Commentary: The effect of kangaroo care in relieving pain of vaccination procedures in newborns in a hospital in Saudi Arabia.

The effect of kangaroo care in relieving pain of vaccination procedures in newborns in a hospital in Saudi Arabia.

The stress level of nurses, especially frontline staff, directly impacts their physical and mental health as well as work efficiency. However, few studies have been conductedto understand the stress level of nurses related to the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study is to assess the level of perceived stress among nurses at a tertiary care teaching hospital (King Abdulaziz University Hospital, Jeddah) in Saudi Arabia during the COVID-19 pandemic. A cross-sectional survey-based descriptive study involved 1044 nurses working at a tertiary care/teaching hospital in Saudi Arabia. The Perceived Stress Scale (PSS) was used to assess nurses' stress levels. The study was conducted in July 2021 by selecting clinical nurses from different nursing units. Considering the current situation of social isolation, an online cross-sectional survey using Google Forms was used. Data analysis was performed using IBMSPSSStatistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). Out of 1044 nursing professionals, 93 (8.9%) reported experiencing low levels of stress, 915 (87.6%) reported moderate levels of stress, and 36 (3.4%) reported high perceived stress during the COVID-19 pandemic. The study found that gender (p=0.001) and nationality (p=0.016) had significant effects on stress levels. The three major causes of stress identified by the nurses were workload, lack of resources, and fear of contracting COVID-19. Job-related stress continues to be an issue in the nursing workforce. The effects of stress experienced by nurses impact job satisfaction and retention, which, in turn, can affect the quality of patient care. This study highlights that nurses in a tertiary care (COVID care) teaching hospital in our setting often experience stress and anxiety during the pandemic. It is worth noting that this is the first study conducted to understand the level of stress perceived by nursing staff during the COVID-19 pandemic in our current study setting. The findings indicate that a considerable number of nurses experienced moderate levels of stress during COVID-19, which can have implications for patient care. Recognizing and understanding the job-related stressors of nurses can help nurse leaders implement more effective strategies aimed at reducing nurses' stress and subsequently improving patient outcomes.

The terms palliative care, supportive care, and comfort care are used to describe individualized care that can provide a dying person the best quality of life until the end. The term “end-of-life care” is also used in a general sense to refer to all aspects of care of a patient with a potentially fatal condition. While the concept of palliative care is not new, it has only recently been applied to the neonatal population. To the best of our knowledge, none of the neonatal intensive care units (NICUs) in Saudi Arabia have adopted a neonatal program for palliative care. We believe the main reason is lack of knowledge of such programs and the fear of being accused of being heartless and cruel by providing comfort care for dying babies. Comfort care begins with the diagnosis of a life-threatening/terminal condition, and continues throughout the course of illness regardless of the outcome. In this perspective, our aim is to introduce these programs for caregivers in the NICUs in Saudi Arabia. For this purpose, we have reviewed the current recommendations in establishing neonatal palliative care programs and discussed some of the social and religious aspects pertaining to this issue.

Background Pediatric myopia is a growing global public health concern, exacerbated by the increasing screen time among children, who spend more time on devices for both entertainment and education. Understanding the link between myopia and screen media use is crucial for promoting children’s long-term eye health and mitigating the burden of myopia. Methods The study was a retrospective study design that investigated 94 complete medical records of myopic patients who had attended pediatric ophthalmology clinic at King Fahad University Hospital (KFUH) in Saudi Arabia between November 2021 and November 2023. Data was cleaned, coded and analyzed using SPSS version 20 to obtain important insights. Results The results revealed a statistically significant difference in total screen time between age groups (4–6 years, 7–9 years, and 10–12 years), with a p-value of 0.021. The most commonly used screen media devices among myopic children were smartphones (98.9%) and laptops (87.2%). Regression analysis indicated that the differences in screen time based on the children’s age at first use of screen media devices (smartphones, tablets, and laptops) were not statistically significant (p =0.196). Additionally, the study found a statistically significant association between patients’ age, the age at which they were first diagnosed with myopia, and their myopia category (p = 0.030 and p = 0.005, respectively). Conclusion The study established a significant association between myopia and screen use in pediatric patients, with total screen time increasing significantly with age. Smartphones and laptops were the most commonly used devices among myopic children. These findings highlight the need to understand the relationship between myopia and screen time in order to develop evidence-based guidelines for managing screen time, protecting children from the adverse effects of screen media exposure, and promoting their eye health and overall well-being.

Central line-associated bloodstream infections (CLABSIs) are severe bloodstream infections caused by catheter use and are often associated with a longer hospital stay, increased healthcare costs, and a higher mortality rate. However, catheter-related bloodstream infections can be successfully treated. It is essential that healthcare workers are aware of central line (CL) insertion and maintenance bundles to reduce and prevent the incidence of CLABSI. The objective of this study was to assess the impact of implementing CL care bundles on hospital-wide CLABSI incidence rates. This is a prospective study conducted at the King Faisal Specialist Hospital and Research Center in Saudi Arabia from January 2017 to December 2021. The research period was divided into two phases: the pre-intervention phase (January 1, 2017 to December 31, 2018) and the post-intervention phase (January, 2019 to December 31, 2020). During both phases, outcome variables, including CLABSI rate, were assessed. In the present study, the total number of CLABSIs is 439, of which 266 were in the pre-intervention phase and 173 were in the post-intervention phase. The overall CLABSI rate significantly decreased from 1.6±0.05 in the pre-intervention phase to 0.9±0.05 in the post-intervention phase. This decline in CLABSI was significant (p<0.0001) across all hospital settings, including critical care and non-critical care units. The implementation of care bundles is essential and has been shown to significantly reduce CLABSI rates in nearly all participating units.

In recent years, there has been a rapid dissemination of carbapenem resistant Enterobacteriaceae (CRE). This study aimed to compare phenotypic and molecular methods for detection and characterization of CRE isolates at a large tertiary care hospital in Saudi Arabia. This study was carried out between January 2011 and November 2013 at the King Khalid University Hospital (KKUH) in Saudi Arabia. Determination of presence of extended-spectrum beta-lactamases (ESBL) and carbapenem resistance was in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines. Phenotypic classification was done by the MASTDISCS(TM) ID inhibitor combination disk method. Genotypic characterization of ESBL and carbapenemase genes was performed by the Check-MDR CT102. Diversilab rep-PCR was used for the determination of clonal relationship. Of the 883 ESBL-positive Enterobacteriaceae detected during the study period, 14 (1.6%) isolates were carbapenem resistant. Both the molecular genotypic characterization and phenotypic testing were in agreement in the detection of all 8 metalo-beta-lactamases (MBL) producing isolates. Of these 8 MBL-producers, 5 were positive for blaNDM gene and 3 were positive for blaVIM gene. Molecular method identified additional blaOXA gene isolates while MASTDISCS(TM) ID detected one AmpC producer isolate. Both methods agreed in identifying 2 carbapenem resistant isolates which were negative for carbapenemase genes. Diversilab rep-PCR analysis of the 9 Klebsiella pneumoniae isolates revealed polyclonal distribution into eight clusters. MASTDISCS(TM) ID is a reliable simple cheap phenotypic method for detection of majority of carbapenemase genes with the exception of the blaOXA gene. We recommend to use such method in the clinical laboratory.

Background Pediatric myopia is a growing global public health concern, exacerbated by the increasing screen time among children, who spend more time on devices for both entertainment and education. Understanding the link between myopia and screen media use is crucial for promoting children’s long-term eye health and mitigating the burden of myopia. Methods The study was a retrospective study design that investigated 94 complete medical records of myopic patients who had attended pediatric ophthalmology clinic at King Fahad University Hospital (KFUH) in Saudi Arabia between November 2021 and November 2023. Data was cleaned, coded and analyzed using SPSS version 20 to obtain important insights. Results The results revealed a statistically significant difference in total screen time between age groups (4–6 years, 7–9 years, and 10–12 years), with a p-value of 0.021. The most commonly used screen media devices among myopic children were smartphones (98.9%) and laptops (87.2%). Regression analysis indicated that the differences in screen time based on the children’s age at first use of screen media devices (smartphones, tablets, and laptops) were not statistically significant (p =0.196). Additionally, the study found a statistically significant association between patients’ age, the age at which they were first diagnosed with myopia, and their myopia category (p = 0.030 and p = 0.005, respectively). Conclusion The study established a significant association between myopia and screen use in pediatric patients, with total screen time increasing significantly with age. Smartphones and laptops were the most commonly used devices among myopic children. These findings highlight the need to understand the relationship between myopia and screen time in order to develop evidence-based guidelines for managing screen time, protecting children from the adverse effects of screen media exposure, and promoting their eye health and overall well-being.

This study investigated the spiritual climate of a hospital in Saudi Arabia as perceived by nurses. A spiritually conducive environment improves patient, nurse and organizational outcomes. Despite being important, no studies have investigated this area in the Muslim-dominated Middle Eastern countries. A snapshot on the degree of spiritual climate perception may provide insight into the aspects that may need improvement and may become basis for the creation of health and nursing policies directed towards creating a spiritually-accepting and respecting clinical workplace. A sample of 219 nurses employed in a 500-bed capacity hospital in Saudi Arabia was included in this cross-sectional study utilizing the spiritual climate scale. The nurses perceived their hospital's spiritual climate to be fair. The item 'I am encouraged to express spirituality in this clinical area' received the lowest mean, whereas the item 'My spiritual views are respected in this clinical area' received the highest mean. Being Saudi, having less total experience as a nurse, and having greater total experience as a nurse in Saudi Arabia and in the present hospital positively influenced the perception of the spiritual climate among nurses. The findings stress the need to improve the spiritual climate in the hospital. Hospitals are recommended to create policies to implement interventions geared towards creating a spiritually-friendly environment. Hospitals are encouraged to create a safe place where nurses can freely express their spirituality regardless of preference or religious denomination. Spiritual education may be provided by hospitals as part of continuing education. Managers may also focus on the existential spirituality of nurses, especially for spiritually-sensitive environments such as Saudi Arabia.

Job satisfaction improves the outcome of health care services. Nurses' job satisfaction should receive more attention in Saudi Arabia, and worldwide. This study was undertaken to measure factors that affect job satisfaction among critical care nurses at King Khalid Hospital in Saudi Arabia. This study used a quantitative, cross-sectional method. A convenient sample of 190 critical care nurses was recruited from the main government hospital in Saudi Arabia. Job satisfaction scales were used in this study. Overall, the staff nurses were neither satisfied nor dissatisfied with their work. The majority of participating nurses were moderately satisfied with their relationships with coworkers (mean = 4.24, standard deviation [SD] = 1.66) and nature of their jobs (mean = 4.13, SD = 0.74). Their lowest satisfaction scores were related to communication (mean = 3.42, SD = 0.82), followed by pay (mean = 3.7, SD = 0.65), and supervision (mean = 3.75, SD = 0.55). Job satisfaction of staff nurses is marginal. This calls for leadership intervention. Decision-makers must consider this when adopting new policies to enhance nurses' job satisfaction.

Background & Objective: The massive burden of COVID-19 disease is believed to be associated with significant psychological disturbances on healthcare professionals. Increasing levels of stress may lead to anxiety, depression, burnout syndrome, and in severe cases, post-traumatic stress disorder. The objective of this study was to examine the presence of stress among resident trainee doctors working in a tertiary care hospital in Saudi Arabia in the context of the corona pandemic.
 Methodology: This was a cross-sectional study conducted in Security Forces Hospital, Riyadh, Saudi Arabia. We included the resident trainee doctors from different specialties of our hospital including medical, surgical, anesthesia, emergency room (ER), and critical care units. We used convenience sampling to select study respondents. Perceived Stress Scale (PSS) was used for assessing the stress levels among trainees. Trainees were requested to fill the questionnaire either online survey monkey or in paper form. All data were entered and analyzed using SPSS version 26. We calculated mean, standard deviation, frequency count, and percentages for the perceived stress.
 Results: A total of 60 trainees were included in this study. Mean PSS-10 score was 20 ± 5.51, with a range between 6 and 34. Four (6.7 %) trainees had low stress and 50 (83.3 %) trainees had moderate stress while 6 (10 %) trainees had high stress
 Conclusion: The majority of resident trainees in our study experienced a moderate level of anxiety during this COVID pandemic.
 Key words: Stress, Resident trainees, COVID-19, pandemic
 Citation: ul Huda A, Yasir M, Saulat SA, AlShaqha MW. Assessment of perceived stress among resident trainees of a tertiary care hospital in Saudi Arabia during COVID–19 pandemic – a cross-sectional study. Anaesth. pain intensive care 2021;25(2):185-188. DOI: 10.35975/apic.v25i2.1471

This study was conducted to determine the frequency of antenatal intrauterine fetal death (IUFD) and the associated maternal and fetal risk factors in women who presented at a regional tertiary hospital in Saudi Arabia. Over a 5-year period, 191 consecutive cases of IUFD presented and were studied prospectively. Relevant maternal and fetal data were obtained. The stillbirth rate during the period was 10 per 1000 deliveries. In 41% of the cases, the associated causal factors could not be determined. There was a significant ( P = 0.00122) linear trend showing an increased risk of IUFD above the age of 20 years and, similarly, a significant ( P = 0.00047) linear trend after the first pregnancy. Lack of antenatal care (88.5%), hypertensive diseases in pregnancy (12%) and diabetes mellitus (8%) were associated risk factors while 'major congenital malformation' (14%) was an outstanding fetal factor. The risk factors of antenatal stillbirth in our community seem to be avoidable. Health education to encourage the utilisation of the available antenatal care services, family planning and genetic counselling are being advocated strongly as possible preventive measures.

Objectives:To explore the effects of empagliflozin (25 mg) on metabolic and renal parameters in patients with type 2 diabetes mellitus (T2DM).Methods:This retrospective observational comparative study was conducted at a military hospital in southern Saudi Arabia. All adults (aged >18 years) with T2DM who attended diabetic clinics between October 2021 to March 2022 (6 months), with or without insulin treatment, were eligible for inclusion in the study.Results:Following the initiation of empagliflozin treatment, statistically significant reductions in patient weight (kg) were observed at 1, 3-5, and 6 months. In addition, low-density lipoprotein levels significantly decreased 3-5 months post-treatment initiation (p=0.011). However, serum creatinine level decreased gradually with time during the treatment with empagliflozin, from 87.45±31.78 (0.105) to 78.39±27.43 (0.033). Furthermore, after empagliflozin treatment, the urinary albumin-to-creatinine ratio significantly decreased at 3-5 and 6 months. Moreover, HbA1c levels exhibited statistically significant decreases at 3-5 months (p<0.001) and at 6 months (p<0.001) following the initiation of empagliflozin treatment. Notably, systolic and diastolic blood pressure significantly reduced 6 months after empagliflozin treatment.Conclusion:In the current study, empagliflozin has demonstrated efficacy in controlling blood pressure and body weight, and improving renal function, short-term dyslipidemia, and glycemic control in patients with T2DM.

Uptake of influenza vaccination, awareness and its associated barriers among medical students of a University Hospital in Central Saudi Arabia.

Efficient management of hospital resources is essential for providing high-quality healthcare while ensuring sustainability. Length of stay (LOS), measuring the duration from admission to discharge, directly impacts patient outcomes and resource utilization. Accurate LOS prediction offers numerous benefits, including reducing re-admissions, ensuring appropriate staffing, and facilitating informed discharge planning. While conventional methods rely on statistical models and clinical expertise, recent advances in machine learning (ML) present promising avenues for enhancing LOS prediction. This research focuses on developing an ML-based LOS prediction model trained on a comprehensive real-world dataset and discussing the important factors towards practical deployment of trained ML models in clinical settings. This research involves the development of a comprehensive adult cardiac patient dataset (SaudiCardioStay (SCS)) from the King Faisal Specialist Hospital & Research Centre (KFSH&RC) hospital in Saudi Arabia, comprising 4930 patient encounters for 3611 unique patients collected from 2019 to 2022 (excluding 2020). A diverse range of classical ML models (i.e., Random Forest (RF), Extreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LGBM), artificial neural networks (ANNs), Average Voting Regression (AvgVotReg)) are implemented for the SCS dataset to explore the potential of existing ML models in LOS prediction. In addition, this study introduces a novel approach for LOS prediction by incorporating a dedicated LOS classifier within a sophisticated ensemble methodology (i.e., Two-Level Sequential Cascade Generalization (2LSCG), Three-Level Sequential Cascade Generalization (3LSCG), Parallel Cascade Generalization (PCG)), aiming to enhance prediction accuracy and capture nuanced patterns in healthcare data. The experimental results indicate the best mean absolute error (MAE) of 0.1700 for the 3LSCG model. Relatively comparable performance was observed for the AvgVotReg model, with a MAE of 0.1703. In the end, a detailed analysis of the practical implications, limitations, and recommendations concerning the deployment of ML approaches in actual clinical settings is presented.

We reviewed a total of 169 deaths among 969 infants referred from various health institutions in the Asir Region to the neonatal intensive care unit of Asir Central Hospital, Abha, Saudi Arabia, during a four-year period (January 1992 to December 1995). The results showed that the major causes of neonatal mortality in the region were low birth weight (LBW) (45%), congenital malformations (CM) (30.8%), infection (13.6%), and birth asphyxia (7.7%). The majority of the LBW infants died from respiratory insufficiency, sepsis, and necrotizing enterocolitis. The alimentary, central nervous and cardiovascular systems were the parts most commonly involved in CM, with cardiac defect accounting for the highest fatality rate due to lack of facilities for cardiac surgery in the region, and delay in effecting a transfer. Klebsiella, Serratia and E. coli are the predominant organisms causing neonatal sepsis, in contrast with the group B streptococcus dominating in America and the United Kingdom. Generally, factors causing neonatal deaths in the Asir region are similar to those reported in other tertiary hospitals in Saudi Arabia, and tally closely with observations in America and Europe, where the standard of health care is excellent. Nevertheless, the study indicates the need for upgrading of facilities, as well as for more trained personnel for obstetric and neonatal care in Asir region. It may be necessary to consider the need for the establishment of a regional cardiac surgery center in the region.