Physicians' knowledge and practice towards medical error reporting: a cross-sectional hospital-based study in Saudi Arabia

Identifying reasons for under-reporting is crucial in reducing the incidence of medical errors. We studied physicians' knowledge of the occurrence, frequency and causes of medical errors and their actual practice toward reporting them. A cross-sectional, self-administered questionnaire was answered by 107 physicians at a tertiary-care hospital in Saudi Arabia. The questionnaire had 6 sections covering demographic data, knowledge, attitudes and practice towards reporting medical errors, perceived causes of and frequency of medical errors in their hospital and personal experiences of medical error reporting. Physicians tended not to report medical errors when no harm had occurred to patients. One-third of respondents feared punitive actions if they reported errors and only 56.4% felt that error reporting had led to positive changes in overall care. A majority of errors were related to late interventions and misdiagnosis. Under-reporting of medical errors was common in this hospital. Physicians did not appreciate attempts to improve the system of error reporting and a culture of blame still prevailed

Comparison of the tuberculin skin test and Quanti-FERON-TB Gold In-Tube [QFT-G] test for the diagnosis of latent tuberculosis infection in dialysis patients

Dialysis patients are more likely than the general population to develop active tuberculosis [TB]. In these patients, the availability of a highly sensitive and specific test to diagnose latent TB will ensure earlier treatment and decreased progression to active disease. In the current study, the Quanti-FERON-TB Gold In-Tube [QFT-G] test was compared with the tuberculin skin test [TST] for the diagnosis of latent tuberculosis infection [LTBI] among 200 hemodialysis patients and 15 confirmed TB disease cases in a tertiary care center in Saudi Arabia. Among the LTBI cases, 26 [13%] were TST positive, and 65 [32.5%] were positive by the QTF-G test, with an overall agreement between the 2 tests of 75.5% [k = 0.34] being observed. Among the confirmed tuberculosis disease cases, none were positive by TST, and 10 [66.7%] were positive by the QTF-G test, resulting in an overall agreement of 33.3% [k = 0]. A comparison between the TST and the QTF-G test was performed based on the sensitivity, specificity, and area under the curve [AUC] obtained for the tests. The QTF-G test was more sensitive and less specific than the TST in predicting the confirmed TB disease cases. When we tested the correspondence of the AUC values between the 2 diagnostic modalities, the obtained p-value was 0.0003. In conclusion, the AUCs of the examined diagnostic modalities are significantly different in predicting LTBI and tuberculosis

Prevalence of vitamin D deficiency in Saudi adults

To determine the prevalence of vitamin D deficiency in healthy Saudi adults. A cross-sectional study carried out as part of the screening and early evaluation of kidney disease project. Vitamin D was measured in subjects recruited at 2 screening camps in Riyadh, Saudi Arabia, between March to May 2008. Subjects from the 2 large commercial centers in Riyadh aged >/= 18 years and Saudi nationals were invited. The study sample comprised of 488 subjects. The mean age of the subjects was 37.43 [11.32] years, of which 50.2% [n=245] were males. Twenty-nine percent of subjects were in the vitamin D deficiency group, 22.7% were in the relative insufficiency group, and 47.5% had normal levels of 25-hydroxy vitamin D. We observed that female gender was an independent predictor of vitamin D deficiency or insufficiency [odds ratio [OR]: 2.992; 95% confidence intervals [CI] 2.069-4.327]. Anemia was also a predictor for vitamin D deficiency or insufficiency [OR: 3.16; 95% CI 2.02-4.92]. Age was positively correlated with vitamin D levels [Pearson correlation=0.183, p<0.000]. Vitamin D deficiency is common in healthy Saudi adults. This is more pronounced in females and in the younger age groups. Wearing of traditional clothes, deliberate avoidance of the sun, and inadequate dietary intake are likely to be the principal causes of low vitamin D levels

Inpatients' care experience and satisfaction study

Measures to promote patient satisfaction are important components of the assessment of outcome and strategies for the delivery of health care. In this article, we assess satisfaction among inpatients and the impact of demographics on satisfaction levels. This cross-sectional survey adapted from previously used survey tools and validated in our patient group included questions on demographics, communication skills, hospital environment, and the patients' overall evaluation of the hospital. Inpatients from acute wards of five different specialties who stayed for at least 2 days were enrolled. There were 988 respondents with a mean age of 39.1 years [25.9%] and the mean length of stay [LOS] of 10.0 days [24.1%]. Illiteracy rate was 42.4%, and 43.1% were male. The overall satisfaction scores-out of five-were 4.3 [0.6%] for communication with nurses, 4.4 [0.4%] for communication with doctors, and 4.1 [0.3%] for hospital environment; 98.9% of the patients would recommend the hospital to their family and friends. The lowest score was for the "room environment" [3.99, 0.8%] and the highest for "overall services of the hospital" [4.7, 0.5%]. Satisfaction levels drop significantly with LOS of more than 4 days [P < 0.006]. The satisfaction was higher in females than males across all the three domains of care assessed [P < 0.005]. The highest satisfaction seen in the obstetrics service could be explained by the nature of the condition normally seen in this department and the normally good outcome. There was higher satisfaction in the medical than surgical services but this reached a significant level for the overall center score domain only [4.1, 0.3% versus 4.0, 0.3%; P < 0.0001]. The factors with positive impact on satisfaction were the female gender and shorter LOS. There was higher satisfaction in the medical than surgical services for all three domains reaching significant levels for center score only

End stage chronic kidney disease in Saudi Arabia. A rapidly changing scene

There have been a marked rise in the prevalence and incidence of end stage chronic kidney disease [CKD] in Saudi Arabia over the last 3 decades. This rise exceeds those reported from many countries. The enormous and rapid changes in lifestyle, high population growth, and fast increase in life expectancy, and massive urbanization that has occurred over the last 3 decades combined to make the current CKD status different to what it was. The 2 major factors that influence the CKD status are the very high rate of diabetic nephropathy and shift in age demographics