Organizational Excellence and Corporate Performance Management: Strategic Performance Management Systems in Government Organizations

The use of appropriate performance management systems provides organizations with accurate and timely reports. This creates a rigid base to make strategic decisions that enhance overall performance and boost operational efficiency. The initiation of performance management systems begins with strategic planning development towards preparing the balanced scorecard and measuring performance. The paper investigated organizational excellence and corporate performance management for government organizations dealing with services and operations. The resulting work is of value to semi government or private organizations. The main research aims were to evaluate performance management in terms of alignment with the organization’s corporate strategic plan. The success factors needed to implement the performance management framework are a strategic plan, transparency and accountability. Development initiatives in government organizations to implement performance management concepts is through the development of a national charter, performance award, implementing total quality management and the balanced scorecard performance management tool. The outcome of the research recommends a mechanism for developing and implementing a strategic performance management framework through analyzing the current performance management systems of government departments in the United Arab Emirates (UAE). Moreover, a comprehensive procedure for evaluating critical success factors to build a performance management system in organizations was developed. The research has enabled the identification of a more appropriate organizational excellence systems within all government and private organizations

A Cost Analysis of Carpal Tunnel Release Surgery Performed Wide Awake versus under Sedation.

BACKGROUND: Hand surgery under local anesthesia only has been used more frequently in recent years. The purpose of this study was to compare perioperative time and cost for carpal tunnel release performed under local anesthesia ( wide-awake local anesthesia no tourniquet, or WALANT) only to carpal tunnel release performed under intravenous sedation. METHODS: A retrospective comparison of intraoperative (operating room) surgical time and postoperative (postanesthesia care unit) time for consecutive carpal tunnel release procedures performed under both intravenous sedation and wide-awake local anesthesia was undertaken. All operations were performed by the same surgeon using the same mini-open surgical technique. A cost analysis was performed by means of standardized anesthesia billing based on base units, time, and conversion rates. RESULTS: There were no significant differences between the two groups in terms of total operative time, 28 minutes in the intravenous sedation group versus 26 minutes in the wide-awake local anesthesia group. Postanesthesia care unit times were significantly longer in the intravenous sedation group (84 minutes) compared to the wide-awake local anesthesia group (7 minutes). Depending on conversion rates used, a total of $139 to$432 was saved in each case performed with wide-awake local anesthesia by not using anesthesia services. In addition, a range of $1320 to$1613 was saved for the full episode of care, including anesthesia costs, operating room time, and postanesthesia care unit time for each patient undergoing wide-awake local anesthesia carpal tunnel release. CONCLUSION: Carpal tunnel release surgery performed with the wide-awake local anesthesia technique offers significant reduction in cost for use of anesthesia and postanesthesia care unit resources

Probabilities of ICU admission and hospital discharge according to patient characteristics in the designated COVID-19 hospital of Kuwait.

BACKGROUND: Subsequent epidemic waves have already emerged in many countries and in the absence of highly effective preventive and curative options, the role of patient characteristics on the development of outcomes needs to be thoroughly examined, especially in middle-east countries where such epidemiological studies are lacking. There is a huge pressure on the hospital services and in particular, on the Intensive Care Units (ICU). Describing the need for critical care as well as the chance of being discharged from hospital according to patient characteristics, is essential for a more efficient hospital management. The objective of this study is to describe the probabilities of admission to the ICU and the probabilities of hospital discharge among positive COVID-19 patients according to demographics and comorbidities recorded at hospital admission. METHODS: A prospective cohort study of all patients with COVID-19 found in the Electronic Medical Records of Jaber Al-Ahmad Al-Sabah Hospital in Kuwait was conducted. The study included 3995 individuals (symptomatic and asymptomatic) of all ages who tested positive from February 24th to May 27th, 2020, out of which 315 were treated in the ICU and 3619 were discharged including those who were transferred to a different healthcare unit without having previously entered the ICU. A competing risk analysis considering two events, namely, ICU admission and hospital discharge using flexible hazard models was performed to describe the association between event-specific probabilities and patient characteristics. RESULTS: Results showed that being male, increasing age and comorbidities such as chronic kidney disease (CKD), asthma or chronic obstructive pulmonary disease and weakened immune system increased the risk of ICU admission within 10 days of entering the hospital. CKD and weakened immune system decreased the probabilities of discharge in both females and males however, the age-related pattern differed by gender. Diabetes, which was the most prevalent comorbid condition, had only a moderate impact on both probabilities (18% overall) in contrast to CKD which had the largest effect, but presented only in 7% of those admitted to ICU and in 1% of those who got discharged. For instance, within 5 days a 50-year-old male had 19% (95% C.I.: [15,23]) probability of entering the ICU if he had none of these comorbidities, yet this risk jumped to 31% (95% C.I.: [20,46]) if he had also CKD, and to 27% in the presence of asthma/COPD (95% C.I.: [19,36]) or of weakened immune system (95% C.I.: [16,42]). CONCLUSIONS: This study provides useful insight in describing the probabilities of ICU admission and hospital discharge according to age, gender, and comorbidities among confirmed COVID-19 cases in Kuwait. A web-tool is also provided to allow the user to estimate these probabilities for any combination of these covariates. These probabilities enable deeper understanding of the hospital demand according to patient characteristics which is essential to hospital management and useful for developing a vaccination strategy

Tendon Is Covered by a Basement Membrane Epithelium That Is Required for Cell Retention and the Prevention of Adhesion Formation

The ability of tendons to glide smoothly during muscle contraction is impaired after injury by fibrous adhesions that form between the damaged tendon surface and surrounding tissues. To understand how adhesions form we incubated excised tendons in fibrin gels (to mimic the homeostatic environment at the injury site) and assessed cell migration. We noticed cells exiting the tendon from only the cut ends. Furthermore, treatment of the tendon with trypsin resulted in cell extravagation from the shaft of the tendons. Electron microscopy and immunolocalisation studies showed that the tendons are covered by a novel cell layer in which a collagen type IV/laminin basement membrane (BM) overlies a keratinised epithelium. PCR and western blot analyses confirmed the expression of laminin β1 in surface cells, only. To evaluate the cell retentive properties of the BM in vivo we examined the tendons of the Col4a1+/Svc mouse that is heterozygous for a G-to-A transition in the Col4a1 gene that produces a G1064D substitution in the α1(IV) chain of collagen IV. The flexor tendons had a discontinuous BM, developed fibrous adhesions with overlying tissues, and were acellular at sites of adhesion formation. In further experiments, tenotomy of wild-type mice resulted in expression of laminin throughout the adhesion. In conclusion, we show the existence of a novel tendon BM-epithelium that is required to prevent adhesion formation. The Col4a1+/Svc mouse is an effective animal model for studying adhesion formation because of the presence of a structurally-defective collagen type IV-containing BM

Inventing the khalījī state: formation of political sovereignty in the Gulf

This thesis examines the processes that gave way to formation of the khalījī (‘of the Gulf’ (khalīj) in Arabic) state. Existing literatures and state-sponsored discourse fail to capture the complexity of how Gulf states formed, nor does it capture implications of British indirect rule on khalījī coastal inhabitants. Monarchism is tacitly accepted as tradition. By freezing “tradition” to observe it through nation-state logics, scholars have misread the region’s socio-political past. More often, the literature centres around ruling families, neglecting excluded voices in khalījī political history. Britain first recognised semi-independent Arab sheikhs’ sovereignty in 1820. This precipitated a new era of British imperialism built on Anglo-Khalījī treaties conceding power over khalījī waters to Britain in exchange for political protection. This shift concentrated colonial power over khalījī waters, disturbing old identities while upending maritime tribal traditions and governance. It fixed sovereignty through territory and created new meanings of being between rulers (sovereigns) and ruled (subjects). A century later, the khalīj experienced new seismic changes. In a region where movement was common, consolidation of nationhood within states did not organically evolve to form a homogenous state identity. Instead, national identities were imposed through drawing territories and turning residents into rulers’ subjects. This thesis argues Gulf states became so-called “traditional” monarchies because they became modern nation-states. Monarchism as a regime type is an invented tradition, and the one-dimensional national identity khalījī states construct does not mirror khalījī socio-political history. By focusing on primary archival material and secondary sources, I (1) provide context to a pivotal period that led to monarchic state formation; (2) interrogate monarchism as a conceptual tool to study the political system’s origins in the khalīj; (3) demystify khalījī socio-political exceptionalism; and (4) return agency to absent khalījī voices

Labor Protection in the Gulf Countries: A Comparative Analysis of Kenyan Governmental Dilemmas in Saudi Arabia and the United Arab Emirates

In recent years, the Kenyan government has increasingly developed labor export policies to secure employment for its nationals in the Gulf countries. Between 100,000 – 300,000 Kenyan migrants—mostly unskilled laborers — are represented in the Gulf countries’ population, and this number is expected to grow given the high demand for inexpensive foreign workers in the Gulf countries. Kenya’s labor export policies facilitate important economic strategies that enable the government to address the Gulf countries’ labor shortages, while easing the growing unemployment problems in Ken-ya. However, the Kenyan government has not formed a comprehensive protection policy nor developed bilateral labor arrangements and institutional/diplomatic capacity to safeguard Kenyans from labor violations and exploitation. This paper examines the Kenyan government's complex role in and its challenges with protecting its nationals in the Gulf countries, while analyzing the emerging contemporary migration flow between Kenya and the Gulf countries, mainly in Saudi Arabia and the United Arab Emirates. We argue that the power asymmetry between the Kenyan and Gulf governments directly affects bilateral migration policymaking, particularly labor protection and migrant welfare. This paper further asserts that macro-factors - the Gulf countries’ bilateral trade with Kenya, humanitarian aid assistance as “soft-power”, and open immigration systems - have constrained the Kenyan government's ability to protect its nationals in the host countries.Malit_Jr_and_Al__Youha__2016__Labor_Protection_in_the_Gulf_Countries__Final_Version___7_.pdf: 1254 downloads, before Oct. 1, 2020

Update/Review: Changing of Use of Local Anesthesia in the Hand

Summary: Among the many advances in local anesthesia of the hand, some of the most significant changes in the last 5 years have been the following: (1) the acceptance of safety of locally infiltrated epinephrine with lidocaine for hemostasis, which has removed the need for sedation, brachial plexus blocks, and general anesthesia for most common hand surgery operations and minor hand trauma. (2) The elimination of the 2 injection finger block technique in favor of the single injection palmar block. (3) Local anesthesia can now be consistently injected in the hand with minimal pain. (4) Liposomal release of local anesthetic after injection into the surgical site can provide pain control up to 3 days. This article reviews the impact and best evidence related to these changes