PubMed · 14970079
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Patrick J Potter. 2004-02-17. Anticoagulation.. https://pubmed.ncbi.nlm.nih.gov/14970079/
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In response to Hurricane Katrina, CDC and the Louisiana Department of Health and Hospitals (LDHH) implemented active surveillance on September 9, 2005, to monitor for injuries and illnesses at functioning hospitals and other acute-care facilities in the greater New Orleans area (Jefferson, Orleans, Plaquemines, St. Bernard, St. Charles, and St. Tammany parishes). On September 20, the system was interrupted because of mandatory evacuation for Hurricane Rita. Surveillance was reestablished on September 24, and repopulation of Orleans Parish began on September 30. This report updates a previous report on injuries and illness surveillance during September 8-25, 2005, after Hurricane Katrina and describes frequencies of these events during the days after Hurricane Rita and during repopulation of the city. The results indicate that 17,446 visits occurred at participating facilities during this period. Whereas the proportion of relief workers who had acute respiratory illnesses and unintentional injuries was higher compared with residents, the proportion of falls and motor-vehicle crashes among relief workers was lower. Moreover, although the collection of detailed data using a paper-based active surveillance system was required in response to Hurricane Katrina, the burden of this system required the implementation of an electronic syndromic surveillance system, which is more sustainable.
OBJECTIVE: To evaluate an intervention to promote health workers' use of the World Health Organization's Integrated Management of Childhood Illness clinical guidelines and to identify other factors influencing quality of care received by Moroccan children. SETTING: Public outpatient health facilities. DESIGN: Cross-sectional survey of consultations with sick children under 5 years old at facilities in two intervention and two comparison provinces in April 2000 (6-12 months after intervention). Consultations were observed, children's caretakers and health workers were interviewed, and children were re-examined by a 'gold standard' study clinician. STUDY PARTICIPANTS: Probability sample of 467 consultations (97.9% participation) performed by 101 health workers in 62 facilities. INTERVENTION: Health workers received in-service training with job aids and a follow-up visit with feedback 4-6 weeks after training. MAIN OUTCOME MEASURES: Index of overall guideline adherence (mean percentage of recommended tasks that were done per child) and the percentage of children requiring antibiotics correctly prescribed antibiotics. RESULTS: Quality of care was better in intervention provinces, according to the adherence index (79.7 versus 19.5%, P < 0.0001), correct prescription of antibiotics (60.8 versus 31.3%, P = 0.0013), and other indicators. Multivariate modeling revealed a variety of factors significantly associated with quality, including health worker attributes (pre-service training, residence in government-subsidized housing, sex, and opinions) and child/consultation attributes (child's age and temperature, number of chief complaints, and caretaker type). CONCLUSIONS: Exposure to the intervention was strongly associated with adherence to the guidelines and correct prescribing of antibiotics 6-12 months after exposure. Many other factors may influence health worker performance.
The organization of neurology as a specialty and of neurology training specifically has evolved tremendously over the last 130 years. Originally primarily an outpatient specialty, the focus of training shifted to inpatient neurology in the early 20th century when accreditation of programs required training in newly established inpatient-based neurologic departments. Now and in the near future, the growth of neurologic critical care and the expansion of neurology intensive care units may require even more inpatient responsibilities in neurology residency programs. Contrary to these trends in training, most community neurology practice is still focused on outpatients, and surveys of neurologists have consistently indicated a need for more outpatient exposure in neurology training. This article briefly reviews the history of neurology training, discusses current challenges to outpatient training, and recommends possible solutions for the future.