Establishing Competencies for a Global Health Workforce: Recommendations from the Association of Pacific Rim Universities.

BACKGROUND: The Association of Pacific Rim Universities Global Health Program facilitates exchange of information, knowledge and experiences in global health education and research among its 50 member universities. Despite the proliferation of global health educational programs worldwide, a lack of consensus exists regarding core competencies in global health training and how these are best taught. METHODS: A workshop was convened with 30 faculty, university administrators, students, and NGO workers representing both the Global North and South to gain consensus on core competencies in masters'-level global health training. The co-authors then collaborated to refine the list of competencies, categorize them into domains, and develop a plan for how academic institutions can ensure that these competencies are effectively taught. FINDINGS: Nineteen competencies across five domains were identified: knowledge of trends and determinants of global disease patterns; cultural competency; global health governance, diplomacy and leadership; project management; and ethics and human rights. The plan for how academic institutions can best train students on these competencies outlined five key opportunities: coursework; practicums; research opportunities; mentorship; and evaluation. The plan recommended additional institutional strategies such as maximizing collaborative research opportunities, international partnerships, capacity-building grants, and use of educational technology to support these goals. CONCLUSIONS AND RECOMMENDATIONS: While further research on the implementation of competency-based training is warranted, this work offers a step forward in advancing competency-based global health masters' education as identified by a globally diverse group of expert stakeholders and economies. Given the challenges facing the current global health landscape, comparable competency-based training across institutions is critical to ensure the training of competent global health professionals.

Changing culture in interventional areas to promote patient safety.

During the past decade, physicians have begun to perform an increasing number of interventional procedures in various locations outside the traditional OR. Changes in technology and practice have generated the need for a paradigm shift about perioperative practice because these interventional areas have become perioperative centers of care in which patients undergo operative and other invasive procedures. Physicians, nursing staff members, support staff members, and administrators in these interventional areas must consider perioperative practice standards, institutional policies, state practice acts, and regulatory and accreditation requirements when creating policies and procedures. Personnel must be familiar with AORN standards and recommended practices and understand the perioperative practice guidelines related to nurse staffing in invasive procedure areas. Advanced practice nurses and other leaders must use evidence-based research as the basis for policy and procedure changes.

The intended-and unintended-consequences of healthcare reform.

Healthcare reform will affect providers by: Changing employer-sponsored health plans. Cutting Medicare payment. Expanding Medicaid coverage. Penalizing excessive avoidable readmissions. Increasing Medicaid payment to primary care physicians. Increasing payment to community health centers. Changing patient-provider relationships.

Increased activity of Coxsackievirus B1 strains associated with severe disease among young infants in the United States, 2007-2008.

BACKGROUND: Enterovirus infections are very common and typically cause mild illness, although neonates are at higher risk for severe illness. In 2007, the Centers for Disease Control and Prevention (CDC) received multiple reports of severe neonatal illness and death associated with coxsackievirus B1 (CVB1), a less common enterovirus serotype not previously associated with death in surveillance reports to the CDC. METHODS: This report includes clinical, epidemiologic, and virologic data from cases of severe neonatal illness associated with CVB1 reported during the period from 2007 through 2008 to the National Enterovirus Surveillance System (NESS), a voluntary, passive surveillance system. Also included are data on additional cases reported to the CDC outside of the NESS. Virus isolates or original specimens obtained from patients from 25 states were referred to the CDC picornavirus laboratory for molecular typing or characterization. RESULTS: During 2007-2008, the NESS received 1079 reports of enterovirus infection. CVB1 accounted for 176 (23%) of 775 reported cases with known serotype, making it the most commonly reported serotype for the first time ever in the NESS. Six neonatal deaths due to CVB1 infection were also reported to the CDC during that time. Phylogenetic analysis of the 2007 and 2008 CVB1 strains indicated that the increase in cases resulted from widespread circulation of a single genetic lineage that had been present in the United States since at least 2001. CONCLUSIONS: Healthcare providers and public health departments should be vigilant to the possibility of continuing CVB1-associated neonatal illness, and testing and continued reporting of enterovirus infections should be encouraged.

Detection of immunoglobulin M antibody to hepatitis A virus in Alaska residents without other evidence of hepatitis.

During a 38-month period, 13 of 41 persons with test results positive for IgM antibody to hepatitis A virus did not meet the case definition for hepatitis A or have a clear indication for testing, which suggests that test results were falsely positive. No single testing platform or kit was used. Health care providers should restrict serologic testing for hepatitis A to patients with clinical or epidemiologic indications.