Interprofessional education and collaborative practice in Kuwait: attitudes and perceptions of health sciences students.

Interprofessional education (IPE) prepares health students to become collaboration-ready healthcare professionals. Assessing students' baseline attitudes toward IPE and collaborative practice is essential to inform development of IPE curricula. Kuwait University Health Sciences Center (HSC) is early in its IPE journey but is planning to join the broader global movement toward IPE. A cross-sectional survey was conducted to explore the attitudes of HSC students from Faculties of Medicine, Dentistry, Pharmacy, and Allied Health Sciences toward collaborative practice and IPE at early and late stages of study. A total of 770 students completed the survey (81.1% response rate). Students expressed positive attitudes toward interprofessional healthcare teams and IPE (median [IQR] overall attitudes were rated 4.0 [1.0] and 4.0 [2.0], respectively, on a scale of 5). Overall attitudes toward both scales were significantly more positive among pharmacy students than students from other faculties (p < .001). Final-year students reported more positive attitudes toward healthcare teams than early- and middle-year students, while early- and final-year students expressed more positive attitudes toward IPE than middle-year students (p < .001). There were no significant differences in overall attitudes between female and male students toward the two scales (p > .05). These findings have implications for engaging students from different professions in IPE initiatives.

Discordance between day-3 follicle stimulating hormone & anti-Müllerian hormone is predictive of clinical pregnancy during fertility treatment.

OBJECTIVE: To evaluate the role of discordant Day-3 follicle stimulating hormone (FSH) & anti-Müllerian hormone (AMH) levels in predicting pregnancy outcome after controlled ovarian stimulation (COS) followed by intrauterine insemination or timed intercourse. METHODS: Retrospective study of 745 couples with regular menstrual cycles, at least one patent fallopian tube, and normal semen analysis that underwent infertility treatment between June 2013 and March 2017. Women with documented serum AMH and FSH levels (<10 (mIU/ml were considered normal), and undergo COS were studied. Clinical pregnancy rate is the cumulative pregnancy obtained after maximum of three cycles of COS with or without IUI. RESULTS: As expected, patients with normal concordant AMH/FSH achieved a significantly (p < .01) higher pregnancy than all other groups. 22.4% of those with discordant normal AMH/abnormal FSH became pregnant while only 10.8% of those with discordant abnormal AMH/normal FSH levels did. 11.7% of patients with abnormal concordant values achieved pregnancy. Patients with discordant abnormal AMH/normal FSH were not statistically different (p = .084) from abnormal concordance AMH/FSH but significantly (p < .01) lower than normal concordant AMH/FSH. However, patients with discordant normal AMH/abnormal FSH were statistically different from both concordant normal and concordant abnormal AMH/FSH values (p < .04). CONCLUSIONS: This study showed that both discordant abnormal Day-3 FSH and/or abnormal AMH serum levels, as well as concordant abnormal FSH and AMH values, were predictive of lower clinical pregnancy rates after COS. However, abnormal FSH with a normal AMH does not have as poor a prognosis as the presence of an abnormal AMH.

Interprofessional education and collaborative practice in Kuwait: attitudes and barriers from faculty.

Interprofessional education (IPE) has been adopted in many educational systems to prepare students in the health professions for team-based practice, but its implementation is still limited in many countries. In preparation for the introduction of IPE within Kuwait University Health Sciences Center, a cross-sectional survey was conducted to explore the attitudes of faculty members (academic staff/academic support staff) toward collaborative practice and IPE, their training needs, and perceived barriers to implementing IPE. Two hundred and ten individuals completed the survey (60% response rate). Respondents expressed positive attitudes toward interprofessional healthcare teams, IPE, and interprofessional learning in the academic setting (median [IQR] overall attitude for each scale was 4.0 [1.0] on a scale of 5). Overall attitudes were significantly more positive among assistant professors, females, and faculty members with ≤ 10 years of experience (p < .05). Most respondents (91.9%) indicated willingness to be trained to implement IPE, with small-group learning as the preferred teaching method (85.7%). A longitudinal curriculum was less popular than discrete IPE experiences. The top reported barriers to implementing IPE were leadership challenges (86.6%), curriculum challenges (82.4%), teaching challenges (81.4%), and resistance to change (80.5%). These findings have implications for developing strategies to engage faculty in effective IPE initiatives internationally.

Public Perceptions, Expectations, and Views of Community Pharmacy Practice in Kuwait.

OBJECTIVES: This study was designed to determine public patterns for use of community pharmacies, perceptions of pharmacists, confidence and trust in pharmacists, and expectations about the pharmacist's roles, and to explore the public views and satisfaction with the current pharmacy services. SUBJECTS AND METHODS: A descriptive, cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 481 individuals selected using a 2-stage stratified cluster sampling design. Descriptive and multivariate logistic regression analyses were used for data analysis. p < 0.05 was considered statistically significant. RESULTS: The most common reasons for visiting a pharmacy were to purchase medications (prescription: n = 338 [78.1%] and nonprescription: n = 296 [68.4%]). Of the 433 respondents, 87 believed that pharmacists had a good balance between health and business matters; regarding any drug-related problem, 229 (52.9%) identified the physician as the first person to contact, followed by the pharmacist (n = 140; 32.3%); 255 (58.9%) agreed that they trust pharmacists, while 237 (54.8%) agreed that pharmacists have the ability to answer drug- or disease-related questions. Of the 433 respondents, 236 (54.5%) did not expect the pharmacist's role to include monitoring health progress to ensure safe and effective use of medications, and 258 (59.6%) were satisfied with the current pharmacy services. CONCLUSION: The current study indicated that respondents had overall negative perceptions of community pharmacists, expressed moderate expectations of their role, and viewed the current pharmacy services as slightly positive. These findings highlight the need for designing multifaceted interventions targeting specific areas to advance the community pharmacy practice in Kuwait.

Drug use practices at pediatric hospitals of Khartoum State, Sudan.

BACKGROUND: Irrational drug utilization is a major concern in developing countries. The World Health Organization (WHO) has developed first-level informative indicators in assessing drug use practices and encouraging improvement in the quality of patient care. OBJECTIVE: To assess the current drug use practices in 4 pediatric teaching hospitals in Khartoum State, and to compare the results with studies conducted in Sudan and other developing countries. METHODS: A descriptive, quantitative, and cross-sectional study using the WHO drug use indicators methodology was conducted in the outpatient settings of 4 pediatric hospitals. The study sample was selected using systematic random sampling. In each hospital, prescribing was assessed through a collection of 150 prescriptions, determination of consultation time and dispensing time for 150 patients, and by interview of 150 patients for the evaluation of dispensing practices and parents' knowledge. RESULTS: The mean number of drugs prescribed per prescription was 2.0 (95% CI 1.9 to 2.1); 49.3% (95% CI 46.3 to 52.4) were prescribed by generic name, 81.3% (95% CI 77.9 to 84.3) of prescriptions involved an antibiotic, and 3.5% (95% CI 2.2 to 5.4) of prescriptions were in injection form. The mean consultation and dispensing times were 4.7 minutes (95% CI 4.4 to 5.1) and 28.2 seconds (95% CI 26.5 to 29.9), respectively. The percentage of drugs actually dispensed was 80.1% (95% CI 77.9 to 82.2), 55.7% (95% CI 52.0 to 59.4) of drugs were adequately labeled, and 83.5% (95% CI 80.2 to 86.3) of parents knew the correct dosage of all drugs dispensed for their children. The percentage of availability of key drugs was 81.3% (95% CI 77.1 to 84.9). The essential medicines list was not available at the 4 hospitals. CONCLUSIONS: Our findings reveal problem areas in prescribing and dispensing practices in pediatric hospitals. Further in-depth quantitative research to answer the shortcomings of this study and cost-effective multifaceted interventions to improve current drug use practices are highly needed to secure the quality of medical care in pediatric hospitals.

Permeability of the rhesus monkey oocyte membrane to water and common cryoprotectants.

Successful cryopreservation of oocytes of the rhesus monkey (Macaca mulatta) would facilitate the use of this valuable animal model in research on reproduction and development, while providing a stepping stone towards human oocyte cryopreservation and the conservation of endangered primate species. To enable rational design of cryopreservation techniques for rhesus monkey oocytes, we have determined their osmotic and permeability characteristics in the presence of dimethylsulfoxide (DMSO), ethylene glycol (EG), and propylene glycol (PROH), three widely used cryoprotectants. Using nonlinear regression to fit a membrane transport model to measurements of dynamic cell volume changes, we estimated the hydraulic conductivity (L(p)) and cryoprotectant permeability (P(s)) of mature and immature oocytes at 23.5 degrees C. Mature oocyte membranes were most permeable to PROH (P(s) = 0.56 +/- 0.05 microm/sec) and least permeable to DMSO (P(s) = 0.24 +/- 0.02 microm/sec); the permeability to EG was 0.34 +/- 0.07 microm/sec. In the absence of penetrating cryoprotectants, mature oocytes had L(p) = 0.55 +/- 0.05 microm/min/atm, whereas the hydraulic conductivity increased to 1.01 +/- 0.10, 0.61 +/- 0.07, or 0.86 +/- 0.06 microm/min/atm when mature oocytes were exposed to DMSO, EG, or PROH, respectively. The osmotically inactive volume (V(b)) in mature oocytes was 19.7 +/- 2.4% of the isotonic cell volume. The only statistically significant difference between mature and immature oocytes was a larger hydraulic conductivity in immature oocytes that were exposed to DMSO. The biophysical parameters measured in this study were used to demonstrate the design of cryoprotectant loading and dilution protocols by computer-aided optimization.

Injection safety at primary health care level in south-western Saudi Arabia.

In a study of injection safety in Abha health district, Saudi Arabia, data were collected from 47 physicians and 85 nurses at 24 primary health care centres, using an observation checklist and an interview questionnaire. All centres used individually packed disposable syringes and puncture-proof containers to collect used needles. Needlestick injury in the previous year was reported by 14.9% of physicians and 16.5% of nurses (0.21 and 0.38 injuries/person/year respectively). Logistic regression analysis identified recapping the needle after use (physicians and nurses) and bending the needle before disposal (physicians) as significant risk factors for injury.

Altitude and bronchial asthma in south-western Saudi Arabia.

Through a house-to-house survey, 1325 people aged 11+ years registered at 2 primary health care centres (1 at high altitude and 1 at sea level) in Asir region, Saudi Arabia, were interviewed and examined for weight, height and peak expiratory flow rate. The prevalence of bronchial asthma at sea level (19.5%) was significantly higher than at high altitude (6.9%). Illiteracy, low income, use of coal and wood for heating, having a mud or tent house, lack of electricity inside dwellings and presence of sheep were also significant risk factors for bronchial asthma. In multivariate logistic regression, only altitude was found to be significantly associated with bronchial asthma (adjusted odds ratio = 3.94).

Self-medication practices with antibiotics and antimalarials among Sudanese undergraduate university students.

BACKGROUND: In many developing countries, up to 60-80% of health problems are self-medicated. OBJECTIVE: To estimate the prevalence of self-medication with antibiotics and/or antimalarials and identify factors promoting such use among university students in Sudan. METHODS: A descriptive cross-sectional study was performed, using a pretested questionnaire on a sample of 1300 students selected from 5 universities in Khartoum State, Sudan. RESULTS: Eight hundred ninety-one (79.5%; 95% CI 77.0 to 81.8) students from the study population had used antibiotics or antimalarials without a prescription within 1-2 months prior to the study. Four hundred ninety (55%; 95% CI 51.7 to 58.3) of the respondents stated that they had used antibiotics, 39 (4.4%; 95% CI 3.2 to 6.0) had used antimalarials, and 362 (40.6%; 95% CI 37.4 to 43.9) had used both. Overall, self-medication with antibiotics or antimalarials was significantly more common among students 21 years of age or older compared with those 20 years of age or younger (OR 1.55; 95% CI 1.15 to 2.09; p = 0.004) and among students attending private universities compared with those attending public universities (OR 1.42; 95% CI 1.04 to 1.95; p = 0.028). Self-medication with antibiotics followed a similar pattern, which was significantly more common among students 21 years of age or older (OR 1.36; 95% CI 1.03 to 1.81; p = 0.03) and private university respondents (OR 1.52; 95% CI 1.15 to 2.02; p = 0.003). Self-medication with antimalarials was found to be significantly less common among females (OR 0.76; 95% CI 0.59 to 0.97; p = 0.028) and higher among the 21 years or older age group (OR 1.84; 95% CI 1.42 to 2.40; p < 0.001). The most common reason indicated for self-medication was the respondents' previous experiences with similar ailments. The main source of drugs was community pharmacies. CONCLUSIONS: The prevalence of self-medication with antibiotics/antimalarials among undergraduate university students in Khartoum State is high. Our findings highlight the need for planning interventions to promote the judicious use of antibiotics/antimicrobials.

Primary health care emergency services in Abha district of southwestern Saudi Arabia.

To study emergency services delivery in all 30 primary health care centres in Abha district of Asir region, Saudi Arabia, data were collected about equipment and facilities, physicians' practices and attitudes, and patients' utilization of and satisfaction with emergency services. Two centres had no devoted place for emergency services. Lack of some essential equipment and drugs was evident. The greatest continuing medical education need for doctors was the management of cardiovascular emergencies (72.3%). Many doctors (40.4%) did not consider the majority of cases as true emergencies. Many patients (43.7%) used the centres for emergency services, the most common being trauma, burns and orthopaedics (47.8%). Most patients were satisfied overall with emergency services (82.2%).

Medical and pharmacy students' attitudes towards physician-pharmacist collaboration in Kuwait.

OBJECTIVE: To assess and compare the attitudes of medical and pharmacy students towards physician-pharmacist collaboration and explore their opinions about the barriers to collaborative practice in Kuwait. METHODS: A cross-sectional survey of pharmacy and medical students (n=467) was conducted in Faculties of Medicine and Pharmacy, Kuwait University. Data were collected via self-administered questionnaire from first-year pharmacy and medical students and students in the last two professional years of the pharmacy and medical programs. Descriptive and comparative analyses were performed using SPSS, version 22. Statistical significance was accepted at p<0.05. RESULTS: The response rate was 82.4%. Respondents had overall positive attitudes towards physician-pharmacist collaboration. Pharmacy students expressed significantly more positive attitudes than medical students (p< 0.001). Medical students rated the three most significant barriers to collaboration to be: pharmacists' separation from patient care areas (n=100, 70.0%), lack of pharmacists' access to patients' medical record (n=90, 63.0%) and physicians assuming total responsibility for clinical decision-making (n=87, 60.8%). Pharmacy students' top three perceived barriers were: lack of pharmacists' access to patients' medical record (n=80, 84.2%), organizational obstacles (n=79, 83.2%), and pharmacists' separation from patient care areas (n=77, 81.1%). Lack of interprofessional education was rated the fourth-largest barrier by both medical (n=79, 55.2%) and pharmacy (n=76, 80.0%) students. CONCLUSIONS: Medical and pharmacy students in Kuwait advocate physician-pharmacist collaborative practice, but both groups identified substantial barriers to implementation. Efforts are needed to enhance undergraduate/postgraduate training in interprofessional collaboration, and to overcome barriers to physician-pharmacist collaboration to advance a team approach to patient care.

A study of determinants of low birth weight in Abha, Saudi Arabia.

This study examined the role of women's work as a possible determinant (among others) of low birth weight in the population of women followed in a Primary Health Care (PHC) center in Abha, Southern Saudi Arabia. All antenatal care files for all deliveries in the preceding 5 years were studied and the relevant data from 7067 files were collected and analyzed. Low birth weight was significantly higher in working mothers (odds ratio=1.31), adolescent mothers (odds ratio= 2.56), and low parity mothers (OR= 1.28). Anemia of the mother contributed an odds ratio of 1.23 for low birth weight baby and inadequate antenatal care (less than 3 visits during pregnancy) had an odds ratio of 1.9. Female babies were significantly more prone to low birth weight (odds ratio 1.34). It is suggested that further evaluation of women's work conditions to detect and remedy stressful conditions especially during pregnancies, health education and better antenatal care may prevent a good proportion of low birth weight deliveries.

Health education in the management of diabetes at the primary health care level: is there a gender difference?

We examined differences between male and female diabetic patients, as recipients of health education messages provided in a primary health care setting and its implications on the control of the disease. The files of 198 diabetic patients attending a diabetes clinic in Abha, Saudi Arabia were analysed. The results showed that females had significantly higher body mass index and fasting blood sugar levels than men with significantly fewer mean number of health education sessions in the last 12 months. Multiple logistic regression model pointed to the female sex as a significant predictor of poor glycaemic control. The model for females alone showed significantly poorer diabetes control when the number of health education sessions received was less.

Knowledge and attitudes towards AIDS among Saudi and non-Saudi bus drivers.

We explored the AIDS knowledge and attitudes of long-distance (non-Saudi) and in-city (Saudi) bus drivers in Saudi Arabia. The 69 non-Saudi drivers tended to score higher on knowledge than the 40 Saudi drivers although there were several gaps in their knowledge. As regards attitude, more Saudis knew that chastity could protect against AIDS and both groups tended to think that they were not the kind of people to get AIDS. Intensive health education and follow up is highly recommended for this sector of workers.

Pharmacokinetics of artesunate alone and in combination with sulfadoxine/pyrimethamine in healthy Sudanese volunteers.

Artesunate (AS) in combination with sulfadoxine/pyrimethamine (SP) is the first-line therapy for management of uncomplicated Plasmodium falciparum malaria in Sudan. The objective of this study was to assess the potential impact of SP on the pharmacokinetics of AS and its active metabolite, dihydroartemisinin (DHA), in healthy adults. A single-dose, randomized, open-label, crossover study design with a washout period of three weeks was performed with 16 volunteers. After oral administration of AS alone or in combination with SP, Tmax values of AS and DHA were significantly prolonged in the combination group (P < 0.05). However, there was no significant effect on the other pharmacokinetic parameters (P > 0.05). The t1/2 values of AS and DHA were significantly higher in females than in males (P < 0.05). The present findings suggest that co-administration of SP with AS has no clinically relevant impact on the pharmacokinetics of AS or DHA in healthy persons.

Pharmaceutical care education in Kuwait: pharmacy students' perspectives.

BACKGROUND: Pharmaceutical care is defined as the responsible provision of medication therapy to achieve definite outcomes that improve patients' quality of life. Pharmacy education should equip students with the knowledge, skills, and attitudes they need to practise pharmaceutical care competently. OBJECTIVE: To investigate pharmacy students' attitudes towards pharmaceutical care, perceptions of their preparedness to perform pharmaceutical care competencies, opinions about the importance of the various pharmaceutical care activities, and the barriers to its implementation in Kuwait. METHODS: A descriptive, cross-sectional survey of pharmacy students (n=126) was conducted at Faculty of Pharmacy, Kuwait University. Data were collected via a pre-tested self-administered questionnaire. Descriptive statistics including percentages, medians and means Likert scale rating (SD) were calculated and compared using SPSS, version 19. Statistical significance was accepted at a p value of 0.05 or lower. RESULTS: The response rate was 99.2%. Pharmacy students expressed overall positive attitudes towards pharmaceutical care. They felt prepared to implement the various aspects of pharmaceutical care, with the least preparedness in the administrative/management aspects. Perceived pharmaceutical care competencies grew as students progressed through the curriculum. The students also appreciated the importance of the various pharmaceutical care competencies. They agreed/strongly agreed that the major barriers to the integration of pharmaceutical care into practice were lack of private counseling areas or inappropriate pharmacy layout (95.2%), lack of pharmacist time (83.3%), organizational obstacles (82.6%), and pharmacists' physical separation from patient care areas (82.6%). CONCLUSION: Pharmacy students' attitudes and perceived preparedness can serve as needs assessment tools to guide curricular change and improvement. Student pharmacists at Kuwait University understand and advocate implementation of pharmaceutical care while also recognizing the barriers to its widespread adoption. The education and training provided at Kuwait University Faculty of Pharmacy is designed to develop students to be the change agents who can advance pharmacist-provided direct patient care.

Pharmaceutical care in Kuwait: hospital pharmacists' perspectives.

BACKGROUND: Pharmaceutical care practice has been championed as the primary mission of the pharmacy profession, but its implementation has been suboptimal in many developing countries including Kuwait. Pharmacists must have sufficient knowledge, skills, and positive attitudes to practise pharmaceutical care, and barriers in the pharmacy practice model must be overcome before pharmaceutical care can be broadly implemented in a given healthcare system. OBJECTIVE: To investigate hospital pharmacists' attitudes towards pharmaceutical care, perceptions of their preparedness to provide pharmaceutical care, and the barriers to its implementation in Kuwait. SETTING: Six general hospitals, eight specialized hospitals and seven specialized health centers in Kuwait. METHOD: A descriptive, cross-sectional survey was distributed to all pharmacists working in the governmental hospitals in Kuwait (385 pharmacists). Data were collected via a pre-tested self-administered questionnaire. Descriptive statistics including percentages, medians and means Likert scale rating (standard deviations) were calculated and compared using statistical package for social sciences, version 20. Statistical significance was accepted at a p value of <0.05. MAIN OUTCOME MEASURE: Pharmacists' attitudes towards pharmaceutical care, perceptions of their preparedness to provide pharmaceutical care competencies, and the barriers to its implementation in Kuwait. RESULTS: Completed surveys were received from 250 (64.9%) of the 385 pharmacists. Pharmacists expressed overall positive attitudes towards pharmaceutical care. They felt well prepared to implement the various aspects of pharmaceutical care, with the least preparedness in the administrative/management aspects. Pharmacists with more practice experience expressed significantly more positive attitudes towards pharmaceutical care (p = 0.001) and they felt better prepared to provide pharmaceutical care competencies (p < 0.001) than those with less experience as practitioners. The respondents agreed/strongly agreed that the most significant barriers to the integration of pharmaceutical care into practice were lack of private counseling areas or inappropriate pharmacy layout (87.6%), organizational obstacles (81.6%), inadequate staff (79.6%), and lack of pharmacist time and adequate technology (76.0%). CONCLUSION: Hospital pharmacists in Kuwait advocate implementation of pharmaceutical care while also appreciating the organizational, technical and professional barriers to its widespread adoption. Collaborative efforts between health authorities and educational institutions, and the integration of innovative approaches in pharmacy management and education could overcome these barriers and achieve the transition towards pharmaceutical care practice.

Role of community pharmacists in the prevention and management of the metabolic syndrome in Kuwait.

BACKGROUND: The metabolic syndrome is a cluster of cardiovascular risk factors and its prevalence is alarmingly high in Kuwait, affecting nearly one third of the adult population. There is lack of information about the role of community pharmacists in the care of patients with the metabolic syndrome. OBJECTIVE: To assess the awareness and opinions of community pharmacists about the metabolic syndrome and identify the services they provide for identification, management and monitoring of patients with the metabolic syndrome. SETTING: Community pharmacies in Kuwait. METHOD: A descriptive, cross-sectional study was performed on a randomly selected sample of 225 community pharmacists. Data were collected via face-to-face structured interview of the pharmacists using a pre-tested questionnaire. MAIN OUTCOME MEASURES: Pharmacists' knowledge and views on the metabolic syndrome, monitoring services provided, self-reported practices and perceived effectiveness of the various management interventions for the metabolic syndrome. RESULTS: The response rate was 97.8 %. Nine pharmacists claimed to know about the metabolic syndrome, but only one pharmacist could identify the condition correctly. After being given a definition of the metabolic syndrome, 67.7 % of respondents strongly agreed that its prevalence was rising in Kuwait. Nearly two thirds of respondents reported providing height and weight measurement service while 82.7 and 59.5 % of pharmacies provided blood pressure and blood glucose measurements, respectively. Waist circumference and lipid profile measurements were the least provided services (1.8 %). Respondents claimed to be involved in counseling patients on lifestyle modifications including increased exercise (98.1 %) and weight reduction through diet (96.9 %). Most pharmacists were involved in encouraging patients' adherence with prescribed treatments (98.6 %) and perceived these as the most effective intervention for the management of the metabolic syndrome (95.0 %). Respondents were less involved in monitoring patients' response to therapy (75.0 %) and documenting patient care services (5.0 %). CONCLUSION: This study revealed significant deficits in awareness among community pharmacists about the metabolic syndrome. Given the proper education and training, community pharmacists could be important front-line contributors to the control of this emerging epidemic in Kuwait.

Evaluation of adherence to international guidelines for treating patients with type 2 diabetes mellitus in Kuwait.

BACKGROUND: Clinical guidelines derived from scientific evidence provide the basis of consistent standardized prescribing. Despite an alarming increase of diabetes in Kuwait, no studies related to the quality of prescribing in diabetes were found. Before pharmaceutical care can be implemented to improve the quality of care of patients with diabetes, it is important to determine whether prescribers are compliant with comprehensive international guidelines for cardioprevention and glycaemic control. OBJECTIVE: To evaluate the adherence to clinical guidelines for treating patients with type 2 diabetes mellitus in primary care centres and secondary care centres (hospitals) using a developed and validated medication assessment tool with reference to international guidelines. SETTING: Outpatient diabetes clinics in 8 primary care centres and 4 secondary care centres across four healthcare regions in Kuwait. METHOD: A quantitative, cross-sectional study involving a sample of 652 Kuwaiti patients with type 2 diabetes, who were selected using systematic sampling from the study settings. Data were collected retrospectively from the patients' medical records using a validated 43-criterion medication assessment tool (MATKW) designed to assess cardioprevention and treatment in patients with type 2 diabetes. Descriptive and comparative analysis was conducted using SPSS version 17. MAIN OUTCOME MEASURE: Frequency of prescribing adherence to agreed definitions of criteria derived from international guidelines. RESULTS: Overall adherence to prescribing diabetes guidelines was 77.7 % (95 % CI 76.7-78.6 %). Significantly higher prescribing adherence was found in the secondary care facilities, 82.4 % (95 % CI 81.2-83.6 %) compared to primary care 72.5 % (95 % CI 71.0-73.9 %) (p < 0.001). Nineteen criteria out of 43 achieved an adherence >80 % in secondary care compared to ten criteria in primary care. The documentation of patients' records was found to be inconsistent at the study healthcare facilities. Nonoptimal achievement of target goals for HbA1c, blood pressure and BMI was prevalent among the study population. CONCLUSION: A tool such as MATKW highlights areas for review and possible improvement in prescribing adherence. Our findings reveal problem areas in prescribing practices and documentation of patients' records. Cost-effective multifaceted interventions are needed to improve current prescribing practices and documentation.

Changing patterns in the management and outcome of breech presentation over a 7-year period. Review from a referral hospital in Saudi Arabia.

A retrospective study that was conducted on 755 singleton breech deliveries over a 7-year period between January 1994 and December 2000 at a referral hospital in Saudi Arabia showed that it represented 3.35% of all deliveries. There was a statistically significant trend in caesarean section (P = 0.001) accompanied by a modest linear trend in perinatal mortality (P = 0.049). There were no statistically significant differences in the mean age, parity and birth weight when the women delivered during each year were compared (P > 0.05), but there were statistically significant differences in the gestation at delivery (P < 0.05). Furthermore, statistically significant differences were found in the trends of the preterm breech deliveries and booking status over the period of study (P > 0.05). However, there was no statistically significant linear trend in the birth trauma (P > 0.05). Nineteen cases of the fetal birth trauma (67.8%) were associated with vaginal breech delivery while nine cases (32.2%) were reported from caesarean section. This was statistically significant (P = 0.00074). The role of selective external cephalic version as a way of reducing the caesarean section rate and also trauma during vaginal breech delivery at term in our community is discussed.