Effect of Educational Program on Outcomes of Patients Undergoing Permanent Pacemakers’ Implantation

Contents: Patients undergoing permanent implantable pacemaker, challenge with multiple physical, psychological along with social complications. Teaching patients the essential points involving pacemaker management can prevent complications.Aim: The current study aimed to evaluate the effect of an educational program on outcomes of patients undergoing permanent pacemakers' implantation. Methods: A quasi-experimental pre/posttest and follow-up design were used to conduct this study. A convenient sample of 35 adult patients from both genders undergoing permanent pacemaker implantation was recruited from Beni-Suef University hospital's catheter lab, inpatient department, ICU, CCU, and outpatient cardiology clinic. Patients' interviewing questionnaire, patient performance checklist, pacemaker self-efficacy scale, and Aga Khan University Anxiety and Depression Scale were used to achieve this study's aim. Results: 91.4% of the studied patients had unsatisfactory total knowledge at the baseline, improved to 85.7% had a satisfactory knowledge immediately post educational intervention, and relatively maintained to 68.6% of them had a satisfactory level of total knowledge after four weeks of the program implementation. 97.1% of the studied patients had unsatisfactory total practice at the baseline, improved to 65.7% had a satisfactory practice immediately post educational intervention, and improved to 77.1% of them had a satisfactory level of total practice after four weeks of program implementation. 71.4%, and 85.7% of the studied patients were not confident at all with their ability to control symptoms and maintain their usual functions respectively before education. 91.4% of them reported a total low self-efficacy score before the educational intervention. In comparison, 45.7% were very confident in controlling symptoms and moderately confident in maintaining usual functions at the follow-up phase. Besides, 65.7 exhibited total high self-efficacy at the follow-up assessment. 57.1% of the studied patients exhibit severe anxiety at the baseline assessment, while 65.7% and 74.3% exhibit mild anxiety at the post and follow-up assessment. Conclusion: A statistically significant improvement in patients' knowledge, practice, self-efficacy, anxiety, and depression immediately and after four weeks compared to their baseline. The study recommended that the educational program be an essential part of the total management of patients undergoing implanted pacemakers

THE IMPACT OF AIRCRAFT CABIN DIGITALIZATION ON IMPROVING PASSENGER EXPERIENCE IN EGYPTAIR

This study aims to investigate the impact of aircraft cabin digitalization (smart electronically dimmable windows, intelligent seats, smart overhead bins, radio-frequency identification tags for luggage tracking, futuristic intelligent seats, and inflight virtual reality) on improving the inflight passenger experience in EgyptAir, as well as measuring passengers' interest in using digital cabins. Furthermore, exploring passengers’ intention to pay to use digital services, including futuristic intelligent seats, inflight virtual reality, and radio frequency identification tags for tracking luggage. To meet the research goals, a structured survey was designed and distributed among Egyptian frequent travelers in EgyptAir. A total of 311 complete surveys were collected and analyzed. Results indicated the high interest of Egyptian passengers in using the digital aircraft cabins in EgyptAir due to its significant impact on improving their inflight experience. Furthermore, analyses revealed the high intention of Egyptian passengers to pay to use inflight virtual reality and futuristic intelligent seats. However, they showed a moderate intention to pay to use radio frequency identification tags for tracking luggage

Variation in clinical presentation of childhood group A streptococcal pharyngitis in four countries

Funding Information: This study was supported by USAID. The Croatian and Latvian site was funded by the Department of Child and Adolescent Health and Development, World Health Organization, Geneva.We conducted a cross-sectional study from September 2001 to August 2003 during which children between 2 and 12 years of age presenting with complaint of sore throat were recruited from urban pediatric clinics in Brazil, Croatia, Egypt and Latvia. The objective of the study was to compare clinical signs and symptoms of children presenting to urban pediatric clinics with sore throat in and between countries and to identify common clinical criteria predicting group A beta hemolytic streptococcal (GAS) pharyngitis. Using a single standard protocol in all four sites, clinical data were recorded and throat swabs obtained for standard GAS culture in 2040 children. Signs and symptoms were tested for statistical association with GAS positive/negative pharyngitis, and were compared using X2 tests, ANOVA and Odds Ratios. Clinical signs of GAS pharyngitis in children presenting to clinics varied significantly between countries, and there were few signs or symptom that could statistically be associated with GAS pharyngitis in all four countries, though several were useful in two or three countries. Our results indicate that the clinical manifestations of pharyngitis in clinics may vary by region. It is therefore critical that clinical decision rules for management of pharyngitis should have local validation.publishersversionPeer reviewe

The utility of rapid antigen detection testing for the diagnosis of streptococcal pharyngitis in low-resource settings

Funding Information: This study was supported by USAID. The Croatian and Latvian sites were funded by the Department of Child and Adolescent Health and Development, World Health Organization, Geneva. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or the stated policy of the World Health Organization. Thermo Biostar donated the STREP A OIA MAX rapid test kits for use in this study free of charge.Objectives: To evaluate the utility of rapid antigen detection testing (RADT) for the diagnosis of group A streptococcal (GAS) pharyngitis in pediatric outpatient clinics in four countries with varied socio-economic and geographic profiles. Methods: We prospectively evaluated the utility of a commercial RADT in children aged 2-12 years presenting with symptoms of pharyngitis to urban outpatient clinics in Brazil, Croatia, Egypt, and Latvia between August 2001 and December 2005. We compared the performance of the RADT to culture using diagnostic and agreement statistics, including sensitivity, specificity, and positive and negative predictive values. The Centor scores for GAS diagnosis were used to assess the potential effect of spectrum bias on RADT results. Results: Two thousand four hundred and seventy-two children were enrolled at four sites. The prevalence of GAS by throat culture varied by country (range 24.5-39.4%) and by RADT (range 23.9-41.8%). Compared to culture, RADT sensitivity ranged from 72.4% to 91.8% and specificity ranged from 85.7% to 96.4%. The positive predictive value ranged from 67.9% to 88.6% and negative predictive value ranged from 88.1% to 95.7%. Conclusions: In limited-resource regions where microbiological diagnosis is not feasible or practical, RADTs should be considered an option that can be performed in a clinic and provide timely results.publishersversionPeer reviewe

Perceptions of young Jordanian adults to proposed anti-tobacco pictorial warning labels

<p>Abstract</p> <p>Background</p> <p>In commitment to the Framework Convention on Tobacco Control (FCTC), four new pictorial warnings are now being proposed for display on cigarette packages sold in Jordan. The aim of this study was to gauge the immediate perceptions of young Jordanian adults towards these new pictorials and compare these perceptions to those of the pictorial currently being used in the country.</p> <p>Methods</p> <p>A cross-sectional survey was conducted on a convenience sample of youth aged 17-26. The interviewer-administered survey gauged participants' perceptions of salience, fear elicitation, and gained information as well as participants' motivation to remain non-smokers or quit smoking after viewing each of the four proposed new pictorials as well as the current pictorial used in Jordan. Perceptions regarding each new pictorial were compared to the current pictorial.</p> <p>Results</p> <p>A total of 450 surveys were included in the analysis. The sample (mean age 20.9) was 51.6% female and 31.3% cigarette (regular or occasional) smokers. In smokers, only one proposed pictorial had significantly more smokers perceiving it as salient or adding to information when compared to the current pictorial. More smokers reported fear when observing the proposed pictorials compared with current pictorial, but overall proportions reporting fear were generally less than 50%. Furthermore, all new pictorials motivated significantly more smokers to consider quitting compared with the current pictorial; however, the overall proportion of smokers reporting motivation was < 25%. Among nonsmokers, significantly more respondents perceived the new pictorials as salient and fear-eliciting compared to the old pictorial, but there were no major differences in information added. Motivation to remain non-smokers was comparable between the old and new pictorials.</p> <p>Conclusion</p> <p>Given the variability of response across both smokers and nonsmokers, and across the three elements of perception (salience, added information, fear) for each pictorial, further testing of the pictorials in a more diverse sample of Jordanian young adults prior to launch is recommended.</p

Treatment of streptococcal pharyngitis with once-daily amoxicillin versus intramuscular benzathine penicillin g in low-resource settings : A randomized controlled trial

Background: Primary prevention of acute rheumatic fever is achieved by proper antibiotic treatment of group A β -hemolytic streptococcal (GAS) pharyngitis. Methods: To assess noninferiority of oral amoxicillin to intramuscular benzathine penicillin G (IM BPG). Children (2 to 12 years) meeting enrollment criteria were randomized 1:1 to receive antibiotic treatment in 2 urban outpatient clinics in Egypt and Croatia. Results: A total of 558 children (Croatia = 166, Egypt = 392) were randomized, with 368 evaluable in an intention-to-treat (ITT) analysis, and 272 evaluable in the per protocol (PP) analysis. In Croatia, ITT and PP treatment success rates were comparable for IM BPG and amoxicillin (2.5% difference vs 1.1% difference, respectively). In Egypt, amoxicillin was not comparable with IM BPG in ITT analysis (15.1% difference), but was comparable in PP analysis (-9.3% difference). Conclusion: If compliance is a major issue, a single dose of IM BPG may be preferable for treatment of GAS pharyngitis.publishersversionPeer reviewe

Autosomal recessive IL12RB1 mutation: A case report of a Sudanese child and his father

IntroductionMendelian susceptibility to mycobacterial disease (MSMD) is a rare inherited condition characterized by selective susceptibility to weakly virulent mycobacteria, such as substrains of the bacille Calmette–Guérin (BCG) vaccine and different environmental mycobacteria.Case presentationA 7-year-old Sudanese boy was referred to the immunology clinic with a suspected diagnosis of MSMD. This followed multiple presentations with disseminated tuberculosis and typhoid fever. Genetic testing surprisingly revealed pathogenic homozygous variants in IL12RB1 Exon 9, c.913A&gt;T (p. Lys305*) in both the patient and his father, with a completely healthy asymptomatic carrier mother who is not blood related to the patient’s father.ConclusionIt is challenging to diagnose MSMD, especially in developing countries where health systems are poor and have limited resources. Family history and genetic tests may help in early MSMD treatment and avoiding disease complications

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London