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INTRODUCTION: In hemodialysis patients, pain associated with needle insertion into an arteriovenous fistula is a physical and psychological problem. The aim of this study was to assess the effectiveness of pre-puncture application of an ice pack, EMLA cream, or lidocaine spray to reduce pain associated with access puncture. METHODS: This was a multicenter study done in nine hemodialysis centers in Iraq. The study utilized a randomized, parallel-group design, in which patients being dialyzed using an arteriovenous access were allocated into one of four groups. Access puncture was preceded by nothing (control group), by use of ice pack cooling at the puncture site, by application of EMLA cream, or by application of lidocaine spray. Pain after access puncture was assessed during a single treatment for each patient. Pain was quantified using a Visual Analogue Scale. FINDINGS: A total of 1548 patients agreed to participate, and 1041 patients were included in the data analysis. Use of an ice pack, EMLA cream, or lidocaine spray each was associated with a lower pain score on access puncture compared with no pretreatment. The mean Visual Analogue Scores in the four groups were: 69.7 ± 15.7 in the controls, 39.8 ± 13.2 in the ice pack group, 45 ± 18.4 in the EMLA group, and 52.9 ± 15.2 in lidocaine group. Ranking of the pain severity scores suggested that ice pack use was associated with the least pain, followed by use of EMLA cream and use of lidocaine spray (severity score ranking, from lowest to highest, being 1.62, 2.18, and 2.63, respectively). DISCUSSION: Application of an ice pack prior to vascular access puncture is a fast and inexpensive technique to limit pain associated with this procedure.
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Background: Health care providers (HCPs) have always been a common target of stigmatization during widespread infections and COVID-19 is not an exception. Aim: This study aims to investigate the prevalence of stigmatization during the COVID-19 pandemic among HCPs in seven different countries using the Stigma COVID-19 Healthcare Providers tool (S19-HCPs). Design: Cross-sectional. Methods: The S19-HCPs is a self-administered online survey (16-item) developed and validated by the research team. The participants were invited to complete an online survey. Data collection started from June-July 2020 using a convenience sample of HCPs from Iraq, Jordan, Egypt, Saudi Arabia, Indonesia, Philippines, and Kuwait. Results: A total number of 1726 participants were included in the final analysis. The majority of the study participants were Jordanians (22%), followed by Kuwaitis (19%), Filipinos (18%) and the lowest participants were Indonesians (6%). Other nationalities were Iraqis, Saudis, and Egyptians with 15%, 11% and 9% respectively. Among the respondents, 57% have worked either in a COVID-19 designated facility or in a quarantine center and 78% claimed that they had received training for COVID-19. Statistical significance between COVID-19 stigma and demographic variables were found in all aspect of the S19-HCPs. Conclusion: The findings of this study demonstrated high levels of stigmatization against HCPs in all the included seven countries. On the other hand, they are still perceived positively by their communities and in their utmost, highly motivated to care for COVID-19 patients. Educational and awareness programs could have a crucial role in the solution of stigmatization problems over the world.
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PURPOSE: The S19-HCPs tool evaluates the stigma towards healthcare providers working with patients with COVID-19. MATERIALS AND METHODS: The psychometric properties of the Arabic and English versions of the S19-HCPs were examined. A survey using the S19-HCPs scale was administered online. Two reliability analyses were used in this study to identify the extent to which S19-HCPs shows consistent results (internal consistency and test-retest reliability). The English version of the scale was piloted on 33 Jordanian and the Arabic version on 27 Iraqi participants. RESULTS: The internal consistency of the English and Arabic S19-HCPs was satisfactory (α = 0.79, 0.74, respectively). Two-week test-retest correlations were all statistically significant (ICC = 0.91, 0.89, respectively). CONCLUSION: The S19-HCPs is psychometrically robust and can be used in research assessing the stigma towards healthcare providers working with patients with COVID-19 in English and Arabic-speaking countries.