Marwa Shoeb

The Harvard Trauma Questionnaire: Adapting a Cross-Cultural Instrument for Measuring Torture, Trauma and Posttraumatic Stress Disorder in Iraqi Refugees

Background: Mental health assessments in post-conflict zones have relied heavily on Western psychiatric scales. Yet, a strict dependence on the paradigms of Western psychiatry risks inappropriately prioritizing syndromes, such as PTSD, which, however important, are eclipsed by local concerns. Material and discussion: In Dearborn, Michigan, home to the largest population of Iraqi refugees in the United States, 60 Iraqi refugee life stories were collected in order to adapt the Harvard Trauma Questionnaire (HTQ) to the Iraqi context. Conclusion: The methodology described proved to be a useful approach to developing a trauma measure that is culturally grounded in a multi-dimensional model of mental health.

Assessing Bleeding Risk in Patients Taking Anticoagulants

Anticoagulant medications are commonly used for the prevention and treatment of thromboembolism. Although highly effective, they are also associated with significant bleeding risks. Numerous individual clinical factors have been linked to an increased risk of hemorrhage, including older age, anemia, and renal disease. To help quantify hemorrhage risk for individual patients, a number of clinical risk prediction tools have been developed. These risk prediction tools differ in how they were derived and how they identify and weight individual risk factors. At present, their ability to effective predict anticoagulant-associated hemorrhage remains modest. Use of risk prediction tools to estimate bleeding in clinical practice is most influential when applied to patients at the lower spectrum of thromboembolic risk, when the risk of hemorrhage will more strongly affect clinical decisions about anticoagulation. Using risk tools may also help counsel and inform patients about their potential risk for hemorrhage while on anticoagulants, and can identify patients who might benefit from more careful management of anticoagulation.

Global health hospitalists: the fastest growing specialty's newest niche.

Over the last decade, health systems strengthening, workforce training, and patient safety have come to the forefront of global health (GH) priorities. Although a growing literature describes the advantages and challenges of GH experience during medical school and residency, little is known about patterns of GH activity among hospitalists. As the fastest growing US medical specialty, hospital medicine is well suited to meet these global health challenges through specific emphasis on quality improvement, safety, systems thinking, and medical education. To learn about hospitalist involvement in GH, we conducted a survey study of hospitalist members of the Society of Hospital Medicine (SHM). Our survey was sent to the entire SHM membership ( 8000) and examined demographics, characteristics, and patterns of involvement in GH, and explored perceived synergies as well as barriers to GH work. Among the 232 participants who responded to the questionnaire, 60% were male; the mean age was 43 years. Seventy percent had internal medicine training, 41% indicated a community-based nonacademic hospital as their primary professional setting, and 81% indicated that clinical work was their primary professional activity (Table 1). Overall, 51% of all respondents in our study reported having GH experience prior to becoming hospitalists, and 33% of all respondents said that they participated in GH activities after entering the field of hospital medicine. Sixty-five percent of respondents stated that their GH work since becoming hospitalists primarily addressed infectious diseases, and 42% indicated that their activities were in the outpatient setting. Seventy-eight percent of respondents had no funding to support their GH work. Among the 67 respondents who answered a question on the possible influence of GH work on their decision to enter hospital medicine, 29% indicated that scheduling flexibility inherent in hospitalist work is an important enabling factor for continued engagement in GH. Qualitative analysis of responses to open-ended questions revealed several challenges that hospitalists face in the field: 1) lack of mentorship, career development plan, and recognition of GH activities; 2) lack of GH training and knowledge of local systems of care, and difficulty applying domestic clinical experience in GH settings; 3) lack of materials resources and funding; and 4) lack of hospitalist model for inpatient care in many GH settings (Table 2). Despite these challenges, respondents thought that hospitalists could make several important contributions to GH: 1) service delivery, 2) clinical training of healthcare providers and capacity building, 3) quality improvement and systems change, 4) donation of TABLE 1. Demographics (Total N5232)

Postdischarge Focus Groups to Improve the Hospital Experience

Improving the inpatient experience is challenging because physicians often lack the feedback needed to understand the patient and family perspective. Multiple studies show that clinician perceptions of patients’ priorities and patients’ actual priorities differ. Although patient satisfaction surveys can provide meaningful insight into patients’ experiences, they often do not offer specific actionable information. However, patient and care partner focus groups can provide the detail and the dialogue needed to stimulate improvement efforts. We share a proposed framework for conducting and using the feedback of such focus groups based on our recent experience.

The forest for the trees: tuberculosis control efforts in west Kalimantan

Alam Sehat Lestari (ASRI), an Indonesian-American, non-profit organization located on the border of Gunung Palung National Park in west Kalimantan on the island of Borneo, is linking the delivery of health care to the conservation of natural resources. The clinics experience shows that an unconventional ‘forests-for-health care’ incentive programme can provide a powerful way to break the cycle that links poverty, poor health and environmental destruction around the park. However, the challenges of preventing, diagnosing and treating tuberculosis in this setting remain considerable and success will still depend upon a multilateral collaborative approach.