Ranibizumab for idiopathic epiretinal membranes: A retrospective case series

AbstractPurposeTo study the effect of intravitreal ranibizumab on idiopathic epiretinal membranes (ERMs).MethodsA retrospective cohort study on a consecutive series of ranibizumab intravitreal injections for epiretinal membranes was performed. Four cases were identified by reviewing a claims database linked to electronic medical records. All patients received a total of three 0.05mg/0.05ml ranibizumab intravitreal injections at a monthly interval. The primary outcome measure was the final best-corrected visual acuity (BCVA) at the end of the injection series, and the final central macular thickness (CMT).ResultsAll four patients completed 3months follow-up after the last ranibizumab injection. The mean baseline CMT was 509microns (SD=111). A trend was noticed for reduction in CMT (Δ=41microns) P=0.08. Three patients improved by one line in their BCVA. The remaining patient maintained the same BCVA. No complications were noted.ConclusionIn this study, intravitreal injection of ranibizumab marginally reduced retinal thickness in four patients with minimal improvement in visual acuity. No safety concerns were noticed. Further basic science and clinical studies may be warranted to assess the role of vascular endothelial growth factor and the effect of ranibizumab on idiopathic epiretinal membranes

Multivariate discrete distributions via sums and shares

In this article, we develop a sum and share decomposition to model multivariate discrete distributions, and more specifically multivariate count data that can be divided into a number of distinct categories. From a Poisson mixture model for the sum and a multinomial mixture model for the shares, a rich ensemble of properties, examples and relationships arises. As a main example, a seemingly new multivariate model involving a negative binomial sum and Polya shares is considered, previously seen only in the bivariate case, for which we present two contrasting applications. For other choices of the distribution of the sum, natural but novel discrete multivariate Liouville distributions emerge; an important special case of these is that of Schur constant distributions. Analogies and interactions with related continuous distributions are to the fore throughout

Virtual Handover of Patients in the Pediatric Intensive Care Unit During the Covid-19 Crisis

Objective: A key measure to mitigate coronavirus disease 2019 (COVID-19) has been social distancing. Incorporating video-conferencing applications in the patient handover process between healthcare workers can enhance social distancing while maintaining handover elements. This study describes pediatric intensive care unit (PICU) physicians' experience using an online video-conferencing application for handover during the COVID-19 pandemic. Design: Qualitative content analysis. Setting: PICU at a university hospital in Riyadh, Saudi Arabia. Subjects: PICU Physicians. Interventions: Due to the pandemic, the hospital's PICU used Zoom® as a remote conferencing application instead of a face-to-face handover. Following institutional review board approval, data were collected over two weeks (1 Jul 2020 to 14 Jul 2020). Measurements: An online survey was conducted using open-ended questions to capture demographic data and the perceived efficacy of remote handovers. Thematic framework analysis process included open coding, creating categories, and abstraction. Main Results: All 37 PICU physicians who participated in the handover completed the survey. The participants comprised six attendings, nine specialists, and 22 residents. While 20 (54.1%) physicians reported attending 1-5 Zoom handovers by the time of the study, some (n. 6, 16.2%) had more than ten virtual handovers. They had variable previous teleconferencing experiences. Most physicians (78.4%) were comfortable conducting a remote handover. Most found that Situation-Background-Assessment-Recommendation handover elements were properly achieved through this remote handover process. The perceived advantages of online handover included fewer interruptions, time efficiency, and facilitation of social distancing. The perceived disadvantages were the paucity of nonverbal communication and teaching during virtual meetings. Conclusion: Video-conferencing applications for online handovers could supplement traditional face-to-face intensive care unit patient handover during outbreaks of infectious diseases. The use of video streaming and more emphasis on teaching should be encouraged to optimize the users' experience

A New Family of Extended Lindley Models: Properties, Estimation and Applications

There are many proposed life models in the literature, based on Lindley distribution. In this paper, a unified approach is used to derive a general form for these life models. The present generalization greatly simplifies the derivation of new life distributions and significantly increases the number of lifetime models available for testing and fitting life data sets for biological, engineering, and other fields of life. Several distributions based on the disparity of the underlying weights of Lindley are shown to be special cases of these forms. Some basic statistical properties and reliability functions are derived for the general forms. In addition, comparisons among various forms are investigated. Moreover, the power distribution of this generalization has also been considered. Maximum likelihood estimator for complete and right-censored data has been discussed and in simulation studies, the efficiency and behavior of it have been investigated. Finally, the proposed models have been fit to some data sets

Experiences of International Medical Graduates Caring for Type 2 Diabetes Patients in Saudi Arabia: Perspectives of Physicians and Patients

Background Around 80% of the physicians working in Saudi Arabia providing primary health care are international medical graduates from other countries. They may not share their patients’ cultural background or language, yet are expected to deal with local patients with chronic health conditions, such as type 2 diabetes mellitus, who need culturally sensitive lifestyle advice. Study aim To explore and understand challenges and facilitators to effective communication between international medical graduates and patients with type 2 diabetes mellitus and how this may influence care provision in Saudi Arabia. Methods Data were collected in three phases: i) A focus group discussion with 6 international medical graduates from one hospital and 13 semi-structured interviews with international medical graduates from the hospital as well as 8 primary health care centres. ii) Semi-structured interviews with 16 Saudi patients with type 2 diabetes mellitus and iii) follow-up interviews with 5 international medical graduates. Data were analyzed with the aid of NVivo using thematic analysis. Findings Most of the international medical graduate participants reported that dealing with local patients was challenging because patients did not trust them for culturally-related reasons. Prejudice among local patients towards international medical graduates was identified, and this contributed to patients not acknowledging international medical graduates’ ability to provide culturally sensitive advice. Furthermore, some international medical graduates had a stereotypical view of local patients, which had led to an inflexible approach when advising patients. Both groups of participants identified contrasting expectations regarding relationship-building style. Participants also identified self-adopted strategies to overcome communication barriers and suggested new ones. Conclusion Findings suggest that efforts need to be targeted towards changing patient attitudes, as well as addressing the training needs of international medical graduates, in order to enhance the effectiveness of diabetes management and improve overall the delivery of health care in Saudi Arabia

Title New better than renewal-used classes of life distributions

The concept of stochastic dominance in economics is used to compare the conditional life distribution of a used device that has lived until time t greater than or equal to 0 and its life distributions at time t = 0. This comparison gives two classes of life distributions namely, the NBRU class of life distribution and its dual. Relations of these classes to existing criteria of aging and some of their closure properties under reliability operations are studied. The preservation of these aging properties for the survival probability under the homogeneous shock model process are investigated

Higher Education in Saudi Arabia: Conclusions

For more than a decade, the Saudi government has enacted a series of major policy and funding initiatives designed to position its universities - individually and collectively - on the world academic stage. Many opportunities have been grasped, and just as many barriers have been encountered. Much still needs to be done. In this final chapter, the editors identify five overriding issues that emerged from an holistic analysis they undertook of the information, findings, trends and recommendations provided in the previous 16 chapters: the tension between academic vision and cultural norms; the lack of an appropriate governance model for Saudi universities; developing and sustaining international credibility; maximising opportunities and achievements for women in higher education; and the tension between traditional Saudi approaches to teaching, learning and student assessment and the needs of a global knowledge economy. The chapter concludes by arguing the case for two key priorities capable of leveraging significant and sustainable improvement in the Saudi higher education system in its quest for 'world-class' standards