Background: In problem-based learning (PBL) curricula implemented around the world, it is assumed that students adopt a deep learning approach to studying and aim to gain a profound understanding of the subjects being studied. However, it is not clear which PBL components initiate or deter deep learning and to what extent this happens and why. Aim: This study explored to which extent students used a deep or surface learning approach in PBL and whether this differs across years. We also investigated which PBL components students perceived to be hindrances to deep or surface learning. Methods: The study took place at Sulaiman Al Rajhi Medical College, Qassim, Kingdom of Saudi Arabia. A mixed-methods approach was applied. A validated questionnaire and semi-structured focus group interviews were conducted sequentially. Results: First-, second-, and third-year students reported, in scale 1–5, for deep learning scores, respectively, with mean (M) = 3.55, M = 3.41, and M = 3.55. First-, second-, and third-year students reported, in scale 1–5, for surface learning scores, respectively, with M = 2.88, M = 2.78, and M = 2.89. The differences for both deep and surface learning across the years were statistically nonsignificant. According to students, they study deeply on main learning objectives and superficially on minor objectives as indicated by tutors, they are stimulated toward deep learning through interesting topics during self-study, and examinations drive them toward deep or surface learning depending on the question format and necessity to pass. Conclusions: The results of this study confirm that students' perceptions of PBL components affect their approaches to deep and surface learning. These effects are not entirely negative or positive. Students seem to frequently employ a deep learning approach in PBL throughout the 3 years. These conclusions will allow program administrators/educationalists to constructively design curricula around the perceptions of learners of PBL tutors, topics, and examinations.

Context: An important subject for nurse educators both nationally and internationally is reducing the gap between the limited teaching time and unlimited content, and one approach to reducing the theory–practice gap is internship programs which provide support and mentorship to nursing interns in order to increase competence and satisfaction. Aims: This study aimed to assess different internship clinical training programs provided by the College of Nursing, Jeddah, Saudi Arabia, and to test the effect of these two internship models on students' perceptions of competency enhancement and satisfaction. Settings and Design: This study followed an exploratory comparative design at the College of Nursing, Jeddah, Saudi Arabia. Subjects and Methods: A convenience sample of 64 nurses was included. Data collection included the validated Nurse Competence Scale and Interns Satisfaction questionnaire. Statistical Analysis Used: Descriptive statistics included mean, standard deviation, frequencies, and percentages, and inferential statistics such as independent t-test and Chi-square were carried out using the Statistical Package for the Social Sciences software. Results: No statistically significant differences (P = 0.38) were noted between the two groups of nurse interns. The average overall perceived self-rated competence was 84.82 ± 9.34 with 75.47 frequency of use of competencies. The most highly rated subscale of competency was a work role (mean competence level of 87.86 and frequency of use of 78.67%). Conclusions: This study highlighted no significant differences between the two internship models and the mean satisfaction score for nurse interns from the new training model group was higher compared to those from the traditional model group. However, it is important to note that internship programs have brought about significant changes within nursing worldwide and more specifically within Saudi Arabia.

Background: Cervical malignancy is a major health problem threatening women community in the developing countries. Aims: The main objective of this study is to investigate the awareness, knowledge of human papillomavirus (HPV) and cervical cancer (CC) risk factors among women. Methods: A cross-sectional, questionnaire-based, survey was conducted among females aged from 15 to 64 years in Tamil Nadu. It contained questions on sociodemographic data, awareness, knowledge of HPV and CC. Results and Conclusion: Of the 573 participants, only about 19% of women in Tamil Nadu were aware of CC and they know it is the second-most common gynecological cancer found among women in the country. About 14% of women were aware of HPV and HPV vaccine. Merely about 9% recognize that CC can be prevented and 7% say that HPV can be sexually transmitted. This study reveals that there is a low level of awareness and knowledge of HPV, CC among women in Tamil Nadu. The present study indicates the need for government organizations, health-care providers to join hands to educate middle-aged women with low educational status, create social awareness about the disease, its symptoms and reduce the risk of having CC in the population.

Background: Type 2 diabetes (T2D) is a major health problem worldwide, and anxiety is a serious psychiatric problem that can lead to serious consequences such as substance abuse. The prevalence of anxiety has been found to be high in T2D patients in several studies; data in Saudi Arabia are scarce; however, our primary goal was to identify the prevalence of anxiety among T2D patients and to examine the impact of anxiety on glycemic control, measured cardiovascular markers, and T2D-related complications. Methods: This cross-sectional, interview-based study was conducted from October 2015 to July 2016 in Taif City, Saudi Arabia. Researchers took anthropometric measures, and the laboratory results were taken from the patients' electronic files using medical record numbers. For anxiety screening, we used the Generalized Anxiety Disorder-7 (GAD-7) scale. Results: The prevalence of anxiety was 45.45%, and it was not significantly associated with socioeconomic factors. Neither hemoglobin A1c level nor lipid profile levels were affected by anxiety. After adjusting for multiple variables, retinopathy and neuropathy were negatively correlated with GAD-7 score. Conclusion: Anxiety was highly prevalent among the screened T2D patients. Although the anxiety diagnosis did not correlate with worse glycemic control or cardiovascular markers, it was negatively associated with T2D-related microvascular complications.

Background: Stroke, a cerebrovascular disease, is the second-most common cause of mortality worldwide while it ranks third among other causes of disability. The incidence of stroke in the Middle East is even higher than in developed countries. Despite the increasing disease burden, presently, there is only one established acute stroke unit at King Fahad Medical City in Riyadh, Saudi Arabia. Objective: The objective of the study is to assess the number of stroke patients admitted to different units in all hospitals across Riyadh city at one point of time. Materials and Methods: A cross-sectional survey was conducted in 30 hospitals distributed across Riyadh in 2016 and included newly diagnosed stroke patients. Data were extracted using case report forms depicting all patient data collected during admission to the specified hospital wards. Descriptive statistics were used to describe the quantitative and categorical variables. Results: Of the total of 30 hospitals invited to participate, only 3 (10%) hospitals agreed to participate. A total of 33 stroke patients were admitted to these hospitals, majority (27 [81.8%]) were admitted to internal medicine, 5 (15.2%) to surgery, and 1 (3%) to a neurosurgery unit. The prevalence of stroke among patients with age groups of 51–60, 61–70, and >80 years was higher in men than women. Conclusion: More epidemiological studies on stroke need to be conducted in different regions of the Middle East for effective planning and management. Further, other key areas to be improved include the development of wellequipped and trained health-care providers, collaboration of a multidisciplinary team, and raising public awareness.

Objectives: The knowledge and behavior of caregivers are playing a significant role in preventing and managing the emergency conditions of disease or disorder suffered by their children. Pediatric asthma is one such severe health disorder, which cripples the child from regular activities and exerts enormous stress on parents if not appropriately managed with adequate knowledge and skills in the initial stage of onset. This research paper, thus, is aimed to appraise the caregivers' knowledge and behavior (n = 250) of asthmatic children admitted to general hospitals in Jazan province, Kingdom of Saudi Arabia, about the cause, prognosis, and therapy of asthma in preventing and handling emergency asthmatic attacks in their children. Materials and Methods: Caregivers were interviewed with the help of a questionnaire (35 items) about pediatric asthma. The questionnaire was adapted from the Chicago Community Asthma Survey. Results: The results revealed that information regarding complications of pediatric asthma, behavioral skills, and knowledge on its management that are required to practice during an emergency was very little among the caregivers of asthmatic children. Lack of proper education, insufficient knowledge of asthma, underprivileged socioeconomic class, and substandard living conditions came out as reasons for poor knowledge and behavior among them. Conclusion: The study recommends that there is an urgent and pressing need to educate caregivers and provide continuous training on the right practice during asthma attacks to take proper and efficient care of their children.

Background: Studies involving the measurement of physicians' satisfaction with electronic medical records (EMRs) using a branch of artificial intelligence known as machine learning is rare in Saudi Arabia. Most of the studies have relied on traditional statistical methods. This study focuses on comparing an artificial neural network (ANN) model with linear regression model to predict physicians' satisfaction with their EMR. Aims: This study aims to compare the performance of ANN versus logistic regression (LR) modeling in predicting physician satisfaction with their institution's EMRs and compare sensitivity analysis results for both models. Methodology: Data were collected through a self-administered survey that was distributed to physicians working in inpatient departments at a major Saudi Arabian hospital (360-bed capacity). Using machine learning software, ANN and LR models were developed to compare performance power and identifying factors affecting physician's satisfaction through running sensitivity analyses. Results: The analysis included 115 physicians who answered the survey. ANN model produced a more accurate prediction when compared to the prediction produced by LR. ANN correctly classified the instances with 86.09% accuracy, compared to LR, which achieved 82.61% accuracy. In addition, sensitivity was higher in ANN model (0.86) compared to LR model (0.83). Specificity was lower in ANN (0.39) compared to the LR model (0.44), and the receiver operating characteristic curve was higher (0.79) for ANN, (0.76) for LR. ANN model identified three factors affecting physician's satisfaction: System integration with workflow; system features to enable physicians to perform their work well; and training. Conclusion: The results show the ANN model performed better than LR due to its nonlinear characteristics and discovered three new factors affecting physician's satisfaction. Therefore, ANN model should be used in physician's satisfaction prediction studies.

Objective: The aim of this study is to identify the knowledge, attitude, and practices related to weight reduction among women with polycystic ovary syndrome (PCOS) of reproductive age group. Materials and Methods: The descriptive cross-sectional study was conducted from August 2017 to July 2018 in the Department of Obstetrics and Gynecology, King Abdul Aziz Specialists Hospital, Taif, Saudi Arabia. One hundred participants were recruited from the outpatient clinic having satisfied the eligibility criteria through nonprobability consecutive sampling. Through closed-ended questions, participants were inquired about sociodemographic conditions, marriage, presenting complaints, knowledge, awareness of symptoms, and attitude and practices of weight reduction related to PCOS. The study is approved by the Ethical Review Committee of Taif University. Written informed consent was obtained from all the participants prior to enrollment in this research. The data were analyzed using Computer program SPSS Version 22 for Microsoft Window (Statistical Package for Social Science; SPSS Inc., Chicago, IL, USA). Results: A total of 100 study participants completed the pro forma with the mean age as 31.29 years. Majority (89%) had heard about the ovarian cyst before, with around 34% had received knowledge through health education. Moreover, 81% were aware about the problems of the disease, with around 69% reported delay of pregnancy and 31% informed menstrual problems as problems of PCOS. Importantly, 63% were aware about the methods of treatment, with treatment options as weight reduction (44.44%). Two-third (66%) of the study participants believed that weight reduction is an effective treatment. Among those, 21 (31.8%) believed improving ovulation, 2 (3.04%) improving psychological condition and both (60.61%) were improved by weight reduction. Conclusion: The current level of awareness among Saudi women with PCOS about the beneficial effects of weight reduction as the first line of therapy was poor.

Few pregnancies in microscopic polyangiitis (MPA) are described, that a high-risk nursery association and/or fetal. We report the case of a pregnancy carried to a successful conclusion without maternal or fetal complications in a patient followed for MPA in remission with azathioprine as a sequela-stage renal disease dialysis. This observation underlines the importance to plan pregnancy in patients treated for vasculitis, full and sustained remission, and taking into account the consequences of the vasculitis. Treatment decisions in case of relapse during pregnancy are based on the severity of the visceral and the term pregnancy.

Hydrometrocolpos (HMC) is a rare clinical condition resulting in accumulation of fluid in the endometrial and vaginal cavities secondary to vaginal obstruction. Vaginal obstruction can be caused by imperforate hymen, transverse vaginal septum, vaginal atresia, abnormal vaginal opening, and malformation of the urogenital sinus. Imperforate hymen is the most common cause. Time of presentation can be from the neonatal period to mid-adolescent age and can present as an isolated case or part of a syndrome. The usual clinical symptom is suprapubic abdominal mass. Symptoms from mass effect on surrounding organs, such as urinary retention and constipation, as well as complications of chronic fluid accumulation, such as tuboovarian abscess can be the initial presentation. With a high index of suspicion, diagnosis can be made with adequate clinical history, examination, and imaging. HMC should be considered in female neonates and infants presenting with midline suprapubic intra-abdominal mass irrespective of other clinical presentations.

The habitual chewing of areca nut causes severe wear of incisal and occlusal surfaces of the tooth. However, in implant-supported occlusion, the effect of areca nut chewing is not documented in the literature. This study presents a case of areca nut chewing habit, which causes occlusal overload in the patient with implant-supported prosthesis. Areca nut chewing should be strictly avoided by implant patients, as it causes marginal bone loss due to overload and may lead to failure of prosthesis.