Background: Trust is pivotal for a productive relationship between patients and healthcare providers and is positively correlated with multiple clinical and humanistic outcomes. However, the impact of trust in healthcare providers on different domains of health-related quality of life (HRQoL) among diabetic patients has not been studied in detail. Purpose: The aim of this study was to examine the association between the physical, mental or psychological, social, and environmental domains of HRQoL with the patients’ trust in their primary care physicians while controlling for several sociodemographic and clinical factors. The study was conducted among a sample of diabetic patients. Patients and Methods: This study had a prospective questionnaire-based, multi-center, cross-sectional design. The patients were recruited from three public hospitals in Saudi Arabia. Patients’ experiences and trust in their primary care physicians were assessed using the Health Care Relationship Trust (HCR-Trust) scale. HRQoL was assessed using the Arabic version of the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Multiple linear regression was conducted to assess the relationship between HCR-Trust and the WHOQOL-BREF physical, psychological, social, and environmental domains controlling for age, Charlson Comorbidity Index (CCI) score, health literacy, sex, education, annual income, nationality, and illness duration. Results: Three hundred and sixty-four patients participated in the study. The scores in all four domains of WHOQOL-BREF were positively associated with HCR-Trust scores of the diabetic patients. Additionally, the scores in the physical (β = − 10.26; 95% CI: − 13.77 to − 6.74; P < 0.0001) and psychological (β = − 3.91; 95% CI: − 7.44 to − 0.38; P < 0.0001) domains were negatively associated with female gender. Furthermore, the physical domain score was negatively associated with the duration of illness (β = − 0.26; 95% CI: − 0.506 to − 0.02; P = 0.032). The environmental domain score was positively associated with annual income (β = 2.31; 95% CI: 1.05 to 3.56; P = 0.030). Other patient characteristics, such as age and education, were not associated with the scores of any of the WHOQOL-BREF domains. Conclusion: Patient trust in healthcare providers is positively associated with different domains of HRQoL. Therefore, building and maintaining trust with patients is important to achieve favorable treatment outcomes.

Background: Cyclophosphamide is an alkylating agent associated with significant toxicities, most importantly hemorrhagic cystitis. Many approaches including mesna use were established to reduce this toxicity. However, data on mesna efficacy are conflicting. Objective: To investigate the incidence of hemorrhagic cystitis in patients receiving cyclophosphamide therapy with or without mesna. Methods: A retrospective chart review was done on all adult patients receiving cyclophosphamide therapy with or without mesna at the King Saud University Medical City. The incidence of hemorrhagic cystitis was recorded. Patients receiving mesna were compared with those not receiving mesna. Data were reported as numbers and percentages, and appropriate statistical tests of association were used. This step was followed by a comprehensive literature review using appropriate keywords in PubMed from the inception of the database until August 2019. All studies of interest were reported. Results: A total of 718 patients’ medical records were reviewed. The majority of the patients received mesna (n = 433, 60%). The mesna group had a greater incidence of hemorrhagic cystitis (3.5% vs. 0.4%, p < 0.004) and received a significantly larger cumulative dose (3103 ± 1696 vs. 2465 ± 1528, p < 0.001) mg of cyclophosphamide therapy. Our literature review revealed large differences in the conclusions of published trials with highly diverse study designs and populations, emphasizing on the need of large prospective trials to address this topic. Conclusion and relevance: Our study results do not support the use of mesna in preventing hemorrhagic cystitis. We found that the only influential factor in the development of hemorrhagic cystitis was the dose of cyclophosphamide therapy.

The use of complementary and alternative medicine (CAM) is unexplored among Saudi rheumatoid arthritis (RA) patients. The aim of this study was to estimate the prevalence and types of CAM used among patients with RA and factors associated with their use. A cross-sectional study was conducted at rheumatology clinics in two tertiary hospitals located in Riyadh, Saudi Arabia. The data was collected between May 2017 and February 2018. Unpaired Student's t-tests, Chi-square tests, and Pearson correlation tests were used to compare users vs nonusers. A total of 438 patients (mean age = 49, SD ± 15 years; 89.7% females) were included in this study. Sixty seven percent of included patients had used CAM for their RA. The majority of CAM users were female (92.1%). The most frequently used CAM products were vitamin D (47%), calcium (37%), honey (15%), ginger (13%), turmeric (11%), black seeds (8%), and fenugreek (8%). One hundred ninety-six (45%) patients believe that CAM is safe, and 287 (96%) patients took it because they believed that CAM had "added benefits". Statistically significant differences were found for gender, RA duration, erythrocyte sedimentation rate (ESR) level, and seropositivity between CAM users and nonusers (P = 0.019, P = 0.011, P = 0.022, and P < 0.0001, respectively). A significant correlation was found between the Erythrocyte Sedimentation Rate (ESR) level, RA duration and CAM use (r = 0.110, P = 0.022 and r = 0.121, P = 0.012, respectively). These data indicated that patients who used CAM had higher ESR level and longer disease duration than patients didn't use CAM. There is a high prevalence of CAM use among RA patients. CAM use was perceived to add benefit and patients using it had higher ESR. Larger studies are needed to assess the use of CAM and its impact on RA and its management.

Background and Purpose: Although health science programs run parallel to each other and comprise of shared core subjects between the different disciplines, students of the different disciplines rarely mix or interact with each other during their undergraduate studies. Extracurricular activities are a big part of university students’ life, through which students have an opportunity to express themselves and enhance their soft skills in a safe and relaxed environment. Recently, King Saud University (KSU), Saudi Arabia, launched a multi-disciplinary event aimed at raising public’s awareness of their rights and responsibilities in the healthcare system. Although the event was designed to educate the public about their rights and responsibilities in the healthcare system, it has proven to be a good opportunity to promote interprofessional education among participating students. This study aims to review and assess the impact of this multi-disciplinary public awareness event on the acquisition of core interprofessional competencies by participating students from the health sciences using Kolb’s experiential learning theory as a framework. Patients and Methods: This qualitative study used semi-structured Zoom interviews in Nov 2020 with health science students who participated in the event. The research team used a pre-designed topic guide based on Kolb’s experiential learning theory (KELT) for the interview questions. The interviews were recorded, transcribed, coded, and analysed using thematic analysis. Results: Twenty-one students, representing four health science colleges at KSU participated in three focus groups. The main themes identified were participants’ attitudes towards the event, the types of knowledge and skills acquired from the event, and how they practically applied the knowledge acquired. These themes were aligned to KELT as this study’s framework. Conclusion: The event covered the most important concepts of interprofessional education and could be a potential tool to educate students from multiple disciplines.

Background: Methotrexate (MTX) Intolerance Severity Score (MISS) has been previously validated in the Arabic language and has helped to detect high levels of intolerance in rheumatoid arthritis (RA) patients. The aim of the current study was to evaluate patient and disease characteristics associated with a high risk of MTX intolerance. Materials and Methods: A cross-sectional interview-based survey was conducted using adult RA patients as a study group, who were visiting a specialized rheumatology clinic at King Saud University Medical City. The Arabic MISS was used in this survey. Statistical analyses were performed to understand associations between MTX-intolerant and MTX-tolerant patients. Results: A total of 117 patients were involved in this study. Of those, 101 (86.3%) were females with a mean (SD) disease duration of 6.6 (5.7) years. The median (interquartile range (IQR)) Disease Activity Score-28 (DAS28) was 3.6 (3.6– 4.1). MTX intolerance was observed in 55 (47%) patients. The most predominant component in patients with a positive test was the behavioral component. Intolerant patients had a higher median of pain (47.3 vs. 50.0; P = 0.010) and patient global assessment (50.0 vs. 60.0; P = 0.004) scales compared to those in tolerant patients. Additionally, MTX intolerance was associated with the female gender (adjusted odds ratio (AOR) 6.724; 95% CI 1.420, 31.843, P = 0.016), marital status (AOR 2.549; 95% CI 1.037, 6.270, P = 0.042) and DAS28 (AOR 1.612; 95% CI 1.032, 2.517, P = 0.036). There was no significant difference between the two groups in the remaining disease activity parameters, background therapies, seropositivity, and smoking status (P > 0.05). Conclusion: Patient characteristics, rather than disease activity, significantly impact MTX intolerance. Behavioral component is the main driver of intolerance. Intolerant patients have higher patient-reported outcomes. Qualitative studies are needed to explore causes and potential solutions to MTX intolerance.

Coronavirus disease 2019 (COVID-19) has placed healthcare workers, including pharmacists, at an increased risk of infection and has increased their workload, which could lead to burnout. Therefore, the present study aimed to measure the levels of burnout among hospital and community pharmacists in Saudi Arabia during the COVID-19 pandemic and to identify the risk factors associated with burnout. In the present cross-sectional study, an online survey was distributed among community and hospital (inpatient, outpatient, clinical, and administration) pharmacists in Saudi Arabia. The Copenhagen Burnout Inventory (CBI) survey was used to measure burnout levels. This 19-item survey covered three aspects: personal, work, and patient-related burnout. The survey included questions about socio-demographic factors and the major causes of psychological distress among pharmacists during the COVID-19 pandemic. Inferential statistics were used for data analysis. A total of 502 pharmacists were included in the present study. Of these, 59.1% were categorized as having clinically relevant burnout levels (scores ≥ 50). Univariate analysis revealed that the burnout level was significantly higher (p < 0.05) among pharmacists who were younger, were females, had lesser years of experience, or worked in the community pharmacy. The main factors associated with high burnout levels among community pharmacists were younger age, lesser years of experience, male gender, non-Saudi nationality, and higher numbers of customers. In the COVID-19 part of the survey, burnout was found to be strongly related to the COVID-19 pandemic. Fears of getting infected or of a family member getting infected, fears of the pandemic lasting for too long, and increased working hours were factors contributing to increased burnout levels during the COVID-19 pandemic with unadjusted β of 8.336 and (95% CI 7.082–9.589, p value < 0.001). A lack of supportive work culture and sleeping disturbances were also found to be related to high burnout levels (p < 0.001). Pharmacy staff in Saudi Arabia were found to experience high levels of burnout. The major risk factors causing burnout included younger age, female gender, lesser years of experience, a lack of supportive work culture, sleep disturbances, worries associated with increased workload during the pandemic, fears of getting infected, and increased working hours.