Professional Education

  • Doctor of Medicine, George Washington University (2018)
  • Bachelor of Arts, Princeton University (2012)
  • Residency, University of California San Francisco (UCSF)/ San Francisco General Hospital (SFGH), Emergency Medicine

Stanford Advisors

All Publications

  • Emergency department antimicrobial use in a low-resource setting: results from a retrospective observational study at a referral hospital in Liberia BMJ OPEN Yi, S., Ramachandran, A., Epps, L., Mayah, A., Burkholder, T. W., Jaung, M., Haider, A., Whesseh, P., Shakpeh, J., Enriquez, K., Bills, C. 2022; 12 (4): e056709


    Data on antimicrobial use in low-income and middle-income countries (LMICs) remain limited. In Liberia, the absence of local data impedes surveillance and may lead to suboptimal treatment, injudicious use and resistance against antimicrobials. This study aims to examine antimicrobial prescribing patterns for patients in the emergency department (ED) of a large Liberian public hospital. Secondarily, this prescribing was compared with WHO prescribing indicators.Retrospective observational study.An adult ED of a large public hospital in Monrovia, Liberia.A total of 1082 adult patients (>18 years of age) were recorded in the ED, from 1 January to 30 June 2019.Number, type and name of antimicrobials ordered per patient were presented as number and percentages, with comparison to known WHO prescribing indicators. Pearson χ2 tests were used to assess patient variables and trends in medication use.Of the total patients, 44.0% (n=476) were female and the mean age was 40.2 years (SD=17.4). An average of 2.78 (SD=2.02) medicines were prescribed per patient encounter. At least one antimicrobial was ordered for 64.5% encounters (n=713) and two or more antimicrobials for 35.7% (n=386). All antimicrobial orders in our sample used the generic name. Ceftriaxone, metronidazole and ampicillin were the most common and accounted for 61.2% (n=743) of antimicrobial prescriptions. The majority (99.9%, n=1211) of antimicrobials prescribed were from the WHO Essential Drugs List.This study is one of the first on ED-specific antimicrobial use in LMICs. We revealed a high rate of antimicrobial prescription, regardless of patient demographic or diagnosis. While empiric antimicrobial use is justified in certain acute clinical scenarios, the high rate from this setting warrants further investigation. The results of this study underscore the importance of ED surveillance to develop targeted antimicrobial stewardship interventions and improve patient care.

    View details for DOI 10.1136/bmjopen-2021-056709

    View details for Web of Science ID 000783842400015

    View details for PubMedID 35437249

    View details for PubMedCentralID PMC9016394

  • Critical care service delivery across healthcare systems in low-income and low-middle-income countries: protocol for a systematic review. BMJ open Lim, A. G., Kivlehan, S., Losonczy, L. I., Murthy, S., Dippenaar, E., Lowsby, R., Yang, M. L., Jaung, M. S., Stephens, P. A., Benzoni, N., Sefa, N., Bartlett, E. S., Chaffay, B. A., Haridasa, N., Velasco, B. P., Yi, S., Contag, C. A., Rashed, A. L., McCarville, P., Sonenthal, P. D., Shukur, N., Bellou, A., Mickman, C., Ghatak-Roy, A., Ferreira, A., Adhikari, N. K., Reynolds, T. 2021; 11 (8): e048423


    INTRODUCTION: Critical care in low-income and low-middle income countries (LLMICs) is an underdeveloped component of the healthcare system. Given the increasing growth in demand for critical care services in LLMICs, understanding the current capacity to provide critical care is imperative to inform policy on service expansion. Thus, our aim is to describe the provision of critical care in LLMICs with respect to patients, providers, location of care and services and interventions delivered.METHODS AND ANALYSIS: We will search PubMed/MEDLINE, Web of Science and EMBASE for full-text original research articles available in English describing critical care services that specify the location of service delivery and describe patients and interventions. We will restrict our review to populations from LLMICs (using 2016 World Bank classifications) and published from 1 January 2008 to 1 January 2020. Two-reviewer agreement will be required for both title/abstract and full text review stages, and rate of agreement will be calculated for each stage. We will extract data regarding the location of critical care service delivery, the training of the healthcare professionals providing services, and the illnesses treated according to classification by the WHO Universal Health Coverage Compendium.ETHICS AND DISSEMINATION: Reviewed and exempted by the Stanford University Office for Human Subjects Research and IRB on 20 May 2020. The results of this review will be disseminated through scholarly publication and presentation at regional and international conferences. This review is designed to inform broader WHO, International Federation for Emergency Medicine and partner efforts to strengthen critical care globally.PROSPERO REGISTRATION NUMBER: CRD42019146802.

    View details for DOI 10.1136/bmjopen-2020-048423

    View details for PubMedID 34462281