Hind Almodaimegh

Sickness presenteeism among health care providers in an academic tertiary care center in Riyadh

The term sickness presenteeism (SP) has been described as the act of going to work despite having a state of health that may be regarded as poor enough to justify sick leave. SP has been observed to be prevalent among three-quarters of health care providers (HCPs). Working while sick not only puts patients at risk but also decreases productivity and increases the probability of medical errors. Moreover, SP has been identified as a risk factor for many negative health outcomes among the HCPs themselves, such as depression, burnout, and serious cardiac events. The aim of this study was to identify the reasons for and prevalence of SP and perceptions of the impact of this practice on patient safety among HCPs. A cross-sectional study was conducted, including 279 purposively selected healthcare professionals (doctors, nurses, dentists, pharmacists and other health care professionals) working at the Ministry of National Guard Health Affairs-King Abdulaziz Medical City (MNGHA-KAMC). While nearly all of the participants (91%) believed that working while sick exposed patients to risk, the rate of SP during the past year was reported as 74%, and one fourth of respondents reported working while sick 3-4 times during the past year. More than half of the participants were not aware of the existence of a departmental policy regarding sick leave. The most common reasons reported for working while sick were not wanting to burden co-workers (71%), feelings of duty toward patients (67%), and avoiding an increased future workload caused by absence (59%). A lack of awareness regarding the existing rules and polices related to sick leave was reported by more than half of the participants. Several predisposing and enabling factors were reported as determinants influencing SP, e.g., observation of the practice of SP by peers and feelings of sympathy towards coworkers, including not wanting to overburden them, were reported to be determinants informing the decision of whether to work while sick.

Prevalence of musculoskeletal pain of the neck, upper extremities and lower back among dental practitioners working in Riyadh, Saudi Arabia: a cross-sectional study

Objectives Studies have shown that dentists have a higher incidence of work-related musculoskeletal (MSK) pain than those in other occupations. The risk factors contributing to MSK pain among Saudi dentists has not been fully studied so this study aims to estimate the prevalence of MSK pain and investigate its associated risk factors among dentists in Saudi Arabia. Setting and participants A cross-sectional survey was carried out in the capital city Riyadh, Saudi Arabia, using random cluster sampling. 224 surveys were distributed among dentists with a 91.1% response rate (101 women and 103 men). Outcomes The prevalence of MSK pain and its associated risk factors were investigated. Results 184 (90.2%) respondents reported having MSK pain. Lower back pain was the most commonly reported MSK pain (68.1%). Gender and age were reported to be predictors for at least one type of MSK pain. Older age was associated with lower back pain (OR 1.23; 95% CI 1.00 to 1.50) and women had double the risk of shoulder pain (OR 2.52; 95% CI 1.12 to 5.68). In addition, lower back pain was related to the time the dentist spent with patients (OR 0.28; 95% CI 0.14 to 0.54), while shoulder pain (OR 1.03; 95% CI 1.00 to 1.06) and lower back pain (OR 1.06; 95% CI 1.03 to 1.10) were significantly related to years of experience. Conclusions MSK pain is common among older and female Saudi dentists. Research on the impact of exercise and the ergonomics of the workplace on the intensity of MSK pain and the timing of its onset is required.

Adult cardiac critical care at the King Abdulaziz Cardiac Center

Abstract Adult Cardiac Critical Cardiac Care division at the King Abdulaziz Cardiac Center – Riyadh, Saudi Arabia, was created in 2011 to address the critical care needs of cardiac surgery and adult cardiology patients that were beyond the scope of their specialties. The division offers its services in two semi-closed intensive care units consisting of 17 beds of Level 3 care. The concept and rationale behind this relatively new subspecialty and its organization in our center are presented in this brief report.

Awareness of venous thromboembolism and thromboprophylaxis among hospitalized patients: a cross-sectional study

BackgroundPatient awareness of venous thromboembolism (VTE) and thromboprophylaxis is essential for their safety. In this study, we evaluated patients’ awareness of VTE and their perceptions of thromboprophylaxis.MethodsWe administered a cross-sectional survey to patients hospitalized at the King Abdulaziz Medical City, Riyadh, Saudi Arabia.ResultsOf 190 patients approached, 174 completed the survey, constituting a response rate of 95%. Most participants (72%) were receiving thromboprophylaxis. However, only 32 and 15% reported knowledge of deep vein thrombosis (DVT) and pulmonary embolism (PE), respectively. Fifty-five percent of participants with knowledge of DVT identified swelling of the leg as a symptom. Risk factors for blood clot development were correctly identified by about half of participants, although most agreed that blood clots can cause death (77%). The level of awareness of DVT or PE did not significantly differ by respondents’ demographics. However, awareness of DVT or PE was significantly higher among those with a personal or family history of VTE. Participants had positive perceptions of thromboprophylaxis and were satisfied with treatment (> 69%), but perceived its adverse effects less favorably and reported lower satisfaction with the information provided about DVT and PE (46%).ConclusionThis study demonstrates the lack of awareness of VTE, DVT, and PE among hospitalized patients. More attention must be paid to patient education to ensure safe and high-quality patient care.

Haloperidol-Induced Pulseless Electrical Activity: A Case Report

Background: Pulseless electrical activity (PEA) is a clinical condition characterized by unresponsiveness and lack of palpable pulse in the presence of organized cardiac electrical activity. It is induced by factors that results in the inability of cardiac muscle to generate sufficient force in response to electrical depolarization. Those factors could be physiological, pathological, or drug-induced. Previous reports have identified haloperidol-induced QTprolongation, but to the best of our knowledge this is the first case report of a patient with documentation of a normal baseline echocardiogram who experience haloperidol-induced PEA. Case Report: A 46-year-old woman was observed who developed a PEA a few minutes after receiving 2 mg of intravenous (IV) haloperidol. Haloperidol was administered to control her agitation and aggressiveness. A few minutes after administering the haloperidol, she experienced PEA and cardiac arrest. She recovered after receiving CPR for six minutes and 1 mg IV epinephrine, then she was intubated for mechanical ventilation and sedated. The drug was discontinue and was not restarted. For the rest of her stay in the hospital, the patient experienced no further cardiac events. Two days later, she became stable and she was extubated. She was discharged after 60 days with an out-patient follow-up appointment. Applying the Naranjo adverse drug reaction probability scale to this case (score of 4) indicated the possible relationship between the patient’s adverse cardiac event and haloperidol. Conclusions: IV haloperidol is advocated as safe effective therapy for agitated delirium in medical or surgical cardiac patients in the intensive care unit. Thus, it may be overlooked as a cause of pulseless electrical activity. Therefore, practitioners should be instructed about the potential for IV haloperidol to bring about bradycardia prompting pulseless electrical movement despite performing comprehensive cardiac examination before prescribing haloperidol.

Exploring Factors Associated with Depression and Anxiety among Hospitalized Patients with Type 2 Diabetes Mellitus

Objectives: The aims of the current study were to determine the prevalence and severity of anxiety and depression, and to explore associated factors among hospitalized patients with type 2 diabetes mellitus. Subjects and Methods: All patients with type 2 diabetes (160 patients) who were admitted to the Internal Medicine Wards of the King Abdulaziz Medical City, Riyadh, Saudi Arabia, from January to August 2015 were asked to participate, and 158 patients agreed to do so. A self-administered questionnaire consisting of 2 parts was used. The first part was on sociodemographic information, and the second part was a validated screening tool for assessing depression and anxiety. The severity of anxiety and depression was classified as normal, mild, moderate, and severe. Logistic regression was carried out to identify variables that were independently associated with anxiety and depression. Results: Using the screening tool, 85 (53.8%) and 80 (50.6%) study patients were identified as patients who suffered from depression and anxiety, respectively. The severity of distress was moderate/severe in 36 (42.4%) patients with depression and 41 (51.3%) patients with anxiety. The factors independently associated with the risk for anxiety in hospitalized patients with diabetes were physical inactivity and staying 8 days or longer in the hospital. On the other hand, factors that were independently associated with the risk for depression were older age, low income, and nephropathy. Conclusion: The majority of hospitalized patients with diabetes developed moderate/severe anxiety or depression, or both, during hospitalization. Hence, screening for anxiety and depression in high-risk hospitalized diabetic patients is recommended during hospitalization.