BackgroundAntibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. We aimed to determine the percentage of pharmacies who sell antibiotics without medical prescriptions, examining the potential associated risks of such practice in Riyadh, Saudi Arabia, by simulation of different clinical scenarios.MethodsA cross sectional study of a quasi-random sample of pharmacies stratified by the five regions of Riyadh. Each pharmacy was visited once by two investigators who simulated having a relative with a specific clinical illness (sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection (UTI) in childbearing aged women).ResultsA total of 327 pharmacies were visited. Antibiotics were dispensed without a medical prescription in 244 (77.6%) of 327, of which 231 (95%) were dispensed without a patient request. Simulated cases of sore throat and diarrhea resulted in an antibiotic being dispensed in (90%) of encounters, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%). Metronidazole (89%) and ciprofloxacin (86%) were commonly given for diarrhea and UTI, respectively, whereas amoxicillin/clavulanate was dispensed (51%) for the other simulated cases. None of the pharmacists asked about antibiotic allergy history or provided information about drug interactions. Only 23% asked about pregnancy status when dispensing antibiotics for UTI-simulated cases.ConclusionsWe observed that an antibiotic could be obtained in Riyadh without a medical prescription or an evidence-based indication with associated potential clinical risks. Strict enforcement and adherence to existing regulations are warranted.

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BackgroundNurse turnover has a negative impact on the ability to meet patient needs and provide a high quality of care, which may create more stress on other staff due to increased workloads. This can lead to critical changes in the behavior of nurses towards their jobs resulting in low work satisfaction, low productivity, and leaving the organization. Thus, this study aimed to assess the quality of nursing work life (QNWL), to explore the nurses’ turnover intention and to examine the correlation between QNWL and nurses’ turnover intention.MethodsA cross-sectional survey was conducted on nurses with at least 1 year of nursing experience at two hospitals selected randomly from Riyadh, Saudi Arabia: King Fahad Medical City and King Faisal Specialized Hospitals. Data were collected using a self-administered questionnaire comprising four sections (Brooks’ survey of QNWL, Anticipated Turnover Scale (ATS), open-ended questions and demographic characteristics).ResultsA sample of 364 nurses was recruited. Results proposed that the participants were dissatisfied with their work life (54.7%), with almost 94% indicating a turnover intention from their current hospital. Moreover, 154 (93.3%) out of 165 nurses who reported satisfaction with QNWL indicated the intention to turnover. The correlation between QNWL and ATS for binary variables was too week (r = − 0.024) and statistically not significant (p = 0.206).ConclusionThe QNWL and nurse turnover are challenging issues for healthcare organizations because of its consequences and impact on patient care. Our study provided critical findings low indication satisfaction of nurses with their QNWL and a high turnover intention. The results of this study could be used as a nexus for the development of regulations and practical strategies to enhance QNWL and to decrease the turnover.

IntroductionEmerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI).MethodsOvid MEDLINE, EMBASE, ISI Web of Science, and Scopus were searched from 1990 to January 2012 for analytical studies that reported an adjusted effect estimate of the association between PPI use and CDI. We performed random-effect meta-analyses. We used the GRADE framework to interpret the findings.ResultsWe identified 47 eligible citations (37 case-control and 14 cohort studies) with corresponding 51 effect estimates. The pooled OR was 1.65, 95% CI (1.47, 1.85), I2 = 89.9%, with evidence of publication bias suggested by a contour funnel plot. A novel regression based method was used to adjust for publication bias and resulted in an adjusted pooled OR of 1.51 (95% CI, 1.26–1.83). In a speculative analysis that assumes that this association is based on causality, and based on published baseline CDI incidence, the risk of CDI would be very low in the general population taking PPIs with an estimated NNH of 3925 at 1 year.ConclusionsIn this rigorously conducted systemic review and meta-analysis, we found very low quality evidence (GRADE class) for an association between PPI use and CDI that does not support a cause-effect relationship.

The main finding of the present study was that multiple paravertebral injections resulted in more reliable radiographic and clinical distribution compared with a single-injection technique.