Cadaveric device-injected very high-viscosity cement during vertebroplasty.

INTRODUCTION: Cement extravasation during vertebroplasty (VP) is the most commonly reported complication. Cement viscosity is considered the single most important predictor of the risk of extravasation. Certainly, injecting high-viscosity cement (HVC) is difficult to utilize in real practice. We invented a new device capable of injecting high-viscosity with ease and at a distance to avoid radiation. The aim of this study is to confirm the efficacy and safety of the new device on cadaveric vertebrae. METHODOLOGY: A 126 osteoporotic vertebral bodies were harvested from cadavers. Eighty vertebrae were included in the study. Computer-randomization software was used to allocate specimens over two main groups, Conventional VP and New Device. Both groups were further subdivided into two subgroups; high-viscosity and low-viscosity. A custom device was used on each vertebra to induce a compression fracture. RESULTS: Injecting HVC was associated with a lower leakage volume compared with low-viscosity cement. HVC was associated with no leakage into the spinal canal. It was also associated with a low incidence of vascular extravasation (P < 0.001). The mean volume of cement leakage in the low-viscosity group was 0.23 and 0.15 cc, for the Conventional VP and New Device, respectively. In both groups, the most common site for leakage was the vertebral end plate, which was exhibited more in the low-viscosity group (71.5%) compared with the high-viscosity group (42.5%). The preset target amount of cement to be injected was reached in 99% of the time when injecting HVC with the New Device, compared with 62% using the Conventional VP. In both groups, there was no correlation between the amount of cement injected and the amount of leakage. CONCLUSION: The new device is capable of injecting HVC easily, with a lower incidence of cement leakage. It also minimized the risk of radiation exposure to the surgeon.

Acceptance of pharmaceutical gifts. Variability by specialty and job rank in a Saudi healthcare setting.

OBJECTIVE: To examine the variability in accepting different types of gifts by clinical specialty as well as job rank among physicians working in Saudi Arabia. METHODS: This cross-sectional study was carried out between March and July of 2012 in different regions of Saudi Arabia. A self-administrated questionnaire was developed and administered to all participants, both in paper and electronic formats. RESULTS: A total of 281 participants answered the question `do you accept pharmaceutical gifts and/or promotions?` Most of the participants (80.1%) admitted acceptance of pharmaceutical gifts of any type. The most common gifts accepted were free drug samples (58.2%), stationary items such as pens and notepads (52.9%), free meals (37.8%), financial support to attend educational activities (33.3%), prepaid promotion cards/codes (7.1%), and funding research (5.8%).While there were no significant differences in the overall gift acceptance by job rank or specialty, there were significant differences in type-specific gift acceptance by job rank and specialty. There were some differences in the reasons behind gift acceptance by specialty and job rank. CONCLUSION: The results of this study indicate that gift acceptance among physicians working in Saudi Arabia is common; however, there was no significant differences in the overall gift acceptance by job rank or specialty. Nevertheless, there were significant differences in type-specific gift acceptance by job rank and specialty.

Interactions between physicians and pharmaceutical sales representatives in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Interaction between physicians and pharmaceutical sales representative (PR) is a major component of the promotional activities by pharmaceutical companies. The lack of studies examining the magnitude of this interaction in Saudi Arabia is evident. The objective of this study is to estimate the magnitude and associated characteristics of physician-PR interaction. DESIGN AND SETTINGS: A cross-sectional study was conducted among physicians working in the different regions of Saudi Arabia between March and July of 2012. METHODS: A cross-sectional study was undertaken between March and July of 2012 in the different regions of Saudi Arabia. A self-administrated questionnaire was developed and handed to all participants, both in paper and electronic formats. RESULTS: A total of 663 participants completed the questionnaire. The participation rate was 66.3% (663/1000). The majority of the participants (72.9%) reported interaction with PRs. This was lower among residents/interns compared to higher ranking employees (55.6% vs 83.6%, P < .001). Approximately half (48.3%) of the interactions occurred at a rate of more than once a month. A majority of the participants (72.1%) occasionally accepted gifts such as stationery (57%), drug samples (54%), meals (38%), and sponsorship of educational activities (30%). The following characteristics were independently associated with physician-PR interaction: non-Saudi nationals, a higher monthly income, Western medical education, working in a private hospital, being a specialist or registrar (rather than resident or intern), working on certain specialties (such as psychiatry and family medicine), and having limited number of patients with high socioeconomic status. CONCLUSION: Although lower than seen in many parts of the world, a high prevalence of physician-PR inter.action in Saudi hospitals is reported. Delineating associated characteristics may assist with future interventions. Further research should focus on ethical, clinical, prescription, and economic impact of interaction as well as determining the best strategy to reduce negative impact.