Prediction of 10-year risk of hard coronary events among Saudi adults based on prevalence of heart disease risk factors

Cardiovascular disease is becoming the lead cause of mortality and morbidity worldwide, and developing countries are the main contributors to this trend. Saudi Arabia, which is considered a rapidly developing country, faces progressive urbanization and the adoption of a westernized lifestyle, factors which contribute to the rising burden of cardiovascular disease. Our study evaluates the prevalence of coronary risk factors and predicts hard coronary artery events over 10 years in an urban Saudi cohort. A cross-sectional observational study was conducted on a Saudi population. The study involved Saudi subjects aged more than 20 years without a history of coronary heart disease. Demographic variables and hard coronary events [HCE] risk factors were measured. Each subject's 10-year HCE risk was estimated by means of the Framingham Risk Score [FRS]. A total of 4932 subjects [2215 men and 2717 women] were examined, the majority [85%] of whom were less than 40 years old. The risk of developing HCE within the next 10 years was low in 92.6% of subjects, intermediate in 3.2% and high in 4.1%. On considering diabetes as coronary heart disease [CHD] risk-equivalent, 26% of subjects were at high risk for hard coronary events in 10 years. The HCE risk progressively increased with age and was higher in men. Our study, the first to estimate the 10-year risk of HCE among adults in an emerging country, deter-mined that a significant proportion of a younger aged population is at risk for the development of hard coronary events. Public awareness programs to control risk factors are warranted

Contraindicated medications administered to inpatients with renal insufficiency in a Saudi Arabian hospital that has a computerized clinical decision support system

The aim of this study was to determine various types of contraindicated medications that are administered to patients with renal insufficiency by physicians who override alerts provided by the Computerized Decision Support Systems [CDSS]. This retrospective study incorporated all admitted patients during the period from January 1st through December 31st, 2010, with serum creatinine levels >1.7 mg/dL in a major tertiary hospital in the Eastern Province of the Kingdom of Saudi Arabia [KSA]. Chi-square and multivariate logistic regression tests were used to evaluate the factors associated with the increased likelihood of patients receiving contraindicated medication due to physicians overriding the CDSS alert. A total of 314 patients received at least one medication that was renally cleared and/or potentially nephrotoxic. Fourteen percent of these medications were contraindicated and resulted in a system alert and yet were administered to the patients. The administered contraindicated medications were limited to 4 drugs: aspirin, gliclazide, nitrofurantoin, and spironolactone, with aspirin accounting for approximately 60% of all of the medications received by patients. Multivariate logistic regression showed that the odds of receiving these four contraindicated drugs increased in those with severe renal insufficiency [OR = 23.4, 95% CI 9.9-54.9, p < 0.001] after adjusting for confounding factors. Physicians override the CDSS alerts and prescribe medications that are contraindicated for patients with renal impairment. These medications are limited in number. This study also emphasizes that the medication database system might need to be updated with input from the physicians using the system

Physician satisfaction with electronic medical records in a major Saudi government hospital

The objectives of this study were to measure physician satisfaction with a recently introduced electronic medical record [EMR] system and to determine which of the individual attributes of EMR were related to physician satisfaction. One year after introduction of an EMR system, physicians in an inpatient department were asked to answer a self-administered survey. Pearson's correlation coefficient was used to determine which attributes were significantly related to overall satisfaction with the system. Linear regression analysis was then performed to examine the association between the three main domains of the questionnaire and overall satisfaction with the system, with adjustment for physician demographic characteristics. A total of 115 physicians answered the survey. Only 40% were satisfied with the system overall. The best predictors of overall satisfaction were performance in the form of speed, integration with workflow, and patient information, such as accuracy, completeness and timeliness. Physicians were generally not satisfied with the system. Continued evaluation of such systems and feedback from users should guide future selection and implementation

Physicians' override of computerized alerts for contraindicated medications in patients hospitalized with chronic kidney disease

Objectives: To determine the effectiveness of a clinical decision support system [CDSS] as indicated by a lower proportion of receiving contraindicated medications by patients with severe chronic kidney disease [CKD] compared with patients with less severe CKD

Materials and Methods: This was a retrospective analysis of inpatients with CKD [ICD9-CM 585.xx] admitted to a major tertiary hospital in Saudi Arabia and receiving one of the medications that were documented in the knowledge base of the hospital CDSS to be renally cleared and/or nephrotoxic. Using the Chi square test, the proportion of receiving contraindicated medication was compared between patients with severe CKD and patients with mild/moderate CKD. Multivariate logistic regression was then used to examine the adjusted risk of receiving contraindicated medications among patients with severe CKD despite the presence of guided medication by CDSS

Results: The final analysis was conducted on 346 patients who received prescriptions that were renally cleared and/or nephrotoxic. Of these patients, 17% [n = 58] had severe CKD and 83% [n = 288] had mild/moderate CKD. Among patients with severe CKD, 51.7% [n = 30] received contraindicated medications compared with patients with mild/moderate CKD, 4.9% [n = 14], P < 0.01. Multivariate logistic regression showed that the likelihood of receiving contraindicated medications was several folds higher among patients with severe CKD compared with patients with mild/moderate CKD [P < 0.001]

Conclusion: Patients with severe CKD continued to receive contraindicated medications despite the availability of medication guidance by the CDSS to prescribing physicians. Improved compliance by physicians to CDSS alerts and better understanding of reasons for non-compliance is still needed, particularly for patients with severe CKD

Effectiveness of text message reminders on nonattendance of outpatient clinic appointments in three different specialties: a randomized controlled trial in a Saudi Hospital

Nonattendance at outpatient appointment is a major problem particularly in public hospitals that leads to long waiting time and inefficient use of hospital recourses. The aim of this study was to evaluate the effectiveness of sending short message service [SMS] reminders to the mobile phones of patients scheduled for an outpatient appointment on nonattendance rate. A randomized controlled trial was conducted at three outpatient clinics [General Medicine [GM], Neurology [Neuro], Obstetrics and Gynecology [OB/GYN]. Eligible patients were randomly allocated to either receive SMS reminder message of their outpatient appointment [intervention group] or receive no reminder [control group]. The electronic database of the hospital was used to collect patient appointment information, mobile phone number, type of clinic and other patient characteristics. The primary outcome measure was nonattendance rate. Chi-square test and multivariate logistic regression were used to compare nonattendance rate between the two groups. A total of 1499 patients were entered in the two arms of the study between April 2011 and June 2011. These were divided as follows [GM= 502, Neuro =297, and OB/GYN =700]. The nonattendance rate was significantly lower in the reminder groups compared to the nonreminder groups in the GM and Neuro clinics [26.3% vs. 39.8% and 29.3% vs. 43.9%, respectively P

Acute effects of cigarette smoking on the cardiac diastolic functions

Smoking is an independent risk factor for coronary heart diseases and it increases all causes of cardiovascular morbidity and mortality. To assess the acute effect of cigarette smoking on ventricular diastolic functions [LV and RV] in healthy, young, and slim smokers. Thirty volunteers who had recently commenced smoking [less than one year] and who smoked 1-2 cigarettes per day, underwent ECG, 2D and M-mode echocardiography, standard Doppler echocardiography, pulsed TDI [tissue Doppler imaging] on septal and lateral side of mitral annulus and lateral tricuspid annulus. Vp values were measured. The investigator asked them to hold smoking for at least two days after which echocardiographic examination was conducted before smoking one cigarette and the second examination conducted immediately after smoking one cigarette containing at least 0.4 mg of nicotine. Doppler findings over the mitral valve showed the E wave was significantly reduced from 82.7 +/- 10.4 to 74.6 +/- 10.4 after smoking; the A wave increased; the E/A ratio was reduced from 1.5 +/- 0.3 to 1.2 +/- 0.2; the E' septal significantly decreased [15.3 +/- 2.4 vs. 11.2 +/- 1.1] after smoking, and the E/E' ratio increased from 5.5 +/- 1.1 to 6.7 +/- 1.1. Doppler findings over the tricuspid valve showed the E wave was reduced from 60.6 +/- 9.7 to 52.7 +/- 9.6; the A wave increased from 42.2 +/- 6.5 to 50.1 +/- 6.6; and the E/A ratio decreased [1.45 +/- 0.25 vs. 1.06 +/- 0.19]. The E' significantly decreased from 14.1 +/- 1.8 to 10.9 +/- 2.4, while the A' increased [10.2 +/- 2.4 vs. 12.7 +/- 3.6] after smoking; and the IVRT of the RV was significantly prolonged from 62.9 +/- 7.5 to 68.7 +/- 7.9 after smoking. The Vp was markedly reduced from 67.8 +/- 8 to 55.2 +/- 3.5 after smoking. These findings reflected on the LV filling pressure [LVFvp] which increased from 9.8 +/- 1.4 to 10.5 +/- 1.3 after smoking. All changes were statistically significant at P < 0.001. Our study reveals that cigarette smoking can result in significant acute alteration in the diastolic functions of both ventricles

Development of an assessment tool to measure students' perceptions of respiratory care education programs: item generation, item reduction, and preliminary validation

Students who perceived their learning environment positively are more likely to develop effective learning strategies, and adopt a deep learning approach. Currently, there is no validated instrument for measuring the educational environment of educational programs on respiratory care [RC]. The aim of this study was to develop an instrument to measure students' perception of the RC educational environment. Based on the literature review and an assessment of content validity by multiple focus groups of RC educationalists, potential items of the instrument relevant to RC educational environment construct were generated by the research group. The initial 71 item questionnaire was then field-tested on all students from the 3 RC programs in Saudi Arabia and was subjected to multi-trait scaling analysis. Cronbach's alpha was used to assess internal consistency reliabilities. Two hundred and twelve students [100%] completed the survey. The initial instrument of 71 items was reduced to 65 across 5 scales. Convergent and discriminant validity assessment demonstrated that the majority of items correlated more highly with their intended scale than a competing one. Cronbach's alpha exceeded the standard criterion of >0.70 in all scales except one. There was no floor or ceiling effect for scale or overall score. This instrument is the first assessment tool developed to measure the RC educational environment. There was evidence of its good feasibility, validity, and reliability. This first validation of the instrument supports its use by RC students to evaluate educational environment

Transurethral versus open prostatectomy - 6 years experience

In 864 operations done for prostatic obstruction over 6 years, 237 were Millin prostatectomy and 627 TUR. Of the latter, 17 patients [2.7%] needed re-doing. The postoperative complications following open surgery were stricture urethra in 8 cases [3.4%], incontinence in two [0.8%], suprapubic fistula in 7 [2.6%] and death in four [1.7%]. Following TUR only 9 cases had stricture [1.4%], 6 were incontinent [0.9%] and 17 [2.7%] had prostatic obstruction. Uroflowmetry was done for 85 patients with no change between the pattern done two and four weeks postoperatively and with a mean flow of 16.5 and 17.7 ml/sec respectively. Suprapubic real-time ultrasonic assessment of the size of the prostate was done with comparison to the postoperative symptoms and residual prostatic tissue. All the cases resected once or twice had finally a satisfactory voiding pattern although 54% had residual prostatic tissue on ultrasound