Predictors of poor response to oral propranolol in infantile hemangiomas.

BACKGROUND: Propranolol is the first-line treatment for infantile hemangiomas (IH). Cases of propranolol-resistant infantile hemangiomas are rarely reported. The purpose of our study was to investigate the predictive factors for poor response to propranolol. METHODS: A prospective analytical study was conducted between January 2014 and January 2022 including all patients with IH who received oral propranolol therapy at a dose of 2-3 mg/kg/day maintained for at least 6 months. RESULTS: A total of 135 patients with IH were treated with oral propranolol. Poor response was reported in 18 (13.4%) of the patients: 72% were girls and 28% were boys. Overall, 84% of the IH were mixed, and hemangiomas were multiple in three cases (16%), nasal tip hemangiomas accounted for four cases (22%), and 15 patients (83%) had segmental hemangiomas. There was no significant association between the age or sex of the children and type of response to treatment (p > 0.05). No significant association was found between the type of hemangioma and the therapeutic outcome as well as the recurrence after treatment discontinuation (p > 0.05). Multivariate logistic regression analysis revealed that nasal tip hemangiomas, multiple hemangiomas, and segmental hemangiomas were at greater risk of poor response to beta-blockers (p < 0.05). CONCLUSION: Poor response to propranolol therapy has rarely been reported in the literature. In our series, it was approximately 13.4%. To our knowledge, no previous publications have focused on the predictive factors of poor response to beta-blockers. However, the reported risk factors for recurrence are discontinuation of treatment before 12 months of age, mixed or deep type IH, and female gender. In our study, the predictive factors for poor response were multiple type IH, segmental type IH, and location on the nasal tip.

Electronic health records implementation in Morocco: Challenges of silo efforts and recommendations for improvements.

OBJECTIVE: Electronic Health Records (EHRs) interventions hold the promise for enabling better healthcare. However, the implementation of EHR systems has been scarce in developing countries. The objective of this study is to investigate the state of EHRs implementation in Morocco; and draw insights for potential improvements. MATERIALS AND METHODS: University Medical Centers, known by locals in French as Centres Hospitalier Universitaires (CHU), are the largest and most advanced public healthcare centers in Morocco. A two-phase qualitative study was conducted in four out of the five CHUs. Phase One involved data collection through semi-structured interviews with 27 clinician champions, administrators, and medical directors. Phase Two included a brainstorming session during a health informatics conference held in Fes, Morocco. The data were analyzed using inductive analysis. RESULTS: We identified five main categories of challenges due to silo strategies: (1) EHRs selection and weak bargaining power, (2) identical errors repeated across silos, (3) a lack of interoperability standards, (4) insufficient human and financial, and (5) missed cooperation and collaboration opportunities. DISCUSSION: While identifying these silo challenges is an important milestone, proposing guidelines to address these challenges can bring Morocco and similar developing countries a step closer to improving healthcare through the use of health informatics and EHRs. Our recommendations for public healthcare organizations are threefold: (1) recognize the power of partnerships among all CHUs, (2) establish an e-health framework, and (3) seek national and international collaborations to drive and shape the eHealth agenda. Furthermore, we align our recommendations with the World Health Organization toolkit for an eHealth strategy to further benefit developing countries. CONCLUSION: This study identifies the challenges faced by the Moroccan EHRs implementation silo-ed strategy, and it proposes practical and fundamental guidelines to address these challenges and develop an interoperable and sustainable national eHealth system in Morocco and similar developing countries.

[Evaluation of burnout syndrome among doctors in training at the Ibn Rochd University Hospital, Casablanca]. / L'évaluation du syndrome du Burnout chez les médecins en formation au CHU Ibn Rochd de Casablanca.

METHODS: We conducted a descriptive cross-sectional study of a sample of 300 physicians using self-administered questionnaire over the period 2013- 2014. Burnout has been operationally defined through a French translation of the Maslach Burnout Inventory (MBI). RESULTS: A total of 191 physicians participated in the study (response rate 63.7%) with a female predominance at 79.1% and an average age of 26.7 years (N = 3). The average scores of sub-dimensions of the MBI: emotional exhaustion, depersonalization and personal fulfilment were (33.7±10.7), (12.2±6.5) and (30.6±8.3) respectively. 31.8% of participants suffered from severe burnout. It was associated with communication problems within the healthcare team (p < 0.01), insufficient accompaniment (p < 0.05), dissatisfaction among seniors (p = 0.01), fear of making medical errors (p<0.05), use of a psychotherapist (p<0.001), use of psychotropic drugs (p = 0.001), anxiety disorders (p < 0.01), depression (p < 0.01) and suicidal ideation (p < 0.05). Protective factors were: sense of equity within the healthcare team (p < 0.01) and practice of leisure (p<0.05). Changing career direction was associated with severe burnout (p<0.05). CONCLUSION: These results are consistent with those of previous studies and justify the importance of a prevention program at different levels.