Implementation of risk minimization measures to reduce the risk of tuberculosis among tumor necrosis factor medication users.

PURPOSE: To examine the adherence to risk minimization measures (RMMs) in newly treated patients with anti-tumor necrosis factor-alpha (anti-TNF-α) medications at one of the largest tertiary care hospitals in Saudi Arabia. METHODS: We included patients who had at least one prescription of infliximab or adalimumab. The index date was the first recorded date of infliximab or adalimumab prescription. New users of anti-TNF-α were divided into pre- and post-RMM implementation groups. The outcome of interest was the proportion of patients that received tuberculosis (TB) screening, including a chest X-ray (CXR) or a QuantiFERON test within 1 month prior to the index date. RESULTS: A pre-post RMM implementation comparison of TB screening among infliximab users showed a significant increase in the rates of CXR tests (from 7.5% before RMM implementation to 13.8% after RMM implementation, p < 0.001) and the rates of QuantiFERON tests (4.5% before RMM implementation to 24.1% after RMM implementation, p < 0.001). RMMs were introduced to the study site at the same time as adalimumab was approved and the proportion of patients receiving TB screening was 25.2%. CONCLUSION: TB screening prior to initiation of infliximab or adalimumab was not optimal. However, we noted an improvement in TB screening after the implementation of RMMs for infliximab. Future research may address reasons for low adherence to testing requirements for TB prior to initiation of anti-TNF-α medications.

A Review of the Impact of Pharmacogenetics and Metabolomics on the Efficacy of Metformin in Type 2 Diabetes.

Metformin is the most often prescribed drug for people with type 2 diabetes (T2D). More than 120 million patients with T2D use metformin worldwide. However, monotherapy fails to achieve glycemic control in a third of the treated patients. Genetics contribute to some of the inter-individual variations in glycemic response to metformin. Numerous pharmacogenetic studies have demonstrated that variations in genes related to pharmacokinetics and pharmacodynamics of metformin's encoding transporters are mainly associated with metformin response. The goal of this review is to evaluate the current state of metformin pharmacogenetics and metabolomics research, discuss the clinical and scientific issues that need to be resolved in order to increase our knowledge of patient response variability to metformin, and how to improve patient outcomes. Metformin's hydrophilic nature and absorption as well as its action mechanism and effectiveness on T2D initiation are discussed. The impacts of variations associated with various genes are analysed to identify and evaluate the effect of genetic polymorphisms on the therapeutic activity of metformin. The metabolic pattern of T2D and metformin is also indicated. This is to emphasise that studies of pharmacogenetics and metabolomics could expand our knowledge of metformin response in T2D.

Immune checkpoint inhibitors and potential risk of thromboembolic events: Analysis of the WHO global database of individual case safety reports.

Introduction: Thromboembolic events with the use of immune checkpoint inhibitors (ICIs) in patients with cancer have been reported in few studies. However, the detailed profile of these cases remains mostly uncertain. Method: A descriptive analysis of Thromboembolic events associated with ICIs retrieved from the VigiBase, between 1967 to November 2020. We extracted the data using the terms of 'pulmonary embolism' OR 'deep vein thrombosis' OR 'acute coronary syndrome' OR 'myocardial infarction' OR 'ischemic stroke' (preferred term (PT) (MedDRA). Results: We included 161 cases from 26 countries in our descriptive analysis. Patients' ages were reported in 141 (87.6%) cases, with a median of 68 years (interquartile range 61-74), and 63.4% of the patients were male. Indications for ICIs were reported in 151 (93.8%) cases, as follows: lung cancer (n = 85, 52.8%), renal cell carcinoma (n = 24, 14.9%), melanoma (n = 20, 12.4%), urethral carcinoma (n = 12, 7.45%), breast cancer (n = 4, 2.48%), adenocarcinoma of the gastroesophageal junction (n = 3, 1.9%), gastric cancer (n = 2, 1.24%), and skin cancer (n = 1, 0.62%). Nivolumab was reported as a suspected drug in 76 cases (47%), pembrolizumab in 46 cases (28.5%), atezolizumab in 21 cases (13%), durvalumab in 14 cases (8.6%), and avelumab in four cases (2.4%).The time to onset of thromboembolic events was reported in 127 (78.8%) cases. Most of these patients (n = 109, 85.8%) reported thromboembolic events within the first six months. The causality assessment of included cases showed that 50.3% of reported thromboembolic events were possibly related to the suspected reported medication, 13.7% were probably related, 13% were unlikely to be related, and 23% were not assessable due to insufficient information. Conclusion: This study demonstrates a possible association between the use of ICIs and thromboembolic events. Further epidemiological studies are needed to assess this association and to elucidate the underlying mechanism.

The Impact of Cybersecurity Practices on Cyberattack Damage: The Perspective of Small Enterprises in Saudi Arabia.

Small and medium-sized enterprises represent the majority of enterprises globally and yet have some difficulties in understanding the impact that cybersecurity threats could have on their businesses and the damage they could do to their assets. This study aims to measure the effectiveness of security practices at small-sized enterprises in Saudi Arabia in the event of a cybersecurity attack. Our paper is among the first research papers to measure the effectiveness of cybersecurity practices and the threat posed by cybersecurity breaches among small enterprises in the event of cybersecurity attacks. A total of 282 respondents participated, all of them representing small-sized enterprises in Saudi Arabia. The study applies multiple regression tests to analyze the effectiveness of 12 cybersecurity practices in three aspects: financial damage, loss of sensitive data, and restoration time, at small enterprises. The findings indicate that having an inspection team and a recovery plan may limit the financial damage caused by cybersecurity attacks on small enterprises. The results also show that cybersecurity awareness, knowledge of cybersecurity damage, and professionals' salaries were related to the loss of sensitive data. Furthermore, the results indicate that contact with cybersecurity authorities and having an inspection team have statistically significant effects on restoration time.

Assessing the pharmacy students' knowledge of common medical terms after a curricular change in Saudi Arabia.

Medical terminology is the vocabulary used to describe the human body and its conditions; fluency in this language is essential for health care professionals. We examined the level of basic medical terminology understanding among 347 pharmacy students in four different colleges of pharmacy in Saudi Arabia using a newly developed test of 30 multiple choice questions. Students in the relatively new colleges of pharmacy were more likely to have a higher score in the medical terminology test compared to their counterparts from the old college of pharmacy (ß = 1.23, 95% CI = 0.16-2.30, P-value = 0.02). Female gender (ß = 1.72, 95% CI = 0.57-2.88, P-value = 0.003), and advanced class level (ß = 0.84, 95% CI = 0.36-1.32, P-value < 0.001) were also positively associated with high medical terminology test scores. The findings of this study reveal a deficiency in the pharmacy students' level of understanding of basic medical terms which may necessitate a reintroduction of the medical terminology course into the pharmacy curriculum.

Translation and validation of the Arabic version of the General Medication Adherence Scale (GMAS) in Saudi patients with chronic illnesses.

PURPOSE: The study aimed to translate and validate the Arabic version of General Medication Adherence Scale (GMAS) in Saudi patients with chronic diseases. METHODS: A multi-center cross sectional study was conducted for a month in out-patient wards of hospitals in Khobar, Dammam, Makkah, and Madinah, Saudi Arabia. Patients were randomly selected from a registered patient pools at hospitals and the item-subject ratio was kept at 1:20. The tool was assessed for factorial, construct, convergent, known group and predictive validities as well as, reliability and internal consistency of scale were also evaluated. Sensitivity, specificity, and accuracy were also evaluated. Data were analyzed using SPSS v24 and MedCalc v19.2. The study was approved by concerned ethics committees (IRB-129-25/6/1439) and (IRB-2019-05-002). RESULTS: A total of 282 responses were received. The values for normed fit index (NFI), comparative fit index (CFI), Tucker Lewis index (TLI) and incremental fit index (IFI) were 0.960, 0.979, 0.954 and 0.980. All values were >0.95. The value for root mean square error of approximation (RMSEA) was 0.059, i.e., <0.06. Hence, factorial validity was established. The average factor loading of the scale was 0.725, i.e., >0.7, that established convergent validity. Known group validity was established by obtaining significant p-value <0.05, for the associations based on hypotheses. Cronbach's α was 0.865, i.e., >0.7. Predictive validity was established by evaluating odds ratios (OR) of demographic factors with adherence score using logistic regression. Sensitivity was 78.16%, specificity was 76.85% and, accuracy of the tool was 77.66%, i.e., >70%. CONCLUSION: The Arabic version of GMAS achieved all required statistical parameters and was validated in Saudi patients with chronic diseases.

The impact of serum potassium-influencing antihypertensive drugs on the risk of out-of-hospital cardiac arrest: A case-control study.

AIMS: Sudden cardiac arrest (SCA) is a complex multifactorial event and most commonly caused by ventricular tachycardia/ fibrillation (VT/ VF). Some antihypertensive drugs could induce hypokalaemia or hyperkalaemia, which may increase susceptibility to VT/VF and SCA. OBJECTIVE: To assess the association between different classes of antihypertensive drugs classified according to their potential impact on serum potassium levels and the occurrence of out-of-hospital cardiac arrest (OHCA) based on VT/VF. METHODS: A case-control study was performed among current users of antihypertensive drugs. Cases were OHCA victims with electrocardiogram documented VT/VF drawn from the AmsteRdam REsuscitation STudies (ARREST) registry, and controls were non-OHCA individuals from the PHARMO database. Antihypertensive drugs were classified into: (i) antihypertensives with neutral effect on serum potassium levels; (ii) hypokalaemia-inducing antihypertensives; (iii) hyperkalaemia-inducing antihypertensives; (iv) combination of antihypertensives with hypo- and hyperkalaemic effects. RESULTS: We included 1345 cases and 4145 controls. The risk of OHCA was significantly increased among users of hypokalaemia-inducing antihypertensives [adjusted odds ratio (OR) 1.39; 95% confidence interval (CI) 1.10-1.76] and among users of a combination of antihypertensives with hypo- and hyperkalaemic effects (adjusted OR 1.42; 95%CI 1.17-1.72) vs. users of antihypertensives with neutral effect. There was no difference in OHCA risk between users of hyperkalaemia-inducing antihypertensives vs. users of antihypertensive drugs with neutral effect (adjusted OR 1.15; 95%CI 0.95-1.40). CONCLUSION: The risk of OHCA is significantly increased in patients who were current users of hypokalaemia-inducing antihypertensives and patients using a combination of antihypertensives with hypo- and hyperkalaemic effects.

CT following US for possible appendicitis: anatomic coverage.

OBJECTIVE: To determine superior-inferior anatomic borders for CT following inconclusive/nondiagnostic US for possible appendicitis. METHODS: Ninety-nine patients with possible appendicitis and inconclusive/nondiagnostic US followed by CT were included in this retrospective study. Two radiologists reviewed CT images and determined superior-inferior anatomic borders required to diagnose or exclude appendicitis and diagnose alternative causes. This "targeted" coverage was used to estimate potential reduction in anatomic coverage compared to standard abdominal/pelvic CT. RESULTS: The study group included 83 women and 16 men; mean age 32 (median, 29; range 18-73) years. Final diagnoses were: nonspecific abdominal pain 50/99 (51%), appendicitis 26/99 (26%), gynaecological 12/99 (12%), gastrointestinal 9/99 (10%), and musculoskeletal 2/99 (2%). Median dose-length product for standard CT was 890.0 (range, 306.3 - 2493.9) mGy.cm. To confidently diagnose/exclude appendicitis or identify alternative diagnoses, maximum superior-inferior anatomic CT coverage was the superior border of L2-superior border of pubic symphysis, for both reviewers. Targeted CT would reduce anatomic coverage by 30-55% (mean 39%, median 40%) compared to standard CT. CONCLUSIONS: When CT is performed for appendicitis following inconclusive/nondiagnostic US, targeted CT from the superior border of L2-superior border of pubic symphysis can be used resulting in significant reduction in exposure to ionizing radiation compared to standard CT. KEY POINTS: • When CT is used following inconclusive/ nondiagnostic ultrasound, anatomic coverage can be reduced. • CT from L2 to pubic symphysis can be used to diagnose/exclude appendicitis. • Reduced anatomic coverage for CT results in reduced exposure to ionizing radiation.

Long-term outcome of pulmonary involvement in patients with coronavirus disease 2019: The role of high-resolution computed tomography and functional status - A prospective single-center observational study.

BACKGROUND: Since its first outbreak, coronavirus disease 2019 (COVID-19) has led to a great deal of published literature highlighting the short-term determinants of morbidity and mortality. Recently, several studies have reported radiological and functional sequelae from 3 months to 1 year among hospitalized COVID-19 survivors; however, long-term (more than 1 year) respiratory consequences in this population remain to be evaluated. OBJECTIVE: To assess the long-term radiological and pulmonary function outcomes of patients with COVID-19 2 years after resolution of the initial infection. METHODS: Hospitalized COVID-19 patients with moderate to severe disease who survived acute illness were included in this prospective and partially retrospective study. Clinical assessment, laboratory tests, high-resolution computed tomography scans, and pulmonary function tests (PFTs) were performed at baseline, followed by radiological and lung function assessments at 6 and 24 months. RESULTS: Among 106 enrolled participants (mean age 62 ± 13.5 years; males: 61), 44 (41.5%) and 27 (25.4%) underwent radiological assessment at 6 and 24 months, respectively. Overall, 22.6% (24) of patients had residual radiological abnormalities. Overt fibrosis was observed in 12.2% of patients. Computed tomography disease severity and extent diminished significantly at 6 (13 ± 6, P < 0.001) and 24 months (11 ± 6, P < 0.001) from baseline. PFTs were performed in 65 (61.3%), 22 (20.7%), and 34 (32%) patients at baseline, 6 and 24 months, respectively. Impaired diffusion capacity (median diffusion capacity for carbon monoxide: 60%, interquartile range [IQR]: 51-80), restrictive lung defect (mean total lung capacity: 73.4% ± 18% predicted), and reduced exercise tolerance (median 6-min walk distance: 360 m, IQR: 210-400) were the predominant features at baseline. With the exception of exercise tolerance, a statistically significant improvement was observed in lung function parameters at the extended follow-up (2 years). CONCLUSIONS: Hospitalized COVID-19 survivors are at increased risk of developing long-term pulmonary complications, including lung fibrosis. A protocol-based approach to the management of post-COVID-19 patients is mandatory to improve future outcomes.

The Impact of Smartphone Addiction on Sleep Quality Among High School Students in Makkah, Saudi Arabia.

Background Smartphones are Internet-accessible devices that everyone can use in any setting, and their popularity is growing. However, the pervasiveness of smartphone technology has raised concerns owing to its addictive effect among adolescents and its association with sleep quality and mental and physical health issues. Objectives This study aimed to determine the effect of smartphone addiction on sleep quality among secondary high schools in Makkah, Saudi Arabia. Methods The study was conducted on high school students in Makkah, Saudi Arabia, using an analytical cross-sectional design, from January 2023 to August 2023. The study used a multistage stratified random sampling technique to select participants. The data were collected from an online self-administered survey and analyzed using IBM SPSS Statistics for Windows (IBM Corp., Armonk, New York, United States). Results This study included 373 respondents. Among those, males represent two-thirds of the study population (66%), while females are 34%. The median age of the participants is 16 years old, and the interquartile range (IQR) is 6. Our results show that the median number of hours spent on mobile phones is six per day, and the IQR is 5. Furthermore, our findings reveal that the mean Smartphone Addiction Scale-Short Version (SAS-SV) score is 38.5 ± 10.8 out of 60, and the average global PSQI score is 6.63 ± 3.03 out of 21. The results show that the study participants have problems using smartphones longer than they intended, constantly checking them, and missing planned works due to smartphone use. There is a positive correlation between smartphone addiction and sleep quality (r = 0.261; p < 0.001), indicating that the respondents have worse sleep quality when smartphone addiction and the global PSQI increased. Conclusion Our study concluded that high school students in Makkah, Saudi Arabia, have high smartphone addiction. Moreover, high smartphone addiction is significantly associated with poor sleep quality. This study can help with the development of measures to improve better sleep quality among high school students.

Signal Detection and Assessment of Herb-Drug Interactions: Saudi Food and Drug Authority Experience.

INTRODUCTION: Numerous investigations on herbal medicine that have been undertaken in the past several years demonstrate the general acceptance of its safety. The Saudi Food and Drug Authority (SFDA) established the Herb-Drug Interaction (HDI) project to detect and assess potential HDIs to ensure safety. The aim is to detect safety signals and assess them based on available evidence. METHODS: First, SFDA-registered herbal products (n = 30) were selected and prioritized based on commonly used herbs. Second, reported potential HDIs were retrieved from the World Health Organization global database of individual case safety reports (VigiBase), AdisInsight®, and the Natural Medicines database. We excluded drugs non-registered by SFDA and labeled interactions in the product information of SFDA, the US Food and Drug Administration (FDA), and the European Medicines Agency (EMA). Finally, a comprehensive evaluation of potential HDIs was carried out using several evidence sources: literature, global cases, local cases, and other relevant documents. The Drug Interaction Probability Scale (DIPS) scale was used to assess the probability of a causal relationship between the interacting herb and drug and the event. RESULTS: The search yielded 566 potential signals, and 41 had published evidence and were referred for assessment. The assessment results using DIPS were: 22 possible (53.6 %), 7 probable (17%), and 12 doubtful (29.2%) interactions. The recommendation was to include probable HDIs in the product information, including turmeric-tacrolimus, etoposide-Echinacea, Ginkgo biloba-ibuprofen, green tea-warfarin, and licorice-thiazides interactions. CONCLUSION: The HDI project assessed the screening and identification of potential HDIs. The action plan of this project can be used in post-marketing activities to identify potential drug interactions.

Regulatory effects of ketogenic diet on the inflammatory response in obese Saudi women.

Objective: In recent years, the use of a ketogenic diet (KD) against obesity has gained popularity in KSA. This study was designed to determine the impact of KD on anthropometric indices and on the abnormal regulation of inflammatory activities in obese Saudi women. Moreover, we investigated the potential of beta-hydroxybutyrate (BHB) supplementation on the inhibition of pro-inflammatory activities. Methods: We enrolled 31 Saudi women (aged, 35.3 ± 8.4 years) with an average BMI of 33.96 ± 4.44 kg/m2 underwent an 8-week KD (8KD) from January to March 2021. Changes in anthropometric measurements were collected at baseline and after 4-8 weeks of intervention. Compliance with the dietary regimen was monitored weekly by plasma BHB level. Results: Twenty-nine females commenced the diets and 23 completed the study (a 79% completion rate). In comparison to pre-intervention, the 8KD resulted in a significant increase in the levels of plasma BHB (P < 0.001) throughout the duration of the trial. This was accompanied by a significant reduction in weight loss (7.7 kg ± 11.3; P < 0.001), BMI, waist circumference (P < 0.001), and levels of the inflammatory cytokine IL-1ß (P < 0.001). Conclusions: An 8-week KD was found to be useful in producing a positive impact on anthropometric indices, biochemical and inflammatory processes. This study indicated that the intake of a KD by obese Saudi women induced the release of BHB in the blood without stimulation of an overall starvation response. This may be useful to alleviate the severity of chronic inflammatory disorders associated with obesity.

Uptake, Safety and Attitudes Towards COVID-19 Vaccination: A Cross-Sectional Study on First and Second Doses Among the General Public.

Objective: To investigate public uptake, attitudes and the safety of the first and second doses of COVID-19 vaccination. Methods: This was a cross-sectional web-based survey study. A self-administered questionnaire was prepared from a literature search and information about COVID-19 available at various resources. The developed questionnaire was validated for readability by experts and refined in light of the feedback received from the experts and the final version was prepared. The reliability of the questionnaire was 0.7 which shows an acceptable level of scale internal consistency. The data analysis was performed using IBM SPSS software (version 25). Results: A total of 513 participants completed the survey, including 311 (60.6%) women and 202 (39.4%) men. The mean age was (31.5±12.8) years. It was found that 493 (96.1%) took the first and second doses of COVID-19 and 376 (73.3%) suffered from side effects, of these 14% (56/376) reported the side effects to the health authorities. The most common side effects were fatigue (51.5%), fever (42.3%), headache (39.5%), and injection site pain (37.6%). Half of the participants (50.5%) had a positive attitude towards COVID-19 preventive measures. Females had higher odds of experiencing side effects than males OR (95% CI); 2.002 (1.312-3.056). Individuals living in urban areas had lower odds of experiencing side effects than those living in rural areas OR (95% CI); 0.364 (0.142-0.933). Conclusion: Vaccine uptake was massive and side effects due to the COVID-19 vaccine were common but minor. The majority of the participants had positive attitudes towards recommended COVID-19 preventive measures. Being female and living in rural areas were associated with experiencing side effects.

Feasibility of radiology online structured oral examination for undergraduate medical students.

BACKGROUND: Online summative assessment has emerged during the COVID-19 pandemic as an alternative to traditional examinations, bringing opportunities and challenges. The study aims to evaluate the feasibility and effectiveness of online structured oral examination (SOE) in radiology clerkships. The study identifies measures taken to successfully implement online SOE and minimize chances of cheating. It also discusses the challenges encountered and how they were addressed. METHODS: SOE percent scores of fourth-year medical students from two institutions were correlated with students' grade point average (GPA). The scores were compared among different institutions, students' genders, students' batches, examination versions, and examiners with different experience levels. Students' perceived satisfaction and concerns were captured using anonymous self-administered questionnaire. Technical problems and success rate of SOE implementation were recorded. Results were analyzed using descriptive and inferential statistics. RESULTS: A total of 79 students participated in the study, out of which 81.0% (n = 64) responded to the survey. SOE scores showed poor positive correlation with the students' GPAs (r = 0.22, and p = .09). Scores showed no significant difference between the two institutions or genders. Scores were also not significantly different between students who were examined by junior or senior examiners. All but one version of examination showed no significant difference in students' scores. No significant difference was observed in students' scores between each two subsequent batches who were exposed to the same examination version. CONCLUSION: Online summative SOE is a feasible alternative whenever face-to-face SOE could not be implemented provided that appropriate measures are taken to ensure its successful execution.

Facilitators of and barriers to success in nursing internship programs: A qualitative study of interns' and faculty members' perspectives.

BACKGROUND: Through internship programs, nursing students learn information and skills in multiple hospital departments. Internships can also help with transitioning from student roles to graduate roles. However, the factors contributing to successful clinical internships in different education and health systems have not yet been sufficiently explored. OBJECTIVE: The purpose of this study was to explore the factors that contribute to successful clinical internships in both public and private hospitals in Saudi Arabia. DESIGN: This study uses a qualitative descriptive design. SETTING: Due to precautionary measures for COVID-19 and the inclusion of participants from different locations across Saudi Arabia, this study was conducted virtually. PARTICIPANTS: The study was conducted with a purposive sample of 16 nursing interns and four instructors. METHODS: Data were collected via semi-structured interviews to provide a wide variety of perspectives from nursing students and instructors. Each interview was recorded, transcribed verbatim in Arabic, and then translated into English. Collected data were analyzed using a thematic analysis approach. RESULTS: Three facilitators of success and four barriers to success emerged in the study. Facilitators of success included the program curriculum, hospital internship program, and contribution to the nursing board exam. Barriers to success were as follows: exploitation, lack of self-confidence, lack of incentives, and the long duration of the programs. CONCLUSIONS: The findings of this study could contribute to the creation of more effective clinical internship. It is recommended that clinical internship programs be enhanced and that appropriate support be given to nursing students.

Healthcare-Associated Infections (HAIs): Challenges and Measures Taken by the Radiology Department to Control Infection Transmission.

Infections contracted during healthcare delivery in a hospital or ambulatory setting are collectively referred to as healthcare-associated infections (HAIs). Healthcare workers and patients alike are vulnerable to serious problems as a result of the risk of HAIs. In the healthcare system, HAIs are considered among the most common and serious health problems. However, the occurrence of HAIs differs between different types of clinical departments within the hospital. Recently, the risk of HAIs has been increasing in radiology departments globally due to the central role of radiology in guiding clinical decisions for the diagnosis, treatment, and monitoring of different diseases from almost all medical specialties. The radiology department is particularly vulnerable to HAIs because it serves as a transit hub for infected patients, non-infected patients, and healthcare workers. Furthermore, as the number of patients referred to radiology and the length of patient contact time has increased, thanks to modern imaging techniques such as computed tomography and magnetic resonance imaging, the risk of HAIs has also increased significantly. With the increasing use of interventional radiological procedures, patients and healthcare workers face a potentially greater risk of contracting HAIs due to the invasive nature of such procedures. Although not exhaustive, we attempted through a literature search to provide a general overview of infection prevention and control practices, address HAIs in the radiology departments, and highlight the challenges and measures taken to control infection transmission in the radiology departments.

The Use of Digital Healthcare Platforms During the COVID-19 Pandemic: the Consumer Perspective.

BACKGROUND: The spending on digital healthcare solutions is estimated to reach EUR 232 billion by 2025. Digital healthcare platforms are making transformative changes to conventional healthcare processes which can provide many beneficial improvements for both citizen and government provision to society. These benefits are obvious during pandemics such as Covid-19, when most healthcare services are offered through digital means. OBJECTIVE: The objective of this study is to measure the role of trust and information quality when using digital healthcare platforms. These constructs are integrated with the Unified Theory of Acceptance and Use of Technology (UTAUT) to provide a better understanding of the consumer perspective regarding the use of digital healthcare platforms. METHODS: Online structured self-administered questionnaire was utilized to collect the data. A sample consisting of 249 respondents participated in the questionnaire. Descriptive analysis was used to characterize the attributes of participants, and other statistical tests were conducted to ensure the reliability and validity of the survey. The model of the study was evaluated using Structural Equation Modelling (SEM) to explain the extent of the relationship among latent variables. RESULTS: The study determined that facilitating conditions (t=0.233, p=0.023) and trust (t=0.324, p=0.005) had a significant impact on consumers' behavioral intention of using such platforms during Covid-19 pandemic. CONCLUSION: This study highlighted the importance of facilitating conditions and trust factors for healthcare consumers of digital healthcare platforms especially during the pandemic time.

Synchronous distance teaching of radiology clerkship promotes medical students' learning and engagement.

BACKGROUND: The COVID-19 pandemic has impacted education in myriad ways, primarily leading to an abrupt paradigm shift in teaching and learning practices towards distance learning. The study aims to assess the effectiveness of teaching radiology to undergraduate medical students using synchronous distance learning compared to traditional on-campus learning through exploring students' perceived satisfaction and concerns. Students' perceptions were correlated with their attendance, grades, and frequency of technical difficulties. METHODS: The study was designed as an observational study involving fourth-year medical students (2019/2020) from two institutions. The cohort students were exposed to traditional learning, distance learning, or both. Students completed an online self-administered questionnaire concerning their perceptions of distance learning. Students' attendance, engagement, technical difficulties, and post-clerkship knowledge assessments were analyzed using descriptive and inferential statistics. RESULTS: A total of 145 participants completed the clerkship using the following strategies: traditional learning (n = 66), both traditional and distance learning (n = 67), and distance learning alone (n = 12). The most important result indicates that the abrupt transition to distance learning was well perceived. Most students preferred distance learning over traditional learning in the radiology clerkship (p = .05). During the synchronous sessions, student attendance was high, reaching to 100%. Technical difficulties were limited (1.9%), and they did not affect learning. CONCLUSION: Synchronous distance teaching promotes learning, interaction, and enjoyment in undergraduate radiology education, and it can be as effective as traditional on-campus learning. The technical difficulties encountered, although they were limited, can be overcome by recording the synchronous sessions.

A New Pedestrian Crossing Level of Service (PCLOS) Method for Promoting Safe Pedestrian Crossing in Urban Areas.

Crosswalks are critical locations in the urban transport network that need to be designed carefully as pedestrians are directly exposed to vehicular traffic. Although various methods are available to evaluate the level of service (LOS) at pedestrian crossings, pedestrian crossing facilities are frequently ignored in assessing crosswalk conditions. This study attempts to provide a comprehensive framework for evaluating crosswalks based on several essential indicators adopted from different guidelines. A new pedestrian crossing level of service (PCLOS) method is introduced in this research, with an aimto promote safe and sustainable operations at such locations. The new PCLOS employs an analytical point system to compare existing street crossing conditions to the guidelines' standards, taking into account the scores and coefficients of the indicators. The quantitative scores and coefficients of indicators are assigned based on field observations and respondent opinions. The method was tested to evaluate four pedestrian crosswalks in the city of Putrajaya, Malaysia. A total of 17 indicators were selected for the study after a comprehensive literature review. Survey results show that the provision of a zebra crossing was the most critical indicator at the pedestrian crossings, while drainage near crosswalks was regarded as the least important. Four indicators had a coefficient value above 4, indicating that these are very critical pedestrian crossing facilities and significantly impact the calculation of LOS for pedestrian crossings. Four crosswalks were evaluated using the proposed method in Putrajaya, Malaysia. The crosswalk at the Ministry of Domestic Trade Putrajaya got the "PCLOS A". In contrast, the midblock crossing in front of the Putrajaya Corporation was graded "PCLOS C". While the remaining two crosswalks were graded as "PCLOS B" crosswalks. Based on the assigned PCLOS grade, the proposed method could also assist in identifying current design and operation issues in existing pedestrian crossings and providing sound policy recommendations for improvements to ensure pedestrian safety.

Location of aortic bifurcation and transverse colon in postmenopausal women: relevance to laparoscopy.

This was a prospective study of postmenopausal women who underwent a computerized tomography (CT) examination of the abdomen and pelvis. We evaluated the location of the aortic bifurcation and transverse colon relative to the umbilicus at midline axis. Of 66 women, 24 were of normal weight, 23 were classified as overweight, and 19 as obese. The ages of the women in all groups were comparable. In the normal weight and overweight women, the mean location of the umbilicus was 0.6 cm +/- 0.4 cm and 0.4 cm +/- 0.3 cm cranial to the aortic bifurcation, respectively, and in obese women its mean location was 1.4 cm +/- 0.5 cm caudal to the aortic bifurcation. In approximately half of the normal weight and overweight women, the umbilicus was located cranial to the aortic bifurcation, and in 62.2% of obese women it was located caudal to the aortic bifurcation. Compared to those with normal weight (0.3 cm +/- 1.1 cm), the distance between umbilicus and transverse colon was greater in overweight (4.5 cm +/- 1.2 cm) and obese women (7.1 cm +/- 0.7 cm). In approximately one third of the normal weight women and over half of the overweight women, the umbilicus was located caudal to the transverse colon. In contrast, the umbilicus in 84.2% of the obese women was located caudal to transverse colon. There was a linear correlation between the distance of umbilicus and transverse colon distance and body mass index (BMI; r = 0.54, p < 0.0001). Regardless of the BMI, there was a wide variability whether the umbilicus was cranial or caudal to the aortic bifurcation or transverse colon. Similar to that in reproductive-aged women, in postmenopausal women the location of the aortic bifurcation and transverse colon varies. Proper insertion of the Veress needle and trocar is more important than a particular angle of insertion.