Quality of care in university hospitals in Saudi Arabia: a systematic review

OBJECTIVES

To identify the key issues, problems, barriers and challenges particularly in relation to the quality of care in university hospitals in the Kingdom of Saudi Arabia (KSA), and to provide recommendations for improvement.

METHODS

A systematic search was carried out using five electronic databases, for articles published between January 2004 and January 2015. We included studies conducted in university hospitals in KSA that focused on the quality of healthcare. Three independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted their relevant characteristics. All studies were assessed using the Institute of Medicine indicators of quality of care.

RESULTS

Of the 1430 references identified in the initial search, eight studies were identified that met the inclusion criteria. The included studies clearly highlight a need to improve the quality of healthcare delivery, specifically in areas of patient safety, clinical effectiveness and patient-centredness, at university hospitals in KSA. Problems with quality of care could be due to failures of leadership, a requirement for better management and a need to establish a culture of safety alongside leadership reform in university hospitals. Lack of instructions given to patients and language communication were key factors impeding optimum delivery of patient-centred care. Decision-makers in KSA university hospitals should consider programmes and assessment tools to reveal problems and issues related to language as a barrier to quality of care.

CONCLUSIONS

This review exemplifies the need for further improvement in the quality of healthcare in university hospitals in KSA. Many of the problems identified in this review could be addressed by establishing an independent body in KSA, which could monitor healthcare services and push for improvements in efficiency and quality of care.

Person-Centered Care in a Tertiary Hospital Through Patient's Eyes: A Cross-Sectional Study

BACKGROUND

The current trend in healthcare systems around the world is moving towards a person (or patient)-centered care (PCC) model. While some healthcare organizations have only recently embraced the PCC approach, there is no evidence of person-centered care in Saudi hospitals. This study aimed to assess patients' perspectives on the climate of person-centered care and its associated factors in a tertiary hospital in Saudi Arabia.

METHODS

A cross-sectional study design was conducted in 16 inpatient departments at a tertiary hospital in Riyadh, Saudi Arabia. The validated version of the Person-centered Climate Questionnaire-Patient (PCQ-P) was distributed to 300 adult patients admitted to the hospital for more than 48 hours. The patients were interviewed face-to-face, using the PCQ-P. Descriptive and inferential statistical analysis were performed using SPSS (version 22; IBM, NY, USA).

RESULTS

A total of 300 questionnaires were completed. More than half (53%) were females; 39.7% aged 21-40 years; 72.7% married; 49% hold a high school diploma; and 67.4% unemployed. For route of admission into hospital, 39.8% of the respondents were admitted as elective or outpatient appointments, and 45% had been admitted for less than a week. Most patients (84.3%) reported that they preferred to be treated in a governmental hospital. Inpatients' overall mean PCQ-P score was 73 ± 9.988 out of 85. Results suggested significant associations between patient characteristics and their perspectives on person-centered care, such as age (P=0.005), gender (P<0.001), nationality (P=0.026), area of residency (P=0.001), route to admission (P=0.002), length of stay (P=0.003), and hospital preference (P=0.010).

CONCLUSION

Overall, patients' perspective on person-centered care seems positive. Patient and hospital characteristics could play an important role in shaping patients' perceptions of the climate of person-centered care domains.

Risk factors associated with in-hospital mortality patients with COVID-19 in Saudi Arabia

Risk factors for in-hospital mortality of COVID-19 patients in Saudi Arabia have not been well studied. Previous reports from other countries have highlighted the effect of age, gender, clinical presentation and health conditions on the outcome of COVID-19 patients. Saudi Arabia has a different epidemiological structure with a predominance of young population, which calls for separate study. The objective of this study is to assess the predictors of mortality among hospitalized patients with COVID-19 in Saudi Arabia. This is a retrospective observational cohort study of hospitalized adult COVID-19 patients at two tertiary hospitals in Saudi Arabia between May to July 2020. Electronic charts were retrospectively reviewed comparing survivors and non-survivors in terms of demographic and clinical variables and comorbid conditions. A total of 564 hospitalized patients with COVID-19 were included in the study. The overall in-hospital mortality rate was 20%. The non-survivors were significantly older than survivors (59.4 ± 13.7 years and 50.5 ± 13.9 years respectively P< 0.001). Diabetes mellitus, hypertension, heart failure and ischemic heart disease were more prevalent among non-survivors (P< 0.001). The mean values of glycosylated hemoglobin HgA1C, D-dimer, ferritin, lactate dehydrogenase LDH, Alanin aminotransferase ALT and creatinine were significantly higher among non-survivors (P < 0.05). Multivariate logistic regression analysis revealed that age (aOR = 1.04; 95% CI 1.02-1.08; P < 0.01), chronic kidney disease (aOR = 4.04; 95% CI 1.11-14.77; P < 0.05), acute respiratory distress syndrome ARDS (aOR = 14.53; 95% CI 5.42-38.69; P < 0.01), Mechanical Ventilation (aOR = 10.57; 95% CI 5.74-23.59; P < 0.01), Shock (aOR = 3.85; 95% CI 1.02-14.57; P < 0.05), admission to intensive care unit (ICU) (aOR = 0.12; 95% CI 0.04-0.33; P < 0.01) and length of stay (aOR = 0.96; 95% CI 0.93-0.99; P < 0.05) were significant contributors towards mortality. The in-hospital mortality rate of COVID-19 patients admitted to tertiary hospitals in Saudi Arabia is high. Older age, chronic kidney disease and ARDS were the most important predictors of mortality.

Child-Pugh Score, MELD Score and Glasgow Blatchford Score to Predict the In-Hospital Outcome of Portal Hypertensive Patients Presenting with Upper Gastrointestinal Bleeding: An Experience from Tertiary Healthcare System

The two most familiar scores used for prognostication of liver cirrhosis are the Model for End-stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP), while the Glasgow-Blatchford (GB) score is used for sorting non-variceal upper gastrointestinal hemorrhage into high- or low-risk categories. This study evaluates the validity of the CTP, MELD, and GB scoring systems in prognosticating the in-hospital outcome of bleeding portal hypertensive patients. In this study, the ROC curve and Younden index determine the efficacy of three scoring systems. The results indicate that CTP was the most efficient score as the predictor of outcome (AUC = 0.9, cut-off value > 7); followed by MELD (AUC = 0.8, cut-off value > 18) and then the GB score (AUC = 0.64, cut-off value > 14) (p < 0.05). In pair-wise comparison, the difference between CTP and MELD was insignificant (p > 0.05). Patients with a CTP score of >7 had notably higher in-hospital mortality (19.8% vs. 0.9%, p < 0.0001). Similarly, mortality with a MELD score > 18 was significant (14.8% vs. 5.9% (p < 0.0001). The GB score was not a good indicator of the outcome. Platelets, albumin, CTP, and MELD scores were the independent contributors to mortality. Thus, as liver cirrhosis prognosticators, CTP and MELD scores can also both be used as predictive scores of the in-hospital outcomes of bleeding patients due to portal hypertension. Compared to the GB score, CTP and MELD scores are fairly efficient predictors in these patients.

Sequence-structure functional implications and molecular simulation of high deleterious nonsynonymous substitutions in IDH1 revealed the mechanism of drug resistance in glioma

In the past few years, various somatic point mutations of isocitrate dehydrogenase (IDH) encoding genes (IDH1 and IDH2) have been identified in a broad range of cancers, including glioma. Despite the important function of IDH1 in tumorigenesis and its very polymorphic nature, it is not yet clear how different nsSNPs affect the structure and function of IDH1. In the present study, we employed different machine learning algorithms to screen nsSNPs in the IDH1 gene that are highly deleterious. From a total of 207 SNPs, all of the servers classified 80 mutations as deleterious. Among the 80 deleterious mutations, 14 were reported to be highly destabilizing using structure-based prediction methods. Three highly destabilizing mutations G15E, W92G, and I333S were further subjected to molecular docking and simulation validation. The docking results and molecular simulation analysis further displayed variation in dynamics features. The results from molecular docking and binding free energy demonstrated reduced binding of the drug in contrast to the wild type. This, consequently, shows the impact of these deleterious substitutions on the binding of the small molecule. PCA (principal component analysis) and FEL (free energy landscape) analysis revealed that these mutations had caused different arrangements to bind small molecules than the wild type where the total internal motion is decreased, thus consequently producing minimal binding effects. This study is the first extensive in silico analysis of the IDH1 gene that can narrow down the candidate mutations for further validation and targeting for therapeutic purposes.

Cardiovascular Risk Factors Among Patients Infected with COVID-19 in Saudi Arabia

Background

Coronavirus disease (COVID-19) is a global pandemic with more than 60 million cases worldwide and over 1.5 million deaths by March 2021. Its outbreak has caused a huge burden on healthcare systems all over the world. Several studies in the medical literature have suggested that patients with underlying cardiovascular disease (CVD) are at higher risk for developing severe symptoms, poor prognosis, and high mortality rates. The aim of this study was to assess the prevalence of CVD risk factors among COVID-19 patients based on the Framingham risk score (FRS), and to evaluate the association of CVD risk factors with clinical outcomes.

Patients and Methods

In this retrospective cross-sectional study, we identified 264 confirmed cases with COVID‐19 at King Saud University Medical City in Riyadh, Saudi Arabia. Patients aged 18–80 years were included, and their electronic records were reviewed. They were classified into low, intermediate, and high risk of CVD according to FRS classification.

Results

Two-hundred-six patients (67% male) were included in this study. The mean age was 55.3 ± 15.1 years. Most patients had comorbidities: the most common were hypertension (48.1%), diabetes (45.1%), and ischemic heart disease (11.2%). More than half required intensive care admission, and 58 (28.2%) patients died. Pneumonia was the most frequently observed complication (85%), followed by mechanical ventilation (28.3%) and acute kidney injury (27.7%). Age, male gender, hypertension, and diabetes mellitus showed significant differences between FRS categories, and were associated with intermediate and high-risk groups of FRS (p < 0.05). Pneumonia and length of stay were associated with the Intermediate risk group of FRS.

Conclusion

Cardiovascular disease risk factors are prevalent in Saudi patients infected with COVID-19. FRS could be a useful tool to identify CVD risk factors among COVID-19 patients and predict a complicated course.

A bibliometric approach to understanding the recent development of self-sufficient fish feed production utilizing agri-food wastes and by-products towards sustainable aquaculture

The global agri-food industry generates a large volume of waste annually, which causes both environmental and economic problems. Recently, there has been a growing interest in the use of agri-food wastes and by-products to produce self-sufficient fish feed. This study aimed to analyze the intellectual structure of the recent research on the utilization of agri-food wastes and by-products as self-sufficient fish feed materials based on 922 Scopus-indexed core collection documents from 252 journals written by 4420 authors from 73 countries with an annual growth rate of 18.65% over the last four years (2019-2022). This bibliometric study implemented knowledge domain visualization (KDV) using VOSViewer and Biblioshiny in the Bibliometrix R-package to investigate the basic scientometric profile of the selected fields. The results showed that Dawood M.A.O., with PageRanks of 0.0732, 19 total publications, 695 global citations from 2019 to 2022, and closeness values of 0.25, was the most productive author within the field. Subsequently, China was determined to be the most productive country (93 valid documents) and have the strongest collaboration network. Major research hotspots in the field included aquaculture and sustainable aquaculture, fish feed with agri-food waste, rainbow trout species, the development of a circular economy, probiotic applications, and cell signaling cytokines and peptides. This bibliometric study provides comprehensive information on the intellectual domain and research landscape on self-sufficient fish feed and also shows how interest in this research topic and similar ones is growing.

The Effect of Transformational Leadership and Remote Working on Employee Performance During COVID-19 Pandemic

The COVID-19 outbreak has emphasized the importance of leadership style in achieving organizational performance. It also implies changes in administrative processes to remote working, impacting employee activities, and performance. Employee performance is one of the aspects that might influence a company's success. If employees are productive and provide high-quality work, the company's performance will increase. This study aims to analyze the effect of Transformational Leadership and Remote Working on Employee Performance during the COVID-19 pandemic. This study was conducted by performing a questionnaire distribution survey and acquiring 136 respondents. The research was conducted on a Jakarta area company that had implemented Remote Working. The number of samples in this study was determined using a simple random sampling procedure, in which the sampling was done at random without consideration for the population's existing strata. This study uses a quantitative approach method based on factual data and research data in statistical figures related to concluding research problems. The source of data in this study is primary data that was directly obtained from sources without going through intermediaries. This study shows that Transformational Leadership has no significant impact on Employee Performance during the COVID-19 pandemic, and Remote Working has a significant impact on Employee Performance during the COVID-19 pandemic.

Are partnerships in nonprofit organizations being governed for sustainability? A partnering life cycle assessment

Goal 17 of the sustainable development goals (SDGs) attracted attention to the importance of partnerships between governments, the private sector, and nonprofit organizations (NPOs) for sustainable development. This paper aims to analyze the processes of establishing and operating the partnerships between NPOs and other actors in terms of governance. The best practices for partnership governance were examined according to the partnering life cycle framework. A simple random sample of 184 NPOs in six regions of Saudi Arabia was selected for data collection. These organizations were analyzed according to their governance practices in 937 partnerships established during 2016-2018. The findings showed that the organizations had strongly implemented the phases of building and scoping and managing and maintaining, while their governance practices regarding phases of reviewing and revising and sustaining outcomes ranged between moderate and low levels. The results also revealed significant differences between the overall implementation of the partnering life cycle practices and the NPO's year of establishment. It was concluded that analyzing the current situation of implementing the best practices of partnership governance is useful to explore the efficiency and effectiveness of partnerships between NPOs and other actors, as well as the existing policy gaps, so as to create and implement sustainable-oriented partnerships.

Synthesis and [2+2]-photodimerisation of monothiomaleimide functionalised linear and brush-like polymers

[2+2]-Photodimerisation of monothiomaleimides has been demonstrated on functionalised linear and brush-like polymers. In water/acetonitrile (95 : 5) mixtures the rate of reaction is accelerated significantly by irradiation of the thiomaleimide end group (λmax = 350 nm) with UV light, reaching full conversion within 10 minutes.

Psychometric evaluation of the Arabic language person-centred climate questionnaire-staff version

AIM

To evaluate the psychometric properties of the Arabic language person-centred climate questionnaire-staff version.

BACKGROUND

There have been increasing calls for a person-centred rather than a disease-centred approach to health care. A limited number of tools measure the extent to which care is delivered in a person-centred manner, and none of these tools have been validated for us in Arab settings.

METHOD

The validated form of the person-centred climate questionnaire-staff version was translated into Arabic and distributed to 152 health care staff in teaching and non-teaching hospitals in Saudi Arabia. Statistical estimates of validity and reliability were used for psychometric evaluation.

RESULTS

Items on the Arabic form of the person-centred climate questionnaire-staff version had high reliability (Cronbach's alpha .98). Cronbach's alpha values for the three sub-scales (safety, everydayness and community), were .96, .97 and .95 respectively. Internal consistency was also high and measures of validity were very good.

CONCLUSION

Arabic form of the person-centred climate questionnaire-staff version provides a valid and reliable way to measure the degree of perceived person-centredness.

IMPLICATIONS FOR NURSING MANAGEMENT

The tool can be used for comparing levels of person-centredness between wards, units, and public and private hospitals. The tool can also be used to measure the extent of person-centredness in health care settings in other Arab countries.

Quality of Life among Caregivers of Patients Diagnosed with Major Chronic Disease during COVID-19 in Saudi Arabia

Quality of life (QoL) is considered one of the measures of health outcomes. Limited research studies have assessed family caregivers’ QoL, especially among patients diagnosed with chronic disease. This study measures the QoL of caregivers who guardian patients diagnosed with cardiovascular disease, diabetes, cancer, and/or other diseases during the COVID-19 pandemic. Participants were primary caregivers who were supporting, in the last six months, individuals diagnosed with one of the previously mentioned chronic diseases. This included caregivers of patients admitted to a tertiary hospital from January 2021 to July of the same year (n = 1081); all participants completed the World Health Organization Quality of Life Assessment tool (WHOQOL-BREF) questionnaire. Caregivers of patients with cancer reported the highest mean level of QoL, followed by diabetes, cardiovascular diseases, then other different diseases (M = 3.80; M = 3.38; M = 3.37; and M = 2.51, respectively). A chi-square test of independence was performed to examine the relationship between the QoL of the four groups and their behaviors (i.e., caregivers’ psychological onuses and physical actions/reactions). The relation between these variables was significant, X² (3, n = 1081) = 8.9, p = 0.001. The Kruskal–Wallis test indicated significant differences among the four groups (p ≤ 0.001). While the overall results of the QoL level of participants were low, a major recommendation of this study was to incorporate a QoL assessment to caregivers of chronically ill patients. Regular psychological and physical health check-ups of caregivers should be mandated in the healthcare system. Research studies should consider investigating and identifying the factors affecting health outcomes and positive developments which have a great impact on the wellbeing of both caregivers and patients on personal, organizational, and national levels.

Medication Error During the Day and Night Shift on Weekdays and Weekends: A Single Teaching Hospital Experience in Riyadh, Saudi Arabia

Background

The association between medication error incidence and time (day shift vs night shift) have not been extensively studied in Saudi Arabia, this study aimed to answer this question: is there a relationship between medication error incidence and time of the day (day shifts vs night shifts) on weekdays and weekends?.

Objective

To identify whether medication errors and their sub-categories are significantly different between day shifts, night shifts, during weekdays and weekends.

Methods

A retrospective analysis of medication errors reported by health-care practitioners from January 2018 to December 2019 through the Electronic-Occurrence Variance Reporting System (E-OVR) of a university teaching hospital in Riyadh, Saudi Arabia. Statistical analysis was used to determine the differences between the medication errors and their sub-categories and day and night shifts during weekdays (from Sunday to Thursday) and weekends (Friday and Saturday).

Results

A total of 2626 medication errors were reported over 2 years from January 2018 to December 2019. The most prevalent sub-category of medication errors was prescribing errors (55%), while the least common sub-category of medication errors was administration errors (0.6%). There was a statistically significant difference between medication errors and day of the week. Medication errors that happened on weekdays were greater than at weekends (P = 0.01). During weekends, medication errors were more likely to occur at the night shift compared to the day shift (P < 0.05).

Conclusion

Timing of medication errors incidence is an important factor to be considered for improving the medication use process and improving patient safety. Further researches are needed that focus on intervention to reduce these errors, especially during night shifts.

Decomposed and composed effects of economic freedom on economic growth in south Asia

It is frequently asserted that high levels of economic growth are supported by economic freedom. For the period 1995-2021, this study examines the influence of the composed economic freedom index and several subcomponents of economic freedom on the economic growth of four South Asian economies, namely Bangladesh, India, Pakistan, and Sri Lanka. The Ordinary Least Squares, Random Effect Model, and Robust Least Squares approaches are utilized to estimate the composed and decomposed influence of economic freedom on economic growth. Robust Least Squares reflects the robustness of the connection between economic liberty and growth. According to the results of these tests, economic liberty has a strong and favorable stimulus on growth. When the different indicators of economic liberty are evaluated independently, we discovered that the magnitudes of most economic freedom indicators are significant. Conversely, monetary freedom contributes very little to economic expansion. The effects of government spending, public trust, and labor flexibility on economic expansion are hypothetical. The tax load hinders economic expansion in the economies under consideration. Property rights, freedom to do business, trade liberty, investment choice, and financial liberty all have a positive, strong, and sizeable stimulus on economic growth. The decomposed influence of each indicator of economic freedom will help develop policy choices.

The effect of global price movements on the energy sector commodity on bitcoin price movement during the COVID-19 pandemic

This study aims to determine the effect of global price movements for energy sector commodities, especially Crude Oil and Natural Gas Prices, on cryptocurrency price movements. This study focuses more on the Bitcoin cryptocurrency. This study uses quantitative methods, and the data collection used is secondary data with weekly data and the period from January 1, 2020-July 31, 2021. The number of observations used in this study amounted to 79 observations. Secondary data sources are obtained through the website finance.yahoo.com. The data processing technique will be carried out using Stata and SPSS software, the Multiple Linear Regression method, and the Classical Assumption Test. The results of this study show that global prices for energy sector commodities, especially Crude Oil, Natural Gas, have a positive effect on Bitcoin price movements. These results indicate a link between energy and Bitcoin caused by Bitcoin miners who are mining Bitcoin using energy so that when the price of Bitcoin rises, the price of energy will also increase.

Needlestick injuries in radiology: prevention and management

Needlestick injuries are common and often underreported in invasive radiological procedures. Prior needlestick injuries have been reported in 86-91% of interventional radiologists, and on average, one needlestick injury occurs for every 5 years of practice. Of those that have had a needlestick injury, only 58% had formal education on needlestick injury prevention. Needlestick injuries can often result in long-term debility if not properly managed. Injuries can result in transmission of blood-borne pathogens, such as hepatitis B, hepatitis C, and human immunodeficiency virus. Preventative measures, such as vaccination, proper sharps selection, handling, and disposal during radiological procedures, minimising procedure time, and team communication, can decrease the risk of needlestick injuries and pathogen transmission rate. Initial management involves proper cleaning of the wound and activating the injury reporting system. Further lab testing and post-exposure prophylaxis will depend on the serology status of the source and exposed patient. Needlestick injuries with pathogen transmission can result in long-term health issues and psychological damage, therefore, it is imperative for radiologists to understand factors that increase the risk for transmission, methods to prevent injury, and how to manage an injury when it occurs.

Globalization and employment nexus: Moderating role of human capital

While globalization has increased the movement and interconnection of goods, technology, and information, it has also affected employment. Many studies have analyzed the impact of globalization on employment creation resulting in positive and negative findings. However, an area of literature still needs to be explored studying how human capital affects the impact of globalization on employment creation. The current study contributes to the literature by analyzing the moderating role of human capital in the globalization-employment nexus in 26 Asian countries. For this, annual panel data were collected from 1996 to 2019. The estimations have been done using 12 model specifications, 6 for direct and 6 for indirect impact association between globalization and employment through the human capital channel. The study uses generalized least square (GLS) method and generalized method of moments (GMM) for empirical analysis. The static and dynamic analysis shows that globalization's direct and indirect impact on employment through the channel of human capital is positive. Industrial value added and economic growth leads to more employment creation, whereas population growth dampens it. Human capital plays a positive role in getting the advantage of globalization in terms of employment creation. This study confirms the literature recommendations of promoting human capital development to achieve globalization's benefits for more employment creation.

The evolving role of social media in enhancing quality of life: a global perspective across 10 countries

BACKGROUND

Excessive or inappropriate use of social media has been linked to disruptions in regular work, well-being, mental health, and overall reduction of quality of life. However, a limited number of studies documenting the impact of social media on health-related quality of life (HRQoL) are available globally.

AIM

This study aimed to explore the perceived social media needs and their impact on the quality of life among the adult population of various selected countries.

METHODOLOGY

A cross-sectional, quantitative design and analytical study utilized an online survey disseminated from November to December 2021.

RESULTS

A total of 6689 respondents from ten countries participated in the study. The largest number of respondents was from Malaysia (23.9%), followed by Bangladesh (15.5%), Georgia (14.8%), and Turkey (12.2%). The prevalence of social media users was over 90% in Austria, Georgia, Myanmar, Nigeria, and the Philippines. The majority of social media users were from the 18-24 age group. Multiple regression analysis showed that higher education level was positively correlated with all four domains of WHOQoL. In addition, the psychological health domain of quality of life was positively associated in all countries. Predictors among Social Media Needs, Affective Needs (β = -0.07), and Social Integrative Needs (β = 0.09) were significantly associated with psychological health.

CONCLUSION

The study illuminates the positive correlation between higher education levels and improved life quality among social media users, highlighting an opportunity for policymakers to craft education-focused initiatives that enhance well-being. The findings call for strategic interventions to safeguard the mental health of the global social media populace, particularly those at educational and health disadvantages.

The impact of COVID-19 pandemic on key performance indicators in three Saudi hospitals

OBJECTIVE

The coronavirus disease (COVID-19) disrupted healthcare systems and medical care worldwide. This study attempts to assess the performance of three Saudi hospitals during COVID-19 by comparing waiting times for outpatient appointments and the volume of elective surgeries before and after COVID-19.

METHODS

We used ADA'A data collected from three Saudi hospitals for this retrospective cohort study. The outcome variables were "Waiting Time for Appointment" and "Elective OR Utilization". The hospitals included in this study were: a 300-bed maternity and children's hospital; a 643-bed general hospital; and a 1230-bed tertiary hospital. We included all patients who visited the OPD and OR in the time period from September 2019 to December 2021. A two-way ANOVA test was used to examine the differences in the outcome variables by hospital and by the phase of COVID-19.

RESULTS

For the elective OR utilization rate, the results showed that both the hospital and the phase of COVID-19 were significantly different (p-value < 0.05). On average, the elective OR utilization rate dipped considerably in the early phase of COVID-19 (33.2% vs 44.9%) and jumped sharply in the later phase (50.3%). The results showed that the waiting time for OPD appointment was significantly different across hospitals and before and after COVID-19 in each hospital (p-value < 0.05). the waiting time dropped during the early phase of COVID-19 for both the general hospital (GEN) (24.6 days vs 34.8 days) and the tertiary hospital (MDC) (40.3 days vs 48.6 days), while the maternity and children's hospital (MCH)'s score deteriorated sharply (24.6 days vs 9.5 days).

CONCLUSION

This study indicates that COVID-19 led to a significant impact on elective surgery rates and waiting time for OPD appointments in the early stage of the pandemic when the lockdown strategy was implemented in the country. Although the elective surgery rate had decreased at the designated COVID-hospital, the waiting time for OPD appointment had improved. This is a clear indication that the careful planning and management of resources for essential services during pandemic was effective.

Thermoreversible [2 + 2] Photodimers of Monothiomaleimides and Intrinsically Recyclable Covalent Networks Thereof

The development of intrinsically recyclable cross-linked materials remains challenged by the inherently unfavorable chemical equilibrium that dictates the efficiency of the reversible covalent bonding/debonding chemistry. Rather than having to (externally) manipulate the bonding equilibrium, we here introduce a new reversible chemistry platform based on monosubstituted thiomaleimides that can undergo complete and independent light-activated covalent bonding and on-demand thermal debonding above 120 °C. Specifically, repeated bonding/debonding of a small-molecule thiomaleimide [2 + 2] photodimer is demonstrated over five heat/light cycles with full conversion in both directions, thereby regenerating its initial monothiomaleimide constituents. This motivated the synthesis of multifunctional thiomaleimide reagents as precursors for the design of covalently cross-linked networks that display intrinsic switching between a monomeric and polymeric state. The resulting materials are shown to covalently dissociate and depolymerize upon heating both in solution and in bulk, thus transforming the densely photo-cross-linked material back into a viscous liquid. Temperature-regulated photorheology evidenced the intrinsic recyclability of the thiomaleimide-based thermosets during multiple cycles of UV cross-linking and thermal de-cross-linking. The thermally reversible photodimerization of thiomaleimides presents a new addition to the designer playground of dynamic polymer networks, providing interesting opportunities for the reprocessing and closed-loop recycling of covalently cross-linked materials.

Photocrosslinking of Polyacrylamides Using [2 + 2] Photodimerisation of Monothiomaleimides

The [2 + 2] photocycloaddition of monothiomaleimides (MTMs) has been exploited for the photocrosslinking of polyacrylamides. Polymer scaffolds composed of dimethylacrylamide and varying amounts of d,l-homocysteine thiolactone acrylamide (5, 10, and 20 mol %) were synthesized via free-radical polymerization, whereby the latent thiol functionality was exploited to incorporate MTM motifs. Subsequent exposure to UV light (λ = 365 nm, 15 mW cm^–2) triggered intermolecular crosslinking via the photodimerization of MTM side chains, thus resulting in the formation of polyacrylamide gels. The polymer scaffolds were characterized using Fourier transform infrared spectroscopy, UV–visible spectroscopy, ¹H NMR spectroscopy, and size exclusion chromatography, confirming the occurrence of the [2 + 2] photocycloaddition between the MTM moieties. The mechanical and physical properties of the resulting gels containing various MTM mol % were evaluated by rheology, compression testing, and swelling experiments. In addition, scanning electron microscopy was used to characterize the xerogel morphology of 5 and 10 mol % MTM hydro- and organo-gels. The macro-porous morphology obtained for the hydrogels was attributed to phase separation due to the difference in solubility of the PDMA modified with thiolactone side chains, provided that a more homogeneous morphology was obtained when the photo-gels were prepared in DMF as the solvent.

Patients and Health Professionals' Perceptions of Primary Health Care Services in Saudi Arabia: A Scoping Review

Objective

This scoping review aims to identify and summarize existing evidence concerning the quality and capacity of PHC services in the Kingdom of Saudi Arabia (KSA) with a focus on the patients and healthcare professionals' perceptions of PHC.

Methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The digital library, PubMed, and the search engine Google Scholar were searched to broaden our results for primary research involving patient and/or health professionals' perspectives on Primary Healthcare in KSA.

Results

A total of 38 publications were selected for the scoping review. Several studies examined patients' overall satisfaction with PHC services (n=14) while others focused their investigation on specific services provided by PHC (n=3). Several studies assessed the perceptions of certain groups of patients (n=5). Several studies examined health professionals' perceptions of the use of electronic health records (n=3), the safety culture (n=2), communicable disease management (n=1), emergency services (n=1), laboratory services (n=1), cost-effectiveness (n=1), and leadership (n=1). This review also included studies that assessed the health professionals' job satisfaction and burnout (n=6).

Conclusion

Patients were satisfied with some aspects of PHC services while recognizing that improvements in some areas were needed. These included waiting time, physician-patient communication, access to the services in rural areas, patient involvement in disease management, and oral health. Health workers were positive about certain quality aspects and services provided by PHC such as EHRs, safety culture, communicable disease management, emergency services, and laboratory services. Health workers demonstrated a low level of job satisfaction due to several reasons, including, working conditions, financial incentives, and burnout.

Women and entrepreneurship for economic growth in Indonesia

Business and entrepreneurship are certainly not a monopoly on men. As inhabitants of half the world, women also have the right to engage in the business world. In line with the ideals of emancipation, many women currently have the opportunity to become business partners of men. This research aims to clarify the role of absorptive capacity and entrepreneurial competencies in strengthening women's leadership toward success. This research was conducted in 3 provinces in Indonesia involving 114 women entrepreneurs in the MSME (micro, small, and medium enterprises) category. This research used a structural equation model with the SmartPLS software tool. The results of this research showed that absorptive capacity and entrepreneurial competencies were able to increase women's leadership toward successful entrepreneurship. City and age moderation failed to moderate the effect of women's leadership on successful entrepreneurship. The government on a macro scale needs to pay attention to providing understanding or special training for women MSME business actors who are trying to build their business from scratch. Business challenges for women entrepreneurs are heavier than for men because there are several social, value, and cultural barriers that require special treatment and strategies in developing the potential of women entrepreneurs in Indonesia.