Hospital In Oman Research Articles

Risk factors profile of shoulder dystocia in oman: a case control study.

This study aimed to assess the risk factor profile of shoulder dystocia and associated neonatal complications in Oman, a developing Arab country. A retrospective case-control study was conducted among 111 cases with dystocia and 111 controls, identified during 1994-2006 period in a tertiary care hospital in Oman. Controls were randomly selected among women who did not have dystocia, and were matched to cases on the day of delivery. Data related to potential risk factors, delivery, and obstetric complications were collected. Dystocia was significantly associated with older maternal age, higher parity, larger BMI, diabetes, and previous record of dystocia. In addition, dystocia was associated more with vacuum and forceps deliveries. Routine traction (51%) was the most used manoeuvre. Among dystocia cases, 13% were associated with fetal complications of which Erb's Palsy was the most prevalent (79%). Our finding of significant associations with risk factors lays out the ground to develop a predictability index for shoulder dystocia, which would help in making it preventable. Further p rospective studies are required to confirm the obtained results.

2014 Oman Heart Association protocol for the management of acute atrial fibrillation.

Although atrial fibrillation (AF) is the most common cardiac arrhythmia, there is variation in practice with regard to the management of acute AF among the hospitals and even within the same hospital in Oman. This variation likely reflects a lack of high-quality evidence. Standard guidelines and textbooks do not offer clear evidence-based direction for physicians to guide the management of acute AF. Particularly controversial is the issue of using rhythm control or rate control. This stimulated Oman Heart Association (OHA) to issue a simplified protocol for the management of acute AF to be applied by the entire cardiac caregivers all over the country. The priorities for acute management of AF include stabilizing the patient's hemodynamic status, symptom control, treatment of the underlying and precipitating cause, and more importantly protecting the brain.

Peer review and audit of morbidity after three or more caesarean sections

A review of maternal and newborn outcomes after a third or more caesarean section was conducted among six obstetrician registrars. The main outcome measures were maternal morbidity, intraoperative and postoperative complications and neonatal outcome. A retrospective cohort study was conducted of caesarean sections for women who had previously undergone two or more caesarean section performed by six obstetrician registrars in Sultan Qaboos University Hospital, a tertiary referral hospital in Oman. Retrospective data were collected from electronic health records of 120 Omani women between January 2010 and December 2011 (20 per registrar). Haemorrhage of more than 1000 ml was recorded in 10% of patients, one patient was found to have a bladder injury intraoperatively, and postoperative wound infection occurred in 5% of patients. Difficulty in opening the abdomen was found in one patient, and one case of deep vein thrombosis occurred despite prophylactic heparinisation. One infant was preterm, and four had intrauterine growth restriction. Intraoperative complications, such as blood loss, visceral injury and long mean operating time and postoperative complications, such as deep vein thrombosis, wound infection and febrile morbidity, were comparable among the registrars. The standard of the registrars was comparable, and similar to international standards.

Known and New δ-Globin Gene Mutations and Other Factors Influencing Hb A2 Measurement in the Omani Population

Although δ-thalassemia (δ-thal) is not categorized as a severe disease, it is essential to know the molecular spectrum of the δ gene mutations frequently occurring in specific areas, particularly if these areas are characterized by a high rate of β-thalassemia (β-thal) such as Oman. This is because coinherited δ-globin gene defects can interfere with the basic diagnosis of a β-thal carrier when this is based upon the measurement of the Hb A2 only. Because of that, we have investigated 33 patients with low Hb A2 levels, collected from different hospitals in Oman. Some cases had a second Hb A2 fraction, while others had only significantly lower Hb A2 levels. Among these patients, 20 did carry a δ-globin gene mutation, the rest were carriers of α thalassemia (α-thal) defects or could be iron depleted or both. In total, eight different known mutations and two novel δ variants were found. The characterization of the δ-globin gene mutation spectrum will improve carrier diagnostics and genetic counseling in the Omani population screened for β-thal.

The epidemiology and outcomes of infective endocarditis in a tertiary care hospital in Oman.

We undertook this study to describe the epidemiological and clinical features of infective endocarditis (IE) and to study the complications and management of IE in a tertiary care hospital in Oman. This is a retrospective study of 58 adult patients (>13 years of age) admitted to the Royal Hospital with IE from June 2006 to June 2011. Of the 58 patients, 40 (69%) were males, and 18 (31%) were females (ratio 2.2). The median age was 43.6 years (range: 14-85). Forty-eight cases (82.7%) had native valves, nine patients (15.6%) had prosthetic valves, and one case (1.7%) had a pacemaker. The most commonly involved valves were mitral (33, 56.9%) and aortic (23, 39.7%). The blood cultures were positive in 47 (81%) patients, and the most commonly isolated organisms were Streptococci spp., which were found in 20 (34.5%) patients, and Staphylococci spp., which were found in 19 (32.8%) patients. The complication rate was 21%. A total of 15 (25.9%) patients underwent surgical intervention, and the in-hospital mortality rate was 27.6%. Native-valve IE is the predominant type of endocarditis and is more of an acute disease. The prevalence of Staphylococci spp. IE is similar to that of Streptococci spp. IE, and its associated mortality remains high.

Genotyping of methicillin-resistant Staphylococcus aureus in the Sultan Qaboos University Hospital, Oman reveals the dominance of Panton-Valentine leucocidin-negative ST6-IV/t304 clone.

The objective of this study was to determine the prevalence and distribution of methicillin-resistant Staphylococcus aureus (MRSA) genotypes circulating at a tertiary hospital in the Sultanate of Oman. A total of 79 MRSA isolates were obtained from different clinical samples and investigated using antibiogram, pulsed-field gel electrophoresis (PFGE), staphylococcal chromosome cassette mec (SCCmec), Spa typing and multilocus sequence typing (MLST). The isolates were susceptible to linezolid, vancomycin, teicoplanin, tigecycline and mupirocin but were resistant to tetracycline (30.4%), erythromycin (26.6%), clindamycin (24.1%), trimethoprim (19.0%), ciprofloxacin (17.7%), fusidic acid (15.2%) and gentamicin (12.7%). Molecular typing revealed 19 PFGE patterns, 26 Spa types and 21 sequence types. SCCmec-IV (86.0%) was the dominant SCCmec type, followed by SCCmec-V (10.1%). SCCmec-III (2.5%) and SCCmec-II (1.3%) were less common. ST6-IV/t304 (n = 30) and ST1295-IV/t690 (n = 12) were the dominant genotypes followed by ST772-V/t657 (n = 5), ST30-IV/t019/t021 (n = 5), ST22-IV/t852 (n = 4), ST80-IV/t044 (n = 3) and 18 single genotypes that were isolated sporadically. On the basis of SCCmec typing and MLST, 91.2% of the isolates were classified as community-associated MRSA and 8.8% of the isolates (consisting of four ST22-IV/t852, one ST239-III/t632, one ST5-III/t311 and one ST5-II/t003) were classified as healthcare-associated MRSA. The study has revealed the dominance of a Panton–Valentine leucocidin-negative ST6-IV/t304 clone and provided insights into the distribution of antibiotic resistance in MRSA at the tertiary hospital in Oman. It also highlights the importance of surveillance in detecting the emergence of new MRSA clones in a healthcare facility.

Clinical and histological profile of surgically managed benign adnexal masses.

To study the clinical and histological nature of benign adnexal masses managed surgically. A retrospective descriptive study in a teaching hospital in Oman of all the women who had surgical management of benign adnexal masses from January 2008 to May 2012. Data pertaining to age, parity, presenting symptoms, imaging and tumor markers performed and the surgical intervention done on those women with benign adnexal masses was collected from the electronic health records of the patients. There were 198 women during this period operated for benign adnexal masses. The most common benign neoplasm was mature teratoma of the ovary followed by endometriosis. Conservative surgery in the form of ovarian cystectomy was necessary in three fourths of women and in about just less than 50% of women, the procedure was completed laparoscopically. The most common benign tumor was teratoma but laparoscopic approach, which is the standard of care in these women, was possible only in just about 50% of the women.

Audit of orthopedic trauma theatre usage: Observation from a secondary regional referral hospital in Oman

Background: Trauma is the leading cause of admission to our hospital and its unpredictability along with mismatch in demand and supply requires more use of resources and system streamlining. The operation theatre is described as the engine room of the hospital. There is no audit from Gulf region on the orthopedic operation theatre usage. The present study was undertaken to assess theatre utilization in our hospital and identify areas where improvement could be done which in turn can be applied to other surgical specialties in our hospital and beyond. Findings: This prospective audit was carried out in 303 bedded regional referral Nizwa hospital in the Department of Orthopedics. A total of 853 cases were electively operated upon during 12 months period from 1 st January 2011 to 31 st December 2011 in orthopedic operation theatre which was run for 261 days electively during that period. Cases performed on public holidays or during weekend and after 1400 hrs were excluded and classified as emergency procedures. The data was recorded from the time the patient entered the operation theatre (Enter OT) to the time he left (Exit OT). The data was recorded for surgery, anesthesia, changeover, total operating time respectively and calculations made for other variables. 632 cases (74%) started later than scheduled time with average of 22.8 min late start time. Delay in starting the list was due to late arrival of surgeons (22.2%) or anesthetist (28%) in 50.2% cases. Delay due to late or incomplete preparation of the patient or transportation of patient accounted for 44.4% cases. Other causes of delay such as physician or anesthesia review prior to surgery accounted for 5.4% of the delay. Conclusion: Operation theatre, being an area of maximum and complex activity in any hospital, needs multipronged strategy to improve its utilization continuously with regular theatre committee meetings to discuss and anticipate problems and chalk out new ideas and strategies.

Identifying nurse managers' essential communication skills: an analysis of nurses' perceptions in Oman

The aim of the present study was to analyse nurses' perceptions of the communication qualities that are essential for nurse managers to carry out their jobs effectively. An examination of effective communication may help to identify nurse manager behaviours that promote dignity and respect. A paper-and-pencil survey collected open-ended data from 1526 nursing professionals (RNs) representing 22 hospitals in Oman. Qualitative content analysis was conducted first, followed by a quantitative descriptive analysis. The participants reported frustration with nurse managers who seemed overly focused on mistakes. Many participants felt there was little to no appreciation for tasks that were well done. Nurses also disliked being disciplined openly in front of colleagues or patients. The participants stressed that nurse manager feedback should be shared privately and framed in a positive and constructive tone. Active listening, team collaboration and the avoidance of discrimination/favouritism were also emphasised. A supportive and communicative work environment promotes nurses' dignity and respect. Embarrassing nurses in front of other health care professionals may be counterproductive. Instead, the study results suggested privately discussing concerns in a positive, constructive tone is more likely to foster nurse trust and dignity.

Utilization Pattern of Antipsychotics at a Tertiary Care Hospital in Oman

Results: Among 535 analyzed records, females accounted for 57.3% of prescriptions and the age group between 18 to 39 years constitutes the major (54.7%) utilizer of antipsychotics. Atypical antipsychotics accounted for 68.8% of prescriptions. Olanzapine was the most common prescribed atypical drug (48.1%) while haloperidol was the most utilized (34.1%) typical agent. Schizophrenia was the main indication for the use of antipsychotics (26.9%) followed by depressive disorders (23.2%) and bipolar affective disorder (11.6%). Monotherapy accounted for the majority (93.0%) of prescriptions. Conclusion: At SQUH atypical antipsychotics accounted for the majority of antipsychotic prescriptions which is in-line with most standard therapeutic guidelines recommendations for the treatment of psychotic disorders. Further research exploring the tolerability and outcome of such treatment is needed.

Utilization Pattern of Anti-Depressants at a Tertiary Hospital in Oman: A Retrospective Analysis

Introduction: Antidepressants play a major role in managing depression and other conditions. The use of various classes of antidepressants varies from a country to another but information about the use of these agents in the developing countries is scarce. Results: A total number of 1416 prescriptions were analyzed. Of these 880 (62.1%) were for females and 536 (37.9%) were for males. Tricyclic antidepressant (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin/ norepinephrine reuptake inhibitors (SNRIs) and mirtazapine accounted for 34.6%, 32.1%, 13.3% and 19.9% of prescriptions, respectively. Monotherapy accounted for 89.3% of prescriptions. The most used single antidepressant drug was amitriptyline (28.5%) followed by mirtazapine (19.9%) and paroxetine (17.9%). SSRIs, SNRIs and mirtazapine were mainly used for psychiatric conditions in 82.2%, 73.0% and 68.8% of the cases, respectively, while TCAs were mainly indicated (63.7%) for non-psychiatric conditions. Conclusion: Monotherapy antidepressant is the preferred mode of therapy with SSRIs and mirtazapine as first line therapy for depression which is consistent with therapeutic guidelines recommendations.

Epidemiology of Multi-Drug Resistant Organisms in a Teaching Hospital in Oman: A One-Year Hospital-Based Study

Background. Antimicrobial resistance is increasingly recognized as a global challenge. A few studies have emerged on epidemiology of multidrug resistant organisms in tertiary care settings in the Arabian Gulf. Aim. To describe the epidemiology of multi-drug resistant organisms (MDRO) at Sultan Qaboos University Hospital, a tertiary hospital in Oman. Methods. A retrospective review of MDRO records has been conducted throughout the period from January 2012 till December 2012. Organisms were identified and tested by an automated identification and susceptibility system, and the antibiotic susceptibility testing was confirmed by the disk diffusion method. Results. Out of the total of 29,245 admissions, there have been 315 patients registered as MDRO patients giving an overall prevalence rate of 10.8 (95% CI 9.3, 12.4) MDRO cases per 1000 admissions. In addition, the prevalence rate of MDRO isolates was 11.2 (95% CI 9.7, 12.9) per 1000 admissions. Overall, increasing trends in prevalence rates of MDRO patients and MDRO isolates were observed throughout the study period. Conclusion. Antimicrobial resistance is an emerging challenge in Oman. Continuous monitoring of antimicrobial susceptibility and strict adherence to infection prevention guidelines are essential to prevent proliferation of MDRO. Along such quest, stringent antibiotic prescription guidelines are needed in the country.

TREND of occupational doses of radiation workers in cath labs in ministry of health hospitals, Oman: A dose analysis

In Ministry of Health (MOH), Oman, ionizing radiation is widely used in many areas such as for diagnosis, radiation therapy, bio-medical research and use of sealed radioisotope(s) for blood irradiation etc. Use of radiation and particularly the diagnostic use of x-rays in the Sultanate of Oman is increasing with the proliferation of hospitals and clinics. The great benefits of increased and improved diagnostic services have improved the quality of life for those in Oman. The World Health Organisation in 2000 applauded the quality, efficiency and delivery of health care to the population and ranked the Oman's health care system eighth in the world(1). The increased resources are clear from the statistics: in 1970 there were only 2 hospitals in Oman, in 2010 the number was 50 and with 172 health centres(2). One of the balancing consequences of increased x-ray use in Oman is the increased radiation dose to the population. Medical radiation accounts for the majority of the manmade radiation dose to populations(3). Use of radiation must always be according to the ALARP (as low as reasonably practical) philosophy so as to avoid unnecessary radiation doses and minimise the doses where required which in turn reduces the occupational exposure. During 2012, a total of 1,247,016 radiological procedures were performed in Ministry of Health (MOH) institutions. The corresponding number in 2000 was 799,452. This shows that there is about 35% increase in radiological examinations for the last 12 year period. This indicates that the population dose is on the rise as the radiological facilities are increasing in Oman which in turn increases the occupational dose of radiation workers.

Utilization Pattern of Anti-Depressants at a Tertiary Hospital in Oman: A Retrospective Analysis

Utilization Pattern of Anti-Depressants at a Tertiary Hospital in Oman: A Retrospective Analysis

Quality control for digital radiography and fluroscopy equipment in a large university hospital in Oman: Implementation of European acceptability criteria

Quality control for digital radiography and fluroscopy equipment in a large university hospital in Oman: Implementation of European acceptability criteria

Utilization Pattern of Antipsychotics at a Tertiary Care Hospital in Oman

Utilization Pattern of Antipsychotics at a Tertiary Care Hospital in Oman

Evaluation of nurses' knowledge of oral solid dosage forms that should not be crushed at a university hospital in Oman

Objective To evaluate nurses' knowledge of oral solid dosage forms that should not be crushed at Sultan Qaboos University Hospital (SQUH), Oman, the methods used in crushing and the references consulted prior to crushing. Method A questionnaire-based study of a convenience sample of nurses in inpatient practice areas of SQUH, Oman, from 14 to 21 of November 2012. Key findings One hundred twenty-six (76.51%) of nurses regularly crushed oral solids for patients who are unable to swallow. Eighty-seven point thirty per cent (145) are aware that there are some specially formulated oral solids that should not be crushed, but only 38% (63) could correctly indicate how such medications can be recognised. Only half of nurses check the pharmaceutical characteristics of oral solids before crushing. When multiple medications are prescribed for a patient who cannot swallow, 42.16% (70) crush all together and mix with some water before giving to the patient. Five point seven per cent (10) of nurses put on personal protective equipment all the time before crushing, 26.58% (27) rarely and 25.95% (49) never do. Sixty-nine point three per cent (115) consult their pharmacist when they are in doubt about crushing. Conclusions Crushing of oral solid dosage forms was common among nurses in SQUH. There were knowledge deficits regarding special formulations that should not be crushed. When oral solids were crushed, attention to possible drug–drug, drug–food interactions, contamination and safety was overlooked. Majority of nurses consulted their pharmacist when in doubt about crushing. Further research is required to see if collaboration among nurses and pharmacists would improve this practice.

The Patterns and Causes of Neonatal Mortality at a Tertiary Hospital in Oman

To report the patterns and causes of neonatal death from a tertiary care neonatal intensive care unit over a period of four years. This is a retrospective cohort study where four years data (January 2006 - December 2009) of all inborn neonatal admissions and deaths were collected from the neonatal intensive care unit at Sultan Qaboos University hospital on predesigned forms. All out born admissions and deaths were excluded. The causes of neonatal death were classified using Wigglesworth's classification. The number of inborn live births during the study period was 10064 and the total number of inborn neonatal admissions was 1475. The total deaths (neonatal and post neonatal) at the neonatal intensive care unit was 73 (63 inborn and 10 out born). Among the inborn, five deaths were post neonatal deaths and hence, excluded from analysis. Among the remaining inborn neonatal deaths (n=58), 34 (59%) were males and 24 (41%) were females. The number of neonatal admissions increased over the years during the study period from 248 to 356, while the number of deaths also increased from 10 deaths in 2006, to 20 deaths in 2009. The primary causes of neonatal deaths were prematurity and its complications 52% (n=30). Lethal congenital malformations lead to 17 (29%) newborn deaths, specific diagnosis in 7 newborns (12%), and birth asphyxia in four (7%) of cases. There was an increasing trend of neonatal admissions and deaths among inborn babies. Prematurity, with sepsis as its major complication and congenital malformations were the leading cause of neonatal mortality.

Discharge against Medical Advice among Children in Oman : A University Hospital Experience = الخروج ضد المشورة الطبية بين الأطفال في عمان : تجربة مستشفى جامعي

Discharge against medical advice (DAMA) is a major problem in healthcare delivery as it can complicate the health problems from which patients are suffering. The aim of this study was to understand DAMA among children in a tertiary teaching hospital in Oman and to evaluate the documentation of the events in the medical records. A retrospective survey of the medical records of patients discharged against medical advice over a two-year interval was performed (2004-2006). Of the 11,802 admissions, there were 38 cases of DAMA, giving a prevalence rate of 0.32%. In 39.5% of the cases, the discharge happened within 24 hours of hospital admission. The majority of the cases were infants (n = 24; 63.25%). The diagnosis at discharge in some cases included life-threatening conditions. However, in 57.9% of the cases, the reasons for DAMA were neither reported nor documented in the patients' medical records. Although the results of this study yielded a low prevalence rate compared to the rates reported in other studies, the occurrence of DAMA for children in a tertiary hospital is a distressing phenomenon. It was evident that the documentation of the DAMA process was poor. More studies should be conducted to understand the details of the problem. Policies should be established and implemented in order to attempt to reduce DAMA among child patients and to protect them from the consequences of such discharges.

Epidemiology of chemotherapy-induced neutropenia at a tertiary university hospital in Oman

Little is known about the incidence and burden of chemotherapy-induced neutropenia (CIN) in Oman or the Arabian Gulf. To determine the epidemiology of CIN at Sultan Qaboos University Hospital in Oman. A retrospective observational study of all eligible CIN episodes in adult (>18 years) patients with solid tumors and hematological malignancies at Sultan Qaboos University Hospital (SQUH) from January to December 2010. Analyses were performed using univariate statistics. A total of 1,357 episodes in 159 patients with a mean age of 50 ± 15 years (19-91) were evaluated. Fifty-four percent (n = 86) of the patients were female. A total of 46 % (73/159) of the patients developed CIN accounting for 15 % (210/1,357) of all episodes. Twelve percent (25/210) of these CIN episodes were associated with fever in 26 % (19/73) patients. There was significant association between CIN and chemotherapy regimen (P < 0.001), younger age (P < 0.001), low hemoglobin (Hb) levels (P < 0.001) and advanced cancer stage (P = 0.006). This study suggests a high incidence of CIN in SQUH patients which resulted in chemotherapy delays, longer hospital stays, and inpatient mortality. CIN was significantly correlated with chemotherapy regimen, younger age, low Hb levels and cancer stage.