Abdulmalik S. Alotaibi

Background: Healthcare entrepreneurship is increasingly relevant to the transformation of the Saudi healthcare system, private-sector participation, digital health, and innovation. However, evidence regarding healthcare providers’ entrepreneurial intentions, awareness, and perceived facilitators and barriers in Saudi Arabia remains limited. Objectives: This study assessed entrepreneurial intention, awareness, perceived facilitators, motivators, and barriers among healthcare providers in Saudi Arabia and examined factors associated with entrepreneurial readiness and willingness. Methods: A cross-sectional online survey was conducted in November 2023 among 435 healthcare providers working in Saudi Arabia. Participants were recruited through convenience sampling, and the bilingual questionnaire was distributed electronically via professional networks and social media platforms, including LinkedIn and X/Twitter. Descriptive statistics were used to summarize the findings, and Mann-Whitney U and Kruskal–Wallis tests were used to examine factors associated with entrepreneurial readiness and willingness scores. Results: Among 435 participants, 82.8% reported interest in entrepreneurship, 76.3% believed that healthcare providers could become entrepreneurs, and 72.2% had considered starting a healthcare-related business. However, only 32.9% were familiar with entrepreneurship concepts, 35.6% had completed entrepreneurship courses, and 6.2% had started a healthcare-related business. The mean entrepreneurial readiness and willingness score was 3.94 ± 0.72 out of 5. Entrepreneurial readiness and willingness scores were significantly higher among female participants than among male participants (4.05 ± 0.64 vs. 3.85 ± 0.77; P = 0.004) and differed significantly across professional groups (P < 0.001). Higher scores were also associated with interest in entrepreneurship, prior entrepreneurship education, institutional support, and previous healthcare-related business experience (all P < 0.001). Conclusions: Among surveyed healthcare providers in Saudi Arabia, entrepreneurial interest was high; however, the establishment of healthcare-related businesses remained uncommon. This intention–implementation gap underscores the need for structured entrepreneurship education, institutional support for innovation, mentorship, regulatory guidance, and access to funding or incubation pathways within the Saudi healthcare system.

Background: Pharmacists in Saudi Arabia are assuming increasingly diverse and specialized roles amid rapid healthcare transformation. However, evolving expectations and expanding responsibilities may influence their job satisfaction, well-being, and career stability. This study aimed to assess job satisfaction, burnout, well-being, and career intentions among pharmacists across multiple practice sectors in Saudi Arabia. Method: A nationwide cross-sectional survey was conducted between December 2024 and January 2025 using an electronic questionnaire distributed to licensed pharmacists. The instrument assessed mental well-being, job satisfaction, burnout, workplace environment, and career mobility. Descriptive and inferential analyses were performed using SPSS version 20.0. Results: A total of 531 pharmacists completed the survey; 65% were male, and 89.3% were Saudi nationals. Sector distribution differed significantly by gender (p < 0.001): females were more represented in clinical and hospital pharmacy, while males predominated in the pharmaceutical industry–related roles. Male pharmacists reported higher work environment scores (p = 0.028) and greater sector mobility (34.2% vs. 23.7%, p = 0.012). Approximately 30.5% of participants had changed their employment sector at least once. Community pharmacists reported the highest burnout levels, whereas those in regulatory and administrative roles demonstrated the greatest job satisfaction (both p < 0.001). Participation in professional development showed strong positive associations with job satisfaction and intention to remain in the current role. Conclusions: Marked variations exist in pharmacists’ well-being, satisfaction, and career mobility across sectors in Saudi Arabia, with notable gender differences. Enhancing professional development, ensuring equitable work environments, and promoting sector-specific support strategies may help inform discussions on pharmacist engagement and retention within the evolving national healthcare system.

Background: Urinary tract infections (UTIs) are the most common infections among kidney transplant recipients, with prevalence rates ranging from 12% to 75% in studies from North America and Australia and from 4.5% to 85% in the Middle East. These infections can significantly impact graft survival and patient quality of life, increasing the risk of hospitalization, morbidity, and mortality. Escherichia coli is the leading cause of UTIs in transplant patients, but multidrug-resistant (MDR) pathogens are a growing concern, especially in Saudi Arabia. Several factors, including advanced age, female gender, and use of urinary catheters, contribute to post-transplant UTIs. This study focuses on the Saudi population, aiming to assess the prevalence, risk factors, and treatment strategies for recurrent and multidrug-resistant UTIs in kidney transplant recipients. Methods: This retrospective cohort study reviewed the medical records of kidney transplant patients at King Faisal Specialist Hospital & Research Center, Jeddah, in addition to data from King Fahad Hospital, Madinah, Saudi Arabia, between March and May 2022. Adult patients (≥18 years) who developed recurrent UTIs within two years post-transplant were included, while those with one or no UTI episode or incomplete records were excluded. Results: Seventy-five of 491 screened patients (15.3%) experienced recurrent UTIs, contributing to a total of 219 episodes. Klebsiella pneumoniae was the most frequent pathogen, isolated in 94 episodes (42.9%). Key risk factors for recurrence included complicated UTIs (OR = 4.60, p = 0.005), multidrug-resistant organisms (MDROs) (OR = 3.14, p = 0.021), and ureteric stents (OR = 4.07, p = 0.042). Carbapenems were primarily used for complicated UTIs, while cephalosporins and penicillins were used for uncomplicated infections. A significant post-UTI rise in serum creatinine was observed (p < 0.001). Conclusions: Recurrent UTIs predominantly caused by K. pneumoniae are common in kidney transplant recipients, particularly in patients over 45, with multidrug-resistant organisms, or with ureteric stents. While a direct causal link to graft loss was not established, these infections can lead to increased creatinine levels, hospitalizations, and healthcare costs and increased carbapenem use. These findings highlight the critical need for institution-specific antimicrobial stewardship programs focused on infection prevention and optimized antibiotic use to improve outcomes in this vulnerable population.

Background: Urinary tract infections (UTIs) are the most common infections among kidney transplant recipients, with prevalence rates ranging from 12% to 75% in studies from North America and Australia, and 4.5% to 85% in the Middle East. These infections can significantly impact graft survival and patient quality of life, increasing the risk of hospitalization, morbidity, and mor-tality. Escherichia coli is the leading cause of UTIs in transplant patients, followed by Klebsiella pneumoniae, Enterococcus species, Pseudomonas aeruginosa, and Proteus. Several factors, including advanced age, female gender, and use of urinary catheters, contribute to post-transplant UTIs. This study focuses on the Saudi population, aiming to assess the prevalence, risk factors, and treatment strategies for recurrent and multi-drug-resistant UTIs in kidney transplant recipients. Methods: This cross-sectional study reviewed the medical records of kidney transplant patients at King Faisal Specialist Hospital & Research Center, Jeddah, in addition to data from King Fahad Hospital, Madinah, Saudi Arabia between March and May 2022. Adult patients who developed recurrent UTIs within two years post-transplant were included, while those with one or no UTI episode or incomplete records were excluded. Results: Among the study population, Klebsiella pneumoniae was the most frequently identified pathogen (42.9%). The majority of cases involved complicated infections. Carbapenems were primarily used for complicated UTIs, while cephalosporins and penicillin were used for uncomplicated infections. Despite the high recurrence of UTIs, antimicrobial prevention was rarely applied. Conclusion: Recurrent UTIs are common in kidney transplant recipients, particularly in patients over 45, with multi-drug-resistant organ-sms, or with ureteric stents. Though these infections do not directly threaten the graft, they can lead to increased creatinine levels, hospitalizations, and healthcare costs. Further research on prevention strategies is needed to reduce the burden on both patients and healthcare systems. Keywords: Urinary tract infection, kidney transplant, Saudi Arabia, Infection, Multi-Drug-Resistant

Background: Lipid metabolism disturbances are common in end-stage renal disease (ESRD) patients on hemodialysis (HD), leading to dyslipidemia, which is characterized by abnormal plasma lipids and lipoproteins. Although large randomized controlled trials have generally not demonstrated a survival benefit associated with statin therapy among patients receiving hemodialysis, limited observational studies have reported potential associations with improved clinical outcomes in this population. Methods: This retrospective cohort study investigated the clinical and safety outcomes of statin use in ESRD patients on HD with documented dyslipidemia over a two-year period from 1 January 2018 to 30 December 2019. The primary endpoints evaluated the clinical outcomes of statins by assessing changes in specific lipid parameters, including low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C). The secondary endpoints assessed safety by monitoring liver enzymes and creatine kinase (CK) levels. Results: Among 179 participants, diabetes mellitus was present in 134 patients (74.9%), while 168 patients (93.9%) had hypertension. Cardiovascular events occurred in 95 patients (53.1%). Statin therapy was administered to 146 patients (82.0%), with atorvastatin being the most frequently prescribed statin (69.3%). Modest reductions in LDL-C levels were observed in the rosuvastatin and atorvastatin groups, whereas slight increases were noted in the simvastatin and non-statin groups. None of these within-group changes were statistically significant. In the atorvastatin group, LDL-C decreased slightly from 2.058 to 2.003 mmol/L. The rosuvastatin group experienced a more pronounced LDL-C reduction from 2.607 to 2.113 mmol/L. Conversely, the simvastatin group showed an LDL-C increase from 1.550 to 1.901 mmol/L. Among the non-statin group, LDL-C increased from 2.678 to 2.820 mmol/L. Liver enzyme and CK levels fluctuated slightly but remained within normal ranges. Conclusions: This study evaluated statin therapy in hemodialysis patients with dyslipidemia. Although modest reductions in LDL-C levels were observed in the atorvastatin and rosuvastatin groups, statin therapy did not reduce the incidence of atherosclerotic events in hemodialysis patients with dyslipidemia. Additionally, statin use was not associated with any clinically or statistically significant effects.

Introduction: Ticagrelor is a widely used antiplatelet agent approved in over 70 countries, including the European Union and the United States, for reducing thrombotic events in patients with acute coronary syndromes (ACS). In clinical practice, combining ticagrelor with high-intensity statins is considered standard therapy for ACS. However, recent pharmacodynamic studies and case reports suggest potential drug-drug interactions that may increase the risk of adverse events, particularly muscular and renal complications. This study aimed to evaluate these risks in a real-world clinical setting in Saudi Arabia. Methods: This retrospective observational cohort study was conducted at the Makkah Cardiology Center, Saudi Arabia. The study included adult patients (n = 577) who were prescribed high-intensity statins, with or without concurrent ticagrelor. The primary outcomes were the incidence of statin-associated muscular complications—defined as myalgia, myopathy, myositis, or rhabdomyolysis—and acute kidney injury (AKI). Clinical data were extracted from the hospital information system, and statistical comparisons were conducted between patients receiving statin monotherapy and those receiving combination therapy. Results: The cohort consisted predominantly of male patients (74.5%). Muscle-related complications were significantly more common in the group receiving both ticagrelor and statins (20.2%) compared to the statin-only group (10.5%) (P = 0.001). Among comorbid conditions, hypertension was the only factor significantly associated with a higher incidence of muscle-related complications. Although a trend toward increased AKI incidence was observed in the combination therapy group, this difference did not reach statistical significance. Conclusion: This study highlights potential safety concerns related to the co-administration of ticagrelor and high-intensity statins, particularly the increased risk of muscle-related complications. While the findings on AKI were inconclusive, the results support the need for cautious use of this combination and call for larger prospective studies to further evaluate its safety profile and optimize treatment strategies.

Introduction: As the pharmaceutical advertising landscape evolves with digital advancements, this study examines public awareness and perceptions of medication advertisements in Saudi Arabia. It focuses on the effects of regulatory frameworks and evaluates how they influence public understanding and attitudes toward these advertisements. Method: A cross-sectional study was conducted using an electronic survey in Saudi Arabia in December 2023. The survey was distributed on social media platforms and reached a diverse sample of 440 participants. It covered public perception and attitudes toward drug advertisements, knowledge of regulatory laws, and preferences regarding advertising mediums. Results: Out of the 440 participants in the study, who were primarily employees with bachelor’s degrees, there was a clear awareness of drug advertisements. The average age of the group was 33 years, and a significant portion (71.1%) held a bachelor’s degree, with 51.1% being employed. The findings revealed that 25.5% of participants frequently noticed drug ads, while 22.7% saw them very often. Although many found the ads informative, there were significant concerns about unrealistic expectations and the risk of overmedication; 89.8% believed the ads set unrealistic expectations about the effectiveness of medications. Additionally, 60.7% thought that celebrity endorsements might mislead the audience, and 91.1% felt that ads should provide more detailed information about potential risks and side effects. Regarding preferred advertising platforms, mobile apps and websites were favored (47%), followed closely by social media (46.4%). A striking 93.2% of participants believed that drug ads on social media should be subject to stricter regulations, and 96.4% wanted more proactive monitoring of online advertising. Many also reported using other sources, such as medical review sites, to verify medication information. Conclusions: Pharmaceutical advertising in Saudi Arabia must balance ethical transparency with educational value. The influence of digital platforms underscores the necessity for stricter regulation and accurate information dissemination. A collaborative approach is essential to align advertising practices with public health interests and regulatory standards.

Background: This study aims to compare resource utilization and staff satisfaction between the point-of-care (POC) activated system and the traditional intravenous piggyback (PB) system in hospital pharmacy settings. Methods: Employing a pre-post quasi-experimental design from November 2019 to April 2020, the study assessed resource requirements for both the POC activated system and the traditional PB system. Additionally, a staff satisfaction survey was conducted, focusing on staff experiences related to the pharmacy preparation process and the subsequent activation of the system by nurses. Results: The POC activated system required significantly fewer full-time equivalents (FTEs) per month compared to the PB system (0.36 ± 0.05 vs. 1.56 ± 0.07; p < 0.0001). Using POC in automated dispensing cabinets (ADCs) reduced medication administration time and returns (6.41% vs. 1.75%; p < 0.0001). The staff satisfaction survey revealed greater satisfaction with the POC activated system. A subsequent analysis showed the POC activated system had a low expiration rate of 0.1% and a cost of 39 Saudi riyal, while the traditional system had higher expiration rates and cost of 46,260 SR. Conclusions: The POC activated system reduced FTEs, decreased returned medications, and enhanced staff satisfaction compared to the PB system.

Background: Effective medication management, disposal, and donation are vital for public health and environmental sustainability. Improper handling of medications can lead to drug misuse, accidental poisoning, and environmental damage. This study examines current practices and challenges in Saudi Arabia, identifying opportunities for improvement. Method: A cross-sectional survey conducted in October and November 2023 targeted the general population in Saudi Arabia. This study employed convenience sampling to explore medication usage, storage, disposal practices, and awareness of donation procedures. Data were analyzed through both descriptive and inferential statistical methods. Results: This study involved 430 respondents. Of these, 73.0% held a university degree, yet 66.3% were unaware of drug donation programs, and 84.2% lacked knowledge about proper medication disposal. Despite this, 71.4% believed that drug donation programs positively impact healthcare, and 87.9% saw them as reducing drug waste and environmental pollution. However, 48.1% expressed concerns about the potential misuse of donated medicines. Awareness and knowledge were significantly higher among participants aged 30 and above. Conclusions: The findings highlight the need for enhanced public awareness, clear medication disposal guidelines, and ethically governed donation practices in Saudi Arabia. These measures can improve healthcare outcomes, protect the environment, and support global health and sustainability goals.

Background: Pharmacovigilance (PV) is an essential part of the healthcare system’s framework. In Saudi Arabia, pharmacovigilance is still a relatively new concept though it is well established in many countries. Study Aim: In this study, we aim to evaluate knowledge, attitude, and practice regarding pharmacovigilance and barriers to reporting adverse drug reactions (ADRs) among the general public in Saudi Arabia. Methods: This is a cross-sectional study that used a self-administered online questionnaire to assess knowledge, attitude, and practice of PV and ADRs. The study included only the adult population in Saudi Arabia. A scoring system was generated with a scale from 0 to 100, where 80% was set as a cut-off point, as any higher score resembled adequate knowledge, a positive attitude, and good practice. We used the Statistical Package for Social Sciences (SPSS) version 26 for performing the statistical analysis, where para-normal tests were used to associate scores with the socio-demographic characteristics of participants. Results: The study collected 1098 complete responses. The mean age (±SD) of participants was 37.9± 11.2 years. Females comprised 68.9% of the participants. The average knowledge score among participants was 37.8± 18.5, where only 4.3% of respondents had adequate knowledge. The average attitude score was 90.1± 19.2, where 83.4% had a positive attitude. The average practice score was 70.4± 18, and 34.5% of participants had good practice. Conclusion: The study found that the majority of participants had inadequate knowledge, a positive attitude, and poor practice. Individuals holding a master’s degree or higher and those working in the healthcare sector had the highest knowledge scores, whereas the group aged 31 to 50 years old, participants from the Al Jawf region, participants who are married with children, holders of a master’s degree or higher, and healthcare workers had the best attitude scores. Higher practice scores were seen among married individuals with children and those who work in the healthcare sector.