VOL.13 2006 Issue 1 (January-April)
Permanent URI for this collectionhttps://repository.iau.edu.sa/handle/123456789/131
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Item Assessment of care for type 2 diabetic patients at the primary care clinics of a referral hospital(2006) Alfadda, Assim; Bin Abdulrahman, KhalidBackground: There is rapid increase in the incidence of Diabetes Mellitus (DM) in the Kingdom of Saudi Arabia (KSA), as in other countries. An optimal care of diabetic patients depends on the health care providers as well as the type of health care setting. Due to the severity of chronic complications in Type 2 diabetic patients, it is essential to assess both the practices of the providers and the patient outcomes at any clinical setting. Objectives : To assess the screening patterns of diabetes associated health care problems in primary care clinics of King Khalid University Hospital (KKUH) and while compare them to the current diabetes clinical practice recommendations of American Diabetes Association (ADA). Methods: The retrospective review of charts of 103 eligible patients who attended the primary care clinics of KKUH over a 3 year-period (1/12001-31/12/2003) had provided 99 type 2 diabetic patients. The study variables included demographic data, complications, treatment, the provider screening practices (measurements of HbA1c, BP, Lipid profile, number of eye and foot examination). From these data, the frequency of provider screening tests, normalized by patient-year could be compared with the ADA guidelines. Results: The mean age of 99 type 2 diabetic patients was 57 years, with a mean BMI of 30.8 kg/m2 and with a mean duration of diabetes of 11.8 years. Many had comorbidites or complications: 25% had retinopathy, 17.2% had nephropathy, and 12.1% had neuropathy. The HbA1c level of ≤ 7.0 was maintained by only 24.7% of patients. About 85% of patients had > 1 lipid profile, during their follow-up period. During 2 nd and 3 rd year follow up only 30% had > 1 HbA1c measurement and 26.5% (at 2 nd year), 22%(at 3 rd year) had > 1 foot examination. The proportion of patients, who had > 1 eye examination was also reduced during their follow up. The provider practice screening results per patient-year was well below the specified guidelines of ADA. Conclusion: Type 2 diabetic patients care at our primary care clinics did not adhere to the guidelines of ADA. The reasons for the deficiencies were not evident from this study. More detailed studies are needed to find out the relevant causes for the lack of adequate diabetic care at primary care clinics.Item Knowledge & practices of childhood immunization among primary health care providers in Riyadh city: Part ii - precautions and contraindications to vaccination(2006) Al-Ayed, Ibrahim; Sheik, ShaffiObjectives: To assess 1) how aware those who administer vaccines in the primary health care centres (PHCs) are of the appropriate precautions and contraindicaitons of vaccines and 2) the extent to which their practice complies with standards, and 3) the correlation between the levels of knowledge and practice on one hand with the duration of practice and attendance at a training course on vaccination on the other hand, for physicians and nurses separately. Methods: A self-adminstered questionnaire including 16 statements related to knowledge and practice of precautions and contraindications of vaccines was distributed among workers in 50 MOH PHCs in Riyadh. Results: 506 questionnaires were returned, only 331 were completed for this part of the study giving a response rate of almost 65%. However, the statement-specific response rate varied. Except for a few, most statements were correctly responded to by a majority of the respondents reflecting adequate knowlegde and appropriate practice. Experience in dealing with vaccination, and formal training in vaccination were not statistically significantly associated with the responses of both physicians and nurses. Conclusion : Inspite of the limitations of this study it could be fairly concluded that the overall knowledge and practices regarding precautions and contraindications of childhood immunizations among the primary care providers surveyed was good. Significant gaps still exist. This underlines the need for continuous training and supervision of health care providers who deal with the immunization of children.Item Item Outpatient management of type 2 diabetic patients: A review of evidence-based literature(2006) Al-Faris, Eiad; Amin, Hussein; Al-Rukban, MohammedDiabetes mellitus is a common, serious, and treatable disease. Good control is associated with fewer complications. The impact of the disease on the patient, family and the community psychologically and physically is staggering. This paper aims to update the reader on certain issues related to the management of diabetes. Recent criteria for the diagnosis are presented followed by non-pharmacological and pharmacological management, glycemic monitoring, prevention, continuity of diabetes care and the control of co-morbidities. Throughout, as far as possible, the best available evidence was used.Item Pattern of haemoglobin among high and low altitude children of Southwestern Saudi Arabia(2006) Al-Hashem, FahaidObjective: To determine the levels of haemoglobin and to study some of its correlates in high and low altitude children of the Southwestern region of the kingdom of Saudi Arabia. Methods: A cross-sectional study of 1331 Saudi children aged 1-15 years born and living permanently at high altitude (2800-3150 m above sea level) and 1185 Saudi children of comparable age born and living permanently at low altitude (500 m above sea level) was conducted. Their haemoglobin levels were estimated by using cyanmethaemoglobin method and correlated with age, weight and height. Results: The mean haemoglobin levels were significantly greater in highland children compared with lowland children (p<0.0001 for both boys and girls). There were no significant differences in the mean haemoglobin levels between boys and girls at each study site. In both high and lowland children haemoglobin levels rose with age although lowland girls showed a drop beyond the age of 11-13 years and highland girls did not show any increase beyond the age of 9-11 years. In both boys and girls haemoglobin was found to be positively and significantly correlated with weight and height. Conclusions: The difference in haemoglobin levels between high and lowland children was attributed to the combined effect of high altitude hypoxia and the higher incidence of tropical infections among lowland children.Item The profile of long-term care patients in Al-Khobar and Dammam, Saudi Arabia(2006) Al- Hazmi, Ali; Kurashi, NabilObjectives. To find out the profile of patients who stay more than 20 days in hospital in Al-Khobar and Al-Dammam. Methods. A cross sectional descriptive study was designed using a questionnaire completed by health care providers (physicians, nurses, physiotherapists, and social workers) of a random sample of 159 patients out of 318 patients identified as having stayed in the hospital for more than 20 days. Results. The mean length of stay of the patients were 358.6 ±776 days in government hospitals, and 1014.4 ±1018.3 days in private hospitals. Patients were seen as stable by their doctors, 66.7% in government hospitals and 93.9% in private hospitals (statistically significant different at p<0.001. Physicians agreed that about two thirds of the patients could have been managed at home. 57.2% of the patients had no active problems. Diseases of the nervous system and sense organs accounted for 67.9% of the diagnoses, followed by endocrine, nutritional, and metabolic diseases (37.1%), diseases of the circulatory system (32.7%), and neoplasms (1.9%). Diabetes mellitus was the commonest illness making up 53.2% and 57.1% of the long-term patients in private and government hospitals respectively. The active problems of 25% and 23.5% of the patients was tracheostomy care and ventilation respectively. Conclusions. Long-term patients tended to stay longer in private hospitals than in government hospitals, had diseases related to the nervous and endocrine systems and nutritional metabolism, were in stable condition with no active problems, and could thus, be managed at home.Item The role of medical students in patient education to promote home management of diabetes mellitus in wad Medani town, Sudan 2003(2006) Ahmed, Magda; Abdelrhan, SamiraIntroduction: Faculty of Medicine University of Gezira, utilized a community based educational strategy. In the module primary health care centre practice and family medicine (PHCCP & FM), each student is assigned a family for whom priority health problems are identified and education given accordingly. Objectives: To provide, through medical students, health education to diabetics in the assigned families and to assess the impact of the students' intervention. Methods: This is longitudinal interventional study which was conducted in three stages: training of medical students, education to diabetic patients and evaluation of the intervention. Results: There was a highly significant difference in the students' knowledge and skills including communication skills on the home management of diabetes mellitus. Diabetics in the families were 80(3.3%), 42 (52.5%) females, 38 (47.5%) males. Their ages ranged between 22-78 years. Illiteracy rate was 9 (11.2%), most of the families' incomes ranged from low to middle, only 25% were of the high income bracket. More than half 47(58.7%) of the diabetics reported complications of diabetes. Eye complications 6 (7.5%), peripheral neuropathy 15 (18.7%), foot sepsis 4 (4.5%), urinary tract infection 11 (13.7%), renal failure 2 (2.5%), others 9 (11.2%). There was a highly significant improvement in the knowledge, attitudes and practices of the diabetics, as a result of the student intervention. These included compliance to treatment, adherence to diabetic diet, regular care of the feet, knowledge of major diabetic complications, knowledge of signs of hypoglycaemia, and home management of hypoglycemia. Ten cases with serious complications were referred to Wad Medani teaching hospital.Item A retrospective study of some clinical and epidemiological features of impetigo patients seen in dermatology clinic in the eastern province of Saudi Arabia(2006) Al-Ghamdi, KhalidBackground : Impetigo is a common contagious superficial skin infection, most frequently seen in children. Objectives : To determine the clinical and epidemiological features of impetigo patients seen in the dermatology clinic of King Fahd Hospital of the University (KFHU). Methods : This is a retrospective study of impetigo patients seen in the dermatology clinic at KFHU, Al-Khobar, Saudi Arabia, during the period January 1990 to December 2001. Data collected from patients' records included demographic features, clinical features, investigations and treatment. Only patients with positive skin culture were included in the study. Results : The total number of patients included in this study was 65 and constituted 0.08% of all the cases presenting with dermatology problems in that period. Males were affected by impetigo more than the females, giving a ratio of 1.7:1. The majority of the cases occurred in children less than 10 years of age, and the bullous form of impetigo was the predominant type. The sites affected by impetigo were mainly the extremities and the face. The highest number of patients was seen during summer and Staphylococcus was the most common causative agent. Conclusion : The incidence and prevalence of impetigo in Saudi Arabia is unknown and can be best defined by prospective community-based study. The diagnosis and management of impetigo is best achieved by microbiological cultures and sensitivities laboratory investigations.