Persuasive Strategies in the Discourses of World Health Organization on Covid-19

       في 31 ديسمبر 2019، تلقت منظمة الصحة العالمية معلومات من لجنة الصحة الوطنية بشأن تفشي فايروس كوفيد-19الذي حددته السلطات الصينية. يبدو أن منظمة الصحة العالمية اعتمدت إلى حد كبير في توجيهاتها وتعليماتها على ما تقدمه او تعلنه السلطات الصينية. وبالتالي، تم تبني استراتيجيات إيجابية وسلبية في التعامل مع هذا الوباء. وقد سبب هذا الامر قدرًا كبيرًا من الخوف والارتباك عند الناس في العالم على الرغم من كل الجهود الكبيرة التي تبذلها منظمة الصحة العالمية لاجتياز هذه المرحلة المصيرية بنجاح وأمان. تعد الدراسة الحالية واحدة من أولى الدراسات التي تسعى إلى تقديم تحليل خطاب نقدي ووصف لإستراتيجيات الإقناع المستخدمة في الخطاب المؤسسي وتفسيرها وشرحها، وبشكل أكثر تحديدًا لخطابات منظمة الصحة العالمية  (WHO) بشأن كوفيد-19 باستخدام إستراتيجيات لارسن للإقناع (2010).           لقد وجدت الدراسة أن منظمة الصحة العالمية تستخدم إستراتيجيات إقناع معينة تتمثل باستخدام جمل بسيطة تعكس أن الموقف بسيط خاصة في بداية الأزمة، ثم استخدام جملة معقدة لإظهار أن الموقف قد أصبح أكثر تعقيدًا وأن هناك حاجة لاتباع التدابير العلمية الصحيحة حتى العثور على لقاح مناسب. هناك أيضًا استخدام الصفات التي تعكس عدم اليقين لدى منظمة الصحة العالمية في إيجاد خارطة الطريق المناسبة للتعامل مع هذا الوباء. وتوصلت الدراسة إلى أن هذه الإستراتيجيات المقنعة يجب أن تستند إلى وجهات نظر علمية ونفسية ومعرفية واجتماعية وثقافية وليست علمية فقط لكونها تستخدم لإقناع مختلف شرائح الناس في العالم وقد تؤثر فعليًا على حياتهم بشكل إيجابي أو سلبي.          On 31 December 2019, WHO received information from National Health Commission concerning the outbreak of Covid-19 which was identified by the Chinese authorities. Unfortunately, it seems that WHO depends to great extent on its announcements and instructions on China authorities’ declaration. Consequently, positive and negative announcements and strategies are adopted in dealing with this pandemic. This causes a great extent of fear and confusion for people around the world despite all the great efforts that WHO to pass this crucial period successfully and safely. The present study is one of the first studies that seeks to offer critical discourse analysis, description, interpretation, and explanation of persuasive strategies of institutional discourse, and more specifically of WHO on Covid-19 by using Larson’s persuasive strategies (2010). It is found that WHO uses certain persuasive strategies by using simple sentences which reflect that the situation is a simple one especially at the beginning of the crisis, then using a complex sentence to show that the situation becomes more complex and there is a need to follow the right measures till finding a suitable vaccine. There is also the use of adjectives that reflect the uncertainty of WHO in finding a suitable roadmap for dealing with this pandemic. It is also found that these persuasive strategies should be based on scientific, psychological, cognitive, social, and cultural perspectives and not just scientific ones because they are used to persuade different people around the world and may affect their lives positively or negatively. &nbsp

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

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

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

Comparison of ED patients satisfaction score between pre-implementation and post-implementation (The scale score based on: 1 = very poor; 2 = poor; 3 = fair; 4 = good; 5 = very good).

Comparison of ED patients satisfaction score between pre-implementation and post-implementation (The scale score based on: 1 = very poor; 2 = poor; 3 = fair; 4 = good; 5 = very good).</p

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

Bounce-back and high-risk bounce-back rate in the pre- and post-implementation periods.

Bounce-back and high-risk bounce-back rate in the pre- and post-implementation periods.</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

Vendor recommendations and specific recommendations for low-resource setting.

Vendor recommendations and specific recommendations for low-resource setting.</p

Mean visit to admission decision time for the post-implementation period by month with the mean of the pre-implementation period as baseline.

Mean visit to admission decision time for the post-implementation period by month with the mean of the pre-implementation period as baseline.</p