Samy A. Azer

Research papers are often rejected due to methodological problems, inappropriate tools, and poor alignment between aims, methods, and conclusions. This editorial argues that these problems often stem from neglecting research philosophy when pursuing an idea. Based on the literature and our peer-reviewed experience in medical education and biochemical sciences, we emphasize that clarifying ontological, epistemological, methodological, and axiological assumptions helps select the appropriate paradigm—positivism, post-positivism, interpretivism, critical theory, or pragmatism. To avoid such methodological problems, researchers should clarify their philosophical assumptions, explicitly state the selected paradigm, and ensure that this process is outlined in the methods section or the appendix. This approach increases the rationality, transparency, reproducibility, and defensibility of research, especially in fields like artificial intelligence in healthcare education.

The management of gastrointestinal (GI) bleeding patients during endoscopy remains a challenge. Hemorrhage is still one of the significant causes of morbidity and even death. Several therapeutic options have been used over the years depending on the extent, site and cause of bleeding. These include thermal therapy, injection therapy, and mechanical methods of hemostasis (e.g. , endoscopic clips and ligation bands). Patients with refractory bleeding, high-risk ulcer lesions, malignant disease, antiplatelet medications, and chronic kidney disease are at increased risk of upper and lower GI bleeding (LGIB). In this editorial, I commented on the paper by Ballester et al . Their work aimed at evaluating PuraStat® (TDM-621), a novel hemostatic agent, particularly its efficacy, applications, feasibility, and safety in treating GI bleeding lesions. The authors concluded that PuraStat® is an effective therapy for GI bleeding and is usually easy to use. Although the authors recommended its consideration as a frontline therapy in the future, they did not explore the clinical and GI uses of PuraStat®. This editorial focuses on the pharmacology of PuraStat® and how it differs from Hemospray® (TC-325) (hemostatic powder). It also explores the current experience of using PuraStat® in upper and LGIB, its uses and safety, and the need for further research to fully understand its potential.

An essential aspect of becoming a physician is learning and incorporating high standards of medical professionalism. The progressive rise of social media platforms has brought challenges to medical programs. This study aimed to examine medical students’ and interns’ use of social media, compare the attitudes and beliefs toward social media, and analyze potential exposure to unprofessional behaviors. This was a cross-sectional study of 275 medical students from King Saud University and 200 interns employed by King Khalid University Hospital, King Abdulaziz University Hospital, and King Saud Medical City. A validated questionnaire was used to explore this topic. The questionnaire included 3 parts to examine the participants’ demographics, use of social media, attitudes, and beliefs regarding the use of social media. The collected data were analyzed using SPSS (PC, 21.0 version, IBM, New York) statistical software. Our Results indicated: Nearly all participants (99.4%) used social media, with Twitter (now X) being the most used platform, followed by Snapchat and Instagram. YouTube, Facebook, and LinkedIn were used less frequently by students and interns. Fourteen students (5.1%) and 25 interns (12.5%) had either patients or members of patients’ families listed as friends on social media platforms. Thirty-six (13.8%) students and 38 (19.0%) interns believed they had information on their social media accounts that would seem inappropriate if disclosed to the medical community. Students and interns were unaware of any guidelines regarding the use of social media within hospitals or universities. No significant difference was found between medical students and interns regarding their overall beliefs about the use of social media. The use of social networking during undergraduate training and internships is rising, and a significant proportion of participants do not have private accounts and share inappropriate content. These findings, coupled with a lack of knowledge of hospital and university policies regarding social media use, necessitate clear instructions and guidance to separate personal matters from professional attitudes. The study emphasizes that the use of social media by medical students and interns could be part of professional assessment, as it may reveal behaviors and attitudes that are typically undisclosed in clinical encounters.

Purpose: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition with debilitating manifestations that adversely affect patients’ health-related quality of life (HRQoL). The clinical course is complicated by patients’ low medication adherence level. Low adherence and poor HRQoL are linked to unfavorable disease outcomes. Although many factors affect adherence and HRQoL in COPD, the impact of adherence on HRQoL remain controversial. This study aimed to measure medication adherence and its impact on HRQoL in patients with COPD. Patients and Methods: This cross-sectional observational study included patients with COPD from two health centers in Riyadh, Saudi Arabia. Patients were identified using the medical database and only those fulfilling the GOLD 2020 criteria for COPD diagnosis were recruited. Data were collected via phone interviews and included sociodemographic information, the level of medication adherence assessed using the 5-item Medication Adherence Report Scale (MARS-5), and the HRQoL measured using the St. George Respiratory Questionnaire for COPD (SGRQ-C). Simple and multiple-regression analysis was used to study the factors affecting both parameters and the relation between adherence and HRQoL. Results: The mean MARS-5 score was 21.17± 4.8 (mean ± SD) with only 56.4% of patients with COPD reporting high adherence to their medications. The average total SGRQ score was 51.35 ± 23.82 indicating low HRQoL. Using multiple-regression analysis, comorbidity and intermediate disease duration were associated with lower adherence, while older age, female gender, polypharmacy, and concomitant hypertension predicted lower HRQoL. Moreover, higher adherence to medications was associated with higher overall HRQoL in patients with COPD. Conclusion: Patients with COPD have low medication adherence and low HRQoL. Several patient-, disease-, and therapy-related factors were shown to affect both outcomes; however, higher adherence to medication per se was associated with higher HRQoL in patients with COPD.

OBJECTIVE: During the COVID-19 pandemic, communication between patients and their treatment teams was severely limited due to restriction laws, which had a devastating impact on both patients and their families. This study examined the adequacy of clinical communication and sufficiency between the treating physicians and relatives of patients with COVID-19 infection. MATERIALS AND METHODS: This is a descriptive, retrospective study using a validated questionnaire. The study targeted the relatives of patients admitted to King Saud University Medical City (KSUMS) in Riyadh from March 2020 to May 2022. The contact information of the patients' relatives was retrieved from the hospital's electronic admission system (e-SEHAI). A phone questionnaire was completed after contacting identified family members or relatives. RESULTS: The total number of completed questionnaire responses was 404. Of these, 216 (54%) of participants were males, and the remaining 46% were females. Participants comprised parents (41.3%), partners (17.4%), siblings (10%) and other relatives (31.2%). Forty-four percent of participants were satisfied with the quality of communication of the treating team, while 113 (28%) were not satisfied, and 113 (28%) preferred not to express their views. Sixty-nine percent of participants considered consultants the best way to communicate with relatives, while only 17% chose residents. One hundred and forty-seven (36%) of the participants believed that too much communication would not interfere with the clinical work of the physicians, while only 18% agreed it would, and 45% were undecided. CONCLUSIONS: While the authors found a moderate level of participants' satisfaction regarding physician communication during the COVID-19 pandemic, the study identified gaps and areas for potential improvement. The findings could guide more effective hospital communication strategies in the future and better approaches for patient care and family satisfaction. https://www.europeanreview.org/wp/wp-content/uploads/Graphic-jpg.

Dual primary gastric and colorectal cancer: The known hereditary causes and underlying mechanisms

Background: The unprecedented COVID-19 pandemic has caused significant disruption to medical students’ education. It imposed challenges that required rapid adaptation to enforced lockdowns and remote learning and changed curriculum delivery from in-person to online learning and virtual technology.Objective: This study aimed to determine the trends and ratings of using Internet resources and social media platforms by medical students during the COVID-19 pandemic.Methods: A validated questionnaire was used to explore preferences for Internet resources and social media platforms among undergraduate medical students (years 1, 3, and 5) at King Saud University. The questionnaire comprised three sections- (i) demographic information, (ii) access and use of Internet resources/social media platforms, and (iii) students’ ratings and reasons for using technology-enabled learning during the COVID-19 pandemic.Results: A total of 320 undergraduate medical students responded to the online questionnaire. The difference in the number of students using the Internet daily across academic years increased significantly as they progressed in the medical course (p = 0.025). For learning, YouTube and Videoconferencing (e.g. Zoom) were used by 83.1% and 73.4% of students, respectively, followed by WhatsApp 198 (61.9%). For social interaction, WhatsApp, 310 (96.6%); YouTube, 296 (92.8%); Twitter, 288 (90%); and Zoom, 269 (84.1%) were the platforms used by most students. Regarding concerns about the impact of COVID-19 and social isolation, 250 (78.1%) agreed that technology helped them gain a sense of connectedness to their peers. Over half of students, 187 (58.4%) wished that technologies be integrated more often in their courses, as 245 (76.7%) agreed that it helped engage them with classes.Conclusion: The study shows that the use of the Internet and social media resources is increasing at all levels to fill the gap in learning and social interaction because of the COVID-19 pandemic. Medical institutions should embrace the effective use of Internet resources and use the experience gained and lessons learned in guiding educators on what type of online resources should be created to add value to students learning even post-pandemic.

Artificial intelligence (AI) is the science and engineering of making intelligent machines. In medical education, the usefulness of AI and its applications is being explored in training, learning, simulation, curriculum, and developing new assessment tools. This editorial encourages authors to submit their research on AI concerning medical education to enrich our knowledge.

Background: Academics and clinicians are exposed to significant workload pressures and are at a high risk of stress and burnout. Objectives: This study aimed to examine the relationship between burnout and emotional intelligence (EI) by comparing and corelating burnout and EI scores among academics and clinicians against several factors. Methods: In this cross-sectional study, academics and clinicians at King Saud University and King Saud University Medical City and Affiliated Hospitals were invited to complete anonymous questionnaires: Maslach Burnout Inventory-Human Services Survey and the Trait Emotional Intelligence Questionnaire Short Form. The collected data were analyzed using the SPSS software for descriptive studies, group comparisons, regression analyses, and Pearson's (r) correlation tests. Results: Study participants included 126 individuals (men = 65, 51.6%; women = 61, 48.4%). Of these, 65% were Saudi nationals and 35% were expatriates, and 76 were academics while 50 were clinicians. The mean (minimum to maximum) burnout total score was 55 ± 18.9 (8 to 97) and the global TEIQue-SF score ranged between 2.8 and 6.7 (5.04 ± 0.7). Burnout scores varied between departments and were higher among younger participants and non-Saudis. Age had a small direct correlation with self-control (r = .17, p = .05), and there was no statistically significant correlation with other EI factors. However, there was a moderate inverse correlation between age and emotional exhaustion (EE) (r = -0.33, p < 0.0001), and a small inverse correlation with depersonalization (DP) (r = -0.21, p = 0.02). T-tests demonstrated a statistically significant difference in EI factor "emotionality" among Saudis (5.2 ± .8) and non-Saudis (4.9 ± .8) (t124 = 2.2, p = 0.03), and for burnout subscales, there was a statistically significant difference in DP among Saudis (6.4 ± 4.8) and non-Saudis (8.5 ± 5.6), (p = 0.03). Moderate (r = -0.3, p = 0.01) and weak (r = -0.2, p = 0.05) negative correlations were found between EI factors and burnout subscales (EE, DP). Conclusion: This study confirmed an inverse relationship between burnout and EI scores among academics and clinicians. The findings suggest the need for introducing measures and implementing a system for early detection of burnout among staff and providing support to enhance EI and requisite care for those undergoing burnout episodes.