A nudge strategy to increase the uptake of colorectal cancer screening in Saudi Arabia: A pragmatic randomized trial in the Hail region.

Purpose: The purpose of this research was to examine the effectiveness of using a nudge strategy to encourage eligible clients to participate in colorectal cancer screening (CRCS) at primary care facilities. Additionally, it emphasizes the good outcomes of utilizing nudge in primary healthcare settings by reflecting on the novel experience of family physicians and nurses in the field of CRCS. Nudge is a cost-effective intervention that serves as a choice architect to assist people in making wise decisions for their lives. It is a subtly changed environment or combination of words that push individuals to make a decision without restricting their alternatives. Research Methods: This is a six-month, pragmatic trial with open-label recruitment that enrolled people with an average CRC risk from four screening healthcare zones that included 34 public primary care facilities. The study protocol is registered and can be accessed here: https://clinicaltrials.gov/ct2/show/NCT05785975. Results: An obvious increase in the proportion of the uptake of CRCS screening is higher in the two intervention sites-Al Hait General Hospital Zone (38%) and Al-Shamli General Hospital Zone (26%), than in the two control sites, Bagaa General Hospital Zone (18%) and King Khalid Hospital Zone (18%). Conclusions: Using the nudge strategy to increase CRCS uptake is valuable and effective; additionally, front-line family physicians and nurses in primary care are encouraged to use a planned, positive, and highly selective set of words when offering screening. Policymakers could make use of these research outcomes when designing new guidelines for CRCS.

Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study.

BACKGROUND: Inhaled nitric oxide (iNO) is used as rescue therapy in patients with refractory hypoxemia due to severe COVID-19 acute respiratory distress syndrome (ARDS) despite the recommendation against the use of this treatment. To date, the effect of iNO on the clinical outcomes of critically ill COVID-19 patients with moderate-to-severe ARDS remains arguable. Therefore, this study aimed to evaluate the use of iNO in critically ill COVID-19 patients with moderate-to-severe ARDS. METHODS: This multicenter, retrospective cohort study included critically ill adult patients with confirmed COVID-19 treated from March 01, 2020, until July 31, 2021. Eligible patients with moderate-to-severe ARDS were subsequently categorized into two groups based on inhaled nitric oxide (iNO) use throughout their ICU stay. The primary endpoint was the improvement in oxygenation parameters 24 h after iNO use. Other outcomes were considered secondary. Propensity score matching (1:2) was used based on the predefined criteria. RESULTS: A total of 1598 patients were screened, and 815 were included based on the eligibility criteria. Among them, 210 patients were matched based on predefined criteria. Oxygenation parameters (PaO2, FiO2 requirement, P/F ratio, oxygenation index) were significantly improved 24 h after iNO administration within a median of six days of ICU admission. However, the risk of 30-day and in-hospital mortality were found to be similar between the two groups (HR: 1.18; 95% CI: 0.77, 1.82; p = 0.45 and HR: 1.40; 95% CI: 0.94, 2.11; p= 0.10, respectively). On the other hand, ventilator-free days (VFDs) were significantly fewer, and  ICU and hospital LOS were significantly longer in the iNO group. In addition, patients who received iNO had higher odds of acute kidney injury (AKI) (OR (95% CI): 2.35 (1.30, 4.26), p value = 0.005) and hospital/ventilator-acquired pneumonia (OR (95% CI): 3.2 (1.76, 5.83), p value = 0.001). CONCLUSION: In critically ill COVID-19 patients with moderate-to-severe ARDS, iNO rescue therapy is associated with improved oxygenation parameters but no mortality benefits. Moreover, iNO use is associated with higher odds of AKI, pneumonia, longer LOS, and fewer VFDs.

Patterns and grades of presentation of colon cancer in Northern Saudi Arabia.

INTRODUCTION: The primary concern related to colon cancer in Saudi Arabia is the presentation of many patients with advanced disease stages. AIM: To determine the patterns and grades of colon cancer presentation in Northern Saudi Arabia. MATERIAL AND METHODS: Retrieved data and tissue blocks related to 50 colorectal patients from King Khalid Hospital, Hai'l province, Northern Saudi Arabia were used. The sample represented all available colorectal specimens (full coverage of cancer cases within 10 years). The retrieved data included a full histopathology report, gender, and age. All tissues were retrieved in the form of formalin-fixed paraffin wax processed blocks. The tissues were found to be obtained in the form of colonoscopy or/and biopsy. RESULTS: The diagnosed colon cancers included conventional adenocarcinoma 36 (72%), mucinous adenocarcinoma 4 (8%), carcinoma-in-situ 4 (8%), and invasive adenocarcinoma 6 (12%). Moderately differentiated and poorly differentiated stages were confirmed in 46 (92%) and 4 (8%), respectively. CONCLUSIONS: Conventional adenocarcinoma is the most common presenting colon cancer at and relatively younger age. Mucinous adenocarcinoma is frequently presented in female patients of a somewhat more youthful generation. Most patients are diagnosed with moderately differentiated adenocarcinoma, followed by poorly differentiated adenocarcinoma. The findings necessitate the urgent intervention of national policies for early detection by implementing sustainable screening programs.