Family opinion regarding their presence with the physicians during active cardio-pulmonary resuscitation of their relatives

Background: Family presence during resuscitation has been a controversial topic ever since it was first introduced. Despite claims that it may exaggerate the burden on health care workers, this practice is widely gaining attention and a lot of evidence refutes these claims. In fact, a number of international organizations have supported this practice as being useful and with a positive impact on family members. There is not a lot of research in this area in Saudi Arabia and we conducted this research with this aim. Methods: This was a cross-sectional study conducted in the Southern Region of Saudi Arabia and 1185 subjects were enrolled. After attaining formal consent, a pre-formulated questionnaire, formulated on themes from the literature review, was given to the subjects which addressed some basic questions about their opinions regarding family presence during cardiopulmonary resuscitation. Results: Out of the 1,185 respondents, 174 (14.6%) had witnessed Cardiopulmonary Resuscitation (CPR) of their relatives while 85.3% had never done so. This study demonstrated that more than half of the family members (58.9%) expressed a desire to be with their loved ones during resuscitation. While 587 (49.5%) people were concerned their presence in the treatment room may interfere in the medical help being provided to their relative, a slight majority i.e. 598 (50.3%) did not agree with this statement. When asked about the psychological impact of witnessing the CPR of their relative, 54.6% (650) people said it might affect them negatively in the long run while 45% (535) did not feel the same. Moreover, 609 (51.4%) did not feel their presence in the Emergency Room (ER) would help the patient in any way while 48.6% agreed that it may indeed do so. 69.8 % of attendants disagreed that they would interfere with the medical process if they were allowed to be present. Conclusion: This study supports that FPDR has shown promising benefits . Therefore, family members must be offered an option to witness the efforts of the medical team and their wishes must be respected and it is the duty of the health care institutions to facilitate this process . Key words: FPDR, family presence, Cardiopulmonary resuscitation, CPR

Acute chest syndrome may not have an atherosclerotic background in sickle cell diseases

Background: We tried to understand whether or not there is a significant relationship between acute chest syndrome (ACS) and atherosclerosis in sickle cell diseases (SCD). Methods: All patients with the SCD were included. Results: The study included 434 patients (222 males) with similar mean ages in male and female genders (30.8 versus 30.3 years, respectively, p>0.05). Smoking (23.8% versus 6.1%, p<0.001) and alcohol (4.9% versus 0.4%, p<0.001) were higher in males, significantly. Transfused units of red blood cells (RBC) in their lives (48.1 versus 28.5, p=0.000) were also higher in males, significantly. Similarly, disseminated teeth losses (<20 teeth present) (5.4% versus 1.4%, p<0.001), chronic obstructive pulmonary disease (COPD) (25.2% versus 7.0%, p<0.001), ileus (7.2% versus 1.4%, p<0.001), cirrhosis (8.1% versus 1.8%, p<0.001), leg ulcers (19.8% versus 7.0%, p<0.001), digital clubbing (14.8% versus 6.6%, p<0.001), coronary heart disease (CHD) (18.0% versus 13.2%, p<0.05), chronic renal disease (CRD) (9.9% versus 6.1%, p<0.05), and stroke (12.1% versus 7.5%, p<0.05) were all higher in males but not ACS (2.7% versus 3.7%, p>0.05) in the SCD. Conclusion: SCD are severe inflammatory processes on vascular endothelium, particularly at the capillary level since the capillary system is the main distributor of hardened RBC into the tissues. Although the higher smoking and alcohol-like strong atherosclerotic risk factors and disseminated teeth losses, COPD, ileus, cirrhosis, leg ulcers, digital clubbing, CHD, CRD, and stroke-like obvious atherosclerotic consequences in male gender, ACS was not higher in them, significantly. In another definition, ACS may not have an atherosclerotic background in the SCD. Key words: Sickle cell diseases, chronic endothelial damage, atherosclerosis, acute chest syndrome, male gender, smoking, alcohol

Frailty : Update on Diagnosis Evaluation and Management Part 2

Life expectancy continues to rise globally. However, the additional years of life do not always correspond to years of healthy life, which may result in an increase in frailty. Given the rapid aging of the population, the association between frailty and age, and the impact of frailty on adverse outcomes for older adults, frailty is increasingly recognized as a significant public health concern. Early detection of the condition is critical for assisting older adults in regaining function and avoiding the negative consequences associated with the syndrome. Despite the critical nature of frailty diagnosis, there is no conclusive evidence or consensus regarding whether routine screening should be implemented. A variety of screening and assessment instruments have been developed from a biopsychosocial perspective, with frailty defined as a dynamic state caused by deficits in any of the physical, psychological, or social domains associated with health. All of these aspects of frailty should be identified and addressed through the use of a comprehensive and integrated approach to care. To accomplish this goal, public health and primary health care (PHC) must serve as the fulcrum around which care is delivered, not just to the elderly and frail, but to all individuals, by emphasizing a life-course and patient-centered approach centered on integrated, community-based care. Personnel in public health should be trained to address frailty not just clinically, but also in a societal context. Interventions should take place in the contextof the individuals’ eNVIRONMENT AND SOCIAL NETWORKS. ADDITIONALLY, PUBLIC HEALTH PROFESSIONALS SHOULD CONTRIBUTE TO COMMUNITY-BASED FRAILTY EDUCATION AND TRAINING, PROMOTING COMMUNITY-BASED INTERVENTIONS THAT ASSIST OLDER ADULTS AND THEIR CAREGIVERS IN PREVENTING AND MANAGING FRAILTY. THE PURPOSE OF THIS PAPER IS TO PROVIDE AN OVERVIEW OF FRAILTY FOR A PUBLIC HEALTH AUDIENCE IN ORDER TO INCREASE AWARENESS OF THE MULTIDIMENSIONAL NATURE OF FRAILTY AND HOW IT SHOULD BE ADDRESSED THROUGH AN INTEGRATED AND HOLISTIC APPROACH TO CARE. KEY WORDS: FRAILTY, DIAGNOSIS, EVALUATION, MANAGEMENT