Putting research findings into clinical practice feasibility of integrated evidence-based care pathways in otorhinolaryngology head and neck surgery at Sultan Qaboos University Hospital, Oman

A perception exists that clinicians in Oman are reluctant to adopt evidence-based practice [EBP]. This pilot study was undertaken to study the feasibility of using EBP pathways at the point of care in otorhinolaryngology head and neck surgery. The ultimate aim was to facilitate EBP with the probability of developing a new system for implementing research findings/translational research at the clinical point of care. A cross-sectional prospective questionnaire pilot survey of clinicians at Sultan Qaboos University Hospital [SQUH], Oman, a tertiary care medical centre, was undertaken. Respondents included 135 physicians and surgeons with between 3 months and 25 years of clinical experience and included personnel ranging from interns to senior consultants, in areas ranging from primary care to specialist care. Of those polled, 90% [95% confidence interval [CI] 85-95%] either strongly agreed or agreed that evidence-based practice protocols [EBPP] could help in decision making. A total of 87.4% of participants [95% CI 81.8-93%] either strongly agreed or agreed that EBPPs can improve clinical outcomes; 91.8% of participants [95% CI 87.2-96.4%] would use and apply EBPP in day-to-day care if they were available at the point of care and embedded in the hospital information system. The perception that clinicians at SQUH are reluctant to adopt EBP is incorrect. The introduction of EBP pathways is very feasible at the primary care level. Institutional support for embedding EBP in hospital information systems is needed as well as further outcome research to assess the improvement in quality of care

Prevalence of depressive symptoms among university students in Oman

To study the prevalence of depressive symptoms and its association with gender, academic year, and college among university students in Oman. A cross-sectional study was conducted among Omani students attending the students' clinic of the Sultan Qaboos University [SQU]. A systematic sampling of students, males and females, from different colleges, who visited the clinic during the study period, was carried out. The self-administered Patient Health Questionnaire [PHQ-9] was used to screen for propensity to depression. A total of 481 students participated in the study [243 males and 238 females]. Overall, 133 [27.7%] of the participants [66 males and 67 females] had depression of various grades based on the PHQ-9 diagnostic criteria using a cut point of more than 11. Depression score at the cut point of 11 was not statistically associated with gender, college and the academic year. Tendency for depression might be a common health problem among college students in Oman attending primary health care facilities. Further research on socio-demographic characteristics and the effect of depression on the academic performance is needed

audit of hypertension at university health center in Oman

To audit the documentation of medical care provided to hypertensive patients and to evaluate the management of hypertension in a primary healthcare center, Family Medicine Staff Clinic, Sultan Qaboos University [SQU] in Oman. An audit of electronic medical records [EMR] was carried out during 2007and 2008 on a representative sample of 150 patients, selected randomly using a simple randomization method. The mean age of the patients was 54.8 +/- 9.9 years. The majority were Omanis; 53.3% were female, 46.7% were male. All patients' records were reviewed for proper recording in a pre designed structured form. Re-auditing was done in 2008. McNemar's test was used to compare data in 2007 with data in 2008. Age, gender, blood pressure recording, renal function tests, and lipid levels were sufficiently recorded [>75%] in the computer system. Histories of pertinent symptoms and smoking history were poorly recorded [<1%]. Fifty-five percent of the hypertensive patients were sufficiently controlled [BP<140/90]. There were significant differences between 2007 and 2008 with respect to documentation and recording of pertinent symptoms [p<0.001] and renal function tests [p=0.026]. Conducting an audit of EMR is essential to evaluate clinical performance and to determine what changes should be made to improve quality of care. There was significant improvement in documentation of pertinent symptoms in the second audit

Information mastery, effective health care, evidence-based practice and the otolaryngologist

The objectives of this study were to study the information-seeking behaviour of otolaryngologists in Oman, and their willingness to learn and acquire evidence-based practice [EBP] skills. A cross-sectional survey was carried out by distribution of a questionnaire to 63 otolaryngologists [ranging from residents to consultants] employed in Oman who attended a national otolaryngology meeting in January 2010. Forty-nine completed questionnaires were received; 57% of the respondents had more than 10 years' experience, and 60% were from tertiary care; 38.8% "totally agreed", and 36.7% "partially agreed" that EBP would improve the quality of care and thus provide effective health care to patients. More than 46.9% had 1-5 questions per week, 18.4% had 11 or more questions per week at the point-of-care; 69.4% were willing to acquire information mastery skills. There was a statistical correlation between the number of years of experience, the number of questions, and willingness to acquire information mastery skills. In day-to-day clinical practice, web-based resources are of increasing significance. Most otolaryngologists in Oman not only believed that it is essential to acquire information mastery skills, but also that effective health care depends on such skills and on EBP. Most were willing to acquire these skills. In the future, these skills will be vital in helping otolaryngologists deliver effective health care solutions

Non allergic rhinitis: prevalence, clinical profile and knowledge gaps in literature

Although Nasal symptoms induced by Non-allergic rhinitis| [NAR] are a cause of wide spread morbidity; the disease is trivialized. There is a lack of Epidemiological studies on the prevalence of non-allergic rhinitis. In spite of being one of the commonest conditions presenting to the General practitioner and otolaryngologists, the clinical profile, diagnosis, and management outcomes are unknown. The objectives of the study were to examine the prevalence and clinical profile of non-allergic rhinitis in Oman. Secondary objective was to identify Knowledge gaps in literature with the aim of directing future research. A cross sectional study of 610 consecutive adult patients presenting to the Ear, Nose and Throat clinic at Sultan Qaboos University Hospital is presented in this paper. The diagnosis of NAR was mainly based on step wise fashion; including a thorough clinical history and exclusion of other causes of rhinitis; all consecutive patients diagnosed with rhinitis [n=113] had a detailed history, nasal endoscopy, nasal smears, CT scans and an antihistamine response trial. The prevalence of NAR with its clinical profile was subsequently determined. Primary research articles and meta-analysis evaluated for the knowledge gap study were identified through MEDLINE search of English language literature published between 2000-2011. A total of 610 consecutive patients were studied. The overall prevalence of rhinitis was 18.5% [n=113]. The prevalence of NAR was 7.5% [n=46]. Cases of allergic rhinitis [5.7%; n=35], Chronic rhinosinusitis [1.8%; n=11], and miscellaneous causes [3.4%; n=21] were excluded. Among the rhinitis population [n=113], the prevalence of NAR was 57% [n=46]. The major presenting symptoms included nasal obstruction [93%; n=43], postnasal drainage [78%; n=36], and rhinorrhea [62%; n=29]. For the knowledge gap study; 115 Medline titles were reviewed, four systematic reviews, and 34 research papers were reviewed. The text of two recent otolaryngology text books was also reviewed, and the main results of the study revealed the prevalence of NAR had not previously been studied in Oman. Although the recent text now clearly defines NAR, there is scant literature on the prevalence, diagnosis and management outcomes of NAR in the literature. The study found that more than half of rhinitis patients suffered from NAR. There are no specific diagnostic tests for NAR; a thorough case history is the best diagnostic tool to date. A substantial knowledge gap exists in literature with relations to pathogenesis, clinical and laboratory diagnosis, as well as in reference to medical and surgical outcomes. Larger studies are required and management outcomes need to be studied

Evidence-based Medicine: an overview

Evidence-based Medicine [EBM] has been proposed as the most significant intellectual advance in the process of clinical decision-making in the past decade. With more than 25,000 medical journals publishing 4 million articles a year, doctors are unable to cope with the information overload. The principles and practice of EBM show the way to bridge the gap between research and practice. Reactions evoked in the medical profession towards this new discipline have been in extremes, from outright rejection to enthusiastic acceptance. The goal of this paper is to familiarise the readers with the ideas and concepts associated with the phrase Evidence-based Medicine