Evaluating factors affecting the implementation of evidence based medicine in primary healthcare centers in Dubai

Objectives

To assess the current evidence based medicine (EBM) knowledge, attitude and perceptions of physicians at Dubai Primary Health Care Sector (PHCS). Further to evaluate barrier and facilitator factors toward implementing the EBM practice.

Methodology

A cross-sectional study, at Dubai PHCS, UAE between June and August 2010. The survey was composed of two phases. The first phase was a self administrated questionnaire employed for data collection and the second phase was qualitative method, which was in the form of individual interviews. Statistical Package for Social Sciences (SPSS) was used for data analysis.

Results

In total 48 participants responded to the survey questionnaire and 13 responded to individual interviews. The response rate was 70.0%. Mean age was 42.18 (SD 10.46). The majority were females (64.6%). The physicians who attended EBM courses reported 70.30% using EBM and showed statistical significance (p = 0.002) from those who did not attend the EBM courses. 65.0% believe that 50–75% of the patients are capable of participating in clinical decision while 71.8% disagreed that the concept of EBM is not applicable to their culture. In addition they showed significance (p = 0.03) between physician beliefs with regard to patient capacity to take decision. About 67.0% of the family physicians were knowledgeable and followed systematic review as the strongest evidence. They had no access to the EBM resources (37.0%) and had no time to practice the EBM (38.0%). Nearly 40.0% interviewees reported lack of encouragement to attend EBM courses. EBM activities (22.0%) and active audit (18.0%) were top rated facilitating factors.

Conclusions

EBM is not fully utilized by indefinite physicians in the Dubai PHC sector. Factors associated with non-utilization of EBM in the PHCS are lack of encouragement to attend EBM courses, senior physicians resist adoption of EBM, lack of time and insufficient dissemination process for implementing the clinical guideline.     

Complications of pediatric facial fractures

Pediatric facial fractures account for only 5% of all facial fractures, with even a much lower incidence in children younger than 5 years (1%-1.5%). The evolution of principles in the management of pediatric facial fractures and the differences in management between adult and pediatric patients have been well documented in the literature. Pediatric facial fracture management presents unique challenges because it might affect growth in the area specific to the trauma segment. Children are, in several ways, at a regenerative advantage: greater osteogenic potential, faster healing rate, primary dentition that is thereby temporary, and the capacity for significant dental compensation. Perhaps because of this, complications such as infection, malunion, nonunion, and postinjury malocclusion are relatively rare compared with the adult population. In this article, we will focus on different approaches to complications that arise after pediatric fracture management.     

Influence of HPMC K100LV and Compritol® HD5 ATO on Drug Release and Rheological Behavior of HPMC K4M Matrix Tablets

Purpose

The objectives of this study were to develop once-a-day oral controlled-release tablets of quetiapine fumarate (QF) and to determine the effect of polymer type, viscosity grade, polymer ratio, and polymer rheological properties on the rate of QF release from hydroxypropyl methylcellulose (HPMC) matrix tablets.

Methods

Tablets were prepared from low-viscosity-grade HPMC K100LV (K100LV), high-viscosity-grade HPMC K4M (K4M), Compritol® HD5 ATO (PEGylated glyceryl behenate (PGB)), and binary combinations of these polymers. In vitro drug release from all tablets was evaluated over 24 h.

Results

In vitro drug release studies revealed that formulations containing K100LV/K4M and PGB/K4M at a ratio of 170:70 resulted in similar release profiles which extended for 24 h (f2 > 50). QF release kinetics followed either diffusion, anomalous transport, case II transport, or super case II transport, as fitted by the Korsmeyer-Peppas model. Tablet swelling and erosion studies were consistent with dissolution profiles. A linear relationship between % swelling and % QF released was observed in tablets containing K4M alone or in combination with K100LV or PGB, indicating the direct role of polymer swelling in controlling the mechanism of drug release. The viscoelastic properties of single and binary polymeric gels made with the three polymers (K100LV, K4M, and PGB) corroborated the in vitro release studies of QF tablets.

Conclusions

Our results provide evidence that blending polymers with different viscosities and hydrophilicities can result in unique matrices with tunable release profiles.

     

The dumbo rat mutant: a cytogenetic, morphologic and sagittal morphometric analysis

Objective: to study the possibility of use Dumbo rat as, experimental model for understanding abnormal craniofacial development.Design: we investigated craniofacial morphogenesis in the Dumbo rat by morphologic and morphometric technics. We also performed a cytogenetic study of this rat. Wistar strain was considered as control. For morphologic and morphometric studies, we used Dumbo and Wistar embryos at E15 to 21. We stained these embryos in toto with alcian blue and alizarin red. The skeletons of the embryos were examined and drawn under a Lucida camera, and the following sagittal measurements were taken: zygomatic length and thickness, length of the mandible and its anterior and posterior thicknesses, length of the maxillary, and petrous bone height. Statistical analyses were realized using Mann Whitney test in SPSS. For cytogenetic study, chromosome spreads were prepared from lymphocyte cultures obtained from the blood of adult rats of both strains. Results: the Dumbo embryos exhibed hypoplasia of the zygomatic, maxillar and mandibular bones, and micrognathia, evoking some human dysmorphogenesis . Moreover, the position of the preliminary ear was abnormally low. The differences in the measurements of the craniofacial structures between the two groups of rats are significant. However, the cytogenetic study did not reveal any differences between the two strains.Conclusion: our data indicate that the considerable morphometric differences between the craniofacial structures of Dumbo and Wistar rats might be due to genetic mutations that are undetectable by chromosome mapping. Further histologic and genetic analyses might contribute to elucidate the early determinism of the Dumbo phenotype.