Background: Hypertension is a significant public health problem in Saudi Arabia that has affected 20.7% of the population. Undertreated hypertension patients face severe, potentially deadly health complications, including cardiovascular disease and stroke. In Saudi Arabia, increasing demand for primary care has made it challenging for patients with hypertension to obtain conventional primary care services. Virtual health coaching clinics are a recent innovation in Saudi Arabia that help patients with chronic diseases make lifestyle changes to reduce their risk of complications. Aim: To evaluate the effect of virtual health coaching on the Quality of Life of patients with hypertension in the Jeddah community. Methods: A cross-sectional quantitative research method was used. Adult patients with hypertension in the Jeddah city community completed an online survey comprising a sociodemographic form and the Arabic version of the 36 Item Short Form Survey, which measures Quality of Life. Descriptive and correlational analyses were performed to evaluate the Quality of Life and health-related outcomes. Results: Ninety-five patients participated in this study. Female patients, under 40 years of age, unmarried, and with higher education levels reported better general health and physical functioning. In addition, the frequency of clinic sessions was positively associated with improvements in physical and mental health. A substantial positive correlation was observed between vitality and mental health. As well as between social functioning and emotional role. Conclusion: This study highlights the essential need for continuous support and guidance to achieve a high Quality of Life by delivering individualized assistance, promoting sustainable behavioral changes, and enhancing patient involvement. Recommendations: Clinicians should incorporate digital health training in remote monitoring and chronic disease management. Policymakers must implement legislation, allocate resources to telemedicine, guarantee reimbursement, and enhance visibility. Addressing these patient-related areas will improve health outcomes and facilitate sustained hypertension management.
Circulating microRNAs (miRNAs) are stable, minimally invasive biomarkers with potential prognostic value in pediatric hematologic malignancies; however, evidence is fragmented and inconsistently reported. To systematically review and meta-analyze the prognostic performance of circulating miRNAs in pediatric/AYA hematologic malignancies over the last 15 years.PubMed/MEDLINE, Scopus, Web of Science, and Embase were searched, with supplementary citation chasing and targeted Google Scholar searching. Studies enrolling pediatric/AYA patients with hematologic malignancies and measuring circulating miRNAs (serum/plasma/whole blood) with survival outcomes (OS/EFS/DFS/RFS or related time-to-event outcomes) were eligible. Two reviewers screened records and extracted data. Hazard ratios (HRs) were pooled using random-effects models with direction standardized so HR > 1 indicated worse prognosis. When HRs were reported without CIs but accompanied by two-sided p-values, SEs were approximated from the z-statistic. Of 2,718 records, 15 studies met inclusion criteria for qualitative synthesis and 5 provided sufficient data for meta-analysis. Included studies were predominantly AML (11/15), with fewer ALL (3/15) and Burkitt lymphoma (1/15). The overall pooled estimate indicated worse outcomes with higher-risk miRNA profiles (pooled HR 2.34, 95% CI 1.74–3.14; I² ≈ 0%). In AML OS–only sensitivity analysis (3 studies), the pooled HR was 2.15 (95% CI 1.43–3.25; I² ≈ 17%). Circulating miRNAs show promise for prognostication in pediatric hematologic malignancies, but clinical adoption is limited by small cohorts, heterogeneous methods, and incomplete reporting of HRs/CIs. Standardized assays, transparent reporting, and external validation are essential.
Cervical spine injuries (CSIs) pose significant risks due to their potential for catastrophic neurological consequences. Paramedics play a crucial role in the prehospital management of suspected CSIs, as their decisions and actions can significantly impact patient outcomes. This review provides a comprehensive synthesis of current evidence and practices related to the prehospital management of suspected CSIs from a paramedic perspective. The epidemiology of CSIs is discussed, highlighting the predominance of these injuries in young adult males and the increasing incidence among the elderly population. The pathophysiology of CSIs is explored, emphasizing the importance of minimizing secondary injury through early immobilization and careful patient handling. The paramedic's role and responsibilities in assessing and managing suspected CSIs are outlined, including the use of clinical decision tools and immobilization techniques. Airway management in the context of suspected CSIs is a critical challenge for paramedics, requiring a balance between maintaining airway patency and minimizing cervical spine movement. Pain and sedation management is also discussed, considering the need to provide effective analgesia while preserving neurological assessment integrity. Extrication and transport considerations are reviewed, focusing on safe patient movement techniques and the decision between air and ground transport. Finally, recommendations for practice improvement are provided, summarizing best practices supported by current evidence, identifying areas requiring further research, and emphasizing the importance of interprofessional collaboration between paramedics, nurses, and physicians in optimizing patient care.
Background: Chest pain is a common emergency medical complaint with a wide diagnostic spectrum, ranging from benign causes to life-threatening acute coronary syndromes (ACS). Early recognition and management by paramedics in the prehospital setting are critical to reducing morbidity and mortality through rapid diagnosis and timely reperfusion. Methods: This review synthesizes current evidence on paramedics' roles in early chest pain recognition, including diagnostic tools such as 12-lead electrocardiography, symptom-based risk scores, and novel point-of-care biomarker testing. It evaluates prehospital interventions, reperfusion strategies, and system-level factors influencing outcomes. Results: Paramedics effectively use structured assessments and ECG interpretation to identify high-risk ACS patients, enabling early activation of catheterization labs and direct transport to PCI-capable centers. Early administration of aspirin and nitrates, coupled with emerging technologies like AI-assisted ECG interpretation and prehospital troponin testing, shorten treatment delays and improve outcomes. System disparities and training variations impact diagnostic accuracy and treatment equity. Innovative extended paramedic roles, including community-based management, are emerging. Conclusions: Paramedics play a pivotal role in the early recognition and management of chest pain syndromes, contributing to reduced ischemic times and improved patient outcomes. Standardized training, adoption of advanced diagnostic tools, and integration into regional cardiac care systems are essential to optimize prehospital chest pain care. Future research should address gaps in paramedic-specific diagnostic accuracy, technology integration, and equity in care delivery.
Poisoning and overdose constitute a significant global health burden, with acute poisoning causing substantial morbidity and mortality worldwide. Paramedics play a pivotal role in the early detection and treatment of these emergencies during the prehospital phase. This review comprehensively examines the role of paramedics in managing poisoning and overdose, focusing on their interventions, protocols, challenges, and future directions. Key aspects of prehospital management include scene safety assessment, clinical evaluation, utilization of point-of-care diagnostics, airway and circulatory support, antidote administration, and decontamination. Paramedics face challenges such as limited diagnostic tools, incomplete exposure information, occupational hazards, and complex legal and ethical issues surrounding antidote administration. Innovations in artificial intelligence-powered biosensors, portable toxicology kits, community paramedicine programs, and interdisciplinary collaboration between emergency medical services, public health, and mental health services represent promising avenues for enhancing prehospital care in poisoning and overdose. Strengthening paramedic training, integrating real-time toxicological support, and developing evidence-based protocols are essential for optimizing patient outcomes. This review highlights the critical role of paramedics in the early recognition and management of poisoning and overdose emergencies while emphasizing the need for continued research and innovation to address the evolving challenges in prehospital toxicology.
