Qatar Journal of Public Health - Current Issue

The COVID-19 pandemic has had a profound impact on healthcare systems worldwide, necessitating adaptations in service delivery to ensure patient care and safety.

Aim: This study investigates patient and healthcare provider satisfaction at the Anticoagulant Clinic of Hamad Medical Corporation amidst the pandemic.

Methodology: Data were collected through surveys conducted with patients and healthcare providers and analyzed various implemented measures such as direct oral anticoagulant (DOAC) conversion, extended international normalized ratio (INR) testing, hotline services, and telehealth consultations.

Results: Results indicate significant patient satisfaction with DOAC conversion (75% satisfaction rate) and extended INR testing intervals (95.3% satisfaction rate), despite a minor bleeding incidence of 11%, with 3.4% experiencing moderate bleeding and 0.4% encountering life-threatening bleeding. The implementation of the hotline service garnered an 83% satisfaction rate among patients. Healthcare providers, including clinical pharmacists, perceived the implemented measures as safe, with 83.3% endorsing DOAC conversion safety and 58.3% expressing confidence in the safety of extended INR testing intervals.

Conclusion: This study highlights the effectiveness of patient-centered strategies in managing anticoagulation therapy during health crises such as COVID-19, emphasizing the importance of flexibility, proactive monitoring, and continuous improvement to ensure patient safety and satisfaction. These findings offer valuable insights for optimizing anticoagulation clinic operations and enhancing patient care both in times of crisis and in routine healthcare delivery settings.

Background: Epistaxis attacks in childhood are an important reason for pediatric emergency visits, most of which are minor and infrequent. However, recurrent epistaxis can be a sign of an underlying bleeding disorder such as von Willebrand disease. This case report highlights controversies and obstacles that may arise during the diagnostic process, hindering a clear confirmation.

Case presentation: An eight-year-old boy, who had a history of recurrent epistaxis and easy bruising since infancy, was presented to the Pediatric Emergency Department of Al Khor Hospital for a repeat episode of nosebleed. Local examination showed dilated capillaries in addition to nasal bleeding signs. Family history revealed similar past complaints in both his brother and his father. Previous epistaxis attacks were mostly left-sided. Blood workups were not diagnostic. Later, repeated blood tests led by high clinical suspicion resulted in the diagnosis of von Willebrand disease. The new diagnosis had a direct effect on the patient’s bleeding management. Nose bleeds peaked in frequency and severity over the next two years and decreased remarkably thereafter, the same pattern as before in the father and older brother.

Discussion: The heterogeneous nature of von Willebrand disease, overlapping with the healthy population, creates a diagnostic dilemma. Therefore, balanced diagnostic approach is crucial. Bleeding history and family history provide invaluable clues but are not definitive. The blood workups may struggle with the variations in function and fluctuating levels of the von Willebrand factor molecule. Although genetic testing is helpful in some cases, it has its limitations.

Conclusion: The diagnosis of von Willebrand’s disease generally follows the traditional approach. It begins with a detailed bleeding history combined with a focused family history that pinpoints potential cases, followed by blood testing. However, interpretation of blood workups can be challenging due to the patient-to-patient and within-patient variability of the disease, the wide panel of investigations, and the different cutoff levels in different guidelines. Despite all this, testing is irreplaceable. Management of bleeding should begin immediately and should not be affected by inconclusive blood workups.

Background: People of all ages, genders, social classes, income levels, and geographical regions can be affected by mental illness. Families of individuals diagnosed with mental illnesses face significant burdens, particularly due to their role as family caregivers.

Aim: This integrative review aims to characterize the interventions that support family caregivers to reduce their burden of caregiving.

Methodology: Whittemore and Knafl’s methodology guided this integrative literature review. CINAHL, MEDLINE, and PsycINFO were searched for articles published between 2014 and 2023. Eighteen articles were identified as eligible studies to identify supportive interventions. These articles were then critically appraised and relevant data analyzed and synthesized to formulate the results.

Findings: The included studies reported interventions focused on family caregivers of relatives with mental illnesses. The two main themes of these studies are (a) interventions to offset the burden of caregiving and (b) outcomes related to these interventions. These interventions include psychoeducation, adaptive cognitive-behavioral strategies, peer support, and religious support.

Conclusion: Caring for a mentally ill family member is an extremely stressful situation for family caregivers. Supportive interventions found in this integrative review could help these family caregivers overcome their burdens.

Background: Pediatric vision impairment (VI) has profound implications for a child's development, intellectual skills, and quality of life. The aim of this study was to assess the prevalence of VI among primary and preparatory school students in Qatar.

Methods: A school-based cross-sectional study was conducted among students in grades 1, 3, 5, 7, and 9 in Qatar. School nurses conducted visual acuity (VA) measurement using a Snellen chart placed 6 meters away, with an E symbol, in which the 6/6 line is the standard for normal vision. Each student's information was recorded in their electronic health records (government schools, GSs) or in Excel sheets (private schools, PSs).

Results: Three hundred and thirty schools participated in this survey, with 99,379 students divided into 45,670 from GSs and 53,709 from PSs. The prevalence of abnormal VA among students was 10.4% in GSs and 12.6% in PSs. There was no significant association between VI and gender or nationality, although VI was higher in grades 5, 7, and 9 but not statistically significant. Furthermore, the proportion of visually impaired students diagnosed with refractive errors and wearing glasses or contact lenses during vision measurement was 14.7% in GSs and 27% in PSs.

Conclusion: The study provides comprehensive and baseline data on VI among the school children of Qatar. The vision screening helped in the early detection of VI in one-tenth of the affected students. However, urgent interventions are needed to enhance screening strategies for future studies on the causes of VI.