Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. MethodsWe did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FindingsWe included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•4...
Background: ED overcrowding is described as one of the main issues in emergency departments (EDs) of any hospital. In Saudi Arabia, the ministry of health applied new telemedicine technology to serve patients by using the mobile application which include Sehha application and 937 medical call center. The main aim of this study is to determine the role of different telemedicine services in reducing non-urgent visits to EDs in Saudi Arabia. Methods: A cross-section study was conducted during August 2020 - May 2021 among 319 patients were using two telemedicine services in Saudi Arabia, including medical call center, and Sehha smart phone application. The primary endpoint of this study aims to determine the role of different telemedicine services in reducing non-urgent visits to EDs in Saudi Arabia. Results: This study analyzed the data from 319 patients who completed the survey provided by the Saudi Ministry of Health that concerning on information related to their health status, and ED visits. Among patients that had the intention to visit the ED (N=159), 53 of them did not go to EDs after using telemedicine services (p-value < 0.01). Regarding medical call center and Sehha application, 9.6% and 24.4%, respectively of the patients used these telemedicine services had changed their mind concerning visiting ED after taking the medical advice (p-values < 0.01).Conclusion: The implemented telemedicine services in Saudi Arabia, namely Sehha application and medical call center showed to be effective in reducing ED overload by providing medical advices to less- and non-urgent patients and deal with their minor medical issues.
Background Emergency department (ED) overcrowding is described as one of the main issues in any hospital. In Saudi Arabia, the ministry of health applied new telemedicine technology to serve patients by using the mobile application, including the Sehha application and 937 medical call center. The main aim of this study is to determine the role of different telemedicine services in changing the intention users’ intentions for visiting the emergency departments in Saudi Arabia. Methods A cross-sectional study was conducted during August 2020 to May 2021 among 319 patients using two telemedicine services in Saudi Arabia, including the medical call center and Sehha smartphone application. The primary endpoint of this study was to determine the number of patients intended to visit ER before and after contacting one of the two telemedicine services and the frequency of people who changed their opinion to visit an ED. Results This study analyzed the data from 319 patients who completed the survey provided by the Saudi Ministry of Health concerning information related to their health status and ED visits. Among patients that had the intention to visit the ED ( N = 159), 53 of them did not go to EDs after using telemedicine services ( p < 0.01). Regarding the medical call center and Sehha application, 9.6% and 24.4%, respectively, of the patients who used these telemedicine services changed their minds concerning visiting ED after taking the medical advice ( p < 0.01). Conclusions The implemented telemedicine services in Saudi Arabia, namely the Sehha application and medical call center, could reduce those intended to visit ED and consequently reduce the overload of EDs by providing medical advice to patients concerning their minor medical issues.
Job satisfaction is determined as the measure to know the individuals’ feelings toward their work. The working conditions that can affect satisfaction and performance of the call center agents have received particular concern. This study aimed to determine the role of remote call center working on agents’ satisfaction compared to onsite workers. A cross-section study was conducted between December 2020 and April 2021 that include 124 agents working in a governmental medical call center in Saudi Arabia. Each agent was receiving a questionnaire that investigates his/her satisfaction with the job nature, supervisor support, job autonomy, job productivity, and performance. Seventy-seven physicians working onsite were compared to forty-seven physicians remotely working in the medical call center. The mean age of the physicians included was 43.17 ± 8.4 years, and most of them were male (>70%), married (>85%), and family medicine specialists (>50%). The mean years of experience in the medical field of the physicians included was 16.87 ± 8.07 years, and the mean years of experience in the medical call center was 1.44 ± .97 years. Onsite agents were more satisfied concerning job nature, supervisor support, productivity, and performance compared to remote agents (70.82 vs 53.47%, 63.38 vs 55.05%, and 66.51 vs 56.03%, respectively). However, onsite agents were less satisfied regarding job autonomy than remote physicians (46.81 vs 53.19%, P-value = .128). Overall, general satisfaction was more seen in physicians working onsite as opposed to remote workers in the medical call center in Saudi Arabia (64.90 vs 54.25%, P-value < .01).
ObjectivesPatients’ satisfaction with the healthcare system is a good indicator for measuring the quality of health services. This study aims to determine patients’ satisfaction with different types of telemedicine services (937 Call Center and Sehha Application) provided by the Ministry of Health in Saudi Arabia.MethodsA cross-section study was conducted to evaluate consumers’ satisfaction toward telemedicine services in Saudi Arabia. A systematic random sampling method was used to collect consumers from each of the two telemedicine services including 937 medical call center and the Sehha application.ResultsTwo hundred and forty-nine (249) randomly chosen consumers of 937 medical call center and the Sehha application have been answered the predesigned questionnaire about satisfaction towards different items of the two medical services. Among 249 consumers of telemedicine services, 83.14% of them were satisfied in general with medical services compared to 8.03% of consumers who were not satisfied. The satisfaction percentages toward physicians’ recommendations, communication skills, listening skills, and waiting time were 77.29%, 83.53%, 85.14%, and 67.87% respectively.ConclusionTelemedicine applications are commonly used nowadays in most developed countries and some developing countries in order to maximize the delivery of healthcare to patients with different medical conditions. The overall satisfaction rates toward different telemedicine services in Saudi Arabia were high, and there was no significant difference in concern to the satisfaction rates between 937 medical call center and Sehha application. In general, consumers of telemedicine services were satisfied, and most of them considered advising other people to use them.
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