Otolaryngologists, Pediatricians, and Emergency and Family Medicine Physicians Adherence to Acute Otitis Media Diagnosis and Management Guidelines: A Retrospective Study in a Saudi Arabian Tertiary Center.

Background Acute otitis media (AOM) is one of the most common conditions in the pediatric population and a common reason for physicians to prescribe antibiotics. Most children will develop otitis media at least once during their life. Objectives Our study aimed to evaluate and compare the adherence of family medicine physicians, otolaryngologists, pediatricians, and emergency medicine physicians to the American Academy of Pediatrics and American Academy of Family Physicians guidelines for the diagnosis and the management of AOM. Methods This is a retrospective study that was conducted at the Ministry of National Guard - Health Affairs affiliated hospitals and primary clinics in Riyadh, Saudi Arabia. All patients diagnosed with AOM and treated between 2016 and 2019 were included in the study. Exclusion criteria included any patient above the age of 18 years old or patients with incomplete data on their files. Variables included demographic data of the patients and treating physicians, associated infections, and whether the treating physician followed the diagnosis and management guidelines. Results Most patients were below the age of two years. Emergency medicine physicians were the most common to treat patients with AOM. Although most documentations were sufficient, 39.8% were insufficient or not written. Most (74%) physicians adhered to the diagnosis guidelines, while 57.5% adhered to management guidelines. Conclusion Although most physicians adhered to the diagnosis and treatment guidelines, stressing on the matter is essential to avoid unnecessary antibiotics use. We recommend further prospective studies with a bigger sample size of more than one center to have a more accurate reflection of the current situation.

The Impact of Drug-induced Sleep Endoscopy on Therapeutic Decisions in Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.

Objective The aim of this study was to assess the ability of drug-induced sleep endoscopy (DISE) to change therapeutic decisions through the identification of obstruction sites in patients with obstructive sleep apnea (OSA). Materials and methods A systematic review and meta-analysis were conducted concerning studies that reported the impact of DISE on therapeutic recommendations. The percentage of change was collected for each study and per site of the collapse. The pooled rate of change and the respective 95% confidence interval (CI) were computed. Subgroup analysis was performed based on patients' age, sample size, the applied DISE protocol, and the originally used diagnostic modality before DISE. Results In a total of nine studies, 1247 patients were included (69.2% males, 59.7% children, 78.04% with a multilevel collapse). Therapeutic decisions changed in 43.69% of patients (CI, 33.84 to 53.54). The change rates were significantly higher in adults (54.0% versus 25.9% in children, P = 0.001), midazolam-based DISE protocols (78.4% versus 48.45% for midazolam plus propofol and 33.9% for propofol, P < 0.001), and after awake endoscopy (62.2% as compared to 44.6% after clinical basic examination [CBE], 40.1% after CBE, lateral cephalometry, and Müller maneuver, P = 0.02). Changes at uvular and palatal sites were more frequent in adults and at the tonsils in children. Conclusion The DISE approach can be promoted via implementing unified classification systems of obstruction sites; the widescale application of target-controlled infusion and its therapeutic benefits can be explored in well-designed randomized studies that compare its efficacy with other diagnostic modalities.

Tertiary care availability and adolescent pregnancy characteristics in Saudi Arabia.

BACKGROUND: In this study, we aimed to assess the rate of adolescent delivery in a Saudi tertiary health care center and to investigate the association between maternal age and fetal, neonatal, and maternal complications where a professional tertiary medical care service is provided. METHODS: A cross-sectional study was performed between 2005 and 2010 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. All primigravid Saudi women ≥24 weeks gestation, carrying a singleton pregnancy, aged <35 years, and with no chronic medical problems were eligible. Women were divided into three groups based on their age, ie, group 1 (G1) <16 years, group 2 (G2) ≥16 up to 19 years, and group 3 (G3) ≥19 up to 35 years. Data were collected from maternal and neonatal medical records. We calculated the association between the different age groups and maternal characteristics, as well as events and complications during the antenatal period, labor, and delivery. RESULTS: The rates of adolescent delivery were 20.0 and 16.3 per 1,000 births in 2009 and 2010, respectively. Compared with G1 and G2 women, G3 women tended to have a higher body mass index, a longer first and second stage of labor, more blood loss at delivery, and a longer hospital stay. Compared with G1 and G2 women, respectively, G3 women had a 42% and a 67% increased risk of cesarean section, and had a 52% increased risk of instrumental delivery. G3 women were more likely to develop gestational diabetes or anemia, G2 women had a three-fold increased risk of premature delivery (odds ratio 2.81), and G3 neonates had a 50% increased overall risk of neonatal complications (odds ratio 0.51). CONCLUSION: The adolescent birth rate appears to be low in central Saudi Arabia compared with other parts of the world. Excluding preterm delivery, adolescent delivery cared for in a tertiary health care center is not associated with a significantly increased medical risk to the mother, fetus, or neonate. The psychosocial effect of adolescent pregnancy and delivery needs to be assessed.

Workplace-based assessment and students' approaches to learning: a qualitative inquiry.

BACKGROUND: We have performed this research to assess the effect of work-place based assessment (WBA) practice on medical students' learning approaches. METHODS: The research was conducted at the King Saud bin Abdulaziz University for Health Sciences, College of Medicine from 1 March to 31 July 2012. We conducted a qualitative, phenomenological research utilizing semi-structured individual interviews with medical students exposed to WBA. The audio-taped interviews were transcribed verbatim, analyzed, and themes were identified. We preformed investigators' triangulation, member checking with clinical supervisors and we triangulated the data with a similar research performed prior to the implementation of WBA. RESULTS: WBA results in variable learning approaches. Based on several affecting factors; clinical supervisors, faculty-given feedback, and assessment function, students may swing between surface, deep and effort and achievement learning approaches. Students' and supervisors' orientations on the process of WBA, utilization of peer feedback and formative rather than summative assessment facilitate successful implementation of WBA and lead to students' deeper approaches to learning. Interestingly, students and their supervisors have contradicting perceptions to WBA. CONCLUSION: A change in culture to unify students' and supervisors' perceptions of WBA, more accommodation of formative assessment, and feedback may result in students' deeper approach to learning.

Value of subspecialty experience in internal medicine undergraduate training.

We aimed from our study to assess how students and clinical supervisors perceive students' achievement in the internal medicine subspecialty clinical attachments in comparison with the general attachments. We conducted a cross-sectional study comparing students' self-assessment ratings during the Medicine Block general and subspecialties clinical attachments at our college of medicine during the period between February 2007 and June 2009. We assessed the level of agreement between students' self-assessment in the different subspecialties with their self-assessment in the general attachments. We repeated the same calculation for the supervisors' assessment. Eighty-three students were included; these students attended eight different clinical attachments. A total of 517 self-assessment forms were completed (120 general internal medicine clinical attachments and 397 forms in different specialty attachments). The clinical supervisors completed parallel assessment forms. The undergraduate medical students' perceived their achievement in the subspecialty attachments well. This was similar to their perception of their achievement in the general clinical attachments. The clinical supervisors perceived students achievement in the subspecialties to be similar to their achievement in the general clinical attachments. In conclusion, we do encourage the implementation of specialty and subspecialty undergraduate clinical attachments for all students as part of their curriculum requirements. Furthermore, we encourage the strategic utilization of specialties/subspecialties attachment distribution aiming to enhance students' future interest to achieve balance in the different health specialties/subspecialties manpower. Further research to support this recommendation is needed.