Patients' perception towards digital health services in Saudi Arabia: A cross-sectional study.

The COVID-19 pandemic has highlighted the importance of the widespread use of digital health services (DHS). Despite evidence of the benefits of DHS, there are many barriers to their adaptation worldwide. This study aimed to measure the effectiveness of DHS from the patient perspective. A cross-sectional study was conducted in the Jazan region of Saudi Arabia from December 2022 to March 2023. Of the 323 participants who completed the online questionnaire, 63.5% were female, and 55.4% of participants found that DHS was satisfactory. 34% of the participants preferred DHS via telephone calls and 40.2% found that DHS was comparable to direct regular services in building trust between patients and doctors. A total of 79.2% agreed that DHS could reduce unnecessary outpatient visits and 70.9% agreed that it could be used effectively to follow patients with chronic diseases. DHS was found to be cost-effective in 76.8%. Digital healthcare has the potential to significantly improve health care outcomes and effectiveness in Saudi Arabia. Therefore, the use of a DHS for monitoring and dispensing care would be advantageous. However, difficulties such as lack of time or a packed schedule have prevented patients in Saudi Arabia from using telemedicine.

Feasibility of tele-guided patient-administered lung ultrasound in heart failure.

BACKGROUND: Readmission rates for heart failure remain high, and affordable technology for early detection of heart failure decompensation in the home environment is needed. Lung ultrasound has been shown to be a sensitive tool to detect pulmonary congestion due to heart failure, and monitoring patients in their home environment with lung ultrasound could help to prevent hospital admissions. The aim of this project was to investigate whether patient-performed tele-guided ultrasound in the home environment using an ultraportable device is feasible.Affiliations: Journal instruction requires a country for affiliations; however, these are missing in affiliations [1, 2]. Please verify if the provided country are correct and amend if necessary.Correct METHODS: Stable ambulatory patients with heart failure received a handheld ultrasound probe connected to a smart phone or tablet. Instructions for setup were given in person during a clinic visit or over the phone. During each ultrasound session, patients obtained six ultrasound clips from the anterior and lateral chest with verbal and visual tele-guidance from an ultrasound trained clinician. Patients also reported their weight and degree of dyspnea, graded on a 5-point scale. Two independent reviewers graded the ultrasound clips based on the visibility of the pleural line and A or B lines. RESULTS: Eight stable heart failure patients each performed 10-12 lung ultrasound examinations at home under remote guidance within a 1-month period. There were no major technical difficulties. A total of 89 ultrasound sessions resulted in 534 clips of which 88% (reviewer 1) and 84% (reviewer 2) were interpretable. 91% of ultrasound sessions produced interpretable clips bilaterally from the lateral chest area, which is most sensitive for the detection of pulmonary congestion. The average time to complete an ultrasound session was 5 min with even shorter recording times for the last session. All patients were clinically stable during the study period and no false positive B-lines were observed. CONCLUSIONS: In this feasibility study, patients were able to produce interpretable lung ultrasound exams in more than 90% of remotely supervised sessions in their home environment. Larger studies are needed to determine whether remotely guided lung ultrasound could be useful to detect heart failure decompensation early in the home environment.

Factors Influencing the Adoption of IoT for E-Learning in Higher Educational Institutes in Developing Countries.

The internet of things (IoT) is an emerging paradigm of educational applications and innovative technology in the current era. While capabilities are increasing day by day, there are still many limitations and challenges to utilizing these technologies within E-Learning in higher educational institutes (HEIs). The IoT is well-implemented in the United States of America (USA), United Kingdom (UK), Japan, and China but not in developing countries, including Saudi Arabia, Malaysia, Pakistan, Bangladesh, etc. Few studies have investigated the adoption of IoT in E-Learning within developing countries. Therefore, this research aims to examine the factors influencing IoT adoption for E-Learning to be utilized in HEIs. Further, an adoption model is proposed for IoT-based E-Learning in the contexts of developing countries and provides recommendations for enhancing the IoT adoption for E-Learning in HEIs. The IoT-based E-Learning model categorizes these influencing factors into four groups: individual, organizational, environmental, and technological. Influencing factors are compared along with a detailed description in order to determine which factors should be prioritized for efficient IoT-based E-Learning in HEIs. We identify the privacy (27%), infrastructure readiness (24%), financial constraints (24%), ease of use (20%), support of faculty (18%), interaction (15%), attitude (14%), and network and data security (14%), as the significant E-Learning influencing factors on IoT adoption in HEIs. These findings from the researcher's perspective will show that the national culture has a significant role in the individual, organizational, technological, and environmental behavior toward using new technology in developing countries.

Association of Atrial Fibrillation With Patient Characteristics in Postoperative Coronary Artery Bypass Grafting Surgery.

Introduction Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is correlated with poor patient outcomes. The study evaluated the association of patients' clinical and sociodemographic characteristics with the incidence of atrial fibrillation, postoperatively.  Methodology A longitudinal study was performed in the cardiology department of a tertiary care unit, Sindh, Pakistan between October 2019 and November 2020. All patients who underwent CABG surgery irrespective of gender aged 30 to 75 years were included in the study. Patients with a history of atrial fibrillation or severe left ventricular dysfunction were excluded from the study. The incidence of atrial fibrillation was determined by observing an irregular pattern on electrocardiography (ECG) with no definite P-wave and irregular R-R interval. The patients were monitored for seven postoperative days. The final outcome was measured on the seventh postoperative day.  Results A total of 247 patients with a mean age of 63.43 ± 9.72 were enrolled in the study. Out of the 247 patients, 9.7% developed new-onset atrial fibrillation, postoperatively. Age above 65 years was associated with the occurrence of AF but it was not statistically significant (p>0.05). Similarly, patients who developed AF were more likely to have a left ventricle ejection fraction (LVEF) of less than 35% than those without AF (66.67% vs 43.95%; p=0.033).  Conclusion A high rate of AF was observed in the study. Older age and impaired ventricular function were significantly associated with atrial fibrillation. It is recommended that hospitals should devise guidelines and protocols for the prevention and management of atrial fibrillation in patients undergoing cardiothoracic surgeries in order to minimize patient mortality and improve patient outcomes.

Submassive pulmonary embolism with a right heart thrombus.

A 49-year-old woman presented to the hospital with shortness of breath 2 weeks after a left total hip replacement. She was found to have a submassive pulmonary embolism (PE), with her case complicated by the detection of a large mobile clot in transit extending through a patent foramen ovale between the right and left atria. The presence of this free-floating right heart thrombus (FFRHT) increases her risks of stroke and mortality, yet the optimal approach to her treatment was unclear. Ultimately, intravenous tissue plasminogen activator was administered with resolution of the clot. Treatment was complicated by haemodynamically insignificant bleeding at the site of recent surgery. Herein, we further discuss the implications and treatment options for patients with an FFRHT in the setting of an acute PE.

Adequacy of Completion of Computed Tomography Scan Request Forms at a Tertiary Care Center in Pakistan: A Clinical Audit.

Introduction A lot of radiation exposure to a population comes from medical sources. Clinicians must justify the need for radiology procedures on a request form to prevent unnecessary scans and radiation exposure. Moreover, the properly-filled form will help to identify the patient correctly and provide clinical details to make a radiological diagnosis. Objective The purpose of the study was to audit the computed tomography (CT) scan request forms and find out the adequacy of completion of the request forms at Bahawal Victoria Hospital, Bahawalpur, Pakistan. Materials and methods We scrutinized 300 CT scan request forms received at the tertiary care center, Bahawal Victoria Hospital. We checked the adequacy of filling of different fields in the request forms like name, address, clinical and surgical history, and the name of required examination. We also looked for the missing subjects in the CT request form currently used in our hospital like the contact numbers of the patient and the doctor, the identity of the requesting doctor, renal function tests (RFTs), last menstrual period (LMP), and history of allergy. The results were analyzed using Statistical Package for the Social Sciences 20 (SPSS 20) (IBM, NY, USA) and Microsoft Office Excel Worksheet (Microsoft Corporation, NM, USA). Results The name of the patient was present in 100% of the request forms, surname in 27.66%, age in 73.33%, gender in 64.33%, date in 91.66%, bed number in 37.90%, address in 1% and the name of required examination in 99.6%. Information about diagnosis included clinical history in 50.66%, past surgical history in 1%, laboratory investigations in 1%, and clinical examination in 8.66% of the forms. All the forms had the name and signature of the referring consultant, but only 10.33% forms contained the identity of the requesting junior doctor. More than half of the request forms for CT scan provided RFTs. We found no record of the allergy, LMP, and the contact number of the doctor and the patient. Conclusion The information provided in the CT scan request forms was inadequate. The practice of filling these forms needs to be improved to protect the patients from unnecessary radiation exposure.

Sudden sensorineural hearing loss: A missed opportunity for treatment

@#Sudden sensorineural hearing loss (SSNHL) is an otology emergency and carries significant morbidity if the diagnosis is missed. It can present to any specialty but in our local setting the patient usually presents to primary care as it is easily accessible. We present a case of SSNHL that was initially presented to a primary care centre and the patient was reassured without any investigation being carried out. SSNHL has many causes thus making diagnosis difficult. However, with knowledge of its possible, a diagnosis can be made and appropriate management can be advocated to the patient. Hence, we discuss the three main causes of SSNHL, while emphasizing the immune system-mediated mechanism as the main cause in this case.

Evaluation of the rabbit as an experimental model for human uterine synechia.

CONTEXT: Pathogenesis of uterine synechia remains unsolved, the causal relationship between synechia and infertility is not clearly established. AIMS: To evaluate the rabbit as an experimental model for Asherman's syndrome using the endometrial curettage as trigger mechanism then to evaluate its impact on fertility. SETTINGS AND DESIGN: Experimental study MATERIALS AND METHODS: 13 female rabbits. All submitted traumatic endometrial curettage. Animals of Group 1 (n = 7) were sacrificed at various times following surgery (day 7, 15 and 30), animals of Group 2 (n = 6) were bred and sacrificed during pregnancy. Main outcome were synechia occurring, number of implanted fetus, lumen surface/ global horn perimeter ratio (LS-GHP ratio) and epithelium thickness. STATISTICAL ANALYSIS: Means were compared using Student 't' test (P < 0.05 was considered significant). Number of implantation sites of two horns were compared with the Wilcoxon test. RESULTS: No synechia have been observed. Examinations at Day 7, 15 and 30 demonstrate a complete regeneration of endometrium. We observed a significant diminished LS-GHP ratio at day 7 (0.042 ± 0.004 vs 0.074 ± 0.002 mm; P = 0.013) with a higher simple columnar epithelium compared to control (16.6 ± 3.39 vs 10.98 ± 1.7; P = 0.001). We observed a diminished ovum implantation in traumatized horns, even if it was not statistically significant. CONCLUSION: Even if no intrauterine adhesion were observed, this model represents a pathogenesis condition in the rabbit similar to intrauterine adhesions observed in the human with negative impact on implantation.