Sami Ayed

Objective: During the COVID-19 pandemic, there was a significant decrease in the number of operated elective cases due to the shutdown procedures. This situation created a substantial surgical backlog. Several visits are generally necessary before a surgical decision making and booking the surgery time. Improving patient access by creating "one-stop" clinics might help decrease the number of visits before the surgery. This study investigated the effect of one-stop clinic application as a new care model on COVID-19 surgical backlog clearance. Methods: We conducted a quasi-experimental, interrupted time-series, pretest-posttest study design in the northern areas of Saudi Arabia. The study outcomes were the number of surgeries and the time elapsed from the first seen day to the booked room day. Results: A total of 358 surgeries were included. Of them, 107 (29.9%) surgeries were performed before initiation of the one-stop clinic and 251 (70.1%) after initiation. The median (quartile Q1, Q3) time elapsed from the first seen day until the booked OR day post-one-stop clinic was 10 (6-17), which was significantly lower than pre-one-stop clinic 20 (11-33), P < 0.0001. Conclusion: One-stop clinics shortened the period between first visit and booking in the operating room. One-stop clinics may alleviate the surgical backlog resulting from the COVID-19 crisis.

Background: One of the most prevalent bacterial infections in children is urinary tract infection (UTI), which has become a major concern with increasing resistance of the pathogens to the routinely used antimicrobial agents. The aim of the study is to determine the antimicrobial susceptibility patterns of pediatric UTI-causing pathogens, including ESBL-producing bacteria, in Saudi Arabia. Methods: This cross-sectional retrospective study was conducted to ascertain the frequency of isolation and the antimicrobial resistance pattern of uropathogens among children aged 0–15 years. The data from the urine cultures was collected during 2019–2020 at the King Fahad Medical City, a major tertiary hospital in Riyadh, Saudi Arabia. A total of 1022 urine samples from patients diagnosed with urinary tract infections (UTIs) were collected for this study. Microbial species present in the samples were cultured and identified using standard biochemical techniques. To assess the resistance of these...

Objective: During the COVID-19 pandemic, there was a significant decrease in the number of operated elective cases due to the shutdown procedures. This situation created a substantial surgical backlog. Several visits are generally necessary before a surgical decision making and booking the surgery time. Improving patient access by creating “one-stop” clinics might help decrease the number of visits before the surgery. This study investigated the effect of one-stop clinic application as a new care model on COVID-19 surgical backlog clearance. Methods: We conducted a quasi-experimental, interrupted time-series, pretest-posttest study design in the northern areas of Saudi Arabia. The study outcomes were the number of surgeries and the time elapsed from the first seen day to the booked room day. Results: A total of 358 surgeries were included. Of them, 107 (29.9%) surgeries were performed before initiation of the one-stop clinic and 251 (70.1%) after initiation. The median (quartile Q1, Q3) time elapsed from the first seen day until the booked OR day post-one-stop clinic was 10 (6-17), which was significantly lower than pre-one-stop clinic 20 (11-33), P &lt; 0.0001. Conclusion: One-stop clinics shortened the period between first visit and booking in the operating room. One-stop clinics may alleviate the surgical backlog resulting from the COVID-19 crisis.

Background: Hospital admission can be scary for a child, most especially for hospitalized pediatric cancer patients, but studies show that there is growing evidence that environmental modification has a great impact in patient experience and health outcomes. Majority of pediatric cancer patients and their family was not satisfied with the unit environment. The aim of this study was to explore the impact of creating a child-friendly hospital environment in pediatric cancer patients and their families. Method: General surveys were conducted. Performance improvement team studied the result of the surveys, a specific survey was formulated. Relevant data were collected. After studying the results, suggestions for improvement were considered. Contributing factors for their dissatisfaction were also analyzed in a form of Cause-and-Effect Diagram. A post-intervention survey was conducted. Result: Result of general, specific survey and repeated focus group discussion showed that we need to c...

Background: Breaking bad news to patients with a cancer diagnosis is not an easy task for physicians. The diagnosis must be explicitly stated and understood, and the prognosis must be well-discussed in the most gentle and comfortable manner. It is important that the disclosure is performed in a way that patients will not lose all hope and get very depressed and undergo an abrupt change in their outlook on life. Objective: The aim of this study was to explore physicians&#39; perceptions and perspectives of breaking the bad news to cancer patients before and after attending training workshops. Methods and Settings: A quasi-experimental design was performed among physicians working in a comprehensive cancer centre. It compared the performance of the respondents in breaking bad news before and after attending a communication skill workshop. It was conducted from March to April 2017. Results: Pre-intervention survey result showed 68% responded to the survey. Eighty-four percent were comfortable with breaking bad news, and 70% had training in breaking bad news. Eighty-six percent of the responders (86.3%) stated that patients should be told about their cancer. Almost 30% of the respondents stated that they would still disclose the diagnosis to patients even if it would be against the preference of the relatives. Nearly 61% said that they would only tell the details to the patients if asked. Nearly 67% of them disagreed that patients should be told about the diagnoses only if the relatives consent. About 51% of physicians wanted to discuss the bad news with the family and patient together, whereas 24% stated that the patient alone should be involved in the discussion. Conclusion: Physicians face a dilemma when families do not wish the patient to know about the cancer diagnosis, and this highlights the necessity of taking into consideration the social circumstances in healthcare. When taking these into consideration, curriculum in the medical school must, therefore, be updated and must integrate the acquisition of skills in breaking bad news early in training.

This article described our experience in implementing a quality improvement project to overcome the bed overcapacity problem at a comprehensive cancer centre in a tertiary care centre. We formed a multidisciplinary team including a representative from patient and family support (six members), hospice care and home care services (four members), multidisciplinary team development (four members) and the national lead. The primary responsibility of the formulated team was implementing measures to optimise and manage patient flow. We used the plan–do–study–act cycle to engage all stakeholders from all service layers, test some interventions in simplified pilots and develop a more detailed plan and business case for further implementation and roll-out, which was used as a problem-solving approach in our project for refining a process or implementing changes. As a result, we observed a significant reduction in bed capacity from 35% in 2017 to 13.8% in 2018. While the original length of sta...

Background: Breaking bad news to patients with cancer diagnosis is not an easy task for physicians. The diagnosis must be explicitly stated and understood, and prognosis must be well-discussed in the most gentle and comfortable manner. It is important that the disclosure is performed in a way that patients will not lose all hope and get very depressed, leading them to undergo an abrupt change of their outlook in life. Objective: The aim of this study was to explore the physicians&#39; perceptions and perspectives of breaking bad news to cancer patients. Methods: A cross-sectional survey of all comprehensive cancer centre physicians currently working in a university teaching hospital in the Middle East was conducted from August to September 2016. Results: Sixty-eight percent responded to the survey. Eighty-four percent were comfortable with breaking bad news, and 70% had training in breaking bad news. Eighty-six percent of responders stated that patients should be told about their cancer. Almost 30% of the respondents stated that they would still disclose the diagnosis to patients even if it would be against the preference of the relatives. Nearly 61% said that they would only tell the details to the patients if asked while 67% of them disagreed that patients should be told about the diagnoses only if the relatives consent. About 51% of physicians wanted to discuss the bad news with the family members and patient together, whereas 24% stated that the patient alone should be involved in the discussion. Conclusion: Physicians face a dilemma when families do not wish the patient to know the cancer diagnosis and this highlights the necessity of taking into consideration the social circumstances in healthcare. When taking these into considerations, curriculum in the medical school must, therefore, be updated and must integrate the acquisition of skills in breaking bad news early in training.

Intractable hiccupping is distressing for both patients under palliative care and their families, particularly if the patients have advanced cancer. The lack of clear management guidelines renders hiccup management challenging for health professionals. We report our management of intractable hiccups in a 70-year-old man with a progressive malignant brain tumour who was under palliative care. The hiccups were difficult to control; several drugs were tested before we finally introduced (and upwardly titrated) gabapentin, which appears to be safe when used to manage intractable hiccups.

Background: The terminally ill diabetic inpatients who had blood glucose monitoring continued until the day of death ranged from 32% to 76% according to previous studies. Researches regarding the management of diabetes in palliative care services in Saudi Arabia are insufficient, although it is of high prevalence. Balancing the goals of avoiding symptoms of hyperglycaemia and hypoglycaemia as well as minimising the burden of blood glucose monitoring and treatment have become a struggle to palliative care physicians due to limited evidence-based resources. This intensifies the complexity of managing diabetes during a terminal illness. Objective: The purpose of this study was to describe the management of diabetes among patients who were admitted to hospital-based palliative care unit (PCU) at King Fahad Medical City, Riyadh, Saudi Arabia. Methods: A retrospective chart review, cohort study for all PCU inpatients was done. The study was conducted on the charts of 12 months from January to December 2013. Measures included diabetes prevalence, monitoring of blood glucose by laboratory and/or bedside testing and diabetes treatment with the use of oral hypoglycaemic agents and insulin. Prevalence of diabetes associated comorbidities, hypertension and dyslipedemia were also measured along with their treatment. A descriptive analysis of collected data was carried out. Results: Eighteen adult diabetic patients (15.25%) out of the whole 118 patients admitted to PCU over the 12 months&#39; study period were reported. Ten (55.6%) were males, and 8 (44.4%) were females, with a mean age of 59.26 years. Blood glucose monitoring in the diabetic patients was done for ten patients; bedside glucometer utilized for 9 patients (50%), glucometer + serum glucose measurement done in one patient (5.6%), and no glucose monitoring was done in eight patients (44.4%). The majority of the patients 11/18 (61%) stayed at the hospital until death while 7/18 (39%) did well and were discharged. The monitoring of blood sugar was continued for six patients until the last week of life. Blood glucose management dropped to 33% at the end of life. Initially, half of the patients (50%) had their blood glucose managed with hypoglycaemic medications with or without insulin. This dropped during the last week of life to 33%. In the comorbidity group, 72% were using antihypertensive or lipid lowering agents, as a result of which it dropped to 50% during the last week of life. Conclusion: Diabetes management varied among PCU patients. There is a real need for evidence-based guidelines for diabetes management among patients at the end of life. These guidelines should be tailored to patients&#39; individual preferences in goals of care. Advance care planning should include discussion about patient preferences for management of diabetes at the end of life.

ABSTRACT We describe a case of liver failure in a child with repeated therapeutic doeses of paracetamol after being given multiple doses to manage pyrexia during a viral illness. The child was treated successfully with only a single loading dose of N-acetylcysteine. This case highlights the importance of parental advice and physician vigilance in preventing hepatotoxicity paracetamol overdose during viral illnesses.

ABSTRACT Introduction: Palliative care is a multidisciplinary approach that aims to improve the quality of life of patients with lifethreatening illnesses. It has been recognized as a crucial part of patient care in oncology. Palliative care service was established in the comprehensive cancer center of King Fahad Medical City (KFMC), Riyadh, Saudi Arabia in March 2010. The objective of this study was to determine the interval between the first palliative care consult (PCC1) and death, and explore the possible cause of suggestive short timeframe between PCC1 and death. Patients and Methods: This study included 210 cancer patients who had their PCC1 in KFMC within the period of March 2012 and March 2014. Demographic information, cancer diagnosis, date of cancer diagnosis, reason for referral, all symptoms reported in Palliative Care Unit, and date of death were gathered from the patients’ charts. The interval between the PCC1 and death were computed and analyzed. Results: Of the 210 patients, 121 (57.6%) were female, 127 (60.5%) were &amp;lt;60 years old, and 190 (90.5%) had nonhaematological tumours. The main reasons for referral were symptom control (62.4%), symptom control and end of life (EOL) care (12.4%), symptom control and transfer of care (11.4%), and EOL care (8.6%). The median interval between PCC1 and death, diagnosis to PCC1, and diagnosis to death intervals were 19, 212, and 360 days, respectively. Patients diagnosed with haematological tumours were referred relatively earlier to palliative care. The difference in the mean (haematology &amp;gt; non-haematology) for the interval between PCC1 and death was 146.2 days (P &amp;lt; 0.001). Conclusions: Late referrals to palliative care services KFMC is the strongest predictor of the short interval between PCC1 to death of advanced stage cancer patients. Identifying the potential cause of the late referrals can lead to developing optimal policies for the timely referral of cancer patients to palliative care upon diagnosis regardless of the stage of their disease. Education and advocacy are needed among the referring oncologists in the cancer center for earlier access to palliative care. Future studies are needed to establish the appropriate timing of the PCC1.

ABSTRACT Palliative care is a relatively new medical speciality in Saudi Arabia, but it has shown tremendous growth in the last two decades. Nevertheless, there are challenges to this development. The paper reviews these barriers in context of the growing need for palliative care and possible ways to overcome these challenges. Keywords: Cancer, life-threatening diseases, multidisciplinary team, pain, palliative care

The purpose of this study was to describe the development, implementation, and evaluation of an educational program in family medicine for general practitioners in Saudi Arabia from 2009 to 2011. A continuing medical education program called Family Medicine Education (FAME) was developed with 7 modules each consisting of 12-14 hours of teaching to be delivered in 3 day blocks, over 45 days. Twenty percent (2,761) of all general practitioners participated in the FAME program. Initial assessment of the program showed significant improvement of knowledge from scores of 49% on a pre-test to 89% on post-tests. FAME program in Saudi Arabia facilitated primary care physicians’ knowledge.

Background: The COVID-19 pandemic prompted a number of shifts on healthcare. Conventional face-to-face visits were shifted during lockdown to virtual ones. Palliative care (PC) virtual visits have had high satisfaction rates, especially with patients in remote areas. Due to a number of factors, further studies are needed to develop tools that can be helpful and cost effective in improving patient’s quality of life. Objective: Our aim is to learn the main reasons palliative patients in Saudi Arabia sought help via calling the free 24/7 hotline and to discuss the hotline’s satisfaction and effectiveness in solving the palliative patient’s concerns during COVID-19. Methods: A cross-sectional sample analysis was obtained from 214 patients from different regions in Saudi Arabia. A total number of 843 calls were made to the 24/7 PC hotlines from the period of 17 April 2020 to 28 February 2021, shortly after COVID-19 pandemic began. The purpose of the call, the caller&#39;s relationship to...

The shipping industry is facing a major challenge. Current and future emission requirements result in considerably increased operating costs. Studies have shown that it is a large potential to reduce the ship operating costs by energy effectivisation. The focus has naturally been on systems with major energy losses, such as combustion engines, propulsion and hull friction.A passenger ship like Stena Danica with a big climate controlled accommodation could be expected to have major heat losses. By calculating transmission losses from walls, ceilings, window sections, and the energy losses by ventilation, a general view of how heat losses are distributed has been established. The primary goal is to gather information that could be useful in further energy improvements.Due to lack of information and deficiently measured data have several assumptions and simplifications been made. Despite this, the calculations can be considered as indicative. The results indicated that about 50 percent...

Palliative care is required for a wide range of diseases. Worldwide, there is a major population of adults in need of palliative care who have chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, AIDS and diabetes. Many other conditions may require palliative care, including kidney failure, chronic liver disease, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological disease, dementia, congenital anomalies and drug-resistant tuberculosis.

Background Prognostication is important for patients and their family members as they need this information for the preparation and planning of their future. It is important for physicians as they desire to be accurate in their prognostication skills in order to plan and deliver better care to their patients; healthcare managers require it as they need this information for planning and distribution of hospital resources. We intended to study the accuracy of imminent death diagnosis (IDD) in a palliative care setting in all patients who died at the Palliative Care Unit (PCU) at King Fahad Medical City between December 2012 and December 2014. Methods We conducted a retrospective chart review of all consecutive patients who died in the PCU between 2012 and 2014. We studied the percentage of patients who were diagnosed with imminent death. We further looked at the accuracy of IDD by calculating the time between the diagnosis of imminent death and death. The primary outcomes were the per...

This paper describes the management of a 65 years old male patienttransferred to the palliative care ward from the Intensive Care Unit, withbrain metastasis and infarction admission, epilepsy, neurological dysfunction,cognitive impairment and a history of previous delirium episodes. Wediscuss four delirium assessment methods and possible collaborativemultidisciplinary approaches to manage persistent delirium in palliative carepatients.1.Agar M, Alici Y, and Breitbart (2015)W.17.5 Delirium. In In Oxford Textbookof Palliative Medicine 5th edition. Cherny N, Fallon M, Kaasa S, Portenoy R, Currow D. Oxford University Press . pp 1092-11002.Hosker CM and Bennet MI. Delirium andagitation at the end of life. BMJ2016;353:i3085 doi: 10.1136/bmj.i30853.Cherny N, Fallon M, Kaasa S, PortenoyR, Currow D. Oxford Textbook of Palliative Medicine 5th edition. Oxford.Oxford University Press. 20154.Ryan K, Leonard M, Guerin S, et al.Validation of the confusion assessmentmethod in the palliative care se...

Palliative sedation is a unique concern for the patient as well as the family. It is a difficult serious ethical dilemma for the physicians to handle. The conflicting ethical principles of autonomy, beneficence and nonmaleficence in continuing versus discontinuing all supportive devices raise concerns among health professionals whether this is euthanasia (physician-assisted suicide) or is just prolonging the patient&#39;s unnecessary suffering.

Background: Saudi Commission for Health Specialties (SCFHS) has adopted CanMEDS competency framework for developing curriculum for postgraduate training programmes. Purpose: The purpose of this paper is to share the process of developing postgraduate curricula under SCFHS&#39;s patronage and to identify potential barriers to implement newly developed curricula and suggest strategies to overcome the barriers. Methods: The process of consensus building started with one-one interview with key stakeholders, review of literature, and comparison of various curricular models. A prototype curriculum was developed with inputs from international advisors. The proposal for the curriculum development and outcomes was reviewed amongst SCHS education committee members and approved. Two medical education experts have been involved in coordinating the process of curriculum development. Results: Over the last two years, SCFHS has been working with several residency and fellowship programmes to develop formal curricula. The goal is to complete formal curriculum for all residency and fellowship programmes using CanMEDS competency frameworks.

Background The World Health Organization (WHO) has recognized access to palliative care as a basic human right. Palliative care service has been established in Saudi Arabia for more than two decades; however, it is still limited to secondary and tertiary healthcare institutions. While primary care is the first level of care in the Saudi healthcare system and covers the largest amount of the population, palliative care is still far from implemented at this level. Objectives This study sought to evaluate the outcome of integrating palliative care service at the primary healthcare level and assess patient satisfaction with services provided by primary healthcare centers (PHCCs). Results Two hundred patients participated in the study, including 50 new patients and 150 existing patients for follow-up. One hundred ten patients, in addition to 200 caregivers, attended the clinic. Twenty percent were on active oncology treatment. The no-show rate was 45%, and the overall satisfaction score ...

BackgroundPeople with cancer usually experience some degree of depression, anxiety, and fear, as if embracing the fact that cancer has become part of their lives. Additionally, religious beliefs can influence a patient's support system, as well as the patient's own emotional response, behavior, and decision-making, which can create a conflict with medical treatment. The objective of this study was to assess cancer patients' religious beliefs and social support.MethodsA cross-sectional study was conducted in 294 adult patients at the Comprehensive Cancer Center of King Fahad Medical City in Riyadh, Saudi Arabia. Patients were interviewed using the System of Belief Inventory (SBI-15R) questionnaire, and responses were noted in the survey form.ResultsThe majority (82.3%) of patients were newly diagnosed with cancer and in the treatment phase, whereas 9.9% were in the metastatic phase. The total mean score of the SBI-15R scale was 27.9. The mean score of the social support subscale was 13.1 ± 1.68, whereas the mean score for the beliefs and practice subscale was 29.7 ± 0.81. For the social support subscale, a statistically significant difference was found in age (P < 0.001), gender (P < 0.001), and occupation (P = 0.009). However, for the beliefs and practice subscale, a statistically significant difference was found only with gender (P = 0.001). ConclusionsThis study concluded that social support is important for the study participants, and they were attached to their beliefs and cultural practices, as indicated by the high total mean score on the SBI-15R. Understanding this topic is important in order for healthcare organizations to provide holistic patient care.

Introduction: Palliative care is a multidisciplinary approach that aims to improve the quality of life of patients with lifethreatening
illnesses. It has been recognized as a crucial part of patient care in oncology. Palliative care service was
established in the comprehensive cancer center of King Fahad Medical City (KFMC), Riyadh, Saudi Arabia in March 2010.
The objective of this study was to determine the interval between the first palliative care consult (PCC1) and death, and
explore the possible cause of suggestive short timeframe between PCC1 and death.
Patients and Methods: This study included 210 cancer patients who had their PCC1 in KFMC within the period of March
2012 and March 2014. Demographic information, cancer diagnosis, date of cancer diagnosis, reason for referral, all symptoms
reported in Palliative Care Unit, and date of death were gathered from the patients’ charts. The interval between the PCC1
and death were computed and analyzed.
Results: Of the 210 patients, 121 (57.6%) were female, 127 (60.5%) were <60 years old, and 190 (90.5%) had nonhaematological
tumours. The main reasons for referral were symptom control (62.4%), symptom control and end of life (EOL)
care (12.4%), symptom control and transfer of care (11.4%), and EOL care (8.6%). The median interval between PCC1 and
death, diagnosis to PCC1, and diagnosis to death intervals were 19, 212, and 360 days, respectively. Patients diagnosed
with haematological tumours were referred relatively earlier to palliative care. The difference in the mean (haematology >
non-haematology) for the interval between PCC1 and death was 146.2 days (P < 0.001).
Conclusions: Late referrals to palliative care services KFMC is the strongest predictor of the short interval between PCC1 to
death of advanced stage cancer patients. Identifying the potential cause of the late referrals can lead to developing optimal
policies for the timely referral of cancer patients to palliative care upon diagnosis regardless of the stage of their disease.
Education and advocacy are needed among the referring oncologists in the cancer center for earlier access to palliative care.
Future studies are needed to establish the appropriate timing of the PCC1.

Background: Breaking bad news to patients with cancer diagnosis is not an easy task for physicians. The diagnosis must be explicitly stated and
understood, and prognosis must be well‑discussed in the most gentle and comfortable manner. It is important that the disclosure is performed
in a way that patients will not lose all hope and get very depressed, leading them to undergo an abrupt change of their outlook in life.
Objective: The aim of this study was to explore the physicians’ perceptions and perspectives of breaking bad news to cancer patients.
Methods: A cross‑sectional survey of all comprehensive cancer centre physicians currently working in a university teaching hospital in the
Middle East was conducted from August to September 2016.
Results: Sixty‑eight percent responded to the survey. Eighty‑four percent were comfortable with breaking bad news, and 70% had training
in breaking bad news. Eighty‑six percent of responders stated that patients should be told about their cancer. Almost 30% of the respondents
stated that they would still disclose the diagnosis to patients even if it would be against the preference of the relatives. Nearly 61% said that
they would only tell the details to the patients if asked while 67% of them disagreed that patients should be told about the diagnoses only if
the relatives consent. About 51% of physicians wanted to discuss the bad news with the family members and patient together, whereas 24%
stated that the patient alone should be involved in the discussion.
Conclusion: Physicians face a dilemma when families do not wish the patient to know the cancer diagnosis and this highlights the necessity
of taking into consideration the social circumstances in healthcare. When taking these into considerations, curriculum in the medical school
must, therefore, be updated and must integrate the acquisition of skills in breaking bad news early in training.
Keywords: Attitude, breaking bad news, comprehensive cancer centre, perception, psychosocial distress, survey

Pruritus or itch is an uncommon symptom observed in palliative care, even more uncommon in cancer patients. However, if a patient experiences pruritus, the 'itch-scratch' cycle can damage the skin integrity and can increase the susceptibility of patients to infection owing to their frail immune system. The outcome can be very distressing, dramatically impacting the quality-of-life of the patient. Moreover, since severe pruritus seen in patients with advanced disease can be associated with failure of different organ systems, pruritus must be assessed based on the underlying organ systems and the pathophysiology involved. Regardless of the cause of pruritus, general skin care is important. Depending on the origin of pruritus, specific approach and medications must be considered. Caution must be taken during management of pruritus since most cancer patients take pain medications that interact with some antipruritic medications. In addition to the complex and unclear nature of cutaneous and central pathogenesis of pruritus, treatment of pruritus is challenging.

Palliative care is a relatively new medical speciality in Saudi Arabia, but it has shown tremendous growth in the last two decades. Nevertheless, there are challenges to this development. The paper reviews these barriers in context of the growing need for palliative care and possible ways to overcome these challenges.