Promise of Real-World Evidence for Patient Centricity in Gulf Cooperation Council Countries: Call to Action.

Presently, Gulf Cooperation Council countries are lagging in the generation of real-world data and use of real-world evidence for patient-centered care compared with the global average. In a collaborative effort, experts from multiple domains of the healthcare environment from the Gulf Cooperation Council countries came together to present their views and recommended key action points for the generation of robust real-world data and leveraging real-world evidence in the countries. The opinions of the experts are presented, along with existing barriers to the effective generation of real-world evidence in the countries. The Gulf Cooperation Council countries are undergoing transformative changes paving the way for improved healthcare measures; however, the challenges in generating reliable, robust, accessible, and secure real-world evidence are persistent. Hence, ongoing public-private engagements, as well as collaborations between regulators, policymakers, healthcare professionals, insurance and pharmaceutical companies, and patients, are warranted. A few notable examples of real-world evidence studies highlighting the benefits of real-world evidence for gaining valuable insights into patient-centric decision making are also discussed. The actionable steps identified for successful real-world evidence generation would provide long-term, real-world evidence-based patient-centric benefits for the countries.

The Incidence and Risk Factors of Cholelithiasis Development After Bariatric Surgery in Saudi Arabia: A Two-Center Retrospective Cohort Study.

Background: Rapid weight loss after bariatric surgery is a known risk factor for cholelithiasis development. This study aimed to estimate the incidence of cholelithiasis following bariatric surgery among morbidly obese patients who underwent bariatric surgery. Methods: This is a retrospective cohort study of all morbidly obese patients who underwent bariatric surgery in King Abdulaziz Medical City (Riyadh, Saudi Arabia) or King Abdulaziz Hospital (Al Ahsa, Saudi Arabia) between January 2015 and December 2018. Patients with a history of cholecystectomy or previous bariatric surgery were excluded. We estimated the incidence rate of cholelithiasis among the cohort. We also examined the associated risk factors of cholelithiasis development. Results: The study cohort contained 490 patients (38.7% males; 61.43% females) with a mean age of 36.87 ± 11.44 years. Most patients (58.54%) were followed up for 12 months. The incidence of cholelithiasis post-operation was 6.53% (n = 32). The average period of cholelithiasis formation was 12-24 months. The percentage of total weight loss (TWL%) was significantly associated with the development of cholelithiasis post-operatively. Conclusion: A significant association was found between weight loss following bariatric surgery and the incidence of cholelithiasis. Gender, age, and comorbidities were not associated with the formation of cholelithiasis. We recommend regular follow-up appointments with thorough patient education about gradual weight loss to reduce the risk of developing cholelithiasis.

Dental esthetic and the likelihood of finding a job in Saudi Arabia. A cross-sectional study.

BACKGROUND: Person's physical, dental appearance, and sexual identity are the characteristics most obvious to others. Prior researches suggest that visible sign of unhealthy dental status may lead to an individual's social or professional exclusion, so the aim of the study was to measure the influence of dental appearance on hiring managers' perception of intelligence, honesty and efficiency of job applicants in Saudi Arabia, and the likelihood of employment opportunity. MATERIALS AND METHODS: This cross-sectional study comprised 280 hiring managers. All participants were assigned randomly into two groups and received a survey with 10 different images for hypothetical job applicants. The images were digitally manipulated to have the Saudi national dress and to represent different dental conditions. The photos in both surveys were the opposite with no repetition except for 3 for reliability. Each evaluator randomly received one survey without knowing of the other. Participants were asked questions about their perception of honesty, intelligence, efficiency, and potential employability of the provided applicants' photos. RESULTS: There was no statistically significant difference in demographics data between the hiring managers assigned to both groups. Hypothetical job applicants with smiles affected by malocclusion were perceived to be less intelligent with P value = 0.0001, but there was no altered perception for honesty and efficiency. Moreover, applicants with caries were perceived to be less honest, intelligent, and efficient by the hiring managers with P value of 0.0007, 0.0011 and 0.0138, respectively. Applicants with dental imperfections compared to normal smile were 52% less likely to be employed. CONCLUSION: Dental appearance might alter people perception about the character of the affected person, and it might influence the judgment of future employers when screening for candidates; as a result, we recommend more educational programs for the public and hiring managers.

Early childhood caries and infant's oral health; pediatricians' and family physicians' practice, knowledge and attitude in Riyadh city, Saudi Arabia.

BACKGROUND: Early childhood caries (ECC) is a significant worldwide oral health problem. However, parents do not take their children to the dentist for regular screening of oral diseases as early as they do with pediatricians and family physicians. As a result, pediatricians and family physicians are considered as a reliable and perfect source for children's oral health promotion and disease prevention. Studies assessing pediatricians' and family physicians' practice, knowledge and attitude regarding ECC and infant's oral health in Saudi Arabia are few. As a result, this study aimed to assess these aspects. METHODOLOGY: A cross-sectional study based on a structured close-ended questionnaire was conveniently distributed among pediatricians and family physicians in Riyadh city, Saudi Arabia. The questionnaire composed of two main sections; demographic characteristics and questions assessing participants' practice, knowledge and attitude. The data was analyzed using SAS software, frequency and chi-square test were conducted, and P-value of <0.05 and less was considered significant. RESULTS: There was a discrepancy between the participants' knowledge, attitude and practice. The participants' practice was lower (42.6%) compared with their attitude (86.1%) and knowledge (65.3%). Most of the participants (52.5%) indicated lack of clinical time was the main barrier for performing oral health related activities. Majority of the participants (76.7%) indicated that they need more dental training and education. Dental caries preventive methods (44.6%) was the most requested topic, of which workshops and seminars were the main preferred method (39.6%). CONCLUSION: Although most of the participants reported good dental attitude and knowledge, a lack of the associated dental practice was detected. Therefore, more efforts are encouraged to enhance and facilitate dental practice among pediatricians and family physicians.

Public motives and willingness to participate in first-in-human clinical trials in Saudi Arabia: A new era in the making.

BACKGROUND: Participation in first-in-human (FIH) clinical trials is a valuable contribution to science. This study aims to investigate the Saudi public's attitude toward FIH clinical trials, identify their willingness to take part in it, and their preferences for participating in these kinds of trials, given the fact that the Saudi FDA has never approved such studies in Saudi Arabia. METHODS: This was a cross sectional study conducted in February 2018. It was based on a self-reported survey distributed by convenience among Saudi adults visiting a national festival in Riyadh and through social media. Data were analysed using descriptive and bivariate statistics, as well as linear and binary logistic regression. RESULTS: Study participants who were invited and completed the survey were 657. The percentage mean score of participants' attitudes and concern was 70.1 ± 16.4 and 58.3 ± 15.3 respectively. Almost 71.5% expressed their intention to enroll in such trials. Higher attitudinal scores were reported by those who perceived healthcare services as good/excellent (adj.P < 0.001), and by those who had less concerns (adj.P = 0.005). Less educated participants were 1.75 [1.04-2.93] times more likely to enroll in future clinical trials, adj.P = 0.035. For every one unit increase in the attitudinal score, study participants were 1.03 [1.02-1.04] more likely to enroll in future trials, adj.P < 0.001. In contrary, for every one unit increase in concern scores, the odds of enrollment decreased among study participants by 0.98 [0.97-0.99], adj.P = 0.017. The factors causing people to decline participation were mainly fear of the unknown, social reasons, religious reasons, moral reasons, and the concern over human beings being treated as animals. The preferred duration for participation was 1-3 days (n = 268, 57%). Participants revealed their preferences of clinical trial studies were in favor: (a) vaccines (n = 209, 44.5%); (b) treatment drugs (n = 232, 49.4%); and (c) medical devices (n = 310, 66.0%). CONCLUSION: The Saudi public community showed a high level of enthusiasm for participation in future FIH clinical trials, yet they had some reservations. Increasing public awareness about the benefits of clinical trials and conduction process helps to alleviate the concerns of the Saudi people and to increase their likelihood of enrollment.

Prevalence of severe moral distress among healthcare providers in Saudi Arabia.

BACKGROUND: Moral distress is a serious problem in healthcare environments that requires urgent attention and management. It occurs when healthcare providers are unable to provide the care that they feel is right or take, what they believe to be, ethically appropriate actions for their patients. Thus, this study aims to examine moral distress among nurses and physicians working in tertiary teaching hospitals in Saudi Arabia, as well as to evaluate the level of association between moral distress and turnover. METHODS: This cross-sectional study, which employed an anonymous 21-item Moral Distress Scale, was undertaken at a large medical institution located in different regions of Saudi Arabia. The data were analyzed using bivariate analyses, and logistic regression. RESULTS: Of the 342 participants, 239 (69.9%) were nurses/staff physicians and 103 (30.1%) were fellows/consultants. Approximately 24.3% of respondents experienced severe moral distress, whereas 75.7% reported mild moral distress. There was no statistically significant difference between men and women in terms of moral distress. Age was found to be a notable factor: moral distress was significantly higher in those younger than 37 years compared to those 37 years and older (P=0.015). Less than half of the participants (137, 42.8%) indicated their willingness to leave their jobs. A significant association was observed between severe moral distress and leaving the career (OR=3.16; P<0.01). Job category was also an important factor: nurses/staff physicians were almost two times more likely (OR =1.95, P=0.038) to leave their positions compared to fellows/consultants. CONCLUSION: This study revealed that moral distress, which is a serious problem that compromises the well-being of caregivers, was a predictive variable for the intention of healthcare providers to leave their jobs. Therefore, it should be routinely examined, and efficient action plans should be implemented to alleviate its consequences.

Attitudes toward mental illness, mentally ill persons, and help-seeking among the Saudi public and sociodemographic correlates.

BACKGROUND: It has been reported that the majority of individuals with mental illnesses (MIs) do not seek help. Few studies have focused on correlates of a positive attitude toward professional help-seeking for MI. This study aimed to determine levels of knowledge, perception, and attitudes toward MI, determine attitudes toward mental health help-seeking, and identify sociodemographic predictors of correct knowledge and favorable attitudes among the Saudi public. METHODS: A cross-sectional survey was conducted on 650 Saudi adults aged >18 years who attended the Saudi Jenadriyah annual cultural and heritage festival during February 2016. The previously validated Attitudes to Mental Illness Questionnaire was used. Attitude to professional help-seeking was also assessed, using a tool retrieved from the World Mental Health Composite International Diagnostic Interview part II. Multiple regression analyses were applied, and statistical significance considered at P<0.05. RESULTS: The majority of the Saudi public reported lack of knowledge about the nature of MI (87.5%, percentage mean score [PMS] 45.02±19.98), negative perception (59%, PMS 59.76±9.16), negative attitudes to MI (66.5%, PMS 65.86±7.77), and negative attitudes to professional help-seeking (54.5%, PMS 62.45±8.54). Marital status was a predictor of knowledge (t=-3.12, P=0.002), attitudes to MI (t=2.93, P=0.003), and attitudes to help-seeking (t=2.20, P=0.03). Attitudes to help-seeking were also predicted by sex (t=-2.72, P=0.007), employment (t=3.05, P=0.002), and monthly income (t=2.79, P=0.005). Perceptions toward the mentally ill were not predicted by these socioeconomic characteristics (P>0.05). CONCLUSION: The Saudi public reported lack of knowledge of MI and stigmatizing attitudes toward people with MI in relation to treatment, work, marriage, and recovery and toward professional help-seeking. Sociodemographic characteristics predicted correct knowledge and favorable attitudes, while Saudi culture was the likely factor behind negative judgments about mentally ill persons. Efforts to challenge this negative publicity and stigma through antistigma campaigns and public education through schools and media are recommended.

The public's risk perception of blood transfusion in Saudi Arabia.

BACKGROUND: Human beings may face many circumstances, such as surgery, trauma, and anemia, in which they could require an urgent blood transfusion. However, only a few studies have examined people's risk perception of blood transfusion. Therefore, this study aims to evaluate the public's risk perception of blood transfusion in Saudi Arabia, and to identify factors associated with their risk perception. METHODS: Self-reported questionnaires on blood transfusion risk perception were distributed to the public during a Saudi national festival in Riyadh. Data were analyzed using mean, SD, Student's t-test, and linear regression. RESULTS: The overall percentage mean score±SD of risk perception was 59.8±16.1. Male participants were significantly more likely to perceive blood transfusion negatively, both in terms of the dread/severity domain (ß=-0.23, p=0.003) and their overall risk perception score (ß=-0.17, p=0.028). Older participants were considerably more likely to have a more negative perception (ß=0.12, p=0.041) of the benefits of blood transfusion compared with younger participants. Study participants who received blood in the past had a significantly better perception (ß=-0.13, p=0.029) of the benefits of transfusion. Additionally, participants who had previously donated blood had a considerably more positive perception in the dread/severity domain (ß=-0.18, p=0.017) and their overall score (ß=-0.15, p=0.045). CONCLUSION: Saudi males are more likely to perceive blood transfusion as a high-risk procedure. Similarly, older Saudis will probably have a more negative perception of the benefits of blood transfusion. Previous recipients and donors will likely have a better perception of the benefits of blood transfusion and a more positive overall risk perception.

Dental Students' Knowledge and Attitudes towards Antibiotic Prescribing Guidelines in Riyadh, Saudi Arabia.

Background: The use of antibiotics prophylactically and therapeutically in dentistry has become common practice. Inappropriate prescription may lead to adverse side effects and bacterial resistance. During clinical training, dental students in Saudi Arabia are authorized to prescribe antibiotics. Aim: To evaluate dental students’ knowledge and attitudes regarding antibiotic prescription in Riyadh, Saudi Arabia. Methods: A cross-sectional study based on a validated questionnaire consisting of 34 questions focusing on antibiotic indications in dentistry, antibiotic regimens, and knowledge regarding resistance was distributed amongst dental students in five leading dental colleges in Riyadh. Results: A large proportion of students (71.7%) were familiar with the concept of antibiotic resistance. When comparing junior and senior dental students’ knowledge with regards to indications of antibiotic use in commonly encountered conditions, it was found that there was no significant difference in antibiotic prescription frequency between these groups. Most dental students choose to prescribe amoxicillin as their first-choice of antibiotic (88.4%), and most also chose to use it for a duration of 3⁻5 days (69.2%). Conclusions: This study concludes that dental students may prescribe antibiotics inappropriately to manage various conditions when not indicated. This may indicate a defect in education of students with regards to current antibiotic guidelines.

Patterns of Self-Medication Behavior for Oral Health Problems Among Adults Living in Riyadh, Saudi Arabia.

Self-medication is a widespread behavior worldwide. It is defined as the practice of self-diagnosis and drug prescription without proper professional consultation. Aim: To determine the prevalence and predictors of self-medication for oral health problems among adults living in Riyadh city. Methods: A cross-sectional study based on a structured close-ended questionnaire was distributed among adults visiting shopping malls in all different five regions of Riyadh. A two-stage sampling technique was used: cluster and simple random sampling. The questionnaire was composed of two main sections: demographic characteristics and questions assessing the behavior of self-medication. Results: The prevalence of self-medication was found to be 63.25%, with a higher prevalence among females than males. Gender and nationality were significantly associated with self-medication. Salt in hot water locally (52.57%) and acetaminophen (47.43%), a type of an analgesic, were, systemically, the most frequently used. Pharmacy shops were the main source of these medicaments (66.01%). Similarly, the advice for using them was mainly given by pharmacists (53.36%). Lack of time was claimed to be the main reason for practicing self-medication (54.55%) with abscess, toothache, and gingival bleeding being the main predictors. Conclusions: Self-medication was found to be a common practice among the population of Riyadh city.

"It feels like I'm the dirtiest person in the world.": Exploring the experiences of healthcare providers who survived MERS-CoV in Saudi Arabia.

In summer 2015, a Saudi 1000-bed tertiary care hospital experienced a serious outbreak among patients of Middle Eastern Respiratory Syndrome (MERS); during which, some healthcare providers contracted the virus, but none died. The outbreak provoked not only fear and stress; but also professional, emotional, ethical, and social conflicts and tension among healthcare providers and patients alike. Therefore, this study aims to explore what healthcare providers, who survived coronavirus infection, have experienced as a MERS patient and how the infection affected their relationship with their colleagues. Semi-structured, face-to-face interviews were conducted individually with seven survivors (healthcare providers). Each interview lasted up to 90min, and the data were analyzed using the thematic analysis technique. Within the participants' rich and illuminating experiences, four themes were identified: caring for others in the defining moments, perceived prejudice behaviours and stigmatization, lived moments of traumatic fear and despair, and denial and underestimation of the seriousness of the disease at the individual and organizational levels. Survivors still suffered as a result of their traumatic experiences, which might negatively influence their performance. As these survivors are vulnerable, it is their organization's responsibility to provide a system that embraces HCPs during and after disastrous events.

Perceptions of the critical cultural competence of registered nurses in Canada.

BACKGROUND: Cultural diversity often leads to misunderstandings, clashes, conflicts, ethnocentrism, discrimination, and stereotyping due to the frequent intersection of many variables, such as differences in traditions, behaviours, ethical and moral perspectives, conceptions of health and illness, and language barriers. The root of the issue is related to the way people conceptualise differences and the unique cultural and historical circumstances that have shaped different groups' heritages. In this study, therefore, we aimed to investigate the perceptions of critical cultural competence (CCC) of registered nurses working in various hospitals across the province of British Columbia, Canada. METHOD: Data were collected using Almutairi's Critical Cultural Competence Scale (CCC Scale) with a random sample of 170 registered nurses. This scale measures four essential multidimensional components of the CCC model: critical awareness, critical knowledge, critical skills, and critical empowerment. Data were analysed using descriptive and inferential statistics (Kruskal-Wallis test). RESULTS: The data revealed that participants' perceptions of CCC were positive with a mean score of 5.22 out of 7.00 for the total number of items (n = 43) and a standard deviation of 0.54. The mean scores for the CCC subscales ranged from 4.76 (for critical skills) to 5.42 (for critical empowerment). The results indicated a statistical difference in CCC perceptions based on participants' age and country of birth with p = 0.05 < 0.05 and 0.029 < 0.05, respectively. CONCLUSION: Nurses' age (experience) and country of birth may influence their perceptions of CCC as gaining cultural competence requires exposure to caring for patients from various cultures and countries, and is associated with cultural knowledge and awareness. Therefore, this finding reveals that healthcare organizations must provide ongoing cultural education programs to increase their nursing staff's level of cultural competence so they are better able to deal with the difficulties that might arise during cross-cultural interactions.

The dilemma of revealing sensitive information on paternity status in Arabian social and cultural contexts: telling the truth about paternity in Saudi Arabia.

Telling the truth is one of the most respected virtues in medical history and one of the most emphasized in the code of medical ethics. Health care providers are frequently confronted with the dilemma as to whether or not to tell the truth. This dilemma deepens when both choices are critically vicious: The choice is no longer between "right and right" or "right and wrong," it is between "wrong and wrong." In the case presented and discussed in this paper, a research team in Saudi Arabia unintentionally uncovered information regarding misattributed paternity. In such a situation and in the context of a tribal cultural system, what should the team do with this information? This case analysis demonstrates the joint application of ethical resources originating from within and outside the Saudi Arabian context. The article analyses the case based on the moral problems involved, relevant medical application, and the impact of such information in the Saudi tribal and Islamic domains. The most pertinent relevant values and secular debates on similar matters are discussed. Finally, the article aims to provide an Islamic dimension of family, fatherhood, and adultery.

Quality of informed consent for invasive procedures in central Saudi Arabia.

BACKGROUND: Informed consent is considered the most important step in clinical interventions. The aims of this study were (1) to assess the quality of informed consent for invasive procedures with regard to consent process and information given about risks and alternative treatments, and (2) to determine patients' attitude toward informed consent at King Abdulaziz Medical City, Riyadh, Saudi Arabia. METHODS: A cross-sectional study was conducted of 162 adult patients in different wards after undergoing surgery or invasive procedures within 1-2 days of signing the informed consent, using a previously validated interview questionnaire. Data on patients' characteristics, type of invasive procedure, and some informed consent-related issues were collected. Multiple linear regression analysis was used to identify the predictors of the percentage mean score of quality of informed consent, and significance was considered at P ≤ 0.05. RESULTS: The quality of informed consent was generally poor (% mean score = 50.98 ± 17.49). About two-thirds of patients were told during the informed consent process that they have to sign merely as routine, 48% thought that if they refused the treatment plan they would lose the interest of the treating physician to help them, 42% thought that by saying no they would lose the good relationship with their physician, and 42.6% were not interested in having a copy of the informed consent document. Significantly higher quality was predicted when the physicians were the ones who explained the informed consent (t = 4.15, P < 0.001) and when informed consent was explained to younger patients (t = 2.754, P = 0.007). The overall attitude of the patients toward the process of informed consent was satisfactory (% mean score = 76.31 ± 7.63). CONCLUSION: The results suggest either that patients are not aware of their rights or that physician paternalism is practiced in Saudi Arabia. Cultural barriers should not be an argument to diminish the role of informed consent. Further studies should focus on how the value of autonomy can be appreciated in the Saudi culture.