Bahrain Defense Force Hospital Research Articles

Adverse Skin Reactions Among Frontline Personnel Due To Personal Protective Equipment Against COVID-19

Background: Coronavirus disease 2019 (COVID-19) has attracted global attention as it has expeditiously spread. Therefore, adherence to Personal Protective Equipment (PPE) has become a daily necessity, particularly among front-line personnel. However, PPE is associated with some adverse skin reactions; hence, this study aimed to investigate the characteristics and prevalence of adverse skin reactions from PPE usage. Methods: This cross-sectional study with a random sample was carried out at Bahrain Defense Force Hospital (BDF) from January to March 2021, targeting the front-line personnel. An online questionnaire was sent regarding adverse skin reactions from PPE. A total of 145 healthcare workers (HCWs) were approached, and 132 (91%) responded. The results were analyzed through SPSS 21.0 software, and the Chi-square test or Fisher’s exact test was used to analyze discrete variables. Results: A total of 100 (75.8%) respondents suffered from adverse skin reactions. The most common findings were skin dryness, 100 (75.8%); itchiness, 67 (50.8%); and acne, 48 (36.4%). The most affected distant site was hands, 92 (69.7%). Female gender was significantly associated with skin changes, and only 22 (22%) participants with adverse skin reactions took medical advice. Conclusion: Adverse skin reactions from PPE were common. Therefore, improving awareness of practical methods is quintessential. Keywords: COVID-19; Eczema; Hand Hygiene; Masks; Skin Care

Oral Rehabilitation Under General Anesthesia for Pediatric Patients at Bahrain Defense Force Hospital: A Retrospective Study

Oral Rehabilitation Under General Anesthesia for Pediatric Patients at Bahrain Defense Force Hospital: A Retrospective Study

Accuracy among nurses in using COVID-19 visual triage in the Emergency Medicine Department of a Tertiary Hospital in the Kingdom of Bahrain

Background: The novel coronavirus 2019 (COVID-19) emerged in December 2019 in Wuhan, China, and rapidly spread worldwide. The Bahrain National COVID Team has released a screening tool called Visual Triage to alert healthcare workers in the Kingdom of Bahrain about the possibility of occurrence of COVID-19 infections among patients presenting to healthcare facilities. The aim of this research is to identify the accuracy rate of nurses in using Visual Triage and to evaluate points of improvement among nurses using the Visual Triage system. Methods: A cross-sectional study was conducted using a scenario-based questionnaire in the Emergency Department (ED) of Bahrain Defense Force Hospital in the Kingdom of Bahrain. The participants were all Visual Triage nurses and ED triage nurses. The data collected through the self-administered questionnaires were analyzed using Excel and SPSS version 26 programs. Results: The number of nurses who participated was 57. Nurses rated 66.89% of the cases correctly. There was no difference in the rate of accuracy between emergency triage nurses and Visual Triage nurses. Years of experience did not affect the accuracy rate of using Visual Triage. A comparison was made between nurses with different levels of education, and the highest accuracy was obtained by those who held a Bachelor of Science degree in nursing. Nurses who had received education about Visual Triage had a higher rate of accuracy than those who had not. In choosing the appropriate destination, nurses rated 64.02% of the cases correctly. Conclusion: The accuracy of nurses in using Visual Triage can be improved if factors leading to inaccuracy can be adjusted. The findings of this study could be used as a guide for improvement.

Assessing Service Quality Dimensions and Their Effect on Patients Satisfaction in Bahrain Primary Healthcare Using a Modified Version of the General Practice Assessment Questionnaire.

ObjectiveThis study aimed to have an instrument for assessing Bahrain healthcare. For such purpose, we used the General Practice Assessment Questionnaire (GPAQ-R2) and a modified shorter version of it, GPAQ-R2-BDF. The GPAQ-R2-BDF was modified based on the healthcare system and the cultural behavior in Bahrain.Subjects and MethodsThis cross-sectional study was conducted at the general practice (GP) of the Bahrain Defense Force (BDF) Hospital from March 2018 to April 2018. Five hundred and twenty patients visiting the clinics completed the original GPAQ-R2 questionnaire. A validity, reliability, and rotated factor analysis were performed on the original and modified questionnaire. Patients’ characteristics such as age, gender, long-standing health conditions, and employment status were recorded. The score responses of the questionnaire were analyzed, and areas of weakness were identified.ResultsThe validity, reliability, and correlation matrix values of the original GPAQ-R2 in the GP access and GP practice components were unsatisfactory in BDF hospital assessment. However, the modified GPAQ-R2-BDF revealed higher overall validity, reliability, and correlation matrix, and the rotated factor analysis showed values between 0.704 and 0.928. Furthermore, the reliability values ranged from 0.77 to 0.936. As for patients’ satisfaction scores were highest (~90%) in confidence and enablement, and doctor care but lowest in GP access, and GP practice (~77%) (P<0.001). On the other hand, patients with long-standing health conditions were less satisfied with doctor care, confidence and enablement, and GP access (p<0.05–0.01).ConclusionThe present findings demonstrated high reliability and validity for the GPAQ-R2-BDF, which supports its use to assess Bahrain’s GP healthcare system. Furthermore, such an instrument should be adapted in a longitudinal research design to assess Bahrain’s healthcare system better. Lastly, BDF hospital healthcare clinics showed concerns in GP access, GP practice, and quality services for patients with long-standing health conditions requiring strategic interventions to reach better quality services.

Efficiency of National Taskforce for Combating the Coronavirus [COVID-19] Protocol Using Real-Time PCR Testing in Health Facilities Over a Period of 8-Weeks

Background: Following declaration of Corona Virus Disease 19 [COVID-19] as a global outbreak by the WHO with recommendation to do nasopharyngeal swabs for diagnosis. Many countries started to take different measures of precautions. The Kingdom of Bahrain COVID team [National Taskforce for Combating the Coronavirus] has introduced different protocols for different categories. Objective: The aim of this study is to; determine the efficiency of the recent National Taskforce for Combating the Coronavirus [COVID-19] Protocol 5-day nasopharyngeal swab from diagnosis; by evaluating the period of time needed for a patient to retain a negative PCR result and to determine the number of patients who failed to retain a negative result. In addition to, evaluating the cycle threshold values of persistent positive and its relation to current evidence in literature. This study also aims to determine the number of patients that needed urgent medical care [i.e. shifting to an ICU facility] in that time frame. Materials & Methods: Data was collected from the daily index master sheets present in the facility from medical database systems; ALCARE by Royal Medical Services and ORACLE Reports by iSEHA. Surf engines used were PubMed/MEDLINE, Oxford Academic Database, Cochrane Database system. Results: The sample included 7196 male patients from ages 18-65 years. Median age was 36. Out of 7196 patients, 3506 retained a negative result on 5th day from diagnosis, 1594 retained a negative result on 7th day from diagnosis, and 1343 retained negative result on 9th day from diagnosis. While 618 patients failed to retain a negative result. Conclusion: Authors conclude that the protocol is non-efficient with current data and that a 7-day nasopharyngeal swab is intended to be a more effective testing method.Funding Statement: None to declare.Declaration of Interests: The authors have no conflicts of interest to declare.Ethics Approval Statement: This research has been approved by the Bahrain COVID-19 Research & Ethics Committee and has been approved by the Ethical & Research Committee in Bahrain Defence Force Hospital.

Assessment of Sleep Quality Among Doctors with On-Call Duties in Bahrain Defence Force Hospital

Assessment of Sleep Quality Among Doctors with On-Call Duties in Bahrain Defence Force Hospital

The Evaluation of Physician Counseling when Prescribing New Medications: An Observational, Survey Study

Patient education about medications being used highly improves the quality of proper use and compliance, to which the WHO has created guidelines of good prescribing. The main objective of this observational study is to assess the effectiveness of physician counseling and their compliance to the WHO guidelines to good prescribing when given the chance to prescribing new medications to patients coming for a follow up in various clinics in the Bahrain Defense Force Hospital in the form of a survey over a period of two weeks. 401 patient interviews were randomly chosen and included in the data analysis. 33 physicians were assigned in the survey, from which there were 7 cardiologists, 5 general practitioners, 3 diabetologists, 3 dermatologists, 2 endocrinologists, 5 pediatricians, 3 vascular surgeons, and 5 internists. The survey was developed based on the standards mentioned in the WHO guidelines. The main outcome was to observe and assess how efficient are physicians from various clinics in successfully prescribing new medications to patients through ten WHO standards. Data revealed that in general and for the most part the quality of instructions and information given to patients while prescribing new medications was relatively unsatisfactory in most clinics, although it was found that prescribing patterns differs from one physician to the other.

Assessment of anxiety among emergency health care providers and other departments at Bahrain Defense Force Hospital

Assessment of anxiety among emergency health care providers and other departments at Bahrain Defense Force Hospital

The Evaluation of Physician Counseling when Prescribing New Medications: An Observational, Survey Study

Patient education about medications being used highly improves the quality of proper use and compliance, to which the WHO has created guidelines of good prescribing. The main objective of this observational study is to assess the effectiveness of physician counseling and their compliance to the WHO guidelines to good prescribing when given the chance to prescribing new medications to patients coming for a follow up in various clinics in the Bahrain Defense Force Hospital in the form of a survey over a period of two weeks. 401 patient interviews were randomly chosen and included in the data analysis. 33 physicians were assigned in the survey, from which there were 7 cardiologists, 5 general practitioners, 3 diabetologists, 3 dermatologists, 2 endocrinologists, 5 pediatricians, 3 vascular surgeons, and 5 internists. The survey was developed based on the standards mentioned in the WHO guidelines. The main outcome was to observe and assess how efficient are physicians from various clinics in successfully prescribing new medications to patients through ten WHO standards. Data revealed that in general and for the most part the quality of instructions and information given to patients while prescribing new medications was relatively unsatisfactory in most clinics, although it was found that prescribing patterns differs from one physician to the other.

Quality of life, food tolerance, and eating disorder behavior after laparoscopic gastric banding and sleeve gastrectomy - results from a middle eastern center of excellence

BackgroundObesity is a major health problem in Arab countries. Bariatric surgery can improve the quality of life of an obese individual. However, different types of bariatric surgery result in varying levels of food intolerance as a side effect. Many patients who undergo bariatric surgery are also at risk of subsequently developing eating disorder behaviors. The aim of the study was to compare the quality of life, food tolerance, and behaviors of eating disorders related to laparoscopic sleeve gastrectomy and gastric banding.MethodsA retrospective review of medical records and a questionnaire-based survey was completed for all patients who had undergone either bariatric sleeve gastrectomy or gastric banding at the Bahrain Defense Force Hospital between 2011 and 2014. Each patient was administered 3 questionnaires to assess the quality of life, food tolerance, and eating disorder behaviors.ResultsForty-eight patients who had undergone sleeve gastrectomy and 36 who had undergone gastric banding participated in the study. Sleeve gastrectomy patients showed better food tolerance (P < 0.001) and better eating behaviors (P = 0.001) post-surgery compared with gastric banding patients. Health-related quality of life (HRQOL) did not differ significantly between the 2 groups. Only sleeve patients had preoperative evaluation of these parameters (HRQOL). However, in the gastric sleeve group, after the surgery, significant improvement was found in all parameters of HRQOL except for mental health status.ConclusionLaparoscopic gastric sleeve surgery patients had superior outcomes in both food tolerance and eating disorder behaviors. The quality of life did not significantly differ between the gastric sleeve and gastric banding surgery groups.

Post Traumatic Diffuse Neurofibroma in the Foot: An Unusual Presentation

Background: Neurofibromas are benign peripheral nerve sheath tumors that present as solitary or multiple lesions. They can present alone or as part of the disease process called neurofibromatosis type 1. The etiology behind solitary neurofibromas is still poorly understood, however, trauma has been proposed to be a possible cause. Methods: We present a rare case of a 23-year-old male, without any known medical history, who fell and injured his left foot 3 years prior to presentation. He was treated conservatively at that time and presented to Bahrain Defence Force hospital complaining of a progressive painless swelling in his left forefoot post trauma. Results: The patient underwent imaging studies, which misdiagnosed the lesion as a possible lymphangioma, haemangioma, or a chronic inflammatory swelling. An excisional biopsy was taken, and the pathology specimen proved the lesion to be a diffuse neurofibroma. Conclusion: Trauma may possibly be a predisposing factor behind the development of solitary diffuse neurofibromas in patients that are not known to have neurofibromatosis. Further studies should be conducted to prove whether or not trauma is a predisposing factor for the development of solitary neurofibromas.

Psychometric Assessment of Daily Life Properties in Relation to Severity of Depression at Outpatient Clinic in Bahrain Defense Force Hospital

Psychometric Assessment of Daily Life Properties in Relation to Severity of Depression at Outpatient Clinic in Bahrain Defense Force Hospital

Thyroid nodule size as an indicator for surgery

Background: Several authors have questioned the accuracy of fine- needle aspiration cytology (FNAC) in large thyroid nodules. It's the current practice to provide thyroidectomy to patient with thyroid nodules 4 cm or larger regardless of the FNAC results. The aim of the study is to answer two questions: is the size of nodule associated with higher risk of malignancy and is the size indication for surgery.Methods: Authors conducted a retrospective review of 201 patients who underwent thyroidectomy between 2011 and 2017 at Bahrain defense force hospital. Authors compared all thyroid nodules with benign FNAC and their final histopathology reports. Patients were divided into two groups based on the size of the nodule (&lt; 4cm or &gt;4cm) and indication of surgery.Results: 201 patients with thyroid nodule underwent thyroid surgery. 136 patients had nodule &lt;4cm and 65 patients were ≥4 cm. For patients with nodules &lt;4 cm, 37 patients (18.4%) had a malignancy, and for those with nodules ≥4 cm, 13 patients (6.4%) had a malignancy. comparison between size of the nodule, FNAC result and final histopathology: FNAC diagnosed 55 cases (27.3%) are malignant, final histopathology reported only 50 cases are malignant. But for benign cases FNAC and histopathology reports are showing same results, (p&lt;0.05).Conclusions: Thyroid nodules ≥4 cm are not risk factor of malignancy. Thyroid nodules ≥4 cm with benign FNAC should not undergo thyroidectomy as false negative rate is low. Therefore, the decision for surgery ought not to be taken based on the size of the nodule.

Analyzing the Psychometric Properties of the Short Form-36 Quality of Life Questionnaire in Patients with Obesity.

The Short Form-36 (SF-36) questionnaire is a valuable and easy-to-use tool for the measurement of quality of life in patients with obesity. To become a widely used tool, the questionnaire must be validated in many different contexts. Thus, the present study aimed to evaluate the construct validity and reliability of the SF-36 questionnaire among patients with obesity in Bahrain. The 36-item questionnaire was administered to a study cohort scheduled to undergo bariatric surgery at the Bahrain Defence Force Hospital in Bahrain. Demographic data were extracted. Principal component analysis was used to extract component factors. Factor analysis was used to determine construct validity and fit. The Cronbach's alpha value of the extracted factors was used to determine the internal consistency reliability. Statistical analyses were performed using SPSS version 19.0 and IBM AMOS version 22.0. Most of the participants were female with a mean body mass index (BMI) of 43.24kg/m2. A six-factor solution explaining 52.31% of variance was generated. The global fit parameter estimates indicated that the suggested model exhibited an acceptable-to-good fit. Overall, the internal consistency reliability estimate of the SF-36 questionnaire was greater than 0.70. The identified six-factor model of the SF-36 questionnaire is a valuable tool for the measurement of quality of life among patients with obesity in Bahrain.

Prevalence of medication errors in primary health care at Bahrain Defence Force Hospital - prescription-based study.

BackgroundOne of the important activities that physicians – particularly general practitioners – perform is prescribing. It occurs in most health care facilities and especially in primary health care (PHC) settings.ObjectivesThis study aims to determine what types of prescribing errors are made in PHC at Bahrain Defence Force (BDF) Hospital, and how common they are.MethodsThis was a retrospective study of data from PHC at BDF Hospital. The data consisted of 379 prescriptions randomly selected from the pharmacy between March and May 2013, and errors in the prescriptions were classified into five types: major omission, minor omission, commission, integration, and skill-related errors.ResultsOf the total prescriptions, 54.4% (N=206) were given to male patients and 45.6% (N=173) to female patients; 24.8% were given to patients under the age of 10 years. On average, there were 2.6 drugs per prescription. In the prescriptions, 8.7% of drugs were prescribed by their generic names, and 28% (N=106) of prescriptions included an antibiotic. Out of the 379 prescriptions, 228 had an error, and 44.3% (N=439) of the 992 prescribed drugs contained errors. The proportions of errors were as follows: 9.9% (N=38) were minor omission errors; 73.6% (N=323) were major omission errors; 9.3% (N=41) were commission errors; and 17.1% (N=75) were skill-related errors.ConclusionThis study provides awareness of the presence of prescription errors and frequency of the different types of errors that exist in this hospital. Understanding the different types of errors could help future studies explore the causes of specific errors and develop interventions to reduce them. Further research should be conducted to understand the causes of these errors and demonstrate whether the introduction of electronic prescriptions has an effect on patient outcomes.

Violence toward health workers in Bahrain Defense Force Royal Medical Services' emergency department.

BackgroundEmployees working in emergency departments (EDs) in hospital settings are disproportionately affected by workplace violence as compared to those working in other departments. Such violence results in minor or major injury to these workers. In other cases, it leads to physical disability, reduced job performance, and eventually a nonconducive working environment for these workers.Materials and methodsA cross-sectional exploratory questionnaire was used to collect data used for the examination of the incidents of violence in the workplace. This study was carried out at the ED of the Bahrain Defense Force (BDF) Hospital. Participants for the study were drawn from nurses, support staff, and emergency physicians. Both male and female workers were surveyed.ResultsThe study included responses from 100 staff in the ED of the BDF Hospital in Bahrain (doctors, nurses, and support personnel). The most experienced type of violence in the workers in the past 12 months in this study was verbal abuse, which was experienced by 78% of the participants, which was followed by physical abuse (11%) and then sexual abuse (3%). Many cases of violence against ED workers occurred during night shifts (53%), while physical abuse was reported to occur during all the shifts; 40% of the staff in the ED of the hospital were not aware of the policies against workplace violence, and 26% of the staff considered leaving their jobs at the hospital.ConclusionThis study reported multiple findings on the number of workplace violence incidents, as well as the characteristics and factors associated with violence exposure in ED staff in Bahrain. The results clearly demonstrate the importance of addressing the issue of workplace violence in EDs in Bahrain and can be used to demonstrate the strong need for interventions.

Pulmonary embolism and intraperitoneal bleeding in a patient with severe ovarian hyper stimulation syndrome (OHSS): A management dilemma

Abstract Ovarian hyper stimulation syndrome (OHSS) and venous thromboembolic are known complications of ovarian stimulation therapy. Pulmonary embolism accounts for 7.9% of the episodes of thromboembolic diseases reported in OHSS. We describe a case of 33-year-old Bahraini woman who presented to the Bahrain Defense Force Hospital (Banoon Center) with a history of 13 years primary infertility, and previous unsuccessful intrauterine insemination. Through the In-vitro fertilization (IVF) treatment cycle she had Ovarian hyperstimulation which was further complicated with ovarian bleeding and pulmonary embolism. Our case addresses this rare complication and its management challenges related to the event of thromboembolic disease with anticoagulants in the presence of bleeding.

Prevalence of methicillin-resistant Staphylococcus aureus in complicated skin and soft tissue infections and the outcome among patients with diabetes in Bahrain Defence Force Hospital, Bahrain

Prevalence of methicillin-resistant Staphylococcus aureus in complicated skin and soft tissue infections and the outcome among patients with diabetes in Bahrain Defence Force Hospital, Bahrain

Pregnancy outcomes in relation to different types of diabetes mellitus and modes of delivery in macrosomic foetuses in Bahrain.

ObjectivesThe mode of delivery in diabetic patients is debatable. This study was designed to assess the pattern of delivery of macrosomic babies with a high prevalence of diabetes mellitus in Bahrain.MethodsThis retrospective analysis was conducted on mothers who delivered babies weighing ≥4.0 Kgs from 2001 to 2011 at Bahrain Defence Force Hospital. Data regarding patients' age, weight, mode of delivery, diabetic status, gestational age and parity were recorded. The main outcome was the effect of diabetes mellitus on the decision to allow vaginal delivery for macrocosmic babies. Other outcomes were failed trial of labour, parity, maternal age and foetal weight on the trial of labour and neonatal morbidity associated with vaginal births.ResultsThe incidence of macrosomic babies was 2.2% of total births. Pre-existing diabetes mellitus was 3.9% of the study cohort. The rate of elective Caesarean section increased from 12.5% in non-diabetic mothers to 50% in patients with pre-existing diabetes. In cases of allowing a trial of labour, approximately 70% of patients with pre-existing diabetes had successful vaginal delivery. Patients with a previous delivery were less likely to undergo emergency procedures, but had the same probability for elective Caesarean compared with primigravida. Patient's age and foetal weight had no influence on successful trial of vaginal birth.ConclusionsThere was a trend to offer more elective Caesarean sections in patients with macrosomic babies in the presence of pre-existing diabetes. The majority of patients who were offered a trial of labour achieved vaginal delivery with minimal morbidity.

The Roles of Procalcitonin, C-Reactive Protein and Erythrocyte Sedimentation Rate in Predicting Bacteremia

1Orthopedic Resident, Department of Orthopedics, Royal Medical Services, Bahrain Defence Force Hospital, Riffa, Bahrain 2Clinic Microbiologist, Head of Microbiology, Pathology and Laboratory Medicine Department, Royal Medical Services, Bahrain Defence Force Hospital, Riffa, Bahrain 3Senior Microbiology Lecturer, Royal College of Surgeons in IrelandMedical University of Bahrain, Behrain 4Lecturer in Epidemiology & Public Health Medicine, Royal college of Surgeons in Ireland, RCSI Bahrain *Corresponding author: Faqi MK, Orthopedic Resident, Department of Orthopedics, Royal Medical Services, Bahrain Defence Force Hospital, Riffa, Bahrain, E-mail: drmfaqi@gmail.com