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Papers by Anhar Alhussaini

The New American Journal of Medicine, 2021

National Early Warning Score (NEWS) 2 was developed by the Royal College of Physicians to be used... more National Early Warning Score (NEWS) 2 was developed by the Royal College of Physicians to be used as early detection of in-hospital patient deterioration. The score has been shown to improve prognosis and triage efficiency. While the benefit of using a triage system has been established, in the real world, inefficient manual data entry and human error contribute to possible delays in identifying patients requiring intensive care transfers. Our team wanted to create an automated predictive model using informatics to improve the quality of patient care and healthcare provider workflow efficiency to identify high-risk patients who would benefit from early interventions by rapid-response teams.

Annals of Clinical and Medical Case Reports, 2021

Annals of Clinical and Medical Case Reports, 2021

Cureus, 2021

Communicating uncertainty with patients and families in the intensive care unit is challenging an... more Communicating uncertainty with patients and families in the intensive care unit is challenging and requires time and skill to convey the information. This proposal aims to provide a structured path for identifying and communicating uncertainty with patients and families in the unit. The focus is to improve the quality of care and timely communication to meet the expectations and needs of families and patients. The project focuses on the first 24 hours of intensive care unit admission to improve communication of uncertainty. By utilizing the Plan-Do-Study-Act cycle, the workflow uses a screening tool to identify uncertainty and communicate using evidence-based recommendations and the mnemonic VALUE (Value family statements, Acknowledge emotions, Listen, Understand the patient as a person, Elicit questions) as the standard of care. The workflow can be incorporated during the routine rounds as part of the A-F liberation bundle. The outcome is to improve patient and family satisfaction scores using a validated Family Satisfaction with Care in the Intensive Care Unit (FS-ICU 24) questionnaire to achieve a score of 75 or more, which correlates with very good. Challenges and limitations are discussed in the proposal.

The New American Journal of Medicine, 2021

National Early Warning Score (NEWS) 2 was developed by the Royal College of Physicians to be used... more National Early Warning Score (NEWS) 2 was developed by the Royal College of Physicians to be used as early detection of in-hospital patient deterioration. The score has been shown to improve prognosis and triage efficiency. While the benefit of using a triage system has been established, in the real world, inefficient manual data entry and human error contribute to possible delays in identifying patients requiring intensive care transfers. Our team wanted to create an automated predictive model using informatics to improve the quality of patient care and healthcare provider workflow efficiency to identify high-risk patients who would benefit from early interventions by rapid-response teams.

Annals of Clinical and Medical Case Reports, 2021

Benzodiazepines use in the elderly are associated with morbidity including increased falls, fract... more Benzodiazepines use in the elderly are associated with morbidity including increased falls, fractures, and mortality. The common reason for re-prescribing benzodiazepine by physicians is dependency. Our project proposal aims to enhance medication safety in the elderly. It requires a multidisciplinary approach and patient-centred care focusing on benzodiazepine deprescribing using the 3Es model of Educating, Empowering, and Engaging. The education starts with patients, providers, and the community about benzodiazepine adverse effects on the elderly and provides alternative approaches for symptoms management. Empowering patients in the decision to deprescribe will prove to be successful when the patient finds value. Engaging stakeholders in the process will facilitate adeptness and attainability in the target community. Using information technology to deliver the protocol will ensure reminders, track changes and suggest alternatives. The project goal is a 50% reduction in benzodiazepine prescription by six months. Limitations, challenges, and modifications anticipated are discussed.

Annals of Clinical and Medical Case Reports, 2021

We present a delirium care pathway model that we have dubbed STOP DELIRIUM. Due to delirium's mag... more We present a delirium care pathway model that we have dubbed STOP DELIRIUM. Due to delirium's magnitude and effect in el- derly hospitalized patients, we recommend hospitals must have a delirium care pathway for early identification, prevention, and delirium management. The protocol STOP DELIRIUM is driven from evidence-based guidelines to help establish the aim "STOP" for Spot, Think, Optimize and Prevent delirium. The clinical pathway model needs to incorporate a clinical information man- agement system and educational materials to increase delirium awareness. The implementation should be scalable and adaptable to incorporate other departments.

CJC open, 2020

Coronavirus Disease 2019 (COVID-19) has been associated with cardiovascular complications, includ... more Coronavirus Disease 2019 (COVID-19) has been associated with cardiovascular complications, including acute cardiac injury, heart failure, and cardiogenic shock (CS). The role of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the event of COVID-19–associated cardiovascular collapse has not been established. We reviewed the existing literature surrounding the role of VA-ECMO in the treatment of coronavirus-related cardiovascular collapse. COVID-19 is associated with a higher incidence of cardiovascular complications compared with previous coronavirus outbreaks (Severe Acute Respiratory Syndrome Coronavirus and Middle East Respiratory Syndrome Coronavirus). We found only 1 case report from China in which COVID-19–associated fulminant myocarditis and CS were successfully rescued using VA-ECMO as a bridge to recovery. We identified potential clinical scenarios (cardiac injury, myocardial infarction with and without obstructive coronary artery disease, viral myocarditis, and decompensated heart failure) leading to CS and risk factors for poor/uncertain benefit (age, sepsis, mixed/predominantly vasodilatory shock, prothrombotic state or coagulopathy, severe acute respiratory distress syndrome, multiorgan failure, or high-risk prognostic scores) specific to using VA-ECMO as a bridge to recovery in COVID-19 infection. Additional considerations and proposed recommendations specific to the COVID-19 pandemic were formulated with guidance from published data and expert consensus. A small subset of patients with cardiovascular complications from COVID-19 infection may progress to refractory CS. While accepting that resource scarcity may be the overwhelming concern for healthcare systems during this pandemic, VA-ECMO can be considered in highly selected cases of refractory CS and echocardiographic evidence of biventricular failure. The decision to initiate this therapy should take into consideration the availability of resources, perceived benefit, and risks of transmitting disease.

Conference Presentations by Anhar Alhussaini

20th Annual Canadian Society of Echocardiography Weekend meeting, 2018

Pacemaker insertion technique has improved since the first implantation in 1958. Nevertheless, th... more Pacemaker insertion technique has improved since the first implantation in 1958. Nevertheless, the rate of early complications is 4-5%, and late complications are 2.7%. Insertion of pacemaker leads into the left heart are rare and usually identified immediately under fluoroscopy with LAO view, RBBB on paced ECG or lateral CXR. However, Patients with superior venosus defects can be missed, and when undergoing pacemaker implantation, insertion to the left side is higher. We present a unique case of undiagnosed superior sinus venosus defect with partial anomalous pulmonary venous drainage undergoing dual-chamber pacemaker insertion and presenting with stroke.

20th Annual Canadian Society of Echocardiography Weekend meeting, 2018

Incidental findings on a transthoracic echocardiogram are not uncommon and they become clinically... more Incidental findings on a transthoracic echocardiogram are not
uncommon and they become clinically challenging as they lead to
further testing. Blood cyst on the mitral valve has been described in
case reports and they are a common finding in infants and
neonates(1). There are 38 case reports of blood cyst on the mitral
valve that we are aware of through PubMed search with about 60%
of the cases had pathological confirmation. Given their distinct
appearance on the transthoracic echocardiogram, it became the
modality in which these cysts have been recognized. We describe a
case of incidental mitral valve blood cyst with a review of the
literature.

Talks by Anhar Alhussaini

Concept map of the learning theories, frameworks and models.

Table comparison between adult learning theory and the following: behaviorism, cognitivism, human... more Table comparison between adult learning theory and the following: behaviorism, cognitivism, humanism, constructivism, social learning theory, adult development, self-directed learning, transformative learning, critical reflective, critical theory, postmodern feminism, and resurgent theories.

The New American Journal of Medicine, 2021

National Early Warning Score (NEWS) 2 was developed by the Royal College of Physicians to be used... more National Early Warning Score (NEWS) 2 was developed by the Royal College of Physicians to be used as early detection of in-hospital patient deterioration. The score has been shown to improve prognosis and triage efficiency. While the benefit of using a triage system has been established, in the real world, inefficient manual data entry and human error contribute to possible delays in identifying patients requiring intensive care transfers. Our team wanted to create an automated predictive model using informatics to improve the quality of patient care and healthcare provider workflow efficiency to identify high-risk patients who would benefit from early interventions by rapid-response teams.

Annals of Clinical and Medical Case Reports, 2021

Annals of Clinical and Medical Case Reports, 2021

Cureus, 2021

Communicating uncertainty with patients and families in the intensive care unit is challenging an... more Communicating uncertainty with patients and families in the intensive care unit is challenging and requires time and skill to convey the information. This proposal aims to provide a structured path for identifying and communicating uncertainty with patients and families in the unit. The focus is to improve the quality of care and timely communication to meet the expectations and needs of families and patients. The project focuses on the first 24 hours of intensive care unit admission to improve communication of uncertainty. By utilizing the Plan-Do-Study-Act cycle, the workflow uses a screening tool to identify uncertainty and communicate using evidence-based recommendations and the mnemonic VALUE (Value family statements, Acknowledge emotions, Listen, Understand the patient as a person, Elicit questions) as the standard of care. The workflow can be incorporated during the routine rounds as part of the A-F liberation bundle. The outcome is to improve patient and family satisfaction scores using a validated Family Satisfaction with Care in the Intensive Care Unit (FS-ICU 24) questionnaire to achieve a score of 75 or more, which correlates with very good. Challenges and limitations are discussed in the proposal.

The New American Journal of Medicine, 2021

National Early Warning Score (NEWS) 2 was developed by the Royal College of Physicians to be used... more National Early Warning Score (NEWS) 2 was developed by the Royal College of Physicians to be used as early detection of in-hospital patient deterioration. The score has been shown to improve prognosis and triage efficiency. While the benefit of using a triage system has been established, in the real world, inefficient manual data entry and human error contribute to possible delays in identifying patients requiring intensive care transfers. Our team wanted to create an automated predictive model using informatics to improve the quality of patient care and healthcare provider workflow efficiency to identify high-risk patients who would benefit from early interventions by rapid-response teams.

Annals of Clinical and Medical Case Reports, 2021

Benzodiazepines use in the elderly are associated with morbidity including increased falls, fract... more Benzodiazepines use in the elderly are associated with morbidity including increased falls, fractures, and mortality. The common reason for re-prescribing benzodiazepine by physicians is dependency. Our project proposal aims to enhance medication safety in the elderly. It requires a multidisciplinary approach and patient-centred care focusing on benzodiazepine deprescribing using the 3Es model of Educating, Empowering, and Engaging. The education starts with patients, providers, and the community about benzodiazepine adverse effects on the elderly and provides alternative approaches for symptoms management. Empowering patients in the decision to deprescribe will prove to be successful when the patient finds value. Engaging stakeholders in the process will facilitate adeptness and attainability in the target community. Using information technology to deliver the protocol will ensure reminders, track changes and suggest alternatives. The project goal is a 50% reduction in benzodiazepine prescription by six months. Limitations, challenges, and modifications anticipated are discussed.

Annals of Clinical and Medical Case Reports, 2021

We present a delirium care pathway model that we have dubbed STOP DELIRIUM. Due to delirium's mag... more We present a delirium care pathway model that we have dubbed STOP DELIRIUM. Due to delirium's magnitude and effect in el- derly hospitalized patients, we recommend hospitals must have a delirium care pathway for early identification, prevention, and delirium management. The protocol STOP DELIRIUM is driven from evidence-based guidelines to help establish the aim "STOP" for Spot, Think, Optimize and Prevent delirium. The clinical pathway model needs to incorporate a clinical information man- agement system and educational materials to increase delirium awareness. The implementation should be scalable and adaptable to incorporate other departments.

CJC open, 2020

Coronavirus Disease 2019 (COVID-19) has been associated with cardiovascular complications, includ... more Coronavirus Disease 2019 (COVID-19) has been associated with cardiovascular complications, including acute cardiac injury, heart failure, and cardiogenic shock (CS). The role of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the event of COVID-19–associated cardiovascular collapse has not been established. We reviewed the existing literature surrounding the role of VA-ECMO in the treatment of coronavirus-related cardiovascular collapse. COVID-19 is associated with a higher incidence of cardiovascular complications compared with previous coronavirus outbreaks (Severe Acute Respiratory Syndrome Coronavirus and Middle East Respiratory Syndrome Coronavirus). We found only 1 case report from China in which COVID-19–associated fulminant myocarditis and CS were successfully rescued using VA-ECMO as a bridge to recovery. We identified potential clinical scenarios (cardiac injury, myocardial infarction with and without obstructive coronary artery disease, viral myocarditis, and decompensated heart failure) leading to CS and risk factors for poor/uncertain benefit (age, sepsis, mixed/predominantly vasodilatory shock, prothrombotic state or coagulopathy, severe acute respiratory distress syndrome, multiorgan failure, or high-risk prognostic scores) specific to using VA-ECMO as a bridge to recovery in COVID-19 infection. Additional considerations and proposed recommendations specific to the COVID-19 pandemic were formulated with guidance from published data and expert consensus. A small subset of patients with cardiovascular complications from COVID-19 infection may progress to refractory CS. While accepting that resource scarcity may be the overwhelming concern for healthcare systems during this pandemic, VA-ECMO can be considered in highly selected cases of refractory CS and echocardiographic evidence of biventricular failure. The decision to initiate this therapy should take into consideration the availability of resources, perceived benefit, and risks of transmitting disease.

20th Annual Canadian Society of Echocardiography Weekend meeting, 2018

Pacemaker insertion technique has improved since the first implantation in 1958. Nevertheless, th... more Pacemaker insertion technique has improved since the first implantation in 1958. Nevertheless, the rate of early complications is 4-5%, and late complications are 2.7%. Insertion of pacemaker leads into the left heart are rare and usually identified immediately under fluoroscopy with LAO view, RBBB on paced ECG or lateral CXR. However, Patients with superior venosus defects can be missed, and when undergoing pacemaker implantation, insertion to the left side is higher. We present a unique case of undiagnosed superior sinus venosus defect with partial anomalous pulmonary venous drainage undergoing dual-chamber pacemaker insertion and presenting with stroke.

20th Annual Canadian Society of Echocardiography Weekend meeting, 2018

Incidental findings on a transthoracic echocardiogram are not uncommon and they become clinically... more Incidental findings on a transthoracic echocardiogram are not
uncommon and they become clinically challenging as they lead to
further testing. Blood cyst on the mitral valve has been described in
case reports and they are a common finding in infants and
neonates(1). There are 38 case reports of blood cyst on the mitral
valve that we are aware of through PubMed search with about 60%
of the cases had pathological confirmation. Given their distinct
appearance on the transthoracic echocardiogram, it became the
modality in which these cysts have been recognized. We describe a
case of incidental mitral valve blood cyst with a review of the
literature.

Concept map of the learning theories, frameworks and models.

Table comparison between adult learning theory and the following: behaviorism, cognitivism, human... more Table comparison between adult learning theory and the following: behaviorism, cognitivism, humanism, constructivism, social learning theory, adult development, self-directed learning, transformative learning, critical reflective, critical theory, postmodern feminism, and resurgent theories.