Factors Influencing Medical Interns' Choice of Hospital for Training, Saudi Arabia: A Cross-Sectional Study.

Background High-quality, adequately resourced, and strategically oriented medical internship training plays a pivotal role in the continual growth of junior doctors. Evaluating the perspectives of final-year medical students regarding their internship year and their preferred placement is of paramount importance. This study aims to furnish internship programs with valuable insights into interns' perceptions and attitudes toward an optimal internship experience. By doing so, we aim to empower internship programs with the necessary knowledge to enhance their offerings, ensuring they are better tailored to the needs and preparation of future doctors. Objective The objective of this study was to elucidate the primary factors that influence the preferences of medical interns in selecting a hospital for their internship training. Methods In the academic year spanning September 2023 to 2024, a comprehensive cross-sectional study was conducted at three esteemed medical universities in Riyadh, Saudi Arabia. A meticulously crafted questionnaire, consisting of twenty questions was disseminated via various social media platforms, targeting all final-year medical students of the selected medical schools. Overall 241 students actively participated in the survey, their valuable contributions enriching the overall quality and depth of the research findings. Results Among the 241 respondents, 67.22% were male, 83.40% identified as Saudi, and 43.57% hailed from King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). A predominant 94.61% of participants fell within the age group of 22-25 years. Notably, the top four influential factors influencing participants' choice of internship training programs were encouraging consultants (93.80%), the hospital working environment (91.29%), an internship program with effective teamwork (88.38%), and a subspecialty residency program (85.48%). Furthermore, our findings underscored that access to electronic health record (EHR) systems, orientation prior to clinical rotations, and seniors' experiences significantly impact students' decisions when selecting a hospital for rotations. It was also observed that considerations such as the number of on-calls and working hours, salary, location, and extracurricular activities wield a substantial influence over their choices, as indicated by the majority of the surveyed students. Conclusion Given that internship training is one of the most critical stages of medical education, it is recommended to take into account the elements that students believe can influence their hospital choice for conducting their internship. We hope that by acknowledging these aspects, potential approaches to improve and advance hospital training can be formulated in order to provide interns with effective training, a reasonable workload, and a conducive and supportive environment to work in.

Emergency Department Frequentation and Unscheduled Visits of Liver Transplant Patients: Ten Years Experience in Tertiary Care Center, Saudi Arabia.

Introduction and objectives Liver transplantation and its indications represent an increased burden on patients' health. This can be represented in a variety of ways, such as in emergency visits, unscheduled clinic visits, and unanticipated admissions. This study aims to analyze emergency department (ED) visits, the most common presenting complaints, and the outcomes of those visits. Methods A retrospective observational study was performed in which electronic medical records were reviewed for all patients who underwent liver transplantation and presented to the emergency department between October 2011 and October 2021. The following data were collected: demographics, comorbidities, liver transplant features, and emergency department visit data and outcomes. Recurrent visits were assessed and labeled as first, second, third, fourth, and fifth or more. Results A total of 699 patients and 5,225 visits were included in the analysis. Living donors accounted for 80% of all transplants. The mean post-operative length of stay was 22.6 ± 17.8. The majority of patients (74%) had at least one comorbidity, with diabetes (47%), hypertension (31%), and chronic kidney disease (CKD) (16%) being the commonest comorbidities; however, comorbidities were not associated with an increased risk of emergency department visits. Out of the 5,225 visits to the emergency department, 2,265 (41%) were within the first year. Emergency department visits in the first seven days after discharge amounted to 22% of total first visits. By 30 days, six months, and one year, they increased to 46%, 83%, and 91%, respectively. Living donor recipients had an average of 7.3 ED visits as compared to deceased donor recipients, who had an average of 8.4 ED visits. The most common presenting complaints were gastrointestinal (GI) symptoms (18%), infectious disease symptoms (9%), and respiratory symptoms (8%). There were a total of 296 patients who were readmitted at least once since discharge after liver transplantation. Conclusion The majority of first-time presentations to ED occurred in the first year post-transplant, marking this time period as critical for liver transplant patients. Our study also highlighted the continual presentations of liver transplant patients to the ED a few years post-transplant. This requires close scrutiny of the main causes of such presentations as well as comparison with other transplant cases to identify whether they are specific to liver transplants or not.

Emergency management of critically ill adult patients with inherited metabolic disorders.

INTRODUCTION: An increasing number of pediatric patients with inherited metabolic disorders are reaching adulthood. In addition, many patients are diagnosed for the first time in adult life due to improved awareness of these disorders and the availability of advanced diagnostic technology. Knowledge of these inherited metabolic disorders in adults is crucial for the emergency physician to promptly recognize their acute illness and appropriately manage them in the emergency department. OBJECTIVE: This review provides an overview of various inherited metabolic disorders which present to the emergency department with acute metabolic decompensation. EVALUATION AND MANAGEMENT: Acute illness in these patients is often triggered by a catabolic event such as intercurrent illness, fasting, postpartum, or use of certain medication. It may present in a variety of ways related to severe hyperammonemia, metabolic acidosis, leucine encephalopathy or hypoglycemia. In this review, we describe the clinical presentation, evaluation and immediate management of their critical illness in the emergency department. CONCLUSION: Acute metabolic decompensation is a life-threatening condition. The emergency physician is usually the first provider to evaluate these patients when they present to the emergency department. Early recognition of their illness and prompt management of these cases improve patient outcomes.

Impact of Intermittent Fasting on Lipid Profile-A Quasi-Randomized Clinical Trial.

Background: Sub-optimal HDL is a prognostic marker of cardiovascular disease. South Asia has a high prevalence of sub-optimal HDL compared to other parts of the world. Intermittent fasting (IF) is a type of energy restriction which may improve serum HDL and other lipids thereby reducing the risk of cardiovascular diseases. Objective: The aim of the study was to evaluate the effect of IF on lipid profile and HDL-cholesterol in a sample of South Asian adults. Methods: A 6-week quasi-experimental (non-randomized) clinical trial was conducted on participants with low HDL (< 40 mg/dl for men and < 50 mg/dl for women). Participants of the control group were recommended not to change their diet. The intervention group was recommended to fast for ~12 h during day time, three times per week for 6 weeks. Pulse rate, blood pressure, body weight, waist circumference, serum lipid profile, and blood glucose levels were measured at baseline and after 6 weeks. Result: A total of 40 participants were enrolled in the study (N = 20 in each group), while 35 (20 control and 15 intervention) completed the trial and were included in data analysis of the study. Body measurements, including body weight, BMI and waist circumference, showed significant interaction effects (p's < 0.001), indicating that there were larger reductions in the IF group than in the control group. Significant interaction effects were also observed for total (p = 0.033), HDL (p = 0.0001), and LDL cholesterol (p = 0.010) with larger improvements in the IF group. Conclusion: This study suggests that intermittent fasting may protect cardiovascular health by improving the lipid profile and raising the sub-optimal HDL. Intermittent fasting may be adopted as a lifestyle intervention for the prevention, management and treatment of cardiovascular disorders. Clinical Trial Registration: NCT03805776, registered on January 16, 2019, https://clinicaltrials.gov/ct2/show/NCT03805776.

Emphysematous Pyelonephritis in Renal Allograft - a case report.

Emphysematous pyelonephritis (EPN) is a rare disease with devastating outcomes in healthy adults. It may affect renal allografts resulting in higher mortality rate, graft loss and permanent dialysis. Presentation is highly variable and non-specific requiring higher degree of suspension. Optimal management of EPN is controversial with recent case reports challenging a previously suggested management pathway. We report a case of a 71-year-old man who presented in septic shock who was diagnosed with EPN in an allograft kidney in the emergency department, treated with antibiotics and medical support but died on the 6th day of presentation. Based on the scarce literature of EPN in allograft kidneys, a nephrectomy might be indicated in a similar patient presentation.

Variability of emergency color codes for critical events between hospitals in Riyadh.

BACKGROUND: Emergency color codes were developed to alert healthcare personnel in a hospital to critical situations. They are often developed independently by each hospital, leading to variability. This could be a source of confusion to healthcare personnel, who move frequently between hospitals and may work at multiple hospitals. This study evaluated the variability of emergency codes for different critical events in hospitals in Riyadh. METHODS: A prospective, cross-sectional survey was carried out on a representative sample of hospitals. Twenty-four of 28 hospitals took part in the study. Semi-structured questionnaires were completed by the Quality/Safety Department of each hospital, on general hospital characteristics, emergency department characteristics, code-response mock-up, code determination, emergency codes used and code meanings. RESULTS: Thirty-four different codes were used across hospitals. The codes used most variably were yellow (10 meanings), orange, black, green (7 meanings each), and gray (5 meanings), while the most consistently used code was 'Code Red' for 'Fire' in 75% of hospitals. Another source of variability was the use of non-color codes, representing 7.7% of total codes. CONCLUSIONS: There is large variability in the type and meaning of emergency codes between hospitals in Riyadh City, reflecting a lack of standardization. Hospitals use color and non-color emergency codes, which could cause confusion to responders and mitigate the effectiveness and speed of response in critical events.