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Al-Jedai A, Almudaiheem H, Al-Salamah T, Aldosari M, Almutairi AR, Almogbel Y, AlRuthia Y, Althemery AU, Alluhidan M, Roudijk B, Purba FD, Awad N, O'jeil R. Valuation of EQ-5D-5L in the Kingdom of Saudi Arabia: A National Representative Study. Value Health 2024; 27:552-561. [PMID: 38342365 DOI: 10.1016/j.jval.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES To estimate a Saudi-specific value set for the EQ-5D-5L questionnaire using the EuroQol Valuation Technology program and the EuroQol Group's standard protocol. METHODS Participants were quota-sampled from the Saudi adult population based on residency location, age group, gender, education level, and employment status. The participants were guided through the completion of composite time trade-off (cTTO) and discrete choice experiment (DCE) tasks by trained interviewers using EuroQol Valuation Technology software. Quality control (QC) measures were used to ensure good data quality. Random intercept and Tobit models analyzed the cTTO data, as well as models correcting for heteroskedasticity. DCE data were analyzed using conditional logit models, whereas hybrid models were used to analyze the cTTO and DCE data jointly. To evaluate model performance, prediction accuracy, logical consistency, significance level, and goodness of fit were used. RESULTS The valuation study included a representative sample of the Saudi population (N = 1000). The hybrid heteroskedastic model without a constant was chosen as the preferred model for generating the value set. The predicted values ranged from -0.683 for the worst health state ("55555") to 1 for the full health state ("11111"). Pain and discomfort had the largest impact on health-state preference values, whereas usual activities had the least. CONCLUSION The value set for the Kingdom of Saudi Arabia is the first value set for the EQ-5D-5L for any country in the Middle East. The value set can be used in Saudi health system economic evaluations and decision making.
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Affiliation(s)
- Ahmed Al-Jedai
- Alfaisal University Alfaisal University, Colleges of Medicine and Pharmacy, Riyadh, Saudi Arabia; Therapeutics Affairs, Ministry of Health, Riyadh, Saudi Arabia.
| | - Hajer Almudaiheem
- Drug Policy and Regulation Department, Ministry of Health, Riyadh, Saudi Arabia
| | - Tareq Al-Salamah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Emergency Medicine, University of Maryland Medical Centre, Baltimore, MD, USA
| | - Muath Aldosari
- King Saud University College of Dentistry, Riyadh, Saudi Arabia; Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | | | - Yasser Almogbel
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah U Althemery
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | | | - Bram Roudijk
- EuroQol Research Foundation, Marten Meesweg 107, Rotterdam, The Netherlands
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Alyahya B, Alalshaikh A, Alkhulaif A, Al-Salamah T, Aldawood B, Alsubaie A, Alohali M, Alshenaifi S, Alohali A, Alzin MB, Almana A, Habib M, Hasanato R. Are We Overusing Coagulation Studies in the Emergency Department? Emerg Med Int 2024; 2024:8694183. [PMID: 38689634 PMCID: PMC11060872 DOI: 10.1155/2024/8694183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Methods This retrospective observational study, conducted in the ED of King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia, during July and August of 2021(2 months) examined coagulation profile requests. Patients' demographic data (age and gender), medical and clinical history (presenting complaint, comorbidities, and diagnosis), the use of antiplatelets or anticoagulant agents and laboratory values for PT, APTT, and INR were collected. We calculated the total cost of unnecessary coagulation profile testing based on the independent assessment of two ED consultants. Results Of 1,754 patients included in the study, 811 (46.2%) were males and 943 (53.8%) were females, with a mean age of 42.1 ± 18.5 years. There were 29 (1.7%) patients with liver disease and 21 (1.2%) patients had thromboembolic disease. The majority of the patients' results were within normal levels of PT (n = 1,409, 80.3%), APTT (n = 1,262, 71.9%), and INR (n = 1,711, 97.4%). Evidence of active bleeding was detected in 29 patients (1.7%). Among patients with bleeding only one had an abnormal INR (3.01) and was on warfarin. Forty-six (2.6%) patients had elevated INR level. Cohen's kappa between the two consultants was recorded at 0.681 (substantial agreement) in their assessment of the appropriateness of coagulation tests requests and both consultants believed that 1,051 tests (59.9%) were not indicated and were unnecessary. The expected annual cost saving if the unnecessary tests were removed would be around SAR 1,897,200 (approximately US$ 503,232) which is about SAR 180000 (US$ 48000)/1000 patients. Conclusion This study showed that coagulation tests are overused in the ED. More than half of coagulation profile tests in our study population were deemed unnecessary and associated with significant cost. Targeted testing based on specific patient presentation and medical history can guide physicians in wisely choosing who needs coagulation studies.
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Affiliation(s)
- Bader Alyahya
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alalshaikh
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali Alkhulaif
- King Abdullah University Hospital, Riyadh, Saudi Arabia
| | - Tareq Al-Salamah
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Badr Aldawood
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alwaleed Alsubaie
- Department of Emergency Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Meshal Alohali
- Medical Services Saudi Royal Guard, Riyadh, Saudi Arabia
| | - Saud Alshenaifi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Majed B. Alzin
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Almana
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Habib
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rana Hasanato
- Laboratory Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Alblaihed L, Kositz C, Brady WJ, Al-Salamah T, Mattu A. Diagnosis and management of arrhythmogenic right ventricular cardiomyopathy. Am J Emerg Med 2023; 65:146-153. [PMID: 36638611 DOI: 10.1016/j.ajem.2022.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder of the myocardium that can lead to ventricular arrhythmia and sudden cardiac death. The condition has been identified as a significant cause of arrhythmic death among young people and athletes, therefore, early recognition of the disease by emergency clinicians is critical to prevent subsequent death. The diagnosis of ARVC can be very challenging and requires a systematic approach. This publication reviews the pathophysiology, classification, clinical presentations, and appropriate approach to diagnosis and management of ARVC.
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Affiliation(s)
- Leen Alblaihed
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca Street, 6(th) Floor, Suite 200, Baltimore, MD 21201, United States of America.
| | - Christine Kositz
- Depratment of Emergency Medicine, University of Maryland Shore Medical Center at Easton, 219 S Washington St, Easton, MD 21601, United States of America
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Tareq Al-Salamah
- Department of Emergency Medicine, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia
| | - Amal Mattu
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca Street, 6(th) Floor, Suite 200, Baltimore, MD 21201, United States of America
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Alblaihed L, Brady WJ, Al-Salamah T, Mattu A. Dysrhythmias associated with COVID-19: Review and management considerations. Am J Emerg Med 2023; 64:161-168. [PMID: 36563500 PMCID: PMC9721478 DOI: 10.1016/j.ajem.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is known to affect the cardiovascular system. Cardiac manifestations in COVID-19 can be due to direct damage to the myocardium and conduction system as well as by the disease's effect on the various organ systems. These manifestations include acute coronary syndrome, ST- segment elevations, cardiomyopathy, and dysrhythmias. Some of these dysrhythmias can be detrimental to the patient. Therefore, it is important for the emergency physician to be aware of the different arrhythmias associated with COVID-19 and how to manage them. This narrative review discusses the pathophysiology underlying the various arrhythmias associated with COVID-19 and their management considerations.
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Affiliation(s)
- Leen Alblaihed
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, United States of America,Corresponding author
| | - William J. Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, United States of America
| | - Tareq Al-Salamah
- Department of Emergency Medicine, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia
| | - Amal Mattu
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, United States of America
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Hines MC, Al-Salamah T, Heil EL, Mallemat H, Witting MD, Johnson JK, Winters ME, Hayes BD. Resistance Patterns of Escherichia coli in Women with Uncomplicated Urinary Tract Infection Do Not Correlate with Emergency Department Antibiogram. J Emerg Med 2015; 49:998-1003. [PMID: 26281821 DOI: 10.1016/j.jemermed.2015.06.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/04/2015] [Accepted: 06/12/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Urine cultures are not always performed for female Emergency Department (ED) patients with uncomplicated urinary tract infection (UTI). Accordingly, hospital, and even ED-specific, antibiograms might be skewed toward elderly patients with many comorbidities and relatively high rates of antimicrobial resistance, and thus do not accurately reflect otherwise healthy women. Our ED antibiogram indicates Escherichia coli resistance rates for ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole (TMP-SMX) of 42%, 26%, and 33%, respectively. OBJECTIVES This study aims to compare resistance rates of urinary E. coli from otherwise healthy women with uncomplicated UTI and pyelonephritis in the ED to rates in our ED antibiogram. METHODS Females > 18 years old with acute onset of urinary frequency, urgency, or dysuria with pyuria identified on urinalysis (white blood cell count > 10/high-power field) were prospectively enrolled in the ED of an urban, academic medical center. Exclusion criteria indicating a complicated UTI were consistent with Infectious Diseases Society of America guidelines. Susceptibility patterns of E. coli to ciprofloxacin, levofloxacin, and TMP-SMX in the study group were compared to our ED antibiogram. RESULTS Forty-five patients grew E. coli. Pyelonephritis was suspected in nine (20%) subjects. Compared with the ED antibiogram, significantly lower rates of resistance to ciprofloxacin (2% vs. 42%, p < 0.001), levofloxacin (2% vs. 26%, p < 0.001), and TMP-SMX (16% vs. 33%, p = 0.016) were observed. Six patients grew non-E. coli uropathogens. All were susceptible to both levofloxacin and TMP-SMX. CONCLUSIONS ED antibiograms may overestimate resistance rates for uropathogens causing uncomplicated UTIs. In cases where nitrofurantoin cannot be used, fluoroquinolones and possibly TMP-SMX may remain viable options for treatment of uncomplicated UTI and pyelonephritis in women.
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Affiliation(s)
- Michelle C Hines
- Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland
| | - Tareq Al-Salamah
- Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland; King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Emily L Heil
- Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland
| | - Haney Mallemat
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael D Witting
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer K Johnson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael E Winters
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bryan D Hayes
- Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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