National Guard Health Affairs Research Articles

Clinical Characteristics and Risk Factors among Patients with Positive COVID-19 Test Admitted to ICU.

Background Studies that show common characteristics among ICU-admitted patients due to COVID-19 are available on the net, but such studies in Saudi Arabia are limited. Methods A descriptive cross-sectional study establishing common comorbidities and risk factors among critically ill patients who tested positive for COVID-19 at the National Guard Hospital from March 2, 2020, to March 20, 2021. The data were obtained from the BEST Care System of King Abdulaziz Medical City, computed, and analyzed using SPSS. Results Three hundred eighty-five COVID-19 patients admitted to the intensive care unit (ICU) were included in this study. The mean age was 60.85 ± 20.46, 60.85% were males, and 39.2% were females. There was statistically significant positive relationship between severity of the symptoms and age (P = 0.002). The mean duration of hospital stay in the sample was 21.85 ± 28.47. More than one-third (37.4%) of cases admitted to the hospital died while about two-thirds of the cases were discharged after complete recovery. Two hundred ninety (75.3%) of the patients who were admitted to the National Guard Health Affairs (Riyadh, Saudi Arabia) had respiratory disease. Two hundred twelve patients (55.1%) had diabetes mellitus, while the number of hypertensive patients was 203 (52.7%). There was a significant positive relation among patients with gastrointestinal tract infection (GIT) risk factors and the severity of the symptoms of COVID-19 (P = 0.000). In addition, there was a strong significant relation between hypertension patients and the severity of the COVID-19 symptoms (P = 0.017). Conclusion COVID-19 patients who have GIT and hypertension have been found to be at an increased risk of COVID-19 symptom severity. Old age was also found to have an increased risk for COVID-19 symptom severity.

KNOWLEDGE AND PRACTICE REGARDING DIABETIC FOOT CARE AMONG DIABETIC PATIENTS ATTENDING OUTPATIENT DEPARTMENT IN MINISTRY OF NATIONAL GUARD HEALTH AFFAIRS AL-AHSA, KINGDOM OF SAUDI ARABIA

Background; Diabetic foot ulcer is a major cause of lower limb amputation. Diabetic foot problems and amputation can be prevented by proper foot care. Patient's awareness is important in reducing the incidence of foot ulcers and complication. Education of the Patient with diabetes will lower the rate of foot complications and subsequent amputations. Guidelines regarding proper foot care should be provided to the diabetic patients is vital important. The study aim was to determine the knowledge and practice regarding diabetic foot care among diabetic patients. Methodology; The present study is a cross-sectional descriptive study was carried out among 288 patients attending OPD in ministry of National Guard health Affairs Al-Ahsa, kingdom of Saudi Arabia. Samples were selected from December 2019 to March 2020. Systematic random sampling technique was done to collect the data. The data was collected after obtaining consent from all subjects. Information related to demographic variables and knowledge, practice questionnaire survey was collected using interview technique. There were 10 items inclusive of each knowledge and practice components regarding diabetes foot care was selected. SPSS version 20 was used for analysis. Results; The study report showed that 53.8% of patients had adequate level of knowledge regarding diabetes, 43.5% of patients had intermediate level of knowledge and 2.8% of patients had inadequate level of knowledge.ly 30.6% of patients had good practice and 51% of patients had very fair practice and also 18.4% of patients doing poor practice.

Early prediction of diabetes by applying data mining techniques: A retrospective cohort study.

Background:Saudi Arabia ranks 7th globally in terms of diabetes prevalence, and its prevalence is expected to reach 45.36% by 2030. The cost of diabetes is expected to increase to 27 billion Saudi riyals in cases where undiagnosed individuals are also documented. Prevention and early detection can effectively address these challenges.Objective:To improve healthcare services and assist in building predictive models to estimate the probability of diabetes in patients.Methods:A chart review, which was a retrospective cohort study, was conducted at the National Guard Health Affairs in Riyadh, Saudi Arabia. Data were collected from 5 hospitals using National Guard Health Affairs databases. We used 38 attributes of 21431 patients between 2015 and 2019. The following phases were performed: (1) data collection, (2) data preparation, (3) data mining and model building, and (4) model evaluation and validation. Subsequently, 6 algorithms were compared with and without the synthetic minority oversampling technique.Results:The highest performance was found in the Bayesian network, which had an area under the curve of 0.75 and 0.71.Conclusion:Although the results were acceptable, they could be improved. In this context, missing data owing to technical issues played a major role in affecting the performance of our model. Nevertheless, the model could be used in prevention, health monitoring programs, and as an automated mass population screening tool without the need for extra costs compared to traditional methods.

Comparison of Hospital Readmission and Mortality between COVID-19 and Pneumonia Patients.

Coronavirus disease 2019 (COVID-19) survivors can have lasting signs and symptoms, including various organ damage, indicating that COVID-19 can be a chronic illness. The current study aims to compare the 30-day hospital readmission and death rate of patients admitted to the hospital with COVID-19 and pneumonia due to other causes. A retrospective cohort study was conducted using data from the Saudi National Guard Health Affairs (NGHA). Records of patients admitted with COVID-19 between 1 March 202 and 31 December 2020 (n = 3597) and pneumonia during 2017 and 2019 (n = 6324) were retrieved and analyzed. We compared the likelihood of 30-day hospital readmission, intensive care unit (ICU) admission, and death between the two groups. Compared with the control group, COVID-19 patients had higher odds of 30-day readmission (odds ratio 1.90, 95% confidence interval 1.61–2.24), higher risk of ICU transfer (hazard ratio 1.85, 95% confidence interval 1.65–2.07), more extended hospital stay (7 vs. 4 days), but less risk of death (hazard ratio 0.18, 95% confidence interval 0.14–0.24). The findings that hospital readmission was higher in COVID-19 recovered patients than in other pneumonia patients inform the current discussion about readmission and death in COVID-19 patients.

Prevalence of exposure to pharmacogenetic drugs by the Saudis treated at the health care centers of the Ministry of National Guard

BackgroundThe drugs impacted by genetic variants are known as pharmacogenetic (PGx) drugs. Patients’ responses to these drugs may vary according to the variability in patients’ genetic makeup. Hence, exploring the pharmacogenes that affect drug treatment is vital to ensure optimal therapy and patients’ safety. This study aimed to describe the usage rate of PGx drugs and the frequency of relevant variants in the Saudi population. MethodologyPrescription patterns over seven years (2015–2021) for Saudi patients on PGx drugs treated at the Ministry of National Guard-Health Affairs (MNG-HA) were investigated. Only registered drugs in the MNG-HA formulary (n = 78) were included. The patients were subgrouped into four age groups: ≤24, 25–44, 45–64, and ≥65 years. Further subgrouping was made according to gender and drugs’ therapeutic categories following anatomical therapeutic chemical (ATC) classification.Furthermore, an online searching was carried out to identify the pharmacogenes reported in the literature among healthy Saudis. The search included 45 genes that may affect drug outcomes based on evidence rated by either CPIC (A-B levels) or PharmGKB (1–2 levels). ResultsThe screened patients were 1,483,905. Patients on PGx drugs accounted for 46.7% (n = 693,077 patients). The analgesic group was the most prescribed drug category (47%), which included ibuprofen (20.5%), celecoxib (6.3%), tramadol (5.8%), and others. Cardiovascular agents were the second-most utilized drug class (24.4%). Omeprazole was the second most commonly used medication (11.1%) but ranked third as a class (gastroenterology). Females used PGx drugs more frequently than males (53.5% versus 46.5%) and a higher usage rate by patients aged 45–64 years (31.3%) was noted. The cytochrome P450 genes (CYP2C9, CYP2C19, and CYP2D6) were estimated to impact responses of 54.3% (n = 1,156,113) of the used drugs (27.2% are possibly affected by CYP2C9, 12.8% by CYP2C19, and 14.3% by CYP2D6). Thirty-five pharmacogenes that characterize Saudi population and their variants’ allele frequencies were identified from previous reports. This study presents the largest reported number of genes that may affect drug therapies among Saudis. ConclusionThis study confirmed that a high percentage of Saudi patients use PGx drugs and various genotypes of certain pharmacogenes are inherited by the Saudi population.

Trends in emergency department visits for mental health disorder diagnoses before and during the COVID-19 pandemic: a retrospective cohort study 2018–2021

BackgroundAs the pandemic started, Saudi Arabia applied extreme measures in responses to the pandemic crises, which have adversely affected individuals’ mental health. Therefore, the aim of this study is to describe trends in mental health disorder ED visit before and after the pandemic in two medical centers in Saudi Arabia.MethodsA retrospective cohort study using data from electronic health records in the Ministry of National Guard Health Affairs’ (MNG-HA) in Saudi Arabia. Multiple logistic regression model was used to examine the age and sex differences in mental health disorder ED visits before and during the COVID19 pandemic.ResultsA total of 1117 ED psychiatric visits, a sharp increase in the number of psychiatric ED visits during the pandemic with an average increase of 25.66% was observed. During the pandemic, psychiatric ED visits were significantly higher in females (adjusted AOR 1.41, 95% CI 1.08, 1.83) than males. During the COVID19 pandemic, generalized anxiety disorder was the most common psychiatric ED disorder with reported increase of visits by 53.34% (p-value 0.005).ConclusionED psychiatric visits have consistently increased before and during the COVID19 pandemic. Interventions for mental health related disorders are urgently needed for preventing mental health problems among females.

Child neglect in Saudi Arabia: The neglected form of child maltreatment.

Objectives:To shed light on types, family profiles, risk factors, and outcomes of child neglect in Saudi Arabia.Methods:A retrospective chart review was carried out at King Abdullah Specialized Children’s Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. Cases of child neglect diagnosed by the Suspected Child Abuse and Neglect (SCAN) team were reviewed. Data were extracted from patients’ electronic charts and SCAN team records.Results:A total of 309 cases of child neglect were diagnosed between 2015-2019. Mean age of victims was 4.4±4.1 years, and 51.8% were male gender.Supervisory neglect was the most common form (63.1%), followed by medical neglect (39.2%), emotional neglect (6.8%), physical neglect (5.5%), and educational neglect (3.2%). Children between the ages of one and 3 years were 3.3 times more likely to be victims of supervisory neglect and girls were 4.5 times more likely to be victims of educational neglect. Children living with ≥4 siblings were 7 times more likely to be victims of physical neglect and 1.9 times of medical neglect. With regard to emotional neglect, children of unemployed fathers were 3.5 times more likely to be parentally neglected than children of employed fathers. Worsening of the underlying disease (30%) and internal injuries (23.5%) were the most common consequences of neglect. Mortality attributed to neglect was documented in 8 (2.6%) children.Conclusion:Although child neglect is common in Saudi Arabia, it has not been recognized as an important cause of morbidity and mortality of children. This implies the need for a national protocol that would help identify high-risk families for early detection and implementation of prevention programs.

Differences of Lipid Profile Among Ischemic and Hemorrhagic Stroke Patients in a Tertiary Hospital in Riyadh, Saudi Arabia: A Retrospective Cohort Study.

ObjectiveThis study aims to compare the serum lipid profiles of patients with ischaemic and hemorrhagic strokes.Study designThis was a retrospective, comparative study.Place and duration of the studyThe study was conducted at Military Hospital, Riyadh, from January 1, 2018, to December 31, 2020.MethodologyPatients with a diagnosis of stroke who presented to the emergency department and was confirmed to have ischemic or hemorrhagic strokes by computed tomography (CT) from January 1, 2018, to December 31, 2020. This study was based on data extracted from an electronic hospital information system (BESTCare) of patients presenting to King Abdulaziz Medical City, National Guard Health Affairs, which is a tertiary medical center in Riyadh, Saudi Arabia. Patients who lack lipid profile reading within six months before the incident or had a traumatic hemorrhagic stroke were excluded from the study. All these variables were included in the study: age, gender, height, weight, date of the incident, date of last lipid profile results, type of stroke, comorbidities, on a statin or not, and lipid profile including (high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, and triglycerides). Microsoft Excel 2019 (Microsoft Corporation, Redmond, WA) was used for data entry and data cleaning, and Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY) was used for data analysis and visualization of the results.ResultsThe mean age of presentation of stroke was 68±13, 59% of patients were males, and 41% were females. BMI ranged from 30±8. Obesity (BMI 30 or above) was predominant in both stroke subtypes. Among all patient comorbidities, hypertension was the most predominant. Diabetes was present in 71% of the population. Of the participants in this study, 114 had ischemic stroke and 87 had a hemorrhagic type. A comparison of the serum lipid profile of two categories of strokes showed no statistical significance in serum values of total cholesterol, triglycerides, and LDL-C in ischemic and hemorrhagic stroke patients.

The Impact of Obesity on Hodgkin's Lymphoma Patients Treated With Uniform Chemotherapy Protocol at Princess Noorah Oncology Center, National Guard Health Affairs, Jeddah, Saudi Arabia: Retrospective Matched Cohort.

BackgroundHodgkin's lymphoma (HL) is a disease that affects lymphocytes, mostly B cells, and it is commonly diagnosed by the presence of Reed-Sternberg cells. The influence of obesity on the disease course of HL is still controversial. This study’s aim was to investigate the treatment outcomes in obese patients suffering from HL and compare them to the outcomes of non-obese patients.MethodsThis study is a single-center retrospective cohort study that included 280 patients admitted between 2009 and 2020 with different subtypes of HL who received the chemotherapy regimen of Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) at Princess Norah Oncology Center, National Guard Hospital, Jeddah, Saudi Arabia. Based on WHO criteria, the participants were divided into two groups (obese with a BMI that exceeds 30 kg/m2 versus non-obese with any BMI less than 29,9 kg/m2). All demographic data including age, gender, BMI, body surface area (BSA), and HL subtype (nodular sclerosis, mixed cellularity, lymphocyte depletion) were recorded. In addition, the presence of diabetes mellitus (DM), previous cancer, smoking, staging of HL, number of cycles of ABVD, dose intensity of ABVD, and outcomes (emergency visits, death during therapy, primary resistance, relapse) were collected from the participant files.ResultsRegarding therapy outcomes, 24.1% of obese patients were admitted to the hospital after receiving the first cycle of ABVD as compared to 75.9% of non-obese patients. However, there was no significant statistical difference between obese and non-obese patients in their hospital admission (p value=0.500). In addition, non-obese patients had a higher chance of being admitted to the hospital after receiving the chemotherapy dose with an odds ratio of 1.22 compared to obese patients. For the emergency visits, 20.8% of obese patients were admitted to ER as a complication of the chemotherapy regimen, whereas 79.3% of non-obese patients were admitted to ER after receiving the chemotherapy. The P-value was statistically not significant (0.396), but the odds of ER admissions after ABVD cycles were 1.28 times higher in non-obese patients compared to obese.ConclusionThe study outcomes showed a higher odds of hospital admission and ER admission as complications of the chemotherapy regimen in non-obese HL patients as compared to obese patients.

The Ability of Saudi Parents' To Detect Early Language Delay in Their Children: A Study in Primary Health Care Centers, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

PurposeOur study aims to assess parents’ ability to detect early language delay in their children in association with related demographic and environmental factors to help in predicting its risk.MethodsA cross-sectional study was conducted at three main primary health care centers at National Guard Health Affairs, Riyadh, Saudi Arabia. Participating parents were asked if they think their children have language delay and if they were able to detect it early. Then, validated age-appropriate screening tools were administered to assess the child’s language development. The parents' answers regarding their child’s language development were then compared to the screening tool assessment results.ParticipantsA total of 250 parents attending a well-baby clinic for their children’s routine vaccinations participated in the study after informed consent was obtained.ResultsLanguage delay was more prominent in the one-year-old age group (26.7%). In addition, children who were not breastfed were significantly more likely to have language delays (P-value 0.014). The parents’ ability to detect language delay varied among the different age groups. Fifty-seven point one percent (57.1%) of children aged two years old and 61.5% of children aged five years old who were found to have language delay were not noticed by their parents (P-value 0.03, 0.02).ConclusionParents showed a lack of ability to detect language delay early. Increasing their awareness of the typical language development milestones and the importance of early intervention is very important to minimize the consequences of late intervention.

Early Prediction of Neoplasms Using Machine Learning: A Study of Electronic Health Records from the Ministry of National Guard Health Affairs in Saudi Arabia.

The early detection and treatment of neoplasms, and in particular the malignant, can save lives. However, identifying those most at risk of developing neoplasms remains challenging. Electronic Health Records (EHR) provide a rich source of "big" data on large numbers of patients. We hypothesised that in the period preceding a definitive diagnosis, there exists a series of ordered healthcare events captured within EHR data that characterise the onset and progression of neoplasms that can be exploited to predict future neoplasms occurrence. Using data from the EHR of the Ministry of National Guard Health Affairs (MNG-HA), a large healthcare provider in Saudi Arabia, we aimed to discover health event patterns present in EHR data that predict the development of neoplasms in the year prior to diagnosis. After data cleaning, pre-processing, and applying the inclusion and exclusion criteria, 5,466 patients were available for model construction: 1,715 cases and 3,751 controls. Two predictive models were developed (using Decision tree (DT), and Random Forests (RF)). Age, gender, ethnicity, and ICD-10-chapter (broad disease classification) codes as predictor variables and the presence or absence of neoplasms as the output variable. The common factors associated with a diagnosis of neoplasms within one or more years after their occurrence across all the models were: (1) age at neoplasms/event diagnosis; (2) gender; and patient medical history of (3) diseases of the blood and blood-forming organs and certain disorders involving immune mechanisms, and (4) diseases of the genitourinary system. Model performance assessment showed that RF has higher Area Under the Curve (AUC)=0.76 whereas the DT was less complex. This study is a demonstration that EHR data can be used to predict future neoplasm occurrence.

Issues Facing the Pharmacy Technicians While Maintaining the Automated Dispensing Cabinets (ADCs) and How to Overcome Them in the National Guard Health Affairs (NGHA) in Riyadh: A Qualitative Study

Issues Facing the Pharmacy Technicians While Maintaining the Automated Dispensing Cabinets (ADCs) and How to Overcome Them in the National Guard Health Affairs (NGHA) in Riyadh: A Qualitative Study

Physicians awareness of Celiac disease screening in high risk pediatric age groups in King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia

Background: Celiac disease (CD) is an autoimmune disease triggered by a permanent sensitivity to gluten, causing a significant disturbance to the small intestines and multiple other organs. We aim in this study to assess physicians’ knowledge, practice and attitude towards celiac disease screening. Assessing the physicians’ knowledge will help us to understand how we can improve the practice regarding celiac disease. Methodology: A cross-sectional study using a validated questionnaire from previous studies distributed electronically among primary care and pediatric physicians. The questionnaire consisted of: 7 questions about physicians characteristics, 15 questions about knowledge, 15 questions about attitude and 5 practice questions. Respondents were asked to identify any queries they had about the questions. Time needed to fill the questionnaire was approximately 10 minutes. Results: The final sample was 264 participants with mean age of 32.31 years old where 79.9 % of the participants were aged under 40 years old. Moreover, 52.3 % of the participants were females. Considering specialty, we found that 48.5 % of the participants were family medicine physicians while 47.0 % were general pediatrics. Chronic/ intermittent diarrhea and weight loss were the most commonly known symptoms among the participants (85.1 % and 85.6 % respectively) followed by abdominal pain (78.1 %). Considering the best first line screening tool of celiac disease, 78.1 % of the participants successfully identified Anti-tissue transglutaminase antibody and 85.6 % of them were able to identify bowel biopsy as the best tool in order to confirm the diagnosis of CD, however only 20.9 % correctly identified Anti-endomysium antibody as the best tool for follow-up. Conclusion: We found that there is a deficiency in knowledge about CD among physicians with no significant difference between pediatrics and family medicine physicians. The physicians had moderate knowledge considering symptoms and risk factors of CD with good knowledge considering the diagnosis tool. More educating courses should be provided to the physicians about the diagnosis and management of CD. Key words: awareness, Celiac disease, pediatric age group, Saudi Arabia

Hyponatremia management among patients admitted to tertiary hospital: A retrospective evaluation.

Objective:The aim of this study is to compare the adherence to the guidelines in patients presenting with hyponatremia defined as a sodium (Na) level ⩽120 mEq/L, treated with 3% hypertonic saline or normal saline. The comparison included 3% hypertonic saline use, safe serum sodium increases within 24 and 48 h, frequency of hyponatremia-related complications, and length of stay.Methods:This retrospective observational study enrolled 122 patients with serum sodium ⩽120 mEq/L admitted to the Internal Medicine Department, King Abdulaziz Medical City, National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia, from January 2016 to December 2017. The patients were treated with either 3% hypertonic saline or normal saline.Results:Of the 122 patients, 105 (83.3%) received normal saline, and 17 (13.5%) received hypertonic saline. In the normal saline group, the mean serum sodium increase at 24 h was lower (6.60 ± 4.75) compared to the hypertonic saline group (9.24 ± 5.04). The length of stay was longer in the normal saline group (10.35 ± 13.90) compared to the hypertonic saline group (4.35 ± 3.39). A small proportion (8.7%) of the normal saline group had a serum sodium increase >12 mg/dL at 24 h compared to 29.4% for the hypertonic saline group, and the difference was statistically significant (p value = 0.013). Almost one-third of the sample (36%) presented with complications, the majority (77.3%, n = 34) had a serum sodium of ⩽115 mg/dL, and 22.7% (n = 10) with a serum sodium of 116–120 mg/dL (p value = 0.041).Conclusion:Despite the strong recommendation for 3% hypertonic saline use in severe hyponatremia, many practitioners still use normal saline, even in patients with serum sodium ⩽120 mEq/L. Normal saline showed some efficacy in managing hyponatremia in asymptomatic cases; however, severe cases may have a delayed correction, hyponatremia-related complications, and an extended length of stay.

Predicting Health Care Providers' Acceptance of a Personal Health Record Secure Messaging Feature.

Personal health records (PHRs) can facilitate patient-centered communication through the secure messaging feature. As health care organizations in the Kingdom of Saudi Arabia implement PHRs and begin to implement the secure messaging feature, studies are needed to evaluate health care providers' acceptance. The aim of this study was to identify predictors of health care providers' behavioral intention to support the addition of a secure messaging feature in PHRs using an adapted model of the Unified Theory of Acceptance and Use of Technology as the theoretical framework. Using a cross-sectional survey design, data on acceptance of secure messaging features in PHRs were collected from health care providers working at the Ministry of National Guard Health Affairs between April and May 2021. The proposed model was tested using partial least squares structural equation modeling in SmartPLS. There were 224 participants: female (66.5%), 40 to 49 years of age (39.9%), nurses (45.1%), and those working more than 10 years in the organization (68.8%). Behavioral intention to support the addition of a secure messaging feature was significantly influenced by performance expectancy (β = 0.21, p = 0.01) and attitude (β = 0.50, p < 0.01), while other predicting factors, such as effort expectancy, social influence, and facilitating condition, did not significantly affect the intention. Furthermore, age, years of experience, and professional role did not moderate the relationships. Health care professionals will support introducing a secure messaging feature in the PHRs if they serve the intended purpose. Considering attitude also plays a significant role in acceptance, it is necessary to arrange for training and support, so that caregivers, health care providers, and the patients become familiar with the benefits and expected outcomes of using the feature.

Impact of simulation training for teamwork and communication intervention on patient safety in the emergency department

Background: The emergency department (ED) is the hospital division that is most vulnerable to poor communication and teamwork-based medical errors that affect patient safety. One approach to prevent medical errors is by training and assessing healthcare workers using simulation-based (SB) teamwork and communication training. This study aimed to explore the extent to which SB training could improve teamwork and communication and reduce preventable medical errors in the ED. Method: The study was conducted at the Ministry of National Guard Health Affairs, a tertiary care center with a 39-bed ED, in Saudi Arabia. A total of 123 ED healthcare staff participated in the study. This study adopted a single-subject experimental design with the intervention of simulation training in ED cases. The methodology focused on three domains: 1) patient safety in the ED, 2) inter-professional and multidisciplinary simulation team training, and 3) team dynamic enhancement use. Staff perceptions regarding teamwork and communication pre-and post-intervention and the relationship between changes in their perception of performance in the ED and patient outcomes. The chi-square test was used for univariate analysis, and a generalized linear regression model was adjusted for demographics in multivariate analysis. Results: Staff perceptions were collected from all multidisciplinary team members before and after simulation training. The data revealed a significant improvement in overall staff perceptions toward teamwork and communication (8% to 34%, p-value = 0.001). Conclusion: SB communication and teamwork training in the ED resulted in a sustained and measurable improvement in ED staff perceptions toward teamwork and communication. The results suggest that simulation sessions may improve staff perceptions and multidisciplinary team communication during critical situations in the ED.

The Prediction of Pediatric Outpatient No-Show Visits by Employing Machine Learning Framework

Patient no-show for a booked medical appointment is a significant problem that negatively impacts healthcare resource utilization, cost, efficiency, quality, and patient outcomes. This paper developed a machine learning framework to predict pediatric patients' no-shows to medical appointments accurately. Thirty months of outpatient visits data were extracted from data warehouse from January 2017 to July 2019 of the Ministry of National Guard Health Affairs (MNGHA), Saudi Arabia. The researchers retrieved the data from all healthcare facilities in the central region, and more than 100 attributes were generated. The data includes over 100,000 pediatric patients and more than 3.7 million visits. Five machine learning algorithms were deployed, where Gradient Boosting (GB) algorithm outperformed the other four machine learning algorithms: decision tree, random forest, logistic regression, and neural network. The study evaluated and compared the performance of the five models based on five evaluations criteria. GB achieved a Receiver Operating Characteristic (ROC) score of 97.1%. Furthermore, this research paper identified the factors that have massive potential for effecting patients' adherence to scheduled appointments.

Patterns and Impact of Traumatic Brain Injury at King Abdulaziz Medical City in Jeddah, Saudi Arabia: A Retrospective Cohort Study.

ObjectivesThe objectives of this study are to explore the most common causes, patterns, and severities of head traumas, to evaluate the outcomes of traumatic head injury (TBI) patients followed in the clinic, and to calculate the prevalence of admitted cases.MethodsIn our retrospective cohort study, we included all the cases of adults above 18 years old diagnosed with head traumas (171 patients). The inclusion criteria were patients who presented to the emergency department at National Guard Health Affairs (NGHA), Jeddah, Saudi Arabia from 2016 to 2020. Patients were categorized according to their Glasgow Coma Scale (GCS) score upon admission.ResultsOf the 171 patients in this study, 151 (88.3%) were males and 20 (11.7%) were females. The median age of our patients was 31 years. Most of the cases had no medical illnesses 124 (72.5%). The most common mechanism of injury was motor vehicle accidents (MVAs) in the majority of our cases (105, 61.4%), followed by falls from heights (34, 19.9%). The commonest computed tomography (CT) finding was subdural hematoma (47, 27.4%). The majority of the associated injuries were thoracic cases (43, 25.1%), followed by spinal (40, 23.4%). Most of the patients were admitted to NGHA (120, 70.2%), while the rest (51, 29.8%) were transferred from other hospitals. Of the total of 171 patients, 134 (78.4%) were treated conservatively. There were no associations between mortality nor length of stay and patients’ demographics, except for GCS on admission showed a significant p-value (<0.005).ConclusionIn this study, it was found that the most common causes of TBI are MVAs followed by falls from heights. Therefore, preventive measures such as traffic safety rules need to be addressed.

Patients’ Attendance to The Virtual Compared to The In-person Complimentary Outpatient Clinics at a Tertiary Care Hospital in Western Saudi Arabia: A Comparative Cross-sectional Study

Background: During the COVID-19 pandemic, outpatient clinics in National Guard-Health Affairs Hospitals, Saudi Arabia, have shifted their healthcare services towards virtual clinics to keep up with patient appointments while maintaining infection control precautions. This study aimed to determine if patient attendance compliance has changed by implementing virtual “phone call” appointments compared to the conventional physical appointments in outpatient clinics. Methods: This comparative cross-sectional study was conducted by comparing patients’ demographic information, and compliance to virtual calls and physician recommendations during 2020 with the regular physical attendance clinics in 2019. Patient data was collected from the electronic medical records after randomly selecting the sample for each year from 6 main outpatient clinics. Results: During the 4-month period of 2020 (March-June), in which virtual clinics were implemented, there was a significant decrease in the attendance compliance when compared to the same period in 2019 conventional clinics. Data were analyzed for 404 and 407 patients’ medical records from each year, respectively. The drop in the clinic attendance compliance was the highest in the pediatric oncology clinic. Moreover, physician orders of investigations and medications were significantly reduced. Conclusion: COVID-19 pandemic had a significant negative impact on patient care. Although that impact was seen greatest among those with chronic conditions and oncology patients, it was an essential step towards infection control during this difficult period. However, the pandemic is an opportunity to establish a comprehensive virtual care system that will ensure easy access and continuity of patient care. Key words: virtual clinic; patient attendance; telemedicine; telehealth

The Association between Obesity and Chronic Conditions: Results from a Large Electronic Health Records System in Saudi Arabia.

This cross-sectional study aimed to estimate the prevalence of obesity and its association with diabetes and hypertension among beneficiaries in the National Guard Health Affairs system of Saudi Arabia. We included individuals aged 17 years and older, and patients were classified as diabetic or hypertensive if they had any visit during the 4 years where the primary diagnosis was one of those conditions or they were taking diabetes or hypertension medications. The association between obesity (body mass index ≥30) and diabetes and hypertension were evaluated using a multiple logistic regression model, adjusting for age, gender, nationality, and region. A total of 616,092 individuals were included. The majority were Saudi nationals (93.1%). Approximately 68% of the population were either obese (38.9%) or overweight (29.30%). Obesity was more prevalent among Saudi nationals (39.8% vs. 26.7%, p < 0.01) and females (45.3% vs. 31.2%, p < 0.01). Obesity was independently associated with diabetes mellitus (OR = 2.24, p < 0.01) and hypertension (OR = 2.15, p < 0.01). The prevalence of obesity in the study population was alarming and more pronounced among women. Our findings call for efforts to intensify preventive measures to reduce obesity and associated conditions. Using electronic records to examine the impact of interventions to reduce obesity and chronic conditions may help monitor and improve population health.