The American journal of tropical medicine and hygiene
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Am. J. Trop. Med. Hyg. · May 2015
Maji: a new tool to prevent overhydration of children receiving intravenous fluid therapy in low-resource settings.
We designed and evaluated the accuracy and usability of a device to regulate the volume of fluid dispensed during intravenous drip therapy. The mechanical system was developed in response to a pressing need articulated by clinicians in pediatric wards throughout sub-Saharan Africa, who require a tool to prevent overhydration in children receiving intravenous fluid in settings that lack burettes or electronic infusion pumps. ⋯ The ease of use is "excellent," with a mean system usability score of 84.4 out of 100. Use of the device limits the volume of fluid dispensed during intravenous therapy and could potentially reduce the morbidity and mortality associated with overhydration in children receiving intravenous therapy.
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Am. J. Trop. Med. Hyg. · May 2015
Etiology of pediatric fever in western Kenya: a case-control study of falciparum malaria, respiratory viruses, and streptococcal pharyngitis.
In Kenya, more than 10 million episodes of acute febrile illness are treated annually among children under 5 years. Most are clinically managed as malaria without parasitological confirmation. There is an unmet need to describe pathogen-specific etiologies of fever. ⋯ Malaria was overdiagnosed and overtreated. Few children presented to the hospital with GAS pharyngitis. An enhanced understanding of carriage of common pathogens, improved diagnostic capacity, and better-informed clinical algorithms for febrile illness are needed.
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Am. J. Trop. Med. Hyg. · Apr 2015
Direct killing of patients in humanitarian situations and armed conflicts: the profession of medicine is losing its meaning.
During armed conflicts over the past several years, attacks on humanitarian workers and patients have increased, including the most recent overt killing of patients in their hospital beds in South Sudan and Central African Republic, and bombardments of hospitals in Iraq, Syria, and other countries. Direct attacks on patients inside hospitals, as well as social structural dynamics that undermine patient safety and security, are met with apparent indifference by international and medical communities. How can the medical profession remain silent and stand by while these factors render its core mission futile? In this article, I aim to shed light on this issue, and its implications for the future of the neutral and impartial provision of medical care; provide an analysis of underlying and contributing factors; discuss current international strategies; reflect on the responsibility of health providers; explore ways to strengthen our roles as physician advocates; and call for the medical profession to do more to protect medicine's core values.
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As the outbreak of Ebola virus disease (EVD) in West Africa continues, clinical preparedness is needed in countries at risk for EVD (e.g., United States) and more fully equipped and supported clinical teams in those countries with epidemic spread of EVD in Africa. Clinical staff must approach the patient with a very deliberate focus on providing effective care while assuring personal safety. ⋯ Although formal guidance toward these goals exists from the World Health Organization, Medecin Sans Frontières, the Centers for Disease Control and Prevention, and other groups, some of the most critical lessons come from personal experience. In this narrative, clinicians deployed by the World Health Organization into a wide range of clinical settings in West Africa distill key, practical considerations for working safely and effectively with patients with EVD.
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Am. J. Trop. Med. Hyg. · Feb 2015
Ebola policies that hinder epidemic response by limiting scientific discourse.
There is an unprecedented epidemic of Ebola virus disease (EVD) in west Africa. There has been a strong response from dedicated health professionals. ⋯ We argue against such policies, question evidence and motivations, and discuss their practical and ethical implications in hampering effective responses to EVD by the scientific community. We aim to shed light on this issue and its implications for the future of public health interventions, reflect on the responsibility of health providers and professional societies as advocates for patients and the public health, and call for health professionals and societies to work to challenge inappropriate political responses to public health crises.