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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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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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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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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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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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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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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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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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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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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This article discusses the observational analytic study designs, i.e., case–control and cohort studies. These two study designs are useful for testing a hypothesis to determine the association between a risk factor and a disease. The analysis for both the studies is based on the conventional 2 × 2 table with the disease status in columns and the risk factor status in rows. The case–control studies start from the disease status and compare the exposure to the risk factor(s) between the diseased (cases) and the not diseased (controls) groups. The odds ratio is determined to compare the proportion of exposed persons in the two groups. The cohort studies start from the exposure to the risk factor status and compare the incidence of the disease in the exposed and not exposed groups. The relative risk compares the incidence between the two groups. The 95% confidence interval is estimated for both studies to determine an actual association between the risk factor and the disease. The strengths and limitations of the two study designs differ based on the direction of the two designs. The case–control study goes backward from the disease status so is more useful for rare diseases and for evaluating multiple risk factors, but it cannot determine causality, and there are chances of recall bias affecting the results of the study. The cohort studies are generally prospective in design from the exposure status and can determine the causal association between the risk factor and the disease. However, the cohort studies are more expensive and require a longer time as well as a larger sample size; the loss to follow-up and misclassification biases can affect the results of the cohort studies.

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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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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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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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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 2^nd year to 4^th year nursing students. The respondents were the 2^nd to 4^th 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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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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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 (t_90%) 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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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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Background: Nursing research promotes optimum care for patients through evidence-based nursing practice. Students' attitude towards research motivates them to engage in research, develop research skills and apply research findings in clinical settings to promote positive patient outcome. Aim: The aim of this study is to analyse the attitudes of undergraduate nursing students towards research component in order to discover implications for the best practices in teaching/learning process. Materials and Methods: A descriptive, cross-sectional investigation was carried out with purposively selected n = 186, level 5–8 students at the College of Nursing-A, King Saud bin Abdulaziz University for Health Sciences, Al-Ahsa from 2016 to 2107. With informed, voluntary consent, data on students' attitudes towards research were collected using a self-administered questionnaire. The questionnaire consisted of 32 items on a Likert scale of strongly agree (4) to strongly disagree (1) with the scores ranging from 32 to 128. Analyses were performed using SPSS version 20. Results: The overall attitude towards research was positive with a mean score (68.4 ± 6.580). Most of the students (78%) regarded that research is useful for the nursing profession. Positive attitude towards research was demonstrated by 68% of the nursing students, 61% reported that research plays an important role in professional and personal life, whereas the highest proportion of students (71%) perceived research as a difficult, complicated, stressful subject and 64% reported statistical difficulty. Conclusion: Although many of the students have a favourable attitude towards the research process and acknowledge its usefulness and benefit to the nursing profession, many of them perceived their research course as stressful. Most of them reported having negative feelings and anxiety towards the research process. Incorporating research course(s) into the curriculum at the pre-university level and having a statistical expert from the research centre teach learning strategies, would yield more positive experiences for students.

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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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Context: Determining factors that influence medical students' choice in selecting their future careers are the key to achieving a balanced distribution of future doctors among all specialties. Aims: This study aimed to determine the factors associated with choosing Dermatology as a future career stream among medical students. Settings and Design: A cross-sectional study using consecutive sampling was carried out among Saudi medical students who were enrolled in King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) during the study. Subjects and Methods: A validated newly developed English questionnaire was sent via e-mail to 268 eligible students, of which 200 (75.3%) participated. Statistical Analysis Used: Categorical data were compared using Chi-square test and Fisher's exact test. All tests were two-sided, and P < 0.05 was considered statistically significant. Results: A total of six (3%) students were considering Dermatology as their first choice, while it was the second choice for seven students (4.7%). Of the participants, 118 (60.8%) found 'the difficulty of getting into a Dermatology residency programme' to be the least attractive factor. Factors that significantly attracted medical students to consider Dermatology as a career choice were the appeal of being a dermatologist, how dermatologists lead a satisfying family life, reliance on clinical diagnostic skills and research opportunities in Dermatology (P = 0.004, 0.024, 0.039 and 0.010, respectively). Conclusions: A variety of factors influenced the medical students of KSAU-HS when choosing a future specialty. Identification of these factors can help medical student mentors and residency training programme directors to motivate students choose specialties that are limited in our nation.

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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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