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Sample size estimation and sampling techniques for selecting a representative sample
Aamir Omair
October-December 2014, 2(4):142-147
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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Selecting the appropriate study design for your research: Descriptive study designs
Aamir Omair
July-September 2015, 3(3):153-156
This article describes the importance of selecting the appropriate epidemiological study design for a given study question. It provides an explanation to the different terms used in describing study designs with regards to observational versus interventional and descriptive versus analytical types of study designs. This article focuses on the description of the different types of descriptive study designs, that is, case report, case series, correlational, and cross-sectional study designs. The requirements for selecting these study designs are discussed along with the advantages and disadvantages of each study design. The descriptive studies are similar in the context that they are based on a single sample with no comparative group within the study design. Their basic purpose is to describe the characteristics of the sample with regards to the characteristics that are present and so are useful in generating a hypothesis. The absence of a comparative group is the main limitation of the descriptive studies, and this is the reason they cannot be used to determine an association by testing a hypothesis showing a relationship between a risk factor and disease. The analytical study designs will be discussed in the next article in this series.
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Segmented and sectional orthodontic technique: Review and case report
Tarek El-Bialy
May-August 2013, 1(2):90-96
Friction in orthodontics has been blamed for many orthodontic-related problems in the literature. Much research as well as research and development by numerous companies have attempted to minimize friction in orthodontics. The aim of the present study was to critically review friction in orthodontics and present frictionless mechanics as well as differentiate between segmented arch mechanics (frictionless technique) as compared to sectional arch mechanics. Comparison of the two techniques will be presented and cases treated by either technique are presented and critically reviewed regarding treatment outcome and anchorage preservation/loss.
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Palliative management of intractable hiccups in a patient with an advanced brain tumour
Sami Ayed Alshammary, Balaji P Duraisamy, Lobna M. A. Saleem, Luma Al Fraihat, Abdullah Altamimi, Stuart Brown
October-December 2016, 4(4):294-296
Intractable hiccupping is distressing for both patients under palliative care and their families, particularly if the patients have advanced cancer. The lack of clear management guidelines renders hiccup management challenging for health professionals. We report our management of intractable hiccups in a 70-year-old man with a progressive malignant brain tumour who was under palliative care. The hiccups were difficult to control; several drugs were tested before we finally introduced (and upwardly titrated) gabapentin, which appears to be safe when used to manage intractable hiccups.
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Palliative care in Saudi Arabia: Two decades of progress and going strong
Sami Ayed Alshammary, Alsuhail Abdullah, Balaji P Duraisamy, Mahmoud Anbar
April-June 2014, 2(2):59-60
Palliative care is a relatively new medical speciality in Saudi Arabia, but it has shown tremendous growth in the last two decades. Nevertheless, there are challenges to this development. The paper reviews these barriers in context of the growing need for palliative care and possible ways to overcome these challenges.
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An overview of nursing in Saudi Arabia
Mansour Saleh AlYami, Roger Watson
January-March 2014, 2(1):10-12
Achieving and maintaining a stable nursing workforce is an important issue for the well-being of the rapidly growing population of Saudi Arabia. However, high turnover of expatriate staff and low recruitment of Saudi nationals have led to a serious staff shortage in the professions, particularly of well-qualified and experienced nurses. Nursing leaders need to work to improve the image of nurses and facilitate the recruitment of women into the nursing profession. Reduced working hours and part-time contracts with increased salaries and benefits could attract more young women to the profession, as might the provision of facilities such as private transportation and on-site childcare. Furthermore, establishing a national association for nurses would advance the nursing profession and help to ensure that all nurses undertake fully comprehensive training before entering the workforce.
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The criteria of constructive feedback: The feedback that counts
Ahmad AbdulAzeem Abdullah Omer, Mohhamed Elnibras Abdularhim
January-March 2017, 5(1):45-48
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Design of ultra-stable insulin analogues for the developing world
Michael A Weiss
May-August 2013, 1(2):59-70
The engineering of insulin analogues illustrates the application of structure-based protein design to clinical medicine. Such design has traditionally been based on structures of wild-type insulin hexamers in an effort to optimize the pharmacokinetic (PK) and pharmacodynamic properties of the hormone. Rapid-acting insulin analogues (in chronological order of their clinical introduction, Humalog ® [Eli Lilly & Co.], Novolog ® [Novo-Nordisk], and Apidra ® [Sanofi-Aventis]) exploit the targeted destabilization of subunit interfaces to facilitate capillary absorption. Conversely, long-acting insulin analogues exploit the stability of the insulin hexamer and its higher-order self-assembly within the subcutaneous depot to enhance basal glycemic control. Current products either operate through isoelectric precipitation (insulin glargine, the active component of Lantus ® ; Sanofi-Aventis) or employ an albumin-binding acyl tether (insulin detemir, the active component of Levemir ® ; Novo-Nordisk). Such molecular engineering has often encountered a trade-off between PK goals and product stability. Given the global dimensions of the diabetes pandemic and complexity of an associated cold chain of insulin distribution, we envisage that concurrent engineering of ultra-stable protein analogue formulations would benefit the developing world, especially for patients exposed to high temperatures with inconsistent access to refrigeration. We review the principal mechanisms of insulin degradation above room temperature and novel molecular approaches toward the design of ultra-stable rapid-acting and basal formulations.
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Knowledge, attitude and intention towards nursing profession among pre-clinical students
Wajed A Hatamleh, Erik Hans L Sorio
July-September 2017, 5(3):135-141
Context: In Saudi Arabia, there is still an insufficient supply of nursing graduates to meet the growing demand for nurses to provide patient care. Aims: The aim of this study was to further investigate on the knowledge, attitude and intention towards nursing profession among pre-clinical students. Settings and Design: A descriptive-correlational design was used in this study with a total of 128 pre-clinical male and female students from a nursing school in Riyadh. Subjects and Methods: Data were obtained using an adopted survey instrument for describing the knowledge, attitude and intention among the participants. In the last two parts of the instrument, the participants answered the questions using 5-point Likert scale. Statistical Analysis Used: Data were analysed using SPSS version 20.0. Descriptive statistics was utilised to describe the variables and Chi-square to show correlation between variables. Results: In general, the participants had good knowledge of the nursing profession and a majority of the students disagreed that nursing is a job for females only. However, about 60% of the participants were not interested to study nursing. Conclusions: The findings concluded that working with the opposite sex and people not respecting the nursing profession were found to have the highest influence in preventing the students from becoming a nurse. Moreover, positive attitude towards nursing would significantly result in students becoming more interested to the profession.
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Nursing education: The past, present and future
Karen H Morin
October-December 2014, 2(4):136-141
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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Strategic approaches to simulation-based education: A case study from Australia
Debra Nestel, Marcus O Watson, Margaret L Bearman, Tracy Morrison, Shane A Pritchard, Pamela B Andreatta
January-April 2013, 1(1):4-12
This paper addresses some of the challenges met when developing widely distributed, broad spectrum, simulation-based education (SBE) for health professionals, such as resource duplication, inconsistent facilities utilization, discipline-specific silos, and the intersection of academic institutions and health services sectors. We examine three primary contributors to successful simulation-based practices - strategic planning, program development, and professional networks. Further, we provide examples of how each of these contributors function at different levels to assure comprehensive, yet sustainable approaches to implementing SBE for greatest impact at national, state, regional, and institutional levels. We draw on the example of Australia and its state and regional government structures, including the challenges in providing health services across a widely variable geography and population distribution. The types of health services and issues relating to health provision and management reflect those found in many western countries. Our hope is that the experiences gained at each level of governance within Australia may inform similar, successful development in other countries. We emphasize the importance of leadership and investment at the national level that serves to inform state, regional, and institutional efforts through a "trickle down" effect. Although evaluation of the strategic planning, program development, and professional networks described in this case study is still ongoing, their preliminary coordination has resulted in significant investment and support at all levels.
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2 nd SCHS International Conference 2015 Saudi Commission For Health Specialities

April-June 2015, 3(2):75-135
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Nursing research in the 21 st century
Roger Watson
January-April 2013, 1(1):13-18
Aim: To explore the development of nursing research and provide some examples of research relevant to clinical practice. Background: Nursing research developed in the last century as did nursing theories and models. However, nursing research does not have the same high profile as, for example, medical research and has tended to lag behind medical, and other forms of research, in terms of funding and in the apparent impact it has on clinical practice. Design: Discussion paper. Methods: Using a popular nursing model based on activities of daily living, nursing research that is relevant to these activities of daily living is explored and exemplified using a few key examples. Some of these examples are historical and some are current. Conclusion: Nursing research has developed greatly over the past century and continues to develop in the 21 st century. Nursing research is relevant to the needs of patients and has had an impact on clinical practice.
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Expected benefits of clinical practice guidelines: Factors affecting their adherence and methods of implementation and dissemination
Saja H Almazrou Mazrou
September-December 2013, 1(3):141-147
The aim of this paper was to determine the expected benefits of clinical practice guideline implementation, discuss the criteria of a successful clinical guideline, explore the common factors that affect the adherence to their implementation and finally to identify the widely used guidelines dissemination methods.
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Interval between first palliative care consultation and death among patients in a comprehensive cancer center in Saudi Arabia
Sami Ayed Alshammary, Abdullah Alsuhail, Balaji P Duraisamy, Saad Hamad Alabdullateef, Savithiri Ratnapalan
April-June 2015, 3(2):61-66
Introduction: Palliative care is a multidisciplinary approach that aims to improve the quality of life of patients with life-threatening illnesses. It has been recognized as a crucial part of patient care in oncology. Palliative care service was established in the comprehensive cancer center of King Fahad Medical City (KFMC), Riyadh, Saudi Arabia in March 2010. The objective of this study was to determine the interval between the first palliative care consult (PCC1) and death, and explore the possible cause of suggestive short timeframe between PCC1 and death. Patients and Methods: This study included 210 cancer patients who had their PCC1 in KFMC within the period of March 2012 and March 2014. Demographic information, cancer diagnosis, date of cancer diagnosis, reason for referral, all symptoms reported in Palliative Care Unit, and date of death were gathered from the patients' charts. The interval between the PCC1 and death were computed and analyzed. Results: Of the 210 patients, 121 (57.6%) were female, 127 (60.5%) were <60 years old, and 190 (90.5%) had non-haematological tumours. The main reasons for referral were symptom control (62.4%), symptom control and end of life (EOL) care (12.4%), symptom control and transfer of care (11.4%), and EOL care (8.6%). The median interval between PCC1 and death, diagnosis to PCC1, and diagnosis to death intervals were 19, 212, and 360 days, respectively. Patients diagnosed with haematological tumours were referred relatively earlier to palliative care. The difference in the mean (haematology > non-haematology) for the interval between PCC1 and death was 146.2 days (P < 0.001). Conclusions: Late referrals to palliative care services KFMC is the strongest predictor of the short interval between PCC1 to death of advanced stage cancer patients. Identifying the potential cause of the late referrals can lead to developing optimal policies for the timely referral of cancer patients to palliative care upon diagnosis regardless of the stage of their disease. Education and advocacy are needed among the referring oncologists in the cancer center for earlier access to palliative care. Future studies are needed to establish the appropriate timing of the PCC1.
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The role legitimacy of nurses in Saudi Arabia
Ameera Mohammed Aldossary
January-April 2013, 1(1):28-37
Context: Nationally, there is no clear scope of practice for nurses working in Saudi Arabia identifying their role legitimacy as the Nursing Board in the Saudi Commission of Health Specialties has not yet formalized a scope of nursing practice. Role legitimacy can be identified either by a supervisory body or by an agreement that may exist among individual groups. Aims: This study aimed to identify nurses' role legitimacy in Saudi Arabia from the view of nurses, doctors, and patients. Settings and Design: A large survey was undertaken in 2008 in 10 hospitals located in the Eastern Province of Saudi Arabia related to three major healthcare sectors (government, military, private). Materials and Methods: A quota sample of nurses (n = 614, RR = 61.4%), doctors (n = 130, RR = 26.0%) and patients (n = 322, RR = 64.4%) was undertaken, utilizing a self-administered questionnaire that drew upon the King's Nurse Performance Scale. Statistical Analysis Used: A descriptive analysis was undertaken, using the Chi-square test to compare the views of the participants. Results: The domains of physical care, professional aspects and care management formed a major focus of the nurses' role, with no evidence of role legitimacy regarding the psychosocial and communication aspects of patient care. Conclusions: There was a traditional view of the nurses' role within acute care delivery which will need to be addressed if nurses are to contribute significantly to promoting the health of people in Saudi Arabia.
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Continuing medical education in Saudi Arabia: Experiences and perception of participants
Mohammad A Alkhazim, Alaa Althubaiti
January-March 2014, 2(1):13-19
Introduction: Continuing medical education (CME) is important in developing competencies of medical practitioners with all the different influencing factors that have impact on their opinions and preferences. Despite the broad range of work on CME, very few studies have examined participants' opinions and attitudes towards CME. However, understanding them is critical in improving the practice of CME. Purpose: The purpose of this study was to explore attendees' perception of CME in Saudi Arabia regarding the different aspects of its practices and preferences. Materials and Methods: A survey composed of demographic questions, frequency of reading habits and 24 other related items was developed for CME participants. Participants were asked to indicate the extent to which they agreed or disagreed with each of the 24 items on a 5-point Likert scale. In total, 601 surveys were analysed. Results: The response to each item in the questionnaire was compared on the basis of demographic variables. The results showed that healthcare practitioners acknowledged the importance of CME in improving their knowledge, attitudes, clinical and academic skills, as well as improve their clinical practice outcome. Differences of opinion were categorised by gender, profession, nationality and age. Conclusion: The study showed that opinions related to CME varied among different disciplines and nationalities. Moreover, it raised questions related to the system of sponsoring participants to attend CME events and its consideration for ethical issues. There is a need to embed the concept of lifelong learning into the education of basic health professions. In addition, the policies related to sponsoring and accrediting CME in Saudi Arabia should be improved. We recommend further research into this matter.
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Knowledge, attitude and practice of breast self-examination among females in medical and non-medical colleges in Qassim University
Safiya K Ibnawadh, Mashael A Alawad, Shorouq S Alharbi, Nada A Alduawihi, Feda S Alkowiter, Anfal E Alsalhy, Ameerah A Alzahrani, Lamia A Alenizy
October-December 2017, 5(4):219-224
Aims: The objective of this study was to investigate any difference between females in medical and non-medical colleges for (1) knowledge and attitude of breast self-examination (BSE) and (2) practice of BSE. Subjects and Methods: A cross-sectional study was conducted in Qassim University during 2014-2015. Cluster random sample method was used. The sample size consisted of 365 females. A confidential and self-administered questionnaire was used to collect data. Results: Age range of the study participants was from 18 to 55 years, with a mean of 20.3 years. Moreover, 11% of the subjects had positive family history of breast cancer. Regarding their knowledge levels about BSE, 95.8% of medical students had heard of BSE in comparison to 93.3% of non-medical students. Social media was the most commonly reported source of BSE information (50.14%). We found that 49.7% of medical students had carried out BSE previously in comparison to 35.71% of the non-medical students. Conclusions: Both medical and non-medical students showed lack of knowledge in BSE and even though their attitude towards it was positive, medical students had a better attitude towards it. Moreover, regarding the practice, the percentage of medical students who perform BSE was higher than that of non-medical students.
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Knowledge, attitude and practice of tobacco smoking among health colleges' students at Najran University, Saudi Arabia: A cross-sectional descriptive study
Jobran Miree AlQahtani
January-March 2017, 5(1):35-41
Objectives: To assess the prevalence of tobacco smoking among health colleges' students at Najran University, and to investigate the students' attitude, practice and knowledge towards smoking and its risks. Settings and Design: A cross-sectional descriptive study was conducted at Najran University during the month of March 2014. Subjects and Methods: A pre-tested validated questionnaire based on the Global Adult Tobacco Survey was answered by 433 students (226 males and 207 females). Results: The prevalence of current cigarettes smokers was 30.1% for males and 0.5% for females (P < 0.001). For males, the prevalence of shisha smoking, snuff and smokeless tobacco usage was 28.3%, 16.8% and 14.6%, respectively. Applied medical sciences college's students had the highest prevalence (72%) of smoking, compared to 4% only at the college of medicine. Females had a better knowledge than males regarding the hazardous effects of smoking on health (87.1% vs. 99.5%; P = 0.007) and as a risk factor of brain thrombosis (67.2% vs. 94.2%; P = 0.001), heart attack (78.3% vs. 95.7%; P = 0.005) and lung cancer (82.3% vs. 99.5%; P = 0.001). Male and female students believed smokeless tobacco and shisha smoking are less harmful (59.7% vs. 30%; P = 0.001 and 38.5% vs. 7.7%; P = 0.001, respectively). Conclusions: Our results highlight the importance of initiating on-campus managed tobacco dependence treatment clinics to provide professional help for students to quit smoking. The results of this study can be used as a basis for the development of tobacco education programmes at Najran University and elsewhere.
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Tuberculosis diagnosis: Challenges and solutions
Sophie Huddart, Madlen Nash, Madhukar Pai
October-December 2016, 4(4):230-237
More than 9 million people develop tuberculosis (TB) every year, but nearly a third are not diagnosed or not reported. The current diagnostic tools available range from a 100-year-old microscopy technique to the newest generation automated nucleic acid amplification tests, but they alone are not sufficient to ensure that we meet the goals of the end TB strategy. Several new TB tests are under development. As new diagnostics are developed, it is critical that we understand the particular challenges that arise in TB diagnosis, and ensure that existing tools are implemented correctly. We must encourage the development of diagnostics that meet the specific needs of the TB community as well as ensuring that new technologies are accessible to low- and middle-income countries. Finally, strong policy guidance is required to ensure that new and existing diagnostics are used as efficiently as possible. With this co-ordinated approach, new diagnostic tools can be the cornerstone of the effort to end TB.
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Global non-communicable disease prevention: Building on success by addressing an emerging health need in developing countries
Ali H Mokdad
April-June 2016, 4(2):92-104
Non-communicable diseases (NCDs) are beginning to dominate the global health landscape. Despite numerous calls to action for chronic disease preventive and control, the response to the urgency is insufficient, especially in terms of their prevention efforts. Worldwide, the total number of people dying from NCDs is twice that of the combined total of all infectious diseases (including HIV/AIDS, tuberculosis and malaria), maternal and perinatal conditions and nutritional deficiencies. Cardiovascular disease is the leading cause of death in the world and accounts for about 30% of all deaths. Increased interventions in global NCDs prevention and control programs are needed as a global strategy to improve the current scenario. Specifically, we present this case for the United States to provide leadership in global NCD prevention and control.
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Test blueprinting for multiple choice questions exams
Imran Siddiqui, James Ware
July-September 2014, 2(3):123-125
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The selection of graduates for residency training and the research that is needed
James Ware, Mohammed Al Sultan
October-December 2015, 3(4):189-190
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Review of management of pruritus in palliative care
Sami Ayed Alshammary, Balaji P Duraisamy, Abdullah Alsuhail
January-March 2016, 4(1):17-23
Pruritus or itch is an uncommon symptom observed in palliative care, even more uncommon in cancer patients. However, if a patient experiences pruritus, the 'itch-scratch' cycle can damage the skin integrity and can increase the susceptibility of patients to infection owing to their frail immune system. The outcome can be very distressing, dramatically impacting the quality-of-life of the patient. Moreover, since severe pruritus seen in patients with advanced disease can be associated with failure of different organ systems, pruritus must be assessed based on the underlying organ systems and the pathophysiology involved. Regardless of the cause of pruritus, general skin care is important. Depending on the origin of pruritus, specific approach and medications must be considered. Caution must be taken during management of pruritus since most cancer patients take pain medications that interact with some antipruritic medications. In addition to the complex and unclear nature of cutaneous and central pathogenesis of pruritus, treatment of pruritus is challenging.
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The perfect MCQ exam
James Ware, Thuraya Essam Kattan, Imran Siddiqui, Ahmed M Mohammed
July-September 2014, 2(3):94-99
Aims: The Saudi Commission for Health Specialties' question banks for licensing international medical graduates and certifying Saudi trained residents are currently being upgraded. The process is briefly explained with the justification for the developments made to all the banks over the last 3 years. A process of quality assurance has been introduced to ensure the banks are maintained at the highest standards and procedures that are fit for purpose introduced for the management of test results. Results: An analysis of 16 undergraduate exams shows a sigmoid relationship between mean test scores (MTS) and numbers of functioning distractors. Sixteen computer-based Saudi Licencing Exam (SLE) banks were also analyzed to determine the mean MTS for all, 52.3 ± 7.88, which justifies the use of four option items and also validates the quality of the exams with a majority of items falling within the desired range of medium difficulty to obtain the highest reliability. Conclusion: The Saudi Commission believes that it is achieving increased quality in all aspects of test measurement and would hope that over the next 3 - 5 years achieve levels of excellence for all aspects of it licensing and certifying assessments.
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