Impact of an electronic medical record-based automated screening program for critical congenital heart disease: Emirates Health Services, United Arab Emirates.

BACKGROUND: Almost eight children per 1000 live births are expected to have a congenital heart defect globally. The seven most critical congenital heart conditions that cause severe compromise on the patient's quality and duration of life are collectively referred to as the Critical Congenital Heart Diseases (CCHD). CCHD is a critical condition that requires prompt detection and intervention as a life-saving measure. Pulse oximetry is a non-invasive, highly specific, and moderately sensitive method that can be used for screening new-borns for CCHD. The Emirates Health Services (EHS), UAE, adopted a strategy of developing a stringent program for newborn screening of Critical Congenital Heart disease, which would help in the early diagnosis and treatment of CCHD patients. An automated EMR (Wareed) driven solution was introduced to enhance this program as part of the routine workflow for the nurse care providers. METHODS: Our study is a retrospective observational study that aims to understand: the prevalence of CCHD in our target population and to study the impact of an automated program on screening compliance and its implications for early diagnosis of CCHD. RESULTS: We found that an EMR-driven automated screening program was highly effective in achieving high compliance (98.9%). It created a (statistically significant) improvement in the disease identification for CCHD in live births at EHS facilities. CONCLUSION: We conclude that implementing an automated protocol through the EMR can effectively improve new-born screening coverage. It reduces the days to CCHD diagnosis, which would improve health outcomes in neonates.

Triage Accuracy and Its Association with Patient Factors Using Emergency Severity Index: Findings from United Arab Emirates.

INTRODUCTION: The Ministry of Health and Prevention of the UAE acquired an electronic medical record system (Wareed) through which they incorporated the Emergency Severity Index as the standard triaging tool. This raised the need to review population dynamics and the accuracy of triage performed by the health-care providers utilizing the tool. OBJECTIVE: This research aimed to study demographics and dynamics of the population presenting to emergency departments (EDs) during 2018, evaluate the accuracy of triage assessment using comparative analysis techniques, and determine relationships between patient factors (severity of illness, age-group) and the accuracy of triage. METHODS: This was an observational study that aimed to ascertain findings from ED data over 1 year (January 2018-December 2018) and explore factors associated with reduced accuracy in acuity assignment. We employed comparative analysis to measure the level of agreement between standard guidelines and local findings. RESULTS: A total of 576,154 patients visited EDs in 2018, of which 54.4% were male. A statistically significant increase in length of stay with increasing severity of illness was observed (Kruskal-Wallis test). Overall triage accuracy was 41.6%, with a positive association with increasing severity of illness. We found a positive association between severity of illness and accuracy of triage (OR 0.14, p=0). We also found on logistic regression that the age-group 11-20 years had the highest probability of accurate triage acuity (R 2=0.41, p=0). CONCLUSION: Conducted on a very large data set from the UAE, our study reflects upon population dynamics and triage accuracy distribution among different variables. This study paves the way for further in-depth analysis of factors that may impact triage accuracy within EDs, and utilizing a similar approach it can be replicated in other settings as well.

Improved efficiency and patient safety through bespoke electronic thalassaemia care module.

OBJECTIVES: To investigate the impact of electronic medical record (EMR) on improvement of healthcare parameters in a thalassaemia centre located at the Fujairah Hospital, Fujairah, UAE. MATERIALS AND METHODS: A hospital-wide EMR system (Wareed) was implemented across the hospitals in the Ministry of Health and Prevention, UAE, including two major thalassaemia centres. We aim to investigate the impact of this intervention across a number of healthcare parameters over two quarters (before and after implementation of the system). RESULTS: Since preimplementation data were not available for one facility, comparisons were made between parameters in two quarters in Fujairah hospital only. After introduction of Wareed, we found an increase in number of appointments (12%) (p=0.00), decrease in the number of appointment cancellations due to non-availability of blood products (p=0.02), reduction in the time to cannulation (p=0.00), decrease in number of physician days (p=0.295) among other parameters observed. DISCUSSION: Research shows that EMR systems have a positive impact on reduction in medical expenditure, improvement of healthcare quality and overall health outcomes. thalassaemia is highly prevalent in the Middle Eastern countries and drains the medical, social and financial resources of these nations. Our study is an attempt to create an insight into the difference in healthcare parameters before and after introduction of the system. CONCLUSION: Being the first of a kind in this region, our study created favourable evidence that introduction of an EMR has an overall positive impact on the healthcare delivery system for thalassaemia care.

Sex-based difference in the perception of exercise and level of physical activity among residents of Karachi City, Pakistan.

OBJECTIVES: To identify sex-based differences in the perception of benefits and barriers toward exercise and to determine the sex- and age-based differences in the level of physical activity (PA) among adult residents of Karachi. METHODS: Three hundred adult individuals were included in cross sectional survey conducted during July-October 2010. Perception of benefits and barriers to exercise and the level of PA were measured through a questionnaire. Differences in the perception of benefits and barriers of exercise and level of PA were calculated with age and sex strata. RESULTS: Women perceived more barriers to exercise than men (P-value < 0.001). In all age strata women have higher ranks for domestic-related physical activity while men have higher ranks for job-related PA. Leisure time PA were significantly lower for females in all age groups. Total PA is also affected by age and socioeconomic status, higher among people having monthly income < 6000 rupees and lower in males > 45 years of age. CONCLUSION: Sex-based differences exists in the level of PA and perception regarding exercise in mega city of Pakistan. There is a need to design programs that influence PA determinants connected to sex to prevent impending epidemic of non communicable diseases.

Tobacco cessation counselling for women in rural Sindh: is it being offered?

BACKGROUND: Tobacco is the single leading and most preventable cause of death in today's worlds and responsible for six of the eight leading mortality causes in the world. Diseases related to tobacco use are known to cause about 5.4 million deaths every year, 80% of which are contributed by the developing world, and this toll is estimated to increase up to 8 million deaths per year by 2030. This study was conducted to determine the number of women who were offered counselling regarding cessation of tobacco use by all health care providers (medical and alternate), in rural Sindh, Pakistan. METHODS: This cross-sectional survey was conducted during January to March, 2008 in District Khairpur, Sindh, Pakistan. A validated, pre-tested, translated questionnaire was used to collect the data from 502, adult women (aged between 18-60 years). These women were asked about the type of health provider they visited in the past 12 months and practices of provider regarding tobacco control including cessation and advice. RESULTS: A large majority of women (nearly 71%) were illiterate, and 44% of women were in the age group 18-24 years. High prevalence (10%) of adult women were smokers. Only 12% of the total women who visited physicians during this time period were asked about their smoking status as compared to 7% who visited hakims and 13% who were approached by lady health visitors. CONCLUSION: A very small segment of the women users of health care system is enquired and counselled about tobacco use in any form by the health providers in Rural Sindh. Revisiting practices for health care professionals is urgently needed to address inevitable tobacco use in the region.