COMPLIANCE OF HEALTHCARE STAFF TOWARDS INFECTION CONTROL PRECAUTIONS IN HEMODIALYSIS UNITS – GAZA GOVERNORATES

Abstract:Objective: Health care associated infections are the most frequent adverse event in health care delivery, which lead to significant mortality and financial burden for health systems. This study aimed to assess the health care providers' compliance with infection control practices in the hemodialysis units.Methods: A cross sectional, analytical design with census sample was used.  The data were collected using interviewing questionnaire and observational checklist for the practice of health care providers. In total, 77 questionnaires were collected, 228 practice observational checklists and five physical environment observational checklists.Results: The study findings revealed that hospital management does not practice its role efficiently in encouraging health care providers to be compliant with infection prevention and control protocol. Findings of the study revealed that the majority of the study participants had not adequate training (79.2%) about the infection prevention and control protocol. The findings of the standard precaution showed that the compliance with hand hygiene score was 56.2%; personnel protective equipment score was 87.5%; using waste management score was 39.6%; environmental infection control practices score was 54.3% and aseptic technique score was 62.8%. however, additional precaution score was 56.5%.  Moreover, the study revealed that 45.8% of the health care providers were exposed to an injury from used needles or sharp medical instruments. The study also found that 93.5% of the health care providers working in the hemodialysis unit received the recommended three doses of hepatitis B vaccine. Finally, the study showed that there are a statistical deference's between hospitals and all standard precaution domains (P value= .000), while part of standard precaution domains (personnel protective equipment, waste management, environmental infection control practices) had a statistical difference with occupational type respectively (.000, .008, .031).Conclusion: There is a need to develop a Palestinian infection prevention and control protocol special for hemodialysis unit. A continuous education and training programs for healthcare staff and physical environmental fitness concerning Infection Prevention and Control protocol should be implemented.Key words:  Hospital acquired, Hemodialysis units, Infection control, Complianc

ASSESSMENT OF THE STATUS OF PRIVATE AND NON-GOVERNMENTAL PHARMACEUTICALS SUPPLY WAREHOUSES IN GAZA STRIP, PALESTINE.

  Objective: Storage of medicine is one of the most important stages in the pharmaceuticals and medical preparations management, which influences the quality and the effectiveness of these products. The study was conducted to assess the storage system of the drugs, medical disposables and their management in the private and local NGOs medical warehouses in Gaza Strip.Methods: A cross-sectional study using interviewing questionnaire and checklist was carried out at (16) local NGOs including 33 employees and (29) private warehouses including 57 employees.Results: The quality of construction of private and local warehouses were enough satisfied (80%), while stock management and quality control were in a need to improvement (44.5%), in which the quality of stock control and conditions of local NGOs were higher than private warehouses. Inadequate training courses were given in store related work. The majority of warehouses did not have practical guidelines and written procedures for dealing with storage procedure; also, there is inadequate safety and security system. About 37% of them kept controlled drugs in a separate storage space designated for this purpose. More than half of warehouses always quarantined medical supplies until the quality is checked. 60% of warehouses used first expire first out dispensing policy for medical supplies. 56% of the warehouses measure temperature, while not all warehouses measured humidity.Conclusion: Warehouses need to pay attention to the commodity management cycle and to ensure the availability of safety measurements. Provision of training to employees dealing with the storage process is essential accompanied by monitoring and supervision

Optimization of Exploration and Production Sharing Agreements Using the Maxi-Min and Nash Solutions

Cooperation between supply chain partners in the oil industry is essential, especially when oil prices suffer from fluctuations that affect the profitability of each party. An essential task in oil field development projects is to create an optimum agreement between the national oil company and the international oil company to guarantee agreement optimization. In this paper, the national oil company is the first party (FP) and the international oil company is the second party (SP). The paper’s purpose is to investigate the use of game theory to obtain the best agreement between the FP and SP in order to enhance the cooperation and reduce conflict. In this paper, Nash and Maxi-min solutions have been applied for the first time in a special type of petroleum agreement, called exploration and production sharing agreements (EPSA). This is conducted for a case study in Libya. The study considers nine negotiation factors (issues) in the EPSA, which are the share percent, the four “A” factors, and the four “B” factors, which are usually affected by the fluctuations of oil prices; and the study investigates their effect on the total payoff function, the net present value (NPV), and internal rate of return (IRR) for both parties. The Maxi-min solution has shown an improvement in the NPV and IRR of the SP, where NPV increased from USD 148 million to USD 195 million, and IRR from 15.65% to 17.01%. The Nash solution has shown a little more improvement than the Maxi-min solution in the NPV and IRR for the SP, where the NPV and IRR have increased from USD 148 million to USD 222 million and from 15.65% to 17.94%, respectively

Efficiency of High and Standard b Value Diffusion-Weighted Magnetic Resonance Imaging in Grading of Gliomas

Background. Glioma is the most common fatal malignant tumor of the CNS. Early detection of glioma grades based on diffusion-weighted imaging (DWI) properties is considered one of the most recent noninvasive promising tools in the assessment of glioma grade and could be helpful in monitoring patient prognosis and response to therapy. Aim. This study aimed to investigate the accuracy of DWI at both standard and high b values (b = 1000 s/mm2 and b = 3000 s/mm2) to distinguish high-grade glioma (HGG) from low-grade glioma (LGG) in clinical practice based on histopathological results. Materials and Methods. Twenty-three patients with glioma had DWI at l.5 T MR using two different b values (b = 1000 s/mm2 and b = 3000 s/mm2) at Al-Shifa Medical Complex after obtaining ethical and administrative approvals, and data were collected from March 2019 to March 2020. Minimum, maximum, and mean of apparent diffusion coefficient (ADC) values were measured through drawing region of interest (ROI) on a solid part at ADC maps. Data were analyzed by using the MedCalc analysis program, version 19.0.4, receiver operating characteristic (ROC) curve analysis was done, and optimal cutoff values for grading gliomas were determined. Sensitivity and specificity were also calculated. Results. The obtained results showed the ADCmean, ADCratio, ADCmax, and ADCmin were performed to differentiate between LGG and HGG at both standard and high b values. Moreover, ADC values were inversely proportional to glioma grade, and these differences are more obvious at high b value. Minimum ADC values using standard b value were 1.13 ± 0.17 × 10−3 mm2/s, 0.89 ± 0.85 × 10−3 mm2/s, and 0.82 ± 0.17 × 10−3 mm2/s for grades II, III, and IV, respectively. Concerning high b value, ADCmin values were 0.76 ± 0.07 × 10−3 mm2/s, 0.61 ± 0.01 × 10−3 mm2/s, and 0.48 ± 0.07 × 10−3 mm2/s for grades II, III, and IV, respectively. ADC values were inversely correlated with results of glioma grades, and the correlation was stronger at ADC3000 (r = −0.722, P≤0.001). The ADC3000 achieved the highest diagnostic accuracy with an area under the curve (AUC) of 0.618, 100% sensitivity, 85.7% specificity, and 85.7% accuracy for glioma grading at a cutoff point of ≤0.618 × 10−3 mm2/s. The high b value showed stronger agreement with histopathology compared with standard b value results (k = 0.89 and 0.79), respectively. Conclusion. The ADC values decrease with an increase in tumor cellularity. Meanwhile, high b value provides better tissue contrast by reflecting more tissue diffusivity. Therefore, ADC-derived parameters at high b value are more useful in the grading of glioma than those obtained at standard b value. They might be a better surrogate imaging sequence in the preoperative evaluation of gliomas

Towards a Scale of Islamic Work Ethic: Validation from Middle Eastern Countries

This paper aims at developing a valid scale of Islamic work ethics in the Middle Eastern region. Building on an extensive review of the work ethic scales presented in the literature, 15 items were formulated and assessed by experts in the field of Islamic studies. Data were collected from two samples: Sample A (N. 525) represents employees working in diverse sectors in Palestine and Jordan, and Sample B (N. 727) represents employees working in several sectors in Oman, Qatar, and UAE. Questionnaires were distributed online to the participants. Data were subject to different validity and reliability checks. These included exploratory factor analysis, confirmatory factor analysis, convergent validity, discriminant validity, and internal consistency. Our results suggested a 12-item unidimensional scale. The originality of this work stems from the fact that it presents the first Islamic work ethic scale developed and confirmed using data collected from several countries in the region

Influence of Oral Dipping Tombak Smokeless Tobacco on Coagulation Profile and Platelet Counts

The goal of this paper is to investigate the influence of oral dipping of Tombak Smokeless Tobacco (SLT) on prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio(INR) values, and platelet counts (PLTs), in Sudanese Tombak users. An analytical cross-sectional study was conducted at Kosti health insurance hospital, Sudan, in 2019. According to the inclusion and exclusion criteria, 100 adult users of oral Tombak for three or more years were chosen randomly as a study group. Another 100 matched healthy individuals who never used Tombak were randomly selected as a comparative group. Venous blood specimens were collected in ethylene diamine tetra-acetic acid (EDTA) containers for the PLT counts using the automated haematology analyser (Sysmex, Tokyo, Japan XK-21SYSMEX) and in trisodium citrate anti-coagulant containers for coagulation tests using a co-agulometer machine analyser. Our findings show a significant decrease in PLT count mean values in the Tombak users group (212.1 × 103/mm3 ± 74.3 × 103/mm3) compared with the non-taking Tombak group mean values (243.2 × 103/mm3 ± 83.0 × 103/mm3), (p p p p p < 0.001). In conclusion, using Tombak a Smokeless Tobacco (SLT) for a long period significantly affect Platelet counts and coagulation profile

Effect of B12 supplementation on renal anemia among hemodialysis patients at El-Najar hospital, Gaza strip

Introduction: Patients with end-stage renal disease (ESRD) are predisposed to nutritional deficiencies, resulting in vitamin B12 deficiency with negative hematologic consequences. Objective: This study aimed to investigate the impact of intramuscular B12 on renal anemia among ESRD patients receiving hemodialysis (HD) at El-Najar hospital, Gaza Strip. Patients and Methods: A case-control study conducted, which included 110 healthy controls and 110 HD patients who received B12 on a daily, weekly, and monthly basis over two months. Sociodemographics and current diseases were reported. Serum levels of serum B12, white blood cell (WBC), red blood cell (RBC), hemoglobin (Hb), mean corpuscular volume (MCV), and platelet (PLT) were recorded before and after treatment. Data analysis was conducted using SPSS. Results: Baseline serum B12 level was significantly lower in HD patients compared to controls (362.62 ± 166.40 versus 483.36 ± 115.07 ρg/mL, P<0.001), which significantly improved after vitamin B12 treatment (639.08 ± 362.99 ρg/mL, P<0.001). Additionally, mean WBCs, RBCs, Hb, and PLT levels were significantly increased after treatment (P<0.001). Serum B12 level was positively and significantly (P<0.001) correlated with levels of WBC (r = 0.45), RBC (r = 0.43), Hb (r = 0.39) and PLT (r = 0.51), and negatively correlated with MCV (r = -0.46, P<0.001). Conclusion: Administration of vitamin B12 improves serum B12 levels in HD patients, which was associated with increased WBCs, RBCs, Hb, and PLT levels and decreased MCV levels. Treatment by vitamin B12 can improve HD patients’ renal anemia. Future studies with larger sample sizes and prolonged follow-up are advocated