VOL.24 2017 Issue 3 (September-December)
Permanent URI for this collectionhttps://repository.iau.edu.sa/handle/123456789/176
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Item Assessment of perceived needs and preferences with regard to the education of residents in Medical Ethics in King Abdulaziz University Hospital(2017) Ghamri, Ranya; Al-Raddadi, RajaaINTRODUCTION: Medical ethics is the branch of ethics that deals with moral issues in medical practice. Many postgraduate training programs have developed educational interventions in ethics to meet accreditation standards and prepare learners for certification examinations and clinical practice. The aim of this study was to assess the attitude of residents in King Abdulaziz University Hospital (KAUH) toward the need for ethics education and identify the most effective methods of teaching ethical issues. MATERIALS AND METHODS: A cross-sectional study of residents in different specialties at KAUH was conducted using a self-administered questionnaire. The questionnaire consisted of four parts: demographic data, assessment of the educational need for ethics education, assessment of the impact of various learning methods, and assessment of the need for ethically important practices and behavior. SPSS version 16.0 was used for data entry and analysis. Descriptive analysis included frequency distribution, percentages, mean, and standard deviation (SD); Chi-square test and t-test were employed to determine statistical significance. RESULTS: Eighty-eight of the 102 residents invited to participate in the study returned completed questionnaires, providing a response rate of 86.3%. Their ages ranged between 24 and 38 years with a mean of 27.7 (standard deviation 2.8) years. Approximately two-thirds of the residents (65.9%) agreed that medical ethics can be taught and learned while only 19.3% of them disagreed. The most effective methods of ethical education according to the residents were discussion groups of peers led by a knowledgeable clinician (78.4%), clinical rounds (72.7%), and an incorporation of ethical issues into lectures and teaching rounds (69.3%). CONCLUSION: This study documents the importance residents placed on ethics education directed at practical, real-world dilemmas and ethically important professional developmental issues.Item The impact of outpatient clinical teaching on students' academic performance in obstetrics and gynecology(2017) Hassan, Bahaeldin; Elfaki, Omer; Khan, MuhammedINTRODUCTION: Clinical teaching at outpatient settings is an essential part of undergraduate medical students' training. The increasing number of students in many medical schools and short hospital stays makes inpatient teaching alone insufficient to provide students with the required clinical skills. To make up this shortfall, outpatient clinical teaching has been implemented by our Department of Obstetrics and Gynecology, King Khalid University, KSA, throughout the academic year 2015–2016. The aim of this study was to evaluate the impact of clinical teaching at outpatient settings on the academic performance of our students. MATERIALS AND METHODS: In this comparative retrospective study, the effects of outpatient clinical teaching of obstetrics and gynecology on the academic performance of student was assessed through an objective structured clinical examination (OSCE). During their course on obstetrics and gynecology, 58 students had their clinical teaching both at inpatient and outpatient settings and constituted “study group”. The remaining 52 students had clinical teaching only at inpatient settings and were considered “control group”. Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Four stations were used for assessment: obstetric history, gynecological history, obstetric physical examination of pregnant women, and gynecological procedure station. Twenty marks were allocated for each station giving a total score of 80. The OSCE scores for study group were compared with those of the control group using Student's t-test; p < 0.05 was considered statistically significant. RESULTS: The total mean OSCE score was statistically significantly higher in the study group (62.36 vs. 47.94, p < 0.001). The study group participants showed significantly higher scores in the gynecological procedure station (16.74 vs. 11.62, p < 0.0001) and obstetric examination station (16.72 vs. 10.79, p < 0.0001). CONCLUSION: Clinical teaching at outpatient settings leads to an improvement in students' performance in OSCE. There is evidence of remarkable improvement in the mastery of clinical skills as manifested in the students' scores in physical examination and procedures stations. These results will encourage us to have clinical teaching in other disciplines at outpatient settings.Item Salivary duct carcinoma of accessory parotid(2017) Al-Hashim, Mohammed; Al-Jazan, NasserAccessory parotid gland (APG) is seen in around 21%–56% of individuals. Tumors of accessory parotid are uncommon with an incidence rate of 1%–8% of all parotid tumors. Ductal carcinoma of APG is rare, so no reported incidence was seen in the literature. However, salivary gland ductal carcinoma is reported to be 1% of all salivary gland neoplasms. We report here a case of salivary duct carcinoma of APG. Clinical presentation, investigation, and management are discussed. A 69-year-old female presented with a history of the left cheek progressive swelling of 6 years' duration. Computed tomography and magnetic resonance imaging showed heterogeneous lobulated ill-defined mass over the left masseter. Fine needle aspiration was inconclusive. Excision of the mass showed salivary duct carcinoma. Ductal carcinoma of APG is an aggressive tumor which needs to be managed aggressively. Standard parotidectomy incision approach seems to be a safe and efficient way of management.Item A bump in the groin: Cutaneous actinomycosis(2017) Piggott, Susan; Khodaee, MortezaAbstract Not Available (Letter to Editor)Item Preparedness of Dammam primary health care centers to deal with emergency cases(2017) Alsaad, Sanaa; Abu-Grain, Salma; El-Kheir, DaliaOBJECTIVES: The objective of the study was to assess the availability of human and nonhuman resources for emergency medical services (EMSs) at the primary health care (PHC) level. MATERIALS AND METHODS: A cross-sectional study with mixed research methods (quantitative and qualitative) was carried out in governmental PHC centers in Dammam, Eastern Province of Saudi Arabia, between September 2014 and January 2015. Using systematic random sampling technique, 13 out of 26 PHC centers were included in the study. The study consisted of two main parts: The first involved the completion of an observational checklist to assess the availability and adequacy of human and nonhuman resources (workforce, emergency infrastructure, equipment, drugs and supporting facilities). The second part involved face-to-face interviews with key informants of nurses from the emergency room (ER) in the sampled centers. RESULTS: Analysis of the checklist showed that the total number of physicians “actually” present ranged from 2 to 8 per center and nurses actually present were 4–11 whereas the officially assigned number was 3–12 physicians and 8–17 nurses per center. Only 2 out of 13 (15.4%) centers had a place reserved for EMS in each male and female section. Only 4 (30.8%) PHC centers had a male ER located on the ground floor, near the entrance, and with a separate ramp. None of the centers had the emergency drugs such as metergotamine, calcium chloride, and naloxone. Regarding ER equipment, none of the studied centers had cervical collars, mouth gags, or a tracheostomy sets. Only one (7.6%) center had a functioning fully equipped ambulance. Five (38.46%) centers were equipped with electrocardiogram and X-ray machines. In the interviews, the informants confirmed the deficiencies identified in the checklist. CONCLUSION: Resources for EMS at Dammam PHC centers were deficient in infrastructure and supporting facilities.Item Are nurses verbally abused? A cross-sectional study of nurses at a university hospital, Eastern Province, Saudi Arabia(2017) Al-Shamlan, Nouf; Jayaseeli, Nithya; Al-Shawi, Moneera; Al-Joudi, AbdullahBACKGROUND: Workplace violence against health-care workers is a significant problem worldwide. Nurses are at a higher risk of exposure to violence. Studies available in Saudi Arabia are few. OBJECTIVES: The objective of the study was to estimate the prevalence of verbal abuse of nurses at King Fahd Hospital of the University (KFHU) in Khobar, Saudi Arabia, and to identify consequences and the demographic and work-related characteristics associated with it. MATERIALS AND METHODS: This cross-sectional study of 391 nurses by total sample was conducted between November and December 2015, using a modified self-administered questionnaire developed by the World Health Organization. Data was entered, and analyzed using SPSS Version 16.0. The descriptive statistics were reported using frequency and percentages for all categorical variables. Chi-squared tests or Fisher's Exact test, as appropriate, were performed to test the associations of verbal abuse with the demographic and work-related characteristics of the participants. Variables with p < 0.05 were considered significant. Logistic regression analysis performed to determine association between verbal abuse and independent variables. RESULTS: In a period of 1 year before the study, about three out of ten nurses experienced verbal abuse (30.7%). In the majority of cases, the victims did not report the incidents, mostly because they believed that reporting would yield no positive results. Logistic regression analysis revealed that male nurses, nurses in the emergency department, and nurses who indicated that there were procedures for reporting violence in their workplace were more vulnerable to workplace verbal abuse. CONCLUSION: Workplace verbal abuse is a significant challenge in KFHU. For decision makers, it is rather disturbing that a lot of cases go unreported even though procedures for reporting exist. Implementation of an efficient transparent reporting system that provides follow-up investigations is mandatory. In addition, all victims should be helped with counseling and support.Item Family medicine practice in Saudi Arabia: The current situation and Proposed Strategic Directions Plan 2020(2017) Al-Khaldi, Yahia; Al-Ghamdi, Essam; Al-Mogbil, Tariq; Al-Khashan, HeshamOBJECTIVES: The objectives of this study were to assess the current situation of the teaching and training of undergraduate and postgraduate programs in family medicine in KSA, assess the current practice of family medicine, and draw a roadmap to achieve Saudi vision 2020.MATERIALS AND METHODS: This study was conducted with the support and collaboration of the Primary Health Care Department of the Ministry of Health, Saudi Arabia, and World Health Organization (EMRO) in November 2015. Based on the literature review of previous studies conducted for similar purposes, relevant questionnaires were developed. These consisted of four forms, each of which was directed at a different authority to achieve the above-mentioned objectives. Data of all questionnaires were coded, entered, and analyzed using SPSS version 16. RESULTS: There are 2282 primary health-care centers (PHCCs), 60% of which are in rural areas. More than half of the PHCCs have a laboratory and more than one-third have a Radiology Department. Out of the 6107 physicians, 636 are family physicians (10%). All medical colleges have a family medicine department with a total staff of 170 medical teachers. Thirteen departments run family medicine courses of 4–8 weeks' duration for students. Fourteen colleges have internship programs in family medicine and four colleges have postgraduate centers for family medicine (27%). There are 95 training centers for Saudi Board (Saudi Board of Family Medicine [SBFM]) and 68 centers for Saudi Diploma (Saudi Diploma of Family Medicine [SDFM]). The total number of trainers was 241, while the total trainees were 756 in SBFM and 137 in SDFM. CONCLUSIONS: This survey showed that there is a shortage of qualified family physicians in all health sectors in Saudi Arabia as a result of the lack of a strategic plan for the training of family physicians. A national strategic plan with specific objectives and an explicit budget are necessary to deal with this shortage and improve the quality of health-care services at PHCCs.Item The efficacy of a diabetic educational program and predictors of compliance of patients with noninsulin-dependent (type 2) diabetes mellitus in Al-Khobar, Saudi Arabia(2017) Mokabel, Fatma; Aboulazm, Shadia; Hassan, Hanan; Al-Qahtani, Mona; Alrashedi, Seham; Zainuddin, FatmaBACKGROUND: The concept of detection and management of diabetes mellitus at primary health-care centers is justified and widely practised in Saudi Arabia. The objective of this study was to assess the efficacy of diabetic educational programs for noninsulin-dependent (type 2) diabetes mellitus patients, and to determine the predictors of compliance. MATERIALS AND METHODS: A longitudinal experimental research design was adopted for this study and conducted at the diabetic outpatient clinic of King Fahd Hospital of the University, Al Khobar, Kingdom of Saudi Arabia. A convenient sample of 150 adult patients diagnosed as type 2 diabetes was included in this study. RESULTS: There was a significant reduction in the body mass index (BMI) of patients, an improvement in regular self-checks of blood sugar, dietary regimen, foot care, and exercise and lifestyle behavior following the educational program. It was observed that patients' knowledge of diabetes had improved after exposure to the educational program in the three-time intervals. CONCLUSIONS: Type 2 diabetes mellitus exhibited significant change in both BMI, sugar accumulation, and adherence to medication after attending the educational program, and there was evidence of improved knowledge of regular self-checks of blood sugar, dietary regimen, foot care, exercise, and lifestyle behavior.Item The use of performance-enhancing substances (doping) by athletes in Saudi Arabia(2017) Al Ghobain, MohammedBACKGROUND: Data on doping violation in Saudi Arabia are scarce. Our aim was to investigate the Saudi experience of anti-doping and review all positive samples and adverse analytical findings (AAFs) of Saudi athletes. MATERIALS AND METHODS: This study analyzed databases of the Saudi Arabian Anti-Doping Committee from 2008 to May 2016. The samples originated from various sporting events and were collected in and outside sport competitions. The substances investigated were those included in the annual lists of prohibited substances produced by the World Anti-Doping Agency (WADA). All urine samples were tested in laboratories accredited by the WADA. Samples were declared positive if they contained any prohibited substance on the WADA list for that year. RESULTS: In 4482 urine samples tested, 141 positive samples (3.1%) and 195 AAFs of prohibited substances were detected. The prevalence of positive samples was highest in 2012 (6.6%) and lowest in 2015 (1%). The most prevalent prohibited substances detected were anabolic steroids (32.8%) and stimulants (27.6%). The most frequently detected compounds were amphetamines (22%) and tetrahydrocannabinol (12.8%). The highest prevalence of AAFs was in bodybuilders. CONCLUSION: The prevalence of doping in Saudi Arabia seems to be higher than western countries, but this needs to be confirmed with further research.Item The burden perceived by informal caregivers of the elderly in Saudi Arabia(2017) Alshammari, Sulaiman; Alzahrani, Abdullah; Alabduljabbar, Khaled; Aldaghri, Abdulaziz; Alhusainy, Yazeed; Khan, Mohammed; Alshuwaier, Rakan; Kariz, IsmailOBJECTIVES: The objective of this study was to discover the characteristics of informal caregivers of elderly patients; to determine the socioeconomic, psychological, and physical consequences facing informal caregivers; and to measure their burdens and needs. MATERIALS AND METHODS: This study was a cross-sectional survey of informal caregivers of elderly patients. Participants were recruited from different hospitals and primary care clinics in Riyadh, Saudi Arabia. For an intended sample size of 384 caregivers, a multistage sampling was used. A self-administered questionnaire was used to collect data. Data analysis included student's t-test and ANOVA to test for statistical significance.RESULTS: The study included 315 caregivers of elderly patients. Over half of the elderly patients were female (55.9%) and over 70 years old (65.7%); about 31% had chronic diseases or disabilities, which represented the majority of health problems reported by the elderly population. Most of the caregivers were family members (87.9%), young (43.8%), female (52.7%), unemployed (54.6%), and unmarried (58.1%). Most caregivers suffered from musculoskeletal problems (78.1%). The mean Zarit Burden Interview score was 31.3, which indicated a moderate burden. More than half of caregivers requested blood pressure (55.6%) and blood sugar measuring devices (53%). Three quarters (74.9%) of the caregivers wanted educational training to cope with emergencies. Most caregivers expressed a need for frequent healthcare for themselves (58.4%) and a home health visit service (72.9%) to support them in the care of their elderly. CONCLUSIONS AND RECOMMENDATIONS:Mobilization of resources in locations where these carers of the elderly live are greatly needed. In addition, health authorities should provide devices and essential training to manage the common problems and emergencies that informal caregivers have to deal with. Moreover, caregivers need follow-up supervision by a home visit team. Further studies are required to guide the implementation of the above advice.
