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1.  Prevalence and Determinants of Diabetic Retinopathy in Al Hasa Region of Saudi Arabia: Primary Health Care Centre Based Cross-Sectional Survey, 2007–2009 
Purpose:
To evaluate the prevalence of diabetic retinopathy (DR) in the urban and rural areas of Al Hasa region of Saudi Arabia and to determine risk factors related to DR.
Materials and Methods:
This study was conducted on patient attending primary health care centers between July 2007 and June 2009. A retrospective chart review was conducted on subjects with diabetes mellitus greater than 18 years old. Ophthalmologists examined DR status through dilated pupils by using direct, indirect, and slit lamp bio-microscopy. Frequencies, percentage, and their 95% confidence intervals (CIs) were calculated. Odd’s ratio was used to associate DR with possible risk factors. A P value less than 0.05 was considered statistically significant.
Results:
The prevalence of DR among 473 diabetic subjects was 30% (95% CI: 25.80–34.20). The odd ratios (ORs) of DR among diabetic residing in an urban area was significantly higher than diabetics residing in rural areas [OR = 1.94 (95% CI of OR 0.82–2.89)]. DR was associated to the duration of diabetes (adjusted OR = 1.70), uncontrolled blood sugar level (adjusted OR = 1.96), hyperlipidemia (adjusted OR = 2.04), and hypercholesterolemia (adjusted OR = 2.80).
Conclusions:
DR appears to be a public health problem in the Al Hasa district of Saudi Arabia, and a planned approach is required to avoid severe visual impairment in patients with diabetes mellitus. Primary prevention and early detection could be implemented through primary health centers and non-ophthalmologists.
doi:10.4103/0974-9233.65502
PMCID: PMC2934719  PMID: 20844683
Diabetes Mellitus; Diabetic Retinopathy; Prevention of Blindness; Primary Health Care Centers
2.  Chronic obstructive pulmonary disease: hospital and intensive care unit outcomes in the Kingdom of Saudi Arabia 
Background
There is little data surrounding the survival of patients with chronic obstructive pulmonary disease (COPD) who are admitted to the critical care unit with exacerbation of symptoms. We conducted a study to measure the in-hospital and intensive care unit (ICU) outcomes of patients admitted with COPD exacerbation, and identified the related prognostic factors.
Method
We performed a retrospective cohort study of patients who were admitted to the adult ICU between January 2006 and July 2011 for COPD exacerbation in King Abdulaziz National Guard Hospital, Al-Hasa, Saudi Arabia.
Results
During the study period, a total of 119 patients were admitted to the ICU with acute respiratory failure attributed to COPD exacerbation. The mean age was 72 ± 13 years, and 44 (37%) were females. The main cause of respiratory failure was infection, which occurred in 102 (86%) patients. Thirty-nine (33%) of the admitted patients were mechanically ventilated, and the median duration was 2.6 (1–42) days. The median lengths of the ICU and hospital stays were 3 (1–40) and 9 (2–43) days, respectively. The ICU mortality was 6%, and hospital mortality was 11%. Low Glasgow Coma Scale on admission, intubation, duration of mechanical ventilation, current smoking, tracheostomy, cardiopulmonary arrest, and the development of acute renal failure were associated with higher hospital mortality.
Conclusion
Early ICU and hospital mortality is low for COPD patients who have been admitted to the ICU with exacerbation. Low Glasgow Coma Scale scores on admission, intubation, prolonged use of mechanical ventilation, and the development of acute renal failure were identified as risk factors associated with increased hospital mortality.
doi:10.2147/COPD.S37611
PMCID: PMC3529632  PMID: 23269866
intensive care unit; chronic obstructive pulmonary disease; mortality rates; acute respiratory failure
3.  Socio-demographic Determinants of Compliance among Type 2 Diabetic Patients in Abha, Saudi Arabia 
Background and Objectives: Saudi Arabia has one of the highest prevalence of diabetes. This study was conducted with the following objectives: (1) To study the socio-demographic profile of diabetic patients in Abha. (2) To find the socio-demographic determinants of compliance among diabetic patients in Abha.
Material and Methods: A self administered questionnaire which had detailed the socio-demographic features and various aspects of compliance was used on a random sample of registered diabetics at two primary health care centres of Abha.
Results: Most of the patients (70.4 percent) were between 40-60 years age. Most of the patients were men (about 60 percent) and Saudis. Majority of patients did not have a university education. Young patients (age<40) were more compliant with all aspects of management, except medication (23.8 percent). Women were significantly more compliant with exercise (49.7 percent), while men were significantly more compliant with follow up (81.1 percent). Saudi patients were significantly compliant with medication (79.2 percent), while non Saudis were compliant with exercise (62.9 percent). All single patients were diet compliant. Smokers were significantly less compliant with exercise. Patients with normal BMI were significantly more compliant with diet and exercise.
Conclusion: Patients were found to be generally less compliant towards the regimen. Socio-demographic factors which were significantly associated with non compliance were age, gender, nationality, educational status, marital status, smoking status and BMI.
doi:10.7860/JCDR/2013/6986.3708
PMCID: PMC3919358  PMID: 24551644
Diabetes; Socio-demographic; Compliance; Saudi Arabia
4.  Design and Development of a Web-Based Saudi National Diabetes Registry 
Background
Given that diabetes is an extremely common disorder in Saudi Arabia, the National Diabetes Registry was designed by King Saud University Hospital Diabetes Center in collaboration with King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, in the year 2001. The aim of the registry is to identify risk factors related to diabetes and to provide statistics to public health programs and health care professionals for use in planning and evaluation. The registry was designed to provide information on the extent and nature of specific types of diabetes, diabetes complications, and treatment of diabetes in the Kingdom.
The registry has been available since 2001, with major collaborations from 26 hospitals as part of Phase I in which 100,000 patient data is to be collected on a regional level from Ar-Riyadh before extending the program to other regions of Saudi Arabia.
Methods
The web application was designed using relational database techniques along with on-line help topics to assist users to get acquainted with application functionalities. All Internet forms were designed with validation checks and appropriate messages to ensure quality of data.
The security measures established within the application ensure that only authorized users can gain access to the functionalities of the registry at allowed times. Administrative features were designed to manage the registry-related operations easily.
Results
The diabetes registry has been in operation for almost 10 years, and around 67,000 patients have been registered to date. The Web-application offers an anytime-anywhere access to the registry’s data, removing geographical boundaries and allowing the national registry to provide real-time data entry, updates, reporting, and mapping functionalities more easily.
Conclusion
Merging related information in the form of databases can provide improved health care operations through instant access to data, ease of managing complex data structures, and creation of reports to be used by health care planners and hospital administrators.
PMCID: PMC3005071  PMID: 21129356
centralized; diabetes; Internet; registry; Web-based
5.  QUALITY OF LIFE IN A SAMPLE OF HYPERTENSIVE PATIENTS ATTENDING PRIMARY HEALTH CARE FACILITIES IN AL-KHOBAR, SAUDI ARABIA 
Background:
Hypertension is one of the most prevalent chronic conditions in Saudi Arabia. It is the leading risk factor for cardiovascular diseases and a major reason for visits to clinic and prescription of medications. Inspite of this, the degree of its control is not to the optimum. This could be due to its impact on patients’ quality of life (QOL). Impaired physical and psychological well-being may lead to non-compliance or even the withdrawal of treatment . The aim of this study was to assess QOL of hypertensive patients registered in Al-Khobar.
Methods:
The QOL of hypertensive patients was compared with QOL of a control group. A total of 404 subjects (202 cases and 202 controls) were interviewed. The cases and controls were matched for age and sex. Patients’ self-assessment of QOL was measured with an Arabic version of SF-36, a 36-item Short Form Health Survey Questionnaire encompassing two main dimensions, physical and mental.
Results:
The QOL of hypertensive patients was substantially impaired in comparison to the control group. The mean scores for the physical component summary scale (PCS) were 39.3 and 50.8 for cases and controls respectively. The mean scores for the mental component summary scale (MCS) were 43.7 and 50.8 for cases and controls respectively. The burden of hypertension was concentrated in the physical dimension of health. Older age, female gender, unmarried patients, patients with hypertension complications, comorbid DM, use of Aldomet and shorter duration of hypertension were independently related to poorer QOL. The variability of the two summary measures explained by selected demographic and clinical characteristics was 24.3% and 10% for the PCS and MCS respectively.
Conclusions and recommendations:
The QOL of hypertensive patients was substantially impaired in comparison to the control group. Notably, the total explained variation of QOL by the selected characteristics was small, suggesting that the determinants of QOL are multi-factorial. Further research to explore the determinants and indices of QOL in hypertensive patients is warranted. From a clinical perspective, QOL should be considered in the monitoring of hypertensive patients to estimate the burden of hypertension and monitor their outcome.
PMCID: PMC3430172  PMID: 23008659
Quality of life; hypertension; primary health care; SF-36 questionnaire
6.  Compliance to Anti-Diabetic Drugs: Observations from the Diabetic Clinic of a Medical College in Kolkata, India 
Background: The poor glycaemic control among the patients with type 2 diabetes constitutes a major public health problem and a major risk factor for the development of diabetes complications.
Aim of the Study: To study the compliance rate of the patients with type 2 diabetes to the prescribed medications, to find out its correlation with different socio-demographic factors and other patient characteristics and to find out the reasons behind the non-compliance, if any.
Settings and Design: This cross sectional study was conducted on the patients with type 2 diabetes, who Attended the Diabetic Clinic of a Medical College in Kolkata, India.
Methods and Material: The patients of type 2 diabetes who attended the diabetes clinic between April to August 2012 were recruited in the study by systematic random sampling and they were interviewed by using the help of a structured interview schedule. The patients who reported taking less than 80% of their prescribed anti-diabetes medicines in the preceding week and had HbA1C of < 7% were considered to be non-compliant.
Statistical Analysis Used: The data was analyzed by using the SPSS software. The Chi-square test was used to assess the association of the compliance with the different study variables. A binary logistic regression analysis helped in identifying the factors which contributed to the non-compliance.
Results: The compliance rate to the anti-diabetic drugs was found to be 57.7%. A univariate analysis showed that it decreased significantly with increasing age and that it was also significantly lower among males, illiterates, those with a poor per capita monthly income and those who had a longer duration of diabetes. It varied significantly with the type of drugs, being lowest with an oral drug and insulin combination (43.4%). No knowledge on the complications of diabetes was significantly associated with a lower compliance. The binary logistic regression also helped in identifying these as the significant contributory factors. The common reasons behind the non-compliance were forgetfulness (44.7%) and financial constraints (32.7%).
Conclusion: It can be concluded that the compliance to anti-diabetic drugs was quite poor among the participants. Increasing age, the male sex, illiteracy, a low monthly income and a longer duration of diabetes were significantly associated with the non compliance. A more concerning fact was the significant association of the non-compliance with the types of drug regimens and a lack of knowledge on the complications of diabetes, which emphasized the role of a repeated patient education regarding the basic aspects of diabetes.
doi:10.7860/JCDR/2013/5352.2876
PMCID: PMC3644439  PMID: 23730641
Type 2 diabetes; Anti-Diabetic drugs; Compliance
7.  Vitamin D Deficiency in Patients with Type-2 Diabetes Mellitus in Southern Region of Saudi Arabia 
Mædica  2013;8(3):231-236.
ABSTRACT
Introduction: Type-2 diabetes mellitus and Vitamin D deficiency are both common in Saudi Arabian population. New roles of vitamin D have emerged recently especially in the prevention of cardiovascular disease, cancer and insulin resistance.
Objective: To estimate 25-OH vitamin D deficiency in patients with type-2 diabetes mellitus in comparison to normal age-matched non-diabetic control population. Methods: A Randomized Case-Control study was done in three tertiary care hospitals in Southern Region, Saudi Arabia from June 2010 to June 2012 and 345 patients were selected; 172 in the diabetic group and 173 in the non-diabetic group. Biochemical workup and 25-OH vitamin D levels were done.
Results: The mean serum 25-OH vitamin D levels in the diabetic group were 15.7 + 7.5 ng/mL as compared healthy non-diabetic group having 11.1 + 5.9 ng/mL and a total of 340 patients (98.5%) from both groups were found to be deficient in 25-OH vitamin D which is the highest reported so far in Saudi Arabia.
Conclusion: The population in our study was generally deficient in 25-OH vitamin D irrespective of diabetes mellitus indicating a greater need for vitamin D supplementation.
PMCID: PMC3869110  PMID: 24371490
vitamin D deficiency; Saudi Arabia; sunlight exposure; diabetes mellitus
8.  Dietary Practices, Physical Activity and Health Education in Qassim Region of Saudi Arabia 
Objectives:
Diabetes, hypertension and coronary artery disease are emerging threats to the health status in Saudi Arabia. These diseases are attributed largely to unhealthy dietary habits and lack of physical activity. Health education through primary health care (PHC) centers can play a significant role in changing behaviors and reducing the burden of non-communicable diseases.
Methods:
We present the results of analysis of a moderately large dataset on dietary practices, physical activity and exposure to health education among patients visiting the PHC centers in Qassim region of Saudi Arabia. We examined this cross-sectional data to identify the relationships between these three variables after controlling for the effects of age, sex, marital status, education and disease status.
Results:
Our results suggest that women, older people, divorced and widowed persons and those with low education are more likely to have poor dietary habits and lack of physical activity. Patients suffering from chronic illnesses are more likely to be exposed to health education from PHC centers, which help to significantly improve their dietary practices and, to some extent, increase physical activity at all ages. Our analysis indicates that health education provided through the PHC centers plays a modest but significant role in improving lifestyles and dietary practices.
Conclusion:
We conclude that better emphasis on high quality health education would significantly reduce the burden of non-communicable diseases in our target population.
PMCID: PMC3068799  PMID: 21475520
9.  Concerns and Awareness of Acne Patients About Isotretinoin in Qassim Region of Saudi Arabia 
Background:
Oral Isotretinoin is the most effective choice in the treatment of severe acne, It is the most widely prescribed teratogenic drug in the USA and Canada. Due to large number of its adverse effects and the necessity of long term use, patients have difficulties in complying with the treatment and some may refuse taking the drug.
Objectives:
To assess knowledge, concerns and awareness of acne patients in Qassim region, Saudi Arabia, about Isotretinoin, including the factors that may affect compliance.
Subjects and Method:
This non-interventional cross-sectional survey was conducted through distribution of questionnaires over two months period from 8th May to 23rd July 2009 in acne patients from the Qassim region. The returned questionnaires were analyzed using SPSS version 17.0. The P <0.05 was accepted as cut-off point for statistical significance.
Results:
Three hundred fifty six acne patients were included in the study, 57.6% were female and 42.3% were male; 76.7% knew about Isotretinoin and its uses, the main source of information (for both genders) was the physician, followed by other acne patients. Sixty three percent of subjects knew about the adverse effects of the drug. Dryness and teratogenicity were the most well-known adverse effects and 85.9% didn't have any objection in using the drug. Adverse effects followed by duration of the treatment were the top concerned issues. Out of those who were using the drug, dryness of the lips and face were the most disturbing adverse effects.
Conclusion:
A majority of acne patients have the knowledge about Isotretinoin and its adverse effects. This study highlighted the importance of health education for better acceptance of this drug. Patients should be instructed about proper moisturization methods while using this drug.
PMCID: PMC3068800  PMID: 21475525
Isotretinoin; Teratogenicity; Acne vulgaris; Adverse effects
10.  Impact of an education program on patient anxiety, depression, glycemic control, and adherence to self-care and medication in Type 2 diabetes 
Background:
Diabetes mellitus (DM) requires continuous medical care, patients’ self-management, education, and adherence to prescribed medication to reduce the risk of long-term complications. The aim of this study was to assess the benefits of an education program on diabetes, patient self-management, adherence to medication, anxiety, depression and glycemic control in type 2 diabetics in Saudi Arabia.
Materials and Methods:
This was a prospective study, conducted among 104 diabetic patients at a major tertiary hospital in Riyadh, Saudi Arabia, between May 2011 and October 2012. Education materials given to diabetic patients included pamphlets/handouts written in Arabic, the national language. Special videotapes about DM were made and distributed to all participants. In addition, specific educational programs through the diabetes educators and one-on-one counseling sessions with the doctor were also arranged. Patients were interviewed using a structured interview schedule both during the baseline, and after 6 months of the program. The interview schedule included, socio-demographics, clinical characteristics, diabetes self-management, adherence to medication, anxiety, and depression. Glycemic control was considered poor, if hemoglobin A1c (HbA1c) was ≥ 7%.
Results:
The mean age of the study population was 57.3 ± 14.4 years. Seventy one were males (68.3%) and 33 (31.7%) were females. After six months of the diabetes education program, there were significant improvements in patients’ dietary plan (P = 0.0001), physical exercise (P = 0.0001), self-monitoring of blood glucose (SMBG) (P = 0.0001), HbA1c (P = 0.04), adherence to medication (P = 0.007), and depression (P = 0.03).
Conclusions:
Implementation of education programs on diabetes among type 2 diabetic patients is associated with better outcomes such as their dietary plan, physical exercise, SMBG, adherence to medication, HbA1c and depression.
doi:10.4103/2230-8229.114766
PMCID: PMC3748651  PMID: 23983558
Anxiety; depression; diabetes education; diabetes self-management; Saudi Arabia
11.  Factors affecting compliance to chiropractic prescribed home exercise: a review of the literature 
Canadians are often confronted with health conditions that impede their lifestyles. To overcome health related limitations individuals often seek assistance from chiropractors or other allied health care professionals. However, despite the recognized benefits of at home exercise programs, patients continue to remain non-compliant to prescribed routines. Non-compliance to home based routines reduces the probability of successful outcome for therapeutic intervention. The advent of the rehabilitation focus in the Chiropractic profession warrants an examination of factors influencing compliance to home exercise prescribed by the chiropractor. The physiological and psychological benefits are well established. If compliance is high, results will typically be positive (i.e. reduced symptoms of pain, reduced anxiety related to condition, and therapeutic goals attained). However, if compliance is low, therapeutic outcomes will often plateau or worse, reverse. Why does non-compliance seem to prevail? The purpose of this paper is to define exercise compliance, identify factors influencing compliance and to suggest intervention strategies that may improve adherence to home-based exercise prescription by chiropractors.
PMCID: PMC2485527
chiropractic; rehabilitation; exercise
12.  Knowledge of diabetes risk factors and preventive measures among attendees of a primary care center in eastern Saudi Arabia 
Annals of Saudi Medicine  2009;29(1):15-19.
BACKGROUND AND OBJECTIVE:
Few studies have been conducted in Saudi Arabia to assess the level of awareness and knowledge of the population about diabetes mellitus (DM) risk factors and preventative measures. The objective of this study was to measure this knowledge among attendees of a primary care center in eastern Saudi Arabia.
METHODS:
A sample of 300 male and female Saudis aged 18 years and older from the catchment area of the Aqrabya Primary Care Center were randomly selected for this cross-sectional survey. Data were collected through a structured face-to-face interview using a pre-piloted Arabic instrument. Regression analysis was used to identify the predictors of knowledge.
RESULTS:
The 288 participants interviewed included 100 males and 188 females. The mean (SD) age was 44.7 (12.6) years for males and 33.8 (12.4) years for females. Fewer than 50% of participants knew about DM risk factors and preventive measures. In a regression model that included age, sex and education, education had a statistically significant positive association with knowledge of risk factors (odds ratio 12.5, 95% CI 6.26-25.2, P<.001) and preventive measures (odds ratio 7.6, 95% CI 4.01-14.2, P<.001), and age had a statistically significant negative association with knowledge of DM risk factors (odds ratio 0.377, 95% CI 0.207-0.685, P=.001) and prevention (odds ratio 0.407, 95% CI 0.231-0.717, P=.001). The main risk factor stated by participants was obesity (35.8%), while the main preventive measure mentioned was weight reduction (37.9%).
CONCLUSION:
Attendees had poor knowledge of DM risk factors and preventive measures. The level of education and age were important predictors of knowledge. Programs for health education of the community about DM risk factors and preventive measures are needed.
doi:10.4103/0256-4947.51813
PMCID: PMC2813608  PMID: 19139622
13.  Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance 
Postgraduate Medical Journal  2001;77(913):703-707.
BACKGROUND—Adverse drug reactions and non-compliance are important causes of admissions in the elderly to medical clinics. The contribution of adverse drug reactions and non-compliance to admission by the medical emergency department was analysed.
METHODS—A total of 578 consecutive elderly patients admitted to the medical emergency department were interviewed to determine the percentage of admissions due to adverse drug reactions or non-compliance with medication regimens, their causes, consequences, and predictors.
RESULTS—Eighty three (14.4%) of the 578 admissions were drug related: 39 (6.7%) caused by adverse drug reactions and 44 (7.6%) caused by non-compliance with medication. One hundred ninety two (33.2%) patients had a history of non-compliance. Factors associated with an increased risk of admission because of an adverse drug reaction were patients with diabetes or neoplasms, and patients using numerous different medications. Factors associated with a higher risk of hospitalisation because of non-compliance were poor recall of the medication regimen, seeing numerous physicians, female sex, polypharmacy, drug costs, and switching over to non-conventional forms of treatment.
CONCLUSION—Many elderly admissions are drug related, with non-compliance accounting for a substantial fraction of these. Elderly people at high risk of suffering a drug related medical emergency are identified and suitable interventions may be planned by the healthcare policymakers to target them.


Keywords: adverse drug reactions; non-compliance; drug related medical emergencies; elderly
doi:10.1136/pmj.77.913.703
PMCID: PMC1742171  PMID: 11677279
14.  First case report of human myiasis with Sarcophaga species in Makkah city in the wound of a diabetic patient 
We have reported a case of a 40-year-old male diabetic patient, resident of a rural area, who visited the outpatient clinic of the diabetic center in Alnoor Specialist Hospital, Makkah, Saudi Arabia. He came to seek medical advice for a single wound in the back of the shoulder since 1 month. After examination, a larva was eliminated and sent to laboratory for confirmation. It was confirmed as the third-stage larva of Sarcophaga species after macroscopic and microscopic examination. This is the first case of a patient having diabetic wound myiasis with the larva of Sarcophaga species reported in the Makkah region of Saudi Arabia.
doi:10.4103/0976-9668.107301
PMCID: PMC3633283  PMID: 23633868
Diabetes mellitus; larva; myiasis; Sarcophagi
15.  FREQUENCY OF RISK FACTORS FOR CORONARY HEART DISEASE AMONG DIABETIC PATIENTS IN AL-RABWAH PHC CENTER IN RIYADH 
Background:
Diabetes mellitus associated with high prevalence and incidence of CHD is a common problem in Saudi Arabia.
Objectives:
To assess the percentage of major modifiable risk factors for CHD among diabetic patients.
Methods:
This is a retrospective study conducted on 495 diabetic patients (292 males and 203 females) attending the Miniclinic at Al-Rabwah PHC center in Riyadh. Their records for the months of April and May 2001 were reviewed. Data collected from the patient's files included body mass index (BMI), blood pressure, total cholesterol, triglyceride, and smoking status. In addition, information on the duration of diabetes was obtained and fasting blood sugar was done.
Results:
The percentage of overweight males was 43.2% as against 22% females, the figure for males being highly significant (p<0.0001). Obesity which was 27.9% in males and 64.1% in females, was highly significant in females (p<0.0001). For cholesterol (≥ 5.2 mmol/l) was 49.5% in males versus 68.5% in females (p=0.0036). High triglyceride (≥ 1.7%) was 50% in both genders. 13.4% of males were hypertensive as against 44.3% female hypertensives which was highly significant in females (p<0.0001). 19.5% of the males smoked. There was no significant difference between risk factors for CHD and duration of diabetes except that there were more smokers among those who had had diabetes for less than 10 years. Most of the diabetics with poor glycemic control (FBS> 8.3mmol/l) tended to be smokers, were more obese, had high triglyceride and high total cholesterol.
Conclusion:
The findings indicated that diabetic patients have high percentage of risk factors for CHD and more females than males are at risk. Therefore, early intervention is required if the incidence of CHD among diabetic patients is to be reduced.
PMCID: PMC3410090  PMID: 23012049
Risk factor; Coronary heart disease; Diabetes Mellitus; Primary Health Care Center
16.  Hospital pharmacy practice in Saudi Arabia: Prescribing and transcribing in the Riyadh region 
Purpose
The purpose of this survey is to outline pharmacy services in hospitals on a regional level in the Kingdom of Saudi Arabia.
Methods
A modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire as pertinent to Saudi Arabia was used to conduct a national survey. After discussing with the pharmacy directors of 48 hospitals in the Riyadh region over the phone on the survey’s purpose, the questionnaires were personally delivered and collected upon completion. The hospital lists were drawn from the Ministry of Health hospital database.
Results
Twenty-nine hospitals participated in the survey giving a response rate of 60.4%. Approximately 60% of the hospitals which participated in the survey required prior approval for the use of non-formulary medications. About 83.3% of hospitals reviewed compliance with clinical practice guidelines and 72.7% hospitals reported that pharmacists are also actively involved in these activities. Pharmacists in more than 95% of hospitals provided consultations on drug information. A staff pharmacist routinely answering questions was the most frequently cited (74.1%) method by which objective drug information was provided to prescribers. Electronic drug information resources were available in 77.7% of hospitals, although internet use is not widely available to hospital pharmacists, with only 58.6% of hospitals providing pharmacist access to the internet. About, 34.5% of hospitals had computerized prescriber order entry (CPOE) systems with clinical decision-support systems (CDSSs) and 51.9% of the hospitals had electronic medical record (EMR) system.
Conclusion
Hospital pharmacists are increasingly using electronic technologies to improve prescribing and transcribing of medications in Saudi Arabia.
doi:10.1016/j.jsps.2011.11.001
PMCID: PMC3745200  PMID: 23960794
Pharmacy services; Formulary management; Clinical practice; Pharmacist consultation; Drug information; Medication use
17.  Musculoskeletal manifestations in diabetic patients at a tertiary center 
The Libyan Journal of Medicine  2012;7:10.3402/ljm.v7i0.19162.
Objectives
Diabetes mellitus is a major public health problem worldwide. Most diabetic patients will develop functional disabilities due to multiple factors, including musculoskeletal (MSK) manifestations. The purpose of this study was to determine the frequency of MSK in diabetic patients and to examine the possible predictors for its development.
Methods
We performed a cross-sectional study from June 1, 2010, to June 30, 2011, to evaluate MSK manifestations in adult diabetic patients at an outpatient clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Baseline variables were examined to determine predictors for the development of MSK complications. Analyses were carried out using the Statistical Package for Social sciences.
Results
We included 252 diabetic patients; 45 (17.9%) had MSK manifestations. Of these 45 patients, 41 (91.1%) had type 2 diabetes. The most common manifestations were carpal tunnel syndrome (n=17, 6.7%), shoulder adhesive capsulitis (n=17, 6.7%), and diabetic amyotrophy (n=12, 4.8%). A significant association was found between the development of MSK manifestations and manual labor, overweight, and vascular complications. On logistic regression analysis, the presence of vascular complications in general (B-coefficient=1.27, odds ratio=3.57, P<0.05, 95% confidence interval=1.31–9.78), and retinopathy in particular (B-coefficient=1.17, odds ratio=3.21, P<0.05, 95% confidence interval=1.47–7.02) can predict the development of MSK manifestations in about 82% of the cases.
Conclusion
Musculoskeletal manifestations are under recognized in adult diabetic patients, occurring in 18% of the cases. Physicians should consider examining the periarticular region of the joints in the hands and shoulders whenever a diabetic patient presents with MSK symptoms.
doi:10.3402/ljm.v7i0.19162
PMCID: PMC3484174  PMID: 23115579
arthritis; diabetes mellitus; manifestations; musculoskeletal; rheumatological
18.  ERECTILE DYSFUNCTION AMONG DIABETIC PATIENTS IN SAUDI ARABIA: A HOSPITAL-BASED PRIMARY CARE STUDY 
Objectives:
The aim of the present study was to estimate the prevalence of erectile dysfunction in men with diabetes mellitus attending a primary care clinic in King Khalid University Hospital, Riyadh, Saudi Arabia.
Methods:
A cross sectional study was carried out on men with diabetes mellitus followed in a primary care clinic of King Khalid University Hospital in Riyadh, Saudi Arabia, from 13 November 2005 to 13 June 2006. A total of 186 diabetic patients were interviewed. Data collection forms were completed by a member of the medical staff, a family medicine consultant, during the consultation of diabetic patients in the primary care clinic. Erectile dysfunction was categorized as absent erectile dysfunction (normal function), partial erectile dysfunction, and complete erectile dysfunction. The data was analyzed using the Statistical Package of Social Science (SPSS) version 11.5. A p-value of less than 0.05 was considered statistically significant.
Results:
A total of 186 men with diabetes mellitus were interviewed during the study period. The majority of diabetic patients (95%) had type 2 diabetes. Most of the patients (68.8%) were on oral hypoglycemic agents, 24.7% on insulin injection, and 6.5% on diet only. The present study showed that 11.2% of the diabetic patients were suffering from complete and severe erectile dysfunction, while 64% of the patients complained of partial erectile dysfunction which was affecting their marital relationship. The cardiovascular risk factors in the 186 diabetic patients were hypertension 34.9%, smoking 13.4%, obesity 40%, and dyslipidemia 16.6%.
Conclusions:
Complete (severe) and partial erectile dysfunction was quite common among adult diabetic patients in a hospital-based primary care setting in Saudi Arabia. It is important for primary care physicians to diagnose erectile dysfunction in diabetic patients, and to counsel them early, as most patients are hesitant to discuss their concern during a consultation. Further studies are recommended to evaluate the effect of other risk factors on erectile dysfunction in diabetic patients.
PMCID: PMC3410114  PMID: 23012139
Erectile dysfunction; diabetes; primary care
19.  Reasons behind non-adherence of healthcare practitioners to pediatric asthma guidelines in an emergency department in Saudi Arabia 
Background
The prevalence of childhood bronchial asthma in Saudi Arabia has increased in less than a decade from 8% to 23%. Innovations in the management of asthma led to the development of evidence based clinical practice guidelines and protocols to improve the patients’ outcomes. The objectives of this study are to examine the compliance of the healthcare providers in the Pediatrics Emergency Department, in King Khalid University Hospital, with the recommendations of the Pediatrics Asthma Management Protocol (PAMP), and to explore the reasons behind non-adherence.
Methods
This study is designed in 2 parts, a patients’ chart review and a focus group interview. The medical records of all the children who presented to the Pediatric Emergency Department (PED) and were diagnosed as asthmatic, during the period from the 1st of January 2009 to the 31st of March 2009, were reviewed to investigate the compliance of healthcare providers (physicians and nurses) with 8 recommendations of the PAMP which are considered to be frequently encountered evidence-practice gaps, and these are 1) documentation of asthma severity grading by the treating physician and nurse 2) limiting the prescription of Ipratropium for children with severe asthma 3) administration of Salbutamol through an inhaler and a spacer 4) documentation of parental education 5) prescription of systemic corticosteroids to all cases of acute asthma 6) limiting chest x-ray requisition for children with suspected chest infection 7) management of all cases of asthma as outpatients, unless diagnosed as severe or life threatening asthma 8) limiting prescription of antibiotics to children with chest infection. The second part of this study is a focus group interview designed to elicit the reasons behind non- adherence to the recommendations detected by the chart review. Two separate focus group interviews were conducted for 10 physicians and 10 nurses. The focus group interviews were tape-recorded and transcribed verbatim. Theory-based content analysis was used to analyze interviews into themes and sub-themes.
Results and discussion
A total of 657 charts were reviewed. The percentage of adherence by the healthcare providers to the 8 previously mentioned recommendations was established. There was non-adherence to the first 5 of the 8 aforementioned recommendations. Analysis of the focus group interview revealed 3 main themes as reasons behind non-compliance to the 5 recommendations mentioned above and those are 1) factors related to the organization, 2) factors related to the asthma management protocol 3) factors related to healthcare providers.
Conclusion
The organizational barriers and the lack of an implementation strategy for the protocol, in addition to the attitude and beliefs of the healthcare providers, are the main factors behind non-compliance to the PAMP recommendations.
doi:10.1186/1472-6963-12-226
PMCID: PMC3464177  PMID: 22846162
20.  Cure or control: complying with biomedical regime of diabetes in Cameroon 
Background
The objective of the study was to explore the cultural aspect of compliance, its underlying principles and how these cultural aspects can be used to improve patient centred care for diabetes in Cameroon.
Methods
We used participant observation to collect data from a rural and an urban health district of Cameroon from June 2001 to June 2003. Patients were studied in their natural settings through daily interactions with them. The analysis was inductive and a continuous process from the early stages of fieldwork.
Results
The ethnography revealed a lack of basic knowledge about diabetes and diabetes risk factors amongst people with diabetes. The issue of compliance was identified as one of the main themes in the process of treating diabetes. Compliance emerged as part of the discourse of healthcare providers in clinics and filtered into the daily discourses of people with diabetes. The clinical encounters offered treatment packages that were socially inappropriate therefore rejected or modified for most of the time by people with diabetes. Compliance to biomedical therapy suffered a setback for four main reasons: dealing with competing regimes of treatment; coming to terms with biomedical treatment of diabetes; the cost of biomedical therapy; and the impact of AIDS on accepting weight loss as a lifestyle measure in prescription packages. People with diabetes had fears about and negative opinions of accepting certain prescriptions that they thought could interfere with their accustomed social image especially that which had to do with bridging their relationship with ancestors and losing weight in the era of HIV/AIDS.
Conclusion
The cultural pressures on patients are responsible for patients' partial acceptance of and adherence to prescriptions. Understanding the self-image of patients and their background cultures are vital ingredients to improve diabetes care in low-income countries of Sub-Sahara Africa like Cameroon.
doi:10.1186/1472-6963-8-43
PMCID: PMC2267458  PMID: 18298835
21.  Prevalence and causes of visual impairment among Saudi adults attending primary health care centers in northern Saudi Arabia 
Annals of Saudi Medicine  2011;31(5):473-480.
BACKGROUND AND OBJECTIVES:
Few studies have been conducted in Saudi Arabia to estimate the prevalence of visual impairment and its causes. The objective of this study was to estimate the prevalence of visual impairment, and identify its causes and associated factors among the adult population attending primary health care (PHC) centers in Aljouf province, in northern Saudi Arabia.
DESIGN AND SETTING:
A cross-sectional study during the year 2005 in PHC centers in Aljouf province in northern Saudi Arabia
PATIENTS AND METHODS:
A sample of 620 Saudi adults, of age 18 years and older, from the catchment area of the Aljouf PHC centers, were randomly selected through a multistage random sampling technique. Data were collected using a questionnaire about socioeconomic and related information and a visual acuity test was performed using the Snellen chart (E). Diagnosis was established according to World Health Organization (WHO) criteria. Visual impairment was categorized into blindness for a visual acuity of less than 3/60 (20/400, 0.05) in the better eye with the best correction and low vision for a best corrected visual acuity of less than 6/18 (20/60, 0.3) but not less than 3/60 (20/400, 0.05) in the better eye. Regression analysis was used to identify the predictors of visual impairment.
RESULTS:
Of 617 adult Saudis interviewed and examined, 269 (43.6%) were females. The mean (SD) age was 38.6 (16.2) years. The overall prevalence of visual impairment was 13.9% (95% CI: 11.4%-16.9%). The main medical causes of visual impairments were refractive errors (36.0%) followed by cataract (29.1%) and diabetic retinopathy (20.9%), and the least leading cause was glaucoma (5.8%). The most prominent determinants of visual impairment were age (P<.05), sex (P<.001), and a history of previous eye injury (P<.05).
CONCLUSION:
Prevalence of visual impairment in the study population from the Aljouf area is high. It is recommended that regular checks of visual acuity be conducted for all Saudis of age 50+ years, who attend the PHC centers.
doi:10.4103/0256-4947.84624
PMCID: PMC3183681  PMID: 21911984
22.  Self-reported use of complementary and alternative medicine (CAM) products in topical treatment of diabetic foot disorders by diabetic patients in Jeddah, Western Saudi Arabia 
BMC Research Notes  2010;3:254.
Background
There is little published on current Saudi diabetic patients' practices when they are exposed to foot disorders such as open wound, ulcer, and skin cracks. These factors are usually influenced by local culture and communities beliefs. The aim of the current study was to identify the pattern of patients' use of CAM products in dealing with diabetic foot disorders topically in a group of diabetic patients.
Findings
A Cross-sectional descriptive study of a representative cohort of diabetic patients living in Jeddah, Saudi Arabia was designed. A pre-designed questionnaire to identify local diabetics' practices in dealing topically with foot disorders including open wound, chronic ulcer, and skin cracks was designed. Questionnaire was administered by a group of trained nutrition female students to diabetics face to face living in their neighborhood. A total of 1634 Saudi diabetics were interviewed. Foot disorders occurred in approximately two thirds of the respondents 1006 (61.6%). Out of the 1006 patients who had foot disorders, 653 reported trying some sort of treatment as 307 patients (47.1%) used conventional topical medical treatment alone, 142 (21.7%) used CAM products alone, and 204 (31.2%) used both treatments. The most commonly used CAM product by the patients was Honey (56.6%) followed by Commiphora Molmol (Myrrh) in (37.4%) and Nigellia Sativa (Black seed) in (35.1%). The least to be used was Lawsonia inermis (Henna) in (12.1%). Ten common natural preparations used topically to treat diabetic foot disorders were also identified.
Conclusions
The use of CAM products in topical treatment of diabetic foot disorders is fairly common among Saudi diabetic patients. Honey headed the list as a solo topical preparation or in combination with other herbs namely black seeds and myrrh. The efficacy of the most common products needs further research.
doi:10.1186/1756-0500-3-254
PMCID: PMC2958887  PMID: 20925956
23.  DIETARY MISCONCEPTIONS AMONG DIABETIC PATIENTS IN MAKKA CITY, SAUDI ARABIA 
Objectives:
To assess the prevalence of some dietary misconceptions among primary health care center-registered diabetic patients in Makka City, Saudi Arabia.
Methods:
A sample of 1039 primary health care center- registered diabetic patients was interviewed using a structured questionnaire on diabetic diet -related misconceptions. A scoring system was used to document the frequency of misconceptions. The relationship of the misconceptions to socio-demographic and diabetes-related variables was assessed using chi-squared tests.
Results:
Most patients (68.7%) had a high diet misconception score. More than half of the sample had the misconception that carbohydrates were to be completely eliminated from the diet, and only dried bread and bitter foods were to be consumed. Data included the belief in the consumption of honey and dates; the omission of snacks; belief in the carcinogenicity of the sugar substitutes; and obesity as a sign of good health. The score was significantly higher among males (p<0.01), patients older than 35 years (p<0.02), and among patients whose level of education was low (p<0.01).
Conclusion:
It is important to note that the rate of diet-related misconceptions among diabetics in Makka city is high. The study pointed to the target fraction of diabetic patients among whom these misconceptions prevailed. There is a need for constant motivation and appropriate education at frequent intervals to encourage better knowledge of the disease so that there is compliance to treatment.
PMCID: PMC3430184  PMID: 23008671
Misconceptions; diabetes; diet; Saudi Arabia
24.  Factors affecting therapeutic compliance: A review from the patient’s perspective 
Objective
To explore and evaluate the most common factors causing therapeutic non-compliance.
Methods
A qualitative review was undertaken by a literature search of the Medline database from 1970 to 2005 to identify studies evaluating the factors contributing to therapeutic non-compliance.
Results
A total of 102 articles was retrieved and used in the review from the 2095 articles identified by the literature review process. From the literature review, it would appear that the definition of therapeutic compliance is adequately resolved. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact on compliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory.
Conclusion
There are numerous studies on therapeutic noncompliance over the years. The factors related to compliance may be better categorized as “soft” and “hard” factors as the approach in countering their effects may differ. The review also highlights that the interaction of the various factors has not been studied systematically. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes.
PMCID: PMC2503662  PMID: 18728716
patient compliance; adherence; factors
25.  Determinants of Compliance Behaviours among Patients Undergoing Hemodialysis in Malaysia 
PLoS ONE  2012;7(8):e41362.
Background
Patients with end stage renal disease often fail to follow prescribed dietary and fluid regimen, leading to undesirable outcomes. This study aimed to examine and identify factors influencing dietary, fluid, medication and dialysis compliance behaviours in patients undergoing hemodialysis.
Methods
This was a cross-sectional study which employed purposive sampling design. A total of 188 respondents were recruited from 14 dialysis centres in Malaysia between 2008–2011. Self-reported compliance behaviours and biochemical measurements were used as evaluation tools.
Results
Compliance rates of dietary, fluid, medication and dialysis were 27.7%, 24.5%, 66.5% and 91.0%, respectively. Younger, male, working patients and those with longer duration on hemodialysis were found more likely to be non-compliant. Lacks of adequate knowledge, inadequate self-efficacy skills, forgetfulness and financial constraints were the major perceived barriers towards better compliance to fluid, dietary, medication and dialysis, respectively.
Conclusions
Healthcare professionals should recognise the factors hindering compliance from the patients' perspective while assisting them with appropriate skills in making necessary changes possible.
doi:10.1371/journal.pone.0041362
PMCID: PMC3411710  PMID: 22870215

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