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Objective: This study aimed to determine the prevalence of polypharmacy, comorbidities and to investigate factors associated with polypharmacy among adult patients with Chronic Obstructive Pulmonary Disease (COPD). Methods: This was a retrospective single-centre cross-sectional study. Patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 February 2020 and 1 March 2023 were included in this study. Patients were excluded if a pre-emptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Population characteristics were presented as frequency for categorical variable. Logistic regression analysis was used to identify predictors of polypharmacy. Results: The study sample included a total of 705 patients with COPD. Most of the study sample were males (60%). The mean age of the study population was 65 years old. The majority of the study population had comorbid diseases (68%), hypertension and diabetes were the most common co-existent diseases. Around 55% of the study sample had polypharmacy. Females were significantly less likely to be on polypharmacy compared to males (OR = 0.68, 95% CI = [0.50–0.92], P-value = 0.012)). On the other hand, older patients aged 65.4 or more (OR = 2.31, 95% CI = [1.71–3.14], P-value ≤ 0.001), those with high BMI (≥ 29.2) (OR = 1.42, 95% CI = [1.05–1.92], P-value = 0.024), current smokers (OR = 1.9, 95% CI = [1.39–2.62], P-value ≤ 0.001), those who are receiving home care (OR = 5.29, 95% CI = [2.46–11.37], P-value ≤ 0.001), those who have comorbidities (OR = 19.74, 95% CI = [12.70–30.68], P-value ≤ 0.001) were significantly more likely to be on polypharmacy (p ≤ 0.05). Conclusions: Polypharmacy is common among patients with COPD. Patients with high BMI, previous ICU hospitalization and older age are more likely to have polypharmacy. Future analytical studies are warranted to investigate outcomes in patients with COPD and polypharmacy. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess the prevalence of needle phobia among Saudi and Egyptian adult populations. In addition, underlying causes and strategies that can be utilized to address needle fear were investigated. Methods: A cross-sectional online survey study was conducted in Saudi Arabia and Egypt between 1 May and 30 June 2023. Participants aged 18 years and above and living in Saudi Arabia and Egypt were eligible to complete the survey. Participants were invited to participate in this study through social media platforms (Facebook, X, Snapchat, and Instagram). A convenience sampling technique was used to recruit the study participants. A 21-item questionnaire consisting of four sections including a Likert scale score was used to answer the research objectives. Numeric data were presented as mean ± SD. For categorical variables, percentages were used. Comparison between groups were made by Student's t-test or Mann Whitney test according to data distribution. Chi squared tests for categorical values were conducted. A binary logistic regression analysis was conducted to investigate factors associated with needle phobia. Results: A total of 4065 participants were involved in this study (Saudi Arabia: 2628 and Egypt: 1437). Around one-third of the study participants (36.5%) confirmed that they have needle phobia. Most of the study participants (81.1%) reported that they have had needle phobia since they were under 18 years of age. Pain, general anxiety, and fear of making a mistake during the procedure were the most commonly reported contributors for fear of needles during or before a medical procedure. Around 15.8% of the study participants reported that they have tried to get rid of phobia from needles. Non-surgical alternatives (such as oral medications and patches) and using smaller/thinner needles were the most commonly reported interventions that reduced fear of needles. Binary logistic regression analysis identified that females, those who are aged (41–50 years), widowed, those with bachelor's degrees and higher education, and those unemployed were more likely to have needle phobia compared to others. Conclusion: Our study highlighted the high prevalence of needle fear within an adult population in Egypt and Saudi Arabia. Females, those who are aged (41–50 years), those widowed, those with higher education degrees, those unemployed, those working in the health sector and people with low income were more likely to have needle phobia compared to others. [ABSTRACT FROM AUTHOR]

This study aims to assess beliefs about asthma controller medications among parents of Saudi Arabian children with asthma and the association between these beliefs and medication adherence using the Necessity-Concerns Framework. A cross-sectional survey was provided to parents of children with asthma when they brought their children to routine appointments at local public clinics between May 16 and July 10, 2018. Participants electronically filled out validated Arabic versions of the Medication Adherence Reported Scale (MARS) and Beliefs About Medications Questionnaire (BMQ). Descriptive statistics were used to characterize the study participants, while hierarchical linear regression analysis assessed associations between parental beliefs about controller medications and medication adherence. A total of 381 parents of children with asthma completed the study survey. The vast majority (89%) of study participants were non-adherent to their children's prescribed medications while only 11% were adherent. Additionally, our study revealed a significantly positive association between adherence and parents' beliefs in the necessity of the medication (p <.001), with concerns about the adverse effects of medication being negatively associated with parental adherence. A higher mean score for medication adherence was reported among the ambivalent groups compared to the accepting, indifferent, and skeptical groups. Medication adherence among parents of children with asthma was relatively low. In addition, necessity beliefs were significantly associated with parental adherence to controller medications for their children with asthma. Further studies are warranted to investigate potential factors contributing to poor parental adherence and develop tailored interventions that support parental medication adherence for their asthmatic children. [ABSTRACT FROM AUTHOR]

Background: Nonadherence to therapies and psychological disorders are associated with poor asthma control. This study aims to assess the prevalence of anxiety and depressive symptoms, asthma control, and adherence to inhalers and to investigate whether there is an association of anxiety and depressive symptoms with adherence to inhalers and asthma control. Methods: We measured anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale in patients with asthma. Asthma Control Test and the 10-Item Test of Adherence to Inhalers Scale were used to assess levels of asthma control adherence to inhalers, respectively. Univariate and multivariate regression models assessed the associations of anxiety and depressive symptoms with adherence to inhalers and asthma control. Results: A total of 287 patients completed the study, of whom 72% were female. The mean ± SD age and body mass index of our study population were 44 ± 13 years and 29 ± 7.2 kg/m2, respectively. Poor adherence to inhaler use was highly prevalent (49.8%; 95% CI: 43.8 to 55.7). The prevalence of anxiety, depression and poor asthma control was 27.2% (95% CI: 22.1 to 32.7), 20.9% (95% CI: 16.3 to 26.1), and 22.7% (95% CI: 17.9 to 27.9), respectively. We found a negative relationship between asthma control and anxiety, and depressive symptoms (adjusted β: -0.25; 95% CI: -0.36 to -0.14; p < 0.001 and adjusted β: -0.29; 95% CI: -0.40 to -0.18; p < 0.001, respectively). A negative relationship was also observed between adherence to inhalers and anxiety and depressive symptoms (adjusted β: -0.34; 95% CI: -0.46 to -0.22; p < 0.001 and adjusted β: -0.36; 95% CI: − 0.48 to − 0.24; p < 0.001, respectively). Conclusions: The high prevalence of uncontrolled asthma symptoms and poor adherence to inhalers and their impact on anxiety and depression levels among patients with asthma point to the need for early screening for psychological symptoms and recognition of nonadherence as part of asthma assessment and management plan in primary care in Saudi Arabia to avoid further worsening of asthma symptoms. Further studies are needed to explore the effectiveness of specific psychoeducational interventions and investigate the long-term impact of early psychological symptom detection on asthma outcomes. [ABSTRACT FROM AUTHOR]

Background: High-flow nasal cannula (HFNC) is an essential non-invasive oxygen therapy in acute respiratory distress syndrome (ARDS) patients. Despite its wide use, research assessing the knowledge, practice, and barriers to using HFNC among respiratory therapists (RT) is lacking. Methods: A cross-sectional questionnaire was conducted among RTs in Saudi Arabia between December 19, 2022, and July 15, 2023. Data were analyzed as means and standard deviation or frequency and percentages. A Chi-square test was used to compare the differences between groups. Results: A total of 1001 RTs completed the online survey. Two-thirds of the respondents 659 (65.8%) had received training in using HFNC and 785 (78.4%) had used HFNC in clinical settings. The top conditions for HFNC indication were COVID-19 (78%), post-extubation (65%), and do-not-intubate patients (64%). Participants strongly agreed that helping maintain conversation and eating abilities (32.95%) and improving shortness of breath (34.1%) were advantages of HFNC. Surprisingly, 568 (57%) of RT staff did not follow a protocol for HFNC with ARDS patients. When starting HFNC, 40.2% of the participants started with FiO2 of 61% to 80%. Additionally, high percentages of RT staff started with a flow rate between 30 L/minute and 40 L/minute (40.6%) and a temperature of 37°C (57.7%). When weaning ARDS patients, 482 (48.1%) recommended first reducing gas flow by 5– 10 L/minute every two to four hours. Moreover, 549 (54.8%) believed that ARDS patients could be disconnected from HFNC if they achieved a flow rate of < 20 L/minute and FiO2 of < 35%. Lack of knowledge was the most common challenge concerning HFNC implementation. Conclusion: The findings revealed nuanced applications marked by significant endorsement in certain clinical scenarios and a lack of protocol adherence, underscoring the need for uniform, evidence-based guidelines and enhanced training for RTs. Addressing these challenges is pivotal to optimizing the benefits of HFNC across varied clinical contexts. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the knowledge and current practice of using the airway pressure release ventilation (APRV) mode with acute respiratory distress syndrome (ARDS) patients and identify barriers to not using this mode of ventilation among nurses who work in critical areas in Saudi Arabia. Methods: Between December 2022 and April 2023, a cross-sectional online survey was disseminated to nurses working in critical care areas in Saudi Arabia. The characteristics of the respondents were analyzed using descriptive statistics. Percentages and frequencies were used to report categorical variables. Results: Overall, 1,002 nurses responded to the online survey, of whom 592 (59.1%) were female. Only 248 (24.7%) nurses had ever used APRV mode, whereas only 229 (22.8%) received training on APRV mode. Moreover, 602 (60.0%) nurses did not know whether APRV was utilized in their hospital. Additionally, 658 (65.6%) nurses did not know whether APRV mode was managed using a standard protocol. Prone positioning was the highest recommended intervention by 444 (43.8%) when a conventional MV failed to improve oxygenation in patients with ARDS. 323 (32.2%) respondents stated that the P-high should be set equal to the plateau pressure on a conventional ventilator, while 400 (39.9%) said that the P-low should match PEEP from a conventional ventilator. Almost half of the respondents (446, 44.5%) stated that the T-high should be set between 4 and 6 s, while 415 (41.4%) said that the T-low should be set at 0.4 to 0.8 s. Over half of the nurses (540, 53.9%) thought that the maximum allowed tidal volume during the release phase should be 4–6 ml/kg. Moreover, 475 (47.4%) believed that the maximum allowed P-high setting should be 35 cm H2O. One-third of the responders (329, 32.8%) stated that when weaning patients with ARDS while in APRV mode, the P-high should be reduced gradually to reach a target of 10 cm H2O. However, 444 (44.3%) thought that the T-high should be gradually increased to reach a target of 10 s. Half of the responders (556, 55.5%) felt that the criteria to switch the patient to continuous positive airway pressure (CPAP) were for the patient to have an FiO2 ≤ 0.4, P-high ≤ 10 cm H2O, and T-high ≥ 10 s. Lack of training was the most common barrier to not using APRV by 615 (61.4%). Conclusion: The majority of nurses who work in critical care units have not received sufficient training in APRV mode. A significant discrepancy was observed regarding the clinical application and management of APRV parameters. Inadequate training was the most frequently reported barrier to the use of APRV in patients with ARDS. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of intensive care unit (ICU) admission and its predictors among hospitalized chronic obstructive pulmonary disease (COPD) patients. Methods: An observational retrospective study was conducted. All patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 and 2020 and 1 March 2023 at Al-Noor Specialist Hospital were included in this study. Patients were excluded if a preemptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Descriptive results were presented as frequency (percentage) for categorical variables and mean (SD) for continuous variables and to estimate prevalence of ICU admission. Predictors of ICU admission among hospitalized COPD patients were determined using logistic regression analysis. A SPSS (Statistical Package for the Social Sciences) version 25 was used to perform all statistical analysis. Results: A total of 705 patients with COPD were included in this study. The mean age was 65.4 (25.3) years. Around 12.4% of the hospitalized patients were admitted to the ICD. Logistic regression analysis identified that older age (OR; 1.92, (1.41–2.62)), smoking (OR; 1.60 (1.17–2.19)), and having specific comorbidities (Hypertension (OR; 1.98 (1.45–2.71)), Diabetes mellitus (OR; 1.42 (1.04–1.93)), GERD (OR; 2.81 (1.99–3.96)), Ischemic heart disease (OR; 3.22 (2.19–4.75)), Obstructive sleep apnea syndrome (OR; 2.14 (1.38–3.33)), stroke (OR; 4.51 (2.20–9.26))) were predictors of ICU admissions among patients with COPD. Conclusions: Our study found that a step-up approach to inpatient COPD management requires admission to the ICU in 12.4%, for which age, smoking status, cardiovascular, and stroke were important predictors. Further clinical research is needed to provide a validated model that can be incorporated into clinical practice to monitor this patient population during their admission and identify at-risk individuals for early transfer to higher acuity settings and intensive care units. [ABSTRACT FROM AUTHOR]

Background: There is a concerning lack of representative data on chronic obstructive pulmonary disease (COPD) awareness in Saudi Arabia, and a significant proportion of the population is vulnerable to developing a smoking habit, which is a major risk factor for the disease. Methods: Population-Based Survey of 15,000 people was conducted to assess the public knowledge and awareness of COPD across Saudi Arabia from October 2022 to March 2023. Results: A total of 15002 responders completed the survey, with a completion rate of 82%. The majority 10314 (69%) were 18–30 year and 6112 (41%) had high school education. The most common comorbidities among the responders were depression (7.67%); hypertension (6%); diabetes (5.77%) and Chronic Lung Disease (4.12%). The most common symptoms were dyspnea (17.80%); chest tightness (14.09%) and sputum (11.19%). Among those who complains of any symptoms, only 16.44% had consulted their doctor. Around 14.16% were diagnosed with a respiratory disease and only 15.56% had performed pulmonary function test (PFT). The prevalence of smoking history was 15.16%, in which current smokers were 9.09%. About 48% of smokers used cigarette, 25% used waterpipe and around 27% were E-cigarette users. About 77% of the total sample have never heard about COPD. Majority of current smokers (73.5%; 1002), ex-smokers (68%; 619), and non-smokers (77.9%; 9911) are unaware of COPD, p value <0.001. Seventy five percent (1028) of the current smokers and 70% (633) of the ex-smokers have never performed PFT, p value <0.001. Male, younger age (18–30 years), higher education, family history of respiratory diseases, previous diagnosis of respiratory disease, previous PFT, and being an ex-smokers increases the odds of COPD awareness, p-value <0.05. Conclusion: There is a significantly low awareness about COPD in Saudi Arabia, especially among smokers. A nationwide approach must include targeted public awareness campaigns, continued healthcare professional education, community-based activities encouraging diagnosis and early detection, advice on smoking cessation and lifestyle changes, as well as coordinated national COPD screening programs. [ABSTRACT FROM AUTHOR]

A high body mass index (BMI) is a known risk factor for coronavirus infection in hospitalized patients. Our study examined the association between BMI and complications and the survival rate among COVID-19 patients. This retrospective analysis used data from a tertiary hospital in the Eastern Region of Saudi Arabia during two waves of the COVID-19 pandemic. The study included 600 participants, with the majority being between 41 and 60 years old (41.3%) and men comprising 63.5% of the sample. Approximately 42.5% of patients were obese, and 31.3% were overweight. The results showed that BMI was significantly linked to respiratory diseases (p = 0.013); end-stage renal disease (p = 0.021); and cardiovascular disease (p = 0.003) but not diabetes mellitus (p = 0.064). Death occurred in 10.8% of patients; 33.8% were admitted to the ICU; 13.8% needed mechanical ventilation; and 60.7% had lung infiltration. Obese patients with oxygen saturation levels below 93% were 2.45 times more likely to require mechanical ventilation than those in the normal-weight group. Overweight and obese patients were also more likely to require mechanical ventilation than normal-weight patients, with odds ratios of 3.66 and 2.81, respectively. The BMI categorized was not associated with survival rate in COVID-19-hospitalized patients using Kaplan-Meier survival plots (p = 0.061). However, the BMI categorized was associated with survival rate in COVID-19 ICU patients (p < 0.001). In addition, the overweight showed a statistically significant higher hazard ratio of 2.22 (p = 0.01) compared to normal-weight patients using a Cox regression model. A high BMI was identified as an independent risk factor for reduced oxygen saturation (<93%), the need for mechanical ventilation, lung infiltration, mortality, and longer ICU stays in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Nomophobia is common among students in many healthcare disciplines, and its association with academic performance has been explore before. However, there is no available data on its prevalence and association with academic performance among undergraduate physiotherapy (PT) students in Saudi Arabia.Methods: Between 22 December 2022 and 30 January 2023, a cross-sectional survey was conducted by dissemination using an online platform (Survey Monkey).Results: In total, 806 PT students, with males accounting for 494 (61%), responded to the survey. The prevalence of nomophobia among PT students was 98.4% (793). The mean (±SD) of the total NMP-Q items scores was 49 (± 17), indicating a mild level of nomophobia. Female PT students had significantly higher nomophobia scores than the males (47 (39– 65); 44 (38– 52); (p < 0.001)). Non-smokers had significant higher nomophobia scores than smokers (46 (38– 61); 44 (38– 49); (p = 0.004)). Regarding grade point averages (GPA), the students with a GPA of less than 3.49 had the highest nomophobia score (51 (43– 74); p < 0.001)). Concerning the stage of their studies, bridging students had the highest nomophobia score (51 (34– 76); p = 0.023)). Regarding academic warnings, those who reported no academic warnings had the highest nomophobia score (46 (42– 50); p = 0.023)). Finally, regarding study hours, the students who spent ≥ five hours studying per week had the highest nomophobia score (54 (42– 68); p < 0.001)).Conclusion: Nomophobia is common among PT students, with the majority experiencing a mild level. Being female, non-smoker, and having a higher academic performance were risk factors associated with higher nomophobia levels. [ABSTRACT FROM AUTHOR]

Objective: Depression is a common comorbidity in patients with asthma with a significant impact on clinical management. However, little information is available about physicians' perceptions and current practices in identifying and managing depression in individuals with asthma in Saudi Arabia. Thus, this study aims to assess physicians' views and current practices of identifying and managing depression in patients with asthma in Saudi Arabia. Methods: A cross-sectional study was employed. Between September 2022 and February 2023, an online survey was distributed to physicians (general practitioners and family, internal and pulmonary medicine specialists) in Saudi Arabia. Descriptive statistics were performed to analyze the collected responses. Results: Out of 1800 invited participants, a total of 1162 physicians completed the online survey. Nearly 40% of the respondents received adequate training for managing depression. More than 60% of physicians reported that depression interferes with self-management and worsens asthma symptoms, while 50% viewed the importance of regular screening for depression. Less than 40% (n=443) aim to identify depression during patients' visits. Of those, only 20% always screen for depression in asthma patients. Physicians show a low level of confidence when asking patients about their feelings (30%), being able to recognize depression (23%), and knowing if patients have depression (23%). The most common barriers linked to recognizing depression are high workload (50%), lack of time to screen for depression (46%), limited knowledge about depression (42%), and poor training (41%). Conclusion: The rate of recognizing and confidently managing depression in asthmatic patients is significantly low. This is attributed to high workload, poor training, and limited knowledge about depression. There is a need to support psychiatric training and implement a systematic approach to depression detection in clinical settings. [ABSTRACT FROM AUTHOR]

Quality of life (QoL) is essential for maintaining a healthy, balanced lifestyle, especially among individuals with chronic diseases. Saudi Arabia (SA) launched a health sector transformation program as part of the nationwide Vision 2030 initiative to ensure the sustainable development of efficient healthcare services, aiming to improve health by increasing well-being and QoL. More investigation into the current status of health rehabilitation services provided to individuals with chronic diseases and future needs to optimize services and improve QoL is needed. This was narratively discussed by experts from different health rehabilitation services in SA. Comprehensive health rehabilitation services including orthopedic, occupational, cardiac, pulmonary, critical care, perioperative, hearing and speech, substance use disorders, and vocational rehabilitation services were addressed. Health rehabilitation services in SA, as in other countries, are suboptimal for individuals in health rehabilitation programs. To optimize the QoL of individuals with chronic diseases, health rehabilitation services should be tailored based on the unique requirements of each service and its serving patients. The shared need to improve health rehabilitation services includes the adoption of home-based and telehealth services, the integration of multi-governmental sectors, the empowerment and allocation of health rehabilitation specialists, public awareness campaigns, policy legislation and guideline development, and the implementation of a long-term follow-up system. This review is one of the first to address the intersection of health rehabilitation services and QoL in SA; urgent and holistic actions are paramount to address the pressing need to optimize SA's health rehabilitation services. The experts' recommendations in this study may be applicable to other countries' health systems, as health rehabilitation services are not well optimized globally. [ABSTRACT FROM AUTHOR]

Religious mass gatherings, especially pilgrimages of various faiths, involve overcrowding and the international movement of people, exposing individuals to significant health risks, such as the spread of infectious diseases, crowds, exposure to bad weather, physical stress, or risks due to pre-existing medical conditions. This paper aims to review the literature related to health care research on religious mass gatherings, with special reference to the role of awareness creation, training, and risk awareness for individuals during Hajj. The results indicated that the research on health risks associated with large-scale gatherings showed that some countries (which witness religious gatherings) follow effective preventive measures to reduce health risks, while some countries did not (and linked this to its poor infrastructure and the low standard of living in it, such as India). It also showed that most studies overlooked identifying the causes of infectious diseases and determining the perceptions of participants in mass gatherings. While it showed that environmental factors strongly influence the emergence of infectious diseases among individuals, the results also showed the scarcity of research that revolves around the awareness of community members, the health risks of mass gatherings, preventive measures against diseases, and the main effects on individuals' perceptions of risks. The results also showed a lack of research evidence on how pilgrims perceive risks, adopt information, and interact with their willingness to be trained in preventive measures. [ABSTRACT FROM AUTHOR]

Background: Multiple vaccines have been tested in clinical trials for their efficacy and safety. In Saudi Arabia, Pfizer–BioNTech or Moderna were approved for children, however, previous studies to report their safety profile are limited. This research aims to understand the side effect of children's vaccination against SARS-CoV-2 infection in Saudi Arabia. Methods: This was an observational retrospective cross-sectional study was conducted using an online survey in Saudi Arabia from March to May 2022. The inclusion criteria were parents aged 18 years and above who live in Saudi Arabia and have vaccinated their children. The self-reported questionnaire was adopted from published studies to investigate the study objectives Descriptive statistics were used to describe patients' demographic characteristics, continuous data were reported as mean ± S.D., categorical data were reported as percentages (frequencies), and logistic regression was used to identify predictors of persistent post-COVID-19 symptoms. Results: This study had a total of 4,069 participants. Only 41.9% of the participants reported that their child(ren) had been infected with the coronavirus. 2.00 was the median number of children (IQR: 1.00–4.00). More than half of the study participants (64.2%) reported that a family member had been infected with the coronavirus. Both parents received COVID-19 vaccination, according to most participants (88.7%). Most participants (70.5%) stated that all children who met the vaccination criteria had received the vaccine. Most participants (83.5%) said their child or children had two doses of their vaccine, and about half (50.4%) of those who received the vaccine reported experiencing side effects. In addition, the majority (78.9%) reported that the side effects appeared within one day of receiving the vaccine, and nearly two-thirds (65.7%) reported that the side effects lasted between one and three. A total of 11,831 side effects cases were documented. Pain at the injection site, hyperthermia, and fatigue were the most reported side effects, accounting for 15.3%, 14.1%, and 13.2%, respectively. Conclusion: It appears that the side effects of the COVID-19 vaccine for children are minor, tolerable, and like those described previously in clinical trials. Our data should encourage the public about the safety of receiving the COVID-19 vaccine for children. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary rehabilitation (CR) is an effective management approach for heart failure (HF) patients and is delivered by multidisciplinary teams including physiotherapists (PTs). PT attitudes about delivering CR and barriers that might affect referral have not been explored. Thus, this study is aimed to explore PT attitudes about delivering CR programs to patients with HF and identify factors and barriers that might affect referral decisions. Methods: A cross-sectional online survey was disseminated to all PTs in Saudi Arabia between 19 February and 27 June, 2022. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. Results: Overall, 553 PTs, 289 (52.30%) male and 264 (47.70%) females, completed the online survey. Of these, 360 (65.1%) strongly agreed that CR would improve patients' physical fitness and 334 (60.4%) strongly agreed that CR would reduce breathlessness in patients with HF. The majority of PTs (321, 58%) strongly agreed that CR would improve HF patients' palpitation and fatigue. Out of 553 PTs, 349 (63.1%) strongly agreed that CR would improve patients' ability to perform daily activities. A hospital-supervised program was the preferred mode of delivering CR programs by 499 (90.20%) of the respondents. Apart from the exercise component, stress management was perceived by 455 (82.30%) as an essential component of CR programs. The most common patient-related factor that strongly influenced referral decisions was "fatigue related to disease" (42%). A lack of CR centers was reported by 59.90% as the most common referring barrier. Conclusion: PTs perceived CR as a successful strategy for patients with HF. Although a supervised hospital-based program with stress management as an essential component aside from the exercise component was perceived as the preferred mode of delivery, CR was lacking, which caused a significant barrier to CR referral from the PTs' perspective. [ABSTRACT FROM AUTHOR]

Since the beginning of the coronavirus disease (COVID-19) pandemic, the responses of countries to emerging infectious diseases have altered dramatically, increasing the demand for health-care practitioners. Telehealth (TH) applications could have an important role in supporting public health precautions and the control of the spread of the COVID-19 pandemic. This review summarizes the existing literature on the current status of TH applications used during COVID-19 in Saudi Arabia and discusses the extent to which TH can support public health measures. TH mobile applications (e.g., Seha, Mawid, Tawakklna, Tabaud, and Tetamman) have found effective tools to facilitate delivering healthcare to persons with COVID-19, and tracking of COVID-19 patients. TH has been essential in the control of the spread of COVID-19 and has helped to flatten the growth curve in Saudi Arabia. Further research is needed to explore the impact of TH applications on the progression of COVID-19 in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Background: Simulation-based education (SBE) provides a safe, effective, and stimulating environment for training medical and healthcare students. This is especially valuable for skills that cannot be practiced on real patients due to ethical and practical reasons. We aimed to assess medical students' attitude, perception, and experience of simulation-based medical education in Saudi Arabia. Method: A validated cross-sectional survey, using the KidSIM scale, was conducted to measure the level of perception and experience of students from different health sciences specialties toward integrating simulation as an educational tool. Participants responded to questions investigated the importance of simulation, opportunities for Inter-Professional Education (IPE), communication, roles and responsibilities, and situation awareness. Only students with previous experience of SBE were considered for participation. Result: This survey was completed by 246 participants, of whom 165 (67%) were male students and 228 (93%) were aged between the range of 18–30 years old. Of the respondents, 104 (67%) were respiratory care students, 90 (37%) were anesthesia technology students, and 45 (18%) were nursing students. Most of the participants had previous experience in IPE simulation activities (84%), and more than half of the students (54%) had a grade point average (GPA) ranging between 5.00 and 4.50. Overall, students had positive attitudes toward and beliefs about SBE, with a mean score of 129.76 ± 14.27, on the KidSIM scale, out of 150. Students' GPA was significantly associated with a better perception to the relevance of simulation (p = 0.005), communication (p = 0.003), roles and responsibilities (p = 0.04), and situation awareness (p = 0.009). GPA is merely the sole predictor for positive attitude toward simulation with coefficient Beta value of 4.285 (p = 0.001). There were no significant correlations between other students' characteristic variables (gender, specialty, study year, experience in IPE, and prior critical care experience). Conclusion: We found that health sciences students' perception of SBE in Saudi Arabia is generally positive, and students' performance is a significant determinant of the positive perception. [ABSTRACT FROM AUTHOR]

Background: Telehealth services are widely used in Saudi Arabia. Despite this, neither the use rate nor the attitudes, perceptions, and barriers concerning telehealth applications have been evaluated nationally from the perspective of healthcare providers (HCPs). Aim: This study aims to explore the use rate of telehealth, as well as the attitudes, perceptions, and barriers concerning telehealth use in Saudi Arabia from the perspective of HCPs. Methods and design: A cross-sectional survey was conducted and distributed to all HCPs between 16 November 2021 and 16 March 2022, through an online platform (Survey Monkey). Results: Overall, 1034 HCPs completed the online survey, of which 65.0% (n = 677) were male. Physicians accounted for 22.34%, while nurses and respiratory therapists accounted for 22.34% and 21.47%, respectively. Only 491 HCPs (47%) have used telehealth applications, the majority for less than a year (21.47%) or from one to three years (14.51%). Around 44% of HCPs perceived telehealth as being useful in quality and care delivery. Around 43% of HCPs felt comfortable using telehealth, and 45.45% perceived telehealth as being useful for patients with transportation difficulties. Additionally, 38% believed that telehealth provides a confidential way of protecting patients' information, and 36% would like to receive more training in telehealth. Speech-language therapists and public health professionals were the highest HCP users (98% and 95%, respectively), while general physicians and dentists were the lowest users (44% and 55%, respectively). Lack of time or a busy schedule was the most common barrier to not using telehealth among all HCPs (38%). Conclusion: The use of telehealth was perceived as being positive as well as valuable and confidential in monitoring and providing care. However, challenges such as the lack of time or a busy schedule impeded the use of telehealth among HCPs in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Background: The available data to determine the chronic obstructive pulmonary disease (COPD) burden in Saudi Arabia are scarce. Therefore, this study closely examines and tracks the trends of the COPD burden in Saudi Arabia from 1990 to 2019 using the dataset of the Global Burden of Disease (GBD) 2019. Methods: This study used the GBD 2019 dataset to analyse the COPD prevalence, incidence, morbidity and mortality rates in the Saudi Arabian population from 1990 to 2019, stratified by sex and age. The age-standardised rate was used to determine the prevalence, incidence, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs) and deaths. Results: In 2019, an estimated 434,560.64 people (95% Uncertainty Interval (UI) 396,011.72–473,596.71) had COPD in Saudi Arabia, corresponding to an increase of 329.82% compared with the number of diagnosed people in 1990 [101,104.05 (95% UI 91,334.4–111,223.91)]. The prevalence rate of COPD increased by 49%, from 1,381.26 (1,285.35–1,484.96) cases per 100,000 in 1990 to 2,053.04 (1918.06–2194.29) cases per 100,000 in 2019, and this trend was higher in males than females. The incidence rate of COPD in 2019 was 145.06 (136.62–154.76) new cases per 100,000, representing an increase of 43.4% from the 1990 incidence rate [101.18 (95.27–107.86)]. In 2019, the DALYs rate was 508.15 (95% UI 434.85–581.58) per 100,000 population. This was higher in males than females, with a 14.12% increase among males. In 2019, YLLs contributed to 63.6% of DALYs due to COPD. The death rate due to COPD was 19.6 (95% UI 15.94–23.39) deaths per 100 000 in 2019, indicating a decrease of 41.44% compared with the death rate in 1990 [33.55 deaths per 100 000 (95% UI 25.13–47.69)]. In 2019, COPD deaths accounted for 1.65% (1.39–1.88) of the total of deaths in Saudi Arabia and 57% of all deaths caused by chronic respiratory diseases. Conclusion: Over the period 1990–2019, the prevalence and incidence of COPD in Saudi Arabia have been steadily rising. Even though COPD morbidity and death rates have been decreasing, they remain higher in men and older age. The holistic assessment and interventions with careful attention to optimising the community-based primary care management, such as screening for early diagnosis, smoking cessation programs and pulmonary rehabilitation, are likely to be the most successful strategies to reduce the burden of COPD in Saudi Arabia. [ABSTRACT FROM AUTHOR]

This study aimed to assess physicians' attitudes toward delivering pulmonary rehabilitation (PR) to chronic obstructive pulmonary disease (COPD) patients and identify factors and barriers that might influence referral decisions. Between September 2021 and January 2022, a cross-sectional online survey was distributed to all physicians in Saudi Arabia. A total of 502 physicians completed the online survey, of which 62.0% (n = 312) were male. General physicians accounted for 51.2%, while internal-medicine specialists and pulmonologists accounted for 26.9% and 6.6%, respectively. Only 146 (29%) physicians had referred COPD patients to a PR program. The difference in referral rates between all specialties (p = 0.011) was statistically significant. Physicians with more years of experience were more likely to refer COPD patients to PR (p < 0.001). Moreover, a home-based PR program was preferred by 379 physicians (75.5%), and 448 (89.2%) perceived smoking cessation as an essential component of PR. Availability of PR centers (69%) was the most common barrier for not referring patients to PR. The overall referral rate was low among all physicians, owing to a lack of PR centers and trained staff. Home-based delivery was the preferred method of delivering PR, with smoking cessation as an essential component. [ABSTRACT FROM AUTHOR]

aim,8 Abdullah A Alqarni,3 Hassan Alwafi91Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 3Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 4UCL Respiratory, University College London, London, WC1E 6BT, UK; 5Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 6National Heart and Lung Institute, Imperial College London, London, UK; 7Department of Pharmaceutical and Biological Sciences, UCL School of Pharmacy, London, UK; 8Department of Computer Science, College of Science and Humanities in Jubail, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 9Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi ArabiaCorrespondence: Abdulelah M Aldhahir, Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia, Email [email protected] Background: General population knowledge, satisfaction, and barriers to using Seha app have not been evaluated from a large-scale perspective. Therefore, this study aimed to explore current knowledge, satisfaction, and barriers of using Seha app and identify the most common mobile health application used among the general population in Saudi Arabia. Methods: A cross-sectional online survey, consisting of 25 questions, was distributed among the general population of Saudi Arabia. Descriptive statistics were used to describe the respondents' characteristics. Categorical variables were reported as frequencies and percentages. A chi-square (χ 2) test was conducted to assess the statistical difference between respondents' demographic characteristics and their knowledge and use of the app. Results: Overall, 5008 respondents, both Saudi (3723: 74%) and non-Saudi (1285: 26%) as well as male 2142 (43%) and female 2866 (57%), across the Kingdom of Saudi Arabia completed the online survey. A total of 2921 (58%) had heard of the Seha app, although only 1286 (25%) had used the app. Higher percentages of users were from the western region, females and those within the age group of ≥ 51 years old, 388 users (29%: P< 0.001), 804 (28%; P< 0.001) and 67 (35%; P=0.013), respectively. Consulting a doctor was the most frequently utilized service, 576 users (58%). Respondents strongly agreed 402 (41%) that Seha was easy to use, and 538 (54%) strongly agreed that they would recommend Seha to others. The most common barrier of using Seha was a lack of knowledge about the app and its benefits, at 1556 (35%). Overall, the Tawakkalna app was the most utilized mobile health application provided by MOH used 2170 (48%). Conclusion: Utilization of the Seha app is quite low due to a lack of knowledge about the app and its benefits. Thus, the MOH should promote public awareness about the app and its benefits. [ABSTRACT FROM AUTHOR]

COVID-19 poses a significant burden to healthcare systems. Healthcare organisations with better health innovation infrastructures have faced a reduced burden and achieved success in curbing COVID-19. In Saudi Arabia, digital technologies have played a vital role in fighting SARS-CoV-2 transmission. In this paper, we aimed to summarise the experience of optimising digital health technologies in Saudi Arabia as well as to discuss capabilities and opportunities during and beyond the COVID-19 pandemic. A literature search was conducted up to September 2021 to document the experience of using DHTPs in Saudi Arabia in response to the COVID-19 outbreak. We also considered any published data, press briefings, and announcements by the MOH in Saudi Arabia. The findings were synthesised in narrative form. Health officials succeeded in optimising and maintaining a strategy to mitigate the spread of the virus via different digital technologies, such as mobile health applications, artificial intelligence, and machine learning. The quick digital response in Saudi Arabia was facilitated by governmental support and by considering users and technology determinants. Future research must concentrate on establishing and updating the guidelines for using DHTPs. [ABSTRACT FROM AUTHOR]

Background: Every year, over 2 million people gather together to observe the Hajj pilgrimage in Mecca. This presents a public health risk to both Saudi and the pilgrims' country of origin. The aim of this study was to evaluate the risk perception and the source of health advice by the pilgrims. Methods: We conducted a cross-sectional survey among internal and external pilgrims performing the Hajj. The survey evaluates the general safety and preventative measures applied, factors influencing public health safety at Hajj, source of pre-travel health advice, recommended preventative health measures, and the effective preventative measures. Results: A total of 280 pilgrims from 28 different countries were approached of which 233 completed the survey with response rate of 83%. The majority (219 [94%]) of the respondents considered the Hajj as safe while 205 (88%) sought pretravel health advice. The most popular source of pre-travel health advice among the pilgrims were from medical professionals (83 [25.6%]) and other pilgrims (44 [18.9%]). Diversity and carelessness were believed to be the main factors influencing public health safety in the Hajj by 184 (79%) and 181 (78%) of the respondents respectively. Yellow fever (117 [50%]) and wearing of face masks (56 [24%]) were the most and least adopted recommended public health measures respectively while most pilgrims believed handwashing (137 [59%]) and wearing of face mask (119 [51%]) are the most effective preventative health measures. Conclusion: Our study shows a reduced perception by pilgrims of the health risk of the Hajj and highlights the need to improve how information is channelled to prospective pilgrims about preventative health measures. The discordance between recommended preventative health measures and adherences by pilgrims shows a need for a comprehensive enforcement program underpinned by the Saudi Ministry of Health (MoH). [ABSTRACT FROM AUTHOR]

Background: Tobacco smoking is one of the most significant health-related problems worldwide. However, the prevalence and sociodemographic determinants of tobacco and nicotine use among students on healthcare courses in Saudi Arabia are limited., Methods: This cross-sectional study used a questionnaire that was distributed via SurveyMonkey between November 2022 and June 2023 to all student universities offering healthcare courses. Data are presented as frequency and percentages. The associated sociodemographic factors with current tobacco and nicotine use were subjected to logistic regression., Results: Overall, 5,012, of whom 3,872 (77.25%) were males, responded to the online survey. The prevalence of current tobacco and nicotine use was 3,553 (71%). The majority of users used electronic nicotine delivery systems (1,622: 32.36%). The current use of cigarettes (AOR: 1.75 (1.42 to 2.15)), e-cigarettes (AOR: 1.17 (1.01 to 1.37)), and smokeless tobacco substances (AOR: 1.35 (1.02 to 1.90)) were more pronounced among males compared to female students. However, the current use of a hookah was less among males (AOR: 0.74 (95% CI: 61 to 0.91)). Smoking cigarettes was practiced less among students living in other regions compared to the Central Region. However, smokeless tobacco substances seem to be more prevalent in the Western, Southern, and Northern Regions, (AOR: 1.57 (95% CI: 1.09 to 2.26)), (AOR: 1.43 (95% CI: 1.04 to 1.95)), and (AOR: 1.57 (95% CI: 1.09 to 2.26)), respectively., Conclusion: Smoking is prevalent among students in the healthcare disciplines, with electronic nicotine delivery systems being the most used product. Several sociodemographic factors were associated with higher tobacco or nicotine use., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Aldhahir, Siraj, Alqarni, Alqahtani, Alyami, Majrshi, Alwafi, Alqahtani, Monshi, Al-Zalabani and Alanazi.)

Background: Obesity is common among chronic obstructive pulmonary disease (COPD) patients and is associated with an increase in acute exacerbation episodes. However, data on obesity's impact on and association with clinical outcomes among patients with COPD are limited. This study aimed to determine overweight and obesity prevalence and associations with spirometry profiles, intensive care unit (ICU) admission, and comorbidities in patients with COPD., Methods: In this retrospective cohort study, we reviewed the electronic health records of adult individuals diagnosed with COPD who visited the studied pulmonary clinics between 1 January 2018 and 31 December 2022 and then collected key demographic variables and relevant clinical outcomes and comorbidities., Results: A total of 474 patients with COPD were included in the final analysis, of whom 60% were male. The occurrences of overweight and obesity were 32.7% and 38.2%, respectively. The presence of comorbidities was high in obese patients (78.4%), followed by overweight patients (63.8%) with COPD. Obese and overweight patients had the highest ward admission rates (38.3% and 34.2%, respectively). ICU admissions were higher in obese and overweight patients (16% and 12%, respectively) compared with normal-weight patients (9%). Although no significant correlation was found between body mass index and spirometry parameters, comorbidities and ICU admission were linked to overweight and obesity in COPD patients (AOR: 1.82 95% CI: 1.15 to 2.86 and AOR: 3.34 95% CI 1.35 to 8.22, respectively)., Conclusion: Our findings imply that obesity in COPD is prevalent and is associated with adverse clinical outcomes including a greater number of comorbidities and higher rates of hospitalization and admission to ICUs although no associations were found between body weight and spirometry parameters. Further studies are needed to assess whether implementing and optimising obesity screening and management at an early stage in COPD can prevent further deterioration., Competing Interests: The authors declare no conflict of interest in this work., (© 2024 Alqarni et al.)

Background: Acute respiratory tract infections (ARTIs) are frequently observed in infants and young children. The dynamics and transmission of ARTIs have been significantly impacted by the global COVID-19 pandemic. This study investigates the change in admission rates of Respiratory Syncytial virus (RSV) in a hospital in Saudi Arabia., Methods: The study included hospitalized pediatric patients who underwent RSV testing in three periods: pre-pandemic (2019), during the pandemic (2020-2021), and the immediate post-pandemic (2022). RSV testing was conducted using either PCR or antigen tests., Results: Between January 2019 to December 2022, out of 927 tested patients, 173 (18.7%) were positive for RSV. The yearly positivity rates were as follows: 42 (35.6%) of 118, 24 (33.3%) of 72, 15 (18.5%) of 81, and 92 (14%) of 656, yearly from 2019 to 2022, respectively (P < 0.00001). Among all cases, 150 (16.2%) required hospitalization, including 94 (62.7%) males and 56 (37.3%) females. The admission rate to the intensive care unit (ICU) was 25 (16.7%), and mechanical ventilation was required for 10 (6.6%) patients. The overall case fatality rate was 0.7%. A Binary logistic regression analysis showed upper respiratory tract symptoms were more common in patients admitted in 2019 compared to 2022 (odd ratio:20.9, 95% CI: 4.2-104.1, P value < 0.0001)., Conclusion: The study showed that there were differences in RSV infection before and after COVID-19. Understanding how COVID-19 mitigation measures affect RSV transmission can aid in the development of effective prevention and control strategies., Competing Interests: Declaration of Competing Interest Authors have no conflict of interest to declare., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Productive cough with sputum is a prominent sign generally associated with respiratory diseases, including chronic obstructive pulmonary disease (COPD). Airway clearance devices are an option for COPD management, but physicians' preferences for and clinical practice with them are not known., Objective: This study aims to explore preferences for and clinical practice with airway clearance devices among physicians in Saudi Arabia., Design: An observational, cross-sectional survey., Methods: A self-administered questionnaire was conducted between October 2022 and September 2023, which included a review of respiratory medication prescriptions by physicians for patients with COPD. The analysis was performed using the Statistical Package for the Social Sciences., Results: The participants were 445 physicians. The majority were female, accounting for 64.3% of the sample. Flutter and Acapella were the most commonly preferred airway clearance devices (45.8% and 20.7%, respectively). Among the participants, 12.6% reported unfamiliarity with any of the mentioned devices. Of the participants, 43.6% "usually" suggested the devices for patients with daily, difficult-to-clear, thick sputum, while 27% "sometimes" recommended them to COPD patients who had experienced four exacerbations or more. In routine clinical practice, physicians prescribe pharmacological therapies as the main treatment. The prescribing data showed that in the last year, there was no record of prescribed airway clearance devices for COPD by physicians., Conclusion: Family and pulmonary physicians prefer Flutter and Acapella devices, but a significant number of physicians are unaware of such devices. Prescribing data showed no record of prescribed airway clearance devices for COPD management. Further initiatives are needed to increase awareness in clinical practice.

Objectives: Clearing secretions from the airway can be difficult for people with chronic obstructive pulmonary disease (COPD). Mucus clearance devices (MCDs) are an option in disease management to help with this, but healthcare provider awareness and knowledge about them as well as current clinical practice in Saudi Arabia are not known., Design: A cross-sectional online survey consisting of four themes; demographics, awareness, recommendations and clinical practice, for MCDs with COPD patients., Setting: Saudi Arabia., Participants: 1188 healthcare providers including general practitioners, family physicians, pulmonologists, nursing staff, respiratory therapists and physiotherapists., Primary Outcome Measures: Healthcare providers' level of awareness about MCDs, and the identification of current clinical practices of COPD care in Saudi Arabia., Results: 1188 healthcare providers (44.4% female) completed the survey. Regarding devices, 54.2% were aware of the Flutter, 23.8% the Acapella and 5.4% the positive expiratory pressure mask. 40.7% of the respondents identified the Acapella, and 22.3% the Flutter as first choice for COPD management. 75% would usually or always consider their use in COPD patients reporting daily difficulty clearing mucus, whereas 55.9% would sometimes or usually consider the use of MCDs with COPD patients who produced and were able to clear mucus with cough. In clinical practice, 380 (32%) of the respondents would prescribe MCDs, 378 (31.8%) would give MCDs without prescriptions, 314 (26.4%) would not provide them at all and 116 (9.8%) would only advise patients about them., Conclusion: Healthcare providers are aware of the existence of MCDs and their benefits for sputum clearance and believe that MCDs are beneficial for sputum clearance in some COPD patients., Trial Registration Number: ISRCTN44651852., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To investigate physicians' perceptions and current practices of identifying and managing depression in patients with chronic obstructive pulmonary disease (COPD)., Design: A cross-sectional online survey was employed between March and September 2022., Settings: Saudi Arabia., Participants: 1015 physicians, including general practitioners and family, internal and pulmonary medicine specialists., Primary Outcome Measures: Physicians' perceptions, confidence, practices and barriers to recognising and managing depression in patients with COPD., Results: A total of 1015 physicians completed to the online survey. Only 31% of study participants received adequate training for managing depression. While 60% of physicians reported that depression interferes with self-management and worsens COPD symptoms, less than 50% viewed the importance of regular screening for depression. Only 414 (41%) physicians aim to identify depression. Of whom, 29% use depression screening tools, and 38% feel confident in discussing patients' feelings. Having adequate training to manage depression (OR: 2.89; 95% CI: 2.02 to 3.81; p<0.001) and more years of experience (OR: 1.25; 95% CI: 1.08 to 1.45; p=0.002) were associated with the intention to detect depression in COPD patients. The most common barriers linked to recognising depression are poor training (54%), absence of standard procedures (54%) and limited knowledge about depression (53%)., Conclusion: The prevalence of identifying and confidently managing depression in patients with COPD is suboptimal, owing to poor training, the absence of a standardised protocol and inadequate knowledge. Psychiatric training should be supported in addition to adopting a systematic approach to detect depression in clinical practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Although personal resilience and supervisory support are known to reduce the impact of burnout and quitting intention, there is limited data available to explore these relationships among healthcare professionals (HCPs) in Saudi Arabia. This study aimed to assess the prevalence of burnout and explore its association with resilience, supervisory support, and intention to quit among Saudi Arabian HCPs., Methods: A cross-sectional survey was distributed to a convenience sample of HCPs between April and November 2022. Participants responded to socio-demographic questions, the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS (MP)), the Connor-Davidson resilience scale 10 (CD-RISC 10), and the Perceived of Supervisor Support Scale (PSS). Descriptive, inferential, correlation, and logistic regression tests were performed for data analyses., Results: Of the 1174 HCPs included in the analysis, 77% were presented with high burnout levels: 58% with emotional exhaustion (EE), 72% with depersonalization (DP), and 66% with low personal accomplishment (PA). Females were associated with increased odds of burnout (OR: 1.47; 95% CI: 1.04-2.06) compared to males. Burnout and its subscales were associated with higher intention to leave practice, with 33% of HCPs considering quitting their jobs. Furthermore, HCPs reported a low resilience score overall, and negative correlations were found between EE (r = -0.21; p < 0.001) and DP (r = -0.12; p < 0.01), and positive correlation with low PA (r = 0.38; p < 0.001). In addition, most HCPs perceived supervisory support as low, and it is associated with increased burnout and quitting intention., Conclusion: Burnout is common among HCPs across all clinical settings and is associated with higher intention to quit and low resilience and supervisory support. Workplace management should provide a supportive workplace to reduce burnout symptoms and promote resiliency.

Background: Cardiopulmonary rehabilitation (CR) serves as a core component of the management strategy for patients with heart failure (HF). CR is administered by multidisciplinary healthcare providers, but their perceptions toward delivering CR to HF patients, and the factors and barriers that might influence referral, have not been studied. This study aims to assess physicians' perceptions toward delivering CR programs to HF patients and identify factors and barriers that might influence their referral decisions., Methods: Between 15 February and 5 June 2022, a cross-sectional online survey with ten multiple-choice items was distributed to all general and cardiac physicians in Saudi Arabia. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. The statistical significance of the difference between categorical variables was determined using the chi-square (2) test. Logistic regression was used to identify referral factors., Results: Overall, 513 physicians (general physicians (78%) and cardiac doctors (22%)) completed the online survey, of which 65.0% ( n = 332) were male. Of the general physicians, 236 (59%) had referred patients with HF to CR. Sixty-six (58%) of the cardiac doctors had referred patients with HF to CR. A hospital-supervised program was the preferred mode of delivering CR programs among 315 (79%) general physicians, while 84 (74%) cardiac doctors preferred to deliver CR programs at home. Apart from the exercise component, information about HF disease was perceived by 321 (80%) general physicians as the essential component of a CR program, while symptom management was perceived by 108 (95%) cardiac doctors as the essential component of a CR program. The most common patient-related factor that strongly influenced referral decisions was "fatigue related to disease" (63.40%). The availability of CR centers (48%) was the most common barrier preventing the referral of patients to CR., Conclusions: CR is an effective management strategy for HF patients, but the lack of CR centers is a major barrier to the referral of patients. A hospital-supervised program is the preferred method of delivering CR from the general physicians' perspective, while cardiac doctors prefer home-based CR programs. Apart from the exercise component, information about HF disease and symptom management is essential components of CR programs from general physicians' and cardiac doctors' perspectives, respectively.

Background: Improved outcomes for patients on mechanical ventilation may be achieved with early mobilization (EM). However, it is not clear how widely this strategy is adopted into routine intensive care unit (ICU) practice in Saudi Arabia., Objectives: This study was conducted to describe the present practices and challenges to providing EM for mechanically ventilated patients, which may drive dissemination and implementation activities., Methods: We approached 205 ICUs across Saudi Arabia using a validated tool to assess ICU characteristics, the practices of EM for mechanically ventilated patients, and the barriers to providing EM., Results: We approached 205 ICU persons in charge and achieved a 65% response rate (133 ICUs). The prevalence of EM for mechanically ventilated patients was 47% (63 ICUs). A total of 85 (64%) of the respondents reported having no previous training in EM. The absence of a written protocol was reported by 55% of the ICU practitioners in charge, 36% started EM within 2 to 5 days of critical illness, and 35% reported that performing EM for mechanically ventilated patients was totally dependent on physicians' orders. Forty-seven percent of the ICUs that practised EM had at least one coordinator or person in charge of facilitating EM. The highest level of EM with mechanically ventilated patients was 35/63 (55%) with patients remaining in-bed and 28/63 (45%) with patient getting out of bed. A majority of the respondents (39, 64%) performed EM once daily for an interval period of more than 15 min. Previous training in EM and years of experience of the ICU person in charge were significant factors that promoted EM for mechanically ventilated ICU patients (OR: 7.6 (3.37-17.26); p < 0.001 and OR: 1.07 (1.01-1.14), p = 0.004, respectively). Existing protocols increased the odds of starting EM within 2 to 5 days of critical illness by six-fold (OR: 6.03 (1.79-20.30); p = 0.004). No written guidelines/protocols available for EM, medical instability, and limited staff were the most common hospital-, patient- and health care provider-related barriers to EM in the ICUs, respectively., Conclusion: The prevalence of EM for mechanically ventilated patients across Saudi Arabia was 47%, although only 36% of the ICU staff had previous training in EM. Targeting modifiable barriers to EM, including a lack of training, guidelines and protocols, and staffing, will help to promote EM in Saudi Arabian ICUs., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: To assess the attitude of healthcare providers (HCPs) towards the delivering of pulmonary rehabilitation (PR) to patients with chronic obstructive pulmonary disease (COPD) and identify factors and barriers that might influence referral., Design: A cross-sectional online survey consisting of nine multiple-choice questions., Settings: Saudi Arabia., Participants: 980 HCPs including nurses, respiratory therapists (RT) and physiotherapists., Primary Outcome Measures: HCPs attitudes towards and expectations of the delivery of PR to COPD patients and the identification of factors and barriers that might influence referral in Saudi Arabia., Results: Overall, 980 HCPs, 53.1% of whom were men, completed the survey. Nurses accounted for 40.1% of the total sample size, and RTs and physiotherapists accounted for 32.1% and 16.5%, respectively. The majority of HCPs strongly agreed that PR would improve exercise capacity 589 (60.1%), health-related quality of life 571 (58.3%), and disease self-management in patients with COPD 589 (60.1%). Moreover, the in-hospital supervised PR programme was the preferred method of delivering PR, according to 374 (38.16%) HCPs. Around 85% of HCPs perceived information about COPD, followed by smoking cessation 787 (80.3%) as essential components of PR besides the exercise component. The most common patient-related factor that strongly influenced referral decisions was 'mobility affected by breathlessness' (64%), while the 'availability of PR centres' (61%), the 'lack of trained HCPs' (52%) and the 'lack of authority to refer patients' (44%) were the most common barriers to referral., Conclusion: PR is perceived as an effective management strategy for patients with COPD. A supervised hospital-based programme is the preferred method of delivering PR, with information about COPD and smoking cessation considered essential components of PR besides the exercise component. A lack of PR centres, well-trained staff and the authority to refer patients were major barriers to referring patients with COPD. Further research is needed to confirm HCP perceptions of patient-related barriers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The epidemic of burnout has been widely documented among health discipline students. However, there is limited information available on the prevalence of burnout and its association with resilience among clinical-level respiratory therapy (RT) students., Methods: Between March 2022 and May 2022, a descriptive, cross-sectional study using a convenience sample of RT students and interns was conducted. A total of 559 RT students and interns from 15 RT programs responded to socio-demographic questions and the Maslach Burnout Inventory (MBI) and the Brief Resilience Scale (BRS) questionnaires. The data were analyzed using descriptive, inferential, and correlation tests., Results: Of the 559 respondents, 78% reported a high level of burnout. Within the three subscales of burnout, 52% reported emotional exhaustion (EE), 59% reported depersonalization (DP), and 55% reported low personal achievement (PA). The prevalence of burnout increased as students proceeded to senior years ( p = 0.006). In addition, participants with higher grade point averages (GPA) reported a higher level of burnout. Only 2% of the respondents reported a high level of resiliency. Further, there were negative correlations between resilience and EE (r = -41, p < 0.001) and DP (r = -32, p = 0.03), and a positive correlation with low PA (r = 0.56, p = 0.002)., Conclusion: The findings showed a high prevalence of burnout among RT students and interns during clinical training in Saudi Arabia. Resilience was associated with all domains of burnout and is likely to play a protective role. Therefore, there is a need for collaborative interventions to promote resiliency during clinical training to alleviate and overcome burnout symptoms.

Objective: Cognitive impairment is a common comorbidity, yet overlooked, in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the current practice and perceptions of physicians on recognising and managing cognitive impairment in patients with COPD in Saudi Arabia. This study aimed to investigate current practices and perceptions of physicians in Saudi Arabia regarding the recognition and management of cognitive impairment in COPD patients., Methods: An online cross-sectional questionnaire was distributed between March and October 2023 to physicians in Saudi Arabia. The collected responses were analysed using descriptive statistics., Results: A total of 808 physicians completed the online survey. Of whom, only 19% indicated receiving adequate training for managing cognitive impairment. Although the vast majority of physicians reported that cognitive impairment leads to underestimation of COPD severity (85%) and interferes with self-management (85%), only 11% agreed on the important role of screening. In addition, only half of the study participants aimed to identify possible cognitive impairment, with only 4% screening for cognitive impairment during patients' assessment. The overall confidence level in recognising and managing cognitive impairment was relatively low. The most common barriers contributing to the suboptimal management of cognitive impairment in COPD were poor training (62%), the absence of standardised procedures (63%) and limited knowledge (58%) about cognitive impairment in COPD., Conclusion: The current practice of recognising and managing cognitive impairment in Saudi Arabia is suboptimal. This is likely to be attributed to inadequate training, the absence of standardised procedures, and limited knowledge about cognitive impairment in COPD. Healthcare systems should provide more training and implement a holistic approach to detect and manage cognitive impairment during patients' visits.

Objectives: In the Kingdom of Saudi Arabia (KSA), current data on diabetes are lacking, and a rise of the epidemic is feared, given the epidemiologic transition in the country. To inform public health authorities on the current status of the diabetes epidemic, we analyzed data from the Saudi Health Interview Survey (SHIS)., Methods: Saudi Health Interview Survey is a cross-sectional national multistage survey of individuals aged 15 years or older. A total of 10,735 participants completed a health questionnaire and were invited to the local health clinics for biomedical exams., Results: 1,745,532 (13.4 %) Saudis aged 15 years or older have diabetes. Among those, 57.8, 20.2, 16.6, and 5.4 % are undiagnosed, treated uncontrolled, treated controlled, and untreated, respectively. Males, older individuals, and those who were previously diagnosed with hypertension or hypercholesterolemia were more likely to be diabetic., Conclusions: Our findings call for increased awareness of pre-diabetes, diabetes, and undiagnosed diabetes in KSA. Combatting diabetes and other non-communicable diseases should be the task of the Ministry of Health and other ministries as well, to offer a comprehensive socio-cultural approach to fighting this epidemic.

Purpose: To assess the prevalence of hypercholesterolemia and its associated factors in the Kingdom of Saudi Arabia., Methods: A national multistage representative sample of Saudis aged 15 years or older was surveyed through face-to-face interviews. Data on sociodemographics, risk factors, and health information were collected, and blood sample analysis was performed. Data were analyzed using SAS 9.3 to account for the sample weights and complex survey design., Results: Between April and June 2013, a total of 10,735 participants completed the survey. Overall, 8.5% of Saudis had hypercholesterolemia. Another 19.6% had borderline hypercholesterolemia. Among hypercholesterolemic Saudis, 65.1% were undiagnosed, 2.3% were treated uncontrolled, 28.3% were treated controlled, and 4.3% were untreated. The risk of being hypercholesterolemic increased with age and among individuals who reported consuming margarine, obese individuals, and those who have been previously diagnosed with hypertension or diabetes., Conclusions: More than a million Saudis have hypercholesterolemia, and 700,000 of them are unaware of their condition which can be controlled through early detection campaigns and lifestyle change and medication. An urgent awareness and screening campaign is needed in Kingdom of Saudi Arabia to prevent and avoid disease progression toward more serious stages., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Introduction: Data on obesity from the Kingdom of Saudi Arabia (KSA) are nonexistent, making it impossible to determine whether the efforts of the Saudi Ministry of Health are having an effect on obesity trends. To determine obesity prevalence and associated factors in the KSA, we conducted a national survey on chronic diseases and their risk factors., Methods: We interviewed 10,735 Saudis aged 15 years or older (51.1% women) through a multistage survey. Data on sociodemographic characteristics, health-related habits and behaviors, diet, physical activity, chronic diseases, access to and use of health care, and anthropometric measurements were collected through computer-assisted personal interviews. We first compared sociodemographic factors and body mass index between men and women. Next, we conducted a sex-specific analysis for obesity and its associated factors using backward elimination multivariate logistic regression models. We used SAS 9.3 for the statistical analyses and to account for the complex sampling design., Results: Of the 10,735 participants evaluated, 28.7% were obese (body mass index ≥ 30 kg/m(2)). Prevalence of obesity was higher among women (33.5% vs 24.1%). Among men, obesity was associated with marital status, diet, physical activity, diagnoses of diabetes and hypercholesterolemia, and hypertension. Among women, obesity was associated with marital status, education, history of chronic conditions, and hypertension., Conclusion: Obesity remains strongly associated with diabetes, hypercholesterolemia, and hypertension in the KSA, although the epidemic's characteristics differ between men and women.

Introduction: We report the burden of disease and risk factors measured by causes of death, years of life lost attributable to premature mortality (YLLs), years of life lived with disability (YLDs), and disability-adjusted life years (DALYs) for 1990, 2005, and 2010 in the Kingdom of Saudi Arabia (KSA)., Methods: We used the Global Burden of Diseases 2010 (GBD 2010) methodology to estimate the country-level burden of disease in KSA. We used data from systematic reviews of the literature, household survey data, antenatal clinic surveillance data, reportable disease notifications, disease registries, hospital admissions data, outpatient visit data, population-based cancer registries, active screening data, and other administrative data., Results: Noncommunicable diseases and road traffic injuries became the leading cause of death and disability in KSA in 2010. Elevated body mass index was the leading risk factor for disease (7.02% for males and 4.61% for females in 2010). High glucose levels were the second leading disease risk factor for females (3.28%) and third for males (6.25%) in 2010. Preterm birth complications were the main cause for DALYs in 1990; however, in 2010, the leading cause of DALYs for males was road traffic injuries (12.40%) and for females it was major depressive disorder (7.88%)., Conclusion: KSA is facing a rising burden of noncommunicable diseases and road traffic injuries as a result of rapid changes in behaviors. Our results demonstrate the need for major intervention to reduce these burdens and to engage other sectors of the government and the community in these efforts.

The aerial part of Commiphora opobalsamum L. (Burseraceae) growing in Saudi Arabia was subjected to a phytopharmacological investigation in order to identify its major chemical constituents and to evaluate its extracts and isolated compounds in preliminary in vitro assays for antimicrobial, antimalarial, antitumor, anti-inflammatory (COX-2 inhibition), antioxidant and estrogenic activity. Six compounds were isolated and identified as the triterpenes friedelin, canophyllal, and oleanonic acid; the flavonols mearnsetin and quercetin; and syringic acid. The ethyl acetate extract was moderately active against Staphylococcus aureus, Pseudomonas aeruginosa, and Plasmodium falciparum; while the petroleum ether and chloroform extracts inhibited COX-2 at 5 and 10 microg mL(-1), respectively. Of the isolated compounds, syringic acid showed moderate antimalarial, anticandidal, and antimycobacterial activity; while mearnsetin and quercetin exhibited antioxidant activity comparable to ascorbic acid and trolox. This is the first detailed phytochemical investigation of C. opobalsamum L. growing in Saudi Arabia and elsewhere. The isolated compounds are reported from this plant for the first time and their full (1)H and (13)C NMR assignments are included.

The synergistic activity of antimycobacterial constituents from Saudi plants was evaluated in combination with isonicotinic acid hydrazide (INH) against four atypical organisms, namely, Mycobacterium intracellulare, M. smegmatis, M. xenopei and M. chelonei. The potency of INH was increased four-fold, using an in vitro checkerboard method, against each mycobacteria when tested with a subtoxic concentration of the totarol, isolated from J. procera. The MIC values of totarol, ferulenol (from Ferula communis) and plumbagin (from Plumbago zeylanica) were thus lowered from 1.25-2.5 to 0.15-0.3 microg/mL due to synergism with INH. When tested against the resistant strain of M. tuberculosis H37Rv, plumbagin and 7beta-hydroxyabieta-8,13-dien-11,12-dione exhibited inhibitory activity at <12.5 microg/mL, while others were inactive at this concentration., (Copyright 2004 John Wiley & Sons, Ltd.)

A preliminary survey on the medicinal plant diversity in the flora of the Kingdom of Saudi Arabia has been made with seven families: Amaranthaceae, Apocynaceae, Capparidaceae, Euphorbiaceae, Labiatae, Polygonaceae and Solanaceae, as an initial study. These families are represented in the flora with 254 species (i.e. 12% of the total species), and individually with 21, 7, 29, 66, 76, 22 and 33 species, respectively. Of these, 86 species, so far investigated, are medicinal, distributed in these seven families as follows: 7, 5, 12, 20, 23, 7 and 12, respectively. The Labiatae have the highest number (23) of medicinal plants among them while maximum medicinal plant diversity within the family has been observed with the Apocynaceae. An enumeration of these 86 medicinal species is presented with the current nomenclature, Arabic names and medicinal uses. This communication aims at emphasizing the importance of setting up conservation priorities, and sustained development of various medicinal plants of Saudi Arabia.

Two new isomeric axane and oppositane sesquiterpene derivatives, named teclenone A (1) and teclenone B (2), were isolated from the aerial parts of Teclea nobilis. Their structures have been established on the basis of (1)H and (13)C NMR spectral data, notably 2D NMR (1)H-(1)H COSY, (1)H-(13)C HMQC, (1)H-(13)C HMBC, and (1)H-(1)H NOESY experiments. This appears to be the first report of the rare axane and oppositane sesquiterpenes from the plant family Rutaceae.