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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Aims and objectives: Evisceration of the abdominal parts following traumatic injury with high velocity impact is a rare entity. We are reporting five cases of high velocity injury with different findings. Our objectives are to present the potential clinical impact of injury and requirement of early management. Materials and Methods: The present study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar University, Mullana, from March 2010 to March 2013. A total of 150 cases were admitted, diagnosed with blunt and penetrating abdominal wall injury. We are presenting five cases diagnosed as eviscerated abdominal injury. Ultrasonography (USG) and computed tomography was done which helped us in their management. Results: A total of five cases were admitted with evisceration of the abdominal parts. One case presented with a rare finding as the stomach and intestine were lying outside and on surgery, multiple perforations of the small intestine were seen. Ultrasonography and computed tomography (CT) helped in the management of the patient. Conclusion: High velocity impact due to road side accidents can lead to severe abdominal organ injury or evisceration of the abdominal parts. It can cause morbidity and mortality, if not treated on time. USG and CT scans are the important diagnostic tools for diagnosing and preventing further complications. We came out with better prognosis as cases were operated on time. We treated the patients successfully without any mortality.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

The Kingdom of Saudi Arabia (KSA) has experienced rapid growth in its healthcare system, leading to an influx of many foreign professional nurses in the healthcare workforce. This increasing trend of foreign professional nurses into the KSA healthcare system has serious implications such as cultural, language and communication barriers that in turn have the potential to compromise the ability to ensure quality of care to Saudi patients. KSA is a conservative Islamic country that is guided by strict adherence to a religious belief that if foreign nurses are not sensitive to or understand their Saudi patients, it may interfere with their ability to communicate effectively. This paper examines the language and communication barriers within the KSA healthcare systems and how such barriers have the potential to compromise the quality of care. The paper concludes with strategies and recommendations related to addressing language and communication barriers within the KSA healthcare system.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Medical leadership and management are increasingly receiving widespread attention internationally. Significant focus has been paid as to the style of leadership within healthcare and how to develop both leadership and management skills and competencies (the two are inseparable yet distinct) throughout the careers of all healthcare professionals. This article discusses how leadership and management development is being considered internationally, both at an organisational and personal level, helpful models and frameworks and challenges and opportunities.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Introduction: The aim of the proposed system is to give students a flexible, realistic, and interactive learning environment to study the physical limit of different postures and various imaging procedures. The suggested system will also familiarise the students with various imaging modalities, the anatomical structures that are observable under different X-ray tube settings and the quality of the resulting image. Current teaching practice for radiological sciences asks students to simulate the imaging procedure in role plays - consisting of one student as a patient and the other as the radiologist. Other ways include the use of a physical phantom consisting of bone and soft tissue equivalent material but in either way X-ray has to be used with all the requirements of such an examination room shielding, lead apron, and other radiation protection procedures. Proposed System: The proposed system has several physical components and virtual components. Students manipulate the mannequin into the model of the imaging modality and in a posture suitable for the purpose of the imaging study. The virtual components of our simulation system include a posture interface, a computational phantom generator, and a physics simulator. The synthetic image will be produced and conformed to the Digital Imaging and Communications in Medicine standard so that it can be stored, retrieved, and displayed in a standard picture archiving and communication system that hospitals use. Conclusion: The suggested system will familiarise the students and improve their competency level, not only for X-ray but various other imaging modalities, including the anatomical structures that are observable under different X-ray tube settings and the quality of the resulting image.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: This is an analysis of medical litigations in Saudi Arabia from closed medical claims referred to the Legal Health Organization (LHO) from various provinces of the Kingdom. Methods: A pre-designed data collection sheet from the annual official reports of the LHO over the period of 1999-2013 was used. Data were analysed to study the trend of parameters simultaneously, along with a comparison of incidence in different medical specialties and facilities. Results: This showed a substantial increase in the number of claims over the study period of 15 years (1999-2013). The final findings of guilt, on the contrary, showed a decreasing trend despite increased number of claims. Conclusion: Quality of care for patients has definite international standards, which when implemented effectively will alleviate the incidence of medical malpractice to a great extent, thereby improving Medical Professional Liability.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable severity with onset of first recognition during pregnancy. GDM occurs in at least 30% of women with a family history of T2DM/GDM, suggesting that some women are genetically predisposed to develop GDM. Phosphatase and tensin homolog (PTEN) on chromosome 10 is a tumor-suppressor gene. Studies have demonstrated that PTEN dysfunction affects the function of insulin. However, the relationship between GDM and PTEN has not been studied. The aim of the present study was to investigate the relationship between PTEN and GDM in Asian Indian women. The case-control study used PCR-RFLP analysis to assess the PTEN−9C/G polymorphism in 150 GDM cases and 150 controls (non-GDM). No alleles or genotypes were detected at statistically significant frequencies. All subjects were normal, and no variants were detected in any of the pregnant women. In conclusion, PTEN has no role in GDM, consistent with previous studies.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background and Objective: To describe the clinical presentation, surgical intervention and treatment, complications, tumour histopathology characteristics, follow-up and survival of 23 patients at or below the age of 21 at the time of diagnosis of differentiated thyroid carcinoma (DTC) diagnosis. Materials and Methods: A retrospective medical chart review of 23 patients diagnosed with DTC and treated in our institute from January 2003 to December 2013 was done. Pertinent data were collected regarding clinical presentation, workups, surgical intervention and treatment, postoperative complications, histopathology, follow-up events and survival. Results: The median age at diagnosis was 17 years. 15 patients (65.2%) had papillary carcinoma and 7 patients (30.4%) had papillary carcinoma with follicular variant. Multifocality and extrathyroidal extension were found in 11 (47.8%) and 6 (26.1%) patients respectively. 21 patients underwent total thyroidectomy with neck dissection and were subjected to thyroid ablation with radioactive iodine (radioiodine) and thyroid stimulation hormone (TSH)-suppressant thyroxine replacement therapy. Median follow-up was 6.6 years. Recurrence occurred in 1 patient. No significant postoperative complications were observed. Conclusion: Appropriate investigations should be carried out to exclude thyroid cancer in children and adolescents presenting with a neck mass. Total thyroidectomy with appropriate cervical lymph node dissection, followed by radioiodine ablation therapy and TSH-suppressant thyroxine replacement therapy is the recommended option to manage children and adolescents with DTC. Neck examination should be part of the routine clinical examination in the paediatric and adolescent age group. A local elaborate genetic database for this disease is essential and may help compare its behaviour with that seen in other populations.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Objective: This study was designed to measure the outcome of the continuous professional development (CPD) course (Family Medicine Essentials) conducted and organised by the Ministry of Health (MOH) on the knowledge, skills, and attitude of primary healthcare (PHC) physicians in patient care. Materials and Methods: This study was based on pre- and post-implementation of training evaluation, which included the seven CPD modules in family medicine customised for non-certified family physicians working at MOH and PHCs in Saudi Arabia. The study was conducted from March 2009 to 2010 and it included 259 family physicians working in PHCs and MOH. The pre- and post-test scores for mean knowledge, skills and attitude were compared using paired t-test. P < 0.05 was considered significant. Results: The results showed that the percentage of male participants (80.3%) was higher than females (19.7%). The mean age of the participants was 39.6 ± 8.0 years. A significant difference was found in pre- and post-test scores of PHC physicians' attitude, knowledge and skills. Attitude increased from 77.5 ± 6.1 to 83.0 ± 7.8 (P < 0.0001), knowledge increased from 51.3 ± 14.8 to 66.7 ± 14.3 (P < 0.0001) while skills increased from 41.2 ± 20.1 to 66.9 ± 19.1 (P < 0.0001). Conclusion: Participants in the CPD course showed significant improvement in their level of knowledge, clinical skills and attitude in patient care. However, further case-control studies and practice evaluations are required to obtain more in-depth information on the impact of this course on PHC physicians.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]