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.

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

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.

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

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.

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

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

The professions of nursing and midwifery currently face many challenges, such as an increasing number of patients with communicable and non-communicable diseases, which strains resources and requires nurses and midwives to develop their knowledge and skills to a higher level. This is also true in the Middle East, including the Mediterranean East and North African regions, which means it is vitally important that nurses and midwives have access to and use current research to inform their practice, with research targeting the most relevant issues, including complex humanitarian emergency situations that increase health issues and challenge health infrastructure. For this to be achieved, a scoping review of the indexed clinical nursing and midwifery literature in the Middle East was performed to identify gaps in clinical nursing and midwifery research and areas requiring focus. A search of PubMed, CINAHL/EBSCO, EMBASE, the Jordanian Database for Nursing Research resulted in 210/1398 articles which met the inclusion criteria: (1) original research, (2) conducted in Middle Eastern countries as defined by the World Health Organization, (3) had at least one nurse or midwife author (but not limited to nurses in Middle Eastern countries), (4) published in an indexed, peer-reviewed journal between January 1, 2000, and December 31, 2015, (5) included patient outcomes in the results, (6) written in English or Arabic and (7) included an abstract. Studies were found from 10 of the 22 countries; the majority (n = 199; 94.76%) was conducted in three countries: Jordan, Iran and Lebanon. Most studies (n = 158, 75.24%) used quantitative designs, primarily cross-sectional, descriptive studies (n = 106) and the most frequently researched topics were related to maternal child health and women's health (n = 95, 48.5%). Strategies are needed to encourage collaboration between nursing and midwifery faculty members including clinicians to assure that clinical research is disseminated and used to improve patient care.

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

Background: An important indication of a child's well-being is evidence of having a normal growth pattern. A child's growth pattern is influenced by multiple factors, genetic and/or environmental. From an environmental point of view, the socio-economic status of the mother plays an important role in a child's growth during the early stages of childhood. Aim: The aim of this study was to explore the association between mothers' educational and socio-economic status on their children's growth in Riyadh. Methods: A cross-sectional study was conducted in eight hospitals in Riyadh. The target population was children aged between 1 month and 7 years and their mothers visiting the vaccination clinics. The mother's data were collected using a structured interview, and the child's weight and height were measured and plotted on growth charts. Results: A total of 744 mothers and children were screened (392 males, 352 females). The proportion of children with weight and height under the 25 ^th percentile was 40% and 29%, respectively. In terms of education, the height of a higher proportion of children (33%) was under the 25 ^th percentile if the mother had a high school education compared with 25% when the mother had a college education (P = 0.02). Private sector-employed mothers had a lower proportion of children (26%) with weight below the 25 ^th percentile compared to mothers who were government-employed or unemployed (both 41%). Mothers living in an apartment had a significantly lower proportion of children (24%) with height under the 25 ^th percentile compared to mothers living in a house (33%) (P = 0.04). In addition, mothers living in a rented residence had a significantly lower proportion (40%) of children with weight under the 25 ^th percentile than mothers living in owned ones (42%) (P = 0.02). Conclusion: Underweight and short stature among children are associated with less educated and unemployed mothers and with mothers who live in a house. The mother's socio-economic background provides various indicators that could be further researched to identify children who are at risk.

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

Objective: To ascertain patient educator interns' (PEIs) views on the internship experience and to explore how the transition to the workplace is experienced by new graduates from emergent professions. Methods: In this case study from Saudi Arabia, semi-structured interviews were conducted with 10 PEIs. Following a narrative type of analysis, case summaries were created, compared and interpreted. Results: Interns held preconceptions regarding the patient educator's role, and these preconceptions were frequently not mirrored by actual practice. The clash of preconceptions and actual experiences led participants to encounter shock. Conclusion: Transition shock for PEIs seemed to be exacerbated due to their position within a new profession. This study adds to a growing literature about the challenges experienced by workers in new and emerging healthcare roles.

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

The objective of this review was to describe the scientific evidence for coordinating health promotion at the workplace and to discuss the required future research in this field. Literature review from March 1990 to November 2014 was performed. Using the keywords 'health, promotion, worksite and workplace', literature was searched in the following databases: Medline, PubMed and Google Scholar; with no time limit. There is emerging evidence that workplace health promotion enhances the effectiveness of effort to promote and protect workers' health. It proves both cost-effective and cost-beneficial to health promotion at the worksite and subsequently further reduces absenteeism. However, future research is needed to identify the impact of other factors such as age, gender and race on workers' exposure. There is also a need to develop valid tests to measure the outcome of these programmes at the workplace. Health promotion should be central to workplace planning and should be recognised as an integral part of proactive occupational health. Indeed, the workplace is viewed as one of the most popular venues for promoting health and preventing diseases among employees.

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

In recent times, Zika virus has engendered concerns throughout the world, prompting the World Health Organization to promote the virus to epidemic status. This dramatic rise to prominence demands comprehensive research oriented towards effectively controlling the spread of this virulent disease. Despite the influx of information afforded by modern technology regarding the virus, there are yet to be licensed medical countermeasures (vaccines, therapies or preventive drugs) available for Zika virus infection and disease. Thus, diverting sizable funds towards prospective Zika virus vaccine candidates as well as appropriately educating the modern healthcare worker regarding the epidemiology of Zika virus is becoming increasingly imperative. Fortunately, a multitude of researchers are working towards instituting pragmatic measures directed towards limiting Zika virus's spread in an interconnected global climate.

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

Background : Violation of item-writing guidelines is still frequently encountered in assessments in medical colleges. Flawed multiple-choice (MC) items affect students' performance and distort examinations' results. Aims: The aim was to assess the frequency and impact of flawed MC items on students' achievement in our setting. Settings and Design: This is a quantitative descriptive study conducted at the Faculty of Medicine in the University of Tabuk, Saudi Arabia. Methods: We evaluated a 100 single-correct answer MC questions summative surgical examination administered to 44 6 ^th year final medical students in November 2014. MC items, which contain one or more violation of item-writing guidelines, were classified as flawed, those with no violation, were classified as standard. The passing rates and median scores of high- and low-achieving students were calculated on both standard and flawed test scales. Item performance parameters (difficulty index, discrimination power and internal consistency reliability (Kuder-Richardson formula 20) were calculated for standard and flawed items. Descriptive and comparative statistics with the relevant tests of significance were performed using the  SPSS (IBM SPSS Inc. Chicago, Illinois) computer software version 16. Results: Thirty-nine flawed items were identified (39%) which contain 49 violations of the item-writing guidelines. The passing rate was 93.2% and 91.8% on the total and standard scales, respectively. Flawed items benefited low-achieving students and disadvantaged the high-achieving students. Overall, flawed items were less difficult, less discriminating and less reliable than standard items. Conclusions: The frequency of flawed items in our examination was high and reflects the need for more training and faculty development programmes.

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

Introduction: As a procedure, simultaneous bilateral total knee arthroplasty (SB-TKA) has not received its acceptance into routine clinical practice yet; perhaps, due to concerns regarding higher rates of perioperative complications associated with it as compared to the conventional unilateral procedure. The objective of the current study is to assess the safety of SB-TKA in relation to the American Society of Anesthesiologists (ASA) score and to assess the incidence of postoperative complications. Materials and Methods: In a prospective study, 25 patients underwent SB-TKA between January 2011 and April 2014. The inclusion criteria comprised patients with bilateral end-stage primary osteoarthritis of knees interfering with daily activities. A well-defined pre-determined protocol for pre- and postoperative care was adhered. Results: The study included 8 male and 17 female patients. Mean age of the patients was 66.4 ± 8.3 years. Five cases were classified as ASA-1 (20%), 11 cases as ASA-2 (44%) and 9 cases as ASA-3 (36%). No death, deep venous thrombosis, pulmonary embolism or neurological injury was reported in any of our patients postoperatively. One patient developed chest congestion on day 2 and was treated conservatively. One patient suffered from non-ST-segment elevation myocardial ischaemia on day 3 and was treated uneventfully. Two patients had a minor complication in the form of wound infection. No statistical relation was found between ASA risking score and postoperative complications. Conclusion: SB-TKA is a safe procedure if done after careful selection of patients in addition to a proper pre- and postoperative management protocol.

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

Ovarian mature cystic teratoma is a common benign neoplastic condition. Pathogenetically, it arises from all three embryonic layers or any combination thereof. Histologically, it appears as disorganised mass of various tissue components. Rarely, these tissues are orchestrated in an orderly fashion to commence organogenesis and simulate a foetus, namely 'homunculus'. However, isolated organic development, particularly of mesodermal derivation, in an otherwise haphazard teratoma is exceptional. Herein, we discuss a case of mature cystic teratoma with multiple foci of haematopoietic bone marrow within its adipocyte-rich Rokitansky protuberance.

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

Meningioma is a common intracranial tumour which is usually benign. It is well-known to be high grade as atypical or anaplastic with grade II or III. Meningiomas are rarely found in paediatric patients. Extracranial metastasis from brain meningioma is rare but can occur in the lungs, pleura, liver, lymph node and bones. In this paper, we report a 16-year-old female with an extracranial metastasis of grade III meningioma to the lung. She underwent gross total resection along with chemo- and radiotherapy. The outcome and treatment modality would also be discussed.

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