King Saud University Medical City Research Articles

Prevalence and factors associated with methicillin-resistant Staphylococcus aureus colonization among clinical medical students

Background: This study was carried out to assess the prevalence and determinants of methicillin-resistant Staphylococcus aureus(MRSA) colonization among clinical clerkship medical students in Saudi Arabia. Methods: A cross-sectional study was performed at King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. Nasal samples were obtained from 360 clinical clerkship medical students (3rd–5th years). Questionnaires were filled. MRSA identification was done using the standard laboratory procedures. Data were analyzed using SPSS Pc + 21.0 software. Results: Of 360 samples, 100 (27.7%) were positive for S. aureus and 12 (3.3%) were MRSA positive. The following variables and the outcome (MRSA+/MRSA−) showed statistically significant association; previous hospital admissions, immunocompromised status, chronic disease, and female gender. We found that our MRSA colonization prevalence rate of 3.3% predominately in female gender. Third-year medical students have the highest MRSA colonization of 4.8%, then 4th year 2.8%, and 5th year 1.2%. 17.6% of students with history of hospital admission where found to be MRSA positive, 10% of bronchial asthma sufferers, and 37.5% of immunocompromised students either due to medication or cancer were MRSA positive. Conclusion: MRSA nasal carriage among clinical medical students in KSUMC was found to be 3.3%. We recommend teaching standard practices of infection control protocols and additional precautions.

Satisfaction and perceived usefulness with newly-implemented Electronic Health Records System among pediatricians at a university hospital

BackgroundApposite implementation of Electronic Health Records (EHR) is anchoring standards of care in healthcare settings by reducing long-run operational costs, improving healthcare quality, and enhancing patient safety. ObjectiveThis study aims to explore factors that might influence Pediatricians’ satisfaction with an implemented EHR system and its perceived usefulness at a tertiary-care teaching hospital, Riyadh, Saudi Arabia. MethodsA cross-sectional survey distributed to all physicians working in the pediatric department of King Saud University Medical City (KSUMC) in the period from June to November 2015, two months after the launch of the EHR system, internally branded as electronic system for integrated health information (eSiHi). Bivariate and multivariate regression were analyzed to examine factors associated with physicians’ satisfaction. ResultsOf the 112 physicians who completed the survey, 97 (86.6%) attended training courses before the implementation of new EHR. On average, the participants rated the perceived usefulness of the new system at 6.4/10 for patient care and physicians' satisfaction levels were 5.2/10. The top indicator of EHR usefulness was the system's ability to reduce errors and improve the quality of care [mean 3.31, SD 0.9, RII 82.8%]; the lowest-ranking indicator was the physicians’ perceived familiarity with functions and benefits [mean 2.68, SD 0.7, RII 67%]. The top indicator of satisfaction with the EHR system was enhanced “individual performance” [mean 3.04, SD 1, RII 60.9%]; the lowest-ranking perceived indicator was the limited availability of workplace computers [mean 1.91, SD 1.2, RII 38.2%]. ConclusionsLimited data regarding EHR implementation and end-users satisfaction in the Middle East region necessitates further work on factors affecting levels of satisfaction with the EHR system among different health institutes. Lack of information technology (IT) support, hardware, and time-consuming data entry process are challenging barriers for proper utilization of EHR for pediatric health care services.

The experience and impact of stigma in Saudi people with a mood disorder

BackgroundStigma plays a powerful role in an individual’s attitude towards mental illness and in their seeking psychiatric and psychological services. Assessing stigma from the perspective of people with mood disorders is important as these disorders have been ranked as major causes of disability.ObjectivesTo determine the extent and impact of stigma experiences in Saudi patients with depression and bipolar disorder, and to examine stigma experiences across cultures.MethodNinety-three individuals with a mood disorder were interviewed at King Saud University Medical City using the Inventory of Stigmatizing Experiences (ISE).ResultsWe detected no significant differences in experiences of stigma or stigma impact in patients with bipolar vs. depressive disorder. However, over 50% of respondents reported trying to hide their mental illness from others to avoiding situations that might cause them to feel stigmatized. In comparison with a Canadian population, the Saudi participants in this study scored significantly lower on the ISE, which might be due to cultural differences.ConclusionMore than half of the Saudi participants with a mood disorder reported avoiding situations that might be potentially stigmatizing. There are higher levels of stigma in Canada and Korea than in Saudi Arabia. Our results suggest that cultural differences and family involvement in patient care can significantly impact self-stigmatization. The ISE is a highly reliable instrument across cultures.

Association between Social Jetlag and glycemic control in diabetic patients at King Saud University Medical City

Introduction Social Jetlag has been linked to many cardiovascular and metabolic diseases, as it disturbs the circadian rhythm. Methodology case-control matched by age and gender conducted among 511 subjects. Control group: Diabetic with HbA1c Results Social Jetlag status was similar among both cases and control participants which indicate that there was no significant association between Social Jetlag and HbA1c (P-value = 0.394). The prevalence of Social Jetlag in the studied population is 58.4%. Conclusion We suggest future studies to have a more precise estimation of sleep duration and Social Jetlag and focusing on Social Jetlag and its related problems.

Optimizing Vancomycin Monitoring in Pediatric Patients.

Several studies have reported that trough levels may not be optimal for monitoring vancomycin therapy, because of overexposure and nephrotoxicity risks. Therefore, we developed a population pharmacokinetic model to optimize vancomycin dosing and monitoring in pediatrics. Data were retrospectively collected on 76 pediatric patients 1-12 years of age, admitted to general pediatric wards or intensive care units at King Saud University Medical City, Riyadh, Saudi Arabia. The predictability of 3 methods for calculating the area under the curve (AUC) at steady state was assessed for optimum vancomycin therapy monitoring. The 3 methods were simple linear regression, Bayesian approach and the 2-sample pharmacokinetic equation method. We also used Monet Carlo simulations to evaluate the dosing of vancomycin. A 1-compartment model adequately described the data. A strong correlation occurred between the observed and predicted AUC from 0 to 24 hours (AUC0-24h) calculated using the Bayesian approach with a trough sample only or pharmacokinetic equations based on 2 measured samples (R = 0.93 and 0.92, respectively). For the simple linear regression method with a trough sample only, the predicted AUC0-24h at steady state with vancomycin trough levels of 10, 15 and 20 µg/mL were 413, 548 and 714 µg·hour/mL, respectively. The target AUC0-24h above 400 was achieved in 46% and 95% of individuals with trough values of 7-11 and 11-15 µg/mL, respectively. Monte Carlo simulations showed that 60-80 mg/kg/d doses are needed to optimize vancomycin therapy. In conclusion, targeting vancomycin trough levels above 15 µg/mL in pediatrics would overshoot the target AUC0-24h above 400 and expose them to unnecessary adverse events.

The effect of caffeine on patients with narcolepsy, in King Khalid Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

Rationale: Caffeine could effectively reverse the effects of increasing sleep propensity1, however, it is not known whether caffeine could increase alertness in narcoleptic patients

Knowledge and willingness of physicians about deprescribing among older patients: a qualitative study.

PurposeThis study aimed to explore the physician’s knowledge and identify the perceived barriers that prevent family medicine physicians from engaging in deprescribing among older patients.MethodsThis qualitative study was designed and conducted using an interpretive theoretical approach. Purposive sampling was undertaken, whereby family medicine physicians of King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia, were invited to participate in the study. The topic guidelines were designed to give the physicians the freedom to express their views on exploring their knowledge about deprescribing and to identify the perceived barriers and enablers that prevent them from engaging in the practice in older patients. The focus group discussions were conducted in English, audio-taped with permission, and transcribed verbatim. Each transcript was independently reviewed and coded separately to explore the themes and sub-themes.ResultsA total of 15 physicians participated in three focus group discussions. Their thematic content analysis identified 24 factors that facilitated or hindered deprescribing. The facilitators included cost-effectiveness and time effectiveness, side effects avoidance, clinical pharmacist’s role, need for system(s) to help in applying deprescribing, and patient counseling/education. Similarly, barriers included lack of knowing the deprescribing term and process, patient comorbidities, risk/fear of conflict between physicians and clinical pharmacists, lack of documentation and communication, lack of time or crowded clinics, and patient resistance/acceptance.ConclusionThe study identified several factors affecting family medicine physician’s deprescribing behavior. The use of theoretical underpinning design helped to provide a comprehensive range of factors that can be directed when defining targets for intervention(s).

The histological spectrum of tubulo-reticular inclusion positive renal biopsies: a tertiary hospital experience and review of the literature

ABSTRACTAim: To identify the underlying diseases with TRI-positive kidney biopsies, and describe the histological pattern and spectrum of TRI-positive kidney biopsies.Methods: A retrospective analysis of all patients’ chart that underwent renal biopsy at King Saud University Medical City between 2012 and 2017 was done. Kidney biopsies that indicated a positive result for tubuloreticular inclusions (TRI’s) on electron microscopy were reviewed and the underlying disease and histological pattern was extracted.Results: Of 1,473 native kidney biopsies reviewed, 96 (6.5%) were TRI-positive. Of the 96 TRI-positive kidney biopsies, 87 (90.6%) were TRI-positive lupus nephritis (LN); of which 10 (11.5%) were Class V, 49 (56.3%) were active LN, and 28 (32.2%) were inactive LN. The underlying diseases of the nine non-LN TRI-positive cases included diabetic nephropathy, connective tissue disorders, immune complex mediated Glomerulonephritis (GN), acute thrombotic microangiopathy, rhabdomyolysis, and Wegener’s disease.Conclusion: LN is a very common finding in TRI-positive kidney biopsies. Active LN and chronic LN are the more common classes of TRI-positive LN kidney biopsies, than pure membranous (Class V) LN. TRI positive kidney biopsies without LN are commonly found in diabetic nephropathy, connective tissue disorders and immune mediated GN’s.This study highlights this finding in our patients cohort in opposition to what has been reported in the literature.

Impact of a multidisciplinary intensive education program on type 2 diabetes mellitus patients' glycemic control and cardiovascular risk factors.

Objectives:To evaluate the impact of a multidisciplinary intensive education program (MIEP) on type 2 diabetes mellitus (T2DM) patients’ outcomes.Methods:A retrospective study was used to evaluate the impact of MIEP on T2DM patients’ outcomes for between May 2016 and May 2017. Data were collected from the diabetes education clinic in King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia where patients were referred from diabetes outpatient clinics to the diabetes education clinic to receive MIEP. In terms of measuring the clinical outcomes of the T2DM patients, glycemic control, blood pressure, weight, and lipid profiles were assessed before MIEP at 3, 6, and 12 months.Results:A total of 174 patients with T2DM fulfilled study inclusion criteria. The results indicate improved glycemic control where patients’ HbA1c and blood sugar levels were significantly reduced 3, 6, and 12 months after MIEP compared to the baseline (p<0.005). Moreover, blood pressure improved after education; a significant improvement was observed in the mean systolic blood pressure (SBP) from baseline to 12 months (p=0.036), and in the mean diastolic blood pressure (DBP) after 12 months (p=0.016). Additionally, the study found significant differences in total cholesterol and low-density lipoprotein (LDL) cholesterol 6 months after the intervention (p=0.014, p=0.02, respectively).Conclusion:Implementing an MIEP for T2DM patients can improve their clinical outcomes, which consequently may delay the disease’s long-term complications.

Age distribution and outcomes in patients undergoing breast cancer resection in Saudi Arabia

ObjectivesIn response to rising incidence and mortality we aimed to investigate the demographic characteristics of patients with operative breast cancer in our region.MethodsWe performed a retrospective study of 224 patients who underwent surgery for breast cancer at King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia between 2005 and 2012.ResultsWe identified a young population overall with a mean age of 48.8±12.2 years (range: 26-93 years). Survival rate were however similar across all age groups with a 10-year overall survival of 87%.ConclusionPatients in our study were generally younger than those with breast cancer in Western nations. However, unlike Western countries, young age was not associated with worse outcomes.

Pediatric acute kidney injury induced by concomitant vancomycin and piperacillin-tazobactam.

Vancomycin is very commonly used in combination with piperacillin-tazobactam (PTZ) as the initial empiric treatment for moderate-severe infection, whenever coverage for both methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa is required. The combination of vancomycin and PTZ in adults has recently been reported to significantly increase the risk of acute kidney injury (AKI) relative to vancomycin monotherapy; such reports in pediatrics, however, are sparse. A retrospective chart review was conducted of pediatric patients, aged 0-14 years, who were admitted to the general wards or intensive care unit and developed AKI after receiving vancomycin and PTZ concomitantly for >48h. AKI is defined as a decrease in estimated glomerular filtration rate ≥50% from baseline. Cases were identified by reviewing the Adverse Drug Reaction program database at King Saud University Medical City in Saudi Arabia from January 2015 to June 2016. Eight children admitted to the present hospital and who received concomitant vancomycin and PTZ treatment for pneumonia (n = 7) or febrile neutropenia (n = 1) developed drug-induced nephrotoxicity. Drug Interaction Probability Scale (DIPS) score for causation assessment was 9 in all cases (highly probable). Caution in utilizing the combination of vancomycin and PTZ is warranted in pediatric patients. Health-care professionals should be vigilant if this combination is to be initiated, and ensure close monitoring of renal function. Antibiotic therapy de-escalation should be considered as soon as culture results are available.

Knowledge and misconceptions of Saudi women about sexually transmitted infections.

Sexually transmitted infections (STIs) are increasingly becoming one of the most important health challenges , especially among women, as they bear long-term consequences such as infertility and cervical cancer owing to STIs. This study aimed to assess the knowledge and misconceptions of Saudi women about STIs. A descriptive study was conducted among adult women attending the dermatology clinic at King Saud University Medical City, Riyadh, Saudi Arabia, for reasons other than STIs. They were randomly approached and asked to complete an anonymous prevalidated questionnaire. Uneducated females were guided by an interviewer during the filling up of the survey questionnaire. Of 1150 women approached, 843 adult Saudi women responded to the survey (response rate: 73.3%). The mean age was 30.6±10.9 years. Knowledge of STIs was highest for HIV (85.9%) and lowest for genital warts (17.0%). Respondents believed that genital pruritus, foul discharge, and painful micturition are symptoms of STIs (71.1, 69.1, and 56.4%, respectively). A considerable percentage believed that STIs are transmitted by masturbation (54.8%), sleeping on contaminated beds (39.3%), and by eating and drinking from contaminated utensils (26.3%) whereas 8% believed that STIs are transmitted by shaking hands. Nearly two-thirds of women thought that condoms protect against STIs. Knowledge on the modes of transmission and symptoms of STIs was significantly correlated with younger age, higher level of education, and higher monthly income. Despite the huge campaigns and information about STIs seen on the internet and television by these women, there is still scarcity of knowledge on the more important aspects of STIs, especially the recognition of clinical features and modes of transmission/spread of STIs. There is still a need for health authorities to intensify information-dissemination campaigns about STIs to the grassroots level, particularly among women in Saudi Arabia.

Prostate cancer screening in a low prevalence population. Is it worth it?

Objectives:To embrace a national screening program for prostate cancer, putting into consideration the cost, and the attitude of the general population towards such screening.Methods:Men aged >45 and <70 years were invited to participate in the current prospective study conducted at King Saud University Medical City, Riyadh, Saudi Arabia between December 2014 and July 2015. Those with confirmed high prostate-specific antigen (PSA) (≥4 ng/ml) were referred to the urology clinic, then subjected to magnetic resonance imaging.Results:The total cohort screened were 2898, we found 118 cases with high PSA (≥4 ng/ml). Fifty-two cases (60.4%) were confirmed high PSA. All of them were subjected to MRI and biopsy. The confirmed prostate cancer were 7 cases (0.24%). The age of confirmed prostate cancer cases ranged from 49 years to 68 years, Gleason score for 4 cases was low grade (3+3), while it was 3+4 for 2 cases, and only one case had advanced cancer (3+5). Approximately 12% of cases with high PSA did not show up for confirmation of their results for further examination.Conclusions:The present study recommends against mass screening among Saudi population; however, men before 50 years of age should start PSA blood testing until before 70 years after discussing the benefits and harms of such screening through shared decision making.

Microdissection testicular sperm extraction in men with nonobstructive azoospermia: Experience of King Saud University Medical City, Riyadh, Saudi Arabia.

Objectives:Microdissection testicular sperm extraction (micro-TESE) is an optimal technique of sperm extraction for intracytoplasmic sperm injection. This study is to present our experience in micro-TESE and evaluate the relation of its sperm retrieval rate (SRR) with patients' characteristics, testicular functions, and histological parameters as well as previous sperm retrieval interventions.Materials and Methods:We retrospectively reviewed records of 255 patients with nonobstructive azoospermia who underwent micro-TESE between 2011 and 2014. Medical records were reviewed for the results of follicle stimulating hormone (FSH), luteinizing hormone (LH), total testosterone levels, karyotype analysis, and testicular histology pattern. Testicular volume was measured with an ultrasound scale.Results:The mean patients' age was 35.8 ± 7.2 years, duration of infertility 7.7 ± 4.5 years, right testicular volume 13.1 ± 5 ml, and left testicular volume 12.9 ± 5 ml. The overall SRR was 43.9%. SRR was significantly higher in testes with hypospermatogenesis histology pattern (P = 0.011). Patients' age, testicular size, serum FSH, LH, prolactin, and testosterone or failed previous sperm retrieval interventions showed no significant impact on SRR. Eleven (4.3%) patients had nonmosaic Klinefelter syndrome with a mean age of 37.8 ± 3.3 years. Sperms were retrieved in 6 (54.5%) patients. Post micro-TESE androgens significantly deteriorated with near complete recovery after 1 year.Conclusions:Micro-TESE has a high SRR, minimal postoperative complications, and reversible long-term androgen deficiency. Sperm retrieval depends on the most advanced pattern of testicular histology. Hypospermatogenesis pattern has the highest SRR. We demonstrated a high SRR with micro-ESE in men with Klinefelter syndrome.

TITLE: DIAGNOSTIC UTILITY OF CONVENTIONAL CELIAC DISEASE SPECIFIC MARKERS.

23Nov 2016 TITLE: DIAGNOSTIC UTILITY OF CONVENTIONAL CELIAC DISEASE SPECIFIC MARKERS. Zahid Shakoor , Mustafa Hussein Adam , Rana Hasanato , Ghadah Ibrahim Al Suhaibani , Raghad Adnan Bokhari , Deema Essam Jomar , Layla Mohammed Zeitouni , Dina Khaled Assiri , Sawsan Saad Bakry and Felwa Abdulaziz Al Marshad. Department of Pathology and Laboratory Medicine, College of Medicine King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia. College of Medicine, King Saud University.

Communication skills between physicians' insights and parents' perceptions in a teaching hospital in KSA.

ObjectivesCommunication between physicians and parents is the cornerstone of their relationship to reach a common goal of better child health. To deliver proper communication, a physician needs to learn certain skills that are not included in the curriculum of medical schools or paediatrics residency training in KSA. This study probed the physicians' attitude towards their styles of communication based on the parents' perception.MethodsThe data were collected from a randomly selected sample of physicians and parents from general paediatrics wards at King Saud University Medical City (KSUMC), Riyadh, KSA. We used a validated Criteria Cognitive Aptitude Test (CAT-T) questionnaire and a translated version of the CAT-T questionnaire for the physicians and parents, respectively. The data were then analyzed using variable qualitative and quantitative statistical methods.ResultsThe data were collected from 63 physicians and 100 parents in the pediatric wards at KSUMC. We observed an increased level of confidence in communication skills (CS) among experienced physicians, while young physicians expressed concerns regarding their communication with parents concerning decision-making. The parents rated the physicians' skill of active listening as poor. However, the parents rated the physicians' introduction as higher than their own self-rating. In addition, the parents' satisfaction with the physicians' CS was inversely related to the parents' level of education.ConclusionOur data suggests a clear discrepancy between the physicians' insights and the parents' perceptions about the CS. This finding emphasizes a need for further training among physicians to satisfy parents and in ultimately improving child health in the KSA.

Length of Stay and Post-operative Complications and Their Relation with the Glucose Level Preoperatively in Diabetic and Non-diabetic Patients Undergoing Spinal Surgeries

Introduction Hyperglycemia in diabetic patients is a well-known risk factor for many perioperative morbidity and mortality, as it alters the normal physiology of the patients responding to many stressors like surgery, it therefore tends to increase the patients’ costs and length of stay in the hospital. Other studies have showed the relation between glycemic instability with the adverse events following spinal surgeries, showing as high as 19% non-diabetic patients, had hyperglycemia and considering it as a risk factor for many adverse events like surgical site infections and sub-optimal wound healing and for the increasing rates of surgical revision, matching our hypothesis of the positive correlation between glycemic instability and the rate of adverse events. The purpose of this study was to expose the effect of glucose level preoperatively on the patient complications and length of stay in the hospital, and to compare between diabetics and non-diabetics with hyperglycemia preoperatively regarding complications and length of stay. Material and Methods Of the 129 patients who underwent spinal surgeries at King Saud University Medical City, Riyadh SA, during two years period (2013–2015) exclusion and inclusion criteria were applied including only the patients whom their preoperative glucose level was documented and a total number of 106 patients were enrolled in a retrospective analysis study design. Each of the patients' records underwent a comprehensive and complete review. Results 34 (32.1%) of our patients were diabetic, 13 (12.2%) of all patients had hyperglycemia, 6 (46.2%) of the hyperglycemic patients had at least one post-operative complication, compared with 9 (10.5%) among the euglycemics ( P value 0.004), having most commonly infections and suboptimal wound healing (23.1%, n 3, P value 0.094, 0.192, respectively), with an increase in length of stay by an average of 4.37 days ( P value 0.256) and the incidence of complications among the hyperglucemic ptients seen in 5 (55.6%) of the diabetics and in 1 (25.0%) of the non-diabetics( P value 0.343). Conclusion Pre-operative hyperglycemia is associated with more adverse events post operatively (seen more in diabetics in this study), hence, along with other factors, increasing patients' length of stay in the hospital which adds to the financial costs as well as predisposing to more infections. However, the number of diabetic patients examined in this study was limited, demanding for more extensive researches addressing the same topic.

Robot-assisted Heller’s myotomy for achalasia in children

Background: Achalasia is rare in children. Surgical options include open, laparoscopic and robotic approaches. However, Heller’s myotomy remains the treatment of choice. This report describes our experience with robot-assisted Heller’s myotomy in children and presents a review of the literature.Methods: Included in this study are children who underwent robot-assisted Heller’s myotomy for esophageal achalasia via the Da Vinci surgical system between 2004 and 2015 at King Saud University Medical City, Riyadh, Saudi Arabia. The medical records of these patients were reviewed for demographic data, presenting symptoms, diagnostic modalities, operative procedures, complications, outcomes and follow-ups.Results: Six patients were identified. The age of the patients at surgery ranged between 2 and 12 years (mean 7.1 years). The most common presenting symptoms were dysphagia, vomiting and nocturnal cough. Contrast swallow and upper gastrointestinal endoscopy established a diagnosis of esophageal achalasia in all of the patients. Four patients underwent esophageal dilatation 2–5 times before the definitive procedure. All patients underwent successful robot-assisted Heller’s myotomy with concomitant partial posterior fundoplication. The postoperative course was uneventful. Five patients had a complete resolution of the symptoms and one patient improved. The follow-up assessments have been consistent and have ranged from 0.5 to 11 years (mean 4.4 years).Conclusion: Robotic-assisted Heller’s myotomy for esophageal achalasia in children is safe and effective and is a suitable alternative to open and laparoscopic approaches.

Central Vascular Access Device: An Adapted Evidence-Based Clinical Practice Guideline

BackgroundOur aim was to adapt recommendations from high-quality, evidence-based clinical practice guidelines (CPGs) for central vascular access device (CVAD) insertion, management, and removal in King Saud University Medical City. Currently, the hospital has a policy and procedure for CVAD insertion; however, the methodology of creating the policy document was not evidence-based, and the clinical content was not up to date. A new CPG will guide the revision of CVAD policies and procedures and eliminate variation in clinician practices. MethodsThe King Saud University Medical City CPG Committee introduced the modified ADAPTE process methodology for adaptation and implementation of CPGs originally developed by the ADAPTE Collaboration. ResultsThe final decision of the panel after full assessment of 2 selected source CPGs was to adopt all Centers for Disease Control and Prevention CPG recommendations and some essential sections from the Infusion Nurses Society CPG recommendations. In addition, the team developed new implementation tools. ConclusionsThe ADAPTE process is an excellent scientific and rigorous process for CPG adaptation and clinical performance improvement. It can be further adapted according to the local context and resources to promote a sense of ownership of the adapted CPG. Furthermore, new CPGs will have a positive effect on hospital-wide accreditation processes and local benchmarking of health care quality outcomes.

Diabète insipide central. Modalité de la prise en charge chez l’enfant

Communication between physicians and parents is the cornerstone of their relationship to reach a common goal of better child health. To deliver proper communication, a physician needs to learn certain skills that are not included in the curriculum of medical schools or paediatrics residency training in KSA. This study probed the physicians' attitude towards their styles of communication based on the parents' perception.The data were collected from a randomly selected sample of physicians and parents from general paediatrics wards at King Saud University Medical City (KSUMC), Riyadh, KSA. We used a validated Criteria Cognitive Aptitude Test (CAT-T) questionnaire and a translated version of the CAT-T questionnaire for the physicians and parents, respectively. The data were then analyzed using variable qualitative and quantitative statistical methods.The data were collected from 63 physicians and 100 parents in the pediatric wards at KSUMC. We observed an increased level of confidence in communication skills (CS) among experienced physicians, while young physicians expressed concerns regarding their communication with parents concerning decision-making. The parents rated the physicians' skill of active listening as poor. However, the parents rated the physicians' introduction as higher than their own self-rating. In addition, the parents' satisfaction with the physicians' CS was inversely related to the parents' level of education.Our data suggests a clear discrepancy between the physicians' insights and the parents' perceptions about the CS. This finding emphasizes a need for further training among physicians to satisfy parents and in ultimately improving child health in the KSA.