King Khalid University Hospital Research Articles

The knowledge and attitude of Saudi adults visiting a primary care clinic in King Khalid University Hospital toward genetic cancer screening

Background: Genetic testing has become an invaluable tool for the fight against cancer. Yet the general population of Saudi Arabia shows a lack of awareness and utilization of this tool. This study aimed at assessing the knowledge, attitudes, and practice of the Saudi population toward genetic cancer screening. Methods: An observational cross-sectional study was conducted at King Khalid University Hospital, Riyadh. Participants were asked complete a self-administered survey to assess their knowledge, attitudes, and practice. Results: Of the 217 individuals surveyed, relatively few had heard of genetic screening for cancer (16.1%) and even fewer had known what genetic cancer screening was (6.9%). Almost all participants had never been genetically tested before (90.3%). About 82.9% of participants would want to know their results if they were genetically tested and 60.3% were likely to share their results with family members even if they were indicated to have a low risk of cancer. Lifestyle changes were highly likely (84.3%) if participants had tested positive for cancer and general perception of medical advancements was positive (70.5%). Some of the perceived barriers toward genetic cancer screening were: lack of awareness of availability (68.2%), lack of knowledge of nearby clinics (67.8%), results of the test (53.4%), and fear of the effect on family (51.6%). Conclusion: The general Saudi population demonstrated poor levels of knowledge of genetic testing and a lack of awareness that such a tool exists. Genetic Cancer Screening educational campaigns could be useful in increasing knowledge among the population and reducing the perceived barriers to testing.

Awareness, preconception, and fear of epidural analgesia among childbearing women in Saudi Arabia: An observational cross-sectional study.

Labor pain is one of the most excruciatingly painful sensations a woman can have. A woman's attitude toward childbirth might be influenced by her lack of understanding of the birth process and the pain she experiences throughout labor and delivery. The control of pain is an important aspect of appropriate obstetrical care. Our study aims to measure the level of awareness, preconception, and fear of epidural analgesia (EDA) among childbearing women. An observational cross-sectional, hospital-based study was conducted using a self-administered questionnaire. The study included all pregnant women who were attending an obstetrical clinic for routine antenatal follow-up at King Khalid university hospital in Riyadh, Saudi Arabia, during the month of August 2022. They were asked about five main parts that tapped their awareness, preconception, and fear of EDA. Data were analyzed by SPSS version 26 using descriptive methods, including mean, frequency, and percentage, and also Pearson's correlation coefficient for regression analysis to find the correlation between socio-demographics and awareness and between awareness and fear. Participants in our study included 202 childbearing women. Most women, about 113 (55.9%), participating in the study were aged between 25 and 34 years old. The majority of the participants of this study were Saudi, about 196 (97.0%). In terms of education, 120 (59.4%) of the participants graduated from university. One hundred and forty two (70.3%) of the participants had a monthly income of less than 10000. When it comes to parity, the majority of participants, about 102 (50.5%), have had more than two pregnancies. The average percentage of awareness among the participants showed 45.9%, with an insignificant very moderate correlation between parity and awareness (r = -0.088, P = 0.107); women's knowledge, income, and age were also insignificantly related to awareness. Also, the result showed a moderate level of fear with an average percentage of 44.6% among the participants, with a moderate correlation between awareness and fear with a value of (r = 0.184, P = 0.004). This study results demonstrate a good level of desirability toward using EDA for labor pain, yet there is a limited level of preconceptions and a low level of awareness and knowledge about EDA. In addition, the results showed that the average percentage of fear is 44.6%. Therefore, we suggest that more awareness, knowledge, and guidance about EDA should be provided to pregnant women through antenatal clinics. Furthermore, educational campaigns should be made to dispel misconceptions and fears about EDA.

Assessment of food labeling knowledge and associated reading barriers among patients with diabetes.

The most challenging part of diabetes management for a patient with diabetes is selecting a healthy diet. The purpose of this study is to evaluate participants' knowledge of food labels, to find out the relationship between the type of diabetes mellitus (DM) and knowledge score of food labels, and to explore the barriers that prevent patients from reading food labels. This observational study was conducted on patients with type 1 or type 2 diabetes using a validated self-administered questionnaire. The study was conducted at diabetes clinics at King Khalid University Hospital and King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia, from November 2019 to February 2020. Data were analyzed using SPSS. A total of 310 participants were enrolled in this study, of which 50.3% had type 1 DM, and more than half of them were female (51.6%). Patients with type 1 DM had higher mean declarative and applied knowledge scores than those with type 2 DM, regardless of whether they were taking pre meals insulin or not. The highest proportion (39.9%) had difficulty in understanding the content of the nutrition labels, and some of them (37.2%) did not receive any educational session about it. Only 9.5% of the participants did not have any difficulties in reading food labels. Patients with both types of diabetes tended to have poor total knowledge about food labels and faced difficulties in reading them. Provided educational sessions by primary health care and specialized physician and DM educator about food labels are recommended to help them to choose food properly.

Satisfactory outcomes of post-operative subtalar extra-articular arthroereisis in juvenile flexible flat foot

To analyze the surgical outcomes of subtalar extra-articular arthroereisis and the patient/parent satisfaction regarding the foot's shape, foot pain, ability to walk, ability to jump, and shoe wear. Our retrospective cross-sectional study was carried out through an online-based questionnaire to assess patient satisfaction postoperatively at 3 hospitals (King Khalid University Hospital, Sultan bin Abdulaziz Humanitarian City, and Dallah Hospital, Riyadh, Saudi Arabia) between the years 2014-2021. A total of 65 patients participated in our study. Approximately 86.1% of them had the operation bilaterally. The most important aspects where patients noticed the most improvement were the foot's shape (90.8%), pain (81.5%), and ability to walk (76.9%). Several studies have been carried out highlighting the surgical technique and complications of the procedure. However, a limited number of studies have been carried out to assess patient satisfaction with the procedure, especially in Saudi Arabia, as the procedure is considered relatively new in the region with insufficient data regarding it. Therefore, this study is considered one of the few articles regarding subtalar extra-articular arthroereisis in the region.

Knowledge, Attitude, and Practice of Diabetic Patients Following Up In King Khalid University Hospital about Insulin Use; a Cross-Sectional Study

Knowledge, Attitude, and Practice of Diabetic Patients Following Up In King Khalid University Hospital about Insulin Use; a Cross-Sectional Study

The Prevalence of Depression and Anxiety in Post-bariatric Surgery Patients at King Khalid University Hospital, Riyadh.

Background Obesity negatively impacts mental and physical health and is a leading cause of disease worldwide. Obesity affects 33% of Saudi adults, with 10% being morbidly obese (body mass index, BMI >40 kg/m2). This study explored the association between bariatric surgery (BS) and a predisposition or exacerbation of depressive and anxiety symptoms. Material and methods A cross-sectional study of patients who underwent bariatric surgery at the King Khalid University Hospital in Riyadh, Saudi Arabia, was conducted between February 2016 and December 2021. The patients were contacted by phone to complete a self-administered questionnaire on demographic information, chronic medical diseases, psychiatric diseases, body mass index, and type of bariatric surgery. In addition, they completed the patient health questionnaire-9 (PHQ-9) and general anxiety disorder-7 (GAD-7) questionnaire to screen for patients' depression and anxiety symptoms. Results The findings of the 367 BS patients showed that 20.7% of the patients were considered to have mild anxiety, 11.2% had moderate anxiety, and 8.7% had high anxiety levels. However, regarding depression, 46.9% had extremely low levels of depression, followed by mild depression in 29.4% and moderate depression in 11.2%. Furthermore, another 8.2% of BS patients had moderately high depression levels, and 4.4% had severe depression. The anxiety and depression levels of the patients in this study did not show any statistically significant changes postoperatively in the short, medium, or long term. On the other hand, almost all of the patients 97% who underwent bariatric surgery were satisfied with the outcome of their surgery. Conclusion Few BS patients had high symptoms of depression and anxiety. We recommend pre- and postoperative psychiatric assessment for all bariatric surgery patients as surgical protocol.

Incidence of peripancreatic fluid collections in patients presenting with acute pancreatitis

To calculate the incidence of acute peripancreatic fluid collection (APFC) in patients with acute pancreatitis. The secondary objective is to determine the underlying etiologies of acute pancreatitis in the Saudi population. A retrospective cohort study was carried out at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. The study analyzed data from patients who were diagnosed with acute pancreatitis between January 2008 and January 202. A total of 327 were included in the study after applying the inclusion and exclusion criteria. Their medical records were subsequently reviewed for the presence or absence of APFC on follow-up imaging studies, evidence of biliary stones, prior endoscopic retrograde cholangiopancreatography (ERCP), a history of alcohol use, and demographic variables. Of the 327 patients with acute pancreatitis, 158 (48.3%) developed APFC, while 169 (51.7%) did not. The majority of patients had an idiopathic etiology of acute pancreatitis (n=251; 76.8%); followed by a biliary etiology (n=51; 15.6%); post-ERCP complications (n=14; 4.3%), and other causes (n=11; 3.3%). The incidence of APFC in patients presenting with acute pancreatitis between January 2008 and January 2021 was 48.3%. The most common etiology of acute pancreatitis in this tertiary care hospital was idiopathic, followed by biliary etiologies and post-ERCP complications. More studies targeting the local complications of pancreatitis are needed to reach more definitive findings.

Attitude and practice of physicians in King Khalid University Hospital, regarding placebo 2021-2022

Attitude and practice of physicians in King Khalid University Hospital, regarding placebo 2021-2022

Clinical Presentation as a Predictor of the Response to Methotrexate Therapy in Patients with Ectopic Pregnancy.

Ectopic pregnancy can be fatal if not diagnosed and timely treated. There is an increase in ectopic pregnancy rate which attributes in part to fertility medications and procedures and early diagnosis. Methotrexate, a folic acid antagonist, is widely used in the medical treatment of ectopic pregnancy. Many studies examined the safety and success rate of methotrexate looking into factors affecting the success rate, if the patient may present with symptoms such as abdominal pain, and some consider this as impeding rupture and it might affect the success of medical treatment. This study evaluates the success rate of methotrexate treatment outcomes in regard to presentation and looks into other factors that can help choosing a single or multiple dose modality. This is a retrospective review of 154 cases of ectopic pregnancy treated with methotrexate from January 2011 to December 2020 at King Khalid University Hospital (KKUH). Demographic data, clinical presentation, treatment progress, and outcome and failure rate were collected and analyzed. Student's t-test was used for statistical analysis of associations in SPSS. 154 patients were treated with MTX; of those patients, 25 received more than one dose. The difference between the responses to MTX treatment in symptomatic and asymptomatic individuals was not significant (p = 0.267). 131 (85%) had successful treatment. There were no associations between patient BMI, ectopic mass size, or ectopic mass site, the presence or absence of pelvic fluid on ultrasound at diagnosis, and the treatment success rate. There was a significant decline in the treatment success rate with increasing β-hCG levels on the presentation day (p = 0.035) and on day 4 (p value <0.001) of treatment. MTX treatment can be used to manage symptomatic patients with ectopic pregnancy. The success rate in symptomatic patients is not different from that in asymptomatic patients. β - hCG levels > 5000 IU/L. Pretreatment and on day 4 posttreatment is associated with higher failure rate.

Prevalence and physician factors associated with Vitamin B12 prescriptions at King Khalid University Hospital

Prevalence and physician factors associated with Vitamin B12 prescriptions at King Khalid University Hospital

RELATIONSHIP BETWEEN HBA1C AND COMPLETE BLOOD COUNT PARAMETERS IN ADULT PATIENTS WITH TYPE 2 DIABETES IN SAUDI ARABIA

Background: Hemoglobin A1c (HbA1c) measures blood glucose over a period of 2–3 months, and its level is closely related to the risk of complications. Several factors affecting HbA1c levels have not been studied. This study mainly focused on the relationship between HbA1c levels and complete blood count (CBC) parameters. Objectives: This study aimed to analyze the relationship between HbA1c levels and CBC parameters in patients with type 2 diabetes mellitus (T2DM) and to evaluate the association of CBC parameters with abnormal HbA1c levels and diabetic complications. Methods: This was a retrospective study of 385 Saudi patients with T2DM aged ≥18 years attending King Khalid University Hospital (KKUH) primary care clinics. Patients with type 1 diabetes mellitus, hematological diseases, infections, or allergies were excluded. AnElectronic System for Integrated Health Information (e-SiHi)was used to collect data, which were analyzed using SPSS 22 using t-test and analysis of variance, with P &lt;0.05 considered significant. Results: This study showed that the mean patient age was 59±13 years, with no significant difference between the sexes. In addition, the mean duration of disease was 10 years, and the mean HbA1c level was 8.5±1.9 %. CBC values were averaged according to their mean values, except for the erythrocyte sedimentation rate (ESR) (36±27 mm/hr) which was higher than the normal value (1.0–25 mm/hr). Conclusion: This study showed an association between HbA1c levels and duration of T2DM and hemoglobin. The progression of diabetic complications was related to CBC changes a high ESR was associated with the incidence of diabetic nephropathy and increased white blood cell count with neuropathy, vasculopathy, and nephropathy. Among all complications, vasculopathy occurred more frequently with each increase in HbA1c values.

A Retrospective Comparative Study of COVID–19 in Heart Failure Patients and its Correlation in the Length of Stay, the Risk for ICU Admissions, Intubation, Risk of Complications, and Mortality Rate Confined in King Khalid University Hospital

A Retrospective Comparative Study of COVID–19 in Heart Failure Patients and its Correlation in the Length of Stay, the Risk for ICU Admissions, Intubation, Risk of Complications, and Mortality Rate Confined in King Khalid University Hospital

The Journey to Diagnose Spondyloarthritis in Patients From Riyadh: A Cross-Sectional Study.

Introduction Ankylosing spondylitis, now frequently referred to as spondyloarthritis (SpA), is a chronic inflammatory disease causing axial arthritis andinflammatory lower back pain resulting in the eventual impairment of spinal mobility. Moreover, its systemiccomplications include stiffness and inflexibility, restriction of lung capacity and function, eye inflammation, compression spinal fractures, and heart problems. Hence,early diagnosis and intervention play a key role in preventing acute complications and improving the quality of life. Objective We aimed to estimate the average duration of diagnosis, the average number of doctors visited, and the association between the specialty of the first physician and the length of SpA diagnosis delay. Methods A cross-sectional retrospective study was conducted from November 2019 to April2020 with patients from King Khalid University Hospital, Riyadh, Saudi Arabia. The patients were 18 years and older and diagnosed with SpA. Call interviews were conducted and patients'medical charts were reviewed. The data were analyzed using the Statistical Package for Social Sciences statistical software, version 23 (IBM Corp., Armonk, NY). Result The total sample was 101 patients: 59 (58.4%) males and 42 (41.6%) females. The average duration from the onset of symptoms until seeking medical advice (lag 1) and from seeking medical advice until the definite diagnosis (lag 2) was 24.74 ± 48.13 and 16.16 ± 34.62 months, respectively. The average number of doctors visited between the first medical encounter and the final diagnosis was 3.56 ± 5.3. Patients who consulted rheumatologists as the first medical encounter showed less delay in diagnosis compared to patients who sought non-rheumatologists, such as orthopedists, emergency physicians, and general physicians(11.81 ± 33.35 months vs. 26.63 ± 44.28, 26.96 ± 44.88, and 44.33 ± 65.75 months, respectively). Conclusion Patients with SpA who were not seen by rheumatologists took a longer period till the final diagnosis than those who visited rheumatologists earlier in the course of the disease. Therefore, more studies are required to define the exact factors leading to the delay.

Low Incidence of Central Nervous System (CNS) Relapse of Diffuse Large B-Cell Lymphoma despite Limited Use of Intrathecal Prophylaxis

Diffuse large B cell lymphoma (DLBCL) is the commonest sub type of non-Hodgkin's lymphoma (NHL) accounting for 30–50 % of NHL cases. Around 2% to 10% of patients with diffuse large B-cell lymphoma (DLBCL) experience central nervous system (CNS) relapse after initial therapy which is associated with a poor prognosis and most often a fatal outcome. The incidence of CNS relapse can vary from <1% in younger, good-risk patients, to around 30% in patients with multiple risk factors, however, the relapse risk was reported to be lower in the rituximab era in some studies. Moreover, optimal modality of CNS prophylaxis remains to be defined, with both systemic and intrathecal (IT) chemotherapy being widely used. As the incidence of CNS relapse and type of prophylaxis used varies in different reports, it is important to study this risk in different populations to implement optimal prophylaxis strategies. The Objectives of this study was to evaluate the incidence of CNS relapse in DLBCL patients at our institution and to study risk factors and the type and role of CNS prophylaxis. We retrospectively analyzed patients diagnosed with DLBCL at King Khalid University Hospital, Riyadh, from January 2011 to June 2019. Data were collected from computerized hospital information system and from the files of the patients. Variables studied included age at diagnosis, stage at diagnosis, international prognostic index (IPI) and CNS-IPI score, site(s) of extra-nodal involvement, type of chemotherapy received, CNS prophylaxis and CNS relapse. CNS prophylaxis was administered on the basis of presence of high-risk features like presence of ≥2 extranodal sites, involvement of bone marrow, bone, testes, nasopharynx and paranasal sinuses. Patients with presence of CNS involvement at diagnosis and primary CNS lymphoma were excluded. A total of 101 patients were diagnosed with DLBCL during the study period. There were 58 males and 43 females with a median age of 56 (range: 16-87) years. Ann Arbor stage of I-IV was assigned in 9, 21, 17 and 50 patients, respectively. The lung was the most common extranodal site involved in 27 (26.7%) patients, and liver and bone marrow involved in 20 (19.8%) patients each. Gastrointestinal tract was involved in 9 (8.9%) patients, kidneys in 5 (4.95%), breast in 4 (4%), and testis and adrenal in 2 (2%) patients each. Twenty-five (24.75%) patients had high risk CNS-IPI score, 44 (43.5%) had intermediate risk score and 32 (31.7%) had low risk score. Ninety-four (93%) patients received R-CHOP chemotherapy while rest of the patients received other types of chemotherapy, mostly a milder regimen (R-CVP), because of comorbidities and poor performance status. Sixteen patients received CNS prophylaxis, which was IT methotrexate (MTX) ± cytarabine/hydrocortisone in all patients. Nine of 25 (36%) patients with high-risk CNS-IPI score did not receive CNS prophylaxis. After a median follow up of 36 months (range 4-114), 2 (2%) patients developed CNS relapse and died shortly after this diagnosis. Both the patients with CNS relapse had high risk CNS-IPI score and did not receive CNS prophylaxis. CNS relapse of DLBCL was uncommon in this patient population despite limited use of IT CNS prophylaxis in high-risk patients. Low incidence of CNS relapse in many high-risk patients despite limited use of IT prophylaxis may be related to rituximab use and/or other factors. Our data indicate that IT CNS prophylaxis may be adequate for DLBCL patients at high risk of CNS relapse.

Pattern and etiology of early childhood epilepsy: An Experience at a tertiary care University Center.

To investigate seizure characteristics, types, and define the etiology of epilepsy in children aged ≤2 years using the 2017 ILAE classification. A retrospective chart review was conducted at King Khalid University Hospital, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia for children below 2 years of age diagnosed with epilepsy, and on anti-seizure medications from January 2017 - December 2018. The collected data involved detailed information on the patients' seizure, electroclinical, neuroimaging, laboratory evaluations, and underlying etiology. One- hundred and fifty patients were included in the study and classified according to etiology into: genetic (43, 28.7%), structural (41, 27.3%), metabolic (10, 6.7%), infectious (8, 5.3%), immune-mediated (1, 0.7%) and unknown (47, 31.3%) groups. The most common seizure types were generalized epilepsy, among which generalized tonic-clonic seizures occurred in 56 (37%) patients, followed by tonic seizures in 31 (21%), infantile spasm in 19 (13%), myoclonic seizures in 4 (2.7%), atonic seizures in 6 (4%), and focal seizures in 33 (22%) patients. Global developmental delay and abnormalities in both neurologic exam and neuroimaging were more common in the structural and genetic groups. Electroencephalography was abnormal in 82 (55%) patients, including the majority of the structural group (26, 63.4%). The etiology of epilepsy in this cohort remains undetermined (unknown) in a large proportion of cases, followed by genetic and structural causes. This result added to the published international data about epilepsy in the first 2-years of life.

Prevalence and Risk Factors of Discordance Between Hip and Spinal Bone Mineral Density Among Saudi Subjects.

BackgroundDiscordance between hip and spine on dual-energy x-ray absorptiometry is a well-known problem in diagnosing osteoporosis. The prevalence and risk factors of this problem have not been studied in the Saudi population. The objective of this study was to document this discordance in our population and its possible risk factors.Materials and methodsWe analyzed data obtained from subjects who had dual x-ray absorptiometry (DXA) between January 2021 and December 2021 at King Khalid University Hospital, Riyadh, Saudi Arabia. Subjects with the following conditions were excluded: secondary osteoporosis, patients taking anti-osteoporotic agents, patients on steroids or hormonal replacement therapy, hyperparathyroidism, hypoparathyroidism, and chronic renal disease. A total of 1388 patients satisfied our inclusion criteria. World Health Organization (WHO) criteria for diagnosis were implemented. Major discordance was defined as osteoporosis in one site and normal in the other. Minor discordance was defined as a difference of no more than one World Health Organization diagnostic class between two sites. Bivariate statistical analysis was achieved using appropriate statistical tests (chi-square, student’s t-test, one-way analysis of variance, and Pearson’s correlation), based on the type of study and outcome variables. A p-value of < 0.05 and 95% CI were used to report the statistical significance and precision of results.ResultsA total of 1388 subjects were analyzed, of which, 1196 (86%) were females with a mean age of 58.8 (13.8 SD) and 192 were males with a mean age of 58 (18.0 SD). Lumbar osteoporosis was found in 312 (22.5%) participants while hip osteoporosis was reported in 73 (5.3%) of the participants. Major discordance was documented in 85 (6.1%) of all participants (6.3% of the male and 6.1% of the female patients). All of these subjects had lumbar spine osteoporosis with normal hip bone mineral density (BMD). Minor discordance was found in 591 patients (42.6%). Obesity (BMI > 30) was found to be a risk factor for both major (2.10-11.6, 95% CI) and minor (2.5-11.4, 95% CI) discordance.ConclusionDiscordance between hip and spine BMD is common among Saudi subjects. Lumbar spine osteoporosis with normal hip BMD caused this discordance in our subjects. Obesity could be responsible for the occurrence of this discordance. Mechanisms may include higher rate of turnover in spine, technical artifacts in the measurements of lumbar spine BMD, or due to the effects of weight loading. Caution should be exercised when interpreting DXA results, especially in obese subjects.

The Diagnostic Yield of Abdominal Ultrasounds Requested by Family Physicians at an Academic Hospital in Riyadh, Saudi Arabia.

Background: Abdominal ultrasound is a non-invasive, relatively inexpensive, and widely available diagnostic modality in family medicine settings.Objectives: Our study aimed to identify the most common indications for requesting abdominal ultrasounds by family physicians, determine the frequency of abdominal ultrasound with abnormal findings, identify the most common findings, and determine patients’ characteristics associated with abnormal findings.Methods: This retrospective chart-based study was conducted from January 2020 to June 2020 to analyze patients’ abdominal ultrasounds reports requested by family physicians in 2019 at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia.Results: We assessed abdominal ultrasound reports of 1,113 patients. There were 620 (55.7%) female patients. The mean age and body mass index (BMI) were 46.35 years ± 15.04 and 29.33 kg/m2 ± 7.06, respectively. The most common indications were abdominal pain (43.2%), suspicion of gallbladder and biliary system diseases (18.5%), and abnormal liver function tests (14.6%). The frequency of abnormal findings was 793 (71.2%), and the most common findings were fatty liver infiltration (49.7%), liver enlargement (20.1%), and gallstones (13.3%). Females had a lower likelihood to have abnormal findings compared to males (odds ratio (OR)=0.688, p=0.009). Lastly, the likelihood of abnormal findings increased with age and was highest among patients aged 71 years or more (OR=25.9, p< 0.001).Conclusion: Abnormal findings were more prevalent in our study compared with other studies. Abnormal findings were more common among males and older age groups. We recommend future studies on patients from community-based family medicine settings, and to examine the association of abnormal findings with patient-centered endpoints. Finally, disseminating the results of this study will inform family physicians with the most common abnormal abdominal ultrasound findings, and will enhance the discussion with patients undergoing an abdominal ultrasound examination.

Phone consultation during COVID-19 in the outpatient clinic at King Khalid University Hospital: What can we infer from this exciting experience for future practice?

Phone consultation during COVID-19 in the outpatient clinic at King Khalid University Hospital: What can we infer from this exciting experience for future practice?

Exploring social determinants of health in a Saudi\xa0Arabian primary health care setting: the need for a multidisciplinary approach

BackgroundAction on social determinants of health (SDH) in primary health care settings is constrained by practitioners, organizational, and contextual factors. The aim of this study is to identify barriers and enablers for addressing SDH in clinical settings in Saudi Arabia, taking into consideration the influence of local cultural and social norms, to improve care and support for marginalized and underserved patients.MethodsWe conducted a qualitative study involving individual in-depth interviews with a sample of 17 primary health care physicians purposefully selected based on the inclusion criteria, as well as a focus group with four social workers, all recruited from King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. All interviews were audio-recorded, translated from Arabic to English, transcribed verbatim, and analyzed using thematic analysis following a deductive-inductive approach.ResultsAccording to study participants, financial burdens, challenges in familial dynamics, mental health issues and aging population difficulties were common social problems in Saudi primary health care. Action on SDH in primary care was hindered by 1) lack of physician knowledge or training; 2) organizational barriers including time constraints, patient referral/follow up; 3) patient cultural norms and 4) lack of awareness of physician’s role in managing SDH. Enablers to more socially accountable care suggested by participants includes: 1) more education and training on addressing SDH in clinical care; 2) organizational innovations to streamline identification of SDH during patient encounters (e.g. case finding questionnaire completed in waiting room); 3) better interprofessional coordination and clarification of roles (e.g. when to refer to social work, what support is provided by physicians); 4) identifying opportunities for broader advocacy to improve living conditions for marginalized groups.ConclusionEnabling more socially accountable care requires a multipronged approach including leadership from the Ministry of Health, hospital administrations and medical schools. In particular, there is a need for: 1) training physicians to help patients in navigating social challenges; 2) improving clinical/administrative interprofessional teams, 3) mobilizing local communities in addressing social challenges; and 4) advocating for intersectoral action to prevent health inequities before they become more complex issues presenting to clinical care.

The role of drug information centers to improve medication safety in Saudi Arabia - a study from healthcare professionals' perspective

Background and objectiveThe primary function of the Drug Information Center (DIC) is to provide drug-related information to healthcare professionals. The purpose of this research was to assess the use of drug information centers by health care the professionals to improve medication safety in Saudi Arabia. MethodsA retrospective study was carried out at King Khalid University Hospital's drug and poison information center (DPIC). During the study period, requests received by drug information specialists were saved in the DPIC questions’ bank. Patients’ demographic, type of drug information request, caller information, number of references used, medications, class of medication, medication error type and subclass were assessed and analyzed using descriptive analysis. Medication error types were captured based on nature of questions. ResultsA total of 243 drug information inquiries were assessed. Most of the inquiries were about adult population (n = 168; 69.1%). Most drug information inquiries were received from pharmacists (n = 117; 48.1%), followed by physicians (n = 94; 38.7%), then nurses (n = 23; 9.5%). Prescribing error were the most type of medication error prevented by drug information specialists (n = 214; 88.1%) followed by dispensing errors (n = 11; 4.5%). Approximately half of the medication errors in this study were near-misses (n = 110; 45.3%), followed by potential near misses (n = 84; 34.6%). Only, (n = 49; 20.2%) were identified as errors. ConclusionThis study highlights the role of drug information specialists in providing evidence-based information and helps in preventing possible medication errors which will enhance the safety of the services provided to the patients.