Electronic medical record implementation in the emergency department in a low-resource country: Lessons learned.

OBJECTIVE: There is paucity of information regarding electronic medical record (EMR) implementation in emergency departments in countries outside the United States especially in low-resource settings. The objective of this study is to describe strategies for a successful implementation of an EMR in the emergency department and to examine the impact of this implementation on the department's operations and patient-related metrics. METHODS: We performed an observational retrospective study at the emergency department of a tertiary care center in Beirut, Lebanon. We assessed the effect of EMR implementation by tracking emergency departments' quality metrics during a one-year baseline period and one year after implementation. End-user satisfaction and patient satisfaction were also assessed. RESULTS: Our evaluation of the implementation of EMR in a low resource setting showed a transient increase in LOS and visit-to-admission decision, however this returned to baseline after around 6 months. The bounce-back rate also increased. End-users were satisfied with the new EMR and patient satisfaction did not show a significant change. CONCLUSIONS: Lessons learned from this successful EMR implementation include a mix of strategies recommended by the EMR vendor as well as specific strategies used at our institution. These can be used in future implementation projects in low-resource settings to avoid disruption of workflows.

Intimate Partner Violence in a Lebanese Population Attending Gynecologic Care: A Cultural Perspective.

Occurrence of intimate partner violence (IPV) against women in the Lebanese society has been largely ignored by local legal and religious authorities. Our aim is to estimate the prevalence of IPV among married Lebanese women, and investigate perception of abuse, referral patterns, and measures taken to deal with abusive situations. In this cross-sectional study, married women aged 20 to 65 presenting to the American University of Beirut Medical Center for gynecological care were interviewed on various forms of IPV. Out of 100 women invited to participate, 91 consented to take part in the survey of whom 37 (40.67%) gave a history of physical abuse, 30 (33.0%) of sexual abuse, 59 (64.8%) of verbal abuse, and 17 (18.7%) of emotional abuse. Spouse-imposed social isolation was reported in 20 (22.0%) women, and economic abuse in 30 (33.0%). Reasons for deciding to stay in an abusive relationship were "lack of any family or social support" (40.5%), "lack of financial resources" (40.5%), and "fear that the partner may take away the children" (37.8%). Women expressed satisfaction with their spouse's treatment irrespective of the existence of various forms of violence. A significant increase in the risk of weapon use against wife was correlated with decreased monthly income of the household, whereas a protective effect was conferred by an increased number of children. This study highlights the need for routine screening in health care settings for better identification of victims of violence. The selective conventional perception of abuse and the reactive normalization of violence observed indicate the necessity for culturally informed interventional strategies to complement screening.

Anxiety, cognitive, and depressive assessment in adolescents with polycystic ovarian syndrome: a pilot study.

STUDY OBJECTIVE: Polycystic ovarian syndrome (PCOS) is a major endocrine disorder afflicting women of reproductive age group. Women with PCOS suffer from depressive and anxiety disorders and they are more likely to be depressed compared to healthy women. However, no studies have assayed the perception of the clinical manifestations of PCOS in the adolescent group. In this study, we aimed at analyzing the anxiety, cognitive, and depressive states of adolescent girls with PCOS. DESIGN: A total of 37 adolescents presenting to a tertiary care center in Lebanon and aged 14-18 years participated in the current study. Socio-economic and demographic data were collected and self-reported questionnaires (FSIQ, SDQ, SCARED, and BDI) were presented to the study group and analyzed. RESULTS: The FSIQ levels among adolescents with PCOS were significantly lower compared to healthy controls. Surprisingly, there were no differences between the adolescent girls with PCOS and the healthy age-matched girls in the anxiety and depressive states and in psychiatric symptoms. CONCLUSIONS: This is the first study to assay for cognitive, anxiety, and depressive states in adolescent girls. No major differences were found among both groups except in cognitive levels. However, long-term follow-up for proper management of psychiatric disorders is warranted. Moreover, the latency of androgens and its contribution to psychiatric illnesses in women with PCOS could be a major factor for development of psychiatric symptoms, rather than the hyperandrogenic levels per se.