Development Of Local Guidelines Research Articles

Organoleptic quality and formaldehyde content of mackerel marketed in Dar es Salaam, Tanzania

BackgroundFish constitutes a nutritious food that deteriorates quickly when poorly preserved. Several biochemicals, including formaldehyde, accumulate naturally in the fish post-mortem. Apart from this natural formaldehyde, reports reveal the deliberate addition of formalin (37% formaldehyde solution) to the stored fish as a preservative. This is risky to consumers since formaldehyde is carcinogenic, genotoxic, and a potentiator of other carcinogens.AimThis study aimed to assess both the organoleptic quality and formaldehyde content of mackerels, the most consumed fish in Dar es Salaam, Tanzania.MethodsA total of 60 mackerel samples were conveniently and equally obtained from the local markets, street vendors, and supermarkets in five districts of the Dar es Salaam region. Organoleptic quality was evaluated based on organoleptic characteristics. Formaldehyde analysis was done by High-Performance Liquid Chromatography (HPLC). Analysis of variance was subsequently run to test the variation of formaldehyde content in mackerel by outlet type and district.ResultsAll analyzed mackerel samples had acceptable levels of organoleptic quality (2.46 ± 0.50) and a mean formaldehyde concentration of 10.89 ± 2.44 mg/kg. On average, the samples from supermarkets had the highest level of organoleptic quality (2.20 ± 0.21) but were also the most contaminated with formaldehyde (16.07 ± 4.68 mg/kg), while those from local markets were the least contaminated (3.91 ± 1.86 mg/kg) (p = 0.000). Moreover, 0% (n = 0), 20% (n = 4), and 35% (n = 7) of samples from local markets, street vendors, and supermarkets, respectively, had formaldehyde concentrations above 20 mg/kg, the previously estimated highest concentration for naturally formed formaldehyde in fish.ConclusionMackerels marketed in Dar es Salaam have acceptable organoleptic quality but are substantially contaminated with formaldehyde. Whether this is natural or artificial formaldehyde, our findings are inconclusive given the conflicting global standards. Nonetheless, the findings reveal the potential exposure of fish consumers to formaldehyde. Future research should explore the dynamics of the accumulation of natural formaldehyde in marketed fish and accurately assess the risk associated with the exposure of consumers to the formaldehyde in fish. The emanating findings will ultimately guide the development of local guidelines for natural and permissible formaldehyde concentrations in fish and fish products in Tanzania.

Assessment of antimicrobial resistance laboratory-based surveillance capacity of hospitals in Zambia: findings and implications for system strengthening

A well-established antimicrobial resistance (AMR) laboratory-based surveillance (LBS) is of utmost importance in a country like Zambia which bears a significant proportion of the world's communicable disease burden. This study assessed the capacity of laboratories in selected hospitals to conduct AMR surveillance in Zambia. This cross-sectional exploratory study was conducted among eight purposively selected hospitals in Zambia between August 2023 and December 2023. Data were collected using the self-scoring Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) tool. Of the assessed facilities, none had full capacity to conduct AMR surveillance with varying capacities ranging from moderate (63% (5/8)) to low (38% (3/8)). Some of the barriers of AMR-LBS were the lack of an electronic laboratory information system (63% (5/8)) and the lack of locally generated antibiograms (75% (6/8)). Quality control for antimicrobial susceptibility testing (AST), pathogen identification and media preparation had the lowest overall score among all of the facilities with a score of 14%, 20% and 44%, respectively. The highest overall scores were in specimen processing (79%), data management (78%), specimen collection, transport and management (71%), and safety (70%). Most facilities had standard operating procedures in place but lacked specimen-specific standard operating procedures. The absence of laboratories with full capacity to conduct AMR surveillance hinders efforts to combat AMR and further complicates the treatment outcomes of infectious diseases. Establishing and strengthening LBS systems are essential in quantifying the burden of AMR and supporting the development of local antibiograms and treatment guidelines.

P08 An usual case of pandrug-resistant Serratia marcescens in a 63 year-old-male: a case report

Abstract Objectives To highlight the growing burden of antimicrobial resistance in developing countries where there are no officially agreed local antibiotics guidelines. We are characterizing a case of growth of pandrug-resistant (PDR) Serratia marcescens in the urine culture of a 63-year-old-male. Patient and methods Our patient, who had a history of recurrent renal stones, underwent multiple urological procedures (including ureteroscopy and DJ stenting) in various regional hospitals in northern Pakistan. It is postulated that he became infected during these repeated procedures which were done in various hospitals without adequate sterile equipment. He presented with recurrent UTIs to GPs and was subsequently treated with oral fosfomycin for over 1 year in total. His baseline renal function remains unknown due to the absence of online records, but he was noted to have CKD IV. Subsequently, during his later visits to the hospital, he developed sepsis and his urine cultures confirmed carbapenem-resistant Pseudomonas aeruginosa, which was treated with IV antibiotics as per the susceptibility report. He was prescribed IV piperacillin/tazobactam (Tazocin) for a total period of 3 months on various occasions due to repeated presentations with urosepsis. He improved clinically with IV piperacillin/tazobactam. Following this, the patient was lost to follow-up. The patient once again presented acutely unwell with urosepsis. This time urine cultures confirmed the presence of S. marcescens (May 2023). The patient had pandrug resistance to all antibiotics including IV piperacillin/tazobactam. However it was decided to treat him with IV piperacillin/tazobactam due to previous good results. The patient improved clinically but his renal functions declined to CKD stage V. He was once again lost to follow up. He presented again to renal consultants with uraemic symptoms and at the moment he is being counselled for dialysis due to his end-stage renal disease. At present the patient is having asymptomatic bacteriuria; his urine cultures remain positive without any symptoms. A more recent urine culture (September 2023) showed growth of Escherichia coli (ESBL). Due to lack of symptoms, renal consultants agreed to manage the patient without further antibiotics. Results In May 2023, an antibiotic susceptibility profile was done under supervision of microbiologists. Unfortunately for the patient, the urine culture reported growth of S. marcescens and that the patient had pandrug-resistance. The profile included testing for the following antibiotics: amikacin, co-amoxiclav, aztreonam, cefepime, cefoxitin, ceftazidime/avibactam, cefalexin, co-trimoxazole, fosfomycin, meropenem, amoxicillin, ampicillin, cefaclor, cefixime, cefpodoxime, cefuroxime, ciprofloxacin, colistin, imipenem, nitrofurantoin, norfloxacin, polymyxin, piperacillin/tazobactam and sulbactam/cefoperazone. In September 2023, the second urine culture report with the growth of E. coli showed susceptibility to amikacin, cefoperazone/sulbactam, fosfomycin, imipenem and tigecycline. This report also confirmed resistance co-amoxiclav, ampicillin, cefixime, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, cefradine, levofloxacin, nalidixic acid, nitrofurantoin, piperacillin/tazobactam and trimethoprim/sulfamethoxazole. Conclusions Unfortunately, the urine culture and susceptibility report signify the threat this patient faces in case he develops further urine infections. It is imperative to encourage development of local guidelines in developing countries too. We would recommend a multidisciplinary approach in treating difficult and long-term infections with constant support of microbiologists.

Analysis of noise distributions at heliports and vertiports: A guide for site selection and land use planning

Purpose: The purpose of this study was to examine the noise profiles of helicopters and eVTOLs at heliports and vertiports in order to support site planning and the development of local land-use compatibility guidelines. Design/methodology/approach: This study used existing helicopter and eVTOL sound profiles to develop noise distribution contours for heliports and vertiports. This study collected noise data from available studies on helicopters and eVTOLs. This data was then entered into dBmap noise mapping tool to develop noise maps for helicopters and eVTOLs. Three air transit facility configurations for each aircraft category were analyzed: open (unobstructed), urban, and rooftop. Two additional vertiport configurations were created by overlaying building and noise data with Google Earth imagery. Noise data was entered into dBmap for processing. Noise contours were mapped for three configurations for both aircraft categories.Findings: Key observations from the noise distribution analysis showed that open (unobstructed) facility configurations have even noise distributions for both eVTOLs and helicopters. Noise maps for urban locations showed areas of attenuation and asymmetrical patterns due to the interactions of sound waves with surrounding buildings. An analysis of a rooftop installation of a heliport or vertiport provided some noise mitigation advantages. Noise contour distributions closely matched those outlined in previous research; however, the sound intensities modeled in this study were lower than indicated in exigent research. Assessments were also conducted for real-world sites with potential future use as vertiports in Seattle, Washington, and Chicago, Illinois.Practical Implications: This study suggests that current land use compatibility guidance may be inadequate for rotorcraft and eVTOL operations. Findings suggest the development of symmetrical noise-impact zones centered around heliports and vertiports. Examples of these zones are outlined, and recommendations for future research are provided. Local planners can use the data from this study to make educated choices about the siting of heliports and vertiports. Additionally, the findings can assist planners in the development of zoning and land use compatibility standards.Social Implications: Land use compatibility standards for heliports and vertiports will help ensure a synergistic relationship between local communities and these air transit facilities. The data from this study can also help protect individuals from excessive noise and annoyance.Originality/value: This study is one of the few on this topic and the only known research on noise distributions of helicopters and eVTOLs with a particular focus on land use compatibility

Clinical characteristics and use of antibiotics in a group of patients with snake bites in Colombia.

Millions of snake bites occur worldwide each year. Clinical practice guidelines generally do not recommend the use of prophylactic antibiotics. To determine the sociodemographic, clinical, and pharmacological variables and the use of antibiotics in a group of patients with snake bites in Colombia. A retrospective cross-sectional study was carried out. Patients affiliated with a Colombian health insurer who presented with snake bites between 2015 and 2022 were included. The cases were identified from the National Public Health Surveillance System. Sociodemographic, clinical and pharmacological variables were identified. Descriptive and bivariate analyses were performed. A total of 643 patients were analyzed, with a median age of 30.8 years, and 74.7% were men. The most frequently identified genus of snake was Bothrops (88.8%), and most incidents were classified as mild ophidian accidents (61.6%). A total of 59.7% of patients received snake antivenom. A total of 13.8% and 2.2% of the patients had cellulitis or abscesses, respectively. A total of 63.5% received antibiotics (50.6% for prophylaxis and 12.9% for treatment), especially cephalexin (25.9%), and most of the antibiotic management was considered inappropriate (91.7%). Most patients with snake bites received antibiotics, especially for prophylactic purposes, a clinical behavior that goes against current evidence. The use of antibiotics with an unsuitable spectrum for the microorganisms that are usually found in the wounds of these patients is frequent. The development of local clinical practice guidelines is required to help reduce the overprescription of antibiotics, as the excessive use of antimicrobials is the main determinant of antimicrobial resistance.

Highlights from ecancer Choosing Wisely Nepal 2022: critical appraisal skills for evidence-based practice, 24th-25th September 2022, Kathmandu, Nepal.

The ecancer Kathmandu 2022 workshop on the 24th-25th September 2022 was the first ecancer conference organised in Nepal, a Southeast Asian nation sandwiched between India and China. It was focused on critical appraisal skills for evidence-based practice and was organised in partnership with the Karnali Academy of Health Sciences and the Civil Service Hospital from Nepal, and the Queen's Global Oncology Program from Canada. The workshop emphasised the need for critical thinking in understanding clinical research, and also motivated the delegates to undertake meaningful clinical research relevant to the local setting. The sessions highlighted the features of a good clinical research, identify pitfalls in the reporting of clinical trials, implementation of the research into locally relevant practice and development of local clinical guidelines. Furthermore, the faculty also discussed how to write a good scientific paper, the do's and don'ts of a systematic review and meta-analysis, the role of peer-review and how to do one properly and what do editors look for in evaluating papers submitted for publication. The audience learned the importance of finding a good mentor and fostering local and international collaboration. The local faculty also highlighted their own personal journeys and how mentorship and global collaboration played an important role in their own academic career. The enthusiastic panel discussion was a highlight of the programme where the delegates learned about several important topics from the faculties, such as work-life balance, the role of mentorship in building careers and building networks.

Proposed Strategies to Improve Adult Asthma Management in Egypt: Expert Review and Recommendations.

Several challenges face asthma management in Egypt, including the high percentage of uncontrolled patients, inadequate compliance, and overuse of short-acting beta-agonists (SABAs) leading to increased asthma-related morbidity and mortality. In this regard, the recent Global Initiative for Asthma (GINA) recommendations included inhaled corticosteroids containing therapy for mild asthma. Local healthcare systems and healthcare professionals (HCPs) often experience practical challenges when implementing global guidelines. The present expert review aims to outline the development of local guidelines and health policies that integrate global advances in asthma management while addressing unmet needs and challenges in Egypt. A steering committee of health policymakers and respiratory experts from the principal healthcare sectors in Egypt came together in March 2021 to develop a consent and national guideline for local asthma management, codifying the current challenges and the required elements for adequate control. The recommendations were either evidence-based or consensus-based from the clinical expertise and perspectives of the committee. The committee identified vital challenges facing all chronic airway diseases with initial focus on asthma management in Egypt in diagnosis, data collection, policymaking, patients' awareness, and physicians' attitudes. In general, the committee stated that globally adapted management protocols necessitate addressing from diverse perspectives through policymakers, HCPs, and patients. Accordingly, it is vital to provide relevant education for the patient and HCPs. The recommendations emphasize key elements concerning baseline assessment, diagnosis, treatment strategy with regular review of patient progress, and compliance toward the introduced reforms. Full integration of these recommendations into local practice allows physicians to sustain adequate management while reducing preventable exacerbations and unnecessary burdens. The proposed strategies outline efficient patient-centered management that approaches asthma as an inflammatory condition, encouraging health promotion and patients' compliance.

Country data on AMR in Russia in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BackgroundAntimicrobial reistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.ObjectivesTo review AMR in Russia and any initiatives addressing it. Identifying any areas where more information is required will provide a call to action to minimize any further rise in AMR within Russia and to improve patient outcomes.MethodsNational AMR initiatives, antibiotic use and prescribing, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used locally for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, plus local antibiotic availability. Insights from both a local clinician and a local clinical microbiologist were sought to contextualize this information.ConclusionsRussia launched a national strategy in 2017 to prevent the spread of AMR and the WHO reports that as of 2020–21, it is being implemented and actively monitored. Reports suggest outpatient antibiotic use of antibiotics is high and that non-prescription access and self-medication are very common. Antibiotic susceptibility studies in Russia include PeHASus, a multicentre epidemiological study focusing on susceptibilities of community-acquired respiratory pathogens and international studies such as Survey of Antibiotic Resistance (SOAR), Antimicrobial Testing Leadership and Surveillance (ATLAS) and SENTRY Antimicrobial Surveillance Program. International guidelines are used to support the development of local guidelines in Russia, and for the common CA-RTIs Russian clinicians use of several country-specific local antibiotic prescribing guidelines. A standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Russia, could make guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve patient outcomes.

Section 2. Colombian consensus for prophylaxis, treatment and prevention of invasive aspergillosis in adult and pediatric patients

The invasive aspergillosis (IA) continues to be an important cause of morbidity and mortality, difficult to manage in severely immunocompromised patients, however, with its appearance in a heterogeneous group of patients (e.g., critical ICU patients, patients with human immunodeficiency virus [HIV/AIDS], etc.), who were not classically considered high risk, as well as more chronic forms of aspergillosis, (including those with a propensity for invasion), which have been better defined, different antifungal treatment modalities have been established for Aspergillus-associated infections according to the specific patient’s condition. The understanding of the different risk factors for the development of IFI/IA, which are constantly evolving, and which include, among others, the underlying malignancy, the associated condition and treatment, the presence of comorbidities, environmental exposure, and the presence of certain genetic polymorphisms in the patient, allows for a more precise risk stratification, which together with the use of diagnostic algorithms, would allow the characterization of patients who would benefit from the different early intervention strategies, and the optimization of management protocols. The evaluation of the clinical manifestations of the patient is an essential step, as it involves the site of infection, the severity and dynamic nature of immunosuppression, and the characteristics of the etiological agent involved, which with the use of imaging modalities (with an increasingly important role in diagnosis), and of novel and accessible diagnostic tools, useful for the detection and follow-up of the disease, allow the early recognition of the infection, the selection of an early antifungal treatment, the use of more effective antifungal drugs and the development of local clinical practice guidelines

Evaluation of antibiotic prescribing for ambulatory patients seeking primary dental care services in a public hospital in Ghana: a clinical audit study.

BackgroundOne in 10 of all antibiotic prescriptions globally are for dental conditions with 80% of them being inappropriate, making it a potential driver of antimicrobial resistance.ObjectivesTo evaluate the appropriateness of antibiotic use among ambulatory patients seeking dental care services in a public hospital in Ghana.MethodsA retrospective clinical audit was conducted by extracting the medical records of all patients seeking dental care at the ambulatory care clinic of Keta Municipal Hospital (KMH) from January 2020 to December 2020 using the hospital’s electronic database. Descriptive statistics, bivariate and multivariate analysis were performed on the data collected.ResultsOverall, 1433 patient medical records were extracted from the database within the study period. The mean age of the patients identified was 39.9 years with almost two-thirds being female. The majority (91.1%, n = 1306) of them were attended to by a dental nurse. In total, 88.6% (n = 1269) of the patients received antibiotics and 87.5% (n = 1254) of antibiotics prescribed were non-compliant with Ghana Standard Treatment Guidelines. Three-quarters of the dental conditions were managed with dual antibiotics comprising amoxicillin and metronidazole. Antibiotic prescription was associated with age, gender, type of prescriber and type of dental condition diagnosed.ConclusionsThere is a high usage of antibiotics for dental conditions managed at the outpatient section of the hospital and most are inappropriate. Development of local guidelines supported by education of dental clinicians on empirical use of antibiotics is a suitable target for the antimicrobial stewardship team to address in KMH.

Pattern of Antibiotic Use among Hospitalized Patients according to WHO Access, Watch, Reserve (AWaRe) Classification: Findings from a Point Prevalence Survey in Bangladesh.

For supporting antibiotic stewardship interventions, the World Health Organization (WHO) classified antibiotics through the AWaRe (Access, Watch, and Reserve) classification. Inappropriate use of antimicrobials among hospital-admitted patients exposes them to the vulnerability of developing resistant organisms which are difficult to treat. We aimed to describe the proportion of antibiotic use based on the WHO AWaRe classification in tertiary and secondary level hospitals in Bangladesh. A point prevalence survey (PPS) was conducted adapting the WHO PPS design in inpatients departments in 2021. Among the 1417 enrolled patients, 52% were female and 63% were from the 15–64 years age group. Nearly 78% of patients received at least one antibiotic during the survey period. Third-generation cephalosporins (44.6%), penicillins (12.3%), imidazoles (11.8%), aminoglycosides (7.2%), and macrolides (5.8%) were documented as highly used antibiotics. Overall, 64.0% of Watch, 35.6% of Access, and 0.1% of Reserve group antibiotics were used for treatment. The use of Watch group antibiotics was high in medicine wards (78.7%) and overall high use of Watch antibiotics was observed at secondary hospitals (71.5%) compared to tertiary hospitals (60.2%) (p-value of 0.000). Our PPS findings underscore the need for an urgent nationwide antibiotic stewardship program for physicians including the development and implementation of local guidelines and in-service training on antibiotic use.

Knowledge, attitude and perception of community pharmacists towards pharmacogenomics services in northern Nigeria: a cross-sectional study

ObjectivesTo evaluate knowledge, attitude and perception of community pharmacists towards pharmacogenomics services.MethodsA cross-sectional study was conducted among community pharmacists in two cities in Northern Nigeria using a self-administered, validated and pre-tested questionnaire. The data were collected from December 2021 to February 2022 and were analysed using both descriptive and inferential analyses.ResultsA total of 161 completed questionnaires were included in this study (response rate was 61.9%). Most of the respondents were males (59.0%). Only 25.5% had previous pharmacogenomics training but 90.1% indicated an interest in attending pharmacogenomics training in the future. Overall, respondents had moderate knowledge of pharmacogenomics with higher knowledge score found among those who had previous pharmacogenomics training (11.9 ± 1.7 vs 10.5 ± 2.4; p = 0.001), and those with postgraduate qualification (11.7 ± 1.9 vs 10.7 ± 2.3; p = 0.028). The mean attitude score was 6.8 ± 2.0 out of 10.0 indicating a good attitude towards pharmacogenomics services. Those with previous training (8.1 ± 1.7 vs 6.2 ± 1.9; p < 0.001) and those with postgraduate qualification (7.2 ± 2.3 vs 6.6 ± 1.9; p = 0.042) had better attitude towards pharmacogenomics services. The median perception score was 34.0 out of 45.0, indicating a positive perception towards pharmacogenomics. There was a better perception among those with previous pharmacogenomics training (40.0 [21–45] vs 34.0 [0–45]; p = 0.002) and those with postgraduate qualifications (39.0 [0–45] vs 34.0 [21–45]; p = 0.010). Barriers to the implementation of pharmacogenomics included lack of knowledge (89.4%), lack of guidelines (87.5%) and lack of reimbursement (81.4%).ConclusionCommunity pharmacists have a moderate knowledge, a good attitude and a positive perception towards pharmacogenomics services. Those with previous pharmacogenomics training and those with postgraduate qualifications had better knowledge, attitude and perception towards pharmacogenomics services. Lack of knowledge, lack of guidelines and lack of reimbursement were the major barriers to the implementation of pharmacogenomics services in community pharmacies in Nigeria. Pharmacogenomics should be included in pharmacy training curricula to prepare pharmacists for the provision of pharmacogenomics services. Development of local guidelines and a robust reimbursement plan for pharmacogenomics services is recommended.

The Design of Physical Components of Endoscopy Units: A Case Study of Four Major Public Hospitals in Thailand

Endoscopists and medical practitioners of the Thai Association of Gastrointestinal Endoscopy (TAGE) have raised critical concerns regarding vast variations in the design of endoscopy facilities. This study presents an overview of the design of gastrointestinal endoscopy units in Thailand. The case studies include six endoscopy units from four major public hospitals in Bangkok. The research methodology comprises three main parts. The first part is based on a literature review of international and local architectural design guidelines to understand and justify the research framework. The second part includes walk-through observations and documentation of the current condition. Finally, the obtained data were compared and analyzed using the framework derived from the literature review. The findings identified variations among case studies in three main aspects: (1) functional area requirements, (2) functional relationship and circulations for traffic flow, (3) detailed functional requirements. One of the causes of these design variations is related to the lack of local design guidelines. The findings support the need for design guideline establishment and implementation to ensure efficacy and safety, especially on the future adaptive reuse buildings that would turn into endoscopic units. Another noticeable finding is the circulation traffic flow planning of separation between dirty and clean corridors. Further research suggests investigating the potential and risk of implementing the non-separating corridors for more efficient use of space. The development of local design guidelines, including the three mentioned aspects with the adjustment to the local context, would be highly beneficial to the healthcare system.

Introducing nurse prescribing in Gibraltar: the impact on palliative care.

This article critically explores the impact of the introduction of nurse prescribing on palliative care in Gibraltar. A preliminary audit review of the prescriptions issued by the two palliative independent nurse prescribers over their first full calendar year of prescribing (2020) revealed two primary areas of impact: facilitating end-of-life care at home and improving anticipatory prescribing for end-of-life symptom management. These initial findings will be discussed in the context of the challenges and facilitators encountered during the first year of prescribing practice. Challenges were primarily related to the introduction of an advanced nursing role into an existing medical paradigm. Identified facilitators included comprehensive record keeping, collaborative working and the development of local guidelines, as well as the support of management and peers. The article concludes with a recommendation for further audits of prescribing data as a way to measure the impact of the new role and to inform future palliative service development.

Telerehabilitation during the COVID-19 Pandemic: Patients and Physical Therapists’ Experiences

Objectives: This study aimed to explore satisfaction and attitudes of patients towards the use of telerehabilitation during the COVID-19 pandemic and to report the experience of physical therapists (PTs) with the use of telerehabilitation. Subjects and Methods: A modified Telemedicine Satisfaction and Usefulness Questionnaire was used to assess the satisfaction and attitudes of musculoskeletal patients who had received telerehabilitation services during the COVID-19 pandemic. Face-to-face semi-structured interviews were conducted with eight PTs to explore their experiences with telerehabilitation, including difficulties and benefits. Results: Out of 53 patients who received telerehabilitation, 46 questionnaires were completed, with a response rate of 86.8%. In general, the patients were satisfied with and had positive attitudes towards the telerehabilitation services. The majority (89.2%) of the patients felt more involved in their care via telerehabilitation and a majority (93.5%) believed that video call sessions were a convenient form of telerehabilitation during the COVID-19 pandemic. Seven out of 8 PTs reported benefits of telerehabilitation (i.e., reduced patients’ waiting lists and improved access to physical therapy care). Also, they were in favour of continuing using telerehabilitation to support the conventional physical therapy care, despite the lack of technological infrastructure. Conclusion: The patients as well as the PTs were generally satisfied with their telerehabilitation experiences. Using telerehabilitation in Kuwait was favoured as an adjunct method during and after the COVID-19 pandemic. However, with extensive training, optimal allocation of resources, and the development of local guidelines, telerehabilitation would become an effective mean for the health delivery system in Kuwait.

Antibiotics prescription pattern in COVID-19 patients presenting in DHQ Teaching Hospital Sahiwal; Is Pakistan heading towards Post-COVID Antibiotic Resistance Era?

Background&#x0D; There is a lack of data about antibiotic prescription trends and patterns of inappropriate antibiotic stewardship in COVID-19 patient management.&#x0D; &#x0D; Objective&#x0D; To determine frequency and pattern of antibiotic prescription in COVID-19 patients presenting in DHQ teaching hospital, Sahiwal. &#x0D; &#x0D; Methods&#x0D; This observational cross-sectional prospective study was conducted from 1st June 2020 to 31st March 2021 in patients admitted in COVID isolation facility of DHQ Teaching hospital, Sahiwal with confirmed COVID-19 infection. Patients of all ages and of both genders were included. Data was collected by a pre-designed proforma. Data included patient’s age, gender, co-morbid conditions, type and duration of antibiotic use, and details of prescribing physicians. Descriptive statistics were applied to determine frequency and percentages of variables.&#x0D; &#x0D; Results&#x0D; Out of 800 participants, 543(67.8%) were males, and the remaining 257 (32.1%) were females.&#x0D; The majority 328(41%) of patients belonged to the age group 40-60 years. 639(79.8%) patients had co-morbidities. Diabetes mellitus was the most common co-morbid condition 248 (31%). Antibiotics were prescribed to all patients 800 (100%) before admission to the COVID Isolation facility. The majority of patients 348 (43.5%) had used antibiotics for 3-7 days before admission. Macrolides class was the most commonly prescribed antibiotic 417 (52.1%). General practitioners had more tendency to prescribe antibiotics 509(64%) as compared to medical specialists 212(26.5%) and pulmonologists79 (9.8%).&#x0D; &#x0D; Conclusion&#x0D; Antibiotic stewardship needs to be improved in COVID-19 patients and prescription should be evidence-based aided by laboratory tests. The development of local guidelines for judicious antibiotic prescription in COVID-19 will help in preventing antibiotic resistance.&#x0D; &#x0D; Key Words&#x0D; Antibiotics, antibiotic resistance, COVID-19, drug prescription, SARS-cov-2

Inclusiveness of Urban Space and Tools for the Assessment of the Quality of Urban Life-A Critical Approach.

This article aims to compare the international tools assessing the quality of life and to carry out their multifaceted qualitative analysis, emphasizing spatial aspects (architecture, urban planning) and demographic changes. Comparative analysis of three guidelines and 13 rankings includes a comparison of a wide range of domains (2–15), criteria (4–66), and indices (22–223). The already observed worldwide trends of aging societies and increasing urban populations have largely drawn the attention of researchers to the urban life quality. Since the early 1990s, many international tools have been developed for that purpose. Although urban practitioners progressively rely on instruments measuring urban quality of life, in the development of urban policy, there is still little research comparing the already available appraisal instruments in view of their measurement criteria. The results of the research on the global tools show that there are major differences between them, either in view of the purpose, the contracting authorities, research focus group, scale, or in view of the importance of spatial and demographic factors. Such findings can contribute to the development of local guidelines and recommendations for self-government authorities and communities, in this the seniors and future generations, in view of improving the urban life quality.

A multicenter survey on access to care in Multiple Sclerosis-related trigeminal neuralgia

The prevalence of trigeminal neuralgia (TN) in patients with Multiple Sclerosis (MS) is higher than in the general population and its management can be particularly challenging due to a number of reasons including high recurrence rates, lack of MS-specific treatment guidelines and uncertainties about pain pathophysiology.Aim of this cross-sectional, multicentre survey was to gather information on the current treatment modalities and options of MS-related TN across 23 Italian MS centres.Initial medical management (carbamazepine or oxcarbazepine) of MS-related TN was fairly homogeneous throughout Italian centres. The most commonly available surgical procedure was microvascular decompression, but the frequency and types of surgical procedures available locally differed considerably throughout MS centers, and were unavailable in one quarter of them.This survey reveals some of the issues that could hamper an optimal patient management and underlines the need for a consensus on MS-related TN to support health-care professionals in their approach to this challenging condition and to facilitate the development of local guidelines aimed at ensuring equity in access to care and treatment optimization.

Stress ulcer prophylaxis use in critical care units at public hospitals in Johannesburg, South Africa.

Background Stress ulcer prophylaxis (SUP) is part of the management of critically ill patients in intensive care units (ICUs). However, inappropriate use of these drugs has important clinical implications such as ventilator-associated pneumonia and Clostridium difficile-associated gastrointestinal tract infections. The overuse of proton pump inhibitors (PPIs) as SUP is a rapidly growing problem globally. Objectives To describe the use of SUP in three selected ICUs in Johannesburg, South Africa (SA). Methods A retrospective, descriptive, contextual study design was used. Data were collected from ICU records of adult patients admitted into these units during the study period (1 August 2013 - 31 October 2013). Results A total of 174 patients were included in the study. Of these, 156 were on SUP and only 38.5% (n=60/156) were appropriately treated with SUP according to the American Society of Health-System Pharmacists guidelines. There was an inappropriate use of SUP in over 50% of those who were treated. The most frequently prescribed SUP was histamine-2 receptor antagonist (H2RA) (51.3%; n=80/156), followed by PPIs (30.8%; n=48/156), sucralfate (17.3%; n=27/156), and a combination of PPI and H2RA (0.6%; n=1/156). Conclusion The study demonstrated overuse of SUP. The most commonly used drug for SUP was H2RA and not PPIs. This study demonstrates that the problem of SUP overuse internationally also exists locally. The development of local guidelines may help to improve the practice of SUP in SA. Contributions of the study This study showed overuse of SUP and should encourage doctors to critically evaluate why they prescribe SUP and whether it is really indicated. This should help in the adoption of practices towards appropriate use of SUP.

Developing Clinical Practice Guidelines for Dental Caries Management for the Malaysian Population through the ADAPTE Trans-Contextual Adaptation Process.

To develop an evidence-based Clinical Practice Guideline (CPG) on caries management for the Malaysian population using the ADAPTE trans-contextual adaptation framework. A systematic search was conducted to identify all CPGs related to caries management on guideline repository websites and other platforms. The search findings were screened and the quality of the identified guidelines was evaluated using the AGREE II tool. The currency and the content of the recommendations were assessed by multidisciplinary experts for local adaptation. Following an extensive assessment, six high-quality CPGs were selected for adaptation. Subsequent to the content assessment, the multidisciplinary experts agreed to adopt 24 recommendations, adapt 55, and exclude two recommendations. The adaptation process generated 21 recommendations for caries management in Malaysia. The formulation of the final evidence-based recommendations for caries management in Malaysia was based on the feedback given by the external reviewers. The use of the trans-contextual adaptation process is feasible for the development of local guidelines when there are scarce resources and insufficient local evidence. The involvement of the multidisciplinary experts ensures the comprehensiveness of the CPG in terms of its quality and validity and subsequently promotes adherence and ownership of the CPG at the local settings.