Medication Safety Unit Programs in King Saud Medical City, 2012 – 2013: Safe Medication Management and Use with a Focus on Patient Safety.

Background: Medication safety unit [MSU] streamlines the safe management and use of prescribed medications and reduction in all types of medication errors [MEs], and associated morbidity and mortality resulting in enhanced patient safety, better quality of healthcare services and cost saving. Objective: This study aims to describe MSU programs together with their purposes developed in King Saud Medical City [KSMC], Saudi Arabia and supports them with related policies and guidelines based on qualitative evidence-based research done across the world. Methods: A mixed study was designed to define programs, roles and annual plan of MSU, which was established in year 2012. Multiple awareness campaigns and training courses were organized for highlighting the significance of MSU among healthcare providers and consumers in KSMC. Results: The MSU developed 14 programs and annual medication safety plan of actions together with respective policies, procedures and guidelines, well supported by qualitative evidence-based research data for improving safe medication management and use associated with reported reduction in MEs, and increased patient safety and quality of healthcare. Conclusion: MSU is a useful tool to encourage reporting of MEs, which are reported to increase patient safety and safe medication management and tends to decrease the number of MEs. Beside establishing MSU in all hospitals, this study calls for a randomized controlled study in future that will identify potential risk factors that impact safe medication management and are associated with patient safety not only in Saudi Arabia but also in other Arabian Gulf countries.

Feasibility of two staged newborn hearing screening and identification of risk factors for hearing loss other than those included in high risk registry (HRR) given by joint committee on infant hearing (JCIH).

Background: Hearing impairment in neonates is a hidden disability, which is usually detected around 2 years of age. Crucial speech and language development begins during first six months of life. Undetected hearing loss present from an early age can impede acquisition of speech language, communication, cognitive and social-emotional development of a child. Across the globe, there is an evolving consensus that all infants should be screened for hearing impairment and appropriate interventions should be instituted in those found to have the problem by six months of age. Most developed countries have introduced mandatory screening and interventional programme with strategies appropriate for their public health concerns. Unfortunately, in developing countries, due to the paucity of resources, infant hearing screening programme has not been introduced as national programme. There have been very few large scale hearing screening studies done in India, to know the feasibility of universal hearing screening or high risk neonate hearing screening. The present study is taken to fill in the lacune in this aspect. Aims & Objective: To study the feasibility of using two staged Transient Evoked Otoacoustic Emissions (TEOAE) followed by confirmation with Auditory Brainstem Response (ABR) in hearing screening of newborns along with an attempt to identify additional risk factors, other than those included in “High Risk Registry (HRR)” given by Joint Committee on Infant Hearing (JCIH) in 2007. Material and Methods: A prospective observational study of hearing impairment screening was conducted on 800 newborns, who were screened with two staged Transient Evoked Otoacoustic Emissions TEOAE, using handheld TEOAE device, followed by confirmation with Auditory Brainstem Response (ABR). The study was done in Command Hospital Air Force, Bangalore, during Jan 2010 to May 2011, where in all new born, born during the study period were screened, which included 757 healthy neonates and remaining 43 high risk neonates as per HRR of JCIH 2007. Additional risk factors that could affect the hearing in the normal neonates was also studied. Results: At the end of the two TEOAE tests, 15 (1.8%) neonates of the 800 cohort screened were suspected of hearing impairment and referred for ABR test. Sensorineural hearing loss was confirmed by ABR in 5 (0.6%) of those 15 referred, with a 1.2% false positive rate at the end of 2nd TEOAE. 2 of the hearing impaired infants belonged to “at risk group” neonates with remaining 3 not having any risk factor as per “High Risk Registry (HRR)” of Joint Committee on Infant Hearing (JCIH). This study showed the presence of medical conditions like maternal Urinary Tract Infection (UTI), Gestational Diabetes Mellitus (GDM) or maternal Diabetes Mellitus (DM) and Pregnancy Induced Hypertension (PIH) along with the well-known risk factors of HRR in the infants with hearing loss. But a strong association between these maternal conditions and hearing impairment could not be established due to small sample size, warranting a detailed study of these other possible risk factor. Conclusion: This study has shown that two–stage hearing screening with TEOAE & ABR is a feasible method that can be successfully implemented for newborn hearing screening, for early detection of hearing impaired, on a large scale, in hospital, to achieve the high quality standard of screening programs. 3 of the 5 hearing impaired detected in the study had no known risk factor for hearing loss, advocating universal hearing screening and an extensive efforts are required to find additional risk factors that can be included in the HRR of JCIH so as to make high risk screening more effective.

A Comparative Analysis of Electronic Prescribing Near Misses in King Saud Medical City, Riyadh, Saudi Arabia.

Background: A “near miss” or close call is a medication error that happened but did not result in injury or damage to the patient. These medication errors (MEs) are captured and corrected before affecting the patient either fortuitously or purposefully by designed system controls imbedded in electronic health record (EHR) as well as electronic prescribing systems (EPS). Objective: This study analyzed the reported electronic prescribing near misses (NMs) in King Saud Medical City (KSMC) in Riyadh city. Methods: The ME report forms were consecutively collected over a period of one year, from 1 January to 31 December, 2012. These forms were evaluated for data abstraction and a comparative analysis of NMs/NM report forms of first 6-month (n=1025, timeline 1) versus second 6-month (n=2398, timeline 2) was carried out. No systematic intervention prior to timeline 2 was used in this study. Results: The total number of MEs/NMs report forms was 3423 and total number of reported NMs was 7415, as each form could contain more than one NM. Drug prescription items, medication dispensing stages, NM makers and identifiers, underlying causes, sites of errors, prescribed drugs and suggested actions to avoid NM errors all differed significantly between the two timelines, which could be attributed to natural, real world practices in KSMC. Conclusion: This prospective study found significant differences in factors related to NMs between two six month periods in a single year. Reasons for these differences between two timeframes remain poorly understood. NMs comparative studies using systematic interventions are warranted in the Kingdom of Saudi Arabia.

A Rare Case of Idiopathic Congenital Complete Heart Block in a Neonate.

Congenital complete heart block in utero has become diagnosed more frequently with the clinical use of fetal echocardiography. Autoimmune-associated congenital complete heart block (CHB) is a rare but important disease that can now be diagnosed in utero using fetal echocardiography1,2,3,4. The overall incidence of isolated CHB has been reported to be approximately 1:15,000 to 20,000 live births5. Several reviews have shown that children diagnosed prenatally have an increased mortality compared to those diagnosed immediately after birth or later in childhood1,2,3,4. At birth, some neonate with complete heart block may remain asymptomatic and may not require a pacemaker but majority require pacemaker to increase the heart rate. We report a rare case of idiopathic congenital complete heart block in a newborn male.

Impact of adding antioxidant vitamins [A or E] with antihelmintic treatment on naturally gastrointestinal nematode infected ewes

The present study was aimed to examine the oxidative stress/antioxidant status in naturally infected ewes with gastrointestinal nematodes [GIN] after use of antioxidant vitamins such as vitamin A or E with antihelmintic treatment [ivermectin] .A total of 12 Barki ewes were chosen naturally infected with GIN, aged between [1.5 - 2.5] years, weighted between [35 -38 kg]. All ewes were treated with 2ml/50kg BW ivermectin. They were divided into three groups [n=4]. The first group was non-vitamin treated [the control group], the second group, was orally treated with vitamin A [0.5X10[5] IU/ewe/day] for four weeks, the third group was orally treated with vitamin E [75mg/ewe/day] also for four weeks. Fecal samples were collected from rectum of each ewe before the beginning of the trial and weekly after treatments. Degree of infestation was performed by fecal egg counting [FEC] and identified by fecal culture technique. Blood samples were collected from each ewe for biochemical analysis of serum lipid peroxide-Malondialdehyd [MDA], Nitricoxide [NO], total-antioxidant capacity [TAG] and glutathione-S-transferase [GST]. Ewes were weighed every two weeks till the end of the study. Four weeks post-treatment, MDA significantly [p <0.05] decreased in their levels in both vitamin treated groups in comparison to the control one, meanwhile NO showed no alterations in their levels in both treated groups in comparison to the control one all over the expermental period. Four weeks post treatment, there was significant [p <0.05] increase in the mean value of TAC in vitamin E treated group comparing with the other groups. While there were significant increase in GST level after the second and the fourth weeks in vitamin E treated group. It was concluded that vitamin E should be used at least 2 weeks with other antihelmintic protocols in order to obtain a more effective and earlier cure against GI parasites in infected sheep for improving their health and reproductive performance

Autopsy study of pediatric deaths.

OBJECTIVE: Childhood autopsies occurring during January 1997 to December 1999 were reviewed. METHOD: Of the total 1,445 deaths autopsied, 441 (30.5%) were of pediatric patients. RESULT: Of these deaths, 70.3% occurred during neonatal period, 8.6% in infancy, and 21.1% in childhood. Birth asphyxia (57.7%) was the most frequent mode of death in the neonatal period. Infections (67.2%) predominantly accounted for infant and childhood mortality, those of respiratory tract (46.1%) being most frequent in infancy, early and mid childhood, and enteric fever in late childhood (33.3%). Discrepancy between ante-mortem and post-mortem diagnosis occurred in 29 cases (6.6%). CONCLUSION: Autopsy is an important clinical tool providing useful information to the physician. Few published reports are available on pediatric autopsies. This study aims to help in a better understanding of causes of deaths in neonates, infants and children.

Cardiomyopathy in children in Ahmedabad.

A clinical study and follow up of 20 children with cardiomyopathies upto age of 16 years are presented. The DCM was most common variety followed by RCM and HCM in pediatric age group. SHMD presenting with cardiomyopathy were common in infancy and early childhood. Cardiomyopathies presented most frequently between 2-5 years and 10-16 years age group with DCM having almost equal distribution. Clinical presentation of various types is described, despite of vigorous decongestive and vasodilator treatment in advanced cases, course was rapidly downhill and prognosis is poor in general.

Distribution frequency of various types of myelodysplastic syndromes

Twenty-seven patients [3-70 years old, 17 males and 10 females, 3 pediatrics and 24 adults] were diagnosed as MDS among 1520 acute and chronic leukemia cases referred to the National Cancer Institute [NCI], Cairo University, over the period from 1983-1987. All cases were subjected to clinical and hematological studies. According to the FAB criteria, the cases were classified as follows: One case [4%] had refractory anemia [RA], 8 cases [30%] had refractory anemia with excess blasts [RAEB], 16 cases [59%] had RAEB in transformation [RAEB-T], and 2 cases [7%] had chronic myelomonocytes leukemia [CMML]. The majority of the patients were under 50 years [15/24], in contrast to previously published reports. The median survival for the entire group was 10 months RA; 4 RAEB; 10 RAEB-T; 9 and CMML; 12 months. Shorter survival was observed in patients with marrow dysplasia involving the three cell lines [5.57 months]. Acute leukemia developed in 15 cases [55%], 3 cases of RAEB [11%] and 12 cases of RAEB-T [44%], while 37% of cases died from infection [RA 4%, RAEB 15%, RAEB-T 11% and CMML 7%]. The present study showed that among the MDS cases, the majority belonged to RAEB and RAEB-T subtypes. However, this observed high frequency could be due to the small number of patients with refractory anemia [RA] and refractory anemia with ringed sideroblasts [RARS] referred to the institute

Leucoctye acid phosphatase in haematologic disroders

Variations in the level of scores and reaction patterns of the acid phosphatase [APh] activity were estimated in blood films of 60 patients with various hematologic disorders and 30 normal controls using the azo-dye method of Goldberg and Barka [1962] with some modifications. The percentage of lymphocytes showing dot-like APh. Positivity was high in disseminated lymphoblastic lymphoma [T cell pattern], but low in acute and chronic lymphatic leukaemia [Non T pattern]. These findings are considered an additional proof to the validity of APh. As a cytochemical marker for the recognition of T-lymphocytes in malignant lymphoproliferative disorders. Also, our study showed that APh. May be helpful in the detection of remission in malignant lymphoma. Neutrophil APh. Activity is increased in malignant lympho-proliferative disorders, myeloproliferative disease, bacterial infection and leukaemoid reaction