Adapting evidence-based clinical practice guidelines at university teaching hospitals: A model for the Eastern Mediterranean Region.

RATIONALE, AIMS, AND OBJECTIVES: Clinical practice guidelines (CPGs) are significant tools for evidence-based health care quality improvement. The CPG program at King Saud University was launched as a quality improvement program to fulfil the international accreditation standards. This program was a collaboration between the Research Chair for Evidence-Based Healthcare and Knowledge Translation and the Quality Management Department. This study aims to develop a fast-track method for adaptation of evidence-based CPGs and describe results of the program. METHODS: Twenty-two clinical departments participated in the program. Following a CPGs awareness week directed to all health care professionals (HCPs), 22 teams were trained to set priorities, search, screen, assess, select, and customize the best available CPGs. The teams were technically supported by the program's CPG advisors. To address the local health care context, a modified version of the ADAPTE was used where recommendations were either accepted or rejected but not changed. A strict peer-review process for clinical content and methodology was employed. RESULTS: In addition to raising awareness and building capacity, 35 CPGs were approved for implementation by March 2018. These CPGs were integrated with other existing projects such as accreditation, electronic medical records, performance management, and training and education. Preliminary implementation audits suggest a positive impact on patient outcomes. Leadership commitment was a strength, but the high turnover of the team members required frequent and extensive training for HCPs. CONCLUSION: This model for CPG adaptation represents a quick, practical, economical method with a sense of ownership by staff. Using this modified version can be replicated in other countries to assess its validity.

Sleep-disordered breathing in children with craniosynostosis.

BACKGROUND: Syndromic craniosynostosis (SC) is associated with a high prevalence of sleep-disordered breathing (SDB). However, it remains unclear whether non-syndromic craniosynostosis (NSC) is associated with an increased risk for SDB. SETTING: This study was conducted at a tertiary referral pediatric medical center. METHODS: A prospective polysomnographic (PSG) evaluation was conducted of all children diagnosed with craniosynostosis over a 3-year period and who had not undergone previous PSG for SDB-related symptoms. RESULTS: Among 14 children fulfilling inclusion criteria, 10 had NSC and 4 were diagnosed with SC (Crouzon syndrome). SDB was present in 50 % of the NSC and in 75 % of SC. No associations emerged between the number of sutures affected and the presence of SDB. CONCLUSIONS: SDB is highly prevalent not only in SC but also among asymptomatic children with NSC. The diagnosis of NSC should prompt a diagnostic PSG as a routine component of the clinical evaluation, and PSG findings may aid in the formulation of decisions regarding timing and need for surgical interventions.

Sleep-disordered breathing in children with Chiari malformation type II and myelomeningocele.

BACKGROUND: The prevalence of sleep-disordered breathing (SDB) in children with Chiari malformation type II (CM-II), a known association of neural tube defects (NTD), has not been well documented. The aim of the present study was to assess the prevalence and possible predictive factors of SDB in patients with CM-II. METHODS: The study included all patients with documented CM-II who were routinely referred from the Neurosurgery Clinic to the University Sleep Disorders Centre at King Khalid University Hospital, Riyadh, Saudi Arabia, between January 2002 and July 2009. Overnight full polysomnography (PSG) was performed in all patients. Polysomnographic data were analyzed using descriptive statistics. RESULTS: Sixteen children (11 boys, five girls) were included in the study; their mean age was 4.7 years (range, 0.8-10 years) and their mean body mass index was 18.05 kg/m(2) (range, 15.4-25.4 kg/m(2) ). For the whole group, the mean apnea-hypopnea index (AHI) was 6.3/h (range, 0.2-24.5/h), with AHI recorded as >5/h in five patients (31.3%) and ≥ 10/h in three patients (18.8%). The mean central apnea-hypopnea index was 5.9/h (range, 0-24.5/h) and the mean obstructive apnea-hypopnea index was 0.4/h (range, 0-2.9/h). The mean arousal index was 15.1/h (range, 5-34/h). CONCLUSION: The major assumption linking CM-II and NTD with potential brainstem compression and respiratory dysfunction during sleep was confirmed. Indeed, SDB is highly prevalent, and clearly underreported and undertreated in patients with CM-II associated with NTD.

Managing wheeze in preschool children: How difficult can it be?

Wheeze is a common symptom in infants and preschool children. Up to 30% of children wheeze at least once before the age of 3 years and 2% of those have it severe enough to warrant hospital admission. Not only parents but also physicians have difficulty in recognizing wheeze. Wrong diagnosis of the underlying condition leads to inappropriate and unnecessary management and patient morbidity. Asthma is the commonest underlying condition in children with wheeze, but the differential diagnosis is quite broad and a systematic approach including a good clinical history, thorough physical examination and appropriate investigations are essential to reach the accurate diagnosis.

Unilateral primary pulmonary agenesis and hypoplasia in monozygotic twins.

We describe 10-month-old identical female twin infants, one with primary left-sided pulmonary agenesis and the other with primary left-sided pulmonary hypoplasia. They came to our outpatient clinic complaining of persistent dry cough. The clinical examination revealed decreased air entry over the left hemithorax. Chest x-rays showed complete left-sided radio-opacity in both the twins. The chest computed tomography scan with contrast confirmed the diagnoses of left-sided pulmonary agenesis (twin A) and left-sided hypoplasia (twin B). No other associated congenital anomaly was noted in either of the twins. To our knowledge, such a condition in live monozygotic twins has not been previously reported in published studies.