Home-Based Remedies to Prevent COVID-19-Associated Risk of Infection, Admission, Severe Disease, and Death: A Nested Case-Control Study.

Objective: This study aimed at determining the various types of home-based remedies, mode of administration, prevalence of use, and their relevance in reducing the risk of infection, hospital admission, severe disease, and death. Methods: The study design is an open cohort of all participants who presented for testing for COVID-19 at the Infectious Disease Treatment Centre (Tamale) and were followed up for a period of six weeks. A nested case-control study was designed. Numerical data were analysed using STATA version 14, and qualitative data were thematically analysed. Results: A total of 882 participants made up of 358 (40.6%) cases and 524 (59.4%) unmatched controls took part in the study. The prevalence of usage of home-based remedies to prevent COVID-19 was 29.6% (n = 261). These include drinks (34.1% (n = 100)), changes in eating habits/food (33.8% (n = 99)), physical exercise (18.8% (n = 55)), steam inhalation (9.9% (n = 29)), herbal baths (2.7% (n = 8)), and gurgle (0.7 (n = 2)). Participants who practiced any form of home-based therapy were protected from SARS-CoV-2 infection (OR = 0.28 (0.20-0.39)), severe/critical COVID-19 (OR = 0.15 (0.05-0.48)), hospital admission (OR = 0.15 (0.06-0.38)), and death (OR = 0.31 (0.07-1.38)). Analysis of the various subgroups of the home-based therapies, however, demonstrated that not all the home-based remedies were effective. Steam inhalation and herbal baths were associated with 26.6 (95% CI = 6.10-116.24) and 2.7 (95% CI = 0.49-14.78) times increased risk of infection, respectively. However, change in diet (AOR = 0.01 (0.00-0.13)) and physical exercise (AOR = 0.02 (0.00-0.26)) remained significantly associated with a reduced risk of infection. We described results of thematic content analysis regarding the common ingredients in the drinks, diets, and other home-based methods administered. Conclusion: Almost a third of persons presenting for COVID-19 test were involved in some form of home-based remedy to prevent COVID-19. Steam inhalation and herbal baths increased risk of COVID-19 infection, while physical exercise and dietary changes were protective against COVID-19 infection and hospital admission. Future protocols might consider inclusion of physical activity and dietary changes based on demonstrated health gains.

Identifying priorities for quality improvement at an emergency Department in Ghana.

BACKGROUND: Healthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educate staff about the World Health Organization's (WHO) definition of quality in healthcare, and to identify an initial focus for building a departmental QI program. METHODS: Semi-structured interviews were conducted with ED staff using open-ended questions to probe their understanding and valuation of the six dimensions of quality defined by the WHO. Participants were then asked to rank the dimensions in order of importance for QI. Qualitative responses were thematically analyzed, and ordinal rank-order was determined for quantitative data regarding QI priorities. RESULTS: Twenty (20) members of staff of different cadres participated, including ED physicians, nurses, orderlies, a security officer, and an accountant. A majority of participants (61%) ranked access to emergency healthcare as high priority for QI. Two recurrent themes - financial accessibility and hospital bed availability - accounted for the majority of discussions, each linked to all the dimensions of healthcare quality. CONCLUSIONS: ED staff related all of the WHO quality dimensions to their work, and prioritized access to emergency care as the most important area for improvement. Participants expressed a high degree of motivation to improve healthcare quality, and the study helped with the development of a departmental QI program focused on the broad topic of access to ED services.

A Comprehensive Framework for International Medical Programs: A 2017 consensus statement from the American College of Academic International Medicine.

The American College of Academic International Medicine (ACAIM) represents a group of clinicians who seek to promote clinical, educational, and scientific collaboration in the area of Academic International Medicine (AIM) to address health care disparities and improve patient care and outcomes globally. Significant health care delivery and quality gaps persist between high-income countries (HICs) and low-and-middle-income countries (LMICs). International Medical Programs (IMPs) are an important mechanism for addressing these inequalities. IMPs are international partnerships that primarily use education and training-based interventions to build sustainable clinical capacity. Within this overall context, a comprehensive framework for IMPs (CFIMPs) is needed to assist HICs and LMICs navigate the development of IMPs. The aim of this consensus statement is to highlight best practices and engage the global community in ACAIM's mission. Through this work, we highlight key aspects of IMPs including: (1) the structure; (2) core principles for successful and ethical development; (3) information technology; (4) medical education and training; (5) research and scientific investigation; and (6) program durability. The ultimate goal of current initiatives is to create a foundation upon which ACAIM and other organizations can begin to formalize a truly global network of clinical education/training and care delivery sites, with long-term sustainability as the primary pillar of international inter-institutional collaborations.

Impact of Mandatory Carbon Monoxide Alarms: An Investigation of the Effects on Detection and Poisoning Rates in New York City.

OBJECTIVES: We sought to evaluate the impact of New York City's (NYC's) 2004 carbon monoxide (CO) alarm legislation on CO incident detection and poisoning rates. METHODS: We compared CO poisoning deaths, hospitalizations, exposures reported to Poison Control, and fire department investigations, before and after the law for 2000 to 2010. Use of CO alarms was assessed in the 2009 NYC Community Health Survey. RESULTS: Investigations that found indoor CO levels greater than 9 parts per million increased nearly 7-fold after the law (P < .001). There were nonsignificant decreases in unintentional, nonfire-related CO poisoning hospitalization rates (P = .114) and death rates (P = .216). After we controlled for ambient temperature, the law's effect on hospitalizations remained nonsignificantly protective (incidence rate ratio = 0.747; 95% confidence interval = 0.520, 1.074). By 2009, 83% of NYC residents reported having CO alarms; only 54% also recently tested or replaced their batteries. CONCLUSIONS: Mandating CO alarms significantly increased the detection of potentially hazardous CO levels in NYC homes. Small numbers and detection bias might have limited the discovery of significant decreases in poisoning outcomes. Investigation of individual poisoning circumstances since the law might elucidate remaining gaps in awareness and proper use of CO alarms.

Preparing for Ebola Virus Disease in West African countries not yet affected: perspectives from Ghanaian health professionals.

BACKGROUND: The current Ebola Virus Disease (EVD) epidemic has ravaged the social fabric of three West African countries and affected people worldwide. We report key themes from an agenda-setting, multi-disciplinary roundtable convened to examine experiences and implications for health systems in Ghana, a nation without cases but where risk for spread is high and the economic, social and political impact of the impending threat is already felt. DISCUSSION: Participants' personal stories and the broader debates to define fundamental issues and opportunities for preparedness focused on three inter-related themes. First, the dangers of the fear response itself were highlighted as a threat to the integrity and continuity of quality care. Second, healthcare workers' fears were compounded by a demonstrable lack of societal and personal protections for infection prevention and control in communities and healthcare facilities, as evidenced by an ongoing cholera epidemic affecting over 20,000 patients in the capital Accra alone since June 2014. Third, a lack of coherent messaging and direction from leadership seems to have limited coordination and reinforced a level of mistrust in the government's ability and commitment to mobilize an adequate response. Initial recommendations include urgent investment in the needed supplies and infrastructure for basic, routine infection control in communities and healthcare facilities, provision of assurances with securities for frontline healthcare workers, establishment of a multi-sector, "all-hazards" outbreak surveillance system, and engaging directly with key community groups to co-produce contextually relevant educational messages that will help decrease stigma, fear, and the demoralizing perception that the disease defies remedy or control. The EVD epidemic provides an unprecedented opportunity for West African countries not yet affected by EVD cases to make progress on tackling long-standing health systems weaknesses. This roundtable discussion emphasized the urgent need to strengthen capacity for infection control, occupational health and safety, and leadership coordination. Significant commitment is needed to raise standards of hygiene in communities and health facilities, build mechanisms for collaboration across sectors, and engage community stakeholders in creating the needed solutions. It would be both devastating and irresponsible to waste the opportunity.

Essentials for emergency care: lessons from an inventory assessment of an emergency centre in Sub-Saharan Africa

Introduction:The World Health Organization (WHO) has published lists of essential equipment and supplies for delivering emergency care in resource-limited settings. The objective of this study was to assess material resources available for adult emergency care at a major academic tertiary care referral centre in Accra; Ghana; to determine quality improvement needs.Methods A spot inventory of emergency centre equipment and supplies was conducted in Korle-Bu Teaching Hospital (KBTH) and compared to the WHO essential emergency equipment list released in 2006. Results :Most items considered essential were available at the time of inventory. Notable exceptions included: equipment and supplies for healthcare provider safety and infection control; advanced airway management; and ophthalmologic or gynaecological examinations. Several additional items; such as glucometers and pulse oximeters; were available and often used for patient care. Conclusion:Beyond pointing out specific material resource deficiencies at the Surgical Medical Emergency (SME) centre; our inventory assessment indicated a need to develop better implementation strategies for infection control policies; to collaborate with other departments on coordination of patient care; and to set a research agenda to develop emergency and acute care protocols that are both effective and sustainable in our setting. Equipment and supplies are essential elements of emergency preparedness that must be both available and 'ready-to-hand'. Consequently; key factors in determining readiness to provide quality emergency care include supply-chain; healthcare financing; functionality of systems; and a coordinated institutional vision. Lessons learnt may be useful for others facing similar challenges to emergency medicine development

Ethylene glycol toxicity presenting with non-anion gap metabolic acidosis.

Ethylene glycol classically produces an elevated anion gap metabolic acidosis. We report a series of patients with ethylene glycol toxicity with a component of non-anion gap metabolic acidosis without known associated confounding factors. A retrospective review of Poison Control Center records were searched more than 8 years (2000-2007) for ethylene glycol and antifreeze. Cases were reviewed and excluded for miscoding, information calls, animal exposures, or non-ingestion exposures. The bicarbonate gap, or delta ratio (DR), was calculated using the formula: DR = (AG - 12)/[24 - measured serum where anion gap (AG) = [Na(+)] - [Cl(-)] - , all in mEq/l. Non-anion gap metabolic acidosis was considered present when the DR < 1. Of 254 cases, 175 were excluded. Of the remaining 79 cases, 14 had a component of non-anion gap metabolic acidosis at presentation. Their calculated anion gap was 14-28, and measured serum ranged from 2-20 mEq/l. A normal anion gap was present in two patients who presented with non-anion gap metabolic acidosis. The DR ranged from 0.28-0.95. Seven out of 14 patients with non-anion gap metabolic acidosis had elevated serum [Cl(-)]. In the other cases, no explanation for the non-anion gap metabolic acidosis could be determined. The absence of a significant anion gap elevation in the setting of metabolic acidosis after ethylene glycol ingestion without other confounding factors (such as ethanol, lithium carbonate or bromide) has not previously been recognized. Clinicians should be aware of the potential for non-anion gap metabolic acidosis in patients with ethylene glycol toxicity, and should not exclude the diagnosis in patients who present with a non-anion gap metabolic acidosis. Further study is needed to determine the mechanisms by which this occurs.