Effect of a Dengue Clinical Case Management Course on Physician Practices in Puerto Rico

Han, George; Gregory, Christopher J.; Biggerstaff, Brad J.; Horiuchi, Kalanthe; Pérez-Guerra, Carmen L.; Soto-Gomez, Eunice; Matos, Desiree; Margolis, Harold S.; Tomashek, Kay M.

doi:10.1093/cid/ciw511

Cited by 8 publications

(11 citation statements)

References 23 publications

(27 reference statements)

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“…Previous physician trainings on dengue clinical management in Puerto Rico demonstrated improved management of hospitalized dengue patients after the implementation of a classroom-style physician training course. 27 Medical curriculum should emphasize identified knowledge gaps, including warning signs for severe dengue and the clinical management of severe dengue. Online curriculum such as the CDC's Dengue Clinical Management Course (http://www.cdc.gov/dengue/training/cme.…”

Section: Discussionmentioning

confidence: 99%

Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014

Adam

Abeyta

Smith

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract. Dengue, a mosquito-borne viral disease, is increasingly being identified as a cause of outbreaks in the United States. During July-December 2013, a total of three south Texas counties reported 53 laboratory-confirmed dengue cases; 26 were locally acquired, constituting the largest outbreak in Texas since 2005. Because dengue outbreaks are expected to continue in south Texas and early case identification and timely treatment can reduce mortality, we sought to determine clinicians' knowledge of dengue and its clinical management. A survey was sent to 2,375 south Texas clinicians; 217 (9%) completed the survey. Approximately half of participants demonstrated knowledge needed to identify dengue cases, including symptoms (56%), early indicators of shock (54%), or timing of thrombocytopenia (48%). Fewer than 20% correctly identified all prevention messages, severe dengue warning signs, or circumstances in which a dengue patient should return for care. Knowledge of clinical management was limited; few participants correctly identified scenarios when plasma leakage occurred (10%) or a crystalloid solution was indicated (7%); however, 45% correctly identified when a blood transfusion was indicated. Because of the ongoing threat of dengue, we recommend clinicians in south Texas receive dengue clinical management training.

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Section: Discussionmentioning

confidence: 99%

Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014

Adam

Abeyta

Smith

et al. 2017

The American Society of Tropical Medicine and Hygiene

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“…Third, a lack of clinical experience in the ED professional staff may delay the timely diagnosis and appropriate care for severe diseases. A recent study found that case management training can improve dengue outcomes [28] and protocolized care may accelerate the transformation of knowledge [29] and help inexperienced healthcare providers.…”

Section: Discussionmentioning

confidence: 99%

Causes of death among hospitalized adults with dengue fever in Tainan, 2015: emphasis on cardiac events and bacterial infections

Lee

Cia

Lee

et al. 2018

Preprint

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PLC) 2 26 27 Keyword: dengue fever, fatality, mortality, bacterial infection, bacteremia, cardiac 28 arrest, Taiwan 3 29 Abstract 30 Introduction. The 2015 dengue outbreak in southern Taiwan caused substantial 31 mortality rates in the elderly. We analyzed here the causes of death among adults with 32 dengue. 33 Methods. The retrospective study was conducted at a medical center in Tainan from 34 the 1 st of August to 31th of December in the year 2015. The detection of the dengue 35 NS1 antigen IgM or viral RNA in patients' blood were used to diagnose dengue.36 Clinical courses and causes of death were retrieved from chart reviews by two 37 intensivists.38 Results. There were 4,488 cases of dengue diagnosed in the study hospital, and these 39 cases had an in-hospital case fatality rate of 1.34% (60 cases). Of these, the mean age 40 was 73 years and gender did not predict outcome. Twenty-eight (46.7%) cases died of 41 severe dengue, and 29 (48.3%) deaths were possibly caused by dengue-related 42 complications, which were mostly secondary infections (24 cases). Most of the 43 families of fatal case (70%) signed do-not-resuscitate (DNR) orders prior to the 44 patients' death. When the dengue epidemic peaked, 13 cardiac arrest events, including 45 out-of-hospital (5 events) and in-hospital (8) cardiac arrests at the emergency 46 department, occurred within four weeks of the dengue epidemic. Notably, in half (7) 47 of these cases, the patients did not search for medical aid prior to experiencing cardiac 48 arrest. Of the 40 cases that had early death (occurring within one week after 49 hospitalization), 60% died of severe dengue. In contrast, 50% of the 20 deaths that 50 occurred later than one week after hospitalization were related to hospital-acquired 51 infections, mainly pneumonia.52 Conclusion. The elderly that experience dengue fever may die of severe dengue early 4 53 or die of secondary infections later. Cardiac arrests can also occur unpredictably at the 54 first aids, which highlight the need of professional and patient education regarding the 55 danger signs that are related to severe dengue in an epidemic setting. 5 56 Author summary 57 The 2015 dengue outbreak in Tainan City caused substantial deaths among the 58 elderly. The main causes of death were severe dengue and its complications. We here 59 highlight the deaths caused by heart complications of dengue that the elderly has 60 underlying cardiovascular comorbidities is more prone to be involved. The 61 presentations of heart complications vary, ranging from arrythmia to myocarditis and 62 to unexpected cardiac arrest. Clinicians should carefully evaluate and monitor the 63 heart function of patients with severe dengue and provide timing intervention. 64 Secondary infections or healthcare-associated infections may occur throughout the 65 whole hospitalized course. They were also the leading causes of death during the late 66 or recovery phase of dengue in the study. Judicious application of antimicrobial 67 agents and early elimination of infection ...

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“…Investigation of fatal dengue cases during the 2007 epidemic and a survey of physicians’ practices revealed common missteps in dengue patient management ( 33 , 34 ). Because similar issues had been observed in Southeast Asia and Central America, the 2009 WHO guidelines for clinical care of dengue patients were incorporated into a 4-hour dengue clinical management course ( 35 ).…”

Section: Community and Clinician Education Campaignsmentioning

confidence: 99%

Lessons Learned from Dengue Surveillance and Research, Puerto Rico, 1899–2013

Sharp¹,

Ryff²,

Santiago³

et al. 2019

Emerg. Infect. Dis.

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Dengue was first reported in Puerto Rico in 1899 and sporadically thereafter. Following outbreaks in 1963 and 1969, the Centers for Disease Control and Prevention has worked closely with the Puerto Rico Department of Health to monitor and reduce the public health burden of dengue. During that time, evolving epidemiologic scenarios have provided opportunities to establish, improve, and expand disease surveillance and interventional research projects. These initiatives have enriched the tools available to the global public health community to understand and combat dengue, including diagnostic tests, methods for disease and vector surveillance, and vector control techniques. Our review serves as a guide to organizations seeking to establish dengue surveillance and research programs by highlighting accomplishments, challenges, and lessons learned during more than a century of dengue surveillance and research conducted in Puerto Rico.

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Effect of a Dengue Clinical Case Management Course on Physician Practices in Puerto Rico

Cited by 8 publications

References 23 publications

Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014

Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014

Causes of death among hospitalized adults with dengue fever in Tainan, 2015: emphasis on cardiac events and bacterial infections

Lessons Learned from Dengue Surveillance and Research, Puerto Rico, 1899–2013

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