Exploring the outcome of multiple sclerosis among Saudi adult patients. A single-centered cross-sectional study at King Abdulaziz Medical City in Riyadh, Saudi Arabia.

OBJECTIVE: To assess the outcome and impact of multiple sclerosis (MS) using validated Arabic versions of the Barthel index (BI) multiple sclerosis impact scale (MSIS-29), the modified Rankin scale (mRS), and the expanded disability status scale (EDSS). METHODS: A cross-sectional study conducted at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia, during July-November 2017. All Saudi adult patients diagnosed with MS between 2000-2016 (269 patients) were included. Patients were contacted via phone calls and were assessed using a newly developed and validated multi-component questionnaire that included demographic data, disease course, and Arabic versions of the scales RESULTS: Out of 269 patients, 210 (78.2%) responded. The average patient age was 37.44+/-10.3 years. The majority were females (69.5%). Only, 51 (24.3%) patients reported worsening conditions. Annually, the average relapse rate was 2.28+/-1.91. In regard to patient outcomes, 120 (57.1%) showed no significant disability in mRS, 146 (69.5%) were ambulatory without aid in EDSS, and 185 (89.4%) were independent in BI scores. The average MSIS-29-PHYS score was 33.6+/-27.6 and MSIS-29-PSYCH score was 38.2+/-25.8. Modified Rankin scale and EDSS were significantly associated with the current use of disease-modifying therapy (DMT). Modified Rankin scale was negatively associated with delayed diagnosis. Barthel index showed significant association with medication compliance and the absence of attacks. CONCLUSION: Majority of patients had a favorable outcome that was linked with the use of DMT, compliance, early diagnosis, and absence of attacks.

The impact of `admit no bed` and long boarding times in the emergency department on stroke outcome.

OBJECTIVES: To examine and test the possible association between boarding time and stroke patients` outcome. METHODS: This study is a retrospective review of stroke patients presenting to the Emergency Department (ED) of King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia from 2007-2010. We excluded thrombolysis cases and those deemed critically ill. We collected time of stroke onset, ED arrival, decision to admit, and arrival to ward. Boarding time (BT) was defined as time of arrival to ward minus time of decision to admit. Primary outcome (PO) was defined as a composite of mortality, and/or any of post-stroke complications. RESULTS: We included 300 patients with a mean age +/- standard deviation of 69 +/- 12 years, and 66.3% were men. The PO occurred in 37.7%. There was no association between BT and PO (odds ratio [OR]=0.9, p=0.3), or any of the secondary outcomes, such as, death (OR=0.97, p=0.5), severe disability (OR=0.97, p=0.3), pneumonia (OR=1, p=0.9), urinary tract infection (OR=1, p=0.9), or neurological deterioration (OR=0.8, p=0.1). Multivariate analysis included gender, age, stroke severity, subtype, hypertension, diabetes, coronary disease, atrial fibrillation, heart failure (HF), onset to ED, BT and ED wait time; only moderate to severe stroke, HF, and previous stroke predicted poor outcome. CONCLUSION: Although `admit no bed` was not associated with adverse effects, the results should be interpreted with caution, and early admission to the stroke unit should be encouraged.

The effect of nurse-patient language barrier on patients' satisfaction.

OBJECTIVE: To study Saudi patients' perception of nursing care delivered by non-Arabic speaking nurses (NASNs). METHODS: A cross-sectional survey of randomly selected patients admitted to King Abdul-Aziz Medical City, Riyadh, Saudi Arabia during the summer of 2009. We conducted structured face-to-face interviews, and the Institutional Review Board approved the study. RESULTS: We interviewed 116 patients with a 100% response rate. The mean age was 48 years and 47% were men. Half was illiterate or had a low level of education. Eighty percent was served by NASNs. Most believed that the Arabic language is important to provide high quality of care. Two thirds reported difficulties in understanding nursing instructions, and felt that NASNs could not understand their concerns on many occasions. Half believed that NASNs are more susceptible to error. Seventy percent felt uncomfortable dealing with a nurse who cannot communicate in the same language, and 30% question the reliability of information delivered by NASNs. Patients noticed that NASN avoid (50%) or end conversation (70%) due to language barriers. Sixty-one percent reported that NASNs never or rarely called the interpreter. Overall satisfaction of nursing care was high (90%), with no significant difference between patients who were served by Arabic versus NASNs. CONCLUSION: Our patients were concerned about the language barrier during nursing care delivery. It may lead to miscommunication and compromise the patient-nurse relationship. Further exploration of this issue is recommended.