Gender Differences in Prevalence of Sleepy Driving Among Young Drivers in Saudi Arabia.

Introduction: Sleepy driving is associated with Motor Vehicles Accidents (MVAs). In Saudi Arabia, previous studies have addressed this association among men only. Therefore, the aim of this study was to compare the prevalence of sleepy driving and associated factors between genders. Methods: In a cross-sectional study design, we offered a self-administered online questionnaire to 3272 participants from different regions of Saudi Arabia. The questionnaire included 46 questions covering sociodemographics, driving habits, sleeping habits, Epworth Sleepiness Scale, and Berlin questionnaire to assess the risk of sleep apnea. Univariable and multivariable logistic regression analyses were used to determine the significant factors associated with self-reported sleepy driving, defined as operating a motor vehicle while feeling sleepy in the preceding six months. Results: Of the 3272 invitees, 2958 (90%) completed the questionnaire, of which 1414 (48%) were women. The prevalence of sleepy driving in the preceding six months was 42% (men: 50% and women 32%, p<0.001). Specifically, participants reported the following: 12% had had to stop their vehicle due to sleepiness (men: 16.2% and women 7%, p<0.001), 12.4% reported near-miss accidents (men: 16.2% and women: 8.2%, p<0.001) and 4.2% reported an accident due to sleepiness (men: 4.3% and women: 4%, p=0.645). In multivariable analysis, being male, younger age, use of any type of medications, shift working, working more than 12 hours per day, driving duration of 3-5 hours per day, driving experience of more than 2 years, excessive daytime sleepiness and risk of having obstructive sleep apnea were all associated with increased likelihood of falling asleep while driving in the preceding 6 months. Conclusion: Sleepy driving and MVA are prevalent in both gender but was higher in men. Future public health initiatives should particularly focus on men, since men reported a greater likelihood of both sleep-related MVA and "near miss" events.

Preoperative Patient Education: Perceptions and Actual Practice among Nurses Working in Surgical Units.

Introduction: Preoperative education is an essential nursing task that can be affected by the nurses' perception. Patients may be receiving insufficient vital information before surgery. However, the essential information that should be provided to patients undergoing surgery is not fully addressed. Objective: To assess the essential elements of preoperative information as perceived by the surgical nurses. Methods: This was a cross-sectional study. A convenience sample of 224 registered nurses who were working at surgical units was recruited from two hospitals. A preoperative teaching questionnaire was used. Results: Details about the operation (4.39 ± 0.61) and preoperative preparation (4.36 ± 0.61) were the most important domains of preoperative education as perceived by nurses. The results show significant differences between the perceived and actual preoperative educational practice across all domains except the preoperative preparation. Conclusions: The delivery of preoperative education could be affected by nurses' perceptions. Efforts to facilitate the implementation of effective education as perceived by nurses should be conducted by minimizing potential barriers.

Exploring the Needs of Patients Undergoing Hemodialysis: A Qualitative Study.

BACKGROUND:  Many studies have focused on patients' experiences living with hemodialysis therapy; however, there is little research exploring their needs. Therefore, the purpose of this study was to explore hemodialysis patients' needs in Saudi Arabia. METHODS: A qualitative research design with semi-structured interviews was used. Data were collected from Aghrass Medical Center, Jeddah, Saudi Arabia. Data were analyzed using thematic analysis. RESULTS: A total of 16 hemodialysis patients underwent in-depth interviews. The mean age of the participants was 49 ± 14.93 years of age. More than half of the participants were male (56.25%), and most of them were married (75%). Regarding the clinical characteristics, all patients had three sessions in a week, and the average duration was four hours per session. The mean number of years on dialysis therapy was 3.80 ± 2.8. Using thematic analysis, four themes emerged. These were the impact of fatigue and need for fatigue self-management, need for family and social support, psychological and emotional support from healthcare professionals, and changes in the patients' role performance and their need for adaptation.  Conclusions: This study highlights the aspects of needs among hemodialysis patients from their own perspective. Four themes of needs emerged from this study. Consequently, healthcare professionals should assess patients' needs frequently to ensure high-quality care.

Depression, sleep disturbance, and quality of life in patients undergoing dialysis therapy.

AIMS: To examine the association between depression, excessive daytime sleepiness (EDS), and quality of life (QOL) in patients undergoing dialysis. BACKGROUND: Sleep disturbance and depression are highly prevalent symptoms in patients on dialysis and are associated with poor clinical outcomes. Nevertheless, the complex association between EDS and depression in patients on dialysis and the determination of which of the two has a greater impact on QOL are not well documented. METHODS: This study used a correlational cross-sectional design. A convenience sample of 180 patients on dialysis was surveyed using the Beck Depression Inventory-II (BDI-II), Epworth Sleepiness Scale (ESS), and the short version of the Kidney Disease Quality of Life. Multiple regression analyses were performed to assess the predictors of QOL. RESULTS: The overall mean total QOL score was 52.13 ± 19.22. The mean scores of depression and EDS were 16.36 ± 9.95 and 7.544 ± 531, respectively. Considering cut-off scores of ≥11 for BDI-II and ≥10 for ESS, 5.6 % of the participants had depression and 32.2 % had EDS. Depression was independently associated with a lower QOL score (r = -0.57, p < 0.001). The model showed a 38 % variation in the total QOL score. CONCLUSIONS: Depression and EDS were high among patients on dialysis, and depression was the main predictor of QOL. Screening for these unpleasant symptoms using brief and proven methods should be included in the standard clinical practice.

The Effect of Social Isolation Types on Quality of Life during the Coronavirus Disease 2019 Pandemic in Saudi Arabia: A Cross-Sectional Study.

COVID-19 has caused a global pandemic that has spread rapidly to six continents, with over 2.5 million deaths from December 2019 to March 2021. The number of confirmed COVID-19 cases is still growing worldwide, and quarantines have been recommended to prevent the disease's spread. However, quarantines affect people's quality of life (QOL). The aim of this study is to assess the effect of social isolation-quarantine-on QOL during the first wave of the COVID-19 pandemic in Saudi Arabia. A cross-sectional, descriptive design was used in the present study. We obtained data from an online survey conducted in Saudi Arabia. We included a convenience sample of 775 participants in the study. Most of the participants were female (67%), with a mean age of 46 years ranging from 18 to 75 years. Many participants were government employees (n = 308, 39.7%) and had a bachelor's degree or greater (n = 513, 66.2%). Most of the participants (n = 629, 81%) were free from any chronic disease. Nearly 88% of participants were partially isolated socially owing to COVID-19. Concerning QOL, the means of both the Physical Health Composite Scale and the Mental Health Composite Scale SF-12 scores were 44.7 and 34.6, respectively. Furthermore, the results demonstrate that partially socially isolated participants appeared to have significantly better physical health statuses (M = 44.96, SD = 5.90) than completely socially isolated participants (M = 42.87 ± 7.26). There was no significant social isolation effect on mental health status (t (773) = 2.5, p = 0.115). Social isolation during the COVID-19 pandemic considerably influenced various aspects of QOL including physical and mental health. Community-based interventions such as online counseling services and wellness programs are required to reduce the pandemic's negative impact and enhance overall health status and QOL.

Factors Influencing Self-Management among Non-Dialysis Chronic Kidney Disease Patients.

Aim: The new trend in the management of chronic kidney disease (CKD) is based on the adoption of self-management approaches. However, there is a paucity of research assessing the level of self-management behavior among non-dialysis patients. The aim of the study is to assess the association between self-management behaviors and the level of disease-specific knowledge among non-dialysis CKD patients. In addition, this study aimed to assess the predictors of self-management among non-CKD patients. Methods: A convenience sample of 203 non-dialysis patients with stage 3−5 CKD was surveyed from the nephrology clinics in Saudi Arabia. Descriptive statistics and linear regression were used to analyze the data. Results: The mean level of knowledge and self-management was 17.9 ± 3.2 and 76.9 ± 13.3, respectively. The results of the multiple regression of self-management showed that knowledge was independently associated with self-management (r = 0.51, **, p < 0.001). Conclusions: This study demonstrated that knowledge and self-management were associated with each other in non-dialysis patients. More efforts are needed to track and enhance the knowledge levels in patients with CKD. Future research should focus on the effectiveness of educational programs of self-management behavior.

A Cross-sectional Study of Depression among Non-dialysis Stage 3-5 Chronic Kidney Disease Patients.

Depression is common among patients undergoing dialysis. However, there is a dearth of data on depression and its predictors among patients at different stages of chronic kidney disease (CKD). This study assessed the prevalence of depression and the relationships between depression and sociodemographic and clinical factors among non-dialysis CKD patients. A convenience sample of 88 CKD patients was recruited using a cross-sectional study design. The Beck Depression Inventory-II (BDI-II) was used to assess the levels of depression among CKD patients, with a cutoff score of ≥11. Data on the sociodemographic factors and clinical factors were also collected. Inferential statistics were used to determine the characteristics of the sample and assess the prevalence and severity of depression. Multiple regression analysis was used to assess the associations between the characteristics of the sample and depression. The overall mean BDI-II score was 6.23 ± 6.13. With a cutoff score of ≥11, patients with major depressive episodes constituted 18.2% of the sample. Stages of the disease, comorbidities, and sex were independently associated with a high depression score. The model explained 39% of the variation in the depression score. Depression is common among non-dialysis CKD patients. Screening for depression with brief validated tools should be integrated into routine clinical practice at renal clinics because patients in the advanced stages of CKD and those with multiple comorbidities require close attention. Furthermore, large studies assessing the prevalence and predictors of depression among different stages of CKD are required.

Impact of anxiety and depression on the quality of life of haemodialysis patients.

AIMS AND OBJECTIVES: This study aimed to assess the impact of anxiety and depression on the quality of life (QOL) of haemodialysis patients. BACKGROUND: The growing number of people undergoing haemodialysis therapy on a global scale is becoming a universal concern. Although haemodialysis treatment is known to affect one's psychological well-being, the impact of depression and anxiety on one's QOL has not been well addressed. DESIGN: A correlational cross-sectional design. METHODS: A convenience sample of 114 patients who had been undergoing haemodialysis therapy participated in this study. The research methods used complied with the STROBE checklist. Data were collected using the Kidney Disease and Quality of Life Survey-36 and the Hospital Anxiety and Depression Scale. Descriptive and inferential statistics were used. The association between the KDQOL, anxiety and depression based on the characteristics of participants was investigated using an independent t test and one-way analysis of variance. RESULTS: The mean anxiety score of the participants was 7.7 ± 5.3, while the mean score for depression was 7.01 ± 4.2. Based on the cut-off points, 50% of the participants had anxiety, 44.7% depression. There were negative correlations between anxiety and QOL (r = -0.599, p < 0.001) and between depression and QOL (r = -.599, p < .001). The burden of the disease and physical component scores were mostly affected by both anxiety and depression. CONCLUSIONS: Anxiety and depression are common symptoms among patients undergoing haemodialysis, and they have a negative impact on all domains of the QOL. Early detection and treatment of anxiety and depression may have a positive impact on disease outcomes. RELEVANCE TO CLINICAL PRACTICE: The findings of the current study support the need to adopt effective strategies to improve screening for anxiety and depression. The detection of high physical symptom burden should draw attention to potential psychological issues.

Evaluating Self-Efficacy among Patients Undergoing Dialysis Therapy.

(1) Background: Perceived disease-related self-efficacy is considered a fundamental component of the successful self-management of chronic diseases. Prior studies have found that self-efficacy is associated with improvements in health behaviors and health status among people with chronic kidney disease (CKD). However, few studies have evaluated self-efficacy among patients undergoing dialysis. (2) Methods: This study was performed to evaluate CKD patients' self-efficacy and to determine the factors that significantly affect self-efficacy among dialysis patients. This was a cross-sectional study using a convenience sample of 190 patients undergoing dialysis. The patients' self-efficacy was measured using the CKD Self-Efficacy Scale. Inferential statistics were used to analyze the data. (3) Results: The mean age of the participants was 49.24 ± 13.15 years. Almost half of them were males (48.4%), and 75.3% were married. The majority of the patients (83%) were undergoing hemodialysis. The total score for self-efficacy was 192.57 ± 39.23. Only occupational status and the type of dialysis were significantly and positively correlated with patients' perceived self-efficacy scores. (4) Conclusions: This study provides primary evidence of the perceived self-efficacy among CKD patients who are on dialysis. The results of this cross-sectional study showed that greater self-efficacy was associated with employment and peritoneal dialysis. Strategies to enhance self-efficacy among dialysis patients, especially those on hemodialysis, are needed.

Translation, Adaptation, and Validation of Chronic Kidney Disease Self-Management and Knowledge Instruments for People at Pre-Dialysis Stage in the Arab World.

Knowledge is critical for self- management, however there are no measures available in Arabic to effectively assess knowledge and self-management for chronic kidney disease (CKD). The aim of this study was to translate, culturally adapt, and validate Chronic Kidney Disease Self-Management Instrument-29 (CKD-SM-29) and Kidney Disease Knowledge survey (KiKs) for use by Arabic-speaking health professionals and patients. The study was carried out in two phases: translation and cultural adaptation, and validation. Instruments were translated from English to Arabic then adapted and validated using 203 pre-dialysis CKD patients. Face validity and internal consistency were demonstrated for Arabic versions of CKD-SM-29 and KiKs. Cronbach's α for the CKD-SM-29 was .91 for KiKS was .78. Test-retest revealed good stability over a 1-week period. Intra Class Correlation coefficient for CKD-SM-29 was .90 and was .78 for KiKS. Convergent and discriminative validity were also demonstrated for the translated instruments. The validity and reliability of the Arabic CKD-SM-29 and KiKs were demonstrated. The translated instruments are culturally adapted and will support care of patients with CKD in Arabic-speaking countries.

Assessment of kidney disease knowledge among chronic kidney disease patients in the Kingdom of Saudi Arabia.

BACKGROUND: The persistent global increase in chronic kidney disease (CKD) prevalence highlights the importance of providing patients with sufficient knowledge to allow them to self-manage their disease. OBJECTIVES: To gain insights into non-dialysis CKD patients' knowledge of their disease, and assess associations between knowledge and sample characteristics. DESIGN: A descriptive cross-sectional design was undertaken. PARTICIPANTS: A convenience sample of 203 stages 3-5 CKD patients was recruited. MEASUREMENTS: The Kidney Disease Knowledge Survey (KiKs) was used. RESULTS: This study revealed that the mean age of the patients was 47.34 years. 50.2% were male and most (75.9%) were married. The mean score of knowledge (measured using KiKs) relating to kidney disease was 17.87 ± 3.212. The lowest scores were related to knowledge of effects of proteinuria (13.3%), meanings of "glomerular filtration rate" (29.6%) and "targeted blood pressure" (31.5%). Although more than 60% of participants knew about some kidney functions, they misunderstood others, including those related to glucose control (23.6%) and blood pressure (54.7%). Patients displayed knowledge scores >70% for five other areas, including disease stage and time since diagnosis. Almost all participants did not know that chronic kidney disease (CKD) could be asymptomatic. The results showed that late-stage CKD (Stages 4 and 5) and longer time since diagnosis of CKD were independently associated with a higher score of knowledge (r = 0.18, p = 0.017; r = 0.41, p < 0.001; r = 0.26, p = 0.001, respectively). CONCLUSIONS: This study provided initial insights on CKD-related knowledge among patients with Stage 3-5 CKD in the Kingdom of Saudi Arabia. Many gaps in knowledge were identified, especially those relating to blood pressure. More studies are required to fully understand the extent of the knowledge deficit in the wider population; however, these findings will allow nurses to address significant gaps.

Quality of Life of Patients with Chronic Kidney Disease: A Comparative Study between Nondialysis and Dialysis Patients.

Quality of life (QOL) in patients with chronic diseases has become an important measure to evaluate patient outcomes. However, there is a lack of evidence regarding QOL and its determinants among patients at different stages of chronic kidney disease (CKD). The aim of this study was to compare the QOL between nondialysis patients and those who commenced dialysis treatment and to determine the predictors of QOL. Sample of 436 CKD patients was recruited from three hospitals in this cross-sectional study. The Kidney Disease Quality of Life short version-36™ was used to assess QOL among CKD patients. Demographic and clinical characteristics were also collected. The descriptive statistics were conducted for the whole sample and then for each CKD group. Multiple regression analysis was used to assess associations between the sample characteristics and QOL. The overall mean of QOL was 58.08 ± 20.04. The QOL score was worse among the dialysis group than the non-dialysis (53.47 ± 18.66 vs. 72.28 ± 17.35). Results show significant differences between the two groups for each domain of QOL. The most affected domain was physical function. Dialysis treatment, older age, male gender, and lower education levels were independently associated with lower score of QOL. The model explained 29% of the variation in the total QOL score. QOL in CKD is low. The results underscore the significance of paying more attention to older patients who are on dialysis therapy and have a lower education level. Consideration of these factors will help clinicians to identify at an early stage those patients who are at risk of experiencing a lower QOL and assist in planning appropriate interventions.

Psychometric properties of factors influencing Healthcare Career Choice Scale.

Aim: The aim of this paper was to modify Factors Influencing Teaching Choice scale (FIT-Choice scale) to be appropriate for healthcare professionals and to assess the psychometric properties of the modified scale. Design: A cross-sectional study was used. Methods: A convenience sample of 395 students at the preparatory stage of their health path participated in study to evaluate the psychometric properties of "Healthcare Career Choice Scale" (HCC Scale). The study involves two phases: instrument modification and psychometric evaluation. Results: The content validity index was 0.88. Using factor analysis, 12 factors were extracted and explained 71.8% of the total variance. The internal consistency was demonstrated with Cronbach's α = .91.

Factors associated with exercise self-efficacy among people with chronic diseases.

AIM: The aim of this study is to assess the level of exercise self-efficacy in a population with chronic diseases and identify the factors that could influence exercise self-efficacy. BACKGROUND: Performing physical exercise is an important part of self-care in chronic diseases. It is highly influenced by individual's self- efficacy. However, little attention has been given to the identification of the factors that could affect the exercise self-efficacy among people with chronic diseases. METHODS: This cross-sectional study was conducted to assess the exercise self-efficacy among people with chronic diseases using the Exercise Self-Efficacy Scale (ESE). Demographic and exercise profiles were also collected. RESULTS: A total of eighty-five people with chronic diseases from outpatients' clinics participated in this study. The mean age of the participants was 52 ± 13.92 and more than half of them were females (58.8%). The mean score of exercise self-efficacy was 39 ± 21.55. Education level was the main factor that correlated with lower levels of exercise self-efficacy. CONCLUSIONS: This study is first to provide preliminary evidence about levels of exercise self-efficacy and its associated factors among people with chronic diseases in Saudi Arabia. The level of exercise self-efficacy is low in people with chronic diseases and this mainly associated with educational factor. Nurses have an important role to promoting exercise self-efficacy through implementing a comprehensive plan that is patient's centered approach. However, further research is needed to assess perception, detect barriers and conduct intervention that aims to improve exercise Self-efficacy.

Towards a symptom cluster model in chronic kidney disease: A structural equation approach.

AIMS: The aim of this study was to test a symptom cluster model in chronic kidney disease patients based on the Theory of Unpleasant Symptoms, accounting for the relationships between influencing factors, symptom experience and consequences for quality of life. BACKGROUND: The evaluation of symptom clusters is a new field of scientific inquiry directed towards more focused symptom management. Yet, little is known about relationships between symptom clusters, predictors and the synergistic effect of multiple symptoms on outcomes. DESIGN: Cross-sectional. METHODS: Data were collected from 436 patients with advanced stages of chronic kidney disease during July 2013-February 2014 using validated measures of symptom burden and quality of life. Analysis involved structural equation modelling. RESULTS: The final model demonstrated good fit with the data and provided strong evidence for the predicted relationships. Psychological distress, stage of chronic kidney disease and age explained most of the variance in symptom experience. Symptom clusters had a strong negative effect on quality of life, with fatigue, sexual symptoms and restless legs being the strongest predictors. Overall, the model explained more than half of the deterioration in quality of life. However, a reciprocal path between quality of life and symptom experience was not found. CONCLUSIONS: Interventions targeting symptom clusters could greatly improve quality of life in patients with chronic kidney disease. The symptom cluster model presented has important clinical and heuristic implications, serving as a framework to encourage and guide new lines of intervention research to reduce symptom burden in chronic kidney disease.

Multidimensional symptom clusters: an exploratory factor analysis in advanced chronic kidney disease.

AIMS: To explore the existence of symptom clusters in advanced chronic kidney disease. BACKGROUND: People with chronic kidney disease commonly report multiple symptoms. However, the complex relationships among these symptoms are still poorly understood. DESIGN: Cross-sectional. METHODS: A total of 436 people with stage 4 and 5 chronic kidney disease were recruited from three tertiary hospitals during 2013-2014. Participants completed the Chronic Kidney Disease-Symptom Burden Index that assesses four symptom dimensions (occurrence, distress, severity and frequency) of 32 symptoms. Exploratory factor analysis was used to identify symptom clusters across each symptom dimension. Core symptoms in each cluster were determined based on stability across dimensions and clinical plausibility. A high cutoff of 0·50 for factor loading was used for all analyses. RESULTS: Five symptom clusters were consistently identified across all symptom dimensions: fluid volume symptoms, neuromuscular symptoms, gastrointestinal symptoms, sexual symptoms and psychological symptoms. Overall, clusters ranged from 2-10 symptoms. Several symptoms were also interconnected with multiple clusters. Fatigue cross-loaded on all five clusters, whereas sleep disturbance and restless leg symptoms cross-loaded across three clusters. CONCLUSIONS: Adopting a symptom cluster approach has the potential to significantly advance symptom assessment and nursing care for people in advanced stages of chronic kidney disease. Routine clinical assessment and management strategies targeted at the cluster level should have synergistic effects in reducing symptoms. Fatigue is a pervasive symptom in advanced chronic kidney disease that is interconnected with global symptom burden, suggesting better management of symptom clusters may also reduce fatigue.

WHICH PATIENTS WITH CHRONIC KIDNEY DISEASE HAVE THE GREATEST SYMPTOM BURDEN? A COMPARATIVE STUDY OF ADVANCED CKD STAGE AND DIALYSIS MODALITY.

BACKGROUND: Chronic kidney disease (CKD) leads to a range of symptoms, which are often under-recognised and little is known about the multidimensional symptom experience in advanced CKD. OBJECTIVES: To examine (1) symptom burden at CKD stages 4 and 5, and dialysis modalities, and (2) demographic and renal history correlates of symptom burden. METHODS: Using a cross-sectional design, a convenience sample of 436 people with CKD was recruited from three hospitals. The CKD Symptom Burden Index (CKD-SBI) was used to measure the prevalence, severity, distress and frequency of 32 symptoms. Demographic and renal history data were also collected. RESULTS: Of the sample, 75.5 % were receiving dialysis (haemodialysis, n = 287; peritoneal dialysis, n = 42) and 24.5 % were not undergoing dialysis (stage 4, n = 69; stage 5, n = 38). Participants reported an average of 13.01 ± 7.67 symptoms. Fatigue and pain were common and burdensome across all symptom dimensions. While approximately one-third experienced sexual symptoms, when reported these symptoms were frequent, severe and distressing. Haemodialysis, older age and being female were independently associated with greater symptom burden. CONCLUSIONS: In CKD, symptom burden is better understood when capturing the multidimensional aspects of a range of physical and psychological symptoms. Fatigue, pain and sexual dysfunction are key contributors to symptom burden, and these symptoms are often under-recognised and warrant routine assessment. The CKD-SBI offers a valuable tool for renal clinicians to assess symptom burden, leading to the commencement of timely and appropriate interventions.

Arabic translation, adaptation and modification of the Dialysis Symptom Index for chronic kidney disease stages four and five.

BACKGROUND: Symptom burden in chronic kidney disease (CKD) is poorly understood. To date, the majority of research focuses on single symptoms and there is a lack of suitable multidimensional symptom measures. The purpose of this study was to modify, translate, cross-culturally adapt and psychometrically analyse the Dialysis Symptom Index (DSI). METHODS: The study methods involved four phases: modification, translation, pilot-testing with a bilingual non-CKD sample and then psychometric testing with the target population. Content validity was assessed using an expert panel. Inter-rater agreement, test-retest reliability and Cronbach's alpha coefficient were calculated to demonstrate reliability of the modified DSI. Discriminative and convergent validity were assessed to demonstrate construct validity. RESULTS: Content validity index during translation was 0.98. In the pilot study with 25 bilingual students a moderate to perfect agreement (Kappa statistic = 0.60-1.00) was found between English and Arabic versions of the modified DSI. The main study recruited 433 patients CKD with stages 4 and 5. The modified DSI was able to discriminate between non-dialysis and dialysis groups (p < 0.001) and demonstrated convergent validity with domains of the Kidney Disease Quality of Life short form. Excellent test-retest and internal consistency (Cronbach's α = 0.91) reliability were also demonstrated. CONCLUSION: The Arabic version of the modified DSI demonstrated good psychometric properties, measures the multidimensional nature of symptoms and can be used to assess symptom burden at different stages of CKD. The modified instrument, renamed the CKD Symptom Burden Index (CKD-SBI), should encourage greater clinical and research attention to symptom burden in CKD.

Symptom burden in chronic kidney disease: a review of recent literature.

BACKGROUND: People living with chronic kidney disease (CKD) experience multiple symptoms due to both the disease and its treatment. However, these symptoms are often underrecognised. In addition, the majority of studies have focused on an individual symptom; however, these symptoms rarely occur in isolation and may instead occur in clusters. AIM OF REVIEW: To investigate the total symptom burden in advanced CKD (Stages 4 and 5) and to identify the key instruments that are used to assess multiple symptoms. METHODS: A literature search from 2006 to 2012 was undertaken and a total of 19 articles were included. RESULTS: The most common CKD symptoms were fatigue or lack of energy, feeling drowsy, pain and pruritus. However, symptom assessment instruments varied between studies, often with inconsistent or inadequate symptom dimensions. CONCLUSION: People with CKD experience a high symptom burden, although little is known about the burden for people with CKD Stage 4 and for those with CKD Stage 5 receiving peritoneal dialysis. This review recommends that a full range of symptoms be assessed for those at different stages of CKD. Improved understanding of the burden of symptoms can be used as the basis for treatment choices and for identifying priorities which are likely to contribute to a better quality of life and improve the quality of care.

Nurses' willingness to report medication administration errors in Saudi Arabia.

Reporting of medication administration errors (MAEs) is one means by which health care facilities monitor their practice in an attempt to maintain the safest patient environment. This study examined the likelihood of registered nurses (RNs) reporting MAEs when working in Saudi Arabia. It also attempted to identify potential barriers in the reporting of MAE. This study found that 63% of RNs raised concerns about reporting of MAEs in Saudi Arabia-nursing administration was the largest impediment affecting nurses' willingness to report MAEs. Changing attitude to a non-blame system and implementation of anonymous reporting systems may encourage a greater reporting of MAEs.