bluuebunny/crossref_metadata_2025 huggingface dataset:
Extracorporeal membrane oxygenation to facilitate lung protective ventilation and prevent ventilator-induced lung injury in severe pneumocystis pneumonia with pneumomediastinum
Authors: Shabbir Ali Husain , Hassan Ibrahim Fawzy , George Saibu
Published: May 2017

Background: Pulmonary infections caused by Pneumocystis in immunocompromised host can be associated with cysts, pneumatoceles and air leaks that can progress to pneumomediastinum and pneumothoraces. In such cases, it can be challenging to maintain adequate gas exchange by mechanical ventilation and at the same time prevent further barotrauma or ventilator-induced lung injury (VILI). We report a young HIV positive male with poorly compliant lungs and pneumomediastinum secondary to severe Pneumocystis jirovecii infection, rescued with veno-venous extracorporeal membrane oxygenation (V-V ECMO).

Case: A 26-year-old male with no significant past medical history was admitted with fever, cough and shortness of breath. He initially required non-invasive ventilation to reduce work of breathing. However, his respiratory function progressively deteriorated due to increasing pulmonary infiltrates and development of pneumomediastinum, eventually requiring endotracheal intubation and invasive ventilation. Despite attempts at optimizing gas exchange by ventilatory maneuvers, patients’ pulmonary parameters worsened and he developed severe type 2 respiratory failure necessitating rescue ECMO therapy. The introduction of V-V ECMO facilitated the use of ultra-lung protective ventilation and prevented progression of pneumomediastinum, maintaining optimal gas exchange. It allowed time for the antibiotics to show effect and pulmonary parenchyma to heal. Further diagnostic workup revealed Pneumocystis jirovecii as the causative organism for pneumonia and serology confirmed Human Immunodeficiency Virus (HIV) infection. Patient was successfully treated with appropriate antibiotics and de-cannulated after six days of ECMO support.

Conclusion: ECMO was an effective salvage therapy in HIV positive patient with an otherwise fatal respiratory failure due to Pneumocystis pneumonia.
Validation of weekly teaching activities of Emergency Medicine Residency Training Program, Qatar against the American Board of Emergency Medicine Curriculum
Authors: Shariff Mohammed , Gafoor Biju , Farook Saleem , Alkahlout Baha
Published: May 2017

Introduction: The Emergency Medicine Residency Training Program (EMRTP) in Qatar conducts weekly didactic teaching activities based on syllabus from the Arab Board of Emergency Medicine, but with the accreditation by Accreditation Council for Graduate Medical Education International (ACGMEI) in 2013, we set out to validate the teaching activities against an internationally recognized curriculum of the American Board of Emergency Medicine (ABEM) known as the EM Model.

Methods: We undertook a full review of all the teaching topics undertaken throughout the academic year of 2012–13 and found a moderate degree of compliance with the ABEM curriculum. Following this review, we identified developmental points addressed during the last three years. A further review was repeated for the academic year 2015–16 to ensure ongoing improvement.

Results: The results show improved content delivery. The overall compliance increased by 16% (58% to 74%) in the domain of medical knowledge and patient care and a staggering 48% (46% to 94%) in the other competencies.

Conclusion: On the whole the EMRTP annual curriculum has achieved a strong emphasis on the medical knowledge and patient care competencies (including procedures & skills). Further improvement was noted in other core competencies.
Co-ordination between emergency physicians and psychiatric liaison service is a must for a safe and good quality care
Authors: Khan Mir Aman , Malik Humayoon , Niaz Omair , Mellard Timothy
Published: May 2017

Background: 75% of mental health illnesses and problems are treated in local communities in United Kingdom. There is a well-structured community service with a personal holistic management of these psychiatric problems patients and the arrangements are done according to needs and environment of the patient. However these services are not round the clock and they do not have an access to the acute psychiatric beds or any input for other medical problems. This is covered by Emergency Department of the country which has a 24 hours open access 7 days a week throughout the year. These patients are seen by Emergency Department clinicians and then managed in coordination with the psychiatric liaison nurses and on call psychiatric team.

Methods: We looked retrospectively to our practice in our two different trusts to see the actual increase in number of attending psychiatric patients in our emergency departments and the effect of these attendance and other related changes. Patients re-attending (Unplanned) in 72 hours are calculated separately.

Results: There is an increase of patients attending ED year after year with an average of 7.6% yearly increase. Over the last 5 years the overall increase of patient referral to PLS is 38.3%. Peak referral time is 0800—1000 and 1400–1500. 100% of ED doctors were aware of pathway for referral to PLS and could easily find it. All doctors were aware of the PLS point of contact and phone number. 90% of our ED doctors were happy with the initial management of these patients. 60% of junior and middle grade doctors have attended some kind of mental health teaching. 15% of these doctors were happy to discharge themselves the patient with low score (SAD PERSON Score).

Conclusions: Emergency physicians in collaboration with Psychiatric liaison service serve patients with mental health problems safe and effectively.
Epidemiological situation of chickenpox in Qatar (2012-2014)
Authors: Sallam Mohamed , Nadeem Shazia , Kumar Nanda
Published: May 2017

Background: Chickenpox is a contagious viral disease that affects any age group. Chickenpox is the most common infectious disease in Qatar. Most affected age groups in Qatar in the last three years are children. Chickenpox vaccination has been included in Qatar National Immunization Program in 2000.

Aim: To describe the epidemiological characteristics of chickenpox in Qatar in the year 2012–2014.

Methods: Descriptive analysis based on data retrieved from routine surveillance system, Qatar Information Exchange, Ministry Of Development Planning And Statistics and National Immunization Program. Incidence rate was calculated for each year by gender and age groups.

Results: Total number of chickenpox cases registered in Qatar in 2014 was 574 with the incidence (259.1 per 100,000) which was higher than 2012 (244.5) and 2013 (237.4). Most affected age groups in 2012 and 2013 were 5–9 years old (105.6 per 10,000) and (82.7 per 10,000) respectively while in 2014 age group 0–4 was most affected one (87.9 per 10,000). There was a remarkable increase in the incidence rate of chickenpox in the age groups 15–19, 45–49 and 50+ in 2014 comparing to 2012 and 2013. Although the number of affected cases was higher among men comparing to women, the incidence rate in men was lower.

Conclusion: Increase of incidence rate in 2014 comparing to 2012 and 2013 influenced by the increase of the incidence rate in middle and older age groups. Our results indicate that more evidence is needed to recommend use of varicella vaccine in adults and not only in children.
Management of patients with suspected meningitis or meningoencephalitis. Are we compliant with guidelines?
Authors: Zahid Muhammad , Ahmed Khalid Mohamed , Salameh Sarah , Mushtaq Kamran , Athreya Akshay , Al-Mohanadi Dabia Hamad S H , Al-Mohammad Ahmed Ali A A
Published: May 2017

Background: Central Nervous system infections are associated with high morbidity and mortality. Initial presentation can be very non-specific, the classic triad of: fever, headache and altered mental status only found in 44% of patients with acute bacterial meningitis. In a recent study a delay in antimicrobial treatment of more than three hours after hospital admission was a strong and independent risk factor for mortality.

Methods: We reviewed case notes of patients presented with suspected meningitis or meningoencephalitis. We designed a Performa to collect information on presentation, clinical findings, investigation and management of these patients.

Results: 30 case notes were reviewed. 16 out of 30 patients had at-least 2 out of 3 classic features. Skin rash was not looked for in 53% patients. 83% patients had no documentation regarding presence or absence of papilledema. 75% of patients appropriately had CT Brain done before LP. 56% of patients had appropriate antibiotics in less than 3 hours. Mean time to perform LP was 10.38 hours. No patients had steroids before or along with antibiotics. One patient had CSF opening pressure checked on lumber puncture. In 10 patients paired serum sample was sent for glucose.

Conclusion: Major deficiencies are noted in documentation of key symptoms, signs investigations and management for CNS infection. We have planned three major interventions: 1) Senior physician review of all patients suspected of CNS infection within one hour. 2) All patients suspected of CNS infection have appropriate antibiotics administered within three hours of presentation. Steroids should be given along with first dose of antibiotic where indicated. 3) Implement LP sticker to improve documentation We will run few PDSA cycles of suggested interventions and study the results. Recommendations will be made based on PDSA results.
Acute brachial artery thrombosis with diabetic ketoacidosis
Authors: Khan Ejaz Salam , Rahman Syed Abdul , Kumar Neeraj
Published: May 2017

Background: Diabetes Mellitus is a worldwide disease that leads to several acute complications including diabetic ketoacidosis. Diabetic ketoacidosis is usually preceded by infection, acute myocardial infarction, stroke, or other dire events. There is one report where diabetic ketoacidosis was reported to be associated with acute arterial embolism. Acute arterial thrombosis is a rare disease that requires immediate treatment.

Methods: We present a diabetic patient who presented with acute arterial embolism and developed diabetic ketoacidosis. This is the first case in our hospital in which we have reported with acute brachial artery thrombosis and DKA.

Results: We present a 68 years old male chronic smoker with a 25 year history of type 2 Diabetes (non-compliant to medications), Peripheral vascular disease, dyslipidemia and transient ischemic attack. He experienced severe pain and numbness in his right arm and forearm with no wound, puncture lesion or ecchymosis. Forearm was cold, pale with delayed capillary refill on right hand. Right brachial, right radial and right ulnar arteries were not palpable. Strong pulsations of the right subclavicular and right carotid arteries were palpated. This led to a strong suspicion of an acute thrombosis of the right brachial artery. Emergency thrombectomy with +/ −  fasciotomy was planned. Patient was anticoagulated with intravenous heparin. Patient's blood sugar was persistently elevated and blood gases showed mild acidosis. Urinary examination confirmed presence of diabetic ketoacidosis.

Conclusions: A high index of suspicion of diabetic ketoacidosis in patients with acute arterial thrombosis may lead to early recognition and treatment, avoiding any adverse outcome.
Physician associates - A new way of delivering of healthcare in the Emergency Department
Authors: Emmings Katie , Tullin Amy , Kumar Suresh
Published: May 2017

Objective: Physician Associates were employed in a busy London Emergency Department to provide a new level of integrated Emergency Medical care.

Background: Physician Associates have proved invaluable in the USA medical field over the past 30 years and have been identified as a possible workforce solution in the UK1,2. There are currently 19 Physician Associates (PAs) working in Emergency Departments across the UK3, with the aim of improving the ED staffing crisis.

Case Description: Two Physician Associates were employed in a London Emergency Department 18 months ago, initially to assist in the Observation ward previously run by locum SHO's. As well as providing permanent, reliable junior staff members, this also alleviated the expenditure on locums in the Observation Ward at approximately half the cost per year. Despite initial skepticism, the role has developed following structured teaching sessions and reliable support from a designated consultant. A vigorous appraisal system was instigated with the clinical supervisor to ensure that the PAs’ clinical skills were developing appropriately and the PA's now see new unselected patients in the ED. The PAs also contribute to achieving CQUIN targets within the department by completing VTE assessments and discharge summaries. All patients in the observation ward now receive a senior review by either a Consultant or Registrar within 12 hours of admission - improving patient outcome. Research shows that patients do not mind whether they are seen by a PA4 and the role has been well received.

Conclusion: PAs have been so well received in the department that there has been a proposal to employ further individuals as a workforce solution. Doctors who work regularly with PAs are pleased with the role5. This model could be used in other hospitals to help with staffing pressures and also reduce cost of employing locums.
Institutionalize patient related communication in the Emergency Department of Hamad General Hospital through the use of SBAR approach
Authors: Venugopal Parvathy
Published: May 2017

Background: It has been found that 89% of the ED staff in HGH has very low knowledge on the approach of SBAR, due to which they don't converse it accordingly with other staff especially during endorsements, face-face & critical call scenarios.

Aim: To increase and standardize the usage of SBAR as a communication tool among the clinical staff in the ED of high to 100% by FEB 2016.

Methods: The project was done in an iterative four-step continuous improvement method through careful monitoring in various areas of ED to collect the baseline data. SBAR champions were chosen from each area to facilitate and coordinate the project to most of ED. SBAR endorsement form was introduced for the nurses between shifts to notify information. Nurse educators & quality reviewers decided on educational sessions for the ED-nurses which consisted of role play, scenario based & simulation training for the nurses to make them understand the relevance of SBAR. A monitoring tool was developed for secret audit on SBAR usage to know the efficacy in the area.

Results: There has been a spike in the usage of SBAR by the nurses during the endorsement time and between the work schedules. With the help of the CN's and SBAR champions who regularly change from day to day, Careful monitoring has been placed in various areas of the ED which has led to such significant achievement. As of now the measurement and the testing has been done with the nurses, physicians, ECG technicians, respiratory therapists and also the quality reviewers. we are soon planning to include ems for the same training by end of February, we will make sure the whole ED will be talking & reporting in SBAR.

Conclusions: Interprofessional communication activity is needed at the entry level for all professionals. SBAR - teachable skill that is recognized by all healthcare workers as safe effective method of communicating among providers. We will soon spread this communication between units & during transfers also. Registration number: 0000-0003-0866-6512.
Interagency collaboration among public health and safety providers in the 2012 London Olympic Games: Perspectives on Leadership
Authors: Bistaraki Angeliki
Published: May 2017

Background: This study used the 2012 London Olympic Games as the empirical context to examine how interagency collaboration took place among the diverse public health and safety agencies involved in this mass gathering event. In order to develop our understanding of how collaboration among the key stakeholders in a mass event may be improved, this study aims at capturing the components that affected the ability of interagency collaboration to deliver its potential.

Methods: An exploratory case study design was used. Data were collected before, during and after the Games through semi-structured interviews, direct observations and documentary analysis. Template analysis was used to analyze the interviews' transcripts, the field notes from observations and the documents. The analysis generated a framework of factors influencing interagency collaboration including leadership, communication, governance and knowledge.

Results: Leadership shaped interagency collaboration through several characteristics including processes, skills, behaviours and relationships. Findings indicated that accountability issues, the use of guidelines and legislation and the physical presence of the leaders were perceived as fundamental to the implementation of effective collaboration. Effective leaders were supportive, persistent, good listeners and easy to talk. Moreover, interpersonal trust formed the basis for positive interagency collaboration.

Conclusion: Recognizing and understanding the above leadership characteristics is an important step towards the support of the collaborative endeavours in mass gathering events.
Progress towards measles, rubella and congenital rubella syndrome elimination: Oman experience
Authors: Al Awaidy Salah Thabit
Published: May 2017

Oman has committed to the goal of eliminating measles, rubella and congenital rubella syndrome (CRS) by 2015 year. Elimination is defined as the absence of endemic measles and rubella transmission in a defined geographical area for ≥ 12 months in the presence of a well-performing surveillance system and for rubella without the occurrence of CRS cases associated with endemic transmission in the presence of high-quality surveillance system. Strategies to reach this goal included: a) achieving and maintenance high rates of vaccination coverage; b) syndromic surveillance programs to monitor fever and rash illness syndromes for effective detection of cases; c) and high-quality surveillance system, and sensitive for CRS. Measles and rubella was a leading cause of infant and child morbidity and mortality in Oman before the introduction of measles vaccine by 1975 and thereafter until 1994. With the introduction of a second dose of measles and first rubella vaccines in 1994, coverage for first and second doses of measles and rubella vaccines increased more than 95% in 1996 and has been sustained thereafter. A national measles and rubella immunization catch-up campaign targeting children ages 15 months to 18 years was conducted in 1994 that achieved 94% coverage. As a result, the incidence of measles and rubella have declined markedly in recent years, to ≤  1 case per million persons in 2012 and to zero cases for measles and rubella in 2013. Similarly, no case of CRS has been notified since 2007. Oman has made signiﬁcant progress toward measles and rubella elimination and has met the regional elimination goals. However, new challenges faced by Oman, for instance with increased globalization, has led to issues such as outbreaks from imported cases. Additional challenges still remain with regard to increasing identiﬁcation and immunization of unvaccinated non-Omani workers and their families.
Central neurogenic hyperventilation with acute respiratory alkalosis, transient lactic acidosis and tachycardia following endoscopic third ventriculostomy in a child
Authors: Habib Fajish , Mehta Tejas , Aliyar Ahamed Lafir , Youssef Ahmed Sayed , Khan Adnan , Kumar Neeraj
Published: May 2017

Endoscopic third ventriculostomy (ETV) is a common minimal-invasive neurosurgical procedure with well-documented complications. We report the case of a 6-year-old female child who underwent ETV, external ventricular drainage (EVD) catheter insertion and biopsy for a tumour arising from the pineal gland causing obstructive hydrocephalus and raised intra cranial pressure (ICP). Vital signs were stable pre-operatively and anaesthesia was maintained using propofol infusion. The operative bed was irrigated with normal saline under pressure after ETV, which immediately resulted in sinus tachycardia intra-operatively and central neurogenic hyperventilation (CNH) with respiratory alkalosis and transient lactic acidosis an hour after the surgery. Only few case reports have been reported in adults with CNH and respiratory alkalosis. Hyperventilation resulting in lactic acidosis is a well-known entity but lactic acidosis following CNH due to transient hypothalamic dysfunction after endoscopic third ventriculostomy has not been reported previously. Our patient was managed with benzodiazepines and oxygen delivered by a rebreathing mask, which resulted in complete recovery within 12 hours. This case highlights the importance of ICP measurement and monitoring and assessment of the type, volume and pressure of fluid used for brain irrigation during ETV, to prevent complications. ETV may cause intra-operative hemodynamic disturbances such as tachycardia, hypertension and hyperthermia followed by post-operative transient hypothalamic dysfunction and CSF acidosis leading to sequelae of CNH with acute respiratory alkalosis and transient lactic acidosis. We emphasize the importance of ICP monitoring during neuroendoscopic procedures, as an inadvertant rise in ICP appears to be the central factor leading to the various ill effects encountered both intra and post-operatively. Moreover, although normal saline has been the irrigation fluid of choice for neurosurgeons, a multitude of laboratory studies suggest it being less ideal and it might be prudent to look into alternatives, namely artificial CSF and Ringer's Lactate.
Stress and burnout among Red Crescent paramedic ambulance workers in Riyadh
Authors: Alenazi Salem K. , AL-Otaibi Bader S. , Alenaz Adel N. , Alrashidi Qais S.
Published: May 2017

Background: Ambulance services in Saudi Arabia are organised through the Red Crescent, the organisation that is responsible for ensuring adequate ambulance service for all communities in Riyadh. Paramedics are the first responders among the healthcare providers responsible for saving patients' live outside hospital settings. Work-related stress is a serious problem that affects the health and well-being of employees as well as the productivity of organisations. Stress has a huge impact on the performance and productivity of emergency health workers.

Objective: To explored the factors associated with stress and identified the effects of stress and burnout on Red Crescent ambulance workers.

Methods: This study explored the factors associated with stress and identified the effects of stress and burnout on Red Crescent ambulance workers. A cross-sectional study was conducted among ambulance workers at Saudi Red Crescent centers across four regions of the Ar-Riyadh province of Saudi Arabia. Questions about sociodemographic information, working conditions, level of burnout, and job stress were included in the questionnaires.

Results: Study sample responses regarding personal burnout level. The arithmetic mean, standard deviation, frequencies, and the responses (in %) to statements describing the personal burnout level are shown in Table 14.

Conclusion: Stress level and work-related burnout was a leading cause of poor performance and resulted in the inability of employees to perform assigned tasks.
Physician and nurse satisfaction with a newly introduced electronic medical record system at an emergency department of a Qatari Hospital
Authors: Daf Alla El Fadil , Al Hadil Bassem , Batir Mohsen , Kassim Muayed , Al Khawaldeh Amjad , Khader Hisham , Osman Hanaa
Published: May 2017

Introduction: Despite the potential benefits of EMR systems to improve patient care, many attempts at implementing them have failed or met with high levels of user resistance, Implementations that failed have often been those with which the users were dissatisfied with the system.

Aim: The aim of this study is to assess the satisfaction of both the physicians and nurses with the newly introduced EMR system at the Emergency Department of Al Wakra Hospital, to find out if there was a significant difference between physician and nurse's perception to the system. And to determine which of the individual attributes of EMR were related to physician and nurse satisfaction.

Methods: Study design: cross sectional survey four month after of the introduction of the EMR system (Cerner) we surveyed 40 physicians and 96 nurses at the Emergency Department of Al Wakra Hospital. The questionnaire assessed: perceptions regarding EMR ease of use; concerns about impact upon work, and quality of patient care.

Results: The total satisfaction rate was 88.2%. 72.5% among the physicians and 94.5% among the nurses, both physicians and nurses were satisfied with the ease of use of the system, they find it generally to have a positive impact on their work, however both didn't find it to have an impact in reducing ED overcrowding.

Conclusion: Both physicians and nurses were satisfied with the EMR system.
Impact of rapid response system implementation at the Cuban Hospital. September 2014-September 2015
Authors: Avila Dalsy Torres , Molina Hector Roche , Alfonso Ramon Nonato , Garcia Jorge Rosales , Arias Katiana Figueredo
Published: May 2017

Hospitals' track-and-trigger systems to identify and respond efficiently to patient's deterioration became an evidence base tool for patient safety and medical management worldwide. A prospective study about the Impact of Rapid Response Team Implementation in the Cuban Hospital was developed since September 2014 up to September 2015. The patients admitted in medical and surgical wards were screened upon admission and rescreened during every shift by nurses using the National Early Warning Score (NEWS), a multidisciplinary medical response team was designed and proper actions were done according to the acuity of illnesses and patient needs. The 100% of patients admitted were screened and properly followed during every shift, the system gave us the possibility for early detection of all the patients deteriorated, 9.9% in total, the 3.6% of patients admitted were transferred to ICU in deteriorated condition, decreasing to 0 the code blue activation and the unexpected mortality in wards. Early recognition and timely and competent clinical response gave us the opportunity to be proactive to protect our patients against life threatening situations. We recommend extend this result to all the hospital service using a wider system to include maternity and pediatric population, the implementation of the Qatar Early Warning System (QEWS) will be our next step to protect all the patients admitted in our Hospital.
The effect of demographic and lifestyle factors on mode of travel in school-aged children in the UK, from understanding society database, 2009–2010
Authors: Fadl Sahar , Millett Christopher , Laverty Anthony
Published: May 2017

Background: Increasing levels of physical inactivity is associated with growing trends of childhood obesity as evidence suggests today's children physically inactive and unfit. The study aims to assess the effect of socio-demographic and lifestyle factors on mode of travel in school-aged children (10–15 years).

Methods: 4,497 school-aged children were selected from wave-1 of Understanding Society database in a multi-stage random sample with 81.8% response rate. Cross-sectional design was used to examine the relationship between active travel with demographic and lifestyle factors.

Results: Univariate analysis showed significant relation of age, region, smoking and eating fast food to the active commuter school-children. Multivariate adjusted analyses shows that children of ages 13 to 15 years were more likely to travel actively compared to those aged 10 to 12 years (OR = 1.92, 95%CI:1.65-2.23). Those engaged in sporting activity 3 times or more per week were more likely to be active travel compared to those less than twice per week (OR = 1.21, 95%CI:1.02-1.43). Children eating fast food once or less than per week were more likely to travel actively compared to unhealthy eaters. Most children living in their respective regions were less likely to travel actively.

Discussion: The positive association between active mode of travel and elder school children (13–15 years), who perform sport activities three times or greater per week and eating fast food once or less per week with active travel, reflect their free choice of mode of travel. Children who practiced sport more than three times per week and who ate less fast food showed healthy behaviors.
Sustainment of a weekly OSCE with new staff in an Ambulance Paramedic Training Department
Authors: Alinier Guillaume , Mraidi Raouf , Hamzaoui Mourad , Vincent Fedrick , Naidoo Vernon , Meyer John , Singh Kanhaiya , Dipalac Joseph , Sevanesan Pravin , Al Badawi Anan , Mahmoud Mongi , Aguba Jane , Balan Vishnu , Zarrougui Chokri , Narido Jayson
Published: May 2017

Background: “Orientation” is an important phase when joining a new institution. It is the period when someone builds an understanding of their role/responsibilities in a new setting, and for colleagues to gauge someone's level of knowledge and competence. HMCAS recruits mostly overseas nursing qualified staff with variable experience and transforms them into Ambulance Paramedics (AP) all providing the same level of care in accordance to our Clinical Practice Guidelines.

Methods: Skills assessment using a 17–20 stations Objective Structured Clinical Examination (OSCE) process was introduced in the Training Department during a week-long instructor development workshop in 2013. Instructors were coached to develop practical/theoretical OSCE stations and took part in pilot sessions as examiners with new APs. The OSCE is now a core AP training programme component with weekly sessions to assess new staff on what they have been taught up to that point in time.

Results: Over 120 OSCE sessions have occurred in 2 years exposing about 600 staff to a minimum of 3 sessions each. A bank of over 40 stations has been developed and validated, and a team of trained examiners is used. As determined by the course evaluation form, although seen as a stressful experience, instructors and staff find it a very beneficial and effective assessment modality to prepare them for clinical practice. It motivates staff to study and they even request to have an OSCE per year as part of their continuing professional development.

Conclusion: We are committed and have processes in place to sustain the facilitation of OSCE sessions as it is a very practical way of assessing a wide range of skills over a set time period and gauging staff progress through consecutive sessions. The initial preparation is time consuming but we encourage other departments to explore this approach as part of their orientation/training programme.
Save kids, not all children with minor head injury need CT head, QIP in Hamad General Hospital Emergency Department, Qatar
Authors: Elmoheen Amr , Qotb Mohamed , Alkahky Sherif , Salem Waleed , Elessae Galal , Farook Saleem
Published: May 2017

Background: Whilst Head CT scanning carries an important role in the identification of clinically significant intracranial injuries, there are associated risks of radiation. Our initial audit of clinical notes and survey of EM physicians revealed a rate of 45% CT scans for pediatric minor head injuries with around half of requests not indicated. In 36% there were issues with documentation. The aim is to achieve a sustained compliance with Internationally acceptable guidelines of Head CT scanning for pediatric minor head trauma at Hamad General Hospital Emergency Department (ED).

Intervention: We conducted staff education through weekly program of Continuing Medical Education for emergency physicians, prominent display and availability of handouts of the International clinical decision rules (NICE guidelines, PECARN) in all clinical areas within the ED, encourage proper documentation for all head injury cases to meet JCI standards of documentation, and formulate a revised pediatric head injury guideline based on the international clinical decision rules.

Methods and results: The audit in August 2014 showed that 62 CT head were done, 45% of them were deemed unnecessary when measured against NICE guidelines. Also there was deficient documentation in 36% of cases due to the unavailability and difficulty accessing the guidelines. We supplied all areas in the ED with handouts of the guidelines, and conducted shop floor education for ED physicians. Regular sessions were conducted during educational activities and emergency seminars. The re-audit in January 2015 showed decreasing rate of CT scans at the rate of 22% achieving a reduction by 33% and improvement in the documentation by 31%. The overall reduction of and decreasing the percentage of unindicated CT head by around 30%.

Conclusion and recommendation: Managing minor head injury in pediatric age group becomes more safe by increasing the physician awareness about the evidence based updated guidelines.
Delivering of safe and effective CPR by means of an external chest compression device at Hamad Medical Corporation
Authors: Meyer John Thomas , Campbell Craig , Hamzaoui Mourad
Published: May 2017

Objective: The objective of this study was to collect feedback from Ambulance Paramedics (AP) with respect of their experience of using an External Chest Compression Device (ECCD) on cardiac arrest patients. Aspects of particular interest were ease of use and their perceived effectiveness of delivered CPR.

Background: HMCAS crews attend to several hundreds of cardiac arrests a year. To achieve Return of Spontaneous Circulation (ROSC), the key requirements are the provision of effective chest compressions delivering oxygen to the brain, maintaining coronary perfusion pressure, and priming the heart for successful defibrillation. Providing effective manual chest compressions in the austere Qatar pre-hospital setting with high temperatures is challenging, hence all HMCAS emergency vehicles have been equipped with ECCD.

Methods: HMCAS receives daily reports compiled by its Documentation Officers. These reports highlight specific cases in which use of the ECCD was indicated but not implemented. These cases are followed up and audited to assess if non-provision of automated chest compressions was clinically acceptable. HMCAS monitors specific key performance indicators, i.e. ’Use of the LUCAS™2 in Adult Medical CPR Cases’ as well as ’ROSC in Medical CPR’. Feedback was collected over a 3-month period using a 10-point Likert scale type questionnaire distributed to ambulance paramedic teams who had used the ECCD during a real medical cardiac arrest case.

Results: The results are based on 54 returned feedback questionnaires. Using a scale with 1 being very difficult and 10 being very easy, ambulance paramedics’ mean rating of the device's ease of use was of 8.8/10. Similarly, on a scale indicating perceived effectiveness, staff indicated that they found the chest compressions provided by ECCD to be highly effective (mean = 9.41/10).

Conclusion: HMCAS staffs are highly satisfied with making use of the device since it provides them with a safer work environment and they are less fatigued after finishing a CPR case, especially during the summer months.
Needs assessment of breast health care in the Gaza Strip
Authors: Lafi Mohamed Abdulla , Shaheen Rola
Published: May 2017

Background: Breast cancer is the most common malignancy and leading cause of cancer mortality among females in Gaza. Most cases are diagnosed at late stage. Survival rates are persistently low in contrast to improved rates worldwide. Our study examined awareness, knowledge, attitude, practice and access to breast healthcare among both health professionals and women in Gaza.

Methods: In May and June 2014, using convenience and representative sampling, 100 health professionals from medical, surgical and obstetrics-gynecology completed a survey on basic knowledge of breast cancer, attitudes and practices. Structured interviews were conducted with 100 women 30 years and older across all districts and socioeconomic backgrounds. Women were interviewed about basic knowledge of breast cancer, self-exam, attitude and practice when a breast problem encountered, access, and barriers. Data was analyzed using excel to find frequency distributions.

Results: The health professional surveys showed: Only 15% offer breast exam to their patients, 13% believe mammography can cause cancer, 48% do not know that radiotherapy is not available in Gaza, 4% believe cancer breast is contagious. Health professionals expressed the need for standardized protocols and guidelines. Only 25% of surveyed women reported practice of self-examination, 87% had never had a mammogram or had been offered a breast exam, 26% think mammogram can cause cancer. However 80% were positive about seeking healthcare when needed. Most women accepted screening if affordable and were interested in receiving information about breast care.

Conclusion: Knowledge gaps in breast healthcare exist among healthcare professionals and women in Gaza strip. Awareness sessions, capacity building and specialized training of healthcare professionals are needed to improve quality of breast healthcare in Gaza. Increasing utility of mammography among women with access to multidisciplinary breast care may improve survival rate, particularly because most women in Gaza are keen on seeking medical care when needed.
Analysis of dengue surveillance data in Punjab, Pakistan, 2013
Authors: Altaf Asim
Published: May 2017

Introduction: Pakistan has seen repeated outbreaks of the disease over the past decade or so. In 2011 the largest outbreak was seen in Punjab where 20,864 cases were reported. This study was conducted to estimate the disease burden and analyze epidemiological trends using data from the provincial Dengue Surveillance System, Punjab.

Methods: A descriptive analysis of data from January 1 to December 31, 2013, was undertaken. A case of dengue fever was defined as any person with fever from 2–10 days with any three of the following symptoms: headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestation, leucopenia, abdominal pain and restlessness. Population estimates from Federal Bureau of Statistics were used to calculate attack rates.

Results: From January 1 to December 31, 2013, a total of 14,145 suspected cases were reported and 2,662 were confirmed. Out of cases 9,038 (69.3%) were males and 03 deaths were reported with CFR 0.11%. Mean age was 28.5 years (range 1–99 years). About 28 (0.2%) had previous history of dengue fever. Lahore was the most severely hit city (AR = 173/100,000) followed by Rawalpindi (AR = 52/100,000), Kasur (AR = 6.8/100,000) and Faisalabad (AR = 3.1/100,000). Most severely affected age group was 15–49 (AR = 30.8/100,000) followed by 50+ age group (AR = 15.5/100,000). Males were more affected (AR = 26.3/100,000) than females (AR = 11.8/100,000). The cases started increasing in August (1,128), peaking in November with 4,210 cases reported and then declining in December (758).

Conclusion: The analysis showed predominant involvement of adult males. Moreover highest number of cases was reported in the post-monsoon months of September through December. Age, gender specific health education and area specific larvae and vector control activities should be initiated. In 2014 there was significant decrease in dengue cases in Punjab and especially in Lahore where age and area specific targeted activities were conducted and AR was decreased to 21/100000.
Review: Injury Severity Score (ISS) >15 in trauma units within the South West London and Surrey Major Trauma Network
Authors: Baron Christopher Francis , Kumar Suresh
Published: May 2017

Background: In April 2014, the South West London and Surrey Major Trauma Network entered its 4th year as an operational network, consisting of one Major Trauma Centre (MTC) and 7 acute Trauma Units (TUs) over a wide geographical area. In the year ending March 2014, 75% of the major trauma patients were taken to the MTC. However many patients with ISS >15 were admitted to TUs. Regular governance meetings are key to ensure these patients have received an appropriate level of care.

Case description: A service evaluation of care provided under governance framework, using the ISS as a guideline, was carried out. Patients who sustain traumatic injuries are managed in accordance with the Major Trauma Clinical Standards, the Trauma Audit and Research Network (TARN) measurable quality indicators and Trauma Quality Network System (TQuINS) recommendations. Available data indicates that there is a possibility that patients who present to a TU rather than a MTC may receive less than optimal care. In order to mitigate this difference it is necessary to have a governance system to ensure the patient care is optimal.

Methods: A proforma was developed for data collection with key trauma measures as quality indicators and the results collated in an Excel spreadsheet. A standard operating procedure and flow chart processes were developed to review major trauma cases. The TARN Office identified suitable patients and a multidisciplinary team reviewed the notes. Issues with care were formally registered with trust incident reporting system and registered in the trauma risk register. Findings were presented in the trust audit study day, in the Trust governance committee and disseminated for development.

Conclusions: Initiating a robust governance system and process will minimise substandard care and help standardise care across the network.
Modelos de acumulación de capital y estructura laboral en El Salvador. 1900–2007
Authors: Barrera Saira Johanna , Flores José Luis , Herrera Rodolfo Eduardo , Montoya José Ernesto
Published: May 2017

En este trabajo se pretende mostrar cómo las características de la fuerza de trabajo se han ido adaptando a los distintos modelos de acumulación de capital que han existido en El Salvador desde el año de 1900 hasta la actualidad. La investigación y la exposición se realizó atendiendo a los tres modelos económicos identificados en El Salvador: modelo agroexportador basado en el café (1900-1944), modelo agroexportador con impulso a la industria manufacturera (1948-1979) y modelo terciario-maquilero (1989-2007). Una buena parte del instrumental teórico de este trabajo proviene del pensamiento del economista Aquiles Montoya.Realidad: Revista de Ciencias Sociales y Humanidades No. 131, 2012: 65-104
Genocidio cultural: diálogos teóricos, históricos y culturales sobre la represión de 1932
Authors: Martínez Martínez Ricardo
Published: May 2017

No hay resúmenes disponiblesRealidad: Revista de Ciencias Sociales y Humanidades No. 133, 2012: 411-459
Introducción a la lectura del texto El hombre y Dios, de Xavier Zubiri
Authors: Cornejo Ojeda Juan Patricio
Published: May 2017

El hombre y Dios de Xavier Zubiri es una obra que por derecho propio ha de ocupar un sitial en la historia de la filosofía. ¿Qué significa esta “y” del título del texto El hombre y Dios? Toda la clave del libro radica en descifrar qué sentido tiene esa “y”. Acceder, pues, al texto El hombre y Dios, implica forzosamente retrotraer nuestra investigación a la raíz misma de la “existencia humana”. Pretendo presentar una humilde vía de esclarecimiento. Mostrando la postura de Zubiri frente a Heidegger en ciertos puntos que considero capitales como “puerto” de acceso a la lectura de El hombre y Dios. Por tanto, llevaré a cabo esta investigación en tres breves navegaciones: I. El problema de la “y”. II. Sobre la “Erschlossenheit”. III. De la “Geworfenheit” a la “religación”.Realidad: Revista de Ciencias Sociales y Humanidades No. 132, 2012: 295-314
Remotando el 32 De la represión a la supresión
Authors: Lara-Martínez Rafael
Published: May 2017

No hay resúmenes disponiblesRealidad: Revista de Ciencias Sociales y Humanidades No. 134, 2012: 599-606
Un mara, una madre: “hijos de...” en un país sin padres
Authors: Arroba Anna
Published: May 2017

En este documento, la autora va más allá de las imágenes tradicionales de los miembros de maras y reflexiona al respecto desde la perspectiva de la historia y política del cuerpo.Realidad: Revista de Ciencias Sociales y Humanidades No. 134, 2012: 677-696
De niño perseguí a los protestantes
Authors: Tamayo Juan José
Published: May 2017

Speech at the reception of the diploma and gold medal of the Spanish Pro-Human Rights League to Juan José Tamayo, for his commitment and his intellectual work in favor of dialogue between religions.Realidad: Revista de Ciencias Sociales y Humanidades No.139, 2013: 93-104
Imagine No Religion
Authors: Barton Carlin A. , Boyarin Daniel
Published: May 2017

There are two lines of argument in the book. The first, supported by some current and previous scholarship, develops the idea that ancient Hellenic and Roman cultures did not have and would not have recognized a concept of “religion” as a distinct or separate sphere of experience and cultural practice, and that the nouns thrēskeia and religio (usually translated as “religion”) had a range of culturally specific meanings very distinct from our “religion.” The second argument is that understanding the array of meanings of these words enables us to see connections and patterns within these cultures easily occluded by the imposition of our notions of “religion.”
Corporate Romanticism
Authors: Stout Daniel M.
Published: May 2017

Corporate Romanticism offers an alternative history of the connections between modernity, individualism, and the rise of the novel. In early nineteenth-century England, two developments—the rise of corporate persons and the expanded scale of industrial action—undermined the basic assumption underpinning both liberalism and the law: that individual human persons can be meaningfully correlated with specific actions and particular effects. Reading a set of important Romantic novels—Caleb Williams, Mansfield Park, The Private Memoirs and Confessions of a Justified Sinner, Frankenstein, and A Tale of Two Cities—alongside a wide-ranging set of debates in nineteenth-century law and Romantic politics and aesthetics, this book argues that the novel, a literary form long understood as a reflection of individualism’s ideological ascent, in fact registered the fragile fictionality of accountable individuals in a period defined by corporate actors and expansively entangled fields of action. Examining how liberalism, the law, and the novel all wrestled with the moral implications of a highly collectivized and densely packed modernity, Corporate Romanticism reconfigures our sense of the nineteenth century and its novels, arguing that we see in them not simply the apotheosis of laissez-fair individualism but the first chapter of a crucial and distinctly modern problem about how to fit the individualist and humanist terms of justice onto a world in which the most consequential agents are no longer persons.