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1.  The major medical ethical challenges facing the public and healthcare providers in Saudi Arabia 
Despite the relatively high expenditure on healthcare in Saudi Arabia, its health system remains highly centralized in the main cities with its primary focus on secondary and tertiary care rather than primary care. This has led to numerous ethical challenges for the healthcare providers. This article reports the results of a study conducted with a panel of practitioners, and non-clinicians, in Saudi Arabia, in order to identify the top ten ethical challenges for healthcare providers, patients, and their families.
Materials and Methods:
The study design was a cross-sectional, descriptive, and qualitative one. The participants were asked the question: “What top ten ethical challenges are Saudis likely to face in health care?” The participants were asked to rank the top ten ethical challenges throughout a modified Delphi process, using a ranking Scale. A consensus was reached after three rounds of questions and an experts’ meeting.
The major 10 ethical issues, as perceived by the participants in order of their importance, were: (1) Patients’ Rights, (2) Equity of resources, (3) Confidentiality of the patients, (4) Patient Safety, (5) Conflict of Interests, (6) Ethics of privatization, (7) Informed Consent, (8) Dealing with the opposite sex, (9) Beginning and end of life, and (10) Healthcare team ethics.
Although many of the challenges listed by the participants have received significant public and specialized attention worldwide, scant attention has been paid to these top challenges in Saudi Arabia. We propose several possible steps to help address these key challenges.
PMCID: PMC3326764  PMID: 22518351
Bioethics; ethical issues; ethics priorities; medical ethics
2.  Dynamics of doctor–patient relationship: A cross-sectional study on concordance, trust, and patient enablement 
The rapid pace of medical advances coupled with specialization and super-specialization, is eroding the traditional doctor–patient relationship.
(a) To study the determinants of core dimensions, such as, concordance, trust, and enablement in a doctor–patient relationship; (b) to explore associations, if any, among these core dimensions.
Materials and Methods:
A cross–sectional study design with both quantitative and qualitative methods was employed. One hundred and ninety-eight outdoor patients were interviewed as part of the quantitative study. Three dimensions of the doctor–patient relationship, that is, physician patient concordance, trust in physician, and patient enablement were assessed using validated tools. Focus group interviews using an open-ended format among few physicians was carried out as part of the qualitative study.
In the quantitative analysis most of the sociocultural factors did not show any significant association with the doctor–patient relationship. However, gender was significantly and strongly associated with trust in the physician. Female patients showed a much lower trust in the physician (50%) as compared to male patients (75%) (OR = 0.33, 95% CI 0.17 – 0.64, Chi Sq = 12.86, P = 0.0003). A qualitative study revealed language and culture, alternative medicines, commercialization of medicine, and crowding at specialist and super-specialist clinics as barriers to a good doctor–patient relationship. Better concordance was associated with improved trust in the doctor (OR = 5.30, 95% CI 2.06 – 13.98, Chi Sq = 14.46, P = 0.0001), which in turn was associated with improved patient enablement (OR = 3.89, 95% CI = 1.60 - 9.64, Chi Sq = 10.15, P = 0.001).
Good doctor–patient concordance (agreement) leads to better trust in the physician, which in turn leads to better patient enablement, irrespective of the sociocultural determinants.
PMCID: PMC3326765  PMID: 22518353
Concordance; doctor; enablement; patient; trust
3.  Orthostatic hypotension before and after meal intake in diabetic patients and healthy elderly people 
The symptoms of orthostatic hypotension may be ignored or go unnoticed and may predispose some diabetic or elderly people to repeated falls and trauma, leading to immobility and prolongation of rehabilitation. The present investigation is concerned mainly with testing the reaction of the cardiovascular system in response to physiological stimuli, such as, standing upright from a supine position before and after meal intake in diabetic patients and the healthy Saudi population.
Materials and Methods:
Seventy-five healthy and 49 diabetic patients were selected for this study. Parameters of heart rate, systolic and diastolic blood pressures, and electrocardiograms (ECG) were obtained for each subject by Dinamap (an automatic recorder), after 10 minutes of rest in the supine position and then after one and two minutes of standing. All parameters were taken before and after an intake of a standard meal. The results were compared between the diabetic and non-diabetic groups, and between the elderly diabetic and the healthy elderly ≥ 65 year olds, and between the young adults ≤ 40 year olds and the elderly ≥ 65 year olds.
The postural changes of blood pressure and heart rate between the diabetic and non-diabetic groups, and between the elderly diabetic and the healthy elderly groups, were not significant. However, a highly significant postural drop in blood pressure, and an increase in the resting heart rate were recorded before and after a meal intake in the elderly compared to the young adults.
The highly significant postural drop in blood pressure and increase in the resting heart rate in the elderly diabetic and healthy elderly people can be attributed to a defect in the arterial baroreceptors control of blood pressure and parasympathetic control of heart rate in this population.
PMCID: PMC3326766  PMID: 22518354
Blood pressure; diabetic; elderly; heart rate; orthostatic hypotension
4.  Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia 
The purpose of the study was to measure the rate of non-compliance and the factors contributing to non-compliance among the diabetic patients in the Al Hasa region of Saudi Arabia.
Materials and Methods:
A cross-sectional survey was conducted in the Al Hasa region during the period of June 2010 to June 2011. Random sampling was carried out for the selection of 535 diabetic patients from three chronic disease centers in different parts of Al Hasa. The data were collected by means of interviewing questionnaires and file records. Any patient who had been prescribed optimum treatment and was properly advised on diet and exercise for his / her diabetes, but did not follow the medical advice, with Hb1AC of more than 7% at the time of interview, was considered as non-compliant.
The overall prevalence of therapeutic non-compliance of the participants was 67.9% (n = 318, 95% CI 63.59 – 72.02%). The non-compliance of males (69.34%) was higher than females (65.45%, P = .003). The non-compliance among the urban participants was significantly higher than (71.04 vs. 60.15%, P = .023) in the rural participants. There was a statistically significant difference in the prevalence rate of non-compliance among the participants with different levels of education. Factors found to be significantly associated with non-compliance on bi-variate analysis were: female gender (OR = 1.90, CI =1.32-4.57),level of education (Illiteracy) (OR = 5.27, CI = 4.63 – 7.19), urban population (OR =5.22, CI= 3.65 – 8.22), irregularity of the follow-up (OR = 8.41, CI = 4.90 – 11.92), non-adherence to drug prescription (OR = 4.55 , CI = 3.54 – 5.56), non-adherence to exercise regimen (OR = 5.55, CI = 4.2 6 – 6.), insulin (OR = 1.29, CI = .71 – 1.87), and insulin with oral Metformin (OR = 1.20, CI = .65 – 1.75).
The findings indicate that there is a high rate of non-compliance among the diabetes patients in the Al Hasa region of Saudi Arabia and there is a definite need for improvement in the healthcare system, health education, and training of diabetic patients.
PMCID: PMC3326767  PMID: 22518355
Diabetes; Hb1AC; noncompliance
5.  Reliability and validity of an Arabic version of the revised two-factor study process questionnaire R-SPQ-2F 
How students accomplish their learning and what they learn is an indicator of the quality of student learning. An insight into the learning approaches of a student could assist educators of the health profession in their planning for the first year of study. The aim of this study was to develop a reliable and valid Arabic version of the revised two-factor study process questionnaire.
Materials and Methods:
The translation of the revised two-Factor Study Process Questionnaire (R-SPQ-2F) into Arabic was done by an established forward–backward translation procedure. The Arabic version was then distributed to high school graduates applying for a place in the medical program at King Fahad Medical City. A total of 83 students voluntarily completed the questionnaire. The internal consistency and construct validity of the Arabic version of the R-SPQ-2F were computed.
The exploratory factor analysis revealed two components. The two factors were similar to the main scales described in the original English questionnaire. The main scales were the deep and surface approach. The items for the subscales (deep motive, deep strategy and surface motive, surface strategy) had a high internal consistency of more than 0.80.
The results of this study should provide a valid and reliable instrument for the evaluation of the study approaches of Arabic speaking students.
PMCID: PMC3326768  PMID: 22518356
Learning approach; R-SPQ-2F; study process
6.  A survey of the attitude and practice of research among doctors in Riyadh Military Hospital primary care centers, Saudi Arabia 
To assess the attitude and practice of doctors in the Military Hospital Primary Care Centers in Riyadh (RMH) toward research and to identify the main barriers to conduct research.
Materials and Methods:
A cross-sectional study was conducted from March to April, 2010, at RMH primary care centers. The sample included all general practitioners (GPs) working in primary healthcare centers. A self-administered questionnaire was formulated from different sources and used as a tool for data collection.
The response rate was 75%. Among the respondents 96.9% agreed that research in primary care was important for different reasons. Most of the GPs had a positive attitude toward research: 68% had been influenced by research in their clinical practice and 66% had an interest in conducting research, and74.2% of the respondents had plans to do research in the future. Insufficient time was the most frequently cited barrier (83.5%) for participating in research, followed by the lack of support (58.8%).
Many of the GPs had a positive attitude toward research, but had no publications or plan for new research. Lack of time, support, and money were the main constraints for carrying out research.
PMCID: PMC3326769  PMID: 22518357
Family doctors; publishing; research
7.  A study on rapid confirmation of pulmonary tuberculosis in smear-negative acid fast bacilli cases by using fiberoptic bronchoscopy, done through a trans oro pharyngeal spacer 
The tuberculosis control program is based on a felt need–oriented basis. The diagnosis is mainly microbiological. However, sputum smear-negative Acid Fast Bacilli (AFB) cases with suspected radiological findings can be problematic in diagnosis.
To confirm the diagnosis of tuberculosis early, in smear-negative AFB cases by using a Fiberoptic Bronchoscope.
Materials and Methods:
We embarked on Fiberoptic Bronchoscopy (FOB) and Spot Scopy smear Microscopy (SSM) for 533 suspected Pulmonary Tuberculosis (PT) cases (sputum smear negative and radiologically suggestive) from February 2007 to May 2010. FOB was performed using a special device, a Trans Oro Pharyngeal Spacer (TOPS), as a conduit.
The yield for positivity for AFB was 341 (64%) out of 533 cases.
Conclusion and Recommendation:
The specimens collected by using the fiberoptic bronchoscope confirmed the disease in the smear-negative cases. Hence, FOB was recommended in smear-negative cases, to avoid delay in the treatment of tuberculosis.
PMCID: PMC3326770  PMID: 22518358
Fiberoptic bronchoscopy; pulmonary tuberculosis; spot scopy smear microscopy; trans oro pharyngeal spacer
8.  Prevalence of mental disorders among high school students in National Guard Housing, Riyadh, Saudi Arabia 
Adolescents experience rapid biological, psychological, and social transitions that can be associated with mental health problems. During the high school period there are also more academic stressors.
(1) To study the prevalence of mental disorders in high school (grade 12) students. (2) To study some related sociodemographic data.
Materials and Methods:
A cross-sectional study, using GHQ-28, that included 354 students randomly selected from grade 12 in four high schools – two male and two female high schools – in the National Guard Housing (Iskan), in Kashmalaan (suburb of Riyadh).
The overall prevalence of mental disorders was found to be 48% (41% in males and 51% in females); more than 80% of these cases were mild to moderate. Females showed significantly more severe disorders than males (P = 0.017) and students with excellent performance degrees showed a significantly lower rate of mental disorders than others (P = 0.021). However, our study did not show a significant association between psychiatric disorders and other social variables (family size, birth order, and polygamous family) or smoking.
The adolescent age groups in our community had high rates of mental disorders, which required more attention from the family, as well as the educational and health institutes in our country.
PMCID: PMC3326771  PMID: 22518359
Adolescents; GHQ-28; high school students; mental disorder; prevalence; Saudi Arabia
9.  Nicolau syndrome as an avoidable complication 
PMCID: PMC3326772  PMID: 22518360
10.  Metabolic syndrome among obese Qataris attending primary health care centers in Doha, 2010 
To determine the prevalence of metabolic syndrome among obese patients using the IDF definition and to identify factors that are associated with it.
Materials and Methods:
A cross-sectional randomized study was conducted at four primary care centers inside Doha, Qatar. One hundred and thirty-six Adults, ≥ 18 Qatari obese patients, were chosen by systematic random sampling. They were interviewed and screened for the presence of metabolic syndrome, which was diagnosed according to the International Diabetes Federation criteria: An abdominal circumference ≥ 94 cm in males or ≥ 80 cm in females, plus any two of the following: HDL cholesterol < 1.03 mmol / mL (< 40 mg / dL) [males] or < 1.3 mmol / mL (< 50 mg / dL) [females], Triglycerides ≥ 1.7 mmol / mL (≥150 mg / dL), Blood pressure ≥ 130 / 85 mmHg or the patient receiving antihypertensive treatment and baseline glycemia > 5.6 mmol / mL (> 100 mg / dL), or previously-diagnosed type 2 diabetes mellitus.
The overall prevalence of the metabolic syndrome among obese patients was 46.3%. The prevalence was higher in females (50%) than in males (42.4%). It was seen to increase with increasing body mass index class, from class 1 to class 2. The prevalence of metabolic comorbidities of abnormal waist circumference, raised blood pressure, raised fasting blood glucose, high triglycerides, and reduced high density lipoprotein was 88.2, 42.6, 32.4, 31.6, and 27.9%, respectively. Based on the logistic regression multivariable analysis, increasing age and being diabetic were the only significant associated factors that influenced the risk of having the metabolic syndrome.
The prevalence of the metabolic syndrome was high, and the highest comorbidities were abnormal waist circumference and high blood pressure. Diabetes and increasing age were the only significant risk factors of having this syndrome.
PMCID: PMC3326773  PMID: 22518352
Blood glucose; high density lipoprotein; metabolic syndrome; obesity; triglycerides
11.  Medical angioplasty - Hope and expectations: An optimistic overview 
Primary and secondary prevention of cardiovascular diseases (CVD) are markedly overlooked worldwide. The use of these kinds of preventive methods will greatly improve outcome of or even reverse major CVD, especially coronary atherosclerosis. Comprehensive lifestyle changes combined with aggressive medical therapy [lipid lowering agents “statins”, antiplatelet agents, beta-blockers and angiotensin-converting enzyme inhibitors] for patients suffering from coronary heart disease significantly reduce all major adverse cardiovascular events (MACE), especially in those with stable coronary artery disease (CAD), even if their coronary lesions are significant. The main mechanistic pathways for the significant reduction of MACE are: Stabilization of atheromatous plaques through endothelial function reparation, strengthening of the fibrous cap of the atheromatous plaque and reduction of atheroma burden, i.e., reversal of the process of coronary artery stenosis, the great dream of “medical angioplasty”. Despite the compelling data indicating the great beneficial effects of both primary and secondary prevention of coronary atherosclerosis, the US national survey data reveals that only a minority of patients eligible by guidelines for these therapies in fact receive them. Hence, we strongly believe that our main duties as cardiologists is to improve the up-to-date knowledge of the practicing physicians about utility of aggressive medical therapy for both prevention and reversal of CVD, and also to promote useful primary and secondary prevention programs among physicians and patients. Meanwhile, further improvement and refinement of the current therapeutic modalities and introduction of new modalities for the management of lipid parameters other than LDL-C, such as HDL-C, triglyceride, lipoprotein (a), LDL particle size and susceptibility to oxidation may add further favourable effects in prevention and reversal of atherosclerotic process. Cardiologists should be just as aggressive with prevention as many have been with intervention. This optimistic overview is a valley cry to all practicing physicians; please depart from usual methods of intervention to preventive strategies which are largely overlooked.
PMCID: PMC3237197  PMID: 22175036
Atheromatous plaque; endothelial function; hypercholesterolemia; high density lipoprotein cholesterol; low density lipoprotein cholesterol; nitric oxide; percutaneous coronary intervention; statins
12.  Inpatients’ care experience and satisfaction study 
Objective and Background:
Measures to promote patient satisfaction are important components of the assessment of outcome and strategies for the delivery of health care. In this article, we assess satisfaction among inpatients and the impact of demographics on satisfaction levels.
Materials and Methods:
This cross-sectional survey adapted from previously used survey tools and validated in our patient group included questions on demographics, communication skills, hospital environment, and the patients’ overall evaluation of the hospital. Inpatients from acute wards of five different specialties who stayed for at least 2 days were enrolled.
There were 988 respondents with a mean age of 39.1 years (25.9%) and the mean length of stay (LOS) of 10.0 days (24.1%). Illiteracy rate was 42.4%, and 43.1% were male. The overall satisfaction scores—out of five—were 4.3 (0.6%) for communication with nurses, 4.4 (0.4%) for communication with doctors, and 4.1 (0.3%) for hospital environment; 98.9% of the patients would recommend the hospital to their family and friends. The lowest score was for the “room environment” (3.99, 0.8%) and the highest for overall services of the hospital (4.7, 0.5%). Satisfaction levels drop significantly with LOS of more than 4 days (P < 0.006). The satisfaction was higher in females than males across all the three domains of care assessed (P < 0.005). The highest satisfaction seen in the obstetrics service could be explained by the nature of the condition normally seen in this department and the normally good outcome. There was higher satisfaction in the medical than surgical services but this reached a significant level for the overall center score domain only (4.1, 0.3% versus 4.0, 0.3%; P < 0.0001).
The factors with positive impact on satisfaction were the female gender and shorter LOS. There was higher satisfaction in the medical than surgical services for all three domains reaching significant levels for center score only.
PMCID: PMC3237198  PMID: 22175037
Patient satisfaction; Saudi Arabia
13.  Effect of adopting integrated management of childhood illness guidelines on drug use at a primary health care center: A case study from Egypt 
Integrated Management of Childhood Illness (IMCI) is a cost- effective strategy that improves the quality of care through the use of evidence- based management protocols for the most common causes of childhood death and illness. Evidence- based clinical guidelines are critical to promoting rational use of medicines. Despite the large number of studies that assessed process and outcome of care delivered to children utilizing IMCI protocol, there is a scarcity of studies that assessed the effect of adopting IMCI on the drug use.
To examine the impact of adopting IMCI guidelines on drug use at one of the primary health care (PHC) centers, Alexandria, Egypt.
Settings and Design:
Retrospective cohort study, conducted in clinic “A” not adopting IMCI guidelines and clinic “B” adopting IMCI guidelines at one of the PHC centers in Alexandria, Egypt for the period from January-- end of June 2010.
Materials and Methods:
A data collection sheet was designed to collect the required variables (based on WHO/ INRUD selected drug use indicators) from the medical records of children under five years.
Statistical Analysis Used:
SPSS version 16 was used. Percentages, means, and standard deviations were measured. Chi square, t, and Fisher's exact tests were applied.
Correct drug choice, dose, dosage form, route of administration were significantly higher in the clinic adopting IMCI {clinic B} (89.3%, 87.3%, 91.3%, and 91.3%, respectively) than in the clinic not adopting it {clinic A} (78% each). Non pharmacological remedies prescribed were significantly higher in clinic B than A (64.7% vs 4.6%). Average no of drugs/ encounter was lower in clinic B than A (0.93± 0.2 vs 1.37 ± 0.6) and the difference between clinics was statistically significant. Difference between clinics regarding percentages of drugs prescribed by generic name, antibiotics prescribed, drugs prescribed from essential drug list, and drugs prescribed out of stock was significant.
Adopting IMCI strategy improved prescribing performance and treatment regimen.
PMCID: PMC3237199  PMID: 22175038
IMCI; improving drug use; prescribing indicators; technical quality of treatment regimen
14.  Knowledge regarding risk factors of hypertension among entry year students of a medical university 
Hypertension in youth is increasing, but there is a dearth of data about the knowledge of risk factors in this age group.
To assess the knowledge of risk factors of hypertension among university students and associate it with the blood pressure, physical activity, family history of cardiovascular disease (CVD), and sociodemographic variables.
Materials and Methods:
A cross-sectional survey among students enrolled in the first year, in the four academic programs, with the use of a validated, self-administered questionnaire on physical activity in the past 30 days and knowledge of risk factors of hypertension. A score of 6 on 11 was considered as good knowledge for modifiable risk factors. Blood pressure was also measured. The data was analyzed using PASW-17, Chi square test, and binary logistic regression analysis was done.
Of the 110 participants, 69.2% were < 20 years of age, 76.4% were females, and 40% were Arabs. Stress, high cholesterol, obesity, and smoking were identified as risk factors by 75.5, 73.6, 77.6, and 71.8%, respectively; 69.1% considered high salt intake and 62.7% considered high calorie diet as risk factors. Energy drink was considered as a risk factor by 64.5%, coffee consumption 35.5%, physical inactivity 47%, and oral contraceptives 13.6%. Half the group did not consider a family history of CVD as a risk factor, 60% did not consider older age as a risk factor, and 88% did not think male gender was a risk factor. Knowledge of modifiable risk factors was better than that of non-modifiable risk factors. Although nationality, course of study, raised blood pressure, and history of diabetes showed significant association with good knowledge, their net effect was not significant by the Adjusted Odd's Ratio.
The study identified some gaps in knowledge regarding both modifiable and non-modifiable risk factors of hypertension among students. A larger study would enable health promotion activities tailored to the needs of this age group.
PMCID: PMC3237200  PMID: 22175039
Hypertension; knowledge; risk factors; university students
15.  Experience of the health promotion clinics in Aseer region, Saudi Arabia 
Health promotion is the most important element of primary health care. Therefore, it is essential for the health team to apply such activity.
To describe a newly established health promotion clinic at primary health care centers, in Abha city, KSA.
Materials and Methods:
The study was conducted during the year 2009. The files of 429 individuals were reviewed after one year from attending the health promotion clinics in Abha city, KSA. Master sheet was designed based on the relevant items of the file. The health promotion services used in the study were based on the recommendation of the relevant guidelines. Data entry and analysis was carried out using Statistical Program for the Social Sciences (SPSS). P-values less than 0.05 were selected for statistical significance.
After one year, the percentage of the individuals who intake imbalanced diet and did not perform any type of physical activity was more than 90% while 8% are currently smokers and 14% had depression. Clinical examination and investigation revealed that more than one quarter of our subjects were overweight. Obesity was 42% in males versus 51% in females (P<0.04). Pre-hypertension and hypertension were detected among 44 and 12% respectively. About one fifth of our subjects had pre-diabetes 21% and 3% were confirmed to have diabetes mellitus. Diet and physical activity counseling was given to all participants while referral to concerned clinics was done for individuals who suffer from high blood sugar, abnormal lipid profile, obesity and depression.
This study demonstrated that health promotion clinics provided by trained professional health care team can be used as a new approach for early detection and management of the common health problems in primary health care centers.
PMCID: PMC3237201  PMID: 22175040
Health promotion; primary health care center; services
16.  Knowledge, attitude, and behavior among Saudis toward cancer preventive practice 
To examine self-reported knowledge, attitude, and preventive practices on cancer among Saudis.
Materials and Methods:
Data was collected from Saudis aged 15 years or more, who attended one of the randomly selected 20 Primary Health Centers (PHC) or the four major private hospitals located in the Riyadh region, either as patients or their escorts. The association between the variables was evaluated by the Chi square test.
The study population consisted of 618 males and 719 females. Among the female respondents 23.1% reported that they practiced breast self-examination (BSE); 14.2 and 8.1%, respectively, had clinical breast examination (CBE) and mammography. However, 10.0 and 16.1% of the females, aged 40 years and older, reported having had mammograms and CBE, respectively. The BSE performers were more educated, knew someone with cancer, and had heard of the cancer warning signal. Both educational level and ‘heard of cancer warning signal’ were significantly related to CBE. Cancer information was received from television / radio by 65.1% and from the physician by 29.4%. Even though 69.4% believed that cancer could be detected early, a vast majority (95.8%) felt early detection of cancer was extremely desirable and 55.1% said their participation was definite in any screening program. A majority of the respondents (92.6%) insisted on the need for physician recommendation to participate and 78.1% expected that any such program should be conducted in the existing hospitals / clinics.
Culturally sensitive health education messages should be tailored to fulfill the knowledge gap among all population strata. Saudis will benefit from partnerships between public health educators and media to speed up the dissemination of cancer information.
PMCID: PMC3237202  PMID: 22175041
Attitude; breast self-examination; clinical breast examination; cancer prevention; cancer knowledge; mammography
17.  Implementation of computerized physician order entry in National Guard hospitals: Assessment of critical success factors 
The purpose of this study is to describe the needs, process and experience of implementing a computerized physician order entry (CPOE) system in a leading healthcare organization in Saudi Arabia.
Materials and Methods:
The National Guard Health Affairs (NGHA) deployed the CPOE in a pilot department, which was the intensive care unit (ICU) in order to assess its benefits and risks and to test the system. After the CPOE was implemented in the ICU area, a survey was sent to the ICU clinicians to assess their perception on the importance of 32 critical success factors (CSFs) that was acquired from the literature. The project team also had several meetings to gather lessons learned from the pilot project in order to utilize them for the expansion of the project to other NGHA clinics and hospitals.
The results of the survey indicated that the selected CSFs, even though they were developed with regard to international settings, are very much applicable for the pilot area. The top three CSFs rated by the survey respondents were: The “before go-live training”, the adequate clinical resources during implementation, and the ordering time. After the assessment of the survey and the lessons learned from the pilot project, NGHA decided that the potential benefits of the CPOE are expected to be greater the risks expected. The project was then expanded to cover all NGHA clinics and hospitals in a phased approach. Currently, the project is in its final stages and expected to be completed by the end of 2011.
The role of CPOE systems is very important in hospitals in order to reduce medication errors and to improve the quality of care. In spite of their great benefits, many studies suggest that a high percentage of these projects fail. In order to increase the chances of success and due to the fact that CPOE is a clinical system, NGHA implemented the system first in a pilot area in order to test the system without putting patients at risk and to learn from mistakes before expanding the system to other areas. As a result of the pilot project, NGHA developed a list of CSFs to increase the likelihood of project success for the expansion of the system to other clinics and hospitals. The authors recommend a future study for the CPOE implementation to be done that covers the implementation in all the four NGHA hospitals. The results of the study can then be generalized to other hospitals in Saudi Arabia.
PMCID: PMC3237203  PMID: 22175042
Computerized physician order entry; critical success factor; health information systems; Saudi hospitals
18.  Propolis and its direct and indirect hypoglycemic effect 
Propolis means a gum that is gathered by bees from various plants. It is strongly adhesive resinous substance, collected, transformed, and used by bees to seal holes in their honeycombs. Bees use it to seal holes in their honeycombs, smooth out internal walls, as well as to cover carcasses of intruders who died inside the hive in order to avoid their decomposition. Propolis also protects the colony from diseases because of its antiseptic efficacy and antimicrobial properties. It also has been reported to possess various biological activities, namely anticancer, antioxidant, anti-inflammatory, antibacterial, antifungal, and hypolipidemic. The aim of this review is to evaluate the hypoglycemic effect of propolis since a little number of researches studied this effect when we compare with the huge number of papers that reported many other biological activities.
PMCID: PMC3237204  PMID: 22175043
Anticancer; antioxidant; anti-inflammatory; antibiotic; antifungal and antihepatotoxic; bees; propolis
19.  HIV/AIDS knowledge among first year MBBS, Nursing, Pharmacy students of a health university, India 
To determine level of HIV/AIDS knowledge among first-year MBBS, nursing and pharmacy students of a health university.
Materials and Methods:
A pre-designed, pre-tested, anonymous self-administered, semi-structured questionnaire was circulated among available 129, 53 and 55 first-year MBBS, nursing and pharmacy students during Oct’ 09. Data entry, management and analysis were carried out using MS excel and software statistical package.
Out of the total 237 students, there were 123 (51.9%) female and 103 (44.0%) students from rural native place. A majority of students were able to correctly write the full form of AIDS (95.8%) in comparison to HIV (72.6%) and the difference between two terminologies were known to 87.6%, 81.1% and 70.9% of MBBS, nursing and pharmacy students, respectively. All four common routes of transmission of infection and methods of prevention were known to majority of the lot. However, injecting drug users (IDU) and truck driver as a risk category was correctly reported by 67.5% and 55.3% students, whereas 35.9% incorrectly mentioned that smoking is a risk factor for acquiring infection. A statistically significant (P <0.05) proportion of MBBS followed by nursing and pharmacy students were aware that infection neither spreads by social activities like handshake/playing nor by mosquito bite. However, low level was ascertained with regard to items related to non-curability of infection (57.4%) and availability of anti-retro viral therapy (27.4%).
Overall high level of knowledge was recorded in the present study with a difference noted among students in three professional streams.
PMCID: PMC3237205  PMID: 22175044
Aids; HIV; knowledge; university students
20.  Recurrent hydatidiform mole: A case report of six consecutive molar pregnancies complicated by choriocarcinoma, and review of the literature 
Hydatidiform mole (HM) is the most common form of gestational trophoblastic neoplasia. Recurrence of HM is extremely rare. Here, we report the case of a patient with six consecutive partial HMs without normal pregnancy. A 42-year-old lady who was referred to us at King Fahad Hospital of the University, Al Khobar, initially as a case of 26-year-old with persistent trophoblastic disease after three recurrent molar pregnancies that were confirmed histologically in the referring hospital. She underwent evacuation and curettage and was followed up by serial β-human chorionic gonadotropin levels, and did not require chemotherapy. She then had three more molar pregnancies in 1995, 1996, and 2004; all molar pregnancies were evacuated by suction curettage at her base hospital, but in the last event, she complained of shortness of breath and abdominal pain. Diagnostic workup in our hospital confirmed choriocarcinoma, for which she received multiple regimen chemotherapy and was cured. Unfortunately, she lately presented with symptoms suggestive of premature menopause.
PMCID: PMC3237206  PMID: 22175045
Choriocarcinoma; hydatidiform mole; recurrent mole
21.  Peripheral polyneuropathy after bariatric surgery for morbid obesity 
A patient with peripheral polyneuropathy after bariatric surgery for morbid obesity is reported. She suffered from frequent episodes of vomiting and abdominal pain after surgery. Muscle weakness in her lower limbs developed 5 months later and she experienced difficulty in walking and standing. Wrist drop, foot drop, and marked distal limb muscle atrophy were found bilaterally. Electromyography showed the presence of sensorimotor axonal polyneuropathy. Nutritional deficiencies may play an important role in pathogenesis. This uncommon neurological complication might be due to rapid weight loss and vitamin deficiency. Physicians who take care for patients after bariatric surgery should have a high index of awareness for the neurologic complications, and routine vitamin supplementation might be useful for these patients.
PMCID: PMC3237207  PMID: 22175046
Bariatric surgery; morbid obesity; polyneuropathy
22.  An unusual complication of unsafe abortion 
Unsafe abortion is a significant medical and social problem worldwide. In developing countries, most of the unsafe abortions are performed by untrained personnel leading to high mortality and morbidity
Case Report:
A 30 year-old female, gravida 7, para 6 underwent uterine evacuation for heavy bleeding per vaginum following intake of abortifacient to abort a 14 weeks gestation. The procedure was performed at a rural setup and her bowel was pulled out of the introitus through the perforated wound, an unusual complication of unsafe abortion. Illiteracy, unawareness about health services, and easy accessibility to untrained abortion providers lead to very high mortality and morbidity in India. There is unmet need to bring awareness among the people about the safe and effective methods of contraception and abortion services to avoid such complications.
PMCID: PMC3237208  PMID: 22175047
Unsafe abortion; uterine evacuation; uterine perforation
24.  Quality of hypertension care in the family practice center, Aseer Region, Saudi Arabia 
Hypertension (HTN) is a common health problem in Saudi Arabia. Good control depends on the quality of care, which should be supervised and monitored regularly through clinical audit.
The objective of this study was to assess the quality of HTN care at Al-Manhal Family Practice, Aseer Region, Saudi Arabia.
Settings and Design:
This study was conductedin 2009 at Al-Manhal Family Practice, Aseer Region, Saudi Arabia.
Materials and Methods:
Medical records of all hypertensive patients were extracted and reviewed using master sheets. Assessment of processes and outcomes of HTN care were based on the standards of quality assurance manual issuedby the Ministry of Health.
Statistical Analysis Used:
Data were entered and analyzed by SPPS, version 15. Relevant statistical tests were used accordingly and the P-value was considered significant when it was less than 0.05.
A total of 295 medical records were reviewed and assessed. Most patients were Saudi, married, and about 50% were educated. Two-hundred and thirty-one records were assessed for processes and outcomes of HTN care. Weight measurement and physical examination were carried out for 99% and 97% of the patients, respectively. For 53% of the patients, blood was checked for glucose and kidney function and a lipid profile was done. More than two-thirds of the patients were overweight and obese while 46% had diabetes. Less than one half of the patients had good control of HTN.
By most standards, quality of HTN care in Al-Manhal Family Practice was unsatisfactory. Most of the patients had comorbidities and poor HTN control. Essential facilities should be provided to the practice to optimize HTN care and to improve the degree of control.
PMCID: PMC3159226  PMID: 21897909
Aseer Region; family practice; hypertension; quality
25.  Was there a change in the body mass index of Saudi adolescent girls in Al-Khobar between 1997 and 2007? 
Background and Objectives:
Special concern is focused on the nutritional status of adolescent girls in order to avoid future health problems. The aim of this study was to determine the change in body mass index (BMI) among adolescent Saudi girls living in Al-Khobar between 1997 and 2007.
Materials and Methods:
A cross-sectional sample of adolescent Saudi girls, 15–19-years-old, living in Al-Khobar, Saudi Arabia, was analyzed through two data sets. The first data set (n = 400) was collected in 1997 and the second (n = 321) was collected in 2007. Both data sets used the same sampling method. Anthropometric measurements were made and the BMI was used to determine participants’ nutritional status. Statistical analysis was performed.
There was an increase in the median weight of Saudi adolescent girls from 1997 to 2007, but the change was not statistically significant. There was a statistically significant change, however, in adolescent girls’ height during the 10-year interval. Using BMI to determine the nutritional status of the sample, no statistically significant difference was found. Overweight and obesity remain prevalent in about 30% of the adolescent girls, and about 3.5% of the girls in both sets were underweight.
This study concluded that there was no change in BMI among Saudi adolescent girls living in Al-Khobar during the 10-year span. Underweight is of low prevalence, and overweight and obesity are the critical nutritional problems that are faced by this population. Further research using time span comparisons is important to assess changes in maladaptive overweight and obesity.
PMCID: PMC3159227  PMID: 21897910
Adolescent girls; body mass index; obesity; overweight; Saudi Arabia

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