International Clinical Guidelines at the American University of Beirut, Physical Therapy Department: Strategy of Implementation and Evaluation

Purpose. The purpose of the study is (1) to describe the selection process of an international clinical guideline (CGL) for patients with low back pain (LBP) for adoption and implementation at the Physical Therapy Department at the American University of Beirut Medical Center (AUBMC), and (2) to evaluate the physiotherapists’ compliance. Method. International guidelines were identified through a literature search and compared according to the AGREE instrument for selection. Quality indicators were selected. Physiotherapists were educated about guidelines’ benefits and the content of the adopted guidelines during interactive sessions; patients’ files were optimized and audited in order to evaluate compliance. Results. Out of six guidelines for LBP, we selected that of the Royal Dutch Association of Physiotherapy. Full adherence of physiotherapists to the educational sessions was noted. A total of 72 patient files were available. However, only 23 out of 72 files (32%) were complete to test the therapists’ adherence to the new assessment forms using 13 quality indicators. A high level of compliance with a mean score of 90% was recorded for the diagnostic process indicators, and a low level for the mean score of therapeutic process indicators (42%) except the indicator for the advice to stay active (100%). The mean score for the outcome of care was very low (13%). Conclusions. Dutch guidelines for low back pain were selected for adoption and implementation. A relatively high level of adherence to guidelines recommendations was noticed in the diagnostic process and a low level in the therapeutic process

Sedation as an alternative anesthetic technique for frail patients in transurethral resection of the prostate

Background: Transurethral resection of the prostate (TURP) under Monitored Anesthesia Care MAC/Sedation (macTURP), as compared with TURP under general (genTURP) or spinal (spTURP) anesthesia, is a safer and infrequently used technique reserved for high-risk patients. Objectives: The aim of this study is to compare 30-day postoperative outcomes of TURP using the three types of anesthesia techniques. Design and methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TURP between 2008 and 2019. Demographics, lab values, medical history, and 30-day outcomes were compared. Univariate and multivariate regression models for postoperative complications were constructed. A propensity score–matched analysis was then performed for genTURP and macTURP and for spTURP and macTURP as a sensitivity analysis. Results: A total of 53,182 patients underwent TURP. Older patients (>80) with diabetes requiring insulin (7.9%), leukocytosis (7.4%), history of chronic obstructive pulmonary disease (COPD) (7.8%), dyspnea (7.2%), and of ASA > 2 (58.8%) were more likely to undergo macTURP as compared with genTURP ( p  < 0.013). SpTURP showed lower rates of urinary tract infection (UTI) [odds ratio (OR) = 0.869] as compared with genTURP ( p  = 0.049), whereas macTURP showed higher rates of major adverse cardiovascular events (OR = 2.179) as compared with genTURP ( p  = 0.005). All other postoperative complications showed similar rates between the three procedures. The propensity-matched cohorts demonstrated that no differences in postoperative complication rates were noted between macTURP and genTURP and between macTURP and spTURP. Conclusion: MacTURP was found to be feasible with a good safety profile as compared with genTURP and spTURP. MacTURP could be used in elderly, frail, and co-morbid patients with a similar safety profile as compared with more invasive anesthetic techniques

Establishing a High-Quality Congenital Cardiac Surgery Program in a Developing Country: Lessons Learned.

Background: Developing countries are profoundly affected by the burden of congenital heart disease (CHD) because of limited resources, poverty, cost, and inefficient governance. The outcome of pediatric cardiac surgery in developing countries is suboptimal, and the availability of sustainable programs is minimal. Aim: This study describes the establishment of a high quality in-situ pediatric cardiac surgery program in Lebanon, a limited resource country. Methods: We enrolled all patients operated for CHD at the Children's Heart Center at the American University of Beirut between January 2014 and December 2018. Financial information was obtained. We established a partnership between the state, private University hospital, and philanthropic organizations to support the program. Results: In 5 years, 856 consecutive patients underwent 993 surgical procedures. Neonates and infants constituted 22.5 and 22.6% of our cohort, respectively. Most patients (82.6%) underwent one cardiac procedure. Our results were similar to those of the Society of Thoracic Surgeons (STS) harvest and to the expected mortalities in RACHS-1 scores with an overall mortality of 2.8%. The government (Public) covered 43% of the hospital bill, the Philanthropic organizations covered 30%, and the Private hospital provided a 25% discount. The parents' out-of-pocket contribution included another 2%. The average cost per patient, including neonates, was $19,800. Conclusion: High standard pediatric cardiac surgery programs can be achieved in limited-resource countries, with outcome measures comparable to developed countries. We established a viable financial model through a tripartite partnership between Public, Private, and Philanthropy (3P system) to provide high caliber care to children with CHD