Validation of intraocular pressure measurement using tonometer AVIA across different postures: A Bland Altman analysis.

AIMS/OBJECTIVES: Tonometry is a fundamental procedure in the diagnosis and management of glaucoma. Different tonometers have been proposed but none are as accurate as the Goldman applanation tonometry (GAT). Nonetheless, due to the limitations of GAT, mobile tonometry methods became prevalent. This study aims to examine the reliability of the Tono-Pen AVIA® (TPA) in measuring intraocular pressure (IOP) across different postures. METHODS: A total of 196 eyes were prospectively examined for IOP changes using GAT and TPA. IOP measurements were taken across different postures using the TPA. Reliability of measurements was compared using interclass correlation coefficients (ICC), while agreement was represented using Bland-Altman analysis. Pearson r coefficient was used to measure correlations. RESULTS: When compared to GAT (14.5 ± 4.4 mmHg), IOP readings were significantly higher for TPA at both seated (16.5 ± 4.5 mmHg; p < 0.001) and supine (16.9 ± 5.7; p < 0.001) positions. The ICC values for GAT and TPA among seated and supine patients were 0.79 (0.54-0.90) and 0.76 (0.48-0.87) indicating good reliability between the readings. There were significantly positive correlations between GAT and TPA at both seated (r = 0.626, p < 0.001) and supine (r = 0.727, p < 0.001) positions. Per Bland-Altman analysis, limits of agreement were -8.57 to 4.37 for GAT and seated TPA and -10.34 and 5.34 for GAT and supine TPA. CONCLUSION: Good reliability exists between IOP measurements using GAT and TPA. However, the devices are not interchangeable and therefore cannot be used reciprocally in the same patient.

Prevalence of respiratory failure and use of mechanical ventilation in heart failure patients undergoing left atrial appendage occlusion device implantation.

BACKGROUND: We sought to evaluate respiratory complications in heart failure patients undergoing left atrial appendage occlusion (LAAO) for stroke prevention in atrial fibrillation. METHODS: Adult admissions (>18 years) undergoing LAAO during 2016-2020 were identified from the National Inpatient Sample. Heart failure (HF) was stratified into systolic (SHF) and diastolic heart failure (DHF) and were compared to those without HF. Outcomes of interested included acute respiratory failure, use of non-invasive and invasive mechanical ventilation, and in-hospital mortality. RESULTS: Of 74,440 admissions for atrial fibrillation undergoing LAAO, SHF and DHF were noted in 8335 (11.2%) and 10,925 (14.7%), respectively. The SHF cohort was predominantly male (78%) whereas DHF cohort were female (53%). Compared to those without HF, presence of SHF (2.3% vs. 0.6%; adjusted odds ratio [OR] 1.61 [95% confidence interval {CI} 1.10-2.36]; p = 0.01) and DHF (2.8% vs. 0.6%; adjusted OR 2.20 [95% CI 1.58-3.06]; p < 0.001) were associated with higher rates of acute respiratory failure. SHF (1.7% vs. 0.6%; adjusted OR 1.70 [95% CI 1.07-2.71]; p = 0.02) group but not DHF (1.2% vs. 0.6%; adjusted OR 1.21 [95% CI 0.78-1.89]; p = 0.39) was associated with higher rates of non-invasive ventilation, whereas the DHF group (0.9% vs. 0.2%; adjusted OR 1.91 [95% CI 1.08-3.34]; p = 0.02) but not SHF (0.8% vs. 0.2%; adjusted OR 1.54 [95% CI 0.83-2.84]; p = 0.17) was associated with higher rates of invasive mechanical ventilation use. In-hospital mortality was comparable between cohorts. CONCLUSION: Compared to those without HF, atrial fibrillation admissions with HF undergoing LAAO had higher rates of acute respiratory failure and mechanical ventilation rates without differences in in-hospital mortality.

The Value of Auditing Surgical Records in a Tertiary Hospital Setting.

BACKGROUND: Assessing and improving quality of care should be of paramount importance to health care systems and providers. This study aimed to evaluate the quality of surgical records at the Jordan University Hospital. METHODS: We used the previously validated Surgical Tool for Auditing Records (STAR) to retrospectively evaluate the quality of surgical records of patients who underwent surgery in the general surgery department from 2016 to 2021. Total STAR and section-specific STAR scores were compared using the two independent sample Student's ttest on SPSS Statistics, version 23 (IBM Corp, Armonk, NY). RESULTS: A total of 488 records were selected and evaluated using the STAR. The total STAR scores significantly improved steadily throughout the years compared to the baseline in 2016, reaching the highest in 2021. All domains had improved compared to the baseline except for anesthesia records that did not change from an already high baseline. The highest improvements between STAR domains were observed in Initial Clerking and Consent domains. CONCLUSION: Our study demonstrates that significant improvements in the quality of surgical records can be achieved by simply using an electronic record entry system, personnel education, and systematic auditing.

Complex, Isolated Pulmonary Arteriovenous Malformation in Two Children With Severe Cyanosis.

We present two cases of Isolated complex pulmonary arteriovenous malformations in two children presenting with cyanosis and exercise intolerance. We present the anatomical features and the management of each case. One patient was treated with surgical ligation of the draining vein, and one patient was treated percutaneously by closure of the feeding segmental artery.

Validation of the Psychometric Properties of the NEO-FFI-3 in an Arabic Context.

AIM: The present study aims to assess the validity and reliability of the psychometric properties of the Arabic adaptation of the NEO Five-Factor Inventory (NEO-FFI-3) to be used in research of personality inventory in the Arabic context. METHODS: It is a validation study of an Arabic version (NEO-AR) of the NEO-FFI-3. An online version was used to collect 1306 samples using convenient sampling in two phases. The collected data tested the validity of the inventory by using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while reliability was verified using Cronbach's alpha after an Arabic version was conjured using forward translation, testing, and back-translation. RESULTS: The principal axis factoring (PAF) and the confirmatory factor analysis (CFA) are the analyses used to validate the factorial structure of the NEO-FFI-3 (NEO-AR). The reproduction of the original structure of NEO-FFI was proven using PAF, and CFA revealed a satisfactory fit of single-factor models for the five dimensions. The reliability analysis showed high values of internal consistency, which are congruent with previous international adaptations of the NEO-FFI-3. CONCLUSION: The findings of the current study suggest that the Arabic version of the NEO-FFI-3 (NEO-AR) is a reliable and robust instrument to measure the five dimensions of personality of the Five-Factor Model facets as the original North America NEO-FFI-3. The results imply that the approach measuring psychological characteristics is successful across different cultures as in previous studies and the Arab World in this study.

Burnout Syndrome during Residency Training in Jordan: Prevalence, Risk Factors, and Implications.

Burnout syndrome is common among healthcare professions, including resident physicians. We aimed to assess the prevalence of burnout among resident physicians in Jordan, and a secondary aim was to evaluate the risk factors associated with the development of burnout syndrome in those residents, including gender, working hours, psychological distress, training sector, and specialty. In this cross-sectional study, 481 residents were recruited utilizing multistage stratified sampling to represent the four major health sectors in Jordan. Data were collected using an online questionnaire, where the Copenhagen Burnout Inventory (CBI) was used to assess the prevalence of burnout. The prevalence, group differences, and predictors of burnout were statistically analyzed using STATA 15. Overall, 373 (77.5%) residents were found to have burnout. Factors associated with higher levels of burnout were psychological stress (ß = 2.34, CI = [1.88-2.81]), longer working hours (ß = 4.07, CI = [0.52-7.62], for 51-75 h a week, ß = 7.27, CI = [2.86-11.69], for 76-100 h a week and ß = 7.27, CI = [0.06-14.49], for >100 h a week), and obstetrics/gynecology residents (ß = 9.66, CI = [3.59-15.73]). Conversely, medical sub-specialty residents, as well as private and university hospital residents, had lower burnout levels. We concluded that decreasing the workload on residents, offering psychological counseling, and promoting a safety culture for residents might help in mitigating burnout consequences.

Clinical Evaluation of Respiratory Rate Measurements on COPD (Male) Patients Using Wearable Inkjet-Printed Sensor.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that causes long-term breathing problems. The reliable monitoring of respiratory rate (RR) is very important for the treatment and management of COPD. Based on inkjet printing technology, we have developed a stretchable and wearable sensor that can accurately measure RR on normal subjects. Currently, there is a lack of comprehensive evaluation of stretchable sensors in the monitoring of RR on COPD patients. We aimed to investigate the measurement accuracy of our sensor on COPD patients. METHODOLOGY: Thirty-five patients (Mean ± SD of age: 55.25 ± 13.76 years) in different stages of COPD were recruited. The measurement accuracy of our inkjet-printed (IJPT) sensor was evaluated at different body postures (i.e., standing, sitting at 90°, and lying at 45°) on COPD patients. The RR recorded by the IJPT sensor was compared with that recorded by the reference e-Health sensor using paired T-test and Wilcoxon signed-rank test. Analysis of variation (ANOVA) was performed to investigate if there was any significant effect of individual difference or posture on the measurement error. Statistical significance was defined as p-value less than 0.05. RESULTS: There was no significant difference between the RR measurements collected by the IJPT sensor and the e-Health reference sensor overall and in three postures (p > 0.05 in paired T-tests and Wilcoxon signed-rank tests). The sitting posture had the least measurement error of -0.0542 ± 1.451 bpm. There was no significant effect of posture or individual difference on the measurement error or relative measurement error (p > 0.05 in ANOVA). CONCLUSION: The IJPT sensor can accurately measure the RR of COPD patients at different body postures, which provides the possibility for reliable monitoring of RR on COPD patients.

Do Medical Students Experience Writing Anxiety While Learning English as a Foreign Language?

AIM: The study examines English Foreign Language (EFL) writing anxiety among medical students in terms of the levels, types, and causes of writing anxiety. METHODS: This study is a cross-sectional study consisting of 684 first-year medical students from Jordanian universities. The participants responded to an online survey consists of Second Language Writing Anxiety Inventory (SLWAI) and Causes of Writing Anxiety Inventory (CWAI), 15 of whom were invited for semi-structured interviews. RESULTS: The results reveal that the participants experience a high level of writing anxiety, with cognitive anxiety as its dominant type. As for the main causes of writing anxiety, they are linguistic difficulties, insufficient writing practice, low self-confidence in writing, and fear of writing tests. The findings from qualitative data obtained from semi-structured interviews reinforce the results of quantitative data. CONCLUSION: The study sheds light on the problems of English Foreign Language writing anxiety and raises awareness of language teachers and syllabus designers.