Al Ain Region Research Articles

312.5: Establishment of an organ donation unit in accordance to the national laws and meeting the standards of regional KPIs in Tawam Hospital, Al Ain Region, Abu Dhabi, UAE.

312.5: Establishment of an organ donation unit in accordance to the national laws and meeting the standards of regional KPIs in Tawam Hospital, Al Ain Region, Abu Dhabi, UAE.

213.3: Optimizing the donor detection and referral process in collaboration with organ donation champions: An experience-based review of referral performance from an organ donation unit in Al Ain Region, United Arab Emirates.

213.3: Optimizing the donor detection and referral process in collaboration with organ donation champions: An experience-based review of referral performance from an organ donation unit in Al Ain Region, United Arab Emirates.

Breaking New Ground in Palliative Care: Examining the Impact of Al Ain - Palliative Care Outreach Program on Patients With Advanced Cancer in the United Arab Emirates.

Introduction This study aimed to evaluate the effectiveness of the Palliative Outreach Program in improving the quality of palliative care for patients with advanced cancer in a Tertiary Hospital in the Al Ain region of the United Arab Emirates (UAE). Methods & Material One hundred patients who met the inclusion criteria were included in the study and administered the patient version of the Consumer Quality (CQ) Index Palliative Care Instrument to assess their perception of the quality of care they received. The demographics, diagnosis, and questionnaire responses were analyzed to determine the effectiveness of the Palliative Outreach Program. Results A total of one hundred patients met the criteria for the study. Most patients were above 50, female, female, Non-Emiratis, and had high school certificates. The top three cancer diagnoses were breast (22%), lung (15%), and head & neck (13%). The patients reported high levels of support from their caregivers regarding physical, psychological, and spiritual well-being, as well as information and expertise. The mean scores for most variables were favorable, except for information (mean = 2.9540, SD= 0.25082) and general appreciation (mean = 6.7150, sd = 0.82344). Overall, the patients rated the care they received positively, with high mean scores for physical/psychological well-being (mean = 3.4950, SD = 0.28668), autonomy (mean = 3.7667, SD= 0.28623), privacy (mean = 3.6490, SD = 0.23159), and spiritual well-being (mean =3.7500, SD = 0.54356). The patients would recommend their caregivers to others in similar situations. Discussion The findings demonstrate that the Palliative Outreach Program effectively improves the quality of palliative care for patients with advanced cancer in the UAE. The CQ Index Palliative Care Instrument proved a novel method for assessing palliative care quality from patients' perspectives. However, there is room for improvement in providing more favorable information and general appreciation outcomes. Caregivers should focus on all areas to enhance their physical/psychological well-being, autonomy, privacy, spiritual well-being, expertise, and general appreciation of their patients. Conclusion In conclusion, the Palliative Outreach Program is an effective intervention to improve the quality of palliative care for patients with advanced cancer in the UAE. The patients reported high levels of support from their caregivers in all aspects of care, except for information and general appreciation. These findings provide valuable insights into the effectiveness of palliative care interventions and highlight the need for continued efforts to improve the quality of care for patients with advanced cancer.

Modeling aquifer storage and recovery in the eastern district of the United Arab Emirates using MODFLOW

The Emirate of Abu Dhabi has relied on groundwater as a source of fresh water for several decades, which has resulted in the deterioration of non-renewable groundwater aquifers. This has led to the installation of desalination plants for fresh water supply. This research aims to increase strategic water reserves in the eastern district of Abu Dhabi by analyzing the best locations for aquifer storage and recovery (ASR). The ASR technology offers an opportunity to store large volumes of water for later beneficial use. This study explores an option of using excess desalination water for ASR recharge in the eastern district Al Ain region of Abu Dhabi. A limiting factor in the application of the ASR technology is the lack of suitable sites. Detailed hydrogeological and operational knowledge of the studied areas helped in identifying potential sites for ASR based on a scoring system. Determining best locations for managed aquifer recharge is a crucial design step. Five scenarios were studied at Al-Khrair and Al-Shuwaib sites in Al Ain region. Results show that a wider distribution of injection wells with intervals more than 1200 m is more suitable to overcome the excessive head buildup. Based on the adopted criteria, Al-Khrair was the best site for recharge followed by Al-Shuwaib. Al-Khrair site can be recharged at 64,000 m3 d−1 for seven years, while Al-Shuwaib site can be recharged at 64,000 m3 d−1 for only two years.

Land surface deformation monitoring in the Al-Ain arid region (UAE) using microgravity and SAR interferometry surveys

The integration of geophysical and satellite-based monitoring techniques can yield new insights in land surface deformation (LSD) studies. In this study, we integrated the microgravity monitoring geophysical technique with Interferometry Synthetic Aperture Radar (InSAR) to reveal the possible sources of LSD changes. A microgravity survey was conducted over Al-Ain city for 1 year at one-month intervals, with time-lapse microgravity changes calculated based on the results. Over the same area of interest and time interval, InSAR analysis was performed using Sentinel-1 (C-band) data. The time-lapse microgravity changes for the whole studied period ranged from −36 to 365 μGal. The InSAR processing showed periodic land surface deformation over the area of interest varying with the season of the year. The InSAR technique detected land surface subsidence at the northeast and western parts of the study area (−7 mm/year and −8 mm/year, respectively) and land surface uplift in the central and southern parts of the study area (2 mm/year). The recorded subsidence may relate to water extraction in these areas. The integration of the two techniques showed a negative correlation, with coefficients of −0.43 and −0.39 for land surface subsidence and uplift, respectively. Furthermore, groundwater level drawdown zones were identified in the west and center of the study area. Overall, LSD is mainly stimulated by water volume exploitation in the Al-Ain region.

Influence of the Built Environment on Physical Activity Choices among Emirati Male and Female Adolescents: An Examination of Parents’ and Students’ Perceptions

The UN Human Development Report 2020 ranked the United Arab Emirates (UAE) as having achieved ‘very high human development’ and as being at the 31st position among all countries. Despite this, the ever increasing obesity rates among Emirati youth, higher than international standards, is alarming. This research aims at identifying how different perceptions of the built environment by parents and adolescents are likely to affect physical activity (PA) choices among male and female Emirati youth. This can help inform better health and education policies to achieve three of the interconnected UN Sustainable Development Goals (SDGs), namely good quality health and well-being, quality education, and gender equality, that the UAE strives to achieve. Responses from 335 students (aged 14–20) from six schools and 250 parent responses in the Al Ain region of Abu Dhabi Emirate were used to understand the mean variation in perception of five built environment constructs. Further, multinomial logit regression was used to assess the health condition using the perception, behavior, and built environment measures. Results indicate that Emirati males perceive the built environment factors as barriers more than female adolescents. Parents perceive street crossing (p < 0.016) and sidewalk characteristics (p < 0.020) to be more of a hindrance. Traffic exposure, self-reported physical activity, and walkability near homes and schools significantly affect Emirati adolescents’ health conditions. Recommendations are made for various stakeholders including parents, school authorities, Abu Dhabi Municipality and Transportation, and the Urban Planning department on ways to enhance the built environment and encourage PA and well-being of Emirati adolescents.

Variation in Utilisation of NICU Across Tertiary Care Centers in Alain Region of Abudhabi, UAE: A Review

Variation in Utilisation of NICU Across Tertiary Care Centers in Alain Region of Abudhabi, UAE: A Review

Impact of land use/land cover changes on groundwater resources in Al Ain region of the United Arab Emirates using remote sensing and GIS techniques

Urbanisation causes land degradation problems, including an increased pressure on natural resources and management of water resources. This study aims to investigate the impact of the spatio-temporal dynamics of land use land cover (LULC) changes on groundwater table in the region of Al Ain, United Arab Emirates (UAE), from 2006 to 2016. The Landsat images, Landsat ETM for 2006 and Landsat 8 for 2016, were acquired from the earth explorer site. A semi-supervised hybrid classification method was used for image classification and post-classification techniques for LULC change detection. The study area was categorised into six major LULC classes. These are agriculture/farms/oasis, gardens/playgrounds, urban areas, sandy areas, lake and mixed urban/sandy areas. Accuracy assessment of LULC were evaluated using confusion matrix and ground truthing. The obtained land use and land cover maps were also correlated with spatial groundwater table maps prepared with groundwater data. It was found that agriculture/farms/oasis and urban areas expanded from 42,560 ha to 45,950 ha (7.38%) and from 8150 ha to 9105 ha (10.49%) from 2006 to 2016, respectively. The corresponding water demand was increased by 9.56% and 22.22%, respectively. Natural sandy area was found to decrease by 8.10%. As groundwater is major source of water for agriculture in this region, the spatial maps also revealead average declining rate of groundwater depth 40.44% with expansion of urban and agricultural areas over the last 10 years. The outcomes of the study would help concerning authorities for a sustainable management of its land and groundwater resources.

Seroprevalence of Coxiella burnetii in a dairy cattle herd from the Al Ain region, United Arab Emirates.

The present study assessed the serostatus of Coxiella burnetii in a dairy cattle herd from the Al Ain region, UAE. In addition, the study evaluated the relationship between C. burnetii seropositivity and history of abortion and cattle age. Blood/sera from 759 cattle were tested by ELISA, and the data analyzed by the Pearson Chi-square test (PCST), odds ratios, and logistic regression. Of the 759 study cattle, 36.5% (277/759) were seropositive while 63.5% (482/759) were seronegative for C. burnetii. Additionally, 19.5% (148/759) of the cattle had ever aborted while 80.5% (611/759) had not. Meanwhile, 34.3% (95/277) of the C. burnetii-seropositive cattle (CBSPos) had history of abortion while 65.7% (182/277) did not. By comparison, only 11.0% (53/482) of the C. burnetii-seronegative (CBSNeg) cattle had history of abortion while 89.0% (429/482) had never aborted. The difference in the conditional probabilities of CBSPos or CBSNeg cattle that had history of abortion was statistically significant (PCST; p value 0.001), as was the association between a CBSPos outcome and history of abortion (p value 0.0001). Moreover, the odds of prior abortion having occurred in CBSPos were 4.3 times higher than in CBSNeg cattle. Similarly, the log of the odds of past abortions was positively correlated with C. burnetii seropositivity and cattle age (p value < 0.001). These data demonstrate apparent C. burnetii infections in cattle from the UAE in which the risk of abortion appears to increase with cattle age. Molecular testing for C. burnetii and comprehensive investigations of other abortigenic pathogens in the study cattle herd are recommended.

THE DIFFERENCES IN SUBJECTIVE QUALITY OF LIFE AMONG THE DIVORCED/SEPARATED IN ABU DHABI

This study attempts to understand various aspects of the quality of life (QoL) of the divorced and the separated in Abu Dhabi. A descriptive analysis approach was adopted to explore the differences in some selected QoL indicators, including health perceptions, depressive feelings, social connection, happiness, and life satisfaction between and among various demographical categories of the divorced and the separated. This research drew data from the second cycle of the Quality-of-Life survey in Abu Dhabi conducted in 2019-2020, in which a total of 3,192 divorced or separated individuals participated. The analysis followed mainly a descriptive approach, presenting the means of each well-being variable by various respondent categories. The analysis of variance (ANOVA) was also used to examine the degree of differences. The results show that the divorced/separated generally exhibit a significantly low level of QoL attributes. Moreover, the divorced/separated show significant differences in those selected QoL indicators when gender, age, nationality, income, residence, and education are factored in. Most of the lowest QoL scores were reported by females, lower-income groups, younger age groups, residents of the Al Ain region, low education groups, and non-Emiratis. Policy implications and future research directions are recommended.

Exploring vaccine hesitancy among healthcare providers in the United Arab Emirates: a qualitative study

ABSTRACT Healthcare providers (HCPs) are at the frontline to curb the spread of vaccine hesitancy in the community. However, HCPs themselves may delay or refuse vaccines. In light of the emerging vaccine hesitancy in the United Arab Emirates (UAE), we aimed to explore HCPs doubts and concerns regarding vaccination. We conducted face-to-face interviews with 33 HCPs from 7 ambulatory healthcare services in the Al Ain region, UAE. An interview guide was developed based on the European Center for Disease Prevention and Control guide for vaccine hesitancy among HCPs. An inductive thematic framework was employed to explore the main and emerging themes conceptualizing the predisposing, reinforcing, and enabling factors that influence HCPs’ hesitancy regarding vaccinations for themselves and while recommending, prescribing, or discussing vaccines with their patients. The sample included general practitioners, family physicians, nurses, pharmacists, and other administrative staff. The major themes included positive predisposing factors such as trust in the system and the government, previous education, and social responsibility. Positive enabling factors included affordability and availability of vaccination services. Many participants were hesitant to receive the mandatory influenza vaccination. Misinformation regarding vaccines on social media was a major concern. However, HCPs showed little interest in being active on social media. Most participants reported never receiving any training on how to address vaccine hesitancy among patients. Because HCPs play an important role in influencing patients’ decisions regarding undergoing vaccination, their confidence in addressing vaccine hesitancy must be improved.

Cryptosporidium parvum and other enteric pathogens in scouring neonatal dairy calves from the Al Ain region, United Arab Emirates.

Faecal specimens from 36 scouring neonatal calves from two dairy farms located in the Al Ain region of the UAE were screened with pathogen-specific antigen ELISA for Cryptosporidium parvum, Escherichia coli K99, rotavirus, and coronavirus. Additionally, faecal smears were stained with modified-acid-fast for Cryptosporidium oocysts, and the VITEK 2 system plus Gram's stain used to identify bacteria isolated from the faecal samples. Farm management practices were also evaluated during a farm visit. Of the 36 calves, 29, 13, 5, and 6 were positive for C. parvum, E. coli K99, bovine coronavirus, and rotavirus antigens respectively, while 27 were positive for Cryptosporidium oocysts. In various combinations, mixed infections were detected in 20/36 calves. This is the first report of C. parvum, E. coli K99, Salmonella spp., rotavirus, and coronavirus in ≤14-days-old scouring neonatal dairy calves from the UAE. Molecular characterization of these pathogens and nationwide epidemiological calf scour studies are recommended.

Serological evidence of enzootic bovine leukosis in the periurban dairy cattle production system of Al Ain, United Arab Emirates.

The serostatus of enzootic bovine leukosis (EBL) was determined at three dairy farms and the Al Ain Livestock Market (AALM), within the Al Ain region of Abu Dhabi, UAE. Of the 957 bovine sera tested by ELISA, 657 were from Holstein-Friesians from three dairy farms, and 300 from Bos indicus cattle at AALM. The chi-square homogeneity test (CSHT) and the Marascuilo multiple comparison procedure (MMCP) assessed the level of significance between the proportions of EBL-seropositive cattle (ESPC) across the study farms and AALM, and between the age groups at farms 1 and 3. Overall, the proportion of ESPC was 25.7% at dairy farms and AALM, 37.0% for farms and 1.0% for AALM. Furthermore, the proportions of ESPC at farms 1, 2 and 3 were 54.7%, 0.0% and 26.3% respectively, and statistically significant differences were seen across the farm/farm and farm/AALM comparisons, and between two age groups at farms 1 and 3. The 37-72-month-old age group showed the highest proportion of ESPC. This is the first serological evidence of EBL in the UAE. As previously reported, the ESPC are comparatively higher in dairy than Bos indicus cattle. Molecular and more extensive serological studies are needed to further corroborate the present data. Meanwhile, the UAE veterinary authorities will need to formulate national EBL control policies.

Predicting Weathering Characteristics of Carbonate Rocks Under Different Geo-Environmental Conditions

Rock moisture content, temperature and physical and chemical conditions of water in the rock mass vary under different geoenvironmental conditions. These factors are critical in the mechanical and chemical disintegration of rocks with time. Changes in weathering characteristics of a rock mass correlate with major changes in shear strength and deformability of rocks. Therefore, durability is an important parameter for rocks and weathered rocks in predicting and assessing long term problems in their use for engineering purposes. Carbonate rocks are generally considered as durable strong rocks. It is important to test this claim in the UAE, where carbonate rocks are the main available rock materials in many locations e.g. in Al Ain city. The slake durability index (SDI), with tests involving several cycles of wetting and drying, is widely recognized and has been used to measure the durability of weathered rocks. Carbonate rocks in the Jabel Hafit mountain, Al Ain region, have highly fractured and cavernous surface and near surface structures. In this study, degradability of samples from three different carbonate sequences: the Rus, Dammam, and Asmari Formations, were studied petrographically, mineralogically and texturally before and after slaking. A number of slaking tests were performed on twenty-one rock samples, seven from each rock formation, in order to investigate the effects of various geoenvironmental conditions on carbonate rocks weatherability at various pH levels 2, 4, 6, 8, 10, 12 and 14. Detailed mineralogical examinations, rock thin sections, Scanning Electronic Microscope (SEM) and X-ray diffractometry (XRD) were employed to reveal the relationship between mineralogy and weathering characteristics of rocks on the representative rock samples, before and after the slake durability tests. Furthermore, the index properties of all samples such as unit weights (dry, γd and saturated, γsat), the water absorption (Wa), the porosity (n), void ratio (e) and the specific gravities (GS,(OD), GS,(SSD), GS,(A)) were measured. The study reveals that the weathering characteristics of carbonate rocks under different geoenvironmental conditions is strongly controlled by the mineralogical composition and textural features of the rocks. The impact of slaking fluid in the degradability of limestone is very limited due to chemical reaction of CaCO3 especially in lower pH level acidic fluid, which reduced the bonding strength between grains. The findings will certainly help to resolve durability problems associated with engineering applications such as tunnels, slope stability, and etc. in the region and elsewhere.

A Multi-Satellite Approach for Water Storage Monitoring in an Arid Watershed

The objective of this study was to use satellite imagery to monitor the water budget of Al Ain region in the United Arab Emirates (UAE). Inflows and outflows were estimated and the trend of water storage variation in the study area was examined from 2005 to 2014. Evapotranspiration was estimated using the simplified Penman-Monteith equation. Landsat images were used to determine the extent of agricultural and green areas. Time series of gravity recovery and climate experiment (GRACE) observations over the study area were used to assess the inferred water storage variation from satellite data. The change of storage inferred from the Water Budget Equation showed a decreasing trend at an average rate of 2.57 Mm3 annually. Moreover, GRACE readings showed a decreasing trend at a rate of 0.35 cm of water depth annually. Mann-Kendal, a non-parametric trend test, proved the presence of significant negative trends in both time series at a 5% significance level. A two-month lag resulted in a better agreement (R2 = 0.55) between the change in water storage and GRACE anomalies within the study area. These results suggest that water storage in the study area is being depleted significantly. Moreover, the potential of remote sensing in water resource management, especially in remote and arid areas, was demonstrated.

Variability of Extreme Hydro-Climate Parameters in the North-Eastern Region of United Arab Emirates

The hydro-climate information is absolutely important for the management of water and environmental resources. However, in many cases, information for extreme hydro-climate variables are neglected. It is acknowledged that the climate change scenarios will affect the variability of extreme hydro-climate variables. In this study, several robust statistical tests were applied to identify the variability of several hydro-climate parameters in the northeastern region of the United Arab Emirates (UAE). The variables are annual maximum daily mean, maximum and minimum temperature; annual maximum daily rainfall; annual maximum mean humidity, wind speed, sea level pressure and solar radiation. Historical trends and step changes were identified. Five climate stations located in Al Ain, Abu Dhabi, Dubai, Fujairah and Ras Al Khaima were considered. Statistically significant increasing trends were observed in extreme temperature and rainfall parameters in all locations except the Al Ain region. The UAE is located in the arid climate region with an average annual rainfall of less than 100mm. Increase of extreme rainfall might increase the risk of flash floods in the mountainous eastern region. Possible impacts of changes of extreme temperature and rainfall in the region are delineated in the study.

Child and Youth Traffic-Related Injuries: Use of a Trauma Registry to Identify Priorities for Prevention in the United Arab Emirates

Objective: Traffic-related injuries are the main cause of death during childhood and youth in the United Arab Emirates (UAE), use of safety restraints by citizens is uncommon, rollovers are frequent, and current legislation does not protect rear-seat occupants. Because little was known about the circumstances of hospitalizations for traffic injuries to guide prevention, a trauma registry was used to assess causes and determinants for traffic-related injuries during childhood and youth (<19 years) and its value for prevention. Methods: One hundred ninety-three children and youth with traffic injuries were admitted for more than 24 h at surgical wards of the main trauma hospital in the Al-Ain region during a 36-month period (2003–2006). Injuries were analyzed by age, nationality, road user and vehicle types, severity, anatomical region, and the presence of head injury using Injury Severity Scores (ISS) and the Abbreviated Injury Scale (AIS). Results: Traffic injuries represented 40 percent (n = 193) of injuries to 0- to 19-year-olds, followed by falls (39 percent). Among 15- to 19-year-olds, who accounted for 46 percent of child and youth victims, the incidence was 150/100,000 person years, compared to an incidence of 15 to 51 for younger age groups. Overall, 53 percent were vehicle occupants, 23 percent were pedestrians, 14 percent were bicyclists, 6 percent were motorcyclists, with 4 percent other. The ratio of male-to-female victims was 6.7:1; for drivers it was 33:0; and for pedestrians, bicyclists, and motorcyclists it was between 10:1 and 12:1; injured females were mainly rear-seat passengers and the male: female ratio was 1.4:1. Seventy-one percent of pedestrians were ≤9 years old. Although the ratio of UAE children to foreign children was estimated at 0.7:1 in the community, 58 percent of the injured were UAE citizens. The ratio of injured UAE: non-UAE citizens was 1.4:1 overall but 5.6:1 for drivers and 4.5:1 for motorcyclists. Forty-one percent of citizens were injured in 4-wheel drive sport utility vehicles compared to 13 percent of non-citizens. Head injuries occurred in 68 percent of vehicle occupants and 51 percent of nonoccupants, with AIS ≥ 3 injuries in 23 percent of occupants and 26 percent of nonoccupants. Sixty-seven percent of rear occupants had head injuries. Conclusions: Male drivers and vulnerable road users were at an unusually high risk relative to females. A relatively high frequency of traffic-related head injuries among UAE children and youth, including rear-seat passengers and other vehicle occupants, suggests that considerable preventable morbidity is associated with nonuse of safety restraints and/or other factors such as excess speed and rollovers of 4-wheel drive vehicles. Trauma registries can be useful for prevention; inclusion of data on safety restraints and helmet use by road user type is essential.

Home and Other Nontraffic Injuries Among Children and Youth in a High-Income Middle Eastern Country

A trauma registry in the United Arab Emirates was used to ascertain nontraffic injuries of 0- to 19-year-olds. The registry's value for prevention was assessed. A total of 292 children and youth with nontraffic injuries were admitted for >24 hours at surgical wards of the main trauma hospital in Al Ain region during 36 months in 2003-2006. Injuries were analyzed by external cause, location, body part, and severity. Nontraffic represented 60% (n = 292) of child and youth injuries. Incidence/100 000 person-years was 91 for males, 43 for females. Unintentional included falls 65% (n = 191), burns 17% (n = 49), animal-related (mainly camel) 3% (n = 10), and others 10% (n = 29). Intentional accounted for 4% (n = 13). Falls affected all ages, burns mainly 1- to 4-year-olds. Of the injuries, 70% occurred at home. Most frequent and severe injuries measured by the Injury Severity Score and Abbreviated Injury Scale involved extremities. Prevention of home falls for all ages and burns of 1- to 4-year-olds are priorities. Registries should cover pediatric wards and include data on fall locations and hazardous products.

Molecular Determinants of Substrate Recognition in Thermostable -glucosidases Belonging to Glycoside Hydrolase Family 13

Bacillus stearothermophilus alpha-1,4-glucosidase (BS) is highly specific for alpha-1,4-glucosidic bonds of maltose, maltooligosaccharides and alpha-glucans. Bacillus thermoglucosdasius oligo-1,6-glucosidase (BT) can specifically hydrolyse alpha-1,6 bonds of isomaltose, isomaltooligosaccharides and alpha-limit dextrin. The two enzymes have high homology in primary structure and belong to glycoside hydrolase family 13, which contain four conservative regions (I, II, III and IV). The two enzymes are suggested to be very close in structure, even though there are strict differences in their substrate specificities. Molecular determinants of substrate recognition in these two enzymes were analysed by site-directed mutagenesis. Twenty BT-based mutants and three BS-based mutants were constructed and characterized. Double substitutions in BT of Val200 -->Ala in region II and Pro258 -->Asn in region III caused an appearance of maltase activity compared with BS, and a large reduction of isomaltase activity. The values of k(0)/K(m) (s(-1). mM(-1)) of the BT-mutant for maltose and isomaltose were 69.0 and 15.4, respectively. We conclude that the Val/Ala200 and Pro/Asn258 residues in the alpha-glucosidases may be largely responsible for substrate recognition, although the regions I and IV also exert a slight influence. Additionally, BT V200A and V200A/P258N possessed high hydrolase activity towards sucrose.

Audit of a Diabetes Clinic at Tawam Hospital, United Arab Emirates, 2004–2005

The aim of this audit was to determine the current management of patients with diabetes compared to international standards and to benchmark the results against current international standards. A retrospective audit of medical records of diabetic patients attending Tawam Hospital, a tertiary healthcare facility in the Al Ain region in the Emirate of Abu Dhabi, United Arab Emirates was performed. A random sample of 30 patients (5% of the target group) was selected from the total number of 600 patients who visited the diabetes clinics in August 2005. An audit form was developed based on the priority aims and measures contained in the Institute for Clinical Systems Improvement (ICSI) Guidelines for the management of type 2 diabetes mellitus. Data analysis was carried out based on measurement specifications in the ICSI Guidelines. All patients had their blood pressure checked at their most recent appointment. All except one patient had an HbA1c test and a lipid profile performed during the study period. Although 75% of patients were referred for a dilated eye examination, only 47% complied. Approximately two-thirds of all patients had evidence of self-monitoring of blood glucose. Less than half of the patients were referred to the nutritionist and only a relatively small proportion of patients had advice on diet and exercise documented in their medical record. There was also lack of documentation, particularly for smoking status, foot examination, and body mass index (BMI). All patients received aspirin (ASA) treatment. The majority had a systolic blood pressure of 130 mmHg or less; just under half of patients had HbA1c of less than 7%. In comparison to the Center for Diseases Control (CDC) targets, we exceeded targets in three areas in relation to HbA1c testing, ASA treatment, and self-report monitoring blood glucose. We did not meet the stated target of 75% for patients having a dilated eye exam due to lack of patient compliance (more than three-quarters of all patients were referred but did not attend for appointment). Documentation of a comprehensive foot examination was present for only one-quarter of all patients compared to the recommended target of three-quarters of patients. Documentation of advice on diet and exercise was present for 40%, which did not meet the CDC target of 60%. Overall, the audit highlighted that Tawam Hospital is providing a good level of care to diabetic patients and compares favorably with international targets; however, key recommended actions have been identified for implementation to improve patient care and maintain a continuous improvement process through effective monitoring with prioritization to those related to preventative care.