bluuebunny/crossref_metadata_2025_split huggingface dataset:
Qatar ambulance service and Hamad General Hospital Emergency Department staff's perception of current patient handover practice
Authors: Jundi Ibrahim , Abujaber Ahmad , Alinier Guillaume , Campbell Craig , Meyer John , Al Shaikh Loua , Cameron Peter , Rull Sandra , Kamel Hany , Govender Kevin 
Published: May 2017

Background: The handover process is meant to ensure patient safety and maintain continuity of care through endorsement of critical patient information. This study evaluates staff's perceptions about the current patient handover process effectiveness between Ambulance Service (AS) and Emergency Department (ED) clinicians. It may help identify barriers and contributing factors to an effective patient handover.

Methods: An electronic questionnaire was circulated to all ED doctors/nurses and AS staff (Estimated N = 1,000). 400 questionnaires were completed of which 92 did not meet the inclusion criteria. Respondents were 43% AS staff, 29% ED nurses, and 28% ED doctors. A 4-point Likert scale (1 = strongly disagree-4 = strongly agree) was used. The mean was calculated for every variable to determine each group perception. One-way ANOVA tested the relationship between demographics and perceptions’ variables.

Results: Although 62% of respondents believe the current handover process is safe and 65% believe AS staff report all critical information, 70% of respondents think that it causes AS/ED staff conflicts, and 72% believe the current handover process needs changing. ANOVA test revealed significant differences in the mean between study groups’ handover safety perceptions. Interestingly, ED nurses expressed more safety concern (2.43) than ED doctors (2.58) and AS staff (2.82) with p-value < 0.05. The main perceived barriers to effective handover were: Lack of handover protocol (89%); Lack of a standardized handover tool (89%); Fragmented communication (85%); and Frequent interruptions (82%). 93% of the respondents believe the use of a standardized handover tool will improve the patient handover process despite 67% of them not knowing any standardized handover tool.

Conclusion: The lack of handover protocol and a standardized tool leads to significant variation and is a patient safety concern due to potential loss of critical information. We believe that a mutually agreed standardized handover tool such as ISBAR would reduce handover variation and ensure quality.
Pre- and post-assessment of conjugated vaccine (MenAfriVac) and case-based surveillance system implementation 2010–2015, Sudan
Authors: Hussein Safaa Ibrahim Musa , Bashab Hind Mohammed , Hassan Deena Mohamed Abdegader , Khogali Hayat Salaheldein 
Published: May 2017

Objective: Since 1998 seasonal epidemic meningitis has been a recurrent problem in Sudan with a variation in the severity between seasons. Mass vaccination campaign with conjugated vaccine (MenAfriVac) for Neisseria meningitidis A was implemented in Sudan since October 2012, since then case base surveillance of meningitis was implemented. The target age group was 1–30 years. Measuring of meningitis trends in three years pre and post the campaign against NmA is mandatory to assess the impact of introducing (MenAfriVac) vaccine.

Objective: To describe the epidemiological profile of NmA in Sudan, 2010–2015.

Methods: Descriptive study using data of notable suspected meningitis cases by national surveillance system.

Results: EpiInfo 7 software used to analyze the data. 2010–2012 a total of 4273 suspected cases were reported (13.08/100,000 Attack Rate (AR)) with 185 deaths (4.35% Case Fatality Rate (CFR)). The most effected Age-Group was ( < 5) representing 62% of cases, 61% of cases were observed among males and 39% among female. The positivity rate of NmA was 4.2%. 2013–2015 After MenAfriVac® and case-based surveillance implementation; a total of 794 suspected cases were reported (4.5/100,000 AR) with 59 deaths (7.0% CFR), the most effected Age-Groups were (1–4) representing 40.3% of cases following by Age-Groups ( < 1) representing 39.7% of cases, 64% of cases among male and 36% among female. The positivity rate of NmA was 0%, no confirmed case of NmA was reported.

Conclusion: Introducing of MenAfriVac® proved to be an effective strategy contributed to decrease the overall number of meningitis suspected cases in Sudan.
Monitoring of toxic metals in dietary supplements before they marketed in Qatar
Authors: Azimi Salman , Arram Noha Reda 
Published: May 2017

The consumption of dietary supplements is widely spread and on the rise in Qatar market. Toxic metals like mercury, lead, cadmium and arsenic can be naturally present in dietary supplements and can pose harmful effects on human health. Pharmacy and Drug Control Department; SCH has been involved in proper counselling of these products before they are marketed to Qatar. In this study Two hundred and thirty five different dietary products (capsule, liquid or powder form) were analyzed which were submitted to our department for registration. Inductively Coupled Plasma-Mass Spectrometer (ICP-MS) and Mercury Analyzer are used to monitor toxic metals that exceed United States Pharmacopeia (USP) maximum limits. Samples were digested with HNO3+HCl (5:1) by utilizing closed vessel microwave system. The validity of the applied method was assessed by the analysis of standard reference material (SRM 1548a), and the recoveries were 100 ± 10% of the certified value for 4 metals. Among the 235 samples, 13 samples contained lead (Pb) exceed the USP limit while 2 samples with arsenic (As) above the limit. No sample contained Cd and Hg above the limits. Pharmacy and Drug Control Department is taking action and monitoring toxic levels of Hg, Pb, Cd and As in herbal and dietary supplements before they market in Qatar by using state of the art technology for the safety of public and for the better health of peoples living in Qatar.
Days, weekends and diurnal variations in the presentation of ST-elevation and non-ST elevation MI: An insight from Primary PCI/ACS Registry
Authors: Gehani Abdurrazak , Al Suwaidi Jassim , Al Qahtani Awad , Arabi A Rahman , Tamimi Omer , Arafa Salah , Rafie Ihsan , Asaad Nidal , Nabti A Rahman , Abujalala Salem , Yacoub Magdi 
Published: May 2017

Background: There appear to be variations in the time of presentation patients with ACS around the world. The working days and weekends differ in Qatar from the Western world.

Methods: In 1846 patients admitted with ACS, 721 had Primary PCI for STEMI and 1125 had Non-ST Elevation ACS (NSTE-ACS). The days and time of onset of symptoms, Door to Balloon Time (DBT) and Out of Hospital Delay were compared in different time periods in relation to the weekend (Friday/Saturday), and 2-days before (B-WKE), or 2-days after (A-WKE). The intra-day variation was compared in day time (6AM-6PM), and night time (6PM-6AM).

Results: Overall, almost half ACS patients (both STEMI and NSTE-ACS) presented in 2 days After WKE (Sun & Mon), with 60% of these presenting on Sunday alone, compared to only 16% over WKE (Fri & Sat). This was true for males with both STEMI and NSTEMI and for females with NSTE-ACS. However, the pattern was reversed in females with STEMI, 39% presented during week days vs only 19% After WKE (Sun & Mon). For both sexes and all ages, most (58%) presented early day time with modal symptoms starting time around 4 AM. In Primary PCI patients, the DBT was longer (77.5 min) during the night vs (61 min) during day, but in both >90% were within 90 min. 66% of STEMI total occlusion (TIMI-0) during the night. TIMI-3 flow was achieved in 94% during the day vs (87%) at night. Out of Hospital Delay was longer at night (270 min) vs (200 min) during the day. However, in-hospital mortality and LV function was similar.

Conclusions: There are interesting variations diurnal and gender variation in time of presentation of ACS. However, this does not seem to make significant impact on in-hospital outcome in the Primary PCI, perhaps because majority achieved optimal Door to Balloon Time.
Disaster-resistant communities, public awareness program
Authors: Elsaeidy Abdallah Mohamed Elsafti , Saboor Ahmed Abdul , Soliman Hassan Ahmed Ali , Redwan Atef 
Published: May 2017

Background: The tremendous increase in disasters in the Middle East whether natural or man-made is unforeseen in its characters and/or catastrophic effects to the communities and infrastructure, thus making public awareness is a mandate to plan, respond and mitigate the community.

Methods: We run Public Awareness program targeting non-medical university students, aiming at raising their knowledge about first aid and response during disasters by designing and conducting hands on First Aid and disaster preparedness course, pretest and post-test was done, graded from 0 to 10 for evaluation of the candidates and their level of knowledge, aiming at achieving 3 grades or above change in the candidates knowledge.

Results: Of 95 candidates attended the course, 84 pre and dost were complete and included in this study. More than half of them were male (n = 55; 65%). There was a significant difference in the candidates grades in the pre and post-test, with near 95% achieved the goal and almost 90% was satisfied by the program.

Discussion and conclusion: The surge in disasters over the last decades is unforeseen, in order to meet that threat national disaster plans should focus on effective disaster public awareness programs, targeting especially the most active and largest part of the community, which is university students.
Creatinine phosphokinase elevation among exertional heat stroke patients
Authors: Oommen Roney Mathew , Abujaber Ahmad 
Published: May 2017

Background: Rhabdomyolysis, which can be defined as a CPK level greater than five times the upper limit of normal, is related to muscle breakdown and hypovolemia in heat stroke patients.1 CPK levels will likely be higher because of increased muscle breakdown in exertional heat stroke when compared with classic heat stroke.

Methods: We reviewed 50 patients who came into the Emergency Department of Hamad General Hospital during the months of July to September 2015, and who were diagnosed with exertional heat stroke.

Results: In 44 out of 50 heat stroke patients, the level of serum CPK was markedly elevated (mean 20,300 ± 25,500 U/l) compared with the elevated levels of other lab values (serum myoglobin 2500 ± 3000 ng/ml, creatinine 1.8 ± 2.4 mg/dL, BUN 90 ± 104 mg/dL, potassium 2.6 ± 3.6 mEq/L, sodium 135 ± 155 mEq/L) on admission. The repeated lab values after the 12th hour showed that the CPK rose further (28,500 ± 32,500 U/L) while the others (serum myoglobin 800 ± 1,200 ng/ml, creatinine 1.1 ± 1.4 mg/dl, BUN 35 ± 60 mg/dL, potassium 2.2 ± 3.4 mEq/L, sodium 110 ± 130 mEq/L) recorded a decrease.

Conclusion: In our cohort of patients, CPK levels were significantly high in the setting of exertional heat stroke. A possible relation to renal failure need to be explored in a prospective research design.

Keywords: exertional heat stroke, rhabdomyolysis, creatinine phosphokinase REFERENCE: [1] Santelli J, Sullivan J. An evidence based approach on emergency medicine. Emerg Med Prac. 2014;16:6–15.
Aortic dissection “the great and deadly mimicker”: A case report
Authors: Nadeem Sana , Baiou Anas , Shukla Dharmesh , Fitori Gamal A.L. , Gehani A.A. 
Published: May 2017

Introduction: Acute aortic dissection (AAD) is one of the most challenging cardiovascular emergencies presenting to the Emergency Department (ED). Prompt diagnosis and treatment is the key to patient survival. Though most AADs present with typical symptoms, it has been reported to present with a myriad of symptoms. We report a case of an AAD, which presented to our ED with predominant neurological symptoms.

Case description: A 47-year-old male was brought to our ED with acute confusion and history of seizure. He did not have any history of trauma or report any chest pain, headache or fever. He was vitally stable except for slight tachycardia and his physical examination was unremarkable. All investigations including a CT head were reported normal except leukocytosis (27 × 109/L). A few hours after admission, he started deteriorating, developed hypotension and became more agitated. Resuscitative measures were started. Ultrasound scan of the heart was performed to confirm central venous access showed a pericardial effusion and a flap in the ascending aorta. A diagnosis of AAD was made. An urgent CT was performed, which showed an extensive Type A aortic dissection extending into the branches, with rupture into pericardial cavity. During transportation for surgery, the patient had a cardiac arrest from which he could not be resuscitated.

Conclusion: AADs may present in an unusual manner with predominantly neurological manifestations such as acute confusion and seizure. In patients with unexplained acute confusional state the possibility of an AAD should be considered in the differential diagnosis. Bedside TTE has a limited sensitivity but high specificity in diagnosis of Type A AD and its early utilization may facilitate timely diagnosis improving outcome. Given the high specificity of TTE and time-dependent survival in Type A AD, institutional protocols to expedite the transfer to the operating room without waiting for CT confirmation might be considered.
A new approach to assure safe and efficient major trauma care and patient experience in a London Trauma Unit
Authors: Suresh Kumar Thirumoorthy Samy , Eden Teresa , Baron Christopher 
Published: May 2017

Background: The South West London & Surrey Trauma Network has one major trauma centre (MTC) and seven acute trauma units (TUs) over a wide geographical area. Seventy-five percent of the major trauma patients (injury severity score >15) were taken to MTC. However, many were admitted in trauma units. Available data indicates that there is a possibility that patients in TU rather than MTC may receive less than optimal care.

Aims: We would like to describe the development of a new system and process to review the management of ISS>15 cases under governance framework, assuring the delivery of safe and effective trauma care outside a MTC.

Description: The standard operating procedure and flow chart process were developed for review of major trauma cases. TARN Office identified patients were reviewed using a proforma, with key trauma measures as quality indicators. The notes were initially reviewed by clinicians, and in due course by the MDT team for the whole patient journey from arrival to discharge.

Outcomes: The commonest age group is >65 years. Head injury is most common, resulting from a fall from standing height (64%) causing subdural haemorrhage (57%). Most arrive by blue-light ambulance (86%). There is evidence of specialist team involvement in 64% of the cases and multidisciplinary team involvement in 55% of the cases. However, there are issues with the quality of record keeping, Timely CT scans and incorporating rehabilitation prescriptions into discharge letters were done.
Issues with care were formally registered with hospital incident reporting system and registered in the trauma risk register. Findings were presented in the hospital audit study day, in the Trust Governance Committee and disseminated for development. This governance system has evolved with more concrete systems now in place.

Conclusion: Initiating a robust governance system and process will minimise substandard care and help standardise care across the network.
Wait a minute: Not all cases of paracetamol overdose need N-acetylcysteine, quality improvement project in Hamad General Hospital Emergency Department
Authors: Salem Waleed A. , Qotb Mohamed , Alkahky Sherif , Elessaei Galal , Elmoheen Amr 
Published: May 2017

Background: Management of serious paracetamol overdose with N-acetylcysteine (NAC) is an effective strategy. Early treatment with NAC prevents the formation of a toxic metabolite that leads to hepatic injury. However, inappropriate treatment with NAC and overtreatment with NAC can lead to potential adverse side effects and unnecessary hospital admission.
The aim of the study was to assess the administration of NAC in the setting of paracetamol overdose and determine whether the institutional use of this antidote is consistent with the international standards. We hypothesize that some patients receive antidotal NAC unnecessarily after paracetamol exposure, and that a simple quality improvement intervention in educational activity may improve the administration of this antidote.

Methods: A retrospective quality improvement chart review evaluated charts of patients who were treated with NAC for paracetamol exposure over a 2-month period in the Emergency Department of Hamad General Hospital. The quality improvement intervention consisted of establishing a paracetamol clinical practice guideline, providing access to a treatment nomogram for NAC use, enhancing educational activities to improve the clinician's understanding of appropriate NAC use, and establishing a clinical toxicology service for all paracetamol exposures.

Results: NAC administration to 67% of the cases after paracetamol exposure were found to be medically unnecessary according to the established international guidelines for management of paracetamol overdose. Post-intervention measurement showed significant improvement by decreasing unnecessary NAC administration to only 33%.

Conclusion: In our institution, NAC treatment after paracetamol exposure is usually administered unnecessarily. Inappropriate administration of this antidote results in a significant waste of resources and unnecessarily prolonged hospital stay.
Adherence to the clinical practice guidelines may lead to a significant improvement in this antidote use after paracetamol exposure. Given that this antidote is used inappropriately despite widespread knowledge that guidelines for paracetamol exposure exist, we believe that continuous education on the topic, chart audits and feedback, and use of a clinical toxicology service may improve the knowledge and appropriate use of this antidote and will improve patient care.
Epidemic of obesity among mothers in the Gaza Strip-Palestine
Authors: El Kishawi Rima , Soo Kah Leng , Abed Yehia , Muda Wan Abdul Manan Wan 
Published: May 2017

Background: Obesity is a public health concern in both developed and developing countries, and it is a main risk factor for chronic diseases. Thus, Palestinian adults aren't spared from obesity and non-communicable diseases epidemic. This study aimed to assess the pattern of obesity among mothers in the Gaza Strip.

Methods: A cross-sectional study was conducted on of 357 mothers aged 18–50 years between April-October 2012 in the Gaza Strip. A structured questionnaire was used to collect sociodemographic information and the short form of the International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity pattern. Mother's nutrition knowledge was evaluated using 16-item questionnaire. Anthropometric measurements were conducted among the mothers, and body mass index (BMI) ≥ 30.0 kg/m2 was computed to determine the prevalence of obesity. Multiple logistic regression was conducted to predict the associated factors of obesity.

Results: The prevalence of obesity among mothers was high (29.6%). About 78% of mothers were classified as moderately active, 21.6% of them were inactive, whereas, vigorous activity was not observed. Results revealed that as the age increased, the risk of mothers to be obese increased (OR: 1.11; 95% CI: 1.06–1.15; p < 0.001). Mothers with the medium education level have higher risks of being obese (OR: 2.39; 95% CI: 1.20–4.78; p = 0.013). Increased scores of nutrition knowledge to a participant increased the risk of being obese (OR: 1.17; 95% CI: 1.03–1.32.0; p = 0.013).

Conclusions: This study highlights obesity as a public health concern in the Gaza Strip. Age, educational level, and nutritional knowledge were found to have more influence on the prevalence of obesity. Community-based intervention programs should be applied to increase awareness among women and to help them to translate their nutrition knowledge into healthy dietary practices. In addition, effective program is required to increase physical activity levels for women.
Waterpipe smoking changes cardiovascular hemodynamics in adolescents: The Irbid-TRY
Authors: Alomari Mahmoud , Al-Sheyab Nihaya A. 
Published: May 2017

Introduction: Tobacco consumption contributes substantially to cardiovascular (CV) diseases (CVD), including hypertension. However, the effect of waterpipe (WP) smoking on CV hemodynamics in adolescents is unknown. Thus, the current study investigated the relationship of WP smoking with CV indices.

Methods: Indices including heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressures, mean arterial blood pressure (MAP), pulse pressure (PP) and rate pressure product (RPP) were obtained from 7th–10th grade male students.

Results: After controlling for confounding factors, SBP, DBP, MAP, and RPP were significantly lower (p < 0.05) in WP smokers versus non-smokers.

Conclusion: The results indicate that WP smoking lowers CV hemodynamics, which is perplexing given that tobacco smoking is associated with an immediate increase in CV hemodynamics and CVDs in adulthood. Therefore, future studies are needed to determine the mechanism(s) for lowered CV hemodynamics and the pathway between WP smoking and heightened risk of developing CV diseases adulthood, namely hypertension.
Prevalence and associated factors of physical activity among mothers in the Gaza Strip-Palestine
Authors: El Kishawi Rima , Soo Kah Leng , Abed Yehia , Muda Wan Abdul Manan Wan 
Published: May 2017

Background: The high prevalence of obesity was observed in numerous developed and developing countries. A reduce in energy expenditure due to the low physical activity level is a factor contributed to the increase in obesity. In the Gaza Strip there is a lack of studies on the pattern of physical activity among adults. The aim of this study was to determine the physical activity prevalence among mothers aged 18–50 years and its associated factors.

Methods: A mixed methods design was conducted using quantitative and qualitative methods. A total of 357 mothers were recruited from the Gaza Strip. The short form of the International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity pattern. Focus groups discussion (FGDs) were conducted for qualitative study.

Results: The prevalence of physical inactivity was 21.6%, about 78% of mothers were classified as moderately active, while vigorous activity was not observed. Results revealed that, physical activity level decreased among mothers who lived in households with low income (OR: 2.30; 95%CI: 1.20–4.45; p = 0.013), and those with high nutrition knowledge were more likely to be physically inactive (OR: 1.15; 95%CI: 1.0–1.314; p = 0.040), while mothers who had low or medium education level were more active (OR: 0.31; 95%CI: 0.15–0.62; p = 0.001), or (OR: 0.47; 95%CI: 0.23–0.96; p = 0.039). The qualitative results showed that most of the mothers believed home chores are kind of exercises and could substitute for practicing sports. The main constraints to physical activity practice attributed to the sociocultural factors due to the limited availability of exercising facilities for Palestinian women and restrictions on their freedom.

Conclusions: Results of this study are important to monitor physical activity levels among mothers in the Gaza Strip. Effective community-based intervention programs should be implemented to improve physical activity levels among mothers in the Gaza Strip.