Healthcare Personnel Opinion and their Implementation Obstacles

Context: Hemodialysis HD patients, as well as the dialysis staff, are vulnerable to contracting health-care-associated infections (HAIs) due to frequent and prolonged exposure to many possible contaminants in the dialysis environment. Aim: Assess healthcare personnel's HCP opinion and their implementation obstacles regarding standard precautions (SPs) in the hemodialysis unit. Methods: The study was conducted at the hemodialysis unit at Al Mouwasat University Hospital, Alexandria, Egypt. A descriptive research design was used to collect data for this study. All healthcare personnel working in the setting mentioned above were included. Two tools were used. The first tool is a standard precautions practices in hemodialysis observational checklist: The second tool is a structured interview questionnaire to assess the opinion of healthcare personnel regarding the applicability of standard precautions in the hemodialysis unit and their implementation obstacles. Results: The standard precautions practice score showed unsatisfactory practice among HCP. Regarding their opinion, the majority of HCP disagreed to follow the five moments and reported that the WHO technique of hand hygiene is so sophisticated and time-consuming; they disagreed with changing gloves between patients and considering gloves as a substitute to hand hygiene. The majority recap the needle by two hand techniques disagreed with following respiratory hygiene, and color-coding was accepted only by nurses. Also, it was found that there was a positive correlation between years of experience, infection control training programs, and the level of SPs practice score. Conclusion: Unsatisfactory SPs practices showed a high percentage of HCP. Healthcare personnel tends to agree to certain infection control practices over other practices. Availability and accessibility of equipment and supplies that interfere with the application of SPs practices and lack of knowledge concerning infection prevention and control were considered as implementation obstacles of SPs practices. Education and training of HCP on SPs, together with consistent and robust management support, are recommended. In addition to the development of national precautions after conducting researches that confirm its effectiveness

Consensus evidence-based clinical practice recommendations for the diagnosis and treat-to-target management of osteoporosis in chronic kidney disease stages G4-G5D and post-transplantation: An initiative of Egyptian Academy of Bone Health

The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts' suggestions, and the percent agreement was calculated. Statements receiving rates of 7-9 by more than 75% of experts' votes were considered as achieving consensus. The surveys were sent to an expert panel ( = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7-9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management. [Abstract copyright: Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.

Diastolic dysfunction in patients with rheumatoid arthritis

Objective The aim of this study was to evaluate left ventricular diastolic function parameters as an early predictor of cardiac involvement in patients with rheumatoid arthritis (RA) without any evidence of hypertension, diabetes mellitus, rheumatic fever or underlying cardiac disease, detected by Doppler echocardiography and to correlate diastolic function in RA patients with different RA disease characteristics. Patients and methods Seventy-five RA patients were diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA and another 38 age-matched and sex-matched healthy participants were included. All patients and the control groups were submitted to M-mode, two-dimensional, Doppler (continuous and pulsed wave) echocardiography. Diastolic dysfunction was defined as when transmitral flow E/A ratio is less than one. Results Left ventricular diastolic dysfunction was found in 28 (37.3%) of 75 RA patients and four (10.5%) of 38 controls with a P value of less than 0.05. In the patients’ group, a statistically significant correlation was found between diastolic dysfunction and duration of the disease (P<0.05), and disease activity was assessed by 28 Joint Disease Activity Score (P<0.05). Conclusion Among those without a history of cardiac disease, patients with RA have a higher prevalence of diastolic dysfunction than those without RA. Diastolic dysfunction in RA was associated with disease duration and disease activity. Thus, early identification of diastolic dysfunction in asymptomatic RA patients by the use of echocardiography may provide an opportunity to manage the underlying etiology to prevent progression to diastolic heart failure

Clinical characteristics and outcome of percutaneous coronary intervention in Yemeni patients

Background: Percutaneous coronary intervention (PCI) is increasingly used in the management of acute coronary syndromes (ACSs). PCI has decreased the demand for coronary artery bypass grafting, and more patients with ACS are now undergoing PCI. No previous data about the characteristics and outcome of patients performing PCI in Yemen. This study aimed to assess the patient presentation, characteristics, and outcome among Yemeni patients having PCI in the Military Cardiac Center. Methods: All patients who underwent PCI either primary or elective in the Military Cardiac Center in Sanaa City were included over 6 months. Clinical, demographic, procedural, and outcome data were extracted and analyzed. Results: During the study period, 250 patients underwent PCI. The mean ± standard deviation age was 57 ± 11 years, with 84% being male. Of all the patients, 61.6% (156) smoked tobacco, 56% (140) had hypertension, 37% (93) had Type 2 diabetes, 48.4% (121) had hyperlipidemia, and 8% (20) had a family history of ischemic heart disease. Coronary artery presentation was in the form of acute ST-elevation myocardial infarction at 41% (102), non-STEMI at 5.2% (58), stable angina at 31% (77), and unstable angina at 5.2% (13). Coronary artery interventions were elective PCI in 81% (203), emergency in 11% (27), and urgent in 8% (20) with only 3% radial artery access and 97% femoral access. PCI was mainly in the left anterior descending artery in 82% (179), right coronary artery in 41% (89), left circumflex artery in 23% (54), and left main in 1.25% (3). All stents were drug-eluting stents during the registry time. Complication occurred in 17.6% (44) and case fatality was 2% (5). Conclusions: Despite the current situation in Yemen, PCI was performed with success in a large number of patients with a low incidence of inhospital complications and mortality that is comparable to high- or middle-income settings

Egyptian consensus on treat-to-target approach for osteoporosis: a clinical practice guideline from the Egyptian Academy of bone health and metabolic bone diseases

Abstract Background This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for osteoporosis using Delphi technique. A scientific committee identified researchers and clinicians with expertise in osteoporosis in Egypt. Delphi process was implemented (2 rounds) to establish a consensus on 15 clinical standards: (1) concept, (2) diagnosis, (3) case identification, (4) whom to treat, (5) who should treat?, (6) case stratification and intervention thresholds, (7) falls risk, (8) investigations, (9) treatment target, (10) management, (11) optimum treatment duration, (12) monitoring, (13) drug holiday, (14) osteoporosis in men, and (15) post-fracture care and fracture liaison service. Results The surveys were sent to an expert panel (n = 25), of whom 24 participated in the two rounds. Respondents were drawn from different governorates and health centres across Egypt including the Ministry of Health. Most of the participants were rheumatologists (76%), followed by internists (8%), orthopaedic doctors (4%), rehabilitation doctors (4%), primary care (4%), and ortho-geriatrics (4%) physicians. Seventy-two recommendations, categorised into 15 sections, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.4 to 100%. Consensus was reached (i.e. ≥ 75% of respondents strongly agreed or agreed) on the wording of all 15 clinical standards identified by the scientific committee. An algorithm for the management of postmenopausal osteoporosis has been suggested. Conclusion A wide and representative panel of experts established a consensus regarding the management of osteoporosis in Egypt. The developed guidelines provide a comprehensive approach to the assessment and management of osteoporosis for all Egyptian healthcare professionals who are involved in its management