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Genetics

New form of EDS identified by mutation in THBS2 gene – Ehlers-Danlos News

A mutation in the gene THBS2 cause a newly defined form of Ehlers-Danlos syndrome (EDS) thats characterized by unusual flexibility as well as prolonged bleeding and blood vessel abnormalities, a new study reports.

The study, Heterozygous THBS2 pathogenic variant causes EhlersDanlos syndrome with prominent vascular features in humans and mice, was published in the European Journal of Human Genetics.

EDS refers to a group of connective tissue disorders that are typically characterized by symptoms including an abnormal range of joint motion and fragile skin. More than a dozen identified types of EDS exist, however, each with different causes and typical manifestations.

The patient at the center of this study is a woman in her late 20s of Ashkenazi Jewish ancestry who sought medical attention for a history of frequent joint dislocations, tendon rupture, easy bruising, and prolonged bleeding when injured. She also reported fatigue in her legs after exercising.

The patients older sister and their mother reported similar symptoms. Imaging studies showed blood vessel abnormalities: the younger sister and her mother both had unusual pooling of blood in veins in the lower legs; the mother also had abnormalities in a heart valve. Of note, the mothers father, who had a history of aneurysms (bulging or swollen blood vessels) while alive, had died of a blood vessel rupture.

The three women underwent EDS-specific genetic testing, but analyses of more than a dozen genes linked to EDS showed no noteworthy findings. A more widespread analysis identified 43 genetic variants that were in both sisters. Most of these were common in people of Ashkenazi Jewish ancestry and were ruled out, and a few others were ruled out by genetic testing of the extended family.

The researchers then zeroed in on a mutation in the THBS2 gene that was found in both sisters, but not their unaffected relatives or in databases of genetic samples from more than 7,000 Ashkenazi Jews.

Everyone inherits two copies of the THBS2 gene, one from each biological parent. In the sisters, just one copy of the gene carried a mutation (called p.Cys896Arg), indicating that this form of EDS is inherited in an autosomal dominant pattern where one mutated copy is sufficient to cause disease.

Our findings demonstrate that the THBS2 p.Cys896Arg variant has a dominant effect, the researchers wrote.

To confirm that this mutation was disease-causing, the researchers generated mice carrying the same mutation in the mouse version of the THBS2 gene. These mice demonstrated excessive flexibility in fact, the researchers said they were able to tie the mices tails into knots without causing the animals any notable distress. The mice also bled excessively when injured.

Upon lab evaluation of the mices tissue, the researchers noted that collagen fibers were disorganized. Collagen is the main protein that gives body tissue its structural integrity, and collagen abnormalities are a defining feature of EDS.

Altogether, these data define a new form of EDS caused by a mutation in the THBS2 gene. The scientists are working on further studies to understand the biological mechanisms of how THBS2 mutations lead to connective tissue abnormalities.

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New form of EDS identified by mutation in THBS2 gene - Ehlers-Danlos News

Pediatrics

Navigating Pediatric Diabetes: A Q&A With Leading Expert David Maahs, MD – Stanford Medicine Children’s Health Blog – Stanford Children’s Health

Diabetes management in pediatric patients has come a long way, with advancements such as continuous glucose monitors and automated insulin delivery systems. In a recent interview, David Maahs, MD, professor of pediatrics and division chief of pediatric endocrinology at Stanford Medicine and Lucile Packard Childrens Hospital Stanford, sheds light on the current state of diabetes care for children and adolescents.

The following Q&A is drawn from Stanford Medcast, Episode 71: Hot Topics Mini Series: Diabetes UnpackedMyths, Facts, and Tips, a podcast hosted by Ruth Adewuya, MD, CHCP, Managing director of the Stanford Center for Continuing Medical Education.

How has diabetes management for pediatric patients evolved, and what advancements are making a significant impact?

David Maahs, MD: Over time, there has been notable progress in diabetes care for children and adolescents. Continuous glucose monitoring (CGMs) have proven highly effective compared to traditional methods, with approximately 70% to 80% of our patients with type 1 diabetes now utilizing CGMs. Additionally, there are now five approved automated insulin delivery systems, providing diverse options for parents. While not everyone may embrace these technologies immediately, the overall landscape is consistently improving.

What are the primary goals in managing diabetes for pediatric patients, and do these goals vary with age or other factors?

The three main goals in pediatric diabetes care are maintaining a low A1C (a measure of your average glucose over the last three months), minimizing hypoglycemia, and prioritizing a good quality of life. Weve adapted to use continuous glucose monitoring metrics, focusing on achieving an average glucose or time in range between 70 and 180. Balancing these goals has become more achievable with the advancements in CGMs.

How do acute and long-term complications factor into pediatric diabetes management, and have there been improvements in addressing these concerns?

Acute concerns such as hypoglycemia have improved significantly with continuous glucose monitors and automated insulin delivery systems. For longer-term complications like damage to the eyes, nerves, kidneys, and heart, reducing A1C levels is crucial. The introduction of these new diabetes technologies and lower A1Cs will reduce these risks over time.

Engaging pediatric patients in their care is vital. How does the multidisciplinary team at Stanford Childrens approach this, and what challenges do you most commonly face?

We are fortunate to have a multidisciplinary team at Stanford Medicine Childrens Health, including certified diabetes care and education specialists, dietitians, social workers, psychologists, an exercise physiologist, and pediatric endocrinologists. Diabetes educators play a vital role in educating families, and the team works closely with patients during regular follow-up appointments. The challenges include the 24/7 nature of diabetes management, but continuous support and periodic monitoring help address these difficulties.

Transitioning from pediatric to adult care is a critical phase. How does Stanford Childrens ensure a seamless transition, and what are the key considerations during this process?

Transitioning from pediatric to adult care poses challenges across various health conditions. Our guided transfer program aims to facilitate this transition by introducing patients to adult care while still in the pediatric clinic, ensuring a warm handoff to the adult diabetes clinic. The approach minimizes the risk of patients getting lost during this crucial life phase.

Reflecting on your experience, what are the most rewarding aspects of working with pediatric patients with diabetes?

One of the joys of pediatrics is getting to know the families. Witnessing the growth of children, often entering their lives during a crisis, and seeing them thrive with the advancements in diabetes care is rewarding. The focus is not only medical management, but also on supporting the general well-being and quality of life of these young patients.

The pediatric endocrinology team at Stanford Medicine Childrens Health is ranked in the top 10 in Diabetes & Endocrinology by U.S. News & World Report and treats children with endocrine disorders at convenient locations throughout the Bay Area.

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Navigating Pediatric Diabetes: A Q&A With Leading Expert David Maahs, MD - Stanford Medicine Children's Health Blog - Stanford Children's Health

Pediatrics

Linaclotide Succeeds for Functional Constipation in Children | GI and Hepatology News – MDedge

Children and adolescents with functional constipation showed significantly greater increases in spontaneous bowel movements with linaclotide compared with placebo, according to data from 330 individuals.

Functional constipation is prevalent in pediatrics and is associated with chronic burdensome symptoms and impaired quality of life with an unmet need for treatment options for this age group, corresponding study author Julie Khlevner, MD, AGAF, a pediatric gastroenterologist at Columbia University Vagelos College of Physicians and Surgeons, New York, said in an interview.

Linaclotide has been approved for adults with chronic idiopathic constipation and irritable bowel syndrome with constipation, but its efficacy and safety in pediatric patients were unknown. Therefore, evaluating its use in this population was crucial to provide evidence-based treatment option, she said.

In a study published in The Lancet Gastroenterology & Hepatology, the researchers randomized 166 pediatric patients with functional constipation to 72 micrograms of linaclotide once daily for 12 weeks and 164 to a placebo. The study was conducted at 64 clinic or hospital sites across 7 countries between October 1, 2019, and March 21, 2022. Approximately half (55%) of the patients were female.

The primary outcome was a change from baseline to 12 weeks in the frequency of spontaneous bowel movements (SBMs) per week, with no rescue medication on the day of or before the bowel movement. The secondary endpoint was change in stool consistency from baseline to 12 weeks. The mean frequency for SBMs at baseline was 1.16 per week in patients randomized to linaclotide and 1.28 for those randomized to placebo; these rates increased to 3.41 and 2.29, respectively, over the study period. The linaclotide patients showed a significantly greater improvement over placebo patients based on least-squares mean change from baseline (2.22 vs. 1.05, P = .0001).

In a subgroup analysis by age, the response was stronger in younger patients aged 6-11 years than in those aged 12-17 years, the researchers noted. This difference might stem from different pathophysiological mechanisms between older and younger ages, such as withholding behavior, they added.

Linaclotide was well tolerated overall; the most frequently reported treatment-emergent events were diarrhea (seven linaclotide patients and three placebo patients). In addition, five linaclotide patients and four placebo patients developed COVID-19 during treatment. No deaths occurred during the study, but one serious adverse event involving severe diarrhea, dehydration, and hospitalization, occurred in a 17-year-old female patient, but resolved after administration of intravenous fluids, the researchers noted.

The study findings reflect previous research on linaclotide in adults, Dr. Khlevner said. The significant improvement in spontaneous bowel movements frequency and stool consistency with linaclotide compared to placebo is consistent with its mechanism of action as a guanylate cyclase C agonist, she noted.

In clinical practice, barriers to the use of linaclotide may include lack of awareness of linaclotides safety and efficacy profile, and of its Food and Drug Administration approval for use in children aged 6-17 years with functional constipation, said Dr. Khlevner. Additionally, access to the medication and insurance coverage may be potential barriers for some patients. However, some of these barriers can be overcome through education and training of healthcare providers regarding the appropriate use of linaclotide in pediatric patients with functional constipation, she added.

The findings were limited by several factors including potential measurement bias and selection bias, lack of assessment of lifestyle modifications as confounding factors, and lack of quality-of-life assessment, the researchers noted. Other limitations included the relatively short 12-week treatment duration, which may not fully capture long-term safety and efficacy, and the focus on patients aged 6-17 years, Dr. Khlevner told this news organization.

Future research could address these limitations through longer-term studies with broader age ranges and incorporating patient-reported outcomes in real world situations to assess the overall impact of linaclotide treatment on pediatric patients with functional constipation, she said.

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Linaclotide Succeeds for Functional Constipation in Children | GI and Hepatology News - MDedge

Pediatrics

Testing and diagnoses capacity of 2009 influenza and COVID-19 pandemics – Contemporary Pediatrics

Testing and diagnoses capacity of 2009 influenza and COVID-19 pandemics | Image Credit: phonlamaiphoto - phonlamaiphoto - stock.adobe.com.

Investigators of an observational study published in Respiratory Investigation sought to examine factors associated with the testing and diagnostic capacity for the influenza pandemic in 2009 were linked to those during the COVID-19 pandemic.

Insights into testing and diagnoses capacity for children could be valuable in preparing health care systems for future pandemics, wrote the study authors, who created an observational study using data obtained from the Japan Medical Data Center.

In the early stages of the COVID-19 pandemic in Japan, few facilities conducted polymerase chain reaction-based (PCR) testing in children, even after the Omicron strain emerged.

The limited testing capacity contrasted from the 2009 influenza pandemic. In this period, approximately 20 million children were diagnosed, while 10,000 required hospitalization.

The study explored organizational factors associated with diagnosis and testing capacity for COVID-19 among children younger than 20 years of age from 2020 to 2021.

To explore the determinants of testing and diagnoses capacity and the association between the pandemics, the investigators used multivariable generalized linear models.

Using a nationally representative administrative database, 4906 medical facilities and 1.7 million infections disease-related visits were used in the study. The majority of medical facilities were clinics (85.6%) with pediatrics (32.3%), or internal medicine departments (54.9%).

The majority of patients (53%) were male and the mean age of the study population was 6.5 years (SD, 4.7).

Compared to clinics, public hospitals (adjusted incidence rate ratio [aIRR], 1.52. 95% CI, 1.26 - 1.82) and university hospitals (aIRR, 1.44. 95% CI, 1.14 - 1.80) were more likely to perform COVID-19 testing among children.

The highest testing rate was demonstrated in the department of internal medicine (aIRR, 1.64; 95%CI, 1.32 2.04). Pediatrics (aIRR, 1.40; 95%CI, 1.10 1.78) and otolaryngology (aIRR, 1.21; 95%CI, 0.89 1.64) followed.

"Compared to the medical facilities in the lowest quartile of testing rate for influenza in 2009, those in the highest quartile were more likely to perform testing for COVID-19 (aIRR, 1.62; 95%CI, 1.431.83)," wrote the study authors.

Insights between the pandemics, with a highlight on the dose-response relationship, "could be valuable in preparing health care systems for future pandemics," concluded the investigators.

Reference:

Okubo Y, Uda K. Structural and organizational determinants of the capacity for COVID-19 testing and diagnoses in children: Insights from the 2009 influenza and COVID-19 pandemics. Respiratory Investigation. Volume 62, Issue 3. 2024. Pages 426-430. ISSN 2212-5345. https://doi.org/10.1016/j.resinv.2024.03.001.

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Testing and diagnoses capacity of 2009 influenza and COVID-19 pandemics - Contemporary Pediatrics

Pediatrics

Predicting Infection Risk in Childhood Cancer – News Center – Feinberg News Center

A statistical model can accurately predict the risk of bloodstream infections in a subset of children with cancer, according to a study published in the Journal of Clinical Oncology.

For children with cancer, fever is a common complication. While guidelines exist for managing fever in children with cancer who have very low white blood cell counts, no such guidelines exist for children with cancer without severely low levels.

Because of this, identifying patients with cancer and fever who are at a higher risk for bloodstream infections can be difficult, said Jenna Rossoff, MD, assistant professor of Pediatrics in the Division of Hematology, Oncology and Stem Cell Transplantation and a co-author of the study.

While some hospitals may choose to pre-emptively administer antibiotics to a feverish child being treated for cancer, that can lead to other complications such as antibiotic resistance later on, Rossoff said.

In the study, Rossoff and her collaborators sought to test a model developed to predict the risk of bloodstream infections, which can develop into sepsis, in feverish children with cancer.

This model has been designed to delineate bloodstream infection risk in these patients at presentation based on a variety of variables, and the overall goal is to reduce unnecessary antibiotic use and also identify patients obviously at high risk for a bloodstream infection, said Rossoff, who is also a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

To test the model, investigators collected data on fever episodes occurring in pediatric cancer patients from 18 academic medical centers. They then compared the models predictions to the seven-day clinical outcomes in each of the 2,500+ cases and found that the model could accurately predict which patients were more likely to experience bloodstream infections, according to the study.

The findings suggest the model accurately identifies high-risk patients and could reduce unnecessary antibiotic use, Rossoff said.

Importantly, the paper showed that in the patients whose predicted risk for bloodstream infections using this model was low, there was a very low rate of true bloodstream infections, Rossoff said. For those few percent of patients who did have a bloodstream infection, there were no severe outcomes.

Moving forward, Rossoff said she would like to see more studies done testing the model in children with cancer who have undergone stem cell transplants and other novel therapies.

Fevers are a pretty frequent complication during treatment and when our kids dont need antibiotics, we should be avoiding them to prevent antibiotic resistance and disruption of the gut microbiome, she said. As much as we can safely safely being the key word decrease antibiotic administration, that would be a great thing overall.

The study was supported by the National Center for Research Resources Grant KL2TR000446.

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Predicting Infection Risk in Childhood Cancer - News Center - Feinberg News Center

Pediatrics

Healing the divide: Advancing access to pediatric care – HealthLeaders Media

While a more privileged child may enjoy the luxury of prompt medical attention and preventive care, their counterpart in a poor area faces a labyrinth of obstacles hindering their access to essential healthcare services. Full story Share this: Tagged Under: healthcare access healthcare disparity pediatrics

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Healing the divide: Advancing access to pediatric care - HealthLeaders Media

Pediatrics

McMaster Child Health Research Day charts the future of pediatric health – Brighter World

From left, researcher Briano Di Rezze, keynote speaker and Edmonton MP Mike Lake, chair of Pediatrics Angelo Mikrogianakis, McMaster Children's Hospital President Bruce Squires, pediatrics researcher Gita Wahi, Hamilton MP Lisa Hepfner, Offord Centre director Stelios Georgiades, and CanChild co-director Olaf Kraus de Camargo at this week's McMaster Child Health Research Day event.

BY Cheryl Crocker

March 28, 2024

More than 130 Health Sciences students, patient family members and special guests gathered to celebrate innovative research and compete for awards this week at the McMaster Child Health Research Day.

The March 27 event was developed in collaboration with Hamiltons child health community, including the Department of Pediatrics, the Offord Centre for Child Studies, CanChild, the Centre for Metabolism, Obesity and Diabetes Research, McMaster Childrens Hospital, and St. Josephs Healthcare Hamilton.

More than 125 studies were presented, spanning a significant breadth of topics, including artificial intelligence applications in health, basic science, chronic conditions and mental health interventions.

AI is not going anywhere, so we need to find ways to mitigate its effects, especially given the prevalence of online surveys and research, said third-year undergraduate student Samantha Rutherford, whose study explored ways to stop chatbots from interfering with online data collection a challenge she recognizes as universal across research fields.

Researcher Andrea Cross, an assistant professor in the department of Pediatrics, is leading an innovative education program to empower youth and families to engage in health research.

Many people who are graduating from the course are now becoming champions and leaders and embedding meaningful family engagement within their communities and organizations, Cross said.

The quality of research and students passion was impressive, said Hamilton Mountain MP Lisa Hepfner, who served as a guest judge.

McMaster shows once again it is at the forefront of health sciences and that it is invested in improving the lives of young people in Canada and around the world.

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McMaster Child Health Research Day charts the future of pediatric health - Brighter World

Pediatrics

This is serious: The results of a measles outbreak have harmful outcomes – Contemporary Pediatrics

This is Serious: The results from a Measles outbreak have harmful outcomes | Image Credit: Prostock-studio - Prostock-studio - stock.adobe.com.

Homers philosophical quote, When it is out of sight, it is out of mind can be applied to the current measles outbreak in the United States and worldwide. Our patients and all pediatric providers need to know and respect the history of measles and remain steadfast in strongly recommending vaccination.

In 1912, measles became a nationally notifiable disease in the United States, which revealed approximately 6,000 measles-related deaths reported each year.1 Prior to 1963, it was estimated that 3 to 4 million individuals in the United States contracted measles annually and included the majority of children under 15 years old.1 The death rate was estimated to be between 400 and 500 people with approximately 1000 individuals experiencing the adverse outcome of measles encephalitis.1

In 1963, the first measles vaccine became available which significantly reduced the incidence and prevalence of measles outbreaks in the United States and later worldwide.2 Because of this, many individuals today have vaccine induced immunity to measles, and providers rarely have patients presenting with symptoms of measles. In fact, due to the vaccination program, measles was declared eliminated from the United States in 2000.1 However, since 2020, there have been measles outbreaks in various states in the United States. The article in Contemporary Pediatrics, by senior editor Joshua Fitch, Measles cases are reported in multiple states, discusses the current spread of measles in the United States.2

Out of sight, out of mind

With the success of the MMR vaccine, most parents no longer are aware of measles as a disease nor fear that their children will contract measles. However, this lack of knowledge results in parents being unaware of the potential harmful outcomes from contracting measles, including the adverse outcomes and even the potential for death in their unvaccinated children under the age of 5 years, as well as in children and adults who are immunocompromised. In addition, pediatric nurse practitioners and all pediatric providers need to know how to diagnose measles and to be aware of the possibility of children who contract measles developing a bacterial or viral superinfection, including but not limited to obstructive laryngitis, mastoiditis, hepatitis, encephalitis, and/or pneumonia.3

The MMR Vaccine Information Statement (VIS) given to parents and any individual at the time of vaccination, provides detailed information focusing on the vaccine itself, and includes brief paragraphs about measles, mumps, and rubella (MMR) diseases at the top of the VIS.4 Perhaps the VIS and providers need to emphasize the potential for adverse outcomes from contracting the disease especially for those parents who are questioning whether to have their child vaccinated or are vaccine hesitant or vaccine refusers.

Measles disease and death rates

Prior to the availability of the measles vaccine in 1963, the World Health Organization reported that major measles epidemics occurred every 2 to 3years resulting in 2.6 million deaths in each epidemic year.2 The MMR vaccine has reduced worldwide deaths to 128,000 in 2021.2 However, in my opinion, this number of deaths related to contracting measles remains significant worldwide. As pediatric nurse practitioners, lets make 2 statements loud and clear, Vaccinate your babies and children against measles and infection deaths from measles are vaccine preventable!

Click here for the each article from the March issue of Contemporary Pediatrics.

References:

1. Centers for Disease Control and Prevention. Measles history. November 5, 2020. Accessed March 19, 2024. Retrieved from https://www.cdc.gov/measles/about/history.html#:~:text=It%20is%20estimated%203%20to,of%20the%20brain)%20from%20measles

2. World Health Organization [WHO]. Measles. August, 9, 2023. Accessed March 20, 2024. https://www.who.int/news-room/fact-sheets/detail/measles

3. Sanderson, S., & Gaylord, N.M. Infectious Diseases. In, Maaks, D.L.G., Starr, N.B., Brady, M.A., Gaylord, N.M., Driessnack, M., & Duderstadt, KG. (2020), Burns pediatric primary care. 7th edition: Elsevier. Pages 479-481.

4. Centers for Disease Control and Prevention. Vaccine information statement, MMR vaccine (Measles, mumps, and rubella: What you need to know. 2021. Accessed March 20, 2024. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.pdf

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This is serious: The results of a measles outbreak have harmful outcomes - Contemporary Pediatrics

Emergency Medicine

Emergency departments prove fertile ground for smoking cessation success – News-Medical.Net

In a recent study published in the Emergency Medicine Journal, researchers discuss the outcomes of the Cessation of Smoking Trial in the Emergency Department (COSTED) study, which aimed to understand the optimal intervention and long-term outcomes of emergency department (ED)-based smoking cessation interventions.

Study:Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre, randomized controlled trial.Image Credit: rangizzz / Shutterstock.com

Tobacco consumption, which is generally in the form of smoking, is responsible for about eight million deaths each year and, as a result, is the leading cause of human mortality worldwide. Research in the United Kingdom has revealed that 22% of its 6.4 million smoking citizens belong to the routine and manual occupations segment, whereas 8.3% belong to the managerial and professional occupational cohort.

Reducing the global dependency on tobacco and tobacco products is one of the highlights of modern medicine, with addiction treatment presenting a potent intervention against premature death, oversaturation of the healthcare system, and health inequalities. EDs present a viable and untapped setting for implementing anti-tobacco interventions, as these departments see large numbers of individuals, many of whom smoke and experience complex health inequalities.

Previously, smoking cessation interventions have been tested in ED settings with generally favorable outcomes. However, current challenges to the widespread implementation of these methodologies are due to these trials having only evaluated behavioral support or a combination of behavioral support and nicotine replacement therapy (NRT), particularly in populations already motivated to quit smoking.

Recent research and anecdotal evidence suggest that e-cigarettes are more potent anti-tobacco addiction tools than NRTs; however, their effectiveness has never been formally tested. Thus, understanding the real-world and long-term effectiveness of smoking cessation interventions carried out in ED settings and involving e-cigarette use may help millions of people worldwide reduce the prevalence of tobacco smoking in the future.

The present study aims to evaluate the long-term effectiveness of an ED-based smoking cessation intervention as compared to usual care. The effectiveness of e-cigarette starter kits in reducing smoking as compared to their absence was also investigated.

The COSTED study is a multicenter, parallel-group, and computer-randomized controlled trial involving six UK National Health Service (NHS) EDs. The study included adults 18 years and older who were either admitted to an NHS ED or accompanying someone who was.

Study participants were identified during routine ED screening and included those who reported daily tobacco use and excluded individuals who exhaled less than eight parts per million (ppm) of carbon monoxide (CO) or were currently using both traditional cigarettes and e-cigarettes daily. Identified individuals who provided informed consent were then enrolled in the study and computer-randomized into either the intervention or control cohort.

The intervention cohort was provided a 15-minute long smoking cessation session with a dedicated smoking cessation advisor, an e-cigarette starter kit along with detailed instructions on its use, and an electronic referral to a local smoking cessation center. Comparatively, individuals in the control group were provided with written cessation advice but no further intervention.

Study outcomes, which included self-reported and biochemically measured smoking abstinence, were measured during routine questionnaires and ED-based follow-ups conducted one, three, and six months following participant randomization. Risk estimates and differences in outcomes between cohorts were calculated using binary regression models, including fixed effects and Gaussian models with robust variances.

Individuals in the intervention cohort were significantly more likely to quit smoking and remain tobacco-free longer than those in the control group. Although the biochemically verified smoking quit rate was not as high as expected, self-reported abstinence, which was defined as six or fewer relapses over the course of the six-month-long study, was higher than expected. These results suggest that biochemical results, both from this and previous studies, are likely underestimates of the true potential contribution of EDs in smoking cessation efforts.

The ED represents an acceptable location for smoking cessation intervention and therefore offers a valuable opportunity to engage those who smoke who are not currently seeking to quit.

The study findings demonstrate the effectiveness of simple and opportunistic smoking cessation interventions provided in real-world ED settings. Self-reported daily tobacco users showed significant reductions in smoking dependency and use following a brief 15-minute-long counseling session with a dedicated smoking cessation advisor, an e-cigarette starter kit, and digital referral to a local stop-smoking service, particularly when compared to controls who only received text-based cessation advice and stop-smoking services referral.

Those attending EDs are generally from more deprived communities and more likely to smoke than the general population. Therefore, this intervention has the potential to address health inequalities that arise from disparities in smoking rates between different socioeconomic groups.

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Emergency departments prove fertile ground for smoking cessation success - News-Medical.Net

Emergency Medicine

Emergency Medicine team trains health care professionals in West Africa – UC Davis Health

(SACRAMENTO)

A team from the UC Davis Health Department of Emergency Medicine is training providers in The Gambia to deliver health care using portable ultrasound equipment.

The crucial initiative aims to enhance the diagnostic capabilities of medical professionals in The Gambia and improve access to care. The training program focuses on diagnosing heart and lung conditions.

The UC Davis team is training the providers to use Point of Care Ultrasound (POCUS), a convenient diagnostic tool that is increasingly being employed in hard-to-reach communities because of its portability.

POCUS can assess patients wherever they are located. It is a vital tool in remote settings because it enables the diagnosis and treatment of critically ill patients without having to be in a clinic or hospital.

The Gambia is a perfect environment for portable ultrasounds to make a real difference in patient care and to save lives, said Christine McBeth, assistant professor of Emergency Medicine at UC Davis Health and course director of the training program. These reliable tools provide real-time information on how to best treat patients and allow us to monitor a patients response to their treatment.

During their recent trip to The Gambia, McBeth and her team provided a week of classroom training with interactive team-based learning activities. The training was funded by the Department of Emergency Medicine, the London School of Hygiene and Tropical Medicine and the Sustainable Cardiovascular Health Equity Development Alliance (SCHEDA) and Medical Research Council Unit. SCHEDA donated four handheld ultrasound probes along with iPads.

The following week, the group from UC Davis led the local providers in hands-on simulations with real-life patient scenarios.

The goal of the training program was to teach these local health care professionals how to use the POCUS tools so they can provide care to acutely ill patients with respiratory and cardiac conditions after we leave, McBeth added.

The Gambia is one of the smallest countries in continental Africa, sharing its borders entirely with Senegal, except for its picturesque coastline along the Atlantic Ocean to the west.

While the West Africa nation has made substantial strides in health care access and delivery, it still struggles with a scarcity and unequal distribution of its health care workforce. A recent report from the World Health Organization (WHO) stated that the country's skilled health care workers stand at a modest 1.33 for 1,000 people, which is short of the WHO benchmark.

Additionally, health care facilities in the country are concentrated in urban regions, which creates disparities between urban and rural communities.

We hope this training will enhance the capacity for health care providers to provide precise and timely medical interventions to patients in these rural and underserved communities, explained McBeth. It is a great starting point, and we will continue with ongoing lectures, quality assurance and follow-up education and training to ensure it is utilized in the best way possible, with patient safety always at the forefront.

The multidisciplinary team's visit to The Gambia in January was in line with UC Davis and UC Davis Healths efforts surrounding global health. Known as One Health, the interdisciplinary approach recognizes the interconnectedness of people, animals, and the environment and aims to identify and address the fundamental causes of poor health to improve the well-being of all.

Our physicians, staff and students can grow through trips like this by gaining practical experience which will reinforce medical knowledge, learning about the many social determinants of health, and gaining experience in cultural competency, explained Shakira Bandolin, director for global health at UC Davis Health. By gaining experience with different populations around the world with different cultures and belief systems global health rotations instill an appreciation for diversity and the importance of practicing among underserved and multicultural populations.

UC Davis Health recently established a new Center for Global Health. The center was created to improve collaboration, organization, financial and administrative support for all specialties and health care providers to improve health and equity for all patients across the globe. Through ongoing collaborations with domestic and international partners, the center creates opportunities for students, residents, fellows and faculty to train to be conscientious health care practitioners. The center also allows UC Davis Health providers to participate in clinical, educational and research endeavors with their global partners.

We understand that a patients health is influenced by many factors including their environment, access to health care, socioeconomic status, and other complex social determinants of health, said Nathan Kuppermann, associate dean for global health at the UC Davis School of Medicine. We are committed to high-quality care for all patients, especially the most vulnerable in our communities and abroad. We aim to collaborate on clinical care, education, research and infrastructure development with our global partners. This commitment raises the bar to care for our patients throughout our health system and across the globe.

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Emergency Medicine team trains health care professionals in West Africa - UC Davis Health