Tertiary Hospital In Riyadh Research Articles

Incidence, types and outcomes of sternal wound infections after cardiac surgery in Saudi Arabia. A retrospective medical chart review.

Objectives:To determine the incidence, types, risk factors, identify organisms, and assess outcomes of surgical wound infections (SWIs) after cardiac surgery at a tertiary hospital in Riyadh, Saudi Arabia.Methods:This historical cohort study reviewed the chart of patients who underwent cardiac surgery at King Khalid University Hospital, Riyadh, Saudi Arabia between January 2009 and December 2014. The proforma contained personal data, comorbidities, type of surgery, microbiological analysis, and management outcomes.Results:A total of 1241 patients were enrolled in the study comprising 1,032 (83.2%) men and 209 (16.8%) women. Forty (3.2%) patients developed SWI, of which 32 (2.5%) were superficial and 8 (0.7%) were deep. Gender, obesity, diabetes mellitus, non-use of statins, and coronary artery bypass graft (CABG) surgery were not significant predictors of infection in the study. Methicillin-susceptible Staphylococcus aureus was isolated predominantly in 45%, followed by Klebsiella and Pseudomonas species. Methicillin-resistant Staphylococcus aureus, Enterococcus faecium, and extended β-lactamase-producing gram-negative organisms were pathogens isolated in last 3 years of the review. Simple and vacuum assisted closure therapies led to complete resolution in 32 (80%) patients, while 8 (20%) developed sternal osteomyelitis. All patients survived except one with a deep SWI who died of uncontrolled sepsis.Conclusion:Despite the low incidence of postoperative SWIs, the risk of sternal osteomyelitis development persists. Meticulous choice of CABG components and appropriate postoperative management, especially detecting early signs of SWI could contribute to lower its incidence and complications.

Exploring factors affecting critical care response team service at a tertiary hospital in Riyadh: A retrospective cohort study

Background: Critical care response team (CCRT) is a proactive department of intensive care unit (ICU) that consists of an intensivist, a staff physician, a critical care nurse, and a respiratory therapist. The purpose of this team is to manage patients in their wards to avoid unnecessary ICU bed occupancies. The aim of the study is to explore factors affecting CCRT service in terms of patient disposition and mortality rate and to analyze interventions provided to the patients by the team. Materials and Methods: This is a retrospective cohort study conducted at a tertiary hospital in Riyadh. All CCRT event data collection forms from the period between February 2018 and April 2019 were reviewed. Patients meeting our criteria were included. Outcome measures were as follows: (1) patient disposition. (2) mortality rate. Factors that were tested for effect on CCRT service were patient age, activation time, and reasons for activation. All statistical analyses were done using SAS software 9.4. Results: A total of 1088 CCRT events were considered during the period of the study. Out of all deaths, the mean age was 70.90 ± 16.67 compared to the mean age of survivors 61.21 ± 20.65 (P

Knowledge, Attitude, and Practice of Pediatricians and Family Physicians about Early Childhood Caries in Riyadh City

ABSTRACT Introduction Early childhood caries (ECC) has an impact on deciduous teeth of infants and children. Pediatricians and family physicians are often in a better position to evaluate children at an early age and are capable of assessing the oral health of children during regular visits. The purpose of this study was to assess the knowledge, attitude, and practice of ECC among pediatricians and family physicians in Riyadh region. Materials and methods A close-ended self-administered questionnaire was hand-circulated and mailed to pediatricians and family physicians in 5 tertiary hospitals in Riyadh (King Khalid University Hospital, King Saud Medical City, King Fahad Medical City, Prince Sultan Medical Military City, Security Forces Hospital) to assess the knowledge, attitude, and practice (KAP) about ECC. Results A total of 207 medical practitioners participated in the study. The mean KAP scores were compared across different categories by applying Kruskal Wallis tests. Pediatricians showed higher knowledge [5.05 vs 4.28, p = 0.000], attitude [2.38 vs 2.30, p = 0.565], and practice [4.0 vs 3.58, p = 0.003] scores toward early childhood caries compared to the family physicians. The mean knowledge and practice scores were significantly higher among pediatricians compared to the family physicians. However, no significant difference was observed in attitude scores. Conclusion Most of the physicians have knowledge regarding some aspects of early childhood caries but not the identification of early childhood caries. It is the need of the hour to formulate oral health information programs catering to both pediatricians and family physicians. How to cite this article Alshammari TM, Ingle NA, Baseer MA, et al. Knowledge, Attitude, and Practice of Pediatricians and Family Physicians about Early Childhood Caries in Riyadh City. J Oral Health Comm Dent 2020;14(2):54–61.

Epidemiology of traumatic head injury among children presenting to a tertiary hospital in Riyadh

Background: Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in children. The aim of this study was to report the burden of isolated pediatric TBI at a major trauma center in Riyadh, Saudi Arabia and assess associations with mechanism of injury. Methods: A retrospective cohort study using chart review, including children aged ≤14 years with isolated TBI over 2 years from 01 Jan 2016 to 31 Dec 2017 was undertaken. Univariable or unadjusted associations of patients presenting after motor vehicle crashes (MVC) and physiological variables were assessed. Intensive care unit (ICU) admission and mortality at hospital discharge were the primary outcome measures. Results: There were 2,501 pediatric patients that presented to the Emergency Department with head injury and 241 (9.6%) patients were admitted to hospital with isolated TBI, with an in-hospital mortality rate of 9%. MVC was the most common mechanism of injury (n = 142; 59%) followed by falls (n = 68; 28.2%), pedestrians (n = 26; 10.8%), and non-accidental injuries (n = 5; 2.1%). Patients presenting after MVC were older (p = 0.001), had similar Glasgow Coma Scale scores (p = 0.12) and more often presented in a coagulopathic state (p

Differences in knowledge about contraception among Saudi males and females at tertiary hospitals in Riyadh.

Context:Family planning is a voluntary practice that individuals engage in to control the number of children for promoting the health and development of countries. The aim is to evaluate the level of contraceptive knowledge in Saudi males and females in Riyadh at King Abdul-Aziz Medical City (KAMC) and King Abdullah Specialist Children's Hospital (KASCH).Methods:A cross-sectional questionnaire-based study conducted among educated, under educated, single, married Saudi males and females (n = 385), and aged (20 to 65) years old. Healthcare providers and participants underwent permanent sterilization were excluded.Results:Approximately half of the participants were aware about contraceptive methods. More males (n = 132, 70%) were significantly aware compared to females (n = 110, 56%) (P-value <0.001). The most commonly used contraceptive methods were oral contraceptive pills, male condom, and intrauterine device (69%, 34%, 22%, respectively). A significant difference was noted for the used and preferred contraceptive method, which was condom for male and oral contraceptive pills in female (P-value < 0.001). Healthcare provider was the main source of information and women significantly consult healthcare provider more than men 47% vs 32%, (χ2 = 9.23, P value = 0.002). Side effects were reported as a main reason for discontinuation 61% (n = 120) of females and 52% (n = 98) in males, respectively. Logistic regression indicated a significant association of contraceptive knowledge with age and parity.Conclusions:Regardless of educational level, high levels of awareness were identified in both genders. Oral contraceptive pills were reported as the most used, safest, and preferred method.

The prevalence of non-syndromic orofacial clefts and associated congenital heart diseases of a tertiary hospital in Riyadh, Saudi Arabia

BackgroundOrofacial clefts are considered one of the most common birth defects and are frequently associated with other malformations. Congenital heart disease is one of the most prevalent congenital malformation. ObjectiveTo investigate the prevalence of congenital heart diseases associated with non-syndromic orofacial clefts in the Saudi population. MethodsElectronic files of non-syndromic orofacial cleft patients who visited the Oral and Maxillofacial Surgery Department in King Abdulaziz Medical City of Riyadh, Saudi Arabia from January 2015 to December 2018 were retrospectively reviewed. Data were recorded in an excel sheet and analyzed using SPSS via frequency tests. ResultsIn the cleft children identified, the prevalence of non-syndromic orofacial clefts was (77%). Orofacial clefts showed a male predominance (62%). The most common orofacial phenotype was unilateral cleft lip and palate (34%). The prevalence of associated congenital malformations with orofacial clefts was (41%). The most prevalent congenital malformation was congenital heart disease (35%), mainly found in unilateral cleft lip and palate patients (33%). The prevalence of associated congenital heart disease with orofacial clefts was (19%). The most frequent type of congenital heart disease was atrial septal defect (37%). ConclusionThis study highlights the recognition of the associated congenital heart disease with non-syndromic orofacial cleft patients. Global screening protocols designed for newborns with non-syndromic orofacial cleft are needed to eliminate late diagnosis of critical congenital heart diseases which might present operative risks of anesthesia and/or surgical procedures.

Bacterial Profile and Antibiotic Susceptibility Pattern of Bacterial Keratitis at a Tertiary Hospital in Riyadh.

BackgroundThe most common cause of ocular infections worldwide is bacteria; therefore, bacterial keratitis requires rapid and proper intervention because it is a major cause of loss of vision and ocular morbidity. Resistance studies have found increases in the resistance to ciprofloxacin, cefazolin, and gentamicin in bacterial keratitis cases that are caused by gram-positive organisms.AimTo identify the common predisposing factors, causative organisms, and antibiotic profile of bacterial keratitis (BK) in a tertiary care hospital in Riyadh, Saudi Arabia.MethodThis is a retrospective study of the microbiological record of all patients diagnosed with BK at KAUH. From the first of May 2015 until the first of January 2018. Demographic data, diabetes mellitus, contact lens use, history of eye trauma, ocular surface disorders, recent ocular surgeries, current and recent medications, initial and final visual acuity, and location and size of the infiltrate were all used in the study. VA was converted to the logarithm of the minimum angle of resolution (LogMAR) for statistical analysis.Results177 cases positive for BK were included. 100 (56.5%) were males, and 77 (43.5%) were females. The mean age was 43.15. Trauma was the most common predisposing factor, which was observed in 68 (38.4%) cases, followed by Ocular surface disease [52 (29.4%)]. Staphylococcus epidermidis was the most commonly isolated organism [61 (34.5%)], followed by Streptococcus pneumoniae [23 (13%)], and Staphylococcus aureus [18 (10.2%)]. All gram-positive cases were Vancomycin sensitive. Staphylococcus epidermidis showed only 4 resistant cases to chloramphenicol (7.27%), and resistance to penicillin and ampicillin was found in 55 (90%) and 53 (89.83%) cases, respectively. All Streptococcus pneumoniae cases were resistant to gentamicin (100%). Staphylococcus aureus showed high sensitivity for erythromycin [18 (100%)].ConclusionThe most common cause of bacterial keratitis was Staphylococcus epidermidis (N=61), followed by Streptococcus pneumoniae (N=23). Trauma was the most common predisposing factor (38.4%), while contact lens use was only identified in 14 cases (7.9%). All organisms tested were sensitive to vancomycin, and there was high resistance toward penicillin (90%).

Outbreak of colistin-resistant organisms at a tertiary hospital in Riyadh, Saudi Arabia, 2016.

IntroductionMultidrug-resistant organisms (MDROs) have been a major concern in King Saud Medical City (KSMC) recently. The number of cases with colistin resistance was growing rapidly in the first half of 2016, challenging the infection control practices and mandating a thorough outbreak investigation. The objective of this study was to determine the extent of the outbreak, identify potential risk factors and prevent further increase in the rates of MDROs.MethodsReviewing the medical records of the 22 admitted cases with colistin resistance using an abstraction form composed of demographical data, comorbidities, details of current admissions, and procedures. Also, tracking patients' movements in the hospital, reviewing all cultures isolates, and reviewing the surveillance and infection control strategies.ResultsMean age was 49.71±17.824 (20-79 years), 90.9% were males, 63.6% cases admitted under medical unit. The average duration of stay in the ED was 1.23 day. Over 2/3 had hypertension and diabetes mellitus. Majority of patients staying between 20-40 days in the hospital & the average number of days until developing colistin resistance was 44.18. Resistance was solely related to two organisms that were Acinetobacter baumanni (59.1%) and Klebsiella pneumoniae (40. 9%). Ventilators and folly's catheters were equally (95.5%) used by 21 patients. The most common site of infection was respiratory (41.3%), of which most were sputum samples. Resistance of over 75% is recorded by antibiotics like tazocin, ciprofloxacin, imepenen and oxacillin.ConclusionThe uncontrolled use of antibiotics, prolonged stay in the Intensive Care Unit (ICU), frequent uses of different devices, are the potential risk factors of developing colistin resistance.

PGI26 A BUDGET IMPACT ANALYSIS OF RIFAXIMIN FOR TREATMENT OF HEPATIC ENCEPHALOPATHY IN TERTIARY HOSPITAL,RIYADH, SAUDI ARABIA

To evaluate the financial consequences of Rifaximin use from the health care payer perspective. Budget impact analysis (BIA) was performed from a payer perspective: Tertiary hospital in Riyadh, Saudi Arabia. Costs of Rifaximin and Lactulose were calculated for patients with an average duration of treatment 52 weeks. The target population was determined using hospital statistical data, and clinical evaluation data. Over 5 years after the addition of the drug to the hospital formulary and from the health care payer perspective “pharmacy budget", we estimated the population eligible for treatment to be 266 in all 5 years, with an estimated uptake rate of 60% in year 1 and 100% in year 5. The gross impact on the pharmacy budget was estimated to be SAR 408,240.00 in year 1 and SAR 6,222,938.40.11 in year 5. Lactulose was assumed to be an alternative; the net medicines budget impact is expected to be SAR 375,030.00 in year 1 and SAR 5,786,260.11 in year 5. Rifaximin is effective in the case of the rehospitalization rate and improving patient outcome. However, because of fewer numbers of patients and pharmacy budget constraint, they are using direct purchase for each patient instead of adding Rifaximin to hospital formulary.

EXPLORING NURSES’ KNOWLEDGE OF THE GLASGOW COMA SCALE IN INTENSIVE CARE AND EMERGENCY DEPARTMENTS AT A TERTIARY HOSPITAL IN RIYADH CITY, SAUDI ARABIA

Purpose: The present study determines the factors affecting knowledge of the Glasgow Coma Scale (GCS) of emergency room (ER) and intensive care unit (ICU) nurses who work at a tertiary hospital in Riyadh, Saudi Arabia. Methods: A cross-sectional study with self-administered questionnaire was conducted among 149 ICU and ER nurses conveniently selected at a tertiary hospital in Saudi Arabia. A standardized tool was used to assess knowledge of the GCS. The study adhered to the STROBE guideline for cross-sectional studies. Results: Expatriate nurses (p<0.001) and those with a postgraduate degree (p<0.05) were found to have more knowledge of the GCS. Nurses with expertise in ICU services scored significantly higher (p<0.001) than those who work in the ER. Nurses reporting no previous training in the GCS had higher scores (p<0.05) than those who had previous training in the GCS. Conclusion: Some of the demographic characteristics and nurses’ knowledge about the GCS were associated. Expatriate, postgraduate, and ICU nurses were more knowledgeable about the GCS tool. Surprisingly, nurses without GCS additional training had more GCS knowledge than nurses who had attended training. The results provide valuable insights into and guidance for improving GCS knowledge among ICU and ER nurses.

Prevalence and Associated Factors of Depressive Symptoms in Patients with Myasthenia Gravis: A Cross-Sectional Study of Two Tertiary Hospitals in Riyadh, Saudi Arabia.

Objectives This study is aimed at elucidating the prevalence of depression in patients with myasthenia gravis (MG) and examining the risk factors associated with depression. Methods We evaluated adult patients with MG who were recruited from two tertiary hospitals in the central region (Riyadh) of Saudi Arabia. Data were collected with a two-part standardized questionnaire: the first part included data on sociodemographic and clinical features of MG including disease type and duration, therapies, prednisolone dose, time of the last relapse, previous critical care unit admissions, MG status (controlled, partially controlled, or uncontrolled), and comorbid diseases; the second part included items from the previously validated Arabic version of the Patient Health Questionnaire-9 (PHQ-9). Results In total, 104/150 (69.3%) patients participated (72 females) with a mean age of 38.0 ± 16.0 years. The mean PHQ-9 score was 7.02 ± 6.1. Among all the participants, 27 (26.0%) patients had depression (PHQ‐9 ≥ 10). Multiple logistic regression analysis revealed that uncontrolled MG status (OR = 12.31, 95%CI = 1.13‐133.8, P = 0.04) was the only factor independently associated with depression. Collectively, the prevalence of depression among patients of the primary care clinics (PCC) as reported by 5 previous studies across multiple regions of the country was 15.8%. The odds of depression among MG patients were twofold higher than those among PCC patients (OR = 2.05, 95%CI = 1.30‐3.22, P = 0.002). Conclusions Approximately a quarter of MG patients have depression. Achieving a minimal manifestation or better MG status may decrease the depression rate in these patients.

The Risk of Stroke Using CHA2 DS2 -VASc Score in Hemodialysis Patients at a Tertiary Hospital in Riyadh, Saudi Arabia

Introduction: Patients undergoing hemodialysis are at increased risk of stroke. However, less known about the impact of some of the stroke risk factors, and the value of stroke risk scores in determining the risk in those patients. Our main goal. To assess the risk factors for stroke in hemodialysis patients and the use of the new CHA2DS2-VASc score for stroke assessment. Methods: Single center, retrospective cohort study of 336 patients undergoing hemodialysis from June 24, 2018, to September 6, 2018, was recruited. Baseline demographics, clinical, and laboratory data were collected. We calculated the CHA2 DS2 -VASc score for stroke assessment in all patients and categorized them into high, moderate and low risk patients according to CHA2 DS2 - VASc score and subcategorized them to two groups atrial fibrillation (AFib) and Non- Atrial fibrillation (Non AFib) patients. Results: 336 patients were included in our study; the majority of patients were at high risk with a CHA2 DS2 -VASc Score mean of 2.9± 1.5, although history of stroke was observed only in 15 patients (4.46%). According to CHA2 DS2 - VASc score, 280 patients were at high risk, 172 (51.19%) were high-risk patients on treatment (anticoagulant or antiplatelet) and 108(32.14%) patients were high risk patients not on treatment 48 were at moderate risk (14.28%) and 8 were at low risk (2.38 %). Patients were divided into subgroups as non-AFib and AFib. In non-AFib patients 320 (95.23%), high-risk patients 103 (32.18%) were not treated; high-risk patients with treatment are 162 (50.62%), moderate patients were 47 (14.68%), 8(2.5%) was in low risk. AFib patients were 16 with a mean CHA2 DS2 -VASc score of 4.4±1.1. Patients with AFib were all at high risk except 1 was at moderate risk (6.25%). There were 11 (68.75%) patients on treatment and 5 (31.25%) patients not on treatment. The risk factors for stroke that were statistically significant in increasing score risk for all patients were: age &gt; 65 (95% CI, -2.04– -1.29; p = 0.000), being female (95% CI, -1.36– -0.68; p = 0.000) hypertension (95% CI, -2.59– -1.37; p = 0.000), diabetes (95% CI, -2.10– -1.50; p = 0.000), CVD (95% CI, -2.07– -1.24; p=0.000), history of stroke or TIA (95% CI, -3.70– -2.03; p = 0.000), CHF or LVEF (95% CI, -2.28– - 0.91; p = 0.000). Conclusions: The risk of stroke in hemodialysis patients is significant according to the use of CHA2 DS2 -VASc score in Non-AFib hemodialysis patients shows supportive evidence of increased risk of stroke in those patients, which suggest the importance of close monitoring of patients with stroke risk factors by the nephrologist and the stroke team which will lead to the initiation of early prophylaxis in those patients.

Validation and Cross-cultural Adaptation of the Sinonasal Outcome Test (SNOT)-22 for the Arabian Patient Population.

Background and objectiveQuality of life measurement is an essential element of healthcare evaluation. The Sino-Nasal Outcome Test 22 (SNOT-22) has been validated in different languages, and in this study we validated the SNOT-22 in Arabic language. The objective of this study is to provide a validated, cross-culturally adapted version of the SNOT-22 for the Arabic speaking population.Materials, methods, and main outcome measuresThis was a prospective cohort study set in a tertiary hospital in Riyadh, Saudi Arabia. The SNOT-22 was translated into Arabic by two native Arabic speakers. A total of 30 patients with chronic rhinosinusitis (CRS) with/without nasal polyps were included in test-retest study. Following that, a prospective study was conducted where the translated SNOT-22 was distributed to a different set of 30 CRS patients before and three months after endoscopic sinus surgery. Another 50 healthy individuals were included as a control group. The main outcome measure was the translation and validation of the SNOT-22 in Arabic.ResultsInternal consistency was assessed by performing a test-retest study. Cronbach’s alpha was 0.803 at both the initial examination and at the retest, showing good internal consistency. There was a statistically significant difference between the results of the control group and the preoperative results of the CRS group (p<.001). The preoperative mean (SD) SNOT-22 score for the CRS group was 64.8 (20.3) and it dropped to 29.2 (11.8) postoperatively showing statistically significant change (p<.001), indicating the responsiveness of the SNOT-22.ConclusionThe Arabic version of the SNOT-22 has internal consistency, reliability, and reproducibility that is needed for it to be a valid instrument to be used in research and clinical practice.

Retinopathy of Prematurity Incidence and Risk Factors in a Tertiary Hospital in Riyadh, Saudi Arabia.

PURPOSE:The purpose of the study was to determine the incidence of retinopathy of prematurity (ROP) in preterm infants in the neonatal intensive care unit (NICU), to identify the risk factors that predispose to ROP, and to assess the outcome of these infants.MATERIALS AND METHODS:This was a retrospective cohort study on premature infants with a birth weight (BW) of <1501 g or gestational age (GA) of <32 weeks. These infants were admitted to the NICU at a tertiary hospital in Riyadh, Saudi Arabia, from January 2010 to December 2014.RESULTS:Five hundred and ninety-three infants were included; data were available for 581 infants. Of them, 224 infants (38.6%) had ROP. Of these, 22 infants (10.4%) had stage 3 ROP. The mean BW of infants with ROP was 938.4 ± 257.9 g, and the mean GA at birth was 27 ± 2.4 weeks. A significant relationship with a P < 0.05 was found between the occurrence of ROP and small GA at birth, low BW, low APGAR score at 1 min, and long duration of receiving oxygen (O2) therapy. Based on charts review, none of the infants had blindness.CONCLUSION:The incidence of ROP in our study falls in the range of incidence in developing countries. The low BW and small GA were the most significant risk factors. Furthermore, it is also recommended to control the amount and duration of O2 therapy to as little as needed.

Correlates of nurses' motivation and their demographic characteristics.

Motivation is a significant concern for workforce management in healthcare organizations as it is linked to many important factors, such as performance, staff retention, and satisfaction. To assess motivation level, assess sources of motivation, and identify the difference in motivation level in relation to nurses' characteristics. The study was carried out in one major tertiary hospital in Riyadh, Kingdom of Saudi Arabia. A total convenient sample of 550 nurses were recruited. All participants are working under the umbrella of executive nursing administration. Data were collected using a self-administered questionnaire, which consisted of 30 items that focused on assessing a nurse's motivation sources and level. In general, 346 nurses (62%) fully completed the survey. The average motivation level of nurses is 3.6 ± 0.5. Additionally, internal self-concept motivation was identified as the most predominant source of motivation (4.1 ± 0.6). Instrumental and goal internalization motivations ranked second (3.7 ± 0.6), whereas external self-concept (3.4 ± 0.7) and intrinsic (3 ± 0.7) motivations are the lowest sources of motivation. There is a significant difference in the motivation mean between males and females (P = 0.034). Another significant difference was revealed with different years of experience ( P = 0.021). The high percentage of internal self-concept motivation among nurses signified that nurses needed more than enjoyment of their work atmosphere, social acknowledgment, higher salary, and good rationale to give maximum effort. Although these should be taken into consideration, more attention should be given to practices that improve a nurse's challenge, autonomy, internal value, and competency.

Perceived causes of prescribing errors by physicians: A qualitative study

Purpose : To explore physicians’ perceived causes of prescribing errors in Saudi hospitals. Methods : This qualitative study was conducted in three tertiary hospitals in Riyadh, Saudi Arabia: two academic and one government military hospital. A total of 13 physicians from three hospitals participated in two focus groups. Discussions were audiotaped and transcribed verbatim. Transcripts were analysed using thematic content analysis and categorised into themes of error-producing conditions, latent conditions and both successful and unsuccessful defences, based on Reason’s Accident Causation Model. Results : Error-producing conditions included the prescriber, the work environment, the team, the task, the patient and the computer system. The most commonly cited category related to the prescriber’s skills and knowledge. The most important latent conditions reported were a shortage of clinical pharmacists followed by lack of computerised physician order entry. The major unsuccessful defences were appropriate references and internet facilities, which were often unavailable. Conclusion : Several causes of prescribing errors were identified. Lack of clinical pharmacists and lack of computerised prescribing systems are the key issues. Keywords : Prescribing errors, Qualitative study, Computerized prescribing system, Reason’s accident causation model

Nursing interns' perception of clinical competence upon completion of preceptorship experience in Saudi Arabia

BackgroundNursing interns are newly graduate students with limited real-life work experiences. These novices are in the process of enhancing their competencies in the delivery of quality nursing care with the guidance of the preceptors. Hence, it is relevant to examine the impact of preceptorship, as a teaching strategy, among nursing interns during their preceptorship years in clinical settings. ObjectiveThe aim of this study is to determine if the preceptorship program has provided the nursing interns the needed education in enhancing clinical competence. SettingThe study was conducted in one of the tertiary hospitals in Riyadh, Saudi Arabia. ParticipantsConvenience sampling was used to recruit 92 undergraduate nursing interns who have completed the five-years nursing education including preceptorship. MethodsThe nursing interns completely answered the survey questionnaires which covers Benner's Competencies, Knowles' Adult Learning Theory and the Nursing Process. DesignThe study followed a mixed-methods design wherein a descriptive cross-sectional approach was used to identify factors affecting the nursing interns' perception towards clinical competence. Two open-ended questions referring to the improvement of internship program and competency were concurrently collected which was the qualitative portion of the study. ResultsThe preceptorship program enhanced the preceptees competencies in the clinical setting primarily in priority-setting with acutely ill patients, multitasking and demonstrating complex nursing skills. The majority of the nursing interns perceived preceptorship as a constructive experience. The availability, approachable attitude, and trustworthiness of the preceptor were viewed as influential factors in improving the interns' clinical competence. Variations were significant with phases of internship and type of school. Furthermore, results showed positive correlation between the nursing interns' efficacy and clinical competencies in professional behavior, general performance, and core nursing skills. ConclusionPreceptorship program positively impacts nursing interns' skills in handling actual patients in clinical setting. Hence, the preceptorship program is an effective teaching strategy which advances the novice to the next stage of developing clinical competence.

Antimicrobial susceptibility of microorganisms causing Urinary Tract Infections in Saudi Arabia.

Urinary Tract Infections (UTIs) is one of the most common infections worldwide. UTIs remain a challenge to the healthcare system because of the emergence of antimicrobial resistance. The aim of this study is to report the most common UTI-causative organisms associated with the emergence of antimicrobial resistance in Saudi Arabia. a retrospective cross sectional study of 1918 positive urine culture samples of both gender collected over 9 months (May 2015 to February 2016) from a major tertiary hospital in Riyadh, Saudi Arabia. the median age of individuals involved in the study was 43 years, with males constituting 27.7% only of the population. Among cases deemed complicated (81.1%), common causes were diabetes, pregnancy, and immunocompromization, comprising 24.7%, 11.9%, and 10.8%, respectively. Escherichia coli (52%) was the most common uropathogen, followed by Klebsiella pneumoniae (15%), Pseudomonas aeruginosa (8%) Streptococcus agalactiae (Group B streptococcus) (7%), and Enterococcus faecalis (5%). Overall sensitivity studies showed the most highly resistant uropathogen was Escherichia coli (60%) followed by Klebsiella pneumoniae (16%), Pseudomonas aeruginosa (4%) Enterococcus faecalis (3%), and Enterobacter cloacae (2%). Concerning the first defense antibiotics prescribed for UTI, E. coli was most frequently resistant to Sulfamethoxazole/Trimethoprim (47%) followed by ciprofloxacin (34%). K. pneumoniae was most frequently resistant to Sulfamethoxazole/trimethoprim (35%) followed by cefuroxime (30%), while P. aeruginosa to ciprofloxacin (13%). Because of a high level of antimicrobial resistance amongst uropathogens in Saudi Arabia, the development of regional and national UTI guidelines is recommended.

Diabetes and driving recommendations among healthcare providers in Saudi Arabia. A significant gap that requires action.

Objectives:To assess healthcare providers’ knowledge and awareness of the recommendations for drivers with insulin-treated diabetes in Saudi Arabia.Methods:A cross-sectional study was conducted among healthcare providers working at 4 tertiary hospitals in Riyadh, Saudi Arabia between April 2016 and December 2016 using a self-administered questionnaire.Results:A total of 285 healthcare providers completed the survey (response rate 88.5%). Most (70.2%) were aware of the safe driving recommendations for patients with insulin-treated diabetes. However, the need to check blood glucose levels before driving was underestimated by almost one-third (30.2%). Only one-quarter (24.6%) identified the correct level of blood glucose level that is safe for a patient when driving, and 28.4% identified the recommended time for checking blood glucose before driving. Participants who were aware of the recommendations for safe driving had a significantly higher average knowledge score (68.8%) than those who were not aware (58.8%; p<0.001). There was a significant difference in the average knowledge score among medical specialties (p=0.002) and job levels (p<0.001).Conclusions:Most healthcare providers identified the importance of evaluating their patients for ability to drive safely, but we found some important areas of knowledge deficit. Professional intervention to improve healthcare providers’ awareness and knowledge regarding diabetes and driving is the first step in improving detection and reporting high-risk drivers with diabetes to prevent future driving mishaps.

Donor-specific HLA-DQ antibodies may contribute to poor graft outcome after heart transplantation.

BACKGROUNDHLA-DQ donor-specific antibodies (DSA) are implicated in allograft dysfunction after renal and lung transplantation. Limited data exists on the impact of HLA-DQ antibodies on heart transplant patients.OBJECTIVETo investigate the impact of DSA formation on allograft function and outcomes in heart transplant patients.DESIGNRetrospective cohort study.SETTINGCollating post-transplantation patient data from computerized database in a tertiary hospital in Riyadh, Saudi Arabia from January 2006 to October 2014.PATIENTS AND METHODSWe excluded recipients with positive preoperative complement-dependent-cytotoxicity crossmatch grafts and those with preformed DSA. Anti-HLA antibodies were identified using Luminex-based assay in sera collected before transplantation with a routine endomyocardial biopsy the first year and then annually.MAIN OUTCOME MEASURESPrimary outcome measures were all-cause mortality, development of antibody mediated rejection, treated acute cellular rejection (ACR) and cardiac allograft vasculopathy (CAV).SAMPLE SIZE127 patients.RESULTSDSA formation occurred in 43/127 (34%), with 33/43 (77%) targeting HLA-DQ antigens alone (n=7) or in combination with -DR, -A or B antibodies (n=26). Most (76%) were male and the mean (SD) age was 36 (14) years. Ten patients developed -A, -B or -DR antibodies without -DQ antibodies also present. Treated ACR (P=.011), reduced left ventricular ejection fraction (P<.001), CAV development (P=.003), and all-cause mortality (P=.01) were all significantly more prevalent in the DSA-positive cohort.CONCLUSIONHLA-DQ donor-specific antibodies were the most common type detected and may play a significant role in poor outcomes post-cardiac transplantation. This emphasizes the importance of HLA-DQ matching and monitoring for DSA formation in order to minimize post-transplantation immunological risk.LIMITATIONSRetrospective design comes with inherent biases, results from single institute, with a particularly young cohort.