Saudi Cultural Missions Theses & Dissertations
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Item Restricted A SYSTEMATIC REVIEW OF METHODOLOGIES IN NEEDS ANALYSIS IN ENGLISH FOR SPECIFIC PURPOSES IN SAUDI ARABIA(The University of Auckland, 2024) Alkhalaf, Abdulrahman Malek; Basturkmen, HelenNeeds analysis is crucial for developing effective English for Specific Purposes (ESP) courses, as it identifies learners' specific language needs. This systematic review examined the methodologies employed in needs analysis research within the Saudi Arabian ESP context from 2014 to 2024. Using a systematic review approach, 57 studies were initially identified through a detailed keyword search across various databases, with 21 studies meeting the inclusion criteria for in-depth analysis. A framework was designed and employed to extract and systematically analyze the data. The findings revealed an increasing reliance on mixed-methods approaches. Questionnaires and interviews were widely employed, with document analysis gaining prominence in recent years. The review also noted that, over the past decade, the majority of studies have concentrated on English for Academic Purposes (EAP) contexts. Additionally, there has been a significant rise in the use of technologies for data collection. The study identified challenges such as data complexity, participant accessibility, low response rates, and the need to ensure objectivity while minimizing bias. This review highlights the critical role of needs analysis in informing the design of ESP courses in Saudi Arabia. The findings underscore a methodological evolution toward mixed methods and digital innovation, offering valuable insights for future research and pedagogical practices aimed at addressing learners' language needs in this context.21 0Item Restricted INTERVENTIONS USED IN THE TREATMENT OF RADIOTHERAPY INDUCED TRISMUS: A SYSTEMATIC REVIEW(University College London, 2024) Aladwani, Reem; Mercadante, ValeriaAbstract Introduction: Trismus is a chronic debilitating complication of radiotherapy to the head and neck highly prevalent among head and neck cancer survivors. Affected patients may experience a marked restriction of jaw movements causing difficulties with daily activities, such as eating, chewing and swallowing, all of which have a direct impact on the quality of life of patients. Objectives: To assess the effects of available intervention to manage radiotherapy-induced trismus. Methods: We have included controlled trials involving adults with a diagnosis of radiotherapy-induced trismus. Four main databases were included in our search (MEDLINE OVID, EMBASE, OVID, the COCHRANE library, and Web of Science core collection) with a throughout, comprehensive search conducted in all databases. Search was carried out in June 2024 for randomized controlled trials (RCTs) and non-randomized controlled studies incorporating trismus treatments for head and neck cancer. Results: In total 9 studies were included, 7 RCT, and two non-randomized controlled studies, with a total of 530 patients who received radiotherapy alone, or combined chemoradiotherapy. Most of the studies were focusing on the range of motion exercise, one study focused on low-intensity ultrasound, and low-level laser therapy, other study focused on photobiomodulation (FTBM) and conventional speech therapy. However, others focused on Myofascial Release (MFR) technique, Therabite System, Engstrom jaw device and Matrix Rhythm Therapy. Conclusion: The results of this systematic review showed that there is no high-level evidence for the effectiveness of one type of management interventions over another. Further RCTs are required to draw reliable and generalizable conclusions on the treatment of trismus in head and neck cancer survivors.12 0Item Restricted Merging paths to healing - efficacy of integrated vs. non-integrated treatment programs for comorbid substance use disorder and posttraumatic stress disorder: A systematic review(London's Global University, 2024) Hakeem, Haneen; Yang, JustinIntroduction: The heightened prevalence of comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitutes an increasing cause for concern as both disorders become more severe and challenging to treat. Integrated treatment (IT) programs address the substantial interaction between symptoms of PTSD and SUD and thus aim to address both disorders simultaneously. Despite rapid development in IT programs in the last decade, there is a scarcity of studies that comprehensively investigate treatment outcomes and patient acceptability. Therefore, the current study aims to examine the evidence for integrated compared to non-integrated programs in the treatment of comorbid PTSD and SUD. Methods: Studies that used randomised controlled trials to examine the efficacy of ITs compared to non- ITs for adults with SUD and PTSD between 2012 and 2023 were searched through Medline, PsycINFO, Embase, CINAHL Plus, Cochrane Central Register of Controlled Trials, Electronic Theses Online Service, OpenGrey, and ProQuest. PROSPERO CRD42023442012. Results: The search identified 871 studies, and after de-duplication, 676 studies were screened for title/ abstract. Of those, 55 studies were assessed for eligibility based on full texts, of which 9 met eligibility criteria. A narrative synthesis revealed that ITs effectively alleviated symptoms of both PTSD and SUD, demonstrating sustained improvement from the initial treatment phase to the longest follow-up. Nevertheless, the studies presented varied outcomes concerning the comparative advantage of IT over non-IT. While some indicated superior effectiveness of IT on either SUD or PTSD symptoms, others found comparable improvement effects. Both treatment approaches exhibited similar levels of acceptability, as evidenced by equivalent retention, engagement, and completion rates. Conclusions. This review showed that IT programs effectively improved symptoms of both PTSD and SUD. However, there was limited evidence supporting the superiority of IT programs over non-IT comparators in reducing PTSD and SUD symptoms, and patient acceptability. Nonetheless, given these similar treatment outcomes, the consideration of treatment choice may shift toward a patient-centred approach, where individuals are educated about treatment choices and can thus make informed decisions about their treatment.50 0Item Restricted The Effectiveness of Virtual Reality Technology for Perioperative Anxiety Among Adults Undergoing Elective Surgery(Queensland University of Technology, 2024-03-11) Asiri, Salihah; Duff, Jed; Currie, Jane; Guilhermino, MichelleBACKGROUND Perioperative anxiety is a common phenomenon that can have a significant impact on a patient's experience and surgical outcomes. Anxiety can manifest in physical symptoms such as increased heart rate, blood pressure, respiratory rate, sweating, and nausea, as well as psychological symptoms such as fear, worry, and panic. Perioperative anxiety can be caused by a variety of factors, including fear of the unknown, fear of pain, fear of the procedure itself, fear of the outcome, and fear of the environment. In addition, perioperative anxiety can lead to postoperative complications such as pain, surgical site infections, and longer hospitalisation. Pharmacological and non-pharmacological interventions have been used to manage anxiety. Pharmacological interventions include medications such as fentanyl, midazolam, morphine, and ketamine. However, side effects can occur from these medicines, such as breathing difficulties, drowsiness, and interactions with other anaesthesia medications. As a result, non-pharmacological interventions, including music, educational videos, psychological counselling, and social support, are becoming more popular. Recently, there has been an increased interest in using virtual reality (VR) to manage perioperative anxiety. The VR technology provides the user with an immersive experience in a three-dimensional simulated environment by allowing them to interact with the virtual environment. This technology is a major area of interest within the field of perioperative anxiety. To date, most studies in the field have focused on the effectiveness of VR on perioperative anxiety among the paediatric population, with limited research on its effectiveness among the adult population. AIMS To evaluate the effectiveness of VR on perioperative anxiety in the adult population undergoing elective surgery. METHODS A systematic review and meta-analysis of the effectiveness of VR in reducing perioperative anxiety for elective adult surgical patients was conducted (Objective 1). Search strategies were employed to identify the literature without language or date restrictions. Searches were completed by July 2023. Two independent reviewers, with a third where consensus was needed, used standardised critical appraisal instruments from the Joanna Briggs Institute, narrative analysis, and meta-analysis using RStudio software. A prospective observational study among 308 adult patients scheduled for elective surgery was conducted to investigate the prevalence of preoperative anxiety at a major metropolitan hospital in Australia from November 2021 to July 2022 (Objective 2). A self- administered questionnaire was used to measure anxiety levels, and other variables, including age, sex, and type of surgery, were collected from the patient's records. Data analysis included univariate logistic regression to evaluate the significance of independent variables , including age, gender, and surgical type. A two-group, parallel, single-centre, superiority, randomised controlled trial (RCT) of the effectiveness of VR in perioperative anxiety for adult elective surgical patients was conducted (Objective 3) based upon a published protocol. The study was conducted from November 2021 to July 2022 in 95 patients who experienced moderate to high levels of preoperative anxiety. Computer-generated randomisation was used to allocate participants to either the control group or the intervention group, who received 10 minutes of a VR session for relaxation purposes. The primary outcome was perioperative anxiety measured using the Visual Analogue Scale for Anxiety (VAS-A). Secondary outcomes included stress levels as measured by saliva cortisol level and heart rate, postoperative pain, patient satisfaction with perioperative care, hospital length of stay, and VR-associated adverse events. Data was analysed using R and RStudio software. RESULTS A systematic review identified that there was support for the effectiveness of VR in alleviating anxiety and enhancing patient satisfaction. Additionally, a meta-analysis of four studies revealed a small, non-significant reduction in preoperative anxiety based on subjective measurements, favouring VR (SMD -0.29, 95% CI -0.83 to 0.24), with moderate heterogeneity (I2 = 47%). The results of a prospective observational study identified that almost one-third (32.4%, n=100/308) of adult elective surgical patients had significant preoperative anxiety, identified as an Amsterdam Preoperative Anxiety and Information Scale (APAIS) score 11 or higher. Women were three times more likely to experience anxiety than men (OR=3.39, 95% CI 1.97-5.82).Older patients were less likely to experience anxiety, with a reduction in anxiety of 2% for each year above 18 years (OR=0.98, 95% CI 0.97-0.99). In addition, patients were more anxious about the surgery than the anaesthesia, with mean scores of 5.04 (± 2.48) and 3.65 (± 2.07) out of 10, respectively. Over half of the patients (54.9%) reported needing more information about the anaesthesia and surgery. The results of the RCT showed a statistically significant difference in preoperative anxiety levels between the intervention and control groups after the intervention (MD -17% points, 95% CI -23.0 to -11.7). However, there was no statistically significant difference in postoperative anxiety levels between the two groups (MD -7.2% points, 95% CI -17.9 to 3.5). Drowsiness and tired eyes were reported as VR side effects. CONCLUSION Perioperative anxiety among adult surgical patients is often overlooked. Findings suggest that adult surgical patients should be screened for preoperative anxiety, taking into account gender differences, and provide appropriate interventions for those with significant anxiety levels. VR interventions could be considered as a potential treatment option due to their efficacy in the adult population.36 0Item Restricted Assess Perspective and Knowledge of Healthcare Providers Towards Telehealth in Saudi Arabia: A Systematic Review(Saudi Digital Library, 2023-11-28) Mulayhi, Badriah Mousa; George, JominBackground and Objective: Telehealth has become a well-known tool for the delivery of health care in Saudi Arabia, and the perspective and knowledge of healthcare providers are influential in the implementation, adoption and advancement of the method. This systematic review was conducted to examine the current literature base regarding telehealth and the related healthcare professional perspective and knowledge in the Kingdom of Saudi Arabia. Materials and Methods: This systematic review was conducted by searching seven databases, including MEDLINE, CINHAL, Web of Science, Scopus, PubMed, PsycINFO and ProQuest Central. Inclusion criteria designated studies that were published in the English language from 2000 to 2023 in Saudi Arabia, full-text available and assessed the perspective or knowledge of healthcare providers towards telehealth. This systematic review was guided by Boland's guidance. All related studies were individually assessed by the researcher using the AXIS tool, which assesses the quality of cross-sectional studies in a systematic review. Data were extracted into a table, and a narrative synthesis was carried out to summarise and report the findings. Results: Ten studies met the inclusion criteria out of the 1840 search results. Positive perspective and low levels of knowledge among providers were observed across the studies. Frequent reasons for a positive attitude toward telehealth among healthcare providers were improving healthcare quality, access and delivery, saving time and money and its effective use. In addition, age, gender, profession and work experience were identified as factors associated with health professionals' knowledge level. The major challenges facing healthcare providers in practicing telehealth in Saudi Arabia are insufficient expert support, patient privacy, internet connection issues, lack of training courses, lack of knowledge of telehealth usage and high cost. Conclusions: This systematic review highlighted the existing perception and knowledge of health care providers towards telehealth. As a compilation of the varied personal attitude and knowledge of concerned professionals, it will assist in the better implementation of telehealth in Saudi Arabia, improve its advancement as a health care delivery option and reduced common challenges to its use.21 0Item Restricted The role of child and parental factors on parents feeding practices in a clinical population of children with poor growth(Saudi Digital Library, 2023-10-15) Almaatani, Dina; Bandsma, Robert H J; Van Den Heuvel, MetaFailure to thrive (FTT) is a symptom of inadequate nutrition and growth. Parental feeding practices are important determinants in shaping weight and eating behaviors in children during a sensitive period of physical and cognitive development. The feeding interaction is a bidirectional relationship between the caregiver and the child and informed by different contextual factors such as family, parental and/or child characteristics. Responsive feeding has been found to promote children’s interest in feeding, as well as their awareness of hunger and satiety cues. This dissertation aims to explore parental beliefs and feeding practices in a clinical population of children with poor growth, as well as the contextual factors that influence parental feeding practices in this population. First, a systematic review and meta-analysis was conducted in order to synthesize the current literature examining association between parents’ stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. Second, a clinical study with cross-sectional design was conducted among a clinical population of children with poor growth to examine the correlation between maternal concern about child weight or perceived feeding difficulties and feeding practices, and to investigate the role of child temperament and maternal mental health in a clinical population of children with poor growth. The findings from the two projects, showed that both general and parenting stress were associated with non-responsive feeding styles. Furthermore, higher maternal concern about child weight and perceived feeding difficulties were associated with less responsive feeding practices. Both child temperament and maternal mental health influenced the use of pressure feeding. Therefore, a review into current policies regarding parents’ mental health screening in a pediatric setting was conducted. The review suggests a lack of clear guidelines and recourse in order to support parents’ mental health screening in a pediatric setting. These findings provide a novel insight into the role of both the child and parents factors on parents’ beliefs and feeding practices. A better understanding of this relationship may provide pathways that could support and improve the clinical management of children with poor growth.17 0Item Restricted THE EFFECTIVENESS OF RADIAL SHOCKWAVE THERAPY IN THE PAIN MANAGEMENT OF PATIENTS WITH LATERAL EPICONDYLITIS: A SYSTEMATIC REVIEW(2023) Atheer, Alaskar; Emma, SargeantBackground: Lateral epicondylitis (LE) is a common and often chronic elbow pain condition with a high prevalence among the working-age population, which poses a social and economic burden worldwide. The most prominent symptom of LE is pain, resulting in emerging research focusing on pain control methods that use extracorporeal shockwave therapy (ESWT), as recommended by national guidelines. The literature, however, is ambiguous regarding the different types of ESWT and their efficacy. Systematic reviews (SR) have previously been conducted on ESWT with LE, but none have been focused on rESWT alone. The SR aims to collate all the available English language evidence regarding the effect of rESWT in terms of pain management for patients with LE. Methodology: A comprehensive search of the Medline, PEDro, EMBASE, Scopus, CINAHL and AMED databases between 7th – 30th October 2022 yielded seven randomised controlled trials (RCTs) suitable for inclusion. Two independent reviewers critically appraised the included studies using the PEDro scale, and five RCTs were forwarded for data extraction. Due to the clinical heterogeneity of the studies, narrative synthesis was performed. Results: Five good-quality RCTs with a total of 273 participants were reviewed. The included RCTs demonstrated statistically significant pain reduction among LE patients pre- and post-rESWT in the short- and intermediate-term (<3 months and ≤6 months follow-up) (p<0.001). However, not all studies agreed that rESWT was superior to sham rESWT or other conventional methods for LE pain management. The findings showed that rESWT was superior to local corticosteroid injection (LCI) (12-week follow-up) and prolotherapy (8-week follow-up) and when rESWT is combined with stretching exercise and massage therapy is superior to sham rESWT with the same exercises and massage (24-week follow-up) (p<0.001). Meanwhile, rESWT had an insignificant statistical effect in comparison to sham rESWT alone (12-week follow-up) and to exercise therapy and platelet-rich plasma (PRP) with exercise (24-week follow-up) (p>0.05). Conclusion: There is inconsistent evidence regarding the efficacy of relying on rESWT for pain management among LE patients. Although rESWT appears to be safe because no adverse effects were reported in the included studies, which might indicate the clinical significance effect of the rESWT, some evidence suggests that rESWT is no better than sham rESWT, exercise therapy or PRP with exercise. However, other evidence suggests using rESWT instead of injection therapy (LCI and prolotherapy) and a combined stretch exercise, massage and rESWT approach is effective for controlling LE pain. Due to the limited quantity and quality of the included RCTs, further, higher-quality RCTs are required to clarify the efficacy of rESWT for pain management among LE patients.48 0Item Restricted Assess the Effectiveness of School-Based Interventions on Obesity-Related Behaviours among Children And Adolescents (5-19 Years Old) in Saudi Arabia: A Systematic Review(2023) AlNassar Noura; Pockett RhysBackground: Childhood obesity poses a public health concern in Saudi Arabia. School-based interventions have been recommended to modify obesity-related behaviours in children and adolescents. Nevertheless, their effectiveness remains unclear, particularly in Saudi Arabia. Aim: This review examined the effectiveness of school-based interventions in positively changing obesity-related behaviour and/or BMI/BMI-Z in Saudi Arabia. The review also attempted to identify the characteristics of the intervention that contributed to its success. Methods: Six databases were searched: Medline (EBSCO host), PsycINFO (EBSCO host), SPORTDiscus (EBSCO host), Education Research Complete (EBSCO host), EMBASE, and Web of Science. Google Scholar was searched for unpublished studies, and reference lists were reviewed by hand. This review included all study designs from inception written in English, aimed at children or adolescents aged 5-19 in Saudi Arabia who received a school-based intervention and reported at least one obesity-related behaviour outcome and/or BMI/BMI-Z. Studies were assessed using the EPHPP quality assessment tool. Findings: Eight studies met the inclusion criteria and were incorporated into a narrative synthesis. 75% of the studies were performed on female participants and 50% on intermediate school students aged 12-15. About 63% of the studies focused on Saudi Arabia's Western region. The duration of the interventions varied from two days to six months. Various intervention approaches are employed in Saudi schools, including environmental modification, educational, behavioural, and sporing interventions. 63% of the interventions were theoretically based. Parents were included in 38% of the studies. Obesity-related behaviours were measured subjectively in most interventions. BMI/BMI-Z was measured using various reference charts. Five studies used multi-component approaches, with 60% achieving positive results. Three studies used single-component approaches, with 67% achieving positive results. Discussion: According to this review, 75% of Saudi Arabian school-based interventions improved obesity-related behaviours or BMI/BMI-Z. Therefore, Saudi Arabian schools could be a focal point for preventing obesity and promoting healthy behaviour. The effectiveness of multi-component interventions in Saudi schools is comparable to single-component interventions. It appears that duration is not a factor in the effectiveness of interventions targeted at the personal level. Also, this study indicated that interventions based on theoretical bases and involving parents are likely effective. Conclusion & Recommendations: This review indicates that most interventions implemented in Saudi schools have successfully modified children and adolescents' obesity-related behaviours and/or BMI/BMIZ. However, school-based interventions are limited in Saudi Arabia, with considerable heterogeneity. The strengths and limitations of the included interventions may have influenced the outcomes. Therefore, health promotion and prevention efforts should be improved methodologically and consider previous experiences when developing evidence-based interventions. In addition, long-term school-based interventions are necessary to evaluate the true impact of these interventions on childhood and adolescent obesity in Saudi Arabia. Implications for public health and health promotion: School-based interventions are suggested as a strategic approach to positively change obesity-related behaviours among children and adolescents. Schools are crucial to health promotion and can be especially beneficial in Saudi Arabia, given the high obesity rate. Investing in school-based interventions can help create a healthier generation of students equipped to make informed decisions and lead healthier lives.116 0Item Restricted Does Using Empagliflozin Reduce Hospitalization for Heart Failure and Angina in People With Diabetes? A Systematic Review(2023-05-02) Alrefaee, Manal Ibrahim; Khan, EhsanBackground Current statistics show that there are over 422 million people with diabetes around the world, and these numbers are in continuous increase (Lin et al 2020). The presence of type 2 diabetes mellitus increases the incidence of cardiovascular diseases (Leon & Thomas 2015). There is an increase trend towards using SGLT2 (Sodium Glucose Cotransporter 2) inhibitors, including empagliflozin, in the treatment of people with diabetes as the have shown beneficial effects in improving glucose control and cardiovascular events. Objectives To examine whether empagliflozin decreases hospitalizations for heart failure or unstable angina for people with type 2 diabetes mellitus (T2DM). Selection method The included studies compared using empagliflozin, 25 mg/10 mg, with placebo, no treatment. Only randomized controlled trials selected. Participants were people ≥18 years old with type 2 diabetes mellitus. Method The preferred method for conducting this systematic review was the Cochrane Handbook for Systematic Reviews (2022). The search for study was carried out through EMBASE database, PubMed, and Cochrane from 2014 to 2022. The search strategy was the PICO, (P) stands for Population, (I) Intervention, (C) Comparison, and (O) Outcome. The selected studies were assessed for quality using CASP (Critical Appraisal Skills Programme) tool. The risk of bias was also assessed using the Cochrane Risk of Bias tool (RoB2). The study search, the quality assessment and risk of bias examination all conducted by one author. Main results Four studies were retrieved for this systematic review. The studies compared using empagliflozin, 25 mg or 10 mg, with placebo, no treatment. Hospitalizations for heart failure were significantly lower in intervention groups, there is no significant difference in all-cause hospitalization, and the as no significant difference in hospitalization for unstable angina between the two groups. Conclusion Provided the notable control of diabetes status, using empagliflozin had an association with decreased hospitalization for heart failure and other cardiovascular diseases. A strong recommendation for using empagliflozin depending on the available data. The effects of empagliflozin on hospitalization for heart failure or unstable angina require more examination in the future.37 0