Background Pre-gestational diabetes mellitus is associated with increased risk of maternal and perinatal adverse outcomes. This systematic review was conducted to evaluate the effectiveness and ...safety of pre-conception care (PCC) in improving maternal and perinatal outcomes. Methods Databases from MEDLINE, EMBASE, WEB OF SCIENCE, and Cochrane Library were searched, including the CENTRAL register of controlled trials, and CINHAL up until March 2019, without any language restrictions, for any pre-pregnancy care aiming at health promotion, glycemic control, and screening and treatment of diabetes complications in women with type I or type II pre-gestational diabetes. Trials and observational studies were included in the review. Newcastle-Ottawa scale and the Cochrane collaboration methodology for data synthesis and analysis were used, along with the GRADE tool to evaluate the body of evidence. Results The search identified 8500 potentially relevant citations of which 40 reports of 36 studies were included. The meta-analysis results show that PCC reduced congenital malformations risk by 71%, (Risk ratio (RR) 0.29; 95% CI: 0.21-0.40, 25 studies; 5903 women; high-certainty evidence). The results also show that PCC may lower HbA1c in the first trimester of pregnancy by an average of 1.27% (Mean difference (MD) 1.27; 95% CI: 1.33-1.22; 4927 women; 24 studies, moderate-certainty evidence). Furthermore, the results suggest that PCC may lead to a slight reduction in the risk of preterm delivery of 15%, (RR 0.85; 95% CI: 0.73-0.99; nine studies, 2414 women; moderate-certainty evidence). Moreover, PCC may result in risk reduction of perinatal mortality by 54%, (RR 0.46; 95% CI: 0.30-0.73; ten studies; 3071 women; moderate-certainty evidence). There is uncertainty about the effects of PCC on the early booking for antenatal care (MD 1.31; 95% CI: 1.40-1.23; five studies, 1081 women; very low-certainty evidence) and maternal hypoglycemia in the first trimester, (RR 1.38; 95% CI: 1.07-1.79; three studies; 686 women; very low- certainty evidence). In addition, results of the meta-analysis indicate that PCC may lead to 48% reduction in the risk of small for gestational age (SGA) (RR 0.52; 95% CI: 0.37-0.75; six studies, 2261 women; moderate-certainty evidence). PCC may reduce the risk of neonatal admission to intensive care unit (NICU) by 25% (RR 0.75; 95% CI: 0.67-0.84; four studies; 1322 women; moderate-certainty evidence). However, PCC may have little or no effect in reducing the cesarean section rate (RR 1.02; 95% CI: 0.96-1.07; 14 studies; 3641 women; low-certainty evidence); miscarriage rate (RR 0.86; 95% CI: 0.70-1.06; 11 studies; 2698 women; low-certainty evidence); macrosomia rate (RR 1.06; 95% CI: 0.97-1.15; nine studies; 2787 women, low-certainty evidence); neonatal hypoglycemia (RR 0.93; 95% CI: 0.74-1.18; five studies; 880 women; low-certainty evidence); respiratory distress syndrome (RR 0.78; 95% CI: 0.47-1.29; four studies; 466 women; very low-certainty evidence); or shoulder dystocia (RR 0.28; 95% CI: 0.07-1.12; 2 studies; 530 women; very low-certainty evidence). Conclusion PCC for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations. In addition, it may improve the risk of preterm delivery and admission to NICU. PCC probably reduces maternal HbA1C in the first trimester of pregnancy, perinatal mortality and SGA. There is uncertainty regarding the effects of PCC on early booking for antenatal care or maternal hypoglycemia during the first trimester of pregnancy. PCC has little or no effect on other maternal and perinatal outcomes.
The management of pregnant women with sickle cell disease (SCD) poses a major challenge for maternal healthcare services owing to the potential for complications associated with morbidity and ...mortality. Trustworthy evidence-based clinical practice guidelines (CPGs) have a major impact on the positive outcomes of appropriate healthcare. The objective of this study was to critically appraise the quality of recent CPGs for SCD in pregnant women.
Clinical questions were identified and the relevant CPG and bibliographic databases were searched and screened for eligible CPGs. Each CPG was appraised by four independent appraisers using the AGREE II Instrument. Inter-rater analysis was conducted.
Four eligible CPGs were appraised: American College of Obstetricians and Gynecologists (ACOG), National Heart, Lung, and Blood Institute (NHLBI), National Institute of Health and Care Excellence (NICE), and Royal College of Obstetricians and Gynaecologists (RCOG). Among them, the overall assessments of three CPGs (NICE, RCOG, NHLBI) scored greater than 70%; these findings were consistent with the high scores in the six domains of AGREE II, including:1 scope and purpose,2 stakeholder involvement,3 rigor of development,4 clarity of presentation,5 applicability, and 6 editorial independence domains. Domain 3 scored (90%, 73%, 71%), domain 5 (90%, 46%, 47%), and domain 6 (71%, 77%, 52%) for NICE, RCOG, and NHLBI, respectively. Overall, the clinical recommendations were not significantly different between the included CPGs.
Three evidence-based CPGs presented superior methodological quality. NICE demonstrated the highest quality followed by RCOG and NHLBI and all three CPGs were recommended for use in practice.
OBJECTIVETo assess the quality of clinical practice guidelines (CPGs) for the use of antimicrobial prophylaxis to prevent infective endocarditis in indicated dental procedures. STUDY DESIGNWe ...searched on Medline/OVID, CINAHL/EBSCO, and EMBASE from January 2011 to January 2022. We included de novo guidelines and excluded adapted or adopted guidelines, and guidelines published before 2011. The guidelines were independently appraised by 4 reviewers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument. RESULTSFour eligible CPGs were appraised: the European Society of Cardiology, the American Heart Association, the National Institute of Health and Care Excellence (NICE), and the Japanese Circulation Society (JCS). Their AGREE II first overall assessments (OA1) were 63%, 58%, 92%, and 71%, respectively. Both NICE and JCS scored the highest in OA1 (>70%), Domain 3 Rigor of Development (85%, 65%), and Domain 5 Applicability (76%, 48%), respectively. The second overall assessment (OA2) of using the CPGs in daily practice was not significantly variable (recommended for use with modifications). CONCLUSIONThree out of 4 CPGs support that the benefits of prevention of infective endocarditis outweigh the risks of antibiotic resistance.
The clinical improvement after assessing patients with cough variant asthma in outpatient clinics, and therapy success varied depending on the subjective improvement. Cough could be controlled within ...appropriate time and subsequent management can consist of inhaled corticosteroids. In this study we used the cough improvement, the only available clinical response, as a predictable factor to determine the effect of different modalities of treatment among patients with cough variant asthma. Retrospective observational analysis was performed in Saudi Arabia's King Saud University Medical City, on the presentation, diagnosis, course of therapy, and responsiveness to oral and inhaled steroids in patients with cough variant asthma. All patients who visited the clinic on multiple occasions with persistent, acute coughing without being pre-screened between September 2021 and September 2022 included based on medical records. Cough resembles cough variant asthma is the term used to describe a cough without a diagnosed etiology. To identify patients eligible for CVA treatment, iindividuals having GERD-associated cough, allergic rhinitis, bronchial asthma, smokers and atopic cough was excluded. For the examination of these findings, IBM SPSS version 28 (Armonk, NY, USA) was employed. As a result of using budesonide-formoterol inhaler, most patients (86.3 %) showed improvement in their cough symptoms (with 95 %CI: 78.3 to 94.9). There was a significant yet weak positive correlation between the frequency of cough symptoms before and after using budesonide-formoterol (r = 0.318, P value < 0.001). The understanding of treatment response and patient selection for budesonide-formoterol inhaler therapy, providing clinicians with valuable information to optimize patient care.
•Higher levels of satisfaction with newly implemented EHR in the developing countries were associated with its perceived positive effect on individual performance and patient care.•Better IT support ...with new EHR implementation and hardware availability may improve satisfaction.•Time needed for patient's data entry warrants attention to improve satisfaction. Prompt super-users and IT support in response to feedback from healthcare workers during the launch of a new EHR system may improve system use.
Apposite implementation of Electronic Health Records (EHR) is anchoring standards of care in healthcare settings by reducing long-run operational costs, improving healthcare quality, and enhancing patient safety.
This study aims to explore factors that might influence Pediatricians’ satisfaction with an implemented EHR system and its perceived usefulness at a tertiary-care teaching hospital, Riyadh, Saudi Arabia.
A cross-sectional survey distributed to all physicians working in the pediatric department of King Saud University Medical City (KSUMC) in the period from June to November 2015, two months after the launch of the EHR system, internally branded as electronic system for integrated health information (eSiHi). Bivariate and multivariate regression were analyzed to examine factors associated with physicians’ satisfaction.
Of the 112 physicians who completed the survey, 97 (86.6%) attended training courses before the implementation of new EHR. On average, the participants rated the perceived usefulness of the new system at 6.4/10 for patient care and physicians' satisfaction levels were 5.2/10. The top indicator of EHR usefulness was the system's ability to reduce errors and improve the quality of care mean 3.31, SD 0.9, RII 82.8%; the lowest-ranking indicator was the physicians’ perceived familiarity with functions and benefits mean 2.68, SD 0.7, RII 67%. The top indicator of satisfaction with the EHR system was enhanced “individual performance” mean 3.04, SD 1, RII 60.9%; the lowest-ranking perceived indicator was the limited availability of workplace computers mean 1.91, SD 1.2, RII 38.2%.
Limited data regarding EHR implementation and end-users satisfaction in the Middle East region necessitates further work on factors affecting levels of satisfaction with the EHR system among different health institutes. Lack of information technology (IT) support, hardware, and time-consuming data entry process are challenging barriers for proper utilization of EHR for pediatric health care services.
Vaccination is considered the best way to prevent the spread of COVID-19 and to prevent the complications of the disease. Nevertheless, no awareness campaigns were conducted in Saudi Arabia until ...March 1, 2021, when the Vaxzevria, or ChAdOx1 nCoV-19 (AZD1222), vaccine became available.
This study aims to determine the factors that can predict healthcare workers’ acceptance of the COVID-19 vaccine.
A cross-sectional study was conducted from July to September 2021, in our university tertiary hospital (King Saud University Medical City KSUMC), Riyadh, Saudi Arabia. The study targeted potential participants among healthcare workers at KSUMC. We assessed healthcare workers’ perceptions and beliefs about the COVID-19 vaccine via a questionnaire that was distributed via social media applications such as WhatsApp, Twitter, and Google. Participants were informed about the questionnaire before they filled it out, and they were asked to respond to three screening questions before beginning the main questionnaire. These screening questions ensured that the participants met the inclusion criteria. Included participants were over the age of 18, agreed to answer the questions, and were residents of Saudi Arabia. The participants filled out the self-administered questionnaire.
A total of 529 participants completed the questionnaires. All participants were vaccinated, 68% were female, 55% were married, 35% had been working for less than five years, and 65% had a bachelor’s degree. More than half of participants had not previously been infected with COVID-19, and most did not interact with COVID-19 patients. More convenient access to the vaccine increased the odds ratio of participant vaccination by 0.39. An increase in the number of vaccinated friends and family members increased the odds ratio of participant vaccination by 0.30. However, COVID- 19 vaccination mandates decreased the odds ratio of participant vaccination by 0.27. The fitted linear regression model explained 32% of the variation observed in the dependent variable, acceptance of the COVID-19 vaccine, and the adjusted R squared was 0.32. The fitted regression model was statistically significant at a 95% confidence interval; the p-value was 0.00001.
In Saudi Arabia, there is an immense need to increase uptake of the COVID-19 vaccine. This requires encouraging more positive beliefs and attitudes regarding vaccination in general and the COVID-19 vaccine in particular.
Psoriasis is considered one of the stubborn lifelong dermatologic diseases, making the patients seized in their social cage. Evidence-based clinical practice guidelines (CPGs) and expert opinions ...ensure that patients with psoriasis render the most recent and developed care. This systematic review assessed and compared the most recently approved international CPGs with the AGREE II instrument.
After we identified our research question, we searched the bibliographic international databases to identify and screen for relevant and eligible guidelines that address the topic of interest. Four independent reviewers (Senior Expert Dermatologist in Psoriasis) have critically appraised the selected guidelines via the AGREE II instrument. We conducted inter-rater analysis and percent agreement among raters and calculation of intra-class correlation coefficient (ICC) 'Kappa'.
Out of 33 articles for CPGs, only Four eligible CPGs fulfill the inclusion criteria. Selected CPGs were critically appraised; first from the American College of Rheumatology that is also National Psoriasis Foundation (ACR/NPF-2018), second from the UK's National Institute for Health and Care Excellence (NICE-2017) for Psoriasis: Assessment and Management, third from the Saudi practical guidelines on the biologic treatment for Psoriasis (Saudi CPGs, 2015), and lastly from the American Academy of Dermatology (AAD/NPF-2019) Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities. The complete assessments (OA) of two CPGs (AAD/NPF and NICE) scored greater than 80%; 'six domains' of AGREE II had greater score that is congruent with results; (1) scope and motive, (2) shareholder involvement, (3) rigor of growth, (4) clarity of speech, (5) validity, and (6) journalistic independence domains. Domain (3) scored (84, 71, and 90%), domain (5) (51%, 47, and 90%), domain (6) (70, 52, and 90%) for (Saudi CPGs, AAD/NPF, and NICE), respectively. Generally, the clinical recommendations were significantly better for NICE CPGs.
Four evidence-based 'CPGs' introduced a high-quality methodological analysis. NICE indicated the greatest quality followed by Saudi CPGs and AAD/NPF and all four CPGs were suggested for practice.
To systematically review, critically appraise the quality of recent clinical practice guidelines (CPGs) for neonatal hypoxic ischemic encephalopathy (HIE), and map their recommendations.
CPG ...databases (GIN, ECRI, NICE, SIGN, DynaMed), Bibliographic databases (PubMed, Embase, CINAHL), and related specialized professional societies (e.g., AAP, CPS, BAPM, RCPCH, and SNS).
Original de-novo developed evidence-based CPGs for HIE, group authorship, Arabic or English languages, and international or national scope. The systematic review was drafted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Johnston et al methodological guide.
Quality assessment of the included HIE CPGs by the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) Instrument and report their characteristics, AGREE II ratings, and recommendations.
Our search retrieved 2,489 citations, of which two recent HIE CPGs were eligible and appraised: Canadian Paediatric Society (CPS) and Queensland Maternity and Neonatal Services (QMN). The overall assessment of the QMN CPG was superior (83%). Domain 1 (Scope & Purpose) scored (47%, 63%), Domain 2 (Stakeholder Involvement) (72%, 39%), Domain 3 (Rigour of Development) (48%, 43%), Domain 4 (Clarity & Presentation) (100%, 96%), Domain 5 (Applicability) (59%, 9%), and Domain 6 (Editorial Independence) (67%, 17%) for the QMN and CPS CPGs respectively. All appraisers recommended the QMN CPG for use in practice.
The methodological quality of the QMN CPG was superior with the relevant recommendations for its use in neonatal practice.
limited to Arabic and English languages.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258291, identifier: CRD42021258291.
Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other ...related complications. Many maternal risk factors were associated with the extremes of birthweight. The objectives of this study are to investigate maternal risk factors for low and high birthweight and to report on the neonatal complications associated with abnormal birth weights.
We conducted a retrospective analysis of medical records of deliveries ≥ 23 weeks. We classified the included participants according to birth weight into normal birth weight (NBW), LBW, very LBW (VLBW), and macrosomia. The following maternal risk factors were included, mother's age, parity, maternal body mass index (BMI), maternal diabetes, and hypertension. The neonatal outcomes were APGAR scores < 7, admission to neonatal intensive care unit (NICU), respiratory distress (RD), and hyperbilirubinemia. Data were analyzed using SAS Studio, multivariable logistic regression analyses were used to investigate the independent effect of maternal risk factors on birthweight categories and results were reported as an adjusted odds ratio (aOR) and 95% Confidence Interval (CI).
A total of 1855 were included in the study. There were 1638 neonates (88.3%) with NBW, 153 (8.2%) with LBW, 27 (1.5%) with VLBW, and 37 (2.0%) with macrosomia. LBW was associated with maternal hypertension (aOR = 3.5, 95% CI = 1.62-7.63), while increasing gestational age was less likely associated with LBW (aOR = 0.51, 95% CI = 0.46-0.57). Macrosomia was associated with maternal diabetes (aOR = 3.75, 95% CI = 1.67-8.41), in addition to maternal obesity (aOR = 3.18, 95% CI = 1.24-8.14). The odds of VLBW were reduced significantly with increasing gestational age (aOR = 0.41, 95% CI = 0.32-0.53). In total, 81.5% of VLBW neonates were admitted to the NICU, compared to 47.7% of LBW and 21.6% of those with macrosomia. RD was diagnosed in 59.3% of VLBW neonates, in 23% of LBW, in 2.7% of macrosomic and in 3% of normal-weight neonates. Hyperbilirubinemia was reported in 37.04%, 34.21%, 22.26%, and 18.92% of VLBW, LBW, NBW, and macrosomic newborns, respectively.
Most neonates in this study had normal birthweights. Maternal hypertension and lower gestational age were associated with increased risk of LBW. Additionally, maternal obesity and diabetes increased the risk of macrosomia. Neonatal complications were predominantly concentrated in the LBW and VLBW, with a rising gradient as birthweight decreased. The main complications included respiratory distress and NICU admissions.
PDF
