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Abdulelah M Aldhahir,1 Heba M Bintalib,2– 4 Munyra Alhotye,5,6 Jaber S Alqahtani,7 Omar A Alqarni,8 Abdullah A Alqarni,9 Khadijah N Alshehri,10 Ahmed H Alasimi,11 Reynie P Raya,12,13 Mohammed M Alyami,14 Abdallah Y Naser,15 Hassan Alwafi,16 Eidan M Alzahrani17 1Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Department of Respiratory Care, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 3King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia; 4UCL Respiratory, University College London, London, UK; 5Department of Respiratory Therapy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 6King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia; 7Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 8Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 9Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 10Physical Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 11Department of Respiratory Therapy, Georgia State University, Atlanta, GA, USA; 12Faculty of Science, Universitas ‘Aisyiyah Bandung, Bandung, Indonesia; 13Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK; 14Respiratory Therapy Department, Batterjee Medical College, Khamis Mushait, Saudi Arabia; 15Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan; 16Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia; 17Physical Therapy Department, Prince Sultan Military College of Health Sciences, Dammam, Saudi ArabiaCorrespondence: Abdulelah M Aldhahir, Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Saudi Arabia, Email Aldhahir.abdulelah@hotmail.com Heba M Bintalib, UCL Respiratory, University College London, London, UK, Email heba.bintalib.20@ucl.ac.ukBackground: 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.Keywords: nomophobia, physiotherapy, PT, Saudi Arabia

Abdulelah M Aldhahir,1,&ast; Munyra Alhotye,2,&ast; Jaber S Alqahtani,3 Ibrahim A AlDraiwiesh,3 Saeed M Alghamdi,4,5 Abdullah S Alsulayyim,1,5 Abdullah A Alqarni,6 Shahad K Khormi,6 Eidan M Alzahrani,7 Ahmed M Al Rajeh,8 Yousef S Aldabayan,8 Rayan A Siraj,8 Naif A Tawhari,1 Faisal M Alhazmi,1 Ayat A Najmi,9 Khalid S Alwadeai,10 Hassan Alwafi11 1Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 4Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 5National Heart and Lung Institute, Imperial College London, London, UK; 6Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 7Department of Physiotherapy, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 8Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia; 9Physical Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 10Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 11Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Munyra Alhotye, Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, Email ma880@leicester.ac.ukBackground: 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.Keywords: cardiopulmonary rehabilitation, heart failure, HF, physiotherapists, PT, Saudi Arabia

Jaber S Alqahtani,1 Mohammed D AlAhmari,1,2 Hajed M Al-Otaibi,3 Saad M AlRabeeah,1 Noor A Al Khathlan,4 Abdulelah M Aldhahir,5 Abdullah S Alqahtani,1 Khalid S Alwadeai,6 Saleh S Algarni,7,8 Rayan A Siraj,9 Abdullah A Alqarni,3 Mohammed A Almeshari,6 Saeed M Alghamdi,10 Mohammed AlTaweel,11 Musallam Alnasser,1 Jithin K Sreedharan,1 Abdullah A Almojaibel,4 Mushabbab Alahmari,12 Yousef S Aldabayan,9 Bodor H Bin Sheeha,13 Fahad H Alahmadi,14 Abdullah S Alsulayyim,5,15 Eidan M Alzahrani16 1Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia; 2Dammam Medical Complex, Dammam Health Network – Eastern Health Cluster, Dammam, 32245, Saudi Arabia; 3Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 4Respiratory Care Department, Imam Abdulrahman bin Faisal University, Dammam, 34212, Saudi Arabia; 5Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, 45142, Saudi Arabia; 6Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 11451, Saudi Arabia; 7Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia; 8King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 9Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, 31982, Saudi Arabia; 10Respiratory Care Program, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, 24382, Saudi Arabia; 11Respiratory Care Department, AlMaarefa University, Riyadh, 13713, Saudi Arabia; 12Department of Respiratory Therapy, Faculty of Applied Medical Sciences, University of Bisha, Bisha, 67714, Saudi Arabia; 13Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11564, Saudi Arabia; 14Respiratory Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Madinah, 42353, Saudi Arabia; 15National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UK; 16Department of Physiotherapy, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi ArabiaCorrespondence: Jaber S Alqahtani, Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia, Email Alqahtani-Jaber@hotmail.comBackground: Despite recent advancements in the respiratory care (RC) profession, no single institution in the Kingdom of Saudi Arabia (KSA) offers a master’s degree program in RC.Methods: A nationwide and validated survey was used to explore the current needs and interests in establishing RC master’s degree programs in the KSA. The process included representatives from the healthcare industry, universities, and professional societies.Results: A total of 1250 stakeholders across the KSA completed the survey. The sample includes 722 (58%) males, 504 (40%) respiratory therapists, 547 (44%) students, 138 (11%) leaders, and 61 (5%) were academic respondents. Most respondents were from Central 491 (39%) and Eastern 307 (25%) regions, with 1003 (80%) of the total sample worked or studied in governmental sectors. A total of 574 (82%) of the leaders and RTs had Bachelor degree and 430 (61%) of them had 1– 5 years working experience. According to 80% of the employers and employees, only 0– 5% of the RTs in their organization had a master’s degree. The calculated mean % of the agreement (agree/strongly agree) on the needs was 83% in all needs’ assessment items, which shows a great support for establishing a master’s in RC to meet the personal, professional and society needs. The mean % of the agreement for the level of interests among all participants was 86%, indicating a great level of interests in establishing a master degree in RC. The agreement % on the needs assessment and level of interests in establishing a master degree in RC in KSA were ≥ 80% in each stakeholder group.Conclusion: There are obvious needs and interests in establishing master’s degree programs in RC in the KSA. A master’s degree in RC should be established to address the growing needs for advanced RC services throughout the nation and enhance RC research.Keywords: respiratory care, master degree, education, Saudi Arabia, NCAAA, accreditation

Carious exposure of an irreversibly inflamed vital pulp in a young permanent tooth presents a significant clinical challenge to clinicians to maintain the vitality. Direct pulp capping, partial pulpotomy, and complete pulpotomy are the available procedures to treat young permanent tooth. Mineral trioxide aggregate and biodentine are currently the material of choice for these procedures. The present case report describes the successful apexogenesis of mandibular left first permanent molar using mineral trioxide aggregate. The 18-month follow-up of the case demonstrated clinical and radiographic success with absence of any signs and symptoms and continued root formation.

In this study, copper oxide (CuO) specimens were successfully prepared by the hydrothermal process at altered calcination temperatures; 350, 450, and 550°C. The synthesized samples were analyzed through X-ray powder diffraction (XRD), scanning electron microscope (SEM), Raman, Fourier-transform infrared spectroscopy (FTIR), and UV-Vis spectroscopy to analyze the impact of calcination temperature on the structural, morphological, vibration spectra, functional group, and optical properties of CuO for optoelectronic device applications. XRD confirms the pure single-phase monoclinic structure of synthesized samples with no impurity phases and has good crystallinity with the development in calcination temperature. The average crystalline size, lattice constant, and porosity were found in the range of 3.98–5.06 nm; a = 3.4357 Å, b = 3.9902 Å, c = 4.8977 Å – a = 3.0573 Å, b = 3.9573 Å, c = 4.6892 Å; and 3.37–1.03%, respectively. SEM exhibited a variation in morphology by increasing calcination temperature. Raman spectra revealed that the CuO sample calcinated at 550°C with a stone-like shape having a large grain size of 3.25 μm exhibited that Raman peak intensity and the multiphonon band became stronger and sharper and exhibited higher intensity compared to the samples calcinated at 350 and 450°C. FTIR spectra confirmed that these synthesized specimens exhibited the peaks associated with the typical stretching vibrations of the Cu–O bond between 400 and 500 cm−1 exhibiting the formation of CuO. The energy bandgap was slightly reduced from 1.61 to 1.43 eV with the increase in the calcination temperature. The optical studies revealed that the calcination temperature of 550°C improves the optical properties of CuO by tuning its optical bandgap. The modified structural, morphological, and optical characteristics of the prepared CuO samples make them an appropriate candidate for optoelectronic device applications.

A unique method was used to synthesize extremely stable silver stearate nanoparticles (AgStNPs) incorporated in an organic-based monolith. The facile strategy was then used to selectively isolate hemeproteins, myoglobin (Myo) and hemoglobin (Hb). Ethyl alcohol, silver nitrate, and stearic acid were, respectively, utilized as reducing agents, silver precursors, and capping agents. The color changed to cloudy from transparent, indicating that AgStNPs had been formed. AgStNP nanostructures were then distinctly integrated into the natural polymeric scaffold. To characterize the AgStNP–methacrylate polymeric monolith and the silver nanoparticles, energy-dispersive X-ray (EDX), scanning electron microscopy (SEM), and Fourier-transform infrared (FT-IR) spectroscopy were used. The results of the SEM analysis indicated that the AgStNP–methacrylate polymeric monolith’s texture was so rough in comparison with that of the methacrylate polymeric monolith, indicating that the extraction process of the monolith materials would be more efficient because of the extended surface area of the absorbent. The comparison between the FT-IR spectra of AgStNPs, the bare organic monolith, and AgStNP–methacrylate polymeric monolith confirms that the AgStNPs were immobilized on the surface of the organic monolith. The EDX profile of the built materials indicated an advanced peak of the Ag sequence which represented an Ag atom of 3.27%. The results therefore established that the AgStNPs had been successfully integrated into the monolithic materials. Extraction efficiencies of 92% and 97% were used to, respectively, recover preconcentrated Myo and Hb. An uncomplicated method is a unique approach of both fabrication and utilization of the nanosorbent to selectively isolate hemeproteins. The process can further be implemented by using other noble metals.

Polymer monoliths modified by using nanoparticles (NPs) integrate high NP specific surface area with different monolith surface chemistry and high porosity. As a result, they have extensive applications within different fields, whereas nanomaterial-functionalised porous polymer monoliths have elicited considerable interest from investigators. This study is aimed at fabricating organic polymer-based monoliths from polybutyl methacrylate-co-ethylenedimethacrylate (BuMA-co-EDMA) monoliths prior to immobilization of gold or silver metal on the pore surface of the monoliths using reducing reagent (extracts of lemon peels). This was intended to denote a sustainable technique of immobilizing nanoparticles that are advantageous over physical and chemical techniques because it is safe in terms of handling, readily available, environmentally friendly, and cheap. Two different methods were used in the study to effectively immobilize nanoparticles on monolithic components. The outcomes showed that soaking the monolith rod in the prepared nano solution directly and placing it within ovens at temperatures of 80°C constituted the most effective method. Characterisation of the fabricated monolith was undertaken using SEM/EDX analysis, UV-vis. spectra analysis, and visual observation. The SEM analysis showed that nanoparticles were extensively immobilised on the surface polymers. Another peak was attained through EDX analysis, thus confirming the Au atom existence at 2.83% alongside another peak that proved the Ag atom existence at 1.92%. The fabricated components were used as sorbents for purifying protein. The ideal performance was achieved using gold nanoparticles (GNPs) immobilised organic monolith that attained a greater pepsin extraction recovery compared to silver nanoparticles (SNPs) immobilised organic monoliths alongside bare organic-based monolith.

Intermittent fasting has gained popularity as a dietary intervention to improve metabolic health. Metabolic syndrome may benefit from intermittent fasting by improving weight, cholesterol levels, blood pressure (BP), and glucose control. This study aims to assess the effects of intermittent fasting on weight, BMI, cholesterol levels, BP, and glucose in individuals with metabolic syndrome. This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and included 11 studies examining the effects of intermittent fasting on metabolic syndrome. A comprehensive search of PubMed and Google Scholar identified 6,451 studies, of which 11 met the inclusion criteria. Data on weight, BMI, cholesterol, BP, and glucose levels were extracted, and a random effects meta-analysis was conducted to assess outcomes. Analysis showed significant improvements in weight, with a mean reduction of 3.59 kg (95% CI: -4.59 to -2.59, p < 0.0001) and a decrease in BMI of 1.39 kg/m 2 (95% CI: -1.87 to -0.92, p < 0.0001). Low-density lipoprotein (LDL) cholesterol levels dropped by 56.22 mg/dL (95% CI: -80.14 to -32.29, p < 0.0001), and systolic BP decreased by 5.54 mmHg (95% CI: -7.55 to -3.53, p < 0.0001). However, high-density lipoprotein (HDL) cholesterol showed minimal changes, and glucose levels remained stable. Intermittent fasting led to significant reductions in weight, BMI, LDL cholesterol, and BP, making it a promising non-pharmacological strategy for managing metabolic syndrome. Further research is needed to explore long-term effects and optimal fasting protocols for different populations., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Almabruk et al.)

Emotional intelligence is commonly associated with career success. Employees with higher emotional intelligence tend to reap greater benefits. However, emotional manipulation has been reported as a dark side of emotional intelligence, which refers to the self-perceived ability to control the emotions and actions of others for self-benefit. Healthcare professionals with high emotional intelligence often improve the overall patient experience. However, their ability to manipulate emotions can have a detrimental impact on the quality of treatment. This cross-sectional correlational study assessed cognitive emotion regulation strategies (CER) and emotional manipulation among students of health colleges. Two instruments were used to collect the data: 1) the emotional manipulation scale and 2) the cognitive emotion regulation questionnaire. A total of 362 students from health colleges responded to the questionnaire. The students had a moderate tendency to use emotional manipulation (25.09 ± 6.79 out of 50). The most frequently used CER strategies included adaptive strategies such as positive reappraisal with a mean score of 7.45 ± 2.15 out of 10 and maladaptive strategies such as rumination with a mean score of 7.33 ± 2.23 out of 10. The emotional manipulation score had a small but statistically significant negative correlation with two adaptive CER strategies: positive refocusing (r = -0.146, p = 0.005) and focus on planning (r = -0.144, p = 0.006). This study sheds light on the relationship between CER strategies and emotional manipulation, suggesting that poor use of adaptive strategies is associated with emotional manipulation. This finding highlights the importance of designing interventional programs that improve the ability of health colleges students to regulate their cognitive and emotional responses, thus improving their overall well-being and performance as future healthcare workers., 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 Alwesmi, Bayounes, Binrushaydan, Alanazi, Salem, Alomairi, Albugami, Alzahrani, Alahmari and Youssef.)

Background: Night shift duties are crucial in the ICU to ensure care continuity, where critically ill patients require round-the-clock care. However, cumulative night shift duties may disturb circadian rhythm, insomnia, fatigue, and depression, and require further elucidation., Objectives: This study aims to examine the negative consequences of various night shift patterns on insomnia, fatigue, and mental health of ICU Workers., Methods: A cross-sectional study examined how cumulative night shift duty affects insomnia, fatigue, and mental health in critical care providers (CCPs)., Results: A total of 1006 participants completed this study between June 2022 and March 2023, including 54.5 % males. About 35 % were between 20 and 30 years of age, and Respiratory Therapists accounted for approximately 46.5 % of the entire sample. Most of our respondents (476; 47 %) reported working night shifts, with a monthly range of 8-15 nights. The prevalence rates for moderate to severe clinical insomnia, fatigue, and moderate to severe depression were 42 %, 48 %, and 32 %, respectively. CCPs working 8-15 nights had a 2-fold risk of clinical insomnia than those working fewer than eight nights with (AOR) and 95 % (CI) of 2.12 and 1.41-3.20, while those working ≥16 nights per month had a greater incidence of clinical insomnia compared to those working <8 nights per month, AOR (CI): 3.09 (1.90-5.03). Only those working ≥16-night shifts per month had a substantially higher fatigue risk compared to those working < 8-night shifts per month, with an AOR (CI) of 1.92 (1.19-3.08). Working 8-15-night shifts per month increases depression risks by 34 % compared to the <8-night shifts group, AOR (CI): 1.34 (0.87-2.08). Those working ≥16-night shifts per month showed a higher depression risk than those working <8-night shifts, AOR (CI): 2.53 (1.53-4.19)., Conclusion: A cumulative night shift above eight nights per month is linked with an increased risk of insomnia, fatigue, and depression. The risk of these conditions was significantly directly proportional to the number of night shifts performed per month., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Lung cancer is currently the most fatal form of cancer worldwide, ranking as the fourth most prevalent type in Saudi Arabia, particularly among males. This trend is expected to increase with growing population, lifestyle changes, and aging population. Understanding the awareness of the Saudi population regarding the risk factors and symptoms of lung cancer is necessary to attenuate the predicted increase in cases., Method: A cross-sectional, population-based survey was performed using a previously validated questionnaire (Lung CAM). Multiple linear regression analysis was used to assess variables associated with deficiency in knowledge and awareness of risk factors and symptoms of lung cancer., Results: Majority of the 15,099 respondents were male (65%), aged between 18 and 30 years (53%), 50% of which were educated up to a bachelor's degree level. Overall awareness of lung cancer signs and symptoms was 53%, with painful cough and coughing up blood being the best-known symptoms. Conversely, persistent shoulder pain (44%) and clubbing fingers (47%) were the least known lung cancer symptoms. Also, 60% of the respondents showed low confidence in identifying the signs and symptoms of lung cancer. The overall awareness of the risk factors for lung cancer development was 74%, with first-hand (74%) and second-hand (68%) smoking being the most known risk factors. However, only ≤ 62% know the other non-smoking risk factors. Awareness of the risk factors and symptoms of lung cancer depended on age, gender, education, marital and employment status (p < 0.001)., Conclusion: Public awareness of the risk factors and symptoms of lung cancer in Saudi Arabia is inadequate and heavily dependent on education and socio-economic status. Awareness can be improved through campaigns to raise awareness about other lesser-known lung cancer risk factors and symptoms., 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 AlRabeeah, Alzahrani, Aldhahir, Siraj, Alqarni, AlDraiwiesh, Alqahtani, Almqati, Alharbi, Almuntashiri, Alghamdi, Aljohani, Almulhim, Alshehri, Naser, Alwafi, Alobaidi, Hjazi, Alsulaimani, Oyelade, Alahmari, Alanazi, Almeshari and Alqahtani.)

The result of the movement restrictions during the COVID-19 pandemic was an impromptu and abrupt switch from in-person to online teaching. Most focus has been on the perception and experience of students during the process. The aim of this international survey is to assess staffs' perspectives and challenges of online teaching during the COVID-19 lockdown. Cross-sectional research using a validated online survey was carried out in seven countries (Brazil, Saudi Arabia, Jordan, Indonesia, India, the United Kingdom, and Egypt) between the months of December 2021 and August 2022, to explore the status of online teaching among faculty members during the COVID-19 pandemic. Variables and response are presented as percentages while logistic regression was used to assess the factors that predict levels of satisfaction and the challenges associated with online instruction. A total of 721 response were received from mainly male (53%) staffs. Most respondents are from Brazil (59%), hold a Doctorate degree (70%) and have over 10 years of working experience (62%). Although, 67% and 79% have relevant tools and received training for online teaching respectively, 44% report that online teaching required more preparation time than face-to-face. Although 41% of respondents were uncertain about the outcome of online teaching, 49% were satisfied with the process. Also, poor internet bandwidth (51%), inability to track students' engagement (18%) and Lack of technical skills (11.5%) were the three main observed limitations. Having little or no prior experience of online teaching before the COVID-19 pandemic [OR, 1.58 (95% CI, 1.35-1.85)], and not supporting the move to online teaching mode [OR, 0.56 (95% CI,0.48-0.64)] were two main factors independently linked with dissatisfaction with online teaching. While staffs who support the move to online teaching were twice likely to report no barriers [OR, 2.15 (95% CI, 1.61-2.86)]. Although, relevant tools and training were provided to support the move to online teaching during COVID-19 lockdown, barriers such as poor internet bandwidth, inability to track students' engagement and lack of technical skills were main limitations observed internationally by teaching staffs. Addressing these barriers should be the focus of higher education institution in preparation for future disruptions to traditional teaching modes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

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.

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 : 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.

Background and Objectives: In both pandemic and non-pandemic situations, nonpharmaceutical public health measures may offer easy, low-cost, and effective means of reducing the spread and impact of acute respiratory infections. It is unknown whether such measures would be acceptable to the Saudi community beyond the current pandemic. Materials and Methods: A validated survey was used to test community acceptance of the measures. Respondents were asked which infection control practices they planned to maintain and which they believed should be policies for the community as a whole after the COVID-19 pandemic has subsided. Results: The survey was completed by 2057 people (95% completion rate), 1486 (72%) of whom were female, 259 (12.5%) of whom were current smokers, and 72 (3.5%) of whom had chronic lung disease. The most prevalent age groups were 18−30 years (933; 45.4%) and 31−40 years (483; 23.5%), with 641 individuals over 40 years old. Of the responses, 93% indicated that they would continue washing their hands more often; 92% wanted both clinicians and patients to wear masks in hospitals; 86% would continue avoiding smoking in indoor and outdoor areas; 73% would continue wearing a face covering on public transportation; 70% indicated that they would continue wearing a face covering in indoor public places. Regarding the respiratory virus infection control measures, 85% (11/13) received significant support (≥70% acceptability level) for continuation as policies in the future. Wearing face coverings outdoors and social distancing outdoors received little support (45% and 66%, respectively). Of the respiratory virus infection control measures, 54% received less support from current smokers than non-smokers (acceptability level < 70%). People with chronic respiratory disease supported 77% of the measures being regarded as policies in the future. Conclusion: The Saudi community supports nonpharmacological respiratory infection control measures that reduce the likelihood of infection. Public health campaigns should target smokers to increase awareness of the importance of these measures in lowering infections. Based on the findings of this study, nonpharmacological treatments should be presented and included in future recommendations for both the public and patients diagnosed with chronic respiratory diseases.