Objectives: This study investigates the relationship between the presence of non-functioning distractors (NFDs) and the difficulty index of multiple choice questions (MCQs). Materials and Methods: The number of NFDs and difficulty index were correlated for each MCQ of Family Medicine Examination, College of Medicine, King Saud University (KSU) in three consecutive years (2010, 2011 and 2012). Results: The MCQs with more NFDs showed high difficulty index as compared to MCQs having less NFDs. The pattern of increasing difficulty index was 1NFD < 2NFD < 3NFD. However, the MCQs with a lesser number of NFDs would not necessarily be always difficult. Conclusion: MCQs with a higher number of NFDs are easier than those with lower number of NFDs.

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Introduction: The purpose of this article is to provide a general understanding of the concepts of sampling as applied to health-related research. Sample Size Estimation: It is important to select a representative sample in quantitative research in order to be able to generalize the results to the target population. The sample should be of the required sample size and must be selected using an appropriate probability sampling technique. There are many hidden biases which can adversely affect the outcome of the study. Important factors to consider for estimating the sample size include the size of the study population, confidence level, expected proportion of the outcome variable (for categorical variables)/standard deviation of the outcome variable (for numerical variables), and the required precision (margin of accuracy) from the study. The more the precision required, the greater is the required sample size. Sampling Techniques: The probability sampling techniques applied for health related research include simple random sampling, systematic random sampling, stratified random sampling, cluster sampling, and multistage sampling. These are more recommended than the nonprobability sampling techniques, because the results of the study can be generalized to the target population.

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Introduction: Accreditation is necessary to maintain the quality of medical education. It requires official bodies to authorize the accreditation; recognized standards against which the medical school can be judged; and a robust process. Effects of accreditation: Accreditation may have positive effects on medical education. The impact of the publication of the General Medical Council recommendations in Tomorrow's Doctors provides a good example. In contrast, out-of-date requirements may inhibit developments in medical schools. Role of accreditation authorities: If accreditation authorities are to provide leadership in medical education they must undertake regular review of their standards. This should be informed by all stakeholders and include experts in medical education. The format of the standards must provide clear direction to medical schools. Accreditation should take place regularly and should result in the production of a publicly accessible report.

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Nurses constitute the greatest number of healthcare workers in the United States and globally. Increasingly, the role they play in meeting societal demands for safe, evidence-informed, quality care is being recognized. However, how they are educated around the world varies greatly. The purpose of the paper is provide a brief review of the evolution of nursing education in the United States and globally, describe the current and projected state of nursing education, and discuss some pressing challenges educators face as they strive to meet the charge to prepare nurses to care for more complex patients situated in ever-changing health-care systems.

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Context: While hypothyroidism is prevalent globally, there may be considerable variation in the use of therapies to treat this condition. Aims: The aim was to examine temporal trends of levothyroxine utilization in Canada, Greece, Ireland and the United States. Settings and Design: A cross-sectional, population-based time series study was conducted to assess monthly utilization rates from January 1, 2005 to September 20, 2011, in Canada, Greece, Ireland and the United States. The primary outcome measure was the monthly rate of levothyroxine utilization for each country analyzed. Materials and Methods: Levothyroxine utilization data were obtained from IMS Health Inc., and temporal trends in monthly units dispensed per 1,000 population were examined. Statistical Analysis Used: Time series analysis was used to examine temporal trends in levothyroxine utilization. Results: While levothyroxine utilization rates increased over time in all regions, considerable differences were noted between regions - 80% relative difference in average monthly utilization between the highest (Greece - 1,664 units/1,000 population) and lowest (Ireland - 925 units/1,000 population) utilization countries was observed. We observed a nearly 3.5-fold difference in utilization of moderate-to-high strength doses (100 μg+) of levothyroxine between the countries examined. Conclusions: We noted considerable regional variation in the use of levothyroxine. Further research is needed to understand the drivers of these variations in utilization rates.

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20-year-old male known case of type 1 diabetes mellitus (T1DM) presented to emergency department with vomiting and abdominal pain, and was diagnosed to have diabetic ketoacidosis (DKA). There was no obvious precipitating cause for DKA. Patient was started on DKA protocol and initially responded well to treatment. Later on, patient developed severe metabolic acidosis and chest pain. The cardiac evaluation established the diagnosis of acute pericarditis and ruled out acute coronary syndrome. The cause for his stormy coarse of DKA, and persistent tachycardia were further evaluated, and he was diagnosed to have concomitant thyrotoxicosis (graves' disease) complicating the DKA. He was successfully treated with aggressive management of DKA and started on thyrotoxicosis treatment. Autoimmune diseases are known to manifest in cluster but concomitant thyrotoxicosis precipitating DKA and causing acute pericarditis is rare. Prompt recognition of thyrotoxicosis in patients with persistent tachycardia, and treatment of thyrotoxicosis will improve outcome in DKA patients.

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An elderly male patient presented with fever and easy fatigability. On examination, no significant clinical findings were noted except for solitary cervical lymph node and hypopigmented patches over the trunk. On serial lab investigation, haemoglobin was found to be rapidly decreasing. Direct Coombs test was positive and diagnosed as autoimmune haemolytic anaemia (AIHA). Peripheral smear showed leukoerythroblastic blood picture. Skin and lymph node biopsy showed features suggestive of non-Hodgkins lymphoma (NHL). Herein, we present a rare clinical presentation of NHL as AIHA.

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Round worm or Ascaris lumbricoides has a worldwide distribution but is more prevalent in the developing countries like India and other South Asian countries. In human beings, round worms are commonly found in the small intestine, particularly the jejunum. If the pathogen load is very high, it may migrate to other sites and manifest different symptoms. In this paper, we share our experience of biliary ascariasis with regards to its clinical presentation, diagnosis, conservative and surgical management.

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Education and health are a fundamental human rights and not a privilege. They are the nation's instruments in generating a society that is knowledgeable, healthy, and innovative. Historical development of education and healthcare sectors in the Sultanate of Oman has experienced numerous reforms over the past 40 years. A main area targeted was embedding a culture of quality in higher education through assessments, quality audits, and by introducing a system of accreditation across the country. Specific to the Ministry of Health Education Institutes, the Ministry of Health (MOH) has taken active steps in fulfilling the requirements of meeting institutional audit, and thereafter prepare for health professions' education programme accreditation. This paper outlines the concept of quality in both the health and education sectors, with a focus on how the MOH in the Sultanate of Oman helped build a culture of quality across its health education sector and the steps taken by members of the health education institutes in embedding a culture of quality across all levels of health professions' education.

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Context: Schools are generally considered promising sites for drug prevention. Some countries such as the United States and United Kingdom widely provide drug education in schools. Aims: The main goal of this study was to evaluate the level of education related to drugs and their effects among students in secondary schools. The secondary goal was to determine the students' opinions on the efforts being made against drug abuse by different agencies in Saudi Arabia. Materials and Methods: This was a cross-sectional survey study. A total of 300 Saudi males from randomly selected secondary schools in Riyadh were given a questionnaire. The questionnaire contained 16 questions, assessing the students' knowledge about drugs and their effects. SPSS version 12.0 was used for data entry and analysis. Descriptive statistics and group comparison were generated. Results: Of the 300 students, the majority (39.3%) relied on friends as the main source of information while only 11.3% depended on schools for such information. Majority of the students (74%) judged the schools' efforts against drugs as poor while 14% assessed that schools made an excellent effort. For the questions of knowledge, final mean results were below 45%, indicating poor levels of knowledge related to drugs and their effects on the body. Conclusions: The general level of knowledge related to the types of drugs among secondary school students was at least very good compared to the poor level of knowledge related to effects on the body and dependency of drugs regardless of what the main source of information the students depended on. Friends should not be the main source of information in preference to agencies such as schools. Research in the area of drug abuse and education is limited, and studies are recommended to be conducted in Saudi Arabia.

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Introduction: The liver has been recognised as a major target of injury in patients with insulin resistance or metabolic syndrome. Non-alcoholic fatty liver disease is characterised by accumulation of hepatic fat in the absence of significant alcohol intake. Serum glutamic pyruvic transaminase (SGPT) appears to have a role in gluconeogenesis and seems to be more related to hepatic fat accumulation than serum glutamic oxaloacetic transaminase (SGOT). Materials and Methods: One-hundred previously diagnosed patients of controlled (HbA1c < 7%) and uncontrolled (HbA1c > 7%) diabetes with fatty liver, diagnosed by ultrasound, were taken and their liver function test (LFT) plus glycated haemoglobin were estimated. One-hundred diagnosed cases of controlled and uncontrolled diabetes without fatty liver and normal controls were taken and LFT was done. Result and Discussion: Serum bilirubin, serum albumin, and alkaline phosphatase were within normal range in all the diabetic cases and control. The SGOT was not significantly raised in diabetics. The SGPT was raised in diabetics without fatty liver as compared to normal controls, but not significantly raised and was within normal limits. However, the SGPT was raised significantly in diabetics with fatty liver (P < .001) irrespective of their controlled and uncontrolled nature but did not correlate with HbA1c. Study showed high level of SGPT in diabetics with fatty liver (55 ± 18) as compared to the normal diabetics (29.5 ± 6.61) and control (25.6 ± 6.1). Conclusion: Non-alcoholic fatty liver disease has been consistently associated with insulin resistance and hyperinsulinaemia. This has raised a concern that treatment with insulin in type 2 diabetes may aggravate liver disease. Routine monitoring of LFTs in patients with type 2 diabetes should be done at the start of drug therapy and in patients if symptoms develop raising concern about hepatic impairment.

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