Showing papers in "Journal of Health Specialties in 2014"

Sample size estimation and sampling techniques for selecting a representative sample

Abstract: Introduction: The purpose of this article is to provide a general understanding of the concepts of sampling as applied to health-related research. Sample Size Estimation: It is important to select a representative sample in quantitative research in order to be able to generalize the results to the target population. The sample should be of the required sample size and must be selected using an appropriate probability sampling technique. There are many hidden biases which can adversely affect the outcome of the study. Important factors to consider for estimating the sample size include the size of the study population, confidence level, expected proportion of the outcome variable (for categorical variables)/standard deviation of the outcome variable (for numerical variables), and the required precision (margin of accuracy) from the study. The more the precision required, the greater is the required sample size. Sampling Techniques: The probability sampling techniques applied for health related research include simple random sampling, systematic random sampling, stratified random sampling, cluster sampling, and multistage sampling. These are more recommended than the nonprobability sampling techniques, because the results of the study can be generalized to the target population.

An overview of nursing in Saudi Arabia

Abstract: Achieving and maintaining a stable nursing workforce is an important issue for the well-being of the rapidly growing population of Saudi Arabia. However, high turnover of expatriate staff and low recruitment of Saudi nationals have led to a serious staff shortage in the professions, particularly of well-qualified and experienced nurses. Nursing leaders need to work to improve the image of nurses and facilitate the recruitment of women into the nursing profession. Reduced working hours and part-time contracts with increased salaries and benefits could attract more young women to the profession, as might the provision of facilities such as private transportation and on-site childcare. Furthermore, establishing a national association for nurses would advance the nursing profession and help to ensure that all nurses undertake fully comprehensive training before entering the workforce.

The relationship between non-functioning distractors and item difficulty of multiple choice questions: A descriptive analysis

Abstract: Objectives: This study investigates the relationship between the presence of non-functioning distractors (NFDs) and the difficulty index of multiple choice questions (MCQs). Materials and Methods: The number of NFDs and difficulty index were correlated for each MCQ of Family Medicine Examination, College of Medicine, King Saud University (KSU) in three consecutive years (2010, 2011 and 2012). Results: The MCQs with more NFDs showed high difficulty index as compared to MCQs having less NFDs. The pattern of increasing difficulty index was 1NFD Conclusion: MCQs with a higher number of NFDs are easier than those with lower number of NFDs.

Palliative care in Saudi Arabia: Two decades of progress and going strong

Abstract: Palliative care is a relatively new medical speciality in Saudi Arabia, but it has shown tremendous growth in the last two decades. Nevertheless, there are challenges to this development. The paper reviews these barriers in context of the growing need for palliative care and possible ways to overcome these challenges.

Continuing medical education in Saudi Arabia: Experiences and perception of participants

Abstract: Introduction: Continuing medical education (CME) is important in developing competencies of medical practitioners with all the different influencing factors that have impact on their opinions and preferences. Despite the broad range of work on CME, very few studies have examined participants' opinions and attitudes towards CME. However, understanding them is critical in improving the practice of CME. Purpose: The purpose of this study was to explore attendees' perception of CME in Saudi Arabia regarding the different aspects of its practices and preferences. Materials and Methods: A survey composed of demographic questions, frequency of reading habits and 24 other related items was developed for CME participants. Participants were asked to indicate the extent to which they agreed or disagreed with each of the 24 items on a 5-point Likert scale. In total, 601 surveys were analysed. Results: The response to each item in the questionnaire was compared on the basis of demographic variables. The results showed that healthcare practitioners acknowledged the importance of CME in improving their knowledge, attitudes, clinical and academic skills, as well as improve their clinical practice outcome. Differences of opinion were categorised by gender, profession, nationality and age. Conclusion: The study showed that opinions related to CME varied among different disciplines and nationalities. Moreover, it raised questions related to the system of sponsoring participants to attend CME events and its consideration for ethical issues. There is a need to embed the concept of lifelong learning into the education of basic health professions. In addition, the policies related to sponsoring and accrediting CME in Saudi Arabia should be improved. We recommend further research into this matter.

Challenges facing postgraduate training in family medicine in Saudi Arabia: Patterns and solutions

Abstract: Objective: The objective of this paper was to show the challenges that are faced by the Family Medicine Training Programmes in the Kingdom of Saudi Arabia as well as suggests appropriate and practical solutions. Materials and Methods: This study was conducted from 2010 - 2013 using a semi-structured questionnaire to achieve the objective. The questionnaire was designed and completed by the investigators during their visits to accredit the training centres all over the Kingdom. It consisted of questions concerning the trainers' and trainees' opinions regarding all the aspects of training. Another tool used was the accreditation checklist, which contained a comprehensive list of training structures and processes mandatory for any training centre. The accreditation checklist and questionnaire were reviewed by the investigators after visiting all the training centres. The challenges were then classified manually and solutions were reviewed as well as approved by the members of the Accreditation Committee. Results: Seventy-five training centres were visited and 250 trainees along with 75 trainers participated in this study. Twenty-five challenges were identified and classified under 6 major groups. The practical solutions to these challenges were discussed with participants and then approved by the investigators. Conclusion: This study showed that Family Medicine Training in the Kingdom of Saudi Arabia faces many different challenges. Early identification along with key solutions to these difficulties are extremely important in the efforts to produce a new generation of competent Saudi Family Physicians who can improve the quality of healthcare for the population of Saudi Arabia.

Nursing education: The past, present and future

Abstract: Nurses constitute the greatest number of healthcare workers in the United States and globally. Increasingly, the role they play in meeting societal demands for safe, evidence-informed, quality care is being recognized. However, how they are educated around the world varies greatly. The purpose of the paper is provide a brief review of the evolution of nursing education in the United States and globally, describe the current and projected state of nursing education, and discuss some pressing challenges educators face as they strive to meet the charge to prepare nurses to care for more complex patients situated in ever-changing health-care systems.

Quality of diabetic care in family practice centre, Aseer Region, Saudi Arabia

Abstract: Objective: The objective of this study was to assess quality of diabetic care at a family practice centre in Saudi Arabia, Asser region. Materials and Methods: This study was conducted at the Al-Manhal Postgraduate Family Practice Centre. All diabetic records at the centre were extracted and reviewed. Processes and outcomes of diabetic care were evaluated based on Standards of Care Delivery issued by the Primary Care Department at the Ministry of Health. Data was inputted and analysed using SPSS version 15. Relevant statistical tests were used accordingly and P-values were considered significant if their value were less than 0.05. Results: The total number of diabetic records reviewed was 637. The majority of patients were married Saudis. The mean age was 60 years while the mean duration of diabetes was 12 years. Weight and blood pressure were recorded for 82% while lipid profile and kidney functions tests were done for 40% of the patients. Two-thirds of the diabetics (64%) were on oral hypoglycaemic agents and more than three-fourths (77%) were prescribed aspirin. More than two-thirds were overweight and obese while 40% had dyslipidaemia. Less than one-third (30%) had a good metabolic control while 26% had poor diabetic control. Conclusion: Care of diabetics in our practice showed some improvement compared to the previous studies. However, we still face some challenges such as weak recall system and poor coordination with our referral hospital that needs urgent action. Providing centres with advanced laboratory facilities would help to implement annual check-ups particularly lipid profile and kidney function tests.

Association of serum glutamic pyruvic transaminase and non-alcoholic fatty liver disease in controlled and uncontrolled diabetes

Abstract: Introduction: The liver has been recognised as a major target of injury in patients with insulin resistance or metabolic syndrome. Non-alcoholic fatty liver disease is characterised by accumulation of hepatic fat in the absence of significant alcohol intake. Serum glutamic pyruvic transaminase (SGPT) appears to have a role in gluconeogenesis and seems to be more related to hepatic fat accumulation than serum glutamic oxaloacetic transaminase (SGOT). Materials and Methods: One-hundred previously diagnosed patients of controlled (HbA1c 7%) diabetes with fatty liver, diagnosed by ultrasound, were taken and their liver function test (LFT) plus glycated haemoglobin were estimated. One-hundred diagnosed cases of controlled and uncontrolled diabetes without fatty liver and normal controls were taken and LFT was done. Result and Discussion: Serum bilirubin, serum albumin, and alkaline phosphatase were within normal range in all the diabetic cases and control. The SGOT was not significantly raised in diabetics. The SGPT was raised in diabetics without fatty liver as compared to normal controls, but not significantly raised and was within normal limits. However, the SGPT was raised significantly in diabetics with fatty liver (P Conclusion: Non-alcoholic fatty liver disease has been consistently associated with insulin resistance and hyperinsulinaemia. This has raised a concern that treatment with insulin in type 2 diabetes may aggravate liver disease. Routine monitoring of LFTs in patients with type 2 diabetes should be done at the start of drug therapy and in patients if symptoms develop raising concern about hepatic impairment.

The hygienic-related microbiological quality of drinking water sources Al-Baha Province, Kingdom of Saudi Arabia

Abstract: Background: Contaminated water is a suitable medium to transmit diseases. The assessment of potential risks from microbial contamination of drinking water supplies is of great concern to human health. Materials and Methods: This observational cross-section study designed to assess the effect of environmental factors on the microbiological quality of drinking water in Baljuorshi city, Al Baha Province, Kingdom of Saudi Arabia (KSA). The study includes bacteriological analysis of all the drinking water sources in the Baljuorshi city. Results: Coliform bacteria and Escherichia coli ( E. coli ) were detected in all types of drinking water sources except the tanks. Significant association was found between sources of the drinking water and bacteriological analysis ( P P E.coli (94%). The bacteriological contamination of drinking water decreased proportionally with the depth of the water well, as shallow wells showed higher contamination rates. There was a significant difference in contamination between the protected and unprotected water sources ( P P E.coli . Conclusion: It was demonstrated that many environmental factors were responsible for contaminating drinking water sources by indicator bacteria in the study area.

Surgical education and the theoretical concept of communities of practice

Abstract: Surgical practice is largely learned in the workplace. Changes in health services and education provision have seen a shift from traditional apprenticeship-type learning to competency-based curricula with the workplace remaining the principal site for learning. Sociocultural learning theories offer valuable lenses through which to observe, design for, and analyze workplace-based learning. In this paper, we consider the theoretical concept of communities of practice in surgery. We describe notions of legitimate peripheral participation and development of professional identity. We highlight the benefits that communities of practice bring to surgical training, as well as the limitations. By understanding community of practice theory as applied to the surgical workplace and the factors that both drive and impede its development, surgical trainers may improve the learning environment, enhancing the attainment of competencies by surgical trainees.

Role of accrediting bodies in providing education leadership in medical education

Abstract: Introduction: Accreditation is necessary to maintain the quality of medical education. It requires official bodies to authorize the accreditation; recognized standards against which the medical school can be judged; and a robust process. Effects of accreditation: Accreditation may have positive effects on medical education. The impact of the publication of the General Medical Council recommendations in Tomorrow's Doctors provides a good example. In contrast, out-of-date requirements may inhibit developments in medical schools. Role of accreditation authorities: If accreditation authorities are to provide leadership in medical education they must undertake regular review of their standards. This should be informed by all stakeholders and include experts in medical education. The format of the standards must provide clear direction to medical schools. Accreditation should take place regularly and should result in the production of a publicly accessible report.

Exploring the perspectives of nurses, physicians, and healthcare administrators in Saudi Arabian hospitals on palliative care and palliative care nursing

Abstract: Palliative care is an area in healthcare that is focused on alleviating and/or preventing the suffering experienced by patients across various conditions. In recent years, palliative care has grown tremendously as an integral part of healthcare institutions worldwide. However, not all countries have well-established palliative care services, or recognise the importance of palliative care. It is important for healthcare professionals to recognise the value of palliative care, and those who work in order to be able to provide such care to patients. However, there may be professional and cultural barriers that prevent practitioners in specific contexts to be able to do so. Specifically, this paper considered the context of the Kingdom of Saudi Arabia (KSA), which is known to be culturally different from the west where the concept of palliative care originated and where the recent progress in palliative care is most evident. In this paper, reviewing of articles regarding cancer care in Saudi Arabia, cancer pain in Saudi Arabia, overview of palliative care in Saudi Arabia and issues with palliative care in Saudi Arabia are analysed and discussed to proceed with the intended research study to solve the research questions.

Cross-national comparison of levothyroxine utilization in four developed countries

Abstract: Context: While hypothyroidism is prevalent globally, there may be considerable variation in the use of therapies to treat this condition. Aims: The aim was to examine temporal trends of levothyroxine utilization in Canada, Greece, Ireland and the United States. Settings and Design: A cross-sectional, population-based time series study was conducted to assess monthly utilization rates from January 1, 2005 to September 20, 2011, in Canada, Greece, Ireland and the United States. The primary outcome measure was the monthly rate of levothyroxine utilization for each country analyzed. Materials and Methods: Levothyroxine utilization data were obtained from IMS Health Inc., and temporal trends in monthly units dispensed per 1,000 population were examined. Statistical Analysis Used: Time series analysis was used to examine temporal trends in levothyroxine utilization. Results: While levothyroxine utilization rates increased over time in all regions, considerable differences were noted between regions - 80% relative difference in average monthly utilization between the highest (Greece - 1,664 units/1,000 population) and lowest (Ireland - 925 units/1,000 population) utilization countries was observed. We observed a nearly 3.5-fold difference in utilization of moderate-to-high strength doses (100 μg+) of levothyroxine between the countries examined. Conclusions: We noted considerable regional variation in the use of levothyroxine. Further research is needed to understand the drivers of these variations in utilization rates.

Spontaneous infarction in fibroadenoma, a diagnostic challenge on cytology: Report of two cases

Abstract: Spontaneous infarction is an uncommon complication of fibroadenoma. Lack of knowledge of this rare entity may lead to an erroneous diagnosis of inflammatory lesion or malignancy on fine needle aspiration cytology (FNAC). We describe two cases of fibroadenoma with spontaneous infarction; one in a 20-year-old unmarried female while the other was a 35-year-old married female. Both patients presented with a history of sudden increase in size and pain for which they sought medical help. FNAC followed by histopathology was done. High index of suspicion would help cytopathologists to avoid misdiagnosis.

Concomitant hypodontia and unusual dental anomalies in families

Abstract: Certain human dental anomalies occur frequently together which supports the accumulated evidence of the shared genetic control of dental developmental disturbances. The present study reports an interesting case series of two families where parent and offspring having hypodontia also showed rare dental abnormalities like talons cusp and macrodontia. The absence of teeth in young patients can cause aesthetic, functional and psychological problems, particularly if the teeth of the anterior region are involved. Diagnosing dental abnormality early can alert healthcare professional to the possible development of others in the same patient or other family members, sometimes, facilitating appropriate treatment intervention.

Kidney herniation through lumbar triangle following open pyeloplasty

Abstract: Kidney herniation through the lumbar triangle is an uncommon type of hernia which is classically managed surgically. Contrast enhanced computerised tomography revealed lower pole of the right kidney herniating through the lumbar triangle in a 60-year-old woman, 10 years after an open right pyeloplasty. Surgical intervention was advised, however, patient opted for non-surgical management. Patient was successfully treated conservatively in clinic requiring regular analgesics for relief of mild pain.

Multiple intracranial lipoma

Abstract: Intracranial lipomas are rare congenital, non-neoplastic lesions discovered incidentally on computerised tomography (CT) or magnetic resonance imaging (MRI) with an incidence rate of less than 0.1% of all intracranial tumours. Most lipomas are asymptomatic pericallosal lesions sometimes presenting with seizures or headache. Corpus callosum agenesis and defects of midline structures differentiation may be present. Callosal lipomas are of two types: Anterior bulky tubulonodular variety associated with forebrain and rostral callosal anomalies, and posterior ribbon-like curvilinear lipoma generally seen with a normal or near normal corpus callosum. Corpus callosal hypogenesis/agenesis is seen in up to 90% of anterior and 30% of posterior pericallosal lipomas. The association of corpus callosal lipoma with choroid plexus lipoma is variable with its reported incidence rate being 20-50%. A 50-year-old patient was referred to our department for CT scan of brain with history of recent onset of headache and one episode of seizure. We present the imaging findings in this rare case of callosal tubulonodular lipoma having prominent intralesional vessels and extensive calcification with a concomitant intraventricular lipoma in a patient with dysgenetic corpus callosum.

Atypical bulimia nervosa in a male patient of rural north-east India

Abstract: Eating disorders such as bulimia nervosa rarely seem to manifest in males from non-Western cultures like India, but occur infrequently in milder forms with fewer symptoms as atypical bulimia nervosa. This report describes a male case of bulimia nervosa from rural area of India presenting with atypical features. He was treated successfully with fluoxetine and cognitive behavioural therapy.

Understanding the process of statistical methods for effective data analysis

Abstract: The purpose of this article is to provide a basic understanding of the statistical methods for conducting effective data analysis. Quantitative research involves the collection and analysis of different types of variable in the form of raw data, which needs to be cleaned before starting the data analysis. A biostatistician must be involved from the planning stages of the research process to ensure the validity of the sampling process and the collected data. The statistical analysis includes descriptive analysis for summarizing the data and inferential statistics for comparing between the subgroups to determine a statistically significant association. The relevant statistical tests must be applied and the results appropriately reported using P-values and confidence intervals. The possibility of type I and type II errors should be considered during the final interpretation of the results as well as the clinical significance of the results even if the P-values are found to be statistically significant.

Recreation with biological restoration: A root canal reconstruction

Abstract: Traumatic injuries are frequent cause of anterior tooth fracture in dentistry. Biological restorations are the reconstruction of extensively damaged teeth with adhesive cementation of biological posts and crowns. This case report refers to the rebuilding of fractured maxillary central incisor through biological post and core in a 14-year-old child. This treatment option represents a low-cost and alternative technique for the aesthetics and functional rehabilitation of extensively damaged anterior teeth.

Guidelines for Mentoring

Abstract: ID# 12 Mentoring an OT colleague or other professional to improve skills of the protégé, including role as a disciplinary monitor (Mentor must be currently certified). 2 hours = 1 PDU (maximum of 18 units per renewal cycle) ID# 18 Receiving mentoring from a currently certified occupational therapy practitioner or other professional in good standing to improve the skills of the protégé. 2 hours = 1 PDU (maximum of 18 units per renewal cycle)

Topiramate-induced secondary angle closure

Abstract: Acute angle closure (AAC) is a serious complication of topiramate therapy. A 43-year-old woman developed simultaneous bilateral AAC following use of topiramate. In another centre, patient was treated as a pupillary block angle closure which included oral acetazolamide. On examination at our centre however, a diagnosis of topiramate-induced secondary angle closure was made but delayed recognition lead to iris atrophy and cataract; both changes affected the quality of vision after recovery. In this case report, we highlight the fact that a careful clinical approach can prevent ambiguity in diagnosis and differentiation from primary angle closure. Awareness among health professionals can also help in early recognition thus evading serious ocular complications.

Factors affecting Family Medicine residents' perception of achievement of training objectives

Abstract: Aims: To measure the association between number of patient encounters and training provided to residents, as well as the residents' perceived achievement of training objectives. Settings and Design: This cross-sectional study was done on Family Medicine residents in Eastern province, Makkah and Asir regions. Materials and Methods: A questionnaire was developed by the investigator and validated by two experts. All residents, except first year residents, were included. Data were collected by the investigator through direct contact with the residents. Statistical analysis: Cronbach's alpha, analysis of variance, t-test, and univariate regression model were used. Results: Reliability of the questionnaire was found to be 75.4%. One hundred and seven residents (response rate, 83.6%) had completed the questionnaire. The mean age was 29.1 ± 2.5 years, half of the residents were male, most of them (83.2%) were married, and more than half (54.2%) of the residents had worked in primary health care (PHC) before joining the programme. Age and duration of work in PHC before joining the programme were significantly and positively associated with the outcome. In Family Medicine rotations, continuity of care, percentage of patients discussed, and number of trainers were associated with the outcome. On the other hand, percentage of patients discussed in different settings and opportunity for the residents to evaluate patients in an outpatient setting were among the factors affecting the outcome in the hospital rotations. Conclusions: Factors identified (age, duration of work in PHC, discussion, and opportunity to evaluate patients) might help residents, trainers, and decision makers in ensuring residents benefit from the different rotations. Further studies to link the effect of the identified factors on resident outcome and patient care are required.

Severe diabetic ketoacidosis and acute pericarditis precipitated by concomitant Graves' thyrotoxicosis in type 1 diabetic patient

Abstract: 20-year-old male known case of type 1 diabetes mellitus (T1DM) presented to emergency department with vomiting and abdominal pain, and was diagnosed to have diabetic ketoacidosis (DKA). There was no obvious precipitating cause for DKA. Patient was started on DKA protocol and initially responded well to treatment. Later on, patient developed severe metabolic acidosis and chest pain. The cardiac evaluation established the diagnosis of acute pericarditis and ruled out acute coronary syndrome. The cause for his stormy coarse of DKA, and persistent tachycardia were further evaluated, and he was diagnosed to have concomitant thyrotoxicosis (graves' disease) complicating the DKA. He was successfully treated with aggressive management of DKA and started on thyrotoxicosis treatment. Autoimmune diseases are known to manifest in cluster but concomitant thyrotoxicosis precipitating DKA and causing acute pericarditis is rare. Prompt recognition of thyrotoxicosis in patients with persistent tachycardia, and treatment of thyrotoxicosis will improve outcome in DKA patients.

Hypothyroidism presenting as acute kidney injury

Abstract: Hypothyroidism presenting as an acute kidney injury is not only very rare but life-threatening if not promptly managed. We report a case of a middle-aged female who presented with features of rhabdomyolysis and acute kidney injury which was attributed to underlying undiagnosed hypothyroidism after meticulous evaluation. This case elucidates the necessity of assessing thyroid function in cases of unexplained renal failure. Awareness about this rare presentation of a common disease would alert clinician to effectively treat this dreaded yet reversible complication.

Chondroblastoma of rib in situs inversus

Abstract: Chondroblastoma is a rare benign cartilaginous tumour accounting for approximately 1% of all bone tumours. It commonly arises from epiphysis of a long bone, particularly the humerus, tibia and femur. Rib is an extremely rare site for this tumour with a few cases reported in the literature. It is commonly seen in children and adults between the ages of 10 - 20 years. Although roentgenographic findings are quite common characteristic of this tumour, it can sometimes be misdiagnosed as giant cell tumour, osteogenic sarcoma and myeloma on histopathology. We report a 26-year-old male patient with situs inversus and chondroblastoma of rib. To the best of our knowledge, this is the first case of chondroblastoma of the rib in a patient of situs inversus. Segmental resection is the treatment of choice. It usually behaves in a benign fashion, but few cases have shown local recurrences and distant metastasis; hence, follow-up of the patient is essential.

A comparison of warfarin utilisation in North America and Ireland

Abstract: Background: The objective of this study was to compare warfarin utilisation trends in Canada, the United States, and Ireland between January 2005 and September 2011. Materials and Methods: We conducted a population-based cross-sectional time series analysis of warfarin utilisation data from January 2005 to September 2011 in the United States, Canada, and Ireland to examine differences in temporal trends in warfarin utilisation. Results: A nearly 50% higher warfarin utilisation rate was observed in Canada and Ireland relative to the United States - the average monthly warfarin utilisation rate was approximately 626 units per 1,000 people in Canada, 423 units per 1,000 people in the United States, and 630 units per 1,000 people in Ireland. However, relative rates of growth in warfarin utilisation were 25.1%, 15.3%, and 38.3% for the United States, Canada, and Ireland, respectively. Interpretation: Rates of warfarin utilisation differ considerably and geographically as evidenced by utilisation rates in the United States, Canada, and Ireland.