Journal of Emergency Medicine, Trauma and Acute Care - 2 - International Conference in Emergency Medicine and Public Health-Qatar Proceedings, October 2016

Developing cultural competency in mental health provision became an imperative skill in the age of globalization. This involves the enhanced knowledge and attitudes of care givers (NKI). We will review the geodemographic, religious, linguistic, and family structure in the Middle East so we can understand some of the special approaches needed to achieve our goal. We evaluate the common pitfalls and caveats of our own practices starting with Read More

Background: Hamad General Hospital (HGH) houses the main Emergency Department (ED) in Qatar. This busy ED has a 27 bedded resuscitation area. Within a 24 hour period there could be any number between 1 to 10 cases that needed emergency or urgent intubation. Over the years, there has been multiple addition of new life saving devices to the resuscitation areas. All these devices add to the clutter of the already crowded resuscitatio Read More

Background: A minority of children attend an Emergency may have a serious underlying, systemic infection as a cause of fever. Blood culture remains the gold standard approach to establish the diagnosis and presence of pathogens in a child with suspected, serious bacterial infection. This study describes the proportion of positive blood cultures and correlation with a basic investigation (C-reactive protein, absolute neutrophil count) an Read More

Background: Neurocysticercosis (NCC) is the most common parasitic disease of the central nervous system. On the basis of an incorrect assumption that human NCC does not occur in countries in which law prohibit swine breeding and consumption of pork, the disease has been considered rare in Arab world. Materials and methods: A retrospective study carried out in Emergency Department, Alkhor hospital, HMC from April 2014 to May 201 Read More

Background: Chickenpox is a contagious viral disease that affects any age group. Chickenpox is the most common infectious disease in Qatar. Most affected age groups in Qatar in the last three years are children. Chickenpox vaccination has been included in Qatar National Immunization Program in 2000. Aim: To describe the epidemiological characteristics of chickenpox in Qatar in the year 2012–2014. Methods: Descriptive analysis based Read More

Background: Marked variations in the incidence and survival of particular types of childhood cancer exist between countries. This study is to explore epidemiology, survival and trends of pediatric cancers in Jordan 2001–2011. Methods: Descriptive study done. Cases were identified from Jordan cancer registry. All Jordanian pediatric cancers which diagnosed during 2001–2011 were included. Data about age, sex, site, morphology, vital status Read More

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 pa Read More

Background: Age and sex are major determinants of cancer incidence. The objective of the study is to explore epidemiology of cancer in Jordan by age and sex for 2001–2011. Methods: Descriptive study done, cases were identified from Jordan cancer registry (JCR), all Jordanian cancers patients that diagnosed and registered in 2001–2011 were included variables collected SPSS 20 used for analysis. Results: Total number of cases in JCR we Read More

Background: To test the effectiveness of a school-based, peer-led smoking and asthma education program, known as the Triple A (Adolescent Asthma Action) in Jordan (TAJ), with an additional class smoke-free pledge strategy (TAJ-Plus) as compared to the TAJ alone on smoking-related knowledge and perception, nicotine dependence, and asthma control in male high school students in Jordan four months post-intervention. Methods: In this c Read More

Objective: The study aimed to measure the status of cold chain management among primary health care professionals at primary healthcare centers (PHCC) in Qatar. Methods: A cross-sectional design with pre-post-intervention study was conducted, and 570 primary health professionals were selected from 21 PHCCs using random sampling. A structured self-administered questionnaire was used to collect data regarding the status of cold ch Read More

Background: Gestational diabetes mellitus is characterized by high blood glucose levels during pregnancy. The reported prevalence of GDM is 7% worldwide while 8% in Pakistan. About 19.5% of the women with GDM develop post-partum metabolic syndrome. Methods: A prospective cohort study carried out at tertiary-care hospital in Lahore from Jan 2013 - Dec 2014 to determine the incidence of Mets in women with GDM. After inform Read More

Background: Early identification and isolation of suspected communicable diseases are a major health concern, especially when there is an outbreak of a communicable disease. The ED is an essential component of the health care system and subject to workflow challenges, which may hinder ED personnel adherence to guideline based infection prevention practices. Methods: In total, 993 suspected MERS-COV patients and their assign Read More

Background: Emergency Department (ED) is amongst the most crucial departments in the hospital. It receives around 1000 patient/day. ED overcrowding (EDOC) and increased Length of Stay (LOS) are key global issues for more than 20 years, as they have serious repercussions. No measurements have been done to assess the situation nationally. Methods: The paper used direct observation for seven days to collect patie Read More

Introduction: A mass casualty incident (MCI) or disaster can happen at any time. People at the extremes of ages are affected more especially children. Working in the nation's biggest Emergency Department (ED), Hamad General Hospital (HGH)-ED, staff preparedness is crucial to handle such unfortunate event or events. This study aims to assess the preparedness level, knowledge and the willingness of the HGH-ED staff to deal wit Read More

Background: Pesticide poisoning is a global public health problem. With growing population and rapid industrialisation in Qatar, there has been a natural increase in pesticide usage and hence, exposure amongst the workers handling them. It is therefore vital to understand existing knowledge, attitudes and practices about handling pesticides. Methods: 100 municipality employees in Qatar who work with pesticides, were interviewed in person Read More

Introduction: Sleeve gastrectomy has been a rising trend in management of morbid obesity in the Qatari population. National health insurance has included sleeve gastrectomy in the coverage scheme for patients with BMI of 40 or above, which has contributed to the consistent increase. Objective: We aim to highlight one complication that we saw in our clinical practice of a 32 years old female who developed acute foot drop after sleeve Read More

Background: Conventional endotracheal intubation (ETI) is challenging and requires high level of individual skills and experience. At the same time we are also committed to provide ETI training for Emergency Medicine Residents (EMR). Video laryngoscope (VDL) like the C-MAC (by Karl Storz) is designed to have a similar blade to the normal Macintosh blades (size 3 and 4). It has a bright light source and blade thickness that allow Direct Laryng Read More

Background: Obesity is a public health concern in both developed and developing countries, and it is a main risk factor for chronic diseases. Thus, Palestinian adults aren't spared from obesity and non-communicable diseases epidemic. This study aimed to assess the pattern of obesity among mothers in the Gaza Strip. Methods: A cross-sectional study was conducted on of 357 mothers aged 18–50 years between April-October 2012 Read More

Background: Worldwide ambulances are regularly involved in accidents as staff may not anticipate other drivers' actions, suffer from fatigue, or overestimate their driving privileges. An ambulance driving safety campaign started in June 2015 targeting some 935 registered HMCAS drivers. We aim to determine if our approach is effective in changing behaviours and believes, and reducing the number of accidents involving HMCAS vehicle Read More

Infant mortality is a sensitive indicator of development of a country and investing in the health of children. Since 1997 Morocco has been engaged in a the program of the integrated care of the child. We evaluated the information system of the integrated child-care program and the opportunity for collecting reliable data and good quality necessary to identify priorities. We conducted an evaluation of the information system of the integra Read More

Background: Vomiting is a symptom commonly encountered in emergency settings, with many differential diagnoses. In the following case, the diagnosis was nearly missed and the outcome could have been critical. Methods: A case study was performed, supported by literature review. A 32 year-old lady presented to the Emergency Department with repeated vomiting for one day. She has had epigastric discomfort for several days. Her blood Read More

Background: Trauma is a major cause of death worldwide that can result death or permanent disability. Globally, 6–10% of all deaths are attributed to traumatic injuries. In Saudi Arabia, trauma is a public burden as a result of its socioeconomic impact. Our aim is to describe the pattern of traumatic injuries and predictors of in-hospital mortality among patients admitted through the ED of King Abdulaziz Medical City. Methods: A retrospecti Read More

Background: Patients experiencing psychiatric emergencies often require resources not available at the hospital to which they present and frequently require transfer to an appropriate psychiatric facility as it is the case at the Emergency Department of HGH. This typically involves being held in the Emergency Department (ED) until a psychiatric bed is available. Boarding of psychiatric patients, (defined as a length of stay greater than fou Read More

Background: Although Retropharyngeal Hematoma (RPH) has unknown frequency but considered a rare condition which can cause a life threatening airway obstruction. Various precipitating factors have been mentioned as causes of RPH as blunt head or neck trauma, whiplash injury, coagulopathy, central line insertion, stellate ganglion block, sneezing, severe coughing as well as spontaneous RPH. Methods: We report a case of severe lif Read More

Urticaria is a common presentation in Emergency Department. Most of the time its idiopathic or immune mediated. In a small proportion of cases it may be a symptom of serious medical illness. We report two case of urticaria with underlying medical causes. Case 1: A 33-year-old female presented to emergency with recurrent urticaria, which started 5 months back. Even though it responded to antihistamines, symptoms recurred on discon Read More

Introduction: Omental infarction is a rare cause of acute abdomen resulting from vascular compromise of the greater omentum. Vague symptoms and non-specific signs at presentation make the clinical presentation diagnostically challenging. Evidence to guide the management of omental infarct is still controversial and limited. However, general approach is to manage it conservatively and to consider surgery only if there is a deterioration in Read More

Background: The American Heart Association (AHA) recommends to treat cardiac arrest due to Torsade de Pointes (TdP) with 1–2 grams of intravenous (IV) magnesium over 5 minutes. A second dose can be repeated within 5–15 minutes, and a continuous infusion may be considered. In cases of TdP due to severe hypokalemia, the doses and rate of administration of IV potassium chloride (KCL) are not described explicitly in the guidelines. Meth Read More

Background: Abdominal pain is one of the most common presenting symptoms in Emergency Department. During a recent audit, it was found that Patients presenting to HGH emergency room with a chief complaint of abdominal pain are the most common patient's category to be delayed to disposition. Currently 62% of patients with abdominal pain admitted to Male Urgent Area in Emergency Department HGH were delayed to Dis Read More

The present paper was designed to reflect the impact of conflict on the health situation in Yemen. A total of 2,305,048 people are displeased from their residences. The consequences of conflict permeate countless aspects of society, and are not limited to the mass causality (death and injured), inaccessibility to the health services and disturbance of health system. The most vulnerable group is the children who are highly affected by t Read More

Background: Reports on burden of hepatitis C and hepatitis B virus (HCV/HBV) are a big challenge for district to minimize the transmission of associated risk factors. Study was conducted to know the prevalence of HCV/HBV infection in pregnant women and their blood donors attended a surgical referral clinic for cesarean delivery. Objective: To determine the prevalence of HCV/HBV infection among pregnant women and their blood donors. M Read More

Background: Previous reports suggest prevalence of high stress levels and psychological morbidity among medical students. This study aimed to elucidate factors for Perceived Stress (PS), role of Emotional Intelligence (EI) in the experience of PS and its association with academic background and satisfaction with career choice among medical students. Methods: A cross-sectional survey was conducted in Riyadh-Medical-College-Saudi-A Read More

Background: Utilization of primary health care services is an important determinant of health. Individuals who receive primary health care are generally healthier than those who do not. Despite the importance of primary health care use, there are many barriers to health care access that are experienced by populations in Arab countries. This study examined primary health-care use and accessibility among adolescents living in the United Arab Read More

Background: Urinary retention is a common presenting complaint in Emergency Department. Meningitis can be an unusual cause for this. This combination is referred to as Meningitis Retention Syndrome (MRS). We present 2 cases of MRS diagnosed in A&E, Alkhor. Case 1: A 43-year-old male presented to ED with low grade fever, head ache of 10 days and dysuria of 2 days duration. Examination was unremarkable except for palpa Read More

Background: Fibrous dysplasia affecting the spine is considered an uncommon entity in polyostotic fibrous dysplasia and aneurysmal bone cysts occurring in this setting is rare. Although, these are benign conditions, they may present with acute cord compression and fractures which necessitate emergency treatment. Clinical course: Our patient is a 38-year-old Egyptian male who presented to the Emergency Department with a 2-wee Read More

Background: While there are benefits for over-the-counter medication (OTC) use, there are serious risks associated with OTC usage. These include self-misdiagnosis, possible delay in receiving needed therapy, use of suboptimal therapy, and increased resistance to antimicrobial agents. The patterns of (OTC) usage among adolescents remains largely understudied. The objectives of this study are: (1) to determine the profile of OTC use amon Read More

Background: Tobacco consumption among youth is a growing public health concern worldwide. This paper examines the prevalence, profile, and predictors of tobacco-use among expatriate and national adolescents attending secondary schools in the United Arab Emirates (UAE). Methods: Using a cross-sectional study design, we collected data on the prevalence of tobacco-use for a sample of 6,363 adolescents aged 13 to 20 years, incl Read More

Background: Globally, almost half of all adolescent deaths occur due to injury. Injuries related to accidental fall, being struck by an object or person, and road traffic injury (RTI) are particularly relevant among adolescents. Accidental falls and RTI are the most common causes of injury among children and adolescents. This study examines the profile of injuries among adolescents in the United Arab Emirates (UAE), including motor vehicle injuries Read More

Background: Tobacco consumption adversely affects cardiovascular (CV) disease (CVD) and risk profile, including hypertension. The long-term effect of cigarette smoking on blood pressure (BP) in adolescents is still, however, equivocal. Thus, the current study examined the CV hemodynamics in male adolescent cigarette smokers versus non-smokers. Methods: Resting heart rate, systolic (SBP) and diastolic (DBP) BP, mean arterial pressure Read More

Background: Pulmonary infections caused by Pneumocystis in immunocompromised host can be associated with cysts, pneumatoceles and air leaks that can progress to pneumomediastinum and pneumothoraces. In such cases, it can be challenging to maintain adequate gas exchange by mechanical ventilation and at the same time prevent further barotrauma or ventilator-induced lung injury (VILI). We report a young HIV positive male wit Read More

Introduction: Tobacco consumption contributes substantially to cardiovascular (CV) diseases (CVD), including hypertension. However, the effect of waterpipe (WP) smoking on CV hemodynamics in adolescents is unknown. Thus, the current study investigated the relationship of WP smoking with CV indices. Methods: Indices including heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressures, mean arterial blood pressure (MAP), p Read More

Introduction: Pain is a very common reason for presenting to the Emergency Department (ED). While the causes for pain are diverse, ranging from fractures and other injuries to chest or abdominal pain or headache, the provision of effective, timely analgesia should be one of the principal goals of emergency staff . Inadequate pain relief and poor treatment in pain management in ED was highlighted by Wilson and Pendleton and they co Read More

Background: Arterial punctures for monitoring respiratory problems are one of the most painful procedures in hospitalized patients. The knowledge regarding non-pharmacologic methods of pain management, including cold application is limited. Objective: This aim of this study was to determine if the application of ice packs before the procedure would decrease the pain perception of patients during the arterial puncture. Materials and Read More

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

Background: The Emergency Medicine Residency Training Program (EMRTP) conducts weekly didactic teaching activities to deliver the curriculum for the Arab Board of Emergency Medicine. Traditional teaching methods often serve to deliver content to the learner passively, while an interactive model engages the resident, and aligns with principles of adult learning. With the accreditation of the EMRTP by the Accreditation Council for Gradu Read More

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

Background: Crowding in hospital Emergency Departments (EDs) is a commonly observed problem all over the world. Objectives: To identify the factors related to patients’ unscheduled revisits to ED. Methods: The Al Khor Hospital annual ED patient volume of 158,000. The census sample of patients who had revisited within 72 hours of discharge from the ED was recruited in the study. The CERNER system was utilized to collect all revisited pati Read More

Background: 75% of mental health illnesses and problems are treated in local communities in United Kingdom. There is a well-structured community service with a personal holistic management of these psychiatric problems patients and the arrangements are done according to needs and environment of the patient. However these services are not round the clock and they do not have an access to the acute psychiatric beds or Read More

Background: Pain, a universal health problem, affects a substantive number of individuals in chronic or acute form. In the emergency and critical care settings, patients suffer moderate-to-severe acute pain from numerous sources. If not adequately managed, acute pain can transform to a chronic pain syndrome. The physical disabilities and psychological disorders associated with poorly controlled pain diminish patients' comfort and quality o Read More

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

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

Objective: Physician Associates were employed in a busy London Emergency Department to provide a new level of integrated Emergency Medical care. Background: Physician Associates have proved invaluable in the USA medical field over the past 30 years and have been identified as a possible workforce solution in the UK1,2. There are currently 19 Physician Associates (PAs) working in Emergency Departments across the UK3, with t Read More

Background: On 3rd March the local newspaper published report regarding measles outbreak in Mansehra Colony Landhi, Karachi. In response to the report the Executive District Office health Karachi constituted a three members investigating team with the objectives to investigate the outbreak and propose recommendations for control of outbreak the affected Mansehra Colony Landhi having population of 600 households. Methods: Inve Read More

Introduction: Diabetic foot is one of the most disabling complications with substantial morbidity. It remains the most common reason for hospital admission, impairs quality of life, engenders high treatment costs and is the most important risk factor for amputation. Objectives: To determine the prevalence of diabetic foot among diabetic patients and the prevalence of main related risk factors. Methods: A cross-sectional study was pe Read More

Background: It has been found that 89% of the ED staff in HGH has very low knowledge on the approach of SBAR, due to which they don't converse it accordingly with other staff especially during endorsements, face-face & critical call scenarios. Aim: To increase and standardize the usage of SBAR as a communication tool among the clinical staff in the ED of high to 100% by FEB 2016. Methods: The project was done in an iterative four-step c Read More

Background: Acute respiratory infections, including influenza, comprise a leading cause of morbidity and mortality globally. Influenza surveillance provides important information to inform policy on influenza control and vaccination. While the epidemiology of influenza has been well characterized in western countries, few data exist on influenza epidemiology in the Eastern Mediterranean Region. We describe the epidemiology of influenza Read More

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

Background: The aim of this study was to evaluate post-injury functional recovery over three years in patients with moderate and major trauma in Hong Kong. Methods: This is a multicentre prospective cohort study conducted in Hong Kong. The inclusion criteria were: trauma patients admitted to one of three trauma centres, with age ≥ 18 years, injury severity score (ISS) ≥ 9, meeting Trauma Registry criteria, and surviving to 48 hours. Functi Read More

Background: There is little evidence of research outcome data or studies into self-reported back pain in Middle Eastern or Gulf region countries. Within HMC there is anecdotal evidence that suggests that back pain in nurses working in critical care environments accounts for a significant percentage of all sick cause leave. This has the potential to impact on productivity, patient care and quality of life in nurses working within critical care in envir Read More

Emergency Medicine (EM) is an officially recognized medical specialty in over 60 countries, with the rate of specialty recognition accelerating in recent years. EM care delivery systems are specifically focused on managing the acute consequences of non-communicable as well as communicable disease processes, and therefore represent an important public health tool for reducing the present and future global. According to the 2006 World H Read More

Oman has committed to the goal of eliminating measles, rubella and congenital rubella syndrome (CRS) by 2015 year. Elimination is defined as the absence of endemic measles and rubella transmission in a defined geographical area for ≥ 12 months in the presence of a well-performing surveillance system and for rubella without the occurrence of CRS cases associated with endemic transmission in the presence of high-quality surveillanc Read More

Introduction: MVC accident is one of the major cause of mortality and morbidity in children. In 2010, road traffic accidents were the major cause of 228 deaths and 568 major injuries in Qatar.(4). Children in cars who are not restrained, have a great risk of being injured. Our aim from this study is to check parents' awareness of the important of using child restrain (car seat) and reasons behind preventing them from not using it. Objectives: Chec Read More

Background: Cranial computed tomography (CT) scan is a commonly performed neuroimaging prior to lumbar puncture (LP) in children with suspected meningitis to rule out intracranial hypertension or space occupying lesions. The purpose of this study was to assess the accuracy of physicians' prediction of CT abnormal cerebral findings in pediatric meningitis. Subjects and methods: A prospective observational study design was perf Read More

Endoscopic third ventriculostomy (ETV) is a common minimal-invasive neurosurgical procedure with well-documented complications. We report the case of a 6-year-old female child who underwent ETV, external ventricular drainage (EVD) catheter insertion and biopsy for a tumour arising from the pineal gland causing obstructive hydrocephalus and raised intra cranial pressure (ICP). Vital signs were stable pre-operatively and anaesthesia was Read More

Introduction: Proteinuria in burn patients is common, and it could be associated with acute kidney injury (AKI) with bad outcomes. We evaluated the incidences, outcomes, characteristics and determinants of proteinuria as a biomarker and its influence on AKI and outcomes in burn patients. Methods: This retrospective study was carried out on a group of patients with burn injuries admitted though Emergency Department to burn unit of Ha Read More

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

Background/aims: Prognosis for patients with cirrhosis admitted to medical intensive care unit (MICU) is poor. The objective of this study was to assess the predictors for hospital mortality and admission of cirrhotic patients to MICU in Qatar. Materials and methods: We conducted a retrospective cohort study of consecutive adult cirrhotic medical-ICU patients whom hospitalized from 2007 through 2012 to Hamad General Hospital-Qatar. We c Read More

Introduction: Use of ECMO has been shown to be an acceptable intervention for patients with respiratory failure refractory to optimal ventilator management. As experience with ECMO grows the indications for its use are also expanding. Case: Our patient is a 20-year-old female who was found lying on the roadside after being hit by a moving vehicle. She was rushed into the trauma room where she was intubated for low Glasgow co Read More

Background: Anticipating falls in the Emergency Department is a very challenging task as it's often the most unpredictable setting. Fall risk assessment tools used in inpatient units do not adequately capture the risk factors present in patients presenting to the Emergency Department. The MORSE scale is implemented only at a latter phase of patient admission to the inpatient unit. The purpose of this study is to develop and implement a simple, Read More

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging infection that causes severe illness in patients, particularly those with comorbidities; and has a high mortality rate. Healthcare associated outbreaks have been reported across the Gulf region and the Republic of Korea. While there have been cases of MERS-CoV in Qatar, no healthcare associated outbreaks have been reported. The aim of this paper is to give Read More

Introduction: Despite the potential benefits of EMR systems to improve patient care, many attempts at implementing them have failed or met with high levels of user resistance, Implementations that failed have often been those with which the users were dissatisfied with the system. Aim: The aim of this study is to assess the satisfaction of both the physicians and nurses with the newly introduced EMR system at the Emergency Department of Read More

Background: Non-adherence to antimicrobial guidelines is a major factor leading to emergence of antimicrobial drug resistance. Objective: This study was carried out to investigate the adherence to local antimicrobial guidelines in the Emergency Department (ED) at Al Wakra Hospital in the state of Qatar. Materials and methods: This cross-sectional, retrospective study was carried out in the Emergency Department of Al Wakra Hospital in Read More

Hospitals' track-and-trigger systems to identify and respond efficiently to patient's deterioration became an evidence base tool for patient safety and medical management worldwide. A prospective study about the Impact of Rapid Response Team Implementation in the Cuban Hospital was developed since September 2014 up to September 2015. The patients admitted in medical and surgical wards were screened upon admission and rescr Read More

Background: In 2011, HMCAS designed new Evidence-Based CPG. The previous protocols were not fit for purpose and not best practice. The service had multiple tiers of clinical practice among staff without standardization of care. CPG development is a knowledge management process to ensure standardization of care and a safer patient experience. This research sets out learning from two rounds of CPG development over 4 years. M Read More

Background: Hip fractures are very common in UK population (excluding Scotland) accounting for 64102 hospital admissions in 2014. FCIB is part of a best practice tariff and a quality indicator audited annually by the National Hip Fracture Database in UK, as part of NICE clinical guidelines. The ED protocol for fracture neck of femur (NOF) includes fascia Iliaca compartment block (FICB), which is a new service development as part of tre Read More

Background: Spontaneous rupture of the renal pelvis is very rare and hence diagnosis may be delayed. Diagnosis of the rupture is best evaluated by CT and treatment is primarily removal of the underlying cause, followed by conservative management. Presentation: An otherwise healthy 31-year-old male suffered abdominal pains and vomiting. His pain was at the right iliac fossa and suprapubic areas, which he rated as 7/10(NRS). He also repor Read More

Background: Increasing levels of physical inactivity is associated with growing trends of childhood obesity as evidence suggests today's children physically inactive and unfit. The study aims to assess the effect of socio-demographic and lifestyle factors on mode of travel in school-aged children (10–15 years). Methods: 4,497 school-aged children were selected from wave-1 of Understanding Society database in a multi-stage random s Read More

Introduction: Simulation is almost synonymous with computerised mannequins although they are not always essential components of the learning experience as what often matters most is the facilitation process of the learning experience rather than the technology. Methods: We developed Visually Enhanced Mental Simulation (VEMS) for staff to demonstrate cognitive and decision making skills away from the practical context. Scenario p Read More

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

Background: Whilst Head CT scanning carries an important role in the identification of clinically significant intracranial injuries, there are associated risks of radiation. Our initial audit of clinical notes and survey of EM physicians revealed a rate of 45% CT scans for pediatric minor head injuries with around half of requests not indicated. In 36% there were issues with documentation. The aim is to achieve a sustained compliance with Internationall Read More

Objective: The objective of this study was to collect feedback from Ambulance Paramedics (AP) with respect of their experience of using an External Chest Compression Device (ECCD) on cardiac arrest patients. Aspects of particular interest were ease of use and their perceived effectiveness of delivered CPR. Background: HMCAS crews attend to several hundreds of cardiac arrests a year. To achieve Return of Spontaneous Circulation Read More

Background: Breast cancer is the most common malignancy and leading cause of cancer mortality among females in Gaza. Most cases are diagnosed at late stage. Survival rates are persistently low in contrast to improved rates worldwide. Our study examined awareness, knowledge, attitude, practice and access to breast healthcare among both health professionals and women in Gaza. Methods: In May and June 2014, using convenience and re Read More

Background: Intraosseous (IO) access are being widely used in resuscitation of patients with difficult intra-venous (IV) access. The United Kingdom Resuscitation Council guidelines recommend the use of IO access, after two minutes of failed IV access in adult patients or two failed IV attempts in pediatric patients. There are various complications associated with IO access such as extravasation of the infusion fluid or medications, bleed Read More

Background: Vaccine preventable diseases continue to kill large numbers of young children each year UNICEF estimates that 1.2 million deaths to children under five years of age could be prevented at low cost by vaccinating children. For example, it is estimated that measles related deaths have been reduced from about 2.5 million per year in 1980 to less than one million in 1990 (2)-a decline of more than 60 percent during the decad Read More

Introduction: The mechanism for carbamate toxicity is reversible cholinesterase inhibition, which leads to accumulation of acetylcholine at the neuromuscular junction.1 The cardiac manifestations of carbamate toxicity are rare. We report a case of carbamate toxicity with atrial fibrillation as the cardiac manifestation. Case presentation: A 28-year-old patient, previously healthy, presented to the ED complaining of diplopia, dizziness, pa Read More

Backgrounds: Infection with Neisseria meningitides can produce a variety of clinical manifestations. Mortality and long-term morbidity can be very high in patients with invasive meningococcal disease if the infection is not treated appropriately. Our main objective was to evaluate mortality of all children admitted with acute meningococcal septicaemia (AMS). Methods: We conducted a retrospective study of all paediatric-cases of acute mening Read More

Background: Qatar is about to host the 2022 FIFA World Cup-WC, this can stress the public health system and resources of Qatar as hosting country. Reducing public health risks and ensuring people's safety at The Qatar 2022WC requires thorough planning and coordination. The aim is to obtain a comprehensive insight into the available practices concerning the infectious diseases preparedness and response for major Sporting events a Read More

Background: The HGH Microbiology lab indicator showed that our blood culture contamination rate has been consistently higher than the international benchmark thereby we aim to reduce it in the critical area of Emergency Department by 50% by the end of July 2015 and at least 90% by end of February 2016. Methods: A pilot area was chosen in the Emergency Department to do a study for 44 weeks after which blood culture kits (pr Read More

To assess if stratification of patients based on clinical severity, laboratory markers and radiological findings at presentation would enable better prediction for the need for a surgical intervention. Single-centre retrospective cohort study done in the in-patient pediatric wards of a tertiary care centre in the State of Qatar. Participants – 56 children (aged 6 months – 14 years) with empyema or parapneumonic effusion, from July 2009- Read More

Background: Approximately 1,000 U.S. citizens suffer from sudden cardiac arrest daily outside of the hospital setting. Providing cardiopulmonary resuscitation (CPR) improves survival if appropriately administered; however, many are resistant to initiate mouth to mouth. Hands only CPR (HOCPR) was developed by the American Heart Association to improve technique retention and increase the willingness to administer CPR. Methods: P Read More

Introduction: Pakistan has seen repeated outbreaks of the disease over the past decade or so. In 2011 the largest outbreak was seen in Punjab where 20,864 cases were reported. This study was conducted to estimate the disease burden and analyze epidemiological trends using data from the provincial Dengue Surveillance System, Punjab. Methods: A descriptive analysis of data from January 1 to December 31, 2013, was undertake Read More

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

Background: Medical missions have become a part of the Global Health Programs at many academic institutions. Commonly these programs involve annual trips to locations in the United States and around the world. The University of Toledo Medical Center (UTMC) sought to develop a sustainable mission that has educational and clinical value to both the local community and academic institution. Methods: The Department of Emergenc Read More

Introduction: Gallbladder volvulus is a rare entity, with a predilection for elderly women in their 7th or 8th decades of life. The condition results in rotation of the gallbladder on its mesentery along the axis of cystic duct and artery. Presence of redundant mesentery is a prerequisite. The disease is a frequent mimicker of acute cholecystitis, often difficult to diagnose preoperatively. Till date only about 300 cases have been reported in the lit Read More

Background/objective: Several inflammatory biomarkers of infection including procalcitonin (PCT) and C – reactive protein (CRP) have been shown to be useful in diagnosis of infection in different clinical settings. The purpose of this study was to determine the diagnostic value of serum PCT, CRP and White Blood Cells (WBC) as markers of sepsis in critically ill patients in Qatar. Materials and methods: The PCT levels and other related inflammatory Read More

Background: The last cholera epidemic in Sudan occurred in 2006/07, over 20,000 cases (4% case fatality rate) were recorded, index case was coming from South Sudan. In regard to recent outbreak in South Sudan June 2015, Sudan carried out preparedness procedures to prevent cholera spread. The uncontrollable open borders and the South Sudan refugees-over 198,000 – settled in Sudan poses a great cholera spread risk. Objective: To ill Read More

Background: Multiple trauma patients are evaluated and managed by the Emergency Department (ED) in Al Wakra. The assessment, management, and disposition of this population have become a significant workload component. The aim of this study was to evaluate the trauma service at Al Wakra ED. Methods: In our study, we aimed to collect data on the trauma patients, admitted between July 2014 and October 2015, who presented to th Read More

Background: Hepatitis C viral infection is a public health concern worldwide and a major cause of morbidity and mortality in several countries that supply the State of Qatar with many of its laborers. The objectives were to measure the prevalence of hepatitis C viral infection among single male laborers; detect the practices that may catalyze the spread of the infection; and assess the knowledge gap. Methods: A cross-sectional study was cond Read More

Background: Hamad General Hospital (HGH) Emergency Department (ED) provided 465,942 patient visits in 2014. (ED) use has increased annually resulting in overcrowding, longer wait periods for service and increased stress on health care workers. Much attention has been paid to factors contributing to this increased usage such as the return visit of an (ED) patient within 48 hours of the initial visit. 48 hours is the benchmark ti Read More

Background: Point-of-care ultrasound is an invaluable tool in the diagnosis and management of many conditions presenting to emergency departments across the world. It has also improved the success rate of invasive bedside procedures. Objectives: This study aimed to investigate the current utilization of point of care ultrasound in a large tertiary care emergency department in the Middle East and to identify barriers to its utilization. Methods Read More

Background: The rate of patients who arrive at the Emergency Department (ED) but leave before being seen (LWBS) is considered an important marker of the quality of care. Objectives: To evaluate the rate of LWBS at ED in Al Wakra Hospital (AWH) and to identify predictive factors associated with LWBS. Methods: This was a retrospective study of patients who left the Emergency Department without being seen by physicians between January 1 Read More