Saudi Arabia’s Vision 2030 has taken a centre stage in the development of its healthcare sector through privatization adopting Public Private Partnerships (PPPs). The objective of this study is to provide an overview of healthcare transformation in Saudi Arabia since the launch of the ambitious Vision 2030, identifying issues those need to be addressed and steps taken towards provision of health systems transformation. Literature review was based on extensive review of published and unpublished articles, where different search engines and databases searched using the key words: ‘Saudi Healthcare’, ‘Healthcare transformation’, ‘Saudi vision: 2030’, ‘Public-Private Partnerships’ and ‘Privatization’, in addition to secondary data as published in government reports, policy, government strategy documents and pertinent press releases. The future of the healthcare like many other developing economies continues to weigh policies for universal coverage while containing costs and the national transformation programme driven by social and economic factors has implemented strategic steps to develop its private healthcare system that includes: establishing health clusters, National Centre for Privatization & PPP – an official enabler for privatization of all government sectors and recently approved Private Sector Participation (PSP) Law involves several legislative enablers designed to enhance investor confidence in the privatization process. Although this study demonstrates systemic legislative progress to facilitate transformation process of healthcare sector, also endorses caution and research in identifying barriers to the implementation of PPPs, Saudi workforce development, implementing effective revenue cycle management function for healthcare reimbursement and ensuring vulnerable population access to good quality and tertiary healthcare. As healthcare of Saudi Arabia embarks on the transformation journey facing daunting challenges, but it appears that the government has laid out a roadmap with the legislative framework; however it is important that there is ongoing monitoring with adjustments as this complex and multifaceted process proceeds.
3100 Background: Hematopoietic cell transplantation (HCT) can cure bone marrow failure in patients with Fanconi Anemia (FA), and it is generally accepted that these patients should receive low intensity conditioning due to the underlying DNA repair defect in their cells. Outcomes of recipients of matched related HCT have generally been favorable, but only few studies have scrutinized the factors that may impact on the eventual outcome of these patients. Thus, the current study was designed to use data from King Faisal Specialist Hospital & Research Center (KFSHRC) to evaluate the impact of different key variables on outcome of related HCT in these patients. Patients and Methods: This is a retrospective analysis of 94 pediatric patients (age ≤ 14 years) with FA who underwent related HCT at KFSHRC from 1993 to 2011. Overall survival (OS) probability was estimated using the Kaplan-Meier method. Univariate analyses were conducted to evaluate the impact of key variables on survival as well as on the incidence of graft failure, graft versus host disease (GVHD), and hemorrhagic cystitis. The small sample size precluded multivariate analysis. Forty-six (48.9%) were male. Eleven had evidence of myelodysplasia and/or abnormal cytogenetic clone (MDS) in bone marrow pre-HCT. Two doses of cyclophosphamide (CY) were used in the conditioning: CY 60 mg/kg, when used alone with ATG (N= 40) and CY 20 mg/kg when used in combination with ATG, and radiation (total body irradiation -TBI-; N=12, or thoraco-abdominal irradiation -TAI-; N=22), or when used in combination with ATG and fludarabine (N=21). Donor source was HLA-matched sibling in 86 patients, HLA-matched parent in 3, and HLA-class I single-antigen-mismatched sibling or parent in 5. Results: Absolute neutrophil count (ANC) recovery occurred in all patients, median of 14 days (range, 9–33 days). Platelet-transfusion independence occurred in 92 patients, median of 29 days (range, 14–97 days). The cumulative incidences of acute GvHD grade II-IV and III-IV were 8.51 % (95% CI: 8.35%-8.67%), and 5.32% (95% CI: 5.12%-5.42%), respectively. Chronic GvHD cumulative incidence was 9.8% (95% CI: 9.6% to 9.10%). Cumulative incidence of secondary graft-failure was 4.3% (95% CI 4.2%-4.4%). Survival probabilities (OS) were 92.5%, 89%, and 86% at 1, 5, and 10 years, respectively. In univariate analysis, survival was not affected by any of the following variables: age at HCT (< 10 years vs. 10–14 years), recipient or donor gender, presence of MDS pre-HCT, use of fludarabine in the conditioning regimen. Only two variables significantly affected survival: use of higher dose CY (60mg/kg) conditioning was associated with a better 10-year OS than lower dose CY (20mg/kg) conditioning (91 % vs. 82 %, respectively; P =0.035), and use of radiation-containing regimens was associated with a lower 10-year OS than non-radiation regimens (76 % vs. 91 %, respectively; P =0.005). Incidence of graft failure, and GVHD was not affected by any of the variables analyzed, but use of higher dose of CY (60mg/kg) was associated with a significantly increased incidence of hemorrhagic cystitis (20% vs. 5.6% respectively; P=0.049). Three patients (3%) developed squamous cell carcinoma (2 oropharyngeal and one genitourinary), at 9.5, 5.5, 14 years post HCT; 2 of them had radiation containing conditioning. Conclusion: Our analysis indicates that related HCT for pediatric FA patients is associated with excellent long-term survival, and suggests that, for patients transplanted ≤ 14 years, early HCT (below 10 years vs. 10–14 years) does not improve survival. Our data also suggest that a higher dose CY (60 mg/kg) conditioning regimen is associated with better survival but is also associated with a significantly increased risk of hemorrhagic cystitis. On the other hand, radiation-containing regimens are associated with significantly lower survival. Our data also show, that in our patient cohort, the presence of pre-HCT MDS does not adversely affect survival. Disclosures: No relevant conflicts of interest to declare.
Background Physicians may be an important source of blood donations as they are more likely to be familiar with the importance of donating and the donation process. The aim of this study is to report physicians' knowledge, attitudes, and practices towards voluntary and non‐voluntary blood donations. Study Design and Methods This was a cross‐sectional study conducted at King Faisal Specialist Hospital and Research Centre (KFSH&RC), Saudi Arabia. One‐hundred‐and‐sixteen physicians and dentists responded to an online structured questionnaire sent to their institutional emails. Results Sixty‐eight percent of participants (79% of males and 43% of females) reported previously having donated blood. Eighty‐six percent of donors had previously donated on a voluntary basis, whereas 31% of donors had previously donated for a specific person. A recent donation within 5 years was associated with the younger age group and knowledge of the minimum interval between donations. Fifty‐six percent of participants agreed with using replacement donations. Compared to participants in the youngest age group (25‐35 years), older participants in the age groups (46‐55 years) and (>55 years) were less likely to express intention to donate in the next 6 months (OR 0.289, P = .022 and OR 0.083, P = .004, respectively). Participants reporting poor nutritional status or other medical reasons as a barrier to donating blood were less likely to intend to donate (OR 0.146, P < .001). Among previous donors, intention to donate was associated with a recent donation within 1 year (OR 27.13, P = .002) and having had a pleasant donation experience (OR 14.98, P < .001). Conclusion Blood donation practices are strongly tied to physicians' gender and age and their knowledge of the donation process. The most significant barrier to blood donation was found to be nutritional and medical status.
Medical records of 82 patients with acute lymphoblastic leukemia (ALL) who underwent hematopoietic cell transplantation (HCT) at our institution from 2005 to 2011 were reviewed. Forty-five patients were male (54.8%). The median age at HCT was 7.46 years (range, 0.98 to 14.31 y), the median time to HCT after diagnosis was 12.56 months. Ten patients were below the age of 1 year (12%). All patients were in complete remission at the time of HCT. In 83 transplants, 64 patients received HCT from human leukocyte antigen-identical-related donors and 19 from other donors. Stem cell source was bone marrow in 65 (78%) and cord blood in 18 (22%). Five-year overall survival was 58.8% and event-free survival was 54.3%. The cumulative incidence of acute graft versus host disease was 4.8%±2.3% and of chronic graft versus host disease was 8.9%±3.2%. The median time to absolute neutrophil count and platelet recovery was 17 days (range, 12 to 43 d) and 28 days (range, 15 to 98 d), respectively. One patient acquired CMV infection after transplant. No one developed venoocclusive disease, hemorrhagic cystitis, or other complication. Patient's age at diagnosis, sex, donor's human leukocyte antigen status and sex, source of transplant and complete remission status at HCT did not affect overall survival and event-free survival. Our results show a favorable outcome to HCT for acute lymphoblastic leukemia patients comparable to published data, and no single factor was associated with superior outcome.
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