95.09 Application of Student Research Objectives in an International Elective: Circumcision in Swaziland

A. R. Oddo1, A. Bales1, R. Siska1, D. J. Dennis1, E. VanderWal2, H. VanderWal2, R. Markert1, M. McCarthy1  1Wright State University Boonshoft School Of Medicine,Department Of Surgery,Dayton, OHIO, USA 2The Luke Commission,Sidvokodvo, MANZINI, Swaziland

Introduction:  Educational objectives for medical student international electives are an important part of any travel program. Objectives such as learning research methodology or engaging in research projects focus students during their travels and are a valuable way to reinforce curriculum goals. Our project focuses on the use of an international database by medical students to produce clinically significant findings impacting international health policy. Our study examines the adverse event rate in voluntary medical male circumcision, a procedure demonstrated to reduce HIV transmission by over 60%. Not only is voluntary medical male circumcision a method of HIV prevention; it is also nearly 40 times more cost effective in comparison with the treatment of HIV using antiretroviral medications. By engaging in an academic research study during the international elective students increased the educational value of the trip.

Methods:  The Luke Commission is a NGO that provides mobile health outreach to rural Swaziland, including HIV testing and prevention.  They perform more than 100 voluntary medical male circumcisions each week. The Luke Commission maintains a database demonstrating program productivity and effectiveness. Information collected from 1500 Swazi males during the first six months of 2014 was de-identified and analyzed after approval by the Wright State University School of Medicine IRB. 

Results: During this time period 34 adverse events occurred in 31/1500 patients, these included bleeding, infection, and wound dehiscence. The overall adverse event rate for the procedure was 2.3%.  Boys ≤12 years old had adverse events in 22/1022 circumcisions (2.2%) and patients ≥13 incurred 11/478 (2.3%; p=0.66).  Patients ≤29 kg body weight had 19/662 (2.9%) and patients ≥30 kg had 13/838 (1.6%; p=0.40).  There were no adverse events reported in 75 HIV-positive patients included. There were more wound dehiscences during the summer months, 10/333 (3.0%) versus 10/630 (1.6%) in fall and 0/517 (0%; p=0.001) in winter.  

Conclusion: Aid organization databases provide a source of information that can be used by medical students for research during international medical electives. The relationship between aid organizations, medical students, and patient populations can be a collectively beneficial one. Global health research has many complexities, but through careful planning and cultural awareness, medical students can contribute by publishing research that brings attention to global health issues and improves policies while having a significant positive effect on their own educational experience.

 

10.08 Maldistribution of Trauma Centers: Impact on Patient Care and Resource Utilization

P. J. Parikh1, B. Guthrie1, T. Erskine2, M. McCarthy1, P. P. Parikh1  1Wright State University,Dayton, OH, USA 2Ohio Department Of Public Safety,Emergency Medical Services,Columbus, OH, USA

Introduction:
Previous studies suggest that geographic distribution of trauma centers correlates with injury-related mortality. However, the impact of distribution of trauma centers on system performance in the state, including statewide resource utilization and patient care is unclear.  

Methods:
All trauma and emergency medical services (EMS) data for 2008-2012 were obtained from the Ohio Department of Public Safety (ODPS), which included 34,494 unique patient records. Overtriage (OT) error was defined as the proportion of patients with ISS≤15 transported to a Level 1/2 trauma center; undertriage (UT) error referred to patients ISS>15 transported to a Level 3 or non-trauma center, where OT indicates resource utilization, and UT and mortality directly impact patient care. Proportions of patients experiencing OT and UT errors, and subsequent mortality across all the homeland security regions of Ohio were compared. 

Results:
Over- and under-triage errors showed specific patterns by region (Table 1).  For instance, Regions 7 and 8 had the highest UT (4.6% and 12.9%, respectively) and lowest OT (24.4% and 3.2%, respectively) errors.  Because there are no L1/L2 trauma centers in these regions, triage patients are likely to be transferred from the scene to the nearest L3 or non-trauma facilities. Similarly, Regions 2 and 5 have the least UT errors (1.8% and 1.5%, respectively) and the highest OT errors (49.4% and 61.5%, respectively), probably because of the ease of accessible L1/L2 centers prompting even less severely-injured patients to be transferred there. Although mortality did not vary substantially between the regions, it was the highest in Region 8 (6.2%).  

Conclusion:
The location of trauma centers in the region can directly affect quality care access and resource utilization in any trauma system. A model or tool that could help the state identify the optimal distribution of trauma centers could improve equity of care among these regions while optimizing trauma resources.