Cerebral vein thrombosis complicating influenza A in a toddler

We describe a child who presented with a respiratory illness in the influenza pandemic season and was found to be positive for the influenza A, he developed neurological manifestations of cranial nerve palsies and was found to have radiological evidence of cerebral sinus thrombosis. He received treatment with oseltamivir and supportive therapy and was discharged home free of long-term neurological sequelae. This is a rare complication which might have associated with this infection and has not been reported in children before as far as we are aware. Children who develop focal neurological signs during the course of flu epidemic should be evaluated for the possibility of cerebral sinus thrombosis

Review the Operational Excellence Factors of Service Firms: A Literature Review

Operational excellence is considered as a competitive weapon for firms, both in service and manufacturing. Firms should therefore carefully study their operation strategy choices due to the high impact that results from applying operation strategy decisions on operational excellence. There are many factors that can lead to operational excellence, including leadership, human resource management practices, operations strategy, and involvement culture, and these will be the focus of this work. This research reviews the literature related to operations and excellence in service firms. Moreover, it investigates the factors that affect the operational excellence of service sector.  In the literature, operational excellence for the service sector is still ambiguous. This research is an attempt to take advantage of the developments made in the industrial field, while at the same time drawing together different factors that have been studied separately in the past. We propose a theoretical framework that investigates some factors that affect operational excellence. Therefore, we propose implementing our theoretical model in the service sector, amongst others. Moreover, we suggest a further investigation on the obstacles may face the firms to reach operational excellence.

Evaluation of an intensive education program on the treatment of tobacco-use disorder for pharmacists: A study protocol for a randomized controlled trial

Background: Tobacco use is presently responsible for the death of over seven million people across the world. In Qatar, it is one of the main causes of premature deaths and preventable diseases. To reduce tobacco use, Qatar has ratified the World Health Organization (WHO)'s Framework Convention on Tobacco Control (FCTC) and has implemented many tobacco-control initiatives. In spite of these measures, tobacco use is still considered a public health threat in Qatar. Pharmacists practicing in retail/community pharmacy settings are often the first port of call for individuals requiring general health advice. Evidence has proven that they have a pivotal role in health promotion and disease prevention including tobacco cessation. However, pharmacists in Qatar are not actively involved in tobacco control and many have not received any education or training about smoking cessation counseling in the past. In an effort to build the capacity of pharmacists towards tobacco control in Qatar, the aim of the proposed study is to design, implement, and evaluate an intensive education program on tobacco dependence treatment for pharmacists in Qatar. Methods/design: The study will be a prospective randomized controlled trial comparing an intensive tobacco-related education program versus non-tobacco-related training on pharmacists' tobacco-use-related knowledge, attitudes, self-efficacy, and skills. Community pharmacists practicing in Qatar will be eligible for participation in the study. A random sample of pharmacists will be selected for participation. Consenting participants will be randomly allocated to intervention or control groups. Participants in the intervention group will receive an intensive education program delivered by a multi-disciplinary group of educators, researchers, and clinicians with expertise in tobacco cessation. A short didactic session on a non-tobacco-related topic will be delivered to pharmacists in the control group. The study has two primary outcomes: post-intervention tobacco-related knowledge and post-intervention skills for tobacco cessation assessed using a multiple-choice-based evaluation instrument and an Objective Structured Clinical Examination (OSCE), respectively. The secondary study outcomes are post-intervention attitudes towards tobacco cessation and self-efficacy in tobacco-cessation interventions assessed using a survey instrument. An additional secondary study outcome is the post-intervention performance difference in relation to tobacco-cessation skills in the practice setting assessed using the simulated client approach. Discussion: If demonstrated to be effective, this education program will be considered as a model that Qatar and the Middle East region can apply to overcome the burden of tobacco-use disorder. Trial registration: ClinicalTrials.gov, ID: NCT03518476. Registered on 8 May 2018. Version 1/22 June 2018. 2019 The Author(s).ASHP: American Society of Health-System Pharmacists; ATTUD: Association for the Treatment of Tobacco use and Dependence; CE: Continuous education; CPG: Clinical practice guidelines; FCTC: Framework Convention on Tobacco Control; FIP: International Pharmaceutical Federation; GATS: Global Adult Tobacco Survey; GYTS: Global Youth Tobacco Survey; HMC: Hamad Medical Corporation; MCQ: Multiple choice question; ME: Middle East; NRT: Nicotine replacement therapy; OSCE: Objective Structured Clinical Examination; PBL: Problem-based learning; QCHP: Qatar Council for Healthcare Practitioners; QU: Qatar University; SPIRIT: Standard Protocol Items: Recommendations for Interventional Trials; SPSS: Statistical Package of Social Sciences; TTM: Transtheoretical model; WHO: World Health OrganizationScopu

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: a retrospective study

Abstract Background Elevated lactate has been found to be associated with a higher mortality in a diverse patient population. The aim of the study is to investigate if initial serum lactate level is independently associated with hospital mortality for critically ill patients presenting to the Emergency Department. Methods Single-center, retrospective study at a tertiary care hospital looking at patients who presented to the Emergency Department (ED) between 2014 and 2016. A total of 450 patients were included in the study. Patients were stratified to lactate levels: 4 mmol/L. The primary outcome was in-hospital mortality. Secondary outcomes included 72-h hospital mortality, ED and hospital lengths of stay. Results The mean age was 64.87 ± 18.08 years in the 4 mmol/L group. All 3 groups were comparable in terms of age, gender and comorbidities except for diabetes, with the 2-4 mmol/L and >4 mmol/L groups having a higher proportion of diabetic patients. The mean lactate level was 1.42 ± 0.38 (4 mmol/L). In-hospital mortality was found to be 4 (2.7%), 18(12%) and 61(40.7%) patients in the low, intermediate and high lactate groups respectively. ED and hospital length of stay were longer for the >4 mmol/L group as compared to the other groups. While adjusting for all variables, patients with intermediate and high lactate had 7.13 (CI 95% 2.22–22.87 p = 0.001) and 29.48 (CI 95% 9.75–89.07 p = <0.001) greater odds of in-hospital mortality respectively. Discussion Our results showed that for all patients presenting to the ED, a rising lactate value is associated with a higher mortality. This pattern was similar regardless of patients’ age, presence of infection or blood pressure at presentation. Conclusion Higher lactate values are associated with higher hospital mortalities and longer ED and hospital lengths of stays. Initial ED lactate is a useful test to risk-stratify critically ill patients presenting to the ED

A pharmacist-delivered smoking cessation program in Qatar: an exploration of pharmacists' and patients' perspectives of the program

Background Tobacco use is one of the major causes of morbidity and mortality. An intensive pharmacist-delivered smoking cessation program was implemented in eight primary care pharmacies in Qatar. Objective This study aimed to qualitatively explore the perspectives of pharmacists and patients regarding their experiences in the program and their recommendations for improving it. Setting Primary care in Doha, Qatar. Method This study used a qualitative case study approach with semi-structured interviews of a sample of patients and pharmacists who participated in the program. Interviews were conducted between October 2016 and June 2017, were audio-recorded and transcribed verbatim. A thematic approach for data analysis was used. Main outcome measures Perspectives of pharmacists and patients. Results Pharmacists who delivered the program (n = 17) and patients who completed the program's outcomes assessment (n = 68) were invited through telephone call or email. Eight pharmacists and 22 patients were interviewed. Seven themes emerged: (1) both pharmacists and patients had positive experiences and both considered pharmacists as among the most suitable healthcare providers to provide smoking cessation interventions (2) both pharmacist and patient participants indicated that the program provided successful services (3) pharmacists identified several challenges for implementing the program including difficulty in motivating and in following-up patients, workplace barriers, communication and cultural barriers, (4) both pharmacists and patients perceived several barriers for quitting including lack of motivation to quit or to commit to the plan, high nicotine dependence, stress and personal problems (5) both pharmacists and patients considered several patient-related facilitators for quitting including development of smoking related complications, religious beliefs and external support; (6) use of smoking cessation medications was considered a program-related facilitator for quitting by patients whereas behavioral therapy was perceived to be a facilitator by pharmacists (7) pharmacists and patients proposed strategies for program improvement including enhancing pharmacist training and patient recruitment. Conclusion The program was perceived to be beneficial in helping patients quit smoking, and it positively contributed to advancing pharmacist role. The study findings can guide future development of successful pharmacist' smoking cessation programs in Qatar. 2021, The Author(s).This publication is made possible by a student grant by Qatar University (QUST-CPH-SPR\2017-1).Scopu

Assessment of an intensive education program on the treatment of tobacco-use disorder for pharmacists using OSCE (Objective Structured Clinical Examination)

Introduction: Tobacco use is one of the main causes of morbidity and mortality in Qatar. The aim of this randomized controlled trial (RCT) is to design, implement, and evaluate an intensive education program on tobacco-use treatment for pharmacists in Qatar. The study objectives are to assess the effectiveness of the program on pharmacists' skills toward tobacco cessation. Methods: A random sample of community pharmacists in Qatar was selected for participation. Consenting participants were randomly allocated to intervention or control groups. Participants in the intervention group received an intensive education program on treatment of tobacco-use disorder. A short didactic session on a non-tobacco-related topic was delivered to pharmacists in the control group. The pharmacists' tobacco cessation skills were assessed using an Objective Structured Clinical Examination (OSCE). Six-station OSCE targeting core smoking cessation competencies and skills was completed by participants in both groups. Performance of participants was assessed using validated assessment checklists that comprised analytical and global assessment sections. Results: A total of 54 and 32 participants in the intervention and the control group respectively completed the OSCE. Overall, pharmacists in the intervention group performed better in the analytical and global assessment sections than those in the control group. For example, for case 1, mean scores for developing rapport, data gathering and management were 2.76 vs 0.97 (p-<0.001), 5 vs 2.81 (p <0.001), and 3.5 vs 2.25 (p=0.001) respectively for the intervention group compared to the control group. Mean total analytical scores were 12.06 vs 6.4 (p-<0.001) for intervention compared to the control group for case 1. Furthermore, mean global assessment scores for case 1 were 3.19 vs 2.41 (p=0.009) for the intervention compared to the control group. Conclusion: The study results suggest that provision of an intensive educational program on the treatment of tobacco use results in improved skills toward tobacco cessation

A pharmacist-delivered smoking cessation program in Qatar: an exploration of pharmacists’ and patients’ perspectives of the program

Background Tobacco use is one of the major causes of morbidity and mortality. An intensive pharmacist-delivered smoking cessation program was implemented in eight primary care pharmacies in Qatar. Objective This study aimed to qualitatively explore the perspectives of pharmacists and patients regarding their experiences in the program and their recommendations for improving it. Setting Primary care in Doha, Qatar. Method This study used a qualitative case study approach with semi-structured interviews of a sample of patients and pharmacists who participated in the program. Interviews were conducted between October 2016 and June 2017, were audio-recorded and transcribed verbatim. A thematic approach for data analysis was used. Main outcome measures Perspectives of pharmacists and patients. Results Pharmacists who delivered the program (n = 17) and patients who completed the program’s outcomes assessment (n = 68) were invited through telephone call or email. Eight pharmacists and 22 patients were interviewed. Seven themes emerged: (1) both pharmacists and patients had positive experiences and both considered pharmacists as among the most suitable healthcare providers to provide smoking cessation interventions (2) both pharmacist and patient participants indicated that the program provided successful services (3) pharmacists identified several challenges for implementing the program including difficulty in motivating and in following-up patients, workplace barriers, communication and cultural barriers, (4) both pharmacists and patients perceived several barriers for quitting including lack of motivation to quit or to commit to the plan, high nicotine dependence, stress and personal problems (5) both pharmacists and patients considered several patient-related facilitators for quitting including development of smoking related complications, religious beliefs and external support; (6) use of smoking cessation medications was considered a program-related facilitator for quitting by patients whereas behavioral therapy was perceived to be a facilitator by pharmacists (7) pharmacists and patients proposed strategies for program improvement including enhancing pharmacist training and patient recruitment. Conclusion The program was perceived to be beneficial in helping patients quit smoking, and it positively contributed to advancing pharmacist role. The study findings can guide future development of successful pharmacist’ smoking cessation programs in Qatar.Other Information Published in: International Journal of Clinical Pharmacy License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1007/s11096-021-01286-3</p

Chemical Characterization of Clove, Basil and Peppermint Essential Oils; Evaluating Their Toxicity on the Development Stages of Two-Spotted Spider Mites Grown on Cucumber Leaves

The two spotted spider mite (TSSM), Tetranychus urticae Koch, is a cosmopolitan mite. It rapidly reproduces and can develop resistance to chemical pesticides. This study aims to evaluate the toxicity and acaricidal activity of three essential oils from basil, clove, and peppermint against T. urticae reproduction, which is grown on three cucumber cultivars, Chief (SC 4145), Raian (CB898), and Toshka (SC 349), under laboratory conditions at 27 + 3 &deg;C and 70 + 5% RH. GC-MS characterized the volatile oils of basil, clove, and peppermint. Methyl cinnamate, eugenol, and menthol were the main essential oils in basil, clove, and peppermint, respectively. The results indicated significant differences in the duration of development between T. urticae feeding on the three cucumber cultivars (p &le; 0.05), including eggs, protonymph, and deutonymph time. The Toshka (SC 349) cultivar recorded the lowest developmental time. The longevity period exhibited the same trend with non-significant differences between Raian (CB898) and Toshka (SC 349). Moreover, the lethal concentration (LC50) and LC90 values in tested essential oils (EOs) showed that clove EOs were the most toxic. In contrast, basil and peppermint EOs were the least effective, and immature stages were more sensitive to EOs than adult stages. The infected Toshka (SC 349) discs treated with essential oils and abamectin under in vitro conditions indicated that clove oil is comparable to abamectin regarding its effect on the egg numbers (18.7 and 17.6 egg), immature development time, longevity, life span, and life cycle (20.6 and 20.8 days) of T. urticae. We conclude that the resistant cultivation of cucumber plants can be recommended in integrated pest management programs. The most effective of the tested oils, clove EOs, should be used as alternatives to pesticides to control T. urticae in the protected cultivation of cucumbers