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Hajed M Al-Otaibi,1,2 Nabeela Abdullah Al-Abdullah,3 Abdulrahman A Naqru,4 Mohammed A Boukhari,5 Ahmed M Almohaimeed,2 Abdulaziz J Alzhrani6 1Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 2Respiratory Therapy Unit, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Public Health, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia; 4Respiratory Therapy Department, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia; 5Respiratory Therapy Department, Andalusia Group Hospital, Jeddah, Saudi Arabia; 6Respiratory Therapy Department, Bugshan Hospital, Jeddah, Saudi ArabiaCorrespondence: Hajed M Al-Otaibi, Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589, Saudi Arabia, Email halotaibi1@kau.edu.saBackground: The use of simulation-based methods for teaching and learning in the education of health professions is increasing, but its prevalence in Saudi Arabia among respiratory therapy programs has yet to be investigated. The purpose of this study is to identify the use of simulation-based learning (SBL) in respiratory therapy programs in Saudi Arabia.Methods: A cross-sectional study was performed by sending Google forms survey via Email to directors of respiratory therapy programs in Saudi Arabia (N=16) to evaluate how each one used simulations as an educational tool.Results: The survey was returned with a total response of 12 out of all 16 program that were initially contacted (75% response rate). Among the respondents, approximately 75% of the programs are using SBL, while high-fidelity simulation is used by all programs. The present data show that 67% of the respiratory therapy programs has a space for simulation within the department, while 33% utilizes institutional simulation centers. For short simulation scenarios, debriefing is not conducted in 67% of the programs. There is acceptance by program directors that simulation hours should be counted towards clinical hours. About 67% of respondent programs have mandatory simulation learning activities, and 100% agree that simulations should be used more. However, lack of training and shortage of staff are among barriers to increase the use of SBL.Conclusion: SBL is commonly used and relatively varied among respiratory therapy programs. However, it requires some improvements in several aspects, including the use of debriefing and increasing the number of properly trained staff.Keywords: respiratory therapy, simulation, debriefing, medical education, Saudi Arabia

Background: Neural mobilisation technique is effective in spinal nerve rehabilitation. However, no study has reported the effect of facial nerve mobilisation in acute Bell’s palsy. Objectives: The objective of our study was to evaluate the effect of facial neural mobilisation over conventional therapy in improving facial symmetry in patients with acute Bell’s palsy. Methods: A randomised controlled trial was conducted in the physical therapy department for 62 patients with acute Bell’s palsy. The intervention included 10 days of drug therapy including 3 weeks of conventional therapy to the experimental and the control group. However, the experimental group received additional nerve mobilisation technique aimed at mobilising the facial nerve at the origin of external auditory meatus. All participants were assessed at baseline and after three weeks using the Sunnybrook facial grading system (SBS) and Kinovea Movement Analysis Software (KMAS). Results: For primary outcome, analysis of covariance with baseline data as covariate showed a significant difference between groups for the post-test mean scores of SBS after 3 weeks (between-group difference, 9.2 [95% CI, 5.1–13.3], [Formula: see text]. Importantly, the effect size calculated by partial [Formula: see text] for neural mobilisation was 0.258 (small effect size). For secondary outcomes, independent sample t-test showed a significant difference between groups for the scores on KMAS after 3 weeks for zygomatic muscle (between-group difference, [Formula: see text] [95% CI, [Formula: see text] to [Formula: see text]], [Formula: see text]), frontalis muscle [Formula: see text] [95% CI, [Formula: see text] to [Formula: see text]], [Formula: see text], and orbicularis oris muscle [Formula: see text] [95% CI, [Formula: see text] to [Formula: see text]], [Formula: see text]. Conclusion: Facial neural mobilisation is likely to be an effective adjunctive intervention in addition to conventional therapy in improving facial symmetry in acute Bell’s palsy.

This study introduces a new model of practitioner research to develop an activist teacher professional identity for student-teachers and to enhance their understanding of the theory and practice of continuous professional development (CPD). The participants were ten female student-teachers enrolled in an MA program for Teaching English to Speakers of Other Languages (TESOL) at a university in Saudi Arabia. In this intervention, student-teachers constructed their version of CPD. Then they subsequently reflected on their definition of CPD and the factors contributing to its success. Qualitative research methods were used to collect data, including document analysis and individual structured interviews. The study sought to discover how the enquiry intervention improved student-teachers' grasp of CPD theory and practice and contributed to the construction of their activist teacher professional identity. The findings may encourage the development and implementation of new forms of practitioner enquiry in MA programs to support the construction of different notions of professional identity found in the literature.

Abstract Objectives To systematically review the prevalence and risk factors of inadvertent facial nerve stimulation (FNS) after cochlear implant (CI) surgery. And to report the different management strategies used for reducing and resolving FNS. Data Source Web of Science, Scopus, PubMed, Cochrane Library, and Virtual Health Library (VHL) of the World Health Organization (WHO). Review Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) on studies that reported FNS as a complication after CI. A comprehensive electronic search strategy was used to identify the relevant articles. We extracted the data on the prevalence of FNS after CI activation, the reported grades, and the management strategies. The number of associated electrodes; cause of deafness; co‐anomalies; and duration of hearing loss and their relationships with FNS were also studied. Results Twenty‐one relevant articles were included in this review. The prevalence of FNS among the CI populations was 5.29% (175/3306 patients). Among those whose ages were reported, 58.3% (95/163) were adults, and 41.7% (68/163) were pediatrics. Modifying the different fitting parameters was the most used strategy, as it successfully resolved FNS in 85.5% of the patients (142/166). The second commonly used management strategy was surgical intervention (reimplantation or explantation), which was reported in seven studies for 23 patients. Conclusion FNS after CI activation could be controlled and resolved with many advances that range from readjusting the fitting parameters to surgical intervention. However, further studies are required to validate the efficacy of each management strategy and its impact on patients' performance. Our findings demonstrate that CI recipients with FNS could still benefit from the CI devices and their FNS could be controlled.

Abstract Nanomedicines are increasingly researched and used for the treatment of chronic inflammatory diseases. Herein, the effect of the size of nanoparticles on their distribution and retention in chronic inflammatory sites, as compared to healthy tissues, was studied in a mouse model with chronic inflammation in one of the hind footpads. Using PEGylated gold nanoparticles of 2, 10, 100, and 200 nm, we found that although the smaller nanoparticles of 2 and 10 nm showed greater distribution and slower clearance in the inflamed footpad than the relatively larger nanoparticles of 100 and 200 nm, the larger nanoparticles of 100 and 200 nm were more selectively distributed in the inflamed hind footpad than in the healthy hind footpad in the same mouse. Based on these findings, we prepared protein nanoparticles of 100–200 nm with albumin, IgG antibody, or anti-TNF-α monoclonal antibody (mAb). The nanoparticles can release proteins in response to high redox activity and/or low pH, conditions seen in chronic inflammation sites. We then showed that upon intravenous injection, those stimuli-responsive protein nanoparticles distributed more selectively in the inflamed footpad than free proteins and remained longer in the inflamed footpad than similar protein nanoparticles that are not sensitive to high redox activity or low pH. These findings support the feasibility of increasing the selectivity of nanomedicines and protein therapeutics to chronic inflammation sites and prolonging their retention at the sites by innovative nanoparticle engineering. Graphical Abstract

Abstract Background Autoimmune/type 1 diabetes mellitus (T1DM) is a recently described rare occurrence following the administration of adjuvants such as coronavirus disease 2019 (COVID-19) vaccines. This systematic review aimed to review all available literature on the potential association between COVID-19 vaccines and T1DM. Methods The Directory of Open Access Journals, MEDLINE, Google Scholar, and Scopus were systematically searched for all published studies from inception to July 2022. Articles reporting T1DM development within 8 weeks of administration of COVID-19 vaccine were included. Two reviewers independently performed the risk of bias assessment following the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. Results Eight eligible studies were retrieved, comprising 12 patients diagnosed with T1DM after being vaccinated with a COVID-19 vaccine. Six patients (50%) reported T1DM after receiving the second dose. Five patients (41.7%) presented with diabetic ketoacidosis, of which four presented within the first eight days after vaccination. Five patients (41.7%) had genetic susceptibility, with RNA binding motif protein 45 (RBM45/DRB1) and major histocompatibility complex, class II, DQ beta 1 (HLA-DQB1) mutations being prominent. Interpretation In this review, we have shown a small number of new-onset diabetes cases coincidently occurring soon after the COVID-19 vaccine, especially in those with genetic susceptibility. Despite being older, these patients had a similar phenotype to T1DM. While there might be a causal relationship between COVID-19 vaccines and T1DM development, this should not influence decisions regarding vaccination since the overall benefit outweighs the risk. Further larger prospective trials are needed to assess causal relationship and to clarify the potential roles of COVID-19 vaccine-derived antigens in autoimmune disease development. Protocol registration PROSPERO-CRD42022342093.

During the ongoing coronavirus disease 2019 pandemic, over 1.5 billion students worldwide have been deprived of access to traditional learning. This situation has necessitated the use of social distancing-based educational methods; consequently, a tremendous shift towards e-learning has been observed. This study assesses medical students' social anxiety levels in e-learning environments. The study was conducted in two phases. In the first phase, the original Turkish Social Anxiety Scale for E-Learning Environments (SASE) was adapted in English and tested for validity and reliability. This instrument has two subscales: social anxiety in learner-learner interaction and in learner-instructor interaction. In the second stage, we explored the associations of gender, age, and perceived academic performance with medical students' social anxiety levels in e-learning environments. A total of 325 responses were analysed. Consistent with the original version, the adapted scale is a reliable and valid measure of social anxiety in e-learning. Social anxiety in e-learning was related to gender (p = 0.008) and age (p = 0.013). Social anxiety levels were higher in students with lower perceived performance during e-learning compared to students with enhanced performance, but the difference was not significant. The SASE is a useful instrument for evaluating social anxiety in e-learning environments across English educational frameworks. Considering the shift in social interaction environments, efforts are required to reduce medical students' social anxiety levels and enhance learning.

Context: With the high prevalence of anterior cruciate ligament rupture among young and active individuals, rehabilitation after the injury and surgery should meet the current evidence-based recommendations to restore knee function and reduce the risk of further injury. This study aimed to investigate the current rehabilitation practices and return to sports (RTS) criteria after anterior cruciate ligament reconstruction (ACLR) among physical therapists in Saudi Arabia. Design: Online cross-sectional survey-based study. Methods: A total of 177 physical therapists in Saudi Arabia participated in this survey. The survey included questions about the preferred postoperative timing and frequency of rehabilitation, current views on the importance of preoperative and postoperative rehabilitation to the overall outcomes, the timeframe of RTS, and the decision-making process to RTS. Results: Most therapists (96.6%) believed preoperative rehabilitation was essential/important to postoperative outcomes. Two-thirds encouraged patients to start rehabilitation program within 1 to 4 days immediately post-ACLR. RTS was permitted 6 to 9 months post-ACLR by 60% of therapists if satisfied with patient progress and capacity. Factors considered before RTS included knee strength (72.9%), functional capacity (86.4%), lower limb and trunk mechanics (62.7%), and psychological readiness (42.2%). Knee strength was assessed by manual muscle testing (39%), handheld dynamometry (15.3%), and isokinetic dynamometer (13.6%). While 60% of the therapists used single-limbed hop for distance for evaluating functional capacity, only 27.1% used a hop test battery. Conclusions: The surveyed physical therapists in Saudi Arabia demonstrated variations in the current rehabilitation practices and RTS criteria post-ACLR. Over half of the surveyed therapists considered preoperative rehabilitation essential to postoperative outcomes. However, the therapists should update their perspective with current evidence-based practice regarding the RTS timeframe, psychological readiness assessment for RTS, and knee strength evaluation using objective measurements. [ABSTRACT FROM AUTHOR]

Abstract Background Tobacco use remains a leading cause of premature death. To combat tobacco use, the Ministry of Health (MOH) improved access to smoking cessation clinics (SCCs) by developing fixed SCCs and mobile SCCs, which move based on demand across locations. The goal of this study was to investigate awareness and utilization of SCCs among tobacco users in Saudi Arabia and the factors that influence their awareness and utilization. Method This cross-sectional study used the 2019 Global Adult Tobacco Survey. Three outcome variables were employed, including tobacco users’ awareness of fixed SCCs, mobile SCCs, and utilization of fixed SCCs. Several independent variables were examined, including sociodemographic characteristics and tobacco use. Multivariable logistic regression analyses were performed. Results One thousand six hundred sixty-seven tobacco users were included in this study. There were 60%, 26%, and 9% of tobacco users who were aware of fixed SCCs, aware of mobile SCCs, and visited fixed SCCs, respectively. The likelihood of being aware of SCCs increased among users residing in urban areas (fixed SCCs: OR = 1.88; 95% CI = 1.31–2.68; mobile SCCs: OR = 2.09; CI = 1.37–3.17) while it decreased among those reported self-employed (fixed SCCs: OR = 0.31; CI = 0.17–0.56; mobile SCCs: OR = 0.42; CI = 0.20–0.89). The likelihood of visiting fixed SCCs increased among educated tobacco users aged 25–34 (OR = 5.61; CI = 1.73–18.21) and 35–44 (OR = 4.22; CI = 1.07–16.64) while the odds of visiting SCCs decreased among those who were working in the private sector (OR = 0.26; CI = 0.09–0.73). Conclusion The decision to quit smoking must be supported by an effective healthcare system that provides accessible and affordable smoking cessation services. Knowing the factors that influence the awareness and utilization of SCCs would help policymakers dedicate efforts targeting those who desire to quit smoking yet face limitations in using SCCs.

Intermittent energy restricted (IER) diets have become popular as a body weight management approach. In this pilot study, we investigated if an IER diet would reduce systemic inflammation and if maintaining an elevated protein level while on an IER diet would enhance satiety. Six healthy women, aged 33–55 years with a BMI of 27–33 kg/m2, were randomized to first adhere to either a low- or high-protein IER diet using whole foods for three weeks. They then returned to their regular diets for a week, after which they adhered to the second diet for three weeks. Each test diet consisted of three low-energy intake days followed by four isocaloric energy intake days. The diets differed only in protein content. High-sensitivity C-reactive protein (hs-CRP), glucose, satiety, body weight, and waist circumference were measured at the beginning and end of each dietary intervention. Most participants showed reductions in hs-CRP levels from baseline on both IER diets but reported greater satiety when adhering to the higher protein IER diet. Overall, the IER diets reduced body weight and appeared to decrease inflammation in these overweight women, and the higher protein version enhanced satiety, which may lead to greater long-term dietary adherence.

Objectives: Worldwide, the COVID-19 pandemic has significantly impacted mental health challenges for adolescent populations. The current study aims to examine the levels of perceived stress of COVID-19 and self-compassion and their relationship among adolescents in Saudi Arabia. Methods: This study employed a cross-sectional online survey of adolescents from secondary schools in Asir, Saudi Arabia. Instruments that we distributed online included the modified Perceived Stress Scale (PSS-10) and the Self-Compassion Scale (SCS), in addition to demographic and health-related questions. A total of 500 adolescents completed the survey. Results: Adolescents in the study reported an average moderate perceived stress level of 18.6 (SD = 6.67) and an average moderate self-compassion level of 3.22 (SD = 0.53). A significant correlation is also found between the two variables (r = −0.460, P

Introduction Saudi Arabia is expected to witness a slight reduction in tobacco use. The Saudi government offers free-of-charge smoking cessation services. Yet, factors influencing the desire to quit smoking are not comprehensively investigated in Saudi Arabia. This study examines the factors influencing the desire to quit among smoking adults in Saudi Arabia and investigates whether using alternative tobacco products, such as e-cigarettes, is associated with the desire to quit smoking. Methods Data from the 2019 nationally representative Global Adults Tobacco Survey (GATS) was used. GATS utilized a face-to-face household cross-sectional survey that collected data from adults aged ≥15 years. Several factors including, sociodemographic characteristics, use of alternative tobacco products, attitude toward tobacco control, and awareness of smoking cessation clinics (SCCs), were examined to predict the desire to quit. Logistic regression analysis was conducted. Results A total of 11381 individuals completed the survey. Of the total sample, 1667 participants were tobacco smokers. The majority of the tobacco smokers were interested in quitting smoking (82.4%); 58% of cigarette smokers and 17.1% of waterpipe smokers were interested in quitting smoking. The desire to quit smoking was positively associated with the awareness of SCCs (AOR=3; 95% CI: 1.8–5), attitude toward raising tobacco taxes (AOR=2.3; 95% CI: 1.4–3.8), and a strict rule of smoking inside the home (AOR=2; 95% CI: 1.1–3.9). No statistical association was found between the desire to quit smoking and the use of e-cigarettes. Conclusions The desire to quit tobacco smoking among Saudi smokers increased with awareness of SCCs, favoring taxes on tobacco products, and implementing strict rules of smoking inside the home. The study reveals valuable insights into the main factors that could inform the development of more effective policy interventions targeting smokers in Saudi Arabia.