Background: Statistics reveal that the number of women diagnosed with breast cancer is increasing in Egypt. It is seen as a terrifying disease due to its high mortality rate and its impacts on the self-image and the sexual relationship. Many of its patients experience psychological reactions and may have psychiatric morbidities. The present study aimed to identify the prevalence and associated psychosocial factors of anxiety, depressive disorders, and perceived stress among breast cancer patients in Menoufia university hospitals. This cross-sectional study was conducted in the Clinical Oncology Department, Menoufia University. Sixty patients were subjected to questionnaires for socio-demographic data, structured psychiatric clinical interview to screen for psychiatric diagnoses, Beck Depression Inventory (BDI-II) for measuring the emotional, cognitive and motivational symptoms of depression, Manifest Anxiety Scale to assess the degree of anxiety, and Perceived Stress Scale (PSS-10) to assess stress level. Results: The prevalence of depressive symptoms, anxiety symptoms, and perceived stress were 68.6%, 73.3%, and 78.1% respectively. Moderate to severe anxiety, depression, and stress were more prevalent among advanced disease patients, patients who underwent surgery, married patients, patients who were living in rural areas, illiterate, and those without satisfactory income but without statistically significant difference except for the effect of occupation on the anxiety state as unemployed patients had significantly higher prevalence of moderate to severe anxiety (100%) than employed patients p = 0.003. Conclusion: Depressive disorders, anxiety, and perceived stress are common psychiatric disorders among the studied breast cancer patients. Understanding these common psychiatric disorders and associated stress can help to plan for their management.

Background: COVID − 19 pandemic pressured medical schools globally to shift to Distance learning (DL) as an alternative way to ensure that the content delivered is satisfactory for student progression. Aim of the work: This work aims at mapping priorities for post-COVID planning for better balance between distance learning and face to face learning. Methods: This qualitative study aimed to develop a model for utilizing DL using The Polarity Approach for Continuity and Transformation (PACT)™. A virtual mapping session was held with 79 faculty from 19 countries. They worked in small groups to determine upsides and downsides of face-to-face and DL subsequently. An initial polarity map was generated identifying five tension areas; Faculty, Students, Curriculum, Social aspects and Logistics. A 63-item assessment tool was generated based on this map, piloted and then distributed as a self-administered assessment. The outcomes of this assessment were utilized for another mapping session to discuss warning signs and action steps to maintain upsides and avoid downsides of each pole. Results: Participants agreed that face-to-face teaching allows them to inspire students and have meaningful connections with them. They also agreed that DL provides a good environment for most students. However, students with financial challenges and special needs may not have equal opportunities to access technology. As regards social issues, participants agreed that face-to-face learning provides a better chance for professionalism through enhanced team-work. Cognitive, communication and clinical skills are best achieved in face-to-face. Participants agreed that logistics for conducting DL are much more complicated when compared to face-to-face learning. Participants identified around 10 warning signs for each method that need to be continuously monitored in order to minimize the drawbacks of over focusing on one pole at the expense of the other. Action steps were determined to ensure optimized use of in either method. Conclusion: In order to plan for the future, we need to understand the dynamics of education within the context of polarities. Educators need to understand that the choice of DL, although was imposed as a no-alternative solution during the COVID era, yet it has always existed as a possible alternative and will continue to exist after this era. The value of polarity mapping and leveraging allows us to maximize the benefit of each method and guide educators’ decisions to minimize the downsides for the good of the learning process.

Background: With the strike of Covid-19, an unprecedented rapid shift to remote learning happened worldwide with a paradigm shift to online learning from an institutional adjuvant luxury package and learner choice into a forced solo choice. This raises the question of quality assurance. While some groups have already established standards for online courses, teaching and programs yet very little information is included on methodology of their development and very little emphasis is placed on the online learning experience. Nevertheless, no work has been done specifically for medical education institutions.Aim: To develop a set of descriptors for best practice in online learning in medical education utilizing existing expertise and needs.Methods: This work utilizes a qualitative multistage approach to identify the descriptors of best practice in online learning starting with a question guided focus group, thematic analysis, Delphi technique and an expert consensus session done simultaneously for triangulation. This was done involving 32 institution in 19 countries.Results: This materialized into the development of a set of standards, indicators, and development of a checklist for each standard area. The standard areas identified were organizational capacity, educational effectiveness, and human resources each of which listed a number of standards. Expert consensus sessions identified the need for qualification of data and thus the development of indicators for best practice.Conclusion: Standards are needed for online learning experience and their development and redesign is situational and needs to be enhanced methodologically in axes that are pertaining to the needs of the education community. Taking such axes into consideration by educators and institutions will lead to planning and implementing successful online learning activities, while taking them into consideration by the evaluators will help them conduct comprehensive audits and provide stakeholders with highly informative evaluation reports.

Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. Objectives: This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC. Methods: Data were collected during a workshop at the WONCA East Mediterranean Regional Conference in 2017. Academic family physicians (FP) presented their country, using the WONCA framework of 11 PowerPoint slides with queries of the country demographics, main health challenges, and the position of PHC in the health system. Results: All six countries have improved the health of their populations, but currently face challenges of non-communicable diseases, aging populations and increasing costs. Main concerns were a lack of trained FPs in community settings, underuse of prevention and of equitable access to care. Countries differed in the extent to which this had resulted in coherent policy. Conclusion: Priorities were (i) advocacy for community-based PHC to policymakers, including the importance of coordination of healthcare at the community level, and UHC to respond to the needs of populations; (ii) collaboration with universities to include PHC as a core component of every medical curriculum; (iii) collaboration with communities to improve public understanding of PHC; (iv) engagement with the private sector to focus on PHC and UHC.

Background: This is a practice guide for the evaluation tool specifically created to objectively evaluate longitudinal faculty development programs (FDP) using the “5×2 -D backward planning faculty development model”. It was necessary to create this tool as existing evaluation methods are designed to evaluate linear faculty development models with a specific endpoint. This backward planning approach is a cyclical model without an endpoint, consisting of 5 dynamic steps that are flexible and interchangeable, therefore can be a base for an evaluation tool that is objective and takes into account all the domains of the FDP in contrast to the existing, traditional, linear evaluation tools which focus on individual aspects of the program. The developed tool will target evaluation of longitudinal faculty development programs regardless of how they were planned. Methodology: Deductive qualitative grounded theory approach was used. Evaluation questions were generated and tailored based on the 5 × 2-D model followed by 2 Delphi rounds to finalize them. Based on the finalized evaluation questions from the results of the Delphi rounds, two online focus group discussions (FGDs) were conducted to deduce the indicators, data sources and data collection method. Results: Based on the suggested additions, the authors added 1 new question to domains B, with a total of 42 modifications, such as wording changes or discarding or merging questions. Some domains received no comments, therefore, were not included in round 2. For each evaluation question, authors generated indicators, data sources and data collection methods during the FGD. Conclusion: The methodology used to develop this tool takes into account expert opinions. Comprehensiveness of this tool makes it an ideal evaluation tool during self-evaluation or external quality assurance for longitudinal FDP. After its validation and testing, this practice guide can be used worldwide, along with the provided indicators which can be quantified and used to suit the local context.

In 2020, a group of international experts reached a consensus to comprehensively revisit the current definition of fatty liver disease. In clinical settings, most of the patients with fatty liver disease are first identified and subsequently followed up in the community by primary care practitioners (PCPs). Therefore, it is crucial to understand PCPs perspectives regarding the proposed redefinition of fatty liver disease as well as the implications on primary care of patients. Thus, the aim of this paper is for an international team of experts in primary care to provide perspective regarding the proposed redefinition of metabolic-dysfunction associated fatty liver disease (MAFLD). Currently, numerous systemic barriers exist for PCPs who are managing fatty liver disease. These include the diagnosis and screening, efficient referral pathway, restrictive policies, disease awareness and continuum of care. The revolutionary simplification in diagnosis and evaluation that the MAFLD definition is providing, we believe can help to overcome some of these barriers and may facilitate the implementation of effective fatty liver disease management, prevent overdiagnosis and overtreatment in secondary and tertiary care but also reduce underdiagnosis in primary care by PCPs by promoting widespread active case findings of MAFLD and reaching to a balance on behalf of public health