Physicians and nurses' knowledge and attitudes towards advance directives for cancer patients in Saudi Arabia.

This study aimed to investigate physicians' and nurses' knowledge and attitudes toward advance directives (ADs) for cancer patients, which empower patients to take decisions on end-of-life needs if they lose their capacity to make medical decisions. A cross-sectional study was conducted using convenience sampling. The outcomes were responses to the knowledge and attitude questions, and the main outcome variables were the total scores for knowledge and attitudes toward ADs. This study included 281 physicians and nurses (60.5%). Most physicians were men (95, 80.5%), whereas most nurses were women (147, 86.5%). The mean (standard deviation; SD) total knowledge score was 6.8 (4.0) for physicians and 9.1 (3.0) for nurses (p < 0.001). There was a significant difference in the total knowledge score between nurses and physicians, with an adjusted mean difference of 1.54 (95% confidence interval [CI]; 0.08-2.97). Other significant independent predictors of knowledge of ADs were female sex (1.60, 95% CI; 0.27-3.13) and education level (master's versus bachelor's: 1.26, 95% CI; 0.30-2.33 and Ph.D. versus bachelor's: 2.22, 95% CI; 0.16-4.52). Nurses' attitudes appeared to be significantly more positive than those of physicians, and the mean total attitude score (SD) was 19.5 for nurses (6.2) and 15.1 (8.1) for physicians (p < 0.001). The adjusted mean difference (95% CI) for nurses versus physicians was 3.71 (0.57-6.98). All participants showed a high level of knowledge of ADs; however, nurses showed considerably more positive attitudes than physicians.

Quality of nursing work life and turnover intention among nurses of tertiary care hospitals in Riyadh: a cross-sectional survey.

BACKGROUND: Nurse turnover has a negative impact on the ability to meet patient needs and provide a high quality of care, which may create more stress on other staff due to increased workloads. This can lead to critical changes in the behavior of nurses towards their jobs resulting in low work satisfaction, low productivity, and leaving the organization. Thus, this study aimed to assess the quality of nursing work life (QNWL), to explore the nurses' turnover intention and to examine the correlation between QNWL and nurses' turnover intention. METHODS: A cross-sectional survey was conducted on nurses with at least 1 year of nursing experience at two hospitals selected randomly from Riyadh, Saudi Arabia: King Fahad Medical City and King Faisal Specialized Hospitals. Data were collected using a self-administered questionnaire comprising four sections (Brooks' survey of QNWL, Anticipated Turnover Scale (ATS), open-ended questions and demographic characteristics). RESULTS: A sample of 364 nurses was recruited. Results proposed that the participants were dissatisfied with their work life (54.7%), with almost 94% indicating a turnover intention from their current hospital. Moreover, 154 (93.3%) out of 165 nurses who reported satisfaction with QNWL indicated the intention to turnover. The correlation between QNWL and ATS for binary variables was too week (r = - 0.024) and statistically not significant (p = 0.206). CONCLUSION: The QNWL and nurse turnover are challenging issues for healthcare organizations because of its consequences and impact on patient care. Our study provided critical findings low indication satisfaction of nurses with their QNWL and a high turnover intention. The results of this study could be used as a nexus for the development of regulations and practical strategies to enhance QNWL and to decrease the turnover.

Knowledge, attitudes, practices and perceptions of clinicians towards conducting clinical trials in an Academic Tertiary Care Center.

OBJECTIVES: To investigate the knowledge, attitudes practices and perceptions of clinicians concerning the conducting of clinical trials (CTs).  Methods: A cross-sectional study was conducted on clinicians at King Fahad Medical City, Riyadh, Saudi Arabia. Data were collected using a self-administered questionnaire which divided into 5 sections: Section 1 covered respondents' demographics. The other 4 sections explored respondents' knowledge, attitudes, perceptions and practice towards conducting CTs.  Results: A total of 316 clinicians completed the questionnaire. The majority were assistant consultants and consultants 125 (39.5%) and 108 (34.2%), respectively. One hundred sixty-nine (56%) respondents were not aware of the Declaration of Helsinki at all. Two hundred seventy-five (88.4%) respondents expressed interest in conducting CTs and 61.7% and participants showed their willingness to facilitate and assist in CTs conducted by other clinicians. Moreover, 112 (35.9%) respondents participated in CTs previously. Regarding the disadvantages in conducting CTs, participants indicated that the paperwork was complicated and they believed that they might lose patients from their clinical practice once they are recruited in CTs. Lack of research protected time for clinicians 295 (97.7%), and a shortage of clinical research coordinators 293 (97%) were the main problems reported by respondents.  Conclusions: Although the majority of participants had an unsatisfactory level of knowledge and misperceptions about CTs, they showed an interest in and positive attitudes about conducting CTs.

Characteristics of Neonatal Pneumothorax in Saudi Arabia: Three Years' Experience.

OBJECTIVES: To identify the incidence, clinical characteristics, predisposing factors, morbidity, and mortality among hospitalized neonates with pneumothorax. METHODS: The records of 2 204 infants admitted to the neonatal intensive care unit at King Fahad Medical City, Saudi Arabia, between 2011 and 2014 were reviewed. All newborns hospitalized in the neonatal intensive care unit with pneumothorax were included in the study. Participants were evaluated for baseline characteristics, predisposing factors of neonatal pneumothorax (NP), accompanying disorders, and mortality. RESULTS: Pneumothorax was diagnosed in 86 patients, with an incidence of 3.9%. The most common predisposing factors of NP were bag mask ventilation, followed by hypoplastic lung disease, and mechanical ventilation. Twenty-five (29.1%) newborns with pneumothorax died. The most common accompanying disorder was premature rupture of membrane. On multivariate analysis, pulmonary hemorrhage, a birth weight < 2 500 g, and low Apgar score (< 7) at one minute were independently associated with mortality. CONCLUSIONS: This study highlights the extent of NP problems among hospitalized neonates and the most common predisposing factors of NP.

Prevalence and predictors of physical exercise among nurses. A cross-sectional study.

OBJECTIVES: To identify the prevalence and predictors of physical exercise among nurses. Methods: This study was conducted at 2 hospitals selected randomly from tertiary hospitals in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia (KSA) and Makassed General Hospital, Beirut, Lebanon in 2014. The study included nurses with at least one year of nursing experience. Data were collected using a self-administered questionnaire. The questionnaire was divided into 2 sections, one covering the respondents' demographics, and the other one assessing the prevalence and the characteristics of physical exercise.  Results: A total of 412 participants responded, of whom 248 (60.2%) are engaged in physical exercise. On multivariate analysis, normal weight and smoking were independently associated with physical exercise. Most 66.1% of respondents reported practicing walking as the most common type of physical activity. One hundred eighty (72.6%) respondents relied on their own motivation to perform physical activity and 64.6% reported the lack of availability of physical activity facilities.  Conclusion: Smoking and obesity were the significant predictors associated with physical inactivity. Encouraging nurses to adopt a healthy lifestyle for their role modeling to patients as health promoters is recommended.

Parental Perceptions and Practices toward Childhood Asthma.

Introduction. Parental perceptions and practices are important for improving the asthma outcomes in children; indeed, evidence shows that parents of asthmatic children harbor considerable misperceptions of the disease. Objective. To investigate the perceptions and practices of parents toward asthma and its management in Saudi children. Methods. Using a self-administered questionnaire, a two-stage cross-sectional survey of parents of children aged between 3 and 15 years, was conducted from schools located in Riyadh province in central Saudi Arabia. Results. During the study interval, 2000 parents were asked to participate in the study; 1450 parents responded, of whom 600 (41.4%) reported that their children had asthma, dyspnea, or chest allergy (recurrent wheezing or coughing), while 478 (32.9%) of the parents reported that their children were diagnosed earlier with asthma by a physician. Therefore, the final statistical analyses were performed with 600 participants. Furthermore, 321 (53.5%) respondents believed that asthma is solely a hereditary disease. Interestingly, 361 (60.3%) were concerned about side effects of inhaled corticosteroids and 192 (32%) about the development of dependency on asthma medications. Almost 76% of parents had previously visited a pediatric emergency department during an asthma attack. Conclusions. Parents had misperceptions regarding asthma and exhibited ineffective practices in its management. Therefore, improving asthma care and compliance requires added parental education.

The Accuracy of Broselow Tape Weight Estimate among Pediatric Population.

Objective. To determine the accuracy of the Broselow Tape (BT) versions 2007 and 2011 in estimating weight among pediatric population. Methods. A cross-sectional study was conducted at King Fahad Medical City and six schools across Riyadh province on 1-143-month-old children. BT 2007 and 2011 estimated weights were recorded. Both tapes via the child's height produce an estimated weight, which was compared with the actual weight. Results. A total of 3537 children were recruited. The height (cm) of the subjects was 97.7 ± 24.1 and the actual weight (kg) was 16.07 ± 8.9, whereas the estimated weight determined by BT 2007 was 15.87 ± 7.56 and by BT 2011 was 16.38 ± 7.95. Across all the five age groups, correlation between actual weight and BT 2007 ranged between 0.702 and 0.788, while correlation between actual weight and BT 2011 ranged between 0.698 and 0.788. Correlation between BT 2007 and BT 2011 across all the five age groups ranged from 0.979 to 0.989. Accuracy of both the tape versions was adversely affected when age was >95 months and body weight was >26 kilograms. Conclusions. Our study showed that BT 2007 and 2011 provided accurate estimation of the body weight based on measured body height. However, 2011 version provided more precise estimate for weight.

Knowledge and attitudes of health professionals towards pressure ulcers at a rehabilitation hospital: a cross-sectional study.

BACKGROUND: Pressure ulcers are common conditions among hospitalized patients and impose substantial burden on patients and their caregivers. To assess the knowledge and attitudes of health professionals towards PUs prevention. METHODS: A cross-sectional study was performed in the rehabilitation hospital at King Fahad Medical City, Riyadh, Saudi Arabia in 2014. The study population consisted of nurses, physical therapists, occupational therapists, and physical medicine rehabilitation physicians who have a minimum of at least one year of clinical practice. The survey that was created for use in this study consisted of demographic characteristics, Pressure Ulcers Knowledge Test and Staff Attitude Scale. RESULTS: The survey was completed by 105 participants of the 120 total eligible staff. The mean knowledge score of correct answers from all participants was 34.1 ± 4.8 (71.5 %). Only 77(73.3 %) participants had a mean knowledge score of ≥ 70 %. The mean attitude score was 30.5 (56.5 %). The study revealed that age and profession factors had a significant relationship with participants' mean knowledge of PUs prevention (P < 0.001), (P < 0.001) respectively. Moreover, 101 (98.1 %) participants are concerned about PUs prevention in their practices. While, 11 (10.7 %) of participants believe that PUs prevention is a time consuming procedure. CONCLUSIONS: The present study assessed the current knowledge and attitudes of health professionals regarding PUs prevention in an acute rehabilitation hospital. The majority of participants had an average level of knowledge and exhibited unsatisfactory attitudes towards PUs prevention. Increased health professionals awareness may improve their attitudes towards PUs prevention.

Knowledge, Attitudes and Perceptions of Saudis towards Participating in Clinical Trials.

AIM: To assess the knowledge, attitudes, and perceptions of Saudis towards participating in clinical trials (CTs). METHODS: A cross-sectional study was conducted on 232 Saudi adult patients and their companions visiting adult outpatient clinics at King Fahad Medical City, Riyadh, Saudi Arabia. Data were collected using a self-administered questionnaire based on information obtained from the literature. The questionnaire was divided into four sections, one covering the respondents' demographics, and the other three assessing knowledge, attitudes, and perceptions towards participating in CTs. RESULTS: A total of 148 (63.8%) respondents were males, and 52 (22.4%) participants had been invited to participate in a CT previously. Of those, 39 (75%) participated. Knowledge about the essential elements of informed consent ranged from 55.7% (number of participants needed) to 85.7% (confidentiality of personal information). The majority (163, 73.8%) of respondents was willing to participate in a CT after consulting their family physician and 130 (58.0%) respondents would be motivated to participate in a CT if they were healthy. Only 36.8% of the respondents believed that patients who participated in a CT received the best care. Moreover, 110 (48.7%) respondents believed that research was conducted in a responsible and ethical manner. CONCLUSIONS: The present study assessed the current understanding of CTs among Saudi participants. Although the majority of participants had an acceptable level of knowledge about CTs, they exhibited conditional attitudes and misperceptions towards participating in a CT. Increased patient awareness may improve patients' attitudes towards ethical conduct of CTs.

Cervical thymic cyst in an adult.

Cervical thymic cysts (CTCs) are unusual lesions, representing only 1% of cystic cervical masses. Diagnosis of this condition in adults is even rarer. We report a 34-year-old female who presented with asymptomatic progressively growing left-sided neck swelling. Neck ultrasound (US) showed a large cystic lesion with septation, compressing the ipsilateral vessels. Magnetic resonance imaging (MRI) confirmed the US findings. Surgical excision was performed which subsequently showed findings consistent with CTC. CTC in adult is extremely rare, with few reported cases identified in the literature. Thymic gland anomalies in the neck are the consequences of an arrest in the descent of the gland, sequestration of the thymic tissue, or failure of involution. The diagnosis of this condition is rarely done prior to surgical excision. The clinical presentation, radiologic imaging, surgical findings, and histologic appearance are all essential components to make the correct diagnosis of this very rare differential diagnosis of cystic lateral neck swelling.

Asthma care practicing among general practitioners in Lebanon: a cross-sectional study.

OBJECTIVES: The aim of this study was to characterize the current practice of asthma among general practitioners (GPs) in Lebanon. METHODS: Out of 2450 Lebanese registered GPs, a representative sample of 330 were stratified by region to fill out the questionnaire constructed on the basis of surveys developed mainly by the Chicago Asthma Surveillance Initiative Report Team in newly moderate persistent asthma patients aged 5 years and above. The questionnaire included information about ascertaining diagnostic techniques, pharmacotherapeutic approaches, formal patient education program; asthma related continuing medical education and asthma practice guidelines. RESULTS: Totally, 302 completed the questionnaire achieving a response rate of 91.5%. Chest radiography was the most commonly used diagnostic test (98%), while stain for eosinophilia was the less commonly used (7.9%). For clinical monitoring, cough and wheezing (98.7%) were mostly assessed. Short acting inhaled ß2-agonists were often the most prescribed (94.3%) followed by inhaled corticosteroids (87.4%) then by long acting ß-agonist (LABA) and theophylline (27.5% and 20.9%, respectively). Moreover, 10% of GPs provided formal asthma education program, 72.2% attended professional education and 65% adopted guidelines. CONCLUSION: Based on current international guidelines, the overall Lebanese GPs practice of asthma management is not at an acceptable standard. Therefore, it is recommended to improve monitoring parameters, implement the asthma guidelines nationally and improve patient education.

Factors impacting job satisfaction among nurses from a tertiary care centre.

AIMS AND OBJECTIVES: To investigate the level of job satisfaction and the impact of personal characteristics and work environment on job satisfaction among nurses. BACKGROUND: Job satisfaction among nurses is of paramount importance to providers of health care because satisfied nurses appear to be endowed with the physical and emotional dexterity and the effort needed to perform their tasks that will enhance the quality of care provided to the patient. DESIGN: A cross-sectional survey. METHODS: The study included nurses of both genders with at least one year of nursing experience, serving in all shifts of various clinical settings (n = 178 nurses). A modified version of measure of nurses' job satisfaction, developed by Whitley and Putzier, was used to assess the effect of personal characteristics profile and work environment on job satisfaction. RESULTS: A total of 140 nurses were (response rate = 78·7%) entered into final data analysis. The study showed that 111 participants (79·3%) were significantly satisfied in their current jobs. Furthermore, 65 nurses (46·4%) were not satisfied with their salaries, and almost half the nurses were not pleased with the nurse/patient ratio, autonomy and enough time to discuss problems with staff. CONCLUSION: This study revealed that almost 50% of nurses are overworked, are unsatisfied with their salaries, and have limited autonomy and inadequate communication with superiors. Strategies must be formulated by hospital and government authorities to decrease workload and empower nurses in controlling their practice in order to retain nurses in their jobs. RELEVANCE TO CLINICAL PRACTICE: The management must provide positive leadership and understand the local issues that affect nurses in order to enhance retaining and avoid shortage. This can be reflected positively on nursing clinical practice and ultimately patient health status.

The efficacy of zinc supplementation in young children with acute lower respiratory infections: a randomized double-blind controlled trial.

BACKGROUND & AIM: Acute lower respiratory infections are the most frequent illnesses globally in children less than 5 years old. The aim of this randomized double blind controlled trial is to assess the effectiveness of zinc gluconate supplementation for 2 months period compared to placebo in reducing respiratory morbidity in acute lower respiratory infected children up to 5 years of age living in zinc poor population. METHODS: Children were randomly assigned to receive either 10 mg zinc gluconate or placebo for 60 days. Demographic and clinical data were collected at baseline and every two weeks for 180 days. RESULTS: The final analysis included 96 children allocated equally to the two groups. The number of episodes of acute lower respiratory infections and severe acute lower respiratory infections were significantly lower in zinc group compared to placebo group (20.8% vs. 45.8% (P = 0.009) and 21.7% vs. 58.3% (P < 0.001), respectively). The acute lower respiratory infections free days were higher in the zinc supplemented group (P < 0.001). The median recovery time of morbidity was significantly shorter in zinc group (P < 0.001). CONCLUSIONS: Zinc supplement may result in significant reduction in respiratory morbidity among children with acute lower respiratory infections in zinc poor population. This study was registered under ClinicalTrials.gov Identifier no. NCT00536133.