The temporal association between adverse drug reactions and antirheumatic drugs utilisation in Western Australia: a retrospective study from real-world data (1995-2015).

BACKGROUND/OBJECTIVES: Adverse drug reactions (ADRs) can result in morbidity, mortality, and higher healthcare costs. Given the limited information available on ADRs associated with antirheumatic medications, this study aims to analyse and compare ADR reporting for these drugs in the pharmacovigilance datasets of Western Australia (WA) and the United States (US). METHODS: Therapeutic Goods Administration provided WA pharmacovigilance data of selected antirheumatic drugs to from 1995 to 2015. The proportional reporting ratio (PRR) for WA case reports was compared to corresponding USA pharmacovigilance data by assessing the disproportionality of each ADR. clinically significant or true ADRs were determined using the Evans 2001 criteria (n > 2, chi-square > 4, PRR > 2). RESULTS: A total of 232 reports were found in WA, mostly on sixty-nine women aged 45 to 69. Methotrexate, leflunomide, azathioprine, sulfasalazine, and infliximab had the highest reported ADRs, related to gastrointestinal disorders. Patients who used biological agents in WA had 2.7 times the likelihood of reporting true ADRs compared to conventional antirheumatic drugs. The ADR rates in the two datasets were comparable over the study period. CONCLUSIONS: The PRR values of ADRs were consistent between WA and US databases. Methotrexate and infliximab use were commonly associated with ADR reports in WA females, with incidence rates comparable to the US; while patients using biological agents were more likely to report true ADRs than those on conventional antirheumatic drugs in WA.

Phytoremediation ability and selected genetic transcription in Hydrocotyle umbellata-under cadmium stress.

Cadmium (Cd) is the most toxic element which may cause serious consequences to microbial communities, animals, and plants. The use of green technologies like phytoremediation employs plants with high biomass and metal tolerance to extract toxic metals from their rooting zones. In the present work, Hydrocotyle umbellata was exposed to five Cd concentrations (2, 4, 6, 8, and 10 µmol) in triplicates to judge its phytoextraction ability. Effects of metal exposure on chlorophyll (Chl), bio-concentration factor (BCF), translocation factor (TF), and electrolyte leakage (EL) were analyzed after 10 days of treatment. Metal-responding genes were also observed through transcriptomic analysis. Roots were the primary organs for cadmium accumulation followed by stolon and leaves. There was an increase in EL. Plants showed various symptoms under increasing metal stress namely, chlorosis, browning of the leaf margins, burn-like areas on the leaves, and stunted growth, suggesting a positive relationship between EL, and programmed cell death (PCD). Metal-responsive genes, including glutathione, expansin, and cystatin were equally expressed. The phytoextraction capacity and adaptability of H. umbellata L. against Cd metal stress was also demonstrated by BCF more than 1 and TF less than 1.

The results of the current study demonstrated that Hydrocotyle umbellata is a good choice for environmental cleanup in areas with mild Cd contamination. According to TF and BCF, the plant demonstrated a considerable uptake of Cd. Additionally, H. umbellata's eligibility as a phytoremediation agent for Cd was supported by the transcription of numerous metal-responsive genes, including glutathione, expansin, cystatin, and other genes associated with growth.

Integrating multisource data and machine learning for supraglacial lake detection: Implications for environmental management and sustainable development goals in high mountainous regions.

The accurate detection and monitoring of supraglacial lakes in high mountainous regions are crucial for understanding their dynamic nature and implications for environmental management and sustainable development goals. In this study, we propose a novel approach that integrates multisource data and machine learning techniques for supra-glacial lake detection in the Passu Batura glacier of the Hunza Basin, Pakistan. We extract pertinent features or parameters by leveraging multisource datasets such as radar backscatter intensity VH and VV parameters from Sentinel-1 Ground Range Detected (GRD) data, near-infrared (NIR), NDWI_green, NDWI_blue parameters from Sentinel-2 Multi-spectral Instrument (MSI) data, and surface slope, aspect, and elevation parameters from topographic data. The entire dataset is partitioned into training and testing sets, with machine learning models including the artificial neural network (ANN), the support vector machine (SVM), logistic regression (LR), random forest (RF), and K-nearest neighbour (KNN) trained on the training data (70%). Accuracy assessment employs testing data and involves the evaluation of metrics such as ROC curves and confusion matrices. The best-performing model, ANN, is validated against manually digitized lake polygons derived from Sentinel-2 and Google Earth Pro imagery. Furthermore, the digitized lake polygons are used to analyze glacial lake dynamics from 2016 to 2022. Key findings of this research presented that the NDWI_green, Sigma0_VH, and elevation are the most significant predictors in detecting supra-glacial lakes. Among the various trained and evaluated models, the Artificial Neural Network (ANN) achieved the highest performance (accuracy: 95%, AUC: 0.99) and accurately mapped supra-glacial lakes regardless of their small size. The findings have significant implications for understanding glacial lake behavior in the context of climate change and informing future research and monitoring efforts.

Metabolomics reveals arbuscular mycorrhizal fungi-mediated tolerance of walnut to soil drought.

BACKGROUND: Arbuscular mycorrhizal fungi (AMF) have a positive effect on drought tolerance of plants after establishing reciprocal resymbiosis with roots, while the underlying mechanism is not deciphered. Metabolomics can explain the mechanism of plant response to environmental stress by analyzing the changes of all small molecular weight metabolites. The purpose of this study was to use Ultra High Performance Liquid Chromatography Q Exactive Mass Spectrometer to analyze changes in root metabolites of walnut (Juglans regia) after inoculation with an arbuscular mycorrhizal fungus Diversispora spurca under well-watered (WW) and drought stress (DS). RESULTS: Sixty days of soil drought significantly inhibited root mycorrhizal colonization rate, shoot and root biomass production, and leaf water potential in walnut, while AMF inoculation significantly increased biomass production and leaf water potential, accompanied by a higher increase magnitude under DS versus under WW. A total of 3278 metabolites were identified. Under WW, AMF inoculation up-regulated 172 metabolites and down-regulated 61 metabolites, along with no changes in 1104 metabolites. However, under DS, AMF inoculation up-regulated 49 metabolites and down-regulated 116 metabolites, coupled with no changes in 1172 metabolites. Among them, juglone (a quinone found in walnuts) as the first ranked differential metabolite was up-regulated by AMF under WW but not under DS; 2,3,5-trihydroxy-5-7-dimethoxyflavanone as the first ranked differential metabolite was increased by AMF under DS but not under WW. The KEGG annotation showed a large number of metabolic pathways triggered by AMF, accompanied by different metabolic pathways under WW and DS. Among them, oxidative phosphorylation and phenylalanine metabolism and biosynthesis were triggered by AMF in response to WW and DS, where N-acetyl-L-phenylalanine was induced by AMF to increase under DS, while decreasing under WW. CONCLUSION: This study provides new insights into the metabolic mechanisms of mycorrhiza-enhanced drought tolerance in walnuts.

The temporal association between hospital admissions, biological therapy usage and direct health care costs in rheumatoid arthritis patients.

The Australian Pharmaceutical Benefits Scheme (PBS) has subsidised biological therapy since 2003. We investigated the association between biological therapy for RA hospitalisation rates and health-care costs.Hospital admissions for RA patients between 1995 and 2014 were identified in the Western Australia (WA) Hospital Morbidity Data Collection (ICD codes 714 and M05.00-M06.99). State-specific dispensing data for conventional and biological therapies for RA was obtained from Statistics Australia and expressed as defined daily doses/1000 population/day (DDD) using WA population census. Principal component analysis (PCA) was applied to determine the relationship between DMARDs use and hospital admission rates.A total of 17,125 patients had 50,353 admissions with a diagnostic code for RA. Between 1995 and 2002, the number of RA admissions fell from 7.9 to 2.6/1000 admissions, while conventional therapy use rose from 1.45 to 1.84 DDD. Between 2003 and 2014, RA admissions decreased further to 1.9/1000 hospital admissions, while conventional therapy use increased to 2.19 DDD and biological therapy from 0.01 to 1.0 DDD. In PCA, conventional and biological therapies use had an inverse relationship with hospital admission rates. Annual costs of biological therapy utilisation was 22.5 million in 2003-2014, while the annual cost saving of RA hospital admissions was 9.2 million.The increased use of conventional therapy use for RA has coincided with a significant decline in hospital admissions for RA patients in WA, while a more modest further decline followed biological therapy introduction. Biological therapy was not as cost-effective as conventional in relation to RA hospital admissions costs.

The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review.

The objective is to determine the global population prevalence of rheumatoid arthritis (RA) based on population-based studies and assess factors that influence RA prevalence estimates. Four electronic databases were searched (ProQuest Central, MEDLINE, Web of Science, and EMBASE) for peer-reviewed English publications that report prevalence estimates of RA from 1980 and 2019. We included case-control studies, cross-sectional studies, and prospective or retrospective cohort studies in our search strategy. A random-effect meta-analysis model was used to produce the pooled prevalence estimates. The potential between-study heterogeneity was identified using sensitivity analysis, sub-group and meta-regression analyses. A total of 67 studies were included in the meta-analysis, containing 742,246 RA patients and 211,592,925 healthy controls in the study period. The global RA prevalence estimate was 0.46% (95% confidence interval [CI] 0.39-0.54; I2 = 99.9%) with a 95% prediction interval (0.06-1.27). The RA point-prevalence was 0.45% (95% CI 0.38-0.53%) between 1986 and 2014, while the pooled period-prevalence was 0.46% (95% CI 0.36% and 0.57%) from 1955 to 2015. The highest RA pooled prevalence (0.69%; 95% CI 0.47-0.95) was derived from linked data source studies. Based on meta-regression, the factors that explain the studies' heterogeneity of RA prevalence, including geographical location, the risk bias assessment of studies and sample size. The global prevalence of RA between 1980 and 2019 was 460 per 100,000 population, with variations due to geographical location and study methodology. Linked data are the preferred method to estimate RA population prevalence as they provide the best case ascertainment.

The accuracy of administrative health data for identifying patients with rheumatoid arthritis: a retrospective validation study using medical records in Western Australia.

The use of administrative health datasets is increasingly important for research on disease trends and outcome. The Western Australian (WA) Rheumatic Disease Epidemiological Registry contains longitudinal health data for over 10,000 patients with rheumatoid arthritis (RA). Accurate coding for RA is essential to the validity of this dataset. Investigate the diagnostic accuracy of International Classification of Diseases (ICD)-based discharge codes for RA at WA's largest tertiary hospital. Medical records for a sample of randomly selected patients with ICD-10 codes (M05.00-M06.99) in the hospital discharge database between 2008 and 2020 were retrospectively reviewed. Rheumatologist-reported diagnoses and ACR/EULAR classification criteria were used as reference standards to determine accuracy measures. Medical chart review was completed for 87 patients (mean (± SD) age 64.7 ± 17.2 years), 67.8% female). A total of 80 (91.9%) patients had specialist confirmed RA diagnosis, while seven patients (8%) had alternate clinical diagnoses. Among 87 patients, 69 patients (79.3%) were fulfilled ACR/EULAR classification criteria. The agreement between the reference standards was moderate (Kappa 0.41). Based on rheumatologist-reported diagnoses and ACR/EULAR classification criteria, primary diagnostic codes for RA alone had a sensitivity of (90% vs 89.8%), and PPV (90.9% vs 63.6%), respectively. A combination of a diagnostic RA code with biologic infusion codes in two or more codes increased the PPV to 97.9%. Hospital discharge diagnostic codes in WA identify RA patients with a high degree of accuracy. Combining a primary diagnostic code for RA with biological infusion codes can further increase the PPV.

Predictors of students' academic achievements in allied health professions at King Saud University: a retrospective cohort study.

BACKGROUND: The admissions criteria for colleges of medicine and allied health professions include several cognitive predictors. Little is known of the admissions criteria for the allied health professions and their correlation with students' academic performance. This study investigates predictors for students' academic achievements at allied health colleges at King Saud University. DESIGN: Retrospective cohort study. SETTINGS: College of Applied Medical Sciences, College of Nursing, and Prince Sultan bin Abdulaziz College for Emergency Medical Services, Saudi Arabia. PARTICIPANTS: The sample comprised 1634 students. METHOD: The high school grade average (HSGA), aptitude test (APT) score, achievement test (ACT) score, and current grade point average (GPA) were retrieved. The data were analysed using Pearson's correlation coefficient and regression analysis. RESULTS: HSGA, ACT, and APT were significantly positively associated with students' academic performance in colleges for all allied health professions. Multivariate regression analysis showed that the most predictive variable for all allied healthcare professions was HSGA (ß = 0.347), followed by ACT (ß = 0.270) and APT (ß = 0.053) scores. The regression model indicated that the HSGA, APT, and ACT together predicted 26.5% of the variation in students' cumulative GPAs at the time of graduation. CONCLUSION: The admissions criteria for the allied health colleges at King Saud University predicted only 26.5% of the students' cumulative GPA at the time of graduation. Other noncognitive admission criteria should be taken into consideration to improve the prediction of students' academic potential.

Nursing Students' Knowledge, Competence and Attitudes towards Vital Signs Monitoring during Clinical Practice.

AIM AND OBJECTIVE: This study assessed the perceived knowledge and competence, and the attitude of Saudi nursing students towards vital signs monitoring for detecting patient deterioration during clinical rotation. It also examined the predictors of students' attitudes. BACKGROUND: One of the most important uses of vital signs monitoring is the early detection of deterioration. Vital signs monitoring is one of the most frequently assigned tasks to students during clinical rotation. However, the attitudes of nursing students towards vital signs monitoring for detecting clinical deterioration remain unexplored. DESIGN: Quantitative, cross-sectional design. METHOD: A convenience sample of 529 baccalaureate nursing students in two universities in Saudi Arabia was surveyed using the V-scale from October 2019-December 2019. A multivariate multiple regression was implemented to examine the multivariate effect of the predictor variables on the five subscales of the V-scale. This study adhered to the STROBE checklist. RESULTS: The overall attitudes of the students towards VS monitoring can be interpreted as poor to modest. The highest mean was reported in the subscale 'communication'. The subscales 'workload', 'key indicators' and 'technology' received low mean scores. The university, age, gender, academic year level and perceived knowledge had significant multivariate effects on the five subscales of the V-scale. CONCLUSIONS: The Saudi nursing students had poor attitudes towards vital signs monitoring, specifically towards the use of technology in vital signs monitoring, the workload associated with vital signs monitoring and vital signs as key indicators of patient deterioration. RELEVANCE TO CLINICAL PRACTICE: The findings reveal the need to improve the curricular content and training of nursing students regarding vital signs and the physiological indicators of clinical deterioration. This study also identified areas that require improvement to ensure positive attitudes among students.

Proximate Composition, Bioactive Compounds, and Antioxidant Potential of Wild Halophytes Grown in Coastal Salt Marsh Habitats.

Halophytes have been characterized as a potential resource for fiber, food, fodder, and bioactive compounds. Proximate composition, bioactive compounds, and antioxidant activity of five wild dominant halophytes (Arthrocnemummacrostachyum, Halocnemumstrobilaceum, Limoniastrummonopetalum, Limoniastrumpruinosum, and Tamarix nilotica) naturally growing along the Nile Delta coast were assessed. The soil supporting these halophytes was sandy to sand-silty, alkaline, with low organic carbon, and relatively high CaCO3. H. strobilaceum attained the highest moisture content, ash, crude fiber, lipids, and total soluble sugars. L. monopetalum showed the highest content of crude protein (18.00%), while T. nilotica had the highest content of total carbohydrates. The studied halophytes can be ranked according to their nutritive value as follows: H.strobilaceum > L.monopetalum > A.macrostachyum > L.pruinosum > T. nilotica. A. macrostachyum attained the highest amount of Na+, K+, Ca2+, and Mg2+. A. macrostachyum showed a high content of phenolic compounds, while H.strobilaceum was rich in tannins and saponin contents. The MeOH extract of A. macrostachyum and H. strobilaceum exhibited substantial antioxidant activity. The present results showed that the studied halophytes could be considered as candidates for forage production or used as green eco-friendly natural resources for bioactive compounds.

Experimental investigation of dehumidification process regulated by the photothermoelectric system.

To decrease indoor relative humidity and have relaxing environments, small dehumidifiers are widely used in tropical climatic. Due to the benefits of eco-friendly, small size and silence operation, the thermoelectric dehumidifier has gained interest but has limited practical application due to poor efficiency. Therefore, this study investigates the dehumidification characteristics of the thermoelectric module powered by a photovoltaic system for the production of fresh water under real climatic conditions. The performance of a novel prototype named as the Photo-Thermoelectric Dehumidifier (PVTE-D) was investigated both numerically and experimentally in different combinations of airflow rate and input power. The results obtained from the experiment suggested that the water condensate collection was increased by increasing the input power from a PV panel to the TE-D. In the month of May, the maximum water condensate collection of 1,852.3 mL/hr was attained at the input supply of 6 A and 5 V to the PVTE-D system. In the majority of cases, when the airflow rate is below 0.013 kg/s, maximum collections of water condensate have been achieved. This study provides a detailed understanding of the optimally suitable structural parameters of the PVTE-D under different operating conditions and reveals a novel configuration for higher water condensation capacity.

Pseudoankylosis Between Lateral Pterygoid Plates and Mandible: Report of One Case.

Temporomandibular joint (TMJ) ankylosis is the abnormal fusion of TMJ anatomic components that impedes free jaw movements. This restriction in motion ranges from minimal to a complete inability to open the jaw. This condition can be categorized as true ankylosis, which is attributed to pathologic conditions of the TMJ, or false ankylosis (pseudoankylosis), which describes restrictions of movement resulting from extracapsular abnormalities outside the TMJ. The literature shows that trauma is the leading cause of TMJ disorders and appears to be the most common cause of pseudoankylosis. Pseudoankylosis caused by pterygomandibular bony impingement has rarely been reported in the literature. This case report adds a new case of pseudoankylosis to the existing scanty literature, which was characterized by bilateral mechanical impingement between abnormally elongated lateral pterygoid plates and the coronoid processes of the mandible.

Health promoting lifestyle of university students in Saudi Arabia: a cross-sectional assessment.

BACKGROUND: College is a critical time where students are more prone to engage in risky health behaviors known to negatively affect well-being, such as physical inactivity, stress, and poor dietary habits. A health promoting lifestyle is an important determinant of health status and is recognized as a major factor for the maintenance and improvement of health. This study was designed to assess the health-promoting lifestyle of students in health colleges and non-health colleges in Saudi Arabia. METHODS: A total of 1656 students participated in this descriptive cross-sectional study. Data gathering was conducted from November 2016 to February 2017 at King Saud University. Participating students completed a self-reported questionnaire that included questions regarding their demographic characteristics and their health-promoting behaviors. RESULTS: The majority of participants were females (70.4%), 20% of the participants were overweight and 11.3%, were obese. The analysis showed that there was a significant difference between health colleges and non-health colleges with regards to the factor of health responsibility. Students at both schools were found to have an inadequate level of adherence to recommendations regarding physical activity and healthy eating habits. The analysis also found that majority of the students in both colleges do not attend educational programs on health care. The model shows that gender, type of college, year in school, and family structure were significant predictors of the health lifestyle of students in Saudi Arabia. CONCLUSION: The results of the current study indicate that university students are leading unhealthy lives, where the majority of them have unhealthy eating habits and poor physical activity level. Universities are ideal settings for implementing health promotion programs. Therefore, planning and implementing programs to motivate students to be more responsible for their own health, to engage more in physical activity, and to practice healthy eating habits and other forms of wellness are of paramount importance.

Nurses' Perceptions of Patient Safety Culture in Three Hospitals in Saudi Arabia.

PURPOSE: To assess the present patient safety culture of three general hospitals in Saudi Arabia, as perceived by nurses. DESIGN: This study utilized a descriptive, cross-sectional design. METHODS: A convenience sample of 351 nurses working in three general hospitals in the central region of Saudi Arabia was surveyed in this study using the Hospital Survey of Patients' Safety Culture (HSOPSC) from October 2016 to April 2017. RESULTS: From the 12 composites of the HSOPSC, the nurses perceived only the following two patient safety areas as strengths: teamwork within units and organizational learning-continuous improvement. Six areas of patient safety were identified as weaknesses, namely overall perception of patient safety, handoffs and transitions, communication openness, staffing, frequency of events reported, and nonpunitive response to errors. Nationality, educational attainment, hospital, length of service in the hospital, work area or unit, length of service in the current work area or unit, current position, and direct patient contact or interaction were significant predictors of the nurses' perceived patient safety culture. CONCLUSIONS: The findings in this study clarify the current status of patient safety culture in three hospitals in the Kingdom of Saudi Arabia. CLINICAL RELEVANCE: The present findings should be considered by policymakers, hospital leaders, and nurse executives in creating interventions aimed at improving the patient safety culture in hospitals. A multidimensional network intervention targeting the different dimensions of patient safety culture and involving different organizational levels should be implemented to improve patient safety.

A Cross-Sectional Assessment of Literacy and Awareness, Attitudes, and Beliefs About Colorectal Cancer and Its Screening in Riyadh Region.

This study aims to explore the association between functional health literacy and awareness for, beliefs, and attitudes of patients with colorectal cancer (CRC) and CRC screening test in Riyadh, Saudi Arabia. A total of 256 participants from two different tertiary level hospitals in Riyadh, Saudi Arabia were recruited in this study. The participants were interviewed by a trained researcher between October and December 2015. All respondents answered a three-part questionnaire which included demographic data, questions related to CRC awareness, attitude, behaviour, and short Test of Functional Health Literacy in Adults (STOFHLA). More than half of the participants had an inadequate awareness of functional health literacy skills (FHLS), 16.4 % had marginal of FHLS awareness and 17.6 % had adequate awareness about FHLS as assessed by the STOFHLA. Overall, the majority of the participants in both marginal and adequate aware groups showed a limited awareness about colorectal cancer screening and testing. A significant association was found on awareness of the patients about frequencies that they should have been tested for colorectal cancer and functional health literacy. No significant association was found between functional health literacy as assessed by STOFHLA and concerns of Faecal Occult Blood Test (FOBT) (p = 0.384) and sigmoidoscopy or colonoscopy might cause embarrassment (p = 0.089), harm (p = 0.917), and pain (p = 0.849). The present study revealed a low level of health literacy among Saudi adults in Riyadh region. Although the level of literacy was low, the bigger concern is that of the poor awareness and beliefs of Saudi adults about CRC and CRC screening.

A Single-Blind Study Evaluating the Efficacy of Gold Nanoparticle Photothermal-Assisted Liposuction in an Ex Vivo Human Tissue Model.

BACKGROUND: Liposuction is one of the most performed cosmetic surgery procedures. In a previously reported study, gold-nanoparticle (GNP) laser-assisted liposuction (NanoLipo) was shown to improve procedure parameters and outcomes in a porcine model. OBJECTIVES: An ex vivo human liposuction model was developed to assess the ease, efficacy, and outcomes of NanoLipo, and to further explore its mechanism of action in facilitating liposuction. METHODS: NanoLipo was compared to a control without GNPs in sets of fresh, nonperfused, anatomically symmetric, matched tissue specimens from 12 patients. A subset of three experiments was performed under single-blinded conditions. Intraoperative assessments included lipoaspirate volume, percentage of free oil, ease of removal, and temperature rise. Specimens were palpated, visualized for evenness, and graded with and without skin. Postoperative assessment included viability staining of the lipoaspirate and remaining tissues. Microcomputed tomography was used to assess the distribution of infused GNPs within the tissues. RESULTS: NanoLipo consistently removed more adipose tissue with more liberated triglycerides compared to control. NanoLipo specimens were smoother, thinner, and had fewer and smaller irregularities. Infused solutions preferentially distributed between fibrous membranes and fat pearls. After NanoLipo, selective structural-tissue disruptions, indicated by loss of metabolic activity, were observed. Thus, NanoLipo likely creates a bimodal mechanism of action whereby fat lobules are dislodged from surrounding fibro-connective tissue, while lipolysis is simultaneously induced. CONCLUSIONS: NanoLipo showed many advantages compared to control under blinded and nonblinded conditions. This technology may be promising in facilitating fat removal.

Satisfaction of Patients Attending in Primary Healthcare Centers in Riyadh, Saudi Arabia: A Random Cross-Sectional Study.

This study aims to determine the level of satisfaction of patients who visit primary healthcare centers in Riyadh, Saudi Arabia. The investigation was a cross-sectional study conducted in twenty randomly selected primary healthcare centers in Riyadh, Saudi Arabia from October to December 2014. A descriptive data analysis was performed. Eligible participants had visited at least one of the selected primary healthcare centers within the past 12 months. A total of 1741 participants completed the survey, providing a response rate of 87 % (43 % male, 57 % female). The highest satisfaction rates were in the following areas: comprehensiveness and coordination 76.2 % (95 % CI 74.8 ± 77.5), communication 72.7 % (95 % CI 71.3 ± 74) and attitude of staff 73.4 % (95 % CI 72.1 ± 74.8) The areas of greatest concern expressed by the participants were the length of the wait and the quality of the facility 55.4 % (95 % CI 53.3 ± 57.5), 50.5 % (95 % CI 48.3 ± 52.7), respectively. The majority of the patients attending primary healthcare centers in Riyadh showed high levels of satisfaction; however, there are still some factors that need to be considered and improved upon. These include the accessibility of primary healthcare centers as well as waiting time of patients. The results of the current study showed relative improvement in other factors such as comprehensiveness and coordination, communication and attitude of staff. The level of satisfaction of patients and stakeholders shows the progress of the quality of care in healthcare facilities in Riyadh, Saudi Arabia.

Assessment of Health-Related Quality of Life Among Caregivers of Patients with Cancer Diagnosis: A Cross-Sectional Study in Saudi Arabia.

A descriptive cross-sectional survey was conducted over 5 months in two tertiary hospitals in Riyadh, Saudi Arabia. The 5-month period was from November 2014 to March 2015. The survey instrument used was a Short-Form Health Survey SF-36 (the RAND 36-item) questionnaire that measure QOL of the caregivers. Our study subjects included 289 randomly selected Saudi caregivers. Almost all the mean scores were increased (higher than 50) with the exception of levels of energy/fatigue. Role functioning/physical scored the highest (81.02 ± 35.33) followed by physical functioning (76.34 ± 29.83). Other domains of QOL scored (71.02 ± 35.33) for the role functioning/emotional; pain (71.15 ± 28.48), emotional well-being (60.58 ± 18.44); social functioning (58.39 ± 25.83), and general health (54.32 ± 17.08). In multivariate regression analysis, the model predicts that the contributions of age, gender, and the cancer type of patients were a statistically significant predictor with the QOL domains of caregivers. Cancer caregivers in Saudi Arabia caring for patients more than 1 year after diagnosis reported favorable QOL. Factors associated with QOL domains included age, gender of the caregivers, and the types of cancer patients. These findings are encouraging as a baseline for providing more information to future studies in QOL of caregivers.

Barriers to Cancer Clinical Trial Participation Among Saudi Nationals: A Cross-Sectional Study.

This study aims to determine the factors that act as barriers to Saudi cancer patients in participating in a clinical trial (CT). A total of 244 patients from two different tertiary level hospitals (King Khalid University Hospital and King Fahad Medical City Hospital) in Riyadh, Saudi Arabia, participated in this cross-sectional study. The participants were interviewed by a trained researcher between September and November 2015. All respondents answered a three-part questionnaire which includes demographics, clinical information, and questions related to awareness of CTs, willingness to participate, and factors affecting participation in CTs. The mean age of the participants was 50.83, and 57 % of the participants were females. Most of the participants (63.5 %) were currently being treated for cancer, and 28 % were diagnosed with breast cancer followed by colorectal cancer. Health status or quality of life was self-reported as acceptable by 27.9 % of the participants, and 25 % of the participants at stage II of cancer. The factors that act as barriers to Saudi cancer patients in participating in a CT can be categorized into patient- and physician-related factors. Patient factors include lack of awareness, misconception and fear in participating in CTs; physician-related factors comprise of lack of encouragement from physician to patients in participating in a CT. The study identified few major barriers to participation in CTs. Increased patient awareness and recruitment strategies are required to increase accrual of patients including training for physicians and disseminating easy-to-read tools to the public.

Random Cross-Sectional Determination of the Level of Awareness Among Female Saudi Patients About Breast Cancer.

The purpose of this study was to randomly determine the level of awareness and knowledge among female Saudi patients about the risk factors and symptoms of breast cancer as well as any awareness about the practices for breast cancer self-examination. A random cross-sectional survey was conducted over 4 months at two private medical clinics in Riyadh, Saudi Arabia. The 4-month period was from December 2013 to March 2014. The survey instrument was a questionnaire that was both self-explanatory and user-friendly. Our study subjects included 174 randomly selected Saudi female patients with no medical history of breast cancer. These patients visited these private clinics for medical advice or for consultation on problems unrelated to breasts. Participants' perception of risk factors regarding early menses showed only 47.1 %. The most common risk factor known by the participants was a family history of breast cancer (84 %). The most widely recognized symptoms of breast cancer were occurrence of breast lumps (86.2 %) and breast pain (93.7 %). Awareness of information regarding breast self-examination (BSE) was 81.6 % in general. Many were aware of the opinion that proper and assisted knowledge about BSE can help in early detection of breast cancer. The patients were also aware that BSE is the most widely used method of screening for breast cancer in clinics and hospitals. All the participants showed sufficient knowledge about the risk factors and symptoms of breast cancer. These baseline findings are encouraging for providing more self-explanatory information (to patients) and guidance to health authorities for developing effective breast health care programs in the entire Kingdom for the female population and not only for patients visiting health care clinics for advice on other medical issues.