Accreditation is usually a voluntary program in which trained external peer reviewers evaluate a healthcare organization's compliance and compare it with pre-established performance standards. The aim of this study was to evaluate the impact of accreditation programs on the quality of healthcare services We did a systematic review of the literature to evaluate the impact of accreditation programs on the quality of healthcare services. Several databases were systematically searched, including Medline, Embase, Healthstar, and Cinhal. Twenty-six studies evaluating the impact of accreditation were identified. The majority of the studies showed general accreditation for acute myocardial infarction (AMI), trauma, ambulatory surgical care, infection control and pain management; and subspecialty accreditation programs to significantly improve the process of care provided by healthcare services by improving the structure and organization of healthcare facilities. Several studies showed that general accreditation programs significantly improve clinical outcomes and the quality of care of these clinical conditions and showed a significant positive impact of subspecialty accreditation programs in improving clinical outcomes in different subspecialties, including sleep medicine, chest pain management and trauma management. There is consistent evidence that shows that accreditation programs improve the process of care provided by healthcare services. There is considerable evidence to show that accreditation programs improve clinical outcomes of a wide spectrum of clinical conditions. Accreditation programs should be supported as a tool to improve the quality of healthcare services.

Introduction: The age of the population in Saudi Arabia is shifting toward elderly, which can lead to an increased risk of mild cognitive impairment (MCI) and dementia. Objective: The aim of this study is to determine the prevalence of cognitive impairment (MCI and dementia) among elderly patients in a community-based setting in Riyadh, Saudi Arabia. Methods: In this cross-sectional study, we included patients aged 60 years and above who were seen in the Family Medicine Clinics affiliated with King Faisal Specialist Hospital and Research Centre. Patients with delirium, active depression, and patients with a history of severe head trauma in the past 3 months were excluded. Patients were interviewed during their regular visit by a trained physician to collect demographic data and to administer the validated Arabic version of the Montreal Cognitive Assessment (MoCA) test. Results: One hundred seventy-one Saudi patients were recruited based on a calculated sample size for the aim of this study. The mean age of included sample was 67 ± 6 years. The prevalence of cognitive impairment was 45%. The prevalence of MCI was 38.6% and the prevalence of dementia was 6.4%. Age, low level of education, hypertension, and cardiovascular disease were risk factors for cognitive impairment. Conclusion: Prevalence of MCI and dementia in Saudi Arabia using MoCA were in the upper range compared to developed and developing countries. The high rate of risk factors for cognitive impairment in Saudi Arabia is contributing to this finding.

Vitamin D deficiency has been linked to an increased risk of osteoporosis. Vitamin D deficiency has reached high levels in the Saudi population, but there is conflicting evidence both in the Saudi population, and worldwide, regarding the existence of a correlation between these low vitamin D levels and reduced BMD (bone mineral density), or osteoporosis. The objective of this study was primarily to determine whether there was a correlation between vitamin D deficiency and osteoporosis in the Saudi population. We aimed to investigate whether the high levels of vitamin D deficiency and insufficiency would translate to higher prevalence of osteoporosis, and whether there is a correlation between vitamin D levels and bone mineral density. This was a community based cross sectional study conducted in the Family Medicine Clinics at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. Electronic records of 1723 patients were reviewed. Laboratory and radiology results were collected, including vitamin D levels, calcium levels, and bone mineral density scan results. Among the whole population, 61.5% had moderate to severe vitamin D deficiency with levels less than 50nmol/L. 9.1% of the population had osteoporosis, and 38.6% had osteopenia. Among the whole population, there was no significant correlation between spine or total femoral BMD and serum 25(OH) D. Vitamin D deficiency is prevalent in the Saudi population. However, no correlation has been found between vitamin D deficiency and reduced bone mineral density in any age group, in males or females, Saudis or Non-Saudis, in our population in Riyadh, Saudi Arabia.

There are conflicting results on published randomized controlled trials (RCTs) on the role of vitamin E in the prevention of cancer. We conducted a meta-analysis of RCTs to evaluate the role of vitamin E in the prevention of cancer in adults. We included RCTs in which the outcomes of the intake of vitamin E supplement alone or with other supplements were compared to a control group. The primary outcomes were total mortality, cancer mortality, total incidence of cancer, and incidence of lung, stomach, esophageal, pancreatic, prostate, breast and thyroid cancers. All identified trials were reviewed independently by the two reviewers to determine whether trials should be included or excluded. The quality of all included studies was scored independently by the two reviewers. Twelve studies, which included 167 025 participants, met the inclusion criteria. There were no statistically significant differences in total mortality (relative risk, 0.99; 95% CI 0.96–1.03), cancer incidence (odds ratio, 0.96; 95% CI 0.92–1.01), and cancer mortality (odds ratio, 1.00; 95% CI, 0.96–1.03) among the different groups of patients included in this meta-analysis. Vitamin E was associated with a significant reduction in the incidence of prostate cancer (relative risk, 0.85; 95% CI, 0.73–0.96, number needed to treat=500), but it did not reduce the incidence of any other types of cancer. Vitamin E supplementation was not associated with a reduction in total mortality, cancer incidence, or cancer mortality, but it was associated with a statistically significant reduction in the incidence of prostate cancer. Vitamin E can be used in the prevention of prostate cancer in men who are at high risk of prostate cancer.

Background: Obesity is a risk factor that leads to many chronic diseases and, unfortunately, its prevalence in Saudi Arabia is on the rise. To successfully manage obesity and its complications, patient must be accurately diagnosed. This study aims to investigate the diagnostic accuracy of body mass index (BMI) when diagnosing obesity within the Saudi population using body fat percentage (BF%) as the gold standard. Materials and Methods: This is a cross-sectional study that includes a calculated sample size of 942 subjects. Subjects were recruited from family medicine clinics that were linked to King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh, Saudi Arabia from January 2005 to March 2016. BF% was estimated using DEXA scan. The diagnostic accuracy of BMI was assessed by using the WHO and the American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE) reference standard for obesity of BF% > 25% in men and > 35% for women. Results: Findings indicate, out of the study population, 29% of men and 53% of women are obese using BMI-defined obesity cut-off point 30 kg/m². The prevalence of obesity was 83.9% and 97.3% in men and women, respectively, using BF%-defined obesity, which corresponds to BMI cut-off of 24 kg/m². Even when considering the highest acceptable BF% based on the mean age of our participants (33% for men and 43% for women), the BMI cut-off to diagnose obesity should not exceed 27 kg/m² among men and women in Saudi Arabia. Conclusion: The accuracy of BMI 30 kg/m² to diagnose obesity among the Saudi population is limited. We have to lower the BMI cut-off point to improve its sensitivity as a screening tool for obesity. Our study suggests that the BMI cut-off point among Saudis and possibly the Arab population should not exceed 27 kg/m² for both sexes.

Accreditation is usually a voluntary program, in which trained external peer reviewers evaluate health care organization’s compliance with pre-established performance standards. Interest in accreditation is growing in developing countries, but there is little published information on the challenges faced by new programs. In Saudi Arabia, the Central Board for Accreditation of Healthcare Institutions (CBAHI) was established to formulate and implement quality standards in all health sectors across the country. The objective of this study was to assess a developing accreditation program (CBAHI standards) against the International Society for Quality in Health Care (ISQua) principles to identify opportunities for improvement of the CBAHI standards. A qualitative appraisal and assessment of CBAHI standards was conducted using the published ISQua principles for accreditation standards. The CBAHI standards did not describe the process of development, evaluation or revision of the standards. Several standards are repetitive and ambiguous. CBAHI standards lack measurable elements for each standard. CBAHI standards met only one criterion (11.1%) of the Quality Improvement principle, two criteria (22.2%) of Patient/Service User Focus principle, four criteria (40%) of the Organizational Planning and Performance principle, the majority (70%) of the criteria for the safety principle, only one criteria (7.1%) for the Standards Development principle, and two criteria (50%) of the Standards Measurement principle. CBAHI standards need significant modifications to meet ISQua principles. New and developing accreditation programs should be encouraged to publish and share their experience in order to promote learning and improvement of local accreditation programs worldwide.