Forces Hospital Research Articles

The Effect of Interpersonal Communication of Outpatient Registration Officers on Patient Satisfaction at dr. Esnawan Antariksa Air Force Hospital

Interpersonal communication is a need and ability that health workers must have so that patients feel happy with the services provided. The research was conducted with a focus on outpatients because researchers wanted to know the effect of interpersonal communication of outpatient registration officers on patient satisfaction. The research method uses inferential analysis with a quantitative approach. Statistical test using Chi-square test. The sampling method used in this research is accidental sampling. Based on the research results, the description of interpersonal communication of officers who are categorized as poor interpersonal communication is 36 (51.4%), officers who are categorized as good interpersonal communication are 34 (48.6%). The description of the satisfaction of patients who are categorized as dissatisfied is 36 (51.4%), the satisfaction of patients who are categorized as satisfied is 34 (48.6%) and there is an influence between the interpersonal communication of registration officers and patient satisfaction at dr. Esnawan Antariksa Air Force Hospital found that the p-value was 0.000 < 0.05. By calculation, the odds ratio obtained a value of 15.98, meaning that interpersonal communication has a 15 times risk factor for patient satisfaction at dr. Esnawan Antariksa Air Force Hospital. In conclusion, there is an effect between interpersonal communication of outpatient registration officers and patient satisfaction at dr. Esnawan Antariksa Air Force Hospital.

Non-alcoholic Fatty Liver in Children and Adolescents in Saudi Arabia.

Objectives This study aims to describe the disease parameters of children and adolescents diagnosed with non-alcoholic fatty liver disease (NAFLD) in Saudi Arabia. It also investigates the disease's progression and compares clinical, biochemical, and radiological parameters at baseline and follow-up of patients with NAFLD. This study was done between two groups of patients: obese and those of average body weight. Methods A retrospective cohort study was conducted between 2014 and 2018 through retrieved data from medical records. It included all children aged between six to 18 years diagnosed with NAFLD. Medical history was taken from each medical record, liver function test results, cholesterol, blood pressure readings, and body weight. Data have been restored from King Abdullah Specialist Children's Hospital (KASCH)​, Security Forces Hospital (SFH), and King Khalid University Hospital (KKUH). Results A total of 116 subjects met the inclusion criteria; 65 (56%) were male, and 81 (70%) were obese. The majority of subjects (n=112) had mild NAFLD, with (71%) obese and(29%) non-obese, followed by moderate NAFLD with 50% among obese and non-obese (N=2), and non-alcoholic steatohepatitis (NASH) with 100% non-obese (N=2). Data showed that patients' proportion of obese to non-obese is 70% (N=81) to 30%(N=35), respectively. Conclusion NAFLDwas found to affect obese children and adolescents more than non-obese, and male patients had a higher proportion of NAFLD than females. Also, obese patients had more advanced stages of NAFLD than non-obese patients. Finally, most subjects had been diagnosed with mild stage while a few had developed NASH.

Surgical and morphological outcome of one-stage laparoscopic orchidopexy with preservation of gubernaculum and interruption of spermatic vessels in comparison to two-stages fowler–Stephens’s orchidopexy technique with preservation of gubernaculum for impalpable testis

Background For the care of nonpalpable testis, laparoscopy has acquired complete acceptability in both diagnostic and therapeutic settings. Standard laparoscopic for situations where the length of the spermatic arteries can prevent tension-free testicular mobilization in the scrotum, Fowler-Stephens’ (F-S) orchidopexy is a widely used and acknowledged procedure. Maintaining a healthy testis’ vascularity requires gubernaculum sparing with testicular vessel cutting. Our research recommends using the F-S approach with the preservation of the gubernaculum in a single stage rather than two phases for the same outcomes. Setting: the pediatric surgery outpatient clinic at hospitals affiliated with Ain Shams University and the Armed Forces Hospitals. Patients and methods This was a Randomized controlled clinical trial (RCT), conducted on boys with nonpalpable testicles between 1 and 6 years old, in 2 Egyptian pediatric surgery units, between October 2019 and September 2022. The patients who met the inclusion criteria were divided into two groups to compare their outcome (atrophy and success rate): (group A with 25 impalpable testicles was subjected to one-stage laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculum, while group B with 25 impalpable testicles was subjected to two-stages laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculum). Results The mean age of all patients was (3.9±1.8), 113 nonpalpable testicles were examined during the period of our study, and 50 nonpalpable testicles met our inclusion criteria. They were divided into two groups according to surgical procedure. There were no significant differences between the two groups according to age, and preoperative testicular volume. Postoperative outcome (atrophy and success rate) had no significant differences. Operative time and hospital stay were statistically decreased in the group performed with one stage. Conclusion To conclude, one-stage laparoscopic F-S orchidopexy with preservation of gubernaculum is as effective as two-stage laparoscopic F-S orchidopexy with preservation of gubernaculum.

Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study.

This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital. Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence. 778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications. In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.

State of Newborn Care in Armed Forces Hospitals

Organized perinatal and newborn care in armed forces hospitals includes preconception and antenatal care, care during labor and childbirth, immediate newborn care, care of small and sick newborn including screening for hypoglycemia, care of healthy newborns in the first week including newborn screening for thyroid disorders, Glucose 6 phosphate dehydrogenase deficiency, universal hearing screening, and universal pulse oximetry. Neonatal mortality was 24.3% in less than 26 weeks (n = 37), 32.6% in neonates born between 26 weeks to 27+6 weeks (n = 95), 6.2% in neonates born between 28 weeks and 31+6 weeks (n = 242), 0.8% in 32 weeks to 36+6 weeks (n = 1890), and 0.1% in term neonates (n = 21,292). The comprehensive health care model in armed forces can be a model for other institutes and health systems for more effective neonatal health care.

Quality of Life Among Adults With Hearing Loss Who Were Prescribed Hearing Aids in Aseer Province, Saudi Arabia: A Cross-Sectional Tertiary Center-Based Study.

Introduction Hearing loss affects people of all ages, and it may become a burden for patients as well as for those around them. It leads to social isolation and impacts the quality of life (QOL). Many studies aim to investigate the outcome of hearing aids as an intervention to treat hearing loss. Our study's objective is to assess the QOL in participants and investigate the possible factors that have an impact on the outcomes of hearing aid use. Methods The study adopted a cross-sectional design and was carried out in the Armed Forces Hospital South Region, a tertiary care center in Aseer Province, Saudi Arabia. Participants were patients who presented to the ENT clinic with a complaint of hearing loss from 2017 to 2019and who were prescribed hearing aids as their treatment. The study uses the World Health Organization Quality of Life BREF (WHOQOL-BREF) questionnaire and the International Outcome Inventory for Hearing Aids (IOI-HA) to measure the QOL and its determinants in patients using hearing aids. Results A total of 210 patients were included in the study. Sensorineural hearing loss (SNHL) was found in 72.2%, and 20% of patients were found to have bilateral hearing loss. Moderate or severe hearing loss was found in 80% of the patients in the worst hearing ear. The overall QOL among the participants was satisfactory, with the highest domain score being the social relationship domain (85.9%). The QOL was significantly higher in participants who were in an intimate relationship (P =0.02). A positive correlation was found between the IOI-HA scores and the WHOQOL-BREF scores in general health (R = 0.14, P =0.034), psychological health (R = 0.16, P = 0.018), and the overall QOL score (R = 0.15, P = 0.035). Conclusion Hearing aids are a cost-effective intervention that improves QOL and prevents associated comorbidities. Compliance and adherence to hearing aids improve the QOL for patients, as well as for their spouses. Patients suffering from hearing loss while also in an intimate relationship had better QOL scores. A correlation was found in outcomes between the IOI-HA scores and the WHOQOL-BREF scores in general health, psychological health, and overall health.

Restless legs syndrome in multiple sclerosis patients: Prevalence, impact, and association with disease-modifying therapies in a Saudi Arabian pilot study

BackgroundRestless legs syndrome (RLS) emerges as a notable sleep disorder characterized by distressing sensations within the lower extremities. Its prevalence appears to be higher among patients afflicted with multiple sclerosis (MS) compared to the general population. Despite this observation, the understanding of the intricacies of RLS and its repercussions within the context of MS patients in Saudi Arabia remains limited. MethodsEmploying a cross-sectional design, a comprehensive investigation was undertaken at King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia, spanning from November 2021 to March 2022. A cohort of 66 individuals diagnosed with MS was recruited and subjected to an assessment for RLS employing the revised diagnostic criteria outlined by the International Restless Legs Syndrome Study Group (IRLSSG). Furthermore, the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Sleepiness Scale were employed to gage the extent of RLS's impact on sleep quality and daily functioning. ResultsThe prevalence of RLS amidst the MS cohort was determined to be 30.4%. An observable association was discerned between RLS presence and higher scores on the Expanded Disability Status Scale (p < 0.001), along with diminished sleep quality scores (p < 0.001) and elevated fatigue scores based on IRLSSG criteria (p < 0.001). Within the studied MS cases, 98.5 % exhibited the relapsing-remitting subtype. Further investigation demonstrated that patients treated with Fingolimod or Ocrevus presented normal IRLSSG scores, whereas those undergoing Rituximab treatment manifested an even distribution between normal and moderate scores. Correspondingly, patients receiving interferons showcased 72.2 % with normal scores and 27.8 % with mild scores. Notably, a statistically significant variance in IRLSSG scores was observed when contrasting Fingolimod and Aubagio treatments (P < 0.001). ConclusionThe presence of RLS as a comorbidity in MS patients within the Saudi Arabian context emerges as a significant finding, exerting a discernible detrimental influence on both disability status and sleep quality. This study underscores the need for further investigations aimed at unraveling the intricate pathophysiological underpinnings, identification of risk factors, and exploration of therapeutic modalities for RLS in this population. Furthermore, additional research endeavors are warranted to elucidate the diverse impact of various disease-modifying therapies on clinical outcomes.

Outcome ofLaparoscopic Versus Open Appendectomy forAcute Appendicitis-Results ofa Propensity Score Matching Analysis of542 Patients andConsequences forthe Military Surgeon.

Appendectomy is the treatment of choice for acute appendicitis. The procedure can be performed open or laparoscopically. However, laparoscopy is not available on military missions abroad. It is unclear whether treatment outcomes differ between the two surgical approaches. Treatment data of all patients undergoing open and laparoscopic appendectomies in the German Armed Forces Hospital of Ulm from 2013 to 2017 were collected retrospectively. A propensity score matching analysis was performed to minimize the influence of potential confounders and to assess the influence of surgical approach on outcome (reoperations, superficial and deep surgical infections, length of postoperative ileus, need for intravenous analgesics, and operative time). A total of 542 patients with complete datasets were included in the propensity score matching analysis, among these 64 with open and 478 laparoscopic procedures. There were no statistically significant differences between open and laparoscopic surgeries with respect to all outcome variables, with the exception of a 25-minute prolonged operative time for the open approach. Open appendectomy can be considered equivalent in outcome to the laparoscopic procedure and thus can be performed on military missions abroad without compromising outcome. Military surgeons must continue to be trained and confident in open appendectomy.

Neonatal Outcome of Mothers With COVID-19 in King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia.

This study was conducted to assess the neonatal outcome of mothers with COVID-19 in King Salman Armed Forces Hospital, Tabuk, Saudi Arabia. This was a hospital record-based, retrospective cohort study. The case group included neonates born to mothers who were positive for the COVID-19 virus during pregnancy, whereas the control group included neonates born to mothers who were not infected with the COVID-19 virus during pregnancy. The data were collected from the records and were analyzed using the Statistical Package for the Social Sciences software (IBM Corp., Armonk, NY, USA). This study covered the hospital records of 342 women (114 cases and 228 control). The rates of cesarean sections and small for gestational age were significantly higher among the cases compared to the controls (71.1% versus 43.4%, p < 0.001 and 24.6% versus 11.8%, p = 0.003; respectively). The mean birth weight was significantly lower among the cases group (3.0 ± 0.6 versus 3.3 ± 0.6 kg, p = 0.022). Only the case group reported the occurrence of neonatal COVID-19 infection (7.9%, p < 0.001). The study reported only a single case of intrauterine fetal death and one stillbirth in the cases group, but no neonatal deaths (p> 0.05). Maternal COVID-19 may be associated with undesirable neonatal outcomes. There is a possibility of vertical transmission of COVID-19 from the mother to the neonate, but this cannot be confirmed.

A Prospective Study on Efficacy of Foam Sclerotherapy in the Management of Varicose Vein

Abstract Introduction: Varicose vein is a common problem. It affects 10%–20% of the population in the Western world, but in India, its incidence is around 5%. There are 150,000 new cases diagnosed each year, with an estimated cost of half a billion dollars annually for their care. There is no single treatment that fits all. Foam sclerotherapy (FST) is one of the proven modalities of treatment for varicose veins. It has the advantage of being minimally invasive, office procedure, cheap, and faster return to work. However, its efficacy and outcomes vary in various studies. The aim of our study was to assess the efficacy of FST in the management of varicose veins. Materials and Methods: This was a prospective observational study, which was conducted between August 1, 2016, and February 28, 2018, at a multispecialty armed forces hospital. In this, the clinical profile of patients with varicose veins and the effectiveness of FST as a treatment modality was studied in 36 patients. All patients underwent FST with polidocanol (ASKLEROL), 3%, 60 mg/2 mL, under strict asepsis and ultrasound (USG) guidance and they were followed up for 1 year. Results: FST revealed high patient satisfaction quotient (87%), improved quality of life, and primary success in 93% of patients on Doppler USG (DUS), less postprocedural analgesia requirement, and faster return to work. Conclusion: USG-guided FST is a safe, fast, and effective modality of treatment for varicose veins and seems to be more beneficial especially for smaller, recurrent, and remnant varicosities.

Impact of the coronavirus disease 2019 pandemic on neurosurgical patients in Taif city, Saudi Arabia

ABSTRACT Background: During the coronavirus disease 2019 (COVID-19) pandemic, the healthcare systems were obligated to work at more than maximum capacity for time due to the high transmission rate and incidence of newly infected cases. During the pandemic, all priority was given to COVID-19 cases, as the pandemic stream may exceed the health-care system’s available resources, affecting many other patients, including those with neurosurgical disorders. Aim: This study was designed to assess how COVID-19 affected neurosurgical patients. Materials and Methods: A retrospective study included all patients who were admitted to the neurosurgical department at King Abdulaziz Specialist Hospital, King Faisal Medical Complex, and Al-Hada Armed Forces Hospital during the COVID-19 pandemic. The data were collected in 5 months (April–August 2022) from the records of accessible patients. Results: A total of 777 neurosurgical patients were included 474 (61%) patients were male and 303 (39%) were female. The mean age of the patients was 41.2 ± 13.9 years old. A total of 481 (61.9%) patients were admitted before the pandemic, and 120 (15.4%) were admitted during the lockdown, 176 (22.7%) were admitted after the lockdown. The patient’s length of stay ranged from 1 day to more than 1 year, where 307 (39.5%) stayed for 1 week, and only 87 (11.2%) stayed for more than 2 weeks. 338 (70.7%) cases were Priority 1A emergencies, 17.8% improved, 52 (6.7%) remained stationary, while 7 (0.9%) showed clinical deterioration, and 15 (1.9%) died. Conclusion: According to the results of this study, both the admission rate for cases and the clinical outcome for neurosurgical patients were adversely affected by the COVID-19 pandemic. Compared to nonurgent cases, urgently admitted cases showed greater improvement.

Perceived School Experience of Children and Adolescents With Type 1 Diabetes in the Kingdom of Saudi Arabia.

Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in children globally affecting more than 1.2 million children worldwide. It is challenging to manage in children and adolescents, as it can have much more serious psychosocial impacts in these groups. The objective of this study was to investigate the perceived experience of children and adolescents with T1DM regarding the management of their condition while in school. We used a cross-sectional study design with descriptive statistics and non-probability consecutive sampling in this work. This study was conducted at the Department of Pediatrics, Qassim Armed Forces Hospital, Al-Qassim, SaudiArabia, from July 2018 to December 2018. In this study, we included 84 school-aged children and adolescents from various schools in the Qassim region of the Kingdom of Saudi Arabia who had T1DM and met the inclusion criteria. After we obtained written informed consent from the participants, they filled out a survey questionnaire about their perceived school experience while being a T1DM patient. Although most of the children believed that they were not prevented from managing their diabetes at school, most also believed that school personnel did not have adequate knowledge about diabetes. In this study, adolescents and children with T1DM had mixed perceptions of their experience at school.

Antimicrobial Susceptibility Patterns: A Four Year (2017-2020) Surveillance Study at a Tertiary Acute Care Hospital in Saudi Arabia

Introduction Objective To analyze the antimicrobial susceptibility patterns in a four years period (2017-2020) at a tertiary acute care hospital in Kingdom of Saudi Arabia. Methods This is a retrospective observational study on a total 28214 pathogens isolated and shown in antibiograms between 2017 and 2020 at tertiary acute care King Salman Armed Forces Hospital Tabuk, Kingdom of Saudi Arabia. Results The four-year (2017-2020) retrospective observational study analyzed antibiograms at King Salman Armed Forces Hospital Tabuk, Saudi Arabia . Among the six most common organisms isolated, Escherichia coli was the most prevalent Gram-negative species, and Staphylococcus aureus was the dominant Gram-positive species. The study revealed an upward trend in antimicrobial resistance, emphasizing the need for strict infection control measures and prudent antibiotic use to combat the rising resistance Conclusion There has been an upward trend in the development of antimicrobial resistant organisms as observed in our study which is in agreement with other local studies showing same trends

Impact of the Prognostic Nutritional Index on Postoperative Outcomes in Patients Undergoing Heart Surgery.

Background Malnutrition is associated with adverse outcomes in patients undergoing cardiac surgery. The prognostic nutritional index (PNI) is a validated tool for assessing nutritional status in cardiovascular diseases. This study aims to evaluate the prognostic value of PNI in heart surgery patients, including mortality rate, length of hospital and ICU stays, and infection rate, while investigating correlations with demographic and clinical characteristics. Methods A retrospective cross-sectional study was conducted in King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia. Data from electronic medical records of patients undergoing heart surgery between 2019 and 2021 were retrospectively reviewed. The study involved patients with valvular heart disease, including those requiring concomitant procedures. Statistical analysis was conducted using t-tests, logistic regression, and Kaplan-Meier survival curve analysis. Results This study included 264 individuals with a mean age of 56.48±12.11 years. The prevalence of low PNI was 50.80% and high PNI was 49.20%. No significant differences in PNI levels were found between individuals with various clinical conditions, except for target vessel revascularization. The mortality rate was slightly higher in the low PNI group, but not statistically significant. Significant differences in laboratory findings were observed between high and low PNI groups. Individuals with low PNI had longer hospital stays. Conclusion Lower PNI levels consistently correlate with longer hospital stays and higher morbidity and mortality rates, suggesting the potential importance of PNI and other nutritional markers in assessing risk and predicting outcomes in cardiac surgery patients.

Prevalence and Characteristics of Needle Stick and Sharp Injuries Among King Salman Armed Forces Hospital Personnel in Tabuk City: A Retrospective Hospital-Based Study.

This study aimed to determine the prevalence and associated characteristics of needle stickand sharp injuries (NSSIs) among King Salman Armed Forces Hospital (KSAFH) personnel. Data was collected by reviewing all reported NSSIs among KSAFH personnel between January 2020 to December 2022. The prevalence of NSSIs was 2.05%, with nurses being the most commonly affected. Most injuries occurred in patients' rooms/wardsand among health care workers (HCWs) aged < 40 years. Of the injured workers, 93.8% were immunized against hepatitis B virus (HBV). Educational and training programs targeting high-risk age groups and professions should be developed. Policies related to locations and situations where injuries occur frequently should be reviewed regularly to reduce the risk of NSSIs.

The effectiveness of hyperbaric oxygen therapy for managing radiation-induced proctitis - results of a 10-year retrospective cohort study.

Despite modern radiotherapy (RT) techniques, radiation-induced proctitis (RIP) remains a significant complication of RT for pelvic organ malignancies. Over the last decades, an enormous therapeutic armamentarium has been considered in RIP, including hyperbaric oxygen therapy (HBOT). However, the evidence regarding the impact of HBOT on RIP is conflicting. This study aims to evaluate the effectiveness and safety of HBOT in the treatment of RIP. Ten-year (2013-2023) retrospective analysis of all consecutive patients with RIP treated with HBOT at Centro de Medicina Subaquática e Hiperbárica (CMSH) (Armed Forces Hospital - Lisbon, Portugal). Patients were exposed to 100% oxygen at 2.5 ATA, in a multiplace first-class hyperbaric chamber, for 70-min periods, once daily, five times per week. Fisher's exact test was performed using SPSS (version 23.0); p<0.05 was accepted as statistically significant. Of a total of 151 patients with RIP, 88 were included in the final analysis, of whom 38.6% evidenced other concurrent radiation-induced soft tissue lesions. The most reported primary pelvic tumor treated with RT was prostate cancer (77.3%), followed by cervical cancer (10.2%). Hematochezia was the most observed clinical manifestation (86.4%). After a median of 60 HBOT sessions (interquartile range [IQR]: 40-87.5), 62.5% and 31.8% of patients achieved a clinical complete and partial response, respectively, with a hematochezia resolution rate of 93.7% (complete or partial). While partial and complete responses require fewer than 70 sessions of HBOT in terms of overall RIP symptoms (p=0.069), isolated hematochezia tends to require at least 70 sessions (p=0.075). Individuals with at least two concurrent late radiation tissue injuries were associated with a complete response to HBOT (p=0.029). Only about 5.7% of patients did not respond to the treatment. Eighteen patients (20.5%) developed reversible ear barotrauma. The number of HBOT sessions was a predictor of HBOT side effects (odds ratio: 1.010; 95% confidence interval, 1.000-1.020; p=0.047). The HBOT proved to be an effective and safe treatment for RIP refractory to medical and/or endoscopic treatments. This real-world evidence study adds value to published data on the management of RIP with HBOT.

Utility of the 4C ISARIC mortality score in hospitalized COVID-19 patients at a large tertiary Saudi Arabian center.

The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) 4C mortality score has been used before as a valuable tool for predicting mortality in COVID-19 patients. We aimed to address the utility of the 4C score in a well-defined Saudi population with COVID-19 admitted to a large tertiary referral hospital in Saudi Arabia. A retrospective study was conducted that included all adults COVID‑19 patients admitted to the Armed Forces Hospital Southern Region (AFHSR), between January 2021 and September 2022. The receiver operating characteristic (ROC) curve depicted the diagnostic performance of the 4C Score for mortality prediction. A total of 1,853 patients were enrolled. The ROC curve of the 4C score had an area under the curve of 0.73 (95% CI: 0.702-0.758), p<0.001. The sensitivity and specificity with scores >8 were 80% and 58%, respectively, the positive and negative predictive values were 28% and 93%, respectively. Three hundred and sixteen (17.1%), 638 (34.4%), 814 (43.9%), and 85 (4.6%) patients had low, intermediate, high, and very high values, respectively. There were significant differences between survivors and non-survivors with regard to all variables used in the calculation of the 4C score. Multivariable logistic regression analysis revealed that all components of the 4C score, except gender and O2 saturation, were independent significant predictors of mortality. Our data support previous international and Saudi studies that the 4C mortality score is a reliable tool with good sensitivity and specificity in the mortality prediction of COVID-19 patients. All components of the 4C score, except gender and O2 saturation, were independent significant predictors of mortality. Within the 4C score, odds ratios increased proportionately with an increase in the score value. Future multi-center prospective studies are warranted.

Leveraging an Experience-Based Codesign Approach to Improve the Inpatient Food Service Experience.

Hospital food service is a key patient experience domain in an inpatient setting, which also plays an important role in responding to clinical and nutritional needs by providing food that is acceptable to patients. To achieve the strategic objective of a "distinguished patient experience," a Food Service Patient Experience Improvement Project was implemented at Al Hada Armed Forces Hospital during the second quarter of 2021 (Q2-2021) to improve the patient experience of meals at inpatient units. A quasi-experimental study design was used to assess the improvements in the inpatient meal experience by implementing an experience-based codesign approach. Improvements in the inpatient setting patient experience survey (Press Ganey) meals domain were measured. SQUIRE 2.0 guidelines were used to report this quality improvement project. A significant improvement was observed in the inpatient meals patient experience mean score before (Q1-2021, 68.75) versus after (Q3-2021, 81.93) the implementation of the Food Service Patient Experience Improvement Project. Food services are an important element in the patient recovery process and experience. The experience-based codesign is an effective coproduction approach to improve the patient experience and promote patient-centered care.

Radiological Features of Zoledronic Acid Therapy in Saudi Children with Osteogenesis Imperfecta

Background: The majority of osteogenesis imperfecta (OI) cases have an autosomal dominant pattern of inheritance and are usually caused by mutations in genes encoding type I collagen. Patients with OI may have blue sclerae, dentinogenesis imperfecta, and growth deficiency. Zoledronic acid is a third-generation bisphosphonate which was reported to inhibit osteoclast-mediated bone resorption, improve bone density, and reduce incidence of fractures. Aim: To describe the radiographic features of cyclic Zoledronic acid administration on the growing skeleton in children with OI and to report the efficacy of Zoledronic acid on bone mineral density. Methods: We retrospectively reviewed the radiographs of 11 children treated with Zoledronic acid. The age of these children ranged from one to 13 years. Zoledronic acid was administrated intravenously at 6 months intervals at the Pediatric Endocrinology Day Medical Unit, King Faisal Specialist Hospital and Research Centre, and Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia for 2 years. Results: During the course of treatment, a gradual increase in bone density was observed. The baseline mean lumbar BMDz score was -4.9SD + 1.3, which improved to a mean score of -2.7SD + 1.1, and a mean whole body BMDz score was -2SD +1.2 and improved to a mean score of -1.1SD + 1.3 by the end of therapy. Post treatment, there were multiple sclerotic metaphyseal bands seen in all children in the long bones paralleling to the growth plates and corresponding to the number of treatment cycles. Conclusion: Intravenous Zoledronic acid in children with osteogenesis imperfecta improved the bone mineral density and resulted in permanent sclerotic metaphyseal bands.

STRATEGIES FOR IMPROVING OPERATIONAL EFFECTIVENESS IN THE CLINICAL LABORATORYAT KING FAHD ARMED FORCES HOSPITAL (KFAFH)

Background:Laboratory turnaround time is considered one of the most important indicators of work efficiency in hospitals. Physicians always need timely results to make effective clinical decisions, especially in the emergency department. These results can guide physicians to admit patients to the hospital, discharge them home, or do further investigations. Objectives:To reduce troponin turnaround time (TAT) to less than 60min using coordinated process improvement methods Methods: A retrospective study in the ED Laboratory at King Fahd Armed Forces Hospital (KFAFH). A team of lab specialists conducted a Root cause analysis with the Fishbone diagram and applied Focus PDCA to the process. The time taken from receiving the test to the release of results in minutes was considered the Turnaround time (TAT) for the Trop I test. Results:The average TAT time was brought down from 101 minutes to consistently less than 35 minutes by September 2019. Conclusion:With an interdisciplinary team of healthcare professionals, the Turnaround time for troponin Iwas successfully reduced in our Emergency Department by 70% in 2019.