: The physicians in our study are likely to disclose errors made by a colleague only if the error resulted in a severe damage to the patient, and as such, medical errors go underreported for a variety of reasons. It was felt that assurance of confidentiality and protection from backlash would promote medical error disclosure.

Medication adherence was assessed in 89 patients on hemodialysis (HD) at the King Abdul Aziz Medical City using an Arabic version of the Morisky Medication Adherence Scale (MASS-8). The results of the study revealed that 31.46% and 40.45% of the participants showed low and medium adherence, respectively, while 28.09% showed high medication adherence. Accordingly, 71.91% of the patients visiting the dialysis unit were considered medication non-adherent. While being of older age (P = 0.012), being married (P = 0.012) increased the level of adherence, being of medium level of education (P = 0.024) decreased adherence levels. On the other hand, gender, presence of a care-giver, number of members in the household and employment status seems to have no effect on the level of medication adherence. These results call upon the practitioners in HD units to develop intervention programs that can increase the level of medication adherence.

Identifying reasons for under-reporting is crucial in reducing the incidence of medical errors. We studied physicians' knowledge of the occurrence, frequency and causes of medical errors and their actual practice toward reporting them. A cross-sectional, self-administered questionnaire was answered by 107 physicians at a tertiary-care hospital in Saudi Arabia. The questionnaire had 6 sections covering demographic data, knowledge, attitudes and practice towards reporting medical errors, perceived causes of and frequency of medical errors in their hospital and personal experiences of medical error reporting. Physicians tended not to report medical errors when no harm had occurred to patients. One-third of respondents feared punitive actions if they reported errors and only 56.4% felt that error reporting had led to positive changes in overall care. A majority of errors were related to late interventions and misdiagnosis. Under-reporting of medical errors was common in this hospital. Physicians did not appreciate attempts to improve the system of error reporting and a culture of blame still prevailed. RÉSUMÉ L'identification des raisons de la sous-notification est cruciale pour réduire l'incidence des erreurs médicales. Nous avons étudié les connaissances des médecins sur la survenue, la fréquence et les causes des erreurs médicales ainsi que leur pratique réelle en termes de notification. Un autoquestionnaire transversal a été rempli par 107 médecins dans un hôpital de soins tertiaires en Arabie saoudite. Le questionnaire présentait six sections couvrant les données démographiques, les connaissances, les attitudes et les pratiques vis-à-vis de la notification des erreurs médicales, les causes perçues et la fréquence des erreurs médicales dans leur hôpital ainsi que les expériences personnelles en matière de notification. Les médecins avaient tendance à ne pas notifier les erreurs médicales lorsque les patients n'avaient souffert d'aucun dommage. Un tiers des répondants craignaient les actions punitives s'ils notifiaient des erreurs et seuls 56,4 % pensaient que la notification des erreurs entraînait des modifications positives pour l'ensemble des soins. Une majorité d'erreurs était liée à des interventions tardives et des erreurs de diagnostic. La sous-notification des erreurs médicales était fréquente dans cet hôpital. Les médecins ne percevaient pas positivement les tentatives d'amélioration du système de notification des erreurs et la culture du blâme restait prévalente. ‫السعودية‬ ‫العربية‬ ‫اململكة‬

BackgroundStudies have shown that insomnia is a common sleep disorder among patients with end-stage renal disease (ESRD). This study aimed to assess the prevalence of insomnia in Saudi patients with ESRD who are on maintenance dialysis.MethodsThis was an observational cross-sectional study carried out over a period of five months in two hemodialysis centers in Saudi Arabia. To assess the prevalence of insomnia, we used the ICSD-2 definition. We also examined the association between insomnia and other sleep disorders, the underlying causes of renal failure, dialysis duration, dialysis shift, and other demographic data.ResultsOut of 227 enrolled patients, insomnia was reported by 60.8%. The mean patient age was 55.7 ± 17.2 years; 53.7% were male and 46.3% were female. Insomnia was significantly associated with female gender, afternoon hemodialysis, Restless Legs Syndrome, high risk for obstructive Sleep Apnea Syndrome and excessive daytime sleepiness (P-values: 0.05, 0.01, < 0.0001, < 0.0001, and < 0.0001, respectively). No significant association was found between insomnia and other variables, including BMI, smoking habits, underlying etiology of renal failure, dialysis duration, association with hemoglobin, ferritin, and phosphorus or dialysis adequacy as measured by the Kt/V index.ConclusionInsomnia is common in dialysis patients and was significantly associated with other sleep disorders. Greater attention needs to be given to the care of dialysis patients with regard to the diagnosis and management of insomnia and associated sleep disorders.

The purpose of this study was to investigate the presentation and factors affecting outcome over a 9-year period in 99 consecutive Saudi patients with biopsy proven lupus nephritis (LN), 35.5% of whom had nephrotic range proteinuria, 46.8% had estimated glomerular filtration rate (eGFR) <60  ml/min/1.73  m(2) and 65.5% had histological class IV. The female:male ratio was 3.7:1. During the observation period, there were significant rises in eGFR (p = 0.005), C4 (p = 0.000) and significant decrease in 24-h urine protein (p = 0.028). No correlation was found between final eGFR and baseline 24-h protein, anti-DNA, C3 or C4. Female patients had a significantly higher rise in eGFR (p = 0.05).During follow-up (FU), 28.2% required dialysis. The survival rates at 5, 10 and 15  years were 92%, 77% and 77% respectively. Baseline C3 and C4 levels were significantly lower in the patients who died (p = 0.0001 and 0.02 respectively). Those who required dialysis were more likely to die (p < 0.000) (risk ratio = 4.46; 95% confidence interval 2.8-7.2). Hypertension at presentation was associated with lower baseline eGFR (p = 0.01) and final eGFR (p = 0.002) but did not affect the baseline proteinuria. Baseline eGFR of <60  ml/min/1.73  m(2) at presentation was associated with lower eGFR at end of FU (p = 0.000), higher activity score (p = 0.0001) and chronicity scores (p = 0.017).

The aim of this study is to investigate the clinical and pathological features and outcome of glomerulonephritis with crescents among adult patients. This is a retrospective study of all cases of crescentic GN seen over a 9-year period (2001-2010). Histological features were assessed, and renal function at baseline and end of follow-up period was recorded. Results among different etiological groups at baseline and end of follow-up period were compared. The mean age in the whole group was 35.6 years (16.2), with the lowest mean in the lupus nephritis (LN) group [27.7 years (9.9)] and the highest in the pauciimmune glomerulonephritis (PIGN) group (P = 0.001). There were 72 cases enrolled in the study. LN accounted for 49.3% of the cases, PIGN for 26.5%, other immune complex glomerulonephritis (ICGN) for 19% and post-infectious GN accounted for 6.3% The majority (85.7%) of the patients had renal impairment at presentation (mean serum creatinine levels were 247 (85) μmol/l, 412 (75) μmol/l and 230 (141) μmol/l in LN, PICN and ICGN, respectively (P = 0.05). Women accounted for 85.3, 76.5 and 36.2% of the patients in LN, PICN and ICGN, respectively (P = 0.025). By the end of the follow-up period of 26 (22.9) months, 25.8% of the patients were requiring dialysis (16.70% in the LN group, 50% in PIGN and 25% in ICGN (P = 0.05) and 21.7% had nephrotic range proteinuria (16.7, 1 and 33.3%, respectively (P = 0.4). Using logistic multivariate analysis, the only independent factors found to predict need for dialysis of prognosis were percent of sclerosed glomeruli (P = 0.05) and presence of ATN (P = 0.028). Baseline proteinuria or SCr, gender and number of glomeruli with crescents, on the other hand, did not impact prognosis. Using linear regression multivariate analysis, SCr, protein excretion and activity score at biopsy did not influence change in SCr or final SCr during the follow-up period. Using ANOVA to compare the groups of LN, PIGN and ICGN), we found significant differences only in gender between LN and ICGN (P = 0.035), in percent glomerular global sclerosis (between LN and PIGN (P = 0.007) and between LN and ICGN (P = 0.012) and in age (between LN and PIGN (P = 0.006). Almost half of our patients with CrGN were due to LN which is higher than that reported by others where PIGN was the more prevalent etiology. Patients with PICN were older and had worse prognosis. This could be explained by the higher number of globally sclerosed glomeruli in the PIGN group.

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BACKGROUND AND OBJECTIVE:Home intravenous (IV) antibiotic programs are becoming increasingly popular worldwide because of their efficacy and safety. However, in Saudi Arabia these programs have not yet become an integrated part of the health care system. We present our experience with a home IV antibiotic program, as one of the major health care providers in Saudi Arabia.DESIGN AND SETTING:Retrospective chart review of patients enrolled in the King Abdulaziz Medical City Home Health Care IV Antibiotic Program from 1 May 2005 (the start of the program) until 30 December 2007.METHODS:In addition to demographic characteristics, we collected data on the site of infection, the clinical diagnosis, the isolated microorganisms, and the type of antibiotics given. Outcome measures evaluated included the relapse rate, failure rate, the safety of the program, and readmission rates.RESULTS:Of the 155 patients enrolled, 152 patients completed the program. Those who completed the program had a mean (SD) age of 52.8 (23.9) years. The mean (SD) duration of the IV antibiotic treatment was 20.6 (17) days. Three patients refused to complete the intended duration of therapy. Peripherally inserted central catheter (PICC) lines were utilized in 130 patients (86%). One-hundred and thirty-one patients completed the intended duration of therapy, although the therapy was changed from the initial plan for 21 (13.8%) patients. Readmission to the hospital during therapy was required for 13 patients (8.5%). Osteomyelitis was the most frequently encountered diagnosis (65 patients, 42.8%), followed by urinary tract infection (36 patients, 23.7%).CONCLUSIONS:The home health care-based IV antibiotic program was an effective and safe alternative for in-patient management of patients with non-life-threatening infections, and was associated with a very low complication rate. Home IV antibiotic programs should be used more frequently as part of the health care system in Saudi Arabia.