Adoption of Electronic Medical Records in Healthcare Facilities in the Emirate of Dubai.

OBJECTIVES: This paper aimed to assess the adoption of electronic medical records (EMRs) in healthcare facilities in Dubai, the largest city in the United Arab Emirates (UAE) and a location where extensive healthcare services are provided. It explored the challenges, milestones, and accomplishments associated with this process. METHODS: A situation analysis was conducted by contacting 2,089 healthcare facilities in Dubai to determine whether they had implemented EMR in their medical practices and to identify the challenges they faced during this process. Additionally, the Electronic Medical Record Adoption Model (EMRAM) was utilized to measure the maturity level of hospitals in terms of EMR adoption. The EMRAM stages were rated on a scale from 0 to 7, with 0 representing the least mature stage and 7 the most mature. RESULTS: By September 2023, all hospitals (100%, n = 54) and 75% of private clinics (n = 1,460) in Dubai had implemented EMRs. Several challenges were identified, including the absence of EMRs within the healthcare facility, having an EMR with a low EMRAM score, or the lack of a unified interoperability standard. Additionally, the absence of a clear licensing program for EMR vendors, whether standalone or cloud-based, was among the other challenges noted. CONCLUSIONS: EMR implementation in healthcare facilities in Dubai is at a mature stage. However, further efforts are required at both the decision-making and technical levels. We believe that our experience can benefit other countries in the region in implementing EMRs and using EMRAM to assess their health information systems.

Knowledge, Attitudes, and Willingness regarding Organ Donation in a Muslim Country: A Report from the United Arab Emirates.

In Islamic countries, many religious scholars have allowed organ transplantation. However, ethical judgments on organ transplantation are disputable and unpredictable. Therefore, opinions about organ transplantation depend on personal beliefs, as well as religious faith, cultural convictions, and sociocultural factors, which deserve discussion and study. The objective of this study was to assess the knowledge of and attitudes toward organ donation in a multicultural society such as Dubai. A questionnaire was designed by a multidisciplinary team through a review of the literature. Participants were approached from October 2018 until September 2019. Our study showed a poor general knowledge of organ donation overall (447, 66%) and low awareness of the organ donation laws and regulations in the United Arab Emirates (UAE) (376, 55%). Most respondents mentioned that they were not willing to register to be an organ donor (393, 58%); nevertheless, they would accept an organ donation (347, 51%), even from a recently deceased person if required (376, 55%). The UAE faces scarcity among plenty as far as organ donation is concerned. Our study identified several consistent themes regarding barriers to organ donation among people in the UAE. The ever-increasing demand for organs can only be met by a multidisciplinary approach to educate the public and health-care providers further.

Digital Health Technology for Remote Care in Primary Care During the COVID-19 Pandemic: Experience from Dubai.

Introduction: We aimed to provide an insight on the feasibility and impact of telemedicine use among primary health care (PHC) providers and on nonurgent health care delivery during the coronavirus disease 2019 (COVID-19) outbreak in the United Arab Emirates (UAE). Methods: This observational study was conducted using telemedicine data from Dubai Health Authority from January 2020 to July 2021. Results: Of 123,944 individuals who booked an appointment for the telemedicine service, 106,408 (86%) showed up. Most patients were 19-59 years old, UAE nationals, female, and having government insurance. The telemedicine care volume grew from 188 visits in January 2020 to 11,757 in April 2020. The most common diagnosis was general health consultation (55,672; 52%), followed by COVID-19-related consultation (18,523; 17%) and laboratory test requests (11,064; 10%). Around 4,997 (5%) telemedicine consultations were for a medication refill. A multiple linear regression model predicting the types of diagnosis-related telemedicine needs by age and the interaction of gender and nationality was statistically significant for dermatology (p = 0.0000), respiratory (p = 0.0000), and cardiovascular (p = 0.0000) diseases. Conclusions: Virtual care services in PHC clinics have been highly successful in meeting the needs of patients during the COVID-19 pandemic. Telemedicine has enabled clinicians to continue providing care to patients while maintaining the necessary public health measures adopted in the fight against COVID-19. However, will the switch to telemedicine be sustainable in the long term and what will be the level and degree of telemedicine adoption beyond COVID-19? This requires more studies to explore how the PHC organizations will provide further support and guidance on the suitability of telemedicine in various circumstances and clinical conditions.

Factors associated with knowledge and practice of optimal breastfeeding among mothers in Dubai.

Although breastfeeding has been the primary source of nutrition for infants, many women do not choose to practise breastfeeding due to lack of knowledge, inability to do so or personal choices. This study aimed at determining the breastfeeding practices and examining the sociodemographic factors associated with optimal breastfeeding among mothers attending child welfare clinic at Dubai Health Authority. A structured questionnaire was designed consisting of sociodemographic data, knowledge, attitude and practice towards breastfeeding. The main reasons for not breastfeeding the baby within 30 min after delivery were having had a caesarean section, followed by separation of the baby from the mother. We found better practice among homemakers, non-United Arab Emirates (UAE) and married women, those with less monthly income, and those with standard delivery. There is a need for better education on optimal breastfeeding, especially in UAE national pregnant women, who have had caesarean sections, or having babies admitted in the intensive care unit.

Population awareness of cardiovascular disease risk factors and health care seeking behavior in the UAE.

OBJECTIVES: We aimed to determine the awareness, knowledge, and attitude of people residing in Dubai, United Arab Emirates, regarding cardiovascular disease (CVD) risk factors. Our aim was to further identify prospects to increase awareness of modifiable CVD risk factors and influence behavior. METHODS: This observational study was conducted in Dubai: a global city in the United Arab Emirates. Participants were selected using simple randomization approach in primary health care centers, and a questionnaire was implemented based on literature review. RESULTS: Out of 1020 individuals approached, 738 agreed to participate in the study (response rate of 72%).The majority of participants surveyed had good knowledge and attitude toward CVD (528, 71.5% and 445, 60% respectively); yet, poor/fair practice related to CVD risk factors (553, 75%). Predictive Margins of Knowledge Scores were significant for age (p<.01), academic level (p<.0001), and nationality (p<.0001) (Table 5). Participants aging 40-49, non-UAE subjects, and university/Postgraduate academic level scored better on the knowledge. Demographics predictor for practice score was highly significant for age (p=.0001) and BMI (p=.0001). Those aging ≥50 and obese participants scored higher on practice toward CVD risk factors. Knowledge score was significant predictor of practice and attitude toward CVD risk factors (p=.0001, p<.0001). CONCLUSIONS: Although more than half of the current study participants had high knowledge and attitude toward CVD, their behaviors were not satisfactory. It is necessary to establish more effective educational interventions intended to promote positive health behaviors. Public health providers need to explain to the public that knowledge and proper actions regarding the reduction of risk factors are associated with reduced CVD and mortality.

The Pupillary Light Reflex as a Biomarker of Concussion.

The size of our pupils changes continuously in response to variations in ambient light levels, a process known as the pupillary light reflex (PLR). The PLR is not a simple reflex as its function is modulated by cognitive brain function and any long-term changes in brain function secondary to injury should cause a change in the parameters of the PLR. We performed a retrospective clinical review of the PLR of our patients using the BrightLamp Reflex iPhone app. The PLR variables of latency, maximum pupil diameter (MaxPD), minimum pupil diameter (MinPD), maximum constriction velocity (MCV), and the 75% recovery time (75% PRT) were associated with significant differences between subjects who had suffered a concussion and those that had not. There were also significant differences in PLR metrics over the life span and between genders and those subjects with and without symptoms. The differences in PLR metrics are modulated not only by concussion history but also by gender and whether or not the person has symptoms associated with a head injury. A concussive injury to the brain is associated with changes in the PLR that persist over the life span, representing biomarkers that might be used in clinical diagnosis, treatment, and decision making.

Pregnant women's perceptions of physical activity: Adaptation of the pregnancy physical activity questionnaire in Dubai, a multicultural society.

BACKGROUND: There are major health benefits of physical activity (PA) during pregnancy, yet there is scant data about a woman's knowledge and understanding of these benefits globally. DESIGN AND METHODS: We aimed to evaluate the knowledge, attitude, and practice of pregnant women in the United Arab Emirates concerning exercise.   We wanted to investigate why some women exercise while others do not exercise during pregnancy. We used a cross-sectional study using a paper-based questionnaire involving pregnant women at antenatal clinics in the Dubai health Authority. The Modified form of Pregnancy Physical Activity Questionnaire (PPAQ) was adapted in both Arabic and English and used in this study. RESULTS:  Women aging 25-35 that had a higher educational level, were employed, having 1 or 2 previous pregnancies, and having better knowledge on the benefits of Physical Activity (PA) during pregnancy had better exercise profiles. CONCLUSIONS: Our results demonstrate that the majority of the women that participated in our study were shown to have low PA during pregnancy. Better education and communication of the benefits of PA during pregnancy are needed to improve exercise among pregnant women in the UAE population. We found that improved education of women specific to PA with involvement of a healthcare provider were associated with an increase in PA during pregnancy.

Large variations in disease severity, death and ICU admission of 2993 patients infected with SARS-CoV-2: The potential impact of genetic vulnerability.

BACKGROUND: The COVID-19 pandemic has had an immeasurable impact, affecting healthcare systems, the global economy, and society. Exploration of trends within the existing COVID-19 data may guide directions for further study and novel treatment development. As the world faces COVID-19 disease, it is essential to study its epidemiological and clinical characteristics further to better understand and aid in its detection and containment. METHODS: We aimed to study the clinical characteristics of patients infected with COVID-19 in Dubai, a multi-national Society. RESULTS: Our findings demonstrate that during the first wave of the COVID-19 epidemic, age, gender, and country of origin were associated with more severe cases of COVID-19, higher risk for hospitalization and death. Male individuals between 41 and 60 years of age from India had the most significant hospitalization and death predictor (p=.0001). The predictors for COVID-19 related deaths were slightly less than UAE Nationals by individuals from GCC (p=.02) that were followed closely behind by Pilipino (p=.02) and Arabs (p=.001). CONCLUSION: The vulnerability of individuals to infection and in the spectrum of COVID-19 symptoms remains to be understood. There are large variations in disease severity, one component of which may be genetic variability in responding to the virus. Genomics of susceptibility to COVID-19 infection and the wide variation in clinical response to COVID-19 in patients should become active investigation areas.

Intravenous methylprednisolone with or without tocilizumab in patients with severe COVID-19 pneumonia requiring oxygen support: A prospective comparison.

BACKGROUND: Cytokine storm is a marker of severity and severe mortality in patients with coronavirus disease 2019 (COVID-19) pneumonia. Immunomodulatory treatments may reduce morbidity and mortality. OBJECTIVES: To determine whether a 7-day course of methylprednisolone (MP) administered with and without tocilizumab improves outcomes in patients with severe COVID-19 (SARS-CoV-2) pneumonia requiring oxygen therapy, relative to historical controls. STUDY DESIGN AND METHOD: In this randomized controlled study, patients hospitalized with severe COVID-19 at Rashid Hospital, Dubai, in June 2020 were randomized 1:1 to receive intravenous MP (40 mg twice daily for 7 days) with or without a single dose of intravenous tocilizumab (400 mg). While data from the control arm, consisting of patients administered usual care, were obtained through retrospective review of their electronic medical records. The patients in the three arms were matched by disease severity and inclusion and exclusion criteria. The primary outcomes were day 45 all-cause mortality after randomization, rate of admission to the intensive care unit (ICU), length of ICU stay, days on ventilators, and length of hospital stay. RESULTS: In total, 76 patients were recruited, including 23 treated with MP, 26 with MP plus tocilizumab, and 27 historical controls. The rates of admission to the ICU and invasive mechanical ventilation were lowest in patients treated with MP alone, with the rates in this group being significantly lower than the rates in the control group (p = 0.04). Time on a ventilator was lowest in the MP group (1.09 ± 3.68 days) and highest in the control group (7.93 ± 14.86 days). The number of days in the ICU was significantly lower in the MP group than in the control and MP plus tocilizumab groups (p = 0.043). One patient (4.3%) in the MP group and five (18.5%) in the control arm died within 45 days. Survival was highest in patients treated with MP alone, with the addition of tocilizumab not improving survival or any of the other outcomes significantly. INTERPRETATION/CONCLUSION: In patients with severe COVID-19 pneumonia on oxygen support, administration of MP daily for 7 days had reduced mortality at 45 days and was associated with significantly lower ICU admission and ventilation rates compared with usual. Adding tocilizumab to MP did not improve any of the studied outcomes significantly.

Women's knowledge and awareness on menopause symptoms and its treatment options remains inadequate: a report from the United Arab Emirates.

OBJECTIVES: We aimed to evaluate the awareness, knowledge, and perception of middle-aged women regarding menopause and hormone therapy (HT). METHODS: This observational study was conducted on pre-, peri-, post-, and surgically menopausal women (n = 591) from January 2020 until June 2020 in Dubai. A structured questionnaire was developed based on previous literature to assess participants' knowledge and awareness of menopause and HT. The questionnaire was implemented by face-to-face interview. Factors associated with the degree of menopausal knowledge were identified. RESULTS: Majority (498, 82%) of participant women had fair to poor overall knowledge on menopause, did not know whom HT is used for (404, 48%), and for whom it is contradicted (455, 77%). Knowledge on menopause and HT was highly associated with better attitudes (P < 0.001 and P < 0.001, respectively).Furthermore, the greater the knowledge on menopause, the better the knowledge of HT (P < 0.001). Education was the primary factor that played a significant role in having better knowledge or attitudes. Nationality showed an association with better attitudes on menopause, with non-Arabs having better attitudes than Arabs and UAE nationals. CONCLUSIONS: Community medicine educators and primary healthcare providers need to prepare tailored premenopausal and postmenopausal educational interventional programs for further educating women and preparing them for this phase of their lives.

Barriers to healthcare seeking, beliefs about ovarian cancer and the role of socio-economic position. A cross-sectional multilevel study in Dubai, a multicultural society.

BACKGROUND: Studies have shown that public awareness of ovarian cancer is weak, and women are often diagnosed at late stages when treatment is difficult. This study aimed to determine the barriers for seeking early medical care and level of knowledge and awareness among women regarding ovarian cancer. DESIGN AND METHODS: A structured questionnaire was designed and adapted from the validated cancer awareness measure. RESULTS: The recognition level of ovarian cancer symptoms among women in this study varied from 12-51%, and the most alarming ones, back pain, eating difficulties, and persistent abdominal pain, were missed by most of the surveyed women. The most recognized ovarian cancer risk factors were never being pregnant, having a history of infertility, and going through menopause, while the least recognized was having personal or family history of breast cancer. Non-UAE nationals women with higher educational levels had better knowledge of ovarian cancer compared to their peers. CONCLUSIONS: A change or implementation model is highly recommended in order to improve women's awareness of ovarian cancer symptoms. Strengthening education among women with regards to risk factors, early symptoms, and the need to seek early medical help should help to increase ovarian cancer awareness and reduce a delay in the diagnosis.

A review of gestational diabetes mellitus management, risk factors, maternal and neonatal outcomes in two major maternity hospitals in the United Arab Emirates: A report from Dubai.

OBJECTIVES: This study was conducted in order to explore and analyze the status of gestational diabetes (GDM) amongst pregnant women in Dubai, United Arab Emirates (UAE); a country with high prevalence of diabetes. We aimed to describe GDM-associated risk factors and clinical outcomes of pregnant women and their neonates. Our objective was to contribute to the broader literature on reproductive health disparities and to inform efforts to improve GDM care at our region. METHODS: Chart review of case records were used to collect data on both maternal and neonatal parameters and outcomes during the specified study period from two main maternity hospitals in Dubai. RESULTS: UAE national women with GDM were more prone to be obese or overweight compared to non-UAE women (p < 0.0001, and p < 0.0001 respectively). In addition, UAE national women with GDM had higher history of GDM in previous pregnancies (p < 0.0001) and more family history of diabetes (p < 0.0001).The neonate admission into NICU was significantly associated with cesarean section (p < 0.0001), twins (p < 0.0001), preeclampsia (p = 0.02), receiving MgSO4 (p = 0.02), birth weight less than 2500 g (p < 0.0001), low Apgar scores (p < 0.0001), baby with congenital anomaly (p < 0.0001), and neonatal hypoglycemia (p < 0.0001). CONCLUSIONS: Our results demonstrate that pregnant women with GDM who are UAE nationals and have higher parity need to be under special attention during their pregnancy in order to improve both maternal and neonatal outcomes.

Association between knowledge, awareness, and practice of patients with type 2 diabetes with socio-economic status, adherence to medication and disease complications.

AIMS: Diabetes is a self-managed condition; knowledge, attitudes, and practices about the condition can influence the overall treatment outcomes and complications of the disease. The aim of this study was to assess the knowledge, attitude, and practice toward diabetes among T2DM patients in the UAE, a highly prevalent country with diabetes. METHODS: We used the revised Michigan Diabetes Knowledge Scale on T2DM patients. The awareness on diabetes was then assessed based on socio-demographic characteristics, illness perceptions, medication adherence, diabetic self-care, and T2DM complications. RESULTS: Overall assessment of T2DM patients on their knowledge, and attitude toward their diabetes were good in the majority of participants (544, 76%; 570, 76% respectively). However, adherence to diabetic self-care practices was fair in the mainstream (437, 57%). The compliance to medication (527, 70%) and eye care practice (475, 63%), were quite high; yet regular checking blood sugar at home 330 (44%) and the foot care practice 336 (45%) were not satisfying. CONCLUSION: Our results demonstrate that the intensive education service being given and time the physician spends with the T2DM patients is highly associated with better practice and outcome of the disease. There is a need for the establishment of better DM education programs in PHC clinics and the development of more campaigns and enlightening programs, both for health care providers and public on T2DM self-care, complications, and nature of the disease. We suggest that new policies be established with a focus on increasing community awareness of diabetes and preventive measures in UAE.

Perceived Academic and Psychological Stress among Adolescents in United Arab Emirates: Role of gender, age, depression, and high expectation of parents.

INTRODUCTION: Academic learning is the most important source of stress among young students worldwide and appears to be quite severe in eastern countries. We aimed to examine the relationship between academic stress and depression among adolescents. METHODS: A cross-sectional study was conducted among adolescents in United Arab Emirates using the Perceived Stress Scale - 14 (PSS-14) and Educational Stress Scale (ESS) for Adolescents (English and Arabic versions). RESULTS: The overall PSS was high in 186 (20%) of the respondents, and moderate in 695 (76%). A multiple regression model of predictors of the PSS showed statistically significant correlations between the total PSS-14 scores and age (p<0.0004), gender (p<0.0001), and grade (p<0.001). A multiple regression model of the PSS-14 questionnaire as predictors of the ESSA revealed that Four variables on PSS-14 were statistically significant predictors of the ESSA: history of depression (p<0.0001), content with academic achievement (p<0.0001), high academic expectation of parents (p<0.003), and a believe capable of meeting parental expectations (p<0.0001). CONCLUSIONS: Adolescents with severe academic stress need to be identified early. We suggest that an interdisciplinary team in the schools including student advisors and counselors be developed to further address stressors. In addition, students should be taught different stress management techniques such as cognitive behavioral skills to improve their ability to cope with school demands. The identification of stressors may lead to strategies that might address the quality of teaching and mental health evaluation among adolescents.

Pattern and determinants of contraceptive usage among women of reproductive age in the United Arab Emirates.

INTRODUCTION: Women in the UAE and Muslim countries are a largely understudied population with significant disparities in knowledge to most basic health concerns and family planning. Our objective was to identify UAE contraceptive knowledge similarities and variances to other world regions, and to inform efforts to improve contraceptive care at Arab world and Muslim countries. METHODS: Structured questionnaire consisting of socio-demographic characteristics, knowledge, beliefs and attitudes related to contraception methods. RESULTS: The use of effective contraception methods was associated with higher educational levels of UAE national women who desired to conceive. These women had knowledge of contraception that was associated with an identified impact of their spouse on their choice of contraception. Religion plays an essential role in knowledge on the risk of contraception and safe type of contraceptive methods in the UAE. Statistically significant predictors of having knowledge on different methods of contraception were nationality, P < 0.002; education level, P < 0.03; number of marriages P < 0.002; monthly income, P < 0.04; and the number of children, P < 0.015. CONCLUSIONS: Our results demonstrate that higher education and communication of the benefits and risks of different types of contraceptive methods are needed to improve the use of contraception in the UAE population. We recommend additional training in this area for healthcare providers. The involvement of the spouse in the mutual understanding of contraception and its choice coupled with third party insurance coverage may decrease knowledge and utilization gaps further assisting in providing a best contraceptive method.

Prevalence of Undiagnosed Depression in Patients With Type 2 Diabetes.

Introduction: Type 2 Diabetes Mellitus (T2DM) is the most prevalent type of diabetes among adults and constitutes around 90% of all cases. Substantial evidence demonstrates that depression in the context of diabetes is associated with a wide range of adverse consequences such as reduced adherence to the prescribed treatment regimen, lower quality of life, higher fasting glucose and HbA1c levels, and higher health expenditures. Methods: This study was conducted to assess the depression among T2DM patients attending diabetic clinics, primary healthcare centers (PHC), Dubai Health Authority (DHA). Depressive symptoms were assessed by using both Arabic and English version of the Beck Depression Inventory. Results: Out of 1,050 diabetic patients approached, 559 were within our inclusion criteria and agreed to participate in this study (Response rate of 53%). The mainstream of the participants had T2DM for <10 years (393, 70%), were under oral hypoglycemic treatment only (479, 86%), and had good medication adherence (526, 94%). The overall depression prevalence using a cutoff of 16 was 17%. When we assessed the level of depression amongst participants in association with their sociodemographic and clinical characteristics, there was a significant difference between age groups (p < 0.00001); gender (p < 0.0001); nationality (p < 0.00001); educational level (p < 0.00001); and employment status (p < 0.0001). The type of clinic in which the T2DM patients were attending (e.g., diabetes mini-clinic vs. General Family Clinic) was also significantly associated with depression (p < 0.0001). Conclusion: Our results demonstrate that the intensive service being given in a diabetes mini-clinic compared to routine PHC clinics appears to benefit the psychological aspects of T2DM patients in the UAE population resulting in a lower incidence of depression than commonly seen in a diabetic population. We have identified a need for the establishment of these mini-clinics in each PHC clinics; and the development of campaigns and educational programs, both for health care providers and the public to decrease depression in T2DM patients in this region.

Implementing Resident Research Program to Enhance Physicians Research in the United Arab Emirates.

OBJECTIVES: The Dubai Residency Training Program (DRTP) commenced in the year 1993; then, a "Residency Research Program (RRP)" has implemented from 2011 to promote research among young physicians. This study was conducted by the Dubai Health Authority to review the RRP to assess its effectiveness in meeting original objectives and generating desired outcomes. METHODS: Source documents such as the chronicles of the DRTP, communication between the stakeholders, resident feedback, research director, and program director reports were accessed and retrospectively reviewed. RESULTS: Seven research workshops and ten advanced statistics courses were held. Ten scholarships were provided to the residents for "Introduction to Clinical Research Training" held by Harvard Medical School. Of 370 residents, a total of 156 residents submitted their research proposal, of which 128 residents presented their thesis. Nineteen residents presented their research on international conferences, 12 published their study, and 9 got award locally. CONCLUSIONS: Efforts are focused on improving the quality of the research projects, as well as getting residents involved in research that leads eventually to publication. Research is a major component of DRTP; nevertheless, it is challenging for residents to conduct research successfully because of some barriers inherent in residency training. This experience was the first in the United Arab Emirates, and we believe that this paper will contribute to the integrating research in residency programs by the educators and academics in across countries within the region.

Exploring Obstetrical Interventions and Stratified Cesarean Section Rates Using the Robson Classification in Tertiary Care Hospitals in the United Arab Emirates.

OBJECTIVE: The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. METHODS: Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). RESULTS: The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS. The rate of vaginal birth after cesarean was 261 (6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. CONCLUSION: The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

Exploring obstetrical interventions and stratified cesarean section rates using the Robson classification in tertiary Care hospitals in the united arab emirates

Abstract Objective The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. Methods Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). Results The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS.The rate of vaginal birth after cesarean was 261(6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. Conclusion The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

Evolution of the Dubai health authority's residency training program: A 25-year review, challenges and outcomes.

BACKGROUND: The Dubai Residency Training Program (DRTP) is a structured postgraduate educational training program started on 1992 to improve healthcare in the United Arab Emirates (UAE) through education and training; align doctors' training in the UAE with internationally recognized standards; deliver educational best practice; and achieve a balance between clinical service delivery and continuing professional development. The aim of this paper is to review the experiences, challenges and outcomes of the DRTP over the last 25 years. METHODS: All documentation relating to the DRTP was reviewed and reevaluated. RESULTS: The DRTP has become a very solid foundation; yet, one of the major challenges we are facing is containing the balance between the health service and education. Another challenge is that our capacity for training is limited, in spite of demand, we are not yet able to open all specialties needed in the UAE. Finally, there is a mandate to separate the educational body from service to better govern the education. CONCLUSIONS: The time has come, however, for the UAE to have its own medical specialty board. This would further support high quality, comprehensive specialty training to deliver the bespoke workforce required by the Dubai Health Authority. The concept of structured training where the resident knows what, when, and how to learn the required knowledge and skills is already established, and the UAE has the required numbers of highly trained professionals to form the board. Nevertheless, we should neither be complacent nor underestimate the challenges that remain to deliver the UAE specialty board.