Ethical uncertainty and COVID-19: exploring the lived experiences of senior physicians at a major medical centre.

Given the wide-reaching and detrimental impact of COVID-19, its strain on healthcare resources, and the urgent need for-sometimes forced-public health interventions, thorough examination of the ethical issues brought to light by the pandemic is especially warranted. This paper aims to identify some of the complex moral dilemmas faced by senior physicians at a major medical centre in Saudi Arabia, in an effort to gain a better understanding of how they navigated ethical uncertainty during a time of crisis. This qualitative study uses a semistructured interview approach and reports the findings of 16 interviews. The study finds that participants were motivated by a profession-based moral obligation to provide care during the toughest and most uncertain times of the pandemic. Although participants described significant moral dilemmas during their practice, very few identified challenges as ethical in nature, and in turn, none sought formal ethics support. Rather, participants took on the burden of resolving ethical challenges themselves-whenever possible-rationalising oft fraught decisions by likening their experiences to wartime action or by minimising attention to the moral. In capturing these accounts, this paper ultimately contemplates what moral lessons can, and must be, learnt from this experience.

Cost Consequence Analysis of Belimumab versus Standard of Care for the Management of Systemic Lupus Erythematosus in Saudi Arabia: A Retrospective Cohort Study.

BACKGROUND: Belimumab use for the management of systemic lupus erythematosus (SLE) has been limited, in part due to its high acquisition cost relative to the standard of care (SoC) and the uncertainties about its cost-effectiveness. Therefore, the aim of this study was to compare the cost and effectiveness of belimumab versus the SoC alone for the management of SLE using real-world data from the perspective of public healthcare payers in Saudi Arabia. METHODS: Data were retrieved from a national prospective cohort of SLE, Saudi Arabia. Adult SLE patients (≥18 yrs.) treated with belimumab plus the SoC or the SoC alone for at least six months were recruited. The effectiveness was measured using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Unit costs for health services and prescription drugs were retrieved from the Saudi ministry of health. Nonparametric bootstrapping with inverse probability weighting was conducted to generate the 95% confidence limits for the cost and effectiveness. RESULTS: A total of 15 patients on belimumab plus the SoC and 41 patients on the SoC alone met the inclusion criteria and were included in the analysis. The majority of patients were females (91.07%) with a mean age of 38 years. The mean difference in cost and SLEDAI-2K score reduction between belimumab versus the SoC were USD 5303.16 [95% CI: USD 2735.61-USD 7802.52] and 3.378 [95% CI: 1.769-6.831], respectively. Belimumab demonstrated better effectiveness but higher cost in 96% of the bootstrap cost-effectiveness distributions. CONCLUSION: Future studies should use more robust research designs and a larger sample size to confirm the findings of this study.

Assessment of Fear of Failure Among Medical Students at King Saud University.

Background: Fear of failure (FoF) is described as a "dispositional tendency to avoid failure in achievement settings." It may potentially and adversely affect students' ability to perform well in their educational activities. Objectives: To measure FoF among medical students at King Saud University, FoF between men and women, academic levels, grade point average (GPA), and other factors among medical students were compared. Method: A cross-sectional observational study was carried out using a stratified random sampling method. A total of 455 medical students completed "the Performance Failure Appraisal Inventory" during the academic year 2019-2020 at King Saud University, Riyadh, Saudi Arabia. Results: The results showed that the mean of FoF was -0.3117. Moreover, higher levels of fear of devaluing one's self-estimate were seen in women, and higher levels of fear of important others losing interest were seen in men. A significant relation was seen between different academic levels and fear of shame and embarrassment, fear of upsetting important others, as well as FoF. Higher levels of FoF were seen in those who had a GPA below 3.5 and a GPA greater than 4.9. Also, it was high in students who were not interested in studying medicine. The Cronbach's α value of 0.93 of all items indicates good internal consistency, and the factor analysis confirms five items of an instrument. Conclusion: The overall level of FoF was low among medical students at King Saud University. However, the domains and levels of FoF differed significantly according to gender, academic level, GPA, and interest in studying medicine.