Publications by authors named "Yasser Alaska"

10 Publications

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Inappropriate use of beta-blockers among medical and dental students at King Saud University, Riyadh.

J Family Med Prim Care 2020 Aug 25;9(8):4391-4395. Epub 2020 Aug 25.

Department of Emergency, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Aim: Self-medication and inappropriate beta-blocker use have been commonly reported among students. This study aimed to determine the prevalence of inappropriate self-prescription of beta-blockers among medical and dental students.

Methods: We conducted a cross-sectional study using a validated self-administered questionnaire distributed via online Google document to all undergraduate medical and dental students, including interns, of King Saud University, Riyadh, Saudi Arabia.

Results: Out of 1,240 emails sent, 885 students (627 [70.8%] medical students and 258 [59.2%] dental students) responded to the survey (response rate, 71.4%). Beta-blockers were used by 198 students (22.4%) during their college years, of which 147 (16.6%) used it ≤5 times. The most common reason of using beta-blockers was to relieve stress and anxiety. The most common sources of information for use were their colleagues/fellow students. Self-prescribed beta-blockers were used by 123 students (13.9%). The usual dose consumed was 20 mg in 84 students (9.5%), while 15 (1.7%) experienced side effects. Although male students used beta-blockers more than females, females used beta-blockers at significantly higher doses (>20 mg). Medical students consumed more beta-blockers than dental students did (33.7% versus 0%, = 0.001). Students in their senior years continued self-prescription and beta-blocker use longer than their juniors. Continued use was associated with their current academic level, who prescribed the drug, their usual dose, and awareness of complications.

Conclusion: Two in ten students inappropriately used beta-blockers to relieve their anxiety and stress during examinations, and most of them were self-prescribed.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_696_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586521PMC
August 2020

Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist.

Saudi J Gastroenterol 2020 Jul 21. Epub 2020 Jul 21.

Department of Surgery, University of Washington Medical Center, Seattle, Washington, United States of America.

Background/aims: : This study aimed to design a structured simulation training curriculum for upper endoscopy and validate a new assessment checklist.

Materials And Methods: A proficiency-based progression stepwise curriculum was developed consisting of didactic, technical and non-technical components using a virtual reality simulator (VRS). It focused on: scope navigation, anatomical landmarks identification, mucosal inspection, retro-flexion, pathology identification, and targeting biopsy. A total of 5 experienced and 10 novice endoscopists were recruited. All participants performed each of the selected modules twice, and mean and median performance were compared between the two groups. Novices pre-set level of proficiency was set as 2 standard deviations below the mean of experts. Performance was assessed using multiple-choice questions for knowledge, while validated simulator parameters incorporated into a novel checklist; Simulation Endoscopic Skill Assessment Score (SESAS) were used for technical skills.

Results: : The following VRS outcome measures have shown expert vs novice baseline discriminative ability: total procedure time, number of attempts for esophageal intubation and time in red-out. All novice trainees achieved the preset level of proficiency by the end of training. There were no statistically significant differences between experts' and trainees' rate of complications, landmarks identification and patient discomfort. SESAS checklist showed high degree of agreement with the VRS metrices (kappa = 0.83) and the previously validated direct observation of procedural skills tool (kappa = 0.90).

Conclusion: : The Fundamentals of Gastrointestinal Endoscopy simulation training curriculum and its SESAS global assessment tool have been primarily validated and can serve as a valuable addition to the gastroenterology fellowship programs. Follow up study of trainee performance in workplaces is recommended for consequences validation.
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http://dx.doi.org/10.4103/sjg.SJG_113_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580730PMC
July 2020

To What Extent the Emergency Physicians in Riyadh City Are Aware of Patient Radiation Exposure From Diagnostic Imaging Requested in the Emergency Department.

Cureus 2020 Jun 15;12(6):e8623. Epub 2020 Jun 15.

Radiology and Medical Imaging, College of Medicine, King Saud University, Riyadh, SAU.

Introduction Radiological imaging that uses ionizing radiation in emergency departments (EDs) has increased with advances in radiological diagnostic methods. Emergency (ER) physicians' awareness of the radiation doses and the associated cancer risks that the patients are exposed to was surveyed using a questionnaire. Aims To assess the ER physicians' awareness of radiation doses associated with the diagnostic imaging and to describe their practice about discussing radiation risk with patients at different hospitals in Riyadh city, Saudi Arabia. Methods A prospective, questionnaire-based observational study was conducted in 2016 among 176 ER physicians at different hospitals in Riyadh city. The percentage knowledge score and the frequency of discussing radiation risk with patients based on responses to three scenarios were rated on a visual analog scale (VAS), where a score of 100 indicated that physicians would always discuss it. Results The overall mean knowledge score was 28% (95% CI: 22-34). None of the studied parameters (gender, experience, country of medical qualification, type of degree, and employment level) showed a significant correlation with the overall awareness of ED physicians about radiation exposure. Over three-quarters of physicians (77%) underestimated the lifetime risk of fatal cancer attributed to a single computed tomography (CT) scan of the abdomen. Majority of physicians (60%) reported never discussing radiation risk with patients. The frequency at which physicians were discussing radiation risk with patients varied greatly depending on the clinical scenario (mean VAS scores between 46 and 82). Conclusions ER physicians of different hospitals in Riyadh city had a varied knowledge about the radiation exposure risks, although overall the perception was inadequate. The physicians should receive education, and the diagnostic imaging request may need to include information on radiation doses and risks.
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http://dx.doi.org/10.7759/cureus.8623DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301442PMC
June 2020

Simulation-Based Examination of Arterial Line Insertion Method Reveals Interdisciplinary Practice Differences.

Simul Healthc 2020 Apr;15(2):89-97

From the Department of Emergency Medicine (A.G., Y.A., G.J., L.K.), Alpert Medical School of Brown University; Lifespan Medical Simulation Center (A.G., Y.A.), Providence, RI; Department of Emergency Medicine (A.G.), FIU Herbert Wertheim College of Medicine Kendall Regional Medical Center, Miami, FL; Division of Pulmonary Critical Care (A.T.L.), Department of Medicine, and Divisions of Anesthesiology (K.R.D.) and Trauma/Critical Care, Department of Surgery (S.N.L.), Alpert Medical School of Brown University; Surgical Services, Rhode Island Hospital (K.A.L.), Providence; and The School of Engineering, Brown University (G.J.), Providence, RI.

Introduction: Arterial cannulation is frequently performed on intensive care unit (ICU) and operating room patients; a 1% complication rate has been reported. Investigators applied simulation to study clinical providers' arterial catheter (AC) insertion performance and to assess for interdisciplinary and intradisciplinary variation that may contribute to complications.

Methods: Anesthesia, medical critical care, and surgical critical care providers with AC insertion experience were enrolled at 2 academic hospitals. Each subject completed a simulated AC insertion on an in situ task trainer. Using a Delphi-derived checklist that incorporated published recommendations, expert opinion, and institutional requirements, 2 investigators completed offline video reviews to compare subjects' technical performance.

Results: Ten anesthesia, 11 medical ICU (MICU, 1 excluded), and 10 surgical ICU (SICU) subjects with significant between-group differences in training level and AC insertion experience were enrolled for 2 years. Differences in procedural planning, equipment preparation, and patient preparation steps did not attain significance across groups except for anesthesia participants using only ad hoc AC kits, and MICU and SICU subjects preferentially using commercial kits (P < 0.001). Time-outs were completed by 1 anesthesia subject, 5 MICU subjects, and 4 SICU subjects (P = 0.29, NS). For proceduralist preparation steps, fewer anesthesiology subjects donned gowns (P < 0.001). Only MICU subjects used ultrasound guidance (P = 0.0053), and only MICU (100%) and SICU (100%) subjects sutured ACs in place. Overall observance of sterile technique was similar across groups at 70% to 100% (P = 0.32).

Conclusions: Simulated AC insertions revealed procedural performance variability that may derive from individual provider differences, discipline-based practice parameters, and setting-specific cultural factors.
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http://dx.doi.org/10.1097/SIH.0000000000000428DOI Listing
April 2020

Simulation-Based Examination of Arterial Line Insertion Method Reveals Interdisciplinary Practice Differences.

Simul Healthc 2020 Apr;15(2):89-97

From the Department of Emergency Medicine (A.G., Y.A., G.J., L.K.), Alpert Medical School of Brown University; Lifespan Medical Simulation Center (A.G., Y.A.), Providence, RI; Department of Emergency Medicine (A.G.), FIU Herbert Wertheim College of Medicine Kendall Regional Medical Center, Miami, FL; Division of Pulmonary Critical Care (A.T.L.), Department of Medicine, and Divisions of Anesthesiology (K.R.D.) and Trauma/Critical Care, Department of Surgery (S.N.L.), Alpert Medical School of Brown University; Surgical Services, Rhode Island Hospital (K.A.L.), Providence; and The School of Engineering, Brown University (G.J.), Providence, RI.

Introduction: Arterial cannulation is frequently performed on intensive care unit (ICU) and operating room patients; a 1% complication rate has been reported. Investigators applied simulation to study clinical providers' arterial catheter (AC) insertion performance and to assess for interdisciplinary and intradisciplinary variation that may contribute to complications.

Methods: Anesthesia, medical critical care, and surgical critical care providers with AC insertion experience were enrolled at 2 academic hospitals. Each subject completed a simulated AC insertion on an in situ task trainer. Using a Delphi-derived checklist that incorporated published recommendations, expert opinion, and institutional requirements, 2 investigators completed offline video reviews to compare subjects' technical performance.

Results: Ten anesthesia, 11 medical ICU (MICU, 1 excluded), and 10 surgical ICU (SICU) subjects with significant between-group differences in training level and AC insertion experience were enrolled for 2 years. Differences in procedural planning, equipment preparation, and patient preparation steps did not attain significance across groups except for anesthesia participants using only ad hoc AC kits, and MICU and SICU subjects preferentially using commercial kits (P < 0.001). Time-outs were completed by 1 anesthesia subject, 5 MICU subjects, and 4 SICU subjects (P = 0.29, NS). For proceduralist preparation steps, fewer anesthesiology subjects donned gowns (P < 0.001). Only MICU subjects used ultrasound guidance (P = 0.0053), and only MICU (100%) and SICU (100%) subjects sutured ACs in place. Overall observance of sterile technique was similar across groups at 70% to 100% (P = 0.32).

Conclusions: Simulated AC insertions revealed procedural performance variability that may derive from individual provider differences, discipline-based practice parameters, and setting-specific cultural factors.
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http://dx.doi.org/10.1097/SIH.0000000000000428DOI Listing
April 2020

Spontaneous Pneumomediastinum Secondary to Hookah Smoking.

Authors:
Yasser A Alaska

Am J Case Rep 2019 May 6;20:651-654. Epub 2019 May 6.

Department of Emergency Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.

BACKGROUND Spontaneous pneumomediastinum (SPM) is an uncommon, self-limiting pathology defined as the presence of free air in the mediastinum without a traumatic cause. Factors that can lead to the development of SPM include alterations in breathing patterns such as bronchial asthma, marijuana smoking, cocaine inhalation, and barotrauma occurring with Valsalva's maneuver. CASE REPORT This is a case of a previously healthy 22-year-old who presented to the Emergency Department complaining of sudden shortness of breath and chest pain after smoking a hookah for the first time. Clinical and radiological findings led to the diagnosis of pneumomediastinum, which was treated conservatively. The only apparent cause of the patient's condition was hookah smoking. CONCLUSIONS SPM should be considered in patients who develop chest pain and shortness of breath after smoking a hookah. To the best of our knowledge, no previous cases of spontaneous pneumomediastinum associated exclusively with hookah smoking in a previously healthy patient have been reported in the English literature.
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http://dx.doi.org/10.12659/AJCR.915118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6523990PMC
May 2019

Can Wearable Devices Accurately Measure Heart Rate Variability? A Systematic Review.

Folia Med (Plovdiv) 2018 Mar;60(1):7-20

Medical Physics Simulation Center, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Background: A growing number of wearable devices claim to provide accurate, cheap and easily applicable heart rate variability (HRV) indices. This is mainly accomplished by using wearable photoplethysmography (PPG) and/or electrocardiography (ECG), through simple and non-invasive techniques, as a substitute of the gold standard RR interval estimation through electrocardiogram. Although the agreement between pulse rate variability (PRV) and HRV has been evaluated in the literature, the reported results are still inconclusive especially when using wearable devices.

Aim: The purpose of this systematic review is to investigate if wearable devices provide a reliable and precise measurement of classic HRV parameters in rest as well as during exercise.

Materials And Methods: A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases, as well as, through internet search. The 308 articles retrieved were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria.

Results: Eighteen studies were included. Sixteen of them integrated ECG - HRV technology and two of them PPG - PRV technology. All of them examined wearable devices accuracy in RV detection during rest, while only eight of them during exercise. The correlation between classic ECG derived HRV and the wearable RV ranged from very good to excellent during rest, yet it declined progressively as exercise level increased.

Conclusions: Wearable devices may provide a promising alternative solution for measuring RV. However, more robust studies in non-stationary conditions are needed using appropriate methodology in terms of number of subjects involved, acquisition and analysis techniques implied.
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http://dx.doi.org/10.2478/folmed-2018-0012DOI Listing
March 2018

Evaluation of Change in Knowledge and Attitude of Emergency Medicine Residents after Introduction of a Rotation in Emergency Medical Services and Disaster Medicine.

J Emerg Trauma Shock 2018 Jan-Mar;11(1):42-46

Department of Emergency Medicine, King Abdullah Specialist Children Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.

Background: Saudi Board of Emergency Medicine (SBEM) graduates are involved in a 1-month rotation in emergency medical services (EMSs) and disaster medicine. The purpose of this study was to evaluate change in knowledge and attitude of EM residents after the introduction of the EMS and disaster medicine rotation.

Materials And Methods: The study included 32 3-year SBEM residents. A pretest/posttest design and a five-point Likert scale were used. The data included a response to a questionnaire developed by EMS and disaster experts. The questionnaire was distributed on the 1 day of the rotation and 45 days after. Satisfaction questionnaires were distributed after the rotation. The data were analyzed using SPSS 20.

Results: Twenty-five residents responded to the satisfaction survey (75%). The overall satisfaction with the course modules was high; the course content showed the highest level of satisfaction (96%), and the lowest satisfaction was for the air ambulance ride outs (56%). The results of the pre-/post-test questionnaire showed an increase of 18.5% in the residents mean score ( < 0.001). In the open-ended section, the residents requested that the schedule is distributed before the course start date, to have more field and hands-on experience, and to present actual disaster incidents as discussion cases. The residents were impressed with the organization and diversity of the lectures, and to a lesser extent for the ambulance ride outs and the mass casualty incident drill l. Seventy-one percent indicated that they would recommend this course to other residents.

Conclusion/recommendation: This study showed that a structured course in EMS and disaster medicine had improved knowledge and had an overall high level of satisfaction among the residents of the SBEM. Although overall satisfaction and improvement in knowledge were significant, there are many areas in need of better organization.
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http://dx.doi.org/10.4103/JETS.JETS_67_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852916PMC
April 2018

Airway Management in Disaster Response: A Manikin Study Comparing Direct and Video Laryngoscopy for Endotracheal Intubation by Prehospital Providers in Level C Personal Protective Equipment.

Prehosp Disaster Med 2017 Aug 20;32(4):352-356. Epub 2017 Mar 20.

4The Warren Alpert Medical School,Brown University,Providence,Rhode IslandUSA.

Introduction Airway management is one of many challenges that medical providers face in disaster response operations. The use of personal protective equipment (PPE), in particular, was found to be associated with higher failure rates and a prolonged time to achieve airway control. Hypothesis/Problem The objective of this study was to determine whether video laryngoscopy could facilitate the performance of endotracheal intubation by disaster responders wearing Level C PPE.

Methods: In this prospective, randomized, crossover study, a convenience sample of practicing prehospital providers were recruited. Following standardized training in PPE use and specific training in the use of airway devices, subjects in Level C PPE were observed while performing endotracheal intubation on a stock airway in a Laerdal Resusci-Anne manikin system (Laerdal Medical; Stavanger, Norway) using one of three laryngoscopic devices in randomized order: a Macintosh direct laryngoscope (Welch Allyn Inc.; New York USA), a GlideScope Ranger video laryngoscope (Verathon Medical; Bothell, Washington USA), and a King Vision video laryngoscope (King Systems; Noblesville, Indiana USA). The primary outcome was time to intubation (TTI), and the secondary outcome was participant perception of the ease of use for each device.

Results: A total of 20 prehospital providers participated in the study: 18 (90%) paramedics and two (10%) Emergency Medical Technicians-Cardiac. Participants took significantly longer when using the GlideScope Ranger [35.82 seconds (95% CI, 32.24-39.80)] to achieve successful intubation than with the Macintosh laryngoscope [25.69 seconds (95% CI, 22.42-29.42); adj. P<.0001] or the King Vision [29.87 seconds (95% CI, 26.08-34.21); adj. P=.033], which did not significantly differ from each other (adj. P=.1017). Self-reported measures of satisfaction evaluated on a 0% to 100% visual analog scale (VAS) identified marginally greater subject satisfaction with the King Vision [86.7% (SD=76.4-92.9%)] over the GlideScope Ranger [73.0% (SD=61.9-81.8%); P=.04] and the Macintosh laryngoscope [69.9% (SD=57.9-79.7%); P=.05] prior to adjustment for multiplicity. The GlideScope Ranger and the Macintosh laryngoscope did not differ themselves (P=.65), and the differences were not statistically significant after adjustment for multiplicity (adj. P=.12 for both comparisons).

Conclusion: Use of video laryngoscopes by prehospital providers in Level C PPE did not result in faster endotracheal intubation than use of a Macintosh laryngoscope. The King Vision video laryngoscope, in particular, performed at least as well as the Macintosh laryngoscope and was reported to be easier to use. Yousif S , Machan JT , Alaska Y , Suner S . Airway management in disaster response: a manikin study comparing direct and video laryngoscopy for endotracheal intubation by prehospital providers in Level C personal protective equipment. Prehosp Disaster Med. 2017;32(4):352-356.
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http://dx.doi.org/10.1017/S1049023X17000188DOI Listing
August 2017

The impact of crowd control measures on the occurrence of stampedes during Mass Gatherings: The Hajj experience.

Travel Med Infect Dis 2017 Jan - Feb;15:67-70. Epub 2016 Sep 14.

Division of Disaster Medicine and Emergency Preparedness, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, USA. Electronic address:

Background: Mass gatherings present enormous challenges for emergency preparedness. Planners must anticipate and prepare for communicable and non-communicable disease outbreaks, illnesses, and injuries to participants, crowd control, and disaster responses to unforeseen natural or man-made threats. The Hajj, the largest annually recurring mass gathering event on earth. It attracts about 3 million pilgrims from over 180 countries who assemble in Mecca over a 1-week period.

Methods: A literature review was conducted using Medline and OVID, while searching for published data concerning human stampedes and crowd control measures implemented to prevent human stampedes. The review was further extended to include media reports and published numbers and reports about Hajj from the Saudi Arabian government, in both the English and Arabic languages.

Results: Because millions of pilgrims undertake their religious ritual within strict constraints in term of space and time; this rigour and strictness have led to a series of large crowd disasters over several years, thus putting pressure on the authorities. In the past few years, the government of Saudi Arabia have put an enormous effort to solve this difficulty using state of the art innovative scientific means. The use of crowd simulation models, assessment of the best ways of grouping and scheduling pilgrims, crowd management and control engineering technologies, luggage management, video monitoring, and changes in the construction of the transport system for the event.

Conclusions: A large gathering such as the Hajj still holds an increasing risk for future disasters. International collaboration and continued vigilance in planning efforts remains an integral part of these annual preparations. The development of educational campaigns for pilgrims regarding the possible dangers is also crucial. Lessons gleaned from experiences at the Hajj may influence planning for mass gatherings of any kind, worldwide.
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http://dx.doi.org/10.1016/j.tmaid.2016.09.002DOI Listing
May 2017