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Coronavirus (cov) disease 2019 pandemic caused by severe acute respiratory syndrome cov 2 has imposed significant demands on healthcare systems across the world. These demands were more significant on obstetrics and gynecology (obgyn) patients, who required services that had to continue despite the closure of other services. This paper describes the change management of an obgyn department at a tertiary health-care center. That experience resulted in a complete management shift in the institution and the formation of an infectious disease epidemic plan for respiratory infections. Description of the change management performed, difficulties encountered, and achievements obtained can assist other departments change management when they face similar situations.

Chronic obstructive pulmonary disease (COPD) has a significant impact on healthcare systems and health-related quality of life. Increased prevalence of smoking is an important factor contributing to high burden of COPD in the Middle East and Africa (MEA). Several other factors including sedentary lifestyle, urbanization, second-hand smoke, air pollution, and occupational exposure are also responsible for the upsurge of COPD in the MEA. Frequent COPD exacerbations accelerate disease progression, progressively deteriorate the lung function, and negatively affect quality of life. This consensus is based on review of the published evidence, international and regional guidelines, and insights provided by the expert committee members from the MEA region. Spirometry, though the gold standard for diagnosis, is often unavailable and/or underutilized leading to underdiagnosis of COPD in primary care settings. Low adherence to the treatment guidelines and delayed use of appropriate combination therapy including triple therapy are additional barriers in management of COPD in MEA. It is necessary to recognize COPD as a screenable condition and develop easy and simple screening tools to facilitate early diagnosis. Knowledge of the disease symptomatology at patient and physician level and adherence to the international or regional guidelines are important to create awareness about harmful effects of smoking and develop national guidelines to focus on prevention on COPD. Implementation of vaccination program and pulmonary rehabilitation are equally valuable to manage patients with COPD at local and regional level. We present recommendations made by the expert panel for improved screening, diagnosis, and management of COPD in MEA.

Since the report of the first case of coronavirus disease 2019 (COVID-19) in China in late December 2019, there have been 204 610 cases worldwide as of 18 March, 2020. As part of the response to this outbreak, there has been an impressive amount of research undertaken to better characterize the disease and to evaluate therapeutic options. By March 12, 2020, there are more than 382 studies registered in the clinical trials databases addressing COVID-19 including more than 80 randomized controlled trials.

Policies addressing limitations of medical therapy in patients with advanced medical conditions are typically referred to as Code Status (No Code) policies or Do-Not-Resuscitate (DNR) status polices. Inconsistencies in implementation, understanding, decision-making, communication and management of No Code or DNR orders have led to delivery of poorer care to some patients. Several experts have called for a change in the current approach. The new approach, Goals of Care paradigm, aims to contextualize the decisions about resuscitation and advanced life support within the overall plan of care, focusing on choices of treatments to be given rather than specifically on treatments not to be given. Adopting “Goals of Care” paradigm is a big step forward on the journey for optimizing the care for patients with advanced medical conditions; a journey that requires collaborative approach and is of high importance for patients, community and healthcare systems.

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

Background The usual scenario for change management in the medical education field is an academic institution creating a patient care facility. The opposite change is however rather rare and challenging. There is not much in the medical education literature on experiences of change management that provides sufficient support to readers who are involved in such process of change. Methods We analyzed the experience of a clinical institution that has changed into an academic one. The methods used were archival analysis and interviews with those involved. The raw data were analyzed using a framework derived from the change management literature. Results Despite the complex change and the use of a directive change strategy, the change managers׳ strategic thinking and timely use of different change strategies have helped in eliminating the initial change difficulties. The directive change strategy was turned into an advantage that has facilitated quick implementation. Conclusion A directive change strategy is not always a disadvantageous method leading to chaos in the process of change. The educational change management experience gained by King Saud bin Abdulaziz University for Health Sciences can be considered a model for other clinical institutions changing into academic ones.

With the recent pandemic of Coronavirus disease-2019 (COVID-19), there has been a higher number of reported cases in children more than to the prior Corona Virus-related diseases, namely, severe acute respiratory syndrome and the Middle East respiratory syndrome. The rate of COVID-19 in children is lower than adults; however, due to high transmission rate, the number of reported cases in children has been increasing. With the rising numbers among children, it is imperative to develop preparedness plans for the pediatric population at the hospital level, departmental level, and patient care areas. This paper summarizes important considerations for pediatric hospital preparedness at the hospital level that includes workforce, equipment, supply; capacity planning, and infection prevention strategies, it also span over the management of COVID-19 pediatric patients in high-risk areas such as critical care areas, Emergency Department and operative rooms.

This article aims to shed light on the management that was taken by the King Saud Bin Abdulaziz University for Health Sciences to accommodate the immediate needs for online curriculum delivery, in response to the total lockdown due to COVID-19 pandemic. We have described the process done, actions implemented, and challenges faced to manage the curriculum delivery during the pandemic and to plan the subsequent year curriculum delivery. Effective management will be enhanced by focused faculty development, curriculum management, assessment planning, and technical support. We believe that the management done can be taken as a model in similar situations where sudden online curriculum delivery is deemed necessary. Further audit on the effectiveness and implication of these actions is required after the end of the pandemic.

The Saudi Thoracic Society (STS) launched the Saudi Initiative for Chronic Airway Diseases (SICAD) to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease (COPD). This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test (CAT) and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation (

Pulmonary rehabilitation (PR) is an integral component of the comprehensive management plan of patients with chronic lung diseases by addressing their functional and psychological deficits. PR is generally recommended to symptomatic patients with chronic lung diseases who develop shortness of breath on their own pace at level ground while receiving optimum therapy. From a regional perspective, this review covers the description of a PR program, its establishment and outcome assessment.

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

Background: Implementing COPD guidelines increases quality of COPD care. Aim: Assess physicians9 knowledge of GOLD guideline recommendations in COPD patients. Methods: A cross-sectional study was conducted in the Eastern province of Saudi Arabia. Physicians involved in COPD care in the 5 hospitals where most COPD patients were referred for specialised care were recruited. Data were collected using questionnaires. Results: A total of 44 physicians were included (respiratory consultants n=7; internal medicine specialists n=12; internal medicine residents n=25). The mean knowledge score was 29.5±4.2 out of 45 points (65.5%); respiratory consultants (mean score: 33.2±5.7; 73.7%) scored significant higher than internal medicine residents (28.3±3.5; 62.8%) (p=0.015), no differences between other physician groups were found. Many physicians (n=27; 61.3%) were not aware of any COPD guidelines and most (n=28; 63.6%) said they did not adhere to guidelines in their practice. Barriers considered by physicians as most important for adherence to COPD guidelines were “Lack of educational material/support” and “Lack of awareness”, reported by 72.7% and 70.5% of the physicians respectively. The mean confidence score in implementing GOLD recommendations was 5.6±3 on a 10-point scale; respiratory consultants (8.5±1.1) reported significantly higher confidence scores than internal medicine residents (4.5±2.2) (p Conclusion: Saudi Physicians had sub-maximal knowledge scores regarding GOLD guidelines. Increasing awareness about COPD related guidelines, and implementing an education intervention to improve physicians9 knowledge of COPD management are therefore highly recommended.

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

Objectives: The aim of the study was to investigate students? perceptions of assessment and the resulting learning styles. Methods Qualitative semi-structured interviews were conducted with 14 students and 8 clinical supervisors from Sydney Medical School and 12 students and 13 clinical supervisors from King Saud bin Abdulaziz University. Both institutions have similar curricula but a different assessment approach. The interviews were transcribed and analyzed using thematic analysis. Interview transcripts were stored and analyzed using ATLAS.ti. Results Three themes emerged from analyses of the interviews: the function of assessment, learning outcomes and, finally, authentic assessment in the clinical environment. A model is presented to show the relationship between contextual and different personal factors and students’ perceptions of the impact of assessment on learning styles. Conclusions Cultural differences and emotions can affect students’ perceptions of assessment and learning styles. A combination of formative and summative assessment based on learning objectives is required. This combination should take into consideration students’ cultural background, values and the implemented education system. This balance should be sufficient to motivate students in order to maintain their focus and attention, and reduce the potential negative impacts of a hidden curriculum. The experience of authentic assessment was a powerful motivator for students’ approaches to learning.

Item does not contain fulltext The aim of this study is to explore the effects of clinical supervision, and assessment characteristics on the study strategies used by undergraduate medical students during their clinical rotations. We conducted a qualitative phenomenological study at King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia during the period from November 2007 to December 2008. We conducted semi-structured focus groups interviews with students and conducted individual interviews with teachers and students to explore students' and clinical teachers' perceptions and interpretations of factors influencing students' study strategies. Data collection was continued until saturation was reached. We used Atlas-ti Computer Software (Version 5.2) to analyse the data, apply the obtained themes to the whole dataset and rearrange the data according to the themes and sub-themes. Analysis of data from interviews with twenty-eight students and thirteen clinical supervisors yielded three major themes relating to factors affecting students' study strategies: "clinical supervisors and supervision", "stress and anxiety" and "assessment". The three themes we identified played a role in students' adoption of different study strategies in the "community of clinical practice". It appeared that teachers played a key role, particularly as assessors, clinical supervisors and as a source of stress to students. 01 december 2011

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

Objectives: Unconventional therapy (UT) is a therapeutic practice of alternative and complementary medicine that is not currently considered an integral part of modern medical practice. The aim of this article is to investigate the experience of Saudi patients with UT modalities in the treatment of asthma. Materials and Methods: We carried out a cross-sectional study of asthma patients referred to King Abdulaziz Medical City, Riyadh, Saudi Arabia, during the year 2004. Information was collected using a pre-designed questionnaire administered through interviews. Results: Two hundred consecutive patients with a mean age of 52.3 years (±18.7) were included in this study. Sixty-nine (34.5%) of those patients used some form of UT in the previous year. There was a tendency to use UT among the older age group ( P = 0.029) and among those with longer duration of disease ( P = 0.009). However, there was no significant correlation observed between the use of UT and gender, FEV 1 , or disease control. The most commonly used form of UT was recitation of Holy Quran (9%), honey (24.5%), herbs (23.5%), cautery (12%), and blackseed (10%). There was no significant correlation between disease control and the use of modalities. Conclusion: Unconventional therapy is frequently practiced by asthma patients in Saudi Arabia, who commonly believe that UT will lead to improvement. The lack of evidence necessitates the fostering of a national project to address the practice of UT.

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

Study objectives Identification of acid-fast bacilli (AFB) in the sputum smear at the completion of tuberculosis therapy is in some settings considered evidence of treatment failure. However, some patients with pulmonary tuberculosis (TB) will have positive smear results with negative sputum culture results at the end of therapy. The objectives of this study were to estimate the prevalence of persisting positive sputum smear results in patients with TB and to identify characteristics that distinguish patients with persistently positive sputum smear results who also had negative sputum culture results from patients identified as treatment failures. Design A population-based, historical cohort study with nested case control study. Setting British Columbia Division of Tuberculosis Control central case registry. Patients All 428 patients with culture-proven pulmonary TB in British Columbia over 7 years with sputum that was positive for AFB. Methods Review of laboratory data of all 428 patients, as well as clinical data of a subset of 30 patients with persistently positive smear results beyond 20 weeks. Results Sputum smears were positive for AFB in 205 patients (48%) at 4 weeks, in 30 patients (7%) at 20 weeks, and in 12 patients (3%) at 36 weeks. Of the patients with smear results that were persistently positive at 20 weeks, 23 (77%) had negative sputum culture results and 7 (23%) had positive sputum culture results (ie, they were treatment failures). Patients identified as treatment failures had more localized disease as shown on chest radiographs, had less radiographic improvement at follow-up, had a higher prevalence of drug resistance, and were less compliant with medications than patients with persistently positive smear results and negative culture results. No subject with a negative culture result relapsed over the 6- to 48-month observation period. Conclusion Sputum that is persistently positive for AFB in patients in developed countries is more likely to be associated with negative culture results than with treatment failure.

Mycobacterium malmoensewas first described in northern Europe and the United Kingdom in 1977. Since then, reports have appeared with increasing frequency. Cases have, however, rarely been reported from the United States, and, until now, none have been reported in Canada. This may reflect either true low prevalence of the disease or underdiagnosis by laboratories due to slow growth of the organism. This report describes a case of pulmonary disease caused byM malmoensein a 44-year-old man from British Columbia who was successfully treated with an 18-month course of conventional antituberculous drugs combined with a macrolide. This is the first report of this disease in British Columbia and, to our knowledge, in Canada.

To derive prediction equations of spirometric values of healthy Saudi adults and to compare the derived equations with equations reported in selected population.Cross-sectional study of healthy nonsmoking men and women Saudi adults. The measured spirometric values were the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), peak expiratory flow (PEF) and forced mid-expiratory flow (FEF 25%-75%).A total of 621 spirometric tests were done. The prediction equations were derived using the following formula: Predicted spirometric value = constant + (b1 × age) + (b2 × height (cm)), where b1 and b2 represent the regression coefficients for age and height, respectively. Variable Constant Age (years) Height (cm) Variable Constant Age (years) Height (cm) Males (n = 292) Females (n = 175) FVC -2.933 -0.018 0.046 FVC -3.470 -0.016 0.045 FEV1 -1.886 -0.019 0.036 FEV1 -2.482 -0.018 0.036 FEV1 /FVC (%) 98.41 -0.095 -0.068 FEV1 /FVC (%) 100.67 -0.142 -0.072 PEF 17.274 -1.243 3.471 PEF -226.648 -0.499 4.076 FEF25%-75% 0.100 -0.024 0.027 FEF25%-75% -1.337 -0.021 0.031 The means of the measured FVC and FEV1 were significantly lower than the predicted values derived by the American equations of -7.2% and -4.6% among males, respectively (P value 0.00001), and -4.7%, and -5.26% among females, respectively (P value 0.00001).The reference spirometric values derived in our study were significantly lower than the predicted values derived by the American equations.

Background: Didactic lectures are frequently used to improve compliance with practice guidelines. This study assessed the knowledge of health-care providers (HCPs) at a tertiary-care hospital of its evidence-based thromboprophylaxis guidelines and the impact of didactic lectures on their knowledge. Methods: The hospital launched a multifaceted approach to improve thromboprophylaxis practices, which included posters, a pocket-size guidelines summary and didactic lectures during the annual thromboprophylaxis awareness days. A self-administered questionnaire was distributed to HCPs before and after lectures on thromboprophylaxis guidelines (June 2010). The questionnaire, formulated and validated by two physicians, two nurses and a clinical pharmacist, covered various subjects such as risk stratification, anticoagulant dosing and the choice of anticoagulants in specific clinical situations. Results: Seventy-two and 63 HCPs submitted the pre- and post-test, respectively (62% physicians, 28% nurses, from different clinical disciplines). The mean scores were 7.8 ± 2.1 (median = 8.0, range = 2-12, maximum possible score = 15) for the pre-test and 8.4 ± 1.8 for the post-test, P = 0.053. There was no significant difference in the pre-test scores of nurses and physicians (7.9 ± 1.7 and 8.2 ± 2.4, respectively, P = 0.67). For the 35 HCPs who completed the pre- and post-tests, their scores were 7.7 ± 1.7 and 8.8 ± 1.6, respectively, P = 0.003. Knowledge of appropriate anticoagulant administration in specific clinical situations was frequently inadequate, with approximately two-thirds of participants failing to adjust low-molecular-weight heparin doses in patients with renal failure. Conclusions: Education via didactic lectures resulted in a modest improvement of HCPs′ knowledge of thromboprophylaxis guidelines. This supports the need for a multifaceted approach to improve the awareness and implementation of thromboprophylaxis guidelines.

To assess the health-related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD) in 4 Gulf Council Cooperation (GCC) countries.We conducted a cross-sectional survey between December 2011 and March 2012 in the following countries: Kingdom of Saudi Arabia (Riyadh, Dammam, and Jeddah), Kuwait, Bahrain, and the United Arab Emirates. The HRQL was measured using the COPD Assessment Test (CAT) and the Chronic Respiratory Disease Questionnaire-Self-Administered Standardized questionnaire (CRQ-SAS).We recruited 120 patients from 6 centers in 4 countries. Their average forced expiratory volume (FEV)1 was 49.3% ( +/- 13.4) of predicted, and the ratio of FEV1 to forced vital capacity was 0.58 ( +/- 0.11). The average COPD Assessment Test (CAT) score was 20.4 +/- 7.6; CAT scores were highest for Riyadh (24.1 +/- 7.7) and lowest for Kuwait (18.5 +/- 9.2), with no significant difference between the centers. For the CRQ-SAS, the dyspnea domain score was 4.6 +/- 1.6, the fatigue domain score was 4.3 +/- 1.3, the emotional domain was 4.6 +/- 1.2, and the mastery domain was 4.8 +/- 1.4. The correlation coefficients of the association between the CAT score and the 4 domains of the CRQ-SAS for all of the centers combined was statistically significant.The CAT and CRQ-SAS revealed that the patients with COPD experienced a moderate to severe impact from the disease, and a considerably compromised quality of life in the GCC countries.

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

Item does not contain fulltext "Assessment steers students' learning" is a statement that has been used repeatedly without solid evidence in the literature. This manuscript aims to evaluate the published literatures on the effect of teaching learning environment in particular, the implemented assessment on students' learning approaches. A literature review was performed on the effect of assessment on students learning approaches. English language literatures were searched in Pubmed, PsycINFO, and Medline without restriction to type or date of publication. Reviewing the literature, the most prominent identified theme was assessment function characterized in summative and formative assessment and general effect of assessment on students' learning approaches. The literature review has pointed clearly to the complexity of the relationship between learning environment, students' perceptions of assessment demands, and students' approaches to learning. Many factors (extrinsic and intrinsic) were theoretically proposed to mediate students' approaches to learning in response to their assessment. However, few of these factors were researched in the published literature. Formative assessment is likely to contribute to students' deep approach to learning while summative is likely to contribute to their surface approach. However, these effects are not definite and further research about the complex relationship between assessment and students' learning is required.

Background: Self-assessment is recognized as a necessary skill for lifelong learning. It is widely reported to offer numerous advantages to the learner. The research evaluated the impact of students’ and supervisors’ self-assessment and feedback training on students’ perceptions and practices of self-assessment. Moreover, it evaluated the effect of self-assessment process on students’ study strategies within a community of clinical practice. Methods: We conducted a qualitative phenomenological study from May 2008 to December 2009. We held 37 semi-structured individual interviews with three different cohorts of undergraduate medical students until we reached data saturation. The cohorts were exposed to different contexts while experiencing their clinical years’ assessment program. In the interviews, students’ perceptions and interpretations of ‘self-assessment practice’ and ‘supervisor-provided feedback’ within different contexts and the resulting study strategies were explored. Results: The analysis of interview data with the three cohorts of students yielded three major themes: strategic practice of self-assessment, self-assessment and study strategies, and feedback and study strategies. It appears that self-assessment is not appropriate within a summative context, and its implementation requires cultural preparation. Despite education and orientation on the two major components of the self-assessment process, feedback was more effective in enhancing deeper study strategies. Conclusion: This research suggests that the theoretical advantages linked to the self-assessment process are a result of its feedback component rather than the practice of self-assessment isolated from feedback. Further research exploring the effects of different contextual and personal factors on students’ self-assessment is needed. Keywords: self-assessment; study strategy; feedback; summative assessment; clinical attachment (Published: 17 February 2012) Citation: Med Educ Online 2012, 17 : 11204 - DOI: 10.3402/meo.v17i0.11204

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

Background "Examinations drive students' learning." This statement refers to what is assumed to be one of the strongest relationships in education. We explored in this research how and why students differ in their approaches to learning, how assessment affects deep learning, and which barriers stand in the way of good assessment and learning in the clinical years of a Problem Based Learning (PBL) graduate entry medical curriculum. Findings Method: We conducted a qualitative, phenomenological study using semi-structured group interviews with students and semi-structured individual interviews with teachers and students. The transcripts were analyzed, and themes were identified. Setting: The research was conducted at the King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia from November 2007 to March 2008. Results: A total of 28 students participated in 7 focus group interviews. Semi-structured individual interviews were conducted with 12 teachers and 12 students. The analysis yielded four themes: summative assessment, formative assessment, continuous assessment of clinical attachments, and learning objectives. Conclusions The results of this study confirm that assessment affects students' perceptions of learning and how they learn. These effects are not uniformly positive. According to the students, the predominantly summative assessment program offers little inducement to engage in deep learning. They express a clear preference for formative assessment, which may foster a deeper approach to learning. Efforts to achieve more clinically relevant assessment with adequate balance between the various types of assessment are required. Research is needed to decide this balance.

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

The measurement of arterial blood gases (ABG) has assumed an increasingly important role in the process of clinical evaluation, and has been widely used during the past three decades. The number of ABG measurements has increased in different medical conditions due to greater availability. 1

g twice a day.In November 1994 she was re-admitted to a secondhospital with a right-sided pneumothorax. In addition tothe pneumothorax, the chest x-ray showed diffuseinterstitial infiltration of both lungs, with normal lungvolumes. Computed tomography (CT) of the chest showeddiffuse interstitial disease, with multiple thin and thick-walled cysts of variable size and multiple nodular changesinvolving the upper two-thirds of both lungs. Thepneumothorax resolved a few days after treatment withclosed chest tube. The patient was discharged homewithout a definite diagnosis of her pulmonary disease.The patient developed progressive shortness of breathover the subsequent three years. In May 1997, she washospitalized in our institution with acute left-sided chestpain and increasing shortness of breath for 24 hours. Chestx-ray and CT scan of the chest revealed a left-sidedpneumothorax; there was also progression of theinterstitial and cystic changes in her lungs and there was

Background: Attempted suicide by intentional drug overdose is an understudied subject in Saudi Arabia. Saudi Arabia is an Islamic country where suicide or attempted suicide is strictly prohibited. Despite the strong religious and constitutional sanctions against suicide, cases of intentional drug overdose occasionally occur. Our study represents the first attempt to better understand and characterize this sensitive topic. Methods: Using a retrospective chart review of patients aged 12 years and over with a diagnosis of intentional drug overdose between 1997 and 1999, we studied the demographic characteristics, the risk factors, the most commonly used drugs, and the resulting morbidities and mortalities of study subjects. Results: Most of the patients were young (mean age 22 years, SD 4.6, range 15 to 40 years), and most were Saudi nationals (n = 76; 96%). Eighty percent of the patients were women. The occurrence of intentional drug overdose peaked during the month of September (that is, 20% of total cases). Previous suicide attempts, family conflicts, and psychiatric disorders represented significant risk factors. Single-agent overdose occurred in 30% of the patients, and most of the drugs used were prescribed medications (53%). Acetaminophen represented the most common drug (30%). While some patients required prolonged hospital stay or admission to the intensive care unit, no mortalities occurred. Conclusions: Intentional drug overdose is a relatively uncommon reason for hospital admission in Saudi Arabia. This study identifies certain risk factors relevant to the Saudi community and raises awareness about intentional drug overdose.

Teaching Evidence Based Medicine (EBM) helps medical students to develop their decision making skills based on current best evidence, especially when it is taught in a clinical context. Few medical schools integrate Evidence Based Medicine into undergraduate curriculum, and those who do so, do it at the academic years only as a standalone (classroom) teaching but not at the clinical years. The College of Medicine at King Saud bin Abdulaziz University for Health Sciences was established in January 2004. The college adopted a four-year Problem Based Learning web-based curriculum. The objective of this paper is to present our experience in the integration of the EBM in the clinical phase of the medical curriculum. We teach EBM in 3 steps: first step is teaching EBM concepts and principles, second is teaching the appraisal and search skills, and the last step is teaching it in clinical rotations. Teaching EBM at clinical years consists of 4 student-centered tutorials. In conclusion, EBM may be taught in a systematic, patient centered approach at clinical rounds. This paper could serve as a model of Evidence Based Medicine integration into the clinical phase of a medical curriculum.

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

Background To produce a conceptually equivalent Arabic version to the original Self-Administered Chronic Respiratory Disease Questionnaire with standardized dyspnea domain (CRQ-SAS) and to assess its reliability. Methods The study was carried out in two stages: stage I which was the translation of the CRQ-SAS questionnaire from the English to the Arabic language, and stage II which represented the test-retest reliability for patients receiving usual care for COPD who were not yet admitted to the pulmonary rehabilitation program. Results Forty five patients with stable COPD were enrolled in this study. Strong test-retest reliability was found for the four domains of the CRQ-SAS, with the intra-class correlation coefficient of 0.97 for each of the domains. The association between most parameters and the four domains of CRQ-SAS were not found to be statistically significant, as measured by Pearson correlation. The number of exacerbations was negatively correlated with the dyspnea domain (correlation = -0.36, p-value = 0.02). The disease duration was negatively correlated with the domain fatigue (correlation = -0.35, p-value = 0.02). The correlation between FEV1/FVC ratio and emotion domain was -0.30 (p-value = 0.05). The mastery domain was negatively correlated with FEV1/FVC ratio with a correlation of -0.27 with borderline statistical significance (p-value = 0.07). Conclusion The Arabic translation of the CRQ-SAS was found to be reliable to assess the quality of life among patients with COPD.