Quality of care in University Hospitals in Saudi Arabia: systematic review

Objectives: To identify the key issues, problems, barriers and challenges particularly in relation to the quality of care in university hospitals in the Kingdom of Saudi Arabia (KSA), and to provide recommendations for improvement. Methods: A systematic search was carried out using five electronic databases, for articles published between January 2004 and January 2015. We included studies conducted in university hospitals in KSA that focused on the quality of healthcare. Three independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted their relevant characteristics. All studies were assessed using the Institute of Medicine indicators of quality of care. Results: Of the 1430 references identified in the initial search, eight studies were identified that met the inclusion criteria. The included studies clearly highlight a need to improve the quality of healthcare delivery, specifically in areas of patient safety, clinical effectiveness and patient-centredness, at university hospitals in KSA. Problems with quality of care could be due to failures of leadership, a requirement for better management and a need to establish a culture of safety alongside leadership reform in university hospitals. Lack of instructions given to patients and language communication were key factors impeding optimum delivery of patient-centred care. Decisionmakers in KSA university hospitals should consider programmes and assessment tools to reveal problems and issues related to language as a barrier to quality of care. Conclusions: This review exemplifies the need for further improvement in the quality of healthcare in university hospitals in KSA. Many of the problems identified in this review could be addressed by establishing an independent body in KSA, which could monitor healthcare services and push for improvements in efficiency and quality of care

Wind tunnel site analysis of Dow Chemical Facility at Rocky Flats, Colorado

CER71-72RNM-FC-451.May 1972.Prepared for Research and Ecology, Rocky Flats Division, Dow Chemical Company.Includes bibliographical references.Tests were conducted on a model of the Dow Chemical Company plutonium recovery facility, Rocky Flats Division, and the surrounding topography to determine the dispersal and trajectories of potential effluents. Profiles of wind and turbulence over the facility were adjusted to forms expected for the given terrain. Dispersion and trajectory characteristics were determined by releasing a krypton-85 tracer gas from specific sources and sampling the plume downwind. Results suggest that the plumes depart only modestly from behavior suggested by the Pasquill-Gifford prediction methods. All results are tabulated and/or presented in a dimensionless manner suitable for prototype site evaluation

Study of wind pressure and air quality around Children's Hospital, National Medical Center

CER70-71FHC-JEC55.March 1971.Prepared under contract to Leo A. Daly Company.Includes bibliographical references.Tests were conducted on a model of the proposed Children's Hospital Facility constructed (1:192 scale) in the Colorado State University Meteorological Wind Tunnel to determine air quality and air pressures around the building. The pressure measurements concentrated on the mean and RMS of the fluctuating pressure at selected locations. Air quality measurements were made by releasing Krypton-85 from specific sources of pollution and sampling it at all the intakes around the building. Data are presented in a manner that these can be directly used to evaluate pressures and air quality. Also, based on these data, recommendations are made on locating the air-conditioning intakes and the sources of pollution

A Novel Energy-Efficient Reservation System for Edge Computing in 6G Vehicular Ad Hoc Network

The roadside unit (RSU) is one of the fundamental components in a vehicular ad hoc network (VANET), where a vehicle communicates in infrastructure mode. The RSU has multiple functions, including the sharing of emergency messages and the updating of vehicles about the traffic situation. Deploying and managing a static RSU (sRSU) requires considerable capital and operating expenditures (CAPEX and OPEX), leading to RSUs that are sparsely distributed, continuous handovers amongst RSUs, and, more importantly, frequent RSU interruptions. At present, researchers remain focused on multiple parameters in the sRSU to improve the vehicle-to-infrastructure (V2I) communication; however, in this research, the mobile RSU (mRSU), an emerging concept for sixth-generation (6G) edge computing vehicular ad hoc networks (VANETs), is proposed to improve the connectivity and efficiency of communication among V2I. In addition to this, the mRSU can serve as a computing resource for edge computing applications. This paper proposes a novel energy-efficient reservation technique for edge computing in 6G VANETs that provides an energy-efficient, reservation-based, cost-effective solution by introducing the concept of the mRSU. The simulation outcomes demonstrate that the mRSU exhibits superior performance compared to the sRSU in multiple aspects. The mRSU surpasses the sRSU with a packet delivery ratio improvement of 7.7%, a throughput increase of 5.1%, a reduction in end-to-end delay by 4.4%, and a decrease in hop count by 8.7%. The results are generated across diverse propagation models, employing realistic urban scenarios with varying packet sizes and numbers of vehicles. However, it is important to note that the enhanced performance parameters and improved connectivity with more nodes lead to a significant increase in energy consumption by 2%

A meta-analysis on the prophylactic use of macrolide antibiotics for the prevention of disease exacerbations in patients with Chronic Obstructive Pulmonary Disease

SummaryIntroductionMacrolides are of unique interest in preventing COPD exacerbations because they possess a variety of antibacterial, antiviral and anti-inflammatory properties. Recent research has generated renewed interest in prophylactic macrolides to reduce the risk of COPD exacerbations. Little is known about how well these recent findings fit within the context of previous research on this subject. The purpose of this article is to evaluate, via exploratory meta-analysis, whether the overall consensus favors prophylactic macrolides for prevention of COPD exacerbations.MethodsEMBASE, Cochrane and Medline databases were searched for all relevant randomized controlled trials (RCTs). Six RCTs were identified. The primary endpoint was incidence of COPD exacerbations. Secondary endpoints including mortality, hospitalization rates, adverse events and likelihood of having at least one COPD exacerbation were also examined.ResultsThere was a 37% relative risk reduction (RR = 0.63, 95% CI: 0.45–0.87, p value = 0.005) in COPD exacerbations among patients taking macrolides compared to placebo. Furthermore, there was a 21% reduced risk of hospitalization (RR = 0.79, 95% CI: 0.69–0.90, p-value = 0.01) and 68% reduced risk of having at least one COPD exacerbation (RR = 0.34, 95% CI 0.21–0.54, p-value = 0.001) among patients taking macrolides versus placebo. There was also a trend toward decreased mortality and increased adverse events among patients taking macrolides but these were not statistically significant.ConclusionsProphylactic macrolides are an effective approach for reducing incident COPD exacerbations. There were several limitations to this study including a lack of consistent adverse event reporting and some degree of clinical and statistical heterogeneity between studies

Cancer treatment associated cardiac toxicities

Cardiovascular disease remains the leading cause of mortality and morbidity in men and women both in the US and worldwide. With increased access to healthcare, it is predicted that life expectancies in developed countries will continue to rise and thus, lead to an increase in both cardiovascular disease and cancer. Similarly, improved survival rates in cancer patients have led to an increased awareness of the presence and potential worsening of cardiovascular disease in these patients. Cardiovascular complications due to side effects from cancer therapy or from cancer progression can be a common occurrence. Although recent advances in cancer therapeutics have led to improved survival rates and quality of life, the increase in life expectancy may be counteracted by the increased morbidity and mortality from progressive cardiac pathology. Examples of such complications include local invasion or distant metastatic spread, which can lead to superior vena cava syndrome, cardiac tamponade, or hyperviscosity syndromes. In addition, many chemo and radiation therapies can be directly toxic to the cardiovascular system. This review aims to discuss the potential cardiac toxicities of the most commonly used chemotherapeutics along with some strategies to manage these complex patients

Wind and air pollution control study of Yerba Buena Center

For McCue - Boone - Tomsick.CER71-72JEC-FHC-ACH-JAG15.June 1972.Includes bibliographical references