The impact of a fast track area on quality and effectiveness outcomes: A Middle Eastern emergency department perspective

<p>Abstract</p> <p>Background</p> <p>Emergency department (ED) overcrowding is a ubiquitous problem with serious public health implications. The fast track area is a novel method which aims to reduce waiting time, patient dissatisfaction and morbidity. |The study objective was to determine the impact of a fast track area (FTA) on both effectiveness measures (i.e. waiting times [WT] and length of stay [LOS]) and quality measures (i.e. LWBS rates and mortality rates) in non-urgent patients. The secondary objective was to assess if a FTA negatively impacted on urgent patients entering the ED.</p> <p>Methods</p> <p>The study took place in a 500 bed, urban, tertiary care hospital in Abu Dhabi, United Arab Emirates. This was a quasi-experimental, which examined the impact of a FTA on a pre-intervention control group (January 2005) (n = 4,779) versus a post-intervention study group (January 2006) (n = 5,706).</p> <p>Results</p> <p>Mean WTs of Canadian Triage Acuity Scale (CTAS) 4 patients decreased by 22 min (95% CI 21 min to 24 min, <it>P </it>< 0.001). Similarly, mean WTs of CTAS 5 patients decreased by 28 min (95% CI 19 min to 37 min, <it>P </it>< 0.001) post FTA. The mean WTs of urgent patients (CTAS 2/3) were also significantly reduced after the FTA was opened (<it>P </it>< 0.001). The LWBS rate was reduced from 4.7% to 0.7% (95% CI 3.37 to 4.64; <it>P </it>< 0.001). Opening a FTA had no significant impact on mortality rates (<it>P </it>= 0.88).</p> <p>Conclusion</p> <p>The FTA improved ED effectiveness (WTs and LOS) and quality measures (LWBS rates) whereas mortality rate remained unchanged.</p

Biallelic GRM7 variants cause epilepsy, microcephaly, and cerebral atrophy

Objective: Defects in ion channels and neurotransmitter receptors are implicated in developmental and epileptic encephalopathy (DEE). Metabotropic glutamate receptor 7 (mGluR7), encoded by GRM7, is a presynaptic G-protein-coupled glutamate receptor critical for synaptic transmission. We previously proposed GRM7 as a candidate disease gene in two families with neurodevelopmental disorders (NDDs). One additional family has been published since. Here, we describe three additional families with GRM7 biallelic variants and deeply characterize the associated clinical neurological and electrophysiological phenotype and molecular data in 11 affected individuals from six unrelated families. Methods: Exome sequencing and family-based rare variant analyses on a cohort of 220 consanguineous families with NDDs revealed three families with GRM7 biallelic variants; three additional families were identified through literature search and collaboration with a clinical molecular laboratory. Results: We compared the observed clinical features and variants of 11 affected individuals from the six unrelated families. Identified novel deleterious variants included two homozygous missense variants (c.2671G>A:p.Glu891Lys and c.1973G>A:p.Arg685Gln) and one homozygous stop-gain variant (c.1975C>T:p.Arg659Ter). Developmental delay, neonatal- or infantile-onset epilepsy, and microcephaly were universal. Three individuals had hypothalamic–pituitary–axis dysfunction without pituitary structural abnormality. Neuroimaging showed cerebral atrophy and hypomyelination in a majority of cases. Two siblings demonstrated progressive loss of myelination by 2 years in both and an acquired microcephaly pattern in one. Five individuals died in early or late childhood. Conclusion: Detailed clinical characterization of 11 individuals from six unrelated families demonstrates that rare biallelic GRM7 pathogenic variants can cause DEEs, microcephaly, hypomyelination, and cerebral atrophy. © 2020 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals, Inc on behalf of American Neurological Association

The burden of pneumococcal disease in children less than 5 years of age in Abu Dhabi, United Arab Emirates

<b>Background and Objective:</b> <i>Streptococcus pneumoniae</i> is a major cause of mortality and morbidity in both developing and industrialized countries, especially among young children and in both immunocompromised and immunocompetent individuals. It is implicated in both invasive (e.g. meningitis and septicemia) as well as noninvasive disease (community-acquired pneumonia and otitis media). The objective of the current study was to describe the overall epidemiology of both invasive and noninvasive pneumococcal disease in Abu Dhabi over a 5-year period. <b>Design and Setting:</b> Retrospective review of all pediatric (&#8804; 5 year old) pneumococcal disease admissions to Shaikh Khalifa Medical City (SKMC) and Mafraq Hospital in Abu Dhabi from 1 January 2001 till 31 December 2005.th <b>Methods</b>: We retrieved computerized data from the health information management systems (International Classification of Diseases, 9th Revision (ICD9) diagnosis codes) as well as manual surveillance in the laboratory record of pneumococcal isolates. <b>Results:</b> The incidence of invasive pneumococcal disease was 13.6/100&#8197;000 per year (95&#x0025; CI, 6.5-24.9) and the incidence of noninvasive pneumococcal disease was 172.5/100&#8197;000 per year (95&#x0025; CI, 143.8-205.2). The total incidence rate was 186.0/100&#8197;000 per year (95&#x0025; CI, 156.2-219.9). <b>Conclusion</b>: This epidemiological survey indicates that the incidence rates in the United Arab Emiratea are higher than in Western countries where conjugate pneumococcal vaccine has been introduced. This study is important as it documents the incidence of pneumococcal disease in the era before introduction of the conjugate pneumococcal vaccine and allows for future research to document the impact of a new vaccine considering the geographic variation of pneumococcal serotypes

INTERNATIONAL JOURNAL OF FOOD AND NUTRITIONAL SCIENCES VITAMIN D STATUS AND BONE MINERAL DENSITY (BMD) IN MOTHERS OF RACHITIC INFANTS

ABSTRACT Vitamin D deficiency is endemic in the Middle East, including United Arab Emirates. It remains a conundrum why rickets selectively affects certain infants, and not others with similar vitamin D status. During the lactation period, calcium supply to the infant is provided through the breast milk by mobilization of mineral stores from the bone. Our primary aim was to examine the vitamin D status and the maternal bone mineral density (BMD) and the secondary aim to provide a descriptive analysis of the biochemical status of mothers whose infants were diagnosed with nutritional rickets.The study was conducted at Sheikh Khalifa Medical City (SKMC) and analyzed at VPS Healthcare, Abu Dhabi, UAE. Data was retrospectively extracted from the files and computerized database for the period from June 2005 till December 2007. Biochemical testing was performed by methods previously described. BMD was studied by dual energy X-Ray absorptiometry (DXA) using Hologic, Inc. -Discovery QDR Series (Bedford, MA, USA). 57% of mothers had normal BMD, 40% had osteopenia and 2.5% had osteoporosis. The T score of the spine was significantly lower than that of the hip (mean difference 0.44, 95% CI 0.55-0.83, P = 0.02). By multiple regression, only the child&apos;s 25(OH) D concentration acted as a predictor of maternal BMD (P= 0.03). The finding of decreased bone density in women of child bearing age raises the possibility of a bidirectional influence between the mother-child dyad. The lactational calcium supply may be limited in children destined to develop rickets

Knowledge, attitudes, and practices of breastfeeding among women visiting primary healthcare clinics on the island of Abu Dhabi, United Arab Emirates

Abstract Background The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond. This study assessed breastfeeding knowledge, attitudes, and practices among women residing on the island of Abu Dhabi and identified associated factors. Methods We conducted a cross-sectional study using a self-administered questionnaire among mothers visiting primary healthcare clinics in Abu Dhabi between November 2014 and 2015. Participants were women aged at least 18 years who had at least one child aged 2 years or younger at the time of the study. Breastfeeding knowledge, attitudes, and practices were assessed on the basis of experience with last child. Selected questions were used to develop a scaled scoring system to categorize these aspects as good, fair, or poor. Exclusive breastfeeding is defined as the act of feeding infants only breast milk since birth, without providing water, formula, or other liquid supplements. Results The participants were 344 women. Exclusive breastfeeding for 6 months was reported by only 46 (16.9%, 95% CI 0.10, 0.17, n = 272). 79 (28.7%, n = 275) of the participants were breastfeeding and planning to continue after the child was ≥24 months. Multivariate logistic regression analysis revealed that the following factors were associated with exclusive breastfeeding: mothers with female children (adjusted OR [AOR] 2.42; 95% CI 1.18, 4.97) and better breastfeeding knowledge scores (AOR 1.25; 95% CI 1.04, 1.50). The following factors were associated with less likelihood of exclusively breastfeeding: working mothers (AOR 0.29; 95% CI 0.12, 0.72), living with relatives (AOR 0.21; 95% CI 0.05, 0.81), no past exclusive breastfeeding experience (AOR 0.23; 95% CI 0.09, 0.58) and being offered readymade liquid formula in hospital (AOR 0.33; 95% CI 0.15, 0.72). The most common reason for stopping breastfeeding was insufficient breast milk production (68/89, 76%), and the most common work related reason was inadequate maternity leave (24/89, 15%). Conclusion Although breastfeeding knowledge was generally good, breastfeeding practice was still suboptimal. Modifiable factors found to predict exclusive breastfeeding included breastfeeding knowledge and mothers’ employment status

Additional file 3: of Knowledge, attitudes, and practices of breastfeeding among women visiting primary healthcare clinics on the island of Abu Dhabi, United Arab Emirates

Factors that affect breastfeeding practices among participants (n = 344). (DOCX 33 kb

Vitamin D status among the juvenile population: A retrospective study

© 2017 Elsevier Ltd Vitamin D deficiency is a clinical problem and recently we have shown that 82.5% of our entire study cohort had inadequate serum 25(OH)D levels. In this study, we analysed serum 25(OH)D levels of juvenile patients admitted to the Burjeel Hospital of VPS Health care in Abu Dhabi, United Arab Emirates (UAE) from October 2012 to September 2014. Out of a total of 7883 juvenile patients considered in this study, almost 58.1% of females and 43.3% of males in the age group of 1–18 years were found to have low serum 25(OH)D levels (\u3c50 nmol/L). According to the coefficient of variation, females had significantly higher variability among juveniles (63.8%) than males (49.9%). Among the juveniles group of patients, age appears to be an important determining factor for defining vitamin D deficiency.The risk of deficiency (\u3c30 nmol/L) was found to be present in 31.4% of patients in the age group of 10–12 years, followed by 50.4% of patients in the age group of 13–15 years and 52.9% of patients in the age group of 16–18 years. The analysed age groups of females were found to have lower levels of 25(OH)D than males. It is important and perhaps alarming to note that such high rate of vitamin D deficiency is present in the juvenile age