Perceptions about the Implementation and Education of Telemedicine among University Students in Riyadh, Saudi Arabia.

Objectives: This study evaluated and compared the perceptions, awareness, and experiences of telemedicine among university students in Riyadh. Methods: In this cross-sectional study, a questionnaire was distributed electronically to undergraduate university students in Riyadh. The study was conducted from September 2021 to March 2022. Five-point Likert scale data were reported as percent agreement, while open-text comments were reported as recurring themes. Besides, the perceptions of medical students were compared with students from other disciplines. Results: Of 564 participants, 209 (37%) were medical students. Most respondents agreed that telemedicine could save patients' time (77.7%) and improve access to healthcare (73.4%). The agreement was low for the statements that doctors would effectively evaluate the clinical features (39.2%) and that patients would effectively communicate their illnesses (44.3%). The agreement of medical students compared to students from other disciplines was even lower for these statements (25% vs. 47%; p<0.001) and (37% vs. 48%; p=0.03), respectively. Most medical students reported that they never learned about telemedicine (65%) and its tools (69%). Lack of awareness, training of healthcare workers and perceived lower quality of healthcare emerged as the most relevant factors for the limited acceptance of telemedicine. Conclusions: Most participants perceived that telemedicine could save patients' time and improve access to healthcare. The low agreement, especially of medical students, for the ability of physicians to evaluate clinical features and of patients to communicate illnesses effectively possibly represented suboptimal education of telemedicine in medical curricula. Thus, incorporating telemedicine into medical curricula and improving public awareness might expedite telemedicine implementation.

Perceived effectiveness of learning methods among preclinical medical students - role of personality and changes over time.

BACKGROUND AND OBJECTIVES: Active learning methods are vital in inculcating skills of critical thinking, lifelong learning and effective communication. Personality may influence learning method preferences and academic performance. The aim of this cross sectional study was to examine the relationship between students' personality and their predilection for learning methods and academic performance. METHODS: Perceived effectiveness of learning methods was assessed over time. Second- and third-year medical students (n=112) completed a questionnaire consisting of Big Five Inventory to measure the personality dimensions, and evaluated lecture, problem-based learning (PBL) and team-based learning (TBL) for their helpfulness in learning. Grade point average (GPA), PBL and TBL grades were obtained. Correlation coefficients were calculated between personality traits and learning method effectiveness scores, and grades. Learning methods effectiveness was compared between second- and third-year students. RESULTS: Positive correlations were identified between conscientiousness and lecture (r = 0.30), agreeableness and lecture (r = 0.20), and agreeableness and TBL (r = 0.23). Likewise, positive correlations were seen between extraversion and PBL grade (r=0.20), and conscientiousness and GPA (r = 0.23). In third year, significant decline in perceived effectiveness of lecture was seen (81% vs 57%; p = 0.006), while increased perceived effectiveness for PBL (38% vs. 50%) was not statistically significant (p = 0.22). CONCLUSIONS: The findings provide an evidence for modest correlations between personality and perceived effectiveness of learning methods. Remarkably, perceived effectiveness decreased for the lecture and increased for the PBL over time. The findings may help educators in better implementing active learning modalities. Besides, an earlier introduction may help students becoming acquainted with and getting the most out of PBL.

Vertical integration of head, neck, and special senses module in undergraduate medical curriculum.

Vertical integration is believed to increase motivation by providing context for the learning. In this quasi-experimental study, cohort I took two horizontally integrated modules: structure and function of head, neck, and special senses in the second year, and pathophysiology and clinical sciences in the third year. Cohort II took a combined, vertically integrated module in the second year. Data from the questionnaire and examination scores were compared. Response rate was 80.1% (125/156) for cohort I and 57.6% (98/170) for cohort II. Response to the statement that vertical integration provides context to basic sciences was mixed with a higher agreement in cohort II (51.5 vs. 37.2%; P = 0.04). Cohort II was least satisfied with the appropriateness of self-study time (52.0 vs. 34.7%; P = 0.01). However, cohort II felt that the basic sciences lectures (90.8 vs. 69.4%; P < 0.01) and the clinical skills sessions (85.7 vs. 62.1%; P < 0.01) were more effective. Cohort II was less satisfied with clinical lectures (80.6 vs. 56.1%; P < 0.01) and was less confident in achieving clinical learning objectives (72.8 vs. 40.8%; P < 0.01). Mean multiple-choice questions and problem-based learning scores were similar. However, the short-answer question score was higher for cohort I [82.48 (SD 14.9) vs. 70.74 (SD 17.9); P < 0.01]. Overall, the idea of early vertical integration had a mixed response. It improved the effectiveness of basic sciences lectures and clinical skills sessions. Achievement of clinical learning outcomes was compromised. A disparity in the module's duration and curricular content, and students' ability to grasp clinical concepts and faculty's expectations are the possible reasons. Increased duration and better communication with clinical faculty may improve early introduction of vertical integration.

Learning clinical skills through audiovisual aids embedded in electronic-PBL sessions in undergraduate medical curriculum: perception and performance.

Learning clinical skills in a large group of undergraduate medical students is challenging. Innovative technology-based modalities are being evaluated to complement limited hospital rotations. We determined the effectiveness of clinical skills-related audiovisual (AV) aids embedded in electronic-problem-based learning (PBL) sessions, in terms of students' feedback and formative Objective Structured Clinical Examinations (OSCE) grades. This mixed-method study was conducted during the Cardiovascular System module in year 3 of the Bachelor of Medicine, Bachelor of Surgery program. The AV aids, mainly consisting of abnormal chest auscultation sounds, were linked to the cases for the intervention group. The control group received only a description of clinical signs. Sessions were conducted using an intranet platform. At the end of the module, feedback was obtained from intervention group students and faculty using a self-administered questionnaire. The learning was compared between intervention and control groups through an OSCE. Finally, focus group interviews were conducted to explore factors underlying deviation from the expected results. Out of 110 intervention group students, 86 (78%) responded. The students appreciated the inclusion of AV aids, as suggested by a high average satisfaction score of 4.2 (SD 0.8). They agreed that, apart from being appropriate and relevant, the aids improved the learning environment and engagement in the process. The tutors also gave a similar feedback. However, no difference in the OSCE scores was found between control and intervention groups. The study indicates that inclusion of AV aids improved students' engagement and classroom environment in electronic-PBL sessions, but did not improve diagnostic abilities based on the learned clinical skills.

Type 2 diabetes mellitus in Pakistan: Current prevalence and future forecast.

Diabetes mellitus is a chronic health problem of all age groups, both gender, involves rural and urban areas and developing and developed countries globally. The aim of this study was to assess the prevalence of type 2 diabetes mellitus in Pakistan. Systematic bibliographic search of scientific databases including PubMed, ISI-web of science and Google Scholar was conducted with key words of "type 2 diabetes mellitus" "prevalence", "incidence", "occurrence". A total of 22 peer reviewed papers published in ISI and PubMed indexed journals were selected and examined. All the epidemiologic and experimental studies reporting the diabetes prevalence in Pakistan were included. Lastly, we analyzed 18 publications and remaining 04 papers were excluded. The current prevalence of type 2 diabetes mellitus in Pakistan is 11.77%. In males the prevalence is 11.20% and in females 9.19%. The mean prevalence in Sindh province is 16.2% in males and 11.70 % in females; in Punjab province it is 12.14% in males and 9.83% in females. In Baluchistan province 13.3% among males, 8.9% in females; while in Khyber Pakhtunkhwa (KPK) it is 9.2% in males and 11.60% in females. The prevalence of type 2 diabetes mellitus in urban areas is 14.81% and 10.34% in rural areas of Pakistan. The prevalence of type 2 diabetes mellitus in Pakistan is11.77%. The prevalence is higher in males than females and more common in urban areas compared to the rural areas. Pakistan must include diabetes preventive measures in their national health policy to minimize the burden of the disease.

Medical Students and Faculty Perceptions About Online Learning During COVID-19 Pandemic: Alfaisal University Experience.

Background and Objectives: Off-campus online learning methods abruptly increased and gained popularity during the COVID-19 pandemic. Previous studies have highlighted the limitations of online learning mode; however, further studies on the experiences of medical students are needed. This study aimed to investigate the preclinical medical students and faculty members' experiences with online education and learning. Subjects and Methods: In this cross-sectional study, data were collected using convenience sampling. Two hundred nine students and 13 faculty members who participated in the online courses offered during the spring semester of 2019-2020 completed an online questionnaire. A 30-item questionnaire for the students and a 25-item questionnaire for the faculty were used in this cross-sectional study. Results: Overall, 30% of the student sample was satisfied; importantly, high-achieving students (GPA > 3.5) were less satisfied (25 vs. 32%; p = 0.006). Satisfaction was also low (35%) for student-faculty interaction opportunities. About half of the student sample agreed that small-group interactive sessions would improve learning (53%). The most favored course format was the blended mode (43%), followed by traditional (40%) and online modes (17%). Six out of 13 (46%) faculty members were satisfied with their online experiences. Most of them found virtual teaching applications convenient (77%). Conversely, few faculty members agreed to interact effectively (54%), while 69% favored a blended format. Conclusions: The level of satisfaction in fully online courses offered during the COVID-19 pandemic remained low, especially among high-achieving students. Both students and faculty favored the blended format for future purposes. Small group active-learning strategies and web-based interactive tools may facilitate engagement and student-faculty interactions.

Pattern of histological findings in chronic hepatitis C with alanine transaminase levels below twice the normal value.

OBJECTIVES: To assess the pattern of liver histology in chronic hepatitis C, with serum alanine transaminase levels persistently upto twice the normal range, and to identify factors associated with minimal and clinically significant histological disease categories. METHODS: This study was carried out at Ziauddin University Karachi and Pakistan Medical Research Council, Karachi, from January 2007 to July 2009. Biopsy specimens were staged and graded according to METAVIR scoring system. A fibrosis score of > or = F2 and activity score of > or = A2 was considered significant. Overall disease severity groups; minimal disease (less than F2 and A2) and significant disease (F2 or A2 and above), were compared for their association with different variables. RESULTS: Out of 83 patients, 32 had significant fibrosis and 15 had significant activity. Twenty three patients with significant fibrosis belonged to F2 stage. Nine had F3 fibrosis and none of our patients had cirrhosis. Overall 33 (40%) patients had significant disease. Age of the patient, alanine transaminase levels, number of the portal tracts and severity of the portal inflammation in liver biopsy were significantly associated with severity of the liver disease. Gender of the patient and steatosis in liver biopsy were not significant. CONCLUSION: A substantial proportion of patients with alanine transaminase levels within twice the upper limit of normal had significant liver disease.

Immunohistochemical study of progesterone receptors in thyroid gland.

OBJECTIVE: To determine the progesterone receptor status in thyroid gland. METHODS: This study was based on immunohistochemical staining of formalin fixed paraffin embedded tissues, for progesterone receptors, in 50 previously diagnosed cases of various thyroid lesions and surrounding normal thyroid tissue. RESULTS: Out of 50 cases, 8 were nodular goiter, 9 cases of adenoma, 19 papillary carcinoma, 10 follicular carcinoma and four cases were of medullary carcinoma. Surrounding normal tissue was available in 4 non-neoplastic and 21 neoplastic lesions. Overall male patients comprised 20% (10 cases) and females 80% (40 cases). Although a wide range of lesions in both the sexes including wide age range were available, none of our cases were positively stained for progesterone receptors. CONCLUSION: In contrary to earlier reports by immunohistochemical method using monoclonal mouse anti-PR antibody clone PgR 636, on formalin-fixed paraffin embedded thyroid tissues, the progesterone receptors were not detectable in our human samples. The effect of progesterone on thyroid gland may be an indirect one.

"Liverscore" is predictive of both liver fibrosis and activity in chronic hepatitis C.

AIM: To formulate a noninvasive index predictive of severity of liver fibrosis and activity in chronic hepatitis C. METHODS: This cross sectional study was conducted on polymerase chain reaction positive, treatment naïve patients. Fibrosis was staged on a five point scale from F0-F4 and activity was graded on a four point scale from A0-A3, according to the METAVIR system. Patients were divided into two overall severity groups, minimal disease (< F2 and < A2) and significant disease (≥ F2 or ≥ A2). Eleven markers were measured in blood. Statistically, the primary outcome variable was identification of minimal and significant overall disease. Indices were formulated using ß regression values of different combinations of nine statistically significant factors. Diagnostic performance of these indices was assessed through receiver-operating characteristic curve analysis. RESULTS: A total of 98 patients were included and of these 46 had an overall clinically significant disease. Our final six marker index, Liverscore for Hepatitis C, consisted of age, alanine transaminase, gamma-glutamyl transpeptidase, apolipoprotein A-1, alpha-2 macroglobulin and hyaluronic acid. The area under the curve was found to be 0.813. On a 0-1 scale, negative predictive value at a cutoff level of ≤ 0.40 was 83%, while positive predictive value at ≥ 0.80 remained 89%. Altogether, 61% of the patients had these discriminative scores. CONCLUSION: This index is discriminative of minimal and significant overall liver disease in a majority of chronic hepatitis C patients and can help in clinical decision making.