Medical Sciences Commons^™

Quality Improvement (Qi) Project Aimed At Reducing Unnecessary Antibiotic Usage Among Older Adult Patients By Addressing Inappropriate Antibiotic Prescribing In Primary And Long-Term Care Settings, Pamela M. Thomas

Seton Hall University Dissertations and Theses (ETDs)

Antibiotic overuse among older adults remains a significant patient safety and public health concern. Recent national data indicate that approximately 30%–50% of outpatient antibiotic prescriptions may be unnecessary, particularly for viral or self-limiting conditions (Chua et al., 2021). Antimicrobial resistance has been associated with more than 1.27 million deaths globally (Murray et al., 2022). This quality improvement project evaluated a multifaceted antimicrobial stewardship intervention in primary and long-term care settings. Baseline review of 167 antibiotic cases revealed 37.1% were inappropriate or questionable, and 28.7% lacked adequate diagnostic documentation. The intervention incorporated provider education, electronic health record decision-support tools, audit and …

Effectiveness Of Cognitive Stimulation Therapy On The Quality Of Life Of Adults With Dementia: A Secondary Analysis, Evelyn Airam

UNLV Theses, Dissertations, Professional Papers, and Capstones

This secondary analysis study evaluated the effectiveness of Cognitive Stimulation Therapy (CST) on quality of life (QoL), depressive symptoms, and cognitive function in 108 community-dwelling older adults with cognitive impairments, including dementia. Outcomes involved Quality of Life (QoL) measured by the Quality of Life in Alzheimer’s Disease (QoL-AD), symptoms of depression by the Cornell Scale for Depression in Dementia (CSDD), and cognitive function using the Saint Louis University Mental Status (SLUMS). After the CST, significant improvements were observed in QoL (p = .004), depressive symptoms (p = .002), and cognitive function (p < .001), with small effect sizes. Additionally, a significant interaction between sex and dementia diagnosis status was found in predicting cognitive changes, suggesting that the relationship between dementia diagnosis and cognitive improvement differs by sex. No between-group differences were found for QoL or depression. Findings support CST as a multidimensional, non-pharmacological intervention that improves cognitive, psychological, and social outcomes. Although effects were small, consistent improvements are clinically meaningful given the progressive nature of dementia. This study extends existing literature by demonstrating CST’s effectiveness in a community-based setting and reinforces its alignment with occupational therapy’s emphasis on participation and holistic care. Results highlight the need for early intervention and expanded access to CST programs to enhance quality of life in this population.

Discharge Rates From Pediatric Emergency Departments Against Medical Advice Can Be Reduced By Improving Service Quality, Sounira Mehri, Josef Finsterer

Saudi Medical Journal

No abstract provided.

Integrating The Private Sector Into Surgical Residency Training: Insights From Dr. Sulaiman Al Habib Medical Group, Saudi Arabia, Nuha A. Alsaleh

Saudi Medical Journal

No abstract provided.

Covid-19–Associated Rhabdomyolysis In Hospitalized Patients: Retrospective Cohort Study, Paula Esquerdo-Serrano, Silvia Otero-Rodriguez, Hector Pinargote-Celorio, Sergio Reus, Esperanza Merino, José-Manuel Ramos-Rincón

Saudi Medical Journal

Objectives: To determine the frequency of rhabdomyolysis in patients hospitalized with COVID-19 and to characterize their clinical features and outcomes. Methods: All adults admitted to the hospital were included in this single-center retrospective cohort study with COVID-19 at a tertiary care institution in Alicante, Spain, between March 2020 and March 2024. A creatine kinase (CK) threshold of 1000 U/L or higher was used to define rhabdomyolysis. Demographic, clinical, laboratory, treatment, and outcome data were collected. Patients with and without rhabdomyolysis were compared, and factors associated with in-hospital mortality (IHM) were analyzed. Results: Among 7,590 hospitalized COVID-19 patients, 20 developed rhabdomyolyses …

Coronary Artery Ectasia: A 10-Year Experience At A Single Center In Saudi Arabia, Talal F. Aljabbary, Meshal S. Alhamed, Mohamed H. Ismaeel, Abdulrahman O. Alhaqbani, Abdullah S. Alhumimidi, Nouf A. Alanazi, Ayman M. Alsaleh, Khalid M. Aljohani, Waleed M. Alharbi, Mostafa Q. Alshamiri

Saudi Medical Journal

Objective: To assess the incidence of coronary artery ectasia (CAE) and its associated clinical characteristics and outcomes over a long follow-up period in Saudi Arabia. Methods: We retrospectively analyzed all coronary angiography procedures performed between January 2013 and June 2023. Patients with CAE were included in the final analysis. Results: During the 10-year period, 10,397 patients underwent coronary angiography. The CAE was diagnosed in 242 patients, yielding an incidence of 2.3%. The majority were male (92.6%). The average age was 57.15 ± 11.76 years. The right coronary artery (RCA) was the most involved vessel (65.2% of all patients). The most …

Tumor Markers And Pancreatic Enzymes Reflect Early Pancreatic Dysfunction In Type 2 Diabetes, Walaa Mohammedsaeed, Suliman Alharbi, Lama Alraddadi, Saja Aljohani, Talat Almehmadi, Sarah Alawfi

Saudi Medical Journal

Objective: To evaluate whether pancreatic enzymes and tumor markers reflect early pancreatic dysfunction in patients with type 2 diabetes mellitus (T2DM). Methods: In this cross-sectional study conducted between January 2023 and January 2024, 300 Saudi adults with T2DM were assessed for serum CA19-9, CA125, amylase, and lipase. Associations with glycemic control, insulin resistance (homeostatic model assessment for insulin resistance [HOMA-IR]), and metabolic parameters were examined using multivariable linear and logistic regression adjusted for age, sex, body mass index, diabetes duration, lipid profile, and medication use. Receiver-operating characteristic analyses evaluated biomarker performance for identifying poor glycemic control (HbA1c >8.5%). Exploratory analyses …

Male Pelvic Health In Saudi Arabia: Knowledge–Practice Gap In Pelvic Floor Muscle Exercises And Implications For Preventive Physiotherapy And Health Policy, Wael A. S. Alghamdi

Saudi Medical Journal

No abstract provided.

Demographic Profiles, Clinical Characteristics, And Meteorological Context Of Heat-Related Illnesses Among Hajj Pilgrims In 2023, Ghadah Alsaleh, Majed Alsalamah, Fahad Alamri, Fatemah Alsaleh, Anas Khan

Saudi Medical Journal

Objective: To describe the demographic profiles, clinical characteristics, and meteorological context of heat-related illnesses among Hajj pilgrims in 2023.

Methods: A retrospective cross-sectional study was conducted using data from 1,129 pilgrims diagnosed with HRIs across healthcare facilities in Mecca, Mina, and Arafat. Demographic and clinical data were extracted from the Hajj Health Information System, while temperature, humidity, wind speed, and rainfall records were obtained from the National Center for Meteorology.

Results: Heat exhaustion (48.2%) and heatstroke (37.4%) were the most common diagnoses, with 24.9% of the cases requiring hospitalization. Males represented 55.4% of cases and accounted for 51.2% of …

Obesity's Role In Stroke Incidence Among Smokers: An Assessment Of Confounding, Interaction, And Mediation Effects, Saeed Awad M. Alqahtani, Moutasem Salih Aboonq

Saudi Medical Journal

Objectives: To examine the association between body mass index (BMI) category and history of stroke among current smokers, while assessing potential confounding, effect modification by age, and mediation by cardiovascular comorbidities. Methods: Data were analyzed from 53,939 current adult smokers participating in the 2021 Behavioral Risk Factor Surveillance System (BRFSS). Survey-weighted logistic regression estimated the association between BMI categories (underweight, normal, overweight, obese) and self-reported stroke history. The study assessed multicollinearity and adjusted for sociodemographic and health variables. Interaction terms were tested to evaluate effect modification by age, and exploratory decomposition analysis was used to assess mediation by conditions such …

Prevalence And Antimicrobial Susceptibility Patterns Of Nosocomial Bacteria Across Different Units At King Faisal Complex Hospital, Taif, Kingdom Of Saudi Arabia, Nahed Hawsawi, Renad N. Al-Jaiud, Layal L. Khyyat, Kholoud Alsulimany, Manhal Shabat

Saudi Medical Journal

Objectives: Nosocomial infections significantly impact patient morbidity, mortality, and healthcare costs. To determine the prevalence, bacteriological profiles, antimicrobial susceptibility patterns, and resistance distribution of pathogens causing nosocomial infections at King Faisal Medical Complex, Taif, Kingdom of Saudi Arabia. Methods: This cross-sectional study was conducted between September 2023 and March 2024 at different hospital units following ethical approval. Samples (n = 667) were collected from patients (both genders; all ages) exhibiting infection symptoms ≥ 48 h post-admission and pre-antibiotic administration. Bacterial identification involved culture, Gram staining, and biochemical tests. Antimicrobial susceptibility was tested using the Phoenix100 system. Results: Of 667 patients, …

From Early Adversity To Adult Health: Quality-Of-Life Consequences In A Mental Illness In Saudi Arabia, Rawan Saad Alghamdi, Ahmad A. Mirza, Ibrahim Fae Asiri, Fatemah Samir Alghamdi, Nawaf Abdulaziz Alharthi, Shaymaa A. Abdalal, Iman K. Ramadan

Saudi Medical Journal

Objectives: Childhood trauma (CT) is prevalent among bipolar disorder (BD) patients and exacerbates clinical outcomes, which may impact the quality of life (QoL). This study explores the prevalence of CT and its association with QoL among BD patients in Saudi Arabia. Methods: Cross-sectional study conducted among adults with BD during the euthymic phase. Sample size was estimated using a single-proportion approach (target n=141), and participants recruited by convenience sampling of eligible outpatients. CT was assessed using the Childhood Trauma Questionnaire (CTQ), and QoL using the the Brief Quality of Life in Bipolar Disorder (Brief QoL.BD). Results: The CT prevalence was …

Re-Emergence Of Pertussis In The Pediatric Population: A Tertiary Care Center's Experience, Haya S. Alshaibani, Tahir K. Hameed, Khaled H. Alsager, Mohammed A. Alshaalan, Syed F. Jamil

Saudi Medical Journal

Objectives: To describe the 2024 surge in pertussis cases in the pediatric population in a large tertiary care center in Riyadh, Saudi Arabia. Methods: A retrospective observational study was conducted on children aged 0–14 years with PCR-confirmed Bordetella pertussis infection diagnosed at a tertiary hospital in Riyadh between January and December 2024. Patients older than 14 years, with negative or indeterminate PCR results, or diagnosed outside the study period were excluded, and demographic, immunization, clinical, and outcome data were analyzed. Results: A total of 36 children were diagnosed with pertussis, with 35 (97.2%) requiring hospital admission. The median age was …

A Retrospective Cohort Study Of Uterine Cancer Epidemiological Analysis And Age-Based Disparities In Saudi Arabian Population Across 32 Years, Sallwa M. Alshehre, Mohammad A. Althubiti

Saudi Medical Journal

Objectives: To investigate the burden of uterine tumour in Saudi Arabia during the past 32 years (1990–2021), with an emphasize on the prevalence, incidence, mortality, and disability-adjusted life years (DALYs). Knowing these patterns strengthen the national aims of cancer control under Kingdom of Saudi Arabia (KSA) Vision 2030. Methods: A retrospective study was performed using data retrieved from the Global Burden of Disease (GBD) database. The work included population from Saudi Arabia between 1990 and 2021 and tested standardization age-specific metrics, involving uterine tumour incidence, prevalence, mortality, and DALYs. Results: Uterine tumour cases raised from 507 in 1990 to 6,366 …

Seroprevalence Of Hepatitis B And Hepatitis C In Patients Hospitalized In Palliative Care Service, Meryem Betos Koçak, Burcu Güler

Saudi Medical Journal

Objectives: Patients receiving palliative care often have complex comorbidities and frequent healthcare exposure, which may place them at risk for blood-borne infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV). However, data on the seroprevalence and prognostic impact of these infections in palliative populations remain limited. This study aimed to determine the seroprevalence of HBV and HCV markers in patients hospitalized in a palliative care unit and to assess their association with mortality. Methods: This retrospective study conducted on 545 adult patients a tertiary palliative care unit between 2018 and 2024. Demographic characteristics, comorbidities, nutritional support, mobility, …

Artificial Intelligence In Dialysis Therapies: Applications In Hemodialysis And Peritoneal Dialysis For Managing Infectious Diseases And Complications, Waleed H. Mahallawi

Saudi Medical Journal

This narrative review synthesizes evidence from a systematic literature search (2019–2025) on artificial intelligence (AI) applications in hemodialysis and peritoneal dialysis for managing infections and complications. Dialysis patients face infection rates 100-fold higher than the general population and sepsis mortality exceeding 35%. The AI, utilizing machine learning algorithms such as XGBoost, deep neural networks, and explainable AI tools, revolutionizes care through precise diagnostics, prognostics, and therapeutics. Key models demonstrate high accuracy in predicting bloodstream infections (area under the curve [AUC] 0.914), classifying peritonitis (F1 0.93), detecting SARS-CoV-2 (AUROC 0.82), and forecasting mortality (AUC 0.979). Therapeutically, AI guides antibiotic stewardship, reducing …

Post-Stroke Fatigue In Saudi Arabia: A Call To Action, Saad Z. Alqahtani

Saudi Medical Journal

Post-stroke fatigue (PSF) is a major consequence of stroke, with a prevalence of approximately 42–53% among stroke survivors. However, over the last 2 decades, only a few studies have explored PSF in Kingdom of Saudi Arabia (KSA). Findings from these studies show that PSF negatively impacts the quality of life of individuals with stroke. Furthermore, they emphasize the need for education for both health care providers and patients regarding PSF. This call-to-action mini narrative review identifies knowledge gaps and provides recommendations for both researchers and policymakers, including the need for standardized management and the exploration of hospital environment settings. Specifically, …

Contribution Of Interleukin-6 (Il-6) To Body Defense And Healing In Pulmonary Tuberculosis, Hasrah Junaidi, Annis C. Adi, Soedarsono Soedarsono, Soetjipto Soetjipto, Chatarina U. Wahyuni, Fariani Syahrul, Mahmudah Mahmudah, Zakiyuddin Zakiyuddin, Iskandar Arfan, Abdullah A. Mamun, Rubia Sari

Saudi Medical Journal

Objective: To examine the contribution of IL-6 to host defense and healing in pulmonary tuberculosis (TB). Pulmonary tuberculosis continues to pose a significant global health challenge, with disease outcomes determined by complex host–pathogen interactions. Interleukin-6 (IL-6), a multifunctional cytokine, has been implicated in immune regulation and tissue recovery during TB, but its specific role is not fully established. This review aimed to examine the contribution of IL-6 to host defense and healing in pulmonary TB. Methods: A comprehensive literature search was performed across PubMed, Scopus, Web of Science, ScienceDirect, and Medline following PRISMA guidelines, covering publications from 2015 to 2025. …

Impact Of Treatment On The Health-Related Quality Of Life Of Children With Cancer In Saudi Arabia, Fayzah Hussain Alhussain, Amany Anwar Saeed Alabdullah

Saudi Medical Journal

Objective: The impact of cancer on health-related quality of life (HRQOL) is considerable, particularly for children undergoing oncological treatment. While research has addressed HRQOL in childhood cancer survivors, less attention has been given to those actively undergoing treatment, including in Saudi Arabia. This systematic review aimed to address this gap by quantitatively evaluating studies reporting on the HRQOL of children in Saudi Arabia during their active cancer treatment phase. We also compare these findings with studies from around the world, emphasising demographic, medical and parental predictors of HRQOL. Methods: A comprehensive search of relevant databases (MEDLINE, CENTRAL, Embase, PsycINFO and …

Stimulant Medications And Bone Health, Christine M Swanson, Julie H Wolfe, Chadi A Calarge

Faculty, Staff and Students Publications

Purpose of review: This review summarizes the potential impact of stimulant medications on bone health, to raise awareness and optimize their safe use.

Recent findings: Stimulant medications can impair bone health through inadequate nutrient/calorie intake and stimulation of the sympathetic nervous system, which regulates bone metabolism. However, their use decreases fracture risk in younger populations ([Formula: see text]25 years old) with attention deficit/hyperactivity disorder (ADHD), likely through reductions in impulsivity and injury. Special care may be needed when fractures occur while using these medications, as recent data suggest psychostimulants are associated with impaired fracture healing. Prescription and non-prescription use of …

Developing Antibodies Against Galectin-3 And Galectin-9 To Target Endometriosis, Ashleigh Burger, Noah Farnsworth, Jared J. Reisnouer, Cheyenne Vue

2026 Symposium

Endometriosis is a disease characterized by pelvic pain and the formation of endometrial-like tissue on the outside of the uterine lining. This condition affects nearly 10% of women across the globe and confirming whether someone has endometriosis requires visualization in surgery. While the specific causes of this disease remain unclear, the over-expression of the Galectins 3 and 9 in ectopic endometrial tissues suggests a role in the development and maintenance of the condition. Monoclonal antibodies (mAbs) are highly specific proteins with potential as diagnostic or treatment tools. The goal of this study is to generate antibodies against Gal3 and Gal9. …

Natural History Of Ngly1 Deficiency: Motor Function & Clinical Features, Grace Morrison, Selina Dwight, Hal Landy, William F Mueller, Pam Ventola, Regina Deck, Becky Schweighardt, Matt Wilsey, Kevin J Lee, Bernhard Suter

Faculty, Staff and Students Publications

N-glycanase 1 (NGLY1) Deficiency is an ultra-rare neurodevelopmental disorder caused by biallelic loss-of-function mutations in the NGLY1 gene, leading to severe impairments in neurocognitive and motor function abilities in the affected patient population. Its core clinical features include global developmental delay, hyperkinetic movement disorders, elevation of liver transaminases, (hypo)alacrima, and progressive sensorimotor neuropathy. Due to the range of phenotypes and severity within the confirmed patient population, ongoing characterization of the disease is critical. A prospective natural history study (NHS) was conducted to further elucidate disease phenotypes and examine any changes in neurocognitive or motor function over a one-year period. Fifteen …

Blue Light Exposure, Eye Strain, And Sleep Quality: Evaluating The Effectiveness Of Blue-Light Filtering Lenses, Sara Rozalowski

Honors Capstones

This study employs a literature review to critically evaluate the benefits of blue light–filtering lenses and to determine whether their use against eye strain and toward sleep quality is supported by empirical evidence. The aim of this research is to provide evidence-based information to better inform patients regarding the clinical utility and practical applications of blue light filtration in corrective lenses.

What Is Screen Apnea And How Does It Affect You?, Kristi M. Soileau

New Orleans Dental Association News

Screen apnea is a modern epidemic of significant proportions. Research suggests that nearly 80% of people unconsciously alter their breathing, often holding their breath or breathing shallowly, while working on digital devices. This subtle shift in respiration, sometimes called “email apnea,” can place the body into a low-grade stress response without being noticed by the individual at the screen. When breathing becomes restricted from poor posting or content anxiety, the nervous system enters into a sympathetic response, much as it interprets signs of threats to that person. The resultant physiological response may be exhibited by muscle tension, mental fog, increased …

Progressive Cardiac Phenotypes And Reduced Reversibility From Long-Term Cugexp Rna Expression In A Dm1 Mouse Model, Rong-Chi Hu, Mohammadreza Tabary, Xander Ht Wehrens, Thomas A Cooper

Faculty, Staff and Students Publications

Myotonic dystrophy type 1 (DM1) is caused by an expanded CTG repeat in the DMPK gene, resulting in mutant transcripts that form expanded CUG (CUGexp) RNA foci and sequester muscleblind-like (MBNL) RNA-binding proteins. DM1 is multisystemic, with progressive worsening of disease manifestations in affected tissues. Disease progression is attributed to somatic expansion of the CTG repeats with age, resulting in production of CUGexp RNA with enhanced intrinsic toxicity due to increased MBNL sequestration. To determine the degree to which cardiac disease progression can occur independently of repeat expansion, we used a transgenic DM1 mouse model with inducible heart-specific expression of …

Genetic Analysis Of The X-Linked Adrenoleukodystrophy Gene Abcd1 In Drosophila Uncovers A Conserved Phenotype, Joshua Manor, Sharayu V Jangam, Hyung-Lok Chung, Pranjali Bhagwat, Jonathan C Andrews, Hillary Chester, Shu Kondo, Saurabh Srivastav, Juan Botas, Ann B Moser, Suzette M Huguenin, Michael F Wangler

Duncan NRI Faculty and Staff Publications

X-linked adrenoleukodystrophy (X-ALD) is a progressive neurodegenerative disorder caused by a loss-of-function (LOF) mutation in the ATP-binding cassette subfamily D member 1 (ABCD1) gene, leading to the accumulation of very long-chain fatty acids (VLCFAs). This disorder exhibits striking heterogeneity; some male patients develop an early childhood neuroinflammatory demyelination disorder, while other patients, including adult males and most affected female carriers, experience a chronic progressive myelopathy. Adrenocortical failure is observed in almost all male patients, with the age of onset varying, sometimes being the first diagnostic finding. The gene underlying this spectrum of disease encodes an ATP-binding cassette (ABC) transporter that …

The Neurobiology Of Interruptions In Emergency Medicine: The Case For Informed Interruption Management In Support Of Cognitive Stability In High-Reliability Clinical Environments, James Espinosa, Henry Schuitema, Alan Lucerna

Rowan-Virtua Research Day

Background: Interruptions are ubiquitous in Emergency Departments (EDs) and have been associated with task delay, multitasking, and increased error risk. While operational and human-factors impacts are well described, the underlying neurocognitive mechanisms remain underexplored. Not all interruptions are avoidable.  However,  interruptions in emergency medicine represent neurocognitive destabilization events that can degrade task representation and increase vulnerability to error during task resumption. Recognizing the neural mechanisms underlying interruptions reframes their management as a systems-level patient safety priority. The aim is not elimination of clinically necessary communication, but thoughtful reduction, prioritization, and design that protects cognitive stability.

Objective: To synthesize cognitive neuroscience …

From Confirmation To Guidance: Making The Case For Intraprocedural Pocus As The Next Developmental Step In Ultrasound-Supported Shoulder Reduction A Conceptual Practice Proposal And Research Agenda, James Espinosa

Rowan-Virtua Research Day

Point-of-care ultrasound (POCUS) is well established for the diagnosis of shoulder dislocation and for the confirmation of successful reduction. However, its role during the reduction maneuver itself remains under-described. This conceptual practice proposal argues that intraprocedural POCUS represents the logical next developmental step in ultrasound-supported shoulder reduction. By introducing real-time visualization of humeral head translation during reduction attempts, clinicians may identify ineffective vectors earlier, adjust technique midstream, and potentially reduce repeated attempts or escalation of procedural sedation. This work does not present outcome data but instead proposes a practical framework, workflow model, and research agenda for intraprocedural implementation. Future study …

The Complex World Of Emergency Department Medication Dosing: Weight Scalars, Dose And Area Under The Curve (Auc) In Medication Dosing--Areas For Future Research, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Weight-based dosing is foundational to emergency medicine practice. With modern ED beds capable of automatic patient weighing, inaccuracies in estimated weight have largely diminished. However, medication misalignment persists, particularly in patients at extremes of body weight and in high-stakes clinical contexts such as rapid sequence intubation (RSI), antimicrobial therapy, and anticoagulation. Emerging pharmacokinetic literature emphasizes total drug exposure—represented by the area under the concentration–time curve (AUC)—as a stronger correlate of efficacy and toxicity than single-point serum levels. This review explores where weight precision most likely matters in the ED, examines weight scalars, and reframes dosing decisions through an exposure-centered paradigm. …

When The Clock Stands Still: Clock Time Vs. Experienced Time In The Emergency Department Brief Review: Neurobiology Of Time Perceptiontemporal Distortion As A Marker Of Cognitive Load And Operational Turbulence, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Emergency clinicians frequently report that time during ED shifts can feel unusually slow or unusually fast. This shared observation has rarely been examined formally in emergency medicine. Altered time perception has also been described in high demand professions such as aviation, sports, military operations, and emergency response. Individuals often report time dilation during critical events and time compression during highly coordinated performance. These findings suggest that temporal perception reflects underlying neurocognitive responses to environmental demands. Emergency departments share many characteristics with these environments, including rapid decision making, task switching, and intermittent high stakes events.

Objective:  Brief narrative review concerning …