Incidence and Risk Factors of Wound Infection in Women Who Underwent Cesarean Section in 2014 at King Abdulaziz Medical City, Jeddah.

Introduction Cesarean section (C/S) is considered one of the most commonly performed procedures among women. The maternal morbidity due to infection post-C/S reaches eight-fold higher than that of vaginal delivery. Our aim is to identify the incidence and risk factors of surgical site infection (SSI) among patients at King Abdul Aziz Medical City (KAMC), Jeddah, Saudi Arabia, in order to develop a strong strategy to reduce its occurrence. Methods This retrospective cohort study was conducted at KAMC, Jeddah. The study included a total of 387 women who underwent cesarean sections from January 2014 to December 2014. The data were collected consecutively by reviewing medical records of pregnant patients who underwent elective or emergency C/S. The risk factors studied included age, presence of underlying diseases, BMI, hemoglobin level, prophylactic antibiotics, pre-labor rupture of membrane, duration of induction of labor, type of C/S, type of uterine incision, duration of operation, type of anesthesia, estimated blood loss, type of organism, and the duration of hospital stay postoperatively.  Results The incidence rate of wound infections (WI) was 3.4% (13/387). The mean age score was 31.1±5.6 years, and the mean score of BMI was 32.7±6.2, where the majority were obese (255, 65.9%). More than half of the participants (205, 53.0%) had elective C/S, with mean hospitalization duration 2.5±1.3 days, and operation duration mean score 59.5±22.0 minutes. The majority (378, 97.7%) received antibiotics before the operation, where cefazolin was the main antibiotic (376, 97.2%). Only 38 (10%) cases had intra-operative complications, where the main complication was postpartum hemorrhage (18, 44.0%). The majority of WI were superficial (11 cases), the main organism was E. coli in four (36.4%) cases, followed by Staphylococcus aureus in three (27.3%) cases. There was a significant association between WI post-C/S and BMI, type of uterine incision, and induction of labor (P=006, P=0.003, respectively).  Conclusions This study showed that WI post-C/S is associated with high BMI, prolonged induction of labor, and Pfannenstiel incision. Reducing the rate of SSI will help to reduce its morbidity by identifying the risk factors pre-pregnancy and encouraging the implementation of preconception counseling clinics and antenatal classes to educate and increase awareness among patients.

Measuring Patient Satisfaction and Factors Affecting it in the General Surgery Setting in Jeddah.

Introduction A patient-centered approach is critical to improving the overall quality of healthcare, and this also applies to the general surgery setting. To achieve this, it is important to assess patient satisfaction with healthcare, but this topic has not been investigated in the context of Jeddah. Therefore, the present study is the first one to assess patient satisfaction with care in the general surgery department and associated factors in Jeddah. Methods This was a descriptive, cross-sectional study that used a convenience sampling technique to select 307 patients from the outpatient clinic of the general surgery department at King Abdulaziz Medical City from November to December 2018. The cohort comprised 53.1% women and the age range was 18-70 years. For data collection, we used the Short Assessment of Patient Satisfaction questionnaire, which contains seven items related to the core domains of patient satisfaction. We modified this by adding two additional items reported in other studies. We also included age, gender, and level of education as variables in the analysis. The scores assigned to each item were compared based on gender, age, and level of education. Results The analysis showed that age, gender, or level of education did not affect the overall satisfaction level, and the majority of participants (93.8%) reported that they were satisfied or very satisfied. Specifically, the majority reported that they were satisfied or very satisfied with the treatment effect, the explanation provided by the clinician, and the care provided at the clinic. Further, the majority of them also felt that they had received a thorough examination and enough time with the consultant, that they felt respected by the healthcare provider and their concerns were heard and respected, and that they were encouraged to voice their feelings and concerns. The lowest score was related to whether the participants felt like their choices were considered when it came to making healthcare decisions. This could, therefore, be a potential area of improvement. Conclusion Overall, the current findings indicate that the practitioners in the current setting use a patient-centered, adult-to-adult approach to healthcare, and the patients are highly satisfied. One area of improvement could be medical decision-making, where patients' preference could be given more consideration. Thus, these findings provide important insight into patient-centered care in this region.

The Effectiveness of Written Asthma Action Plan at the National Guard Health Affairs' Asthma Clinic.

Introduction Bronchial asthma has grown in epidemic proportions, and it is one of the most chronic diseases that affect many societies in the world. As managing asthma is complex, new management approaches have been developed, such as the written asthma action plan. This study aims to assign a baseline for the patients' knowledge about asthma and its management and to assess their need for an asthma action plan. Then, to identify the effect of the written asthma action plan on the following parameters: exacerbations rate, and the frequency of using rescue mediations. Also, to compare the quality of life, functional limitations, and the level of patients' self-confidence in treating their asthma before and after using the written asthma action plan. Method This study is a cross-sectional and interventional mixed-method study design. It was conducted at the National Guard Health Affairs (NGHA) asthma clinics between October 2017 to November 2017. Asthmatic patients who were above five years old and had no other lung comorbidities were evaluated before and after following the written asthma action plan by using three previously validated and published surveys that consist of five sections: demography, knowledge, quality of life, exacerbation rate, and overall evaluation. Results This study enrolled 58% (209) males and 42% (154) females. Regarding asthma medication knowledge and attack management, 62.3% of the patients do not adhere to their maintenance medications when they do not have asthma symptoms. Also, only 24.9% were very confident about knowing how to use their inhalers. For the impact of asthma on patients' quality of life and the functional limitations, we found that 42.1% of patients were absent from school or work more than once a week because of asthma. While 61.0% of patients did not attend social events twice or less per week because of their asthma. The third section of the survey was about asthma exacerbation related events during the past year, we found that 39.0% of patients had one or more asthma attacks, 41.6% visited the emergency room (ER) once or more during the past year, and 28.1% of patients have been hospitalized because of their asthma. Finally, the section about patients' evaluation of their asthma and their confidence about managing their condition, we found that around 20% of patients had poor or no control over their condition. In the second phase of the study, which includes 60 subjects, we found that following the action plan helps in increasing the patients' knowledge about their condition, and improves their quality of life and functional limitations as they learned how to cope with their symptoms. In addition, it has increased the confidence level of patients about controlling their asthma and decreasing the asthma exacerbation related events rates. Overall, the patients' evaluation of their asthma has been increased significantly (p-value= 0.023). Conclusion Most of the asthmatic patients had insufficient knowledge and/or poor adherence to their treatment which impacted their quality of life. The written asthma action plan was effective in increasing the patients' knowledge about their condition, improving their quality of life and functional limitations, and increasing their confidence level about controlling their asthma.