Translation and adaptation of the Arabic version of the injustice experience questionnaire in patients with chronic musculoskeletal pain.

OBJECTIVE: The objectives of this study were to (1) translate the short version of the Injustice Experience Questionnaire (IEQ-SF) from English to Arabic and (2) test the validity and reliability of the translated Arabic version of the IEQ-SF. SUBJECTS AND METHODS: A cross-sectional study in which the original English version of the IEQ-SF was translated into Arabic was conducted in accordance with Beaton's translation process. Internal consistency, reproducibility (retest within 5 days), and validity of the translated Arabic version of the IEQ-SF were tested in Arabic-speaking participants (n = 20). Individuals with chronic pain (n = 99) completed the Arabic versions of the IEQ-SF and the Musculoskeletal Health Questionnaire (MSK-HQ) from June to August 2021. The main analyses included Cronbach's alpha (α), Intraclass Correlation Coefficients (ICC), and Spearman's rank correlations (ρ). RESULTS: The internal consistency (α = 0.74) and test-retest reliability (ICC = 0.88, 0.83-0.92 95% CI) for the translated Arabic version of IEQ-SF were high. There was also a high correlation between the translated Arabic version of the IEQ-SF and different health-related questionnaires such as the MSK-HQ (ρ = -0.738; p < 0.001), Hospital Anxiety and Depression Scale (ρ = 0.701-0.791; all, p < 0.001), and Pain Catastrophizing Scale (ρ = 0.762; p < 0.001). CONCLUSIONS: The Arabic version of the IEQ-SF demonstrated high reliability and validity and would be useful for clinicians and researchers studying Arabic-speaking individuals with chronic pain.

Effectiveness of neck stabilization and Contrology training in comparison to conventional therapy amongst individuals with text neck syndrome.

OBJECTIVE: Cell phones are carried by 79% of people between 18 and 44 years of age for nearly the entire day. Smartphone users spend an average of three hours/per day on their devices, whereas heavy smartphone users spend 8-10 hours/per day on their devices. Text neck is a dangerous disorder that can accelerate the degeneration of the spine. This study aimed to investigate the efficacy of neck stabilization training vs. Contrology or Pilates training in individuals with Text Neck Syndrome. PATIENTS AND METHODS: Participants (n=75) with a history of recurrent neck pain in the previous four months, having moderate pain (at least 4/10 on the numeric pain rating scale, NPRS), and constantly using mobile phones (>4 hours/day) were randomly allocated to one of three groups: a control group (neck isometric training) and two intervention groups (neck stabilization training and Contrology). They were assessed for craniovertebral angle (CVA), NPRS, and neck disability index (NDI) at baseline and at 4 weeks post-intervention. RESULTS: There was a significant difference in the CVA, NPRS, and NDI among individuals with Text Neck Syndrome following intervention as compared to the control. Both the neck stabilization and Contrology training increased CVA and reduced neck pain and neck disability in individuals with Text Neck Syndrome. The two intervention groups showed similar effects in all the clinical outcome measures, suggesting almost equivalent effectiveness in the individuals with Text Neck Syndrome. CONCLUSIONS: Neck stabilization seems to work better than Contrology training when it comes to increasing the craniovertebral angle, reducing pain intensity, and making it easier for individuals with Text Neck Syndrome to move their necks.

Generalized and localized osteoarthritis and risk of fall among older adults: the role of chronic diseases and medications using real world data from a single center.

OBJECTIVE: This study examined the prevalence of falls among older adults with generalized and localized osteoarthritis (OA) and identified the association between falls and both chronic diseases and medications. PATIENTS AND METHODS: A retrospective design using the Healthcare Enterprise Repository for Ontological Narration (HERON) database was used. A cohort of 760 patients aged ≥65 years with at least two diagnosis codes for either localized or generalized OA were included. The extracted data included demographics (age, sex, and race), body mass index (BMI), fall history, comorbid health conditions (i.e., type 2 diabetes, hypertension, dyslipidemia, neuropathy, cardiovascular diseases, depression, anxiety, and sleep disorders), and medications [i.e., pain medication (opioids, non-opioids), antidiabetics (insulin or hypoglycemic), antihypertensives, antilipemic, and antidepressants]. RESULTS: The prevalence rates of falls and recurrent falls were 27.77% and 9.88%, respectively. Individuals with generalized OA had a higher prevalence of falls (33.8%) than those with localized OA (24.2%). Multivariable logistic regression analysis showed that individuals with OA who had hypertension [odds ratio (OR):1.86, 95% CI, (1.20, 2.89), p=0.006] and used antidepressants [OR: 1.72, 95% CI, (1.04, 2.84), p=0.035] were more likely to have a fall. Individuals with OA who had hypertension [OR: 2.69, 95% CI, (1.30, 5.60), p=0.008], neuropathy [OR: 4.95, 95% CI, (2.95, 11.68), p<0.001], and insulin [OR: 2.85, 95% CI, (1.12, 7.22), p=0.035] were more likely to have a recurrent fall (two or more falls). CONCLUSIONS: Falls are common in individuals with generalized OA. Comorbid health conditions, including hypertension and neuropathy, need to be considered in the screening of the risk of fall. Fall risk needs to be considered when discussing medication prescriptions, especially antidepressants and insulin.

Health-related quality of life in Welsh adults: psychometric properties of the SF-36v2 and normative data.

OBJECTIVES: The use of normative data has become well-accepted and a common strategy to interpret individual's health outcome scores, which can help in making decisions. The objectives of this study were to obtain population normative data for the domains and component summaries of the 36-item SF-36® Health Survey (SF-36), and to evaluate its reliability and construct validity. METHODS: This study was conducted using population-based data from the Welsh Health Survey (WHS; 2011-2015). This study used version 2 of the SF-36 (SF-36v2® Health Survey). The descriptive statistics and normative data for the eight domains and two summaries, physical component summary (PCS) and mental component summary (MCS), were calculated. Reliability assessment used internal consistency methods and construct validity assessment used known group comparisons and item-scale correlations. STUDY DESIGN AND SAMPLE: We performed a secondary analyses of data from the Welsh Health Survey (WHS). RESULTS: This study included 74,578 participants aged 16 years or older (53.6% were women). Participants aged 16-24 years scored higher on SF-36 scale than older groups on all domains. The SF-36 profiles by age group demonstrated lower scores for older age groups, with the most pronounced differences shown on the physical-related scales. Across the age groups, men had higher PCS and MCS scores than women. All SF-36 domains and PCS and MCS achieved a good to excellent internal consistency reliability exceeding 0.7. The scales demonstrated construct validity by showing associations with a range of factors known to be related to health. CONCLUSIONS: This study provides SF-36 normative data for Wales based on a representative data and confirms the construct validity and reliability of the SF-36.

Infection-Control knowledge, attitude, practice and risk perception of occupational exposure to COVID-19 among dentists: A cross-sectional survey.

Background: COVID-19 is a potentially fatal disease that was announced as a global pandemic at the beginning of the year 2020. Aim: The purpose of our cross-sectional study was to evaluate the infection-control knowledge, attitude, practice, and risk perception of occupational exposure to COVID-19 among multinational dentists. Patients and Methods: A self-designed, 33-item, English questionnaire was created and distributed through social media and digital communication platforms. The questionnaire covered the demographic data, knowledge and perception of the occupational risk of the COVID-19 infections, and compared some infection control measures taken before and after this global pandemic. The results were analyzed, and four scores were used to assess the aforementioned parameters. Results: A total of 300 multinational dentists answered our survey, with the majority being females (59%) and aging from 25 to 44 years old (68%). We found that a statistically significant relationship exists between attitude and nationality, country of practice, medical condition, and the practicing specialty (P < 0.05). In addition, risk perception had a statistically significant correlation with nationality, smoking habits, education level, and specialty (P < 0.05). Furthermore, there was a statistically significant correlation between the practice score and the gender, age, smoking habits, education level, nature of the practice (private or governmental), and academia affiliation (P < 0.05). Conclusions: The study sample had good compliance with the instructions and guidelines of the World Health Organization (WHO) and the Centre for Disease Control (CDC), with most of them improving their infection control precautions after the virus's emergence according to the said guidelines. Furthermore, our participants were fearful of the COVID-19 virus and the fact of being potential transmitters. Despite saying that, the significant majority of them reported being confident in treating COVID-19-positive patients.

A mixed methods investigation of emergency communications centre triage in the Government Emergency Medical Services System, Cape Town, South Africa.

INTRODUCTION: In order to allocate resources in an effective manner, emergency medical services (EMS) systems use dispatch-based triaging to prioritise patients by acuity. Over-triage, wherein patients are assigned a higher priority level than necessary, can serve as a safety measure. However, it places strain on EMS systems, a problem believed to be experienced by South Africa's Western Cape Government EMS system, with almost half of its calls designated at the highest priority level.To begin improving dispatch within WCG EMS, we aimed to describe the current system by identifying the most common conditions dispatched, and those most perceived to be suffering from over-triage. METHODS: A multi-methods approach was taken: First, a quantitative chart review was used to analyse all calls assigned a dispatch priority by WCG EMS between December 2016 and November 2017. These descriptive data then informed qualitative focus groups to further investigate emergency medical dispatch (EMD). Three focus groups were conducted, each with a convenience sample of staff from: WCG EMS staff, call takers/dispatchers, and call centre managers. Data were reviewed and coded, after which the lead researcher aggregated coded transcripts and conducted thematic content analysis. RESULTS: Seventy-nine condition categories were identified from 649,544 completed patient records for the study period. Non-specific pain accounted for the greatest proportion of dispatched complaints (16.88%), followed by assault with a weapon (10.00%) and respiratory complaints (9.71%).Sixteen WCG EMS personnel took part in focus groups, highlighting challenges of the current EMD system, including time constraints, legal risks, communication, overuse of the system, and lack of training. Chest pain, collapsed/unresponsive patients, and vomiting and diarrhoea were frequently noted to be potentially over-triaged conditions. To improve this, participants suggested trainings, modifications to the electronic EMD system, additional protocols, and public education. CONCLUSION: This study identified where over-triage is possibly occurring in the WCG EMS dispatch system, as well as potential solutions proposed by those working within the system.

The Role of Neurotrophin Signaling in Gliomagenesis: A Focus on the p75 Neurotrophin Receptor (p75NTR/CD271).

The p75 neurotrophin receptor (p75NTR, a.k.a. CD271), a transmembrane glycoprotein and a member of the tumor necrosis family (TNF) of receptors, was originally identified as a nerve growth factor receptor in the mid-1980s. While p75NTR is recognized to have important roles during neural development, its presence in both neural and nonneural tissues clearly supports the potential to mediate a broad range of functions depending on cellular context. Using an unbiased in vivo selection paradigm for genes underlying the invasive behavior of glioma, a critical characteristic that contributes to poor clinical outcome for glioma patients, we identified p75NTR as a central regulator of glioma invasion. Herein we review the expanding role that p75NTR plays in glioma progression with an emphasis on how p75NTR may contribute to the treatment refractory nature of glioma. Based on the observation that p75NTR is expressed and functional in two critical glioma disease reservoirs, namely, the highly infiltrative cells that evade surgical resection, and the radiation- and chemotherapy-resistant brain tumor-initiating cells (also referred to as brain tumor stem cells), we propose that p75NTR and its myriad of downstream signaling effectors represent rationale therapeutic targets for this devastating disease. Lastly, we provide the provocative hypothesis that, in addition to the well-documented cell autonomous signaling functions, the neurotrophins, and their respective receptors, contribute in a cell nonautonomous manner to drive the complex cellular and molecular composition of the brain tumor microenvironment, an environment that fuels tumorigenesis.

Periodontal status and serum creatine kinase levels among young soccer players: A preliminary report.

OBJECTIVES: It is hypothesized that soccer players with periodontal disease exhibit raised serum creatine kinase (CK) levels as compared to those without periodontal disease. We assessed the clinical gingival status and serum CK levels among young soccer players. MATERIALS AND METHODS: Demographic data were collected through a structured questionnaire. Full mouth bleeding on probing (BOP) and probing pocket depth (PPD) were assessed. Blood samples (4 mL) were collected for measurement of serum CK levels. All blood samples were collected from a vein in the antecubital region. Total CK activities in serum were determined with an optimized spectrophotometric method. Statistical analysis was performed using one-way analysis of variance, and P< 0.05 was considered statistically significant. RESULTS: Twenty-seven male soccer players volunteered to participate in the present study. The mean age of the participants in Groups 1 (n = 14) and 2 (n = 13) were 18.2 ± 2.3 years and 19.1 ± 0.6 years, respectively. Mean scores of BOP were significantly higher among individuals in Group 2 (56.8%) compared with individuals in Group 1 (19.4%) (P < 0.001). Mean scores of PPD ≥4 mm were significantly higher among subjects in Group 2 (12.1%) as compared to individuals in Group 1 (0.8%) (P < 0.001). Levels of CK were significantly higher among individuals in Group 2 (292.7 U/L) as compared to those in Group 1 (52.3 U/L) (P < 0.01). CONCLUSION: Increased BOP and PPD are associated with increased serum CK levels in young soccer players.

Glioma invasion mediated by the p75 neurotrophin receptor (p75(NTR)/CD271) requires regulated interaction with PDLIM1.

The invasive nature of glioblastoma renders them incurable by current therapeutic interventions. Using a novel invasive human glioma model, we previously identified the neurotrophin receptor p75(NTR) (aka CD271) as a mediator of glioma invasion. Herein, we provide evidence that preventing phosphorylation of p75(NTR) on S303 by pharmacological inhibition of PKA, or by a mutational strategy (S303G), cripples p75(NTR)-mediated glioma invasion resulting in serine phosphorylation within the C-terminal PDZ-binding motif (SPV) of p75(NTR). Consistent with this, deletion (ΔSPV) or mutation (SPM) of the PDZ motif results in abrogation of p75(NTR)-mediated invasion. Using a peptide-based strategy, we identified PDLIM1 as a novel signaling adaptor for p75(NTR) and provide the first evidence for a regulated interaction via S425 phosphorylation. Importantly, PDLIM1 was shown to interact with p75(NTR) in highly invasive patient-derived glioma stem cells/tumor-initiating cells and shRNA knockdown of PDLIM1 in vitro and in vivo results in complete ablation of p75(NTR)-mediated invasion. Collectively, these data demonstrate a requirement for a regulated interaction of p75(NTR) with PDLIM1 and suggest that targeting either the PDZ domain interactions and/or the phosphorylation of p75(NTR) by PKA could provide therapeutic strategies for patients with glioblastoma.

Effect of exposure to cement dust on Fractional Exhaled Nitric Oxide (FeNO) in non-smoking cement mill workers.

OBJECTIVES: This cross-sectional study aimed to determine the effects of exposure to cement dust on Fractional Exhaled Nitric Oxide (FeNO) in non-smoking cement mill workers. SUBJECTS AND METHODS: We recruited 121 apparently healthy male volunteers, 90 of them were non-smoking cement mill workers and 31 non-smoking un-exposed subjects served as control. The mean age of cement mill workers was 36.62 ± 1.03 years and 36.65 ± 2.28 years of control subjects. Based on the duration of exposure, cement mill workers were divided into four groups, less than 5, 5-10, 10-15 and more than 15 years. All subjects were individually matched for age, ethnicity and socioeconomic status. Fractional Exhaled Nitric Oxide test was performed by using Niox Mino. RESULTS: Significant increased level of Fractional Exhaled Nitric Oxide was observed in cement mill workers (31.71 ± 2.963 ppb) compared to their non-exposed counterparts (25.39 ± 2.46 ppb). The significance difference was further increased with long-term working exposure in cement industry. CONCLUSIONS: Fractional Exhaled Nitric Oxide is significantly increased in cement mill workers and associated with duration of exposure to cement dust. The findings also show that cement mill workers have higher pulmonary inflammation.

Efficacy of nebulized furosemide in children with moderate attack of asthma.

BACKGROUND: Bronchodilators are the most commonly used drugs for asthma. However, alternative treatment is necessary for those patients who experience adverse effects from bronchodilators. OBJECTIVE: To investigate the efficacy of nebulized furosemide in children with moderate asthma exacerbations. METHOD AND MATERIALS: A double-blind randomized, controlled trial involving three groups of children with moderate attack of asthma. Twenty children were enrolled in group A and received nebulized albuterol, 20 children in group B received nebulized furosemide and 19 children in group C received both albuterol and furosemide. Pulmonary function parameters, peak flow rates, respiratory rate, oxygen saturation and clinical scores were obtained before and after treatment. RESULTS: The maximum increases in FEV1 achieved were 21.1 +/- 4.6 %, 20.8 +/- 3.2 and 21.7 +/- 4.9 in groups A, B and C respectively. The differences between the groups were not significant. Maximum increase in FVC was 20.3 +/- 1.6, 22.5 +/- 5.8 % and 24.5 +/- 4.9 % in groups B and C respectively. The difference between the three groups was not statistically significant. With regards to peak expiratory flow rate (PEFR), the mean increase after treatment was 23.5 +/- 8.6% and 21.8 +/- 6.3% in groups A and B respectively. There was significant increase in PEFR in group C children (26.0 +/- 9.1%; p = 0.01). There was no statistical significant difference among the three groups regarding the improvement in respiratory rate, SaO2 and clinical scores. CONCLUSION: Combination of both furosemide and albuterol led to significant increase in peak flow rate but it did not significantly affect FEV1, FVC, FEF 25-75, respiratory rate, SaO2 or clinical scores as compared to other groups. There were no significant adverse effects from the three drugs used.

Risk factors for development of hypoxic-ischemic encephalopathy in Abha City-southwestern Saudi Arabia.

Hypoxic ischaemic encephalopathy (HIE) is an important cause of permanent damage to central nervous system, which may result in neonatal death or manifest as cerebral palsy or mental deficiency. A matched-case control study of neonatal encephalopathy was conducted in Abha General Hospital, Abha City, Saudi Arabia to determine some possible risk factors for HIE. A total of 57 term infants with clinical evidence of HIE at birth were recruited over a period of 3 years, and compared with the same number of a control group of normal newborns. The cumulative incidence of HIE was 4.9 per 1000 live births (95% CI: 3.1 to 6.3). Moderate or severe encephalopathy occurred in about 63% of all infants, with seizures in 67% of these. All the 57 (100%) infants with encephalopathy required one or more of resuscitation measures compared with only 8 (14%) of the control. Significant antepartum risk factors for HIE include: primiparity (OR=3.13), nonaccessibility to antenatal care (OR=1.89), and pregnancy-induced hypertension(OR=2.13). Significant possible labour and delivery risk factors include: noncephalic presentation (OR=2.76)), antepartum haemorrhage (OR=4.32), instrumental delivery (OR=7.91), and prolonged second stage of labour (OR=6.67). In conclusion, both antepartum and intrapartum factors are important in the causation of HIE in Abha city. Improvement of both antenatal care and care during delivery is a necessity.

Assessment of inhalation technique in children with asthma, Abha, Saudi Arabia.

UNLABELLED: The inhalation technique of asthma in children was assessed using the criteria defined by the standardized inhaler checklist of the Netherlands Asthma Foundation and Dutch asthma foundation. Four hundred and thirty seven newly referred patients to chest clinic, department of pediatric, Assir Central Hospital, Southwestern Saudi Arabia were instructed to demonstrate their inhalation technique and to fill out a questionnaire related to the inhalation instructions received before their referral. RESULTS: Four hundred and thirty seven patients newly referred for evaluation of their asthma (5-12 years of age with mean age of 7.16+1.69 years, 202 (46.2%) girls, 235 (53.8%) boys were included in the study. Two hundred two (46.2%) patients use MDI. The remaining (53.8%) patients use the DPI, 123 (52.35%) of them use turbohalers while 112 (47.65%) use diskhalers. Only 36 patients (8.2 %) completed the assessment without making any mistake. Of the remainders, 399 (91.8%) made one or more mistakes. Of the MDI users, eleven patients (5.4%) performed correctly all the steps, and 54 (26.7%) performed correctly four or more steps. Ten (8.9%) of the diskhaler users performed all the steps correctly and forty nine (43.8) performed correctly four or more steps. Fifteen (12 2%) of the turbohaler users performed correctly all the steps and ninety five (77.2%) performed correctly four or more steps. One hundred five of the male patients (44.7%), performed correctly more than three steps as compared to 93 of the female patients (46.5) with p value=0.704. One hundred and one patients (67.3%) between the age of 8-12 years performed more than three steps correctly as compared to 97 (33.8%) of patients aged 5-7 years (p=0.001). CONCLUSION: In conclusion, many asthmatic children use their inhaler devices too poorly with the result of an unreliable drug delivery. Turbohaler device inhalation technique was the easiest, followed by diskhaler then lastly the MDI. Education of asthmatic children and their families is highly needed to make sure the patient perform the correct inhalation technique.

A comparison of inhaled fluticasone and oral prednisone for children with severe acute asthma.

BACKGROUND: Inhaled corticosteroids are effective in the treatment of children with asthma. It is uncertain how inhaled corticosteroids compare with oral corticosteroids in the management of severe acute disease. METHODS: We performed a double-blind, randomized trial involving 100 children five years of age or older who had severe acute asthma (indicated by a forced expiratory volume in one second [FEV1] that was less than 60 percent of the predicted value) and in whom the results could be evaluated. All were treated with an aggressive bronchodilator regimen and received one dose of either 2 mg of inhaled fluticasone through a metered-dose inhaler with a spacer or 2 mg of oral prednisone per kilogram of body weight. They were assessed hourly for up to four hours. RESULTS: The mean (+/-SD) base-line FEV1 as a percentage of the predicted value was 46.3+/-12.5 in the fluticasone group (51 subjects) and 43.9+/-9.9 in the prednisone group (49 subjects). The FEV1 increased by a mean of 9.4+/-12.5 percentage points in the fluticasone group and by 18.9+/-9.8 percentage points in the prednisone group four hours after therapy (P< 0.001). None of the children in the prednisone group had a reduction in FEV1 as a percentage of the predicted value from base line to four hours, as compared with 25 percent of those in the fluticasone group (P<0.001). Sixteen (31 percent) of the children treated with fluticasone were hospitalized, as compared with five (10 percent) of those treated with prednisone (P=0.01). CONCLUSIONS: Children with severe acute asthma should be treated with oral prednisone and not with inhaled fluticasone or a similar inhaled corticosteroid.

Screening for asthma and associated risk factors among urban school boys in Abha city.

OBJECTIVE: The objective of the present study was to measure the prevalence of asthma and asthma-related symptoms among male school children in Abha City and to determine some of the possible risk factors influencing its occurrence. METHODS: A randomly selected sample of 4300 male school children aged 7 to 15 years in Abha were subjected to a previously validated questionnaire for asthma to be completed by parents. Asthma was identified based on the Rush Medical College and International Study of Asthma and Allergies in Children questionnaire. Information of asthma family history, asthma related symptoms, and other atopic conditions, smokers in the family, pets ownership and monthly family income were collected. RESULTS: The overall prevalence of asthma was 9% (95% Confidence Interval: 7.73%-9.67%). Doctor-diagnosed asthma was reported by 4%, exercise-induced asthma by 4% and wheeze in the past year by 8%. Multiple logistic regression analysis showed that positive family history of atopic condition (Odds Ratio=437.11, P<0.001), pets ownership (Odds Ratio=2.91, p<0.001), and lower monthly family income (Odds Ratio=2.00, P<0.02) were significant factors influencing the development of asthma. CONCLUSION: In conclusion, the screening methodology adopted in this study could be applied for all children at the beginning of the school year, being simple and non-invasive measure. The prevalence of asthma in school children in Abha is greater than that reported from most developing countries and closer to the rates reported in developed countries. Avoidance of pets ownership at home, improving social class and premarital counselling for atopic persons are all recommended.

Anaphylaxis and epinephrine auto-injector training: who will teach the teachers?

BACKGROUND: Anaphylaxis is the most urgent clinical immunologic event. Effective treatment is best achieved by administration of epinephrine. Accidental exposure to the responsible allergen is the most common cause of anaphylaxis, and because it could be fatal within minutes, epinephrine in preloaded syringes and auto-injectors has been introduced. In our experience patients and medical personnel are not familiar with the use of this device. OBJECTIVE: We sought to assess community-based professionals' knowledge of epinephrine auto-injector use and their ability to educate patients. METHODS: Study participants consisted of a medical convention's delegates and emergency department personnel in metropolitan Toronto, as well as pharmacists of the target hospitals and retail pharmacists. Research assistants approached eligible professionals to fill out a questionnaire and demonstrate their ability to use a standard placebo auto-injector trainer. RESULTS: A total of 122 professionals (composed of emergency physicians, family practitioners, and pediatricians) consented to participate in this study. The majority of participants (81%) did not have a placebo trainer to educate their patients; 76% did not know the 2 available dose strengths. To provide instructions and reinforcement, physicians clearly must have the necessary skills and knowledge, yet only 25% of the study participants were able to demonstrate the 3 steps of injection correctly. CONCLUSION: Our study highlights a specific and important deficiency in medical professionals' care of patients at risk for anaphylaxis. The results challenge the current methods of educating professionals, as well as patients, when prescribing or using epinephrine auto-injectors. Clearly a new approach to educating and maintaining such skills is required.