Incidence of sickle cell disease patients with pulmonary embolism admitted to the intensive care unit in Bahrain.

OBJECTIVES: To describe the incidence of pulmonary embolism (PE) in sickle cell disease (SCD) patients admitted to the intensive care unit (ICU). METHODS: A retrospective descriptive analysis was conducted with 124 SCD patients diagnosed with PE or suspected PE admitted to the ICU of Salmaniya Medical Complex, Manama, Bahrain between May 2017 and April 2018. A data collection form was used to obtain information on the history and demographics of PE patients. RESULTS: A total of 124 patients diagnosed with SCD were admitted to the ICU during the study period. Male patients slightly outnumbered (n=75; 56.4%) female patients, and the average age was in the mid- thirties (mean=37.4 years). The main diagnosis leading to ICU admission was vaso-occlusive crisis. The average hemoglobin level was 8.6 mg/dl, hemoglobin S% was 55.8%, and the length of stay in the ICU was 5.3 days. A total of 5 patients were diagnosed with PE with an incidence rate of 3.8%. All PE patients were females, which resulted in a significant relationship between gender and the likelihood of developing PE. No statistical relationship existed between the likelihood of developing PE and patient age, hemoglobin, hemoglobin S%, length of stay in ICU, and mortality. CONCLUSION: The demographic characteristics of the population included a male predominance, age in the mid-thirties, and vaso-occlusive crisis diagnosis upon admission to the ICU. The incidence of PE was significantly related to female gender. No significant relationship existed between the likelihood of developing PE and age, hemoglobin, hemoglobin S%, length of ICU stay, or mortality.

A systematic literature review looking for the definition of treatment burden.

BACKGROUND: Treatment burden is an emerging concept in health care literature. It can complicate the patients' condition and perhaps result in poor adherence to treatment, which is linked to worse clinical outcomes. However, until now there is no definition for treatment burden recognized by all stakeholders. This review was prepared in order to find what available definitions for treatment burden are present in the literature. METHODS: A systematic review of the literature was prepared looking for definitions of treatment burden in adult patients. Articles about adults aged 18 years or older from both genders with one or more medical conditions that contained a (new) definition of treatment burden were included. The search approach consisted of conventional systematic review database searching of multiple resources including Embase, Medline, PsycINFO, and CINAHL. Two independent reviewers screened the titles and abstracts, and full papers. RESULTS: The searches resulted in 8045 records, of which 16 articles were included. Based on quality appraisal criteria, we decided that two definitions had better evaluations than the rest of the definitions, the first one defining it as the impact of the 'work of being a patient' on functioning and well-being, the second as the actions and resources they devote to their healthcare. CONCLUSION: We consider the definition concentrating on actions and resources patients devote to their healthcare, including difficulty, time, and out-of-pocket costs dedicated to the healthcare tasks such as adhering to medications, dietary recommendations, and self-monitoring as the one probably comprising most domains of Treatment Burden that we have found in our search in the existing literature. However, adding even more domains to this definition and differentiating explicitly between patient's perception and caregiver's perception in the definition could in our opinion result in an improved definition. Also patients' evaluation of this definition is commendable.