Short-Term Outcomes of Atosiban in the Treatmentof Preterm Labour at the Sultan Qaboos University Hospital, Muscat, Oman

Objectives: This study aimed to generate baseline evidence regarding the effectiveness of atosiban in delaying delivery by ≥48 hours among pregnant women presenting with threatened preterm labour (TPL). The secondary objective was to assess the relationship between atosiban success and various perinatal factors and neonatal outcomes. Methods: This retrospective study was conducted between June 2008 and May 2018 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all pregnant women who received atosiban between 24–34 gestational weeks for TPL during this period were reviewed. Results: A total of 159 women were included in the study. Atosiban was successful in delaying delivery by ≥48 hours in 130 cases (81.8%). Approximately half of the women (50.9%) achieved uterine quiescence in <12 hours. Failure to delay delivery by ≥48 hours was significantly lower among women with normal versus abnormal cervical findings (11.1% versus 25.6%; P = 0.023). Only 9.4% of women experienced minor side-effects. Mean birth weight (2,724.55 versus 1,707.59 g; P <0.001) and Apgar scores at 5 minutes (9.66 versus 8.28; P <0.001) were significantly higher among neonates delivered at ≥48 versus <48 hours post-atosiban, whereas the rate of neonatal respiratory distress syndrome was significantly lower (18.4% versus 81.6%; P <0.001). Conclusion: Atosiban was highly effective in delaying delivery by ≥48 hours and resulted in few adverse maternal side-effects and neonatal outcomes. To the best of the authors’ knowledge, this is the first study conducted in Oman to evaluate the effectiveness of atosiban in preventing preterm labour. Keywords: Preterm Labor; Atosiban; Tocolytic Agents; Treatment Outcome; Patient Outcome Assessment; Oman.

Outcomes of Infants Undergoing Modified Blalock-Taussig Shunt Procedures in Oman

Objectives: A modified Blalock-Taussig (mBT) shunt procedure is a common palliative surgery used to treat infants and children with cyanotic congenital heart disease (CCHD). This study aimed to report the outcomes of infants and children undergoing mBT shunt procedures in Oman. In addition, risk factors associated with early mortality, inter-stage mortality and reintervention were assessed. Methods: This retrospective cohort study was conducted from January 2016 to December 2018 at the National Heart Centre, Muscat, Oman. All paediatric patients with CCHD undergoing mBT shunt procedures as a primary palliative procedure during this period were included. Data were retrieved from electronic hospital records. Kaplan-Meier survival curves were used to describe overall survival. Results: A total of 50 infants and children were included in the study. The in-hospital mortality and inter-stage mortality rates were 10% and 6.7%, respectively. Preoperative mechanical ventilation (odds ratio [OR]: 3.00, 95% confidence interval [CI]: 1.98–4.76; P = 0.007) and cardiopulmonary bypass (OR: 4.09, 95% CI: 2.44–6.85; P = 0.002) were significant risk factors for early mortality. In-hospital and interval surgical reintervention rates were 12% and 13.3%, respectively. Following the primary shunt procedure, the median time to second-stage surgery was 15.5 months (range: 5.0–34.0 months). Conclusion: The findings of this study support those reported in international research regarding the risks associated with mBT shunt surgeries. In particular, preoperative mechanical ventilation and cardiopulmonary bypass were significant risk factors for early mortality. Keywords: Pediatrics; Heart Diseases, congenital; Cardiovascular Surgical Procedures; Modified Blalock-Taussig Procedure; Patient Outcome Assessment; Hospital Mortality; Risk Factors; Oman.

Challenges and Adverse Outcomes of Implementing Reimbursement Mechanisms Based on the Diagnosis-Related Group Classification System: A systematic review

In health insurance, a reimbursement mechanism refers to a method of third-party repayment to offset the use of medical services and equipment. This systematic review aimed to identify challenges and adverse outcomes generated by the implementation of reimbursement mechanisms based on the diagnosis-related group (DRG) classification system. All articles published between 1983 and 2017 and indexed in various databases were reviewed. Of the 1,475 articles identified, 36 were relevant and were included in the analysis. Overall, the most frequent challenges were increased costs (especially for severe diseases and specialised services), a lack of adequate supervision and technical infrastructure and the complexity of the method. Adverse outcomes included reduced length of patient stay, early patient discharge, decreased admissions, increased re-admissions and reduced services. Moreover, DRG-based reimbursement mechanisms often resulted in the referral of patients to other institutions, thus transferring costs to other sectors.Keywords: Health Insurance; Third-Party Payments; Reimbursement Mechanisms; Diagnosis-Related Groups; Quality of Health Care; Patient Outcome Assessment; Systematic Review.

Outcomes of Women with Non-Metastatic Triple-Negative Breast Cancer in Oman: A single-centre experience

Objectives: Triple-negative breast cancer (TNBC) is one of the most aggressive and heterogeneous variants of breast cancer. However, little is known regarding the prevalence and outcome of this entity in the Middle East. This study aimed to evaluate the outcomes of TNBC patients at a university hospital in Oman. Methods: This retrospective study took place at the Sultan Qaboos University Hospital, Muscat, Oman, in May 2017. All patients diagnosed with non-metastatic TNBC between December 2000 and December 2015 were included. The patients’ electronic medical records were reviewed to identify their clinical and pathological characteristics as well as survival outcomes. Results: A total of 79 patients were diagnosed with non-metastatic TNBC during the study period. The median age was 46 years, with approximately one-third of patients (31.6%) under 40 years of age. Almost half had an advanced tumour size (49.4%) or node-positive disease (48.1%) at presentation and only 16.6% demonstrated a complete pathological response (pCR) to neoadjuvant chemotherapy. The median survival for all patients was not reached within the study period; however, the median overall survival for stage III patients was 44.6 months. The five-year overall survival for all patients was 64%, increasing to 100% and 72% for patients with stage I and II, respectively, and dropping to 47% for those with stage III disease. Conclusion: The findings of this study indicate that the majority of women with TNBC in Oman present at an advanced stage; moreover, such women have low rates of pCR to neoadjuvant chemotherapy and poor five-year survival.Keywords: Breast Cancer; Triple-Negative Breast Cancer; Neoadjuvant Therapy; Survival; Patient Outcome Assessment; Oman.

What is geriatric rehabilitation and how should it be organized? A Delphi study aimed at reaching European consensus

Purpose Many European countries have developed services to rehabilitate the increasing number of older people who experience an acute or subacute decrease in function after a medical event such as a hip fracture or stroke. However, there are important differences between countries regarding patient selection, organization of services, length of stay, and content of the rehabilitation process. The lack of consensus around, and quality criteria for, geriatric rehabilitation limits opportunities for exchange of best practice and scientific research. Methods 33 experts, mostly geriatricians with experience in geriatric rehabilitation, from 18 European countries were invited to participate in a modified Delphi study. They were asked to react to 68 statements using a five-point Likert scale. The statements were formulated on the basis of literature review and practice experience, and were initially piloted among Dutch elderly care physicians. Consensus was defined beforehand as an Interquartile Range (IQR) of </= 1 for each statement. Results Consensus was reached on 61 (90%) statements after two rounds. The resulting consensus covers: the need for a multidisciplinary approach to Geriatric Rehabilitation after CGA; inclusion of patients with temporary confusion or cognitive decline; use of structured goal-oriented rehabilitation plans; the necessity of an early start of rehabilitation; preference for ambulatory rehabilitation or Geriatric Rehabilitation at home; the advantage of protocolled treatment programs; the need for consensus on patient outcome assessment instruments; and education and training in Geriatric Rehabilitation for healthcare professionals. Conclusion These consensus statements provide a first step towards more coherent organization and delivery of geriatric rehabilitation across Europe.

Spectrum of Cerebral Venous Thrombosis in Oman

Objectives: Cerebral venous thrombosis (CVT) can have varied and life-threatening manifestations. This study aimed to examine the spectrum of its clinical presentations and outcomes in a tertiary hospital in Oman. Methods: This retrospective study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2017. The medical records of all patients with CVT were reviewed to determine demographic characteristics, clinical features and patient outcomes. Results: A total of 30 patients had CVT. The mean age was 36.8 ± 11 years and the male-to-female ratio was 2:3. Common manifestations included headache (83%), altered sensorium (50%), seizures (43%) and hemiparesis (33%). Underlying risk factors were present in 16 patients (53%). Computed tomography or magnetic resonance imaging of the brain was abnormal in all patients, with indications of infarcts (40%) and major sinus thrombosis (100%). There were five cases (20%) of deep CVT. The patients were treated with low-molecular-weight heparin, mannitol and anticonvulsants. The majority (77%) had no residual neurological deficits at follow-up. Conclusion: These findings indicate that CVT is a relatively uncommon yet treatable disorder in Oman. A high index of suspicion, early diagnosis, prompt anticoagulation treatment and critical care may enhance favourable patient outcomes.Keywords: Venous Thrombosis; Cerebral Thrombosis; Cranial Venous Sinuses; Neurological Manifestations; Patient Outcome Assessment; Oman.

Atuação do time de enfermeiros na ressuscitação cardiopulmonar extracorpórea

RESUMOObjetivo: apresentar a atuação de um time de enfermeiros especialistas na assistência ao paciente submetido à ECMO-VA pós-parada cardíaca. Método: trata-se de estudo qualitativo, descritivo, retrospectivo, na modalidade do estudo de caso, realizado em um hospital filantrópico. Compôs-se a amostra por uma jovem de 18 anos, em que se analisou o prontuário médico e o resultado se apresentou em forma de relato. Resultados: ressalta-se que o estabelecimento de um time bem estruturado, com atuação do enfermeiro na assistência integral contribuíram para evolução do quadro clínico do paciente pós parada cardiorrespiratória resulta em sua recuperação e alta hospitalar. Informa-se que time atuou de forma contínua desde a canulação até a sua retirada, para o cuidado da paciente em ECMO. Conclusão: salienta-se que a atuação do time foi indispensável para um cuidado especializado e um desfecho favorável na assistência à paciente durante todo o seu período em suporte circulatório. Descritores: Oxigenação por Membrana Extracorpórea; Cuidados de Enfermagem; Parada Cardíaca; Reanimação Cardiopulmonar; Avaliação de Resultados da Assistência ao Paciente; Relatos de Casos.ABSTRACT Objective: to present the work of a team of specialist nurses in the care of patients submitted to ECMO-VA after cardiac arrest. Method: this is a qualitative, descriptive, retrospective study, in the modality of the case study, carried out in a philanthropic hospital. The sample was composed by an 18-year-old girl, who analyzed the medical record and the result was presented in the form of a report. Results: it is emphasized that the establishment of a well-structured team with a nurse's role in the integral care contributed to the evolution of the clinical picture of the patient after cardiorespiratory arrest results in their recovery and hospital discharge. It is reported that the team worked continuously from cannulation until its withdrawal, to the care of the patient in ECMO. Conclusion: it should be noted that the team's performance was indispensable for specialized care and a favorable outcome in patient care throughout their period of circulatory support. Descriptors: Extracorporeal Membrane Oxygenation; Nursing Care; Heart Arrest; Cardiopulmonary Resuscitation; Patient Outcome Assessment; Case Reports.RESUMEN Objetivo: presentar la actuación de un equipo de enfermeros especialistas en la asistencia al paciente sometido a la ECMO-VA post-parada cardiaca. Método: se trata de un estudio cualitativo, descriptivo, retrospectivo, en la modalidad del estudio de caso, realizado en un hospital filantrópico. Se compuso la muestra por una joven de 18 años, en la que se analizó el prontuario médico y el resultado se presentó en forma de relato. Resultados: se resalta que el establecimiento de un equipo bien estructurado, con actuación del enfermero en la asistencia integral, contribuyó para la evolución del cuadro clínico del paciente pos paro cardiorrespiratorio resulta en su recuperación y alta hospitalaria. Se informa que el equipo actuó de forma continua desde la canulación hasta su retirada, para el cuidado de la paciente en ECMO. Conclusión: se destaca que la actuación del equipo fue indispensable para un cuidado especializado y un desenlace favorable en la asistencia al paciente durante todo su período en soporte circulatorio. Descriptores: Oxigenación por Membrana Extracorporea; Atención de Enfermería; Paro Cardíaco; Reanimación Cardiopulmonar; Evaluación del Resultado de la Atención al Paciente; Informes de Casos.

Epidemiology, Outcomes and Coronary Angiography Findings of Patients Following Out-of-Hospital Cardiac Arrest: A single-centre experience from Oman

Objectives: Out-of-hospital cardiac arrests (OHCAs) are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman. Methods: This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. All adult patients who presented following an OHCA to the Emergency Department of SQUH during the study period were included. Demographic and clinical data were collected from electronic medical records. Results: A total of 216 patients were included in the study. The majority (63.9%) presented after having collapsed, while 22.3% presented with chest pains. Asystole was the most frequent initial cardiac rhythm (62.5%), with only 10% having ventricular tachycardia/fibrillation. Very few patients (1.4%) had received cardiopulmonary resuscitation (CPR) prior to presentation. In total, 85 patients (39.4%) returned to spontaneous circulation (RSC); of these, post-RSC electrocardiography revealed an ST-segment elevation in 41.2% and normal findings in 23.5%. There were 63 patients who underwent coronary angiography, with 28 requiring stenting. Overall, 13% of patients survived and were discharged, although three survivors suffered permanent hypoxic brain damage. Conclusion: The overall survival rate of patients who had experienced an OHCA was low. Education programmes should focus on the benefits of immediate CPR for individuals experiencing an OHCA, with more opportunities for CPR training to be made available to the general public in Oman.Keywords: Out-of-Hospital Cardiac Arrest; Cardiopulmonary Resuscitation; Patient Outcome Assessment; Survival Rate; Coronary Angiography; Oman.