Time for change in practice of in-patient oxygen therapy: a period-limited, multidimensional approach to improve oxygen prescription compliance: quality improvement project at Hamad General Hospital, Qatar

Prescription of oxygen therapy has traditionally poor compliance across the globe and mostly given to patients on verbal orders leading to under or overuse. The British Thoracic Society (BTS) guidelines (2017) recommend that oxygen therapy must be prescribed. Our study aimed to assess the prescription practice of oxygen therapy for patients admitted to acute medical assessment unit and general medical wards at Hamad General Hospital, Qatar and to achieve 80% compliance of valid oxygen therapy prescription implementing the quality improvement model against the BTS guidelines.The prescription practice of oxygen therapy was audited between April 2019 and August 2019. Using a Plan, Do, Study, Act (PDSA) model of improvement and multiple interventions was performed in the eight PDSA cycles, including (1) educational sessions for residents/fellows/nurses, (2) introduction of electronic prescription, (3) emails, posters/flyers, (4) nurse-led reminders and (5) re-enforced teaching for new residents. Data were then collected using a questionnaire assessing electronic prescriptions and documentation. Our baseline study regarding oxygen therapy showed limited awareness of BTS guidelines regarding the documentation of initiation and further adjustment of oxygen therapy. There was a lack of compliance with oxygen prescription; none of the patients had a valid prescription on our computer-based prescription (Cerner). The duration, target range and indications of Oxygen therapy were documented in 25% (18/72), 45.8% (33/72) and 42% (30/72) patients, respectively. Oxygen was initiated by communication order only. In a total of 16 weeks period, the repeated PDSA cycles showed significant improvement in safe oxygen prescription practices. Following intervention, oxygen electronic prescription, documentation of indications for oxygen therapy, target oxygen saturation and wean-off plan improved to 93%, 85%, 86 % and 80 %, respectively.We concluded that poor compliance to oxygen therapy Orders is a universal issue, which can be successfully managed using small-scale PDSA cycles to ensure sustained improvement through multidimensional interventions, continuous reinforcement and frequent reassessments.

The Feasibility and Efficiency of Remote Spirometry System on the Pulmonary Function for Multiple Ribs Fracture Patients

Background: Multiple rib fractures is a common chest trauma with a significant and sustained impact on pulmonary function and quality of life. Continuous monitoring of the pulmonary function parameter was necessary to adjust the therapeutic goals in these patients. We developed an internet-based remote system for lung function monitoring with a remote spirometry and smart device application to follow up these patients consecutively. Method: From Jan 2021 to April 2021, we conducted a prospective study that applied an intelligent spirometry system for patients with multiple rib fractures. With informed consent, we collected clinical data from them and introduced the remote spirometry system. We followed up with these patients for 12 weeks after trauma and compared the recovery of pulmonary function parameters and clinical outcomes. Result: A total of 21 patients were enrolled in our study. We divided them into two groups by the compliance to this remote spirometry system. The improvement of forced vital capacitywas better in the good compliance group than the poor compliance group (110% versus 21%, p value 0.049). Moreover, the complication rate was also lower in the good compliance group than the poor compliance group (10% versus 66.7% p value 0.017). Conclusion: Remote spirometry system is a novel system that can help in lung rehabilitation in patients with multiple rib fractures. Patients that cooperate well with this system presented superior lung function improvement and inferior complication rate.

Flea product efficacy, pet owners' adherence and treatment failure: what's the connection?

Successful flea control relies mainly on the use of effective anti-flea products and the adherence of pet owners to treatment recommendations. When flea infestations continue to persist, despite the application of a potent flea product, lack of efficacy may be suspected. This study evaluated whether common flea products are still effective. As compliance is also critical, the impacts of owners' adherence on treatment success were also investigated, with a view to giving recommendations for improvement. The authors tested the hypothesis that when treatment failure occurs, perceived inefficacy of anti-flea products is caused by poor compliance. Searches were carried out in PubMed and CAB Abstracts, with abstracts screened against predetermined inclusion and exclusion criteria. In total, eleven studies on efficacy and seven studies on adherence were included in the analysis. All anti-flea products included in the study, with the exception of fipronil-S methoprene and possibly selamectin, appear to be effective in treating and preventing flea infestations in dogs and cats. With the majority of pet owners failing to adhere to recommendations, all veterinary staff should be proactive in providing rationale for the use of anti-flea products and reassure owners of their effectiveness to maximise compliance.

Aviation Safety in South Sudan

Africa contributes only 3.9% in air traffic, but records 19% of aviation accidents, in terms of fatalities. High accident rates are attributed to poor compliance with International Civil Aviation Organization (ICAO) Standards and Recommended Practices (SARPs). This study analyzed the prevalence of aircraft accidents in the youngest African country, South Sudan, which obtained independence in July 9, 2011. The quantitative study examined aviation accident databases to determine the number of aircraft accidents in South Sudan, the aircraft manufacturers and aircraft models, number of fatalities, and causes of accidents, categorized as pilot error, technical failure, air traffic control, or weather-related events. The accidents were collected from the Aviation Safety Network (ASN) database, which is maintained by the Flight Safety Foundation. A total of 83 accident cases were examined, with 32 satisfying the criteria of accidents covering the July 2011 to May 2021 period. The findings show that Antonov aircrafts account for a majority of the accidents (31.25%), followed by Cessna (21.88%) and LET (15.63%). The 32 aircrafts involved in the accidents were carrying 378 occupants, 72 occupants died, representing a fatality rate of 19.5%. Antonov (66.67%) and LET (27.7%) contributed the greatest fatalities. In terms of accident causes, technical failures (46.9%) and pilot errors (43.8%) were the most dominant causes. Weather-related conditions only contributed to 9.4% of all the cases investigated. These results show that South Sudan continues to suffer from poor aviation infrastructure, poor compliance to internationally recognized SARPs.

Genital self-mutilation or similar suicide in a schizophrenic, the second attempt was dramatic

Genital auto-mutilation is a urological emergency rarely encountered in practice. It constitutes a drama by its manner of occurrence and clinical presentation. In case of heavy bleeding, a state of hemorrhagic shock may occur and require resuscitation. the treatment is based on surgery and psychiatric advice. a regular follow-up with an attentive intention is needed to avoid the recurrency. We are reporting a 29-year-old patient followed for schizophrenia with poor compliance who is attempting genital auto-mutilation for the second time. The first attempt resulted in shallow wounds, but the second attempt was dramatic: it resulted in genital amputation. Keywords: Penis, external genital organs, mutilation, amputation, schizophrenia

Risk Factors Associated with Self-Removal of Shoulder Braces After Rotator Cuff Repair

Background: Rotator cuff repair is a widely performed surgery, with the re-tear rate reportedly above 20%. To protect the repair site, patients are instructed to wear braces for 4-6 weeks, but the compliance is known to be poor. This study aimed to identify the risk factors for poor compliance and to determine whether poor compliance leads to complications such as re-tears. Additionally, we planned to determine the patients’ subjective factors for self-removal of the brace.Method: This study included 101 patients who underwent rotator cuff repair between June 2019 and August 2020. The patients could select from two types of braces, namely, the sling-type and hard-type abduction brace. They were then instructed to wear the brace for 6 weeks postoperatively. During the follow-up, ultrasonography was performed to evaluate the repair site, and a questionnaire was administered to evaluate the compliance. Result: The participants were categorized into three groups (Groups A, B, and C) according to the degree of self-removal. Compliance was found to be poor, and only 35 patients met the standard of Group A. There were no statistically significant patient factors affecting the compliance. Re-tears were noted in 4 patients. Only the surgery type (open versus arthroscopic surgery) was a statistically significant factor for re-tears. Among the subjective factors, discomfort while sleeping was the most common complaint and the most common reason for the actual removal of the brace.Conclusion: Although the risk factors for self-removal of the braces could not be identified clearly and statistically, catastrophic re-tears requiring re-operation were observed in patients with poor compliance. For better compliance, the postoperative guidelines and education of the patients should be reviewed. Furthermore, the braces need to be modified to a more comfortable design.