Are acute coronary syndrome patients admitted during off-duty hours treated differently? an analysis of the Saudi Project for assessment of acute coronary syndrome [space] study

It is often suggested that acute coronary syndrome [ACS] patients admitted during off-duty hours [OH] have a worse clinical outcome than those admitted during regular working hours [RH]. Our objective was to compare the management and hospital outcomes of ACS patients admitted during OH with those admitted during RH. Prospective observational study of ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome study from December 2005 to December 2007. ACS patients with available date and admission times were included. RH were defined as weekdays, 8 AM-5 PM, and OH was defined as weekdays 5 PM-8 AM, weekends, during Eid [a period of several days marking the end of two major Islamic holidays], and national days. Of the 2825 patients qualifying for this analysis, 1016 [36%] were admitted during RH and 1809 [64%] during OH. OH patients were more likely to present with heart failure and ST elevation myocardial infarction [STEMI] and to receive fibrinolytic therapy, but were less likely to undergo primary percutaneous coronary interventions [PCI]. The median door to balloon time was significantly longer [P<.01] in OH patients [122 min] than in RH patients. No differences were observed in hospital outcomes including mortality between the two groups, except for higher heart failure rates in OH patients [11.1% vs 7.2%, P<.001]. STEMI patients admitted during OH were disadvantaged with respect to use and speed of delivery of primary PCI but not fibrinolytic therapy. Hospitals providing primary PCI during OH should aim to deliver it in a timely manner throughout the day

Regional variability in hospital mortality in patients hospitalized with st-segment elevation myocardial infarction: findings from the gulf registry of acute coronary events

To study the short-term mortality from ST-segment elevation myocardial infarction [STEMI] in the Arabian Gulf region of the Middle East, and to examine whether these geographically and culturally related countries had similar or different outcomes. The Gulf Registry of Acute Coronary Events recruited consecutive acute coronary syndrome patients from six Middle Eastern countries over a 5-month period. Of 6,706 patients recruited, 2,626 [39%] had STEMI, and a total of 165 patients died in hospital, with a crude mortality rate of 6.3%. However, mortality rates varied geographically between 10% in Yemen, 9.6% in Oman and 3.3% in the other countries. The unadjusted odds ratio of mortality for Yemen was 3.2 [95% CI: 2.2-4.7], and 3.1 [95% CI: 1.9-4.8] for Oman, compared to other Gulf countries. Even after adjusting for age and gender, the mortality remained significantly higher, almost double, in Oman and Yemen compared to other countries. This could be understood in the light of significant differences in a number of practice pattern variables such as reperfusion therapy, timely presentation and use of evidence-based medications. We found significant variability in STEMI mortality among Gulf Arab countries and identified areas requiring further efforts to reduce excess mortality in the region

Evidence-based practice in the use of antibiotics for respiratory tract infections in primary health centers in Kuwait

The objective of this study was to evaluate the use of antibiotics in treating upper respiratory tract infections [URTIs] in primary health centers in Kuwait and investigate the extent to which antibiotic use follows international guidelines. A nationwide cross-sectional study was conducted with a sample size of 615 patients selected by using a multi-stage cluster sampling method. Of these, 270 patients had URTI and were included in the analysis. Data collection was done by observing the whole process starting from patient presentation and history taking to final diagnosis and treatment by the physicians. Our study showed that about 135 [50%] of the patients with URTIs were given antibiotics, of which only 8 [6%] could be justified according to the NICE guidelines. However, prescriptions for 132 [98%] patients who were not given antibiotics could also be considered as evidence-based. Patients presenting with symptoms such as fever [OR=2.7; p < 0.001] and sore throat [OR=1.9; p < 0.01] were more likely be given antibiotics than those presenting without such symptoms. Furthermore, patients diagnosed with tonsillitis [OR=25; p < 0.002], otitis media [OR=9; p < 0.004], common cold [OR=3; p < 0.049] or pharyngitis [OR=2.7; p < 0.003] were more likely be given an antibiotic treatment as well. We also found that non-Kuwaitis were prescribed antibiotics more often than Kuwaitis [OR=2.0; p < 0.005]. This study showed a very high percentage of non-evidence-based prescriptions of antibiotics in Kuwait, and should be of great public health concern. Although overuse of antibiotics in primary care settings has been well reported from around the world, our finding of non-evidence-based use at 94% is of great public health concern since this may be linked primarily to the lack of evidence-based practice in Kuwait

Perception of the educational environment by medical students undergoing a curricular transition in Kuwait

The aim of this study was to measure the students' perceptions of the educational environment in a medical school undergoing curricular transition from a traditional to a problem-based learning [PBL] program in the academic year 2006-2007. The Dundee Ready Education Environment Measure [DREEM] was used to evaluate perception of the educational environment. Multivariate logistic regression models were used to identify the factors related to educational environment perception that differ between students following a traditional curriculum to those following a PBL program at Kuwait University Medical School. Mean DREEM score was 53%. When students moved from the traditional curriculum to the PBL system, Academic Self-Perception deteriorated, while Perception of Atmosphere improved. Academic Self-Perception deteriorated because conventional strategies of learning were perceived as no longer useful, while Perception of Atmosphere improved because of increased relevance of the studies. Our findings suggest that curricular changes require careful planning and thinking, with particular attention upon how they influence the educational climate. When new teaching strategies are introduced, new factors that may lead students to develop an adverse perception of their educational environment may be introduced as well. Identification of such factors can lead to an improved educational outcome

Confidence in performing core clinical skills: preliminary results of a survey of trainees completing internship training in Kuwait

Several surveys suggest the underemphasis of the learning of practical skills during internship training. While the proportion of interns that had performed some of the common practical procedures during training appeared inadequate, the interns themselves had rated their development of practical skills as not high. Many interns had also indicated that they felt confident to initiate management of conditions although they were not experienced in those areas. We did not encounter any publications dealing specifically with internship training in the Arabian Gulf region. This study was aimed at determining the confidence of interns in performing core clinical skills. Interns who completed rotations in the major specialties during 2005/06 responded to a questionnaire that listed 48 core clinical skills. Out of the 124 eligible for the study, 85 responded. They indicated their confidence to perform the skills in future and the number of times these had been performed. The majority of the interns felt confident with routine skills, while approximately half felt confident with emergency resuscitation skills. A third of the trainees were confident in performing artificial ventilation and endotracheal intubation. Similarly, a half was confident in performing pericardiocentesis, indirect laryngoscopy, lumbar puncture irrigation of the ear, insertion of thoracic drainage, venous cutdown and insertion of central venous catheter. Only about a third of trainees, with no significant gender variation, felt confident to perform common skills in obstetrics and gynecology. While half the trainees were confident in performing emergency resuscitative measures, many others lacked confidence in doing these skills or clinical skills needed in routine situations. Interns who may not acquire competency in the core skills need to be identified early and corrective measures taken. The findings may have implications in the review of the medical undergraduate curriculum as well as in internship training

Kuwait acute coronary syndromes registry: baseline characteristics, management practices and in-hospital outcomes of patients hospitalized with acute coronary syndromes in Kuwait

To identify the characteristics of patients with acute coronary syndromes [ACS], their hospital management and in-hospital outcomes, through a prospective registry system in Kuwait. A registry involving all 7 general hospitals in Kuwait was set up. Consecutive patients diagnosed as having ACS over a period of 6 months were enrolled. Of 2,129 patients enrolled, 718 [34%] had ST segment elevation myocardial infarction [STEMI], 576 [27%] non-ST segment elevation myocardial infarction [NSTEMI] and 835 [39%] unstable angina [UA]. Thrombolytic therapy was used in 556 [77%] patients with STEMI. The median time from diagnostic electrocardiogram to administration of thrombolytic therapy was 38 min. Almost all patients with ACS [2,050, 96%] received aspirin during hospitalization. Only a minority received clopidogrel, 18 [3%] STEMI, 36 [6%] NSTEMI and 96 [12%] UA patients. The use of glycoprotein llb/llla antagonists was minimal [38 patients, 2%]. beta-blockers were used in 1,473 [69%] patients, while 982 [46%] received angiotensin-converting enzyme inhibitors. Coronary angiography during hospitalization was performed in 119 [17%], 120 [21%] and 126 [15%] patients with STEMI, NSTEMI and UA, respectively. In-hospital mortality occurred in 31 [4%] myocardial infarction patients and 4 [0.5%] UA patients [p < 0.0001]. This registry has enabled us to determine the incidence and characteristics of ACS patients in Kuwait. It has also enabled us to identify some barriers that we need to overcome for the full implementation of published guidelines for the management of patients with ACS

Prevalence of cardiovascular risk factors amongst the population of Surra, Kuwait

To assess the prevalence of major cardiovascular risk factors to formulate an insight into new potential major health concern in Kuwait. A sample of 600 volunteers aged 30 years and above who lived in Surra area took part in this cross sectional study. History of chronic illnesses, weight, height, blood pressure, life style and other risk factors were recorded. A blood sample of 4 ml was also taken from each participant to determine blood sugar, cholesterol and triglyceride levels. The number of subjects with cardiovascular risk factors was exceptionally high, with about 44% being obese [BMI greater than 30kg/m2]. About 38% had cholesterol levels surpassing the acceptable levels [

Differences in the location and multiplicity of mandibular fractures in Kuwait, Canada and Finland during the 1990s

To compare the location and multiplicity of mandibular fractures in Kuwait, Canada and Finland during the 1990s. Subjects and Data were collected from several hospitals in Kuwait [1991-2000], Toronto General Hospital in Canada [1995-2000] and Oulu University Hospital in Finland [1990-1999]. The data were analyzed statistically using chi-square test, ANOVA, t test and logistic regression. Condylar fractures were more common in Finnish patients [41%] than Canadian [35%] or Kuwaiti patients [21%]. Condylar fractures caused by falls were about 3.4 times more common in Kuwait and Finland compared to Canada. In Finland the risk of road traffic accidents caused by condylar fracture was about 4 times higher than those caused by other etiologies. In Canada male gender was about 2 times higher for the condylar fracture than female gender. Female patients often had more multiple injuries than men in all three countries and multiple fractures were observed especially in traumas caused by falling. Differences in location and multiplicity of mandibular fractures are due to differences in etiologies and demographic patterns