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Irfan FB, Telford B, Hollon N, Dehghani A, Schukow C, Syed AY, Rego RT, Waljee AK, Cunningham W, Ahmed FS. Coronavirus pandemic in the South Asia region: Health policy and economy trade-off. J Glob Health 2023; 13:06014. [PMID: 37141526 PMCID: PMC10159594 DOI: 10.7189/jogh.13.06014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Background The South Asian Association for Regional Cooperation (SAARC) covers Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. We conducted a comparative analysis of the trade-off between the health policies for the prevention of COVID-19 spread and the impact of these policies on the economies and livelihoods of the South Asia populations. Methods We analyzed COVID-19 data on epidemiology, public health and health policy, health system capacity, and macroeconomic indicators from January 2020 to March 2021 to determine temporal trends by conducting joinpoint regression analysis using average weekly percent change (AWPC). Results Bangladesh had the highest statistically significant AWPC for new COVID-19 cases (17.0; 95% CI = 7.7-27.1, P < 0.001), followed by the Maldives (12.9; 95% CI = 5.3-21.0, P < 0.001) and India (10.0; 95% CI = 8.4-11.5, P < 0.001). The AWPC for COVID-19 deaths was significant for India (6.5; 95% CI = 4.3-8.9, P < 0.001) and Bangladesh (6.1; 95% CI = 3.7-8.5, P < 0.001). Nepal (55.79%), and India (34.91%) had the second- and third-highest increase in unemployment, while Afghanistan (6.83%) and Pakistan (16.83%) had the lowest. The rate of change of real GDP had the highest decrease for Maldives (557.51%), and India (297.03%); Pakistan (46.46%) and Bangladesh (70.80%), however, had the lowest decrease. The government response stringency index for Pakistan had a see-saw pattern with a sharp decline followed by an increase in the government health policy restrictions that approximated the test-positivity trend. Conclusions Unlike developed economies, the South Asian developing countries experienced a trade-off between health policy and their economies during the COVID-19 pandemic. South Asian countries (Nepal and India), with extended periods of lockdowns and a mismatch between temporal trends of government response stringency index and the test-positivity or disease incidence, had higher adverse economic effects, unemployment, and burden of COVID-19. Pakistan demonstrated targeted lockdowns with a rapid see-saw pattern of government health policy response that approximated the test-positivity trend and resulted in lesser adverse economic effects, unemployment, and burden of COVID-19.
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Affiliation(s)
- Furqan B Irfan
- Institute of Global Health, Michigan State University, East Lansing, Michigan, USA
- Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Ben Telford
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Nick Hollon
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Ali Dehghani
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Casey Schukow
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | | | - Ryan T Rego
- Center for Global Health Equity, University of Michigan, Ann Arbor, Michigan, USA
| | - Akbar K Waljee
- Center for Global Health Equity, University of Michigan, Ann Arbor, Michigan, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA
| | - William Cunningham
- Institute of Global Health, Michigan State University, East Lansing, Michigan, USA
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Rego RT, Kenney B, Ngugi AK, Espira L, Orwa J, Siwo GH, Sefa C, Shah J, Weinheimer-Haus E, Sophie Delius AJ, Pape UJ, Irfan FB, Abubakar A, Shah R, Wagner A, Kolars J, Boulton ML, Hofer T, Waljee AK. COVID-19 vaccination refusal trends in Kenya over 2021. Vaccine 2023; 41:1161-1168. [PMID: 36624011 PMCID: PMC9808414 DOI: 10.1016/j.vaccine.2022.12.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vaccination refusal exacerbates global COVID-19 vaccination inequities. No studies in East Africa have examined temporal trends in vaccination refusal, precluding addressing refusal. We assessed vaccine refusal over time in Kenya, and characterized factors associated with changes in vaccination refusal. METHODS We analyzed data from the Kenya Rapid Response Phone Survey (RRPS), a household cohort survey representative of the Kenyan population including refugees. Vaccination refusal (defined as the respondent stating they would not receive the vaccine if offered to them at no cost) was measured in February and October 2021. Proportions of vaccination refusal were plotted over time. We analyzed factors in vaccination refusal using a weighted multivariable logistic regression including interactions for time. FINDINGS Among 11,569 households, vaccination refusal in Kenya decreased from 24 % in February 2021 to 9 % in October 2021. Vaccination refusal was associated with having education beyond the primary level (-4.1[-0.7,-8.9] percentage point difference (ppd)); living with somebody who had symptoms of COVID-19 in the past 14 days (-13.72[-8.9,-18.6]ppd); having symptoms of COVID-19 in the past 14 days (11.0[5.1,16.9]ppd); and distrusting the government in responding to COVID-19 (14.7[7.1,22.4]ppd). There were significant interactions with time and: refugee status and geography, living with somebody with symptoms of COVID-19, having symptoms of COVID-19, and believing in misinformation. INTERPRETATION The temporal reduction in vaccination refusal in Kenya likely represents substantial strides by the Kenyan vaccination program and possible learnt lessons which require examination. Going forward, there are still several groups which need specific targeting to decrease vaccination refusal and improve vaccination equity, including those with lower levels of education, those with recent COVID-19 symptoms, those who do not practice personal COVID-19 mitigation measures, refugees in urban settings, and those who do not trust the government. Policy and program should focus on decreasing vaccination refusal in these populations, and research focus on understanding barriers and motivators for vaccination.
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Affiliation(s)
- Ryan T. Rego
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Corresponding author
| | - Brooke Kenney
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Anthony K. Ngugi
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Leon Espira
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA
| | - James Orwa
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Geoffrey H. Siwo
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Christabel Sefa
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA
| | - Jasmit Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya,Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Eileen Weinheimer-Haus
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Utz Johann Pape
- World Bank Group, Washington, DC, USA,University of Goettingen, Goettingen, Germany
| | - Furqan B. Irfan
- Institute of Global Health, Michigan State University, Lansing, MI, USA
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Reena Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Abram Wagner
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joseph Kolars
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Timothy Hofer
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Akbar K. Waljee
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA
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3
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Rani Saggu S, Preethi L, Satapathy P, Manna S, Sai Tipirisetty E, Perween Afsar A, Ravindra K, Chakravarty K, Irfan FB, Sah R, Kumar Padhi B. Acute necrotizing encephalitis outbreak in India: A little-known disease among the adult population. Brain Behav Immun 2023; 107:383-384. [PMID: 36371011 DOI: 10.1016/j.bbi.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sofia Rani Saggu
- Department of Public Health Nutrition, Sam Higginbottom University of Agriculture Technologies and Sciences, Allahabad, India
| | - L Preethi
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Tamil Nadu, India
| | - Prakasini Satapathy
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamalesh Chakravarty
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Furqan B Irfan
- Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USAnstitute of Global Health, Michigan State University, East Lansing, MI, USA
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Irfan FB, Consunji RIGDJ, Peralta R, El-Menyar A, Dsouza LB, Al-Suwaidi JM, Singh R, Castrén M, Djärv T, Alinier G. Comparison of in-hospital and out-of-hospital cardiac arrest of trauma patients in Qatar. Int J Emerg Med 2022; 15:52. [PMID: 36114456 PMCID: PMC9479227 DOI: 10.1186/s12245-022-00454-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac arrests in admitted hospital patients with trauma have not been described in the literature. We defined “in-hospital cardiac arrest of a trauma” (IHCAT) patient as “cessation of circulatory activity in a trauma patient confirmed by the absence of signs of circulation or abnormal cardiac arrest rhythm inside a hospital setting, which was not cardiac re-arrest.” This study aimed to compare epidemiology, clinical presentation, and outcomes between in- and out-of-hospital arrest resuscitations in trauma patients in Qatar. It was conducted as a retrospective cohort study including IHCAT and out-of-hospital trauma cardiac arrest (OHTCA) patients from January 2010 to December 2015 utilizing data from the national trauma registry, the out-of-hospital cardiac arrest registry, and the national ambulance service database. Results There were 716 traumatic cardiac arrest patients in Qatar from 2010 to 2015. A total of 410 OHTCA and 199 IHCAT patients were included for analysis. The mean annual crude incidence of IHCAT was 2.0 per 100,000 population compared to 4.0 per 100,000 population for OHTCA. The univariate comparative analysis between IHCAT and OHTCA patients showed a significant difference between ethnicities (p=0.04). With the exception of head injury, IHCAT had a significantly higher proportion of localization of injuries to anatomical regions compared to OHTCA; spinal injury (OR 3.5, 95% CI 1.5–8.3, p<0.004); chest injury (OR 2.62, 95% CI 1.62–4.19, p<0.00), and abdominal injury (OR 2.0, 95% CI 1.0–3.8, p<0.037). IHCAT patients had significantly higher hypovolemia (OR 1.66, 95% CI 1.18–2.35, p=0.004), higher mean Glasgow Coma Scale (GCS) score (OR 1.4, 95% CI 1.3–1.6, p<0.00), and a greater proportion of initial shockable rhythm (OR 3.51, 95% CI 1.6–7.7, p=0.002) and cardiac re-arrest (OR 6.0, 95% CI 3.3–10.8, p=<0.00) compared to OHTCA patients. Survival to hospital discharge was greater for IHCAT patients compared to OHTCA patients (OR 6.3, 95% CI 1.3–31.2, p=0.005). Multivariable analysis for comparison after adjustment for age and gender showed that IHCAT was associated with higher odds of spinal injury, abdominal injury, higher pre-hospital GCS, higher occurrence of cardiac re-arrest, and better survival than for OHTCA patients. IHCAT patients had a greater proportion of anatomically localized injuries indicating solitary injuries compared to greater polytrauma in OHTCA. In contrast, OHTCA patients had a higher proportion of diffuse blunt non-localizable polytrauma injuries that were severe enough to cause immediate or earlier onset of cardiac arrest. Conclusion In traumatic cardiac arrest patients, IHCAT was less common than OHTCA and might be related to a greater proportion of solitary localized anatomical blunt injuries (head/abdomen/chest/spine). In contrast, OHTCA patients were associated with diffuse blunt non-localizable polytrauma injuries with increased severity leading to immediate cardiac arrest. IHCAT was associated with a higher mean GCS score and a higher rate of initial shockable rhythm and cardiac re-arrest, and improved survival rates.
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Irfan FB, Janahi IA, Alinier G. Development of the Research Forum: A program for biomedicine and health research strengthening in Qatar. Journal of Emergency Medicine, Trauma and Acute Care 2022. [DOI: 10.5339/jemtac.2022.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Furqan B. Irfan
- Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Institute of Global Health, Michigan State University, West Fee Hall, 909 Wilson Road, East Lansing, MI 48824, United States
| | - Ibrahim A. Janahi
- Weill Cornell Medicine – Qatar, Education City, Doha, Qatar
- Department of Pediatric Medicine, Sidra Medicine Education City, Doha, Qatar
| | - Guillaume Alinier
- Faculty of Health and Life Sciences, Coach Lane Campus, Northumbria University, Newcastle upon Tyne, NE7 7TR, UK
- School of Health and Social Work, University of Hertfordshire, College Lane, Hatfield, HERTS, AL10 9AB, UK
- Hamad Medical Corporation - Ambulance Service, Al Rayyan Road, Doha, Qatar
- Weill Cornell Medicine – Qatar, Education City, Doha, Qatar
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6
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Irfan FB, Consunji RI, Janahi IA, Alinier G. Health research-strengthening and capacity development: Research support system model in an academic healthcare system. Qatar Med J 2022; 2022:36. [PMID: 35974887 PMCID: PMC9372480 DOI: 10.5339/qmj.2022.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Healthcare research contributes to the well-being of a population; hence, it is important to use the right system to ensure that junior researchers develop the required skills. Current research-strengthening and capacity development programs might lack a research process-based common framework or model leading to variable and suboptimal outcomes. This study aimed to describe the development and evaluation of a model for health research-capacity development at both individual and institutional levels in a Joint Commission International-accredited governmental healthcare organization in Qatar. Methods: This retrospective observational study evaluated a research support system employed in Qatar for 1 year and constituted of16 stations, each covering a different topic and supported by an experienced faculty member. We recorded how many faculty members were involved and how many people accessed which stations. We developed an outcomes logistic model and obtained feedback about their experience of using the research support system through a short survey. Results: Twenty-one faculty members supported a total of 77 participants, representing various professions and specialties. The majority of the participants received support on multiple stations, and the most solicited were study design and methodology (n = 45, 58.4%) and research idea (n = 29, 37.7%). The most common type of research that participants required support for was clinical research (n = 65, 84.4%). Moreover, 58.4% of the participants answered the survey, and their responses attested to their perceived benefit of making use of the research support system. Conclusion: The research support system presented was positively evaluated by participants and promoted networking. Such aspects are favorable to the development of a research culture within an organization and would be a good addition for implementation in universities running healthcare programs and hospitals with residency programs and a large and varied healthcare workforce. This would contribute to the development of health-related research capacity and quality of research outputs in these institutions.
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Affiliation(s)
- Furqan B Irfan
- Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Institute of Global Health, Michigan State University, West Fee Hall, 909 Wilson Road, East Lansing, MI 48824, United States E-mail:
| | - Rafael I.G.D.J Consunji
- Hamad Injury Prevention Program, Hamad Trauma Center at Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim A. Janahi
- Weill Cornell Medicine–Qatar, Education City, Doha, Qatar
- Department of Pediatric Medicine, Sidra Medicine Education City, Doha, Qatar
| | - Guillaume Alinier
- Weill Cornell Medicine–Qatar, Education City, Doha, Qatar
- School of Health and Social Work, University of Hertfordshire, College Lane, Hatfield, HERTS, AL10 9AB, UK
- Hamad Medical Corporation–Ambulance Service, Al Rayyan Road, Doha, Qatar
- Faculty of Health and Life Sciences, Coach Lane Campus, Northumbria University, Newcastle upon Tyne, NE7 7TR, UK
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7
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Irfan FB, Minetti R, Telford B, Ahmed FS, Syed AY, Hollon N, Brauman SC, Cunningham W, Awad ME, Saleh KJ, Waljee AK, Brusselaers N. Coronavirus pandemic in the Nordic countries: Health policy and economy trade-off. J Glob Health 2022; 12:05017. [PMID: 35932219 PMCID: PMC9356530 DOI: 10.7189/jogh.12.05017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Countries making up the Nordic region – Denmark, Finland, Iceland, Norway, and Sweden – have minimal socioeconomic, cultural, and geographical differences between them, allowing for a fair comparative analysis of the health policy and economy trade-off in their national approaches towards mitigating the impact of the COVID-19 pandemic. Methods This study utilized publicly available COVID-19 data of the Nordic countries from January 2020 to January 3, 2021. COVID-19 epidemiology, public health and health policy, health system capacity, and macroeconomic data were analysed for each Nordic country. Joinpoint regression analysis was performed to identify changes in temporal trends using average monthly percent change (AMPC) and average weekly percent change (AWPC). Results Sweden’s health policy, being by far the most relaxed response to COVID-19, was found to have the largest COVID-19 incidence and mortality, and the highest AWPC increases for both indicators (13.5, 95% CI = 5.6, 22.0, P < 0.001; 6.3, 95% CI = 3.5, 9.1, P < 0.001). Denmark had the highest number of COVID-19 tests per capita, consistent with their approach of increased testing as a preventive strategy for disease transmission. Iceland had the second-highest number of tests per capita due to their mass-testing, contact tracing, quarantine and isolation response. Only Norway had a significant increase in unemployment (AMPC = 2.8%, 95% CI = 0.7-4.9, P < 0.009) while the percentage change in real Gross Domestic Product (GDP) was insignificant for all countries. Conclusions There was no trade-off between public health policy and economy during the COVID-19 pandemic in the Nordic region. Sweden’s relaxed and delayed COVID-19 health policy response did not benefit the economy in the short term, while leading to disproportionate COVID-19 hospitalizations and mortality.
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Affiliation(s)
- Furqan B Irfan
- Institute of Global Health, Michigan State University, East Lansing, Michigan, USA.,Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Raoul Minetti
- Department of Economics, Michigan State University, Marshall-Adams Hall, East Lansing, Michigan, USA
| | - Ben Telford
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Fahad S Ahmed
- Department of Pathology, Wayne State University, Detroit, Michigan, USA
| | | | - Nick Hollon
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Seth C Brauman
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - William Cunningham
- Institute of Global Health, Michigan State University, East Lansing, Michigan, USA
| | - Mohamed E Awad
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Khaled J Saleh
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Akbar K Waljee
- University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA.,University of Michigan Medical School, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Ann Arbor, Michigan, USA
| | - Nele Brusselaers
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Global Health Institute, Antwerp University, Antwerpen, Wilrijk, Belgium
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Crespi Z, Hasan AI, Pearl A, Ismail A, Awad ME, Irfan FB, Jaffar M, Patel P, Saleh KJ. Current Guidelines and Practice Recommendations to Prevent Hospital-Acquired Conditions After Major Orthopaedic Surgeries. JBJS Rev 2022; 10:01874474-202203000-00012. [PMID: 35290253 DOI: 10.2106/jbjs.rvw.21.00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» In 2016, a total of 48,771 hospital-acquired conditions (HACs) were reported in U.S. hospitals. These incidents resulted in an excess cost of >$2 billion, which translates to roughly $40,000 per patient with an HAC. » Current guidelines for the prevention of venous thromboembolism and surgical site infection consist primarily of antithrombotic prophylaxis and antiseptic technique, respectively. » The prevention of catheter-associated urinary tract infection (CA-UTI) and in-hospital falls and trauma is done best via education. In the case of CA-UTI, this consists of training staff about the indications for catheters and their timely removal when they are no longer necessary, and in the case of in-hospital falls and trauma, advising the patient and family about the patient's fall risk and communicating the fall risk to the health-care team. » Blood incompatibility is best prevented by implementation of a pretransfusion testing protocol. Pressure ulcers can be prevented via patient positioning, especially during surgery, and via postoperative skin checks.
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Affiliation(s)
- Zachary Crespi
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan
| | - Ahmad I Hasan
- School of Medicine, Wayne State University, Detroit, Michigan.,FAJR Scientific, Northville, Michigan
| | - Adam Pearl
- School of Medicine, Wayne State University, Detroit, Michigan
| | - Aya Ismail
- FAJR Scientific, Northville, Michigan.,University of Michigan, Dearborn, Michigan
| | - Mohamed E Awad
- FAJR Scientific, Northville, Michigan.,NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Michigan State University-College of Osteopathic Medicine, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Furqan B Irfan
- Michigan State University-College of Osteopathic Medicine, Detroit, Michigan
| | - Muhammed Jaffar
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Padmavathi Patel
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Khaled J Saleh
- FAJR Scientific, Northville, Michigan.,Michigan State University-College of Osteopathic Medicine, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
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Elhage KG, Awad ME, Irfan FB, Lumbley J, Mostafa G, Saleh KJ. Closed‐incision
negative pressure therapy at −125
mmHg
significantly reduces surgical site complications following total hip and knee arthroplasties: A stratified meta‐analysis of randomized controlled trials. Health Sci Rep 2022; 5:e425. [PMID: 35229037 PMCID: PMC8865069 DOI: 10.1002/hsr2.425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background Closed‐incision negative pressure wound therapy (ciNPT) has shown promising effects for managing infected wounds. This meta‐analysis explores the current state of knowledge on ciNPT in orthopedics and addresses whether ciNPT at −125 mmHg or −80 mmHg or conventional dressing reduces the incidence of surgical site complications in hip and knee arthroplasty. Methods This meta‐analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta‐analysis (PRISMA) guidelines and Cochrane Handbook. Prospective randomized controlled trials (RCTs) with ciNPT use compared to conventional dressings following hip and knee surgeries were considered for inclusion. Non‐stratified and stratified meta‐analyses of six RCTs were conducted to test for confounding and biases. A P value less than .05 was considered statistically significant. Results The included six RCTs have 611 patients. Total hip and knee arthroplasties were performed for 51.7% and 48.2% of the included population, respectively. Of 611 patients, conventional dressings were applied in 315 patients and 296 patients received ciNPT. Two ciNPT systems have been used across the six RCTs; PREVENA Incision Management System (−125 mmHg) (63.1%) and PICO dressing (−80 mmHg) (36.8%). The non‐stratified analysis showed that the ciNPT system had a statistically significant, lower risk of persistent wound drainage as compared to conventional dressing following total hip and knee arthroplasties (OR = 0.28; P = .002). There was no difference between ciNPT and conventional dressings in terms of wound hematoma, blistering, seroma, and dehiscence. The stratified meta‐analysis indicated that patients undergoing treatment with high‐pressure ciNPT (120 mmHg) displayed significantly fewer overall complications and persistent wound drainage (P = .00001 and P = .002, respectively) when compared to low‐pressure ciNPT (80 mmHg) and conventional dressings. In addition, ciNPT is associated with shorter hospital stays. (P = .005). Conclusion When compared to conventional wound dressing and −80 mmHg ciNPT, the use of −125 mmHg ciNPT is recommended in patients undergoing total joint arthroplasty.
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Affiliation(s)
- Kareem G. Elhage
- FAJR Scientific Northville Michigan 48167 USA
- Wayne State University, School of Medicine Detroit Michigan USA
| | - Mohamed E. Awad
- FAJR Scientific Northville Michigan 48167 USA
- NorthStar Anesthesia‐Detroit Medical center Detroit Michigan USA
- Michigan State University, College of Osteopathic Medicine Detroit Michigan USA
| | - Furqan B. Irfan
- Michigan State University, College of Osteopathic Medicine Detroit Michigan USA
| | - Joshua Lumbley
- NorthStar Anesthesia‐Detroit Medical center Detroit Michigan USA
| | - Gamal Mostafa
- Wayne State University, School of Medicine Detroit Michigan USA
- Surgical Outcomes Research Institute, John D. Dingell VA Medical Center Detroit Michigan USA
| | - Khaled J. Saleh
- FAJR Scientific Northville Michigan 48167 USA
- Michigan State University, College of Osteopathic Medicine Detroit Michigan USA
- Surgical Outcomes Research Institute, John D. Dingell VA Medical Center Detroit Michigan USA
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10
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Rego RT, Ngugi AK, Sophie Delius AJ, Luchters S, Kolars JC, Irfan FB, Weinheimer-Haus E, Abubakar A, Shah R, Zhu J, Boulton ML, Hofer T, Waljee AK. COVID-19 vaccine hesitancy among non-refugees and refugees in Kenya. PLOS Glob Public Health 2022; 2:e0000917. [PMID: 36962839 PMCID: PMC10021684 DOI: 10.1371/journal.pgph.0000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 07/23/2022] [Indexed: 11/19/2022]
Abstract
Factors associated with COVID-19 vaccine hesitancy (which we define as refusal to be vaccinated when asked, resulting in delayed or non- vaccination) are poorly studied in sub-Saharan Africa and among refugees, particularly in Kenya. Using survey data from wave five (March to June 2021) of the Kenya Rapid Response Phone Survey (RRPS), a household survey representative of the population of Kenya, we estimated the self-reported rates and factors associated with vaccine hesitancy among non-refugees and refugees in Kenya. Non-refugee households were recruited through sampling of the 2015/16 Kenya Household Budget Survey and random digit dialing. Refugee households were recruited through random sampling of registered refugees. Binary response questions on misinformation and information were transformed into a scale. We performed a weighted (to be representative of the overall population of Kenya) multivariable logistic regression including interactions for refugee status, with the main outcome being if the respondent self-reported that they would not take the COVID-19 vaccine if available at no cost. We calculated the marginal effects of the various factors in the model. The weighted univariate analysis estimated that 18.0% of non-refugees and 7.0% of refugees surveyed in Kenya would not take the COVID-19 vaccine if offered at no cost. Adjusted, refugee status was associated with a -13.1[95%CI:-17.5,-8.7] percentage point difference (ppd) in vaccine hesitancy. For the both refugees and non-refugees, having education beyond the primary level, having symptoms of COVID-19, avoiding handshakes, and washing hands more often were also associated with a reduction in vaccine hesitancy. Also for both, having used the internet in the past three months was associated with a 8.1[1.4,14.7] ppd increase in vaccine hesitancy; and disagreeing that the government could be trusted in responding to COVID-19 was associated with a 25.9[14.2,37.5]ppd increase in vaccine hesitancy. There were significant interactions between refugee status and some variables (geography, food security, trust in the Kenyan government's response to COVID-19, knowing somebody with COVID-19, internet use, and TV ownership). These relationships between refugee status and certain variables suggest that programming between refugees and non-refugees be differentiated and specific to the contextual needs of each group.
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Affiliation(s)
- Ryan T Rego
- Center for Global Health Equity, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Anthony K Ngugi
- Dept. of Population Health, Aga Khan University, Nairobi, Kenya
| | | | | | - Joseph C Kolars
- Center for Global Health Equity, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Furqan B Irfan
- Institute of Global Health, Michigan State University, Lansing, Michigan, United States of America
| | - Eileen Weinheimer-Haus
- Center for Global Health Equity, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Reena Shah
- Dept. of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Ji Zhu
- Dept. of Statistics, University of Michigan, LSA, Ann Arbor, Michigan, United States of America
| | - Matthew L Boulton
- Dept. of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Timothy Hofer
- Center for Global Health Equity, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Akbar K Waljee
- Center for Global Health Equity, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
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11
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Crespi Z, Ismail A, Awad ME, Hasan AI, Irfan FB, Jaffar M, El-Othmani MM, Saleh KJ. Hospital-Acquired Conditions: A Review of Classical and Novel Risk Factors Following Total Hip and Knee Arthroplasties. JBJS Rev 2021; 9:01874474-202107000-00006. [PMID: 34270501 DOI: 10.2106/jbjs.rvw.20.00240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» In 2016, a total of 48,771 hospital-acquired conditions (HACs) were reported in U.S. hospitals. These incidents resulted in an excess cost of >$2 billion, which translates to roughly $41,000 per patient per HAC. » In the settings of total hip arthroplasty (THA) and total knee arthroplasty (TKA), increased age, a body mass index of >35 kg/m2, male sex, diabetes mellitus, electrolyte disturbances, and a history of anemia increase the likelihood of surgical site infections. » Institution-specific (surgical) risk factors such as increased tourniquet time, an operative time of >130 minutes, bilateral procedures, a femoral nerve block, and general anesthesia increase the risk of HACs in the settings of THA and TKA.
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Affiliation(s)
- Zachary Crespi
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Aya Ismail
- University of Michigan, Dearborn, Michigan
| | - Mohamed E Awad
- FAJR Scientific, Northville, Michigan.,Saleh Medical Innovations Consulting, PLLC, Northville, Michigan.,NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Michigan State University, College of Osteopathic Medicine, Detroit, Michigan
| | - Ahmad I Hasan
- FAJR Scientific, Northville, Michigan.,Saleh Medical Innovations Consulting, PLLC, Northville, Michigan.,Wayne State University School of Medicine, Detroit, Michigan
| | - Furqan B Irfan
- Michigan State University, College of Osteopathic Medicine, Detroit, Michigan
| | - Muhammad Jaffar
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan
| | | | - Khaled J Saleh
- FAJR Scientific, Northville, Michigan.,Saleh Medical Innovations Consulting, PLLC, Northville, Michigan.,Michigan State University, College of Osteopathic Medicine, Detroit, Michigan
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12
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Irfan FB, Castren M, Bhutta ZA, George P, Qureshi I, Thomas SH, Pathan SA, Alinier G, Shaikh LA, Suwaidi JA, Singh R, Shuaib A, Tariq T, McKenna WJ, Cameron PA, Djarv T. Ethnic differences in out-of-hospital cardiac arrest among Middle Eastern Arabs and North African populations living in Qatar. Ethn Health 2021; 26:460-469. [PMID: 30303400 DOI: 10.1080/13557858.2018.1530736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Abstract
Aims: There are very few studies comparing epidemiology and outcomes of out-of-hospital cardiac arrest (OHCA) in different ethnic groups. Previous ethnicity studies have mostly determined OHCA differences between African American and Caucasian populations. The aim of this study was to compare epidemiology, clinical presentation, and outcomes of OHCA between the local Middle Eastern Gulf Cooperation Council (GCC) Arab and the migrant North African populations living in Qatar.Methods: This was a retrospective cohort study of Middle Eastern GCC Arabs and migrant North African patients with presumed cardiac origin OHCA resuscitated by Emergency Medical Services (EMS) in Qatar, between June 2012 and May 2015.Results: There were 285 Middle Eastern GCC Arabs and 112 North African OHCA patients enrolled during the study period. Compared with the local GCC Arabs, univariate analysis showed that the migrant North African OHCA patients were younger and had higher odds of initial shockable rhythm, pre-hospital interventions (defibrillation and amioderone), pre-hospital scene time, and decreased odds of risk factors (hypertension, respiratory disease, and diabetes) and pre-hospital response time. The survival to hospital discharge had greater odds for North African OHCA patients which did not persist after adjustment. Multivariable logistic regression showed that North Africans were associated with lower odds of diabetes (OR 0.48, 95% CI 0.25-0.91, p = 0.03), and higher odds of initial shockable rhythm (OR 2.86, 95% CI 1.30-6.33, p = 0.01) and greater scene time (OR 1.02 95% CI 1.0-1.04, p = 0.02).Conclusions: North African migrant OHCA patients were younger, had decreased risk factors and favourable OHCA rhythm and received greater ACLS interventions with shorter pre-hospital response times and longer scene times leading to better survival.
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Affiliation(s)
- Furqan B Irfan
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Maaret Castren
- Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Zain A Bhutta
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Pooja George
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Isma Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sameer A Pathan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, Qatar
- School of Health and Social Work, Paramedic Division, University of Hertfordshire, Hatfield, UK
| | - Loua A Shaikh
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, Qatar
| | - Jassim A Suwaidi
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Tooba Tariq
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | | | - Peter A Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Therese Djarv
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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13
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Tariq T, Karabon P, Irfan FB, Sieloff EM, Patterson R, Desai AP. National Trends and Outcomes of Nonautoimmune Hemolytic Anemia in Alcoholic Liver Disease: Analysis of the Nationwide Inpatient Sample. J Clin Gastroenterol 2021; 55:258-262. [PMID: 32740099 DOI: 10.1097/mcg.0000000000001383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/01/2020] [Indexed: 12/12/2022]
Abstract
GOAL The aim of this study was to determine the burden of nonautoimmune hemolytic anemia (NAHA) in hospitalized patients with coexisting alcoholic liver disease (ALD), identify risk factors for NAHA in ALD and describe the hospitalization outcomes. BACKGROUND ALD can result in structural and metabolic alterations in the red-blood cell membrane leading to premature destruction of erythrocytes and hemolytic anemia of varying severity. STUDY Hospitalized ALD patients with concomitant NAHA were identified in the Nationwide Inpatient Sample database using International Classification of Diseases-9 codes from 2009 to 2014. The primary outcome was to determine the nationwide prevalence and risk factors of NAHA in patients hospitalized with ALD. RESULTS The prevalence of NAHA was 0.17% (n=3585) among all ALD patients (n=2,125,311) that were hospitalized. Multivariate analysis indicated higher odds of NAHA in ALD patients in the following groups: female gender [adjusted odds ratio (AOR) AOR 1.80, P<0.0001]; highest quartile of median household income (AOR 1.88, P<0.0001); increasing Charlson-Deyo Comorbidity Index (3 to 4 vs. 0, AOR 2.16, P=0.0042) and cirrhosis (AOR 2.74, P<0.0001). Discharges of ALD with anemia had a significantly longer average length of stay (8.8 vs. 6.0 d, P<0.0001), increased hospital charges ($38,961 vs. $25,244, P<0.0001) and higher mortality (9.0% vs. 5.6%, P<0.0001) when compared with ALD with no anemia. CONCLUSION NAHA in patients with ALD is an important prognostic marker, predicting a longer, costlier hospitalization and increased inpatient mortality in ALD.
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Affiliation(s)
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Detroit
| | - Furqan B Irfan
- College of Osteopathic Medicine, Michigan State University, East Lansing
| | - Eric M Sieloff
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
| | - Rachel Patterson
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Archita P Desai
- Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
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14
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Bhutta ZA, Qureshi I, Shujauddin M, Thomas SA, Masood M, Dsouza LB, Iqbal N, Irfan FB, Pathan SA, Thomas SH. Characterizing Agreement in the Level of Interarm Blood Pressure Readings of Adults in the Emergency Department (CALIBRATE Study). Qatar Med J 2020; 2020:14. [PMID: 32391250 PMCID: PMC7198471 DOI: 10.5339/qmj.2020.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/01/2019] [Indexed: 11/03/2022] Open
Abstract
Background: Increased interarm systolic blood pressure difference (IASBPD) is one of the major predictors of cardiovascular disease. An IASBPD of >10 mmHg is of clinical significance. However, studies have reported a high number of patients visiting the emergency department (ED) with high IASBPD and varying correlation of IASBPD to age, ethnic background, and comorbidities such as hypertension and diabetes. Objective: The CALIBRATE study aimed to measure the IABPDs in the multiethnic patient population presenting to the ED in Qatar and to assess the distribution of IASBPD in this population. Methods: In a sitting position, two consecutive blood pressure (BP) measurements were recorded from the right and left arms for each participant using a calibrated automated machine and appropriate cuff sizes. The data were recorded using predefined data fields, including patient demographics, past medical, and social and family history. The continuous variables were reported as mean or median based on the distribution of data. The data were analyzed using Stata MP 14.0. Results: A total of 1800 patients, with a mean age of 34 (10) years, were prospectively recruited from the ED. The median absolute systolic BP difference (ΔSBP) between the right and left arms was 6 (3-10) mmHg, and it was the same for the first (ΔSBP1) and the second readings (ΔSBP2). The absolute average of ΔSBP1 and ΔSBP2 was 7 (4-10) mmHg. The difference in systolic BP difference (SBP) of < 20 mmHg for interarm blood pressure was seen in the 95th percentile of the population. No meaningful association could be detected between the IABPD and the study variables such as age, demographics, regions of interest, and risk factors. Conclusion: In population presenting to the ED, the IASBPD of at least 20 mmHg reached at the 95th percentile, validating the known significant difference. The utility of SBP difference can be improved further by taking the average of two individual readings.
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Affiliation(s)
- Z A Bhutta
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - I Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - M Shujauddin
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - S A Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - M Masood
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - L B Dsouza
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - N Iqbal
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weil Cornell Medical College in Qatar, Doha, Qatar
| | - F B Irfan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - S A Pathan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
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15
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Tariq T, Karabon P, Irfan FB, Goyal S, Mayeda MM, Parsons A, Judd S, Ehrinpreis M. Secondary angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease: Results from the nationwide inpatient sample. World J Gastrointest Endosc 2019; 11:504-514. [PMID: 31798771 PMCID: PMC6885446 DOI: 10.4253/wjge.v11.i10.504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/21/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease is associated with angiodysplasia of gastrointestinal tract leading to increased risk of gastrointestinal bleeding.
AIM To determine the nationwide prevalence, trends, predictors and resource utilization of angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalizations.
METHODS The Nationwide Inpatient Sample database from 2009 to 2014, was utilized to conduct a retrospective study on patients with angiodysplasia associated- gastrointestinal bleeding and end-stage renal disease. Hospitalizations with end-stage renal disease were included in the Nationwide Inpatient Sample database and a subset of hospitalizations with end-stage renal disease and angiodysplasia-associated gastrointestinal bleeding were identified with International Classification of Diseases, 9th revision, Clinical Modification codes for both end-stage renal disease (585.6) and Angiodysplasia (569.85, 537.83).
RESULTS The prevalence of angiodysplasia-associated gastrointestinal bleeding was 0.45% (n = 24709) among all end-stage renal disease patients (n = 5505252) that were hospitalized. Multivariate analysis indicated that the following were significant factors associated with higher odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients: an increasing trend from 2009-2014 (P < 0.01), increasing age (P < 0.0001); African American race (P = 0.0206); increasing Charlson-Deyo Comorbidity Index (P < 0.01); hypertension (P < 0.0001); and tobacco use (P < 0.0001). Diabetes mellitus (P < 0.0001) was associated with lower odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients. In comparison with urban teaching hospitals, rural and urban nonteaching hospitals were associated with decreased odds of angiodysplasia associated-gastrointestinal hemorrhage.
CONCLUSION Angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease patients showed an increasing trend from 2009-2014. Advanced age, African American race, overall high comorbidities, hypertension and smoking were significant factors for angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalized patients.
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Affiliation(s)
- Tooba Tariq
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, United States
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Oakland University, Detroit, MI 48309, United States
| | - Furqan B Irfan
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Sachin Goyal
- Department of Internal Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University, Detroit, MI 48201, United States
| | - Matthew Masaru Mayeda
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Austin Parsons
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Stephanie Judd
- Department of Internal Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University and John D Dingell VA Medical Center, Detroit, MI 48201, United States
| | - Murray Ehrinpreis
- Department of Internal Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University, Detroit, MI 48201, United States
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16
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Tariq T, Irfan FB, Farishta M, Dykstra B, Sieloff EM, Desai AP. Spontaneous fungal peritonitis: Micro-organisms, management and mortality in liver cirrhosis-A systematic review. World J Hepatol 2019; 11:596-606. [PMID: 31388401 PMCID: PMC6669191 DOI: 10.4254/wjh.v11.i7.596] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/15/2019] [Accepted: 07/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spontaneous peritonitis is an infection of ascitic fluid without a known intra-abdominal source of infection. spontaneous fungal peritonitis (SFP) is a potentially fatal complication of decompensated cirrhosis, defined as fungal infection of ascitic fluid in the presence of ascitic neutrophil count of greater than 250 cells/mL.
AIM To determine the prevalence of fungal pathogens, management and outcomes (mortality) of SFP in critically ill cirrhotic patients.
METHODS Studies were identified using PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Scopus databases until February 2019. Inclusion criteria included intervention trials and observation studies describing the association between SFP and cirrhosis. The primary outcome was in-hospital, 1-mo, and 6-mo mortality rates of SFP in cirrhotic patients. Secondary outcomes were fungal microorganisms identified and in hospital management by anti-fungal medications. The National Heart, Lung and Blood Institute quality assessment tools were used to assess internal validity and risk of bias for each included study.
RESULTS Six observational studies were included in this systematic review. The overall quality of included studies was good. A meta-analysis of results could not be performed because of differences in reporting of outcomes and heterogeneity of the included studies. There were 82 patients with SFP described across all the included studies. Candida species, predominantly Candida albicans was the fungal pathogen in majority of the cases (48%-81.8%) followed by Candida krusei (15%-25%) and Candida glabrata (6.66%-20%). Cryptococcus neoformans (53.3%) was the other major fungal pathogen. Antifungal therapy in SFP patients was utilized in 33.3% to 81.8% cases. The prevalence of in hospital mortality ranged from 33.3% to 100%, whereas 1-mo mortality ranged between 50% to 73.3%.
CONCLUSION This systematic review suggests that SFP in end stage liver disease patient is associated with high mortality both in the hospital and at 1-mo, and that antifungal therapy is currently underutilized.
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Affiliation(s)
- Tooba Tariq
- Department of Internal Medicine, Western Michigan University, Kalamazoo, MI 49008, United States
| | - Furqan B Irfan
- College of Osteopathic Medicine, Michigan State University, WEast Lansing, MI 48824, United States
| | - Mehdi Farishta
- Department of Internal Medicine, Western Michigan University, Kalamazoo, MI 49008, United States
| | - Brian Dykstra
- Department of Pulmonary and Critical Care Medicine, Western Michigan University, Kalamazoo, MI 49008, United States
| | - Eric Martin Sieloff
- Department of Internal Medicine, Western Michigan University, Kalamazoo, MI 49008, United States
| | - Archita P Desai
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
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17
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18
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Tariq T, Farishta M, Rizvi A, Irfan FB. A Case of Concomitant Emphysematous Cystitis and Clostridium difficile Colitis with Pneumoperitoneum. Cureus 2018; 10:e2897. [PMID: 30181931 PMCID: PMC6118292 DOI: 10.7759/cureus.2897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Emphysematous cystitis (EC) is a rare condition described as air within the wall and lumen of the urinary bladder. It is a complicated form of urinary tract infection caused by gas-forming bacteria. Pneumoperitoneum described as gas in the peritoneum is usually seen with abdominal hollow organ perforation, and approximately 10% of cases have been reported that are not associated with abdominal hollow viscus perforation. To the best of our knowledge, no case of EC with pneumoperitoneum in the setting of concurrent Klebsiella urinary tract infection and Clostridium difficile (C. difficile) colitis have been reported. Here we present a unique case of EC with pneumoperitoneum, in a patient with recurrent C. difficile infection and Klebsiella pneumonia-urinary tract infection, treated conservatively with a favorable outcome.
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19
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Farook S, Chaudhry S, Al Kahlout B, Irfan FB, Pathan S. Acceptability and feasibility of the standardized direct observation assessment tool in the emergency department in Qatar. Int J Med Educ 2017; 8:428-429. [PMID: 29278524 PMCID: PMC5768438 DOI: 10.5116/ijme.5a2e.7e16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/11/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Saleem Farook
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sohaib Chaudhry
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Baha Al Kahlout
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Furqan B Irfan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sameer Pathan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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20
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Bhutta ZA, Qureshi I, Shujauddin M, Thomas S, Masood M, Dsouza LB, Iqbal N, Irfan FB, Pathan SA, Thomas SH. Abstract P491: Characterizing Agreement in Level of Inter-extremity Blood-Pressure Readings of Adults in the Emergency Department (CALIBRATE Study). Hypertension 2017. [DOI: 10.1161/hyp.70.suppl_1.p491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Inter-arm blood-pressure difference (IBPD) has been studied previously in multiple settings, but few reports are available from the Emergency department (ED) setting, where BP varies significantly due to acute medical conditions or stress from various factors. CALIBRATE aims to study the inter-arm blood pressure differences in the patients presenting to the ED in Qatar and to assess the IBPD distribution in this population.
Methods:
In sitting position, two consecutive BP measurements were obtained from the right and left arm for each participant using calibrated automated machines and appropriate cuff sizes. Considering the demographic mix of the population presenting to the ED, a 1:1 of male to female and 2:1 for GCC (Gulf Cooperation Council) to non-GCC recruitment strategy was predefined. The data were recorded using predefined data fields including patient demographics, past medical, social and family history. The continuous variables were reported as mean (SD) or median (IQR) based on the distribution of data. The data was analyzed using Stata MP 14.0 (College Station, Texas).
Results:
A total of 1800 patients were prospectively recruited from the ED. The mean age was 34 (10) years. The absolute systolic blood pressure (ΔSBP) difference between the right and left arm was same for the first (ΔSBP1) and the second reading (ΔSBP2), as 6 mmHg (3-10). The absolute average of ΔSBP1 and ΔSBP2
was 7 mmHg (4-10). The difference in SBP of less than 20 mmHg for IBP was seen in 95
th
percentile of the population with single reading, whereas, with the average of two individual readings it was observed in 97
th
percentile. No meaningful association could be detected between the significant IBPD
and the study variables such as age, demographics, regions of interest and risk factors. Although, patients with diagnosed hypertension met the pre-defined criterion for significance, this difference was not clinically significant. There was no significant difference between IBPD noted for the Asia-pacific or Arab population.
Conclusion:
In population presenting to the ED, the IBPD of at least 20 mmHg reached at 95
th
percentile validating the known significant difference. The utility of SBP difference can be improved further by taking the average of two individual readings.
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Pathan SA, Soulek J, Qureshi I, Werman H, Reimer A, Brunko MW, Alinier G, Irfan FB, Thomas SH. Helicopter EMS and rapid transport for ST-elevation myocardial infarction: The HEARTS study. Journal of Emergency Medicine, Trauma and Acute Care 2017. [DOI: 10.5339/jemtac.2017.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Helicopter emergency medical services (HEMS) and ground EMS (GEMS) are both integral parts of out-of-hospital transport systems for patients with ST-elevation myocardial infarction (STEMI) undergoing emergency transport for primary percutaneous coronary intervention (PPCI). There are firm data linking time savings for PPCI transports with improved outcome. A previous pilot analysis generated preliminary estimates for potential HEMS-associated time savings for PPCI transports. Methods: This non-interventional multicenter study conducted over the period 2012–2014 at six centers in the USA and in the State of Qatar assessed a consecutive series of HEMS transports for PPCI; at one center consecutive GEMS transports of at least 15 miles were also assessed if they came from sites that also used HEMS (dual-mode referring hospitals). The study assessed time from ground or air EMS dispatch to transport a patient to a cardiac center, through to the time of patient arrival at the receiving cardiac unit, to determine proportions of patients arriving within accepted 90- and 120-minute time windows for PPCI. Actual times were compared to “route-mapping” GEMS times generated using geographical information software. HEMS' potential time savings were calculated using program-specific aircraft characteristics, and the potential time savings for HEMS was translated into estimated mortality benefit. Results: The study included 257 HEMS and 27 GEMS cases. HEMS cases had a high rate of overall transport time (from dispatch to receiving cardiac unit arrival) that fell within the predefined windows of 90 minutes (67.7% of HEMS cases) and 120 minutes (91.1% of HEMS cases). As compared to the calculated GEMS times, HEMS was estimated to accrue a median time saving of 32 minutes (interquartile range, 17–46). The number needed to transport for HEMS to get one additional case to PPCI within 90 minutes was 3. In the varied contexts of this multicenter study, the number of lives saved by HEMS, solely through time savings, was calculated as 1.34 per 100 HEMS PPCI transports. Conclusions: In this multicenter study, HEMS PPCI transport was found to be appropriate as defined by meeting predefined time windows. The overall estimate for lives saved through time savings alone was consistent with previous pilot data and was also generally consistent with favorable cost-effectiveness. Further research is necessary to confirm these findings, but judicious HEMS deployment for PPCI transports is justified by these data.
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Affiliation(s)
- Sameer A. Pathan
- 1Department of Emergency Medicine, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar
| | - Jason Soulek
- 2Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma, USA
| | - Isma Qureshi
- 1Department of Emergency Medicine, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar
| | - Howard Werman
- 3Department of Emergency Medicine and MedFlight of Ohio, Ohio State University, Columbus, Ohio, USA
| | - Andrew Reimer
- 4Cleveland Clinic Critical Care Transport and Francis Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Guillaume Alinier
- 6Hamad Medical Corporation Ambulance Service, Doha, Qatar
- 7School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
- 8Department of Public Health and Wellbeing, Northumbria University, Newcastle upon Tyne, NE7 7XA, UK
| | - Furqan B. Irfan
- 1Department of Emergency Medicine, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar
| | - Stephen H. Thomas
- 1Department of Emergency Medicine, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar
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Pathan SA, Bhutta ZA, Moinudheen J, Jenkins D, Farook S, Qureshi I, George P, Irfan FB, Al Khal AL, Thomas SH. Partial replacement of board-certified specialist-grade physicians with emergency medicine trainees in a busy emergency department: Lack of adverse effect on time to physician. Journal of Emergency Medicine, Trauma and Acute Care 2017. [DOI: 10.5339/jemtac.2017.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: Standard emergency department (ED) operation goals include minimization of the time interval between patients' initial ED presentation and initial emergency physician (EP) evaluation. Following up on previous work defining factors influencing the “time to physician” (tMD) in a busy ED, the current study was undertaken to evaluate whether tMD was adversely impacted by the ED's partial replacement of specialist-grade EPs with emergency medicine (EM) trainees (at the resident and fellow level). Methods: This retrospective study was conducted for four months (September–December 2015) using an ED administrative database (EDAD) in an urban academic tertiary ED with an annual census of approximately 500,000; during the four study months, the ED census was 165,969. To minimize confounding by time of day and related factors, data analysis focused solely on the “day shift” (0600–1400) of each of the study period's 122 days. EDAD data were combined with EP rostering data to generate a multivariate linear regression model that assessed the dependent variable tMD, for significant changes associated with increasing proportion – not necessarily always the same as increasing the absolute number of trainees (i.e., summed residents and fellows as a total percent of all on-duty EPs). There were trainees in the study ED throughout the study, but the trainee numbers as a proportion of the overall physician staffing fluctuated, thus providing a basis for analysis. The model adjusted for covariates previously demonstrated to impact tMD at the study center. Analyses were conducted with Stata 14MP, with statistical significance defined at p < 0.05 and confidence intervals (CIs) reported at the 95% level. Results: In an acceptable regression model that adjusted for multiple parameters influencing tMD, the introduction of a covariate representing the proportion of on-duty trainee physicians was very small in magnitude (β estimate 0.07, 95% CI − 0.16 to 0.30) and not statistically significant (p = 0.53). Conclusions: A multivariate analysis adjusting for variables contributing to tMD showed no indication of adverse tMD impact from partial replacement of board-certified specialist-grade EPs with EM trainees given adequate supervision by properly trained faculty.
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Affiliation(s)
- Sameer A. Pathan
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Zain A. Bhutta
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Jibin Moinudheen
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Dominic Jenkins
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Saleem Farook
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Isma Qureshi
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Pooja George
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Furqan B. Irfan
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Abdul Latif Al Khal
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
- 2Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Stephen H. Thomas
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
- 2Weill Cornell Medical College in Qatar, Doha, Qatar
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Irfan FB, Consunji R, El-Menyar A, George P, Peralta R, Al-Thani H, Thomas SH, Alinier G, Shuaib A, Al-Suwaidi J, Singh R, Castren M, Cameron PA, Djarv T. Cardiopulmonary resuscitation of out-of-hospital traumatic cardiac arrest in Qatar: A nationwide population-based study. Int J Cardiol 2017; 240:438-443. [PMID: 28395982 DOI: 10.1016/j.ijcard.2017.03.134] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/28/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. METHODS An observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA). RESULTS A total of 410 OHTCA patients were included in the 6-year study period. The mean annual crude incidence rate of OHTCA was 4.0 per 100,000 population, in Qatar. OHTCA mostly occurred in males with a median age of 33. There was a preponderance of blunt injuries (94.3%) and head injuries (66.3%). Overall, the survival rate was 2.4%. Shockable rhythm, prehospital external hemorrhage control, in-hospital blood transfusion, and surgery were associated with higher odds of survival. Adrenaline (Epinephrine) lowered the odds of survival. CONCLUSION The incidence of OHTCA was less than expected, with a low rate of survival. Thoracotomy was not associated with improved survival while Adrenaline administration lowered survival in OHTCA patients with majority blunt injuries. Interventions to enable early prehospital control of hemorrhage, blood transfusion, thoracostomy and surgery improved survival.
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Affiliation(s)
- Furqan B Irfan
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden; Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Rafael Consunji
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Ayman El-Menyar
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Pooja George
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Ruben Peralta
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Stephen Hodges Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, Qatar; School of Health and Social Work, Paramedic Division, University of Hertfordshire, Hatfield AL10 9AB, HERTS, UK.
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Jassim Al-Suwaidi
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Rajvir Singh
- Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Maaret Castren
- Helsinki University, Department of Emergency Medicine and Services, Helsinki University Hospital, Haartmaninkatu 4, 00029 HUS, Finland.
| | - Peter A Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Therese Djarv
- Department of Medicine Solna, 171 00, Karolinska Institutet, Sweden.
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Pathan SA, Bhutta ZA, Moinudheen J, Jenkins D, Silva AD, Sharma Y, Saleh WA, Khudabakhsh Z, Irfan FB, Thomas SH. Marginal analysis in assessing factors contributing time to physician in the Emergency Department using operations data. Qatar Med J 2017; 2016:18. [PMID: 28293539 PMCID: PMC5339449 DOI: 10.5339/qmj.2016.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/27/2016] [Indexed: 11/03/2022] Open
Abstract
Background: Standard Emergency Department (ED) operations goals include minimization of the time interval (tMD) between patients' initial ED presentation and initial physician evaluation. This study assessed factors known (or suspected) to influence tMD with a two-step goal. The first step was generation of a multivariate model identifying parameters associated with prolongation of tMD at a single study center. The second step was the use of a study center-specific multivariate tMD model as a basis for predictive marginal probability analysis; the marginal model allowed for prediction of the degree of ED operations benefit that would be affected with specific ED operations improvements. Methods: The study was conducted using one month (May 2015) of data obtained from an ED administrative database (EDAD) in an urban academic tertiary ED with an annual census of approximately 500,000; during the study month, the ED saw 39,593 cases. The EDAD data were used to generate a multivariate linear regression model assessing the various demographic and operational covariates' effects on the dependent variable tMD. Predictive marginal probability analysis was used to calculate the relative contributions of key covariates as well as demonstrate the likely tMD impact on modifying those covariates with operational improvements. Analyses were conducted with Stata 14MP, with significance defined at p < 0.05 and confidence intervals (CIs) reported at the 95% level. Results: In an acceptable linear regression model that accounted for just over half of the overall variance in tMD (adjusted r2 0.51), important contributors to tMD included shift census (p = 0.008), shift time of day (p = 0.002), and physician coverage n (p = 0.004). These strong associations remained even after adjusting for each other and other covariates. Marginal predictive probability analysis was used to predict the overall tMD impact (improvement from 50 to 43 minutes, p < 0.001) of consistent staffing with 22 physicians. Conclusions: The analysis identified expected variables contributing to tMD with regression demonstrating significance and effect magnitude of alterations in covariates including patient census, shift time of day, and number of physicians. Marginal analysis provided operationally useful demonstration of the need to adjust physician coverage numbers, prompting changes at the study ED. The methods used in this analysis may prove useful in other EDs wishing to analyze operations information with the goal of predicting which interventions may have the most benefit.
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Affiliation(s)
- Sameer A Pathan
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Zain A Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Jibin Moinudheen
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Dominic Jenkins
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Ashwin D Silva
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Yogdutt Sharma
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Warda A Saleh
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Zeenat Khudabakhsh
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Furqan B Irfan
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
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25
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Kamran S, Akhtar N, Salam A, Alboudi A, Kamran K, Ahmed A, Bhutta ZA, Irfan FB, Shuaib A. Abstract TP135: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke: Role of Infarct Growth. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
The purpose of this multi-institutional pooled data analyses from three countries was to determine the impact of DHC timing on the functional outcomes in patients operated beyond 48 hours in comparison with DHC under 48 hours. In addition factors leading to early or late DHC were also identified.
Methods:
Retrospective, multicenter cross-sectional study to measure outcome following DHC <48 or >48 hours using the modified Rankin Scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4, at three months.
Results:
In total 137 patients underwent DHC. There was no significant difference in the functional outcome [P=0.140] and mortality [P=0.975] but with a trend towards better outcome in patients operated over 48 hours. Multivariate analysis showed age ≥ 55, MCA with additional infarction, septum pellucidum deviation ≥1cm, and uncal herniation was independent predictor of poor functional outcome at three months. In the ‘‘best’’ multivariate model IGR >7.5ml/hr, MCA with additional infarction, and patients with temporal lobe involvement were independently associated with surgery under 48 hours. Both first infarct growth rate [IGR1] [DHC<48 hours, 15.2± 8.1ml/hr vs. >48 hours, 7.1 ± 5.03ml/hr] [P<0.001] and second infarct growth rate [IGR2] [DHC 48 13.64 ±8.76 ml/hr, > 48 hours 7.15 ±6.23 ml/hr [P<0.001] were nearly double in patients with early surgery [<48 hours].
Conclusions:
There was no significant difference in the functional outcome and mortality in patients operated >48 hours of stroke onset compared to early [<48 hours]. Time to surgery had no impact on functional outcome. Our data identifies IGR, temporal lobe involvement and MCA with additional infarct were independent predictors of early surgery.
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Affiliation(s)
| | | | | | - Aymen Alboudi
- NEUROSCIENCE, Rashid Hosp, Dubai, United Arab Emirates
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26
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Moinudheen J, Pathan SA, Bhutta ZA, Jenkins DW, Silva AD, Sharma Y, Saleh WA, Khudabakhsh Z, Irfan FB, Thomas SH. Marginal analysis in assessing factors contributing time to physician in Emergency Department using operations data. Journal of Emergency Medicine, Trauma and Acute Care 2016. [DOI: 10.5339/jemtac.2016.icepq.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Standard Emergency Department (ED) operations goals include minimization of the time interval (hereafter tMD) between patients' initial ED presentation and initial physician evaluation.
Methods: The study was conducted using one month (May 2015) of an ED administrative database (EDAD), in HGH-ED, during the study month the ED saw 39,593 cases. The first step was generation of a multivariate model identifying the parameters associated with delay in tMD. In the second step, predictive marginal probability analysis was used to calculate the relative contributions of key covariates as well as demonstrate the likely tMD impact on modifying those covariates with operational improvements. Analyses were conducted with STATA 14 MP, with significance defined at p < .05 and confidence intervals (CIs) reported at the 95% level.
Results: In an acceptable linear regression model that accounted for just over half of the overall variance in tMD (adjusted r2 .51), important contributors to tMD included shift census (p = .008), shift time of day (p = .002), and physician coverage n (p = .004). Marginal predictive probability analysis was used to predict the overall tMD impact (improvement from 50 to 43 minutes, p < .001) of consistent staffing with 22 physicians.
Conclusions: The analysis identified expected variables contributing to tMD with regression demonstrating significance and effect magnitude of alterations in covariates including patient census, shift time of day, and physician n. Marginal analysis provided operationally useful demonstration of the need to adjust physician coverage numbers, prompting changes at the study ED.
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Affiliation(s)
| | | | - Zain A. Bhutta
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Yogdutt Sharma
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Warda A. Saleh
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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27
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Irfan FB, Pathan SA, Bhutta ZA, Abbasy ME, Elmoheen A, Alsaeidy AM, Tariq T, Hugelmeyer CD, Dardouri H, Khial NB, Daniel CY, Silva AD, Farook KS, Sharma Y, Thomas SH. ED case presentations during the largest sandstorm in the Middle East. Journal of Emergency Medicine, Trauma and Acute Care 2016. [DOI: 10.5339/jemtac.2016.icepq.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: The State of Qatar experienced a sandstorm on 1 April 2015, lasting approximately 12 hours, with winds blowing at more than 100 km/hr and average particulate matter of approximately 10 μm in diameter. The Emergency Department of the main tertiary hospital in Qatar managed 62% of the total emergency calls. The peak load of patients during the event manifested approximately 6 hours after the onset.
Methods: A retrospective review of patient mix and case load was performed for patients presenting to Emergency Department during and after the sandstorm.
Results: A total of 254 cases with respiratory illness presented to the Emergency Department within 12 hours of sandstorm onset. Of these cases, 42 had respiratory failure, of which 19 required intubation and 23 were managed conservatively. Of the remaining 212 cases, 28 with severe respiratory exacerbation of asthma, 15 with COPD exacerbation and 169 with minor asthma exacerbation were managed conservatively. In addition, a total of 26 patients presented with ophthalmological complaints. Of these, 12 had foreign body removed from the eye under slit lamp and took topical medication and antibiotics. The remaining 14 patients with anterior eye chamber emergencies were managed conservatively.
Conclusions: Patients presented mainly with exacerbations of asthma and respiratory distress, ophthalmic emergencies and vehicular trauma. Surprisingly, incidence of pedestrian injuries did not vary. With the outline of adaptations and specific areas for improvement identified in this review, we hope that future sandstorm emergencies will be better positioned to respond with optimum efficiency and effectiveness.
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Irfan FB, Bhutta ZA, Castren M, Straney L, Djarv T, Tariq T, Thomas SH, Alinier G, Al Shaikh L, Owen RC, Al Suwaidi J, Shuaib A, Singh R, Cameron PA. Epidemiology and outcomes of out-of-hospital cardiac arrest in Qatar: A nationwide observational study. Int J Cardiol 2016; 223:1007-1013. [PMID: 27611569 DOI: 10.1016/j.ijcard.2016.08.299] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/19/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) studies from the Middle East and Asian region are limited. This study describes the epidemiology, emergency health services, and outcomes of OHCA in Qatar. METHODS This was a prospective nationwide population-based observational study on OHCA patients in Qatar according to Utstein style guidelines, from June 2012 to May 2013. Data was collected from various sources; the national emergency medical service, 4 emergency departments, and 8 public hospitals. RESULTS The annual crude incidence of presumed cardiac OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence was 87.8 per 100,000 population. Of the 447 OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51years (IQR=39-66). Frequently observed nationalities were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Bystander cardiopulmonary resuscitation (CPR) was carried out in 92 (20.6%) OHCA patients. Survival rate was 8.1% (n=36) and multivariable logistic regression indicated that initial shockable rhythm (OR 13.4, 95% CI 5.4-33.3, p=0.001) was associated with higher odds of survival while male gender (OR 0.27, 95% CI 0.1-0.8, p=0.01) and advanced cardiac life support (ACLS) (OR 0.15, 95% CI 0.04-0.5, p=0.02) were associated with lower odds of survival. CONCLUSIONS Standardized incidence and survival rates were comparable to Western countries. Although expatriates comprise more than 80% of the population, Qataris contributed 20% of the total cardiac arrests observed. There are significant opportunities to improve outcomes, including community-based CPR and defibrillation training.
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Affiliation(s)
- Furqan B Irfan
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden; Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Zain Ali Bhutta
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Maaret Castren
- Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Haartmaninkatu 4, 00029 HUS, Finland
| | - Lahn Straney
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia
| | - Therese Djarv
- Department of Medicine Solna, 171 00, Karolinska Institutet, Sweden
| | - Tooba Tariq
- Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA
| | - Stephen Hodges Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, PO Box 3050, Qatar; School of Health and Social Work, Paramedic Division, University of Hertfordshire, Hatfield, AL10 9AB, HERTS, UK
| | - Loua Al Shaikh
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, PO Box 3050, Qatar
| | - Robert Campbell Owen
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, PO Box 3050, Qatar
| | - Jassim Al Suwaidi
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, PO Box 3050, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha, PO Box 3050, Qatar
| | - Peter Alistair Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia
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Bashir K, Tariq T, Irfan FB, Pathan SA. Resolution of severe vertigo in a remote location by the modified Epley maneuver. Journal of Emergency Medicine, Trauma and Acute Care 2015. [DOI: 10.5339/jemtac.2015.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is an extremely common cause of peripheral vertigo. BPPV is believed to be caused by the presence of tiny crystals in the semicircular canals. It is typically diagnosed from a patient's history and examination.
A 55-year-old lady dialed the emergency services due to severe vertigo and vomiting for about two hours. The previous night she travelled around 250 miles in her caravan to North Wales, UK, for a holiday. No ambulance was available to be dispatched, hence the ambulance control contacted the local general practitioner doctor on duty to attend to the patient. The patient was suffering from recurrent vertigo symptoms for nearly two years, despite being on medications. She described her symptoms as room spinning when she wanted to get out of the bed which was associated with vomiting. History and examination revealed no signs attributing to acute stroke.
After performing the Dix-Hallpike test, the doctor confirmed the diagnosis of posterior canal BPPV and the patient was offered the modified Epley maneuver. Post-maneuver, a significant improvement in her symptoms was noticed within a few minutes. On arrival of ambulance crew after an hour, the patient decided not to go to hospital as her symptoms were almost 90 percent better. This case highlights the need for awareness among family medicine and emergency doctors to diagnose and treat BPPV with a physical maneuver rather than medications.
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Affiliation(s)
- Khalid Bashir
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Tooba Tariq
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Furqan B. Irfan
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sameer A. Pathan
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Fares S, Femino M, Sayah A, Weiner DL, Yim ES, Douthwright S, Molloy MS, Irfan FB, Karkoukli MA, Lipton R, Burstein JL, Mazrouei MA, Ciottone G. Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi. Disasters 2014; 38:420-433. [PMID: 24601924 DOI: 10.1111/disa.12047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hazard vulnerability analysis (HVA) is used to risk-stratify potential threats, measure the probability of those threats, and guide disaster preparedness. The primary objective of this project was to analyse the level of disaster preparedness in public hospitals in the Emirate of Abu Dhabi, utilising the HVA tool in collaboration with the Disaster Medicine Section at Harvard Medical School. The secondary objective was to review each facility's disaster plan and make recommendations based on the HVA findings. Based on the review, this article makes eight observations, including on the need for more accurate data; better hazard assessment capabilities; enhanced decontamination capacities; and the development of hospital-specific emergency management programmes, a hospital incident command system, and a centralised, dedicated regional disaster coordination centre. With this project, HVAs were conducted successfully for the first time in health care facilities in Abu Dhabi. This study thus serves as another successful example of multidisciplinary emergency preparedness processes.
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Affiliation(s)
- Saleh Fares
- Adjunct faculty member in the Disaster Medicine Section, Harvard Medical School, Boston, Massachusetts, United States, an adjunct faculty member in the Division of Disaster Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States, and Head of the Emergency Department, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
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Fares S, Irfan FB, Corder RF, Al Marzouqi MA, Al Zaabi AH, Idrees MM, Abbo M. Emergency medicine in the United Arab Emirates. Int J Emerg Med 2014; 7:4. [PMID: 24401695 PMCID: PMC3904470 DOI: 10.1186/1865-1380-7-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/16/2013] [Indexed: 11/10/2022] Open
Abstract
It has been a decade since emergency medicine was recognized as a specialty in the United Arab Emirates (UAE). In this short time, emergency medicine has established itself and developed rapidly in the UAE. Large, well-equipped emergency departments (EDs) are usually located in government hospitals, some of which function as regional trauma centers. Most of the larger EDs are staffed with medically or surgically trained physicians, with board-certified emergency medicine physicians serving as consultants overseeing care.Prehospital care and emergency medical services (EMS) operate under the auspices of the police department. Standardized protocols have been established for paramedic certification, triage, and destination decisions. The majority of ambulances offer basic life support (BLS/Type 2) with a growing minority offering advanced life support (ALS/Type 3).Medicine residency programs were established 5 years ago and form the foundation for training emergency medicine specialists for UAE.This article describes the full spectrum of emergency medicine in the UAE: prehospital care, EMS, hospital-based emergency care, training in emergency medicine, and disaster preparedness. We hope that our experience, our understanding of the challenges faced by the specialty, and the anticipated future directions will be of importance to others advancing emergency medicine in their region and across the globe.
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Affiliation(s)
- Saleh Fares
- Department of Emergency Medicine, Zayed Military Hospital, P,O, Box: 8313, Abu Dhabi, United Arab Emirates.
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Bashir K, Alessai GS, Salem WA, Irfan FB, Cameron PA. Physical maneuvers: effective but underutilized treatment of benign paroxysmal positional vertigo in the ED. Am J Emerg Med 2013; 32:95-6. [PMID: 24211278 DOI: 10.1016/j.ajem.2013.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/04/2013] [Accepted: 10/05/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Khalid Bashir
- Emergency Department, Hamad General Hospital, Doha, Qatar.
| | | | | | - Furqan B Irfan
- Emergency Department, Hamad General Hospital, Doha, Qatar.
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Irfan FB, Irfan BB, Spiegel DA. Barriers to accessing surgical care in Pakistan: healthcare barrier model and quantitative systematic review. J Surg Res 2011; 176:84-94. [PMID: 22079839 DOI: 10.1016/j.jss.2011.07.046] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 07/08/2011] [Accepted: 07/20/2011] [Indexed: 10/17/2022]
Abstract
Inadequate access to surgical services results in increased morbidity and mortality from a spectrum of conditions in Pakistan. We employed a modification of Andersen's model of health services utilization and developed a 'Healthcare Barrier Model,' to characterize the barriers to accessing health care in developing countries, using surgical care in Pakistan as a case study. We performed a literature search from MEDLINE, EMBASE, CINAHL, SCOPUS, Global Health Database, and Cochrane Central Register of Controlled Trials, and selected 64 of 3113 references for analysis. Patient-related variables included age (elderly), gender (female), preferential use of alternative health providers (Hakeem, traditional healers, others), personal perceptions regarding disease and potential for treatment, poverty, personal expenses for healthcare, lack of social support, geographic constraints to accessing a health facility, and compromised general health status as it relates to the development of surgical disease. Environmental barriers include deficiencies in governance, the burden of displaced or refugee populations, and aspects of the medicolegal system, which impact treatment and referral. Barriers relating to the health system include deficiencies in capacity (infrastructure, physical resources, human resources) and organization, and inadequate monitoring. Provider-related barriers include deficiencies in knowledge and skills (and ongoing educational opportunities), delays in referral, deficient communication, and deficient numbers of female health providers for female patients. The Healthcare Barrier model addresses this broad spectrum of barriers and is designed to help formulate a framework of healthcare barriers. To overcome these barriers will require a multidisciplinary, multisectoral effort aimed at strengthening the health system.
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Affiliation(s)
- Furqan B Irfan
- Aga Khan University, School of Medicine, Karachi, Pakistan
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Abstract
INTRODUCTION Gunshot wounds (GSW) to the head are the most lethal form of trauma; unfortunately, the frequency of children being involved in such form of trauma is increasing at an alarming rate worldwide. We present our experience with four children from 2 to 3 years of age with craniocerebral GSW admitted to the neurosurgery service at a tertiary care hospital. METHODS For this study, four children, 2 to 3 years old, injured solely from bullet injuries to the head were selected. Their history, arrival Glasgow Coma Scale (GCS), clinical presentation at the time of arrival in ER, radiological findings, management, and follow-up reviewed. RESULTS Out of four children, only one did not survive. The bullet entrance wound was in the parietal region in robbery-related incidences, and, in three cases, the injury was bihemispheric. The time taken to reach the emergency department was less than 2 h for all patients except one. Of four patients, three presented with GCS between 3 and 5 while 1 presented with GCS well above ten. CONCLUSION Our results show that even in children presenting with low GCS<5, an early act of aggressive surgical intervention can prove to be a life-saving measure.
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Affiliation(s)
- Furqan B Irfan
- Department of Neurosurgery, Aga Khan University, Karachi, 74800, Sindh, Pakistan.
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Haider BA, Irfan FB, Bhutta ZA. Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in developing countries. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd006980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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