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   Table of Contents - Current issue
Coverpage
April-June 2018
Volume 6 | Issue 2
Page Nos. 45-95

Online since Monday, April 2, 2018

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ORIGINAL ARTICLES  

An investigation of the saudi healthcare system's readiness for change in the light of vision 2030: The role of transformational leadership style Highly accessed article p. 45
Mohammad Faleh Alharbi
DOI:10.4103/jhs.JHS_142_17  
Objectives: Organisational change is among the major challenges that face healthcare organisations, and many factors affect their ability to be ready to adopt the change desired. Among these important factors are the significant role of the attitude of the leadership that is responsible for the change. This empirical study was conducted to examine the role and contribution of the transformational leadership style to the readiness for change in healthcare organisations in Saudi Arabia. Materials and Methods: Primary data were collected from a sample of 83 middle managers in the hospitals in the Al-Qassim region in the Kingdom of Saudi Arabia. The study used a self-administered questionnaire to examine the role of transformational leadership in the readiness for change in healthcare organisations. Cross-sectional data were analysed using SPSS. Results: A positive and significant relation was found between transformational leadership and the readiness for change with 30% variation in the dependent variable (R2 = 0.30). Conclusions: This study is valuable for healthcare policymakers and providers, as it offers information about the leadership behaviours desired in readiness for change that have the potential to influence the intentions, attitudes and beliefs of members of healthcare organisations that help them accept and understand a change initiative.
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Assessing the evolution and level of evidence of spine surgery research in Saudi Arabia p. 52
Saleh Baeesa, Yazid Maghrabi, Sadek Bajoh, Suhail Bajammal
DOI:10.4103/jhs.JHS_129_17  
Objectives: To measure the impact of Saudi publications on global spine surgery literature, to evaluate the quality of these papers by measuring the level of evidence (LOE) and then to compare it with similar international studies done on the topic of spine surgery. Materials and Methods: The study design was a systematic review, where a systemic online search using PubMed, Google Scholar and Embase was carried out using search terms related to spine surgery. The impact of each article was measured by the citation number and was reviewed by Oxford Centre for Evidence-Based Medicine LOE scale. Results: We identified 128 articles that met the inclusion criteria, of which 58% were Level IV studies. The most common study design was case reports (45%). We compared our study with the similar or different methodology of international studies for spine surgery research. Conclusion: This first study, for the analysis of spine surgery literature in Saudi Arabia, shows that Saudi publications in spine surgery have little impact on the global spine surgery research. The LOE was low and that there is insignificant change throughout 25 years. A national multicentre or international collaborative research is recommended to produce high LOE research.
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Translating the importance of simulation to practice: Strengthening learning outcomes p. 60
Farhan Alshammari, Eddieson Pasay-an, Maria Charito Laarni Indonto, Ferdinand Gonzales
DOI:10.4103/jhs.JHS_84_17  
Background: Evidence against the positive outcomes of simulation exists, but greater evidence for its effectiveness as an educational approach is recorded. Materials and Methods: A quantitative cross-sectional design was employed using a total enumeration from the 2nd year to 4th year nursing students. The respondents were the 2nd to 4th year level Bachelor of Science in Nursing students enrolled during the school year 2016–2017 in the College of Nursing at the University of Hail, Kingdom of Saudi Arabia. Descriptive statistics were used to determine the level of importance and practices of simulation. Meanwhile, the F-test (one-way ANOVA) was used to examine the differences on year level, course, and the age. Results: The level of simulation practice of the students is generally “often practice,” and the importance of simulation is considered “important.” The active learning level of practice is 3.89 while the level of importance is 4.09; collaboration is 3.75 for the level of practice and 3.93 for the level of importance; for the diverse ways of learning 4.13 and 4.14 for the level of importance. Interestingly, as to “high expectations,” the mean result is 4.42 for the level of practices and for the level of importance the mean result is 3.91. According to year level, age and courses, no significant difference in both the level of importance and in the practice of simulation were recorded, as indicated by the P values that were greater than 0.05 level of significance. Conclusion: Specific variables can greatly influence the practice and simulation technique.
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Attitudes and perceptions towards organ donation in Riyadh p. 68
Basil Mohammed Alhussain, Bader Mohammed Alasmari, Aamir Omair, Ibrahim Altraif, Abdulrahman R Altamimi
DOI:10.4103/jhs.JHS_153_17  
Context: Organ donation is an optimal solution for patients with certain conditions who benefit from transplantation such as liver cirrhosis. The organs come from living and brain-dead donors, who opt to donate parts of their bodies to treat others. This serves to treat and improve the outcome to those in need; however, the awareness in this regard is unclear. Aims: This study aimed to assess the attitude and perceptions towards organ donation and the concept of brain death in the population of Riyadh, Saudi Arabia. Settings and Design: A cross-sectional quantitative design was used. The study was conducted at four large malls in different geographical areas. Data collection was done at random times during the day. Subjects and Methods: A self-administered questionnaire was designed to examine the sociodemographic data. A 4-item questionnaire was developed to assess the attitude and perception of organ donation and brain death. Statistical Analysis Used: Data were entered and analysed using SPSS v21. Descriptive statistics are presented as frequencies and percentages for the categorical variables and mean ± standard deviation for numerical variables. Results: The study included 409 participants from different sociodemographic backgrounds. Over 60% were able to identify the correct definition of brain death and 68.1% stated that they would like to donate their organs in case of brain death. Conclusions: Our findings suggest that the population has an acceptable understanding of the concept of brain death and that they are willing to donate in cases of brain death. It also shows an excellent understanding of the religious aspect, but with poor family and friends' communication regarding the subject.
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Stability testing of extemporaneous preparation of methyl salicylate ointment p. 72
HA Makeen, SS Pancholi, HA Alhazmi, AA Ezzi, AJ A Hazzazi, AM Meraya
DOI:10.4103/jhs.JHS_14_18  
Background: Pharmacist in community pharmacy, hospital or nursing home may be left with only option of preparing extemporaneous formulation using traditional compounding techniques when none of the available commercial dosage forms is appropriate to meet the special needs of some special patients. It is essential to make available safe, effective and stable drug formulation that is well-tolerated by the patient of particular age and condition, but the biggest concern is quality, particularly the stability of extemporaneous preparations which are not subjected to testing like a product approved for market. Unavailability of stability data limits the availability of many medicines for special patients. Aim: The dermatological formulations constitute a large proportion of extemporaneously compounded drugs and condition at which such extemporaneous products shall be stored to maintain the quality of product until use needs to be determined. This research was undertaken to carry out the stability testing of extemporaneous methyl salicylate ointment to determine the shelf life. Materials and Methods: Methyl salicylate analgesic ointment prepared extemporaneously as per extemporaneous preparation manual of King Fahad Central Hospital, Jazan, was subjected to stability study at 25°C ± 5°C and 2°C–8°C for 120 days. Results: The shelf life (t90%) of extemporaneously prepared methyl salicylate ointment was found to be 131 days at room temperature (25°C ± 5°C) and 176 days in the refrigerator (2°C–8°C). Conclusion: The methyl salicylate present in extemporaneous ointment preparation is fairly stable at cool temperatures but shows faster degradation at higher temperature conditions. Therefore, it is recommended that an expiry date of 4 months can be safely mentioned when stored in cool.
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Herbal medicine use by Saudi patients with chronic diseases: A cross-sectional study (experience from Southern Region of Saudi Arabia) p. 77
Mushabab Ayed Alghamdi, Abdel Gaffar A. Mohammed, Fahad Alfahaid, Ali Albshabshe
DOI:10.4103/jhs.JHS_157_17  
Background: Herbal medicine use has become a popular treatment among patients with chronic diseases worldwide. Many patients with chronic illnesses use herbal medicine without consulting their healthcare professionals. Therefore, the primary aim of this study was to determine the frequency and correlates of herbal medicine use in Saudi patients with chronic diseases. The secondary aim was to explore how frequent patients with chronic illnesses consult their healthcare professionals for concomitant use of conventional treatment and herbal medicine. Materials and Method: A cross-sectional study conducted from December 2014 to January 2015 at King Abdullah General Hospital in Bisha. Adults aged > 18 years with chronic illnesses were enrolled in the study. The survey data form included demographic data and types of herbal medicines. Multivariate logistic regression was used to explore the effect of different factors promoting the use of herbal medicine. Results: Of the 235 patients who completed the data form, the prevalence of herbal medicine users was (67.65%), with Trigonella foenum-graecum (32.7%), Pimpinella anisum (19.49%), Nigella sativa (17.61%), Green tea (13.83%) and Peganum (5.66%) as the most frequently used. Nearly 88.67% of herb users did not consult their healthcare professionals. Almost 90.56% of healthcare professionals did not respond to herbs users' questions about herbal medicine. Patients with increased age and living in the urban area are likely to use herbal medicine with odds ratio (OR): 4.12, 95% confidence interval (CI): 1.94–8.74 and OR: 109.20, 95% CI: 31.88–374.02, respectively. Conclusion: This study revealed a high prevalence of herbal medicine use among patients with chronic diseases. More awareness and education about risks and complications of herbal medicine use are needed for both patients and healthcare professionals.
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Co-Morbidities in psoriatic versus non-psoriatic patients p. 82
Rana Omar Al Houssien, Afaf Al Sheikh
DOI:10.4103/jhs.JHS_89_17  
Background: Psoriasis is a chronic dermatological disorder which involves inflammatory and immune mechanisms. It affects the outer surfaces of the body including skin, hair and nails. It has been related to extracutaneous manifestations and systemic disorders. The aim of this study is to compare the chronic illnesses, including diabetes, hypertension, dyslipidaemia, hypothyroidism and abnormal renal and liver profiles, among patients with psoriasis and patients who had appendectomy. Methods: A case–control study took a place in Riyadh. It included a case group of psoriatic patients and a control group of appendectomy patients. Each one had patients from both genders of all age groups. Data were collected by reviewing patients' charts to obtain demographic information, blood pressure, blood glucose level, lipid profile, kidney function, liver function and thyroid function. Results: A total of 140 patients were included (74 males and 66 females). They have been divided into a case group of psoriatic patients and a control group of appendectomy patients, each had 70 participants. The mean age for both groups was 46 ± 18 and 41 ± 15 years, respectively. The proportion of psoriatic patients having diabetes (64%) was found to be higher than the proportion of control patients (46%) (odds ratio [OR], 2.85; 95% confidence interval [CI], 1.12–7.28; P = 0.03). Abnormal renal profile was significantly associated with psoriasis (21%) in comparison to control (3%) (OR, 12.74; 95% CI, 2.28–68.29; P = 0.004). Conclusion: Patients with psoriasis were found to have an increased risk of developing major co-morbid disorders including diabetes, liver and renal function profile abnormalities. This indicates the importance of checking if this group of patients have co-morbid disorders.
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CASE REPORT Top

Palliative sedation and ethical dilemma p. 87
Juri Salamah, Sami Ayed Alshammary, Stuart Brown
DOI:10.4103/jhs.JHS_21_18  
Palliative sedation is a unique concern for the patient as well as the family. It is a difficult serious ethical dilemma for the physicians to handle. The conflicting ethical principles of autonomy, beneficence and nonmaleficence in continuing versus discontinuing all supportive devices raise concerns among health professionals whether this is euthanasia (physician-assisted suicide) or is just prolonging the patient's unnecessary suffering.
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CASE REVIEW Top

A rare case of suicide attempt by subcutaneous self-injection of kerosene: A case report and review of literature p. 91
Fatimah Abdullah Alquraish, Mohammed Yousef Aldossary, Ahmed Mohammed Almuhsin, Omar Yousif Alkhlaiwy, Ahmed Mubarak Alghamdi
DOI:10.4103/jhs.JHS_156_17  
Kerosene is one of the most widely used sources of energy in developing countries. Modes of accidental exposure include inhalation, ingestion and through skin or eye contact. There have been few cases reported in literature where kerosene was injected intravenously and subcutaneously with differing outcomes ranging from mild irritation to serious necrotising fasciitis. It remains challenging to predict the outcome of patients who inject kerosene through a non-venous route as it is difficult to establish the accuracy of tissue layer affected by the injection. The aim of this study is to analyse all the case studies presented with attempt of suicide by self-injection of kerosene, to establish a method of management available in this rare presentation.
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Erratum p. 95

DOI:10.4103/2468-6360.229029  
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