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   Table of Contents - Current issue
Coverpage
July-September 2018
Volume 2 | Issue 3
Page Nos. 35-50

Online since Monday, February 25, 2019

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REVIEW ARTICLE  

Building capacity in critical care research coordination in Saudi Arabia: The role of the Saudi critical care trials group p. 35
Ahmad M Deeb, Eman Al Qasim, Lara Afesh, Sheryl Ann Abdukahil, Musharaf Sadat, Yaseen M Arabi
DOI:10.4103/sccj.sccj_30_18  
Critical care research is growing around the world including Saudi Arabia. The objective of this review is to discuss the building capacity in critical care research coordination in Saudi Arabia as a part of the research strategy of the Saudi Critical Care Trials Group (SCCTG). The SCCTG was developed to promote high impact critical care research in Saudi Arabia and to facilitate collaboration in national and international clinical research. Well-organized coordination between all parties is necessary by the presence of qualified clinical research coordinator (CRC). Critical care has unique features that make clinical research conduct more complex and demanding. It is a high-risk area with increased potentiality of error or adverse events occurrence. Critical care providers such as critical care nurses, critical care pharmacists, respiratory therapists, critical care physiotherapists, or intensive care unit physicians with added skills may be appropriate candidates to handle CRC roles in critical care setting. These skills include but not limited to data collection, obtaining consent, patient assessment, patient screening for the study eligibility, data entry, ethics submissions, providing teaching regarding the study protocol and research topics to clinical staff, attending to regulatory requirements, and designing data collection tools. The SCCTG shall focus on training the clinical research coordination skills through providing specialized courses and workshops that enable different hospitals to conduct and participate in clinical research. It will also help developing network group to connect critical care CRCs in Saudi Arabia and worldwide.
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ORIGINAL ARTICLE Top

A study of hand hygiene technique in intensive care unit of a tertiary care hospital p. 42
Shuchita Vaya, Jitesh Jeswani
DOI:10.4103/sccj.sccj_28_18  
Introduction: Hand hygiene (HH) has been characterized as the keystone and starting point in all infection control programs, with the hands of health-care faculty being the handler and advocates of infection in critically ill patients. Materials and Methods: This was a cross-sectional observational study using direct observation technique. A single observer collected all HH data. This single-observer study was conducted in the 45-bedded intensive care unit (ICU) of Mahatma Gandhi Hospital. HH compliance was monitored using the hand hygiene observation form developed by the World Health Organization. A nonidentified observer was used for monitoring compliance with HH. Results and Discussion: A total of 900 observations were recorded from health-care personnel in ICU. With respect to the personnel, the nursing department had the highest number of observations as 400 circulating nurses were sampled. There were also 110 senior consultants, 250 resident doctors, and 140 paramedical staffs. Of the total opportunities, nurses had the highest number of contacts (67%), followed by allied health-care workers (82.94%). The average compliance was about 75%, which differed significantly among health-care workers, with higher compliance among the nursing staff (82.9%) followed by allied staff (67%). Of the average overall compliance of 75%, maximum compliance was seen for moment 3, that is, the staffs were very careful after body fluid contact as it was perceived important for self-protection. The HH instances after patient contact (86.29%) also suggested similarly. The nurses' compliance was 64.40% before patient contact and 68.35% after touching surroundings. Conclusion: The observance of HH is still low in our local environment. Handwashing practices in our study show that health-care workers pay attention to HH, when it appears, there is a direct observable threat to their well-being. Educational programs need to be developed to address the issue of poor HH.
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CASE REPORTS Top

Rare case of axillary pseudoaneurysm subsequent to an intra-arterial percutaneous cannulation p. 45
Arwa Badeeb, Abdullah Taiyeb, Jana Hudcova
DOI:10.4103/sccj.sccj_26_18  
Axillary pseudoaneurysm (PSA) is a rare condition that mainly presents with traumatic injury. In this case report, we show an iatrogenic axillary PSA, following an intra-arterial line (A-line) removal. A 75-year-old with an extensive past medical history including diabetes hypertension, peripheral vascular disease, and atrial fibrillation on Warfarin came to the hospital for an elective abdominal aortic aneurism repair. During her postsurgical stay, she had multiple A-line placements due to recurrent malfunctions and ended up having an axillary A-line. The development of a PSA complicated the removal of the line; an infrequent complication. This was treated with thrombin injection a couple of times after which homeostasis was achieved. Although axillary PSAs are rare, especially iatrogenic ones, individual attention and care should be taken while handling axillary A-lines. Furthermore, one should have a low level of suspicion, especially in patients with multiple predisposing risk factors such as ours.
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Essence of time in high altitude pulmonary edema – A case report p. 48
Uma Rathi, Ravneet Kaur Gill, Richa Saroa, Puja Saxena
DOI:10.4103/sccj.sccj_31_18  
High-altitude sickness can present with numerous symptoms ranging from headache, blurring of vision, dyspnea on exertion to more critical events such as pulmonary edema and cerebral edema. Rapid ascent, high altitudes of >2500 m, and previous lung disorders are the predisposing factors. Rapid and aggressive management forms the core treatment. Mechanical ventilation should be instituted at the earliest to prevent fatal consequences. Most of the cases are managed at medical centers at high altitudes only. Utmost coordination is required between centers for rapid management. Here, we report a case which was referred to our institute located at foothills with high-altitude pulmonary edema for intensive management.
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