National assessment of prescribing practice of antibiotic prophylaxis among obstetrics and gynaecological surgeries in Kuwait

Antimicrobial resistance has become a significant global health concern, primarily resulting from excessive and inappropriate use of antimicrobials. A significant portion of antibiotics prescribed within hospitals is for surgical patients as prophylaxis (AP) to prevent surgical site infections. Thus, AP must be used judiciously to reduce antibiotic resistance. Proper infection control and judicious use of antibiotics are crucial. This research aims to explore and assess the appropriateness of AP prescribing practice for all obstetrics and gynaecological surgeries in Kuwait. Methods: A national multicentre point prevalence survey (PPS) based on the Global PPS and WHO PPS methodology. The PPS was conducted in all Kuwait governmental and some private hospitals. The PPS was conducted once in every OBS/GYN ward after the day of the most surgical interventions. All patient files were reviewed for AP usage from the past 24 hours to assess the appropriateness of AP against local and international AP guidelines. Results: preliminary results included 208 patients. Antibiotic usage among them was 98%. Only 53% of the patients received antibiotics before surgery, and only 11% were fully appropriate in terms of timing and selection. 85% of the patient received antibiotics for more than 24 hours. This research is still ongoing and requires further analysis. Conclusion: This study is a benchmark for AP utilisation in Kuwait, which helps in the establishment of antibiotic surveillance for surgical prevention as well as the development of ASP and recommendations for national guidelines tailored for the Kuwaiti healthcare system

Comparison of heart team vs interventional cardiologist recommendations for the treatment of patients with multivessel coronary artery disease

Abstract: Importance: Although the heart team approach is recommended in revascularization guidelines, the frequency with which heart team decisions differ from those of the original treating interventional cardiologist is unknown. Objective: To examine the difference in decisions between the heart team and the original treating interventional cardiologist for the treatment of patients with multivessel coronary artery disease. Design, setting, and participants: In this cross-sectional study, 245 consecutive patients with multivessel coronary artery disease were recruited from 1 high-volume tertiary care referral center (185 patients were enrolled through a screening process, and 60 patients were retrospectively enrolled from the center's database). A total of 237 patients were included in the final virtual heart team analysis. Treatment decisions (which comprised coronary artery bypass grafting, percutaneous coronary intervention, and medication therapy) were made by the original treating interventional cardiologists between March 15, 2012, and October 20, 2014. These decisions were then compared with pooled-majority treatment decisions made by 8 blinded heart teams using structured online case presentations between October 1, 2017, and October 15, 2018. The randomized members of the heart teams comprised experts from 3 domains, with each team containing 1 noninvasive cardiologist, 1 interventional cardiologist, and 1 cardiovascular surgeon. Cases in which all 3 of the heart team members disagreed and cases in which procedural discordance occurred (eg, 2 members chose coronary artery bypass grafting and 1 member chose percutaneous coronary intervention) were discussed in a face-to-face heart team review in October 2018 to obtain pooled-majority decisions. Data were analyzed from May 6, 2019, to April 22, 2020. Main outcomes and measures: The Cohen κ coefficient between the treatment recommendation from the heart team and the treatment recommendation from the original treating interventional cardiologist. Results: Among 234 of 237 patients (98.7%) in the analysis for whom complete data were available, the mean (SD) age was 67.8 (10.9) years; 176 patients (75.2%) were male, and 191 patients (81.4%) had stenosis in 3 epicardial coronary vessels. A total of 71 differences (30.3%; 95% CI, 24.5%-36.7%) in treatment decisions between the heart team and the original treating interventional cardiologist occurred, with a Cohen κ of 0.478 (95% CI, 0.336-0.540; P = .006). The heart team decision was more frequently unanimous when it was concordant with the decision of the original treating interventional cardiologist (109 of 163 cases [66.9%]) compared with when it was discordant (28 of 71 cases [39.4%]; P < .001). When the heart team agreed with the original treatment decision, there was more agreement between the heart team interventional cardiologist and the original treating interventional cardiologist (138 of 163 cases [84.7%]) compared with when the heart team disagreed with the original treatment decision (14 of 71 cases [19.7%]); P < .001). Those with an original treatment of coronary artery bypass grafting, percutaneous coronary intervention, and medication therapy, 32 of 148 patients [22.3%], 32 of 71 patients [45.1%], and 6 of 15 patients [40.0%], respectively, received a different treatment recommendation from the heart team than the original treating interventional cardiologist; the difference across the 3 groups was statistically significant (P = .002). Conclusions and relevance: The heart team's recommended treatment for patients with multivessel coronary artery disease differed from that of the original treating interventional cardiologist in up to 30% of cases. This subset of cases was associated with a lower frequency of unanimous decisions within the heart team and less concordance between the interventional cardiologists; discordance was more frequent when percutaneous coronary intervention or medication therapy were considered. Further research is needed to evaluate whether heart team decisions are associated with improvements in outcomes and, if so, how to identify patients for whom the heart team approach would be beneficial

Examining Driver Risk Factors in Road Departure Conflicts Using SHRP2 Data

When a vehicle leaves the roadway, the likelihood of a roadway departure (RwD) crash can be deadly. Roadway departure conflicts usually involve a single vehicle, which occurs after a vehicle crosses an edge line, a centerline, or otherwise leaves the designated traveled way and collide with another vehicle or with a fixed object or overturns, etc. This study investigates the nature of the interrelations between roadway, vehicle, and driver (characteristics and behavior) risk factors in roadway departure conflicts. The purpose of this thesis study was to examine which factors increase the risk of roadway departure conflict and increase the likelihood becoming a roadway departure crash, using the Second Strategic Highway Research program (SHRP2) data. SHRP2 include Naturalistic Driving Study (NDS) and Roadway Information Database (RID), which were collected from six different states in 2010-2012. Stepwise logistic and generalized linear regression models were estimated to provide insights as to those factors that have association with roadway departure conflicts and more importantly to those that are more likely to lead the conflict into crashes.The results revealed that drivers pre-incident maneuvers, judgment maneuvers, secondary tasks (distracted drivers), road alignment (curves) were significant factors. Driver education, average mileage driven per years were also significant factors. However, driver gender and age were non-significant risk factor of roadway departure conflicts in the current study