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The Effects of Travel Burden on Outcomes After Resection of Extrahepatic Biliary Malignancies: Results from the US Extrahepatic Biliary Consortium.
O'Connor SC, Mogal H, Russell G, Ethun C, Fields RC, Jin L, Hatzaras I, Vitiello G, Idrees K, Isom CA, Martin R, Scoggins C, Pawlik TM, Schmidt C, Poultsides G, Tran TB, Weber S, Salem A, Maithel S, Shen P
(2017) J Gastrointest Surg 21: 2016-2024
MeSH Terms: Aged, Biliary Tract Neoplasms, Delivery of Health Care, Female, Hospitals, High-Volume, Humans, Income, Male, Middle Aged, Proportional Hazards Models, Retrospective Studies, Survival Rate, Tertiary Care Centers, Travel, Treatment Outcome, United States
Show Abstract · Added April 10, 2018
BACKGROUND - Surgical resection of extrahepatic biliary malignancies has been increasingly centralized at high-volume tertiary care centers. While this has improved outcomes overall, increased travel burden has been associated with worse survival for many other malignancies. We hypothesized that longer travel distances are associated with worse outcomes for these patients as well.
STUDY DESIGN - Data was analyzed from the US Extrahepatic Biliary Consortium database, which retrospectively reviewed patients who received resection of extrahepatic biliary malignancies at 10 high-volume centers. Driving distance to the patient's treatment center was measured for 1025 patients. These were divided into four quartiles for analysis: < 24.5, 24.5-57.2, 57.2-117, and < 117 mi. Cox proportional hazard models were then used to measure differences in overall survival.
RESULTS - No difference was found between the groups in severity of disease or post-operative complications. The median overall survival in each quartile was as follows: 1st = 1.91, 2nd = 1.60, 3rd = 1.30, and 4th = 1.39 years. Patients in the 3rd and 4th quartile had a significantly lower median household income (p = 0.0001) and a greater proportion Caucasian race (p = 0.0001). However, neither of these was independently associated with overall survival. The two furthest quartiles were found to have decreased overall survival (HR = 1.39, CI = 1.12-1.73 and HR = 1.3, CI = 1.04-1.62), with quartile 3 remaining significant after multivariate analysis (HR = 1.45, CI = 1.04-2.0, p = 0.028).
CONCLUSIONS - Longer travel distances were associated with decreased overall survival, especially in the 3rd quartile of our study. Patients traveling longer distances also had a lower household income, suggesting that these patients have significant barriers to care.
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16 MeSH Terms
Travelers with sickle cell disease.
Willen SM, Thornburg CD, Lantos PM
(2014) J Travel Med 21: 332-9
MeSH Terms: Adolescent, Adult, Aged, Anemia, Sickle Cell, Child, Child, Preschool, Developing Countries, Diarrhea, Female, Humans, Infant, Malaria, Male, Middle Aged, Patient Participation, Travel, Travel Medicine, Vaccination
Show Abstract · Added November 3, 2015
BACKGROUND - Sickle cell disease (SCD) is the most common genetic disease among persons with African ancestry. This article provides a background to SCD and reviews many important aspects of travel preparation in this population.
METHODS - The medical literature was searched for studies on travel-associated preparedness and complications in individuals with SCD. Topics researched included malaria, bacterial infections, vaccinations, dehydration, altitude, air travel, and travel preparedness.
RESULTS - There is very little published literature that specifically addresses the risks faced by travelers with SCD. Rates of medical complications during travel appear to be high. There is a body of literature that describes complications of SCD in indigenous populations, particularly within Africa. The generalizability of these data to a traveler is uncertain. Combining these sources of data and the broader medical literature, we address major travel-related questions that may face a provider preparing an individual with SCD for safe travel.
CONCLUSIONS - Travelers with SCD face considerable medical risks when traveling to developing tropical countries, including malaria, bacterial infections, hypovolemia, and sickle cell-associated vaso-occlusive crises. For individuals with SCD, frank counseling about the risks, vigilant preventative measures, and contingency planning for illness while abroad are necessary aspects of the pre-travel visit.
© 2014 International Society of Travel Medicine.
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18 MeSH Terms
The usefulness of a yearly head and neck surgery trip to rural Kenya.
Pearce EC, Mainthia R, Freeman KL, Mueller JL, Rohde SL, Netterville JL
(2013) Otolaryngol Head Neck Surg 149: 727-32
MeSH Terms: Adolescent, Adult, Aged, 80 and over, Child, Child, Preschool, Cleft Lip, Cleft Palate, Developing Countries, Female, Follow-Up Studies, Health Services Needs and Demand, Humans, Incidence, Infant, International Cooperation, Kenya, Male, Middle Aged, Neck, Prospective Studies, Reconstructive Surgical Procedures, Rural Population, Time Factors, Travel, Young Adult
Show Abstract · Added March 7, 2014
OBJECTIVE - Surgical specialty trips to third world countries have been praised and criticized. Our objective was to learn the usefulness of a yearly head and neck surgery trip through initial analysis of 2 years of patient data.
METHODS - We reviewed data from a prospectively maintained repository of surgical patients treated during head and neck surgical trips to Malindi, Kenya, in 2010 and 2011. Basic demographics, distance traveled for care, access to physicians, preoperative diagnosis, surgical procedure(s), and pathology were recorded when available.
RESULTS - In 2 years, 226 surgeries were performed. Patient age ranged between 3 months and 85 years, and gender was evenly split. Half of patients came from outside the town of Malindi, and a third traveled over 100 kilometers for care. The majority reported access to a local physician, yet very few patients were offered prior surgical treatment. The most common operations performed were adenotonsillectomy and hemithyroidectomy. A wide variety of cases were performed, including parotidectomies, maxillectomies, mandibulectomies, cleft lip and palate repair, and free flap reconstructions. Local and national visiting otolaryngologist-head and neck surgeons participated or observed throughout our visits with teaching emphasis based on their skills and specific learning goals.
CONCLUSIONS - Annual surgical specialty trips to rural, resource-limited regions are useful and worthwhile and offer procedures not otherwise available. On such trips, it is important to collect patient, surgical, and pathology data to help visiting surgeons determine the best procedures to teach local physicians and provide needed resources.
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25 MeSH Terms
International crises and global health electives: lessons for faculty and institutions.
Steiner BD, Carlough M, Dent G, Peña R, Morgan DR
(2010) Acad Med 85: 1560-3
MeSH Terms: Community Medicine, Cyclonic Storms, Developing Countries, Education, Medical, Faculty, Medical, Global Health, Honduras, Humans, Influenza A Virus, H1N1 Subtype, Influenza, Human, International Educational Exchange, Mexico, Nicaragua, North Carolina, Politics, Schools, Medical, Travel
Show Abstract · Added May 18, 2016
Student participation in global health electives and community service initiatives is associated with a number of favorable outcomes, and student interest in participating in such experiences is high. Increasingly, medical schools are facilitating and supervising global health opportunities. The inherent risks and uncertainties of global community service deserve careful consideration as schools engage more actively in this area. This article presents how one institution managed three crises in three electives in a single year. The H1N1 flu epidemic impacted a group of students bound for Mexico, a political upheaval affected a student group working in Honduras, and a hurricane threatened a student group in Nicaragua. This article outlines lessons learned from responding to these crises. Well-defined institutional travel policies, clear communication plans in the event of an emergency, a responsible administrative entity for global experiences, and formal predeparture training for students and faculty can help institutions better respond to unpredictable events. A comprehensive examination of these lessons and reflections on how to institutionalize the various components may help other institutions prepare for such events and lessen negative impact on student learning.
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17 MeSH Terms
Bilateral facial palsy in a case of leptospirosis.
Maldonado F, Portier H, Kisterman JP
(2004) Scand J Infect Dis 36: 386-8
MeSH Terms: Adult, Anti-Bacterial Agents, China, Denmark, Drug Therapy, Combination, Facial Paralysis, Humans, Leptospira, Leptospirosis, Magnetic Resonance Imaging, Male, Risk Assessment, Serologic Tests, Severity of Illness Index, Steroids, Travel, Treatment Outcome
Show Abstract · Added February 1, 2016
When returning from a 5-month trip to China, a 21-y-old Dutch male developed clinical signs, symptoms, and an antibody response compatible with leptospirosis. On d 15 of disease, he also developed facial palsy with a bilateral Bell's phenomenon. Facial palsy is a rare finding in leptospirosis, and if a causal relation exists, the delay of onset in the present case would suggest vasculitis rather than a direct neurotoxic effect.
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17 MeSH Terms
Epidural abscess and vertebral osteomyelitis caused by Listeria monocytogenes: case report and literature review.
Khan KM, Pao W, Kendler J
(2001) Scand J Infect Dis 33: 714-6
MeSH Terms: Aged, Diagnosis, Differential, Epidural Abscess, Humans, Listeria monocytogenes, Listeriosis, Low Back Pain, Lumbar Vertebrae, Magnetic Resonance Imaging, Male, Osteomyelitis, Travel
Show Abstract · Added March 24, 2014
A 69-y-old male with an epidural abscess and concomitant vertebral osteomyelitis caused by Listeria monocytogenes is presented, together with a brief review of the literature. To our knowledge, no cases of epidural abscess and only 3 cases of osteomyelitis have previously been reported in association with this organism.
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12 MeSH Terms