Data-Driven Market Segmentation: The Case of Medical Tourists in Lebanon

Purpose – This research aims to obtain an in-depth understanding of medical tourists’ segments and the variations that exist within them as tourists and patients. Design/Methodology/Approach – A data-driven segmentation approach using the two-step cluster analysis technique was applied on a sample of 212 participants visiting Lebanon for medical purposes. The research instruments combine travel motivation variables, along with socio-demographic, geographic, and behavioral characteristics. Findings and implications – The results identified two distinct segments: “the international patients” and “the elective medical tourists.” The delineated segments have significant implications for scholars, allowing them to understand the profile of tourists and their associated motivations and behaviors better. They can guide medical tourism service providers, marketers, and destination managers in providing specific medical tourism products and services that meet the expectations of each segment. Limitations – Limitations were experienced during the data collection process due to a lack of collaboration and prompt responses by some medical centers, as well as the political and economic contexts of Lebanon that discouraged tourism inflow. These limitations prevented the researchers from obtaining a larger sample size. Originality – There is limited understanding of medical tourists and their diversities in medical tourism literature to date. This study addresses the gap by proposing a new segmentation method in the field of medical tourism that delineates segments by investigating medical tourists’ travel motivations in line with their characteristics

Access-Site Complications in Transfemoral Neuroendovascular Procedures: A Systematic Review of Incidence Rates and Management Strategies

BACKGROUND: The femoral artery is the most common access route for cerebral angiography and neurointerventional procedures. Complications of the transfemoral approach include groin hemorrhages and hematomas, retroperitoneal hematomas, pseudoaneurysms, arteriovenous fistulas, peripheral artery occlusions, femoral nerve injuries, and access-site infections. Incidence rates vary among different randomized and nonrandomized trials, and the literature lacks a comprehensive review of this subject. OBJECTIVE: To gather data from 16 randomized clinical trials (RCT) and 17 nonrandomized cohort studies regarding femoral access-site complications for a review paper. We also briefly discuss management strategies for these complications based on the most recent literature. METHODS: A PubMed indexed search for all neuroendovascular clinical trials, retrospective studies, and prospective studies that reported femoral artery access-site complications in neurointerventional procedures. RESULTS: The overall access-site complication rate in RCTs is 5.13%, while in in non-RCTs, the rate is 2.78%. The most common complication in both groups is groin hematoma followed by access-site hemorrhage and femoral pseudoaneurysm. On the other hand, wound infection was the least common complication. CONCLUSION: The transfemoral approach in neuroendovascular procedures holds risk for several complications. This review will allow further studies to compare access-site complications between the transfemoral approach and other alternative access sites, mainly the transradial approach, which is gaining a lot of interest nowadays

Staged hepatectomy for bilobar colorectal hepatic metastases

AbstractObjectivesThis study describes the management of patients with bilobar colorectal liver metastases (CRLM).MethodsA retrospective collection of data on all patients with CRLM who were considered for staged resection (n= 85) from January 2003 to January 2011 was performed. Patients who underwent one hepatic resection were considered to have had a failed staged resection (FSR), whereas those who underwent a second or third hepatic resection to produce a cure were considered to have had a successful staged resection (SSR). Survival was calculated from the date of diagnosis of liver metastases. Complete follow-up and dates of death were obtained from the Government of Quebec population database.ResultsMedian survival was 46months (range: 30–62months) in the SSR group and 22months (range: 19–29months) in the FSR group. Rates of 5-year survival were 42% and 4% in the SSR and FSR groups, respectively. Fifteen of the 19 patients who remained alive at the last follow-up date belonged to the SSR group.ConclusionsIn patients in whom staged resection for bilobar CRLM is feasible, surgery would appear to offer benefit

Letter: Thrombotic Neurovascular Disease in COVID-19 Patients.

Although the respiratory system is the primary target of the coronavirus, studies have demonstrated a strong tropism to the central nervous system (CNS).1,2 The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. This receptor is also found in the CNS and plays a crucial role in autoregulating cerebral perfusion pressure.3,4 Additionally, epidemiological data demonstrated increased mortality due to cardiovascular and cerebrovascular diseases during flu pandemics due to a hypercoagulable state.5,6 The triad of neuroinvasion of SARS-CoV-2, induction of hypercoagulable state,5-9 and the inhibition of ACE2 blocking the formation of Angiotensin (1-7) serve as the pathophysiology for neurovascular insults.3,4 We present a case series of coronavirus disease 2019 (COVID-19) patients from 2 health systems developing cerebrovascular insult

Transradial approach for diagnostic cerebral angiograms in the elderly: a comparative observational study

Introduction: The transradial approach (TRA) reduces mortality, morbidity, access site complications, hospital cost, and length of stay while maximizing patient satisfaction. We aimed to assess the technical success and safety of TRA for elderly patients (aged ≥75 years). Methods: A retrospective chart review and comparative analysis was performed for elderly patients undergoing a diagnostic cerebral angiogram performed via TRA versus transfemoral approach (TFA). Also, a second comparative analysis was performed among the TRA cohort between elderly patients and their younger counterparts. Results: Comparative analysis in the elderly (TRA vs TFA) showed no significant differences for contrast dose per vessel, fluoroscopy time per vessel, procedure duration, conversion rate, and access site complications. Radiation exposure per vessel was significantly lower in the elderly TRA group. The second comparison (TRA in elderly vs TRA in the young) showed no significant differences for contrast dose per vessel, radiation exposure per vessel, procedure duration, access site complication, and conversation rate. A trend for prolonged fluoroscopy time per vessel was observed in the elderly TRA group. Conclusion/Discussion: TRA is a technically feasible and safe option for diagnostic neurointerventional procedures in the elderly. Our small elderly cohort was not powered enough to show a significant difference in terms of access site complications between TRA and TFA

The Role of Critical Thinking in Helping Students Cope with Problems

Purpose: This research study aims to address the role of higher education programs in developing students’ critical thinking and problem-solving skills, emphasizing on the importance of the university professors’ role in nurturing these skills through the means they use in the classroom. The research also aims to highlight the difference in developing these skills among students between universities that follow the Francophone system and universities that follow the American system. Approach/Methodology/Design: To achieve the goal of this research, a descriptive approach was adopted to test the validity of the research hypotheses which are based on correlations between research variables related to higher education programs and the skill of critical thinking. A questionnaire was employed to collect data from the sample, which consisted of four private universities, divided into two groups which are two private universities that follow the American system, and two private universities that follow the Francophone system. The sample consisted of 120 students from universities that follow the American system, and 132 students from universities that follow the Francophone system. The students were selected from the Faculty of Economics and Business Administration. Findings: It was found out that there are statistically significant differences between the students’ answers regarding the extent of their ability to possess the skills of critical thinking and problem-solving in concerning to the universities in which they study, and we have also found that there are statistically significant differences in the student’s acquisition of these skills between the programs of Francophone and American universities according to their demographic characteristics and majors. Practical Implications: The study will be of great use for concerned authorities, emphasizing on critical thinking and problem-solving skills. Originality/value: The findings revealed a significant correlation between university programs and critical thinking and problem solving skills

The Role of Critical Thinking in Helping Students Cope with Problems

Purpose: This research study aims to address the role of higher education programs in developing students' critical thinking and problem-solving skills, emphasizing on the importance of the university professors' role in nurturing these skills through the means they use in the classroom. The research also aims to highlight the difference in developing these skills among students between universities that follow the Francophone system and universities that follow the American system. Approach/Methodology/Design: To achieve the goal of this research, a descriptive approach was adopted to test the validity of the research hypotheses which are based on correlations between research variables related to higher education programs and the skill of critical thinking. A questionnaire was employed to collect data from the sample, which consisted of four private universities, divided into two groups which are two private universities that follow the American system, and two private universities that follow the Francophone system. The sample consisted of 120 students from universities that follow the American system, and 132 students from universities that follow the Francophone system. The students were selected from the Faculty of Economics and Business Administration. Findings: It was found out that there are statistically significant differences between the students' answers regarding the extent of their ability to possess the skills of critical thinking and problem-solving in concerning to the universities in which they study, and we have also found that there are statistically significant differences in the student's acquisition of these skills between the programs of Francophone and American universities according to their demographic characteristics and majors. Practical Implications: The study will be of great use for concerned authorities, emphasizing on critical thinking and problem-solving skills. Originality/value: The findings revealed a significant correlation between university programs and critical thinking and problem solving skills

Results of the surveys assessing end-user satisfaction (on a scale from 1 to 6).

Results of the surveys assessing end-user satisfaction (on a scale from 1 to 6).</p

Baseline and demographic characteristics.

ObjectiveThere is paucity of information regarding electronic medical record (EMR) implementation in emergency departments in countries outside the United States especially in low-resource settings. The objective of this study is to describe strategies for a successful implementation of an EMR in the emergency department and to examine the impact of this implementation on the department’s operations and patient-related metrics.MethodsWe performed an observational retrospective study at the emergency department of a tertiary care center in Beirut, Lebanon. We assessed the effect of EMR implementation by tracking emergency departments’ quality metrics during a one-year baseline period and one year after implementation. End-user satisfaction and patient satisfaction were also assessed.ResultsOur evaluation of the implementation of EMR in a low resource setting showed a transient increase in LOS and visit-to-admission decision, however this returned to baseline after around 6 months. The bounce-back rate also increased. End-users were satisfied with the new EMR and patient satisfaction did not show a significant change.ConclusionsLessons learned from this successful EMR implementation include a mix of strategies recommended by the EMR vendor as well as specific strategies used at our institution. These can be used in future implementation projects in low-resource settings to avoid disruption of workflows.</div

Mean length of stay (LOS) for the post-implementation period with the mean of the pre-implementation value as baseline.

Mean length of stay (LOS) for the post-implementation period with the mean of the pre-implementation value as baseline.</p