One-year postoperative mortality rate among the elderly with hip fractures at a single tertiary care center.

BACKGROUND: Hip fractures are one of the leading causes of disability and dependency among the elderly. The rate of hip fractures has been progressively increasing due to the continuing increase in average life expectancy. Surgical intervention is the mainstay of treatment, but with an increasing prevalence of comorbid conditions and decreased functional capacity in elderly patients, more patients are prone to postoperative complications. OBJECTIVES: Assess the value of surgical intervention for hip fractures among the elderly by quantifying the 1-year mortality rate and assessing factors associated with mortality. DESIGN: Medical record review. SETTING: Tertiary care center. PATIENTS AND METHODS: All patients 60 years o age or older who sustained a hip fracture between the period of 2008 to 2018 in a single tertiary healthcare center. Data was obtained from case files, using both electronic and paper files. MAIN OUTCOME MEASURES: The 1-year mortality rate for hip fracture, postoperative complications and factors associated with mortality. SAMPLE SIZE: 802 patients. RESULTS: The majority of patients underwent surgical intervention (93%). Intra- and postoperative complications were 3% and 16%, respectively. Four percent of the sample died within 30 days, and 11% died within one year. In a multivariate analysis, an increased risk of 1-year mortality was associated with neck of femur fractures and postoperative complications (P=.034, <.001, respectively) CONCLUSION: The 1-year mortality risk in our study reinforces the importance of aggressive surgical intervention for hip fractures. LIMITATION: Single-centered study. CONFLICT OF INTEREST: None.

Understanding the Knowledge and Attitude of Prehospital Sepsis Care among Emergency Medical Service Personnel.

BACKGROUND: Sepsis represents a huge burden for the health-care system. Septic patients presented by emergency medical services (EMS) are usually sicker in comparison to patients arriving by other means. Knowledge of sepsis is a key factor in recognizing and providing the appropriate care; it is not the only barrier as EMS providers do not have access to the proper diagnostic investigation. This work highlighted the level of knowledge, awareness, and attitude of EMS providers regarding prehospital care of sepsis in Riyadh, Saudi Arabia. METHODS: This study was a cross-sectional study that conducted among EMS personnel of Saudi Red Crescent Authority and King Abdulaziz Medical City. One hundred and ninety-seven individuals were sampled (99 were technicians and 98 were paramedics). RESULTS: Most participants (71%) were aware of the term "sepsis;" however, only 48% of participants correctly defined sepsis (30% between emergency medical technicians [EMTs] vs. 66% paramedics group, P < 0.01). Paramedics were noted to have a better understanding of signs, symptoms, and management of sepsis. Most of the participants thought that sepsis can be identified during prehospital care (55%) and 75% suggested that they should be involved in the management of septic patients. About 80% responded that their intervention would result in a better outcome for patients and would influence the behavior of emergency department medical care. Most of the participants (83%) were willing to be actively engaged in the prehospital care of septic patients. CONCLUSION: This study showed an insufficient level of knowledge and awareness regarding sepsis care in the EMS field in Saudi Arabia. Paramedics had more knowledge and awareness about sepsis care compared to EMT personnel. Future work should focus on exploring the reasons behind this, as well as implementing plans to improve education about sepsis for EMS personnel.

Prevalence of carpal tunnel syndrome symptoms among dentists working in Riyadh.

BACKGROUND: Approximately 3-6% of the general population have carpal tunnel syndrome (CTS). CTS is more prevalent among people with occupations that involve repetitive and forceful maneuvers, such as dentists. It is important to identify risk factors for these symptoms and to understand the impact they may have on clinical practice. OBJECTIVES: Measure the prevalence of CTS-symptoms and identify factors associated with CTS. DESIGN: Cross-sectional. SETTING: Dentists working in Riyadh. SUBJECTS AND METHODS: In-person interviews from 15 July to 10 September 2017 of subjects obtained using random cluster sampling. MAIN OUTCOME MEASURES: Prevalence of CTS-related symptoms among dentists. SAMPLE SIZE: 223 dentists (134 males and 89 females). RESULTS: The prevalence of CTS-related symptoms among dentists working in Riyadh was 30.5% (95% CI 0.25 to 0.36). Female dentists had a significantly greater risk of having CTS symptoms than male dentists (OR 2.13; 95% CI 1.09-4.17). Obese dentists were also more likely to complain of CTS symptoms than dentists within normal weight limits (OR 3.66; 95% CI 1.55-8.64). Left-hand dominance was strongly associated with CTS symptoms, with an estimated OR of 6.28 (95% CI 1.24-31.90). However, there was no relationship between CTS symptoms and age, marital status, history of smoking, exercise, dental specialty, occupation period, or having other educational degrees. CONCLUSION: Thirty percent of dentists working in Riyadh had experienced severe or mild symptoms related to CTS. Several risk factors for CTS have been identified. Future research could explore the reasons behind these risk factors to identify and implement prevention measures. LIMITATIONS: Cannot be generalized to the whole of Saudi Arabia, or the region. Larger controlled studies are needed to further identify the risk factors associated with CTS among dentists. In addition, since the Boston Carpal Tunnel Questionnaire was used, the self-reporting nature of the study might be affected by external bias. CONFLICT OF INTEREST: None.

How informed are the Saudi public about the value of organ donation: A community-based cross-sectional study.

Organ transplantation is often the ideal option for some end-stage organ diseases. However, organ donation is not keeping pace with growing demand for it. Saudi Arabia has one of the widest gaps between supply and demand with respect to transplants, estimated at 2-4 per million population. The purpose of this study is to survey the public's perceptions and opinion about organ donation and transplants in general. This is a cross-sectional study targeting the age group of 18-60 years as they represent potential organ donors in any community. An Arabic-language questionnaire was distributed online. The questionnaire comprised specific questions to assess participants' willingness to donate their organs. The study included 1453 Saudi adults. More than two-thirds (77.7%) expressed a willingness to donate. Interestingly, 325 (22.3%) refused organ donation in principle. Of the participants, 329 (29.1%) were willing to donate only to their relatives. Among those over 40 years, 77.4% were willing to donate to anyone in the community, compared to 78% of those under 40 years, P <0.001. Positive attitudes toward organ donation are evident in the high number of people willing to donate their organs.

Period prevalence, risk factors and consequent injuries of falling among the Saudi elderly living in Riyadh, Saudi Arabia: a cross-sectional study.

OBJECTIVES: Approximately 28% to 35% of people aged 65 and over fall each year. The consequent injuries of falls are considered a major public health problem. Falls account for more than half of injury-related hospitalisations among old people. The aim of this study was to measure a 1-year period prevalence of falling among old people in Riyadh, Saudi Arabia. In addition, this study described the most common risk factors and consequent injuries of falls. SETTING AND PARTICIPANTS: A cross-sectional survey was carried out in Riyadh, using a convenient sampling. The targeted population were Saudi citizens who were 60 years or above. Over a 6-month period, 1182 individuals were sampled (545 men and 637 women). RESULTS: The 1-year prevalence of falling among old Saudis (>=60 years) was 49.9%. Our results show that 74% of the participants who experienced falls had postfall injuries. Old participants who were uneducated and those with middle school certification were associated with falls (adjusted OR (aOR) 1.72; 95% CI 1.15 to 2.56, aOR 1.81; 95% CI 1.15 to 2.85, respectively). Those who live in rented houses had a higher risk of falls. Interestingly, having a caregiver was significantly associated with more falls (aOR 1.39; 95% CI 1.08 to 1.79). However, not using any medications was significantly related to fewer falls. In addition, old individuals using walking aids were more likely to fall than those who did not. Participants who mentioned 'not having stressors were associated with less frequent falls (aOR 0.62; 95% CI 0.39 to 0.97). Cerebrovascular accidents were strongly associated with falls with an estimated OR of 2.75 (95% CI 1.18 to 6.43). Moreover, osteoporosis, poor vision and back pain were found to be predictors for falls among the elderly. CONCLUSION: 49.9% of elderly Saudis had experienced one or more falls during a 12-month period. Several preventable risk factors could be addressed by routine geriatric assessment. Research on the impact of these risk factors is needed.

Clinical Decision-making among Emergency Physicians: Experiential or Rational?

It has been postulated that everyone has an affinity for one of two cognitive approaches: experiential (intuitive) or rational (conscious). The aim of this study was to analyze the thinking processes of Saudi emergency physicians at nine hospitals in Riyadh. This was a cross-sectional study, which was undertaken in Riyadh using a psychometric tool called the Rational-Experiential Inventory-40. The survey, sent by e-mail to 202 emergency physicians, had a 53% response rate. Most respondents were male (86%). The total surveyed participants included consultants (36%), associate consultants (19%), registrars, fellow or staff physicians (7%), and residents (38%). The results found a mean (standard deviation) score of 3.73 (0.51) for rational approaches to decision-making and 3.09 (0.45) for experiential approaches among the emergency physicians surveyed. The difference of 0.46 between the two scores was not statistically significant (p = 0.23). Female emergency physicians tended toward slower logical thinking (rational). Consultant emergency physicians had a higher score for fast intuitive automatic thinking (experiential) than nonconsultant physicians. This was statistically significant, t105 = 2.1, p = 0.4. Our results suggest that although both thinking styles are used in clinical decision-making, consultant emergency physicians prefer rational approaches to decision-making.