Browsing by Subject "Travel"

Now showing 1 - 4 of 4
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    Does distance modify the effect of self-testing in oral anticoagulation?
    (The American journal of managed care, 2016-01) Rose, Adam J; Phibbs, Ciaran S; Uyeda, Lauren; Su, Pon; Edson, Robert; Shih, Mei-Chiung; Jacobson, Alan; Matchar, David B

    Objectives

    Patient self-testing (PST) improves anticoagulation control and patient satisfaction. It is unknown whether these effects are more pronounced when the patient lives farther from the anticoagulation clinic (ACC). If the benefits of PST are limited to a subset of patients (those living farther from care), selectively providing PST to that subset could enhance cost-effectiveness.

    Study design

    This is a secondary analysis of a randomized trial of PST versus usual ACC care, which involved 2922 patients of the Veterans Health Administration (VHA).

    Methods

    Our 3 outcomes were the primary composite clinical end point (stroke, major hemorrhage, or death), anticoagulation control (percent time in therapeutic range), and satisfaction with anticoagulation care. We measured the driving distance between the patient's residence and the nearest VHA facility. We divided patients into quartiles by distance and looked for evidence of an interaction between distance and the effect of the intervention on the 3 outcomes.

    Results

    The median driving distance was 12 miles (interquartile range = 6-21). Patients living in the farthest quartile had higher rates of the primary composite clinical end point in both groups compared with patients living in the nearest quartile. For PST, the hazard ratio (HR) was 1.77 (95% CI, 1.18-2.64), and for usual care, the HR was 1.81 (95% CI, 1.19-2.75). Interaction terms did not suggest that distance to care modified the effect of the intervention on any outcome.

    Conclusions

    The benefits of PST were not enhanced among patients living farther from care. Restricting PST to patients living more than a certain distance from the ACC is not likely to improve its cost-effectiveness.
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    International crises and global health electives: lessons for faculty and institutions.
    (Academic medicine : journal of the Association of American Medical Colleges, 2010-10) Steiner, Beat D; Carlough, Martha; Dent, Georgette; Peña, Rodolfo; Morgan, Douglas R
    Student participation in global health electives and community service initiatives is associated with a number of favorable outcomes, and student interest in participating in such experiences is high. Increasingly, medical schools are facilitating and supervising global health opportunities. The inherent risks and uncertainties of global community service deserve careful consideration as schools engage more actively in this area. This article presents how one institution managed three crises in three electives in a single year. The H1N1 flu epidemic impacted a group of students bound for Mexico, a political upheaval affected a student group working in Honduras, and a hurricane threatened a student group in Nicaragua. This article outlines lessons learned from responding to these crises. Well-defined institutional travel policies, clear communication plans in the event of an emergency, a responsible administrative entity for global experiences, and formal predeparture training for students and faculty can help institutions better respond to unpredictable events. A comprehensive examination of these lessons and reflections on how to institutionalize the various components may help other institutions prepare for such events and lessen negative impact on student learning.
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    Spearheading Sustainability in the Travel Industry
    (2020-04-24) Mercer, Annabelle; McCorstin, Courtney; Burch, Samantha
    Our client, Duke Alumni Travels, offers Duke alumni, family, and friends with enriching educational and cultural travel programs across the globe. In line with Duke University’s goal to become carbon neutral by 2024, Duke Alumni Travels is leading a sustainability movement by transforming how the educational travel industry approaches and measures its environmental impact. In the interest of its educational mission and institutional commitments to sustainability, our client is eager to inform travelers about its tour operators’ sustainability practices both at destinations and within their own operations. This Master’s Project (MP) Team was formed to 1) assess and report on the sustainability practices of Duke Alumni Travels’ tour operators and, 2) to provide recommendations on how to communicate these practices to Duke Alumni Travels’ travelers. With a focus on Environmental, Economic, and Socio-Cultural sustainability, the MP Team developed a framework to benchmark each of the operators’ sustainability practices. Our research has been complemented by opportunities to raise awareness around the need for improved travel practices. Over the year, the MP team has brought sustainability to the forefront of the educational travel industry by: hosting a Sustainable Travel Panel with industry leaders at NSOE (Oct. ‘19), and leading a Keynote Presentation about the project at the annual Educational Travel Consortium Conference (Feb. ‘20). The team’s findings will help the operators address their greatest environmental impact areas, as well as give way to future Master’s Projects.
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    Travelers with sickle cell disease.
    (J Travel Med, 2014-09) Willen, Shaina M; Thornburg, Courtney D; Lantos, Paul M
    BACKGROUND: Sickle cell disease (SCD) is the most common genetic disease among persons with African ancestry. This article provides a background to SCD and reviews many important aspects of travel preparation in this population. METHODS: The medical literature was searched for studies on travel-associated preparedness and complications in individuals with SCD. Topics researched included malaria, bacterial infections, vaccinations, dehydration, altitude, air travel, and travel preparedness. RESULTS: There is very little published literature that specifically addresses the risks faced by travelers with SCD. Rates of medical complications during travel appear to be high. There is a body of literature that describes complications of SCD in indigenous populations, particularly within Africa. The generalizability of these data to a traveler is uncertain. Combining these sources of data and the broader medical literature, we address major travel-related questions that may face a provider preparing an individual with SCD for safe travel. CONCLUSIONS: Travelers with SCD face considerable medical risks when traveling to developing tropical countries, including malaria, bacterial infections, hypovolemia, and sickle cell-associated vaso-occlusive crises. For individuals with SCD, frank counseling about the risks, vigilant preventative measures, and contingency planning for illness while abroad are necessary aspects of the pre-travel visit.