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1.  Patient Satisfaction Survey in a Teaching Hospital in Saudi Arabia: Preliminary Results 
Patient satisfaction is a useful indicator of the quality of health care, but there is no one universally acceptable tool for measuring it. In Saudi Arabia, such studies are, few.
In-patients in a teaching hospital.
Opinions of hospital in-patients were sampled by means of a self-administered questionnaire over a period of 12 consecutive months. Fright areas were evaluated: professional services from medical, nursing anal admission staff, and four amenities, i.e. room and linen, meals, and provision for telephone and television.
A total of 1,319 patients were surveyed, forming 7.9% of the 17,536 admissions. Patients were satisfied with professional services from medical staff. However, they were dissatisfied with silence in wards during day, taste, temperature and variety of meals, as well as provisions for telephone and television. Remedial actions had been taken.
We concluded that the results indicated areas of patients’ dissatisfaction in our hospital, and that such surveys are unique to the hospital involved. We recommend the method used here: it is easy to use, cost-effective, and beneficial to patients.
PMCID: PMC3437122  PMID: 23012220
Quality improvement; Patient satisfaction; Inpatients; Saudi Arabia
2.  Permanent Diversion Stomas: “Guidelines for Muslim Physicians and Patients” 
Ethical issues in medical practice are increasing in number, diversity and complexity and posing professional diemmas for physicians. It is the duty of Muslim physicians in collaboration with jurists, to resolve these issues.
These guidelines aim at answering the following two questions:
1. On religious grounds to what extent is a Muslim patient bound ground to accept surgical treatment requiring permanent diversion of stool and urine?
2. What should be the role of medical staff in convincing the patient aril his relatives to accept diversion stomas.
1. Identification of the consequences of diversion stomas.
2. Verification of the religious rule in relation to seeking treatment.
3. Identify the effect of carrying a stoma bag on the patient's purity during worship
4. Outline the role of the medical staff in convincing the patient vial his relatives to accept a needed stoma
Results & Discussion:
A Muslim patient needing a permanent diversion stoma has a religiously proven duty to listen to the instructions of a proficient physician in order to save himself if safety is most probable. Carrying a stoma bag does not interfere totally with patients purity. The exact role of medical staff in convincing the patient and his relatives to accept the procedure is discussed.
PMCID: PMC3437123  PMID: 23012221
Diversion Stomas; Ileostomy; Colostomy; Islamic Medicine
3.  Hospitalisation due to Acute Poisoning in Children – Tabuk Experience 
Background & Method:
Acute poisoning in children is still a major problem in our community, taking up a lot of resources from the health care system. We report here the result of’ a three year study (1991-1994) carried out in the Northwest Armed Forces Hospital, Tabuk, Saudi Arabia regarding hospitalisation of children as a result of poisoning.
Sixty eight children below twelve years of age were admitted, accounting for a total of approximately 175 inpatient days. The majority of them (n=60, 88.2%) were below the age of five years. house hold products (16.2%), kerosene (10.3%) and antihistamines (19.1%) were the commonest ingested substances. An analysis of various aspects of this problem and the review of relevant literature is included.
Health education about safe storage of medicine at home and a knowledge of first aid is very necessary. This may prevent the occurence of such accidents and reduce morbidity.
PMCID: PMC3437124  PMID: 23012222
Poisoning; overdose; paediatric admissions
4.  The Introduction of Epidemiology in Training Future Doctors: The Oman Experience 
This paper highlights the emphasis put on epidemiology in the training of future doctors at Sultan Qaboos University. It describes the special features of the teaching of epidemiology making it needs-oriented with continuous practical application in the field throughout the preclinical period. The students take an active part in planning field studies using their knowledge of epidemiology. Integration of epidemiology with statistics enables the students to analyze and interpret their own data thus obtaining a quick feed-back of the epidemiological studies conducted by them. They apply their knowledge of epidemiology to evaluate the data and formulate intervention programmes.
Close collaboration with the Ministry of Health provides an opportunity for the students to orient themselves with the important health problems of Oman and participate in the country's national programs. The scheduling of courses and continuation of application of epidemiology in the clinical years help to reinforce their knowledge of epidemiology and statistics for the clinical period and subsequent postgraduation.
PMCID: PMC3437125  PMID: 23012223
needs-oriented; epidemiology; integration; statistics
5.  Asymptomatic Salmonella, Shigella and Intestinal Parasites Among Primary School Children in the Eastern Province 
The main objective of this study was to determine the prevalence of some potential entropathogens among primary school children.
This study was conducted, on a sampled population of3258 primary school going children in the age group of 6-11 years. They were investigated for the presence of some potential enteropathogens in their stools.
The overall prevalence of enteropathogens was 10.44 percent. Salmonella and Shigella species were found among 114 percent children. Multiple drug resistance was common in the isolated species of Salmonella and Shigella with ma exception of Nalidixic acid and cephalothin in Shigella. The prevalence rate of parasitic infection was 9.30%. The most common parasite found was giardia lambia, 8.16 percent, and next most common was Entamoeba histolytica 0.74%, followed by other parasites: (Hemenolepis nana, Ascaris lumbricoides, Trichuris trichuira and Enterobious vermicularis, in order of their frequencies).
This study lays emphasis on the importance of asymptomatic carriers as a potential source of infection and demonstrates the emergence of resistance in salmonella and Shigella species.
PMCID: PMC3437126  PMID: 23012224
Asymptomatic Salmonella; Shigella; Intestinal Parasites; School Children
7.  Health Understanding and its Effect on Health Outcome 
Literature regarding health belief models, health understanding and their effect on health outcome is reviewed. Aspects of the major elements comprising health understanding – including lay explanations of illness, locus of control and the affective meaning of symptoms – are described. The particular problems posed by utilising these models in a developing Middle Eastern country are discussed, together with the importance of applied research to assess the feasibility of improving health outcome by enhanced health understanding.
PMCID: PMC3437128  PMID: 23012219
Health Understanding; Health Outcome; Developing Countries
8.  International Controversies in Interpreting the Mantoux Test with Special Reference to Saudi Arabia 
There is a general decline in the incidence of pulmonary tuberculosis (PTB) in developed countries, but infection by HIV has increased the incidence of PTB in affected countries. There are no signs of a similar decline in the incidence of PTB in some developing countries. The Mantoux technique for tuberculin testing continues to be among the effective diagnostic tools. The medical literature and textbooks of medicine show disagreement as to what constitutes a positive (specific) tuberculin reaction. This short review was intended to cite some examples of these differences and suggest a cutting point for use in the Kingdom of Saudi Arabia (KSA) based on the prevalence of environmental mycobacteria (Mycobacteria other than M. tuberculosis, MOTT). From this review different researchers within the KSA used different cut-off points at a time that the prevalence of MOTT was unknown, until 1993 when it was reported to be as low as 3.8/1000 population (based on sputum culture) and that the Kingdom is categorised among the middle PTB prevalent countries. Consequently, it seems appropriate to have 5 mm as a cutting point (positive) in all unvaccinated patients, particularly for those who were in contact with an infectious case, or having symptoms compatible with PTB, and also patients who were immuno-compromised as in HIV infection. This cut-off point can be revised and raised to 8 mm provided that the prevalence of PTB becomes lower than the current reported rate and MOTT prevalence remains low, but the 5 mm cutting point should remain for the aforementioned categories of patients.
PMCID: PMC3437147  PMID: 23012205
Tuberculosis; MOTs Mantoux
9.  Cardiovascular Risk and Risk Reduction: A Review of Recent Literature 
An account is given of recent literature regarding the major cardiovascular risk factors. It considers high blood pressure, high blood cholesterol, smoking, as well as insulin resistance and its metabolic consequences. The focus is on the current available evidence in terms of causal associations of these risk factors with the occurrence of cardiovascular disease, and the evidence of the benefits of risk factor lowering. The multiplicative effect of risk factors and their multifactorial role in the genesis of cardiovascular disease is now firmly established and will affect the mode of approach to preventive measures. The main preventive options currently available are twofold, a population-wide approach and a high risk approach. The suitability of primary health care as one of the main providers of preventive care is today widely acknowledged. The need for cardiovascular risk assessment to be multifactorial and made in terms of overall actual risk is of paramount importance. The implications of this overall issue for countries like those of the Middle East, where the prevalence of cardiovascular disease is on the rise, are of great concern.
PMCID: PMC3437148  PMID: 23012206
cardiovascular risk; risk reduction; preventive strategies
10.  Factors Associated with Diarrhoea Prevalence in Saudi Arabia 
The weather of Saudi Arabia is hot and dry for most of the year. The country is devoid of surface water which often help the transmission of diarrhoeal diseases. Nevertheless, this country is not free from diarrhoeal diseases. The role of such factors as crowding, patterns of water use, sanitation, quality of housing, feeding practices and region of residence have not been adequately studied. The 1987 National Child Health Survey data were used to earmark the roles of the aforementioned determinants of diarrhoea in Saudi children aged below six. A stratified and representative sample of 8,566 married women living in rural and urban areas were interviewed by 120 female nurses. There were about two episodes of diarrhoea per child per year. Children aged 6 to 23 months had nearly double the prevalence rate of the older children. Children from rural areas and the southern region had higher rates than children from other areas. Children who were both breast and bottle fed, children of 1-4 member families and of families with 3 or more persons per room had higher prevalence rates. Children of families whose homes had earthen floors, those who used well water and those without toilet facilities who used open fields for defecation had significantly higher rates. In spite of adverse climate and little use of surface water these factors were significantly associated with higher prevalence rates of diarrhoea in Saudi children under six years of age.
PMCID: PMC3437149  PMID: 23012207
Diarrhoea; Factors; Prevalence; Saudi Arabia
11.  Assessment of the Knowledge of Primary Health Care Staff about Primary Health Care 
The orientation about Primary Health Care among staff working in the PHC centers was assessed. Staff members numbering 909 were studied. The main criteria for judging orientation were a working knowledge of the definition and elements of PHC in addition to knowledge of the meaning of the word Alma Ata. Differences of this knowledge depending on sex, age, spoken language, type of job, postgraduate experience, previous experience in PHC and previous training in PHC were assessed. The main findings of the study were that the correct definition of PHC was known by only 51.4%, functions of PHC by 62.6%, and what Alma Ata, means in terms of PHC was known by 76.2% of the staff. This knowledge was significantly better in females than males, non-Arabic speaking staff than those who spoke Arabic, General practitioners and nurses than other staff; it was better in those staff who had long postgraduate experience, previous experience or previous training in PHC.
In conclusion, the study reveals the current status of awareness of PHC staff of the implications of simple concepts of PHC and points to the importance of the orientation of staff towards these concepts in order to help them practice PHC effectively.
PMCID: PMC3437150  PMID: 23012208
Primary health care; Alma Ata; General practitioners; Nurses
12.  Evaluation of Drug Prescribing Habits in a Postgraduate Teaching Set-up in Saudi Arabia 
The objective of this retrospective study was to assess the rationale behind the practices of drug use in a teaching hospital that provides primary health care. A total of 500 prescriptions issued 6y faculty and post-graduate fellowship residents in the Department of Family and Community Medicine were collected. An evaluation of these prescriptions was carried out using the INRUD indicators of drug prescribing. The results of this study showed that apart from the low percentage (43.2%) of drugs prescribed generically, the application of INRUD indicators of drug prescribing appeared satisfactory when compared to similar studies from local and other developing countries. This study recommends a review of the current teaching of Pharmacology and Therapeutics to undergraduates in general & in particular to postgraduates specializing in Family & Community Medicine. Quality assurance systems on drug prescribing at primary health care centers should be established and implemented. Large scale studies similar to that under discussion should be encouraged.
PMCID: PMC3437151  PMID: 23012209
Prescribing; Drugs; Habits; Saudi Arabia
13.  Growth Patterns of Jordanian Children: A National Study 
This study examined the growth patterns of Jordanian children below three years of age in comparison with the NCHS reference population. Weight and length measurements of 1224 boys, and 1120 girls were obtained from a national multipurpose study of Jordanian preschool children carried out in 1984. The study results showed that children of both sexes grew at Gentiles that were close and parallel to the NCHS in the first quarter of the first year. However, both weight and length Gentiles departed from the NCHS counterparts later on with length showing marked differences from the reference. The differences observed between the local and the NCHS reference population suggest that the NCHS should be used as a target for planning and evaluation of’ intervention programs at a national level while the need for the local standards to assess individual cases remains a necessity.
PMCID: PMC3437152  PMID: 23012210
Growth; ceding practices; Jordan; NCHS; breast feeding
14.  Trachoma in an Omani Village – A Health Care Study 
This paper reports the findings of a study carried out on 289 families in rural Oman, to assess the knowledge of trachoma in a defined community, identify the determinants of continued transmission and endemicity of the disease, and to assess the effect of health education provided by medical students.
The study identified the prevalence of illiteracy, large family size and overcrowding as potential risk factors. Lack of knowledge in a significant number of families about causes, prevention and transmission of trachoma led to practices that promoted the spread of the disease.
We found that episodic health education by medical students did not have any lasting impact on the community. Between families who had received such health education and those who had not, there were few significant differences regarding misconceptions about the disease and undesirable practices.
The findings of this study concerning deficiency in knowledge, misconceptions and incorrect practices about trachoma are being utilised to plan a subsequent health education programme for the villagers.
PMCID: PMC3437153  PMID: 23012211
Knowledge; Attitude; Practice; Trachoma; Community; Health Education; Developing Country
15.  Developmental Milestones and Additional Disabilities in Children attending ESN/M School in Dammam, Saudi Arabia 
Information about the extent of additional disabilities presented and experienced by the mentally retarded children is essential for proper health services planning for this group.
The objective of this case-control study was to identify the developmental milestones and additional disabilities of mildly mentally retarded male children. Sixty-nine parents of mildly mentally retarded male children (MMR group) and a similar number of matched parents of normal male children (control group) were interviewed and a questionnaire was completed.
Generally, the MMR group children smiled, sat, walked, talked and became continent for urine and bowel significantly later than the control group. Additional disabilities in the children of the MMR group were in the form of speech (65%), visual (28%), limb weakness (20%), hearing (16%), convulsive disorder (15%) and other disabilities (10%).
Well structured health education and I.Q. screening programs were recommended for early detection of mental retardation and subsequent entry to special education. Institutes for mentally retarded children in the Kingdom need to be better vocationally equipped. The role of Family and Community Physicians in early detection and management was also emphasized.
PMCID: PMC3437154  PMID: 23012212
Mental Retardation; Disabilities; Saudi Arabia
16.  “Hot Topics in Neonatology; December 12-14, 1993, Washington DC, USA” 
As a guest discussant, I had the pleasure and privilege of being invited to this important meeting which is held yearly. As the name implies, this meeting has its focus on subjects in which there was tremendous changes in the field of Neonatal Medicine, also on subjects where there is unanswered questions and controversial issues. The meeting was organized and chaired by Prof. J.F. Lucey, a well-known celebrity from the Pediatric World and the editor of the highly reputed journal, Pediatrics.
The topics that were chosen for this year included five subjects based on the criteria mentioned above.
PMCID: PMC3437155  PMID: 23012213
Neonatology; Premature; Anaemia

Results 1-17 (17)