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The aim of this study is to explore the effects of clinical supervision, and assessment characteristics on the study strategies used by undergraduate medical students during their clinical rotations. We conducted a qualitative phenomenological study at King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia during the period from November 2007 to December 2008. We conducted semi-structured focus groups interviews with students and conducted individual interviews with teachers and students to explore students' and clinical teachers' perceptions and interpretations of factors influencing students' study strategies. Data collection was continued until saturation was reached. We used Atlas-ti Computer Software (Version 5.2) to analyse the data, apply the obtained themes to the whole dataset and rearrange the data according to the themes and sub-themes. Analysis of data from interviews with twenty-eight students and thirteen clinical supervisors yielded three major themes relating to factors affecting students' study strategies: "clinical supervisors and supervision", "stress and anxiety" and "assessment". The three themes we identified played a role in students' adoption of different study strategies in the "community of clinical practice". It appeared that teachers played a key role, particularly as assessors, clinical supervisors and as a source of stress to students. (Contains 1 table and 2 figures.)

AIM: The aim of this study was to study the clinical characteristic of patient with refractory asthma (RA) from Saudi Arabia. METHODS: This paper prospectively studied in a university hospital factors leading to RA in a cohort of patients who have inadequately controlled asthma or with frequent exacerbations despite optimum controller therapy. It also studied patients with asthma that requires extended periods of oral steroids to control. RESULTS: The mean age was 45.1 years (±9.1) where 74 patients were enrolled in this study with the age group (37–48 years) is having the highest percentage (64.8%). Female patients represented 62.2%. The two major comorbid conditions were allergic rhinitis (54.1%) and gastroesophageal reflux (33.8%). The vast majority (72 patients) had at least one trigger factor for asthma (97.3%). The asthma control test showed that 86.4% had an uncontrolled status. Spirometry showed mild disease in 9.5%, moderate in 47.3%, and severe in 43.2%. Eosinophilia was seen in only 16.2%. Immunoglobulin E level between 70 and 700 μg/L was found in 58.1% of patients. CONCLUSION: RA has certain clinical characteristics and associated comorbid conditions as well as precipitating factors that facilitate the identifications of these cases. [ABSTRACT FROM AUTHOR]

This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan. [ABSTRACT FROM AUTHOR]

Influenza viruses are responsible for the infl uenza outbreaks that lead to signifi cant burden and cause signifi cant morbidity and mortality worldwide. Based on the core proteins, infl uenza viruses are classifi ed into three types, A, B, and C, of which only A and B cause signifi cant human disease and so the vaccine is directed against these two subtypes only. The effectiveness of the vaccine depends on boosting the immune system against the serotypes included within it. As infl uenza viruses undergo periodic changes in their antigen, the vaccine is modifi ed annually to ensure susceptibility. In contrast to other countries, Saudi Arabia faces a unique and challenging situation due to Hajj and Umrah seasons, when millions of people gather at the holy places in Mecca and Madinah, during which infl uenza outbreaks are commonly found. Such challenges making the adoption of strict vaccination strategy in Saudi Arabia is of great importance. All efforts were made to develop this guideline in an easy-to-read form, making it very handy and easy to use by health care workers. The guideline was designed to provide recommendations for problems frequently encountered in real life, with special consideration for special situations such as Hajj and Umrah seasons and pregnancy. [ABSTRACT FROM AUTHOR]

The diagnosis of deep venous thrombosis (DVT) may be challenging due to the inaccuracy of clinical assessment and diversity of diagnostic tests. On one hand, missed diagnosis may result in life-threatening conditions. On the other hand, unnecessary treatment may lead to serious complications. As a result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia (KSA), an expert panel led by the Saudi Association for Venous Thrombo-Embolism (SAVTE; a subsidiary of the Saudi Thoracic Society) with the methodological support of the McMaster University Working Group, produced this clinical practice guideline to assist healthcare providers in evidence-based clinical decision-making for the diagnosis of a suspected first DVT of the lower extremity. Twenty-four questions were identified and corresponding recommendations were made following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. These recommendations included assessing the clinical probability of DVT using Wells criteria before requesting any test and undergoing a sequential diagnostic evaluation, mainly using highly sensitive D-dimer by enzyme-linked immunosorbent assay (ELISA) and compression ultrasound. Although venography is the reference standard test for the diagnosis of DVT, its use was not recommended. [ABSTRACT FROM AUTHOR]

The Saudi Thoracic Society (STS) launched the Saudi Initiative for Chronic Airway Diseases (SICAD) to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease (COPD). This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test (CAT) and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation (<2 in the past year) can be classified as either Class I when they have less symptoms (CAT < 10) or Class II when they have more symptoms (CAT ≥ 10). High-risk COPD patients, as manifested with ≥2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score ≥10. The article also discusses the diagnosis and management of acute exacerbations in COPD. [ABSTRACT FROM AUTHOR]

Objectives To derive prediction equations of spirometric values of healthy Saudi adults and to compare the derived equations with equations reported in selected population. Methods Cross-sectional study of healthy nonsmoking men and women Saudi adults. The measured spirometric values were the forced vital capacity ( FVC), forced expiratory volume in 1 s ( FEV1), peak expiratory flow ( PEF) and forced mid-expiratory flow ( FEF 25%-75%). Results A total of 621 spirometric tests were done. The prediction equations were derived using the following formula: Predicted spirometric value = constant + (b1 × age) + (b2 × height (cm)), where b1 and b2 represent the regression coefficients for age and height, respectively. [ABSTRACT FROM AUTHOR]

This an updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on "difficult-to-treat asthma." Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient-doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify the predictors that lead to cigarette smoking among high school students by utilizing the global youth tobacco survey in Riyadh, Kingdom of Saudi Arabia (KSA). METHODS: A cross-sectional study was conducted among high school students (grades 10-12) in Riyadh, KSA, between April 24, 2010, and June 16, 2010. RESULTS: The response rate of the students was 92.17%. The percentage of high school students who had previously smoked cigarettes, even just 1-2 puffs, was 43.3% overall. This behavior was more common among male students (56.4%) than females (31.3%). The prevalence of students who reported that they are currently smoking at least one cigarette in the past 30 days was 19.5% (31.3% and 8.9% for males and females, respectively). "Ever smoked" status was associated with male gender (OR = 2.88, confidence interval [CI]: 2.28-3.63), parent smoking (OR = 1.70, CI: 1.25-2.30) or other member of the household smoking (OR = 2.11, CI: 1.59-2.81) who smoked, closest friends who smoked (OR = 8.17, CI: 5.56-12.00), and lack of refusal to sell cigarettes (OR = 5.68, CI: 2.09-15.48). CONCLUSION: Several predictors of cigarette smoking among high school students were identified. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study the prevalence and characteristics of cigarette smoking among secondary school students (16- to 18-year-old boys and girls) in Riyadh city, Saudi Arabia. METHODS: We applied a standard two-stage, cross-sectional study design. Secondary schools for both boys and girls in Riyadh city were randomly selected using a cluster sampling method. We used the global youth tobacco survey (GYTS) tool to achieve our objectives. RESULTS: Among 1272 students (606 boys and 666 girls), the prevalence of those ever smoked cigarettes was 42.8% (55.6% of boys and 31.4% of girls). The prevalence of current smoking was 19.5% (31.2% of boys and 8.9% of girls). Despite the fact that the majority of students think smoking is harmful, most do not wish to stop smoking, and they had not tried to stop in the past year. Cigarette smoking is significantly associated with the male gender, having friends who smoke, and having parents who smoke, but is not significantly associated with the type of school attended. CONCLUSION: Smoking prevalence among secondary schools students in Saudi Arabia is high and alarming. There is a need to implement an education program about the risks of smoking and to include parents and friends as healthy models to prevent students from beginning to smoke. [ABSTRACT FROM AUTHOR]

The Saudi Initiative for Asthma (SINA) provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and longstanding experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Unconventional therapy (UT) is a therapeutic practice of alternative and complementary medicine that is not currently considered an integral part of modern medical practice. The aim of this article is to investigate the experience of Saudi patients with UT modalities in the treatment of asthma. MATERIALS AND METHODS: We carried out a cross-sectional study of asthma patients referred to King Abdulaziz Medical City, Riyadh, Saudi Arabia, during the year 2004. Information was collected using a pre-designed questionnaire administered through interviews. RESULTS: Two hundred consecutive patients with a mean age of 52.3 years (±18.7) were included in this study. Sixty-nine (34.5%) of those patients used some form of UT in the previous year. There was a tendency to use UT among the older age group (P = 0.029) and among those with longer duration of disease (P = 0.009). However, there was no significant correlation observed between the use of UT and gender, FEV1, or disease control. The most commonly used form of UT was recitation of Holy Quran (9%), honey (24.5%), herbs (23.5%), cautery (12%), and blackseed (10%). There was no significant correlation between disease control and the use of modalities. CONCLUSION: Unconventional therapy is frequently practiced by asthma patients in Saudi Arabia, who commonly believe that UT will lead to improvement. The lack of evidence necessitates the fostering of a national project to address the practice of UT. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate asthma control after the introduction of a leukotriene modifier (Montelukast), in addition to the current controller asthma therapies, in patients with inadequately controlled mild-to-moderate persistent asthma. Asthma control and patient perception were assessed prior to, and 4 weeks after, the introduction of Montelukast, and the pre-introduction and post-introduction results were compared. Materials and Methods: A cross-sectional, observational study collected information on 1,490 eligible adult asthmatic patients in Saudi Arabia. The eligibility criteria included patients aged 15 years or more with symptomatic mild-to-moderate persistent asthma despite treatment with inhaled corticosteroids with or without long-acting beta agonist; also, the patient should attend the initial visit and follow-up visits after at least 4 weeks. Results: Of the 1,490 eligible patients, 79.5% received inhaled corticosteroids alone, and the remaining 20.5% received combination of inhaled corticosteroids and long-acting bronchodilator. Despite the treatment with daily controller medications, asthma symptoms persisted in more than two-thirds of the study population. Upon adding Montelukast, more than 80% of patients reported improvement in symptoms, which was consistent in all patients irrespective of corticosteroid type or dose (stratum) or the addition of long-acting β2-agonist. At the follow-up visit, 92.2% of patients reported that they felt better on Montelukast. Conclusion: Leukotriene modifier Montelukast has significant additive benefits in the management of patients who suffer from mild-to-moderate asthma and who are inadequately controlled on inhaled corticosteroids therapy with or without long-acting bronchodilator. [ABSTRACT FROM AUTHOR]

The author ponders the issue of tobacco consumption in Saudi Arabia as of October 2010. He points out the increasing prevalence of smoking and increase in the number of women smokers. He expresses concern over the prevalence of tobacco consumption among healthcare professionals and students. He asserts that the morbidity and mortality related to tobacco consumption can be reduced by re-enforcement of tobacco banning in Saudi Arabia with particular focus on younger people.

Aim:To study authentic leadership characteristics between academic leaders in a health sciences university. Methods:Cross-sectional study at a health sciences university in Saudi Arabia. The Authentic Leadership Questionnaire (ALQ) was utilized to assess authentic leadership. Results:Out of 84 ALQs that were distributed, 75 (89.3%) were eligible. The ALQ scores showed consistency in the dimensions of self-awareness (3.45 ± 0.43), internalized moral prospective (3.46 ± 0.33) and balanced processing (3.42 ± 0.36). The relational transparency dimension had a mean of 3.24 ± 0.31 which was significantly lower than other domains. Academic leaders with medical background represented 57.3%, compared to 42.7% from other professions. Academic leaders from other professions had better ALQ scores that reached statistical significance in the internalized moral perspective and relational transparency dimensions withpvalues of 0.006 and 0.049, respectively. In reference to the impact of hierarchy, there were no significant differences in relation to ALQ scores. Almost one-third of academic leaders (34.7%) had Qualifications in medical education that did not show significant impact on ALQ scores. Conclusion:There was less-relational transparency among academic leaders that was not consistent with other ALQ domains. Being of medical background may enhance leaders’ opportunity to be at a higher hierarchy status but it did not enhance their ALQ scores when compared to those from other professions. Moreover, holding a master in medical education did not impact leadership authenticity. [ABSTRACT FROM PUBLISHER]

The author focuses on the periodical "Annals of Thoracic Medicine" (ATM), founded by The Saudi Thoracic Society to enable original research, experience, and ideas to be communicated to the national and international scientific community. He cites that the periodical has taken the initiative to publish locally applicable guidelines for the management of several diseases, including pulmonary hypertension, lung cancer and bronchial asthma. He notes that ATM strives to adhere strictly to international standards.

We aimed from our study to assess how students and clinical supervisors perceive students' achievement in the internal medicine subspecialty clinical attachments in comparison with the general attachments. We conducted a cross-sectional study comparing students' self-assessment ratings during the Medicine Block general and subspecialties clinical attachments at our college of medicine during the period between February 2007 and June 2009. We assessed the level of agreement between students' self-assessment in the different subspecialties with their self-assessment in the general attachments. We repeated the same calculation for the supervisors' assessment. Eighty-three students were included; these students attended eight different clinical attachments. A total of 517 self-assessment forms were completed (120 general internal medicine clinical attachments and 397 forms in different specialty attachments). The clinical supervisors completed parallel assessment forms. The undergraduate medical students' perceived their achievement in the subspecialty attachments well. This was similar to their perception of their achievement in the general clinical attachments. The clinical supervisors perceived students achievement in the subspecialties to be similar to their achievement in the general clinical attachments. In conclusion, we do encourage the implementation of specialty and subspecialty undergraduate clinical attachments for all students as part of their curriculum requirements. Furthermore, we encourage the strategic utilization of specialties/subspecialties attachment distribution aiming to enhance students' future interest to achieve balance in the different health specialties/subspecialties manpower. Further research to support this recommendation is needed.

Objective: To identify the prevalence and predictors of the water-pipe (WP) smoking epidemic in the Kingdom of Saudi Arabia (KSA)., Methods: A cross-sectional study conducted with 16-18 year-old high school students in Riyadh, Saudi Arabia., Results: Of the 1272 participants, 414 (33.0%) reported having tried WP smoking. Of this group, 141 (34.1%) were female and 273 (65.9%) were male. Further, 129 (10.2%) students were current WP smokers who had used at least one rock in the past month; 20 were female (1.6%) and 120 were male (8.6%). Regarding age, 276 (68.1%) students who tried WP smoking at least once began when they were over 11 years of age, whereas 129 (31.9%) began WP smoking at or before 11 years of age. Adjusted odds ratios showed that trying WP smoking at least once was associated with smoking after the age of 11 (p=0.021, OR 7.7; CI: 1.4-43.6) and accepting water-pipes from a friend (p=0.024, OR 10.6; CI: 1.4-83.4)., Conclusion: A high prevalence of WP smoking exists among male and female high schools students in Riyadh, KSA. WP smoking was reported to begin in early adulthood., (Copyright © 2012 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.)

Background: The aim of this study was to assess the responsiveness of the asthma control test (ACT) to detect changes at the initiation of therapy and its utilization in the initiation of asthma treatment., Methods: This study was designed as a randomized clinical trial conducted in a primary care setting. The subjects were asthma patients who had not received controller therapy for at least two months. The patients were randomized into two groups: The Saudi Initiative for Asthma (SINA) group and the Global Initiative for Asthma (GINA) group. Treatment in the SINA group was initiated at step1 when the ACT scores ≥ 20, step 2 when the score between16-19, and step 3 when the score < 16 began at step 3. The GINA group patients were started on step 2 when they had persistent asthma symptoms or step 3 when they had severely uncontrolled disease., Results: Forty-five patients were analyzed in each group. The improvement in ACT score after treatment initiation was significantly higher when the SINA approach was used (2.9 in the SINA group compared to 1.7 in the GINA group (p = 0.04)). The improvement in FEV1 was 5.8% in the SINA group compared to 3.4% in the GINA group (p = 0.46). The number of patients who achieved asthma control at the follow-up visit and required no treatment adjustment was 33 (73.3%) in the SINA group and 27 (60%) in the GINA group (p = 0.0125)., Conclusion: The ACT was responsive to change at the initiation of asthma treatment and was useful for the initiation of asthma treatment., Trial Registration Number: ISRCTN31998214.

Background: Self-assessment is recognized as a necessary skill for lifelong learning. It is widely reported to offer numerous advantages to the learner. The research evaluated the impact of students' and supervisors' self-assessment and feedback training on students' perceptions and practices of self-assessment. Moreover, it evaluated the effect of self-assessment process on students' study strategies within a community of clinical practice., Methods: We conducted a qualitative phenomenological study from May 2008 to December 2009. We held 37 semi-structured individual interviews with three different cohorts of undergraduate medical students until we reached data saturation. The cohorts were exposed to different contexts while experiencing their clinical years' assessment program. In the interviews, students' perceptions and interpretations of 'self-assessment practice' and 'supervisor-provided feedback' within different contexts and the resulting study strategies were explored., Results: The analysis of interview data with the three cohorts of students yielded three major themes: strategic practice of self-assessment, self-assessment and study strategies, and feedback and study strategies. It appears that self-assessment is not appropriate within a summative context, and its implementation requires cultural preparation. Despite education and orientation on the two major components of the self-assessment process, feedback was more effective in enhancing deeper study strategies., Conclusion: This research suggests that the theoretical advantages linked to the self-assessment process are a result of its feedback component rather than the practice of self-assessment isolated from feedback. Further research exploring the effects of different contextual and personal factors on students' self-assessment is needed.

Objective: To produce a conceptually equivalent Arabic version of the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT), and to assess its reliability., Methods: A prospective observational study was carried out from June 2010 to September 2010 at King Abdulaziz Medical City and King Khalid University Hospital, Riyadh, Saudi Arabia. We conducted this study in 2 phases. Phase 1: the translation of the CAT from English to Arabic, through forward and backward translation, as well as pilot testing. Phase 2: assessment of the test-retest reliability of the CAT for 45 patients with COPD who received optimal care by their pulmonologist., Results: This study was conducted on 45 participants. The CAT mean total (+/- SD) score at the test session was 10.7+/-5.8, and 9.2+/-4.5 at the re-test session. The interclass correlation of the total score was 0.9 (p=0.000076). The strongest correlation was for the item of confidence in leaving home with a value of 0.92 (p=0.000082), whereas the weakest was for the item related to sleep with a value of 0.53 (p=0.007)., Conclusion: The Arabic version of the CAT was found to be easy to administer, reliable, and had a strong interclass correlation reflecting stability over time and across the items.

Objective: To present the experience with the first pulmonary rehabilitation (PR) program in Saudi Arabia., Methods: The prospectively collected data of patients referred to PR program in Saudi Arabia over 30 months starting on July 2004, were reviewed. A standard outpatient PR was offered to those patients with chronic lung diseases. Those patients attended to were classified as adherent or non adherent. There data were analyzed, as well as, the reasons for non-adherence., Results: Out of 121 patients referred to the PR center during the study period, 89 (73.6%) attended PR program and 32 (26.4%) did not attend their initial appointment. Among 89 patients who attended the PR program, 51 (57.3%) were adherent, while 38 (42.7%) attended but were non-adherent. The demographic data and the basic physiological parameters of both groups were not significantly different. Reasons for non-adherence were: difficulties in transportation (34.2%), admission to the hospital (23.7%), and no specific reason (42.1%). Upon completion of the PR, the exercise parameters in the adherent group showed significant improvement in the 6 minutes walk distance, and the distance and time spent in the treadmill, arm ergometer, and bicycle., Conclusion: Implementing a PR program in a tertiary care centre in Saudi Arabia was feasible and led to marked improvement in exercise performance and overall physical fitness.