Cigarette, Water-pipe, and Medwakh Smoking Prevalence Among Applicants to Abu Dhabi's Pre-marital Screening Program, 2011.

BACKGROUND: This study assesses self-reported tobacco use prevalence (cigarette, water-pipe, and medwakh) among applicants to Abu Dhabi's Premarital Screening program during 2011. METHODS: Premarital Screening data reported to the Health Authority - Abu Dhabi from April to December 2011 were utilized to estimate tobacco use prevalence among applicants. Smoking prevalence was examined by nationality, age group and gender. RESULTS: Overall, 24.7% of Premarital Screening Program applicants were current smokers; 11.5% smoked cigarettes, 5.9% smoked medwakh (hand-held pipe), 4.8% smoked water-pipe and 2.5% smoked a combination (more than one type). Men (19.2%) were more likely than women (3.5%) to be current cigarette smokers. Women were much less likely to smoke medwakh (0.1%) than men (11.5%), with male UAE Nationals having the highest medwakh smoking prevalence (16.1%). The overall prevalence of water-pipe smoking was 6.8% among men and 2.8% for women with the highest water-pipe smoking prevalence (10.2%) among Arab expatriate men. CONCLUSIONS: Variations in tobacco use prevalence among Premarital Screening Program applicants reflect preferences for different modes of tobacco consumption by nationality, age group and gender. Enforcement of tobacco control laws, including implementation of clean indoor air laws and tobacco tax increases, and targeted health education programs are required to reduce tobacco consumption and concomitant tobacco-related morbidity and mortality.

Significant improvement in quality of caesarean section documentation with dedicated operative proforma--completion of the audit cycle.

In the current climate of rising caesarean section rates coupled with the increasingly litigious nature of modern medical practice, and particularly obstetrics, well-documented operative notes are important. We therefore set out to audit the quality of caesarean section documentation in a busy Greater London University Hospital with over 4500 deliveries per annum. The study involved 137 case notes between 1 November and 31 December 1999 and the same number at re-audit 2 years later. The results of the initial audit showed important omissions in a high percentage of operative delivery notes, with less than 80% of case notes documenting skin incision time and type, surgical findings of note, type of uterine incision, presenting part, explanation of fetal delivery, uterine cavity check, presence of a paediatrician, adnexal check and complete sutures used. CNST (Clinical Negligence Scheme for Trusts) guidelines were not adhered to, with only 41% and 35% of delivery notes having complete signature with printed name and correct time and date, respectively. There was considerable confusion at the use of the terminology for level of urgency of non-elective sections and the umbilical cord blood gas results were also poorly documented. As a consequence of these findings a dedicated 'operative delivery note' proforma was designed according to CNST guidelines, with clear areas for particular details of note such as the clinician's name and grade, cord pH results as well as the more important surgical findings. It also simplified the documentation of the urgency of the procedure. There was a significant improvement in almost all items assessed. We therefore conclude that the use of a specific dedicated operative proforma leads to significantly improved documentation with potentially beneficial medicolegal implications.