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Nelson, Brett

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Nelson

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Nelson, Brett
Author's Publications: search.filters.isAuthorOfPublication.00dfc7d3-e458-4e5b-a117-f8554a177523

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Now showing 1 - 10 of 18
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    Nurse-midwives’ ability to diagnose acute third- and fourth-degree obstetric lacerations in western Kenya
    (BioMed Central, 2017) Pinder, Leeya F.; Natsuhara, Kelsey; Burke, Thomas; Lozo, Svjetlana; Oguttu, Monica; Miller, Leah; Nelson, Brett; Eckardt, Melody J.
    Background: Obstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings. Unrepaired third- and fourth-degree perineal lacerations have been shown to be the source of approximately one-third of the fistula burden in fistula camps in Kenya. In this study, we assessed potential barriers to accurate identification by Kenyan nurse-midwives of these complex perineal lacerations in postpartum women. Methods: Nurse-midwife trainers from each of the seven sub-counties of Siaya County, Kenya were assessed in their ability to accurately identify obstetric lacerations and anatomical structures of the perineum, using a pictorial assessment tool. Referral pathways, follow-up mechanisms, and barriers to assessing obstetric lacerations were evaluated. Results: Twenty-two nurse-midwife trainers were assessed. Four of the 22 (18.2%) reported ever receiving formal training on evaluating third- and fourth-degree obstetric lacerations, and 20 of 22 (91%) reported health-system challenges to adequately completing their examination of the perineum at delivery. Twenty-one percent of third- and fourth-degree obstetric lacerations in the pictorial assessment were incorrectly identified as first- or second-degree lacerations. Conclusion: County nurse-midwife trainers in Siaya, Kenya, experience inadequate training, equipment, staffing, time, and knowledge as barriers to adequate diagnosis and repair of third- and fourth-degree perineal tears.
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    Delivering primary healthcare in conflict-affected settings: A review of the literature
    (Weston Medical Publishing, 2020-01-01) Chaudhury, Sumona; Ravicz, Miranda; McPherson, Heather; Arlington, Lauren; Lin, Tianyu; Turco, Jessica; Nelson, Brett
    Objective: Conflict is often destructive to existing services and exacerbates population health inequities and the vulnerabilities of existing healthcare. We undertook a scoping review of the literature concerning delivery of primary healthcare (PHC) in post-conflict settings. Design: We undertook a scoping review of the peer-reviewed and gray literature to identify articles related to the development and delivery of PHC in post-conflict settings. We searched PubMed/Medline, Cochrane Library, Embase/Ovid, CAB abstracts, POPLINE, and WHO.int. between January 1990 through the December end of 2017, for articles in the English language. Two researchers independently assessed each article and applied inclusion criteria: referring to post-conflict settings and a range of terms related to PHC or health system development. Search terms were selected by careful review of the World Health Organization’s analytical framework for developing a strategy on universal coverage and analysis according to the availability, accessibility, affordability, and acceptability of healthcare and further themes involving demand-side or user-side concerns. Results: Findings were captured to reflect a range of conflict-affected settings and varied priorities and approaches to PHC reconstruction. Integrated immediate and longer-term strategies, involving needs-assessments, effective administration, development of institutions, and cost-efficient investment in human resources, infrastructure, and capacity building are needed to deliver expanded and equitable services, responsive to population health needs, critical to the delivery of equitable PHC. Conclusions: Scoping review of the literature may be formative in the generation of evidence-base to inform delivery of universal PHC, when applied according to context specificity of conflict-affected setting.
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    Limitations of the Millennium Development Goals: a literature review
    (Taylor & Francis, 2013) Fehling, Maya; Nelson, Brett; Venkatapuram, Sridhar
    With the Millennium Development Goals (MDGs) showing uneven progress, this review identifies possible limitations arising from the MDG framework itself rather than extrinsic issues. A multidisciplinary literature review was conducted with a focus on limitations in the formulation of the MDGs, their structure, content and implementation. Of 1837 MDG-related articles, 90 met criteria for analysis. Articles describe MDGs as being created by only a few stakeholders without adequate involvement by developing countries and overlooking development objectives previously agreed upon. Others claim MDGs are unachievable and simplistic, not adapted to national needs, do not specify accountable parties and reinforce vertical interventions. While MDGs have promoted increased health and well-being in many countries by recognising and deliberating on the possible constraints of the MDG framework, the post-2015 agenda may have even greater impact. Complex problems have simple, easy to understand, wrong answers (Henry Louis Mencken)
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    Development of a scale to measure individuals’ ratings of peace
    (BioMed Central, 2014) Zucker, Howard; Ahn, Roy; Sinclair, Samuel Justin; Blais, Mark; Nelson, Brett; Burke, Thomas
    Background: The evolving concept of peace-building and the interplay between peace and health is examined in many venues, including at the World Health Assembly. However, without a metric to determine effectiveness of intervention programs all efforts are prone to subjective assessment. This paper develops a psychometric index that lays the foundation for measuring community peace stemming from intervention programs. Methods: After developing a working definition of ‘peace’ and delineating a Peace Evaluation Across Cultures and Environments (PEACE) scale with seven constructs comprised of 71 items, a beta version of the index was pilot-tested. Two hundred and fifty subjects in three sites in the U.S. were studied using a five-point Likert scale to evaluate the psychometric functioning of the PEACE scale. Known groups validation was performed using the SOS-10. In addition, test-retest reliability was performed on 20 subjects. Results: The preliminary data demonstrated that the scale has acceptable psychometric properties for measuring an individual’s level of peacefulness. The study also provides reliability and validity data for the scale. The data demonstrated internal consistency, correlation between data and psychological well-being, and test-retest reliability. Conclusions: The PEACE scale may serve as a novel assessment tool in the health sector and be valuable in monitoring and evaluating the peace-building impact of health initiatives in conflict-affected regions.
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    Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania
    (BioMed Central, 2014) Makene, Christina Lulu; Plotkin, Marya; Currie, Sheena; Bishanga, Dunstan; Ugwi, Patience; Louis, Henry; Winani, Kiholeth; Nelson, Brett
    Background: Every year, more than a million of the world’s newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. Simple interventions to improve the quality of essential newborn care in health facilities – for example, improving steps to help newborns breathe at birth – have demonstrated up to 47% reduction in newborn mortality in health facilities in Tanzania. We conducted an evaluation of the effects of a large-scale maternal-newborn quality improvement intervention in Tanzania that assessed the quality of provision of essential newborn care and newborn resuscitation. Methods: Cross-sectional health facility surveys were conducted pre-intervention (2010) and post intervention (2012) in 52 health facilities in the program implementation area. Essential newborn care provided by health care providers immediately following birth was observed for 489 newborns in 2010 and 560 in 2012; actual management of newborns with trouble breathing were observed in 2010 (n = 18) and 2012 (n = 40). Assessments of health worker knowledge were conducted with case studies (2010, n = 206; 2012, n = 217) and a simulated resuscitation using a newborn mannequin (2010, n = 299; 2012, n = 213). Facility audits assessed facility readiness for essential newborn care. Results: Index scores for quality of observed essential newborn care showed significant overall improvement following the quality-of-care intervention, from 39% to 73% (p <0.0001). Health worker knowledge using a case study significantly improved as well, from 23% to 41% (p <0.0001) but skills in resuscitation using a newborn mannequin were persistently low. Availability of essential newborn care supplies, which was high at baseline in the regional hospitals, improved at the lower-level health facilities. Conclusions: Within two years, the quality improvement program was successful in raising the quality of essential newborn care services in the program facilities. Some gaps in newborn care were persistent, notably practical skills in newborn resuscitation. Continued investment in life-saving improvements to newborn care through the health services is a priority for reduction of newborn mortality in Tanzania.
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    A qualitative assessment of the impact of a uterine balloon tamponade package on decisions regarding the role of emergency hysterectomy in women with uncontrolled postpartum haemorrhage in Kenya and Senegal: Table 1
    (BMJ, 2016) Pendleton, Anna; Natarajan, Abirami; Ahn, Roy; Nelson, Brett; Eckardt, Melody J; Burke, Thomas
    Objectives To assess the impact of a every second matters for mothers and babies uterine balloon tamponade package (ESM-UBT) on provider decisions regarding emergency hysterectomy in cases of uncontrolled postpartum haemorrhage (PPH). Design Qualitative assessment and analysis of a subgroup extracted from a larger database that contains all UBT device uses among ESM-UBT trained health providers. Setting Health facilities in Kenya and Senegal with ESM-UBT training and capable of performing emergency hysterectomies. Participants All medical doctors who had placed a UBT for uncontrolled PPH subsequent to implementation of ESM-UBT at their facility, and who also had the capabilities of performing emergency hysterectomies. Primary outcome measures The impact of ESM-UBT on decisions regarding emergency hysterectomy in cases of uncontrolled PPH. Results 30 of the 31 medical doctors (97%) who fulfilled the inclusion criteria were independently interviewed. Collectively the interviewed medical doctors had placed over 80 UBT devices for uncontrolled PPH since ESM-UBT implementation. All 30 responded that UBT devices immediately controlled haemorrhage and prevented women from being taken to emergency hysterectomy. All 30 would continue to use UBT devices in future cases of uncontrolled PPH. Conclusions These preliminary data suggest that following ESM-UBT implementation, emergency hysterectomy for uncontrolled PPH may be averted by use of uterine balloon tamponade.
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    Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya
    (BMJ Publishing Group, 2014) Burke, Thomas; Hines, Rosemary; Ahn, Roy; Walters, Michelle; Young, David; Anderson, Rachel Eleanor; Tom, Sabrina M; Sisodia, Rachel; Obita, Walter; Nelson, Brett
    Objective: Injuries, trauma and non-communicable diseases are responsible for a rising proportion of death and disability in low-income and middle-income countries. Delivering effective emergency and urgent healthcare for these and other conditions in resource-limited settings is challenging. In this study, we sought to examine and characterise emergency and urgent care capacity in a resource-limited setting. Methods: We conducted an assessment within all 30 primary and secondary hospitals and within a stratified random sampling of 30 dispensaries and health centres in western Kenya. The key informants were the most senior facility healthcare provider and manager available. Emergency physician researchers utilised a semistructured assessment tool, and data were analysed using descriptive statistics and thematic coding. Results: No lower level facilities and 30% of higher level facilities reported having a defined, organised approach to trauma. 43% of higher level facilities had access to an anaesthetist. The majority of lower level facilities had suture and wound care supplies and gloves but typically lacked other basic trauma supplies. For cardiac care, 50% of higher level facilities had morphine, but a minority had functioning ECG, sublingual nitroglycerine or a defibrillator. Only 20% of lower level facilities had glucometers, and only 33% of higher level facilities could care for diabetic emergencies. No facilities had sepsis clinical guidelines. Conclusions: Large gaps in essential emergency care capabilities were identified at all facility levels in western Kenya. There are great opportunities for a universally deployed basic emergency care package, an advanced emergency care package and facility designation scheme, and a reliable prehospital care transportation and communications system in resource-limited settings.
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    Provider experiences with improvised uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage in Kenya
    (Elsevier, 2016) Natarajan, Abirami; Alaska Pendleton, Anna; Nelson, Brett; Ahn, Roy; Oguttu, Monica; Dulo, Lidu; Eckardt, Melody J.; Burke, Thomas
    Objective: To understand healthcare providers’ experiences with improvised uterine balloon tamponade (UBT) for the management of uncontrolled postpartum hemorrhage (PPH). Methods: In a qualitative descriptive study, in-depth semi-structured interviews were conducted between November 2014 and June 2015 among Kenyan healthcare providers who had previous experience with improvising a UBT device. Interviews were conducted, audio-recorded, and transcribed. Results: Overall, 29 healthcare providers (14 nurse-midwifes, 7 medical officers, 7 obstetricians, and 1 clinical officer) were interviewed. Providers perceived improvised UBT as valuable for managing uncontrolled PPH. Reported benefits included effectiveness in arresting hemorrhage and averting hysterectomy, and ease of use by providers of all levels of training. Providers used various materials to construct an improvised UBT. Challenges to improvising UBT—e.g. searching for materials during an emergency, procuring male condoms, and inserting fluid via a small syringe—were reported to lead to delays in care. Providers described their introduction to improvised UBT through both formal and informal sources. There was universal enthusiasm for widespread standardized training. Conclusion: Improvised UBT seems to be a valuable second-line treatment for uncontrolled PPH that can be used by providers of all levels. UBT might be optimized by integrating a standard package across the health system.
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    Using low-cost Android tablets and instructional videos to teach clinical skills to medical students in Kenya: a prospective study
    (SAGE Publications, 2016) O’Donovan, James; Ahn, Roy; Nelson, Brett; Kagan, Calvin; Burke, Thomas
    Objectives: To assess the feasibility and impact of using a low-cost Android tablet to deliver clinical skills training to third-year medical students in Kenya. Design: A prospective study using a low cost tablet called ‘connecTAB’, which was designed and manufactured specifically for areas with low bandwidth. Instructional video tutorials demonstrating techniques of cardiovascular and abdominal clinical examinations were pre-loaded onto the tablet. Setting: Maseno University School of Medicine, Western Kenya. Participants: Fifty-one third-year medical students from Maseno University School of Medicine were subjects in the study. Twenty-five students were assigned to the intervention group and 26 to the control group. Main outcome measures At the start of the study, students from both groups completed an Observed Structured Clinical Examination (OSCE) of the cardiovascular and abdominal evaluations. Students who were allocated to the intervention group then received the connecTAB, whereas students in the control group did not. After a period of three weeks, students from both groups completed a post-study OSCE for both the cardiovascular and abdominal evaluations. Results: There were significantly higher improvements in the scores for both cardiovascular and abdominal examinations (p < 0.001) within the group who received the e-tablets as compared to the control group. Conclusion: The study suggests that access to connecTAB improves clinical education and efficacy and holds promise for international training in both medical and allied healthcare professional spheres in resource-limited settings.
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    War-related psychological sequelae among emergency department patients in the former Republic of Yugoslavia
    (Springer Nature, 2004) Nelson, Brett; Fernandez, William G; Galea, Sandro; Sisco, Sarah; Dierberg, Kerry L.; Gorgieva, Gordana Subaric; Nandi, Arijit K; Ahern, Jennifer; Mitrović, Mihajlo; VanRooyen, Michael; Vlahov, David
    Background Residents of the Republic of Serbia faced civil war and a NATO-led bombing campaign in 1999. We sought to assess the burden of metal health dysfunction among emergency department (ED) patients presenting for care three years post-war in Serbia. Methods This study was conducted during July and August 2002 at two sites: a university hospital ED in Belgrade, Serbia and an ED in a remote district hospital serving a Serbian enclave in Laplje Selo, Kosovo. Investigators collected data on a systematic sample of non-acute patients presenting to the ED. All respondents completed a structured questionnaire assessing demographics and symptoms of post-traumatic stress disorder (PTSD) (using the Harvard Trauma Questionnaire), and major depression (using the Center for Epidemiologic Studies Depression Scale). Results A total of 562 respondents participated (310 in Belgrade, 252 in Laplje Selo); the response rate was 83.8%, 43% were female, and mean age was 37.6 years (SD = 13.4). Overall, 73 (13.0%) participants had symptoms consistent with PTSD, and 272 (49.2%) had symptoms consistent with depression. Sixty-six respondents had both disorders (11.9%). In separate multivariable logistic regression models, predictors of PTSD were refugee status and residence in Laplje Selo, and predictors of depression were older age, current unemployment, and lower social support. Conclusions Three years post-war, symptoms of PTSD and major depression in Serbia remained a significant public health concern, particularly among refugees, those suffering subsequent economic instability, and persons living in rural, remote areas.