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Bipolar disorders (BP) are prevalent neuropsychiatric illnesses affecting 1%–5% of the global population and about 3% of the Saudi population. They are associated with significant comorbidities and negative consequences. Despite being common mental health conditions in Saudi Arabia, stigma persists, with weak character, supernatural beliefs, and weak faith considered as causes. In addition, Saudi patients with BP have been reported to seek help from non-psychiatric healthcare professionals and faith healers. More data are required on BP from Saudi Arabia, including the genetic aspects and their treatment approaches. This narrative review paper explores the epidemiology and clinical manifestations, etiology and biological mechanisms, public knowledge and awareness of the illnesses, and treatment of BP in Saudi Arabia.

IntroductionCyber situational awareness is critical for detecting and mitigating cybersecurity threats in real-time. This study introduces a comprehensive methodology that integrates the Isolation Forest and autoencoder algorithms, Structured Threat Information Expression (STIX) implementation, and ontology development to enhance cybersecurity threat detection and intelligence. The Isolation Forest algorithm excels in anomaly detection in high-dimensional datasets, while autoencoders provide nonlinear detection capabilities and adaptive feature learning. Together, they form a robust framework for proactive anomaly detection.MethodsThe proposed methodology leverages the Isolation Forest for efficient anomaly identification and autoencoders for feature learning and nonlinear anomaly detection. Threat information was standardized using the STIX framework, facilitating structured and dynamic assessment of threat intelligence. Ontology development was employed to represent knowledge systematically and enable semantic correlation of threats. Feature mapping enriched datasets with contextual threat information.ResultsThe proposed dual-algorithm framework demonstrated superior performance, achieving 95% accuracy, a 99% F1 score, and a 94.60% recall rate. These results outperformed the benchmarks, highlighting the model’s effectiveness in proactive anomaly detection and cyber situational awareness enhancement.DiscussionThe integration of STIX and ontology development within the proposed methodology significantly enhanced threat information standardization and semantic analysis. The dual-algorithm approach provided improved detection capabilities compared to traditional methods, underscoring its potential for scalable and effective cybersecurity applications. Future research could explore further optimization and real-world deployments to refine and validate the approach.

The use and perceptions of smartphone-based mental health applications (MH-Apps) in Saudi Arabia require exploration. This study investigated MH-App use among Saudi Arabian healthcare workers (HCWs), including psychiatrists, psychologists, and family medicine physicians. It also assessed HCWs' interest in and willingness to integrate these apps into their practices, as well as their cognitive flexibility and its relationship with their attitudes and app use. This cross-sectional study involved 386 participants recruited using convenience and snowball sampling. The Cognitive Flexibility Scale (CFS) was used to assess cognitive flexibility. The results showed that 33.2% of HCWs downloaded MH-Apps, with 67.9% considering them somewhat beneficial. However, most had not yet tried them. Only 7% of HCWs strongly agreed that these apps are evidence-based. Concerns about using these apps in their practices were reported by 36.5% of HCWs, with the most common concern being the lack of evidence-based support. The primary reason for downloading MH-Apps for personal use was to improve mental well-being, whereas patient-related use was psychoeducation. Furthermore, 27.5% of HCWs recommended MH-Apps to their patients, with old age, women, and psychiatrists/psychologists more likely to recommend them. Higher CFS scores were more strongly associated with older HCWs, those who had ever recommended MH-Apps, and those who used the apps. Saudi Arabian HCWs should be encouraged to use and recommend MH-Apps, with more evidence-based research needed to address concerns. Further research on cognitive flexibility's implications for clinical practice is also warranted. [ABSTRACT FROM AUTHOR]

Introduction: Indwelling urinary catheters (IUCs) are frequently used in emergency departments (EDs), but many insertions lack clear indications, leading to potential overuse. This overuse contributes to catheter-associated urinary tract infections (CAUTIs), costing billions in preventable healthcare expenses. Campaigns such as Choosing Wisely and Centers for Disease Control and Prevention guidelines aim to reduce unnecessary IUC use, improve patient outcomes and prevent CAUTIs. Materials and Methods: A cross-sectional survey and retrospective chart review were conducted at an academic tertiary care centre. The survey targeted ED providers, including physicians and nurses, while the chart review encompassed all adult ED patients in 2022. The survey covered demographic information, self-reported understanding and attitudes towards urinary catheters, including clinical scenarios, to evaluate the knowledge of appropriate indications for IUC insertion. The data analysis was performed using NCSS software and involved t -tests or one-way analysis of variance to explore associations between sample characteristics and knowledge scores. The significance level for all analyses was set at P < 0.05. Results: A total of 96 of the 198 ED staff members participated in the survey. The confidence rate for knowledge of appropriate indications for IUC insertion was 100% among physicians and 97.8% among nurses. However, the results from the clinical scenarios in the survey showed that participants incorrectly answered in a range of 8%–75%. The mean scores of correct answers among consultants, residents and nurses were 65%, 67% and 66%, respectively. Conclusion: There is a considerable gap between ED healthcare providers' subjective knowledge and attitudes and objective knowledge of appropriate IUC placement, which serves as a basis for an intervention to reduce the potential for inappropriate IUC insertion. [ABSTRACT FROM AUTHOR]

Bipolar disorders (BP) are prevalent neuropsychiatric illnesses affecting 1%–5% of the global population and about 3% of the Saudi population. They are associated with significant comorbidities and negative consequences. Despite being common mental health conditions in Saudi Arabia, stigma persists, with weak character, supernatural beliefs, and weak faith considered as causes. In addition, Saudi patients with BP have been reported to seek help from non-psychiatric healthcare professionals and faith healers. More data are required on BP from Saudi Arabia, including the genetic aspects and their treatment approaches. This narrative review paper explores the epidemiology and clinical manifestations, etiology and biological mechanisms, public knowledge and awareness of the illnesses, and treatment of BP in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Specialty pharmacy practice requires unique patient-centric care, emphasizing high-cost medications, complex treatment regimens, and medications requiring special handling. We conducted this study to assess the effect of specialty pharmacy practice on patient and healthcare provider (HCP) satisfaction and pharmacy practice–related outcomes. This prospective, concurrent, and historically controlled cohort study was performed in an ambulatory care setting for over 6 months and included 6 specialties: neurology, pediatrics, dermatology, gastroenterology, pediatric liver transplantation, and medical genetics. The workflow of the pharmacy was redesigned to serve the objective of specialized counseling and dispensing windows. Patients who visited selected clinics during the study period were included. The primary endpoint was the weighted scores for patient and HCP satisfaction obtained via a validated satisfaction survey. The secondary endpoints included pharmacy operation-related outcomes, such as patient's waiting time, pharmacist intervention, and patient adherence to specialty medications. Of the 3827 patients approached for study participation, 3620 were recruited (94.5%). Of the 175 HCPs approached, 161 were recruited. Patient satisfaction scores improved from 4.27 to 4.69 after intervention (P < 0.05). Although there was no significant change in pharmacists' satisfaction, a significant improvement in other HCP satisfaction was observed (3.7–4; P = 0.008). The average wait time was reduced from 25 to 12 min (P < 0.05). The number of documented pharmacist interventions was 3 per 100 patients. Patient adherence improved from 73.6% to 85.6% based on the number of days covered (P = 0.03). Implementing specialty pharmacies improved the overall satisfaction of patients and health care providers and enhanced work efficiency, as demonstrated by reduced pharmacy waiting time and patient adherence to specialty medications. [ABSTRACT FROM AUTHOR]

Importance: Sepsis screening is recommended among hospitalized patients but is supported by limited evidence of effectiveness., Objective: To evaluate the effect of electronic sepsis screening, compared with no screening, on mortality among hospitalized ward patients., Design, Setting, and Participants: In a stepped-wedge, cluster randomized trial at 5 hospitals in Saudi Arabia, 45 wards (clusters) were randomized into 9 sequences, 5 wards each, to have sepsis screening implemented at 2-month periods. The study was conducted between October 1, 2019, and July 31, 2021, with follow-up through October 29, 2021., Intervention: An electronic alert, based on the quick Sequential Organ Failure Assessment score, was implemented in the electronic medical record in a silent mode that was activated to a revealed mode for sepsis screening., Main Outcomes and Measures: The primary outcome was 90-day in-hospital mortality. There were 11 secondary outcomes, including code blue activation, vasopressor therapy, incident kidney replacement therapy, multidrug-resistant organisms, and Clostridioides difficile., Results: Among 60 055 patients, 29 442 were in the screening group and 30 613 in the no screening group. They had a median age of 59 years (IQR, 39-68), and 30 596 were male (51.0%). Alerts occurred in 4299 of 29 442 patients (14.6%) in the screening group and 5394 of 30 613 (17.6%) in the no screening group. Within 12 hours of the alert, patients in the screening group were more likely to have serum lactate tested (adjusted relative risk [aRR], 1.30; 95% CI, 1.16-1.45) and intravenous fluid ordered (aRR, 2.17; 95% CI, 1.92-2.46) compared with those in the no screening group. In the primary outcome analysis, electronic screening resulted in lower 90-day in-hospital mortality (aRR, 0.85; 95% CI, 0.77-0.93; P < .001). Screening reduced vasopressor therapy and multidrug-resistant organisms but increased code blue activation, incident kidney replacement therapy, and C difficile., Conclusions and Relevance: Among hospitalized ward patients, electronic sepsis screening compared with no screening resulted in significantly lower in-hospital 90-day mortality., Trial Registration: ClinicalTrials.gov Identifier: NCT04078594.