Pre-departure training for student global health experiences: A scoping review

Abstract: Purpose: To identify: 1) Predeparture training (PDT) best practices for physiotherapy students participating in a global health experience (GHE) in low income countries, 2) current practices in Canadian physiotherapy programs, and 3) to compare best and current practices. Methods: This study employed a mixed method approach. A scoping review was performed to identify PDT best practices discussed in scientific and grey literature. An online questionnaire surveyed Canadian physiotherapy academic coordinators about their current training practices (questions covered student selection, PDT, on-site training and supervision and debriefing). Qualitative and quantitative analysis were performed for both phases of the study; best practices were compared to current practices. Results: Best practices included recommendations about the content and format of PDT, the organization of GHEs (e.g. focus on sustainability), the student selection process and the support offered to students before, during and after the GHE. Canadian universities have varying practices in terms of content, training format and duration. All universities having GHE have mandatory PDT and an established student selection process; half of them have mandatory debriefing. Conclusion: Discrepancies between current and best practices exist. Next steps should focus on reviewing PDT based on best practices and evaluating impacts on students, universities and partners

A Meta Analysis on Risks of Adverse Pregnancy Outcomes in Toxoplasma gondii Infection

OBJECTIVE: Quantified risks of congenital Toxoplasma gondii infection and abnormal pregnancy outcomes following primary maternal infection were evaluated with meta- analysis based on published studies. METHODS: The related literatures were searched in multiple literature databases regardless of languages. Odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the risks of vertical transmission of Toxoplasma gondii and abnormal pregnancy outcomes following primary maternal infection with meta-analysis. RESULTS: 53 of the 2632 searched literatures were included in our analysis. The incidence of abnormal pregnancy outcomes in T. gondii infected pregnant women (infected group) was significantly higher than that in the uninfected pregnant women (control group) (OR = 5.10; 95% CI, 3.85-6.75). Toxoplasma gondii infection rate in the abnormal-pregnancy-outcome group was significantly higher than in the normal-pregnancy group (OR = 3.71; 95% CI, 3.31-4.15). The pooled rate of vertical transmission was 20% (95% CI, 15%-26%) in maternal infection of T. gondii. The incidences of vertical transmission in women who were infected in the first, second or third trimester of pregnancy were 5% (95%CI, 2%-16%), 13% (95%CI, 7%-23%), and 32% (95%CI, 24%-41%), respectively. The rates of vertical transmission in women who were treated with spiramycin-only, PSF (pyrimethamine + sulfadiazine + folinic acid) or PS (pyrimethamine + sulfadiazine) combined with spiramycin, or other untypical treatments were 13% (95%CI, 7%-22%), 13%(95%CI, 7%-25%), and 24%(95%CI, 18%-32%), respectively. CONCLUSIONS: Toxoplasma gondii infection can result in adverse pregnancy outcomes in pregnant women. The pooled rate of vertical transmission was 20% in maternal infection and the incidences of vertical transmission increased in the first, second or third trimester of pregnancy. The pooled rates of transmission in groups treated with spiramycin-only, PSF or PS combined with spiramycin, or other untypical treatments were not significantly different

Managing adult patients with infectious diseases in emergency departments: international ID-IRI study.

We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 ± 0.74. Sepsis (qSOFA ≥ 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 ± 0.963) compared to upper-middle (0.17 ± 0.482) and high-income (0.36 ± 0.714) countries (P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required