Emergency contraception: awareness, attitudes and barriers of Saudi Arabian Women

Objectives: To assess knowledge, attitude, and barriers about emergency contraception [EC] among married women of child bearing age

Methods: A quantitative cross-sectional study was conducted over a 6-month period, commencing in March 2013 at Family Practice Clinics of King Khalid University Hospital [KKUH], Riyadh, Saudi Arabia. Data was collected using a structured pretested questionnaire and analyzed using SPSS version 21.0 statistical software

Result: A total of 242 women were enrolled in the study. Only 6.2% [15/242] had some knowledge of EC and of these only two had ever used it. Health care professionals were the least reported source of EC information [6.6%, n=1]. Majority [73.3%] had negative attitude toward EC being available over-the-counter without a prescription. The most common barriers to using EC were concerns about possible health effects. Only two women [13.3%] considered religious belief as a major hindrance to its use

Conclusion: Awareness of emergency contraception is very low among women of Saudi Arabia. Health care professionals were the least reported source of information, which is a cause for concern. Our findings reveal an urgent need to educate women about EC, keeping in view the social norms and the Islamic values

Routine skin preparation with 70% isopropyl alcohol swab: is it necessary before an injection? quasi study

BACKGROUND: The world is facing economical crises and it has particularly affected third world countries. Therefore we must review the controversial health related procedures to save the cost and time without compromising health. The main goal of this study was to assess the need of skin preparation with 70% isopropyl alcohol swab wiping as an antiseptic measure, to prevent infections before intramuscular, subcutaneous and intradermal injections

DESIGN AND METHOD: Quasi experimental design. Microbiological as well as clinical assessment of pre-injection use of alcohol swabs was studied among the patients who need an injection at King Khalid University Hospital, Riyadh from August 2012 - December 2012

RESULTS: The mean CFU [Colony Forming Units] per ml over the injection site before alcohol swab wiping were significantly higher [2.47 +/- 3.86] than after alcohol swab use [1.31 +/- 1.93]; p = 0.002. Although, 70% isopropyl alcohol swab reduced skin bacterial counts by 47%, there were no significant difference in clinical signs and adverse local or systemic effect with or without skin preparation by alcohol swab before intramuscular, intradermal or subcutaneous injections

CONCLUSION: Routine skin preparation with alcohol swab before an injection is quite unnecessary and is of no significant value in safeguarding infection. Omitting skin cleaning with alcohol swab prior to an injection would save time and money

Evaluation of continuing professional development program for family physicians

Objectives: To evaluate the King Saud University Continuing Professional Development [CPD] Program for Family Physicians in relation to the Convenience, Relevance, Individualization, Self-Assessment, Interest, Speculation and Systematic [CRISIS] criteria

Methodology: A descriptive study was conducted at King Saud University [KSU] in Riyadh, Saudi Arabia. The authors used the six strategies of Convenience, Relevance, Individualization, Self-Assessment, Interest, Speculation and Systematic [CRISIS] for evaluation. The program was independently analyzed by the three authors using CRISIS framework. The results were synthesized. The suggestions were discussed and agreed upon and documented

Results: The results indicate that KSU-CPD program meets the CRISIS criteria for effective continuing professional development and offers a useful approach to learning. The course content covers specific areas of practice, but some shortcomings were found that need to be improved like self assessment area and individual learning needs analysis

Conclusion: This program is suitable for Family Physicians, as it is well planned and utilizes most of the principles of CRISIS, but there is still room for improvement. Designing a program for general practitioners using hybrid model that offers a blend of e-learning as well as face-to-face learning opportunities would be an ideal solution

Views of family medicine trainees of a teaching hospital in Riyadh regarding their hospital rotations: a qualitative study

To explore Family Medicine Trainees views regarding the hospital component of their Family Medicine [FM] training program. This is a qualitative focus group discussion based study. Thirteen trainees, eight from final year of FM training program and five from third year of the same program participated in the study. The structure for discussion included a previously distributed and completed questionnaire that included three sections. The first section was evaluation of the satisfaction of trainees with the different hospital specialties rotations. The second section related to reasons for rating the different rotations as excellent and very good. The third section related to deficiencies in training for those rotations which received a score of 3-5. The items in the questionnaire were utilized in the focus group discussion. Two facilitators who were investigators facilitated the discussion. The data was qualitatively analyzed to identify emergent themes and subthemes that described the trainees' views. The trainees highlighted the following views: Teaching in the hospital component is not relevant to the needs of Family Medicine trainees. Duration of the hospital posts should be reviewed. Emphasis should be on out-patient clinics rather than in-patient. More emphasis must be given to procedural skills, minor surgery and teaching in clinical contexts. Hospital training component of the Family Medicine training program should be reviewed, as the structure and its implementation doesn't reflect the views of trainees regarding its relevance to their day to day practice

validation study comparing the sensitivity and specificity of the new Dr. KSU H1N1 RT-PCR kit with reAl time RT-PCR for diagnosing influenza A [H1N1]

A new test [Dr. KSU H1N1 RT-PCR kit] was recently developed to provide a less expensive alternative to reAl time reverse transcriptase-polymerase chain reaction [RT-PCR]. We report the findings of a validation study designed to assess the diagnostic accuracy, including sensitivity and specificity, of the new kit, as compared to reAl time RT-PCR. Cross-sectional validation study conducted from 18-22 November 2009 at a primary care clinic for H1N1 at a tertiary care teaching hospital in Riyadh. Nasopharyngeal swab samples and data on socio-demographic characteristics and symptoms were collected from 186 patients. Swab samples were sent to the laboratory for testing with both reAl time RT-PCR and the new Dr. KSU H1N1 RT-PCR kit. We measured the sensitivity and specificity of the new test across the entire sample size and investigated how these values were affected by patient socio-demographic characteristics and symptoms. The outcomes of the two tests were highly correlated [kappa=0.85; P<.0001]. The sensitivity and specificity of the new test were 99.11% and 83.78%, respectively. The sensitivity of the new test was affected only minimally [96%-100%] by patient characteristics and number of symptoms. On the other hand, the specificity of the new test varied depending on how soon patients were tested after onset of symptoms [100% specificity when swabs were taken on the first day of the symptoms, decreasing to 75% when swabs were taken on or after the third day]. The specificity of the new test also increased with increasing body temperature. The new test seems to provide a cost-effective alternative to reAl time RT-PCR for diagnosing H1N1 influenza. However, further testing may be needed to verify the efficacy of the test in different settings and communities

Validation of datascope accutorr plus [trade mark sign] using British hypertension society [BHS] and association for the advancement of medical instrumentation [AAMI] protocol guidelines

To assure the accuracy and reliability of blood pressure measurement by non-invasive blood pressure monitor using Datascope Accutorr Plus[trade mark sign] [Paramus, NJ,USA] against mercury manometer, among adult male participants. Eighty participants from a family physician's office at a teaching hospital were recruited. One hundred and sixty measurements of blood pressure were performed according to BHS technique protocol. Descriptive analysis was done according to the AAMI and BHS protocol guidelines. The limits of agreement between the device and the standard were plotted using the method of Bland and Altman plot. The mean difference +/- SD between the Datascope Acutorr Plus[trade mark sign] and observer was 2.7 +/- 5.2 mm Hg and 1.5 +/- 3.26 mm Hg for systolic and diastolic blood pressure, respectively. Datascope Acutorr Plus [trade mark sign] obtained A/A grading for both systolic and diastolic blood pressure. Datascope Accutorr Plus [trade mark sign] [Paramus, NJ, USA] satisfies BHS and AAMI validation protocols for both systolic and diastolic BP and may be recommended for everyday use for BP monitoring at home and in clinical use for adult population

audit of the quality of care indicators for the management of diabetes in family practice clinics in Karachi, Pakistan

Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month. For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient's medical records were selected and analyzed who attended the studied clinics for at least one year and had minimum of four out-patient visits. Majority [68%] of the audited medical records were of females. Of the total medical records analyzed, only one-quarter of the cases qualified the criteria of 'excellent' or 'good' diabetes care. Monitoring of body weight of the patient was only one indicator which was according the recommendations in 100% case at every visit. The other nearest quality of care indicator documented was blood glucose advice at every visit in 79.5% [95% CI: 71.1-87.9] of cases. Physical activity advised/reinforced at every visit was least observed [27.3%; 95% CI: 18.0-36.6]. In addition, blood sugar control was reported in less than a quarter [23.9%] with 95% CI of 15.0-32.8. This work has identified a big gap in the management of type 2 diabetes provided by family practitioners. In addition, majority of the patients found to have poor glycemic control. Interventions are suggested to improve the quality of diabetes care. More such audits and research are recommended at the larger scale

Metabolic syndrome: frequency and gender differences at an out - patient clinic

To determine the frequency of metabolic syndrome among patients attending an out-patient clinic of a teaching hospital and to compare the clinical features regarding metabolic syndrome among males and females. Cross-sectional study. Aga Khan University Hospital [AKUH], Executive and Family Medicine Clinics, from December 2004 to April 2005. All adults, above 25 years, attending the clinics for an executive check-up and giving informed consent were included in the study. Data was collected through a structured questionnaire administered to those eligible to participate. Metabolic syndrome was defined according to ATP-III guidelines. There were 250 participants in this study. Mean age of study participants was 48.94 [SD10.62] years, while approximately two-thirds, 157 [62.8%], were male. Metabolic syndrome [those who had 3 or more risk factors] was present in 35.2% of adults. Fasting blood sugar level was raised in 36.4% of study participants while significant number of participants [78.8%] had a Body Mass Index [BMI] 25 [p = 0.02]. Frequency of metabolic syndrome was significantly high in this study with preponderance of males and prevalence similar to that observed in developed countries. Majority of patients had obesity and high fasting blood sugar levels. Males demonstrated higher levels of triglycerides and low levels of High-density lipoprotein [HDL] compared to females while blood pressure reading was observed to be the same in both males and females

Hepatitis B vaccination status and identification of risk factors for hepatitis B in health care workers

To assess the vaccination status of health care workers and to identify the risk factors for hepatitis B at a tertiary care hospital. A descriptive study. The Aga Khan University Hospital, Karachi from March 2003 to May 2003. Three hundred and ninety-three health care workers were interviewed after taking verbal consent using a self-administered questionnaire by convenience sampling. A sample size of 385 was calculated, using 5% level of significance, margin of error as 5% and an expected prevalence of 50%. Descriptive statistics like percentages, mean and range were obtained. A total of 393 respondents, [age range 19-59 years] were interviewed. Amongst them 86% were completely vaccinated, 12% had incomplete vaccination and 2% didn't have even a single dose. Needle stick injuries were highest amongst those health care workers who had complete vaccination. Despite the availability of free vaccination, a target of 100% coverage has not yet been achieved. All health care workers should be motivated and ensured for vaccination. Regular educational campaigns for health care workers are needed to increase vaccination compliance

Comparison of job satisfaction and stress among male and female doctors in teaching hospitals of Karachi

Background: Job dissatisfaction and stress among doctors affect the quality of health care. We assessed the levels of satisfaction for workplace characteristics and job stress among doctors of three teaching hospitals in Karachi

Methods: A postal-survey was conducted between May to June 2002. Satisfaction for workplace characteristics and stress were inquired and graded by Likert scale [1=very low to 5= very high]. Questions were also asked about its affect on their lives. In order to calculate the differences in means of job satisfaction and stress score by sex of doctors, chi-square and t-test with 95% confidence interval [CI] were used. Out of 270 doctors approached conveniently, 189 [70%] responded and 182 questionnaires were found complete for analysis

Results: Majority [68%] of the doctors was not satisfied with their jobs. Overall, the mean scores for satisfaction were low for workplace characteristics. Lowest scores were found for pay and benefits 2.12 [SE 0.8], safety and security 2.15 [SE 0.8] and workload 2.69 [SE 0.9]. Female doctors had significantly lower satisfaction about workload [mean job satisfaction score difference = 0.60; 95%CI, 0.24-0.97], relation with colleagues [mean job satisfaction score difference = 0.49; 95%CI, 0.11-0.87] and autonomy [mean job satisfaction score difference = 0.45; 95%CI, 0.07-0.82] as compared to their male counterparts. Overall, 48% of doctors graded job stress from high to very high levels

Conclusion: Majority of doctors working at these teaching hospitals of Karachi had poor satisfaction level for workplace characteristics and higher levels of job stress. This suggests that immediate steps should be taken for their control and management. This study invites further research to explore, implement and evaluate intervention strategies for prevention of stress and improvement in job satisfaction

Dyspepsia: Family physician's view

Dyspepsia is a common problem with a variety of presentations. It is described as upper abdominal [epigastric] pain or discomfort and is often associated with fullness, belching, bloating, heartburn, food intolerance, nausea and vomiting. There are different causes of dyspepsia and there are different options of treatment as well. The introduction of new modalities of treatment has revolutionized the management of dyspepsia

Syndrome X and family practitioners

Increased incidence of hypertension, non-insulin dependent diabetes [NIDDM] and coronary heart disease often cluster in the same individuals and there have been speculations that a common mechanism may be responsible for all of these pathological conditions. This risk factor constellation, which is associated with an enhanced risk for cardiovascular disease, is sometimes referred to as the 'Insulin Resistance Syndrome', 'Syndrome X', or the 'Metabolic Syndrome'. To find out the prevalence of Syndrome X in the population of patients coming to a preventive health check clinic at a tertiary care teaching hospital in a megacity of the developing world. A total of 270 patients, above the age of 40 years, who attended preventive health check clinics of 2 Family Physicians at the Aga Khan University from January 1996 to July 1997 were selected. Patients below 40 years were excluded from the study. The prevalence of Syndrome X, defined as association of obesity, NIDDM, hypertension, raised LDL and raised triglycerides is 2.6% in patients above 40 years, who were screened in this study. The significant prevalence of Syndrome X is alarming and we need to strengthen our existing educational programs for prevention of obesity, increased physical activity and better control of hypertension. When drugs are selected for pharmacological treatment, priority should be given to those, which improve the insulin sensitivity index or are at least neutral in this respect