Hospital In United Arab Emirates Research Articles

Improving patient waiting time: A quality initiative at a pharmacy of a public hospital in United Arab Emirates

ABSTRACT High patient waiting times may lead to poor patient satisfaction. This quality improvement project aimed to improve waiting time in polyclinic pharmacy at a public hospital in United Arab Emirates so as to ameliorate patient experience and satisfaction with pharmacy services. A multidisciplinary team evaluated the problem and proposed optimizing the use of hospital information system Cerner® (Malaffi) through electronic prescription (ERX) monitor in retail medication manager module for pharmacy. The project involved sending the prescription electronically to the pharmacy immediately after it was generated in physician’s clinic so that the pharmacy team starts working on it even before the patient reached at the counter for collection. The intervention resulted in reduction of waiting time from 21.5 to 4 min as per Qlik View Customer Satisfaction tool results. The patient satisfaction survey suggested that 82% of patients were either extremely satisfied or satisfied with the reduced waiting time.

Criticality-based reliability-centered maintenance for healthcare

PurposeMedical technologies and assets are one of the main drivers of increasing healthcare cost. The rising number and complexity of medical equipment have forced hospitals to set up and regulate medical equipment management programs to ensure critical devices are safe and reliable. The purpose of this paper is to gain insights into maintenance management-related activities for medical equipment. The paper proposes applying a tailored reliability-centered maintenance (RCM) approach for maintenance activities selection for medical equipment. Such approach will support assets management teams in enhancing operation, decrease risk and cost, and ultimately improve health of patients served by these equipment.Design/methodology/approachThe traditional RCM approach will be used with a focus on criticality reduction. By criticality, the authors refer to the severity of failures and occurrence. The proposed method relies on the use of reliability growth analysis for opportunity identification followed by a thorough failure mode and effect analysis to investigate major failure modes and propose ways to reduce criticality. The effectiveness of the proposed method will be demonstrated using a case of one of the leading obstetric and gynecological hospitals in United Arab Emirates and in the Gulf Cooperation Council region.FindingsThe case examines the relationship between the current practice of planned preventive maintenance and the failure rates of the equipment during its life span. Although a rigorous preventive maintenance program is implemented in the hospital under study, some critical equipment show an increasing failure rates. The analysis highlights the inability of traditional time-driven preventive maintenance alone in preventing failures. Thus, a systematic RCM approach focused on criticality is more beneficial and more time and cost effective than traditional time-driven preventive maintenance practices.Practical implicationsThe study highlights the need for utilizing RCM approach with criticality as the most important prioritization criterion in healthcare. A proper RCM implementation will decrease criticality and minimize the risk of failure, accidents and possible loss of life. In addition to that, it will increase the availability of equipment, and reduce cost and time.Originality/valueThis paper proposes a maintenance methodology that can help healthcare management to improve availability and decrease the risk of critical medical equipment failures. Current practices in healthcare facilities have difficulty identifying the optimal maintenance strategy. Literature focused on medical maintenance approach selection is rather limited, and this paper will help in this discussion. In addition to that, the Association for the Advancement of Medical Instrumentation supports the initiative of adopting RCM on a large scale in healthcare. Therefore, this paper address the gap in the literature for medical equipment maintenance and the work is in line with the recommendation of leading healthcare association. The paper also presents statistical review of the total number of received maintenance work orders during one full year in the hospital under study. The analysis supports the need for more research to examine current practice and propose more effective maintenance approaches.

Sustainable organizational performance

Purpose The purpose of this paper is to identify factors affecting sustainable organizational performance, to build a framework for the United Arab Emirates (UAE) public health-care sector to facilitate sustainable organizational performance and to prioritize the factors for sustainable organizational performance. Design/method/approach The method used in this research is the quantitative method called the analytical hierarchal process (AHP) to help the decision makers in the public health-care sector to prioritize the factors that are affecting sustainable organizational performance. The method will also help to deal with the complexity of the sustainable organizational performance issue by interviewing nine experts in the field. Findings The findings of this research showed 21 sub-factors for sustainable organizational performance in the public health-care sector in UAE. It emphasizes that patient safety and quality of care are the most important factors for sustainable organizational performance. Research limitations/implications This study can be repeated by targeting other private hospitals in UAE. The novelty of this research means that it is the first study done in sustainable organizational performance in the health-care sector in UAE. Practical implications Health-care management can benefit from this research in many ways: Medical errors have a high impact on the hospital’s reputation and these determine the customer demand. Thus, the hospital’s management should give more attention to minimize the medical errors in order to have a sustainable organizational performance. This can be accomplished through clear protocols and procedures that may affect patients’ lives, the hospital’s reputation and organizational performance. Nevertheless, the policymakers should focus on society engagement; focus on social sustainability should be an integral part of their operational and business strategy. According to Abu Dhabi Health Authority (HAAD), the UAE has a highest rate of chronic diseases, such as diabetes, obesity and cardiovascular disease. Cardiovascular disease itself accounted for 36.7% of all 2013 deaths. The health-care sector should focus more on educating the community by conducting workshops, seminars and awareness campaigns across the UAE. In addition, decision makers in the health-care sector should spend more on continued improvement by focusing on lean activities that focus on waste minimization and linking the service quality to the hospital outcomes and patient satisfaction. The fourth highest overall priority weight for both transformational leadership and for the waiting time sub-criteria should also be considered by top management to focus more on hiring, retaining, and developing their transformational leaders, and to keep an eye on the waiting time and improving customer service. This will result in the sustainable organizational performance. Interestingly, all of the HR processes showed the lowest overall weights at 1%, which is a bit strange. HR should play more of a role in sustainable organizational performance, equal to the other sub-factors. Originality/value Originality of this research stems from a reliable and valid framework that can be subsequently used for measuring the organizational performance of health care organizations.

Clinical profiles and precipitating factors for diabetic ketoacidosis at a tertiary center in Dubai, United Arab Emirates

Objectives: Our aim was to assess the clinical profiles and determine the precipitating factors for diabetic ketoacidosis (DKA) in adult patients admitted to a tertiary care center in United Arab Emirates (UAE). Materials and Methods: We conducted a retrospective analysis of all patients admitted with DKA at a tertiary care hospital in UAE during June 2014–December 2017. Variables recorded included gender, type of diabetes, and HbA1c on presentation and identified precipitating factors. Results: Data from a total of 255 patients with DKA were analyzed. One hundred and fifty-seven of these patients had type 1 diabetes (61.6%) whereas 69 patients were diagnosed with type 2 diabetes mellitus (T2DM) (27.1%), and 22 patients could not be classified as type 1 or type 2. A small number of patients (2.7%) were found to have secondary diabetes as their DKA was precipitated by acute pancreatitis. Around 12% of cases occurred in the setting of newly diagnosed diabetes. The most common precipitating factor for DKA was noncompliance to treatment (31.4%), followed by infections (22.7%). Pancreatitis was another important precipitating factor which accounted for 6.3% of the cases. Conclusions: DKA is not limited to patients with T1DM, and there seems to be a steady increase in its occurrence in patients with T2DM. Noncompliance to therapy is a major precipitating factor which needs to be addressed by offering better education programs to prevent hospitalization of these cases.

Use of Phosphate Binders in End-Stage Renal Disease: An Experience From a Secondary Care Hospital in United Arab Emirates.

ABSTRACTObjective:Hyperphosphatemia in end-stage renal disease (ESRD) is associated with many serious patient-level consequences including cardiovascular events and mortality. The purpose of this study was to investigate the use of phosphate binders in ESRD patients on maintenance hemodialysis.Materials and Methods:The study was a prospective observational cohort study including adult ESRD patients undergoing hemodialysis at a secondary hospital in United Arab Emirates. Patient characteristics were compared as per type of phosphate binder used. Bivariate and multivariate multinomial logistic regression analyses were carried out to determine variables that were independently associated with use of different phosphate binders.Results:Phosphate binders used at our study site were sevelamer, calcium carbonate, and a combination of sevelamer and calcium carbonate. Bivariate multinomial logistic regression analysis revealed that serum phosphorous (odds ratio [OR]: 0.14, 95% confidence interval [CI]: 0.04–1.09, P = 0.047; OR: 0.10, 95% CI: 0.03–0.89, P = 0.042), calcium (OR: 0.11, 95% CI: 0.02–0.86, P = 0.041; OR: 0.22, 95% CI: 0.01–0.96, P = 0.012), and calcium–phosphorous product (OR: 0.20, 95% CI: 0.06–0.64, P = 0.008; OR: 0.16, 95% CI: 0.05–0.54, P = 0.003) levels were significantly lower in patients on sevelamer per se as well as in patients on combination therapy, respectively when compared to calcium carbonate per se. Multivariate multinomial logistic regression analysis revealed that in sevelamer and combination groups, cardiovascular diseases (OR: 0.12, 95% CI: 0.02–0.65, P = 0.022; OR: 0.10, 95% CI: 0.01–0.88, P = 0.038) were significantly lesser compared to calcium carbonate group after being adjusted for other variables in the model.Conclusion:We observed that hyperphosphatemia and related events in our study population were better controlled by sevelamer per se and combination therapy than calcium carbonate per se. Further large scale, multicenter studies are required to confirm and establish these findings.

HYPERPHOSPHATEMIA IN END STAGE RENAL DISEASE: PREVALENCE AND PATIENTS CHARACTERISTICS OF MULTIETHNIC POPULATION OF UNITED ARAB EMIRATES

Objective: Hyperphosphatemia is significantly associated with increased mortality among end stage renal disease (ESRD) patients on hemodialysis. There is paucity of data on hyperphosphatemia in ESRD patients of the multiethnic population of United Arab Emirates (UAE). The study aimed to investigate the prevalence and characteristics of hyperphosphatemia in ESRD patients of the multiethnic population of UAE undergoing maintenance hemodialysis.Methods: Adults ESRD patients undergoing maintenance hemodialysis for more than six months at the study site were included. Demographic, clinical and biological data of the patients were collected. Patient characteristics were compared as per the serum phosphate level, between patients with or without hyperphosphatemia. Univariate and multivariate logistic regression analyses were carried out to identify the predictors of hyperphosphatemia.Results: Hyperphosphatemia was present in 73.8% of the study population, while 31.3% presented with high calcium-phosphate product. Univariate logistic analysis revealed that hyperphosphatemia was inversely correlated with age, hemoglobin, serum calcium, and hypertensive nephropathy as cause of renal disease, and positively correlated with female gender, expatriate status, body mass index (BMI), higher number of comorbidities, calcium-phosphate product and parathyroid hormone (PTH). Multivariate logistic regression model revealed that only age, BMI, hemoglobin and PTH independently correlated with hyperphosphatemia.Conclusion: We report a high prevalence of hyperphosphatemia in multiethnic study population undergoing maintenance hemodialysis at a secondary care hospital in UAE. In this study population, only age, BMI, hemoglobin and PTH were identified as independent predictors of hyperphosphatemia.

Invasive Candida Infections (ICI) in Pediatric Population of a Tertiary Care Hospital in United Arab Emirates (UAE): Management and Time to Negative Culture

Background: Invasive candida infection is a growing problem in critically ill patients. Candida species are the most common agent responsible for invasive fungal infections in children. Timely diagnosis and proper selection of antifungal therapy are of paramount importance for a favorable outcome. The increasing rate of non-albiacans candida is becoming a real challenge when choosing an empirical antifungal therapy since a large percentage of them are resistant to azoles. This study aims at identifying the most commonly used antifungal agents in our institute and their success measured by the time needed to reach a negative culture (TNC) in cases of candidemia and candiduriaMethods:We performed a retrospective cohort study of all children (15 years and younger) with invasive candida infection, admitted to Tawam Hospital from 2008 to 2015.Results: Fluconazole seems to be the most common choice of our pediatricians in treating urine ICI (65%)while Amphotericin B Lipid complex is the most common choice in treating blood ICI(56%). Amphoteric B Lipid Complex was associated with the shortest TNC both in treating urine ICI (3 days) and blood ICI (4.4 days0Conclusions: Unfortunately, there aren’t many prospective studies in the literature comparing the efficacy of the major antifungal agents in treating pediatrics ICI. Therefore, we hope that this study, despite being retrospective, will shed some light on the utilization of Amphotericin B Lipid Complex in treating pediatrics ICI.

Telemedicine for diabetic retinopathy screening using an ultra-widefield fundus camera

ObjectiveTelemedicine reporting of diabetic retinopathy (DR) screening using ultra-widefield (UWF) fundus camera.Materials and methodsCross-sectional study of diabetic patients who visited the endocrinology department of a private multi-specialty hospital in United Arab Emirates between April 2015 and January 2017 who underwent UWF fundus imaging. Fundus pictures are then accessed at the Retina Clinic in the Department of Ophthalmology. Primary outcome measure was incidence of any form of DR detected. The secondary outcome measure was failure to take good image and inability to grade.ResultsA total of 1,024 diabetic individuals were screened for DR from April 2015 to January 2017 in the department of Endocrinology. Rate of DR was 9.27%; 165 eyes of 95 individuals were diagnosed to have some form of DR. Mild non-proliferative DR (NPDR) was seen in 114 of 165 eyes (69.09%), moderate NPDR in 32 eyes (19.39%), severe NPDR in six eyes (3.64%), and proliferative DR (PDR) in 13 eyes (7.88%). The secondary outcome measure of poor image acquisition was seen in one individual who had an image acquired in one eye that could not be graded due to bad picture quality.ConclusionsThe present study has shown the effectiveness of DR screening using UWF fundus camera. It has shown the effectiveness of trained nursing personnel taking fundus images. This model can be replicated in any private multi-specialty hospital and reduce the burden of DR screening in the retina clinic and enhance early detection of treatable DR.

Knowledge, attitude and practices associated with diagnosis and management of Skin and Soft Tissue Infections (SSTIs) among Pediatric Residents and Physicians in a Tertiary Hospital in United Arab Emirates (UAE)

Knowledge, attitude and practices associated with diagnosis and management of Skin and Soft Tissue Infections (SSTIs) among Pediatric Residents and Physicians in a Tertiary Hospital in United Arab Emirates (UAE)

Drug utilization review of cephalosporins in a secondary care hospital in United Arab Emirates.

Background Cephalosporins are one of the most commonly used antibiotics in United Arab Emirates (UAE). Few studies have been carried out to evaluate the antibiotic utilization pattern in UAE in spite of the obvious increase in cephalosporins resistance during the past decade. Objective To assess the prescriptions pattern of cephalosporins among physicians at a secondary care hospital in Ras Al Khaimah, UAE. Method This observational prospective study was carried out during October 2013 to April 2014. The data of in patients were documented in the predesigned patient profile form and was analyzed for patient's, drug's and drug's therapy related parameters. Results The 3rd generation cephalosporins constituted 83.6% of the prescriptions, with ceftriaxone being the most commonly used one (81.1%). They were mainly prescribed for the treatment of the lower respiratory tract infections (60.2%). Seven (3.5%) different ADRs linked to cephalosporin use were observed ranging from oral thrush to clostridium difficile infection. A total of 1039 antimicrobial and nonantimicrobial medications were prescribed concomitantly with cephalosporins. Conclusion The 3rd generation cephalosporins were commonly prescribed by parenteral route. Thus, there is a strong need for rationalizing their use to preserve their efficacy and prevent the development of resistance in the region.

The Role of Applying Total Quality Management in Improving Incentives: A Comparative Study between Jordanian and United Arab Emirate Hospitals

<p>This study aims to identify the reality of a Total Quality Management (TQM) system and the level of its application on a sample of hospitals in Jordan and United Arab Emirates (UAE), together with determining the differences between both the Jordanian hospitals and UAE hospitals in their application of TQM. It also aims to identify the monetary and non-monetary incentives in hospitals, and to study the role of each dimension of various TQM dimensions on monetary and non-monetary incentives. A total of 160 questionnaires were distributed in six hospitals that were selected using a convenient sampling method. A total of 129 questionnaires were received, 74 of them were from Jordanian hospitals and 55 questionnaires were from UAEs hospitals. The participants were doctors, nurses, technicians, and administrators of six hospitals in Jordan and the UAE. An independent samples T-test and multiple regression analysis was used to test the hypotheses. The results showed that the application of TQM in both Jordanian and UAE hospitals was good, of a high level, and with a relative advantage for UAE hospitals. The results also showed that the incentives in Jordanian hospitals were generally better than those of the UAE hospitals, particularly in terms of the monetary incentives, while non-monetary incentives were the advantage for UAE hospitals. Moreover, it was found that only one dimension of the TQM dimensions, the participation of employees, had a significant effect on the monetary and non-monetary incentives in each of the Jordanian and the UAE hospitals (P value ≤ 0.05). While the rest of the dimensions of TQM (focus on the customer, continuous improvement, top management commitment, and teamwork) had no significant effect on both monetary and non-monetary incentives in both the Jordanian and the UAE hospitals.</p>

Measuring the Effect of Size on Technical Efficiency of the United Arab Emirates Hospitals

<p><strong>OBJECTIVE:</strong> The main purpose of this study is to estimate the technical efficiency of the United Arab Emirates (UAE) hospitals and examine the effect of hospital size on estimated technical efficiency scores.</p><p><strong>METHODS: </strong>Using 2012 data from Ministry of Health, Dubai Health Authority, and Health Authority in Abu Dhabi,<strong> </strong>we employed a nonparametric method, data envelopment analysis (DEA), to estimate the technical efficiency of 96 private and governmental hospitals in the UAE. Efficiency scores are calculated using both Banker, Charnes, and Cooper (BCC) and Charnes, Cooper, and Rhodes (CCR) models. </p><p><strong>RESULTS: </strong>The average technical efficiency of the UAE hospitals is estimated at 59% based on the BBC model and at 48% based on the CCR model. The optimal size of a hospital in the UAE is between 100 to 300 beds. We also found evidence of economies of scope between the provision of outpatient and inpatient care in the UAE hospitals.</p><p><strong>CONCLUSION: </strong>Our findings indicate that only one third of the UAE hospitals are technically efficient. There is evidence to suggest that there are considerable efficiency gains yet to be made by many UAE hospitals. Additional empirical research is needed to inform future health policies aimed at improving both the technical and allocative efficiency of hospital services in the UAE. </p>

Comparison of Incidences, Hospital Stay and Precipitating Factors of Diabetic Ketoacidosis in Ramadan and the Following Month in Three Major Hospitals in United Arab Emirates. A Prospective Observational Study

1.7 billion Muslims worldwide obey religious commands of fasting for a month. This may increase morbidity in people with diabetes. Objective: Comparing the rate and duration of admissions with diabetic ketoacidosis and the leading precipitating factors during Ramadan and in the following month (Shawal) were our primary and secondary endpoints, respectively. Design and methods: This was a prospective study that included all Muslims who were admitted with DKA to three major hospitals in United Arab Emirates during Ramadan and Shawal. Demographics, clinical, and laboratory indices were collected and analyzed to assess primary and secondary end points. Results: 48 patients were admitted during the study duration, 20 were admitted during Ramadan and 28 in Shawal. All those admitted during Ramadan were people with type1 diabetes while 4 of those admitted during Shawal were people with type 2 diabetes. 75% of those admitted during Ramadan did not receive structured education program on diabetes management in Ramadan. Urinary tract infections represented the commonest cause for admission in both months. Hospital stay was longer during Ramadan compared to Shawal (p=0.04). The average HbA1c was lower in Ramadan group; moreover, frequency of DKA admissions in 6 months period before Ramadan was higher in Ramadan group (P= 0.05). Conclusion: Our study showed lower rate of DKA admissions, but longer hospital stay during Ramadan compared to the following month. The average HbA1c was lower in patients admitted during Ramadan; moreover, frequency of DKA admissions in 6 months period before Ramadan was higher in Ramadan group (P=0.05).

Improving the performance of reflex Human Papilloma Virus (HPV) testing in triaging women with atypical squamous cells of undetermined significance (ASCUS): A restrospective study in a tertiary hospital in United Arab Emirates (UAE)

IntroductionCervical cancer is the second commonest cancer in women worldwide. Infection with oncogenic types of human Papillomavirus (HPV) is the most important risk factor for developing cervical cancer. Reflex High risk HPV (HR-HPV) testing is of significant value in the assessment of Papanicolaou (Pap) smear results where ASCUS are identified. ObjectiveTo improve the performance of reflex HR-HPV testing in triage of ASCUS and analyze the factors impacting it. MethodologyIn this study, we generated a database of 9641 women who had cervical smears collected during the study period from the cytopathology record in a large tertiary hospital in UAE. These included 297 smears with ASCUS diagnosis. All cases were retrospectively followed up with a mean duration of 2.44 years. We analyzed data according to the outcome based on several follow-up Pap smear analysis as the reference assessment. ResultsWe detected HR-HPV infection in 17.9% of cases. 9.1% <25, 28.8% 25–34 and 62.1% ≥35 years old. HR-HPV prevalence was higher among premenopausal women (20.7%) compared to postmenopausal women (9.5%) (P-value=0.044). The rate of progression to high grade lesions was also higher (28.7%) in the premenopausal group compared to (12.8%) in the postmenopausal group. Reflex HPV testing had an overall sensitivity of 41.1%, specificity of 88.2%, positive predictive value (PPV) of 62.1%, and negative predictive value (NPV) of 75.9% in detection of cervical lesions. These figures were higher on combining premenopausal status and complaint of abnormal bleeding or discharge/itching (66.7%, 93.3%, 66.8% and 93.3% respectively). ConclusionsThe sensitivity, specificity and NPV of reflex HPV testing in the triage of ASCUS cases can be more accurate in premenopausal women upon adding age group and presenting complaint as a triage item. This improves the performance of reflex HPV testing and the subsequent selection of high risk patients for colposcopy.

Frontier efficiency of hospitals in United Arab Emirates: An application of data envelopment analysis

Background: Over the past four decades the United Arab Emirates (UAE) has undertaken a series of initiatives to improve the efficiency of hospitals. This study aims to examine the efficiency of private and public hospitals in the UAE. A clearer understanding of the technical efficiency of private and public hospitals will be important in shaping future policy reforms as well as assisting private investors that play an important role in the provision of healthcare within the UAE.Methods: This study employs the Data Envelopment Analysis (DEA) technique to measure the efficiency of both private and public hospitals in the UAE. Efficiency scores are calculated using both Banker, Charnes, and Cooper (BCC) and Charnes, Cooper, and Rhodes (CCR) models. The inputs into the models are number of beds, numbers of doctors, dentists, nurses, pharmacists and allied health staff, and administrative staff, while the outputs are the number of treated inpatients, outpatients, and average length of stay.Results: We find that public hospitals represent about a third of the total number of facilities but treat about 60% of the total number of patients. On the positive side we find that a third of the hospitals in the UAE to be efficient. On the other extreme we find that half the hospitals are less than half as efficient as the top hospital. The average technical efficiency of 96 hospitals is 59% using BCC model and 48% using CCR model. The results show no difference in the average efficiency scores between public and private hospitals, nor between foreign and domestically managed hospitals. We find that there is an almost equal probability to be an efficient or inefficient hospital in any of the emirates.Conclusions: The study contributes to the existing body of literature by establishing baseline technical efficiency scores that could be used in monitoring the efficiency effects of future policy changes. About 41% to 52% of the production factors are wasted during the service delivery process in the hospitals. Using the existing amount of resources, the amount of delivered outputs can be doubled, which can significantly impact patient outcomes. This leads us to believe that the ownership itself and foreign management is not sufficient to bring about improvements in efficiency. Interventions to improve the quality of management in hospitals could help to improve efficiency. National and international benchmarking of hospital performance help to provide more insights on sources of hospital inefficiency.

Abstract 162: Treatment Patterns and Health Resource Utilization among Patients with Atrial Fibrillation in United Arab Emirates and Saudi Arabia

Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and accounts for one-third of hospitalizations for cardiac disturbances. The majority of data on management of AF patients are from western countries, with limited information available from the Middle East region. The objective of this study was to characterize treatment patterns and health resource utilization among AF patients in the Kingdom of Saudi Arabia (KSA) and United Arab Emirates (UAE). METHODS: A retrospective chart review was undertaken at three hospitals in UAE and three in KSA, to identify AF patients diagnosed between January 2005 and June 2010. Patient charts were sampled consecutively backwards by diagnosis date, from June 2010 until the target sample was reached. AF was identified based on ICD-9 code (427.31), from a sample of patients defined by any history of anticoagulant use. Data on demographic and disease-related characteristics, treatment patterns, health resource utilization, and international normalized ratio (INR) control were abstracted from diagnosis until June 2012. AF was categorized as chronic (persistent, long-standing or permanent) or paroxysmal. RESULTS: Among eligible AF patients (UAE, n=157, KSA, n=152), the mean age at diagnosis was 69 years in UAE and 66 years in KSA. Male patients comprised 52.9% of the UAE sample and 48.7% of the KSA sample. The majority were diagnosed with chronic AF (80.9% in UAE, 63.7% in KSA) and had a CHADS 2 score ≥2 at diagnosis (77.1% in UAE, 71.1% in KSA). Treatments prescribed to AF patients differed between countries: warfarin monotherapy was widely used in UAE (59.9%); while a variety of warfarin- and aspirin-based combination therapies were used in KSA, with no single dominant regimen. Warfarin + bisoprolol (12.5%) and aspirin + bisoprolol (10.5%) combination therapies were the most common regimens in KSA. Patterns of health care utilization also varied. In KSA, 29.6% of patients were hospitalized, and 30.9% visited the emergency room, compared to 8.9% and 11.5%, respectively, in UAE. Outpatient visits were more frequent in UAE, with a mean of 1.0 visits per patient per year, compared to 0.3 visits per patient per year in KSA. In both regions, the most common clinical outcome was ischemic/unspecified stroke, with an incidence of 7.0% in UAE and 5.3% in KSA. CONCLUSIONS: Patients with AF in UAE and KSA were relatively young compared to age distributions reported in other regions. Treatments and health resources used by AF patients varied between KSA and UAE. Warfarin monotherapy was widely used in UAE, while a variety of monotherapy and combination therapy regimens were used in KSA. Health care resource utilization was high in this population, particularly hospitalization rates in KSA. While some differences may result from differences in patient and disease characteristics, they likely also reflect variation in management strategies across the regions.

Predictors of success of medical management of ectopic pregnancy in a tertiary care hospital in United arab emirates.

Ectopic pregnancy is the most common cause of pregnancy related deaths in the first trimester of pregnancy. Advances in laboratory and imaging technologies in last few decades allow an early diagnosis of ectopic pregnancy, many times even before the patient develops any symptoms. Consequently in many such patients surgery is not always necessary. Expectant and medical management are feasible options in properly selected cases. In the present study, efficacy of medical management of selected cases of ectopic pregnancy with injection methotrexate and the factors influencing the success of medical management were evaluated. Retrospective study involving 40 women with ectopic pregnancy who met inclusion criteria and were managed medically with Methotrexate (MTX) in a tertiary hospital in United Arab Emirates (UAE). Various factors which could possibly influence the success of medical management were evaluated. ROC analyses for day 1(pretreatment) Beta HCG levels revealed that the optimum cut off for Beta HCG level of 6000 mIU/ml on day 1 can be considered a good predictor of success of medical management with MTX. Falling serum Beta HCG between day 1-4 very well predicted success of MTX therapy (irrespective of number of doses of MTX) with a positive predictive value (PPV) of 100% and negative predictive value (NPV) of 31.25%. Similarly adnexal mass size ≤ 3 cms and duration of amenorrhoea < 6 weeks were found to be good predictors of success of medical management (PPV 96.66% and NPV 90% for both factors).In the present study, irrespective of number of doses received, medical management with MTX was successful in 75% cases (30 out of 40). RESULTS of this study indicate that pretreatment Beta HCG level of < 6000 mIU/ml, adnexal mass size < 3 cms, amenorrhoea < 6 weeks and absence of free fluid in the pelvis are predictors of a successful treatment with MTX. In properly selected cases medical management of ectopic pregnancy with MTX is highly effective and can be considered a forward step taken towards conservation of fallopian tubes especially in countries like UAE where there is inclination towards large family size based on religious and cultural background.

Evaluation of risk factors for ectopic pregnancy among women attending a tertiary care hospital in United Arab Emirates: A case control study

<p style="margin-bottom: 0in;"><span style="color: #000000;"><span style="font-family: Helvetica-Narrow-BoldOblique,sans-serif;"><span style="font-size: x-small;"><span style="color: #231f20;"><span style="font-size: x-small;"><em><strong>Objective: </strong></em></span></span><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow,sans-serif;"><span style="font-size: x-small;">To evaluate and analyze potential risk factors for ectopic pregnancy in a tertiary care Hospital in United Arab Emirates (UAE).</span></span></span></span></span></span> <p style="margin-bottom: 0in;"><span style="color: #000000;"><span style="font-family: Helvetica-Narrow-BoldOblique,sans-serif;"><span style="font-size: x-small;"><span style="color: #231f20;"><span style="font-size: x-small;"><em><strong>Methods: </strong></em></span></span><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow,sans-serif;"><span style="font-size: x-small;">A case control study was conducted in Mafraq Hospital from August 2008 to December 2011. The study subjects included 108 women diagnosed with ectopic pregnancy (cases group) and 216 women who delivered in the study hospital during the same time period (control group).</span></span></span></span></span></span> <p style="margin-bottom: 0in;"><span style="color: #000000;"><span style="font-family: Helvetica-Narrow-BoldOblique,sans-serif;"><span style="font-size: x-small;"><span style="color: #231f20;"><span style="font-size: x-small;"><em><strong>Results: </strong></em></span></span><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow,sans-serif;"><span style="font-size: x-small;">In our study population the risk of ectopic pregnancy was found 8 fold more in women who had past history of pelvic inflammatory disease (OR 8.14, 95% CI, 1.90- 34.77, p=0.005), 6 fold more in women with infertility (OR 6.57,95% CI, 3.06-14.08, p=0.000), 3 fold more in women with previous pelvic surgery (OR 3.33, 95% CI, 1.28- 8.66, p=0.01) and 1.7 fold more in women with previous history of spontaneous miscarriages (OR 1.76, 95% CI, 1.03-3.00, p=0.03) as compared to those women who had normal delivery.</span></span></span></span></span></span> <p style="margin-bottom: 0in;"><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow,sans-serif;"><span style="font-size: x-small;">Conclusion: Results of this study supported the hypothesis that a past history of pelvic inflammatory disease, history of infertility for at least 2 years preceding the ectopic pregnancy, past history of pelvic surgery and previous spontaneous miscarriages are significant risk factors for the occurrence of ectopic pregnancy. Increased awareness and knowledge of risk factors among the women population can enable an early detection and diagnosis of ectopic pregnancy thereby leading to early intervention and conservative approach for management.</span></span></span> <p style="margin-bottom: 0in;">DOI: <a href="http://dx.doi.org/10.4038/sljog.v35i2.6168">http://dx.doi.org/10.4038/sljog.v35i2.6168</a> <p style="margin-bottom: 0in; font-weight: normal;"><span style="color: #231f20;"><span style="font-family: Helvetica-Narrow-Bold,sans-serif;"><span style="font-size: x-small;"><em>Sri Lanka Journal of Obstetrics and Gynaecology </em><span style="font-style: normal;">2013; 35: 53-57</span></span></span></span>

Drug use evaluation of dabigatran in a tertiary care hospital in United Arab Emirates

BackgroundDabigatran etexilate is an oral anticoagulant. It was added to our hospital's formulary in 2010 for the indications of thromboprophylaxis in adult patients following total hip replacement (THR) and total...

Adherence to Surgical Site Infection Guidelines in Cardiac Surgery in a Tertiary Hospital in Dubai, United Arab Emirates

Purpose: To assess the appropriateness and compliance of antibiotic prophylaxis practices in cardiac surgery in a tertiary hospital in United Arab Emirates (UAE) using three international guidelines. Methods: A retrospective study was performed by reviewing patients&#8217; files admitted for cardiac surgery between January 2008 and February 2010. The study evaluated the adherence of health care professionals to three international guidelines with regard to antibiotic prophylaxis. The guidelines were National Surgical Infection Prevention Project (NSIPP), Society of Thoracic Surgeons (STS) and American College of Cardiology/American Heart Association (ACC/AHA). Patients&#8217; records were reviewed for antibiotics used for prophylaxis, frequency of administration, timing and number of doses. Results: A total of 92 patients were included in the study. Based on the international guidelines, only 89.1 and 79.3% of the patients received the recommended pre- and post-operative antibiotics, respectively. On the other hand, 93.5% of the patients received the right antibiotic dose while the total duration of all antimicrobial agents used for prophylaxis was concordant with the guidelines (48 h) in only 67.4% of the patients.Conclusion: Adherence to international antimicrobial prophylaxis guidelines for cardiac surgery was found to be suboptimal in the study hospital in Dubai. Various interventions are needed via developing local evidence-based protocols in collaboration with surgeons, and also to strengthen regulations for ensuring adherence to these guidelines.Keywords: Antimicrobial prophylaxis, International guidelines, Cardiac surgery