Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit最新文献

Background: Pakistan lacks national evidence-based clinical practice guidelines for dermatology, and there are challenges in using the international guidelines.

Aim: To develop context-specific guidelines for clinical management of atopic dermatitis in Pakistan.

Method: We conducted on PubMed, Google Scholar and Cochrane Library a critical review and appraisal of clinical guidelines for the management of atopic dermatitis published between January 2019 and March 2024. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, we selected and reviewed the 2023 Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the Institute of Medicinebased recommendations of the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters. We selected, prioritized, modified, and adopted those recommendations applicable to Pakistan.

Results: Of the 25 recommendations in the source guidelines, 12 were adopted and used to develop 27 recommendations for Pakistan.

Conclusion: GRADE adolopment of clinical practice guidelines is a feasible method that countries with limited resources can use to adapt international guidelines to local context.

Background: Due to the economic and political instability and the influx of refugees, Lebanon has experienced an increased burden of skin diseases among vulnerable populations.

Aim: To assess the demographic characteristics and skin disease profile, with a view to improving dermatological care for Syrian refugees and underserved Lebanese communities in the Bekaa Valley.

Methods: We conducted a dermatological needs assessment and interventions as part of a skin and sexually transmitted infections knowledge, attitude and practice project among Syrian refugees and vulnerable populations in Bekaa Valley and northern Lebanon. We collected and analysed demographic and dermatologic data during a medical mission in May 2023.

Results: Of the 417 patients, 65% were Syrians and 68% were female. The most common diagnoses were inflammatory dermatoses (28.4%), skin infections (21.3%) and disorders of the skin and appendages (37.3%). During the follow-up activities, 40% of additional 204 individuals consulted had infectious skin conditions.

Conclusion: We found a high burden of skin infections among the study participants, most probably due to the high burden of displacement. Urgent interventions are needed to increase dermatological care among the population, including fostering a peaceful and enabling environment for the provision of sustainable health care solutions.

Background: Since the enactment of the universal health insurance law in 2018, Egypt has undertaken major health system reforms. In 2021, the Egypt Healthcare Authority introduced a clinical governance framework to improve the quality and safety of health care services.

Aim: To describe the implementation, early outcomes and lessons learned from introducing a clinical governance framework in Egypt between 2021 and 2024.

Methods: We implemented the clinical governance framework in 29 hospitals and 301 family health units across 6 governorates, serving approximately 5 million beneficiaries. Activities included training and on-site technical support. Key performance indicators were monitored and analysed to assess implementation outcomes.

Results: A total of 494 treatment protocols were developed across 28 medical specialties and more than 5000 physicians were trained to apply the protocols. There was an increase in the detection and timely correction of adverse events in the majority of cases. In Port Said Governorate, 82% of medication errors were detected and corrected in 2023, 84% in Ismailia Governorate and 70% in South Sinai Governorate. In 2024, the percentage of medication errors decreased by 27% in Port Said Governorate and 11% in Luxor Governorate. Hand hygiene compliance increased to 85% in 2024 from 78% in 2023, and surgical site infections decreased to 0.83 from 5 per 100 surgeries.

Conclusion: Despite certain challenges the introduction of a clinical governance framework contributed to improved safety and clinical outcomes in selected facilities. Political commitment and integration within existing structures were crucial to success.

Background: Weak governance of hospital information systems interoperability can impede data accuracy, security and accessibility.

Aim: To review and synthesise published literature on governance of hospital information systems interoperability.

Methods: Using the preferred reporting Items for systematic reviews and meta-analyses method, we reviewed on Scopus, PubMed and ScienceDirect literature on governance of hospital information systems interoperability published between June 2014 and June 2024, across Africa, Asia, Americas, Middle East, Europe, and Oceania.

Results: The key governance strategies are classified into 3: policy and regulation, standards and frameworks, and sustainable funding and resources. Policies and regulations governing hospital information systems interoperability are typically established at national, regional and organisational levels to safeguard patient data privacy. Interoperability frameworks typically address system structures, core functions and interoperability standards, while some also incorporate access to open-source digital tools. Human and technical resources are often recognised as influential and essential factors for efficient interoperability.

Conclusion: Effective governance is essential for building and operating integrated interoperable hospital information systems as well as for improving efficiency, optimising resource use and advancing health outcomes.

Background: Lifestyle modification is a non-pharmacological strategy that can help reduce blood pressure significantly and it is very valuable in hypertension control.

Aim: To review available literature on lifestyle modification practices among hypertensive patients globally.

Methods: We searched and analysed studies published between 2019 and 2024 on adherence to lifestyle modifications by hypertension patients globally.

Results: Adherence to lifestyle modification varied significantly by region (I² = 85.2%, P < 0.001), with a pooled mean of 27.4% (95% CI: 19.8-35.1%): alcohol abstinence 86%, sodium restriction 54.6%, dietary adherence 47.7%, low-density lipoprotein cholesterol goal achievement 40%, and physical activity 34.3%. Barriers to lifestyle modification were lowlevel awareness, misconceptions about hypertension, financial constraints, difficulty adjusting to new habits, laziness, forgetfulness, stress, lack of motivation, social pressure, tasteless meals, use of traditional medicine, and time constraints.

Conclusion: Despite the well-established benefits of lifestyle modifications in the management of hypertension, adherence remains suboptimal globally. There is a need for targeted interventions to enhance adherence, including educational programmes, policy-driven initiatives and personalized support for patients.

Background: Regular evaluation of the performance of research ethics committees is vital to ensure their effectiveness in protecting the rights of research subjects and increasing public trust in biomedical research.

Aim: To evaluate the performance of research ethics committees (RECs) at Tehran University of Medical Sciences and identify key challenges in carrying out their functions.

Methods: Using the WHO ethics oversight benchmarking tool, we interviewed 18 secretaries of research ethics committees, 7 bioethics experts and 14 researchers at Tehran University of Medical Sciences and reviewed relevant documents. We performed a content analysis of the text and interview transcripts to identify key operational mechanisms and challenges.

Results: Of the 26 indicators for structure and composition, resources, procedures, mechanisms to promote transparency and accountability, and mechanisms to monitor self-performance, only 8 were fully implemented, 8 were partially implemented, and 4 were not implemented by all the 18 RECs. There were variations in implementation of the remaining 6 indicators. The most prominent challenges in implementation were absence of post-approval monitoring of research, inadequate conflict of interest management and inconsistent adherence to procedures. The RECs had limited ethics training and there were no policy and procedures for managing conflict of interest.

Conclusion: The WHO tool effectively identified strengths and weaknesses in the performance of RECs at Tehran University of Medical Sciences. A tiered oversight system is recommended to enhance support for, and harmonization among, RECs. Key improvements should focus on post-approval monitoring, conflict of interest management, and institutional accountability. Addressing these gaps will strengthen ethics oversight and increase trust in biomedical research.