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   2009| January-April  | Volume 16 | Issue 1  
    Online since June 16, 2012

 
 
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ORIGINAL ARTICLES
Guideline implementation in clinical practice: Use of statistical process control charts as visual feedback devices
Fahad A Al-Hussein
January-April 2009, 16(1):11-17
PMID:23012184
Objective: To use statistical control charts in a series of audits to improve the acceptance and consistant use of guidelines, and reduce the variations in prescription processing in primary health care. Methods: A series of audits were done at the main satellite of King Saud Housing Family and Community Medicine Center, National Guard Health Affairs, Riyadh, where three general practitioners and six pharmacists provide outpatient care to about 3000 residents. Audits were carried out every fortnight to calculate the proportion of prescriptions that did not conform to the given guidelines of prescribing and dispensing. Simple random samples of thirty were chosen from a sampling frame of all prescriptions given in the two previous weeks. Thirty six audits were carried out from September 2004 to February 2006. P-charts were constructed around a parametric specification of non-conformities not exceeding 25%. Results: Of the 1081 prescriptions, the most frequent non-conformity was failure to write generic names (35.5%), followed by the failure to record patient's weight (16.4%), pharmacist's name (14.3%), duration of therapy (9.1%), and the use of inappropriate abbreviations (6.0%). Initially, 100% of prescriptions did not conform to the guidelines, but within a period of three months, this came down to 40%. Conclusions: A process of audits in the context of statistical process control is necessary for any improvement in the implementation of guidelines in primary care. Statistical process control charts are an effective means of visual feedback to the care providers.
  1,867 235 -
CASE REPORTS
Allgrove's syndrome: Case report and literature review
Mohamed I Yasawy
January-April 2009, 16(1):37-40
PMID:23012188
This report concerns two brothers aged 10 and 18 years with long-standing dysphagia that started at age three and six years respectively. They had been diagnosed as achalasia and treated accordingly. The appearance of additional symptoms and clinical signs required further investigations including abdominal sonography, esophago-gastroduodenoscopy, barium swallow, esophageal manometry, computerized tomography (CT) of abdomen and brain, biochemical profiles, and neurologic and ophthalmic evaluations. The results of these extensive investigations along with the clinical evaluations were consistent with Allgrove's syndrome. Glucocorticoid therapy was initiated. The management consisted of pneumatic cardiac dilatation and initiation of cortisone treatment. The patients' response was impressive and they resumed most of their usual activities.
  1,858 227 -
ORIGINAL ARTICLES
Control of hypertension in eastern Saudi Arabia: Results of screening campaign
Nadira A Al-Baghli, Khalid A Al-Turki, Aqeel J Al-Ghamdi, Ahmad G El-Zubaier, Fadel A Al-Baghli, Nawal H Bohlaiqa
January-April 2009, 16(1):19-25
PMID:23012185
Objective: To assess the pattern of follow-up and level of hypertension control according to sociodemographic, and clinical risk factors in the participants of a screening campaign. Research Design and Methods. In 2004, all Saudi residents in the Eastern Province, aged 30 years and above, were invited to participate in a screening campaign for the early detection of diabetes and hypertension. A structured questionnaire was completed during a face-to-face interview. The presence of hypertension and the place of follow-up were recorded. Blood pressure was measured by trained nurses using a mercury sphygmomanometer, according to the recommendations of The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII). Results: Thirteen point one percent of the participants had been previously diagnosed as having hypertension. In 34.3% of them, blood pressure was controlled, while 40.8% had combined uncontrolled SBP and DBP, 14.4% had isolated uncontrolled SBP, and 10.5% had isolated uncontrolled DBP. The blood pressure control was inversely associated with age. It was higher in women, singles, the educated, in those with BMI of less than 25 kg/m [2] , and in those with positive history of CVD (p<0.001). Conclusion: Co-morbidities relevant for hypertension are very prevalent, so aggressive BP control is mandatory.
  1,698 258 -
Patients' knowledge and attitudes towards health education: Implications for primary health care services in Saudi Arabia
Mohammed S Alnaif, Saad A Alghanim
January-April 2009, 16(1):27-32
PMID:23012186
Objectives: To assess health educational activities in primary health care centers in Riyadh City. Methods: The data were collected through a self-administered questionnaire directed at adult patients who attended primary health care centers from February - April 2006, in Riyadh City. Out of the 750 patients who were selected randomly, 569 (75.9%) successfully completed the questionnaire. The data collected were on a set of variables including socio-demographic characteristics, health-related variables, source of health knowledge and patients' attitudes towards a number of health-related aspects. Data were presented and analyzed in a descriptive fashion. Results: Only 20% of PHC patients had received health education in the past twelve months. The majority of respondents identified TV and friends/relatives as the main sources of their health education. A considerable percentage of the patients with chronic conditions lacked knowledge about their illnesses. The results indicate that the deficiency in knowledge was the result of some of the socio-demographic characteristics of respondents. Conclusion: There is an urgent need to review and evaluate health education programs conducted in PHC centers. Special emphasis should be placed on health education activities for those living with chronic health conditions.
  1,589 328 -
Factors affecting road traffic accidents in benghazi, libya
Ibrahim Al-Ghaweel, Saleh A Mursi, Joel P Jack, Irene Joel
January-April 2009, 16(1):7-9
PMID:23012183
Objectives: The aim of the study was to evaluate the factors responsible for road traffic accidents in Benghazi. Material and Methods: Retrospective and descriptive studies were done in the years 2006-2007. The data was collected from Traffic and License Department, Benghazi. The data were analyzed, based on fatalities, the severely handicapped, hit and run victims and were correlated with age, sex, time, environmental factors, type of roads, etc. Results: One-Thousand-Two-Hundred-Sixty-Five accidents occurred between the years 2006-2007 within the Benghazi city limits; 11.14% of the injuries were fatal; 67.35% of the victims had severe injuries and 21.51% escaped with minor injuries. [Table 1] shows that 73.04% lost their lives within the city limits, 13.47% on the fly-over, and 2.12% on minor roads connected to main roads within the city limits. The mean of the accidents and its standard deviation were 16.66± 25.67 with a variance of fatality of 1.54. Conclusion: It is concluded from the studies that major road traffic accidents occur because of environmental stress factors. In addition, fatalities and the seriousness of the accidents depend on a number of factors such as the age of the vehicle, safety measures, human error and time and place of accident.
  1,630 255 -
Barriers against application of evidence-based medicine in general hospitals in Aseer Region, Kingdom of Saudi Arabia
Khalid S Al-Gelban, Yahia M Al-Khaldi, Abdullah M Al-Wadei, Ossama A Mostafa
January-April 2009, 16(1):1-5
PMID:23012182
Objective: To explore the attitudes of doctors in the general hospitals and their application of evidence-based medicine (EBM) and to identify the barriers that hinder its use. Subjects and Methods: This study included 346 doctors in the general hospitals of Aseer. A questionnaire was designed to assess their awareness as well as the barriers that hinder their practice of EBM. A visual analogue scale was used to assess their attitude. Results: The attitudes of doctors toward aspects of EBM were generally positive. However, their use of EBM sources and application were generally poor. The main reasons for retrieving evidence were to keep them up-to-date (72.8%) and to help make clinical decisions (70.2%). The least mentioned reason for evidence retrieval was research (41.9%). Review of textbooks was the main method of evidence retrieval (71.1%), while a database search was the method least used (22.8%). The main barriers to the practice of EBM practice were "lack of facilities" followed by "lack of time", while the barrier least mentioned was the "lack of interest". Conclusions: Although doctors have positive attitudes toward EBM, their knowledge and application of EBM need much improvement. The main barriers to their application of EBM are the lack of facilities and the lack of time. Recommendations: The necessary infrastructure for the application of EBM should be made available for all medical staff. There is a need for special courses and hands-on workshops in general hospitals to address the necessary knowledge and skills of EBM are essential.
  1,558 287 -
CASE REPORTS
Sonographic diagnosis of gastric-outlet foreign body: Case report and review of literature
Hissa Moammar, Mohammed Al-Edreesi, Rifat Abdi
January-April 2009, 16(1):33-36
PMID:23012187
The diagnosis of unsuspected foreign body ingestion is a common problem in children. We describe a toddler who presented with persistent vomiting and dehydration. A plain radiograph of the abdomen did not reveal a foreign body. However, abdominal ultrasonography promptly identified a funnel-shaped foreign body obstructing the gastric outlet. This was extracted by upper endoscopy. A recent review of the literature shows increasing evidence that abdominal ultrasonography is an equally complementary diagnostic modality for ingested foreign bodies in children.
  1,537 195 -
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010