Saudi Medical Journal最新文献

Objectives: To develop evidence-based national guidelines incorporating recent advancements in clinical research and therapeutic strategies for the management of patients with diabetic kidney disease (DKD) in the Kingdom of Saudi Arabia (KSA).

Methods: We developed the guidelines using the GRADE methodology and a multidisciplinary expert panel comprising nephrologists, endocrinologists, clinical pharmacists, and methodologists across KSA. We conducted a systematic literature review of studies published between 2014-2024. The evidence certainty was evaluated across 5 domains using GRADEpro and categorized into 4 levels: "high", "moderate", "low", and "very low". Recommendations were formulated based on the benefit-risk ratio, evidence quality, and expert consensus, with a minimum agreement threshold of 70%.

Results: We established 39 evidence-based recommendations addressing key aspects of DKD management, including monitoring and treatment. Among the 39 recommendations, 6 focus on lifestyle interventions, 7 address glucose-lowering therapies, one discusses glycemic monitoring and targets, 8 address DKD evaluation and risk assessment, 7 emphasize comprehensive management approaches, and 10 discuss DKD pharmacological management. Two recommendations related to the comprehensive management of DKD were based on expert opinions owing to a lack of supporting evidence.

Conclusion: These Saudi national guidelines offer an evidence-based approach for managing DKD in adults with DM and provide a comprehensive framework for monitoring and treatment. Nevertheless, further local research and data collection are warranted to refine and enhance the guidelines' effectiveness.

Objectives: To investigate how the Qassim Health Cluster (QHC) implemented population health management (PHM) in tandem with the goals of Saudi Vision 2030 and to pinpoint the main issues and lessons gained from this implementation.

Methods: This research used a descriptive population study design and was conducted between November and December 2024. We collected data using a mixed-method approach, gathering qualitative data from 11 PHM implementers and secondary quantitative data from 102,946 healthcare service users.

Results: Qassim Health Cluster's PHM implementation team established a regional 5-year strategic plan to follow the national PHM framework, utilizing data-based decision-making to implement the strategy. The major challenges identified include the lack of availability of relevant comprehensive PHM policy documents and guidelines, ineffective and delayed technical support, and resistance to change among stakeholders. Lobbying and effective communication were 2 useful strategies for PHM implementation.

Conclusion: In the coming decades, the QHC's PHM implementation will drastically shift healthcare practices toward a more sustainable healthcare system that aligns with Vision 2030. To guarantee the successful operation of PHM in the QHC and other health clusters, more advocacy for institutional support, technical assistance, adequate funding, and sponsorship is required.

Objectives: To evaluate clinical trials involving pharmaceutical agents conducted in Saudi Arabia and registered on ClinicalTrials.gov. Since the early 2000s, Saudi Arabia has expanded its involvement in clinical research. Recognizing the importance of clinical trials, we aimed to analyze the clinical trial landscape in the Kingdom to identify well-covered areas and potential gaps.

Methods: In this descriptive cross-sectional study, ClinicalTrials.gov was used as the primary source to collect data regarding pharmacological and biological interventions conducted in Saudi Arabia between 2002 and June 2025.

Results: A total of 474 pharmaceutical studies were included. Of these, 52.95% were completed, indicating moderate research activity but suggesting room for growth compared to global benchmarks. Among completed trials, 38.64% had their results published on ClinicalTrials.gov. Overall, 223 sponsors were identified: 23.32% were international pharmaceutical companies and 24.22% were Saudi sponsors, of which 77.78% were governmental and 22.22% private. Additionally, 239 studies were funded by international companies. Oncology (23.21%) was the most represented medical field, followed by infectious diseases (12.87%).

Conclusion: Saudi Arabia witnessed an increase in registered clinical trials between 2002 and June 2025, with strong contributions from both international and Saudi sponsors, particularly the governmental sector. However, only one-fifth of completed trials had results published on ClinicalTrials.gov, highlighting the need for greater transparency and dissemination of findings.

Objectives: To identify risk factors for moderate-to-severe pain during intraosseous infusion (IOI) in non-cardiac arrest patients in the emergency department (ED). Secondary aims include evaluating pain trajectory across procedural stages and assessing the efficacy of a personalized pain management strategy.

Methods: This mixed-methods study analyzed 220 ED patients undergoing IOI (150 retrospective, 70 prospective). The prospective cohort was randomized to standard care (n=35) or personalized pain management (n=35). Pain was quantified using the numeric rating scale (NRS) and critical-care pain observation tool (CPOT).

Results: During puncture, 35.33% (53/150) reported no/mild pain. Pain severity peaked during flushing, with 73.33% (110/150) experiencing moderate/severe pain. At 15-minute infusion, this decreased to 57.33% (86). Univariate analysis identified gender and BMI as pain-associated factors (p<0.05). Multivariate analysis confirmed female gender (OR=13.468) and low BMI (OR=7.250) as independent risk factors (p<0.05). Compared to the control group, the personalized strategy group demonstrated significantly lower pain scores during puncture, flushing, and early infusion, with reduced analgesic requirements in the first 2 stages. No between-group differences occurred in puncture success or complication rates.

Conclusion: Intraosseous infusion flushing induces the most severe pain, particularly among females and low-BMI patients. Personalized, stage-targeted analgesia significantly improves pain control without compromising safety, supporting its integration into emergency IOI protocols.

Objectives: To evaluate the utility of point-of-care ultrasound (POCUS) devices in prehospital care in Saudi Arabia. Furthermore, the impact of POCUS training on paramedics' knowledge, confidence in use, and attitudes toward POCUS devices was assessed.

Methods: Thirty-seven paramedics who were engaged in providing prehospital emergency care were selected. A quasi-experimental pre-test and post-test study was conducted between February 5 and March 20, 2025. Participants underwent a comprehensive POCUS training involving theoretical lectures, hands-on sessions, and simulation-based exercises.

Results: A significant improvement in overall POCUS knowledge, confidence in use, and diagnostic accuracy were noted on the post-test survey. Pre-test knowledge scores averaged 2.57 on a 5-point scale, whereas post-test scores exceeded 4 in all assessed categories. Confidence in using POCUS devices improved from a mean of 1.51 (not confident) to 3.51 (moderately confident). Training influenced attitudes, as 97% of participants recommended POCUS in Emergency Medical Services (EMS) practice.

Conclusion: Point-of-care ultrasound training can influence diagnostic abilities. The implementation of POCUS devices in the prehospital setting can improve clinical decision-making, ultimately leading to improvement in patients' outcomes.

Objectives: To identify the primary risk factors contributing to stroke incidents and deaths, analyzing the trends and changes in regional stroke statistics between 1990 and 2021 in the Gulf Cooperation Council (GCC) countries.

Methods: This longitudinal time trend study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia, from June to August 2024. The data were recorded from the Institute for Health Metrics and Evaluation (IHME) and the Global Burden of Diseases (GBD) datasets. The incidence, mortality, and disability-adjusted life year (DALY) rates of stroke in the GCC countries, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE), and their association with environmental pollution, dietary, and metabolic risk factors were documented from 1990 to 2021.

Results: From 1990 to 2021, the GCC countries exhibited varied trends in stroke incidence, mortality and DALYs. The UAE had the highest stroke incidence rate in 2021 (106.01 per 100,000). The mortality rates due to stroke decreased in the GCC, except in Kuwait, where they increased by 14.4%. DALYs decreased in GCC countries, with the highest decline in Qatar (56%). Qatar experienced a 59.9% decrease in death rates and a 53.4% reduction in DALYs for hypertension.

Conclusion: In GCC countries, hypertension, air pollution, and dietary factors are dominant risk factors for stroke, stroke-related deaths, and DALY rates. The UAE had the highest stroke incidence rate in 2021. However, mortality rates decreased in all GCC countries except Kuwait.

Objectives: To assess the impact of Acute Coronary Syndrome (ACS) on quality of life (QoL) among patients at King Abdulaziz Medical City in Western Jeddah. Acute Coronary Syndrome significantly affect patients' QoL. Many individuals experience challenges post-ACS. While previous research has identified baseline QoL, access to specialized care, and assessment tools as important factors influencing recovery, limited studies have examined how baseline QoL affects long-term outcomes.

Methods: This hybrid cross-sectional study included ACS patients treated at King Abdulaziz Medical City. A sample size of 268 was calculated using RAOSOFT. A culturally tailored questionnaire, derived from the SF-36, was developed, validated, and administered through phone interviews. Data was analyzed using SPSS, applying descriptive statistics. Statistical significance was set at p<0.05.

Results: A total of 311 patients participated. The mean QoL score was 9.7 (±3.4). Age was found to be a statistically significant predictor of QoL classification (p=0.001), with an odds ratio of 1.04. However, there is an inverse correlation between the quality-of-life score and age and years since diagnosis.

Conclusion: The ACS negatively affects social participation, religious practices, fasting during Ramadan, and willingness to return to work. Higher age was associated with better improvement in QoL after ACS. Additionally, we found a weak but significant invers correlation between age and QoL, and longer time since diagnosis and QoL.