The attitude and acceptability towards medical promotional tools and their influence on physicians' prescribing practices in Jordan and Iraq: a cross-sectional study.

BACKGROUND: Pharmaceutical companies spend more than one-third of their sales revenue on marketing and promotion directed toward healthcare professionals. There has been a focus on the relationship between healthcare professionals and the pharmaceutical industry in recent years. This study aims to explore the attitude toward and acceptability of medical promotional tools and their influence on physicians' prescribing practices in Jordan and Iraq. METHODS: A cross-sectional survey study was conducted to explore the influence of visits by medical representatives (MRs) and medical promotions on physicians' prescribing practices between June and October 2020 in Jordan and Iraq. Previously validated questionnaires were used. RESULTS: A total of 801 physicians completed the questionnaires. Face-to-face visits, followed by the dispensing of medical samples, were the two most common promotional methods used by MRs. 48% of participating physicians reported that they would accept the promotional marketing tools offered to them. MRs focused on the key selling points of their product during medical promotions, and 39.6% of the physicians reported that MRs had a negative attitude toward their competitors' products. 69.9% of the physicians reported that they would change their practice after participating in conferences or meetings. CONCLUSION: Medical promotional tools have a clear influence on physicians' prescribing practices in Jordan and Iraq. Therefore, medical promotion should be controlled and guided by clear and country-specific ethical guidelines. This will ensure safe medical promotion to physicians and optimise the healthcare practices provided to patients.

Hospital admission trends due to respiratory diseases in England and Wales between 1999 and 2019: an ecologic study.

BACKGROUND: Identifying trends of hospital admissions for respiratory diseases is crucial for public health and research to guide future clinical improvements for better outcomes. This study aims to define the trends of respiratory disease-related hospital admissions (RRHA) in England and Wales between 1999 and 2019. METHODS: An ecological study was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admissions data for respiratory diseases were extracted for the period between April 1999 and March 2019. The trend in hospital admissions was assessed using a Poisson model. RESULTS: Hospital admission rate increased by 104.7% [from 1535.05 (95% CI 1531.71-1538.38) in 1999 to 3142.83 (95% CI 3138.39-3147.26) in 2019 per 100,000 persons, trend test, p < 0.01]. The most common causes were influenza and pneumonia, chronic lower respiratory diseases, other acute lower respiratory infections, which accounted for 26.6%, 26.4%, and 14.9%, respectively. The age group 75 years and above accounted for 34.1% of the total number of hospital admissions. Males contributed to 50.5% of the total number of hospital admissions. Hospital admission rate in females increased by 119.8% [from 1442.18 (95% CI 1437.66-1446.70) in 1999 to 3169.38 (95% CI 3163.11-3175.64) in 2019 per 100,000 persons, trend test, p < 0.001]. Hospital admission rate increased by 92.9% in males [from 1633.25 (95% CI 1628.32-1638.17) in 1999 to 3149.78 (95% CI 3143.46-3156.09) in 2019 per 100,000 persons, trend test, p < 0.001]. CONCLUSION: During the study period, hospital admissions rate due to respiratory diseases increased sharply. The rates of hospital admissions were higher among males for the vast majority of respiratory diseases. Further observational studies are warranted to identify risk factors for these hospital admissions and to offer relevant interventions to mitigate the risk.

The safety and efficacy of the use of oral anticoagulant medications in patients with diabetes mellitus: A systematic review.

AIMS: Diabetes mellitus (DM) and atrial fibrillation (AF) commonly co-exist. Oral anticoagulants (OACs) are widely used in patients with DM. This review aims to summarise the available literature on the safety (hypoglycaemia or bleeding) and efficacy (stroke or systemic embolism) of the use of OACs in patients with DM. METHODS: We searched the Medline, the Excerpta Medica dataBASE (Embase) and Cochrane databases up to the 10th of December 2020. The search strategy was conducted using both keywords and MeSH terms. We included randomised controlled trials (RCTs) and observational studies that reported on the safety and efficacy of the use of OACs in patients with diabetes from all age groups. Study selection, data extraction and quality assessment were conducted independently by two reviewers. RESULTS: A total of 3,976 articles were identified through the search process, of which seven studies met the inclusion criteria of the systematic review: four observational studies and three studies that were randomised controlled trials, with a total of 703,855 patients. Two observational studies reported that the use of warfarin was associated with a higher risk of hypoglycaemic events, specifically with sulfonylurea. One observational study and three randomised controlled trials reported that the use of warfarin compared to other oral anticoagulants was associated with a higher risk of bleeding. In addition, three randomised controlled trials reported that the use of warfarin compared to other oral anticoagulants was associated with a lower risk of stroke or systemic embolism. CONCLUSIONS: This systematic review found that DOACs had a better efficacy outcome and safer clinical outcomes in comparison to warfarin in patients with diabetes.

Barriers to Research Publication for Undergraduate Medical Students in Makkah, Saudi Arabia: A Cross-Sectional Study.

Background Scientific research is an approach to acquiring information to enhance the quality of the world. The aim of this study was to identify the obstacles among undergraduate medical students to publish their study papers. Materials and methods This was a web-based descriptive cross-sectional study that used an online survey to collect data from medical students of Umm Al-Qura University in Makkah, Saudi Arabia. The minimum sample size required for the study calculated by the Raosoft website was 323. Statistical analysis was conducted with IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Results A total of 337 medical students were included in the study. The frequencies of male and female students were relatively comparable, with a marginally greater proportion of male students (177, 52.5%). The majority of students (294, 87.2%) had participated in at least one research project. Notably, 159 (47.2%) students had engaged in more than three research projects, whereas 42 (12.4%) had experience with only one previous research project. A notable peak in publication rate was observed for the year 2023, indicating the highest rate within the study period. The most frequently encountered obstacle in research publication was poor academic teaching, as reported by 133 (39.5%) students, followed by lack of active research groups (130, 38.6%), lack of time (122, 36.2%), and lack of supervisors in their preferred specialty (91, 27%). Associations were found between students' participation in research projects and various demographic characteristics. Among medical students who had previously participated in a research group, 174 (51.7%) were female, and 163 (48.3%) were male (p=0.001). In terms of academic year, most students who participated in a research project were in their sixth year (143, 42.5%), followed by medical interns (81, 24.1%) and fourth-year medical students (54, 16%), with these differences being statistically significant (p=0.001). Finally, the medical students' grade point average showed no statistically significant association with participation in a research project. Conclusion To boost publication rates and research experience of graduating medical students, it is important to articulate the barriers that prevent them from publishing their research. Educators and supervisors of medical research should strongly consider developing a framework that addresses current and future obstacles.

Knowledge and Attitudes Regarding Do-Not-Resuscitate Decisions Among Clinical-Year Medical Students and Interns in the Western Region of Saudi Arabia.

Background The directive to withhold emergent interventions in the case of cardiac and/or respiratory arrest with the continuation of standard care and therapy is known as do-not-resuscitate (DNR). The diversity of DNR guidelines depends on moral and religious factors. In Saudi Arabia, a DNR policy was published in 2017 which corresponds to the religious and ethical aspects of Islamic law. To augment future awareness regarding DNR decisions, as they are an essential element in critical care medicine, the foundational principles of DNR must be provided during the clinical years of medical school. Objectives The current study aims to assess and evaluate the knowledge and attitudes regarding DNR decisions among clinical-year medical students and interns in the Western Region of Saudi Arabia. Methods A cross-sectional study was carried out from October to December 2023, utilizing a self-administered online survey distributed via social media platforms. After receiving ethical approval from the institutional review board, data were collected from clinical-year medical students and interns in the Western Region of Saudi Arabia, and an appropriate statistical analysis was performed. Results A total of 397 participants were enrolled in this study. More than half (n = 251, 63.2%) were from Umm Al-Qura University, while the remaining (n=79, 19.9%) were from Taibah University. Of the total, 258 (65%) were male participants, and 139 (35%) were female. A total of 152 (38.3%) were fifth-year medical students, and 102 (25.7%) were interns. The vast majority (n = 364, 91.7%) had heard the term DNR, with the most reported source of information being from healthcare providers (n = 306, 83.2%), while a minority (n = 33, 8.3%) had not. Of the respondents, 226 (56.9%) identified the presence of a clear DNR policy in Saudi Arabia, and 77 (19.4%) had previously had experience with DNR. Most of the studied population (n = 333, 83.9%) expressed a willingness to take a lecture/session regarding DNR. Most of our participants, 347 (87.4%), believe it is essential to consider legal concerns when making a DNR decision. Interestingly, 152 (38.5%) of the participants think it is acceptable to be conservative in investigations and treatments with patients who are labeled as DNR, and 223 (56.2%) agree that patients should be aware of their DNR status. Approximately three-quarters of the study population (n = 290, 73%) agreed that it is stressful to discuss the possibility of a DNR order. In the association of who heard about DNR more, 101 (99%) of the interns had heard about the term DNR, while only 53 (75.7%) of the fourth-year medical students had. At the same time, 74 (72.5%) of the interns showed a positive attitude regarding the DNR definition, compared to 33 (47.1%) of the fourth-year medical students. Conclusion This study highlights the necessity of integrating educational interventions into DNR decisions in addition to clinical placement in the intensive care unit as part of the medical school curriculum.

Developing and Validating Entrustable Professional Activities (EPAs) for Rheumatology Fellowship Training Programs in Saudi Arabia: A Delphi Study.

Background: Entrustable professional activities (EPAs) define the core tasks that a graduating rheumatologist needs to perform independently in practice. The objective of this study was to develop and validate EPAs for rheumatology fellowship training programs in Saudi Arabia. Methods: Experts met to develop an initial set of potential end-of-training EPAs by conducting a comprehensive literature review of EPAs and studying the Saudi rheumatology fellowship curriculum. Then, to validate the EPAs, we conducted two rounds of the modified Delphi technique among rheumatology experts in Saudi Arabia. A response rate of 80% was considered and the minimum number of experts needed to be 25 to 30. Descriptive statistics were utilized to describe participants' demographic characteristics and group responses to each statement in all rounds. The experts were asked to rate the relevancy of each EPA using a 5-point Likert scale in both Delphi rounds. Results: In the preliminary phase, four rheumatologists developed an initial set of 36 core EPAs for rheumatology training program in Saudi Arabia. For the two-rounds Delphi techniques, 32 experts were invited to complete the study. The response rate of the first and second round were, 78.12% (25) and 93.75% (30), respectively. The first-round Delphi resulted in a robust consensus on 31 EPAs for rheumatology training. Five EPAs were excluded, and one new EPA was proposed. In the subsequent round, all 32 EPAs achieved strong consensus. The eliminated EPAs likely fell short in one or more of the following areas: relevance to rheumatology practice in Saudi Arabia, overlapping with other EPAs, or practical challenges in the implementation. Conclusion: We have developed and validated a core set of EPAs for rheumatology fellowship training programs in Saudi Arabia. Mapping and identifying milestones for these EPAs are essential steps to follow to enhance workplace curriculum development.

Public Attitudes Towards Lung Cancer Screening in Saudi Arabia: A Cross-Sectional Study.

Objective: Lung cancer is one of the leading causes of death worldwide, and it is ranked as the first cause of death in more than 100 countries around the world. The aim of this study was to explore the knowledge and attitude of the general population in Saudi Arabia toward lung cancer screening. Methods: A cross-sectional study employing an online survey was conducted between November 2021 and February 2022 in Saudi Arabia. This study utilized a previously developed questionnaire instrument. Logistic regression was used to identify predictors of positive attitude toward lung cancer screening. Results: A total of 473 participants were involved in this study. The majority of the study participants (74.6%) reported that they are current smokers. Almost 31.5% of the study participants reported that if lung cancer is detected early, the person's chance of surviving is poor to very poor. The majority of the study participants reported that they would be willing to do tests to diagnose lung cancer if you were invited by the Ministry of Health or their doctor. Males, participants aged (24-34 years), and current smokers were more likely to have positive attitude towards lung cancer screening (p ≤ 0.05). On the other hand, patients aged 46 years and over and those with higher education had less positive attitude towards lung cancer screening (p ≤ 0.05). Conclusion: This is the first study to look into the general public's attitudes toward lung cancer screening in Saudi Arabia. According to our findings, the majority of people believe that early detection of lung cancer can lead to improved results and have a favourable attitude toward lung cancer screening if it is indicated. Thus, incorporating lung cancer screening into the local guidelines in at-risk population is highly recommended and considering the launch of nation-wide lung cancer screening program is advised.

Physicians' Knowledge and Practices Regarding Asthma: A Cross-Sectional Study in Saudi Arabia.

Objective: This study aimed to explore the characteristics of knowledge and practice of physicians towards asthma in Saudi Arabia. Methods: An online cross-sectional study was conducted in Saudi Arabia between 28 August and 10 November 2021. Convenience sampling technique was applied in this study through social media websites. Previously developed 10-items questionnaire was used to assess the knowledge about asthma among the participating physicians. Descriptive statistics were used to describe the participants' demographic characteristics. Binary logistic regression analysis was conducted to identify factors associated with being adherent to asthma practices guidelines. Results: Overall, participants' knowledge was moderate. The average percentage of physicians who reported practicing asthma management based on recommended guidelines 63.7%. Younger age (30-34 years) and having a work experience of (6-10 years) were significant predictors of being adherent to asthma practices guidelines (OR: 1.96 (95% CI: 1.21-3.17) (p=0.006) and OR: 1.67 (95% CI 1.05-2.67) (p=0.031), receptively). Conclusion: This study showed that the percentage of physicians who reported practicing asthma management based on recommended guidelines in Saudi Arabia are moderate. Future studies to investigate factors associated with improvement in knowledge about asthma and adherence to guidelines are needed.

Hospitalization Pattern for Chronic Lower Respiratory Diseases in Australia: A Retrospective Ecological Study.

BACKGROUND: Chronic lower respiratory diseases are among the commonest causes of hospital admission worldwide. Identifying the trends in hospital admission due to chronic lower respiratory diseases is important for public health and policy makers. AIM: The aim of this study was to examine the hospitalization profile related to chronic lower respiratory diseases in Australia during the past 21 years. METHOD: A retrospective ecological study was conducted using hospital admission data taken from the National Hospital Morbidity Database (NHMD). Hospital admissions data for chronic lower respiratory diseases were extracted for the period between 1998 and 2019. The Pearson Chi-square test for independence was used to estimate the variation in hospital admission rates. RESULTS: The hospitalization rate for chronic lower respiratory diseases rate decreased by 14.4%, from 568.90 (95%CI 565.50-572.30) in 1998 to 486.95 (95%CI 484.24-489.66) in 2019 per 100,000 persons, p<0.05. Rates of same-day hospitalization for chronic lower respiratory diseases increased by 62.7% from 1998 to 2019, while rates of overnight-stay hospital admission for chronic lower respiratory diseases decreased by 23.7% from 1998 to 2019. During the study duration, the hospitalization rates for bronchiectasis and other chronic obstructive pulmonary disease increased by 120.0% and 34.7%, respectively. The hospital admissions rates for emphysema, status asthmaticus, simple and mucopurulent chronic bronchitis, bronchitis, not specified as acute or chronic, unspecified chronic bronchitis, and asthma decreased by 94.8%, 92.6%, 70.7%, 66.3%, 46.0%, and 32.3%, respectively. The rates of hospitalization among patients aged 75 years and above increased by 3.9%, while younger age groups including those aged younger than 15 years, 15-59 years, and 60-74 years showed a reduction in the rate of hospitalization by 53%, 22.8%, and 19.7%, respectively. CONCLUSION: Overall, the hospitalization rate for chronic lower respiratory diseases is seen to have decreased over the study period. Patients with chronic obstructive pulmonary disease (COPD) and the elderly group have a higher rate of hospitalization. Future studies are needed to investigate factors associated with the increase in the rate of hospitalization among the elderly age group.

A Rare Case of Rhupus Syndrome With Systemic Involvement: A Case Report and Literature Review.

Based on clinical signs, symptoms, radiological, and serological findings, a 37-year-old woman was diagnosed with an overlap between rheumatoid arthritis and systemic lupus erythematosus, referred to as rhupus syndrome. Her condition was complicated by lupus nephritis, autoimmune hemolytic anemia, and central nervous system (CNS) vasculitis. She improved after receiving steroids, hydroxyquinone, and cyclophosphamide. There are no established criteria for diagnosing rhupus syndrome. Being aware of autoimmunity and overlapping illness signs and using specific diagnostic tests are crucial. Early therapy may avoid irreversible organ damage.

Knowledge and Competence Towards Critical Care Concepts Among Final Year Medical Students and Interns: A Cross-Sectional Study.

Purpose: Critical care knowledge constitutes an essential component in medicine. Unfortunately, ICU knowledge acquisition is limited in many medical schools. This study is intended to measure the knowledge background, gaps, and the confidence toward critical care concepts among final year medical students and interns at Umm Al-Qura University, Saudi Arabia. Methods: This was a cross-sectional study using a self-administered online questionnaire completed by final-year medical students and interns during January and February 2022. We collected data on demographics, academic year, critical care knowledge, competency, and satisfaction. Results: Two-hundred-twenty-one (221) responses were analyzed. The male gender was 54.3%. A small proportion (15.8%) identified the lowest acceptable oxygen saturation in a normal person. Around three-quarters of the participants did not feel competent about nasal airway suctioning and endotracheal tube suctioning (65.6% and 75.6%, respectively). Only 7.2% of the responder correctly identified the three most useful physiological observations pertinent to quick SOFA criteria. Regarding the training adequacy for identifying critically ill patients, 59.3% answered that they are inadequately trained. Regarding the satisfaction level of exposure to critical care, 54% of the sample responded that they need further improvement. Conclusion: Undergraduate students and interns have limited knowledge and confidence in critical care medicine. Thus, we highly recommend an early institution of a dedicated critical care training module in the medical school curriculum.

Prevalence of Chronic Kidney Diseases in Patients with Diabetes Mellitus in the Middle East: A Systematic Review and Meta-Analysis.

AIMS: The prevalence of CKD in patients with diabetes mellitus in the Middle East region is unknown. Therefore, we aimed to understand the pooled prevalence of CKD in patients with diabetes mellitus in the Middle East region. METHODS: PubMed, Embase, and Cochrane databases were searched for relevant studies up to October 2020. The search strategy was conducted using both keywords and MeSH terms. Randomised controlled trials (RCTs) and observational studies that included patients from all age groups and any study design that reported on the prevalence of CKD in patients with diabetes mellitus were included. The pooled estimate for the prevalence of CKD in patients with diabetes was calculated using random-effect models with 95% confidence intervals (CIs). RESULTS: A total of 489 citations were identified, of which only nine studies matched our inclusion criteria and were included in the meta-analysis. All of the studies used an observational study design covering a total of 59,395 patients with type 2 diabetes mellitus. The pooled estimate of the prevalence of CKD in patients with diabetes mellitus was 28.96% (95% CI: 19.80-38.11). CONCLUSIONS: A high prevalence of CKD in patients with diabetes mellitus in the Middle East region was found. Further epidemiological studies are warranted in this area to have a better estimate of the prevalence of CKD among DM in the Middle East region.

Hospital Admission Trends Due to Viral Infections Characterised by Skin and Mucous Membrane Lesions in the Past Two Decades in England and Wales: An Ecological Study.

OBJECTIVES: This study aimed to investigate the trends in hospital admissions due to viral infections characterized by skin and mucous membrane lesions in England and Wales between 1999 and 2019. METHODS: This is an ecological study using publicly available databases in England and Wales; the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admissions data were collected for the period between April 1999 and March 2019. Hospital admissions due to viral infections characterized by skin and mucous membrane lesions were identified using the tenth version of the International Statistical Classification of Diseases system, diagnostic codes B00-B09. The trend in hospital admissions was assessed using a Poisson model. RESULTS: Hospital admissions for different causes increased by 51.9% (from 25.67 (95% CI 25.23-26.10) in 1999 to 38.98 (95% CI 38.48-39.48) in 2019 per 100,000 persons, trend test, p < 0.01). The most prevalent viral infections characterized by skin and mucous membrane lesions hospital admissions causes were zoster (herpes zoster), varicella (chickenpox), herpesviral (herpes simplex) infections, and viral warts, which accounted for 26.9%, 23.4%, 18.7%, and 17.6%, respectively. The age group below 15 years accounted for 43.2% of the total number of admissions. Females contributed to 50.5% of the total number of admissions. Hospital admission rate in males increased by 61.1% (from 25.21 (95% CI 24.59-25.82) in 1999 to 40.60 (95% CI 39.87-41.32) in 2019 per 100,000 persons). The increase in females was 43.2% (from 26.11 (95% CI 25.49-26.72) in 1999 to 37.40 (95% CI 36.70-38.09) in 2019 per 100,000 persons). CONCLUSION: Our study demonstrates an evident variation in hospital admission of viral infections characterized by skin and mucous membrane lesions based on age and gender. Efforts should be directed towards vaccinating high-risk groups, particularly the elderly and females. Moreover, efforts should be focused on vaccinating the young population against varicella, particularly females who are more susceptible to acquiring the infection. Further observational and epidemiological studies are needed to identify other factors associated with increased hospital admission rates.

Hospital Admissions Due to Ischemic Heart Diseases and Prescriptions of Cardiovascular Diseases Medications in England and Wales in the Past Two Decades.

OBJECTIVES: The aim of this study was to explore the trend of ischemic heart disease (IHD) admission and the prescriptions of IHD medications in England and Wales. METHODS: A secular trends study was conducted during the period of 1999 to 2019. We extracted hospital admission data for patients from all age groups from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Prescriptions of IHD medications were extracted from the Prescription Cost Analysis database from 2004 to 2019. The chi-squared test was used to assess the difference between the admission rates and the difference between IHD medication prescription rates. The trends in IHD-related hospital admission and IHD-related medication prescription were assessed using a Poisson model. The correlation between hospital admissions for IHD and its IHD medication-related prescriptions was assessed using the Pearson correlation coefficient. RESULTS: Our study detected a significant increase in the rate of cardiovascular disease (CVD) medication prescriptions in England and Wales, representing a rise in the CVD medications prescription rate of 41.8% (from 539,334.95 (95% CI = 539,286.30-539,383.59) in 2004 to 764,584.55 (95% CI = 764,545.55-764,623.56) in 2019 prescriptions per 100,000 persons), with a mean increase of 2.8% per year during the past 15 years. This increase was connected with a reduction in the IHD hospital admission rate by 15.4% (from 838.50 (95% CI = 836.05-840.94) in 2004 to 709.78 (95% CI = 707.65-711.92) in 2019 per 100,000 persons, trend test, p < 0.01), with a mean decrease of 1.02% per year during the past 15 years and by 5% (from 747.43 (95% CI = 745.09-749.77) in 1999 to 709.78 (95% CI = 707.65-711.92) in 2019 per 100,000 persons, trend test, p < 0.01) with a mean decrease of 0.25% per year during the past two decades in England and Wales. CONCLUSION: The rate of hospitalisation due to IHD has decreased in England and Wales during the past two decades. Hospitalisation due to IHD was strongly and negatively correlated with the increase in the rates of dispensing of IHD-related medications. Other factors contributing to this decline could be the increase in controlling IHD risk factors during the past few years. Future studies exploring other risk factors that are associated with IHD hospitalisation are warranted.