Examining Jordanians\u27 Attitudes Towards Five Types of Developmental Disabilities

Background: The diagnosis and reported rates of persons with developmental disabilities (PWDDs) in Jordan is steadily increasing. Although initiatives have been implemented to improve the lives of PWDDs, attitudes towards PWDDs hinder successful inclusion in the Jordanian society. Objectives: To examine the relationship between Jordanians socio-economic status and attitudes towards persons with developmental disabilities: autism, blindness, cerebral palsy, Down syndrome and muscular dystrophy. Methods: Jordanians (N=259), ages 18-65 were recruited for this convergent parallel, mixed-methods study. Participants completed the modified 40-item Community Living Attitude Scale-developmental disability (CLAS-DD) and the modified Intellectual Disability Literacy Scale consisting of five vignettes, representing each developmental disability. Of the 259 participants, 32 were randomly selected for the qualitative phase of this study Results: A one-way ANOVA was used to analyze CLAS-DD, results revealed consistent significance between all subscales and income levels. For instance, sheltering scores revealed significance between income levels \u3e800 (Mdn= 4.0) and \u3c180 (Mdn = 4.57) (p= 0.006). Further, using A Welch test, IDLS findings showed differences of relationship between social distance and income level. The qualitative study confirmed the quantitative analysis; however, attitude vary depending by type of contact with persons with developmental disabilities. Conclusions: Few empirical studies related to PWDDs exist in Jordan. This foundation work can be utilized by the social, educational and public health sectors to understand determinants influencing attitudes towards persons with disabilities, prior to designing initiatives. Based on the findings, there is potential for inclusion of PWDDs in Jordan, with strategically designed disability awareness initiatives

Understanding of Abdominal Compartment Syndrome among Pediatric Healthcare Providers

Background. The sparse reporting of abdominal compartment syndrome (ACS) in the pediatric literature may reflect inadequate awareness and recognition among pediatric healthcare providers (HCP). Purpose. To assess awareness of ACS, knowledge of the definition and intraabdominal pressure (IAP) measurement techniques used among pediatric HCP. Method. A written survey distributed at two pediatric critical care conferences. Results. Forty-seven percent of 1107 questionnaires were completed. Participants included pediatric intensivists, pediatric nurses, and others. Seventy-seven percent (n = 513) of participants had heard of ACS. Only 46.8% defined ACS correctly. The threshold IAP value used to define ACS was variable among participants. About one-quarter of participants (83/343), had never measured IAP. Conclusion. Twenty-three percent of HCP surveyed were unaware of ACS. Criteria used to define ACS were variable. Focused education on recognition of ACS and measuring IAP should be promoted among pediatric HCP

The effect of the COVID-19 pandemic on the prescribing of opioid and opioid use disorder medications within an academic medical center in California

IntroductionThe COVID-19 pandemic impacted healthcare operations affecting many patients with chronic pain and substance use disorder. Our study aimed to evaluate the effects of the COVID-19 pandemic on opioid and opioid use disorder (OUD) medication prescribing practices within a large academic health system in southern California.MethodsThis retrospective cohort study included patients who received a prescription for chronic opioids or therapy for OUD between November 1, 2019 and September 1, 2020. The date range was divided into five specific time periods during the pandemic: November through December 2019 (pre-COVID and reference period), January through February 2020 (early COVID), March through April 2020 (policy/guidance change period), May through June 2020 (early post-guidance period), and July through August 2020 (late post-guidance period). The primary outcome was change in morphine milligram equivalents (MME) prescribed. Secondary outcomes included encounter type, mode of prescription ordering, naloxone prescriptions, and urine drug screen obtainment.ResultsThe cohort included 100 patients divided among the designated time periods. Seventy-percent of patients received opioids for chronic non-malignant pain and 10% received therapy for OUD. Although there were numerical increases in MMEs prescribed, no significant changes were seen in the MMEs prescribed at any timepoint relative to the pre-COVID timeframe despite reduced in-person visits, increased video and telephone encounters and increased electronic prescription utilization. Subgroup analyses of those with chronic pain only or OUD had similar findings.ConclusionIt appears that, generally, prescribing practices were sustained despite the various phases of the pandemic including transitions to and from telemedicine

Examining Jordanians\u27 Attitudes Towards Five Types of Developmental Disabilities

Background: The diagnosis and reported rates of persons with developmental disabilities (PWDDs) in Jordan is steadily increasing. Although initiatives have been implemented to improve the lives of PWDDs, attitudes towards PWDDs hinder successful inclusion in the Jordanian society. Objectives: To examine the relationship between Jordanians socio-economic status and attitudes towards persons with developmental disabilities: autism, blindness, cerebral palsy, Down syndrome and muscular dystrophy. Methods: Jordanians (N=259), ages 18-65 were recruited for this convergent parallel, mixed-methods study. Participants completed the modified 40-item Community Living Attitude Scale-developmental disability (CLAS-DD) and the modified Intellectual Disability Literacy Scale consisting of five vignettes, representing each developmental disability. Of the 259 participants, 32 were randomly selected for the qualitative phase of this study. Results: A one-way ANOVA was used to analyze CLAS-DD, results revealed consistent significance between all subscales and income levels. For instance, sheltering scores revealed significance between income levels \u3e800 (Mdn= 4.0) and(Mdn = 4.57) (p= 0.006). Further, using A Welch test, IDLS findings showed differences of relationship between social distance and income level. The qualitative study confirmed the quantitative analysis; however, attitude vary depending by type of contact with persons with developmental disabilities. Conclusions: Few empirical studies related to PWDDs exist in Jordan. This foundation work can be utilized by the social, educational and public health sectors to understand determinants influencing attitudes towards persons with disabilities, prior to designing initiatives. Based on the findings, there is potential for inclusion of PWDDs in Jordan, with strategically designed disability awareness initiatives

Safety and Efficacy of Direct Oral Anticoagulants for Atrial Fibrillation in Patients with Renal Impairment

Direct oral anticoagulants (DOACs) are gaining popularity for patients with nonvalvular atrial fibrillation (AF) for stroke prevention. Less bleeding risk with comparable stroke prevention compared to warfarin was shown. DOACs have predictable anticoagulant effects, infrequent monitoring requirements and less drug-food interactions compared to warfarin. However, safety and efficacy data of DOACs in patients with chronic kidney disease (CKD) are limited. This is a retrospective study to evaluate thromboembolic and bleeding events in patients with AF (with/without CKD) in October 2010 and July 2017. A total of 495 patients were included and only 150 patients had CKD. Our study found that patients with renal impairment on a DOAC do not have a higher incidence of bleeding events. It showed significant increase in thromboembolic events in CKD patients with dabigatran compared to CKD patients with apixaban with odds ratio of 6.58 (95%CI 1.35–32.02, p = 0.02)

The Usage of Concomitant Beta-Blockers with Vasopressors and Inotropes in Cardiogenic Shock

Vasopressors and inotropes (Vs/Is) are widely used in the treatment of cardiogenic shock (CS). Despite improvements in hemodynamic variables and end-organ perfusion, these agents have been associated with an increase in mortality, potentially due to the increased risk of tachyarrhythmias—which we hypothesize may be mitigated by beta-blockers (BBs). We conducted a retrospective chart review of patients who received a V/I (dobutamine, milrinone, dopamine, and norepinephrine) for CS. The primary objective was to assess the effect of BB in patients receiving Vs/Is for CS. In our final analysis of 227 patients, those in the BB group were younger, were more likely to have acute coronary syndrome as the reason for admission, had more reduced left ventricular ejection fraction, were more likely to have coronary artery disease and atrial fibrillation as pre-existing co-morbidities, and had a lower rate of in-hospital mortality. Nevertheless, in our multivariable logistic regression analysis, concurrent BB usage with a V/I was not associated with a reduction in in-hospital mortality. Our present study sheds light on the importance and urgency of large, carefully designed clinical studies to optimize inpatient medical therapy, particularly evaluating the combination of V/I and BB, in this high-risk patient population