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| CONFERENCE REPORTS AND ABSTRACTS |
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| Year : 2017 | Volume
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| Issue : 2 | Page : 295-324 |
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The 2nd Annual Academic International Medicine Congress (AIM 2017) “Connecting Health with Care” in Clearwater Beach, Florida, July 28-30, 2017: Event highlights and scientific forum abstracts
Maryam Saeed1, Mamta Swaroop1, Bhakti Hansoti2, Harry L Anderson3, Bonnie Arquilla4, Michael S Firstenberg5, Manish Garg6, Sagar C Galwankar7, Elizabeth Krebs8, Gregory L Peck9, Joseph V Sakran2, James Salway4, Sherwin P Schrag10, Ziad C Sifri11, Tamara Worlton12, Stanislaw P Stawicki13
1 Northwestern University School of Medicine, Chicago, Illinois, USA
2 Johns Hopkins Medicine, Baltimore, USA
3 St. Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA
4 SUNY Downstate Medical Center, Brooklyn, NY, USA
5 Northeast Ohio Medical University and Summa Health System, Akron, Ohio, USA
6 Temple University Hospital, Jacksonville, Florida, USA
7 University of Florida College of Medicine, Jacksonville, Florida, USA
8 Thomas Jefferson University Hospital, Philadelphia, USA
9 Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
10 Jersey City Medical Center, RWJ Barnabas Health, Jersey City, USA
11 Rutgers New Jersey Medical School, Newark, New Jersey, USA
12 Walter Reed National Military Medical Center, Bethesda, Maryland, USA
13 St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| Date of Web Publication | 9-Jan-2018 |
Correspondence Address:
Stanislaw P Stawicki
St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, Pennsylvania 18015
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/IJAM.IJAM_94_17
The Academic International Medicine (AIM) Congress (the Congress) is the official meeting of the American College of Academic International Medicine, a United States organization dedicated specifically to connecting academic physicians from diverse areas of expertise toward the common goals of sustainable global medical outreach and multinational clinical research and education. The organization's main focus is to promote AIM and to establish a platform for individuals, academic institutions, and a broad range of organizations to collaborate and work collectively to create a foundation for efficient and sustainable resource sharing. World-renowned experts and speakers from the AIM community attended and participated in the 2017 Congress held in Clearwater Beach, Florida, from July 28 to July 30, 2017. This year's Congress also included the participation of the Global Association of Physicians of Indian Origin, the American Association of Physicians of Indian Origin, and the OPUS 12 Foundation, Inc. Finally, the Congress featured the inaugural Annual Scientific Forum as a platform for exchanging scientific knowledge among academic experts. This report presents an overview of this major academic event, including the full listing of podium presentations from the 2017 Scientific Forum.
The following core competencies are addressed in this article: Practice-based learning and improvement, Systems-based practice, Interpersonal and communication skills, Professionalism.
Keywords: Academic International Medicine 2017, Academic International Medicine Congress, American College of Academic International Medicine, Global Association of Physicians of Indian Origin, Global Health, OPUS 12 Foundation, scientific abstracts, scientific forum
How to cite this article:
Saeed M, Swaroop M, Hansoti B, Anderson HL, Arquilla B, Firstenberg MS, Garg M, Galwankar SC, Krebs E, Peck GL, Sakran JV, Salway J, Schrag SP, Sifri ZC, Worlton T, Stawicki SP. The 2nd Annual Academic International Medicine Congress (AIM 2017) “Connecting Health with Care” in Clearwater Beach, Florida, July 28-30, 2017: Event highlights and scientific forum abstracts. Int J Acad Med 2017;3:295-324 |
How to cite this URL:
Saeed M, Swaroop M, Hansoti B, Anderson HL, Arquilla B, Firstenberg MS, Garg M, Galwankar SC, Krebs E, Peck GL, Sakran JV, Salway J, Schrag SP, Sifri ZC, Worlton T, Stawicki SP. The 2nd Annual Academic International Medicine Congress (AIM 2017) “Connecting Health with Care” in Clearwater Beach, Florida, July 28-30, 2017: Event highlights and scientific forum abstracts. Int J Acad Med [serial online] 2017 [cited 2023 Mar 20];3:295-324. Available from: https://www.ijam-web.org/text.asp?2017/3/2/295/222486 |
| Introduction | |  |
The 2nd Annual Academic International Medicine (AIM) Congress titled Connecting Health with Care (the Congress) was held in Clearwater Beach, Florida, between July 28 and July 30, 2017. Conference faculty included physicians from the United States (US), Antigua, Brazil, Canada, India, and the United Kingdom (UK). This 3-day conference was organized jointly by the American College of Academic International Medicine (ACAIM), the OPUS 12 Foundation, the INDO-US Emergency and Trauma Collaborative, the Global Association of Physicians of Indian Origin (GAPIO), the American Association of Physicians of Indian Origin (AAPI-USA), and the Drs. Kiran and Pallavi Patel Foundation. The primary goals of this multilateral consortium were to create a platform for discussions on best practices in international academic medical activities, to formulate strategies for improving global healthcare through the creation of sustainable bidirectional partnerships, and to highlight key issues in AIM through consensus statements and expert panel discussions. Prominent topics discussed included wider recognition of AIM as an alternative promotion and tenure track for the US academic physicians, the importance of women leaders in AIM, low-cost technological innovation for sustainable global medical applications, trauma and critical care in resource-limited environments, dangers of polypharmacy in loosely regulated markets, as well as academic leadership and faculty advancement.
AIM encompasses both clinical and nonclinical activities that broadly constitute a combination of medical outreach and global health. One of the hallmarks of ACAIM is its dedication to multidisciplinary pursuits as the membership is inclusive of all medical and surgical specialties without regard to geographic location of International Medical Programs (IMPs). Over the years, members of the ACAIM have demonstrated their commitment to achieving the above objectives, with an impressive track record of positive and sustainable change around the world, across a broad range of clinical and educational settings.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29] We will build upon these contributions as champions and advocates for AIM.
The participating faculty listing, including biographical profiles, is available under “AIM 2017 e-Program” tab at http://acaim.org/home/aim_2017. Additional details, including multiple photographs and other multimedia links from the Congress, can be found on Twitter at https://twitter.com/acaiminfo. Medical and surgical specialties represented included cardiology, cardiothoracic surgery, emergency medicine, general surgery, geriatric medicine, infectious diseases, internal medicine, orthopedics, primary care, transplantation, and traumatology/critical care. The 3-day conference featured a combination of joint plenary sessions and multi-track specialty sessions.
| Day 1: Friday, July 28, 2017 | | |
The meeting began on a strong note with the ACAIM Consensus Conference titled, “Values and Metrics in International Academic Medicine” [Figure 1]. Consensus statements in this issue of the International Journal of Academic Medicine are the final results of the group's deliberations.[29],[30] Friday's early afternoon activities included parallel GAPIO and ACAIM tracks, with the two groups joining in the late afternoon for a formal 2017 Congress opening ceremony and a series of high-profile lectures, beginning with the commencement speech by ACAIM President, Dr. Stanislaw P. Stawicki, titled Sustainable and Synergistic Global Presence [Figure 2]. Dr. Juan A. Asensio, Professor and Vice Chairman of the Department of Surgery at Creighton University, Omaha, Nebraska, then followed with an inspiring ACAIM Keynote speech titled Penetrating Cardiac Injuries – The Final Frontier [Figure 2]. Subsequent sessions covered the topics of clinical leadership in international medicine (Drs. Manish Garg and Thomas J. Papadimos, moderated by Dr. Bonnie Arquilla); education in global surgery (Drs. Paula Ferrada, Virginia Commonwealth University in Richmond and Tanya Zakrison, University of Miami, Florida); resident training in bilingual, cross-cultural environments (Dr. Keir Thelander, PAACS); and cardiovascular conditions of global concern (Dr. Sudip Nanda, SLUHN, Bethlehem, Pennsylvania). A joint ACAIM-GAPIO networking dinner event followed. Photos from Day 1 of the Congress can be found in [Figure 1] and [Figure 2]. | Figure 1: (Top left) Dr. Manish Garg leads the discussion at the ACAIM 2017 Consensus meeting; (Top right) Dr. Galwankar delivers a speech during the opening ceremony; (Bottom left) ACAIM leaders and guests of honor relaxing between sessions; (Bottom right) It's all about fun! Group photo of ACAIM leaders, panelists, and speakers
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 | Figure 2: (Top left) Prof. Vicente H. Gracias delivers the OPUS 12 Foundation Keynote Address titled Global Surgery Program: Creation and the Path to Strategic Success; (Top right) Prof. Juan A. Asensio demonstrates life-saving surgical maneuvers during the American College of Academic International Medicine Keynote Address titled Penetrating Cardiac Injuries – The Final Frontier; (Bottom left) Dr. Tamara Worlton speaks about medication safety in low-resource environments; (Bottom right) Academic International Medicine Congress opening ceremony
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| Day 2: Saturday, July 29, 2017 | | |
The 2nd day of the conference started with a combined ACAIM-GAPIO networking breakfast, followed by the joint plenary session titled Values and Metrics in Academic International Medicine given by Drs. Manish Garg, Lorenzo Paladino, Gregory L. Peck, and Richard P. Sharpe. Following a brief intermission, conference participants joined one of the four tracks: The ACAIM Annual Scientific Forum; Two Parallel ACAIM Expert Sessions; or the GAPIO track titled Synergizing Technologies and Health for Delivering Better Patient Care.
The American College of Academic International Medicine Annual Scientific Forum
The 2017 inaugural ACAIM Scientific Forum featured a total of 25 quality podium presentations by medical students, postdoctoral researchers, residents, fellows, and faculty members [Figure 3]. The session was organized into five primary tracks: rural and prehospital medicine, surgical care, disaster preparedness, chronic disease management, and medical education. The session's highlight was the moderated question-and-answer discussion that followed each abstract. The depth of understanding by the presenters was impressive, helping to underscore the magnitude of some of the current challenges in global medical care availability and delivery. | Figure 3: Photographs from the 2017 American College of Academic International Medicine Scientific Forum. (Top) Varshini Cherukupalli delivers the winning podium presentation; (Bottom) Session moderators (Drs. Sifri, Firstenberg, and Salway) listen during Dr. Thomas Wojda's presentation
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This year's submission process was competitive, with blinded evaluators of the Abstract Selection Committee using strict objective criteria to determine only the most meritorious submissions for inclusion. Researchers from Brazil, India, Pakistan, Spain, and the US represented 15 major academic institutions. A complete listing of abstracts from the Scientific Forum is included in the latter part of this report. Of note, a joint group consisting of the Abstract Selection Committee and Scientific Forum Moderators ranked each scholarly project based on its scientific merit and quality of presentation. Top performers at this year's competition were as follows:
First place award
- Project title: Implementation and Evaluation of First Responders Course in Nanakpur, Haryana, India
- Presenter: Varshini Cherukupalli, BA from Northwestern University School of Medicine, Chicago, Illinois, USA
- Faculty mentor: Dr. Mamta Swaroop.
Second place award
- Project title: Evidence-informed, Systematic Development of a Clinical Practice Guideline for Acute Care of Traumatic Brain Injury Patients in Rwanda
- Presenter: Grace Amadio, BS from Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
- Faculty mentor: Dr. Elizabeth Krebs.
Third place award #1
- Project title: Needs Assessment for Medical Supplies in Freetown following the Ebola crisis: Ensuring Appropriate Donations
- Presenter: Peter F. Johnston, MD from Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Faculty mentor: Dr. Ziad C. Sifri.
Third place award #2
- Project title: Simulating a Disaster – Preparing Responders in India
- Presenter: Benjamin Kaufman, MD from SUNY Downstate Medical Center, Brooklyn, New York, USA
- Faculty mentor: Dr. Bonnie Arquilla.
American College of Academic International Medicine Expert Sessions, Track #1
Drs. Mamta Swaroop, Jordan Kapper, Thomas Papadimos, Scott Pappada, and Jason Stroud started this track with a panel discussion titled Simulation and Technology in International Medicine. Expert panel participants reviewed up-to-date trends in the dynamically evolving areas of information technology and medical innovation. Session speakers focused on the use of novel technological solutions as tools for enhanced knowledge dissemination, remote education, clinical simulation, patient safety, and research across the globe. Dr. Papadimos, Professor of Anesthesiology, Associate Dean for Interprofessional Immersive Simulation, and Medical Director, Lloyd A. Jacobs Medical Simulation Center at University of Toledo, gave an insightful introduction into the world of cutting edge, immersive simulation experience that can easily be adopted for bidirectional applications involving IMPs. Dr. Pappada from the University of Toledo lectured on Applications of Predictive Modeling relevant to AIM. Dr. Stroud, also from the University of Toledo, gave an informative talk titled Simulation in the Surgical Sciences.
The morning then transitioned to an expert discussion of Trauma in Resource-poor Environments, with a speaker panel consisting of Drs. Jordan Kapper, Chinenye O. Nwachuku, Richard P. Sharpe, and Ziad C. Sifri. Dr. Sharpe began the session with a lecture titled Improving Surgical Care of the Injured in Resource-limited Environments. Dr. Nwachuku, Assistant Clinical Professor in Orthopedic Surgery from St. Luke's University Health Network (SLUHN), followed with his lecture titled It Can Be Done: Orthopedic Trauma in Low- and Middle-income Countries (LMICs). Drs. Kapper and Sifri each shared their unique, experience-based perspectives, with the session providing a comprehensive framework for successful implementation of trauma care in LMICs.
American College of Academic International Medicine Expert Sessions, Track #2
Drs. Manish Garg, Vikas Kapil (Director of Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia), Ricardo Izurieta, and Miguel Reina (both from University of South Florida, Tampa) began this track with a dynamic and insightful expert panel on Global Health Security. Abroad variety of topics were discussed, including identification, management, and prevention of global health security threats; a review of the World Health Organization Sustainable Developmental Goals with special attention to the global tuberculosis epidemic and the Centers for Disease Control and Prevention approach to global security. Panelists provided practical examples of how to deal with major public health threats using innovative, low-cost solutions applicable to resource-limited settings.
The track subsequently transitioned into a session titled Women in International Medicine, highlighting the critical role of women physicians in leading, promoting and contributing to AIM. The expert panel consisting of Drs. Kendra Amico (Osceola Regional Medical Center, Orlando, Florida), Bonnie Arquilla, Christina Bloem (both from SUNY Downstate Medical Center, Brooklyn, New York), Mamta Swaroop (Northwestern University, Chicago, Illinois), and Tamara Worlton (Walter Reed National Military Medical Center, Bethesda, Maryland) provided an insightful and open discussion on this important topic, focusing on the pivotal role of mentorship and institutional support. A lively question-and-answer session followed.
Global Association of Physicians of Indian Origin Sessions, Track #3
This track, titled Synergizing Technologies and Health for Delivering Better Patient Care, organized by GAPIO leadership including Dr. Ramesh Mehta (President) and Mr. Anwar Feroz Siddiqi (Honorary Advisor), featured world-class speakers from top US, UK, and Indian hospitals and universities. Following a welcoming ceremony, the track commenced under the Chairmanship of Prof. Anupam Sibal (Medical Director, Apollo Hospitals Group, New Delhi, India). High-yield, 20-min sessions covered a broad range of topics, including the following presentations:
- Role of Technology in Diabetes Care and Outcomes by Prof. Om Prakash Ganda (Harvard Medical School, Boston, Massachusetts)
- Assessing Cardiovascular Risk: From Prediction to Precision by Prof. Brahma Sharma (University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania)
- Modern Management of Heart Failure by Prof. Harish Chandna (Independent Practitioner, Texas)
- Growing Problem of Hepatitis C Infection by Prof. Sudhakar Jonnalagadda (AAPI-USA Secretary)
- Donor Graft Shuffle: A Salvage Strategy in Pediatric Liver Transplantation by Prof. Neelam Mohan (Medanta Institute of Digestive and Hepatobiliary Services, New Delhi, India)
- Management of Osteoporosis: Beyond Medication by Prof. Meeta Singh (Tanvir Hospital, Hyderabad, India)
- When to Suspect Primary Immune Deficiency in the Adult Patient by Prof. Purvi Parikh (NYU School of Medicine, New York, New York)
- New Perspectives in Treatment of Depression by Prof. Pradeep Kumar Saha (Professor and Head, Department of Psychiatry, R.G. Kar Medical College, Kolkata, India)
- Eliminating Avoidable Childhood Blindness by Prof. V. K. Raju (Founder and Medical Director, Eye Foundation of America, Morgantown, West Virginia).
| Saturday Afternoon Joint Plenary Session | | |
The afternoon session commenced with a joint welcome speech by the ACAIM President, Dr. Stanislaw P. Stawicki, Associate Professor of Surgery and Chair of the Department of Research and Innovation at SLUHN, Bethlehem, Pennsylvania, US, and Dr. Ramesh Mehta, the President of GAPIO and a Consultant Pediatrician, Bedford Hospital, UK.
The presidential welcome was followed by a Presidential Keynote address given by Dr. Keir Thelander, Chief Medical Officer of the Pan-African Academy of Christian Surgeons. The lecture outlined Dr. Thelander's experiences across different educational and health-care settings in Africa and focused on key factors required to succeed in building sustainable, bidirectional IMPs. Concepts discussed included cultural competencies, important geographic and socioeconomic considerations, and role of openness and willingness to learn as critical components of building acceptance and gaining respect.
Dr. Vicente H. Gracias, Professor of Surgery, Senior Vice Chancellor for Clinical Affairs of Rutgers Biomedical and Health Sciences, and President and Chair of Rutgers Health Group, was the OPUS 12 Keynote speaker. Prof. Gracias presented a dynamic lecture titled Global Surgery Program: Creation and the Path to Strategic Success [Figure 2]. The speech highlighted the barriers to, and the importance of, developing bidirectional global health programs, including the commitment to creating institutional AIM champions. Dr. Gracias also shared important team strategies and practical experiences from the process of implementing the Rutgers Global Surgery Program and advised the audience on ways to incorporate the academic global surgery model into the fabric of existing (and often competing) institutional programs.
Dr. Terence Stephenson, Chair of the UK's General Medical Council (GMC), the independent regulator of the UK's 260,000 physicians, gave an excellent GAPIO Keynote speech on Regulation and Professionalism as a Means of Ensuring the Quality of Patient Care. Important aspects of the general framework for evaluation and certification of physicians in the UK were discussed, with focus on ensuring appropriate support for the provider while optimizing the quality and safety of patient care. Through various innovative initiatives, the GMC aims to help physicians attain and maintain professional competencies.
Following the GAPIO Keynote Address, the joint plenary session transitioned to a panel discussion titled Sustainable and Affordable Patient Safety. Experts participating in discussion included Drs. Michael Firstenberg, Bipin Batra (Executive Director, National Board of Examinations, Ministry of Health and Family Welfare, Government of India), Sunil Khetarpal (Rajiv Gandhi Cancer Institution and Research Centre, New Delhi, India), Marian P. McDonald, Mayur Narayan (Weill Cornell Medicine, New York), Sudhir Parikh (Chairman of center for Asthma and Allergy, New Jersey), and Tamara Worlton (Walter Reed National Military Medical Center, Bethesda, Maryland). The session attracted a large number of attendees and started with Dr. Firstenberg, Associate Professor of Surgery (Cardiothoracic) from Northeast Ohio Medical University and Director of Surgical Research at Summa Akron City Hospital, giving a presentation titled Introduction to Patient Safety: Sometimes It's the Easy, Little, and Cheap Things that Make a Difference. Dr. McDonald, Chief of General Surgery from SLUHN – Allentown Campus (Pennsylvania), emphasized the importance of strict adherence to established patient safety protocols in her talk, Operating Room Patient Safety: Review the Checklist. In addition, she also discussed ways in which surgical checklists can be adjusted and implemented in low-resource environments. Dr. Khetarpal subsequently spoke about the impact of medication errors and the identification/avoidance of “near misses”. Subsequent presentations by Drs. Batra (session Co-Chair), Narayan, and Parikh covered a broad range of topics to provide a comprehensive framework for patient safety applicable to health-care institutions around the world. The patient safety panel discussion concluded with a lecture by Dr. Tamara Worlton titled Promoting PI/QI Programs for Affordable Patient Safety [Figure 2].
A special session titled Geriatrics and Polypharmacy – An Emerging Global Problem then followed. Expert panelists included Drs. Bonnie Arquilla (Moderator, SUNY Downstate, Brooklyn, New York), Marian P. McDonald, Alaa-Eldin A. Mira (SLUHN, Bethlehem, Pennsylvania), and Naushira Pandya (NOVA Southeastern University, Fort Lauderdale, Florida). Dr. Mira began the session with a lecture titled Interdisciplinary Care for Older Adults, discussing a broad range of topics applicable to the care of the elderly around the world. This was followed by Dr. McDonald's presentation, Polypharmacy: A Global Problem – Suggestions for Solutions, touching on the importance of appropriate tracking and oversight over the escalating problem of poorly coordinated dispensing of multiple medications by different providers, a common practice in the LMICs. Dr. Pandya then provided an insightful analysis on the modern reality of polypharmacy, increasing prevalence of chronic comorbid conditions, and associated dangers for patients in both high-income countries (HICs) and LMICs.
Saturday joint plenary sessions concluded with a captivating presentation by Dr. Scott Plantz, the co-founder of the American Academy of Emergency Medicine [Figure 4]. The title of his talk was Challenges in Learning and Education Management. The lecture focused on disruptive innovation in medical education and the exciting future of web-based, low-cost alternatives for knowledge sharing. Concepts presented have great relevance to advancing medical education in LMICs, where capacity generation and sustainability are keys to any successful implementations. | Figure 4: (Top left) Group photo between sessions; [Rop right] Dr. Scott Plantz delivers his address on Challenges in Learning and Education Management; (Bottom left) Dr. Galwankar receives GAPIO award (from left to right – Drs. Stawicki, Galwankar, Consul General of India Hon. Nagesh Singh, Drs. Patel, Mehta, and Parikh); (Bottom right) Dr. Firstenberg speaking about patient safety
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The 2nd day of the conference ended with joint GAPIO-ACAIM Dinner Gala and an Awards Program. The Chief Guest was the Counsel General of India, Honorable Nagesh Singh, and the Guest of Honor for the evening was Dr. Kiran Patel. Photographs from various Day 2 activities and sessions of the Congress can be found in [Figure 4].
| Day 3: Sunday, July 30, 2017 | | |
Day 3 of the Congress began with a combined GAPIO-ACAIM breakfast and a networking event. A panel session titled Medical Education and Global Health then followed. Drs. Bonnie Arquilla and Ramesh Mehta (Co-Chairs) led a discussion that included Drs. Manish Garg (Temple University, Philadelphia, PA), Gregory Peck (Rutgers Medical Center, New Brunswick, NJ), and Peter Bell (American University of Antigua, Coolidge, Antigua). Panelists emphasized the critical importance of bidirectional IMP development that incorporates a blend of didactic and clinical training to build the foundation for sustainable long-term development.
Dr. Kiran Patel, the Chairman of the Patel Foundation for Global Understanding, was the esteemed Keynote speaker and presented a lecture titled Role of Entrepreneurship in Global Health. Dr. Patel, a world-renowned philanthropist, encouraged the audience to always seek balance and synergy between profit and social responsibility. The Keynote address was followed by a panel discussion on Entrepreneurship in Global Health with Drs. Michael S. Firstenberg, Thomas J. Papadimos, Kiran C. Patel, Anupam Sibal, and Mamta Swaroop participating. The session, moderated by Dr. Stanislaw P. Stawicki, presented the panel with a set of challenging and thought-provoking questions that the audience was also encouraged to answer [Figure 5]. | Figure 5: Session on Role of Entrepreneurship in Global Health. (Top left) Dr. Kiran Patel delivers his Keynote Address; (Top right) Honorary introductions by Dr. Sagar Galwankar; (Bottom) Members of the expert panel (left to right, Drs. Bell, Plantz, Papadimos, Firstenberg)
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The 3rd day of the conference ended with the ACAIM elections and Committee meetings. Foundational planning for the AIM 2018 Congress and Scientific Forum was also begun.
- Sikka V, Chattu VK, Popli RK, Galwankar SC, Kelkar D, Sawicki SG, et al. The emergence of Zika virus as a global health security threat: A Review and a consensus statement of the INDUSEM Joint Working Group (JWG). J Glob Infect Dis 2016;8:3-15.
- Stawicki SP, Stoltzfus JC, Aggarwal P, Bhoi S, Bhatt S, Kalra OP, et al. Academic college of emergency experts in India's INDO-US Joint Working Group and OPUS12 foundation consensus statement on creating A coordinated, multi-disciplinary, patient-centered, global point-of-care biomarker discovery network. Int J Crit Illn Inj Sci 2014;4:200-8.
- For Academic College of Emergency Experts in India (ACEE-INDIA) – INDO US Emergency and Trauma Collaborative, Mahajan P, Batra P, Thakur N, Patel R, Rai N, et al. Consensus guidelines on evaluation and management of the febrile child presenting to the emergency department in India. Indian Pediatr 2017;54:652-60.
- Chauhan V, Shah PK, Galwankar S, Sammon M, Hosad P, Erickson TB, et al. The 2017 International Joint Working Group (JWG) recommendations of the Indian College of Cardiology, the Academic College of Emergency Experts and INDUSEM on the management of low-risk chest pain in emergency departments across India. J Indian Coll Cardiol 2017 Apr; 10(2):74.
- Galwankar SC, Swaroop M, Bhoi S, Jeanmonod R, Jeanmonod D, Firstenberg MS, et al. The 11th annual INDO-US world congress of academic emergency medicine, “Synergizing science to sustain systems”, A level one international meeting, all india institute of medical sciences, New Delhi, India, September 30 to October 4, 2015. Int J Acad Med 2016;2:72.
- Swaroop M, Galwankar SC, Stawicki SP, Balakrishnan JM, Worlton T, Tripathi RS, et al. The 9th Annual INDUS-EM 2013 Emergency Medicine Summit, “Principles, Practices, and Patients,” a level one international meeting, Kerala University of Health Sciences and Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India, October 23-27, 2013. Philos Ethics Humanit Med 2014;9:8.
- Muñiz SA, Lang RW 3rd, Falcon L, Garces-King J, Willard S, Peck GL, et al. Preparing global trauma nurses for leadership roles in global trauma systems. J Trauma Nurs 2017;24:306-11.
- Kalra S, Kelkar D, Galwankar SC, Papadimos TJ, Stawicki SP, Arquilla B, et al. The emergence of Ebola as a global health security threat: From 'lessons learned' to coordinated multilateral containment efforts. J Glob Infect Dis 2014;6:164-77.
- Wojda TR, Valenza PL, Cornejo K, McGinley T, Galwankar SC, Kelkar D, et al. The Ebola outbreak of 2014-2015: From coordinated multilateral action to effective disease containment, vaccine development, and beyond. J Glob Infect Dis 2015;7:127-38.
- Stawicki SP, Sharpe RP, Galwankar SC, Sweeney J, Martins N, Papadimos TJ, et al. Reflections on the ebola public health emergency of international concern, part 1: Post-Ebola syndrome: The silent outbreak. J Glob Infect Dis 2017;9:41-4.
- Paladino L, Sharpe RP, Galwankar SC, Sholevar F, Marchionni C, Papadimos TJ, et al. Reflections on the ebola public health emergency of international concern, part 2: The unseen epidemic of posttraumatic stress among health-care personnel and survivors of the 2014-2016 Ebola outbreak. J Glob Infect Dis 2017;9:45-50.
- Peck GL, Ferrada P, Hanna J, Ferrada R, Christopher D, Ordonez C, et al. Can we augment the US trauma fellow's operative training? The PTS fellowship: A US surgical critical care fellow's experience in Colombia. Panam J Trauma Crit Care Emerg Surg 2014;3:1.
- Patel A, Krebs E, Andrade L, Rulisa S, Vissoci JR, Staton CA, et al. The epidemiology of road traffic injury hotspots in Kigali, Rwanda from police data. BMC Public Health 2016;16:697.
- Krebs E, Gerardo CJ, Park LP, Nickenig Vissoci JR, Byiringiro JC, Byiringiro F, et al. Mortality-associated characteristics of patients with traumatic brain injury at the university teaching hospital of Kigali, Rwanda. World Neurosurg 2017;102:571-82.
- Henwood PC, Mackenzie DC, Rempell JS, Douglass E, Dukundane D, Liteplo AS, et al. Intensive point-of-care ultrasound training with long-term follow-up in a cohort of Rwandan physicians. Trop Med Int Health 2016;21:1531-8.
- Staton CA, De Silva V, Krebs E, Andrade L, Rulisa S, Mallawaarachchi BC, et al. High road utilizers surveys compared to police data for road traffic crash hotspot localization in Rwanda and Sri Lanka. BMC Public Health 2016;16:53.
- Krebs E, Reardon J. Global Health and Emergency Medicine. (2014). Available from: http://www.emresident.org/global-health-and-emergency-medicine/. [Last accessed on 2017 Dec 01].
- Krishnaswami S, Swaroop M. Preparing and sustaining your career in academic global surgery. In: Academic Global Surgery. Cham, Switzerland: Springer; 2016. p. 41-9.
- Swaroop M, Marie Siddiqui S, Sagar S, Crandall ML. The problem of the pillion rider: India's helmet law and New Delhi's exemption. J Surg Res 2014;188:64-8.
- Gupta S, Gupta SK, Devkota S, Ranjit A, Swaroop M, Kushner AL, et al. Fall injuries in Nepal: A Countrywide population-based survey. Ann Glob Health 2015;81:487-94.
- Pal R, Agarwal A, Galwankar S, Swaroop M, Stawicki SP, Rajaram L, et al. The 2014 academic college of emergency experts in India's INDO-US Joint Working Group (JWG) white paper on “Developing trauma sciences and injury care in India”. Int J Crit Illn Inj Sci 2014;4:114-30.
- Swaroop M, Krishnaswami S. Academic Global Surgery. Cham, Switzerland: Springer; 2015.
- Haider A, Scott JW, Gause CD, Meheš M, Hsiung G, Prelvukaj A, et al. Development of a unifying target and consensus indicators for global surgical systems strengthening: Proposed by the global alliance for surgery, obstetric, trauma, and anaesthesia care (The G4 alliance). World J Surg 2017 May 15:1-9.
- Blair KJ, Paladino L, Shaw PL, Shapiro MB, Nwomeh BC, Swaroop M, et al. Surgical and trauma care in low- and middle-income countries: A review of capacity assessments. J Surg Res 2017;210:139-51.
- Blair KJ, Paladino L, Shaw P, Schuetz SJ, Shapiro MB, Nwomeh BC, et al. Surgical and trauma care in low-and middle-income countries: A systematic review of tools to evaluate capacity. J Am Coll Surg 2015;221:S88.
- Anderson HL 3rd, Arquilla B, Firstenberg MS, Garg M, Galwankar SC, Gracias VH, et al. Mission statement of the American college of academic international medicine. Int J Crit Illn Inj Sci 2017;7:3-7.
- GBD 2013 Risk Factors Collaborators, Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;386:2287-323.
- GBD 2013 DALYs and HALE Collaborators, Murray CJ, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, Abd-Allah F, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: Quantifying the epidemiological transition. Lancet 2015;386:2145-91.
- Garg M, Peck GL, Arquilla B, Miller AC, Soghoian SE, Anderson HL, et al. A comprehensive framework for international medical programs: A 2017 consensus statement from the American College of Academic International Medicine. Int J Acad Med 2017;3:217-30.
- Peck GL, Garg M, Arquilla B, Gracias VH, Anderson HL, Miller A, et al. The American College of Academic Medicine 2017 Consensus Statement on International Medical Programs: Establishing a system of objective valuation and quantitative metrics to facilitate the recognition and incorporation of academic international medical efforts into existing promotion and tenure paradigms. Int J Acad Med 2017;3:231:42.
| Rural Medicine/Prehospital Track | | |
Scientific Abstract Number 1
The Flinders Chronic Condition Management Program: Influence on Patient Outcomes in a Rural Health Center
J. P. Orlando 1, T. R. Wojda 2, M. Kender 1, G. Dobash 1, M. Gursky 1, W. Moyer 1
1 Department of Medical Education, St. Luke's University Health Network, Bethlehem and Coaldale, Pennsylvania;2 Department of Family Medicine, St. Lukes Warren Hospital, Phillipsburg, New Jersey, USA
Introduction: Changing demographic trends have placed substantial monetary pressure on health-care systems. Chronic conditions are predicted to use up around 80% of health-care costs by 2020. In addition, management of comorbidities consumes nearly 80% of the average “US health-care dollar.” Despite that, neither current nor future providers are adequately trained in many of the evidence-based approaches to chronic disease management. Various approaches are available to help guide chronic condition self-management support to patients in this growing area of need. The Flinders Program, first begun in Australian-coordinated care trials during the late 1990s, focuses on patient-centered assessments and organization of care that enables behavioral modification using various instruments designed to encourage patient/provider interaction. The model is based on comprehensive, personalized evaluation, and care planning using standardized forms and tools. The aim of the current project is to evaluate the impact of the implementation of the Flinders Chronic Disease Management Program (FCDMP) on rural health primary care patients with unusually high emergency department utilization (EDU) or HgA1C levels in the setting of a rural health center (RHC).
Methods: The study design included pre-/post-intervention clinical, behavioral, and financial measures such as HgA1Cs, body mass index (BMI), quality of life scores (QOLSs), primary care physician (PCP) versus EDU, and associated health-care financial aspects. Preintervention or “baseline” occurred between January and December 2014 and the “postintervention” period was from January 2015 to March 2016. The study included patients who had four or more emergency department visits in a 6-month period, or had an HgA1C level of 9 or higher, were refractory to traditional therapeutic approaches, and named a St. Luke's Miners RHC (SLM-RHC) provider as their primary care provider (PCP). Fifteen SLM-RHC team members received Flinders Certification Training in October 2014. Patients who met inclusion criteria were identified and tracked as “Flinders patients” in the Allscripts electronic medical records system. RHC providers started enrolling patients into the Flinders program as of January 1, 2015. Study patients were divided into two groups: (a) The interview group (Group 1) who underwent a Flinders interview and (b) the non-Flinders group (Group 2) who did not undergo such interview. Nonparametric tests were used to analyze HgA1C and vital sign data for the pre-/post-intervention periods. Descriptive statistics were used for all other data.
Results: Eighty-five patients met the study inclusion criteria. Following the FCDMP, Group 1 patients were significantly more likely to have lower HgA1C levels compared to Group 2 patients (P< 0.002). For BMI, there was a significant increase among Group 2 patients but no change for Group 1 patients (P< 0.001). There was no significant difference between the two groups in terms of QOLS. Group 1 patients had better self-management skills, but this was not statistically significant. There was no significant difference in terms of PCP versus EDU between the two groups; however, Group 1 patients tended to use their PCP more often while Group 2 patients had higher EDU. Following the FCDMP, Group 1 patients increased PCP use by 50% and decreased EDU by 35%. During the same period, Group 2 patients were noted to have 23% lower PCP use while their EDU increased by 12%. Finally, the FCDMP resulted in reduced costs of care.
Conclusions: This pilot study suggests that successful FCDMP implementation is associated with significant reductions in HgA1C and may prevent increases in BMI. Furthermore, our results suggest that the Flinders approach increases PCP patient utilization while reducing EDU. Finally, the cumulative effect of the above outcomes may be beneficial to hospital finances.
Scientific Abstract Number 2
Implementation and Evaluation of First Responders Course in Nanakpur, Haryana, India
S. Cherukupalli, N. Thakur, N. Suria, I. Helenowski, A. Bhalla, S. Bhoi, M. Swaroop
Department of Surgery, Northwestern University School of Medicine, Chicago, Illinois, USA
Introduction: Approximately 90% of all trauma-related deaths occur in low- and middle-income countries, where prehospital trauma systems are most likely to be insufficient. A layperson first responder training courses is recommended by the World Health Organization to decrease morbidity and mortality in resource-limited settings. India is a lower-middle-income country where as many as 80% of trauma patients cannot access medical care within the 1st h. To address this deficiency in prehospital care, the All India Institute of Medical Sciences (AIIMS) in New Delhi, India, created the Basic Emergency Care Course (BECC) in 2009. The objective of this study was to evaluate implementation and efficacy of the AIIMS BECC in the rural area of Nanakpur, Haryana, India, through pre- and post-course knowledge assessment tests.
Methods: The first responder courses took place over 4 days in January 2017 in Nanakpur. Local community health center physician recruited participants, including accredited social health activists (ASHAs), anganwadi workers (AWWs), and associated nurse midwives (ANMs), who serve as community health workers in rural areas. Each course was 8 h in duration and included adult and infant cardiopulmonary resuscitation, choking, vehicle extrication, helmet removal, trauma management, and special scenarios such as triage, electrocution, drowning, hypothermia, chest pain, stroke, and animal bites. Methods of instruction were PowerPoint lectures, audiovisual materials, and hands-on training with mannequins. Instructors were emergency medicine and anesthesia physicians from the Postgraduate Institute of Medical Education and Research, Chandigarh, India, and the AIIMS. Pre- and post-course tests were conducted to assess participants' baseline knowledge and improvement, and a signed rank test was utilized to determine significance of knowledge improvement. A follow-up survey to assess knowledge retention at 6 months will be sent to participants in July 2017.
Results: Atotal of 204 people took part in the course; pre- and post-course test results were available for 70 participants. Participants included 191 (93.6%) females, 109 (53.4%) ASHAs, 27 (13.2%) AWWs, 14 (6.86%) ANMs, and 12 (5.88%) MBBS graduates. A majority (n = 108) had passed at least eighth standard. Participants who completed both a pre- and post-test (n = 70) demonstrated a significant improvement in knowledge (P< 0.0001). Six-month knowledge retention rates will be assessed in July 2017.
Conclusions: This study in Nanakpur demonstrates the feasibility of utilizing AIIMS BECC to train Nanakpur's rural community health workers as first responders. Participants, most of whom were ASHAs, AWWs, and ANMs, demonstrated a significant improvement in knowledge based on pre- and post-course test results. There was an inadequate amount of time for postcourse testing. Leaving an adequate amount of time for postcourse testing is essential for complete evaluation of knowledge expansion. Information on knowledge retention will be collected in July 2017. Overall, the community health worker systems are constants throughout India and may be employed to develop surgical capacity. These data suggest a potential use of BECC for training community health workers countrywide to strengthen India's prehospital care system.
Scientific Abstract Number 3
Prehospital Process Improvement and Data Collection in Cali, Colombia
Z. Model, D. Mehta, C. C. Gutierrez, P. Truche, V. H. Gracias, C. Ordoñez, L. F. Pino, G. Peck
Department of Surgery, Rutgers Robert Wood Johnson Medical School and University Hospital, New Brunswick, New Jersey, USA
Introduction: Two objectives exist; (1) establish the groundwork for prehospital longitudinal needs assessment and process improvement, (2) prospectively assess prehospital and hospital data collection and integration feasibility for a regional trauma center.
Methods: Three US medical students spent 3 months in collaboration with Colombian medical students and prehospital stakeholders for a prehospital needs assessment in Cali, Colombia, between April and July 2016 at a highest tier public trauma facility. A 1-week feasibility study followed to assess capability of collecting data from prehospital providers at the time of hospital presentation for prospective data collection and process improvement.
Results: Minimal prehospital data penetrate the existing hospital data registry as no process exists to transfer prehospital data at the time of patient arrival [Table 1]. Process improvement led to reciprocal ethics committee analysis and interpretation of the study protocol, multidisciplinary participation between epidemiologists, research students, trauma surgeons, prehospital providers, and emergency department faculty, and secure online database initiation. A data collection form including a short list of variables was created. Feasibility of data collection was demonstrated [Table 2] and [Table 3]. | Table 1: Pre-implementation: Minimal prehospital data makes its way into hospital trauma registry
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Conclusions: This early work lays the foundation for sustainable prehospital and hospital process improvement. Successful early adoption in one hospital indicates that data transfer between prehospital providers and the hospital is feasible. Creating the data collection form as a communication tool was a key step for this initial phase of the project and a direct result of the needs assessment, with input from local stakeholders. Increased communication with triage staff will be necessary to optimize data penetration. The process may be scaled across multiple Colombian agencies and cities, ideally to promote trauma center and system prehospital inclusivity. This process is an important first step toward the goal of developing a data link between prehospital care and hospital registries for eventual trauma outcomes assessment.
Scientific Abstract Number 4
Admission Vital Signs in an Aging Trauma Population: How Low is Too Low?
W. T. H. Terzian, T. R. Wojda, P. G. Thomas, W. S. Hoff, A. M. Szoke, S. P. Stawicki
Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
Introduction: The average age of US trauma population continues to increase. This trend is projected to continue well into the future. Inherent to the aging process is the appearance of various associated physiological manifestations, including alterations in vital signs. The aim of this study was to define important characteristics of fundamental vital signs across a broad spectrum of age groups. We hypothesized that increasing age will be associated with significant alterations in systolic blood pressure and heart rate among patients presenting to our regional trauma network.
Methods: Following institutional review board exemption, we conducted a retrospective audit of the institutional registry serving our regional, three-hospital trauma network. Records were reviewed between January 1999 and December 2015. In addition to basic demographic and injury characteristics, abstracted data included admission systolic blood pressure, heart rate, and respiratory rate for all complete registry entries. These vital signs were then plotted against predefined patient age groups (starting at 15 years and proceeding in 10-year increments and concluding on the final age group of ≥96 years). Analysis-of-covariance (ANCOVA) was used to calculate between-group differences, with adjustments made for patient age, gender, and injury severity.
Results: Atotal of 30,336 registry records were reviewed. Mean age of the study sample was 47.4 ± 25.7 years, with 60.2% males, average injury severity score 8.9, 5.1% penetrating mechanism, and mean mortality of 3.12%. We noted a significant, step-wise increase in systolic blood pressure across patient age groups [Figure 1]a, P < 0.001]. Heart rates were characterized by a significant drop for the younger age ranges, followed by a more gradual drop across the progressively older segments [Figure 1]b, P < 0.001]. We also noted a decrease in respiratory rate with age; however, except for the youngest group, the remaining age-based segments did not show clinically significant differences in this study parameter (21.8 breaths/min versus 19.3 breaths/min, P < 0.001, not shown). | Figure 1: (a) Heart rate was noted to decrease with increasing age, regardless of survivor (double red line) or nonsurvivor (black line) status; (b) blood pressure increased across age groups, regardless of survivor (double red line) or nonsurvivor (black line) status. Data shown as mean±standard error
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Conclusions: We found important trends in systolic blood pressure and heart rate across age groups. The directionality and magnitude of these trends were similar for both injured survivors and nonsurvivors, suggesting that clinical consideration regarding the interpretation of initial trauma vital signs continues to be very important and should not be subject to generalizations or stereotypes.
| Surgical Care Track | | |
Scientific Abstract Number 1
Assessing the State of Surgical Care in Medellin, Colombia
G. L. Peck, D. Sarma 1
Department of Surgery, Rutgers Robert Wood Johnson Medical School, Piscataway,1 Department of Surgery, Division of Acute Care Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
Introduction/Purpose: To establish the preliminary investigation for the Lancet Commission on Global Surgery (LCoGS) Colombia team and investigate the existing data infrastructure for the six LCoGS indicators of surgical burden in Medellin, Colombia: (a) access to surgical facility within 2 h; (b) specialist surgical workforce density; (c) surgical volume; (d) perioperative mortality rate; (e) protection against impoverishing expenditure (country-specific threshold set by World Bank); (f) protection against catastrophic expenditure (>10% household expenditure).
Methods: One Rutgers medical student spent 1 month during June 2016 in Medellin, Colombia, in collaboration with the University of Antioquia (UdeA) and San Vicente Hospital. The student conducted interviews with hospital administrators, policy-makers within the emergency response system, and public health officials at the Ministry of Health. To better understand indicator 1 and its relationship with the Medellin prehospital system, the student completed rotations in the emergency response headquarters as well as shifts in the municipal ambulances.
Results: This initial research has led to a more comprehensive understanding of the data availability for LCoGS surgical indicators as well as potential challenges in obtaining these data [Table 1]. | Table 1: Results of the Assessment of the Lancet Commission on Global Surgery Indicators in Medellin, Colombia
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Conclusion: This preliminary groundwork has led to the development of strong working relationships between the LCoGS, Rutgers, Medellin Ministry of Health, local hospitals, and UdeA, as well as the shared agreement of the importance of the LCoGS goals. As a result, two additional Rutgers medical students will continue the research collaboration in Medellin during June–July 2017.
Scientific Abstract Number 2
Does Timing of Initial Traumatic Brain Injury Patient Assessment Impact Mortality in a Resource-limited Setting?
I. Sanjeevan, E. Krebs, C. J. Gerardo 1, J. C. Byiringiro 2, F. Byiringiro 2, N. M. Thielman 1, S. Rulisa 2, C. A. Staton 1
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania,1 Department of Emergency Medicine, Duke University, Durham, North Carolina, USA,2 University Teaching Hospital of Kigali, Kigali, Rwanda, Africa
Introduction: Atimely assessment of all traumatic brain injury (TBI) patients is a key step in performing appropriate diagnostics and management, but in resource-limited settings, this can be difficult to achieve. There is strong evidence that avoiding secondary brain injury due to factors such as hypoxia and hypotension is associated with improved patient outcomes, but these secondary brain injury causes cannot be identified until vital signs are evaluated. We sought to determine if TBI patient outcomes were significantly impacted by the rapidity of initial clinical assessments. These results provide an essential baseline for local quality improvement efforts and to our knowledge reflect the first efforts to evaluate the impact of initial assessment timing on patient outcomes in a low- and middle-income country TBI patient population.
Methods: We performed a quantitative retrospective review of data from 670 prospectively collected acute TBI cases between October 7, 2013, and April 6, 2014, at the University Teaching Hospital of Kigali Emergency Department (UTHK ED). Methodology of prospective observational data collection and TBI patient inclusion criteria has been previously published by the authors in 2017.[1] The time duration between patient arrival to UTHK ED and initial nursing, vital signs, and physician assessments were directly observed by trained research assistants. Mean minutes and standard deviations as well as frequencies and proportions of categorical time periods were calculated and reported by TBI severity defined by the Glasgow coma score. A multivariate logistic regression for association with mortality among all TBI patients and a subset excluding mild TBI was adjusted for previously determined independent predictors of mortality in this population including age >50 years, TBI severity, tachycardia (heart rate >100), bradycardia (heart rate <60), and hypoxia (oxygen saturation <90%). Multicollinearity of the models was assessed by computation of the variance inflation factor (VIF).
Results: Timing of initial assessments was neither significantly associated with mortality in all TBI patients nor a subset that excluded mild TBI patients. Multicollinearity did not impact this model as each independent variable had a VIF of <2.5. Detailed results of the study are presented in [Table 1] and [Table 2]. | Table 1: Adjusted odds ratio of mortality associated with initial assessment timing (95% confidence interval, P)
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 | Table 2: Times to first assessment by nurses, physicians, and vital signs for mild, moderate, and severe traumatic brain injury
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Conclusions: The timing of initial nurse, physician, or vital signs assessment did not have a statistically significant association with mortality in our large cohort of TBI patients in a resource-limited setting. This secondary analysis may be underpowered to detect such small differences, but this work highlights the need for future evaluations and establishes baseline times that could be improved by local quality improvement efforts.
- Krebs E, Gerardo CJ, Park LP, Nickenig Vissoci JR, Byiringiro JC, Byiringiro F, et al. Mortality-associated characteristics of patients with traumatic brain injury at the University Teaching Hospital of Kigali, Rwanda. World Neurosurg 2017;102:571-82.
Scientific Abstract Number 3
Evidence-informed, Systematic Development of a Clinical Practice Guideline for Acute Care of Traumatic Brain Injury Patients in Rwanda
G. Amadio, E. Krebs, C. J. Gerardo 1, J. C. Byiringiro 2,
F. Byiringiro 2, N. M. Thielman 1, S. Rulisa 2, C. A. Staton 1
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania,1 Department of Emergency Medicine, Duke University, Durham, North Carolina, USA,2 University Teaching Hospital of Kigali, Kigali, Rwanda, Africa
Introduction: Clinical practice guidelines (CPGs) are particularly valuable in resource-limited health systems such as the University Teaching Hospital of Kigali Emergency Department (UTHK ED) in Rwanda. Traumatic brain injury (TBI) is a leading cause of death and disability worldwide and disproportionately impacts low- and middle-income countries (LMICs). Standardizing the assessment and care of TBI patients is an important step toward achieving appropriate use of resources, deceasing mortality, and improving outcomes. This study describes an evidence-informed, systematic methodology used to develop a CPG for use in our LMIC population of adult TBI patients at UTHK, which can be replicated for the use in developing context-specific CPGs for other clinical settings.
Methods: An investigator (EK) compiled components of the seven highest quality TBI-CPGs as identified by methodology described by Patel et al. in 2017.[1] Serving as the facilitator of the CPG development process, EK presented evidence from these TBI-CPGs and preliminary, descriptive data from a local cohort of TBI patients to a multidisciplinary group comprising staff from departments including the ED, nursing, neurosurgery, and trauma surgery, who convened for a 1-day conference. A modified Delphi method was utilized to achieve group consensus. In Round 1, each member independently assigned each presented component a score to indicate how important the element was and how easily it could be implemented. Importance was scored from “not important” to “critically important” while ease of implementation was scored from “able to be implemented immediately” to “requires large resource investments before incorporating into a CPG.” Round 1 results and candid group member suggestions were presented; then, the group numerically ranked CPG components and discussed justification for their selections in Round 2. The 3rd and final round began with presentation of majority consensus ranking of CPG components, discussion of minority opinion, and assembly of a final draft TBI-CPG. A web-based form of the Appraisal of Guidelines for Research and Evaluation (AGREE-2) instrument,[2] as well as the final draft TBI-CPG, was widely distributed to UTHK nurses and physicians as well as partner institution clinicians with TBI expertise and scores from each domain were calculated.
Results: The final CPG was evaluated by seven reviewers; one nurse and six physicians representing neurosurgery, general practitioners, and emergency medicine. The TBI-CPG achieved scores of 85% or higher in all six domains of AGREE II [Table 1]. This CPG had an average overall rating of six (out of a possible seven points), and all seven reviewers reported that they would recommend this CPG for use, with two reviewers recommending use with modifications. This CPG was accepted for use in the UTHK ED, and portions of it have been incorporated into the national Emergency Medicine Clinical Guidelines of Rwanda.[3] | Table 1: Appraisal of Guidelines for Research and Evaluation II domain scoring, total score as a percentage of the maximum score available in each domain
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Conclusions: The CPG development process described here presents evidence-informed, systematic methodology used to generate an acute TBI-CPG that achieved AGREE II scoring consistent with a high-quality CPG and can be simply replicated in other resource-limited settings to standardize medical care.
- Patel A, Vieira MM, Abraham J, Reid N, Tran T, Tomecsek K, et al. Quality of the development of traumatic brain injury clinical practice guidelines: A Systematic review. PLoS One 2016;11:e0161554.
- Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: Advancing guideline development, reporting and evaluation in health care. CMAJ 2010;182:E839-42.
- Available from: http://www.apps.who.int/medicinedocs/en/d/Js23106en/. [Last accessed on 2017 Jun 01].
Scientific Abstract Number 4
National Guideline Adherence and Resource Utilization in the Treatment of Traumatic Brain Injury Patients at the University Teaching Hospital of Kigali Emergency Department in Rwanda
I. Sanjeevan, E. Krebs, C. J. Gerardo 1, J. C. Byiringiro 2, F. Byiringiro 2, N. M. Thielman 1, S. Rulisa 2, C. A. Staton 1
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania,1 Department of Emergency Medicine, Duke University, Durham, North Carolina, USA,2 University Teaching Hospital of Kigali, Kigali, Rwanda, Africa
Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide that disproportionately burdens low- and middle-income countries. Efforts to standardize medical care through clinical practice guidelines have been shown to improve patient outcomes. In 2016, the Rwandan Ministry of Health and partners published the Emergency Medicine Clinical Guideline (EMCG)[1] intended to standardize emergency medical care nationwide. The University Teaching Hospital of Kigali Emergency Department (UTHK ED) is the largest public referral hospital in Rwanda and the primary academic site within the health network. This study aims to evaluate baseline levels of compliance with the EMCG recommendations at the UTHK ED in the evaluation and management of TBI patients.
Methods: We performed a quantitative retrospective review of data from 670 prospectively collected acute TBI cases between October 7, 2013, and April 6, 2014, at UTHK ED. Methodology of prospective observational data collection and TBI patient inclusion criteria has been previously published by the authors in 2017.[2] Variables were chosen according to the EMCG guidelines and the availability of data for analysis. Frequencies and percentages of compliance with EMCG-based recommendations are reported by severity of the TBI defined by the Glasgow coma score (GCS).
Results: The GCS was assessed by a physician (83.7%) of the time. In hypoxic patients (oxygen saturation <90%), oxygen was given in 76% of cases and a chest X-ray was performed in 62%. Among hypotensive patients (systolic blood pressure <90 mmHg), intravenous (IV) fluids were given in 94% of cases. In 100% compliance with EMCG recommendations, computed tomography (CT) of the head was performed for all patients with seizure and mannitol was never utilized in the setting of hypotension. Detailed study results are provided in [Table 1]. | Table 1: Rwandan Emergency Medicine Clinical Guideline diagnostic and treatment variables, performance frequencies (%)
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Conclusions: Before publication of the Rwandan EMCG, there was substantial variability in practice patterns among physicians treating TBI patients at UTHK, the primary public teaching hospital. Vital signs and GCS were appropriately assessed in >80% of all TBI patients. Obtaining IV access and performing CTs of the head in severe TBI patients occurred >90% of the time. These findings also illustrate several areas for improvement such as ordering of skull X-rays and performance of the FAST examination. Similar evaluations can be performed post-EMCG publication to determine the impact of the guideline and ongoing education efforts at standardizing the evaluation and care of TBI patients at UTHK ED.
- Available from: http://www.apps.who.int/medicinedocs/en/d/Js23106en/. [Last accessed on 2017 Jun 01].
- Krebs E, Gerardo CJ, Park LP, Nickenig Vissoci JR, Byiringiro JC, Byiringiro F, et al. Mortality-associated characteristics of patients with traumatic brain injury at the University Teaching Hospital of Kigali, Rwanda. World Neurosurg 2017;102:571-82.
Scientific Abstract Number 5
Palliative Toilet Mastectomy for Advanced Breast Cancer in Cameroon – Sometimes Doing Less is More
S. Dingley, T. R. Wojda1, E. Paul2, R. P. Sharpe3
Departments of Surgery, 1Family Medicine, 2Internal Medicine and 3International Surgical Studies, St. Luke's University Health Network, Bethlehem, PA, USA
Introduction: Breast cancer is the most common cancer of women worldwide comprising 25% of new cancer diagnoses. In 2012, it accounted for 14% of the cancer-related mortalities worldwide in women. In Africa, diagnosis is often delayed because of social and economic issues which lead to advanced disease at presentation. This contributes to a mortality-to-incidence ratio in African breast cancer of 47% relative to 19% in the US.
Case Summary: Here, we discuss two patients who presented to Mbingo Baptist Hospital in Cameroon with fungating, necrotic, advanced breast cancer. Both patients underwent palliative surgical resection with toilet mastectomy. The one patient received a latissimus dorsi and periscapular flap followed by split-thickness skin graft (STSG) while the other patient only received STSG coverage.
Clinical Discussion: Both patients were able to return to their villages where they lived out the remainder of their lives until succumbing to metastatic disease. However, the patient who underwent the toilet mastectomy with simply STSG coverage was able to do this more quickly. He received the same extent of palliation but shorter hospital stay, faster return to normal activities, and fewer complications.
Key Points/Conclusions: In situations of advanced disease, the surgeon must often weigh what can technically be done versus what is best for the patient. This approach often leads to a different management plan in the developing world compared to advanced healthcare systems where more resources and closer follow-up are possible. In terms of palliation and returning to live out the remainder of life, we believe less can be more. The advanced capabilities provided by some volunteers to developing areas may not be needed and can result in worse care.
Scientific Abstract Number 6
Mortality Prediction Testing of General Trauma Scores in Traumatic Brain Injury Patients at the University Teaching Hospital of Kigali, Rwanda
G. M. Amadio, E. Krebs, F. Shofer1, C. J. Gerardo2, J. C. Byiringiro3, F. Byiringiro3, N. M. Thielman2, S. Rulisa3, C. A. Staton2
Department of Emergency Medicine, Thomas Jefferson University Hospital, 1Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 2Department of Emergency Medicine, Duke University, Durham, North Carolina, USA, 3University Teaching Hospital of Kigali, Kigali, Rwanda, Africa
Introduction/Study Objectives: The Glasgow coma scale (GCS), age, and systolic blood pressure (SBP) (GAP) score and the triage-revised trauma score (T-RTS) have been validated for use in predicting mortality in general trauma patients in low- and middle-income countries but have not been applied specifically to TBI. Both scores are simple, can be calculated quickly, and involve values routinely collected at triage, which makes them ideal for use in resource constrained settings. This study aims to assess and compare the ability of the T-RTS and GAP scores to predict mortality in our population of TBI patients at the University Teaching Hospital of Kigali (UTHK).
Methods: Prospectively conducted, consecutive sampling of all TBI patients presenting to UTHK emergency department was undertaken. Patients were screened for the following inclusion criteria: reported head trauma, alteration in consciousness, headache, or visible head trauma. Exclusion criteria were age ≤10 years, presentation >48 h after injury, or repeat visits. Included patients were observed by research trained nurses during their first 4 h in the emergency department and reassessed daily until their death or hospital discharge. This is a secondary analysis of all TBI patients to test the predictive ability of the GAP score and T-RTS. The GAP score assigns values based on the patient's GCS, age, and SBP, while the T-RTS score uses GCS, respiratory rate, and SBP. A higher score corresponds with better outcomes in both scoring systems. Due to the small numbers in each of the original score values, we collapsed the scores into categories that produced a logistic regression model in which all observations were able to be considered, and odds ratios for death were all statistically significant at a level of P < 0.001. Reclassification tables were constructed to compare the GAP score and T-RTS, and the accuracy in predicting death was assessed in each using the c-statistics. These c-statistics were assessed for statistical equality using DeLong methodology.
Results: Receiver operating characteristic (ROC) curves for GAP and T-RTS scores returned area under the curve (AUC) values of 0.8521 and 0.8628, respectively. When compared using DeLong methodology, these AUC values were not significantly different (P = 0.808) as was also demonstrated by the distribution of scores in the reclassification table [Figure 1]. | Figure 1: Reclassification of triage-revised trauma score and Glasgow coma scale, age, and systolic blood pressure score showing frequency and percentage classified by score values corresponding to mild (<5%), moderate (5%–50%), and severe (>50%) risk of mortality
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Conclusion: While both the T-RTS and GAP scores had excellent ROC characteristics for predicting death in our population, it should be noted that the highest scores (lowest risk of death, <5%) in each scoring system included 11 (2.2%) and 9 (1.8%) deaths. While this is still appropriately categorized as described by Sartorious et al. in 2010, these scoring systems require further validation in a larger population of TBI patients before clinical use as a triage tool.
Scientific Abstract Number 7
Postoperative Chewing Gum: An Affordable Alternative for Combating Postoperative Ileus?
T. R. Wojda1,2, B. A. Hoey3, P. L. Valenza2, W. T. H. Terzian1, A. Cipriano1, S. Dingley3, S. Schadt3, M. Schadt3, N. Martins4, K. Chaput4, S. P. Stawicki3
1Departments of Research and Innovation, 3Surgery and 4Medicine, Section of Gastroenterology, St. Luke's University Health Network, Bethlehem, Pennsylvania, 2Coventry Family Practice at St. Luke's Warren Hospital, Phillipsburg, New Jersey, USA
Introduction: Postoperative ileus (POI) continues to be a major barrier to the optimization of surgical outcomes. Morbidity and prolonged hospitalization associated with POI are associated with significant human and economic costs. Despite general progress in perioperative management, the current state of POI fails to keep up with other aspects of clinical care. The aim of this meta-analysis was to determine if postoperative gum chewing (PGC) has beneficial effects on return of bowel function or hospital lengths of stay. Given its low cost, the effectiveness of PGC as a clinical intervention is attractive in both developed and low/middle-income countries, with health-care resources being either scarce or becoming increasingly restricted.
Methods: A total of 4522 candidate studies were identified during a comprehensive literature search using PubMed, Google Scholar, EBSCOHost, and BioLine. Search terms included various combinations of “ileus,” “chewing gum,” “gum,” “postoperative ileus,” “surgery,” “bowel function,” “study,” “clinical trial.” Within the larger subset of candidate publications, 96 studies were suitable for inclusion in the current analysis. Of those, 27 reported on “time to bowel sounds;” 91 reported on “time to flatus;” 70 reported on “time to stool;” and 60 reported on “hospital length of stay.” Data were analyzed using Open MetaAnalyst Software using random effects model to calculate mean differences within each of the above parameters.
Results: The use of chewing gum (CG) was associated with statistically significant decreases in time to bowel sounds, flatus, and bowel movement [Figure 1], bottom three categories]. Patients using CG were, on average, discharged nearly 17 h earlier than control group patients [[Figure 1], top category]. Although the clinical significance of the reduction in time to flatus or bowel movement is questionable, the reduction in hospital length of stay is nontrivial, especially in the context of clinical revenue generation and hospital bed turnover. | Figure 1: Cumulative results of the current meta-analysis of the impact of chewing gum on postoperative ileus. (Top) Hospital length of stay; (second from top) time to bowel movement (h); (second from bottom) time to flatus (h); and (bottom) time to bowel sounds (h)
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Conclusion: The implementation of gum chewing in a variety of surgical populations appears to speed up the return of bowel function. More importantly, the average hospitalization for patients in the CG groups is shortened by nearly 17 h, suggesting significant economic argument for this simple and inexpensive intervention. This is pertinent globally, both for cost-conscious health systems in high-income countries and for resource-poor healthcare settings of the low- and middle-income countries. However, due to source data heterogeneity, applicability of our results is limited.
Scientific Abstract Number 8
Validation of a Risk Prediction Score for Radiographic Head Injuries in Traumatic Brain Injury Patients at the University Teaching Hospital of Kigali, Rwanda
G. M. Amadio, F. Shofer1, C. J. Gerardo2, J. C. Byiringiro3, F. Byiringiro3, N. M. Thielman2, S. Rulisa3, C. A. Staton2, E. Krebs
Department of Emergency Medicine, Thomas Jefferson University Hospital, 1Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 2Department of Emergency Medicine, Duke University, Durham, North Carolina, USA, 3University Teaching Hospital of Kigali, Kigali, Rwanda, Africa
Introduction/Objective: In resource-constrained health systems, risk prediction scores for significant findings are particularly valuable. Data from the Corticosteroid Randomization After Significant Head Injury (CRASH-1) trial have been used to develop a model for predicting intracranial hemorrhage found on computed tomography (CT) of the head. This study's objective was to validate the CRASH model for predicting important CT head findings in traumatic brain injury (TBI) patients at the University Teaching Hospital of Kigali (UTHK).
Methods: Prospective consecutive sampling of all TBI patients presenting to UTHK emergency department (ED) was performed, with the following inclusion criteria: reported head trauma, alteration in consciousness, headache, or visible head trauma. Exclusion criteria were age ≤10 years, presentation >48 h after injury, or repeat visits. Included patients were observed by research trained nurses during their first 1st h in the ED and reassessed daily until their death or hospital discharge. This is a secondary analysis of the original cohort that was altered to match the CRASH cohort of patients with a Glasgow coma scale (GCS) of ≤ 14 who arrived for care within 8 h of their injury. The CRASH-derived model adds 6 points if any abnormality in pupil response was detected, so all patients in our cohort are assumed to have normally reacting pupils due to missing data. Chi-squared testing was performed to assess the differences between the CRASH derived age categories (<20, each decade of life, >79), GCS scores, time from injury to presentation categories (<1, 1–3, >3 h), and presence of extra-cranial injuries (yes or no). We collapsed the scores into categories to produce a logistic regression model, in which all observations were able to be considered. A receiver operator curve (ROC) was constructed to evaluate the model's ability to predict important CT findings in our cohort, which included any intracranial bleed or skull fracture. Results: We found statistically significant differences in GCS and presence of extra-cranial injuries but neither in age categories nor in time from injury to arrival. Given that our cohort included ~1/10th the patients from which the CRASH scoring was derived, we suspect that this could be related to our small numbers, so all predictor variables were included in the score [Figure 1]. The ROC showed very good ability of this scoring system to predict important CT findings with a c-statistic of 0.813. | Figure 1: Frequencies and proportions of patients with and without important head computed tomographic findings (intracranial bleed or skull fracture), classified according to risk score
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Conclusions: To our knowledge, this is the first attempt to validate this scoring system to predict intracranial hemorrhage in another population of TBI patients in a resource-constrained setting. We found very good ROC characteristics of this prediction model modified to fit our population. Our findings support future validation of this score in larger cohorts but should not yet be used for clinical decision-making.
| Disaster Preparedness Track | | |
Scientific Abstract Number 1
Drill of Multiple Victims at Porto Alegre
D. Burguêz, E. B. Montanari, A. F. Benini, A. S. Martins, B. Enzveiler, F. Abtibol, I. Trindade Sá Brito, J. S. Fernandes, S. Teixeira Dal Ponte1
Universidade Federal do Rio Grande do Sul, 1Hospital de Clínica de Porto Alegre, Porto Alegre, Brazil
Introduction: Since the fire at Kiss nightclub in Santa Maria, Brazil (2013), which resulted in 242 deaths and 680 wounded, the search for a plan to care for multiple victims has become a common concern among emergency managers with in health services of Porto Alegre, Brazil.
Aim: To provide summary report of a drill conducted to simulate a mass casualty disaster.
Materials and Methods: In 2016, the first simulation of disasters was conducted by the Hospitals Syndicate of Porto Alegre, in partnership with the Civil Defense, Mobile Prehospital Service (Serviço de Atendimento. Móvel de Urgência [SAMU]) and with the support of the Fire Brigade, Military Brigade, public transport company (EPTC), and private emergency mobile services. The scenario simulated was a collision between a bus and a car, totaling 32 victims. The wounded were transferred to the six participating hospitals: Clinicas Hospital of Porto Alegre, Cristo Redentor Hospital, Mãe de Deus Hospital, Moinhos de Vento Hospital, São Lucas Hospital, and Divina Providência Hospital. The ambulances were provided by the Unimed, Transul, Ecco-Salva, and SAMU companies, and the most severely injured were transported by air transport provided by the Military Brigade. The students of Medicine of the Trauma and Emergency League of Federal University of Rio Grande do Sul participated as observers, whose purpose was to accompany a victim, from the accident site to the intrahospital care, to record the whole process for later analysis in Porto Alegre.
Results: Patients were taken to available hospitals. The closest hospital was 13 km away from the accident site. The public transport company (EPTC) was the first to arrive at the accident site in 6 min, followed by the first ambulance in 8 min and by the fire department after 10 min. The patients' risk classification (triage) was performed 12 min after the event. The helicopter arrived in 29 min and after 13 min began the transfer of the most serious victims to Moinhos de Vento Hospital. The last victim was removed from the scene after 1 h and 29 min. A SAMU's doctors coordinated the attendance at the accident site, but there was a lack of communication among all the professionals. It was noted that most of the ambulances had no medical staff or structure compatible with the severity of the victims. There was no adequate use of personal protective equipment, such as gloves and masks. Some ambulances returned to get another patient without the necessary equipment. The victims within the bus were treated according to proximity to the door and not according to the risk classification. The firefighters were the only ones to follow the protocol properly. The lack of integration between the entities involved and the structural lack of the system points to a vulnerability to catastrophic situations, proving that there is not yet a well-established and effective plan for the care of multiple victims in Porto Alegre.
Scientific Abstract Number 2
Use of Medical Reserve Corps Volunteers in a Hospital-based Disaster Exercise
R. Gist, P. Daniel, A. Grock, C-J. Lin, C. Bryant, S. Kohlhoff, P. Roblin, B. Arquilla
Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA
Introduction: The Medical Reserve Corps (MRC) is a national network of community-based volunteer groups created in 2002 by the Office of the United States Surgeon General (Rockville, Maryland, USA) to augment the nation's ability to respond to medical and public health emergencies. However, there is little evidence-based literature available to guide hospitals on the optimal use of medical volunteers and hesitancy on the part of hospitals to use them.
Methods: A full-scale exercise was designed as a “disaster Olympics,” in which the emergency medicine residents were divided into teams tasked with completing one of the following five challenges: victim decontamination, mass casualty/decontamination tent assembly, patient triage and registration during a disaster, point of distribution (POD) site setup and operation, and infection control management. A surge of patients potentially exposed to avian influenza was the scenario created for the latter three challenges. Some MRC volunteers were assigned clinical roles. These roles included serving as members of the suit support team for victim decontamination, distributing medications at the POD, and managing infection control. Other MRC volunteers functioned as “victim evaluators,” who portrayed the potential avian influenza victims while simultaneously evaluating various aspects of the disaster response. The MRC volunteers provided feedback on their experience and evaluators provided feedback on the performance of the MRC volunteers using evaluation tools.
Results: Twenty-eight (90%) of MRC volunteers reported that they worked well with the residents and hospital staff, felt the exercise was useful, and were assigned clearly defined roles. However, only 21 (67%) reported that their qualifications were assessed before role assignment. For those MRC members who functioned as “victim evaluators,” nine identified errors in aspects of the care they received and the disaster response. Of those who evaluated the MRC, 9 (90%) felt that the MRC worked well with the residents and hospital staff. Ten (100%) of these evaluators recommended that MRC volunteers participate in the future disaster exercises.
Conclusions: Through use of a full-scale exercise, this study was able to identify roles for MRC volunteers in a hospital-based disaster. This study also found MRC volunteers to be uniquely qualified to serve as “victim evaluators” in a hospital-based disaster exercise.
Scientific Abstract Number 3
Simulating a Disaster – Preparing Responders in India
B. Kaufman, P. Daniel, J. Freedman, B. Jarrett, B. Arquilla
Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
Objective: This study evaluates the effectiveness of a novel modality created by our team to teach disaster preparedness consisting of tabletop drills and disaster simulation. Based on the incident command system (ICS) framework, our system prepares medical providers to respond independently to country level disasters.
Background: Disaster response remains an important component of emergency preparedness internationally. To this end, the ICS provides a standardized approach to the command, control, and coordination of emergency response.
Methods: A 2-day workshop was conducted with medical providers in Bangalore, India, that used serial disaster simulations to improve disaster response using the ICS. Through increasing responsibility and self-directed tabletops, the participants (doctors, medical students, nurses, and police) gained the skills to respond independently to a simulated countrywide disaster. After the exercise, they were asked to grade the usefulness of simulation and lectures.
Results: Forty-four providers responded to the questionnaire, all of which (n = 44, 100%) recommended the course. They graded the final disaster drill as most useful (n = 36, 82%) and also graded lectures from topic experts as useful (n = 36, 83%). Based on qualitative written feedback, participants felt drills helped them in communication and leadership.
Conclusion: This novel teaching modality, using simulation and tabletop drills, is an effective tool to teach the ICS to medical providers. Participants felt that they benefitted from training and would respond better to future disasters.
Scientific Abstract Number 4
Disaster Preparedness for Clinics – Further Study from Haiti
M. Riscinti, B. Kaufman, S. Hussain, C. Bloem, B. Arquilla
Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
Introduction: Local clinics are the first stop for patients when disaster strikes low-middle-income (LMI) countries. They are often under-resourced and under-prepared to respond to patient needs. Further effort is required to prepare these crucial institutions to respond effectively, using the incident command system (ICS) framework. Our team created a manual to train clinics in LMI countries to effectively respond to disasters. This study is follow-up to a prior study evaluating disaster response. We returned to previously trained clinics to evaluate retention and performance in a disaster simulation.
Methods: Two clinics in the northeast region of Haiti were trained through a disaster manual created to help clinics in LMI countries respond effectively to disasters. This study measured the clinic staff's response to a disaster drill using the ICS and compared the results to prior responses.
Results: Using the prior study's evaluation scale, clinics were evaluated on their ability to set up an ICS. During the mock disaster, staff was evaluated on a 3-point scale in 13 different metrics grading their ability to mitigate, prepare, respond, and recover in a disaster. By this scale, both clinics were effective (36/39, 92%) in responding to a disaster.
Conclusions: The clinics retained much prior training, and after repeat training, the clinics improved their disaster response. Future study will evaluate the clinics' ability to integrate disaster response with countrywide health resources to enable an effective outcome for patients.
Scientific Abstract Number 5
Needs Assessment for Medical Supplies in Freetown following the Ebola crisis: Ensuring Appropriate Donations
P. F. Johnston, S. Jalloh, P. Fillie, A. Trye, Z. C. Sifri
Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
Introduction: Every year, an enormous amount of medical supplies are discarded from the US hospitals, despite being clean and unused, due to a strict regulatory climate lacking an evidence base. Simultaneously, already significant medical supply shortages in Sierra Leone were exacerbated by the recent Ebola crisis, causing a situation in need of immediate attention. As local hospitals look to rebuild infrastructure, donations of medical supplies may alleviate some of the burden. We developed a survey to gauge the specific needs in hospitals in low-income countries to ensure any medical supply donations sent are appropriate and do not further burden a strained system.
Methods: Local stakeholders in Freetown identified hospitals with a need for donations to include in our survey. A 12-question predonation needs assessment survey was administered. An inventory list of 18 commonly recovered basic surgical supplies from an operating room supply recovery program at a US academic center was provided. The initial surveys were conducted face to face by volunteers. Survey questions asked about the population served, which supplies available were most wanted, and the barriers to acquiring and maintaining stocks of medical supplies. Based on the initial survey, a second visit was held at a later date with samples of materials to be donated.
Results: Five surveys were collected from four hospitals (a medical and surgical division from an urban tertiary center): two tertiary care centers, one district hospital, and one community hospital. By report, these hospitals serve directly or as a referral center for 3.3 million of the total of 6.4 million Sierra Leoneans. Of the supplies available on the survey, the hospitals reported a need for 87% of such materials (mean 15.6 ± 1.6 items). Additional essential items such as pulse oximeters, blood pressure machines, and electrocardiograms were also requested via write-in by a majority of hospitals. Cost, availability, and delays were cited as barriers in 80% of the responses. All respondents reported the ability to resterilize donated supplies.
Conclusions: Following the Ebola crisis, critical shortages continue to exist in Freetown across the spectrum of hospitals. Meanwhile, in the US, regulatory policy leads to disposal of literally tons of usable supplies annually. Our findings reveal an immediate need for many of the most basic supplies which are recovered from programs like ours. Performing needs assessments and providing samples are the keys to ensuring donations that match the specific need and ensure positive impact on the recipient hospital.
| Chronic Disease Management | | |
Scientific Abstract Number 1
Identifying Barriers to Community Health Worker Success in Rural India
C. Pathak, J. Cavanaugh, S. Cherukupalli, R. Singh, N. Suria, A. Bhalla1, M. Swaroop
Department of Surgery, Northwestern University School of Medicine, Chicago, Illinois, USA, 1Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Introduction: The accredited social health activist (ASHA) program is a community health worker program initiated by the National Rural Health Mission of the Government of India to connect the rural Indian population with government health-care resources. The focus of the program is to create awareness of the social determinants of health and mobilize the community toward increased utilization of available health services. Implementation of the platform nationally has been fragmented, leading to a multitude of challenges in programmatic success. This study aims to elucidate barriers to better ASHA performance to improve implementation and ongoing trainings of the ASHA program in rural India.
Methods: In August 2014, two 90-min focus groups, with 12 ASHAs who work in Nanakpur, Haryana, India, were performed. Questions concerning ASHAs responsibilities, resources limitations, transportation, and compensation mechanism were discussed. Audio from the focus groups was translated and transcribed into English. Thematic analysis was then coded by two researchers independently.
Results: ASHAs identified three main barriers damaging to their performance: (1) a lack of resources from the government including adequate training, transportation, and compensation incentives, (2) a lack of community education regarding the ASHA program, and (3) a lack of respect toward ASHAs from other health-care professionals and a lack of ASHA integration into the healthcare system.
Conclusions: Successful community health worker programs pivot on adequate resources, community acceptance, and tight integration into the existing health-care system. ASHAs in Nanakpur felt that they were limited by a lack of government support, lack of engagement from the community, and largely excluded from healthcare delivery in government hospitals. Interventions must not only address resource limitations in the Indian healthcare system but also work to spread community awareness about the ASHA program and work with existing health-care providers to integrate ASHAs into the health-care hierarchy. The ASHA program will reach its full potential when the community health workers feel empowered to advocate on behalf of their community to successfully connect them to the appropriate health-care resources.
Scientific Abstract Number 2
Hypertension, Obesity, and Gender Differences in a Ghanaian Population
M. Garg, S. M. Garg, D. Asihene, D. Escobar, C. Brandon, V. Desai, A. Green, J. Kafer, G. Lagasse
Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA, USA
Background: Medical students have limited opportunity to provide site-specific research impact or engage in scholarship on a short-term global medicine experience. Hypertension and obesity are common in Ghana. Using demographic data on a convenience sample of consecutive patients seeking primary care in Ghana, researchers evaluated whether obese patients had higher rates of hypertension and whether gender differences exist. Researchers hypothesized that more obese patients would have higher rates of hypertension and that male patients would have higher rates of hypertension than their female counterparts.
Methods: Researchers obtained data regarding gender, age, weight, blood pressure, and medical diagnoses on a convenience sample of 61 consecutive adult patients at multiple hospitals in Accra, Ghana. A scatter plot with linear regression was performed with the data. Institutional review board approval was waived as this study was observational without intervention. Photographs were obtained with consent.
Results: Sixty-three percent of the patients in the sample were female. A trend between increased weight and elevated blood pressure was identified [Figure 1]. Linear regression shows a slight progression of increased blood pressures with increased weights overall in all patients and separately in both female and male patients. Furthermore, linear regressions of gender-specific plots indicate that the rate of increase in weight and blood pressure is greater in female patients than their male counterparts. The average weight of a female patient in our sample was 71.8 kg, while the average weight of a male patient was 64.4 kg. | Figure 1: Graphical representation of the relationship between systolic blood pressure and weight for all participants and separately in female and male patients
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Discussion and Conclusion: Medical students can have site-specific research impact and engage in scholarship on a short-term global medicine experience. The data from this study suggest that female patients in our sample trended with higher rates of obesity and hypertension. In discussion with local physicians, this trend occurred even though female patients present more often for medical care than males. Possibilities for this finding include gender-specific sedentary lifestyle norms; accepted beliefs regarding body type and health; and postpregnancy family planning strategies. The study is limited due to power and sampling.
Scientific Abstract Number 3
Garcinia Cambogia: A Low-cost Natural Adjunct to Weight Loss Programs?
S. Schadt, T. R. Wojda1, M. Schadt, W. T. H. Terzian, S. Dingley, S. P. Stawicki1
Departments of Surgery and 1Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
Introduction: Weight gain and obesity are increasingly prevalent across the world. Despite massive governmental and nongovernmental initiatives, success remains remote. Medical treatments dedicated to weight loss are both questionably effective and expensive. The goal of this analysis was to determine if a simple regimen consisting of dietary supplementation of Garcinia Cambogia (GC) can enhance the efficacy of concurrent dietary and/or lifestyle modifications. We hypothesized that the use of GC will result in greater weight loss than comparable regimen(s) without GC.
Methods: A comprehensive literature search using PubMed, Google Scholar, EBSCOHost, and BioLine was performed for various combinations of the terms “Garcinia Cambogia” (GC), “weight loss,” “hydroxycitric acid” (HCA, active component within GC), “obesity,” “program,” “regimen,” and “clinical trial.” A total of 520 results were screened, with 13 publications containing suitable comparison groups (protocols utilizing GC versus non-GC regimens). The primary study outcome was the mean difference in weight loss at the end of the study period. Weight calculations utilized kilograms (kg) as primary units of measurement.
Results: A total of 13 studies with 535 patients (276 GC versus 259 non-GC) were included in the final meta-analysis. Median patient age for the all patients was 40 years, with baseline body mass index of 28.3 kg/m2. Median daily dosing of GC was 1500 mg (range, 500–2800 mg). The median duration of intervention was 9 weeks (range, 8–16 weeks). At the end of the intervention, patients in the GC group experienced weight loss that was 1.163 kg greater than patients non-GC group [P < 0.01, I2 = 90%, [Figure 1]]. | Figure 1: Pooled data showing that patients taking Garcinia Cambogia experienced 1.163 kg greater weight loss than patients not taking Garcinia Cambogia
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Conclusions: In time-limited clinical studies, GC use was associated with greater weight loss compared to non-GC controls. It is uncertain if the effect of GC can be sustained beyond the 9-week median study intervention period. If longer-term studies confirm persistent benefit of GC use, a recommendation could be made that GC represents a viable weight loss supplement, especially in regions where lack of availability or prohibitive costs preclude other medical options.
Scientific Abstract Number 4
Health Insurance Status as a Predictor of Pediatric Weights-For-Age
M. Garg, S. M. Garg, V. Desai, A. Green, D. Asihene, C. Brandon, D. Escobar, J. Kafer, G. Lagasse
Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA, USA
Background: Medical students have limited opportunity to provide site-specific research impact or engage in scholarship on a short-term global medicine experience. At the time of this study, Ghana had well-child visits covered under a popular insurance plan. Using demographic data on a convenience sample of consecutive patients seeking primary care in Ghana, researchers evaluated whether health insurance made a difference in pediatric weights-for-age utilizing the WHO pediatric male and female growth curves. Researchers hypothesized that there would be a difference in insured versus uninsured pediatric weights-for-age and that male children would have less deviation from the WHO growth curve compared to female counterparts.
Methods: Researchers obtained data regarding sex, age, weight, and insurance status information on a convenience sample of consecutive patients aged 0–-24 months and multiple hospitals in Accra, Ghana. Patients over 24 months were excluded from the study as the WHO growth curves only included standards up to 24 months. Institutional review board approval was waived as this study was observational without intervention. Photographs were obtained with consent.
Results: Mean weight deviation for the male uninsured group was −0.84 kg. Mean weight deviation for the male insured group was + 0.97 kg. Mean weight deviation for the female uninsured group was −0.62 kg. Mean weight deviation for the female insured group was −0.48 kg. Key study results are presented in [Table 1]a,[Table 1]b,[Table 1]c and [Figure 1] and [Figure 2]. | Figure 1: Male weight plotted against age for insured and uninsured patients on WHO growth standards[1]
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 | Figure 2: Female weight plotted against age for insured and uninsured patients on WHO growth standards[1]
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Discussion: Medical students can have site-specific research impact and engage in scholarship on a short-term global medicine experience. The data from this study suggest that pediatric patients with insurance demonstrate a less-negative deviation from their mean weights-for-age. This is an important observation since weights that fall under the mean significantly increase a child's risk for comorbidities and death. Male patients demonstrated less deviation from the WHO growth curve compared to their female counterparts. The study is limited due to power and sampling.
| Medical Education | | |
Scientific Abstract Number 1
International Rotation for the 4th-Year Surgical Residents: Productive, Nondisruptive, and a Residency Recruitment Tool
A. Cipriano, B. A. Hoey, S. P. Stawicki, R. P. Sharpe
Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
Introduction: International educational offerings (IEOs) are becoming increasingly popular among general surgery training programs. The implementation of such IEOs is often controversial, for financial, administrative, and logistical reasons. Our institution began the International Surgical Studies (ISS) program in the fall of 2014, with both faculty and graduate medical education trainee (GMET) participation. The primary goal of this study was to demonstrate that the IEOs offered to our GMETs are nondisruptive from the operative experience standpoint. Secondary objectives included the demonstration of enhanced clinical experience and the use of IEOs as a recruitment tool for potential residency candidates.
Methods: Objective operative (e.g., case logs) and nonoperative (subjective) experiences of GMETs from our ISS program were tabulated, comparing pre-IEO (before 2014) and post-IEO (2014–present) periods. Because IEOs at our program are limited to 4th postgraduate year (PGY-4) surgical GMETs; PGY-4 case logs of seven residents who participated in the IEO (Mbingo Baptist Hospital, Cameroon) were compared to five PGY-4 residents who did not participate in IEO. Group characteristics were then compared using Fisher's exact testing (significance set at alpha = 0.05) to determine if unexpected differences in case distribution existed between the two GMET groups. Because our program instituted rotation changes that affected case volumes in thoracic surgery and endoscopy in the pre-IEO versus post-IEO period, those case types were excluded from our analysis. Finally, subjective information regarding resident, accompanying faculty, and GME applicant perceptions of the IEOs were summarized.
Results: A total of seven GMETs participated in the IEOs at our institution. Case logs from additional five GMETs were used as control data. There were no differences in 4th-year resident mean case volumes or overall reported case mix between the two groups [Figure 1]. Residents who participated in IEOs reported 10% more open operations during their 4th year (55% versus 45% per resident), subjective increase in confidence of their clinical assessments, and exposure to various unusual and late-stage pathologic findings rarely seen in the US healthcare setting. In addition, our 2017 post-NRMP match survey results indicate that significant proportion (39%) of residency applicants considered our IEOs as strength during the match decision-making process. The effect of IEOs as an option was similar in importance to the availability of research opportunities (33%). | Figure 1: The overall operative experience of 4th-year residents was not affected by the participation in international surgery rotation. Thoracic and endoscopic categories are not shown due to structural change in those specific rotations during the same period of time
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Conclusions: International rotation during the 4th year of residency provides a valuable educational experience, does not affect average resident case loads, and creates an opportunity to refine clinical diagnostic skills in an era of over-reliance on advanced imaging and laboratory testing. Finally, our postmatch GME survey demonstrated that IEOs make our graduate medical education programs more attractive to potential residency recruits.
Scientific Abstract Number 2
Is Surgical Training the Same Everywhere? Evaluating International Surgical Training Programs using the American College of Graduate of Medical Education Competencies
S. M. Siddiqui, P. Murphy, M. Saeed, S. Shafqat1, Z. Mehmood1, S. Mattar2, J. J. Coleman3, M. Swaroop
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 2Department of Surgery, Oregon Health and Science University, Portland, Oregon, 3Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA, 1Jinnah Postgraduate Medical Center, Karachi, Pakistan
Background: Surgical residency programs in the United States (US) have recently started to incorporate international surgical rotations into their academic curriculum. The utility of these rotations in developing young surgeons has now been documented based on the American College of Graduate of Medical Education (ACGME) metrics. To assess the potential for international rotations to have a more validated role for both the surgical training programs involved, we sought to survey the perspectives of international surgery residency program directors and residents on their own programs utilizing the ACGME competencies.
Methods: A pilot survey tool for international surgical residency program directors and residents was designed based on existing survey tools administered to fellowship program directors and residents to assess their perceptions of preparedness for practice after residency. These were electronically and anonymously administered to program directors and residents at five surgical training programs in Pakistan. Responses were stored in Microsoft Excel.
Results: Five program directors and seven surgical residents responded. Similar to US fellowship program directors, the area where most international program directors (up to 60%) identified deficiencies was the psychomotor ability domain, especially in technical areas involving newer technology (laparoscopy and staplers). Most international program directors did not find their residents proficient in the domain of academia and scholarship. However, they did feel that residents were proficient in the domains of level of independence, clinical evaluation and management, and professionalism. Residents' self-perceptions were similar to US residents and 70% (n = 5) felt that they would be ready to practice independently upon completion of their training program.
Discussion: While this is a small pilot study sample, it does show there are areas where US residents have strengths they can share with international colleagues and areas where international residents have strengths they can share with their US counterparts. As we continue to accrue responses, we anticipate identifying specific complimentary areas of mutual benefit for international exchange rotations and define a broad role for these rotations in the general surgery residency curriculum.
Scientific Abstract Number 3
A Model for Global Health Education: Increasing Clinical Confidence in Junior Medical Students
S. Feldman, N. Vijayvargiya, M. Garg1
Department of Emergency Medicine, Temple University School of Medicine, 1Department of Emergency Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
Background: Participation in international medical service by medical students has steadily increased over the past half century. This introduces the ethical question of whether or not to allow junior medical students the opportunity to deliver care despite their lack of experience. However, a standardized global medicine curriculum which would address these concerns is lacking.
Objective: Our study introduces an effective and efficient global health elective course that can be implemented into medical curriculums which would successfully fill this void.
Methods: This prospective survey-based study investigated the confidence of 200 1st-year medical students in performing ten clinical skills before and after completion of the global health elective at Temple University School of Medicine. The Global Health Elective Survey [Figure 1] assessed ten skills including suturing, placing intravenous (IV) lines, orthopedic splinting, delivering a baby, managing wounds, writing prescriptions, writing subjective/objective/assessment/plan (SOAP) notes, treating infectious diseases, treating medical conditions, and presenting research. Clinical confidence was assessed on a 100-point Likert scale. Following the students' international experiences, an International Medical Service Survey [Figure 2] assessed the value of the skills learned in the global health elective by measuring on a scale from one to ten the degree of enrichment MS1 students experienced while serving abroad. Outline of the Global Health Curriculum can be found in [Figure 3].
Findings: The Global Health Elective Survey showed an overall 3-fold increase in students' confidence in performing the ten emphasized clinical skills (P < 0.001) [Figure 4] and [Figure 5]. The International Medical Service Survey further demonstrated that students on average rated the global health elective as 6.78 out of 10 in terms of utility in preparing them for their international experience [Figure 6]. Treating common presenting complaints and writing SOAP notes and prescriptions were the most valued skills [Figure 7]. | Figure 4: Pre- and post-course mean clinical skill self-confidence ratings
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 | Figure 5: Clinical skill self-confidence ratings in pre- and post-course evaluations
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 | Figure 6: Utility of the global health elective in preparation for international service experience
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 | Figure 7: Utility of skills learned in global health in enhancing student's service board
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Conclusions: Not only is this 14-h global health elective model feasible and reproducible to implement in medical schools throughout the country, but it is also effective in giving students valued impact and the confidence they need to actively participate in patient care abroad.
Scientific Abstract Number 4
Trauma and Emergency League of the Faculty of Medicine of Universidade Federal do Rio Grande do Sul – Activities of the year 2016
J. Fernandes, E. B. Montanari, F. Abtibol, D. Daniela, B. Enzveiler, A. S. Martins, A. F. Benini, S. Teixeira Dal Ponte1
Universidade Federal do Rio Grande do Sul, 1Hospital de Clínica de Porto Alegre, Porto Alegre, Brazil
Introduction: Academic associations have developed among several universities in Brazil. The objectives of the different associations are wide and varied; however, it is possible to identify uniform goals aimed in the promotion of knowledge shared among the associations. This knowledge sharing helps unite academia and lay the population. In the trauma and emergency associations, we have found that these goals are especially important because knowledge sharing can lead to prevention and mitigation of adverse outcomes for our communities.
Aim: To show the importance of the academic associations in the expansion of the knowledge particularly in emergency medicine to medical students of the Federal University of Rio Grande do Sul (UFRGS).
Materials and Methods: Ten students were selected through an interview process; it was prerequisite of selection to be a medical student at the Federal University of Rio Grande do Sul (UFRGS). In addition, the student participated in the Inaugural Symposium organized by the Trauma and Emergency League (LTE-UFRGS) on March 2016, at Hospital de Clínicas de Porto Alegre (HCPA). At this symposium, important subjects were identified as the basis for the rest of the trauma and emergency curriculum. During the year 2016, several activities were carried out with the participation of selected students and the management team that organized the selection. The goal of the league is hold biweekly classes taught by invited professors regardless of their University affiliation. Other activities are participation in the advanced trauma life support and prehospital life support. In addition, a practical hands-on course in emergency and trauma at the Porto Alegre Emergency Hospital, on National Cardiopulmonary Resuscitation Day, and the point of care ultrasound course were conducted in partnership with a private company that trains professionals from HCPA. The students also received training provided by the Brazilian Committee of Trauma Leagues (Cobralt) in partnership with the Brazilian Society of Integrated Traumatized Care (Sbait). These courses included: Saving Lives Project and Pre-Brazilian Congress of the Trauma Leagues.
Results and Conclusions: Students were satisfied with the content learned during the year 2016. Many people in the general public have learned how to proceed in emergency situations with the Saving Lives and Cardiopulmonary Resuscitation Day. The set of activities resulted in a reinforcement of the partnership with educational and private institutions, hospitals, and academic leagues of other universities. Training for more students is required.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19], [Figure 20], [Figure 21]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11]
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