5-year trend of myocardial infarction, hypertension, stroke and diabetes mellitus in gender and different age groups in Erzurum, Turkey

To investigate the trend and risk of coronary artery diseases [CAD], myocardial Infarction [MI], hypertension [HT], stroke, cerebrovascular disease [CVD], and diabetes mellitus type 2 [DMT2] as regard to different age groups and gender. We retrieved retrospectively almost 5-year data [January 1st 2007 through December 31st 2011] from the Ataturk university hospital that has database registry system based on International Classification of Diseases [ICD-10]. We included 88,293 patients in this analysis. A logistic-regression model was used to assess the effect of groups of variables on the associations of interest [sex and its interaction with age] with calculation of odds ratios with their 95 percent confidence intervals. Out of 88,293 patients, 45% [39,514] were females and mean age was 56.86 +/- 16.23. The females were dominant [P = 0.001] in all age groups in diabetes type 2. Whereas in case of hypertension, CAD and strokes except in young age groups males were more prominent. We found that females had high risk 1.54 [95% CI, 1.50-1.59] for diabetes mellitus while for other cardiovascular disease females had lower risk except a slightly high risk for overall CVD [1.01; 95% CI, 0.93-1.09]. The results demonstrated that for diabetes type 2 and young age group for other cardiovascular diseases females are dominant and have higher risk

Continuing medical education as a national strategy to improve access to primary care in Saudi Arabia / 보건의료교육평가

The purpose of this study was to describe the development, implementation, and evaluation of an educational program in family medicine for general practitioners in Saudi Arabia from 2009 to 2011. A continuing medical education program called Family Medicine Education (FAME) was developed with 7 modules each consisting of 12-14 hours of teaching to be delivered in 3 day blocks, over 45 days. Twenty percent (2,761) of all general practitioners participated in the FAME program. Initial assessment of the program showed significant improvement of knowledge from scores of 49% on a pre-test to 89% on post-tests. FAME program in Saudi Arabia facilitated primary care physicians' knowledge.

An objective structured biostatistics examination: a pilot study based on computer-assisted evaluation for undergraduates / 보건의료교육평가

We designed and evaluated an objective structured biostatistics examination (OSBE) on a trial basis to determine whether it was feasible for formative or summative assessment. At Ataturk University, we have a seminar system for curriculum for every cohort of all five years undergraduate education. Each seminar consists of an integrated system for different subjects, every year three to six seminars that meet for six to eight weeks, and at the end of each seminar term we conduct an examination as a formative assessment. In 2010, 201 students took the OSBE, and in 2011, 211 students took the same examination at the end of a seminar that had biostatistics as one module. The examination was conducted in four groups and we examined two groups together. Each group had to complete 5 stations in each row therefore we had two parallel lines with different instructions to be followed, thus we simultaneously examined 10 students in these two parallel lines. The students were invited after the examination to receive feedback from the examiners and provide their reflections. There was a significant (P=0.004) difference between male and female scores in the 2010 students, but no gender difference was found in 2011. The comparison among the parallel lines and among the four groups showed that two groups, A and B, did not show a significant difference (P>0.05) in either class. Nonetheless, among the four groups, there was a significant difference in both 2010 (P=0.001) and 2011 (P=0.001). The inter-rater reliability coefficient was 0.60. Overall, the students were satisfied with the testing method; however, they felt some stress. The overall experience of the OSBE was useful in terms of learning, as well as for assessment.

Evaluation of the Learning Environment for Diploma in Family Medicine with the Dundee Ready Education Environment (DREEM) Inventory / 보건의료교육평가

The primary healthcare system is at a turning point in Saudi Arabia. However, the sustainability of family medicine as the core element of that system is increasingly being called into question because of lack of family physicians. In keeping view this problem; a postgraduate diploma program in family medicine has started in 2008. A validated measure of educational environment i.e., Dundee Ready Education Environment (DREEM) questionnaire consisting of 50 questions having five domains of perception was administered to all 13 trainees of the diploma course at the completion of the program to check their perception about learning evironment. The trainees comprised of 4 males (40%) and 6 females (60%). The overall score showed more positive than negative side (147/200). There is no significant difference (P > 0.05) in the mean scores of five different domains of perception. The subclasses of five domains showed that teaching perceived as positive by 50%, moving towards right direction by 80%, feeling more positive by 50%, positive attitude by 80% and the 70% scored the course as not too bad. The overall high score and positive attitude towards the course assures the better teaching environment. However, there are areas to improve and it requires continuous evaluation.

Knowledge of hepatitis B and vaccination status of some expatriate ethnic groups of blue collar workers in northern Saudi Arabia

To find out the level of knowledge and vaccination status of some expatriate ethnic groups of blue color workers. Hepatitis B [HBV] infection is relatively common throughout the world, but more prevalent in low socioeconomic and underprivileged classes. The chronic infection may lead to severe consequences including Hepatocellular carcinoma [HCC]. A cross-sectional, community-based survey of some ethnic expatriate groups of blue color workers [n=665] living in four main areas along the Northern Borders of Saudi Arabia was completed in 2005. We examined knowledge of HBV and vaccination status and compared them with some socio-demographic factors. The mean age of the participants was 45.61 years [ +/- 8.44], 53% of whom were Non-Arabs [Non Arabic speaking]. Of the total, 41.6% gave seven or more correct answers out of 12 questions addressing knowledge about the transmission and sequelae of HBV. Almost 40% of the respondents had not been vaccinated while the remaining respondents had had three full doses of vaccination. A high level of knowledge [>/= 7 correct answers] was significantly associated [p<0.05] with higher level of education, vaccination status, ethnic groups, occupation, age, marital status, and the time spent in Saudi Arabia. Income and type of accommodation were not associated [p>0.05] with level of knowledge. However vaccination status was associated [p<0.05] with almost all socio-demographic factors

Predictors of outcome for non-traumatic intracerebral hemorrhage

To evaluate the prognosis, neurologic outcome, and predictors of survival in patients with non-traumatic intracerebral hemorrhage. We evaluated prospectively a cohort of 96 Saudi adult males and females with stroke during the month of July 2005 at Arar Central Hospital, Riyadh, Kingdom of Saudi Arabia. Out of 103 patients, 96 patients, who were diagnosed as having intracerebral hemorrhage [ICH] presenting to the emergency department for initial evaluation, were included, except those with recurrent intracerebral hemorrhage, arteriovenous malformation, subarachnoid hemorrhage, traumatic brain injury, hemorrhagic infarctions, and patients receiving anticoagulant therapy. No patient underwent any neurosurgical procedure. The results of 96 patients were analyzed. The mean age at ICH was 67.2 [ +/- 14.7] years [range, 30-100 years], and mean Glasgow coma scale [GCS] score on admission was 8.42 [ +/- 1.73] and [range, 4-13]. Mean ICH volume on initial CT scan was 10.61 [ +/- 14.01] ml3 [range, 1-63]. Mean pulse pressure on hospital arrival was 81.9 [ +/- 22.8] mm Hg [range, 70-120 mm Hg]. In uni-variate analysis, GCS score [p = 0.0005], ICH volume [p = 0.001], mass effect [p = 0.001], and presence of intraventricular hemorrhage [p = 0.0005] were all associated with 30-days mortality, while in multivariable analysis, the most significant independent predictors of 30-day mortality were, GCS score and the intraventricular extension of hemorrhage. This model may aid in making decisions quickly and easily regarding the appropriate level of care for such patients with intracerebral hemorrhage

An Evaluation of Patient Satisfaction in Turkey with the EUROPEP Instrument

Seeking to understand patient perspectives is an important step in the efforts to improve the quality of health care. Developed by the EQuiP Task Force on Patient Evaluations of General Practice Care, the EUROPEP instrument aims to collect information on patient evaluations of general practice care. In order to expose the current state of patient satisfaction and make international comparisons, a study was conducted with relevant data collected from Turkey. The Turkish version of the EUROPEP instrument was administered to 1160 patients in six different Turkish cities. Thirty-three medical practices were included in the study. In every practice, a minimum of 30 adult patients who visited the practice for a consultation were consecutively included. The results were compared with previous values from European countries. "Helping you understand the importance of following his or her advice", "Getting through to the practice on the telephone", and "Providing quick services for urgent health problems" were evaluated best (76.7%, 76.3%, and 76.2%, 'good or excellent' ratings, respectively) and "Helping to deal with emotional problems related to the health status" was rated the worst (60.2%, 'good or excellent'). Other areas which had low ratings were: "Waiting time in the waiting room" (63.0%), "Quick relief of symptoms" (61.3%), and "Involving patients in decisions about medical care" (61.3%). Patient evaluations can help to educate medical staff about their achievements as well as their failures, assisting them to be more responsive to their patients' needs. In order to get the best benefit from EUROPEP, national benchmarking should be started to enable national and international comparisons.