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Objectives In the 2016 Peace Accord with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate 14,000 ex‐combatants into the healthcare system. However, FARC ex‐combatants have faced significant challenges in receiving healthcare, and little is known about physicians’ abilities to address this population's healthcare needs. Methods An electronic questionnaire sent to the Colombian Emergency Medicine professional society and teaching hospitals assessed physicians’ knowledge, attitudes, and experiences with the FARC ex‐combatant reincorporation process. Results Among 53 participants, most were male (60.4%), and ∼25% were affected by the FARC conflict (22.6%). Overall knowledge of FARC reincorporation was low, with nearly two‐thirds of participants (61.6%) scoring in the lowest category. Attitudes around ex‐combatants showed low bias. Few physicians received training about reincorporation (7.5%), but 83% indicated they would like such training. Twenty‐two participants (41.5%) had identified a patient as an ex‐combatant in the healthcare setting. Higher knowledge scores were significantly correlated with training about reincorporation (r = 0.354, n = 53, P = 0.015), and experience identifying patients as ex‐combatants (r = 0.356, n = 47, P = 0.014). Conclusion Findings suggested high interest in training and low knowledge of the reincorporation process. Most physicians had low bias, frequent experiences with ex‐combatants, and cared for these patients when they self‐identify. The emergency department (ED) serves as an entrance into healthcare for this population and a potential setting for interventions to improve care delivery, especially those related to mental healthcare. Future studies could evaluate effects of care delivery following training on ex‐combatant healthcare reintegration.

Background Migration of Venezuelan citizens to other South American countries has increased in recent years. While the prevalence, morbidity, and mortality of infectious diseases in Venezuelan migrants across South America appears to be well described, the non-communicable disease (NCD) and maternal and child health needs in this population is less clear. A scoping review of existing peer-reviewed primary research and grey literature describing the epidemiology of NCDs and maternal and child health needs in Venezuelan migrants in major South American host countries was performed in order to highlight important gaps in knowledge. Methods A scoping review was performed of peer-reviewed research and grey literature for NCD and maternal and child health needs among Venezuelan migrants living in the following host South American countries with greater than 100,000 migrants: Argentina, Brazil, Chile, Colombia, Ecuador, and Peru. A total of 47 electronic databases were searched for primary research published between 2017 and 2020 in either English or Spanish. Results Out of 1,098 initial articles retrieved, 17 records met inclusion criteria, with the majority identified from the grey literature. Most studies were published in 2019 and most were either primary reports published by non-governmental organizations within the grey literature search or cross-sectional qualitative studies. Studies came from Argentina, Chile, Colombia, and Peru, with three records offering a regional perspective. Most studies provided broad data on NCDs and maternal and child health needs but lacked granular statistics. Our analysis found the rate of chronic disease among Venezuelan migrants to range from 9-14% within countries who reported this data. Significant rates of psychiatric conditions such as depression and post-traumatic stress disorder were reported. Other conditions described were ophthalmologic diseases, diabetes, chronic pain, asthma, cough, dyslipidemia, hypertension, arthritis, malnutrition, and obstetric complications, although exact statistics were limited. Obstacles to care included lack of healthcare access and affordability. Conclusions Existing reports discuss important needs related to NCDs and maternal and child health in Venezuelan migrants in South American countries, but there are significant gaps in knowledge. Further research must describe in greater detail the prevalence, morbidity, and mortality of NCDs and maternal and child health needs in Venezuelan migrants in this region in order to assist local governments and international humanitarian organizations with providing strategic and unified responses.

INTRODUCTION Differential standards in academic medicine based on gender have been described for self-promoting behavior. BACKGROUND Objective: To explore differences in office display of professional and personal items between male and female academic physicians as a proxy for self-promotion. METHODS A university hospital's faculty was invited to participate in a study on office setup. Participants were blinded to the study aim. Investigators evaluated offices to assess the number of professional and personal displays. De-identified data on participant characteristics and office physical characteristics were recorded. Correlations with the number of items displayed were analyzed by univariable and multivariable Poisson regression. RESULTS Forty-eight physicians participated: 23 (47.9%) from emergency medicine, 9 (18.8%) from surgery, and 16 (33.3%) from internal medicine. The median number of professional displays was 5.0 for women (interquartile range [IQR] = 3.0-9.0) and 6.0 for men (IQR = 2.0-12.0). Controlling for specialty and academic rank, no significant difference existed in professional display rates by women (incidence rate ratio = 1.1, 95% confidence interval = 0.8-1.4). The median number of personal displays was 14.5 items for women (IQR = 8.0-25.0) and 6.0 items for men (IQR = 3.0-15.0), with a significantly different rate (incidence rate ratio = 1.4, 95% confidence interval = 1.2-1.7) when we controlled for specialty, generation, rank, and office characteristics. CONCLUSION Women displayed more personal items than did men, with no difference in professional display rates. Future studies should examine this difference to understand its cause, which may be linked to differences in academic promotion between men and women.

BackgroundEmergency care is a new but growing specialty across Africa where medical conditions have been estimated to account for 92% of all disability-adjusted life years. This study describes the epidemiology of medical emergencies and the impact of formalized emergency care training on patient outcomes for medical conditions in Rwanda.MethodsA retrospective cohort study was performed using a database of randomly sampled patients presenting to the emergency center (EC) at the University Teaching Hospital of Kigali. All patients, > 15 years of age treated for medical emergencies pre- and post-implementation of an Emergency Medicine (EM) residency training program were eligible for inclusion. Patient characteristics and final diagnosis were described by time period (January 2013–September 2013 versus September 2015–June 2016). Univariate chi-squared analysis was performed for diagnoses, EC interventions, and all cause EC and inpatient mortality stratified by time period.ResultsA random sample of 1704 met inclusion with 929 patients in the pre-residency time period and 775 patients in the post-implementation period. Demographics, triage vital signs, and shock index were not different between time periods. Most frequent diagnoses included gastrointestinal, infectious disease, and neurologic pathology. Differences by time period in EC management included antibiotic use (37.2% vs. 42.2%,p= 0.04), vasopressor use (1.9% vs. 0.5%,p= 0.01), IV crystalloid fluid (IVF) use (55.5% vs. 47.6%,p= 0.001) and mean IVF administration (2057 ml vs. 2526 ml,p< 0.001). EC specific mortality fell from 10.0 to 1.4% (p< 0.0001) across time periods.ConclusionsMortality rates fell across top medical diagnoses after implementation of an EM residency program. Changes in resuscitation care may explain, in part, this mortality decrease. This study demonstrates that committing to emergency care can potentially have large effects on reducing mortality.

To date, the practice of global emergency medicine (GEM) has involved being "on the ground" supporting in-country training of local learners, conducting research, and providing clinical care. This face-to-face interaction has been understood as critically important for developing partnerships and building trust. The COVID-19 pandemic has brought significant uncertainty worldwide, including international travel restrictions of indeterminate permanence. Following the 2020 Society for Academic Emergency Medicine meeting, the Global Emergency Medicine Academy (GEMA) sought to enhance collective understanding of best practices in GEM training with a focus on multidirectional education and remote collaboration in the setting of COVID-19. GEMA members led an initiative to outline thematic areas deemed most pertinent to the continued implementation of impactful GEM programming within the physical and technologic confines of a pandemic. Eighteen GEM practitioners were divided into four workgroups to focus on the following themes: advances in technology, valuation, climate impacts, skill translation, research/scholastic projects, and future challenges. Several opportunities were identified: broadened availability of technology such as video conferencing, Internet, and smartphones; online learning; reduced costs of cloud storage and printing; reduced carbon footprint; and strengthened local leadership. Skills and knowledge bases of GEM practitioners, including practicing in resource-poor settings and allocation of scarce resources, are translatable domestically. The COVID-19 pandemic has accelerated a paradigm shift in the practice of GEM, identifying a previously underrecognized potential to both strengthen partnerships and increase accessibility. This time of change has provided an opportunity to enhance multidirectional education and remote collaboration to improve global health equity.

Background Worldwide, injuries account for approximately five million mortalities annually, with 90% occurring in low- and middle-income countries (LMICs). Although guidelines characterizing data for blood product transfusion in injury resuscitation have been established for high-income countries (HICs), no such information on use of blood products in LMICs exists. This systematic review evaluated the available literature on the use and associated outcomes of blood product transfusion therapies in LMICs for acute care of patients with injuries. Methods A systematic search of PubMed, EMBASE, Global Health, CINAHL and Cochrane databases through November 2018 was performed by a health sciences medical librarian. Prospective and cross-sectional reports of injured patients from LMICs involving data on blood product transfusion therapies were included. Two reviewers identified eligible records (κ=0.92); quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Report elements, patient characteristics, injury information, blood transfusion therapies provided and mortality outcomes were extracted and analyzed. Results Of 3411 records, 150 full-text reports were reviewed and 17 met inclusion criteria. Identified reports came from the World Health Organization regions of Africa, the Eastern Mediterranean, and South-East Asia. A total of 6535 patients were studied, with the majority from exclusively inpatient hospital settings (52.9%). Data on transfusion therapies demonstrated that packed red blood cells were given to 27.0% of patients, fresh frozen plasma to 13.8%, and unspecified product types to 50.1%. Among patients with blunt and penetrating injuries, 5.8% and 15.7% were treated with blood product transfusions, respectively. Four reports provided data on comparative mortality outcomes, of which two found higher mortality in blood transfusion-treated patients than in untreated patients at 17.4% and 30.4%. The overall quality of evidence was either low (52.9%) or very low (41.2%), with one report of moderate quality by GRADE criteria. Conclusion There is a paucity of high-quality data to inform appropriate use of blood transfusion therapies in LMIC injury care. Studies were geographically limited and did not include sufficient data on types of therapies and specific injury patterns treated. Future research in more diverse LMIC settings with improved data collection methods is needed to inform injury care globally.

Background Studies from high-income countries (HIC) support restrictive blood transfusion thresholds in medical patients. In low- and middle-income countries (LMIC), the etiologies of anemia and baseline health states differ greatly; optimal transfusion thresholds are unknown. This study evaluated the association of packed red blood cell (PRBC) transfusion with mortality outcomes across hemoglobin levels amongst emergency center (EC) patients presenting with medical pathology in Kigali, Rwanda. Methods This retrospective cohort study was performed using a random sample of patients presenting to the EC at the University Teaching Hospital of Kigali. Patients ≥15 years of age, treated for medical emergencies during 2013–16, with EC hemoglobin measurements were included. The relationship between EC PRBC transfusion and patient mortality was evaluated using logistic regression, with stratified analyses performed at hemoglobin levels of 7 mg/dL and 5 mg/dL. Results Of 3609 cases sampled, 1116 met inclusion. The median age was 42 years (IQR 29, 60) and 45.2% were female. Transfusion occurred in 12.1% of patients. Hematologic (24.4%) and gastrointestinal pathologies (20.7%) were the primary diagnoses of those transfused. Proportional mortality was higher amongst those receiving transfusions, although not statistically significant (23.7% vs 17.0%, p = 0.06). No significant difference in adjusted odds of overall mortality by PRBC transfusion was found. In stratified analysis, patients receiving EC transfusions with a hemoglobin >5.0 mg/dL, had 2.21 times the odds of mortality (95% CI 1.51–3.21) as compared to those ≤5.0 mg/dL. Conclusions No association between PRBC transfusion and odds of mortality was observed amongst EC patients in this LMIC setting. An increased mortality association was found for patients receiving PRBC transfusions with an initial hemoglobin >5 mg/dL. Results suggest benefits from PRBC transfusion are limited as compared to HIC. Further research evaluating emergent transfusion thresholds for medical pathologies should be performed in LMICs to guide practice.