RESUMO
Background and Objectives: Early diagnosis and treatment is associated with improved outcomes in patients with systemic lupus erythematosus (SLE). Studying the journey of SLE patients in Saudi Arabia is essential to direct future health-care plans. Patients and Methods: This is a cross-sectional, multicenter study. Eligibility criteria included a diagnosis of SLE that was confirmed by a rheumatologist. Patients younger than 18 at the time of interview were excluded. Primary objectives were to determine time from first symptoms to initial physician visit (Lag 1), time from initial physician visit to encounter with rheumatologist (Lag 2), time from first visit to a rheumatologist to diagnosis of SLE (Lag 3), and time from diagnosis to start of treatment (Lag 4). Secondary objectives were to determine the number and specialty of physicians seen by patients, the speciality type that confirmed the diagnosis, first symptoms experienced, and age at first diagnosis of SLE. Results: Three hundred patients (92.3% women) with SLE were evaluated. Mean age at diagnosis was 29.92 years. Mean disease duration was 8.1 years. The majority were college educated (43.0%). The most common initial symptom was joint pain (68%), followed by skin rash (23%), and fever (3.7%). Lag 1 was less than one month in 68.2% of patients. Lag 2 was less than one month in 33.4% of patients and exceeded one year in 25.8%. Lag 3 was less than 1 month in 68.7% of patients. Lag 4 was less than one month in 94.4% of patients. The diagnosis of SLE was made most frequently by rheumatologists (80%). Evaluation by primary care, orthopedic and dermatology physicians were associated with delays in diagnosis. Conclusion: Delay was marked in Lag 2. Causes of delay included evaluation by non-specialists and visiting higher numbers of physicians before diagnosis confirmation.
RESUMO
PHENOMENON: Peer-assisted learning (PAL) is increasingly used in different fields of education, including medical education, due to its established advantages. However, there are scarce data about the best practice guidelines for PAL program evaluation. The aim of this work was to develop a framework that can describe and develop PAL programs and consequently provide a tool for evaluation and comparison of PAL programs among different institutions. APPROACH: A thorough literature review was made for assessment of different PAL programs development and implementation strategies, and PAL leaders at the University of Umm Al-Qura in Saudi Arabia were interviewed for development and revision of a framework for PAL program development, description and evaluation. FINDINGS: A framework of four sections was developed ie context, theory, implementation processes and outcomes, and emergence. The context includes the learning objectives and the logistics. The theory includes the content nature, program design, number of tutees and tutors, participation, program orientation, program duration and timing, tutor recruitment and preparation and faculty involvement. Implementation process and outcome section includes the feedback collection and the pre- and post-intervention students' assessment. The emergence includes tracking the program evolution. INSIGHTS: Development of a clear well-defined framework for description, implementation and evaluation of a PAL educational program can provide a foundation to unify the terms organizations use to communicate the parameters of PAL programs and overcome the jargon about PAL in the literature. It also can provide comparisons between the programs in an attempt to set best practice guidelines in the future for PAL program developing and implementation.
