Research on the Impact of mHealth Apps on the Primary Healthcare Professionals in Patient Care.

The goal of this study was to develop and use a questionnaire in order to analyse the effects of eHealth apps on patient care using Jordanian population. A two-stage cross-sectional research was conducted. A questionnaire was developed in the beginning to evaluate its consistency and legitimacy using Cronbach's alpha coefficient, a multitrait connection atmosphere; the multivariate technique is component examination. In the study's another phase, correlation and regression are used to determine the influence of eHealth apps on patient care. The five major axes of the final surveys were healthcare efficiency, teaching, notices, consultation, and follow-up. Individuals from diverse demographic aspects, such as gender, age, job experience, and education level, have no differing perspectives on cell phone use in their amenities, according to a staff's viewpoint evaluation. In general, mobile health applications had a good influence on health services and healthcare, which would be an important setting for the operative use of mobile headphones in public policy; such a background would affect in workers' intents to practice and adopt mHealth.

Magnesium Sulfate: an adjunctive therapy in the first hour of management of rapid atrial fibrillation in the emergency department.

INTRODUCTION: Rapid Atrial fibrillation (AF) is a common arrhythmia in emergency department (ED) that requires an urgent control of ventricular rate. AIM: To evaluate the safety and efficiency of magnesium sulfate as an adjunctive therapy in addition to usual care for rapid AF in emergency department. METHODS: This was a prospective, randomized, double-blind study. We included patients who presented to ED with rapid AF >110 batt/min. Group A received 3g of magnesium in 100mL of glucose solution and group B received 100 ml of glucose solution. Primary endpoint was slowing the ventricular rates to less than 110 beats/ min in the first 12 hours of management. RESULTS: One hundred and three patients were included. Fifty-three patients in group A with a mean heart rate of 146 ± 18 beats / min and fifty patients in group B with a mean heart rate of 143 ± 17 beats / min. A significantly greater number of patients slowed down their ventricular rate in group A during the first hour of management (p = 0.02). After 12 hours, mean heart rate was significantly lower in group A (p = 0.04). CONCLUSION: The use of 3 g of magnesium sulfate slowed down the ventricular rate of a larger number of patients with rapid AF in the first hour of management. Only minor adverse effects were registered.

Care of the hypertensive urgencies and emergencies in the emergency departement.

INTRODUCTION: Hypertension is a major public health concern leading to multiple acute complications. The purpose of our work was to present the distribution of high blood pressure (BP) measurements in an emergency department, and their significance. METHODS: Our study was prospective, observational and descriptive over a period of one month conducted in the general emergency department. We included non-traumatic patients within 24 hours from the triage. We divided the population into three groups according to the blood pressure measurements at admission; the first group with transient elevation of BP, the second group with hypertensive urgencies and the third group was the group of hypertensive emergencies. RESULTS: We screened 2011 patients, 460 were included, and the frequency of initial (T0) high blood pressure was 22.8%, controlled at 18.5% after 10 minutes of rest (T10). The mean age was 63.2 ± 13.2 years, the sex ratio was 0.77. The mean blood pressure BP (T0) was 182.1 ± 24.4mmHg [150-280] mmHg for systolic (S) BP, and 86.8 ± 14.7mmHg [60-160] mmHg for diastolic (D) BP. At T10, the mean SBP was 165.1 ± 28.6 mmHg, and DBP was 82.8 ± 12.1mmHg. We started treatment for 32.4% of patients after the third BP control (T30): oral captopril (45.5%), intravenous nicardipine (IV) (27.2%), furosemide (23.9%). During the second BP measurement, there was a significant decrease in average SBP: 21 ± 11mmHg (p <0.001), as well as a significant decrease in average PAD: 3.6 ± 2.4 mmHg (p <0.001). At T30, the decrease was also significant for SBP : 16.5mmHg (p = 0.001), and for BPD : 2.5 mmHg (p = 0.001). The decrease was significant after treatment for SBP : 33.3 mmHg and for DBP: 10.4 mmHg (p = 0.001). CONCLUSION: High blood pressure figures are a relatively common in emergencies. The treatment must be chosen according to organ faillure.

[Role of the Alvarado score in the diagnosis of acute appendicitis]. / Intérêt du score d'Alvarado dans le diagnostic des appendicites aigües.

INTRODUCTION: Acute appendicitis is the most frequent surgical emergency in the Emergency Department and diagnosis is mainly based on clinical examination. However, its clinical features are sometimes deceptive as well as the wide range of differential diagnoses are frequently sources of diagnostic errors and of a delayed management. In order to reduce these diagnostic difficulties, the number of complementary examinations and abusive surgical procedures, several clinical scores have been developed, including the Alvarado score. The objective of this study aimed to apply this score to a population of adult patients presenting with pain in the right iliac fossa in order to evaluate its performance as well as its limits. METHODS: We conducted a prospective study of all patients over the age of 15 years presenting with pain of the right iliac fossa. In patients undergoing surgery, the final diagnosis of acute appendicitis was confirmed by the anatomo-pathological examination while it was negated when the symptoms regressed in the absence of any treatment. RESULTS: Our study included 106 patients. In patients with Alvarado score less than 4, the diagnosis of acute appendicitis was never retained. The best sensitivities and specificities were found in patients with a threshold value of 8 (Alvarado score). Our study demonstrated that Alvarado score can provide immediate benefit in the diagnosis of acute appendicitis based on its good sensitivity (81.25%) and correct positive predictive value (74,28%). The group of patients with a score strictly less than 4 was considered to be low risk. The patients with Alvarado score strictly greater than 6 would require hospitalization either to undergo emergency surgery or to undergo imaging examinations and be monitored. In the group of patients with a score between 4 and 6 (extremes included) there was no diagnostic certainty, hence complementary imaging techniques were essential. CONCLUSION: In our Emergency Department Alvarado score helps clinicians to streamline patient's management and to give an indication to the diagnosis by limiting the prescription of radiological examinations, the cost of patients' management and the abusive surgical procedures.

[Is BNP assay useful for the diagnosis of acute dyspnea in emergencies departments?]. / Est-ce que le dosage du brain natriuretic peptide est utile dans le diagnostic de la dyspnée aiguë aux urgences?

BACKGROUND: It would be interesting to the emergency doctor to have at his disposal a helpful diagnostic tool like brain natriuretic peptide (BNP). Such assay is simple, available and reliable. AIMS: To report our experience on the role of BNP in the etiological diagnosis of acute dyspnea (AD) in emergency room (ER) and to assess the cost-effectiveness ratio of such diagnosis strategy. METHODS: A prospective study conducted in the ER of Rabta university teaching hospital of Tunis, from March 1st to June 20th 2010, involving 30 consecutive patients presenting to the emergency for AD. All patients underwent echocardiography in their acute phase and benefited from the dosage of BNP during the first 4 hours. The echocardiography parameters were collected by a single operator who was unaware of the results of the BNP dosage. RESULTS: The mean age of patients was 72.8years with a sex ratio of 1.5. AD was of orthopnea type in 9 cases and stage III NYHA dyspnea in the other patients. Clinical and radiological signs of left heart failure were noted in 30% of cases. Ultrasound data have objectified systolic dysfunction in 4 cases, diastolic in 3 cases and systolic plus diastolic in 10 cases. The BNP levels were below 100 pg/ml in 10 cases with pulmonary origin of the AD. A BNP level between 100 and 400 pg/ml was noted in 3 cases. In our study, the clinical probability of AHF prior to performing the test was estimated at 53% and estimated at 100% after the BNP assay. The BNP assay has reduced the length of stay in the emergency department 4 to 5 days and saved nearly 50% of the cost of care per patient. CONCLUSION: The BNP assay, has allowed us to confirm the AHF all cases. Given the prognostic value and economic benefit of this test we recommend its use in ER of our country.

Role and impact of carbapenem in nosocomial infections.

Although carbapenem antibiotics are one of the most effective agents in the treatment of nosocomial infections caused by Gram-negative bacteria, their use is threatened by the emergence of antibiotic resistance. The bacterial resistance to carbapenems parallels their increasing use and has dramatic clinical implications such as increase in mortality and cost of care. This article reviews recently published patents claiming for carbapenem antibacterial agents. New forms including crystalline forms with high oral bioavailability and modified spectrum including methicillin-resistant Staphylococci are some of new patents described in this review.