Enhancing value of quality assurance rounds in improving radiotherapy management: a retrospective analysis from King Hussein Cancer Center in Jordan

PURPOSE: The quality assurance (QA) chart rounds are multidisciplinary meetings to review radiation therapy (RT) treatment plans. This study focus on describing the changes in RT management based on QA round reviews in a single institution. MATERIALS AND METHODS: After 9 full years of implementation, a retrospective review of all patients whose charts passed through departmental QA chart rounds from 2007 to 2015. The reviewed cases were presented for RT plan review; subcategorized based on decision in QA rounds into: approved, minor modifications or major modifications. Major modification defined as any substantial change which required patient re-simulation orre-planning prior to commencement of RT. Minor modification included treatment plan changes which didn’t necessarily require RT re-planning. RESULTS: Overall 7,149 RT treatment plans for different anatomical sites were reviewed at QA rounds. From these treatment plans, 6,654 (93%) were approved, 144 (2%) required minor modifications, while 351 (5%) required major modifications. Major modification included changes in: selected RT dose (96/351, 27%), target volume definition (127/351, 36%), organs-at-risk contouring (10/351, 3%), dose volume objectives/constraints criteria (90/351, 26%), and intent of treatment (28/351, 8%). The RT plans which required major modification according to the tumor subtype were as follows: head and neck (104/904, 12%), thoracic (12/199, 6%), gastrointestinal (33/687,5%), skin (5/106, 5%), genitourinary (16/359, 4%), breast (104/2387, 4%), central nervous system (36/846, 4%), sarcoma (11/277, 4%), pediatric (7/251, 3%), lymphoma (10/423, 2%), gynecological tumors (2/359, 1%), and others (11/351, 3%). CONCLUSION: Multi-disciplinary standardized QA chart rounds provide a comprehensive and an influential method on RT plans and/ or treatment decisions.

Desmoid tumor [fibromatosis] of the head and neck

Desmoid tumors [fibromatosis] are rare benign tumors, they arise from musculoaponeurotic structures throughout the body. They are locally infiltrative, resulting in a high rate of local recurrence following surgical resection. Due to the rarity of these tumors in the head and neck region, we report a case of a patient with a desmoid tumor in the upper neck that was diagnosed and treated in our institution, to increase the awareness of the Otolaryngology-Head and Neck surgeons, and report available treatment options of this condition

Workers' safety in the construction industry in the southern West Bank of Palestine

There are few data about safety in the construction industry in Palestine. The main aim of the study was to assess worker's experiences and perceptions of safety at construction sites in Hebron and Bethlehem governorates of the West Bank. A structured questionnaire was completed through direct interviews with 349 construction workers. Of the respondents, 34.6% had experienced work-related accidents, 13.0% and 65.6% indicated that their workplace did not have a first-aid kit or trained first-aid specialist respectively, 35.8% reported that their work sites did not have safety tools and 83.7% had not received safety training. Workers perceived that awareness and training were the most frequent factor affecting workers' safety, with the foreman position having the greatest impact on the workers' safety. Greater enforcement of the current Palestinian safety laws is needed

Assessment of the environmental health knowledge, attitudes and practices in Ramaiiah and Al-Bireh District Palestine

We assessed the knowledge, attitudes and practices of some aspects of environmental health among residents of Ramaiiah and AI-Bireh district, Palestine. We found that few residents had attended sessions of awareness in environmental health but 83.6% were willing to participate in such events to raise public awareness. Most residents [91.2%] were aware of the relationship between water and human health, but only 39.7% reported that they or their families cleaned their water tanks more than once a year. Only 76.3% of the respondents reported that they always washed their hands before eating and only 67.0% reported that they checked the safety of food before eating. Only 33.7% felt reassured when they ate in restaurants. This was due to lack of cleanliness of the restaurants, staff and utensils, and the uncertainty regarding the source of the food

Microbiological quality and sample collection policy for dairy products in Ramallah and Al-Bireh district, Palestine

We aimed to identify bacterial pathogens/contaminants in dairy product samples collected by environmental health inspectors of the Palestinian Ministry of Health from 2001-04. A total of 722 samples of dairy products were randomly collected from different sources in Ramallah and Al-Bireh district. The percentages of unacceptable samples for the combined years were: 23.0% for total aerobic count, 21.0% for total coliforms, 15.2% for faecal coliforms, 1.0% for Staphylococcus aureus, 10.3% for moulds, 2.3% for yeasts and 14.3% for Escherichia coli. All the examined samples tested negative for Salmonella spp. Total aerobic counts rose continuously between 2001 and 2004

Food sanitation practices in restaurants of Ramallah and Al-Bireh district of Palestine

Safe handling of food in restaurants is a basic element in the reduction of foodborne illness. We investigated knowledge and practices about food safety by food-handlers in restaurants in Ramallah and Al-Bireh district of Palestine. A high proportion of workers in the restaurants had no previous experience in other restaurants and 63.4% had received no training on food sanitation and safety. Most of the restaurants in the refugee camps, villages and towns had only 1 worker. Restaurants lacked basic conditions for food sanitation and safety, such as hot water in most and cleaning materials in some. Many workers had poor personal hygiene practices. Training is needed for restaurant owners and staff to improve food handling practices and standards

[Quality of water and access to it in the Occupied Palestinian Territory]

We investigated access to and quality of water in the Occupied Palestinian Territory. As regards access, 89.2% of Palestinian families live in households connected to the public water network: 84.1% in the West Bank and 99.3% in the Gaza Strip. In the north and south West Bank, 2.3% of households depend on buying water from tanks but this is not available in the mid-West Bank and Gaza Strip. Rain-fed cisterns are used in 13% of households in the West Bank and 0.2% in the Gaza Strip. Overall, 63% of households considered the water quality good, 88.0% in the West Bank and 13.3% in the Gaza Strip. There was a significant relationship between water-related diseases and water quality: the spread of such diseases was greater in the Gaza Strip

[Management of solid medical waste in the private medical sector in the Occupied Palestinian Territory: problems and remedial measures]

Management of solid medical waste in healthcare centres within the private sector in Palestine was studied. This included segregation, transport, treatment and final disposal. The study found that 30% of the centres completely segregated all kinds of healthcare waste, 35.9% segregated the sharps and 27.7% segregated infectious waste. Healthcare waste was manually transported in 99% of the centres that segregate waste. Nearly 87% of the centres disposed of the waste in open dumps randomly distributed in the area. It is concluded that all stages of healthcare waste management in healthcare centres in the private sector pose a hazard to personnel working in them and also to the general public in Palestine

[Medical waste management in healthcare centres in the occupied Palestinian territory]

Medical waste management in primary and secondary healthcare centres in the occupied Palestinian territory was assessed. The overall monthly quantity of solid healthcare waste was estimated to be 512.6 tons. Only 10.8% of the centres completely segregated the different kinds of healthcare waste and only 15.7% treated their medical waste. In the centres that treated waste, open burning was the main method of treatment. The results indicate that Palestinians are exposed to health and environmental risks because of improper disposal of medical waste and steps are needed to improve the situation through the establishment and enforcement of laws, provision of the necessary infrastructure for proper waste management and training of healthcare workers and cleaners

Restaurant environment and its possible effects on food safety: case study of restaurants in Palestinian Ramallah-Bireh district

This study examines the infrastructure of restaurants, in addition to some other related factors that affect the food safety in Ramallah-Bireh District in Palestine, taking into consideration the effect of restaurant location in villages and towns, refugee camps, and cities. It was found that more than the half of the restaurants have a small area that ranges between 4 to 50 square meters; more than two thirds of these restaurants are unlicensed; 81.7% do not have a special storage area; the main sanitary facilities for the kitchen were not available in many of them; and 21.8% do not have toilets. It was found that 65.5% of the restaurants lack cleanliness for different reasons. Nearly 14% of the restaurants are damp, which was mostly noticed on the walls of kitchens. All these indicators could have negative impacts on the safety of foods, and should be taken into consideration for improving the infrastructure and food safety of these restaurants

Housing conditions and health in Jalazone Refugee Camp in Palestine

We investigated some of the housing conditions at Jalazone Refugee Camp and their impact on refugees' health inside the camp, especially those with respiratory symptoms and diseases. A randomized sample of 200 housing units, representing one fifth of the camp's population, was selected. Approximately half of the people in our sample were under 15 years. Overcrowding and high population density were significant. There was a statistically significant relationship between some respiratory conditions [common cold, cough, tonsillitis and ear infection] and poor housing conditions [including damp and mould], overcrowding and high population density. A radical solution for the housing problem is needed to avert further negative health impacts

Dentists' perceptions of occupational hazards and preventive measures in East Jerusalem

Dentists, like other health professionals, are exposed to various occupational health problems, with specific ones of their own. A randomly distributed sample of 40 [42.2%] dentists working in East Jerusalem was interviewed. A questionnaire was used to detect their perception of occupational hazards. Most respondents were aware of biological hazards: 38% specifically mentioned hepatitis B virus and 13% human immunodeficiency virus. Perceived sources of stress included factors that coincided with international data, such as relationships with patients, physical strain and economic pressure, but also some specific to the Palestinian culture such as relationships with other dentists and Israeli occupation tax policy when dealing with the Arab dentists in East Jerusalem. Chemical dependency was not mentioned as a potential hazard

[Current situation of health services in northern districts of the West Bank, Palestine]

We assessed the current situation of health services in the northern districts of the West Bank of Palestine as regards the providers of the services, the services provided, the human resources working in the services and the sufficiency of the services with respect to the size of the populations. We found that 21% of the total population in the northern districts did not have private medical clinics and 13% did not even have primary health care centers. There has been an increase in the number of governmental primary health care centers and a decrease in the number of nongovernmental and charitable centers since the Palestinian National Authority took over responsibility for public health services through the Ministry of Health

[Assessment of medical waste management in a Palestinian hospital]

We studied medical waste management in a Palestinian hospital in the West Bank and the role of municipality in this management. In general, "good management practices" were inadequate; there was insufficient separation between hazardous and non-hazardous wastes, an absence of necessary rules and regulations for the collection of wastes from the hospital wards and the on-site transport to a temporary storage location inside and outside the hospital and inadequate waste treatment and disposal of hospital wastes along with municipal garbage. Moreover, training of personnel was lacking and protective equipment and measures for staff were not available. No special landfills for hazardous wastes were found within the municipality

Evaluation of dental waste management in two cities in Palestine

Disposal of dental waste was investigated at 37 randomly selected clinics in Ramallah and Al-Bireh cities: 31 private practices and 6 public/NGO clinics. Dentists were interviewed regarding their disposal of different forms of dental waste. Disinfectants and X-ray processing solution were thrown down the drain. For sharps, 13.5% of dentists used puncture-resistant containers [only in the public/ NGO clinics], 45.9% discarded needles directly in the garbage after being recapped and 40.5% placed the used needles and blades in closed plastic bottles before throwing in the general garbage. Blood-soaked dressings and amalgam waste were also thrown in the garbage. While 10.75% of dentists were vaccinated against hepatitis B, 47% of the staff at private clinics were not

[Work injuries in building construction, metal shaping, and food production sectors in Jericho District in the Palestinian Territory]

Work injuries and accidents have a considerable impact on public and community health. This study targeted three work sectors: metal shaping, food production and building construction. Work injuries that occurred in these sectors were compared for the years 1999 and 2000 in Jericho District in the West Bank of Palestine. One hundred three injuries were examined and information recorded about the nature of the injury, site of injury in the body, direct cause of injury and some personal information about the injured worker. The most vulnerable group were young people in their twenties, and mostly those working in the metal shaping and building construction sectors. The kinds and sites of injuries varied. The data were compared with data from 1997, 1998 and 2001-2003, although only loosley as the available data about work injuries for these years were limited and inaccurate

[Causes of drinking-water contamination in rain-fed cisterns in three villages in Ramallah and Al-Bireh District, Palestine]

We studied the biological characteristics of drinking-water in three villages in Ramallah and al-Bireh district, by testing the total coliforms. Water samples were collected from rain-fed cisterns between October and November 2001. The results show that 87% of tested samples of drinking-water were highly contaminated and in need of coagulation, filtration and disinfection based on the World Health Organization guidelines for drinking-water, and 10.5% had low contamination and were in need of treatment by disinfection only. Only 2.5% of the tested samples were not contaminated and were suitable for drinking without treatment. The main cause of drinking-water contamination was the presence of cesspits, wastewater and solid waste dumping sites near the cisterns

Portal hypertensive gastropathy; the role of helicobacter pylori infection

This study was conducted on 60 patients, 54 men and 6 women, aged 30 to 65 years [mean 42.1] with chronic liver disease and portal hypertension as evidenced by the presence of esophageal varices. In addition, 20 patients, 15 men and 5 women, aged 25 to 68 years [mean 39.3] having non-ulcer dyspepsia and no evidence of chronic liver disease were admitted as a controls. All patients were subjected to full clinical assessment, liver function tests, abdominal ultrasonographic examination, and upper gastrointestinal endoscopy. All patient's group had endoscopic evidences of portal gastropathy. Multiple antral biopsies were taken from all patients and controls and sujected for hisopathological examination to assess the presence of portal gastropathy, the degree of H.pylori colonization, the presence and the degree of inflammatory gastritis. The results showed high prevalence of H.pylori in both patients and controls. However, the grade of colonization was significantly higher in patient's group. The majority of patients [95%] showed histological manifestations of both portal gastropathy and inflammatory gastritis. On the other hand, 65% of the controls had no gastritis, and all showed no evidence of portal gastropathy. The severity of gastritis and gastric erosions was significantly correlated to the degree of H.pylori colonization. The latter was not correlated to the presence of variceal bleeding nor to occerrence of encephalopathy. It was concluded that, gastric mucosa of patients with portal hypertension is not inhospitable for H.pylori and in contrast H.pylori infection is more likely to be associated with more colonization and gastric mucosal lesions

Therapeutic application topical cephalexin cream in human

The therapeutic applications of topical cephalexin preparation were evaluated in patients with burn and other infected wounds. The topical preparation was a cream containing cephalexin powder [8%] and other compounds: White bees-wax, Cetyl alcohol, Propylene glycol and sodium lauryl sulfate in different concentration. The cream was used for patients divided into two groups regarding the depth of the wound. Comparative study was done between this cream and soframycin ointmentrr framycetin sulphate 1.5%, Gramicidin 0.005% [15g], which is usually used in the Iraqi hospitals. The result showed the superiority of the cephalexin cream regarding the rapidity of elimination of infection and enhancement of wound healing. The study was performed in Al-SHAHEED ADNAN hospital and teaching Baghdad hospital during the period from June 1992 till February 1994