curricular outcomes was measured using in-class activities, readings, reflections, and longitudinal projects, as well as performance during the outreach trip. Results from pre- and post-course surveys demonstrated significant improvement in student-rated confidence in several components of outreach trip organization and provision of pharmaceutical care. CONCLUSIONS Students completing the course exhibited increased confidence in their abilities to organize and practice on a medical outreach trip. All students met the learning outcomes of the course, which included providing comprehensive patient-specific pharmaceutical care, communicating effectively, promoting health improvement and self-care, thinking critically, and appropriately managing and using resources of the healthcare system. Students agreed that the elective course was a valuable addition to the curriculum.
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Affiliation(s)
- Elizabeth Perry
- University of Louisiana at Monroe College of Pharmacy, Shreveport, LA, USA.
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MARIANO EDWARDR, ILFELD BRIANM, CHENG GLORIAS, NICODEMUS HECTORF, SURESH SANTHANAM. Feasibility of ultrasound-guided peripheral nerve block catheters for pain control on pediatric medical missions in developing countries. Paediatr Anaesth 2008; 18:598-601. [PMID: 18482232 PMCID: PMC2745103 DOI: 10.1111/j.1460-9592.2008.02633.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Continuous peripheral nerve blocks (CPNB) are effective for postoperative pain management in children in the hospital and at home. CPNB techniques are particularly advantageous when compared with systemic or oral opioids on medical missions to unfamiliar environments with minimal monitoring capacity. In addition, ultrasound-guidance facilitates the placement of perineural catheters in anesthetized children even in the absence of commercially packaged regional anesthesia equipment. We present a series of successful cases employing ultrasound-guided CPNB for postoperative analgesia on medical missions and discuss the impact of this technology on present and future patients in underserved countries.
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Affiliation(s)
- EDWARD R. MARIANO
- Department of Anesthesia, University of California, San Diego Medical Center, San Diego, CA, USA
| | - BRIAN M. ILFELD
- Department of Anesthesia, University of California, San Diego Medical Center, San Diego, CA, USA
| | - GLORIA S. CHENG
- Department of Anesthesia, University of California, San Diego Medical Center, San Diego, CA, USA
| | | | - SANTHANAM SURESH
- Department of Anesthesiology and Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA,Department of Anesthesia, Children's Memorial Hospital, Chicago, IL, USA
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