Authentic leadership in a health sciences university.

AIM: To study authentic leadership characteristics between academic leaders in a health sciences university. METHODS: Cross-sectional study at a health sciences university in Saudi Arabia. The Authentic Leadership Questionnaire (ALQ) was utilized to assess authentic leadership. RESULTS: Out of 84 ALQs that were distributed, 75 (89.3%) were eligible. The ALQ scores showed consistency in the dimensions of self-awareness (3.45 ± 0.43), internalized moral prospective (3.46 ± 0.33) and balanced processing (3.42 ± 0.36). The relational transparency dimension had a mean of 3.24 ± 0.31 which was significantly lower than other domains. Academic leaders with medical background represented 57.3%, compared to 42.7% from other professions. Academic leaders from other professions had better ALQ scores that reached statistical significance in the internalized moral perspective and relational transparency dimensions with p values of 0.006 and 0.049, respectively. In reference to the impact of hierarchy, there were no significant differences in relation to ALQ scores. Almost one-third of academic leaders (34.7%) had Qualifications in medical education that did not show significant impact on ALQ scores. CONCLUSION: There was less-relational transparency among academic leaders that was not consistent with other ALQ domains. Being of medical background may enhance leaders' opportunity to be at a higher hierarchy status but it did not enhance their ALQ scores when compared to those from other professions. Moreover, holding a master in medical education did not impact leadership authenticity.

Effect of education and clinical assessment on the accuracy of post partum blood loss estimation.

BACKGROUND: This research aimed to assess the effect of health care provider education on the accuracy of post partum blood loss estimation. METHODS: A non-randomized observational study that was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia between January 1, 2011 and June 30, 2011. Hundred and twenty three health care providers who are involved in the estimation of post partum blood loss were eligible to participate. The participants were subjected to three research phases and an educational intervention. They have assessed a total of 30 different simulated blood loss stations, with 10 stations in each of the research phases. These phases took place before and after educational sessions on how to visually estimate blood loss and how to best utilize patient data in clinical scenarios. We have assessed the differences between the estimated blood loss and the actual measure. P-values were calculated to assess the differences between the three research phases estimations. RESULTS: The participants significantly under-estimated post partum blood loss. The accuracy was improved after training (p-value < 0.0001) and after analysing each patient's clinical information (p-value = 0.042). The overall results were not affected by the participants' clinical backgrounds or their years of experience. Under-estimation was more prominent in cases where more than average-excessive blood losses were simulated while over-estimations or accurate estimations were more prominent in less than average blood loss incidents. CONCLUSION: Simple education programmes can improve traditional findings related to under-estimation of blood loss. More sophisticated clinical education programmes may provide additional improvements.

Antimicrobial resistance among pregnant women with urinary tract infections is on rise: Findings from meta-analysis of observational studies.

Pregnant women have a higher risk of urinary tract infections (UTIs) compared to non-pregnant women, making antibiotics necessary for treatment. However, prescribing antibiotics without culture and sensitivity tests may contribute to antimicrobial resistance. A meta-analysis using R was conducted to determine the prevalence of antibiotic resistance patterns in UTIs among pregnant women. We identified observational studies published in the last 10 years and used a random effects model to calculate the pooled prevalence. The prevalence of Gram-negative organisms causing UTIs in pregnant women was 67 %, while Gram-positive organisms were 22 %. The burden of Gram-positive organisms exhibiting antimicrobial resistance was very high at 95 %, primarily to ampicillin. The most common Gram-negative organisms exhibiting antimicrobial resistance were E. coli, Klebsiella, and Pseudomonas aeruginosa, while the most common Gram-positive organisms resistant to antibiotics were Staphylococcus aureus and coagulase-negative Staphylococcus. Sensitivity and culture testing are recommended for effective treatment in pregnant women with UTIs.

Predictors influencing dental clinic utilization in primary health care: A retrospective analysis of 233,069 patient records in Riyadh, Saudi Arabia.

Aim: This study aims to identify and address the predictors that promote or prevent the utilization of dental services in primary health care (PHC) centers located in Riyadh, Saudi Arabia, with an ultimate goal to increase the uptake of oral health care (OHC) services. Methodology: Registration data from 99 PHC centers was used. For each patient visiting a PHC center, information on the number of dental visits was captured. Continuous data was summarized as means, medians, and ranges, and categorical data as frequencies (%). The strength of association was reported as an incidence rate ratio (IRR) with 95% confidence interval (CI) and a p-value. Further analysis was conducted to illustrate the association between dental care visits and factors found independently significant in the final multivariate model using Karl Pearson correlation coefficient and t-test. All tests were two-sided and a p-value of p < 0.05 was considered significant. Results: The comorbidity profile of patients shows that 11,751(5%) were diabetic, while hypertension amounted to 10,712(4.6%). A statistically significant inverse correlation was observed between dental care visits and both age (r = -0.025, p < 0.001) and BMI (r = -0.013, p < 0.001). Mean dental care visits were significantly higher in patients without hypertension compared with those with hypertension (p < 0.001). Moreover, there was an approximate 4% increase in dental care visits among females compared to males, although this difference was not statistically significant. Conclusion: The study identified three predictors contributing to the low utilization of dental services in PHC centers in Riyadh. These include an inverse association between both age and body mass index (BMI) and the utilization of OHC. Additionally, the mean dental care visits were significantly higher for patients without hypertension in comparison to hypertensive patients.

Factors Associated with Mental Illness in a Primary Healthcare Setting in the Kingdom of Saudi Arabia: A Case-Control Study.

BACKGROUND/OBJECTIVES: Mental health conditions are a leading cause of morbidity and mortality worldwide, with a 13% rise within the last decade. This study aimed to investigate the factors associated with mental illness in patients presenting to a primary healthcare center in the Kingdom of Saudi Arabia (KSA). METHODS: Data were extracted from the electronic health records of 46 primary care centers in Riyadh, Saudi Arabia from March 2022 to March 2023. A total of 2418 age-matched mental health cases and controls were evaluated. Descriptive and logistic regression analyses were performed to examine the distribution and association of relevant risk factors. A total of 1209 cases were age-matched to 1209 controls presenting to a primary clinic. RESULTS: The odds of mental illness in females were 2.2 times that of males. Clinical conditions associated with mental illness were stroke, diabetes, and obesity. Neurodegenerative disorders were also associated with mental illness. CONCLUSIONS: Primary clinics in the KSA can serve as focal points in removing the barriers to mental healthcare. There is an urgent need to spread awareness, remove the stigma, and provide appropriate care and referrals for mental health conditions in the KSA.

Workplace-based assessment and students' approaches to learning: a qualitative inquiry.

BACKGROUND: We have performed this research to assess the effect of work-place based assessment (WBA) practice on medical students' learning approaches. METHODS: The research was conducted at the King Saud bin Abdulaziz University for Health Sciences, College of Medicine from 1 March to 31 July 2012. We conducted a qualitative, phenomenological research utilizing semi-structured individual interviews with medical students exposed to WBA. The audio-taped interviews were transcribed verbatim, analyzed, and themes were identified. We preformed investigators' triangulation, member checking with clinical supervisors and we triangulated the data with a similar research performed prior to the implementation of WBA. RESULTS: WBA results in variable learning approaches. Based on several affecting factors; clinical supervisors, faculty-given feedback, and assessment function, students may swing between surface, deep and effort and achievement learning approaches. Students' and supervisors' orientations on the process of WBA, utilization of peer feedback and formative rather than summative assessment facilitate successful implementation of WBA and lead to students' deeper approaches to learning. Interestingly, students and their supervisors have contradicting perceptions to WBA. CONCLUSION: A change in culture to unify students' and supervisors' perceptions of WBA, more accommodation of formative assessment, and feedback may result in students' deeper approach to learning.

COVID-19 vaccination and menstrual disorders among women: Findings from a meta-analysis study.

BACKGROUND: COVID - 19 vaccine can lead to various local and systemic side effects, including menstrual irregularities in women. There is no robust quantitative evidence of the association between the COVID - 19 vaccine and menstrual irregularities. A meta-analysis was performed to estimate the pooled prevalence of a range of menstrual disorders that may occur in women following COVID - 19 vaccination. METHODS: After searching for epidemiological studies, we systematically performed a meta-analysis on PubMed/Medline, EMBASE, and Science Direct. Sixteen studies were finally included in the study. We estimated the pooled prevalence and corresponding 95 % confidence intervals (CIs) for a group of menstrual disorders, including menorrhagia, polymenorrhea, abnormal cycle length, and oligomenorrhea. Heterogeneity was assessed using the I2 statistic and the Q test. RESULTS: Overall, the pooled prevalence of menorrhagia was 24.24 % (pooled prevalence 24.24 %; 95 % CI: 12.8-35.6 %). The pooled prevalence of polymenorrhea was 16.2 % (pooled prevalence: 16.2 %; 95 % CI: 10.7-21.6 %). The pooled prevalence of abnormal cycle length was relatively lower than that of the other disorders (pooled prevalence: 6.6 %; 95 % CI: 5.0-8.2 %). The pooled prevalence of oligomenorrhea was 22.7 % (95 % CI: 13.5-32.0 %). CONCLUSION: The findings indicate that menorrhagia, oligomenorrhea, and polymenorrhea were the most common menstrual irregularities after vaccination. The findings also suggest that a relatively high proportion of women suffer from menstrual irregularities. Further longitudinal studies are needed to confirm the causal relationship between COVID-19 vaccination and menstrual irregularities.

Epidemiology of Glucose-6-Phosphate Dehydrogenase Deficiency in Arab Countries: Insights from a Systematic Review.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common metabolic disorder affecting more than 400 million individuals worldwide. Being an X-linked disorder, the disease is more common among males than females. Various Arab countries estimated the prevalence of G6PD deficiency; however, findings from different countries have not been synthesized collectively. Hence, a systematic review was undertaken to synthesize the findings on the epidemiology of G6PD deficiency in all Arab countries. We performed an electronic systematic literature search based on the eligibility criteria using databases, including MEDLINE, Embase, and CINHAL. The studies included in the review were primary and original research studies assessing the prevalence or incidence, risk factors, or determinants of G6PD deficiency, and published in the English language in a peer-reviewed scientific journal between 2000 and 2022. The systematic review was carried out with the help of an updated PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. After the screening, 23 full texts were finalized for data extraction. The prevalence of G6PD deficiency ranged from 2 to 31% with a greater burden among high-risk populations like neonates with sickle cell anemia. The determinants included males, family history, consanguineous marriages, and geographic regions, which were all risk factors, except for body weight, which was a protective factor. The prevalence of G6PD deficiency varies across Arab countries, with a higher prevalence in males than females. Different regions of Arab countries need to revisit their screening and diagnostic guidelines to detect G6PD deficiency promptly and prevent unnecessary morbidity and mortality among their communities.

Effect Modification by Age and Gender in the Correlation Between Diabetes Mellitus, Hypertension, and Obesity.

BACKGROUND: Literature has reported differences in the epidemiology or natural history of non-communicable diseases among both the male and female sexes. Stratification of multimorbidity burden based on sex is crucial to identify and implement targeted prevention and control interventions for chronic diseases. OBJECTIVES: To determine the burden of hypertension, type-2 diabetes mellitus, and obesity; and to compare the related multimorbidity among male and female patients. METHODS: The study was a retrospective analysis of 375 802 medical records from primary care centers. Data was extracted from March 2022 to March 2023. A multivariate probit estimation methodology was employed using a 3-equations multivariate multiple probit model to jointly estimate the association of a person's sex with the diagnosis of the 3 chronic conditions: obesity, diabetes, and hypertension. A multinomial logistic regression analysis was conducted to allow each unique combination of these 3 chronic diseases. RESULTS: Females had a relatively higher proportion of obesity (58.1% vs 41.2%), obesity and diabetes only (58.9% vs 41.1%), obesity and hypertension (63.6% vs 36.4%), and joint diagnosis with 3 conditions (65.7% vs 34.3%). Females' participants consistently had a significantly higher likelihood of diagnosis compared with males except for diabetes (OR = 0.59, 95% CI: 0.56-0.62) and the combination of only diabetes and hypertension (OR = 0.67, 95% CI: 0.61-0.74). The likelihood of other combinations ranged from 1.04 (95% CI: 0.98-1.10) for only hypertension to 2.30 (95% CI: 2.10-2.53) for the joint diagnosis of all 3 conditions. An increased likelihood of a single or combined occurrence of 3 chronic conditions was observed with increased age. CONCLUSION: The multimorbidity distribution for diabetes mellitus, hypertension, and obesity differs significantly among male and female patients. The overall burden of morbidity, and mortality, however, tends to rise after 46 years of age, with the highest burden among individuals above 60 years of age.

Factors contributing to intra-uterine fetal death.

PURPOSE: We aimed in this research to explore factors contributing to the occurrence of intra-uterine fetal death (IUFD). METHODS: The study was conducted between 1st January 2008 and 31st December 2009 in the Department of Obstetrics and Gynecology at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patients who were diagnosed to have IUFD at ≥24 weeks of gestation and those whose dead fetuses were found to weigh ≥500 g after delivery were eligible to be included. 138 patients with IUFD and 237 controls with alive fetuses were enrolled. Data were collected from printed and computerized medical records of participants. Factors that may have contributed to the occurrence of IUFD were explored. Comparisons between various risk factors and outcomes of the two groups were done. p value was statistically significant if ≤0.05. RESULTS: Patients who did not receive antenatal care (ANC) services are at 70 % increased risk for developing IUFD (OR 0.31, p < 0.0001). Risk of IUFD increases 25-fold with the occurrence of abruption placenta (OR 25.81, p ≤ 0.0001), tenfolds with the occurrence of intra-uterine growth restrictions (OR 10.78, p = 0.04) and threefolds with the presence of hypertensive disorder in pregnancy (OR 3.17, p = 0.04). Finally, patients carrying IUFD fetuses are at higher risk to develop labor complications compared with their controls (p ≤ 0.0001). CONCLUSION: Despite the difficulty in predicting IUFD occurrence, it appears that carefully implemented ANC and timely management of at risk patients may contribute to its prevention.

Exploring assessment factors contributing to students' study strategies: literature review.

"Assessment steers students' learning" is a statement that has been used repeatedly without solid evidence in the literature. This manuscript aims to evaluate the published literatures on the effect of teaching learning environment in particular, the implemented assessment on students' learning approaches. A literature review was performed on the effect of assessment on students learning approaches. English language literatures were searched in Pubmed, PsycINFO, and Medline without restriction to type or date of publication. Reviewing the literature, the most prominent identified theme was assessment function characterized in summative and formative assessment and general effect of assessment on students' learning approaches. The literature review has pointed clearly to the complexity of the relationship between learning environment, students' perceptions of assessment demands, and students' approaches to learning. Many factors (extrinsic and intrinsic) were theoretically proposed to mediate students' approaches to learning in response to their assessment. However, few of these factors were researched in the published literature. Formative assessment is likely to contribute to students' deep approach to learning while summative is likely to contribute to their surface approach. However, these effects are not definite and further research about the complex relationship between assessment and students' learning is required.

Acute late presentation of a functioning non-communicating rudimentary uterine horn containing an adenomyosis: A case report.

A functioning noncommunicating rudimentary horn is a rare uterine malformation. The presence of rudimentary uterine horn with adenomyosis is even rarer situation. Clinical presentation varies from mild pain that might present late in the clinical course with complications that can be gynecological such as pelvic pain and endometriosis or obstetrical such as preterm delivery, cesarean section, and ectopic pregnancy. We are reporting a case of a young woman who presented with acute abdominal pain that was superimposed by chronic pelvic pain due to endometriosis and deep pelvic vein thrombosis secondary to an enlarging noncommunicating rudimentary uterine horn containing extensive adenomyosis. With the help of MRI, initial diagnosis was given as rudimentary functioning horn containing fibroid and unilateral renal agenesis. The treatment comprised complete laparoscopic excision of the entire horn, and the patient reported significant improvement afterward. Final histopathology was rudimentary horn containing adenomyosis. Our paper is one of few papers reported adenomyosis in function noncommunication rudimentary horn.

Exploring factors affecting undergraduate medical students' study strategies in the clinical years: a qualitative study.

The aim of this study is to explore the effects of clinical supervision, and assessment characteristics on the study strategies used by undergraduate medical students during their clinical rotations. We conducted a qualitative phenomenological study at King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia during the period from November 2007 to December 2008. We conducted semi-structured focus groups interviews with students and conducted individual interviews with teachers and students to explore students' and clinical teachers' perceptions and interpretations of factors influencing students' study strategies. Data collection was continued until saturation was reached. We used Atlas-ti Computer Software (Version 5.2) to analyse the data, apply the obtained themes to the whole dataset and rearrange the data according to the themes and sub-themes. Analysis of data from interviews with twenty-eight students and thirteen clinical supervisors yielded three major themes relating to factors affecting students' study strategies: "clinical supervisors and supervision", "stress and anxiety" and "assessment". The three themes we identified played a role in students' adoption of different study strategies in the "community of clinical practice". It appeared that teachers played a key role, particularly as assessors, clinical supervisors and as a source of stress to students.

Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study.

PURPOSE: One of the major problems in international literature is how to measure postpartum blood loss with accuracy. We aimed in this research to assess the accuracy of visual estimation of postpartum blood loss (by each of two main health-care providers) compared with the gravimetric calculation method. METHODS: We carried out a prospective cohort study at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1 November 2009 and 31 December 2009. All women who were admitted to labor and delivery suite and delivered vaginally were included in the study. Postpartum blood loss was visually estimated by the attending physician and obstetrics nurse and then objectively calculated by a gravimetric machine. Comparison between the three methods of blood loss calculation was carried out. RESULTS: A total of 150 patients were included in this study. There was a significant difference between the gravimetric calculated blood loss and both health-care providers' estimation with a tendency to underestimate the loss by about 30%. The background and seniority of the assessing health-care provider did not affect the accuracy of the estimation. The corrected incidence of postpartum hemorrhage in Saudi Arabia was found to be 1.47%. CONCLUSION: Health-care providers tend to underestimate the volume of postpartum blood loss by about 30%. Training and continuous auditing of the diagnosis of postpartum hemorrhage is needed to avoid missing cases and thus preventing associated morbidity and mortality.

Framework for obstetrics and gynecology department change management in response to COVID-19 pandemic: A tertiary center experience.

Coronavirus (cov) disease 2019 pandemic caused by severe acute respiratory syndrome cov 2 has imposed significant demands on healthcare systems across the world. These demands were more significant on obstetrics and gynecology (obgyn) patients, who required services that had to continue despite the closure of other services. This paper describes the change management of an obgyn department at a tertiary health-care center. That experience resulted in a complete management shift in the institution and the formation of an infectious disease epidemic plan for respiratory infections. Description of the change management performed, difficulties encountered, and achievements obtained can assist other departments change management when they face similar situations.

Role of oxidative stress in the pathogenesis of preeclampsia.

Hypertensive disorders of pregnancy are associated with an increased risk of maternal and fetal morbidity and mortality. The cause and the pathogenesis of the pregnancy-induced syndrome, preeclampsia, is still poorly understood. Published evidence of altered biomarkers for the endothelial dysfunction suggests that the initiating event in preeclampsia is the reduced placental perfusion, which leads to widespread dysfunction of the maternal vascular endothelium. This review focuses on the role of free radicals in generating the oxidative stress taking antioxidants into consideration which tend to overcome it as well as the role of placenta in preeclamptic pregnancy.

Framework for curriculum delivery during COVID-19 pandemic in a health sciences university.

This article aims to shed light on the management that was taken by the King Saud Bin Abdulaziz University for Health Sciences to accommodate the immediate needs for online curriculum delivery, in response to the total lockdown due to COVID-19 pandemic. We have described the process done, actions implemented, and challenges faced to manage the curriculum delivery during the pandemic and to plan the subsequent year curriculum delivery. Effective management will be enhanced by focused faculty development, curriculum management, assessment planning, and technical support. We believe that the management done can be taken as a model in similar situations where sudden online curriculum delivery is deemed necessary. Further audit on the effectiveness and implication of these actions is required after the end of the pandemic.

Research Productivity in the Health Sciences in Saudi Arabia: 2008-2017.

The purpose of this study was to analyze the published research on health sciences carried out by researchers in Saudi Arabia in the last decade by assessing bibliometric output. Data for 2008 to 2017 was retrieved from Scopus. During this period, there was significant growth, from 1332 publications in 2008 to 5529 in 2017, with an average annual growth rate of 14.1%. King Saud University was the most productive institution. Most of the published research was done in collaboration with Egypt. The subject area of medicine was predominant with the main publication source being the Saudi Medical Journal, Life Science Journal, the Acta Zhengzhou University Oversea Version, and the Annals of Saudi Medicine, primarily in the form of original research articles. The growing trend in publications is a sign of the increasing quality of education and more research and development activities, which are made possible by a sufficient budget allocation to these activities during the last decade.

Perceptions of postoutbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study.

OBJECTIVES: This study examines perceptions of the operational and organisational management of a major outbreak of Middle East Respiratory Syndrome (MERS) caused by a novel coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia (KSA). Perspectives were sought from key decision-makers and clinical staff about the factors perceived to promote and inhibit effective and rapid control of the outbreak. SETTING: A large teaching tertiary healthcare centre in KSA; the outbreak lasted 6 weeks from June 2015. PARTICIPANTS: Data were collected via individual and focus group interviews with 28 key informant participants (9 management decision-makers and 19 frontline healthcare workers). DESIGN: We used qualitative methods of process evaluation to examine perceptions of the outbreak and the factors contributing to, or detracting from successful management. Data were analysed using qualitative thematic content analysis. RESULTS: Five themes and 15 subthemes were found. The themes were related to: (1) the high stress of the outbreak, (2) factors perceived to contribute to outbreak occurrence, (3) factors perceived to contribute to success of outbreak control, (4) factors inhibiting outbreak control and (5) long-term institutional gains in response to the outbreak management. CONCLUSION: Management of the MERS-CoV outbreak at King Abdulaziz Medical City-Riyadh was widely recognised by staff as a serious outbreak of local and national significance. While the outbreak was controlled successfully in 6 weeks, progress in management was inhibited by a lack of institutional readiness to implement infection control (IC) measures and reduce patient flow, low staff morale and high anxiety. Effective management was promoted by greater involvement of all staff in sharing learning and knowledge of the outbreak, developing trust and teamwork and harnessing collective leadership. Future major IC crises could be improved via measures to strengthen these areas, better coordination of media management and proactive staff counselling and support.

Improving inventory learning style.

OBJECTIVE: To look into Vermunt learning style inventory as an example of other inventories, identify the students learning style, their experience when they answered the inventory, did it help them to identify their learning style, and how it can be improved. METHODS: Quantitative questionnaire, and qualitative semi structured interviews at King Abdulaziz Medical City, King Fahad National Guard Hospital, Department of Obstetrics and gynecology, from November to December 2006 were recorded. RESULTS: The quantitative comparison between the 17 studied students inventories revealed no significant difference between the students learning styles. In the interviews, the common themes were long questionnaire with frequency of 15/17, time consuming questionnaire 15/17, boring questionnaire 10/17, and agreement with the learning style identified 12/17. CONCLUSION: Inventory learning style questionnaires are in general time-consuming and boring to the students. They are overlapping and using different terminologies for the same meaning. A collaborative work aiming to unify all the terms and reduce the length of the questionnaire is required. We should take into consideration motivation, cultural variations and emotional factors. This will allow more reliable results, better counselling to the students, perform systematic reviews, and enrich the literature with valuable information with avoidance of wasting time and efforts.