Saudi Cultural Missions Theses & Dissertations
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Item Restricted Treatment Strategies for Delayed Cerebral Ischaemia After Subarachnoid Haemorrhage: A Systematic Review(Queen Mary University of London, 1431-07-18) Alanazi, Abdullah; Zolfaghari, ParjamABSTRACT Delayed cerebral ischaemia (DCI) is a devastating complication which may occur after aneurysmal subarachnoid haemorrhage (SAH). It significantly increases mortality among SAH patients and leads to poor functional outcomes. Due to uncertainty among researchers and healthcare professionals regarding the pathophysiology and clinical diagnosis of DCI, no sufficient treatment model has been proposed. Aims and Objectives: The aim of this study is to address the literature gap in the current recommendations on the treatment for DCI. In doing so, we aim to bring to light potential avenues for novel therapies, which have not yet been addressed by treatment models, and to inform directions for future research. Methodology: Three electronic databases (Pubmed, Medline, and Embase) were systematically searched for randomised control trials (RCT) and retrospective cohort studies that addressed various treatment methods of DCI. These included data on the use of statins, endovascular rescue therapy (ERT), calcium antagonists and vasodilators, assessing their efficacy and safety profile. Studies were included on the basis of predetermined inclusion criteria. Primary and secondary outcomes included mortality rate, ICU and hospital length of stay, incidence of vasospasm, and adverse events for each treatment modality. Results: A total of nine studies were included: 3 RCT and 6 retrospective cohort studies. No study reported a significant increase in adverse events, indicating that the included treatments are safe to use. A significant improvement in the severity of vasospasm was reported after the given treatment modalities; however, changes in functional outcome (Glasgow Coma Scale, Glasgow Outcome Scale, modified Rankin Scale) were not significant. Only the studies on statins included the length of hospital stay as a measure, which also showed insignificant results. Adjunct therapy of ERT with nimodipine appears to improve functional outcomes compared to single therapies. Conclusion: There is currently insufficient evidence for the addition of milrinone and statins to the current guidelines. However, adjuvant therapies show promise and more combinations should therefore be explored in the future. Keywords: Delayed cerebral ischaemia, cerebral vasospasm, aneurysmal subarachnoid haemorrhage, treatment, statins, endovascular rescue therapy, balloon angioplasty, nimodipine, milrinone37 0Item Restricted How Much Patient-Centred Care (PCC) is Taught to Medical Students in Saudi Arabia: A Case Study of the University of Tabuk Medical Curriculum(Saudi Digital Library, 2023-08-30) Alanazi, Abdullah; Agius, StevenBackground: Medical education’s role is to equip medical students with competencies to meet the patients’ needs. The CanMEDs framework presents key competency areas of medical practice that a typical medical curriculum should incorporate. The SaudiMeds competency framework was established to achieve the purpose of the CanMEDs framework in Saudi medical schools. As a result, meeting these competencies is meant to enhance the provision of patient-centered care (PCC). However, the extent of incorporation of PCC in Saudi medical curriculum has not been fully explored. Aims: To determine how much PCC content is taught to medical students at the University of Tabuk by mapping the common PCC domain to the MBBS program Methods: This study applied the sequential exploratory mixed-methods design as the qualitative data on the curriculum content was explored widely and then corroborated with the survey findings. Using the case study approach, the study explored how much PCC is taught to medical students at the University of Tabuk. Data was obtained from the MBBS program specification document, course modules for the six academic years, and self-administered questionnaire. Manifest content analysis approach was used to locate 27 PCC domains in the MBBS program learning outcomes (knowledge, skills and values), course learning outcomes, and teaching/learning strategies. Curriculum mapping was done to create links between the PCC domains and the MBBS program documents retrieved from the university. The higher the number of links, the greater the extent of teaching PCC to the university’s medical students. Results: All the 27 PCC domains are incorporated into the MBBS program at the University of Tabuk. The questionnaire results corroborated this finding. Problem-based learning (PBL) and case-based learning (CBL) dominate the teaching/learning strategies used at the university. The study also revealed that PCC is highly concentrated in the clinical years than in the preclinical years. Discussion: There is congruency between the MBBS program at the University of Tabuk and SaudiMeds/CanMeds) frameworks. Since the university’s mission is to churn out competent graduates to serve the community, strict adherence to PCC concepts will contribute positively to the attainment of this mission. In conclusion, there is a positive trend in the incorporation of PCC in the medical curriculum, which should be a norm nationally.14 0Item Restricted High-Precision GNSS Kinematic Relative Positioning: Methods and Assessment(Saudi Digital Library, 2023-12-17) Alanazi, Abdullah; Wang, LeiIn today's dynamic positioning applications, achieving sub-meter or centimeter-level precision has become increasingly crucial in various kinematic positioning applications. This holds particularly true for navigating rovers within challenging environments where GNSS measurements' quality limitations hinder accurate positioning. To enhance positioning accuracy, GNSS carrier phase measurements have gained significant importance. These measurements provide tracking precision approximately a hundred times finer than pseudorange measurements. However, these measurements present a challenge known as 'integer ambiguity,' which prevents their direct application in positioning. While a portion of the carrier phase measurement can be accurately measured, the remaining portion, representing a full cycle, remains unknown. Resolving this unknown cycle number is known as the 'ambiguity estimation problem' within the context of GNSS positioning. Achieving centimeter-level positioning accuracy is only possible if we successfully resolve this integer cycle number. This dissertation focuses on applying carrier phase measurements in demanding scenarios, particularly in vehicle positioning. Our primary goal is to develop an efficient algorithm and software for achieving centimeter-level accuracy in kinematic positioning using carrier phase measurements in these challenging contexts. We realize this goal through GNSS differential techniques that mitigate errors in GNSS-derived positions by leveraging correlated errors in GNSS measurements, augmented with data from a reference GNSS receiver. The dissertation explores various ambiguity resolution methods, including Full Ambiguity Resolution (FAR), Partial Ambiguity Resolution (PAR), and Ionosphere-free (Iono-free), aimed at improving position determination accuracy and enabling the reliable use of carrier phase measurements. We implement MATLAB software to enhance GNSS positioning accuracy, utilizing an extended Kalman filtering technique to better model the kinematics of a moving receiver. Our assessment is based on real-world data collected from Ohio State University's west campus area and CORS stations, spanning diverse baseline lengths and receiver types, from geodetic to low-cost receivers. Our software extends to multi-baseline scenarios, surpassing single baselines. Notably, the PAR method significantly enhances solution fix rates compared to the FAR and Iono-free methods, especially in short baseline scenarios, resulting in improved positioning accuracy. The comprehensive testing and validation conducted underscore the substantial contribution of our software to achieving centimeter-level kinematic positioning accuracy. Moreover, the analysis demonstrates that with the increase in baseline lengths, FAR and PAR methods exhibit a decline in fix rates and an increase in standard deviation values. This highlights the challenge of maintaining precise and fixed solutions over longer baselines. The PAR method outperformed the FAR method, especially in terms of fix rates, particularly for longer baselines. On the other hand, the Iono-free method faced significant challenges in high-dynamic scenarios with longer baselines, resulting in decreased precision and reliability. For CORS station data only in the case of medium to long baseline lengths, the Iono-free method exhibited superior performance compared to the FAR and PAR methods. However, the PAR method delivered results on par with those obtained from the Iono-free method. In contrast, the FAR method faced challenges in maintaining the same level of performance as the PAR and Iono-free methods for these longer baseline scenarios.34 0