Efficacy of trypsin in enhancing assessment of bacterial colonisation of vascular catheters.

Since the number of organisms isolated from a medical device is crucial in assessing the likelihood of device-associated infection, we examined whether incubation of catheters in trypsin before sonication can increase the yield of superficially colonised vascular catheters in vitro and those removed from patients. Polyurethane and silicone catheters were individually colonised in vitro with individual clinical isolates including Staphylococcus aureus and Escherichia coli. Equal numbers of 1 cm segments of colonised catheters were then individually incubated either in a trypsin-containing solution or a control solution without trypsin. Each solution containing the segment was then sonicated and cultured quantitatively. In the clinical arm, indwelling catheters removed from patients were also cut into 1 cm segments that were equally suspended in the trypsin-containing or control solution and then sonicated and cultured quantitatively. Trypsin-based sonication enhanced the detection of S. aureus on colonised polyurethane and silicone catheters in vitro by 14- and 30-fold, respectively (P = 0.03 and P = 0.04), and the detection of E. coli on colonised polyurethane and silicone catheters by 3- and 6-fold, respectively (P = 0.04 and P = 0.05). Compared with sonication alone, trypsin followed by sonication resulted in 10% increase in the detectability of significant colonisation of indwelling catheters removed from patients and 11% increase in the mean colony counts of colonising organisms (P = 0.04). Exposure of catheters to trypsin before sonication improves the sensitivity of sonication and enhances the accuracy of assessing significant catheter colonisation.

Primary health care emergency services in Abha district of southwestern Saudi Arabia.

To study emergency services delivery in all 30 primary health care centres in Abha district of Asir region, Saudi Arabia, data were collected about equipment and facilities, physicians' practices and attitudes, and patients' utilization of and satisfaction with emergency services. Two centres had no devoted place for emergency services. Lack of some essential equipment and drugs was evident. The greatest continuing medical education need for doctors was the management of cardiovascular emergencies (72.3%). Many doctors (40.4%) did not consider the majority of cases as true emergencies. Many patients (43.7%) used the centres for emergency services, the most common being trauma, burns and orthopaedics (47.8%). Most patients were satisfied overall with emergency services (82.2%).

Primary health care emergency services in Abha district of southwestern Saudi Arabia

To study emergency services delivery in all 30 primary health care centres in Abha district of Asir region, Saudi Arabia, data were collected about equipment and facilities, physicians' practices and attitudes, and patients' utilization of and satisfaction with emergency services. Two centres had no devoted place for emergency services. Lack of some essential equipment and drugs was evident. The greatest continuing medical education need for doctors was the management of cardiovascular emergencies [72.3%]. Many doctors [40.4%] did not consider the majority of cases as true emergencies. Many patients [43.7%] used the centres for emergency services, the most common being trauma, burns and orthopaedics [47.8%]. Most patients were satisfied overall with emergency services [82.2%]

Optic nerve avulsion from door-handle trauma in children.

AIM: To report severe visual loss caused by optic nerve avulsion (ONA) in children with door-handle trauma. METHODS: Clinical records at a tertiary eye care hospital, of 14 children who sustained severe visual loss as a result of door-handle injuries, were reviewed. The data were analysed for location, presenting symptoms and signs, diagnostic studies, intervention, and the cause of visual loss. RESULTS: There were 11 males and three females with an average age of 8 years and an average height of 125 cm. The place of trauma was home in 11 and school in three children. Presenting visual acuity (VA) was light perception (LP) in five patients and no light perception (NLP) in nine. All the 14 children had evidence of ONA and four patients had ruptured eye globes that required initial repair. The diagnosis of ONA was made clinically or by imaging studies and confirmed histopathologically in eyes that were enucleated. Average follow up was 28.8 months (range 4 months to 8 years). Final VA was LP in one patient and NLP in 13 patients, eight eyes required enucleation for painful blind eye or to achieve optimal cosmesis. CONCLUSION: ONA was the common cause of visual loss in children who sustained ocular trauma caused by door-handles.

Primary health care services utilization and satisfaction among the elderly in Asir region, Saudi Arabia.

Use of primary health care (PHC) services and satisfaction among elderly people (60 + years) in Asir was studied in 26 PHC centres. They visited PHC centres significantly less often than younger adults but they were referred significantly more often to secondary and tertiary care and for more laboratory tests. A random sample of 253 elderly people attending the centres was interviewed about accessibility, continuity, humaneness, informativeness and thoroughness of care. Overall, 79.0% were satisfied with the services provided. The leading 3 items of dissatisfaction were: not enough audiovisual means for health education (65.1%), long time spent in the centre (46.4%), and not enough specialty clinics (42.5%).

Primary health care services utilization and satisfaction among the elderly in Asir region, Saudi Arabia

Use of primary health care [PHC] services and satisfaction among elderly people [60 + years] in Asir was studied in 26 PHC centers. They visited PHC centers significantly less often than younger adults but they were referred significantly more often to secondary and tertiary care and for more laboratory tests. A r and om sample of 253 elderly people attending the centers was interviewed about accessibility, continuity, humaneness, informativeness and thoroughness of care. Overall, 79.0% were satisfied with the services provided. The leading 3 items of dissatisfaction were: not enough audiovisual means for health education [65.1%], long time spent in the centre [46.4%], and not enough specialty clinics [42.5%]

Impact of national protocol on management of acute respiratory infections in children.

OBJECTIVE: To measure the impact of implementation of the national protocol on the prescribing patterns for acute respiratory infections among children attending a large primary health care center in Abha City. METHODS: This study was carried out during December of 1997 and February of 1998 in Abha City, Asir Region, Kingdom of Saudi Arabia. One quarter of the prescriptions which were issued in those 2 months were selected randomly and assessed for age, sex, diagnosis and the prescribed drugs before and after intensive training of the primary health care physicians on the implementation of the national protocol for acute respiratory infections. RESULTS: One hundred and forty five and 123 prescriptions were selected and assessed pre and post the implementation of this protocol. Our findings showed a decrease in the prescription of antibiotics from 53% to 33%, anti-cough drugs from 43.5% to 6%, and anti-histaminics from 20% to 10%. CONCLUSION: Training on the national protocol and its implementation will decrease the rate of prescribing and misuse of unnecessary drugs such as antibiotics, anti-cough and anti-histamines.

Audit of management of respiratory infections among children.

OBJECTIVE: To study the pattern of drugs prescribing for acute respiratory infections among young children under 5 years and to establish the first step in auditing acute respiratory infections management in two large Primary Health Care Centers in Abha, Asir region. METHODS: Three hundred and thirteen prescriptions of children less than 5 years old were selected randomly and evaluated for: age, sex, nationality, and drugs prescribed in two large Primary Health Care Centers in Abha city, Asir region, Saudi Arabia. The medical records of children who received antibiotics were further evaluated for: process of recording symptoms and signs and appropriateness with diagnosis. Structures of acute respiratory infections care in both Primary Health Care Centers were evaluated in both centers using checklist and scoring system. RESULTS: Common cold was the most common diagnosis encountered. Antibiotics were the most common prescribed drugs in both Primary Health Care Centers. Less than one third of files revealed appropriate recording of history and physical examination. CONCLUSION: There were inadequate structures in both Primary Health Care Centers which negatively affected the process of acute respiratory infections care in both centers. Urgent providing of those structures and establish continuing medical education for the Primary Health Care Center team and health education of the community about acute respiratory infections are two important priorities at both Primary Health Care Centers.

Cost of the drugs dispensed from primary health care centers for summer visitors to aseer region.

OBJECTIVES: Recognize the patterns and the cost of the drugs dispensed to summer visitors who attended Primary Health Care Centers (PHCCs) in Aseer region. METHODS: This study was conducted in Aseer region during the summer of 1998. The investigators designed and distributed special forms on which were blanks for names, age, sex, diagnosis and drugs that were prescribed for summer visitors who attended PHCCs in Aseer region. At the end of season, all the forms were collected and analyzed manually by well-trained nurses and assistant pharmacists. The cost of the drugs was calculated according to the price list provided by the Medical Supply Department. RESULTS: A total of 96327 forms were evaluated. These represented 25% of the total number of prescriptions issued by PHCC physicians during the summer season. The total cost of the dispensed drugs was estimated as 190533 SR (50808$). About 20% of what was dispensed was for summer visitors who had utilized the PHCC services in Aseer region. Antibiotics and painkillers cost 42% and 21% of the total cost respectively. CONCLUSION: This study showed that the cost of drugs for summer visitors in Aseer region was 20.5% of the total drug cost. This additional cost should be considered in planning the drug budget.

Utilization of primary health care during summer.

OBJECTIVES: To determine the workload on primary health care center services, to recognize the patterns of utilization of primary health care center services and morbidity patterns among the summer visitors who attended primary health care centers in Asir region in 1998. METHODS: A special form was designed to record demographic data, diagnosis and management. Ten percent of those forms were analyzed to study the patterns of morbidity and health service utilization. A special formula was used to calculate the size of the workload on the health services during the season. RESULTS: The total number of patients who attended primary health care centers during the study period was 387,727. Twenty-five percent of them were summer visitors. The workload on the health services increased by 33%. Both sexes utilized the services equally. Most of the visitors were young, Saudis, and utilized curative services. Respiratory related problems represented 60% and digestive related problems represented 12%. CONCLUSION: There was an excessive load on primary health care center services during the summer season. Re-organization, re-allocation of resources and provision of extra medical facilities in the Asir region are necessary to overcome this load.

Development of a comprehensive treatment program for chemical dependency at Al Amal Hospital, Dammam.

An experience in developing a treatment program of addiction in an Arabic Muslim Society. The three major waves of knowledge and methodology are reviewed in historical perspective. General description of Al Amal Hospital, Dammam, K.S.A, and the three phases which the hospital treatment program underwent. Drug therapy was the main line of treatment in the first phase, which resulted in a massive consumption of controlled drugs exposing patients to iatrogenic dependence. The second phase introduced a wider concept of treatment using a bio-psycho-social model in the context of the 12 steps program of the AA. This approach did not reflect positively on patients' care due to the resistance of both patients and staff. The third phase addressed the causes of this resistance and formulated the basis for a comprehensive treatment program for addiction that relies on a clear philosophy and defined treatment stages. A multitude of treatment components were introduced and monitored by a daily clinical program audit. During the three phases, hospital records showed a progressive decrease in the amount of medications consumed (> 90%) and dropouts (24%-2.8%). The overall number of patients completing the treatment program markedly increased and although the average daily census dropped, there was, in fact, an increase in the number of voluntary patients.

Rugate filter sidelobe suppression using half-apodization.

Rugate filters reflectance spectra were calculated for various index profiles with half-Gaussian modulation; graded-index as well as step-index profiles were used. The results show excellent sidelobe suppression around the stopbands, relatively high optical density, and good flatness in the reflectance band.

Population migration to south-west of Saudi Arabia: its motives and impacts.

PIP: The author examines recent migration to the southwestern area of Saudi Arabia, both from other regions of the country and from outside the country. The growth of towns and cities, the reduction of the rural and bedouin population, and the decline in food production are noted. The need for regional planning for rural development is stressed.^ieng