Illustrating How to Use the Validated Alsayed_v1 Tools to Improve Medical Care: A Particular Reference to the Global Initiative for Asthma 2022 Recommendations

Assessment of Medical Care Strategies for Primary Hypertension in Iraqi Adults: A Hospital-Based Problem-Oriented Plan

Purpose

This study aimed to assess the medical care strategies for primary Hypertension in Iraqi adults through a hospital-based problem-oriented plan to improve patient outcomes by identifying and addressing medical problems.

Methodology

This cross-sectional study was conducted in a hospital setting of Iraqi adults diagnosed with primary hypertension. Data collection involved patient interviews, medical record reviews, and measurements of blood pressure (BP). The assessment of medical problem-oriented plans (MPOPs) was performed using the validated Alsayed_v1 tool, which includes three main components: the assessment of treatments, the MPOP classification system, and the care plan.

Results

The study participants of 80 Iraqi patients had a mean age of 52.3 years, with 55% male and 45% female. Common comorbid conditions included diabetes mellitus (40%), chronic kidney disease (30%), and coronary artery disease (20%). The most commonly prescribed antihypertensive medications were angiotensin-converting enzyme inhibitors (ACEI) (75.00%). On average, participants were taking 2.087 antihypertensive medications (SD = 0.60), with the majority (63.75%) using a combination of two medications. However, the average BP among participants was 148/92 mmHg, indicating uncontrolled hypertension in most cases (90%). The study identified an average of 3.2 MPOPs per patient, with the most common being inappropriate drug selection (25%), incorrect dosage regimen (20%), and non-adherence to treatment (15%). The chi-squared analysis revealed a significant association between gender and blood pressure status (Χ² = 4.366, p = 0.037). Additionally, the study identified 233 MPOPs across four categories: Indication (23.18%), Effectiveness (53%), Safety (7%), and Patient-related issues (17%). A multiple regression analysis was performed to identify predictors of the number of MPOPs with which heart failure was a significant predictor (β = 4.931, p = 0.003).

Conclusion

The findings highlight the complexity of managing hypertension in Iraqi adults and underscore the need for personalized treatment plans to address the medical problems. Implementing a problem-oriented approach in clinical practice can lead to better BP control and improved health outcomes. This study provides valuable insights for healthcare providers and policymakers to enhance hypertension management strategies in Iraq. However, the study's findings should be interpreted with caution due to limitations such as a relatively small and specific sample, reliance on self-reported data, and the cross-sectional design, which restricts causal inference.

Knowledge and Practice of Healthcare Professionals in the Medical Care of Asthma Adult Patients in Jordan with a Particular Reference to Adherence to GINA Recommendations

Purpose

This study aimed to evaluate Jordanian healthcare professionals' knowledge, skills, and experience in dealing with and treating adult asthmatic patients and assess healthcare professionals' compliance with the Global Initiative for Asthma (GINA) guideline recommendations for asthma treatment and management in Jordan.

Patients and Methods

A cross-sectional survey was conducted in Jordan between May and June 2023. This study included physicians, pharmacists, and nurses working in clinical settings and directly interacting with asthma patients in Jordan's private and governmental healthcare facilities who were eligible to participate in this research. Three primary sections of an online survey were constructed using Google Forms and included demographic data, a diagnosis and management of the illness, and a list of worldwide medical references for asthma.

Results

A total of 300 healthcare professionals, including pharmacists (103), nurses (87), Doctor of Pharmacy (28), and physicians (82), took part in this research. The survey respondents' general knowledge of the nature and symptoms of asthma is quite high, exceeding 84% and 86%, respectively. The survey also showed a high degree of awareness of asthma diagnosis. It was also revealed that around one-quarter of participants consistently reported the severity of asthma. The most frequent factor influencing the decision to take controller or maintenance medicines is symptom severity (reported from 86% of participants). The GINA guidelines were selected as the asthma information source by almost half of the participants. Finally, 47% of participants were aware of the GINA's 2019 adjustments of the recommendations.

Conclusion

This study showed that Jordanian healthcare professionals understand the nature, symptoms, and diagnoses of asthma disease. However, many of the survey participants lack adherence, awareness, and understanding of the GINA recommendations about asthma management. More research is required to assess the adherence to the evidence-based recommendations and evaluate the impact of training courses.

Etiologies of Acute Bronchiolitis in Children at Risk for Asthma, with Emphasis on the Human Rhinovirus Genotyping Protocol

This research aims to determine acute bronchiolitis' causative virus(es) and establish a viable protocol to classify the Human Rhinovirus (HRV) species. During 2021-2022, we included children 1-24 months of age with acute bronchiolitis at risk for asthma. The nasopharyngeal samples were taken and subjected to a quantitative polymerase chain reaction (qPCR) in a viral panel. For HRV-positive samples, a high-throughput assay was applied, directing the VP4/VP2 and VP3/VP1 regions to confirm species. BLAST searching, phylogenetic analysis, and sequence divergence took place to identify the degree to which these regions were appropriate for identifying and differentiating HRV. HRV ranked second, following RSV, as the etiology of acute bronchiolitis in children. The conclusion of the investigation of all available data in this study distributed sequences into 7 HRV-A, 1 HRV-B, and 7 HRV-C types based on the VP4/VP2 and VP3/VP1 sequences. The nucleotide divergence between the clinical samples and the corresponding reference strains was lower in the VP4/VP2 region than in the VP3/VP1 region. The results demonstrated the potential utility of the VP4/VP2 region and the VP3/VP1 region for differentiating HRV genotypes. Confirmatory outcomes were yielded, indicating how nested and semi-nested PCR can establish practical ways to facilitate HRV sequencing and genotyping.