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   Table of Contents - Current issue
January-March 2020
Volume 3 | Issue 1
Page Nos. 1-32

Online since Thursday, February 20, 2020

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An approach to identify “right” problems for initial quality improvement projects p. 1
Sergio R Gutierrez Ubeda
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Determinants of hospital-based physician participation in quality improvement: A survey of hospitalists in British Columbia, Canada p. 6
Vandad Yousefi, Alaleh Asghari-Roodsari, Sarah Evans, Cynthia Chan
Objective: We aimed to understand the extent of hospitalist involvement in system improvement efforts across the province of British Columbia in Canada and provide insights into determinants of such participation. Materials and Methods: We designed a web-based survey and asked about individual, programmatic, and institutional characteristics that may facilitate or impair hospitalist involvement in quality improvement (QI) activities. The survey was sent to all individuals who participated in “hospitalist care” from January 2014 to February 2015, in the province of British Columbia, Canada. We conducted both quantitative and qualitative analysis of responses. Results: We received 57 complete responses to the survey of 322 invited individuals (17.7% response rate). Of these, 15 individuals (26.3%) indicated that they had participated in QI initiatives. Respondents highlighted high clinical workload and lack of time, lack of QI skills and training, lack of access to performance data, poor support from hospital/health authority administration, and lack of financial compensation as main barriers to QI involvement. These themes were also supported in logistic regression, where QI training and the number of weeks worked as a hospitalist showed significant predictive properties for involvement in QI initiatives. Conclusion: Our study attempts to understand the various individual or organizational attributes that could facilitate involvement by hospital-based generalist physicians in QI activities. Our findings show lack of formal QI training is an important barrier for hospitalist involvement in QI, and highlight the need for formal training, dedicated time, support from physician leadership, and financial incentive as important facilitators for participation in systemic improvement efforts.
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Assessing the feasibility and effects of introducing the USA National Surgical Quality Improvement Program on clinical outcomes and cost in Saudi Arabia: An observational study p. 14
Shahenaz Najjar, Adel F Almutairi, Rashad Massoud, Khaled Al-Surimi, Sami Boghdadly
Introduction: This study aimed at introducing a systematic clinical registry to assess the outcomes of surgical performances and the associated costs of surgical complications in hospitals of Saudi Arabia. Materials and Methods: This was an observational retrospective cohort study. Three large Saudi public hospitals from different regions participated in the study. A systematic sample consisting of 2077 medical records was retrospectively reviewed after being received from the hospitals’ surgical wards. The inclusion criteria of the study were inpatients of the surgical cases, patients older than 18 years, and those who underwent major surgery under general anesthesia. The occurrence of adverse events in surgical wards and the direct costs associated with these surgical adverse events were estimated. Results were reported in terms of odds ratio and 95% confidence interval. A value of p < 0.05 was considered statistically significant. Results: Introducing the systematic clinical registry to assess surgical outcomes and complications across multiple hospital sites is feasible. The findings of the study suggest that some areas are exemplary and others need improvement, such as sepsis cases, renal failure, ventilator use for more than 48h, urinary tract infection, surgical site infection (SSI), length of stay after colorectal surgery, and rehospitalization. Additional costs from surgical complications in Riyadh only were approximately 0.5 million Saudi Arabian Riyal (127,764.40 USD) during that year. Most of the additional costs were due to sepsis and SSI. Conclusion: Empirical evidence derived from the idea of introducing a National Surgical Quality Improvement Program might be generally applicable to other countries in the region and worldwide, and can be used to measure surgical adverse events and track interventions over time. As a result, quality improvement initiatives could be identified to be implemented immediately focusing on preventing several surgical adverse events. A future study is needed to explore the underlying factors that contribute to the occurrence of surgical adverse events to be prevented and/or mitigated.
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Emerging role of biosimilars in oncology-hematology in Saudi Arabia: A practical perspective p. 22
Mansoor A Khan, Mohammed A Aseeri, Majed A Alshamrani, Abdelmajid H Alnatsheh, Hani S Alhamdan
Biologics are significant drivers of globally escalating healthcare costs. Biosimilars have potential to offer cost savings with comparable efficacy and safety to innovator products and increase the access of treatment to more patients. This study aimed to increase understanding and perception of biosimilars concept. It also described the pharmacoeconomic impact of biosimilar in oncology and formulary consideration of oncology biosimilars substituting with their originators in major oncology centers in the Saudi Arabia. A biosimilar is a biological product that is similar to a reference biopharmaceutical product. As the manufacturing process hinders the ability to identically replicate the structure of the original product, biosimilar cannot be described as an absolute equivalent of the original medication. Different regulatory agencies such as United States Food and Drug Administration, European Medicines Agency, and Saudi Food and Drug Authority have approved several biosimilars of oncology biologics. The experience of biosimilar use in Europe and USA provides valuable insights into the use of biosimilars. The widespread use of biosimilars has the potential to reduce healthcare expenditure, as well as improving access without compromising patient outcomes. There is a need for increasing awareness about biosimilars to improve acceptance rates. The use of biosimilar filgrastim in Ministry of National Guard Health Affairs, Saudi Arabia, has resulted in a significant cost saving annually. It was proposed that further substitution and switching to biosimilars in oncology would lead to major savings in resources.
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Letter to Editor Regarding “Involving the Family in Patient Care: A Culturally Tailored Communication Model” by Jazieh et al. p. 30
Eman Kamal
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Letter to editor: Implementation of patient and family communication model in different settings p. 32
Abdul Rahman Jazieh
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