Background:The purpose of the study was to evaluate the outcome of warm pediatric near drowning, and assess possible predictors of the outcome. Subjects and Methods: The study was performed at King Khalid University Hospital, Riyadh, Saudi Arabia. Twenty-eight cases of pediatric near drowning (one to 13 years of age) over a 10-year period ending June 1998, were reviewed retrospectively. Multiple variables during the prehospital and the hospital stages were evaluated to assess their effect on the outcome. Results: None of the patients' families had official training in cardiopulmonary resuscitation. Only one of the 21 private swimming pools had features compatible with swimming pool safely regulations. Eleven patients (39.3%) died in the pediatric intensive care, and 17 (60.7%) were discharged alive. Submersion time of >5 minutes and the emergency room documentation of absence of vital signs, Glasgow Coma Scale of ≤4, arterial pH of ≤7.0 and blood sugar of ≥10 mmol/L all predicted bad outcome, with a statistical significance (P< 0.05). Conclusion: This audit highlighted major concerns about our prehospital medical care, general population basic life support education and our society's adherence to swimming pool safety regulations. It demonstrated that hypothermia on arrival to the emergency department in warm near-drowning victims is likely to be associated with bad outcome. The audit results also agree with the opinion of not aggressively intervening or prolonging aggressive intervention in warm near-drowning cases presenting with bad prognostic outcome. Drowning is a preventable catastrophic accident. It is the fourth leading cause of death for children younger than 19 years of age, and the single leading cause of injury death for children under 5 years of age in the US.1,2 A rate of drowning of between 0.7 and 2.9 per 100,000 children younger than 19 years has been reported. 1,3 Roughly 80% of the children with near-drowning histories are admitted for at least one day, and 40%-50% of the cases die, with as many as 20% of the survivors suffering severe permanent disability. [4][5][6] Residential swimming pools continue to be the most common place for immersion injuries, particularly in preschool children. 2,[6][7][8][9][10][11][12] The total annual economic losses due to swimming pool drowning and near drowning of young children in the United States are estimated to be between $450 and $650 million. 13 Adherence to safety precautions for residential swimming pools, such as four-sided fencing, is estimated to have prevented 50%-90% of swimming pool immersion injuries. 4,[14][15][16][17][18] Near-drowning cases in Saudi Arabia do not get the deserved publicity from the media or from pediatricians. To the best of our knowledge, this is the first audit tackling the issue of neardrowning of children in Saudi Arabia. Subjects and MethodsA retrospective case review study was conducted to evaluate near-drowning cases managed at King Khalid University Hospital (KKUH) Pediatric Intensive Care Unit (PICU) in Riyadh, Saudi...

Background: Obstetric drills are being used increasingly to test, improve, and maintain knowledge and skills related to obstetric emergencies as a means to improve proficiency and efficiency of practitioners. The purpose of this study was to assess the feasibility and usefulness of conducting drills to evaluate the response to obstetric emergencies using a holistic approach that tested the hospital system. Methods: A prospective trial was conducted at three hospitals (two tertiary referral centers and one small community hospital) in Beirut, Lebanon. Two different emergency obstetric drills at two points in time were conducted between April and May 2006 either in the emergency room or on the labor floor. The drills included medical and paramedical staff, a female actor (simulating a pregnant woman), a research assistant (acting as her companion), and a physician trained in obstetrics (the drill leader). Responses were recorded and critically analyzed. Results: Although overall quality of care was within standards of care, problems were identified related to hospital policies, supplies and equipment, communication, and clinical management. Some technical problems related to administration of the drills were identified. Most drill participants appreciated the exercise and found it beneficial. Conclusions: Obstetric drills provide a useful tool to identify and address deficiencies in the hospital system. This finding could have implications on improving quality of care provided to obstetric patients. (BIRTH 36

To understand why dronedarone failed to unseat amiodarone as the primary antiarrhythmic treatment of choice for persistent AF, thus uncovering the clinical outcome requirements for a future AF therapy to achieve optimal market access. MethOds: Review published HTA reports and clinical trial outcomes for dronedarone to assess market access outcomes and associated Payer rationale for decision-making. Interview ten (10) managed care medical directors and AF key opinion leaders (KOLs) in US and thirteen (13) ex-Payers and AF KOLs in Europe (mix of stakeholders encompassing France, Germany, Italy, Spain, and UK) for validation and gap filling. Results: Driven by benefits in all efficacy outcomes other than cardiovascular-related hospitalizations, Payers perceive amiodarone as more efficacious than dronedarone. The significant number of deaths during the highrisk PALLAS study crippled the safety image of dronedarone. Finally, a prohibitive price at launch contributed to a multiplicity of negative HTA assessments. In order to succeed where dronedarone failed and qualify as a step function increase over the standard-of-care amiodarone, Payers require at least: 40% reduction in AF recurrence; 30% relative risk reduction in hospitalizations compared to amiodarone; and fewer than 1% deaths as part of the clinical evidence package. Lower rates of bradyarrhythmia, liver toxicity, and no proarrhythmia will drive a favorable regulatory safety evaluation compared to amiodarone. cOnclusiOns: The sub-optimal market access and relatively low utilization of dronedarone resulted primarily from a failure to demonstrate an improvement in recurrence as compared to amiodarone, as well as a significant number of deaths during pivotal trials. Manufacturers considering development of novel antiarrhythmics should strive for equivalent efficacy but superior safety to amiodarone if a 40% reduction in recurrence is not clinically feasible.