- Home
- Search Results
Search Results
Filter :
FILTER BY keyword:
- Middle East [2]
- Qatar [2]
- breast cancer screening [2]
- Arab women [1]
- Arabic women breast cancer screening [1]
- Autoimmune disease [1]
- Brain injury [1]
- COVID-19 [1]
- COVID-19 vaccine [1]
- Charcot's triad [1]
- Customer service [1]
- Emergency Medical Service [1]
- Organ donation [1]
- Pharmacy professionals [1]
- Principal Component Analysis (PCA) [1]
- Qatar females [1]
- Quality [1]
- SARS-COV-2 [1]
- Service provision [1]
- Staff Perception [1]
- TG18 [1]
- Theoretical Domains Framework [1]
- Tokyo guidelines (TG) [1]
- Vaccine acceptance and advocacy behaviour [1]
- acute cholangitis [1]
- attitude [1]
- breast cancer [1]
- breast cancer awareness and knowledge [1]
- breast self-examination [1]
- causes [1]
- [+] More [-] Less
FILTER BY author:
- Rajvir Singh [18]
- Tam Truong Donnelly [5]
- Binny Thomas [3]
- Derek Stewart [3]
- Moza Al Hail [3]
- Nabila Al-Meer [3]
- Salha Bujassoum Al-Bader [3]
- Al-Hareth Al Khater [2]
- Betsy Varughese [2]
- Hassan Al Thani [2]
- Katie Maclure [2]
- Mariam Malik [2]
- Mohamed Ghaith Al Kuwari [2]
- Tulika Mehta Agarwal [2]
- Wessam El Kassem [2]
- Yousuf Al Maslamani [2]
- Abdul-Rahman El-Gamal [1]
- Abdulrouf Pallivalapila [1]
- Ahammed Abdulla Mekkodathil [1]
- Ahmad Zarour [1]
- Ahmed A Shible [1]
- Ahmed Awaisu [1]
- Ahmed Salama [1]
- Al-Hareth Al-Khater [1]
- Alejandro Kohn Tuli [1]
- Ali Toffaha [1]
- Amar Salam [1]
- Amjad Ali Shah [1]
- Amr Salah Omar [1]
- Asma Tarannum [1]
- [+] More [-] Less
FILTER BY date:
FILTER BY language:
FILTER BY content type:
FILTER BY publication:
FILTER BY affiliation:
- 1Hamad Medical Corporation, QA [2]
- 2Qatar University, QA [2]
- 1Faculty of Medicine, The University of Calgary, P.O. Box 23133 Doha, Al Rayyan Campus, Al Forousiya Road, Qatar [1]
- 1Full Professor, Faculty of Nursing; Adjunct Professor, Faculty of Medicine, Community Health Sciences, University of Calgary, Alberta, Canada [1]
- 1Hamad Medical Corporation, Doha, Qatar [1]
- 1Robert Gordon University, GB [1]
- 1Sidra Medical and Research Centre, QA [1]
- 1University of Calgary-Qatar, Al Rayyan Campus, Al Forousiya Road, PO Box 23133, Doha, Qatar [1]
- 1University of Calgary-Qatar, Doha, Qatar [1]
- 2Al-Amal Hospital, Doha, Qatar [1]
- 2Assistant Chairman, Department of Hematology and Oncology, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar [1]
- 2Hamad Medical Corporation [1]
- 2Hamad Medical Corporation, Doha, Qatar [1]
- 2Hamad Medical Corporation, QA [1]
- 2Robert Gordon University, Aberdeen, UK [1]
- 2Senior Consultant, QA [1]
- 3Heart Hospital, QA [1]
- 3Medical Research Center, Hamad Medical Corporation, Doha, Qatar [1]
- 3Primary Health Care [1]
- 3Program Director Hematology and Oncology, Chair person of ICC –AAH, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar [1]
- 3Qatar University, QA [1]
- 3University of Aberdeen, Aberdeen, UK [1]
- 4Director of Healthy Lifestyle Program, Public health consultant, Aspetar, P.O. Box 29222, Doha, Qatar [1]
- 4Imperial College London, GB [1]
- 4Royal College of Surgeons of Ireland, IE [1]
- 4Supreme Council of Health, Primary Healthcare, Doha, Qatar [1]
- 4University of Calgary, Qatar [1]
- 5Department of Nursing, Hamad Medical Corporation, Doha, Qatar [1]
- 5Qatar Supreme Council of Health, Primary Health Care Department, P.O. Box 3050, Doha - Qatar [1]
- 5University of Aberdeen, GB [1]
- [+] More [-] Less
FILTER BY article type:
FILTER BY access type:
Body Mass Index and Pattern of Diabetes in Qatar – A Retrospective Study of 529 Patients with Obesity
Background
Qatar ranks among the top countries with highest prevalence of diabetes and obesity. Obesity is generally measured by a Body mass index (BMI). BMI has been found to be independent risk factor for development of diabetes. Also diabetes when associated with obesity leads not only to its poor control but also causes increased long-term complications from diabetes.
Aim
To delineate the pattern of obesity among residents of Qatar and to classify them as per World Health Organization criteria. Secondary objectives included assessing the pattern of diabetes with increasing body mass index.
Method
All consecutive obese adult patients attending pre-surgical screening endoscopy clinic over an 18 months period were included. Patients under 14 years of age and those who had previous surgical treatment were excluded. Body mass index (BMI) was calculated as per standard criteria [weight (Kg)/Height (meters) 2] and was then classified as per World Health Organization criteria. Overweight Type 1 Type 2 and Type 3 obesity was defined as BMI more than >25 >30 >35 and >40 respectively. Diabetes was defined as fasting plasma glucose ≥ 7 mmol/l. All patients underwent gastroduodenoscopy to assess the presence of helicobacter infection and evidence of mucosal inflammation prior to surgical treatment of obesity.
Results
A total of 529 patients with a mean age of 36.8 years were included 31.4% of obese patients were in 15–30 year age group. The mean weight height and BMI were 123.6 Kg 1.65 meters and 45.2 respectively. Overweight Type I II and III obesity was seen in 3 (0.6%) 30 (5.6%) 95(17.8%) and 401 (76%) patients respectively. Overall 34.5% had associated comorbid diseases. Type 2 Diabetes were seen in 11.1% of the patients. Diabetes was seen in 0% 26.7% 8.4% and 6.7% in overweight Type I Type II Type III obesity respectively. Diabetes was significantly lower among very severely obese patients (Type III) as compared to those with overweight moderately and severely obese patients (Overweight Type I and II) (27/401 6.7% versus 16/8419% p = . 03).No correlation was found related to age sex or helicobacter infection.
Conclusions
Among the residents of Qatar 11% of obese patients were found to have diabetes. The highest prevalence of diabetes was seen in people with BMI of 25–30 (type 1 obese people). Diabetes prevalence did not increase with increasing obesity.
Lipidomics for the Prediction of the Unstable Coronary Plaque
Plaques that build up in the lining of the coronary arteries are made up of lipids inflammatory cells smooth muscle cells and connective tissue. Thormbosis of a not necessarily occlusive but unstable plaque most often causes episodes of unstable angina and myocardial infarction (MI). Preventing this sudden and adverse event seems to be the only effective startegy to reduce mortality and morbidity of coronary artery disease (CAD). Countries in the Middle East bear a heavy burden from cardiovascular disease. The population of Qatar is particularly prone to CAD with patients presenting with MI at a young age. The prevalence of CAD is in turn promoted by risk factors such as smoking hypertension dyslipidemia diabetes and sedentary lifestyles. Metabolomics approaches to the identification of disease biomarkers rely principally on the comparitive analysis of metabolite expression in normal and disease patients animal models or cell cultures to identify aberrantly expressed proteins or concentration changes in metabolites that may represent new biomarkers or elucidate a disease mechanism. Lipidomics is the global identification and quantification of a diverse range of lipids in biological systems and is a subset field in metabolomics. The eukaryotic lipidome might compise of 10000 to 100000 individual species of lipids originating from a few hundred lipid classes. These lipids are distributed as part of biological membranes energy storage substances and sometimes function as signal transducers. Altered lipid metabolism and dyslipidemia in the context of inflammation and oxidative stress are driving forces in the transition from stable to unstable plaques. Therefore a characteristic lipid signature within unstable human plaques and also in the circulating blood plasma could be a predictor of an oncoming cardiac event. This ongoing study was conducted on samples volunteered by acute coronary syndrome (ACS) patients at the Heart Hospital Doha Qatar. ACS is a term that describes any condition brought on by the sudden reduced blood flow to the heart due to thrombosis in the coronary arteries and encompasses unstable angina (UA) and both ST-segment elevation (STEMI) and non ST-segment elevation myocardial infarction (NSTEMI). A complete occlusive thrombi leads to extensive myocardial cell death and typically produces an elevated ST-segment in the electrocardiogram. In UA ischemia occurs unpredictably and suddenly and is caused by the temporary formation of blood clots within the coronary arteries. Unstable angina often occurs before a MI. Distinguished from ACS are patients with stable angina (SA) who develop symptoms due to exertional ischemia. The aim of this study was to profile the global individual lipid levels of subjects in Qatar with unstable CAD comparing global lipid levels between patients with unstable angina and ST-elevated myocardial infarction. We chose to discover the lipid biomarkers using a workflow utilizing tandem mass spectrometry with on-line ultra-high pressure liquid chromatography (UPLC-MS/MS). Mass spectrometry is a powerful technique that can be used to identify unknown compounds to quantify known materials and to elucidate the structure and chemical properties of molecules. Recent advances in the accuracy and speed to the technology allow data acquisition for the global analysis of proteins lipids and metabolites from complex samples such as blood plasma or serum. As we were trying to discover a new lipid biomarker a technique that would maximise the number of compounds detected identified and quantified them was favourable. Once the samples were analysed by tandem mass spectrometry the ion intensity data from each sample was aligned with each other by retention time and lipid mass normalised and deconvoluted. The signals were then attributed to a particular lipid species by utilising a lipid database and comparing the mass of the detected lipid and piecing together information gained from the fragment data of that lipid from the orbitrap. Statistical analyses of the signals for each individual lipid were then conducted by comparing within group percent coefficient of variation (?CV) fold change and analysis of variance (ANOVA) tests between sample groups and q-value and power calculations. Principal component analysis (PCA) was conducted in order to differentiate the samples under supervised conditions into STEMI and UA groups. A total of 1663 and 874 lipid compounds were identified in positive and negative modes of mass spectrometry respectively. Of these 7 compounds showed a significant change (ANOVA p-value < or equal to 0.001) between the STEMI and UA groups. The identities of these compounds are yet to be elucidated. Of the compounds with a significant change between sample groups of ANOVA p-value < or equal to 0.005 five compounds were able to be identified by mass and spectral matching with a lipid database. The PCA scores plot which distributes samples in multi-dimensional space according to the variance seen in each principal component showed very low evidence of discrimination between the sample groups with sample scores clustered in a single mixed pattern. This analysis suggests that the lipid abundance changes between the sample groups were difficult to find. This was most likely due to a combination of two reasons: (1) large within-group biological variance that needs to be overcome to detect the between-group variances and (2) the low differences in lipid concentrations between the sample groups. With a greater number of samples this results is expected to change as the power of the study would increase. Successful results obtained from this study will aid healthcare professional in intervening with appropriate treatment in persons showing no symptoms but are under threat of developing angina or acute MI. The discovery of a lipid biomarker could assist healthcare professionals in prevention of an acute cardiac event thereby saving lives.
Healthcare Workers' Perspective of Organ Donation and Transplant in Qatar – A Qualitative Study
Introduction
Organ donation and transplant is still an evolving field in Qatar. In Qatar a qualitative study to understand the perspective of the healthcare workers towards barriers promoters and system level challenges in organ donation and transplant was lacking. Hence very limited literature is available on these issues as are experienced by healthcare workers actually involved in the various stages of this process.
Objectives
The objective of the present study was to conduct a qualitative study using phenomenological approach with the help of focus group discussions to explore (1) Transplant system level issues; and (2) To understand why people choose to or not to register as organ donors.
Methods
Several key stakeholders in the healthcare sector were included in the discussions. Participants were healthcare professionals (a) who are involved in organ donation and transplant activities (coordinators surgeons physicians) and (b) healthcare professionals involved in organ donation promotion campaigns in Qatar.
An experienced moderator from the research team was employed to conduct the discussion and the trained research assistants collected the data. The audio recordings were transcribed by professional transcribers coded using NVivo software analyzed in the light of Theory of Planned Behavior and researches in the similar field and peer reviewed to derive a conclusion.
Results
The study was able to uncover several gaps in the system that are impacting the consent process and leading to under-utilization and wastage of available organs. Some key system level issues identified during the discussions were communication gap between transplant committee and some of the departments doing transplants absence of multidisciplinary teams for organ assessment and participating through various stages of transplant process difficulties arising because of lack of centralized centers for organ donation and transplant where all formalities could be carried out from start till the end and training deficiency reported by campaign volunteers as well as coordinators besides others. Besides this the study was able to enlist the difficulties faced by the healthcare workers working in field of donor registrations and transplant. The study also brought out volunteers' views based on their direct interaction with public on why people choose to or not to register during the organ donation campaigns in Qatar. Finally the study identified some concerns in the process of organ donation and transplant where formulating new policies and protocols or amending existing ones could affect the efficiency positively.
Conclusion
The study concludes that most challenges in organ donation and transplant in Qatar can be dealt with by focusing on creating awareness and educating people about the various issues related to organ donation through continuous campaigns and extensive media coverage of the issue. Consents which are the core issue behind the gap between brain death cases culminating into donors can be improved by ensuring early communication about donation decision by the donor to his/her family. Also under-utilization and wastage could be reduced by transplant committee representation from relevant departments involved in transplants and having multidisciplinary teams to assess the deceased donors' organs and work through the entire transplant process. This study can be referred to for further policy making in the area of organ donation and transplant in Qatar and modifying certain aspects of campaigns to make them more effective.
Influence Of Time In Range Glucose On Glycemic Control Outcome After Cardiac Surgery. A Qatari Experience
Background: Optimal glycemic control in postoperative cardiac patients is still under debate. In an attempt to reduce wound infection and improving overall mortality variable targets had been prescribed. Aim of the work: To study the outcome of glucose control with a target of 6 to 8.1mmol/L and the associated factors related to poor control. Methodology: We evaluated 227 consecutive patients diabetics and non-diabetics after cardiac surgery in a prospective descriptive study with purposive sampling. Patients subjected to insulin infusion with a target of 6 to 8.1mmol/L. We collected perioperative individual data including age gender race Euro score cardiopulmonary bypass time (CPB) aortic cross clamp time (ACC) length of ventilation stay in intensive care unit (ICU) and in hospital as well as nurses compliance to follow the protocol. Patients divided into 2 groups according to the success of maintaining the target into group I (target maintained over 80% of the time) and group II (target maintained in less than 80 % of the time). The groups were compared by t-test or Mann-Whitney U test as appropriate for interval variables and Chi square tests were for categorical variables. Data expressed as mean±SD or proportions/percentages for interval and categorical variables respectively. P<= 0.05 (two-tailed) was considered the statistical significant level. Results: Both groups were matched regarding the age sex gender and Euro score. Failure to lie within the target was significantly higher in diabetics (p=0.001) patients with glycated hemoglobin (HbA1c) above 8% (p=0.0001) dopamine and adrenaline users (p=0.04&0.05 respectively). No significant difference found between the ethnic groups (Arab and Asians). CPB and ACC time lengths of stay ICU and ventilation were significantly higher in group II. Incidence of hypoglycemia acute kidney injury and in-hospital mortality did not differ between both groups although wound infections were higher in group II. Conclusion: Pertinent aspects regarding better control within the studied population did not involve ethnicity as hypothesized however preoperative high HbA1C appears to be a good predictor of poor control. Patients with proper glucose control had a better outcome in terms of wound infection lengths of ventilation and ICU stay; moreover they were not subject to frequent hypoglycemic events as claimed.
The Effects of Class IV Hemorrhagic Hypotensive Shock and Its Resuscitation with Fluids and Adjuvant Vasopressors or Cellular Energy Replenishment on the Splanchnic Microcirculation
Background
Traumatic exsanguination leading to class IV hemorrhagic shock as defined by the Committee on Trauma of the American College of Surgeons requires aggressive resuscitation with crystalloids and packed cells together with the temporary administration of either norepinephrine or vasopressin to manage a persistent hypotension that is not corrected by aggressive fluid resuscitation. However the use of vasopressors in the resuscitation from hemorrhagic hypovolemic shock is controversial as these drugs may worsen the pre-existing splanchnic hypoperfusion by virtue of their vascular action. In previous intravital microscopy studies of the terminal ileum in rats we demonstrated that adequate resuscitation which restores and maintains central hemodynamics as clinical end-points of resuscitation does not restore or maintain splanchnic tissue perfusion which instead exhibits a persistent and progressive intestinal microvascular vasoconstriction and end-organ tissue hypoperfusion. In other intravital microscopy studies we have shown that resuscitation from hemorrhagic shock with small volumes of hypertonic saline does not restore or maintain the pre-hemorrhage blood pressure but selectively prevent the post-resuscitation vasoconstriction of the pre-mucosal pre-capillary arterioles of the terminal ileum. In contrast the replenishment of the hemorrhage-induced depletion of endothelial energy stores with vitasol restored the pre-hemorrhage arterial pressure and selectively prevented the post-resuscitation vasoconstriction of the pre-mucosal pre-capillary arterioles suggesting a positive inotropic effect of vitasol. Therefore such inotropic action merits the administration of vitasol during fluid resuscitation from severe hemorrhagic shock. It is well established that hemorrhagic shock profoundly depletes cellular adenosine nucleotides. This depletion occurs as the hemorrhage-induced splanchnic hypoperfusion decreases the supply of oxygen to end-organ tissue and cells resulting in failure of ATP generation by oxidative phosphorylation and the activation of the alternative cellular ATP generation from the low yield anaerobic glycolysis pathway. Studies designed to directly assess the status of the splanchnic microcirculation during severe hemorrhage shock and its resuscitation is scant. As the ischemic hypoperfused gut is central in the pathophysiology of shock and largely determine resuscitation outcome we were prompted to use our intravital microscopy technology to directly examine the intestinal microvasculature response to traumatic exsanguinations and during their resuscitations with either norepinephrine or vasopressin as opposed to direct cytosolic energy replenishment.
Methods
Anesthetized male Sprague-Dawley rats underwent initial venous withdrawal of 30% of the calculated animal's blood volume over 15 min (shed blood preserved in heparin-rinsed syringe for later resuscitation). This was followed by phase-2 of uncontrolled hemorrhage as induced by transection of the splenic parenchyma at the two ends of the organ and severing one of the branches of the splenic artery. The transected organ was returned to the abdominal cavity for free arterial and venous bleeding until class IV hemorrhage is achieved [defined by persistent mean arterial pressure MAP < 40 mmHg and a shock index (ratio of heart rate and systolic arterial pressure) SI ≥ 5 for successive 10 minutes during the period of active uncontrolled bleeding]. Following this homeostasis was established by rapid ligation of the splenic pedicle and the animals were assigned to 4 resuscitation groups: 1) Conventional resuscitation (shed blood returned+double the shed blood volume as lactated Ringers CR); or adjuvant resuscitations with: 2) CR+norepinephrine; 3) CR+vasopressin; and 4) CR+vitasol. Four-level A1 through A4 arterioles in the terminal ileum were examined with Intravital Microscopy and their diameters timely measured at baseline during shock and during 2h post-resuscitation.
Results
There were no differences between the four groups in pre-hemorrhage baseline metabolic parameters blood gases and acid base status. In all four groups class IV hemorrhagic shock remarkably decreased hemoglobin hematocrit and produced a metabolic acidosis characterized by low pH PCO2 HCO3 TCO2 and an increase in the base deficit as compared with the baseline pre-hemorrhage levels. None of the four resuscitation methods restored parameters of the metabolic panel or blood gases and acidosis to pre-hemorrhage baseline levels. Class IV hemorrhagic shock caused differential arteriole responses with vasoconstriction from baseline of A1 and A2 ( − 22.1 ± 1.9%) and vasodilation of the A3 and A4 arterioles (+22.2 ± 2.8%). Resuscitation initially restored A1 and A2 diameters to near baseline. This was followed by post-resuscitation A1 and A2 vasoconstriction in all groups except in the vitasol group ( − 8.1 ± 3.4%). The hemorrhage-induced vasodilation of the A3 and A4 arterioles was maintained during the post-resuscitation observation period in the CR (+55.3 ± 6.4%) and the vitasol groups (+39.5 ± 5.2%) but remarkably attenuated in the norepinephrine (+9.6 ± 5.8%) and vasopressin (+9.4 ± 8.8) groups.
Conclusions
The temporary administration of norepinephrine or vasopressin as adjuvants to fluid resuscitation from severe hemorrhagic shock has deleterious effects on the splanchnic microcirculation. Endothelial cell resuscitation by cytosolic energy replenishment produces better metabolic and microvascular profiles as compared with adjuvant vasopressor resuscitation.
Retrospective application and validation of Tokyo 18 guidelines for diagnosis and stratification of acute cholangitis in Qatar
Background: Acute cholangitis (AC) is a life-threatening condition with a mortality risk of 8%–10%. Despite no gold standard for diagnosis Charcot's triad was introduced to diagnose AC. However the triad had a low sensitivity (50%–70%). Recently Tokyo guidelines (TG) for the diagnosis of AC gained international recognition for their excellent diagnostic rate. Objective: In this study we aimed to apply TG18 guidelines in a retrospective manner to diagnose AC in Qatar to validate TG18. Methods: This retrospective observational study recruited 295 patients with clinically proven AC between January 2016 and July 2018. Results: Of the 213 patients 72.2% were men. The mean age was 51.4 ± 17.5 years. The most common co-morbidity was hypertension (36.3%). Common bile duct stones were the most common cause of biliary obstruction found in 165 (55.9%) patients. The diagnostic rate of TG18 was 91.9% in contrast to Charcot's triad (34.9%). By TG18 grading 150 (50.8%) patients were grade I. ERCP was done in 62% patients and 52.5% of them were grade I. Conclusion: AC management in Qatar meets the international standards with a low mortality rate. TG18 guidelines had a high diagnostic rate among our patient population.
Optimal dose and duration of enteral erythromycin as a prokinetic: A surgical intensive care experience
Background: Enteral feeding has various advantages over parenteral feeding in critically ill patients. Acutely ill patients are at risk of developing enteral feeding intolerance. Prokinetic medications improve gastrointestinal mobility and enteral feed migration and absorption. Among the available prokinetic agents erythromycin is the most potent. Erythromycin is used in different dosages and durations with variable efficacy. Intravenous erythromycin has an early and high rate of tachyphylaxis; hence enteral route is preferred. Recently the combination of prokinetic medications has been increasingly used because they accelerate the prokinetic action and decrease the adverse effects.
Aim: This study aimed to determine the optimal effective prokinetic dose and duration of administering enteral erythromycin in combination with metoclopramide in critically ill patients.
Patients and methods: This study has a prospective observation design. After obtaining permission from the medical research center of the institution all patients in the surgical and trauma intensive care unit having enteral feed intolerance and those who were already on metoclopramide for 24 hour (h) were enrolled in the study. Patients’ demographic data diagnosis surgical intervention disease severity scores erythromycin dose duration of administration any adverse effects factors affecting erythromycin response and outcome were recorded. All patients received 125 mg syrup erythromycin twice daily through a nasogastric tube (NGT). The NGT was clamped for 2 h and half amount of previous enteral feeds was resumed. If the patient did not tolerate the feeds the erythromycin dose was increased every 24 h in the increment of 250 500 and 1000 mg (Figure 1). Statistical significance was considered at P < 0.05. A total of 313 patients were enrolled in the study. Majority of the patients were male and the mean age was 45 years.
Results: Majority (48.2%) of the patients (96) with feed intolerance were post laparotomy. Ninety percent (284) of the patients responded to prokinetic erythromycin therapy and 54% received lower dose (125 mg twice daily). In addition 14% had diarrhea and none of these patients tested positive for Clostridium difficile toxin or multidrug resistance bacteria. The mean duration of erythromycin therapy was 4.98 days. The most effective prokinetic dose of erythromycin was 125 mg twice daily (P = 0.001). Erythromycin was significantly effective in patients with multiple organ dysfunction and shock (P = 0.001). Patients with high disease severity index and multiple organ dysfunction had significantly higher mortality (p < 0.05). Patients not responding to erythromycin therapy also had a significant higher mortality (p = 0.001).
Conclusion: Post-laparotomy patients had high enteral feed intolerance. Enteral erythromycin in combination with metoclopramide was effective in low dose and was required for short duration. Patients who did not tolerate feeds despite increasing dose of erythromycin had higher mortality.
Qatar Ambulance Service staff's perception on the Quality-of-Service delivery to patients
Background: Quality improvement has been well documented in various industries to improve safety and processes.1 However limited research has taken place within the pre-hospital sector in this regard. Various factors can be attributed to the delivery of effective services. Studies often investigate customer/patient perception and often sideline the importance of employee perception.2 This study evaluates Qatar's Hamad Medical Corporation Ambulance Service (HMCAS) staffs’ perception on service delivery to patients they treat and transport. Methods: An online survey was designed and distributed to HMCAS staff working within the emergency section (N = 750). A 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) was used. The SERVQUAL model consisting of 5 dimensions (RATER): Reliability Assurance Tangibility Empathy and Responsiveness was used.3 Two variables with the highest perception score were regarded as the drivers of service quality. A negative gap score (perception minus expectation) was used as the basis for the study recommendations. Results: As per the required calculated sample size to achieve a 95% confidence interval 255 questionnaires were completed. Respondents were 79% Ambulance Paramedics 18% supervisors and 3% managers. The weights of each dimension's variables were calculated to obtain perception and expectation scores. Descriptive statistics and gap scores of the survey responses are presented in Table 1 for the two variables of each dimension. None of the gap scores were found to be statistically significant. The proposed recommendations generated from this study are presented in Table 2. Conclusion: A standardized staff quality perception tool can assist in identifying potentially missed quality-related service issue(s). In this study the SERVQUAL model was easily adapted and applied to the pre-hospital Emergency Medical Service setting in Qatar and proved useful in identifying service delivery proponents needing attention. Overall and reassuringly the staff believes that they provide quality service to their patients.
Promoting screening to reduce breast cancer mortality among Arab women: What do healthcare professionals need to do?
Breast cancer (BC) is the most common cancer among Arab women. Early detection of breast cancer through regular screening activities improvement of the quality of screening activities and enhanced treatment have been found to decrease mortality rates. However alarmingly low participation rates in breast cancer screening activities have been reported among Arab women. Drawing on the findings of our recent study in Qatar and a comprehensive literature review of studies in this paper we recommend several categories of intervention strategies to promote early detection of breast cancer among Arab populations. These include: (1) Providing public education about breast cancer and cancer screening methods; (2) Encouraging primary care physicians to incorporated BC screening recommendations into their daily practice and routine with their female patients; (3) Deliver interventions that minimize cognitive barriers at the individual level; (4) Incorporate access-enhancing strategies; and (5) More intervention and evaluation studies are needed to develop culturally sensitive interventions and assess the cost-effectiveness and long-term sustainability of the intervention programs.
Exploring Medication Error Causality and Reporting: A Cross Sectional Survey of Hamad Medical Corporation Health Professionals
Introduction
Medication errors are a major global issue adversely impacting patient safety and health outcomes. Promoting patient safety through minimizing medication errors is therefore a key global healthcare objective. The most widely used and accepted definition of the term ‘medication error’ is that of the United States (US) National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) which defines ‘medication error’ as ‘any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the health care professional patient or consumer’.1 This definition has been adopted by Hamad Medical Corporation (HMC).
Medication error reporting within HMC is policy driven and has migrated from paper-based to computer-based system. The Performance and Monitoring Department within HMC data highlights the scale of medication errors with 19498 errors reported between January 2012 and September 2013. A wide variation in reporting rates was observed among different hospitals (NCCCR 897 Heart Hospital 1046 Hamad General Hospital 1516 Women's Hospital 3041 Al-Khor Hospital 3842 Rumailah Hospital 9156).
Alsulami et al. recently reported the findings of the first systematic review of the literature on medication errors in Middle Eastern countries highlighting that studies were relatively few in number and of poor quality voicing the need for original robust research.2 QNRF has provided funding for a two year research study which aims to explore medication error causality and reporting in HMC from the perspectives of health professionals and other key stakeholders. The data presented in this abstract represents the first phase the aim of which is to quantify the views and attitudes of health professionals.
Method
Design – a web based cross-sectional survey of all health professionals (doctors nurses and pharmacists) working in HMC hospitals.
Questionnaire development validation and piloting – questionnaire items were derived from Reason's Model of Accident Causation and Harm Error3 the theoretical domains framework of behavioural change4 and the ‘Hospital Survey on Patient Survey’.5 The questionnaire was reviewed for face and content validity by a panel of experts in the United Kingdom and Qatar. This was followed by piloting in a sample of 100 HMC health professionals and test-retest reliability for all attitudinal items (all highly reliable Kappa statistics all p < 0.05).
Questionnaire distribution – all health professionals in HMC were invited to complete the web based questionnaire. The study commenced at the end of October 2015 and will be data collection will continue until the end of January 2016. Data collected to 12 November 2015 are presented in the abstract and full study data will be presented at the conference.
Ethics – the study was approved by HMC ethics committee and the ethics committees of Qatar University and Robert Gordon University (United Kingdom).
Results
To date 767 responses have been received from 522 nurses (68.1%) 143 pharmacists (18.6%) and 102 doctors (13.3%). More than two thirds (69.4%) of respondents had been registered as health professionals for 10 years or less and most (83.8%) had direct patient contact. In terms of their involvement with medicines related processes 14.1% were involved in prescribing 30.1% in medicines preparation and dispensing 55.4% in administering medicines and 45.0% in monitoring the effectiveness and toxicity of medicines.
Responses to key statements from the ‘Hospital Survey on Patient Survey’ are given in Table 1 and responses to key statements on medication error reporting in Table 2. While there were positive responses in terms of the efforts to promote patient safety and knowing how to submit a medication error report there were less positive responses around staff pressures patient and information transfers and the perceived consequences of submitting a medication error report. Notably there were concerns around the lack of feedback following submitting a medication error report fears of reprimands and potential impact on career progression.
Conclusion
These preliminary data indicate that there are issues which may compromise patient safety and the effectiveness and efficiency of the medication error reporting system within HMC. While these data are specific to HMC it is likely that they are generalizable to other settings in the Middle East and beyond. Full study data will be analysed in due course and will inform the next stages of the research programme. These stages comprise focus groups of samples of questionnaire respondents to discuss further the issues raised followed by one to one interviews with key policy makers health professional leaders and educators. Full study data will facilitate the development of interventions to reduce medication errors increase the effectiveness and efficiency of the medication error reporting processes and ultimately enhanced patient safety.
This abstract was made possible by NPRP grant NPRP 7 - 388 - 3 - 095 from Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the author(s). We also acknowledge all supporting departments in HMC and study respondents.
References
1. National Coordinating Council for Medication Error Reporting and Prevention. Available at http://www.nccmerp.org [accessed November 2015].
2. Alsulami Z Conroy S Choonara I. Medication errors in the Middle East countries: A systematic review of the literature. European Journal of Clinical Pharmacology 2013;69(4):995–1008.
3. Reason J. Human error. Cambridge: University of Cambridge 1990.
4. Michie S Johnston M Abraham C Lawton R Parker D Walker A on behalf of the “Psychological Theory” Group: Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality Safety in Health Care 2005;14(1):26–33.
5. International Use of the Surveys on Patient Safety Culture. December 2014. Agency forHealthcare Research and Quality Rockville MD. http://www.ahrq.gov/professionals/quality-patientsafetypatientsafetyculture/pscintusers.html [accessed November 2015].
Study exploring depression and cardiovascular diseases amongst Arabic speaking patients living in the State of Qatar: Rationale and methodology
In Qatar cardiovascular diseases are the leading cause of death. Studies show that depression is associated with an increased morbidity and mortality among cardiovascular patients. Thus early detection of and intervention for depression among cardiovascular patients can reduce cardiovascular morbidity and mortality and save health care costs. To date there is no study in the Gulf region exploring depression among cardiovascular patients. The goals of our three-phase research program are to (1) understand the mental health issues specifically depression as experienced by cardiovascular patients living in the State of Qatar; (2) identify and implement strategies that would prevent depression and assist patients to deal with depression; and (3) evaluate facilitate and sustain strategies that are effective at reducing depression and foster its treatment among cardiovascular patients. This paper describe phase I of the research program. Using both quantitative and qualitative research methodologies we will investigate (1) the prevalence and severity of depression among patients who have confirmed diagnosis of cardiovascular diseases (2) how contextual factors such as social cultural and economic factors contribute to the risk of depression and its management among cardiovascular patients and (3) formulate effective intervention strategies that are expected to increase awareness prevention of and treatment for depression among cardiovascular patients thus reducing cardiovascular diseases morbidity and mortality in Qatar.
Prevalence of socio-demographic and behavioral factors about organ donation in Qatar: A household survey
Background: A single organ and tissue donor can serve and save eight-fold lives but availability of organ donors is scarce posing a grim situation for end-stage organ failure worldwide. Knowledge attitudes behaviors and beliefs toward organ donation can help policymakers develop strategies to address the challenges facing organ donation and transplantation in Qatar. Aim: To assess sociodemographic characteristics knowledge attitudes beliefs and intentions regarding organ donation in the household population of Qatar. Methods: A prospective observational household survey was conducted between October and November 2016 in Qatar using a validated questionnaire. One thousand forty-four individuals aged 18 and older residing in eight municipalities in the country were enrolled in the survey. Results: Average age was 38 ± 11 years. There were 27.4% Qatari citizens and 72.6% nonQatari residents in the survey. 48.9% of the total (1044) were males. Knowledge [46% (95% C.I.: 45% − 47%)] attitude [70% (95% C.I.: 66%–74%)] behavioral beliefs [42% (95% C.I.: 39%–50%)] normative beliefs [29% (95% C.I.: 28%–30%)] control beliefs [–27% (95% C.I.: − 24% to − 30%)] and intentions towards organ donation [29% (95% C.I.: 27%–31%)] were observed in the study. Factor analyses were able to explain 70% 72% 70% and 74% variations in knowledge attitude beliefs and intentions domains respectively showing adequacy of construct of the domains for organ donation. Conclusion: Most of the survey participants showed good attitude but less intention towards organ donation.
Incidence, nature and causes of medication errors in hospitalised patients in Middle Eastern countries: A systematic review
Background and aim: Medication errors (MEs) are a major global issue adversely impacting patient safety and health outcomes. Promoting patient safety through minimising MEs is therefore a key global healthcare objective. This study aims to systematically review the incidence nature and causes of MEs in hospitalised patients in Middle Eastern countries. Method: A systematic search of studies related to MEs originated from Middle Eastern countries was performed using the following databases: MEDLINE EMBASE International Pharmaceutical Abstracts Cumulative Index to Nursing and Allied Health Literature PsycINFO Cochrane Database of Systematic Reviews (CDSR) Centre for Review and Dissemination (CRD) database Joanna Briggs Institute Library. A systematic review protocol was developed and registered with the Centre for Reviews and Dissemination (CRD). The title abstract and full article were screened for inclusion. Each paper was assessed by two reviewers for methodological quality prior to inclusion in the review. Studies were critically appraised prior to data extraction and findings synthesised using a narrative approach. Results: Database searching identified 2611 studies; 51 met the inclusion criteria and originated from nine of fifteen Middle Eastern countries largely Iran Saudi Arabia and Israel. Preliminary review results indicate error incidence rates of between 11 and 90% of patients (depending on the method of data collection) with the categories of errors reported being mostly prescribing errors followed by administration dispensing and transcribing. Deficiencies in staff knowledge lack of experience insufficient training poor adherence with protocols and policies miscommunication and excessive workload were identified as major causative factors. Conclusion: MEs occur at high rates of incidence in the Middle East. Causes of errors are multifactorial and should be targeted in future interventions which are likely to be complex interventions at varying levels within the healthcare systems.
This project is funded by QNRF (NPRP project NPRP–388-3-095).
Behavioral determinants potentially influencing COVID-19 vaccine acceptance among pharmacy professionals in Qatar: a nationwide survey using the Theoretical Domains Framework
Background: There is a paucity of robust theory-based research investigating vaccination behavior.1 Using Theoretical Domains Framework (TDF) the study aimed to explore the key behavioral determinants influencing vaccine behavior among pharmacy professionals in Qatar. Methods: A cross-sectional online survey of pharmacy professionals was conducted in April 2021. Survey items included questions related to demographics vaccination behavior and behavioral ‘determinants’ influencing vaccination (Likert statements TDF items). The draft questionnaire was reviewed for face and content validity with experts and piloted among 80 participants. The sample size was calculated (n = 353) using the Raosoft online calculator. Data were analyzed using descriptive and inferential statistics and Principal component analysis (PCA) of TDF items.23Results: The response rate was 37.40% (1065/2400). The majority expressed willingness to receive the COVID-19 vaccines. Participants who refused the influenza vaccine in the past were more likely to refuse the COVID-19 vaccines too (χ2(1) = 12.6 chi-square; p < 0.001). The mean (SD) overall percentage score of behavioral determinants influencing vaccine acceptance and advocacy were 31.2 ± 19.6 and 36.5 ± 28.2 (on a scale from -100 to 100). Vaccine acceptance was lower among those who refused any vaccines in the past (33.2 ± 18.9 vs 28.7 ± 20.1; p < 0.001) (Table 1). The main barriers to vaccine acceptance were safety speed of development and cultural influences. PCA identified ‘belief of consequence and emotions (fear and anxiety) as more negative determinant (-1.4 ± 42.1) potentially influencing vaccine acceptance behavior (Table 2). Although most participants considered it as their professional duty to advocate the use of vaccines they were unsure if patients will accept their recommendations. Conclusion: Most participants expressed an interest to receive the COVID-19 vaccines and considered it as their professional duty to recommend the use of the vaccine. However they were unsure if patients would accept their advice. Study findings will assist to develop behavior change interventions targeting individuals.
Study exploring breast cancer screening practices amongst Arabic women living in the State of Qatar
Breast cancer is a public health threat in the State of Qatar. It is the most common cancer and the incidence rate is increasing. It has been found that women often present with breast cancer at advanced stages in Qatar. Early detection of breast cancer is an important prognostic factor and breast cancer screening has been found successful in decreasing mortality rates. The percentage of women in Qatar engaging in screening activities is alarmingly low. A study has been designed to examine barriers and facilitators that are potentially influencing women in participating in breast cancer screening activities. Understanding these barriers and facilitators is essential in order to create a culturally appropriate and effective intervention that can encourage women in Qatar to participate in screening activities. In this paper the background to the study is presented which highlights the magnitude of the breast cancer problem in Qatar and offers the rationale and information for this potentially groundbreaking study.
Breast cancer screening among Arabic women living in the State of Qatar: Awareness, knowledge, and participation in screening activities
Background: Breast cancer is the most common cancer among women in the State of Qatar and the incidence rate is rising. Previous findings indicate women in Qatar are often diagnosed with breast cancer at advanced stages and their participation rates in screening activities are low.
Purpose: To investigate within the State of Qatar Arabic women’s knowledge regarding breast cancer and breast cancer screening (BCS) methods and their participation rates in BCS. This paper reports on the results of a cross-sectional survey.
Methods: A quantitative cross-sectional interview survey was conducted with 1063 Arabic women (Qatari citizens and non-Qatari Arabic-speaking residents) 35 years of age or older from March 2011 to July 2011.
Results: Of the 1063 women interviewed (87.5% response rate) 90.7% were aware of breast cancer; 7.6% were assessed with having basic knowledge of BCS 28.9% were aware of breast self-examination (BSE) 41.8% were aware of clinical breast exams (CBE) and 26.9% were aware of mammograms. Of the women interviewed 13.8% performed BSE monthly 31.3% had a CBE once a year or once every two years and 26.9% of women 40 years of age or older had a mammogram once a year or once every two years. Participation rates in BCS activities were significantly related to awareness and knowledge of BCS education levels and receiving information about breast cancer self-examination or mammography from any of a variety of sources particularly physicians.
Conclusions: Study results demonstrate that despite the existent breast cancer screening recommendations less than one-third of Arabic women living in Qatar participate in BCS activities. Public health campaigns encouraging more proactive roles for health care professionals regarding awareness and knowledge of breast cancer BCS and the benefits of early detection of breast cancer will help increase screening rates and reduce mortality rates among Arabic women living in the State of Qatar.
Women Versus Men With Depression Among Patients Admitted With Cardiac Events: The Impact Of Age And Socioeconomic Factors-Findings From A Middle-Eastern Contemporary Prospective Study
Introduction: Depression is associated with cardiovascular diseases. Early detection and intervention for depression among cardiovascular (CV) patients can reduce morbidity and mortality rates. Understanding age and gender differences is necessary to adequately address the complex nature of depression as co-morbidity among Arab CV patients in the Middle East region. Objectives: To evaluate the prevalence of depression to find ways to manage depression among male and female Arab CV patients. Methods: A cross-sectional survey was conducted with 686 (69%) male and 314 (31%) females Arab CV patients between January 2013 and March 2014 at the Heart Hospital in Qatar. Inclusion criteria were ≥20 years of age agreeing to participate in the study (98% response rate) and having final confirmation of acute cardiac conditions. Face-to-face interviews were conducted using structured survey questionnaires which included an Arabic demographic questionnaire and the Arabic version of the Beck Depression Inventory 2nd Edition. Results: 80% of the patients had no depressive symptoms 20% of the patients suffered `mild mood disturbance` and clinical depression. Almost twice as many females (28%) than males (17%) were assessed having depression. Chi-square tests indicated that age and socioeconomic factors such as nationality marital status monthly income employment occupation financial stress and support were significantly related to gender and depression (p<0.001 for all). Conclusion: Routine systematic screening for depression is recommended for all CV patients especially for older women group. Although health care services in Qatar are heavily subsidized socioeconomic factors influence male and female CV patients' mental health differently thus their CV conditions and outcomes. To effectively manage depression among Arab CV patients health care providers should be aware and integrate gender differences approach into their clinical practice.
Prevalence of coronavirus disease 2019 in a multiethnic cohort of patients with autoimmune rheumatic diseases in Qatar
Background: Autoimmune rheumatic diseases (ARDs) are characterized by immune dysfunction and associated with an increased risk of infections which were of significant concern during the coronavirus disease 2019 (COVID-19) pandemic. Variable rates of COVID-19 incidence have been reported in patients with ARDs; however the true effect of this infection on this patient population is still unclear. We therefore aimed to evaluate the COVID-19 prevalence among a multiethnic cohort of patients with ARDs in Qatar.
Material and Methods: We used telephonic surveys to collect demographic and clinical information of patients with ARD in Qatar between April 1 and July 31 2020 including any close contact with a COVID-19 case at home or work and polymerase chain reaction (PCR)-confirmed COVID-19 diagnosis. An electronic medical records review was conducted to verify pertinent data collected through the surveys. Prevalence with 95% confidence interval (CI) Student's t-tests and chi-square/Fisher's exact tests were used for univariate analyses whereas multivariate logistic regression was used to identify factors associated with COVID-19.
Results: The study included 700 patients with ARD (mean age 43.2 ± 12.3 years) and 73% were female. Until July 2020 75 (11% 95% CI 9%–13%) patients had COVID-19. Factors associated with COVID-19 included being a man (adjusted odds ratio [aOR] 2.56 95% CI 1.35–4.88 p = 0.01) and having close contact with a COVID-19 case (aOR 27.89 95% CI 14.85–52.38 p = 0.01). Disease severity and rheumatic medications had no significant association with the odds of contracting COVID-19. In the 86 patients with ARD having close contact the frequency of hydroxychloroquine utilization was lower in patients who contracted COVID-19 than in those who did not (35% vs 72.5% p = 0.01).
Conclusions: In Qatar patients with ARDs had an overall higher prevalence of COVID-19 than global estimates. Being male and having close contact with a COVID-19 case were strongly associated with COVID-19 as reported globally. The presence of comorbid conditions disease-specific factors and rheumatic medications had no significant effect on the risk of COVID-19 in our study suggesting alternative mechanisms to the increased prevalence.