Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-22T20:27:17.569Z Has data issue: false hasContentIssue false
  • English
  • Français

Knowledge gaps in the diagnosis and management of patients with tropical diseases presenting to Canadian emergency departments: are the gaps being met?

Published online by Cambridge University Press:  04 March 2015

Nazanin Meshkat ,
Shikha Misra ,
Cheryl Hunchak ,
Paula Cleiman ,
Yasmin Khan  and
Lisa M. Puchalski Ritchie
Nazanin Meshkat*
Affiliation:
Division of Emergency Medicine, Department of Medicine, University Health Network and University of Toronto
Shikha Misra
Affiliation:
Faculty of Medicine, University of Toronto
Cheryl Hunchak
Affiliation:
Division of Emergency Medicine, Department of Family and Community Medicine, University Health Network and University of Toronto, Toronto, ON
Paula Cleiman
Affiliation:
Division of Emergency Medicine, Department of Family and Community Medicine, University Health Network and University of Toronto, Toronto, ON
Yasmin Khan
Affiliation:
Division of Emergency Medicine, Department of Medicine, University Health Network and University of Toronto
Lisa M. Puchalski Ritchie
Affiliation:
Division of Emergency Medicine, Department of Medicine, University Health Network and University of Toronto
*
Correspondence to: Dr. Nazanin Meshkat, 200 Elizabeth Street, RFE-G-480, Toronto, ON M5G 2C4, [email protected].

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

We conducted a needs assessment to identify knowledge gaps in the management of tropical diseases by Canadian emergency physicians and identify available, related continuing medical education (CME) resources.

Methods:

A literature review was conducted to summarize challenges in the management of commonly encountered tropical diseases. An anonymous online survey was administered to Canadian emergency physicians using the Canadian Association of Emergency Physicians survey deployment service in July and August 2012. The survey identified self-reported gaps in knowledge and assessed knowledge using case-based vignettes. A list of CME resources was generated from a review of major academic emergency medicine journals, online cases, and conference topics from emergency medicine associations during 2010– 2011. Two independent reviewers assessed the relevance of the resources; differences were resolved by consensus.

Results:

From 635 citations, 47 articles were selected for full review; the majority (66%) were retrospective chart reviews, few (10.6%) had an emergency medicine focus, and fewer still were Canadian (8.5%). In total, 1,128 surveys were distributed, and 296 (27%) participants were included in the study. Most respondents reported ‘‘no’’ (52.4%) or ‘‘some’’ (45.9%) training in tropical medicine. Most (69.9%) rated their comfort in managing patients with tropical diseases as ‘‘low.’’ Few (11.1%) respondents reported a tropical disease being misdiagnosed or mismanaged; 44.1% indicated malaria. The perceived need for further training was high (76.7%). Conference workshops were the most highly requested CME modality, followed by case studies and podcasts. Correct answers to case vignettes ranged from 30.7 to 58.4%. Although 2,038 CME titles were extracted from extensive searches, only 6 were deemed relevant.

Conclusions:

Most Canadian emergency physicians have had minimal training in tropical diseases, reported a low comfort level in their management, and identified a high need for CME opportunities, which are lacking.

Keywords

educationemergency medicineimported diseasestropical diseases
Type
Original Research • Recherche Originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 6 , November 2014 , pp. 458 - 466
Copyright
Copyright © Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1.Knobler, S, Mahmoud, A, Lemon, S, et al. The impact of globalization on infectious disease emergency and control: exploring the consequences and opportunities. Washington (DC): National Academies Press; 2006. Available at: http://www.ncbi.nlm.nih.gov/books/NBK56589/ (accessed April 2011).Google Scholar
2.Ladhani, S, Aibara, R, Riordan, FA, Shingadia, D. Imported malaria in children: a review of clinical studies. Lancet 2007; 7:349–57.Google Scholar
3.Kyriacou, DN, Spira, AM, Talan, DA, Mabey, DC. Emergency department presentation and misdiagnosis of imported falciparum malaria. Ann Emerg Med 1996;27:696–9, doi:10.1016/S0196-0644(96)70186-5.Google Scholar
4.Suaya, JA, Shepard, DS, Beatty, ME. Dengue: burden of disease and cost of illness. Geneva: World Health Organization on Behalf of the Special Programme for Research and Training in Tropical Disease; 2006. Available at: http://www.who.int/tdr/publications/documents/swg_dengue_2.pdf (accessed September 2011).Google Scholar
5.Candel, FJ, Alramadan, M, Bonilla, I, et al. Malaria, a growing disease. Analysis of the 15-year period 1997-2001 in a Madrid hospital. An Med Intern 2004;21:49–50.Google Scholar
6.Fuentes Soriano, MI, Ruiz-Giardin, JM, Sanz, J.Paludism: emergent diagnosis. Descriptive study of 25 cases. Rev Clin Esp 2006;206:491–4, doi:10.1016/S0014-2565(06)72874-0.Google Scholar
7.Alvarez Fernandez, B, Garcia Esteban, C, Soto Insuga, V, et al. Malaria in the south of Madrid: a clinical and epidemiological review. An Pediatr 2009;71:196–200, doi:10.1016/j.anpedi.2009.05.016.Google Scholar
8.Svenson, JE, MacLean, JD, Gyorkos, TW, Keystone, J.Imported malaria. Clinical presentation and examination of symptomatic travelers. Arch Intern Med 1995;155:861–8, doi:10.1001/archinte.1995.00430080109013.CrossRefGoogle ScholarPubMed
9.Emanuel, B, Aronson, N, Shulman, S.Malaria in children in Chicago. Pediatrics 1993;92:83–5.CrossRefGoogle ScholarPubMed
10.Viani, RM, Bromberg, K.Pediatric imported malaria in New York: delayed diagnosis. Clin Pediatr 1999;38:333–7, doi:10.1177/000992289903800603.Google Scholar
11.Dorsey, G, Gandhi, M, Oyugi, JH, Rosenthal, PJ. Difficulties in the prevention, diagnosis, and treatment of imported malaria. Arch Intern Med 2000;160:2505–10, doi:10.1001/archinte.160.16.2505.CrossRefGoogle ScholarPubMed
12.Kain, KC, MacPherson, DW, Kelton, T, et al. Malaria deaths in visitors to Canada and in Canadian travellers: a case series. CMAJ 2001;164:654–9.Google Scholar
13.Williams, JP, Chitre, M, Sharland, M.Increasing Plasmodium falciparum malaria in southwest London: a 25 year observational study. Arch Dis Child 2002;86:428–30, doi:10.1136/adc.86.6.428.CrossRefGoogle Scholar
14.Hesselink, DA, Yoo, SM, Verhoeven, GT, et al. A high prevalence of culture-positive extrapulmonary tuberculosis in a large Dutch teaching hospital. Neth J Med 2003;61: 65–70.Google Scholar
15.Kambili, C, Murray, HW, Golightly, LM. Malaria: 30 years of experience at a New York City teaching . Am J Trop Med Hyg 2004;70:408–11.Google Scholar
16.Miller, KK, Banerji, A.Epidemiology of malaria presenting at British Columbia’s Children’s Hospital, 1984-2001: lessons for prevention. Can J Public Health 2004;95:245–8.CrossRefGoogle ScholarPubMed
17.Vicas, AE, Albrecht, H, Lennox, JL, del Rio C. Imported malaria at an inner-city hospital in the United States. Am J Med Sci 2005;329:6–12, doi:10.1097/00000441-200501000-00002.CrossRefGoogle ScholarPubMed
18.Ben-Ami, R, Siegman-Igra, Y, Anis, E, et al. Malaria in travelers returning from short organized tours to holiday resorts in Mombassa, Kenya. Isr Med Assoc J 2005;7:364–7.Google Scholar
19.Chalumeau, M, Holvoet, L, Cheron, G, et al. Delay in diagnosis of imported Plasmodium falciparum malaria in children. Eur J Clin Microbiol Infect Dis 2006;25:186–9, doi:10.1007/s10096-006-0105-3.CrossRefGoogle ScholarPubMed
20.Christen, D, Steffen, R, Schlagenhauf, P.Deaths caused by malaria in Switzerland 1988-2002. Am J Trop Med Hyg 2006; 75:1188–94.Google Scholar
21.Thierfelder, C, Schill, C, Hatz, C, Nuesch, R.Trends in imported malaria to Basel, Switzerland. J Travel Med 2008; 15:432–6, doi:10.1111/j.1708-8305.2008.00251.x.Google Scholar
22.Kain, KC, Harrington, MA, Tennyson, S, Keystone, JS. Imported malaria: prospective analysis of problems in diagnosis and management. Clin Infect Dis 1998;27:142–9, doi:10.1086/514616.CrossRefGoogle ScholarPubMed
23.Kean, BH, Reilly, PC Jr. Malaria - the mime. Recent lessons from a group of civilian travelers. Am J Med 1976;61:159–64, doi:10.1016/0002-9343(76)90164-9.CrossRefGoogle Scholar
24.Kortepeter, M, Brown, JD. A review of 79 patients with malaria seen at a military hospital in Hawaii from 1979 to 1995. Mil Med 1998;163:84–9.CrossRefGoogle Scholar
25.Hoshino, Y, Masuda, G, Negishi, M, et al. Clinical and bacteriological profiles of patients with typhoid fever treated during 1975-1998 in the Tokyo Metropolitan Komagome Hospital. Microbiol Immunol 2000;44:577–83.CrossRefGoogle ScholarPubMed
26.Rugina, S, Dumitru, IM, Cernat, RC. Imported cutaneous and visceral leishmaniasis cases in Constanta, Romania. Trop Med Int Health 2009;14:187–8.Google Scholar
27.Charra, B, Sodqi, M, Sandali, O, et al. Imported severe malaria in adults: a retrospective study of ten cases admitted to intensive care units in Casablanca. Med Mal Infect 2007;37: 162–5, doi:10.1016/j.medmal.2006.09.006.Google Scholar
28.Pistone, T, Diallo, A, Receveur, MC, et al. Le paludisme d’importation au CHU de Bordeaux de 2000 a` 2007: épidémiologie, prise en charge et comparaison avec les données nationals. Bull Soc Pathol Exot 2009;103:104–10, doi:10.1007/s13149-010-0045-4.Google Scholar
29.Laferl, H, Szell, M, Bischof, E, Wenisch, C.Imported dengue fever in Austria 1990-2005. Travel Med Infect Dis 2006;4:319–23, doi:10.1016/j.tmaid.2005.10.001.Google Scholar
30.Winters, RA, Murray, HW. Malaria—the mime revisited: fifteen more years of experience at a New York City teaching hospital. Am J Med 1992;93:243–6, doi:10.1016/0002-9343(92)90228-4.Google Scholar
31.Ohnishi, K, Murata, M.Malaria—eight years of experience in a Tokyo metropolitan hospital. Int Med 1996;35:111–4, doi:10.2169/internalmedicine.35.111.Google Scholar
32.Klein, JL, Millman, G.Prospective, hospital based study of fever in children in the United Kingdom who had recently spent time in the tropics. Br Med J 1998;316:1425–6, doi:10.1136/bmj.316.7142.1425.Google Scholar
33.Hoffner, RJ, Slaven, E, Perez, J, et al. Emergency department presentations of typhoid fever. J Emerg Med 2000;19:317–21, doi:10.1016/S0736-4679(00)00260-2.Google Scholar
34.Kockaerts, Y, Vanhees, S, Knockaert, DC, et al. Imported malaria in the 1990s: a review of 101 patients. Eur J Emerg Med 2001;8:287–90, doi:10.1097/00063110-200112000-00007.CrossRefGoogle ScholarPubMed
35.Chung, HC, Wang, JT, Sun, HY, et al. Clinical experience of 17 cases of imported malaria at a Taiwan university hospital, 1999-2005. J Microbiol Immunol Infect 2007;40:209–15.Google Scholar
36.Moore, DA, McCroddan, J, Dekumyoy, P, Chiodini, PL. Gnathostomiasis: an emerging imported disease. Emerg Infect Dis 2003;9:647–50, doi:10.3201/eid0906.020625.CrossRefGoogle ScholarPubMed
37.Minodier, P, Lanza-Silhol, F, Piarroux, R, et al. Imported malaria in children in Marseilles. Arch Pediatr Adolesc Med 1999;6:935–43.CrossRefGoogle Scholar
38.Yu, JR, Sohn, W.A case of human cyclosporiasis causing traveler’s diarrhea after visiting Indonesia. J Korean Med Sci 2003;18:738–41.Google Scholar
39.Flaherty, G, Scott, A, O’Brien, T.Recognition of tropical illness in the returned traveller by healthcare professionals working in an Irish university teaching hospital. Trop Med Int Health 2009;14 Suppl 2:79.Google Scholar
40.Smith, SM. Imported disease in emergency departments: an undiscovered country? J Travel Med 2006;13:73–7, doi:10.1111/j.1708-8305.2006.00019.x.Google Scholar
41.Matteelli, A, Volonterio, A, Gulletta, M, et al. Malaria in illegal Chinese immigrants, Italy. Emerg Infect Dis 2001;7: 1055–8, doi:10.3201/eid0706.010628.CrossRefGoogle ScholarPubMed
42.Robinson, P, Jenney, AW, Tachado, M, et al. Imported malaria treated in Melbourne, Australia: epidemiology and clinical features in 246 patients J Travel Med 2001;8:76–81, doi:10.2310/7060.2001.24309.CrossRefGoogle ScholarPubMed
43.Singh, K, Wester, WC, Trenholme, GM. Problems in the therapy for imported malaria in the United States. Arch Intern Med 2003;163:2027–30, doi:10.1001/archinte.163.17.2027.Google Scholar
44.Newman, RD, Parise, ME, Barber, AM, Steketee, RW. Malaria-related deaths among U.S. travelers, 1963-2001. Ann Intern Med 2004;141:547–55, doi:10.7326/0003-4819-141-7-200410050-00012.Google Scholar
45.Leahy, TR, Malikiwi, A, Cafferkey, M, Butler, KM. Imported childhood malaria: the Dublin experience, 1999-2006. Ir J Med Sci 2009;178:329–32, doi:10.1007/s11845-009-0343-3.CrossRefGoogle ScholarPubMed
46.Goldfarb, DM, Gaboury, I, Dayneka, N, Saux, NL. Protocol for management of imported pediatric malaria decreases time to medication administration. Pediatr Infect Dis J 2009; 28:810–3, doi:10.1097/INF.0b013e3181a3d12f.CrossRefGoogle ScholarPubMed
47.Elmansouf, L, Dubos, F, Dauriac, A, et al. Evaluation of imported pediatric malaria management in northern France. Med Mal Infect 2011;41:145–51, doi:10.1016/j.medmal.2010.11.010.CrossRefGoogle ScholarPubMed
48.Dillman, DA. Mail and Internet surveys: the Tailored Design Method. 2nd ed. New York: Wiley; 2007.Google Scholar
49.Debelleix, MP, Receveur, MC, Pistone, T, et al. One hundred and fifteen cases of imported falciparum malaria admitted at the Bordeaux teaching hospital emergency unit. Med Mal Infect 2009;40:88–93, doi:10.1016/j.medmal.2009.08.008.Google Scholar
50. Centers for Disease Control and Prevention. Select Destinations. In: Yellow Book. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2012/table-of-contents.htm (accessed May 2013).Google Scholar
51. Centers for Disease Control and Prevention, Malaria map application. Available at: http://cdc-malaria.ncsa.uiuc.edu/ (accessed May 2013).Google Scholar
52. Centers for Disease Control and Prevention, Dengue map. Available at: http://www.healthmap.org/dengue/ (accessed May 2013).Google Scholar