Remote interviews for medical residency selection during the initial COVID-19 crisis: a national survey.

BACKGROUND: Medical training programs candidate's interview is an integral part of the residency matching process. During the coronavirus disease 2019 (COVID-19) pandemic, conducting these interviews was challenging due to infection prevention restrains (social distancing, namely) and travel restrictions. E-interviews were implemented by the Saudi Commission for Healthcare Specialties (SCFHS) since the matching cycle of March 2020 to hold the interviews in a safer virtual environment while maintaining the same matching quality and standards. AIM: This study was conducted to assess the medical training residency program applicants' satisfaction, stress, and other perspectives for the (SCFHS) March 2020 Matching-cycle conducted through an urgently implemented E-interviews process. METHOD: A cross-sectional, nationwide survey (Additional file 1) was sent to 4153 residency-nominated applicants to the (SCFHS) March 2020 cycle. RESULTS: Among the 510 candidates who responded, 62.2% applied for medical specialties, 20.2% applied for surgical specialties, and 17.6% applied for critical care and emergency specialties. Most respondents (61.2%) never had previous experience with web-based video conferences. Most respondents (80.2%) used the Zoom application to conduct the current E-interviews, whereas only 15.9% used the FaceTime application. 63.3% of the respondents preferred E-interviews over in-person interviews, and 60.6% rated their experience as very good or excellent. 75.7% of the respondents agreed that all their residency program queries were adequately addressed during the E-interviews. At the same time, 52.2% of them agreed that E-interviews allowed them to represent themselves accurately. 28.2% felt no stress at all with their E-interviews experience, while 41.2% felt little stressed and only 8.2% felt highly stressed. The factors that were independently and inversely associated with applicants' level of stress with E-interviews experience were their ability to represent themselves during the interviews (p = 0.001), cost-savings (p < 0.001), their overall rating of the E-interviews quality (p = 0.007) and the speed of the internet connection (p < 0.006). CONCLUSION: Videoconferencing was implemented on an urgent basis during the COVID-19 pandemic in the medical residency application process in Saudi Arabia. It was perceived as an adequate and promising tool to replace in-person interviews in the future. Applicants' satisfaction was mainly driven by good organization, cost-saving, and their ability to present themselves. Future studies to enhance this experience are warranted.

Improving access to care for children with cancer through implementation of an electronic referral system (IMPACT): A single-center experience from Saudi Arabia.

BACKGROUND: Delayed access to cancer care has been associated with childhood cancer death. Improving timely access to cancer care is the first important step in the cancer treatment journey. We introduced an electronic referral system (e-RS) to improve timely access to cancer care. This study aimed to assess the impact of implementing an e-RS on timely access to cancer care. METHODS: A retrospective cross-sectional study of pediatric oncology patients selected through a consecutive nonprobability sampling technique was performed to determine the turnaround time (TAT) of children with cancer diagnosed 12 months before and after implementation of the e-RS. TAT was defined as time in hours from referral to approval for admission. RESULTS: Of the 326 pediatric oncology patients diagnosed between January 2014 and December 2015, 59.9% were male and 40.1% were female. Median age for both sexes was 5.0 years (interquartile range [IQR]: 2.5-9.0 years). Among these, 98.2% were Saudi nationals. Hematological malignancies accounted for 50.6% of referrals and 16.6% had lymphoma. The median TAT of the manual referral system (m-RS) and e-RS was 18 h (IQR: 2-25 h) and 2 h (IQR: 1-16 h; P = .0001), median length of hospital stay during first admission was 11 days versus 9 days (P = .14), and death events occurred in 11 patients versus zero patients referred using the m-RS versus e-RS (P = .003), respectively. CONCLUSION: The introduction of an e-RS was associated with more rapid processing of pediatric patients for cancer treatment and fewer patient deaths during the initial evaluation and treatment during that time period.

Pattern of drug overdose and chemical poisoning among patients attending an emergency department, western Saudi Arabia.

Poisoning is a medical emergency that represent a major health problem all over the world. Studies on drug overdose and chemical poisoning are very limited in Saudi Arabia (SA). We aimed to describe the current pattern and assess risk factors of drug overdose and chemical poisoning in King Khalid National Guard hospital, Jeddah, SA. Medical records of patients attended emergency department in King Khalid National Guard hospital during the period from January 2008 to December 2012 due to drug overdose and chemical poisoning were reviewed. A total of 129 cases were included in the study. The majority of the population was Saudi (97.7 %), and almost half of them were females (54.3 %). Children under 12 years were the most affected age group (44.2 %). Drug overdose was the most common cause of poisoning (92.2 %). Analgesics and non-steroidal anti-inflammatory drugs represented the highest percentage of used medications (20.4 %). The most commonly reported symptoms were symptoms of the central nervous system (57.4 %) followed by GIT symptoms (41.9 %). Intentional poisoning was reported in 34 cases (26.4 %). Female patients were significantly more likely to attempt suicide than male patients (OR = 7.22, 95 % CI = 1.70, 30.62). Children continue to be at high risk for medication and chemical poisoning. Accessibility to medications at homes encountered for most of poisoning cases among children. Implementing methods to raise public awareness and minimize children access to medications would significantly contribute to reducing burden of this problem on the community.

Pattern of urinary tract infection in children with vesicoureteric reflux: Does breastfeeding reduce the occurrence of urinary tract infection?

Introduction: The protective factors against urinary tract infections (UTIs) in the setting of vesicoureteric reflux (VUR) remain poorly defined. Breastfeeding was suggested as a protective factor against UTI, but its role remains undetermined in this highly susceptible population. Objectives: The objective of the study was to identify the pattern and risk factors of UTI and investigate the effect of breastfeeding on UTI occurrence in VUR children. Materials and Methods: This was a mixed-method design, whereby the first part was a cross-sectional study that included children who were diagnosed with VUR and were assessed for their UTI pattern. The second part was a case-control study, which involved contacting the mothers of the children enrolled and questioning them about their breastfeeding pattern, and UTI development was assessed. Results: Our study included 62 children with a median age of 4.4 (interquartile range = 21) months at diagnosis. Of those, 37 (60%) were male and 25 (40%) were female. Most UTIs occurred in the first 3 months of life, and the first episodes were more frequent in males. Constipation was significantly associated with the occurrence of UTI (relative risk [RR] =1.750 [95% confidence interval (CI): 1.231-2.489], P = 0.003). Children with breakthrough UTIs were more likely to have been breastfed for <9 months (odds ratio [OR] = 4.091 [95% CI: 1.287-13.002], P = 0.015) and to have been exclusively breastfed for <2 months (OR = 4.600 [95% CI: 1.337-15.823], P = 0.012). Conclusion: Children with VUR are more susceptible to UTIs in their 1st year of life. Constipation is a major risk factor for UTI occurrence in VUR children and should be aggressively managed. Breastfeeding for longer durations showed promising protective features against breakthrough UTIs.

Exploring Perceptions and Practices of Interprofessional Shared Decision-Making Education in Palliative Care Settings.

Background: Palliative care teams provide support to patients and their caregivers during terminal illness, which requires interprofessional collaboration. One of the foundational skills is to assist patients with decision-making. This can be facilitated through interprofessional shared decision-making (IP-SDM). So far, IP-SDM education frameworks have only been used to a limited extent in the area of palliative care. Aim: This study aims to explore perceptions and practices of faculty members, health professionals, and students toward IP-SDM education in palliative care and to indicate associated factors to implement an IP-SDM in undergraduate health professions education in palliative care settings. Methods: We used a cross-sectional study design in which the data was obtained via an online self-administered questionnaire adapted from existing validated tools. The questionnaire was distributed to faculty members and health professionals (n = 125) and students (n = 334) at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The sampling technique was a non-probability convenience sampling. Bivariate statistics, such as independent sample t-tests, one-way ANOVA, correlation coefficient, and linear multiple regression were conducted. Findings: The response rate was 54% (85 faculty members and health professionals and 164 students). Perceptions on IP-SDM did not differ between participants. From those who had previous experience with IP-SDM, the mean practices score was slightly higher for faculty members and health professionals (M = 83.1, SD = 15.9) than for students (M = 74.1, SD = 11.5), which was significant (p < 0.05). Factors such as gender, age, discipline, nationality, level of education, years of study, and previous experience that were associated with perceptions and practices were varied among participants. Conclusion: The findings show high levels of perception with low levels of practice of IP-SDM in palliative care. Other factors that could be associated with the topic should be addressed in further studies.

A Qualitative Study of Stakeholders' Perspectives of Implementing Interprofessional Shared Decision-Making Education in Palliative Care.

Introduction Shared decision-making (SDM) in palliative care is a highly complex process that requires an interdisciplinary team. Interprofessional team members need education on how to facilitate discussion of patient/family wishes at the end of life in hospital settings. So far, interprofessional shared decision-making (IP-SDM) education frameworks have been used to a limited extent in the area of education on palliative care. The aim of this study was to explore policymakers', health professionals', faculty members', and students' perspectives on implementing an IP-SDM educational framework in palliative care to identify aspects that should be prioritized to further develop interprofessional education for SDM in palliative care. Methods We used the qualitative method to capture the micro, meso, and macro factors using Oandasan and Reeves' model for the implementation of IP-SDM education regarding palliative care. Data collection tools included in-depth, face-to-face interviews with individual policymakers and focus group interviews with health professionals, faculty members, and undergraduate health professionals. The interview guide explores the teaching of SDM in palliative care, factors that could facilitate or hinder the implementation of IP-SDM education for health professions students in palliative care, and interventions to facilitate the implementation of this approach. This study was conducted at the Oncology and Palliative Care Department at King Abdulaziz Medical City in the Ministry of National Guard Health Affairs and at King Saud bin Abdulaziz University for Health Sciences in Jeddah, Saudi Arabia. Results The results indicated a high demand for IP-SDM in palliative care. The findings revealed factors that can facilitate or hinder the implementation of IP-SDM education in palliative care for undergraduate health professions students that is going to the local community. Factors include culture, religion, gender, power issues, team hierarchy, and respect among team members. Also, our findings have revealed potential solutions to the hindering factors. Conclusions IP-SDM education in palliative care is a highly relevant topic for improving patient outcomes. However, it might be a complex process to implement, especially given the challenges of palliative care settings. We recommend starting such a course in the early clinical phases of undergraduate health professional education.

Healthcare Practitioners' Quality of Life in Rural and Urban Areas of Saudi Arabia.

INTRODUCTION: The quality of care delivered by healthcare practitioners (HCPs) is crucial in promoting optimal health and quality of life (QOL) for a population. To achieve this, understanding the factors that affect the quality of life of healthcare practitioners is essential for governments to develop sustainable healthcare systems. Developed countries have a major role to play in this aspect, as the misallocation of healthcare providers to the wrong geographic regions can significantly impact their performance.  Aim: This study aims to evaluate the factors associated with healthcare practitioners' (HCP) quality of life (QOL) and provide workforce planning with knowledge of the level of QOL among HCPs and its factors in Saudi Arabia in 2021. METHODS: This is an observational, descriptive, cross-sectional study conducted in both rural and urban areas of Saudi Arabia. The study population includes all healthcare practitioners practicing in Saudi Arabia. A probability-stratified random sampling technique was used to recruit healthcare practitioners into the study, with a requirement of at least 380 practitioners to achieve 95% confidence and a 5% margin of error. To assess the quality of life of healthcare practitioners in Saudi Arabia, the study used a national online self-administered questionnaire that was designed by the research team. The data collection process took place from June 2021 to October 2021, and responses were obtained randomly. For analysis, the study used descriptive statistics such as frequency, percentages, mean or median, and standard deviation or interquartile range. The statistical significance was set at p<0.05, and independent sample T-tests and Chi-square tests were calculated to determine any significant differences between groups. RESULTS: A total of 439 participants completed the questionnaire and were included in the final analysis. The participants had a mean age of 38.8 years (SD = 10.173), with 232 (52.8%) male and 207 (47.2%) female. Regarding marital status, 28% were single, 68.6% were married, and 3.4% were divorced or widowed. The prevalence of chronic diseases in the cohort was 9.1%, with hypertension being the most commonly reported. Of the participants, 362 (82.5%) were living in a society considered urban, while 77 (17.5%) were living in rural areas. Urban healthcare practitioners expressed higher levels of satisfaction with safety and security, internet availability and speed, and city infrastructure compared to their rural counterparts. However, rural practitioners reported greater satisfaction with the cost of living, and transportation quality was a point of concern for both groups. CONCLUSION: The study shows that people living in urban and rural areas are all satisfied with their living conditions based on many factors mentioned in the results section. This indicates that there is no significant difference. The most important factor that affects satisfaction with living is health status. The rate of satisfaction is very high for all factors, including security and safety, environmental health, city infrastructure, cost of living, internet availability, and sports activity-all of which are related to the city itself. For factors related to the individual, such as emotional support from family and friends, personal relationships, overall health, and body appearance, the rate of satisfaction is also high.

Employment Rate of Newly Certified Healthcare Specialists in Saudi Arabia: A Survey-Based Study.

Background This study aimed to assess and compare the employment rates of medical and dental specialists across different regions of Saudi Arabia from 2011 to 2019. Methodology With the aid of the Saudi Commission for Health Specialties, the national survey was sent via email to 12,000 healthcare postgraduates who obtained their board certificate within the period 2011-2019. It contained several questions regarding demographics, specialty, employment, satisfaction, and, finally, challenges and obstacles they faced during their job-seeking experience. Results Of the 723 respondents, almost 655 (90.7%) were employed. The employment rate of medical specialists (n = 605, 90.7%) was higher than dental specialists (n = 50, 89.3%). Nevertheless, 96% (n = 48) of dental employees were working at a specialty of their specified qualification, while only 93.7% (n = 562) of medical employees did. Regarding the month of their employment, the month of October (15.25%) had the highest employment rate for medical specialists; however, for a dental specialist, August (18%) had the highest employment rate. However, 64.5% of the respondents admitted that they faced challenges during their job-seeking experience, with few available positions being the most common obstacle for both medical and dental specialists. Conclusions Our survey confirms that medical and dental specialists in Saudi Arabia are facing delays in entering the workforce, which vary by region and specialty. It also sheds light on the reasons for these gaps, with limited job opportunities being a major issue for both groups. For career advancement, it is essential to identify these obstacles and develop a strategy to overcome them, such as involving the private sector.

The Analysis of Job Satisfaction of Health Practitioners in Saudi Arabia: Determinants and Strategic Recommendations for Health Workforce Planning.

BACKGROUND: Job satisfaction plays an important foundation in the health system to deliver high-quality care services to patients. Job satisfaction describes the inside feeling of workers about their jobs whether they like it or not. Job satisfaction of health practitioners is considered an essential factor that affects their efficiency, well-being, and mental health. AIM: This research study is part of an integrated research aiming to understand the determinants of a revised Workforce Planning Strategy in Saudi Arabia, in close relevance to the demand and supply side in Saudi Arabia. RESULTS: This study showed that males were significantly more satisfied than females in relation to specialty, organization, and overall global score. There is also evidence for a significant association between age groups and job satisfaction. Older health practitioners had a higher level of satisfaction than younger ones. Regarding nationality, we found that Saudi health practitioners were less satisfied in all aspects, while non-Saudi (Arab) healthcare practitioners were the most satisfied in all aspects except city happiness. CONCLUSION: Our study found statistically significant differences that medicine and surgery practitioners are the most satisfied professionals and the least satisfied are dentist practitioners. Health practitioners with more than five years of experience were significantly the most satisfied.

Urinary tract infection in children: A narrative review of clinical practice guidelines.

Background: Urinary tract infection (UTI) has been a major burden on the community and the health-care systems all over the globe. It is the most common cause of bacterial infection in the pediatric age group, with an annual incidence of 3%. The aim of this study is to review and summarize all available guidelines on the diagnosis and management of children with UTI. Materials and Methods: This is a narrative review of the management of children with a UTI. All biomedical databases were searched, and any guidelines published from 2000 to 2022 were retrieved, reviewed, and evaluated to be included in the summary statements. The sections of the articles were formulated according to the availability of information in the included guidelines. Results: UTI diagnoses are based on positive urine culture from a specimen of urine obtained through catheterization or suprapubic aspiration, and diagnoses cannot be established on the bases of urine collected from a bag. The criteria for diagnosing UTI are based on the presence of at least 50,000 colony-forming units per milliliter of a uropathogen. Upon confirmation of UTI, the clinician should instruct parents to seek rapid medical assessment (ideally within 48 h) of future febrile disease to ensure that frequent infections can be detected and treated immediately. The choice of therapy depends on several factors, including the age of the child, underlying medical problems, the severity of the disease, the ability to tolerate oral medications, and most importantly local patterns of uropathogens resistance. Initial antibiotic choice of treatment should be according to the sensitivity results or known pathogens patterns with comparable efficacy of oral and parenteral route, for 7 days to 14 days duration. Renal and bladder ultrasonography is the investigation of choice for febrile UTI, and voiding cystourethrography should not be performed routinely unless indicated. Conclusion: This review summarizes all the recommendations related to UTIs in the pediatric population. Due to the lack of appropriate data, further high-quality studies are required to improve the level and strength of recommendations in the future.

Detection of renal anomalies using antenatal and postnatal ultrasound: The consanguinity factor.

Introduction: Antenatal ultrasound (US) is considered the gold standard tool to detect fetal anomalies during the antenatal period. However, its highly operator dependent and maybe affected with other variables. The aim of this study to compare discrepancy between antenatal and postnatal US diagnosis of congenital anomalies of the kidney and urinary tract (CAKUT) and to evaluate the incidence of parent's consanguinity among those patients at King Abdulaziz Medical City - Western Region (KAMC-WR), as it may help changing the current practiced guidelines and applied protocols. Methods: This is an observational, retrospective, cross-sectional study, conducted at the Maternal Fetal Medicine Unit at KAMC-WR, reviewing antenatally detected CAKUT between the years 2009 and 2014. Utilizing the congenital anomalies database and using multiple databases collected the data. A data sheet was completed and divided into four sections, which consist of maternal data, antenatal data, delivery, and postnatal data. The analysis was performed using Statistical Package for Social Sciences program (Armonk, NY: IBM Corp). Results: We included 137 fetuses with renal anomalies in our study, with 17% perinatal mortality rate, and 13% loss of follow-up. Abnormal amniotic fluid was detected in 32%, and bilateral anomalies presented in 41% and it was most commonly seen in male fetuses. Added to that, 41% of the fetuses were product of consanguineous marriage and 11% had a history of other child with renal anomalies. However, the rate of discrepancy between antenatal and postnatal renal US findings was 24%. Finally, the most common anomaly found antenatally and confirmed postnatally was hydronephrosis disease spectrum (60.6%). Conclusion: There is a significant association between children with CAKUT and parents' consanguinity. Furthermore, the discrepancy rate for the detection of CAKUT between antenatal and postnatal US in our study was comparable to other international studies. Further prospective studies are recommended in this field for further understanding.

Perception of the Saudi Population on Abortion Decisions in Congenital Fetal Anomalies.

Introduction Termination of pregnancy for fetal anomalies is well reported in the literature and accepted by the western and other non-Muslim communities, but Muslim communities' perception is poorly reported and rarely mentioned. This study aims to evaluate the perception of the Saudi community on abortion decisions as a management option in congenital fetal anomalies. Methods This is an observational, descriptive cross-sectional study, where participants of Saudi nationality, living in Jeddah, and consenting to participate in the research filled up a self-administrated, structured, close-ended, validated questionnaire. The level of agreement was measured on a Likert scale. Results A total of 574 participants were included in the study; 43.3% were female. The mean age of the participants was 30.3 years (SD = 10.6). Undergraduate students were 58.9%, single participants were 56.3%, and participants without children were 61.3%. The prevalence of abortion was 17.9%. The overall agreement on accepting abortion as an option was 61%. Gender (p<0.001), knowledge level (p=0.003), and religion (p=0.01) were the most important factors that influenced people's perception of abortion. Other factors like participants' age (p=0.09), level of education (p=0.48), marital status (p=0.16), having children (p=0.48), and gender of the fetus (p=0.2) were not significant factors in their decision to choose abortion. Conclusion Overall, Saudis were more inclined to accept abortion in case of a confirmed congenital anomaly, yet females were more accepting of the idea than males.

Attitudes and Perceptions of Health Leaders for the Quality Enhancement of Workforce in Saudi Arabia.

BACKGROUND AND AIM: Besides the unique exposure and experience of health leaders in facing challenges and overcoming them, and the relatively fewer articles relating to the perception of health leaders in workforce quality enhancement, health leadership plays a crucial role in redirecting the workforce, increasing job satisfaction, professional development, and burnout prevention. Thus, this study aimed to understand the current healthcare workforce quality and future expectations from the attitudes and perceptions of health leaders. METHODS: A qualitative research was carried out using semi-structured interviews consisting of 24 different questions. Participants of the study were healthcare leaders from different backgrounds and governmental institutions. All interviews were recorded, transcribed, and then analyzed using thematic analysis via the N-Vivo program. RESULTS: Eleven participants were involved in the study, with one female and ten males. A thematic analysis and N-Vivo program yielded 5 main themes: (1) workforce competency, (2) health transformation, (3) leadership, (4) workforce planning, and (5) healthcare quality, with 22 emerging sub-themes. Moreover, participants responded with different attitudes and perceptions. CONCLUSION: Health leaders are satisfied with the current direction of workforce competency and planning, yet fragmentation of the system and poor accessibility may need further enhancement. Furthermore, misutilization of services and the uncertainty of the future and talent pool are potential barriers for capability building. Moreover, with the existing gap in the workforce, health leaders believe that privatization and corporatization may have a positive effect. Aside from that, Saudization with the current plan of having a minimum standard of accepting non-Saudis in certain areas might benefit in maintaining competition and enriching experience. However, catching up with further research in healthcare quality in Saudi Arabia is needed because of the ongoing health transformation.

Knowledge, Attitude, and Willingness Toward Kidney Donation Among Health Sciences Students at King Saud Bin Abdulaziz University.

Background: End-stage renal disease, as one of the most serious and major health problems, does not have many treatment options available. One of the best treatment modalities used to cure this debilitating disease is kidney transplantation. However, with the continuous increase in number of patients diagnosed with it, there is not enough supply of the organ. The aim of our study is to assess knowledge about, attitude toward, and willingness to donate kidney among health science students at King Saud bin Abdulaziz University in comparison to the general population in Jeddah and to investigate the factors that play a role on their willingness. Methods: This is an observational, analytical, cross-sectional study design conducted in 2019. Two target populations were included: King Saud bin Abdulaziz University for Health Sciences students and the general population in Jeddah. Data were collected via a self-administered, close-ended, structured, and previously validated questionnaire that contained 39 items divided into four sections. SPSS program version 22 was used in data analysis. Results: Out of 685 surveyed participants, 179 (26.1%) were willing to donate their kidney, with students showing a higher rate of willingness (N = 101; 32.3%) than the general population (N = 78; 21%). However, only 46 (6.7%) out of the total population hold an organ donor card. In bivariate analysis, it was found that knowledge significantly associated with a higher rate of willingness among the student population than the general population, while positive beliefs were associated with increased willingness in the general population than students. Positive attitude appeared to play a role in higher willingness among the general population and student population. Conclusion: There is a low perception of awareness regarding kidney donation in both populations of this study. The willingness rate of health science students at King Saud bin Abdulaziz University and the general population was low when compared with other studies conducted internationally.

Renal outcome among children with posterior urethral valve: When to worry?

INTRODUCTION: Posterior urethral valve (PUV) is a congenital obstructive defect of male urethra that is diagnosed early during antenatal period with a presence of hydroureteronephrosis and associated with several morbidities including chronic kidney disease (CKD) that requires management, therefore, this study aim to evaluate the renal outcome of endoscopic valve ablation and urinary tract diversion in children with PUV, "when to worry, and what to do." METHODOLOGY: This is a retrospective cohort study reviewing medical records of all patients diagnosed with PUV that has been managed in Pediatric Urology Unit at King Abdul-Aziz Medical City, Jeddah in the period of 1998-2008 with proven diagnosis at age younger than 16 accounted for 39 patients, and with different multiple demographics such as antenatal and postnatal ultrasound findings, serum levels of preoperative creatinine, mode of surgical treatment (i.e., endoscopic valve ablation and urinary diversions). Patients were divided into two groups according to the initial surgical intervention. Patient's characteristics and other variables were analyzed; t-test and Chi-square test were used. RESULTS: During the follow-up period, (45%) developed CKD with a mean time of 5.5 years, 18% reach to end stage renal disease (ESRD), (10%) requiring dialysis. Abnormal creatinine level was detected in 69% (27/39) of our patients before the intervention and normalized in 97% after intervention. In comparison between the two intervention groups, CKD were developed in 60% of patients with urinary diversion in comparison to 33% for the endoscopic ablation group with no statistical significance with P = 0.09. The time to develop CKD was faster in the diversion group with mean age of 18 months (standard deviation [SD] 2 years) in comparison to endoscopic ablation group with mean age 6 years (SD 4 years). Similar results were observed for development of ESRD, patients who underwent diversion had slightly higher incidence of ESRD. In our cohort group, the main determinant for deterioration of the future kidney function was the level of serum creatinine, preoperatively. Moreover, recurrent urinary tract infections (UTIs) were developed in 64% of our cohort group and 49% of our population diagnosed with voiding dysfunction at 6 years of age. CONCLUSION: A child with PUV who has a risk factor does have an increased potential of developing CKD, knowing that the type of intervention offered to treat PUV has no impact on the outcome. Furthermore, not having any of the study mentioned risk factors doesn't rule out the possibility of developing comorbidities which suggest that any child with PUV always need to be worried about and longer follow-up is indicated. Early intervention, check cystoscopy after ablation, close follow-up with appropriate laboratory and radiological investigation when necessary are recommended, and to improve the quality of data to the level reaching to a meaningful conclusion with high accuracy, a national database system from all centers across the country should be implemented.

Effectiveness and Preparedness of Institutions' E-Learning Methods During the COVID-19 Pandemic for Residents' Medical Training in Saudi Arabia: A Pilot Study.

Background: Under the urgent circumstances of the COVID-19 pandemic, higher education institutions of an international scale have resorted to online education methods, exclusive or not. Among those, medical institutions are under double pressure, fighting the pandemic's effects and, at the same time providing efficient clinical training to their residents. The main aim of the study is to evaluate the preparedness of the educational institutions for the e-learning platform transition for the delivery of medical training and also to evaluate the overall satisfaction level of the participants with their e-learning experience. Methods: This is an observational cross-sectional study design. The survey's sample included 300 medical students and residents of multiple training levels and specialties, coming from more than 15 different cities of Saudi Arabia. Filling the questionnaire required specific inclusion criteria and all obtained data were secured by the Saudi Commission of Health specialty. The main objective was to evaluate the quality of e-learning methods provided by medical universities. For the collection of the data, Survey Monkey software was used and the analysis was conducted with SPSS. Results: The study found that the frequency of digital education use increased by ~61% during the coronavirus crisis, while almost 9 out of 10 residents have used some e-learning platform. It was reported that before the pandemic, participants' online training was deemed to be rather ineffective, given the rate of 3.65 out of 10. However, despite the increase in e-learning use after COVID-19, many obstacles arose duringcthe adaptation process. According to our survey: lectures and training sessions were not conducted as per the curriculum (56.33%); both students and instructors' academic behavior and attitude changed (48.33%); engagement, satisfaction, and motivation in class were rated low (5.93, 6.33, and 6.54 out of 10 accordingly), compared to the desired ones. Still, participants accredited e-learning as a potential mandatory tool (77.67%) and pinpointed the qualifications that in their opinion will maximize educational impact. Conclusion: The study concluded that innovative restructuring of online education should be based on defined critical success factors (technical support, content enhancement, pedagogy etc.) and if possible, set priority levels, so that a more permanent e-learning practice is achievable. Also our study confirmed that students were overall satisfied with the e-learning support of the training method.

Challenges and Obstacles Faced by Trainee Female Physicians: An Integrative Research on Gender Discrimination, Stress, Depression and Harassment.

This study's purpose is to assess the challenges and obstacles faced by female trainee physicians and suggest solutions that could resolve these issues and improve their performance. The study utilized an observational, analytical, cross-sectional design based on a self-administered open-ended and validated questionnaire which was distributed to 133 recruited female resident trainees of medical units in Jeddah, Saudi Arabia. The findings of the study revealed that 52% female trainees experienced gender discrimination, mostly (65%) by their superiors, while 40% were regularly harassed. About half (53%) of the interviewees were severely depressed, resulting in their reconsidering their career in medicine. A total of 14% thought of suicide, while four planned to end and five had attempted to end their life. However, only eight (6%) participants officially reported the cases of harassment to the accountable superiors. Half of them felt neglected by the healthcare administration, and one-fourth (24%) were underachieving in their studies and work. The study concluded that work dissatisfaction, limited clinical correspondence, high depression, burnout, stress and drop-out rates-all deriving from common gender discrimination-compose the alarming and complex challenges that female trainee residents in Jeddah of various levels and specialties have to face.

Faculty Members' Perspective on Virtual Interviews for Medical Residency Matching during the COVID-19 Crisis: A National Survey.

During the COVID-19 pandemic, conducting face-to-face medical residency interviews was challenging due to infection prevention precautions, social distancing, and travel restrictions. Virtual interviews were implemented by the Saudi Commission for Health Specialties (SCFHS) as an alternative process for residency matching while striving to maintain the same quality standards. This national survey was conducted to assess the satisfaction and perceptions of faculty members' virtual interview performance in the assessment for the medical training residency programs. Among the participating 173 faculty members, 34.1% did not have previous experience with video-conferencing. The Zoom application was the most commonly used platform (65.9%). Most (89.6%) of the faculty perceived virtual interviews as "adequate" platforms on which the candidates could express themselves, while almost half of the faculty (53.8%) agreed that virtual interviews allowed them to accurately reach an impression about the candidates. Overall, 73.4% of faculty felt comfortable ranking the virtually interviewed candidates. We conclude that the acceptance of participating faculty members in the first Saudi medical residency training matching cycle virtual interviewing event was well-perceived. This study provides evidence for future application and research of virtual interviews in residency candidates' assessment, especially after the pandemic crisis resolves.

High grade primary vesicoureteral reflux in boys: long-term results of a prospective cohort study.

PURPOSE: We evaluated the incidence of new permanent defects in boys with grade 4 or 5 vesicoureteral reflux, identified the risk factors for new permanent defects and reviewed the outcome of different management approaches by assessing the rates of urinary tract infection and new permanent defects. MATERIALS AND METHODS: This prospective cohort study recruited patients from July 1995 to December 2006. Study inclusion criteria were male gender and grade 4 or 5 primary vesicoureteral reflux. Patients were divided into 2 groups by presentation mode, including group 1-prenatal reflux diagnosis and group 2-reflux diagnosed after investigation for urinary tract infection. All patients underwent initial renal (99m)Tc-dimercapto-succinic acid scan evaluation. Continuous antibiotic prophylaxis was given in all patients until at least age 2 years. Surgical correction for reflux was done in 28 patients and 76 were circumcised. Followup included renal (99m)Tc-dimercapto-succinic acid scan with renal ultrasound at age 12 months with repeat (99m)Tc-dimercapto-succinic acid scan at ages 2 and 4 years. RESULTS: Included in our study were 151 patients (206 high grade refluxing renal units) with a median age at diagnosis of 1.9 months (range 1 day to 8.8 years). Median age at first followup was 14 months (range 3 months to 3 years) and at next followup it was 39 months (range 10 months to 11.3 years). There were 52 boys (34%) in group 1 and 99 (66%) in group 2. Baseline perfusion defects on initial renal (99m)Tc-dimercapto-succinic acid scan were identified in 41 of 52 boys (78.8%) in group 1 and in 74 of 99 (74.7%) in group 2. During followup new permanent defects developed in 8 of 52 boys (15%) in group 1 and in 10 of 99 (10%) in group 2. In 18 patients a total of 20 renal units showed new permanent defects, including 13 in kidneys with baseline perfusion defects and 7 in previously normal kidneys (p >0.9). In groups 1 and 2 combined infection developed before and after circumcision in 62 of 137 (45.2%) and 5 of 74 cases (6.7%), respectively (p <0.001). New permanent defects were seen in 4 of 76 circumcised (5.2%) and in 14 of 137 uncircumcised boys (10.2%) (p >0.3). CONCLUSIONS: Baseline perfusion defects were seen on (99m)Tc-dimercapto-succinic acid scan at presentation in 115 of our 151 patients (76%) independent of presentation mode. New permanent defects developed in abnormal and previously normal kidneys, and were associated with urinary tract infection. Being circumcised was associated with fewer urinary tract infections and a lower incidence of observed new permanent defects (5.2% vs 10.2%).

Extravascular Lung Water and Effect on Oxygenation Assessed by Lung Ultrasound in Adult Cardiac Surgery.

Introduction The extravascular lung water content is determined by the use of lung ultrasound (LUS) which is represented as B-lines. The aim of this study was to investigate whether the LUS measurement of extravascular lung water was correlated to changes in oxygenation. Methods This prospective cohort study was comprised of 73 patients with an average age of 56 (range: 18 to 87 years) who underwent elective cardiac surgery using cardiopulmonary bypass. The LUS score was performed preoperatively, time zero (T0), at one hour (T1), and at 24 hours (T2) post-surgery. Additionally, arterial oxygen partial pressure and fraction of inspired oxygen (PaO2/FiO2) ratio were measured at each time and the time-to-extubation. Results A negative correlation was found between the LUS score and PaO2/FiO2 at T1 (p < 0.004). Extubation time and changes in the lung ultrasound score at T0 - T2 were positively correlated (p < 0.03). Plus, there was a positive correlation between fluid balance and lung ultrasound score at T2 (p < 0.03). Conclusion We found three significant correlations that support the use of LUS in cardiac surgery: 1) the more B-lines, the lower the oxygenation; 2) the more B-lines, the longer the period of ventilation; 3) the more B-lines, the more positive the fluid balance. LUS is a non-invasive bedside investigation that can be used to judge extravascular lung water, providing useful information in the management of patient oxygenation, fluid balance, and extubation.