Publications by authors named "Gitanjli Arora"

18 Publications

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Educational Priorities for Providing End-of-Life Care: Parent Perspectives.

Pediatrics 2021 Oct 13;148(4). Epub 2021 Sep 13.

Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Objectives: Partnership with parents is a tenet of pediatric medicine; however, initiatives to include parents in education and research have been limited. Through focus groups, we included parents at the beginning of curriculum development by asking them to identify the priorities, existing supports, and opportunities for improvement in their child's end-of-life (EOL) care.

Methods: English and Spanish-speaking bereaved parents whose child had been cared for by the palliative care team and had died >18 months before the study initiation were invited to participate. In-person focus groups and a follow-up phone call were used to elicit opinions and capture a diversity of viewpoints. Themes were identified and clustered through an iterative analytic process.

Results: Twenty-seven parents of 17 children participated, with the total sample size determined by thematic saturation. Four themes were identified as important to parents in their child's EOL care: (1) honoring the role of the parent, (2) having confidence in the care team, (3) receiving gestures of love and caring, and (4) navigating logistic challenges.

Conclusions: We asked parents to be partners in guiding priorities for health care education and professional development to improve pediatric EOL care. In addition to strengthening skills in communication, confidence in the team, and compassion, parents in this study identified a need for hospital staff to anticipate financial and social stressors and provide supportive resources more readily. Additionally, parents described clinical and nonclinical staff as providing support, suggesting that a multidisciplinary and interdisciplinary curriculum be developed to improve pediatric EOL care.
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http://dx.doi.org/10.1542/peds.2021-051379DOI Listing
October 2021

A Lovely Family….

Authors:
Gitanjli Arora

J Palliat Med 2021 01;24(1):139-140

Department of Anesthesia and Critical Care Medicine, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

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http://dx.doi.org/10.1089/jpm.2020.0380DOI Listing
January 2021

Vaccine health beliefs and educational influences among pediatric residents.

Vaccine 2019 02 2;37(6):857-862. Epub 2019 Jan 2.

Department of Pediatrics, Children's Hospital Los Angeles, United States; Department of Molecular Microbiology and Immunology, University of Southern California, United States.

Objective: A pilot study of pediatric residents to describe perceived benefits and effects of vaccines and educational influences on vaccine practice among pediatric residents.

Study Design: Eighty-seven residents, from two institutions in a region with relatively high vaccine hesitancy, responded to a survey conducted in 2014-2015.

Results: Residents identified professional experiences with vaccine preventable diseases (VPDs) and observing pediatricians as most impactful to their vaccine beliefs. Residents who had observed pediatric faculty agreeing to alternative or delayed vaccinations were more likely to believe this to be acceptable vaccine practice (70.1% vs. 21.1%, χ = 17.778, p < 0.001). Most residents (68 [79.1%]) reported feeling confident in their ability to discuss vaccines.

Conclusions: Pediatricians must be equipped with accurate vaccine health beliefs to impact parental vaccine hesitancy. This study identifies important gaps in medical education, with pediatric residents reporting limitations in their professional experience with VPDs and high rates of observing alternative vaccination practice.
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http://dx.doi.org/10.1016/j.vaccine.2018.12.038DOI Listing
February 2019

Pediatricians and Global Health: Opportunities and Considerations for Meaningful Engagement.

Pediatrics 2018 08;142(2)

Department of Pediatrics, Middlesex Hospital and University of Connecticut, Middletown, Connecticut.

Pediatric practitioners whose expertise is primarily focused on the care of children within health settings in the United States are increasingly engaged in global child health (GCH). The wide spectrum of this involvement may include incorporating short-term or longer-term GCH commitments in clinical care, teaching and training, mentoring, collaborative research, health policy, and advocacy into a pediatric career. We provide an overview of routes of engagement, identify resources, and describe important considerations for and challenges to better equipping US pediatric practitioners to participate in meaningful GCH experiences. This article is part of a series on GCH describing critical issues relevant to caring for children from an international perspective.
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http://dx.doi.org/10.1542/peds.2017-2964DOI Listing
August 2018

Bidirectional Exchange in Global Health: Moving Toward True Global Health Partnership.

Am J Trop Med Hyg 2017 Jul;97(1):6-9

Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.

Although there has been rapid growth in global health educational experiences over the last two decades, the flow of learners remains overwhelmingly one directional; providers from high-resourced settings travel to limited-resourced environments to participate in clinical care, education, and/or research. Increasingly, there has been a call to promote parity in partnerships, including the development of bidirectional exchanges, where trainees from each institution travel to the partner's setting to learn from and teach each other. As global health educators and steering committee members of the Association of Pediatric Program Directors Global Health Pediatric Education Group, we endorse the belief that we must move away from merely sending learners to international partner sites and instead become true global health partners offering equitable educational experiences. In this article, we summarize the benefits, review common challenges, and highlight solutions to hosting and providing meaningful global health experiences for learners from limited-resourced partner institutions to academic health centers in the United States.
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http://dx.doi.org/10.4269/ajtmh.16-0982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508910PMC
July 2017

Maintaining quality of care for very influential patients.

Clin Teach 2018 04 29;15(2):175-177. Epub 2017 May 29.

David Geffen School of Medicine at UCLA, Psychiatry & Pediatrics Departments, Los Angeles, California, USA.

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http://dx.doi.org/10.1111/tct.12676DOI Listing
April 2018

Development of an HIV Postexposure Prophylaxis (PEP) Protocol for Trainees Engaging in Academic Global Health Experiences.

Acad Med 2017 11;92(11):1574-1577

G. Arora is assistant clinical professor, Department of Pediatrics, Division of Palliative Medicine, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, California. R.M. Hoffman is associate clinical professor, Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California.

Problem: Global health (GH) education programs have become increasingly common in U.S. medical schools and graduate medical education programs, with growing numbers of medical students, residents, and fellows participating in clinical experiences in settings with high HIV prevalence and limited resources. However, there are no guidelines for provision of HIV postexposure prophylaxis (PEP) to trainees engaging in these academic GH experiences.

Approach: Faculty of the Global Health Education Programs (GHEP) at the David Geffen School of Medicine at UCLA and GH partner institutions recognized the need for PEP access for trainees engaged in GH experiences. In 2013-2014, key UCLA faculty collaborated in the development of the UCLA GHEP PEP Protocol, which includes provision of PEP medications to trainees prior to departure, an on-call infectious disease/HIV specialist to advise trainees who have exposures, and a system for following up with exposed trainees while on the GH rotation and after their return.

Outcomes: Between February 2014 and September 2016, 112 medical students and 110 residents received education on the PEP protocol during their predeparture orientation. The protocol was used for 28 exposures (27 occupational, 1 nonoccupational), with PEP recommended in 3 occupational cases (all needlesticks) and the single nonoccupational case. There were no reported HIV seroconversions.

Next Steps: The authors plan to formally evaluate the PEP protocol, conduct a qualitative assessment with trainees and both UCLA and GH partner faculty, and discuss best practices with institutions across the United States and with GH partners.
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http://dx.doi.org/10.1097/ACM.0000000000001684DOI Listing
November 2017

Taking it Global: Structuring Global Health Education in Residency Training.

J Gen Intern Med 2017 May 16;32(5):559-562. Epub 2016 Aug 16.

Department of Internal Medicine, Boston University, Boston, MA, USA.

To meet the demand by residents and to provide knowledge and skills important to the developing physician, global health (GH) training opportunities are increasingly being developed by United States (U.S.) residency training programs. However, many residency programs face common challenges of developing GH curricula, offering safe and mentored international rotations, and creating GH experiences that are of service to resource-limiting settings. Academic GH partnerships allow for the opportunity to collaborate on education and research and improve health care and health systems, but must ensure mutual benefit to U.S. and international partners. This article provides guidance for incorporating GH education into U.S. residency programs in an ethically sound and sustainable manner, and gives examples and solutions for common challenges encountered when developing GH education programs.
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http://dx.doi.org/10.1007/s11606-016-3843-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400750PMC
May 2017

New views on global child health: global solutions for care of vulnerable children in the United States.

Curr Opin Pediatr 2016 10;28(5):667-72

aDivision of General Pediatrics, Hofstra Northwell School of Medicine, Global Pediatrics Program, Cohen Children's Medical Center, New Hyde Park, New York bDepartment of Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California cDivision of Medicine Critical Care, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA.

Purpose Of Review: This paper provides a brief overview of the current landscape of global child health and the impact of social determinants on the world's children. In the United States (US), global child health (GCH) has increasingly been highlighted as a priority area by national organizations, such as the National Academy of Medicine and American Academy of Pediatrics, as well as individual pediatricians committed to ensuring the health of all children regardless of geographic location. Although GCH is commonly used to refer to the health of children outside of the US, here, we highlight the recent call for GCH to also include care of US vulnerable children. Many of the lessons learned from abroad can be applied to pediatrics domestically by addressing social determinants that contribute to health disparities.

Recent Findings: Using the 'three-delay' framework, effective global health interventions target delays in seeking, accessing, and/or receiving adequate care. In resource-limited, international settings, novel health system strengthening approaches, such as peer groups, community health workers, health vouchers, cultural humility training, and provision of family-centered care, can mitigate barriers to healthcare and improve access to medical services.

Summary: The creative use of limited resources for pediatric care internationally may offer insight into effective strategies to address health challenges that children face here in the US. The growing number of child health providers with clinical experience in resource-limited, low-income countries can serve as an unforeseen yet formidable resource for improving pediatric care in underserved US communities.
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http://dx.doi.org/10.1097/MOP.0000000000000402DOI Listing
October 2016

Checklist use in evaluating pediatric disaster training.

Am J Disaster Med 2015 ;10(4):285-94

Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, Connecticut.

Objective: Disaster preparedness training has a small but growing part in medical education. Various strategies have been used to simulate disaster scenarios to safely provide such training. However, a modality to compare their effectiveness is lacking. The authors propose the use of checklists, which have been a standard in aviation safety for decades.

Design: Residents at four different academic pediatric residency programs volunteered to participate in tabletop simulation of a timed, pediatric disaster scenario. Resident teams were required to properly triage and manage simulated patients. Care intervention requests corresponding to each of the patients were recorded on a premade checklist.

Results: Thirty-six teams provided a total of 1,476 possible care intervention requests for three pediatric patients: one with crush injury, one with increased intracranial pressure, and a nonverbal child. Some interventions were more likely to be omitted than others, and some teams performed extra interventions. Twenty-five entries from the checklist intervention responses were missing, affecting three of the teams. On average, teams requested 65 percent, were prompted to request 11 percent, and missed 22 percent of all checklist interventions with only 2 percent of all items not being recorded. Chi-square tests were performed for each patient scenario using R software. Categories compared included total counts of "requested," "prompted," and "missed" responses. Chi-square values were all statistically significant (p value < 0.05).

Conclusions: In the checklist use during a tabletop disaster simulation, the authors have demonstrated that the checklist allows trainees to receive near immediate feedback. This training exercise provided them an opportunity to explore their own preparedness for a disaster scenario in a low-stress environment and allows for evaluation of such preparedness in a safe environment.
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http://dx.doi.org/10.5055/ajdm.2015.0210DOI Listing
July 2016

Screen Media Use in Hospitalized Children.

Hosp Pediatr 2016 May 1;6(5):297-304. Epub 2016 Jan 1.

Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.

Background And Objectives: Screen media overuse is associated with negative physical and mental health effects in children. The American Academy of Pediatrics recommends limiting screen media use at home; however, there are no similar guidelines for children's hospitals. This study was conducted to explore caregiver (parent or other guardian) perceptions about screen media use, compare at-home with in-hospital screen media use, and measure screen use among hospitalized children.

Methods: We obtained data from a convenience cohort of hospitalized children at a single, comprehensive tertiary care children's hospital over 3 periods of 2 weeks each from 2013 to 2014. Home and hospital screen media use was measured through survey and study personnel directly observed hospital screen use. Descriptive statistics are reported and generalized estimating equation was used to identify characteristics associated with screen media use.

Results: Observation (n = 1490 observations) revealed screen media on 80.3% of the time the hospitalized child was in the room and awake, and 47.8% of observations with direct attention to a screen. Surveyed caregivers reported their child engaging in significantly more screen media use in the hospital setting as compared with home, and 42% of caregivers reported the amount of screen time used by their child in the hospital was more than they would have liked.

Conclusions: Hospitalized children have access to a variety of screen media, and this media is used at rates far higher than recommended by the American Academy of Pediatrics. Children's hospitals should consider developing guidelines for screen media use.
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http://dx.doi.org/10.1542/hpeds.2015-0060DOI Listing
May 2016

On Shaky Ground: Learner Response and Confidence After Tabletop Earthquake Simulation.

Pediatr Emerg Care 2016 Aug;32(8):520-4

From the *Section of Emergency Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT; †Children's Hospital Los Angeles, Los Angeles, CA; ‡Division of Pediatric Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA; §Department of Pediatrics, Medical University of South Carolina, Charleston, SC; and ∥Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.

Objective: The aim of this study was to evaluate residents' confidence and attitudes related to management of earthquake victims during a tabletop simulation and 6 months after the intervention.

Methods: Pediatric residents from 4 training programs were recruited via e-mail. The tabletop simulation involved 3 pediatric patients (crush injury, head injury, and a nonverbal patient with minor injuries). A facilitated debriefing took place after the simulation. The same simulation was repeated 6 months later. A survey was administered before the simulation, immediately after, and after the 6-month repeat simulation to determine participants' self-rated confidence and willingness to respond in the event of a disaster. A 5-point Likert scale that ranged through novice, advanced beginner, competent, proficient, and expert was used.

Results: Ninety-nine participants completed the survey before the initial simulation session. Fifty-one residents completed the immediate postsurvey, and 75 completed the 6-month postsurvey. There was a statistically significant improvement in self-rated confidence identifying and managing victims of earthquake disasters after participating in the simulation, with 3% rating themselves as competent on the presurvey and 33% rating themselves as competent on the postsurvey (P < 0.05). There was a nonstatistically significant improvement in confidence treating suspected traumatic head injury as well as willingness to deploy to both domestic and international disasters.

Conclusions: Tabletop simulation can improve resident comfort level with rare events, such as caring for children in the aftermath of an earthquake. Tabletop can also be easily integrated into resident curriculum and may be an effective way to provide disaster medical response training for trainees.
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http://dx.doi.org/10.1097/PEC.0000000000000681DOI Listing
August 2016

Activated learning; providing structure in global health education at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA)- a pilot study.

BMC Med Educ 2016 Feb 16;16:63. Epub 2016 Feb 16.

David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.

Background: Global health rotations are increasingly popular amongst medical students. The training abroad is highly variable and there is a recognized need for global health curriculum development. We sought to create and evaluate a curriculum, applicable to any global health rotation, that requires students to take an active role in their education and promotes engagement.

Methods: Prospective, observational, mixed method study of 4th year medical students enrolled in global health courses at UCLA in 2011-12. Course directors identified 4 topics common to all rotations (traditional medicine, health systems, limited resources, pathology) and developed activities for students to complete abroad: observation, interview and reflection on resources, pathology, medical practices; and compare/contrast their experience with the US healthcare system. Students posted responses on a discussion board moderated by US faculty. After the rotation, students completed an anonymous internet-based evaluative survey. Responses were tabulated. Qualitative data from discussion board postings and free response survey items were analyzed using the framework method.

Results: 14 (100 %) students completed the Activated Learning assignment. 12 submitted the post rotation survey (85.7 %). Activated Learning enhanced GH education for 67 % and facilitated engagement in the local medical culture for 67 %. Qualitative analysis of discussion board posting demonstrated multiple areas of knowledge gain and analysis of free response survey items revealed 5 major themes supporting Activated Learning: guided learning, stimulation of discussion, shared interactions, cultural understanding, and knowledge of global healthcare systems. Increased interactivity emerged as the major theme for future improvement.

Conclusion: The results of this study suggest that an Activated Learning program may enhance education, standardize curricular objectives across multiple sites and promote engagement in local medical culture, pathology and delivery systems. Increased interaction between students and faculty may augment the impact of such a program.
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http://dx.doi.org/10.1186/s12909-016-0581-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755030PMC
February 2016

Evaluation of a Structured Predeparture Orientation at the David Geffen School of Medicine's Global Health Education Programs.

Am J Trop Med Hyg 2016 Mar 11;94(3):563-7. Epub 2016 Jan 11.

Center for World Health, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pediatrics, University of California, Los Angeles, California; Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, California.

Given the lack of a standardized approach to medical student global health predeparture preparation, we evaluated an in-person, interactive predeparture orientation (PDO) at the University of California Los Angeles (UCLA) to understand program strengths, weaknesses, and areas for improvement. We administered anonymous surveys to assess the structure and content of the PDO and also surveyed a subset of students after travel on the utility of the PDO. We used Fisher's exact test to evaluate the association between prior global health experience and satisfaction with the PDO. One hundred and five students attended the PDO between 2010 and 2014 and completed the survey. One hundred and four students (99.0%) reported learning new information. Major strengths included faculty mentorship (N = 38, 19.7%), opportunities to interact with the UCLA global health community (N = 34, 17.6%), and sharing global health experiences (N = 32, 16.6%). Of students surveyed after their elective, 94.4% (N = 51) agreed or strongly agreed that the PDO provided effective preparation. Students with prior global health experience found the PDO to be as useful as students without experience (92.7% versus 94.4%, P = 1.0). On the basis of these findings, we believe that a well-composed PDO is beneficial for students participating in global health experiences and recommend further comparative studies of PDO content and delivery.
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http://dx.doi.org/10.4269/ajtmh.15-0553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775891PMC
March 2016

Global Health Education in US Pediatric Residency Programs.

Pediatrics 2015 Sep 10;136(3):458-65. Epub 2015 Aug 10.

Department of Pediatrics, Emory University, Atlanta, Georgia.

Background And Objective: Despite the growing importance of global health (GH) training for pediatric residents, few mechanisms have cataloged GH educational opportunities offered by US pediatric residency programs. We sought to characterize GH education opportunities across pediatric residency programs and identify program characteristics associated with key GH education elements.

Methods: Data on program and GH training characteristics were sought from program directors or their delegates of all US pediatric residency programs during 2013 to 2014. These data were used to compare programs with and without a GH track as well as across small, medium, and large programs. Program characteristics associated with the presence of key educational elements were identified by using bivariate logistic regression.

Results: Data were collected from 198 of 199 active US pediatric residency programs (99.5%). Seven percent of pediatric trainees went abroad during 2013 to 2014. Forty-nine programs (24.7%) reported having a GH track, 66.1% had a faculty lead, 58.1% offered international field experiences, and 48.5% offered domestic field experiences. Forty-two percent of programs reported international partnerships across 153 countries. Larger programs, those with lead faculty, GH tracks, or partnerships had significantly increased odds of having each GH educational element, including pretravel preparation.

Conclusions: The number of pediatric residency programs offering GH training opportunities continues to rise. However, smaller programs and those without tracks, lead faculty, or formal partnerships lag behind with organized GH curricula. As GH becomes an integral component of pediatric training, a heightened commitment is needed to ensure consistency of training experiences that encompass best practices in all programs.
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http://dx.doi.org/10.1542/peds.2015-0792DOI Listing
September 2015

Optimizing Global Health Electives Through Partnerships: A Pilot Study of Pediatric Residents.

Acad Pediatr 2015 Sep-Oct;15(5):565-7. Epub 2015 Jul 29.

Department of Medicine and Division of Infectious Diseases, UCLA, Los Angeles, Calif; Center for World Health, Global Health Education Programs, UCLA, Los Angeles, Calif.

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http://dx.doi.org/10.1016/j.acap.2015.06.006DOI Listing
December 2016

Healthcare access and health beliefs of the indigenous peoples in remote Amazonian Peru.

Am J Trop Med Hyg 2014 Jan 25;90(1):180-3. Epub 2013 Nov 25.

Christ Church, University of Oxford, Oxford, United Kingdom; University of California Los Angeles, Los Angeles, California; Project Amazonas, Fort Lauderdale, Florida; The Honors College, Florida International University, Miami, Florida.

Little is published about the health issues of traditional communities in the remote Peruvian Amazon. This study assessed healthcare access, health perceptions, and beliefs of the indigenous population along the Ampiyacu and Yaguasyacu rivers in north-eastern Peru. One hundred and seventy-nine adult inhabitants of 10 remote settlements attending health clinics were interviewed during a medical services trip in April 2012. Demographics, health status, access to healthcare, health education, sanitation, alcohol use, and smoke exposure were recorded. Our findings indicate that poverty, household overcrowding, and poor sanitation remain commonplace in this group. Furthermore, there are poor levels of health education and on-going barriers to accessing healthcare. Healthcare access and health education remain poor in the remote Peruvian Amazon. This combined with poverty and its sequelae render this population vulnerable to disease.
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http://dx.doi.org/10.4269/ajtmh.13-0547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886418PMC
January 2014
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