Objectives: The aim of this study was to assess current situations in small size hospitals regarding knowledge of staff, their attitude and practice of quality standards, in order to set a plan to improve the current situations and overcome barriers of quality practice. Materials and Methods: A descriptive cross-sectional research was conducted by a validated self-administered questionnaire using systematic random technique. Results: The study included about 37.7% Physicians followed by 28.3% nurses, and 18.8% administrators. Median percentage of participants' knowledge and attitude scores regarding healthcare quality was 48% and 80% respectively. Meanwhile, the median percentage of participants' perception toward hospital support and implementation of healthcare quality was 54% and 50% respectively. The main barriers for quality standards implementation and practicing were; staff resistance (84.8%) followed by deficient knowledge (81.1%). Knowledge showed significant positive correlation with hospital application of quality standards (P = 0.001). Conclusion: The researcher concluded that improvement of knowledge and attitude toward implementation of quality standards as well as leadership commitment to quality and change management were a critical element for organisational shifting transformation to implementing quality of care. Focusing on small hospital and providing more support with all resources for implementation of quality standards through proper education and training for all staff categories are highly recommended.

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Context: There are accumulating evidences that the metabolism of several trace elements might have specific roles in clinical disorders and the pathogenesis of many diseases, such as diabetes mellitus (DM) and hypertension (HT). Objectives: To validate the analytical procedure and compare the levels of Cd, Cr, Cu, Pb, and Zn in scalp hair (SH) and fingernails (FN) of patients. Furthermore, to prove that human tissues such as hair and nails are useful in the studies pertaining to chronic body exposure and good biomarkers in clinical studies. Setting and Design: Inductively coupled plasma optical emission spectroscopy operating conditions were carefully selected and well-optimised in order to maximise the sensitivity for the desired elements and to obtain the best precision and accuracy. Factors affecting analytical and biological variability of the concentrations under study were discussed and carefully optimised. Materials and Methods: Totally, 160 samples of SH and 130 FN were collected from occupants of urban population from different districts adjacent to Taif city, Kingdom of Saudi Arabia. Different analytical procedures were investigated, and the most reliable one was developed and validated. Method Validity: The validity of the method was checked by standard addition method. The recoveries were in the range of 96.2-105.7%. Results: Cd, Cr, Cu, and Pb levels in SH were significantly higher in DM and HT compared to control groups, whereas, Zn was significantly lower. Cd and Pb levels in FN were significantly higher in DM and HT, whereas, Cr and Zn were lower, and Cu was in the same levels as compared to the control group. Conclusion: These findings may be consistent with those obtained in other studies, confirming that the deficiency and efficiency of trace elements play a role in clinical disorders and the pathogenesis of many diseases.

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This paper outlines the primary steps required in developing a simulation curriculum. We examine forms of simulation in postgraduate training, instructional design models, learner assessment, and modular pattern of postgraduate simulation curriculum. Further, we provide examples of how each of these components are practically described in the literature and applied at the Center for Research, Education, and Simulation-Enhanced Training.

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An 11-month-old infant presented with scrotal migration of the catheter from a ventriculoperitoneal shunt manifesting as left scrotal swelling. Surgical obliteration of the patent processus vaginalis that forms a corridor from the peritoneal cavity to the scrotum was performed on both sides to avoid future shunt herniation. Patent processus vaginalis and small peritoneal cavity probably contributed to the scrotal catheter migration.

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Background: As hematologists teaching in a residency program, we have been constructing lesson plans for residents. In this article, we describe a lesson plan based on Gagne's events of instructions for interpretation of peripheral blood films. Context: Instructional design can be defined as a process through which the character of learning is identified and intended to take place with an approach to the development of teaching and learning methods. Gagne suggested a hierarchy for learning tasks according to the complexity. The main role of the hierarchy is to identify prerequisites that must be completed in order to facilitate learning at each level. The theory emphasizes the point that it is important to teach with a clearly laid plan, to establish course goals early on and design the course with these objectives and outcomes in mind. Innovation: We present here a lesson plan based on Gagne's nine events of instruction in postgraduate haematology residency training program. Each step of Gagne's nine events of instruction is explained stepwise in the teaching of peripheral blood film interpretation sessions. Implications: We have found that Gagne's principles can be used in postgraduate residency and fellowship teaching, and it improves the teaching and learning process by having a structured lesson plan.

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Cystic meningiomas are rare variants of meningiomas; they can pose a radiological as well as histopathological diagnostic dilemma. Leaving behind cystic components at surgery can lead to recurrence of a potentially curable tumour. Cyst will certainly affect the surgical strategy and outcome of these patients, therefore, recognition of this entity and keeping it as a differential is important in making surgical decisions. Here, we discuss 48-year-old female who presented to us with recurrence of left frontotemporal intra-axial tumour according to her previous records as well as new confusing computed tomography and magnetic resonance imaging done after her admission to our institution. The final diagnosis confirmed by intraoperative findings as the tumour was atypical extra-axial dural based cystic meningioma.

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Hepatobiliary surgery has taken a big step forward in recent decades especially in the minimally invasive approach for hepatectomy. From being sceptical at the beginning of the 1990s when laparoscopic surgery had become prevalent, to now, where laparoscopic hepatectomy has been well-established, especially in minor hepatectomies; this new technique has evolved rapidly over the past 20-years demonstrating better short-term outcomes and equivalent oncological outcomes in selected patients and in expert hands. Laparoscopic hepatectomy is indeed, more difficult to master than the open procedure with restrictions in working space, difficulty in haemostasis and the potential risk of gas embolism. However, with better visibility of the operative field around the liver, especially beneath the costal margin, the magnified view and theoretical advantage of pneumoperitoneum acting as haemostatic pressure have made laparoscopic hepatectomy increasingly popular. Another important advancement is the new surgical technique of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). This procedure induces more rapid liver hypertrophy within a median period of 9-days, allowing resection to be performed in candidates with borderline functional liver remnant and at an earlier date. However, studies have shown that ALPPS is associated with a relatively higher rate of morbidity and mortality. Therefore, it remains a highly controversial treatment option and more studies have to be performed to establish its usefulness and define its role in liver surgery.

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Postgraduate medical education for technical skills had been completely informal - until the introduction of simulation technologies and methodologies. Adaptation of over 90 years' experience in other fields (military, aviation, astronauts, nuclear industry, etc.) proved simulation's value and has begun the adoption and adaptation by healthcare. The rationale and evidence for implementing simulation technologies into healthcare are reviewed.

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Background: Shortage of psychiatrists is a worldwide phenomenon. If the factors that attract or repel students towards a specialty can be identified, it may be possible to encourage them towards it. Choice of specialty as a career depends on the complex interplay of experiences before, during or after exposure to the specialty. Objectives: The aim was to understand perceptions of 1 ^st year medical students regarding career choices and the specialty of psychiatry through a cross-sectional questionnaire-based study. Materials and Methods: Perceptions of 137 1 ^st year medical students from the Government Medical College were recorded using a semi-structured questionnaire. Students provided their opinions about future career choices; perspective of these specialties in terms of financial reward, reputation, work-life balance, challenging aspect, ability to help patients effectively and emotional stability; their preferences in life and interaction with psychiatrist and its impact. Statistical Analysis Used: One-way analysis of variance (ANOVA) with post-hoc analysis by Tukey-Kramer test. Results: Surgery was a high priority for 69 (50%) while psychiatry was a high priority only for 11 (8%). Surgery was highest for financial reward and reputation, but lowest for work-life balance. Psychiatry had higher emotional stability, however, its the reputation was lower than surgery, medicine, obstetrics and gynaecology and paediatrics. Students preferred reputation (41%) over social service opportunities (43%), work-life balance (16%), and high-income (11%). Interaction with psychiatrist increased inclination for psychiatry in 69% (9/13) students. Conclusions: Psychiatry is not a preferred specialty among 1 ^st year medical students due to its poor reputation.

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