ST-elevated myocardial infarction (STEMI) is a critical and time-sensitive emergency. The survival depends on prompt initiation of treatment requiring high precision and multi-level coordination ...between healthcare staff. The use of a mobile application may facilitate prompt management and shorten the door-to-balloon time by capturing information at the point of care and provide immediate feedback to all healthcare staff involved in STEMI management. The objective of the present study has two primary components: (i) to explore the suggestions and opinions of stakeholders in the development of a novel mobile app for code activation in management of STEMI patients (ii) to find out the healthcare workers' expectations including facilitating steps and challenges in the activation process of the proposed mobile app.
Unstructured interviews were conducted with key informants (n = 2) to identify all stakeholders, who also helped in developing the interview protocol and prototype designs. In-depth, semi-structured, open-ended, face to face interviews were conducted on 22 stakeholders involved in managing STEMI patients. All interviews were recorded and transcribed verbatim. Data were analyzed using ATLAS.ti 8 software, allowing themes and subthemes to emerge.
The 22 participants included in the study were cardiology physicians (n = 3), emergency consultants (n = 4), emergency room (ER) senior nurses (n = 10), and cardiac catheterization lab staff (n = 5). The main themes identified during analysis were workflow and the App. The themes identified from the interviews surrounding the App were: 1) facilitating ideas 2) management steps needed 3) features 4) preferred code activation method 5) steps of integration 6) possible benefits of the App 7) barriers and 8) possible solutions to the suggested barriers. Most of the interviewed stakeholders expressed their acceptance after viewing the proposed mobile app prototype.
The study identified the mandatory features and the management steps needed from the stakeholder's perspectives. The steps for integrating the current paper-based workflow with the suggested mobile app were identified. The expected benefits of the App may include improved and faster management, accuracy, better communication, and improvement in data quality. Moreover, the possible barriers might comprise of doubtful acceptability, device-related issues, and time and data-related challenges.
Abstract
Background
Primary Empty Sella (PES) syndrome is an increasingly common disorder, mostly diagnosed as an incidental finding during brain imaging scans. We intended to review the clinical ...management and hormonal profile of patients with PES.
Methods
The study included ten-year retrospective analysis of registry containing PES cases in the period 2007 to 2017, from a single tertiary care center. The keyword ‘primary empty sella’ was used to retrieve patient details from the radiology unit. The clinical and biochemical profile of PES patients was analyzed. Case management of PES patients and their rate of referral to endocrinologists was explored.
Results
The registry had 765 cases with a male: female ratio of 1:3.8 suggesting female predominance by almost four times. Although not significant, the onset of disease was earlier for males Mean ± standard deviation (SD) (46.7 years ±17.3 vs 48.8 years±14.1),
p
= 0.110. Almost 79% of the cases were found as an incidental finding during Magnetic Resonance Imaging. Of the total PES cases, only 20% were referred to the endocrinologists and the rest were handled by general physicians. Only 1–2.5% of the cases were evaluated for gonadal, growth and adrenal hormones by the general physicians. The hormonal evaluation by the endocrinologists was also found to be sub-optimal. Headache and visual disturbances were the most common presenting complaints followed by menstrual abnormalities. Endocrine abnormalities like thyroid dysfunction, hyperprolactinemia, hypogonadism and hypocortisolism were highly prevalent among those assessed.
Conclusion
There is a gross under-evaluation of hormonal assessment and minimal case-referral to Endocrinologists. PES is associated with varying degrees of hormonal dysfunction, and hence early assessment and management is needed. Establishing a standard protocol for diagnosis and case management is essential with the involvement of a multidisciplinary team consisting of endocrinologists, neurologists, primary care phys icians and ophthalmologists.
The objective was to assess the knowledge, attitudes, and practices of nurses toward the prevention of falls in older hospitalized patients. A cross-sectional study employing a 54-item questionnaire ...was conducted on 370 nurses at a tertiary care referral center. The mean age of the study population was 36.3 ± 7.7 years, with the majority being females (282; 76.8%). Most of them had attended fall prevention training (335; 90.5%). More than 98% knew fall prevention policies and safety goals, according to their response to a fall and risk assessment, but were less aware of the risk factors of falls, such as recurrent falls (61%), depression (44%), and lower-extremity numbness (40.5%). Similarly, 99% had positive attitudes toward risk assessment, fall prevention intervention, and response to a fall. Around 55% thought they were responsible for patients' falls, and 96% felt the need to undergo more training on fall prevention. Furthermore, 92% strictly followed fall prevention policies and 85.4% followed the color-coding system for high-risk patients. Despite the preventive measures in place, 33% encountered patient falls, and 82.2% experienced unwitnessed patient fall incidents in their units. Although the nurses had higher levels of knowledge about the policies, they lacked information on the risk factors. There is a significant scope that warrants great attention concerning the adherence to guidelines and the provision of fall prevention training programs, with a focus on the intrinsic causative factors of falls.
The study evaluated the levels of academic stress in medical students and investigated its association with eating habits and bowel symptoms.
Two hundred and ninety seven medical students ...participated in the study. Medical students from all five years of study were recruited using a stratified random sampling technique. A well-structured questionnaire containing three sections on stress levels, eating habits, and bowel symptoms was self-administered. Student t-test and ANOVA were used to quantify the association between variables.
The medical students showed high levels of stress accounting for low (2%), moderate (72%), and high-stress levels (26%) during exams. Men showed higher stress levels than women. The levels of stress were similar in distribution across all years of study. Poor dietary habits were noted among the medical students. Around 66% reported skipping breakfast, and 69% consumed frequent unhealthy snacks. Reduced consumption of fruits less than three times per week (61.5%) and drinking water less than 2 L per day (82.3%) was noted. Mean dietary scores worsened as the stress levels increased (p = 0.007). Similarly, higher PAC-SYM scores were associated with higher stress levels (p < 0.001). Women showed more severe constipation symptoms than men (8.83 ± 8.0 2; 5.68 ± 5.87; p < 0.001).
Alarming levels of academic stress were noted during the exam period. There is an urgent need to frame multidisciplinary strategies involving behavior modification, nutrition education and a special focus on stress reduction programs for the medical students.
The Kingdom of Saudi Arabia has a large migrant workforce particularly from North Africa, other Gulf states and South Asia. Migration influences food behavior; however, the change is not often health ...conducive. This study aimed to investigate the dietary acculturation among 880 migrants and their families in a large University in the Kingdoms’ capital city, Riyadh.
Methods:
A cross sectional study design was used based on 2 questionnaires; Rosenmoller et al’s and the WHO STEPS surveillance tool for chronic disease surveillance. Data on length of residency, dietary patterns, anthropometric and biochemical measurements were collected by trained interviewers. Descriptive statistics were reported as a percentage or mean, as appropriate. Chi-square test, Fisher’s exact test or independent t test, Univariate and Multivariate logistic regression analysis were used to compare the significance between variables.
Results:
Both male and female participants showed a similar mean age (39.7 and 38.5 years). Approximately 61% of them had <5 year’s duration of residency. Significant gender differences were observed in blood pressure and biochemical measurements, with men showing higher mean systolic and diastolic blood pressure and dyslipidemia than women (P < .001). Women had significantly higher BMI (P < .001), showed higher mean food practice (P < .001) and awareness scores than men.
Conclusions:
Migration into Saudi Arabia from this subgroup showed marked changes in the food practice; acquisition of unhealthy dietary practices also co-existed despite improved awareness and the presence of comorbidities. Findings from this study have relevance to other migrant communities and public health policy.
Abstract Outbreaks of influenza epidemics are common but influenza vaccination is sub-optimal among the healthcare staff including the medical students. The study aims to assess the rate of vaccine ...uptake among medical students, its associated barriers and levels of awareness. A cross sectional study was done at a University Hospital in Saudi Arabia on 421 medical students by self administered questionnaire from February to March 2015. The immunization rate of seasonal influenza vaccine was just 20.7% in 2015, while it was 57% for cumulative of previous three-year period. The intended uptake among those offered vaccination was 68%. The significant determinants of vaccine uptake were clinical years of medical study (p < 0.05) and previous history of vaccination (p < 0.0001). The major sources influencing vaccine uptake decision were health department guidelines, medical training, social and media influence. Barriers of vaccination constituted, assumption of not being at risk of influenza (37.9%), vaccine side effects (28.9%), questioned effectiveness of the vaccine (14.5%), and inability to allocate time (11%). Knowledge levels were unsatisfactory and males scored lower (5.4 ± 1.7) than females (6.5 ± 1.4) out of total score of 9. Both knowledge and uptake of annual influenza vaccination was inadequate. Policy makers can formulate strategies with a focus on larger coverage of medical students.
Background: As compared with traditional paper-based charts, population-specific Saudi Growth Charts (SGC) integrated into electronic health records offer several functionalities. However, few ...studies have explored clinicians' perceptions and practices related to the recording of growth parameters as they adapt to the electronic methods. Objective: The objective of this study is to estimate clinicians' use of the recently adapted electronic SGC versus other known electronic international growth charts. Methods: This cross-sectional survey was performed on 116 pediatricians serving at the university medical center. An online questionnaire that included the types of growth charts used, clinicians' confidence level with the electronic interface, and documentation practices for children's growth parameters was uploaded using the SurveyMonkey® platform, and participants were invited to participate through an e-mailed link. Data were analyzed using the IBM software Statistical Package for the Social Sciences version 22.0. (SPSS Inc., Chicago, IL, USA) for Windows®. Results: Most of the pediatricians (76.7%) reported using electronic-based growth charts in preference to paper-based charts, whereas 17.3% preferred using both. Seventy-five percent agreed that the SGC can accurately diagnose underweight Saudi infants and children, as compared with 56% for the World Health Organization and 44% for the Centers for Disease Control and Prevention growth charts. Height, weight (body mass index), and nutritional status were the most documented parameters. Multivariate linear regression analysis showed physicians with longer experience in pediatric clinical practice years demonstrated lesser documentation of growth parameters. In addition, physicians caring for more number of children per week were more likely to frequently document growth parameters (P = 0.003). Conclusion: The integration and implementation of the electronic version of SGC have been encouraging, and the SGC shows promising results in recording child growth parameters for Saudi children with minimum discrepancies in interpretation as compared to the other international growth charts.
Objectives: Medical photography is imperative for maintaining documentation of patient records and aiding in diagnosis and management, research, education, and training. Smartphones have replaced ...conventional photography due to their ease of availability, accessibility, and storage; however, their use raises privacy and ethical concerns. The objective of the present study was to determine the current trends in clinical photography and to assess the ethical issues involved in this field. Methods: A cross-sectional survey was used to interview physicians registered at the Saudi Commission for Health Specialties. Data collection was performed using the SurveyMonkey platform, and the final sample included complete responses from 210 participants. Results: A total of 147 physicians (70%) reported taking clinical photographs. Personal smartphones were the most common device used by 116 (79%) physicians, and 43 (29.3%) reported also using hospital cameras for photographing their patients. Patient visit follow-ups and medical education/training were the most popular reasons for clinical photography. Access to these devices was not well secured, with only 42 (28.6%) physicians reporting storing them in a separate folder with a password. Furthermore, no significant differences were observed in consent-taking practices between male and female patients and in the cross-analysis between physicians' and patients' genders. However, significant differences were obtained in the method of consent for identifiable and nonidentifiable photographs, with written consent preferred over verbal in identifiable photographs (P = 0.025). Common misuses included not obtaining proper consent before taking and while sharing the photographs, which raises serious privacy concerns. Patients' refusal to be photographed was the most common barrier reported by 55 (26.2%) physicians. Conclusions: Physicians mostly resorted to personal smartphones for capturing and storing patient photographs. This study identified a widespread prevalence of inadvertent practices related to inadequate consent, photograph sharing, and unsecured storage, which increases the risk of a breach of confidentiality. There is an urgent need to enforce standard guidelines and regulations addressing patients' privacy and ethical concerns involving digital photography in clinical practice.
Background
The usability of a digital library depends on a myriad of factors ranging from the end users’ ability to website complexity. Although digital libraries provide instant access to online ...content, offering an efficient reference platform, their usability is highly variable.
Objective
The aim of this study was to measure users’ perspectives and usability of the digital library of the Saudi Commission for Health Specialties (SCFHS).
Methods
A web-based questionnaire survey was conducted using a validated System Usability Scale (SUS) containing 5 positive and 5 negative items on the usability of the digital library. The SUS standard cut-off score of 68 was considered for interpretation.
Results
The overall mean SUS score of digital library usability was 52.9 (SD 15.2) with a grade “D” categorization, indicating low usability. The perceived measures of attributes of the 10 SUS items of findability, complexity, consistency, and confidence obtained below average scores. Only item 1 relating to perceived willingness to use the digital library frequently obtained a score above the targeted benchmark score (mean score 3.6). Higher SUS scores were associated with training (P=.02). Men felt the digital library to be more complex (P=.04) and board-certified physicians perceived a greater need for training on digital library use (P=.05). Only the UpToDate database was widely used (72/90, 80%).
Conclusions
These findings demonstrate the low usability of the extensive facilities offered by the SCFHS digital library. It is pivotal to improve awareness of the availability of the digital library and popularize the databases. There is also a need for improved user training to enhance the accessibility and usability of the multiple databases.
Aims
The aim of this study was to determine the incidence, predictors, and short‐term and long‐term outcomes associated with in‐hospital sustained ventricular tachycardia (VT) and ventricular ...fibrillation (VF) collectively termed ventricular arrhythmia (VA) in the heart failure (HF) patients.
Methods and results
The HEart function Assessment Registry Trial in Saudi Arabia (HEARTS registry) is a prospective national registry of patients with chronic HF from18 tertiary care hospitals across Saudi Arabia. Diagnosis of HF was in accordance with American Heart Association/European Society of Cardiology definition criteria. The registry had enrolled 2610 HF patients during the 14 month recruitment period between October 2009 and December 2010. Occurrence of in‐hospital cardiac events, prognosis, and outcome were monitored during the 7 year follow‐up period. The incidence of in‐hospital VA in HF was 4.2%. VA was more common among men, and mean age was lesser than non‐VA patients (58.5 ± 16: 61.5 ± 15 years; P = 0.042). Smoking and family history of cardiomyopathy were significant risk factors of VA. Previous history of arrhythmia, ST elevated myocardial infarction, infections, and hypotension remained significant predictors of in‐hospital VA associated with three to seven times more risk. Patients with VA had higher rates of in‐hospital events like recurrent HF, haemodialysis, shock, sepsis, major bleeding, intra‐aortic balloon pump, and stroke compared with those without VA, all being highly significant (P < 0.001). After adjustment for age, gender, and co‐morbidities, in‐hospital VA increased the risk of cardiogenic shock by 24 times, dialysis and major bleeding by 10 times, and recurrent congestive HF and pacing by five times. Survival analysis showed that all‐cause mortality was significantly higher in the VA patients (P < 0.001). Presence of VA increased in‐hospital and 1 month mortality to 23 and 17 times, respectively.
Conclusions
Lower mean age of VA complicated HF patients is a matter of concern in the Saudi population. HF associated with VA increased in‐hospital events and all‐cause mortality indicating poor prognosis and survival. These findings enable risk stratification and reflect on the importance of early recognition of the clinical markers and predictors of VA prompting immediate management.
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