Train the Trainer in Bleeding Control: A Two-Year Pilot Study in Low-Income and Middle-Income Countries.

Introduction: Traumatic hemorrhage represents a major cause of mortality in low-income and middle-income countries (LMICs). Thus, LMICs can benefit from improvements to prehospital hemorrhage management. One strategy is implementation of a bleeding control course using the "train the trainer" model (TTT) to increase course availability.

Timeliness of Point-of-Care Viral Load Results Improves Human Immunodeficiency Virus Monitoring in Nigeria.

Background: Human immunodeficiency virus (HIV) viral load (VL) monitoring is critical for antiretroviral therapy (ART) management. Point-of-care (POC) VL testing has been reported to be feasible and preferred over standard-of-care (SOC) testing in many low- and middle-income country settings where rapid results could improve patient outcomes.

Methods: The timeliness of receipt of VL results was evaluated in an open-label, randomized, controlled trial among patients newly initiating ART.

Clinical Outcomes in a Randomized Controlled Trial Comparing Point-of-Care With Standard Human Immunodeficiency Virus (HIV) Viral Load Monitoring in Nigeria.

Background: Point-of-care (POC) viral load (VL) tests provide results within hours, enabling same-day treatment interventions. We assessed treatment outcomes with POC vs standard-of-care (SOC) VL monitoring.

Methods: We implemented a randomized controlled trial at an urban and rural hospital in Nigeria.

HBV co-infection is associated with persistently elevated liver stiffness measurement in HIV-positive adults: A 6-year single-centre cohort study in Nigeria.

Background: In Nigeria, the effect of Hepatitis B virus (HBV) on long-term liver outcomes in persons with HIV (PLH) has not been described. We determined changes in liver stiffness measure (LSM) using transient elastography over 6 years in HIV mono-infected and HIV-HBV co-infected Nigerians initiating antiretroviral therapy (ART) and factors associated with LSM decline.

Methods: This single centre, cohort study enrolled ART-naïve HIV mono- and HIV-HBV co-infected adults (≥18 years) at the APIN Public Health Initiatives-supported HIV Care and Treatment Centre at Jos University Teaching Hospital, Nigeria, from 7/2011 to 2/2012.

Comparative Microscopic Assessments of the Effect of Aqueous and Ethanol Extracts of Phoenix dactylifera L. in a Rat Model of Mercury-Triggered Hippocampal Changes.

Mercury is an environmental neurotoxicant that triggers structural and physiological alterations in different brain parts. The hippocampus is associated with learning and memory, and injury to this brain part may lead to behavioural and cognitive changes. Phoenix dactylifera (date palm) has been demonstrated to possess a variety of medical benefits.

Disaster Preparedness Training for Emergency Medicine Residents Using a Tabletop Exercise.

Introduction: Emergency medicine (EM) physicians serve at the frontline of disasters in our communities. The 2016 Model of Clinical Practice according to the American Board of EM identifies disaster management as an integral task of EM physicians. We described a low-cost and feasible tabletop exercise to implement such training for EM residents.

Maintenance of Skill Proficiency for Emergency Skills With and Without Adjuncts Despite the Use of Level C Personal Protective Equipment.

Objective To determine the impact of Level C personal protective equipment (PPE) on the time to perform intravenous (IV) cannulation and endotracheal intubation, both with and without the use of adjuncts. Methods This prospective, case-control study of emergency medicine resident physicians was designed to assess the time taken by each subject to perform endotracheal intubation using both direct laryngoscopy (DL) and video laryngoscopy (VL), as well as peripheral IV cannulation both with and without ultrasound guidance and with and without PPE. Results While median times were higher using VL as compared to DL, there was no significant difference between intubation with either DL or VL in subjects with and without Level C PPE.

Significance of Glutamate Racemase for the Viability and Cell Wall Integrity of Streptococcus iniae.

Streptococcus iniae is a pathogenic and zoonotic bacterium responsible for human diseases and mortality of many fish species. Recently, this bacterium has demonstrated an increasing trend for antibiotics resistance, which has warranted a search for new approaches to tackle its infection. Glutamate racemase (MurI) is a ubiquitous enzyme of the peptidoglycan synthesis pathway that plays an important role in the cell wall integrity maintenance; however, the significance of this enzyme differs in different species.

Neurosurgery in the Brazilian Amazon: Is It Possible?

Background: The need for neurosurgical care across the globe remains a public health issue. The creation of sustainable neurological surgery departments and training programs will be indispensable in alleviating the burden of neurological disease in low to middle income countries (LMICs).

Methods: We reviewed the history of the neurological surgery department and residency program of Santarém in the state of Pará, Brazil, from 1999 to the present.

Integrating Bleeding Control Training Into Surgical Missions in Low- and Middle-Income Countries.

Background: Basic bleeding control (BCon) techniques can save lives globally but the knowledge is not widespread in low-income countries where trauma is a common cause of death. Short-term surgical missions (STSMs) are an effective route to share this public health initiative around the world.

Materials And Methods: Over 2017-2018, the International Surgical Health Initiative organized STSMs to locations in Sierra Leone, Bangladesh, Peru, and Ghana.

Social Determinants of Health Curriculum Integrated Into a Core Emergency Medicine Clerkship.

Introduction: Demand that health centers address health inequities has led medical schools to emphasize social determinants of health (SDH). The Emergency Department often serves as first (or sole) point of health care access, making it an ideal environment in which to identify/explore SDH. Yet there are few SDH curricula targeting core emergency medicine (EM) clerkships.

Providing Trainees With an Introduction and Decision-Making Framework for Pursuing an Academic Residency Position.

Introduction: Medical students are a significant source of the future academic medicine workforce, but surprisingly little is typically done to promote academic medicine career awareness during the early stages of medical education. To raise awareness among medical students of the critical role an academic residency plays in pursuing a future academic career, we developed a workshop that describes what an academic residency entails and what to consider when selecting such a program.

Methods: The six-step Kern model was applied to develop a multimodal workshop to help trainees understand characteristics of and explore their interest in an academic residency program.

Treatment Outcomes Among Older Human Immunodeficiency Virus-Infected Adults in Nigeria.

Background: Older age at initiation of combination antiretroviral therapy (cART) has been associated with poorer clinical outcomes. Our objectives were to compare outcomes between older and younger patients in our clinical cohort in Jos, Nigeria.

Methods: This retrospective cohort study evaluated patients enrolled on cART at the Jos University Teaching Hospital, Nigeria between 2004 and 2012.

Using the Association of American Medical Colleges Standardized Video Interview in a Holistic Residency Application Review.

Each year, residency programs work diligently to identify the best applicants for their respective programs, given the increasing volume of applications. Interview offers are often based on a mix of subjective and objective measures, with different programs relying more or less on each. A holistic application review involves a flexible and individualized way of assessing an applicant's capabilities through a balanced consideration of experiences, attributes, and academic metrics.

Sickle Cell Disease in the Emergency Department.

Acute painful episodes are the most common reason for emergency department visits among patients with sickle cell disease (SCD). Early and aggressive pain management is a priority. Emergency providers (EPs) must also diagnose other emergent diagnoses in patients with SCD and differentiate them from vaso-occlusive crisis.

Factors associated with early menopause among women in Nigeria.

Objectives: Effective antiretroviral therapy has prolonged the survival of patients with HIV. Accordingly, studies of the consequences of ageing are increasingly important. We determined the prevalence of early menopause (EM) and its associated factors in a cohort of HIV-infected and HIV-negative controls in Jos, Nigeria.

Prevalence and predictors of severe menopause symptoms among HIV-positive and -negative Nigerian women.

We compared the prevalence of menopause symptoms between women living with HIV to their HIV-negative peers and determined predictors of severe menopause symptoms in Jos, Nigeria. This descriptive cross-sectional study included 714 women aged 40-80 years. We compared prevalence and severity of menopause symptoms using the menopause rating scale (MRS).

Sexual dysfunction and its determinants among women infected with HIV.

Objective: To describe the prevalence of female sexual dysfunction (FSD) and its determinants among women with HIV infection enrolled for care and treatment in an ambulatory care setting.

Methods: A questionnaire-based cross-sectional survey was conducted among women attending the HIV clinic of Jos University Teaching Hospital, Nigeria, between March 2013 and February 2014. The self-administered Female Sexual Function Index (FSFI) was used to assess FSD; a score of less than 26.

Entrustable Professional Activity 10: Case Simulation and Assessment-STEMI With Cardiac Arrest.

Introduction: Entrustable professional activities (EPAs) are units of professional practice defined as tasks or responsibilities that trainees are entrusted to perform unsupervised. AAMC Core EPA 10 is defined as the ability to "recognize a patient who requires emergent care and initiate evaluation and management." We designed a simulation scenario to elicit EPA 10-related behaviors for learner assessment to guide entrustment decisions.

Entrustable Professional Activity 10: Recognizing the Acutely Ill Patient-A Delirium Simulated Case for Students in Emergency Medicine.

Introduction: This simulation case was designed to evaluate the ability of third- and fourth-year emergency medicine clerkship students and acting interns to perform the tasks outlined in the Association of American Medical College's Core Entrustable Professional Activity 10, to "recognize a patient requiring urgent or emergent care and initiate evaluation and management." The overarching goal is to assess medical students' ability to recognize and take steps to stabilize a sick patient.

Methods: In this case, students encounter a physician, simulated with a high-fidelity manikin, who has suddenly become confused.

A suggested emergency medicine boot camp curriculum for medical students based on the mapping of Core Entrustable Professional Activities to Emergency Medicine Level 1 milestones.

Background: An increasing number of students rank Emergency Medicine (EM) as a top specialty choice, requiring medical schools to provide adequate exposure to EM. The Core Entrustable Professional Activities (EPAs) for Entering Residency by the Association of American Medical Colleges combined with the Milestone Project for EM residency training has attempted to standardize the undergraduate and graduate medical education goals. However, it remains unclear as to how the EPAs correlate to the milestones, and who owns the process of ensuring that an entering EM resident has competency at a certain minimum level.

HIV Associated Chronic Obstructive Pulmonary Disease in Nigeria.

Objective: To determine the prevalence and risk factors for chronic obstructive pulmonary disease (COPD) among HIV-infected adults in Nigeria.

Design: Cross-sectional study.

Methods: HIV-infected adults aged ≥ 30 years with no acute ailments accessing care at the antiretroviral therapy clinic of Jos University Teaching Hospital were enrolled consecutively.

Sickle cell disease in the emergency department.

Acute painful episodes are the most common reason for emergency department visits among patients with sickle cell disease (SCD). Early and aggressive pain management is a priority. Emergency providers (EPs) must also diagnose other emergent diagnoses in patients with SCD and differentiate them from vaso-occlusive crisis.

Patients who present late to HIV care and associated risk factors in Nigeria.

Objectives: Our objectives were to assess trends in late presentation and advanced HIV disease (AHD) and determine associated risk factors.

Methods: We conducted a retrospective cohort analysis of patients who had received care and treatment at the AIDS Prevention Initiative Nigeria Plus (APIN)/Harvard School of Public Health-President's Emergency Plan for AIDS Relief (PEPFAR) programme at the Jos University Teaching Hospital, Jos, Nigeria from 2005 to 2010. We used the European Consensus Definition to assess trends in late presentation (CD4 count < 350 cells/μL or AIDS-defining illness) and AHD (CD4 count < 200 cells/μL or AIDS-defining illness) and evaluated associated risk factors using logistic regression methods.