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   2005| May-August  | Volume 12 | Issue 2  
    Online since June 30, 2012

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The role of psychologists in health care delivery
Saeed H Wahass
May-August 2005, 12(2):63-70
Advances in the biomedical and the behavioral sciences have paved the way for the integration of medical practice towards the biopsychosocial approach. Therefore, dealing with health and illness overtakes looking for the presence or absence of the disease and infirmity (the biomedical paradigm) to the biopsychosocial paradigm in which health means a state of complete physical, psychological and social well-being. Psychology as a behavioral health discipline is the key to the biopsychosocial practice, and plays a major role in understanding the concept of health and illness. The clinical role of psychologists as health providers is diverse with the varying areas of care giving (primary, secondary and tertiary care) and a variety of subspecialties. Overall, psychologists assess, diagnose, and treat the psychological problems and the behavioral dysfunctions resulting from, or related to physical and mental health. In addition, they play a major role in the promotion of healthy behavior, preventing diseases and improving patients' quality of life. They perform their clinical roles according to rigorous ethical principles and code of conduct. This article describes and discusses the significant role of clinical health psychology in the provision of health care, following a biopsychosocial perspective of health and illness. Professional and educational issues have also been discussed.
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Giant Juvenile Fibroadenoma: Experience from a university hospital
Maha S.A. AbdelHadi
May-August 2005, 12(2):91-95
Objective: Fibroadenoma is one of the commonest benign breast lesions in our outpatient clinics. Giant Juvenile fibroadenoma (GJF) characterized with their alarming rapid growth and gross disfigurement is less frequently identified. Materials and Methods: A 14-year review (1990-2004) of all fibroadenomas presented to the Outpatient Department was undertaken. Demographic data, duration of symptoms, size at presentation, the use of radiological, cytological and histo-pathological modalities, surgical excision and follow up were all noted. Eight-Hundred-Sixty-Four cases were diagnosed as fibroadenoma by both clinical and radiological examinations and confirmed by FNAC. Patients with fibroadenomas <2 cm in size were followed up regularly in the out patients department, while those >2 cm underwent surgical excision. GJF were defined as those with >5 cm in diameter. Results: The total number of excised fibroadenomas was 202 (23%), while the remaining662 (77%) fell into the follow up category. GJF were diagnosed in 9 patients accounting for 4.5% of all excised fibroadenomas. Age ranged between 14-23 years. Conclusion: However benign these lesions may appear, in view of the history of a sudden rapid breast enlargement as demonstrated in nearly all the clinical presentations, surgical excision remains the mainstay of treatment of such lesions in order to allow the previously compressed normal surrounding breast tissue to expand and retain its normal function and cosmetic appearance. The use of radiological modalities such as ultrasound and MRI may aid the diagnosis, limiting mammography to the older age group
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A review of predonation blood donor deferrals in a university hospital
Layla A.M. Bashawri
May-August 2005, 12(2):79-84
Objectives: To study the main causes of predonation deferral of potentially healthy prospective blood donors in a University Hospital Blood Bank unit, and to make recommendations accordingly. Methods: A retrospective review of the main causes of predonation deferral of blood donors in King Fahd Hospital of the University (KFHU) Al-Khobar, was carried out. Records of all predonation deferrals from 1 st January 1996 to 31 st December 2003 were reviewed and analyzed. Results: A total of 33,900 potential blood donors came to donate blood during the study period. A total of 6508 donors (19.2%) were deferred for various reasons. Analysis of the causes of deferral showed the following as the most common reasons in rank order: (1) recent ingestion or taking of counter-indicative medications; (2) low hematocrit level; (3) underweight; (4) abnormally high pulse rate; (5) low blood pressure; (6) temperature above 37.5 [0] C; (7) High blood pressure; (8) presenting for donation too soon i.e. less than 8 weeks after the previous one; (9) age below or above the accepted limit; (10) a previous serological positive result; (11) general appearance; (12) abnormally low pulse rate. Conclusion and Recommendations: It is important to provide donors with a clear message on their deferral status. Increased public education about blood donation and the common causes of donor deferral may lower deferral rates and prevent a negative impact on the donor himself as well as on subsequent blood donations. Public education is needed also to help recruit as many volunteer donors as possible.
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Prevention of breast cancer
Ali M Al-Amri
May-August 2005, 12(2):71-74
The best therapy for cancer is prevention. Primary prevention involves health promotion and risk reduction in the general population so that invasive cancers do not develop. These primary preventive measures include the cessation of smoking, lifestyle and diet modification, vitamins and micronutrients supplementation. Identification of genetic risk, understanding of carcinogenesis, development of effective screening tools, avoiding risk factors and effective chemoprevention can lead to decreased morbidity and mortality of cancers in general and more importantly breast cancer. Secondary prevention is the identification and treatment of premalignant or subclinical cancers. Screening by means of mammography is a typical example of secondary prevention. Tertiary prevention is defined as symptoms control and rehabilitation. These definitions may become less useful in the future as they do not account for the new incoming data such as molecular data.
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Under fives clinic
David Morley
May-August 2005, 12(2):61-62
  2,357 192 -
Health education resources availability for diabetes and hypertension at primary care settings, Aseer region, Saudi Arabia
Yahia M Al-Khaldi, Abdullah I Al-Sharif
May-August 2005, 12(2):75-77
Objective : The aim of this study was to evaluate the availability of health materials and means on diabetes and hypertension at PHCCs in Aseer region, Saudi Arabia. Materials and methods : This study was carried out in PHCCs in Aseer region. A questionnaire was distributed to all PHCCs in the region. The questionnaire elicited information on the total population served, the number of diabetic and hypertensive patients, and the availability of health materials for diabetes and hypertension. Data were entered and analyzed by using SPSS. Results: A total of 242 PHCCs out of 245 responded to this questionnaire. There were 20 health educators (8%).Availability of health education materials ranged between 10 to 50%. Health education programs for Diabetes and hypertension were available in more than 90% of PHCCs. Conclusion: This study revealed that most of PHCCs in Aseer region lacked essential health education materials and means for diabetes and hypertension and, therefore were in urgent need of these materials from the Health Education Department, private health sectors and drug companies.
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From home to hospital: Beliefs and practices related to severe malaria in Sudan
Elfatih M Malik, Sabah M Nour, Inas K Hamid, Khalid A Elmardi, Tarig A Mohamed, Eldirdieri S Ahmed
May-August 2005, 12(2):85-90
Purpose: To develop effective measures of reducing the proportion of severe malaria presentation and deaths attributed to malaria, an adequate understanding of beliefs and practices in households and at the level of primary health care is necessary. The objectives of this paper are to explore beliefs and practices related to the management of severe malaria, and to identify barriers to early consultation. Subjects and Methods: A cross-sectional hospital-based study was conducted in five hospitals in Sudan in 2003. All malaria cases admitted, or their care givers were interviewed by a medical doctor using pre-coded and pre-tested questionnaire. Results: Enrolled in this study, were a total of 482 patients, 62.9% of whom were female. Almost 75.0% of the respondents perceived that malaria had serious complications. Anaemia as a complication was mentioned by 115 (32.0%) respondents. A total of 418 (86.7%) patients sought advice from health personnel. Of these, 305 (73.0%) did so more than 24 hours after the onset of the illness. Distance, lack of money, unavailability of transportation or all were the reasons mentioned as barriers to seeking care at hospitals. More than 70.0% of the patients received anti-malarial drugs before admission with a clear preference for the injectable form of chloroquine. Multivariate analysis revealed that "cost of services" and "not seeking help from health personnel" were the determinants for late consultation. Conclusion: The study revealed that late consultation was a feature in many parts of Sudan. Among the barriers mentioned by the respondents, the cost of services was of the greatest concern.
  2,161 193 -
Selection of medical students and its implication for students at King Faisal university
Baher A Kamal
May-August 2005, 12(2):107-111
The appropriate selection of medical students is a challenging task. It requires that important assessment criteria principally based upon cognitive skills that include the matriculation and admission test scores of the applicants be fulfilled. Non-cognitive skills are also important, but used to a lower degree include intellectual flexibility, inquisitiveness, critical reasoning, logical thinking, tolerance, ability to cope with uncertainty and problem solving. Other criteria that are also considered important for selection include personal qualities and attitudes of the applicants that reflect directly on doctor-patient relationship. In contrast, such demographic factors as age, gender, race, religion, socio-economic status and schooling should not influence the selection process. The admission criteria adopted at King Faisal University Medical College focus basically on cognitive criteria. Other criteria whether non-cognitive or personal quality assessment are also taken into account through interviews and completed questionaires.
  1,872 151 -
Teaching tips: Twelve tips for making case presentations more interesting*

May-August 2005, 12(2):97-100
  1,551 125 -
An audit of assessment tools in a medical school in eastern Saudi Arabia
Abdullah M Al-Rubaish, Khalid U Al-Umran, Lade Wosornu
May-August 2005, 12(2):101-105
Background : Assessment has a powerful influence on curriculum delivery. Medical instructors must use tools which conform to educational principles, and audit them as part of curriculum review. Aim : To generate information to support recommendations for improving curriculum delivery. Setting : Pre-clinical and clinical departments in a College of Medicine, Saudi Arabia. Method : A self-administered questionnaire was used in a cross-sectional survey to see if assessment tools being used met basic standards of validity, reliability and currency, and if feedback to students was adequate. Excluded were cost, feasibility and tool combinations. Results : Thirty-one (out of 34) courses were evaluated. All 31 respondents used MCQs, especially one-best (28/31) and true/false (13/31). Groups of teachers selected test questions mostly. Pre-clinical departments sourced equally from "new" (10/14) and "used" (10/14) MCQs; clinical departments relied on 'banked' MCQs (16/17). Departments decided pass marks (28/31) and chose the College-set 60%; the timing was pre-examination in 13/17 clinical but post-examination in 5/14 pre-clinical departments. Of six essay users, five used model answers but only one did double marking. OSCE was used by 7/17 clinical departments; five provided checklist. Only 3/31 used optical reader. Post-marking review was done by 13/14 pre-clinical but 10/17 clinical departments. Difficulty and discriminating indices were determined by only 4/31 departments. Feedback was provided by 12/14 pre-clinical and 7/17 clinical departments. Only 10/31 course coordinators had copies of examination regulations. Recommendations: MCQ with single-best answer, if properly constructed and adequately critiqued, is the preferred tool for assessing theory domain. However, there should be fresh questions, item analyses, comparisons with pervious results, optical reader systems and double marking. Departments should use OSCE or OSPE more often. Long essays, true/false, fill-in-the-blank-spaces and more-than-one-correct-answer can be safely abolished. Departments or teams should set test papers and collectively take decisions. Feedback rates should be improved. A Center of Medical Education, including an Examination Center is required. Fruitful future studies can be repeat audit, use of "negative questions" and the number of MCQs per test paper. Comparative audit involving other regional medical schools may be of general interest.
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010