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Tips for a Successful Global Health Sabbatical.

ABSTRACT: There is a high demand for global health experiences among medical students. However, creating and engaging successful global health experiences for students is not without significant challenges for faculty. Lack of broad global health knowledge, first hand experiences in a variety of global health settings, and limited faculty engagement in global health activities at their home institutions may limit overall effectiveness. Thus, sabbaticals may provide unique opportunities for faculty reinvigoration and development of new teaching and/or research activities in global health. This viewpoint stems from my sabbatical experiences in South Africa and Botswana during the 2016-17 academic year and includes important tips for ensuring a successful global health sabbatical.

SUBMITTER: Blackard JT

PROVIDER: S-EPMC6634421 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Tips for a Successful Global Health Sabbatical.

Blackard Jason T JT

Annals of global health 20190509 1

There is a high demand for global health experiences among medical students. However, creating and engaging successful global health experiences for students is not without significant challenges for faculty. Lack of broad global health knowledge, first hand experiences in a variety of global health settings, and limited faculty engagement in global health activities at their home institutions may limit overall effectiveness. Thus, sabbaticals may provide unique opportunities for faculty reinvig ...[more]

PMID: 31074600

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Project description:Background & aimsRefractory ascites is the main reason for the implantation of a transjugular intrahepatic portosystemic shunt (TIPS) in liver cirrhosis, but ascites control by TIPS fails in a relevant proportion of cases. Here, we investigated whether routine parameters pre-TIPS can predict persistent ascites after TIPS implantation and whether persistent ascites predicts long-term clinical outcome.MethodsA detailed retrospective analysis of 128 patients receiving expanded polytetrafluoroethylene-covered stents for the treatment of refractory ascites was performed. Persistent ascites post-TIPS was defined as the prolonged need for paracentesis >3 months after TIPS. The influence of demographics, laboratory results, pre-TIPS heart and liver ultrasound results, and invasive hemodynamic parameters on persistent ascites was evaluated by univariable and multivariable logistic regression. Predictors of the composite endpoint liver transplantation/death were analyzed using a multivariable Cox regression.ResultsAscites control post-TIPS was achieved in 95/128 patients (74%), whereas ascites remained persistent in 33/128 cases (26%). On multivariable analysis, a lower paracentesis frequency pre-TIPS (odds ratio 1.672; 95% CI 1.253-2.355) and lower baseline creatinine levels (odds ratio 2.640; CI 1.201-6.607) were associated with ascites control. Patients with persistent ascites post-TIPS had and impaired transplant-free survival (median 10.0 vs. 25.8 months), for which persistent ascites was the only independent predictor (hazard ratio 5.654; CI 3.019-10.59).ConclusionTIPS-placement in patients with lower paracentesis frequency and creatinine levels is associated with superior ascites control. Thus, TIPS implantation should be considered in moderate decompensation and not as a last resort. Persistent ascites post-TIPS seems to be the only predictor of liver transplantation and death.Lay summaryThe insertion of a transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory ascites should be considered in patients with moderate decompensation and not as a last resort, as lower paracentesis frequency and creatinine levels pre-TIPS are associated with superior ascites control. In turn, failure to control ascites seems to be the only predictor of liver transplantation and death.

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Tips for a Successful Global Health Sabbatical.

Publications

Tips for a Successful Global Health Sabbatical.

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