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Ali Al Qarni,1– 3 Sami Al-Nasser,4,5 Abdullah Alzahem,4– 6 Tarig Awad Mohamed4,5 1Endocrinology and Metabolism, Department of Medicine, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia; 2King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia; 3King Saud bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia; 4Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riaydh, Saudi Arabia; 5King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 6Department of Dental Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaCorrespondence: Ali Al QarniEndocrinology and metabolism, Department Of Medicine, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Po Box 2477, Al Ahsa, Zip, 31982, Saudi ArabiaTel +966 500133678Email qarniaa@ngha.med.saBackground: Quality improvement and patient safety (QIPS) are a global health priority. Accordingly, QIPS education in medical education became mandatory. Despite that, information about QIPS education in postgraduate training in Saudi Arabia is limited. This study aimed to explore the educational aspects of QIPS in the internal medicine residency training program at King Abdulaziz Hospital in Al Ahsa, Saudi Arabia.Methods: This was a qualitative study employing the constructivist grounded theory approach. The sample size was determined using the theoretical saturation point, and we utilized a purposeful sampling technique. A semi-structured interview was used for data collection and was conducted between September 6 and October 20, 2020.Results: Twenty-two internal medicine trainee residents were required to serve the study purpose. The emerged themes were organized under awareness, education, barriers and opportunities and improvement priorities. Awareness of participants about the QIPS concept, importance, and value of education was found. The participants did not recognize specific dedicated QIPS education components under the structured training program. However, they recognized participation in patient safety-oriented activities but not in quality improvement activities. Consultants’ observations and written exams were perceived as the assessment tools. Barriers including time limitation and opportunities including participation in quality improvement projects were identified. Participants suggested making QIPS education mandatory under the training program as an improvement priority.Conclusion: This study highlighted the awareness of internal medicine residents of the QIPS concept, importance, and value of QIPS education. However, we found crucial gaps related to education including lack of a dedicated QIPS component under the training program. There is a need for multicenter studies to measure the magnitude of our findings for improvement of QIPS education in residency training in Saudi Arabia. This is the first study about QIPS education in residency training in Saudi Arabia up to our best knowledge.Keywords: quality improvement and patient safety, QIPS, internal medicine residency training program, QIPS curriculum

Abdullah M Alzahem,1 Henk T Van der Molen,2 Arwa H Alaujan,3 Benjamin J De Boer4 1King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia; 2Institute of Psychology, Faculty of Social Sciences, Erasmus University, Rotterdam, the Netherlands; 3Dental Services, Central Region, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; 4Clinical Psychology, Princess Nora University, Riyadh, Saudi Arabia Abstract: This study compared the effectiveness of stress management programs in dental education by systematic review of the literature. The number of studies concerning stress management programs for dental students is limited compared with studies discussing sources of stress. Several types of programs for stress management have been reported, and differ in their duration, content, and outcomes. Two main strategies have been used to help stressed students, ie, decreasing the number of stressors and increasing the ability to cope with stress. The first strategy includes several components, such as reducing fear of failure and workload pressure due to examinations and requirements. The second strategy includes coping techniques, such as deep breathing exercises. Although positive effects have been reported for most of the programs, these have mainly been evaluated using subjective self-report measures. There is a need for more research to identify the most effective stress management program. Keywords: students, dentistry, education, management, stress

Abdullah M Alzahem,1 Henk T van der Molen,2 Benjamin J de Boer31Advanced Education in General Dentistry (AEGD) Residency Program, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences/National Guard Health Affairs, Riyadh, Saudi Arabia; 2Institute of Psychology, Faculty of Social Sciences, Erasmus University, Rotterdam, The Netherlands; 3Clinical Psychology, Princess Nora University, Riyadh, Saudi ArabiaObjective: Stress among dental students can be a significant threat, resulting in physical and/or mental illness, and have a negative effect on students' performance and the professional practice of dentistry. Stress can occur from different sources. The purpose of this study is to test whether the year of study has an effect on the stress levels of dental students.Method: Our study consisted of a cross-sectional survey using a modified version of the Dental Environment Stress (DES) questionnaire. The questionnaires were filled out by male undergraduate dental students at King Saud University in Riyadh City during the 2010–2011 academic year (n = 214).Results: The results show the most common sources of stress: examinations and completing clinical requirements. Moreover, in the five-year lecture-based traditional curriculum, the third year students reported the highest level of stress, whereas the first year reported the lowest level of stress.Conclusion: Third year undergraduate dental students reported the highest level of stress. This stress could be reduced by reviewing and modifying the dental curriculum by allowing students to have contact with patients more gradually, starting from the first year, in addition to adding stress prevention and intervention programs in dental curricula.Keywords: dental, education, students, stress, study year

Abstract Background The “C group” of the histiocytic disorders is characterized by non-Langerhans-cell histiocytic lesions in the skin, mucosal surfaces, or both, out of which Juvenile xanthogranuloma (JXG) is the most common typically affecting the skin. The eye is the most common extra-cutaneous site of JXG., we aim at providing our clinical and histopathological experience with this group of diseases including the adult-onset xanthogranuloma (AXG). Methods This is a retrospective cohort study of all patients with the tissue diagnosis of ocular and periocular cutaneous and mucocutaneous non-LCH disorders who presented to us over a period of 25 years (January 1993 to December 2018). Results Twenty patients were diagnosed as “Group C” disease with an age range of 2 months-60.9 years. Eleven patients were females (55%) and nine were males (45%). The involvement was mostly unilateral in 80.9%. All cases fell into the xanthogranuloma family with 11 JXG patients, 8 AXG patients of skin and ocular surface, and one patient with solitary reticulohistiocytoma (SRH). The clinical site of involvement in JXG was primarily in the eyelid in 5 patients (45%), ocular surface lesions in 2 (18%), iris in 2 (18%), choroidal and bilateral orbital lesions in 1 patient each (9%). The group of AXG, presented equally with eyelid lesions in 4/8 and ocular surface lesions in 4/8. The non-Langerhans’ histiocytic infiltrate showed supportive immunohistochemical staining properties (reactive to CD68 marker and negative to S-100 and langerin markers). Conclusion Among the rare histiocytic disorders, xanthogranulomatosis is the commonest and has wide clinical manifestations. Accurate diagnosis needs to be supported by typical histopathological findings. JXG was the commonest in our study with relatively older mean age at presentation and frequent eyelid rather than iris involvement. AXG is often confused with xanthelasma when involving the eyelids with corneal limbal involvement is relatively frequent.

Semantic segmentation of Remote Sensing (RS) images involves the classification of each pixel in a satellite image into distinct and non-overlapping regions or segments. This task is crucial in various domains, including land cover classification, autonomous driving, and scene understanding. While deep learning has shown promising results, there is limited research that specifically addresses the challenge of processing fine details in RS images while also considering the high computational demands. To tackle this issue, we propose a novel approach that combines convolutional and transformer architectures. Our design incorporates convolutional layers with a low receptive field to generate fine-grained feature maps for small objects in very high-resolution images. On the other hand, transformer blocks are utilized to capture contextual information from the input. By leveraging convolution and self-attention in this manner, we reduce the need for extensive downsampling and enable the network to work with full-resolution features, which is particularly beneficial for handling small objects. Additionally, our approach eliminates the requirement for vast datasets, which is often necessary for purely transformer-based networks. In our experimental results, we demonstrate the effectiveness of our method in generating local and contextual features using convolutional and transformer layers, respectively. Our approach achieves a mean dice score of 80.41%, outperforming other well-known techniques such as UNet, Fully-Connected Network (FCN), Pyramid Scene Parsing Network (PSP Net), and the recent Convolutional vision Transformer (CvT) model, which achieved mean dice scores of 78.57%, 74.57%, 73.45%, and 62.97% respectively, under the same training conditions and using the same training dataset.

Lecturing has always been one of the traditional instructional methods in medical education. It is cost-effective, especially when it comes to conveying a large amount of information to many students at once. However, disadvantages are plenteous, one of which is its passive way of knowledge delivery and learning. Active learning, on the contrary, has better students' engagement and longer retention, and it results in better students' achievement. The emergency medicine residency training program at KAMC-Jeddah has modified the educational activity to become more aligned with the end-of-year assessment in the form of active learning. This study aimed to explore the experience of the residents regarding the implementation of the new educational approach. An exploratory-qualitative study utilizing constructive grounded theory was conducted, collecting our data through an in-depth 1:1 interview using semi-structured open-ended questions. Purposeful sampling was used, and saturation was reached after interviewing 24 residents. The general perception of residents toward the new teaching modes slightly varied, highlighting the positivity of the new educational environment, the desired impact on their learning, the challenges they encountered, and finally their high satisfaction level and support for this new experience. It was asserted that such experience could be permanently implemented to increase the efficacy of teaching and learning.

Patients with cone dystrophy (CD) can present with virtually normal retinal appearance, which may delay diagnosis. This study describes the inconspicuous clinical features of POC1B-associated CD in two Saudi families. This is a retrospective case study. Clinical data analyzed included multimodal retinal imaging and electroretinography of the affected individuals. Genetic analysis was done for all probands. Three affected males from two Saudi families with POC1B-associated CD were included. The ages at presentation ranged from 18 to 34 years. Ophthalmic examination showed decreased Snellen visual acuities (range: 20/100–20/300) and color vision bilaterally. Fundus examination showed only mild vascular attenuation. Macular optical coherence tomography showed reduced reflectivity of the external limiting membrane, ellipsoid, and interdigitation zones. Full-field electroretinography demonstrated undetectable light-adapted responses and normal dark-adapted responses in all patients. Next-generation sequencing showed one proband to be homozygous for a previously unpublished nonsense variant in POC1B (NM_172240):c.672C>G; p(Tyr224*). Whole exome sequencing for the second proband showed a novel homozygous frameshifting variant in POC1B: c.991del; p(Arg331Glufs*13). We described two novel variants in POC1B and the associated subtle, yet significant retinal features. POC1B-associated CD is a rare cause of visual loss in patients with relatively normal fundus appearance. Deep phenotyping is necessary in formulating appropriate differential diagnosis. [ABSTRACT FROM AUTHOR]