Ambient conditions of the operating theatre and its correlation with fatigue and sleep quality of operating room workers: a cross-sectional survey.

Background: Anesthesia providers face numerous occupational hazards, including exposure to anesthesia gases, which can lead to fatigue. These professionals face challenges such as night shifts, OR stress, limited mobility and sunlight access, high workload, inadequate rest breaks. Health-related sociodemographic variables, such as smoking, sleep patterns, and obesity. Our research aims to explore various risk factors associated with fatigue among operating theatre workers including sleep quality. Methods: A cross-sectional study was conducted on 227 of operating room healthcare professionals from five tertiary hospitals in Saudi Arabia, for a period of 6 months, between January 1, 2023 to June 1, 2023. The study used a five-point Likert scale sheet and the FSS "fatigue severity scale" to analyze and measure fatigue and sleep quality. The questionnaire included all socio-demographic variables, work conditions, and fatigue severity scale items. Results: The major findings revealed a significant correlation between fatigue severity scores and exposure to anesthesia gases. Socio-demographic variables such as smoking have showed major relevance to fatigue in the sample size, as (76.6%) of the participants that answered as regular smokers have showed result of positive correlation to fatigue and with a significant of (0.034). Out of the total sample, 76.1% were exposed to anesthesia gases once daily, showing a positive association with fatigue severity scores. Work-related factors like job experience and position also had a lower association with fatigue severity. p (0.031) Univariate logistic regression p (0.035). Conclusion: The study found that the work-related conditions like workload on Anesthesia technicians and technologists over 44 h per week and gas exposure is directly linked to fatigue severity and sleep quality so is the socio-demographic considerations. With poor sleep quality in younger staff which is documented in the study result a large-scale prospective analysis to understand the factors affecting OR staff's sleep quality and fatigue severity and what can be done to regulate working hours and break time and incorporate naps in to enhance patient safety and well-being for anesthesia providers in Saudi Arabia.

Knowledge, Attitudes, and Practices of Nurses toward Risk Factors and Prevention of Falls in Older Adult Patients in a Large-Sized Tertiary Care Setting.

The objective was to assess the knowledge, attitudes, and practices of nurses toward the prevention of falls in older hospitalized patients. A cross-sectional study employing a 54-item questionnaire was conducted on 370 nurses at a tertiary care referral center. The mean age of the study population was 36.3 ± 7.7 years, with the majority being females (282; 76.8%). Most of them had attended fall prevention training (335; 90.5%). More than 98% knew fall prevention policies and safety goals, according to their response to a fall and risk assessment, but were less aware of the risk factors of falls, such as recurrent falls (61%), depression (44%), and lower-extremity numbness (40.5%). Similarly, 99% had positive attitudes toward risk assessment, fall prevention intervention, and response to a fall. Around 55% thought they were responsible for patients' falls, and 96% felt the need to undergo more training on fall prevention. Furthermore, 92% strictly followed fall prevention policies and 85.4% followed the color-coding system for high-risk patients. Despite the preventive measures in place, 33% encountered patient falls, and 82.2% experienced unwitnessed patient fall incidents in their units. Although the nurses had higher levels of knowledge about the policies, they lacked information on the risk factors. There is a significant scope that warrants great attention concerning the adherence to guidelines and the provision of fall prevention training programs, with a focus on the intrinsic causative factors of falls.

Impact of quarantine on sleep quality and psychological status in COVID-19 suspected cases in Riyadh, Saudi Arabia.

Aim: The purpose of this study was to investigate into mental health outcomes such as stress, anxiety, and depression, as well as sleep quality in suspected COVID-19 quarantined cases. Methods: This is a cross-sectional study that used an online survey to target suspected COVID-19 cases in quarantine facilities. Data were collected on several aspects of participants' sociodemographic characteristics, sleep disturbance, and mental health status. Depression, anxiety, stress scale and Pittsburgh Sleep Quality Index were used to measure both the psychological impact and mental health status. Results: Of the 362 people who took the survey, 234 (64.6%) were men, and 148 were between the ages of 26-35. Poor sleep was found to be prevalent in 65% of study participants. The rates of individuals reporting severe depression, anxiety, and stress symptoms were 14.6%, 15%, and 15%, respectively. According to the findings, there were significant gender differences in depression and anxiety (p = 0.001). When compared to the other age groups, participants aged 26-35 reported the highest level of stress (p = 0.001). Being male [OR = -1.23, 95% CI (-2.75-1.95) P = 0.050], single [OR = 0.98, CI (0.15-4.20), P = 0.001], and a healthcare worker [OR = -2.20, 95% CI (-2.59-1.82), P = 0.001] were all associated with poor sleep quality. Conclusion: Approximately-one-third of quarantine COVID-19 patients had poor sleep quality with mild-moderate depression. Both anxiety and stress scales were prevalent in nearly half of the studied samples.

Evaluation of Risk Factors for Diabetic Peripheral Neuropathy Among Saudi Type 2 Diabetic Patients with Longer Duration of Diabetes.

Background: Neuropathy is the most common microvascular complications among diabetic patients. Diabetic peripheral neuropathy (DPN) is the predominant variety which may associate with increased in mortality and morbidity among type 2 diabetes mellitus (T2DM). Objective: To assess the prevalence of diabetic peripheral neuropathy and its correlation with risk factors among T2DM. Methods: This was a cross-sectional retrospective study, data was collected from a previous cohort study conducted at the University Diabetes Center, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia. The data of T2DM patients were collected from case report form, included demographic data, history of chronic diabetes neuropathy, and laboratory reports. Statistical analysis includes Student`s t test, chi square test, and Pearson correlation and logistic regression were performed. Results: A total of 430 patients with T2DM data was collected and analyzed, and of them 54% were females, with the mean age of 55.88 years. The prevalence of diabetic neuropathy among study participants were 40.2%, and 73.3% of them having the subtype polyneuropathy. The mean BMI; p = 0.006, FBS; p < 0.001, HbA1c; p < 0.001, cholesterol p = 0.001, LDL; p < 0.001, and triglyceride; p < 0.001 levels were a significantly higher among participants with diabetic neuropathy than without neuropathy. The male gender (Risk Ratio: 1.294, 95% CI:1.090, 1.536) p = 0.003, fasting blood glucose (Risk Ratio: 1.157, 95% CI:1.051, 1.273) p = 0.003 Cholesterol (Risk Ratio: 1.588, 95% CI:1.174, 2.147) p = 0.003, triglyceride (Risk Ratio: 1.290, 95% CI:1.086, 1.538), p = 0.004, and LDL (Risk Ratio: 1.299, 95% CI:1.073, 1.574), p = 0.007) were found to be significant risk factors for DPN. Conclusion: DPN is highly prevalent among T2DM patients in Saudi Arabia. Poor glycemic control and hyperlipidemia were associated with significantly higher risk for DPN patients among T2DM.

A retrospective analysis of substance use among female psychiatric patients in Saudi Arabia.

Objective: This study investigated the prevalence of substance use (SU), and its risk factors, among women attending psychiatric outpatients center in Saudi Arabia. Design: A retrospective cross-sectional design. Materials and methods: We reviewed outpatients' records of 200 female patients with a history of SU from a psychiatric unit in Jeddah, Saudi Arabia from December 2018 to February 2019. The researchers developed the pro forma, and 2 psychiatrists and a family medicine physician validated the form. Results: The most common and widely used were psychoactive substances (58%), followed by central nervous system (CNS) depressants (22%), and finally cannabinols (9.5%). Overall, the highest substance use was the amphetamine-cannabis-nicotine (ACN) representing nearly half of the illicit items (46.6%), followed by heroine-alcohol-benzodiazepine (16.4%), and with the lowest being benzodiazepine-nicotine (1.7%). There was a significant difference between the single substance and multiple substance use in terms of age (p = 0.001), smoking behavior (p = 0.001), patients past history (p = 0.005), and age of the patient at the start of drug use (p = 0.005). Conclusion: Although the prevalence of substance use among women is low in Saudi Arabia, screening of substance use disorders risks and building a rehabilitation program to control drug dependence are needed.

Culture-Specific Observations in a Saudi Arabian Digital Home Health Care Program: Focus Group Discussions With Patients and Their Caregivers.

BACKGROUND: There is growing evidence of the need to consider cultural factors in the design and implementation of digital health interventions. However, there is still inadequate knowledge pertaining to the aspects of the Saudi Arabian culture that need to be considered in the design and implementation of digital health programs, especially in the context of home health care services for patients who are chronically and terminally ill. OBJECTIVE: This study aims to explore the specific cultural factors related to patients and their caregivers from the perspective of physicians, nurses, and trainers that have influenced the pilot implementation of Remotely Accessible Healthcare At Home, a connected health program in the Home Health Care department at King Saud University Medical City, Riyadh, Saudi Arabia. METHODS: A qualitative study design was adopted to conduct a focus group discussion in July 2019 using a semistructured interview guide with 3 female and 4 male participants working as nurses, family physicians, and information technologists. Qualitative data obtained were analyzed using a thematic framework analysis. RESULTS: A total of 2 categories emerged from the focus group discussion that influenced the experiences of digital health program intervention: first, culture-related factors including language and communication, cultural views on using cameras during consultation, nonadherence to web-based consultations, and family role and commitment and second, caregiver characteristics in telemedicine that includes their skills and education and electronic literacy. Participants of this study revealed that indirect contact with patients and their family members may work as a barrier to proper communication through the Remotely Accessible Healthcare At Home program. CONCLUSIONS: We recommend exploring the use of interpreters in digital health, creating awareness among the local population regarding privacy in digital health, and actively involving direct family members with the health care providers.

The application of FRAX in Saudi Arabia.

Assessment and treatment pathways based on age-specific intervention thresholds in Saudi Arabi can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low fracture risk. PURPOSE: Intervention thresholds for the treatment of osteoporosis have historically been based on the measurement of bone mineral density. The aim of the present study was to explore treatment paths and characteristics of women eligible for treatment in Saudi Arabia based on fracture probabilities derived from FRAX®. METHODS: The approach to the setting of intervention and assessment thresholds used the methodology adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Saudi Arabia. The methodology was applied to women age 40 years or more drawn from a tertiary referral population for skeletal assessment. Missing data for the calculation of FRAX was simulated using data from the referral and FRAX derivation cohorts. RESULTS: Intervention thresholds expressed as a 10-year probability of a major osteoporotic fracture ranged from 2.0% at the age of 50 years increasing to 7.6% at the age of 70 years. A total of 163 of 1365 women (11.9%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 5 women were eligible for treatment in that MOF probabilities lay above the upper assessment threshold. A BMD test would be recommended for 593 women (43.4%) so that FRAX could be recalculated with the inclusion of femoral neck BMD. Of these, 220 individuals would be eligible for treatment after a BMD test and 373 women categorised at low risk after a BMD test. CONCLUSION: Probability-based assessment of fracture risk using age-specific intervention thresholds was developed for Saudi Arabia to help guide decisions about treatment.

Predictors of Mental Health Status among Quarantined COVID-19 Patients in Saudi Arabia.

BACKGROUND: The negative psychological impact of COVID-19 in the general population has been well documented. Similar studies among those who were infected and who underwent quarantine remain scarce, particularly in the Arab region. The present study aims to fill this gap. METHODS: In this cross-sectional study, suspected/confirmed COVID-19 individuals who were quarantined in the Ministry of Health (MOH) facilities were invited to participate in an online survey. All consenting participants answered a generalized questionnaire that included demographic characteristics, as well as a five-part questionnaire that assessed the symptoms of depression, anxiety, insomnia, and distress. RESULTS: A total of 335 suspected/confirmed COVID-19 individuals (198 males and 137 females) participated. Being female is associated with increased risk of depression (odds ratio OR 1.8 (confidence interval, CI 1.1-3.1; p = 0.03)) as well as being employed by the government (OR 2.8 (CI 1.1-7.0; p = 0.03)). Level of education (OR 2.3 (CI 1.0-5.4; p = 0.049)) and employment in government (OR 3.0 (CI 1.2-7.8; p = 0.02)) were significantly associated with distress. Increasing age (45 years and above) appeared to be protective against distress (OR 0.2 (CI 0.02-0.69; p = 0.008)), as well anxiety and sleep pattern (OR 0.3 p < 0.05). CONCLUSION: Findings of the present study highlight that infected COVID-19 populations are at higher risk for acute and detrimental psychological well-being during quarantine and/or self-isolation. Identification of the coping mechanisms of older adults during periods of distress may prove beneficial in the pandemic preparedness of younger generations.

Gender Difference in Pain Management Among Adult Cancer Patients in Saudi Arabia: A Cross-Sectional Assessment.

OBJECTIVE: To compare gender differences in pain management among adult cancer patients in Saudi Arabia and to explore the predictors associated with attitudinal barriers of cancer patients to pain management. METHODS: A descriptive cross-sectional study was conducted among 325 cancer patients from tertiary hospitals in Saudi Arabia. RESULT: Of the total participants, 67.4% were women (N = 219) and 32.6% were men (N = 106). The overall mean scores of the attitudinal barriers questionnaire were 49.51 ± 13.73 in men and 54.80 ± 22.53 in women. The analysis shows significant differences in scores in subscales of tolerance (men = 7.48 ± 2.37), (women = 8.41 ± 3.01) (p = 0.003) and fear of distraction in the course of treatment (men = 6.55 ± 1.34), and (women = 7.15 ± 2.63) (p = 0.008). Female patients reported a more moderate to severe level of pain than men (worst pain in last week of 7.07 ± 1.50, worst pain in last week of 5.84 ± 2.65, respectively). Splitting by gender, the significant predictor for physiology effect domains in male cancer patients includes age, marital status, employment status, monthly income, cancer type, and presence of comorbid disease (p < 0.050). Age was a significant predictor of the domains of fatalism, communication, and harmful effects (p < 0.050) among female cancer patients. CONCLUSION: The present study revealed significant differences between men and women with attitudinal barriers to cancer pain management. Managing pain requires the involvement of all methods in a comprehensive manner, thus unalleviated pain influences the patient's psychological or cognitive aspect.

Potential therapeutic effects of avenanthramide-C against lung toxicity caused by silver nanoparticles injection in rats.

Most clinical investigations about the impact of nanoparticles on cells and tissues show that nanoparticles may enter the human body by means of respiratory tracts. Humans, animals, plants and environments are continually presented to a wide scope of business items containing silver nanoparticles (Ag NPs) in their piece. Ag NPs, utilized in various consumer products as room showers, surface cleaners, wound dressings, food storage containers and many textiles. The current examination planned to explore the defensive role of Avenanthramide-C (Avns) contrary to the lung toxicity initiated by Ag NPs injection in rats. 40 male Wistar rats were separated into 4 groups (Gp1, control; Gp2, Avns; Gp3, Ag NPs; Gp4, Ag NPs+Avns). Current results revealed that; Ag NPs induced a significant depletion in RBCs count, hemoglobin, platelets counts and a significant increase in total WBCs, lung injury, cyclooxygenase-2 (COX2) and TNFα expressions as compared to control. Treatments of Ag NPs with Avenanthramide-C extract (Ag NPs+Avns) improved the lung structure and blood complete pictures as compared to Ag NPs group.

Sex-specific differences in the prevalence of sarcopenia among pre-frail community-dwelling older adults in Saudi Arabia.

OBJECTIVES: To assess sex differences in the prevalence of sarcopenia among pre-frail community-dwelling older adults in Saudi Arabia. METHODS: This was a cross-sectional study conducted at a tertiary-level hospital in Riyadh, Saudi Arabia, in 2019. The study participants were pre-frail community-dwelling older adults, according to the Edmonton Frail Scale. The SARC-F questionnaire was used to diagnose sarcopenia. The Katz Activities of Daily Living (ADL) was used to rank the adequacy of performance in six functions: bathing, dressing, toileting, transferring, continence, and feeding, while the Lawton Instrumental Activities of Daily Living scale was used to assess the more complex ADL necessary for living in the community. RESULTS: In total, 283 community-dwelling older adults were recruited for this study, with a mean (±SD) age of 70.77 (±6.26) years; 72.7% of the total were female participants. The majority (85.5%) of the patients reported that they needed home care assistance. The mean ADL score of the participants was high, indicating high function and independence (KATZ-ADL: M 4.60 SD 1.75; Lawton Brody: 60%). The overall prevalence of sarcopenia among the studied participants was 65.7%, which was significantly higher among females (71.9%) than among males (59.1%), with a P-value of 0.007. Among the demographic characteristics of the participants, there was a significant difference in the need for home care assistance in female sarcopenic and non-sarcopenic participants (74.1% vs. 25.9%, p = 0.017), but without demonstrable difference in males. Additionally, there was a significant difference (P < 0.05) in the prevalence of sarcopenia between male and female participants according to ADL scores. The strongest predictor for sarcopenia prevalence in males was an ADL score <2 according to the Katz index, with an odds ratio of 6.5, while the need for home care was the only significant predictor of sarcopenia among female participants (OR 3.25, CI: 1.14-9.25, p = 0.02). CONCLUSION: Overall, almost two-thirds of the studied pre-frail community-dwelling older adult population were sarcopenic. The prevalence of sarcopenia was significantly higher among females than males. The strongest predictor of sarcopenia was an ADL score <2 based on the Katz index in males and the need for home care assistance in females.

Detrimental effect of antiepileptic drugs dose in pediatric children with epilepsy in Saudi Arabia: A prospective cohort study.

ABSTRACT: This study aims to evaluate the effect of dose titration for different oral antiepileptic medications among children with epilepsy in Riyadh, Saudi Arabia.A single-center prospective pilot, cohort study was undertaken at a tertiary hospital in Riyadh, Saudi Arabia. All medical records of pediatric patients below the age of 14 years of age who has been newly diagnosed with epilepsy by attending a medical specialist or on a new epileptic treatment plans were enrolled in the study.A total of 76 epileptic patients were screened for 3 months' period and 48 patients were included in this study. Out of the 48 patients, 31 patients followed the regular practice in the titration processes and 17 patients were in the British national formulary (BNF) guideline. Fifteen children who were on monotherapy of levetiracetam were in regular practice guideline experienced poor seizure control with a recorded number of seizure incidence (n = 10). The patient in regular practice guidelines using a combination therapy of phenytoin and levetiracetam were experiencing some behavioral disturbance and sedation effect. Seventeen patients followed in the BNF guideline who were on levetiracetam were experienced less adverse effect (n = 2) with no behavioral changes.The group who followed the regular practice found having a greater incidence of documented adverse effects compared to the patients following the BNF guideline. The titrating antiepileptic medication has a detrimental effect on the pediatric population as observed in this study.

Age and gender differences in the prevalence of chronic diseases and atherosclerotic cardiovascular disease risk scores in adults in Riyadh city, Saudi Arabia.

OBJECTIVES: To evaluate age and gender differences in the prevalence of chronic diseases and to calculate atherosclerotic cardiovascular disease (ASCVD) risk scores in adults aged 30-75 years in Riyadh city, Saudi Arabia. METHODS: This cross-sectional, interview-based study was conducted with 2997 men and women, visiting primary health care centers in Riyadh, during the years 2015 to 2016. Serum glycosylated hemoglobin and lipid levels were measured by ion-exchange high-performance liquid chromatography and fully automated analyzer using enzymatic methods, respectively. The 10-year and lifetime ASCVD risk scores were calculated using an online calculator. RESULTS: The mean age of men was 43.1 (±11.7) and women was 43.8 (± 10.9) years. Prevalence rates of diabetes mellitus, hypertension, hypercholesterolemia, and obesity in men versus women were 20.3% versus 24.8% (p=0.006), 15% versus 19.5% (p=0.003), 50.7% versus 53.4% (p=0.16), and 41.2% versus 56.7% (p<0.001), respectively. Majority of men and women with chronic diseases belonged to the age groups 30-39 and 50-59 years, respectively. High 10-year ASCVD risk was found in 32% men and 7.6% women, whereas lifetime risk was present in 67% and 51%, respectively. CONCLUSION: Women in the age group 50-59 years, with multiple risk factors are at a greater risk of developing cardiovascular diseases than men of same age. Young adults were at more risk for lifetime ASCVD, whereas the 10-year ASCVD risk increased with increasing age.

Association between self-care management practices and glycemic control of patients with type 2 diabetes mellitus in Saud Arabia: A cross -sectional study.

OBJECTIVE: In this cross-sectional study, we aimed to determine the association of self-care management practices and glycemic control of type 2 diabetes mellitus in Saudi Arabia. METHODS: A total of 352 type 2 diabetes mellitus (T2DM) patients from two public tertiary hospitals in Saudi Arabia participated in this study. All T2DM patients were recruited and interviewed by a researcher between January to April 2018 from the outpatient diabetes clinics. All respondents answered a four-part questionnaire which includes demographics data, Diabetes Self-Management Questionnaire (DSMQ). Linear Regression was performed to assess the significance of predictors and compute the coefficient of determination. RESULTS: The mean age of the participants was 51.89 ± 10.94. Of the 352 participants, 52% were obese (BMI: ≥30 kgm2) and 77% of the participants had glycated haemoglobin (HbA1c) over 7%. The analysis showed that subscale of Glucose management was the strongest predictor of Hba1c levels of participants' followed by physical activity. Gender and marital status emerged as significant predictors for their self-care management practices. Female patients had more self-care management practices than male patients (B 0.20; 95CI 0.10- 0.96 (p = 0.015). CONCLUSION: This study provides an evidence on the self-care management of T2DM patients in Saudi Arabia. The high self-care management found in the study highlights that the patients are aware of the severity of and possible complications associated with T2DM.

Angiotensin converting enzyme inhibitors and risk of lung cancer: A systematic review and meta-analysis.

BACKGROUND: We performed a meta-analysis to determine whether a consistent relationship exists between the use of angiotensin converting enzyme inhibitors (ACEIs) and the risk of lung cancer. Accordingly, we summarized and reviewed previously published quantitative studies. METHODS: Eligible studies with reference lists published before June 1st, 2019 were obtained from searching several databases. Random effects' models were used to summarize the overall estimate of the multivariate adjusted odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Thirteen observational studies involving 458,686 ACEI users were included in the analysis, Overall, pooled risk ratios indicate that ACEIs use was not a risk factor for lung cancer (RR 0.982, 95% C.I. 0.873 - 1.104; P = .76). There was significant heterogeneity between the studies (Q = 52.54; P < .001; I2 = 86.07). There was no significant association between ACEIs use and lung cancer in studies with over five years of ACEIs exposure (RR 0.95, 95% C.I. 0.75 - 1.20; P = .70); and ≤ 5years of exposure to ACEIs (RR 0.98, 95% C.I. 0.83 - 1.15; P = .77). There were no statistically significant differences in the pooled risk ratio obtained according to the study design (Q = 0.65; P = .723) and the comparator regimen (Q = 3.37; P = .19). CONCLUSIONS: The use of ACEIs was not associated with an increased risk of lung cancer. Nevertheless, well-designed observational studies with different ethnic populations are still needed to evaluate the long-term (over 10 years) association between ACEIs use and lung cancer.

Evaluation of Educational Workshops for Family Medicine Residents Using the Kirkpatrick Framework.

BACKGROUND/OBJECTIVES: Practicing independently in an ambulatory care setting demands mastering the knowledge and skills of commonly performed minor procedures. Educational hands-on activities are one way to ensure competent family medicine practitioners. This study aims to evaluate a minor procedure workshop for family medicine trainees using the Kirkpatrick model for short- and long-term workshop effectiveness and to identify facilitators and obstacles faced by the trainees during their practices to gain procedural skills. METHODS: A cross-sectional study was conducted in four-time intervals: during the workshop (pre- and post-workshop), 12 weeks after the workshop to evaluate the short-term effectiveness and change of behavior, and 12 months after the workshop to evaluate the long-term effectiveness of the workshop. Statistical Package for Social Sciences 22 was used for data analysis. RESULTS: Forty postgraduate trainees (R1-R4) attended the workshop and participated in the survey. Overall, the workshop was accepted and highly perceived by the trainees, and the pre-workshop confidence level was lower than the post-workshop confidence level. The workshop met the expectation of 100% in obstetric and gynecological procedures workshop with 97% satisfaction rate, followed by dermatology (97.5%, 90%), orthopedic (95%, 87%), general surgery (97.5%, 84%), combined ophthalmology and otorhinolaryngology workshop (82.5%, 74%). At 12 weeks, 24 postgraduate trainees (R2-R4) responded to the survey, and low competency occurred with uncommon procedures in practice. At 12 months only 16 trainees (R3-R4) responded to the survey. Learning effect was higher as post-workshop and varied with the passage of time. Changes in the competency level were noticed, with the number of procedures performed being not statistically significant (P> 0.05). CONCLUSION: Practicing family medicine in an ambulatory health-care setting safely needs the mastering of minor office procedure skills. Evaluating educational workshops is important to ensure effective outcomes and identify the factors of trainees, supervisors, institutions, and patients that influence or hinder the performance of minor procedures in a family medicine clinic.

Frailty, sarcopenia and health related outcomes among elderly patients in Saudi Arabia.

OBJECTIVE: To determine the prevalence of frailty and sarcopenia among elderly patients in Saudi Arabia and explore if there are significant association between frailty and sarcopenia. METHODS: A total of 498 patients from public tertiary hospital in Saudi Arabia participated in this descriptive cross-sectional study between March 2019 to June 2019. All participants answered a 5-part questionnaire, which includes demographic data, Edmonton Frail Scale, SARC-F and questions related to Activities of Daily living. RESULTS: The mean age of the participants was 69.98 ± 6.28. Of the 498 participants, 67.7% were aged 61-70 years and 42% had a BMI of greater than < 30 kg/m2. The prevalence of patients with mild frail, moderate frail and severely frail were 22, 12, and 4%, respectively. The analysis showed that majority of patients who had sarcopenia were females (84%). The analysis show that the level of frailty of patients were significantly different between age, marital status, educational level and patients' needs of home care, activities of daily living, presence of comorbidity and sarcopenia (p = 0.001). In the logistic regression analysis, the pre-frailty group was significantly likely to have sarcopenia (OR 0.02 95% 0.01-0.23p = 0.001) than nonfrailty patients. CONCLUSION: In conclusion, this research highlights the high prevalence of sarcopenia among elderly patients and the increasing percentage of frail patients in Saudi Arabia. In addition, significant difference and association were found with sarcopenia and frailty with many sociodemographic and clinical components of elderly patients in Saudi Arabia.

Recommendation of Aspirin-Guide App and Physicians Clinical Decision of Aspirin Use to Prevent CVD Among Diabetic Patients, Is there any Differences?

OBJECTIVE: This study aims to identify the prevalence of aspirin use among type 2 diabetic (T2DM) patients and assess the concordance in aspirin use among these patients as prescribed by physicians and as recommended by the Aspirin-Guide app. METHODS: A total of 301 T2DM patients from King Khalid University Hospital in Riyadh, Saudi Arabia participated in this cross-sectional study. Patient's electronic medical records through eSihi system were reviewed and all data included in the free online and mobile app called Aspirin-Guide were collected in a specially designed data checklist. RESULT: The prevalence of aspirin use was more common in patients who were in the age group of 51 to 59 and male participants' with T2DM. Males were nearly twice more likely to use aspirin compared to females (P = 0.001). Based on recommendations from the Aspirin-Guide app, 26% of the patients who were on aspirin (N = 51) were not eligible for aspirin therapy, while 37.7% (N = 40) of the patients eligible for aspirin therapy had not been put on aspirin by their physicians (P = 0.039). Male sex (P = 0.003), use of statins (P = 0.001), and being advised to use aspirin (P = 0.041), were significantly associated with aspirin use in T2DM patients. CONCLUSION: There was a significant difference in the proportion of patients currently on aspirin as prescribed by their physicians and those eligible for aspirin therapy as per the Aspirin-Guide app. The use of an app to uniformized aspirin use among eligible patients should be based on up-to-date guidelines and account for patient acceptability and willingness to commence treatment.

Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes.

BACKGROUND: Pre-gestational diabetes mellitus is associated with increased risk of maternal and perinatal adverse outcomes. This systematic review was conducted to evaluate the effectiveness and safety of pre-conception care (PCC) in improving maternal and perinatal outcomes. METHODS: Databases from MEDLINE, EMBASE, WEB OF SCIENCE, and Cochrane Library were searched, including the CENTRAL register of controlled trials, and CINHAL up until March 2019, without any language restrictions, for any pre-pregnancy care aiming at health promotion, glycemic control, and screening and treatment of diabetes complications in women with type I or type II pre-gestational diabetes. Trials and observational studies were included in the review. Newcastle-Ottawa scale and the Cochrane collaboration methodology for data synthesis and analysis were used, along with the GRADE tool to evaluate the body of evidence. RESULTS: The search identified 8500 potentially relevant citations of which 40 reports of 36 studies were included. The meta-analysis results show that PCC reduced congenital malformations risk by 71%, (Risk ratio (RR) 0.29; 95% CI: 0.21-0.40, 25 studies; 5903 women; high-certainty evidence). The results also show that PCC may lower HbA1c in the first trimester of pregnancy by an average of 1.27% (Mean difference (MD) 1.27; 95% CI: 1.33-1.22; 4927 women; 24 studies, moderate-certainty evidence). Furthermore, the results suggest that PCC may lead to a slight reduction in the risk of preterm delivery of 15%, (RR 0.85; 95% CI: 0.73-0.99; nine studies, 2414 women; moderate-certainty evidence). Moreover, PCC may result in risk reduction of perinatal mortality by 54%, (RR 0.46; 95% CI: 0.30-0.73; ten studies; 3071 women; moderate-certainty evidence). There is uncertainty about the effects of PCC on the early booking for antenatal care (MD 1.31; 95% CI: 1.40-1.23; five studies, 1081 women; very low-certainty evidence) and maternal hypoglycemia in the first trimester, (RR 1.38; 95% CI: 1.07-1.79; three studies; 686 women; very low- certainty evidence). In addition, results of the meta-analysis indicate that PCC may lead to 48% reduction in the risk of small for gestational age (SGA) (RR 0.52; 95% CI: 0.37-0.75; six studies, 2261 women; moderate-certainty evidence). PCC may reduce the risk of neonatal admission to intensive care unit (NICU) by 25% (RR 0.75; 95% CI: 0.67-0.84; four studies; 1322 women; moderate-certainty evidence). However, PCC may have little or no effect in reducing the cesarean section rate (RR 1.02; 95% CI: 0.96-1.07; 14 studies; 3641 women; low-certainty evidence); miscarriage rate (RR 0.86; 95% CI: 0.70-1.06; 11 studies; 2698 women; low-certainty evidence); macrosomia rate (RR 1.06; 95% CI: 0.97-1.15; nine studies; 2787 women, low-certainty evidence); neonatal hypoglycemia (RR 0.93; 95% CI: 0.74-1.18; five studies; 880 women; low-certainty evidence); respiratory distress syndrome (RR 0.78; 95% CI: 0.47-1.29; four studies; 466 women; very low-certainty evidence); or shoulder dystocia (RR 0.28; 95% CI: 0.07-1.12; 2 studies; 530 women; very low-certainty evidence). CONCLUSION: PCC for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations. In addition, it may improve the risk of preterm delivery and admission to NICU. PCC probably reduces maternal HbA1C in the first trimester of pregnancy, perinatal mortality and SGA. There is uncertainty regarding the effects of PCC on early booking for antenatal care or maternal hypoglycemia during the first trimester of pregnancy. PCC has little or no effect on other maternal and perinatal outcomes.