Basic Knowledge of Physician about Total Parenteral Nutrition in Saudi Arabia

Objectives: To explore the physician’s basic knowledge about Total Parenteral Nutrition in Saudi Arabia. Materials and Methods: It analyzes a cross-sectional survey that discussed the physician’s basic knowledge of some items for Total Parenteral Nutrition services (TPNs) in Saudi Arabia. The survey consisted of respondents’ demographic information about the Assessment of Total Parenteral Nutrition services (TPNs) knowledge of physicians, The resources of Parenteral Nutrition services (TPNs) used by physicians. The 5-point Likert response scale system was used with closed-ended questions. The survey was validated through the revision of expert reviewers and pilot testing. Besides, various tests of the reliability of McDonald’s ω , Cronbach alpha, Gutmann’s


INTRODUCTION
Healthcare providers provide medical care to all various patients.That starts with emergency services when the patient visits due to an emergency or transfers from the primary health care center.Either followed by medical or surgical care during admission or through ambulatory care services. [1]Then ambulatory care services after discharge.The physician assesses the patient for diseases to make the diagnosis, requests appropriate laboratory tests, prescribes the proper medication according to drug therapy guidelines, and provides supportive treatment when necessary. [1]One of the significant supportive interventions needed for the patient is nutrition.Nutritional support could be given through a regular diet. [2]If the patient can not take normal nutrition, the pre-made diet by tube administration is called enteral nutrition. [2]If the patient can not administer or should not take anything by mouth, the physician will switch to parenteral nutrition, called total parenteral nutrition. [2,3]TPN consists of components such as Fluid demand for the patient, total calories needed, daily carbohydrates, protein, and lipids.Besides, electrolytes, multivitamins, and trace elements. [4]All those substances should be listed within TPN Oder. [5]Therefore, The prescribing of TPN prescriptions needs a fundamental aspect of knowledge.8][9][10][11][12] The authors were unfamiliar with any publication targeting the topic locally or in Gulf and Arabic countries.The aim of the current research was the assessment of knowledge for International Journal of Pharmacology and Clinical Sciences, Vol 12, Issue 1, Jan-Mar, 2023 physicians through the cross-sectional selfreported survey.

MATERIALS AND METHODS
It analyzes a cross-sectional survey that discussed the physician's basic knowledge of some items for Total Parenteral Nutrition services (TPNs) in Saudi Arabia.It self-reported an electronic survey of the physician, including a physician from internship to consultant, physician specialties, and Saudi Arabia.All non-physician or students, non-completed, non-qualified surveys will be excluded from the study.9][10]13] The 5-point Likert response scale system was used with closed-ended questions.According to the previous litterateur with an unlimited population size, the sample was calculated as a cross-sectional study, with a confidence level of 95% with a z score of 1.96 and a margin of error of 5%, a population percentage of 50%, and a drop-out rate 10%.[16] The response rate required for the calculated sample size is at least 60-70% and above. [16,17]The survey was distributed through social media of what›s applications and telegram groups of a physician.The reminder message had been sent every 1-2 weeks.The survey was validated through the revision of expert reviewers and pilot testing.Besides, various tests of reliability McDonald's ω, Cronbach alpha, Gutmann's λ2, and Gutmann's λ6 been done with the study.The data analysis of the physician practice of some items for Total Parenteral Nutrition services (TPNs) at the institution is done through the survey monkey system.Besides, the Statistical Package of Social Sciences (SPSS), Jeffery's Amazing Statistics Program (JASP), and Microsoft Excel sheet version 16.It included a description and frequency analysis, good of fitness analysis, and correlation analysis.Besides, inferential analysis of factors affecting the physician essentional knowledge some items for Total Parenteral Nutrition services (TPNs) at institution with linear regression.The STROBE (Strengthening the reporting of observational studies in epidemiology statement: guidelines for reporting observational studies) guided the reporting of the current study. [18,19]

Factors affecting the physician's basic knowledge about Total Parenteral Nutrition services (TPNs)
Factors affecting the perception were analyzed.We adjusted the significant values using the independent samples Kruskal-Wallis test and the Bonferroni correction for multiple tests.

000). Eleven worksites affected the physician's basic knowledge about Total Parenteral Nutrition services (TPNs).
The highest scores (3.6118) were obtained from National Guard hospitals, with statistically significant differences among all sites (p=0.0.00).The female (3.4942) affected the physician's basic knowledge about Total Parenteral Nutrition services (TPNs) more than the male (3.2918), with a statistically significant difference (p=0.000).

DISCUSSION
Total parenteral nutrition is a primary service in various healthcare departments. [10]That includes neonatal and surgical services.They were followed by critical care and medical services according to the appropriate indications.The only physician was legally authorized to prescribe medication or TPN. [10]That's necessary to have back knowledge of TPN science and information.The current cross-sectional approach demonstrates physicians' knowledge of basic TPN science that demands practical prescribing.The study included physicians' specialties, ages, experiences, and academic qualifications.8] The average score of basic knowledge TPN was insufficient.Most physicians heard about the TPN concept and are familiar with indications for TPN by peripheral administration, which was expected because they studied in medical schools.Besides, most physicians know about TPN drug interactions because they might always discuss TPN and prohibited drug interactions with their preceptor and should mix anything with TPN solutions.The physician should monitor the patient and notice the drug interaction with TPN.In contrast, most physicians are unfamiliar with interpreting the laboratory test while monitoring TPN.They can not make nutrition assessments related to the physician not commonly prescribed TPN or not discussed during medical school. [7,8]esides, most physicians are unfamiliar with the enteral feeding concept like the previous studies [6,8] because the nutrition support services are unavailable to most of the responders working with it or have inadequate knowledge of nutrition support therapy.Most physicians are unfamiliar with various basic part knowledge of TPN, such as adjusting TPN according to patient disease status, dealing with TPN complications, calculating TPN components, appropriate ways of holding or stopping TPN, and TPN cost.That's related to most physicians not attending educational courses or workshops about TPN.Thus, there is no previous investigation to compare with the current findings Various factors might affect the physician's knowledge of TPN.Such as, the location found eastern region has the lowest knowledge related to the unavailability of TPN services or lack of education or the pharmacist taking care of TPN services from prescribing to monitoring until stopping TPN.The working sites might affect the knowledge of TPN.Some healthcare organizations had high basic knowledge, such as the national guard hospital, which had organized TPN services for neonates and adults.Gender might affect the understanding, which found that female physicians had more knowledge than males related more practice of TPN than male physicians.The academic qualifications might affect the TPN knowledge with the highest knowledge with specialist practitioners because they have more experience in practice.In contrast, the young generation of physicians with less than one year of experience had the lowest knowledge of TPN, and that's expected.TPN services availabilities at healthcare institutions with regular prescribing of TPN had high levels of knowledge expected because the organized TPN services had education and training for all healthcare professionals and monitored parameters to improve knowledge and practice of TPN.The number of TPN orders and patient's needs for TPN might affect TPN knowledge positively and negatively.If the number is low, the knowledge will be limited.While if the number increases, the knowledge will increase until it reaches the maximum workload; then, the knowledge returns to a lower level because the physician will not concentrate with TPN with a high workload, and various problems might occur during an increased workload.The most dependable factors that might affect TPN knowledge positively were gender, academic qualifications, experience, and practice of TPN.
In contrast, working sites, the presence of TPN services, and the number of patient's needs for TPN might negatively affect TPN knowledge for the same reasons above.Thus, there is no previous investigation to compare with the current findings.

Limitations
The current study had various advantages, such as demonstrating physician's knowledge about parental nutrition, and the calculated sample size was appropriate.However, there are multiple disadvantages concerning the recent research, such non-randomized sampling methods with high variability of demographic characteristics.Besides, medium reliability findings need to review the survey with a detailed analysis of one-factor analysis to determine the appropriate questions used.Further research is required to overcome all difficulties in the current situation.

CONCLUSION
The knowledge of the physician's profession about parenteral nutrition is insufficient.The physicians are familiar with superficial knowledge such as parenteral nutrition and drug interactions of parenteral feeding.However, the other basic knowledge, including patient assessment for nutrition, enteral feeding, calculation of parenteral nutrition requirements, and TPN complications management, did not reach the optimal level.Although various factors might affect the physician's knowledge, such as a working site with parental feeding services, female gender, medium experience, and specialist qualifications had higher knowledge of parental nutrition.Besides the presence of TPN at healthcare facilities, the number of patients required for TPN and the number of TPN orders.Therefore, education and training in nutrition support are highly recommended for all general practitioners of physicians in Saudi Arabia.
Total Parenteral Nutrition services (TPNs) includes Location, Age (years), Physician gender, and Physician qualification.Physician specialties, Years of experience, Position Held, Presence of the Parenteral Nutrition services (TPNs) at the institution, and Prescribing of Parenteral Nutrition services (TPNs) before, Number of TPN orders, Number of patients needed for TPN.The eastern region showed the lowest scores (3.1863), with statistically significant differences between regions (p=0.

Table 2 : Demographic, social information.
The presence of the Parenteral Nutrition services (TPNs) at the institution with the highest score (3.5528) affected physician's basic International Journal of Pharmacology and Clinical Sciences, Vol 12, Issue 1, Jan-Mar, 2023

International Journal of Pharmacology and Clinical Sciences,
Vol 12, Issue 1, Jan-Mar, 2023

Table 5 : Multiple regression of Factors with the physician's knowledge of Total Parenteral Nutrition services (TPNs) adjusted based on diseases.
Physician's basic knowledge about Total Parenteral Nutrition services, Predictors: (Constant), Location, Age (years), Physician gender, Physician qualification.Physician specialties, Years of experience, Position Held, Presence of the Parenteral Nutrition services (TPNs) at the institution, Prescribing of Parenteral Nutrition services (TPNs) before, Number of TPN orders, Number of patients needed for TPN.