Valuation of EQ-5D-5L in the Kingdom of Saudi Arabia: A National Representative Study.

OBJECTIVES: To estimate a Saudi-specific value set for the EQ-5D-5L questionnaire using the EuroQol Valuation Technology program and the EuroQol Group's standard protocol. METHODS: Participants were quota-sampled from the Saudi adult population based on residency location, age group, gender, education level, and employment status. The participants were guided through the completion of composite time trade-off (cTTO) and discrete choice experiment (DCE) tasks by trained interviewers using EuroQol Valuation Technology software. Quality control (QC) measures were used to ensure good data quality. Random intercept and Tobit models analyzed the cTTO data, as well as models correcting for heteroskedasticity. DCE data were analyzed using conditional logit models, whereas hybrid models were used to analyze the cTTO and DCE data jointly. To evaluate model performance, prediction accuracy, logical consistency, significance level, and goodness of fit were used. RESULTS: The valuation study included a representative sample of the Saudi population (N = 1000). The hybrid heteroskedastic model without a constant was chosen as the preferred model for generating the value set. The predicted values ranged from -0.683 for the worst health state ("55555") to 1 for the full health state ("11111"). Pain and discomfort had the largest impact on health-state preference values, whereas usual activities had the least. CONCLUSION: The value set for the Kingdom of Saudi Arabia is the first value set for the EQ-5D-5L for any country in the Middle East. The value set can be used in Saudi health system economic evaluations and decision making.

Comparing oxygen demand in critical covid-19 patients using single versus double doses of tocilizumab.

OBJECTIVES: To compare the outcomes of single versus double doses of tocilizumab in patients with severe COVID-19, especially on different types of oxygenation requirements. METHODS: This cross-sectional study was carried out from January 2020 to March 2020. Patients diagnosed with COVID-19, who received at least one dose of tocilizumab, were included. The dependent variable was tocilizumab dose (single versus double). The primary outcome variable was oxygen demand on the first and last day of hospitalization. A series of comparisons between patients administered one dose of tocilizumab versus 2 doses were conducted. RESULTS: Herein, 80 patients with severe COVID-19 infection were included, of whom 68.8% received one dose of tocilizumab, while 31.3% received a double dose. Two-thirds of the patients were male, with an overall average age of 58 years. In patients receiving 2 doses, oxygen demand tended to worsen by the seventh day, while in those who received one dose. The group that received 2 doses had a longer length of hospital stay. CONCLUSION: This study could not capture the additional value of the second dose for different health outcomes. However, the results can inform clinician from experience when facing uncertainty due to new virus or variant.

Common clinical pattern of antineutrophil cytoplasmic antibody -associated vasculitis: An experience from a multicenter study in Saudi Arabia.

OBJECTIVES: To understand the most common type and clinical manifestations of associated vasculitis (AAV) in the Saudi Arabia. METHODS: This retrospective study was conducted at King Fahad Medical City and the Security Forces Hospital Program, Riyadh, Saudi Arabia, between January 2014 and May 2022. Patients aged ≥18 years were included in the study and diagnosed based on clinical manifestations, serology, or histopathology according to the EMA algorithm. Univariate analysis was carried out to compare different groups; a series of independent samples t-tests was applied for continuous data. RESULTS: A total of 53 patients were enrolled: eosinophilic granulomatosis with polyangiitis (EGPA), granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA). Overall, proteinase-3 was the most prevalent (52.8%), and myeloperoxidase, myeloperoxidase MPO was the least prevalent antineutrophil cytoplasmic antibody (ANCA)-type (18.9%) among patients; other patients showed negative ANCA test results. The clinical manifestations differed significantly between EGPA and GPA groups in pulmonary, neurological, cardiological, and renal signs and symptoms (p<0.05); there was a higher incidence of the former 3 in the EGPA group. Although upper airway was predominant in all groups, there was no statistical difference between both groups. CONCLUSION: This study validated international reports on AAV clinical manifestations in the Saudi population. The GPA was associated with more upper airway and pulmonary signs and symptoms. Further investigation is needed to understand the treatments and quality of life of patients with AAV.

Sociodemographic characteristics and health-related quality of life of individuals undergoing antidepressant therapy.

An important factor for averting depression and creating awareness about clinical treatment is patient preference. Therefore, investigating health-related quality of life associated with different antidepressants is necessary. A retrospective cohort study was performed using the 2018 Medical Expenditure Panel Survey. The MEPS is a nationally representative database of the civilian and noninstitutionalized population spanning different ages, both sexes, and a wide range of sociodemographic and economic backgrounds. Differences in clinical and sociodemographic characteristics among patients using different antidepressant classes were explored. The differences in Veterans RAND 12-Item Health Survey (VR-12) results among groups were examined. The VR-12 metric was used since it measures a patient's overall perspective of their health. Approximately 34.6 million of the patients reported using at least one antidepressant during 2018. Most patients receiving tricyclic therapy reported substantially better mental HRQoL than patients receiving selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or combination therapy. Patients receiving atypical antidepressants reported substantially better mental HRQoL than those receiving other types of antidepressants. Most patients reported a substantial decline in HRQoL after SNRIs or combination therapy. This study found that HRQoL varied across antidepressant users. Thus, health care providers could benefit from taking into consideration quality of life when prescribing antidepressant agents. Moreover, further research is needed to explore other factors that could contribute to the quality of care for patients with depression.

Effects of Ultra-Long-Acting Insulin Compared to Long-Acting Insulin on Diabetic Ketoacidosis Incidence in Type 1 Diabetes Mellitus Patients.

Purpose: This research was intended to explore the effects of new-generation basal insulin (degludec U100 And glargine U300) versus long-acting basal insulin (glargine U100, detemir) on the incidence of diabetic ketoacidosis episodes and diabetes treatment measures. Patients and methods: This is a cross-sectional, retrospective medical record analysis. The study population included adults with type 1 diabetes mellitus (DM) who were on the hospital records in 2020. Data were collected from 221 eligible participants through review of electronic medical records. Each record was scanned for basal insulin type, total daily insulin dose, diabetic ketoacidosis (DKA) occurrences, and glycated hemoglobin A1C (HbA1c) levels. Data were collected from 6 months before to 6 months after the initiation of ultra-long-acting insulin. Statistical analysis was conducted using R version 3.5.2. The normality of distribution for each independent variable was verified using Shapiro-Wilk tests. The independent paired t-test was used to compare insulin therapy measures between the two insulin regimens. The main outcome measures were the incidence of DKA episodes and clinical outcomes associated with diabetes. Results: The HbA1c did not change significantly before and after ultra-long-acting insulin therapy was initiated (9.9 vs 9.8, respectively; P >0.05). Insulin total daily doses were significantly higher after shifting to ultra-long-acting insulin. Sub-analysis showed higher total daily insulin doses in glargine U300 users compared with degludec U100 users (P =0.0021). However, basal insulin doses did not change after treatment with ultra-long-acting insulin. No statistically significant difference in DKA occurrences was found before and after the start of ultra-long-acting insulin treatment. Conclusion: The frequency of DKA episodes was not affected by changing the treatment to ultra-long-acting insulin. Moreover, the results suggest that insulin dosage and types are not the only cause of uncontrolled diabetes. Additional efforts should be made to cover all factors affecting diabetes complication control.

Impact of empirical oseltamivir discontinuation in hospitalized patients with community-acquired pneumonia after confirmed negative for influenza.

OBJECTIVES: To study the effect of appropriate oseltamivir discontinuation in patients hospitalized with pneumonia, after they tested negative for influenza. METHODS: A retrospective study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patients admitted with a diagnosis of community-acquired pneumonia and started on empirical oseltamivir were included. The duration of stay at the hospital and readmission rates were identified. Additionally, we studied factors that led healthcare providers to continue patients on oseltamivir therapy despite testing negative for influenza. RESULTS: A total of 210 patients were studied. The rate of empirical oseltamivir appropriate discontinuation was 31% (66 patients). No significant difference was noted between the 2 groups in the length of hospital stay (p=0.46). There was no significant difference in terms of 30-day (OR=0.67, 95% CI [0.28-1.59]), 60-day (OR=1.14, 95% CI [0.47, 2.78]), and 90-day readmission rates (OR=1.35, 95% CI [0.35-5.27]). After adjusting for other variables, admission to the intensive care unit was independently associated with appropriate discontinuation compared with patients admitted to general wards. CONCLUSIONS: This study showed that appropriate discontinuation of empirical antiviral therapy is safe, effective, and has no impact on the length of stay and readmission rates.

Barriers in utilizing lipid-lowering agents in non-institutionalized population in the U.S.: Application of a theoretical framework.

Cardiovascular diseases are a major cause of death globally. Epidemiological evidence has linked elevated levels of blood cholesterol with the risk of coronary heart disease. However, lipid-lowering agents, despite their importance for primary prevention, are significantly underused in the United States. The objective of this study was to explore associations among socioeconomic factors and the use of antihyperlipidemic agents in 2018 in U.S. patients with hyperlipidemia by applying a theoretical framework. Data from the 2018 Medical Expenditure Panel Survey were used to identify the population of non-institutionalized U.S. civilians diagnosed with hyperlipidemia. This cross sectional study applied the Andersen Behavioral Model to identify patients' predisposing, enabling, and need factors. Approximately 43 million non-institutionalized adults were diagnosed with hyperlipidemia. With the exception of gender and race, predisposing factors indicated significant differences between patients who used antihyperlipidemic agents and those who did not. The relation between income level and use of antihyperlipidemic agents was significant: X2 (4, N = 3,781) = 7.09, p <.001. Hispanic patients were found to be less likely to receive treatment (OR: 0.62; 95% CI: 0.43-0.88), as observed using a logistic model, with controls for predisposing, enabling, and need factors. Patients without health insurance were less likely to use lipid-lowering agents (OR: 0.33; 95% CI: 0.14-0.77). The present study offers essential data for prioritizing interventions by health policy makers by identifying barriers in utilizing hyperlipidemia therapy. Non-adherence to treatment may lead to severe consequences and increase the frequency of fatal cardiac events in the near future.

Clinical dental students' knowledge regarding proper dental settings for treating patient during COVID-19: A cross-sectional study.

OBJECTIVES: To investigate the clinical dental students' knowledge on the proper dental setting during COVID-19. METHODS: Using multicenter cross-sectional study, a 10-items questionnaire was distributed in April 2020 among senior dental students from two dental schools. It comprised three main domains: demographic questions, questions investigating student's access to the proper recommendations of dental settings during COVID-19 and the specific recommendations questions. RESULTS: The questionnaire was sent to 654 clinical dental students and the total number of respondents were 267 representing a response rate of 40.83%. The overall knowledge mean was low (1±0.92). Gender was not a statistically significant factor affecting the knowledge score (P > 0.05). Most of the participants never visited the Saudi Center for Disease Prevention and Control (Saudi CDC) website and received no guidance or advice regarding proper dental practices during COVID-19. A statistically significant relationship was observed between the mean knowledge score and access to knowledge variables (P < 0.05). CONCLUSION: It was noted that clinical dental students have low knowledge on the proper dental settings during COVID-19 pandemic that was recommended by the Saudi CDC guidelines and they must be equipped with adequate knowledge from reliable sources to overcome their insufficiencies such as a well-structured and dynamic curriculum.

Inclining Trend of the Researchers Interest in Antimicrobial Stewardship: A Systematic Review.

INTRODUCTION: The implementation of antibiotic stewardship programs (ASPs) can improve the treatment of infections and can decrease the adverse events that result from antibiotics use. In the last decades, there is an increasing interest of the researchers in the implementation of ASPs. MATERIALS AND METHODS: The articles published in different journals were retrieved by searching many research databases such as Cochrane library, Europe PMC, PubMed, and Web of Science; we searched these databases for all published articles till November 2018. RESULTS AND DISCUSSION: The searching results using Cochrane library showed an increase in the number of randomized clinical trials that related to the keyword of "antimicrobial stewardship" specially in the last 5 years. Using Europe PMC, we found 6178 results. From these results, there are 3874 free full texts. In addition, there are 2132 original articles in PubMed and by searching Web of Science database till November 8 there are 3085 results. These results show that the number of trusted published articles was increased continuously; this shows the increasing interest of the researchers in ASPs. These researches will help health-care providers to use antibiotics appropriately and to overcome the barriers of implementing ASPs. CONCLUSION: The results of this study show that the researchers had high levels of interest in participating in research activities related to the appropriate use on antibiotics and the implementation of antimicrobial stewardship programs.

A comparison between warfarin and apixaban: A patient's perspective.

BACKGROUND: Novel oral anticoagulants (NOACs) were developed as alternatives to warfarin. However, the patients' preference regarding warfarin or the NOACs has not been established. Quality-of-life (QOL) surveys are a well-established method for determining the patients' preference for a treatment route. AIMS: This study compared the patients' perspectives on treatment with warfarin versus apixaban using the QOL measures. SETTINGS AND DESIGN: This cross-sectional study was conducted in 2019 for patients treated with either warfarin or apixaban at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. METHODS: We used a series of descriptive statistics to examine the differences in sociodemographic characteristics among patients. A propensity score-matching approach was employed to reduce the effect of confounding variables that often influence treatment selection. Greedy matching approach was used to analyze the QOL. RESULTS: A total of 388 patients were identified, of which 124 were matched between the two groups (62 patients in each group). Most of the patients were female, married, below the sufficiency level, educated, and nonsmokers. The patients using warfarin had a significantly better health state (M = 69.64, standard deviation [SD] = 16.52) than those using apixaban (M = 66.33, SD = 23.17), P = 0.011. CONCLUSIONS: Future studies should explore why patients using apixaban showed lower QOL scores and improve health-care providers' awareness of these issues.

Assessment of safety and effectiveness of oral multiple sclerosis medication.

OBJECTIVES: To assess the effectiveness and safety profile of the new disease modifying drugs (fingolimod, teriflunomide, and dimethyl fumarate) at a local hospital in Riyadh, Saudi Arabia. METHODS: This is a retrospective cohort, where institutional review board approval was granted in December 2015. The study was conducted at King Abdulaziz Medical City Research Center, Riyadh, Saudi Arabia. Demographic variables (age, gender, disease onset, and duration on medication), clinical variables (medication side effects and radiological findings), in addition to relapse frequency per year was collected. RESULTS: Fifty-seven patients' records were retrieved from the pharmacy and included in the analysis. Eight patients were on teriflunomide, 5 patients on dimethyl fumarate and 44 patients on fingolimod were enrolled. The patients' average age was 32.5 years with female gender representing 63% the study population. Annual relapse rates were 0.24, 0.34, and 0.5 per patient per year for those taking fingolimod, dimethyl fumarate, and teriflunomide, correspondingly, lymphopenia (91.4%), neutropenia (23%), and bradycardia (16%) were the most reported side effects for fingolimod therapy. CONCLUSION: The study results were able to capture the effectiveness rate for the targeted treatment in the studied population, with the frequency of incidence of side effects. However, as these results cannot be generalized for the entire Saudi population.