Are 25[OH]D levels related to the severity of knee osteoarthritis and function?

To investigate the effect of 25-hydroxyvitamin D [25[OH]D] in Kuwaiti patients with primary knee osteoarthritis [OA] and to assess its relation with radiological grading and functional status. In this cross-sectional study, 25[OH]D was measured using radioimmunoassay in 99 patients [90 women and 9 men; mean age 56.5 +/- 9.1 years [range: 36-80]] with clinical and radiological findings of primary knee OA. X-ray grading using the Kellgren-Lawrence grading scale and the Osteoarthritis Research Society International [OARSI] Atlas grading scale and functional assessments using Lequesne's indices were evaluated in relation to the 25[OH]D level. Other variables studied were age at onset of symptoms, body mass index and duration of disease. The age of the patients at the onset and the duration of disease were 51.58 +/- 7.14 and 3.88 +/- 2.51 years, respectively. Mean scoring for functional assessment was 10.31 +/- 4.35 and mean Kellgren-Lawrence radiological grading was 2.43 +/- 0.85. Radiological finding according to the OARSI Atlas revealed joint space narrowing of grades 2-3 in 87 [87.9%] patients and the presence of osteophytes in 55 [55.6%] patients. The mean value of 25[OH]D level was 11.4 +/- 6.07 ng/ml. Of the 99 patients, 92 [92.9%] were vitamin D deficient. Comparison of 25[OH]D levels to radiological findings and different functional classes showed no significant association. Most of our patients had vitamin D deficiency, but the level of 25[OH]D was not related to the severity of the knee X-ray grading or to the functional assessment in our patients with primary knee OA

Prevalence of the Pro12Ala missense mutation in the PPARG2 gene in Kuwaiti patients with primary knee osteoarthritis

Peroxisome proliferator-activated receptors [PPARs] play an important role in a number of cellular and metabolic functions. This study was carried out to determine the prevalence of a missense mutation [Pro12Ala] in the PPARG2 gene in Kuwaiti Arab patients with primary knee osteoarthritis [OA] and healthy controls with the aim of identifying a possible association. A prospective cross-sectional study carried out at three major teaching hospitals [referral centers] in the country over a one-year period. The prevalence of PPARG2 gene Pro12Ala missense mutation was determined in 104 Kuwaiti Arab patients with primary knee OA and 111 ethnically matched healthy controls. The prevalence of this Pro12Ala missense mutation was also determined in clinical subgroups of OA patients divided on the basis of age at onset, function and radiologic grading. The Pro-Pro genotype of the PPARG2 gene Pro12Ala missense mutation was detected in 95/104 [91.3%] cases compared to 111/111 [100%] in the control subjects. The heterozygous Pro-Ala genotype was detected in 9/104 [8.7%] of the OA patients, while it was not detected in any of the controls. The Ala-Ala genotype was not detected in any of the OA patients or the controls. No significant differences were detected in the PPARG2 gene Pro12Ala genotypes in the subgroups of patients classified on the basis of age at onset, functional assessment using Lequesne's functional index, and radiological grading using Kellgren-Lawrence [K-L] grading. This study found no significant association between the PPARG2 gene Pro12Ala missense mutation and knee OA. However, the presence of the Pro-Pro genotype of the PPARG2 gene mutation has a protective effect against development of OA

Postgraduate specialization in Kuwait: choices of physicians in training during 2003 to 2007

The limited amount of published data on the specialties selected by physicians in the Gulf region for postgraduate training suggest that male trainees prefer the specialties of Medicine and Surgery, with their female colleagues opting for Obstetrics and Gynecology, Pediatrics, or Family Medicine. Senior medical students, too, tend to have a similar pattern of preferences in their choices for subsequent specialization. This study aimed to determine the trend in the choices made for specialization, either within Kuwait or abroad, by Kuwaiti medical graduates during the 2003 to 2007 period. Data pertaining to all trainees registered with Kuwait Institute for Medical Specialization [KIMS] from 2003 to 2007 available in the records maintained by the Postgraduate Training Division of KIMS and the Civil Service Commission of the Government of Kuwait were analyzed. Data on the physicians sent abroad by the Faculty of Medicine, Kuwait University for obtaining postgraduate qualifications in clinical disciplines within the past five-year period were also included. In identifying the specialties and subspecialties and for grouping, the scheme recognized by the American Board of Medical Specialties [ABMS] Member Boards was used. Of the total of 375 trainees in postgraduate training at the training centers in Kuwait, the highest proportion [35.2%] had selected Family Medicine, with Internal Medicine [14.7%], General Surgery [10.1%], Pediatrics [8.3%], Radiology [7.7%], and Laboratory Medicine [7.4%] being next in an order of preference. Out of 231 physicians who had gone abroad for higher training, Internal Medicine and its subspecialties had attracted the highest proportion [20.8%] of trainees. General Surgery and its sub-specialties [13.0%] and Pediatrics and its subspecialties [12.6%] were the next fields in highest demand. A substantial proportion [8.2%] of trainees had chosen Public Health, as well. Only a few physicians had selected the specialties of Emergency Medicine, Intensive Care, Ophthalmology or Radiology. The majority of physicians undertaking postgraduate training locally tend to choose Family Medicine, while those going abroad on scholarship show a preference for hospital-based specialties. With the State providing opportunities to medical graduates for postgraduate specialization locally or abroad, physicians need to be directed towards choosing specialties that match the health-care service needs of the country. Expanding the opportunities available for training within the Gulf region is likely to contribute positively towards success in the measures implemented

Pattern of postgraduate specialization of Kuwaiti medical graduates throughout the last 30 years

The study examines postgraduate specialty training of Kuwaiti medical graduates during the period 1968 to 1999, identifies their attained professional qualifications in order to reveal scarcity in some specialties. A survey was carried out involving review of the records maintained at the Kuwait Institute for Medical Specialization [KIMS] and Ministry of Health for all the trainees who were enrolled in higher training programs for specialization during the study. Information obtained from the records were ascertained through matching with the doctors' career destinations and employment in the recruitment departments of the health sector. Ascertained data included gender, year and awarding country, level of attained qualifications [medium: Diploma and M.Sc.; higher clinical: fellowship/membership: MRCP, FRCS, MRCOG, Boards of Kuwait, Canada, USA, Germany; and higher academic qualification: Ph.D.]. A total of 679 [363 males, 316 females] Kuwaiti medical graduates attained their higher postgraduate qualifications until year 1999. There was an excess of female postgraduates since 1993, and a drop in 1991 due to the Gulf War. Specialty differed according to gender males mostly opted for medicine and surgery, while females mainly chose obstetrics and gynecology, pediatrics and family medicine. The nature of postgraduate qualifications differed according to gender, fewer females undertook academic qualifications. Also, the awarding country differed according to gender: females obtained their qualifications mostly from Kuwait or UK, while males were mainly awarded by Canadian, American or German universities. Scarcity in some clinical specialities was apparent: subspecialities in surgery [vascular, pediatric, h and, chest, laparoscopic, neurosurgery and oncology]; pediatric [nephrology, respiratory, cardiology, and neonatology]; psychiatry, occupational medicine, and immunology. The number of Kuwaiti medical graduates with higher professional qualifications significantly increased after 1985 due to the establishment of KIMS and Kuwait Faculty of Medicine. Excess of female postgraduates since 1993 was due to the social and cultural transitions witnessed by Kuwait resulting in rapid urbanization, changing the structure and content of education, increasing the numbers of females employed, professional redistribution in social dimensions, and modification in life style. Gender significantly affected the nature of postgraduate studies, the awarding countries and the choice of specialty. The pattern of preference of Kuwaiti graduates to specialties was consistent with other parts of the world; males opted mainly to internal medicine and surgery, while females preferred obstetrics and gynecology, pediatrics and family medicine. Scarcity in some specialties has been revealed and needs to be adjusted

role of national medical education in Kuwait

This study highlights the role of national medical education in the promotion of medical manpower. This was emphasized through tracking the development in the size and professional structure of the main category of the Kuwait national health care delivery system, the physicians, throughout the years 1996 to 2001. Data were ascertained from three sources: Department of Vital and Health Statistics and Department of Manpower, Ministry of Health for data on physicians, and Department of Statistics and Information Sector, Ministry of Planning, Kuwait for data on population. The study revealed increasing trends toward employment of Kuwaiti female physicians, employment of Kuwaiti physicians to upper and lower ranks, and rarity of Kuwaiti physicians in some specialties, such as anesthesia. The study emphasized the role of national medical education in increasing the number of Kuwaiti graduates. Moreover, the study highlighted the apparent influence of KIMS in enhancement of higher medical specialization training programs as witnessed by the predominance of Kuwaiti physicians in the leading job categories. Besides, the study generated essential information required for planning the qualitative and quantitative pattern of the higher specialization programs

Speciality choices of women doctors in Kuwait

To identify the medical specialties that were selected by women medical graduates for postgraduate training and the distribution of the specialties among the trainees. Data maintained on women medical graduate registering for postgraduate training provided or monitored by the Kuwait Institute for Medical Specialization during 1974 to 1998 were reviewed. Of the 603 subjects, 543 [90%] were Kuwaiti nationals. They had obtained the basic degree in medicine from many universities in the region, with 358 [59.4%] having graduated from Kuwait University. The specialties of Pediatrics [18.2%], Family Medicine [15%] Obstetrics and Gynecology [13.6%] and Medicine [11.6%] ranked higher than the others among the choices for training as Assistant Registrar. 166 [32%] received training abroad on state-funded scholarships, 93 [56%] opting for the United Kingdom and Irel and. 120 [19.9%] had obtained a Diploma or a Master's degree in the chosen specialties. 152 [25.2%] qualified with Memberships/Fellowships from Royal Colleges in UK and Irel and or Board Certificates from North America or institutions in other countries. Pediatrics, Family Medicine and Obstetrics and Gynecology are preferred for specialist training by women medical graduates in Kuwait. Surgery does not appear as an attractive choice. The findings are similar to observations made in previous investigations in other countries. The socio-cultural factors exiting in the society may act as an additional incentive for women doctors to select specialties that offer 'controllable life styles

Rating errors in the assessment of clinical competence of newly graduated doctors

Clinicians and academicians attached to health care institutions who share the responsibility for training medical graduates, need to guard against common errors of measurement when assessing trainees' competencies. This study aims to identify the rating errors that may occur during the assessment of the clinical competence of interns. Trainers assigned responsibility for the internship program assessed the competencies of 45 internship trainees in the March 2002 cohort in six domains [case presentation, clinical skills, diagnosis, therapy, [h and ling of emergencies and professional behavior] using a structured format provided. Competencies related to different clinical problems were rated under 1 = Unsatisfactory, 2 = Below expected st and ard, 3 = At expected st and ard, 4 = Above expected st and ard or 5 = Excellent. 4868 assessments were made of the performances of 45 interns who completed rotations in Surgery, Medicine, Obstetrics and Gynecology, and Pediatrics. 66% of all ratings fell in Excellent category [mean = 4, mode = 5]. The rotations in Surgery and Pediatrics elicited more Excellent ratings [37.6% and 31.8% respectively] than other specialties. Of all trainers, Registrars allocated the highest proportion [46%] of Excellent ratings. When considering the number of trainers in each category Excellent ratings had been assigned to a high extent by Assistant Registrars [72%], and Registrars [70%] A high proportion of the ratings given by the trainers fell at the upper end of the Rating Scale. This could be a result of the assessments being affected by errors of leniency, compromizing their usefulness. It is desirable that the heads of the respective Clinical Departments take steps to organize appropriate training programs so that the trainers improve their knowledge in the concepts underlying the assessment of clinical competencies and skills and methods of the use of the instruments

Clinical experiences of intern doctors in Kuwait: implications of assessment practices for internship training

This study reviewed the clinical conditions encountered by interns during their specialty rotations and the pattern of assessment ratings of their performances of clinical skills. Trainers used a checklist and a set of Interaction Cards to assess the performances in six clinical domains of 45 interns in the 2002/03 cohort during and at end of rotations over a one year period. Analysis of 4868 assessments revealed that the clinical conditions seen during training matched the health problems of Kuwait adequately. The majority of the ratings were close to upper end in a rating scale of 1 to 5, with 66% in the 5 - excellent category. During their rotations interns encountered clinical conditions common in Kuwait. There was leniency in assessment. Feedback to trainers on the ratings given and workshops in clinical assessment would improve assessment in internship training

Confidence in performing core clinical skills: preliminary results of a survey of trainees completing internship training in Kuwait

Several surveys suggest the underemphasis of the learning of practical skills during internship training. While the proportion of interns that had performed some of the common practical procedures during training appeared inadequate, the interns themselves had rated their development of practical skills as not high. Many interns had also indicated that they felt confident to initiate management of conditions although they were not experienced in those areas. We did not encounter any publications dealing specifically with internship training in the Arabian Gulf region. This study was aimed at determining the confidence of interns in performing core clinical skills. Interns who completed rotations in the major specialties during 2005/06 responded to a questionnaire that listed 48 core clinical skills. Out of the 124 eligible for the study, 85 responded. They indicated their confidence to perform the skills in future and the number of times these had been performed. The majority of the interns felt confident with routine skills, while approximately half felt confident with emergency resuscitation skills. A third of the trainees were confident in performing artificial ventilation and endotracheal intubation. Similarly, a half was confident in performing pericardiocentesis, indirect laryngoscopy, lumbar puncture irrigation of the ear, insertion of thoracic drainage, venous cutdown and insertion of central venous catheter. Only about a third of trainees, with no significant gender variation, felt confident to perform common skills in obstetrics and gynecology. While half the trainees were confident in performing emergency resuscitative measures, many others lacked confidence in doing these skills or clinical skills needed in routine situations. Interns who may not acquire competency in the core skills need to be identified early and corrective measures taken. The findings may have implications in the review of the medical undergraduate curriculum as well as in internship training

Health vision 2020. Workforce needs of health professionals in Kuwait. Part III-Pharmacists

Pharmacists contribute to reducing the cost of health care while at the same time improving patients' use of medications and health outcomes. Pharmacists play an important role in counseling patients, and reducing medication errors. The aims of the study were to: 1. describe the size of the workforce of pharmacists during the years 2000 to 2005; 2. project the future demand of pharmacists, with special reference to the supply of Kuwaiti pharmacists during the years 2006 to 2020. Local and international data on demand and supply of pharmacists were retrieved. Data on actual population and supply of pharmacists during the years 2000 to 2005 were used to project the future demand of pharmacists during the period 2006 to 2020. Population projections were derived using an exponential average annual population growth rate. The future need for pharmacists was projected using the average pharmacists: population ratio during 2000 to 2005, of one pharmacist to 1,613 population [equivalent to 0.6231 pharmacist: 1000 population]. The projected number of Kuwaiti pharmacists at a given year was calculated by incrementing the number of Kuwaiti pharmacists of the previous year by 9.44%, the average annual growth rate of Kuwaiti pharmacists during 2000 to 2005. Projections for the demand of pharmacists were also computed based on the UK ratio of 0.5891 pharmacist: 1000 population [equivalent to one pharmacist to 1698 population. The average annual growth rate of 9.44% for Kuwaiti pharmacists indicates that the number of Kuwaiti pharmacists is increasing. However, there is a gap between the numbers of Kuwaiti and non-Kuwaiti pharmacists. Of the total demand of pharmacists in year 2005, Kuwaiti pharmacists constituted 18.4%, mostly employed by the Ministry of Health. Disparity between the number of Kuwaiti pharmacists available and total demand for pharmacists is expected to become wider if the health authorities were to improve the pharmacist: population ratio to the values that exist in industrialized countries such as UK. It is unlikely that the supply of Kuwaiti pharmacists will meet the projected demand until the year 2020. To minimize the gap between the total demand and the supply of Kuwaiti pharmacists, it is desirable that the Faculty of Pharmacy, Kuwait University consider increasing the annual intake of students, and the Ministry of Higher Education increase the number of scholarships offered for pharmacy education

Health vision 2020. Workforce needs of health professionals in Kuwait. Part IV-Allied Health Professionals

Allied health professionals [AHPs] are a critical resource in any health care system. Shortages in their availability can restrict access to needed health services and may potentially reduce the quality of care. AHPs are central to the modernization of the health care delivery system. Often, they are the first point of contact for patients, reducing waiting time, and helping the latter to recover from disease states. The aims of the study were to: [1] describe the size of the AHPs workforce in Kuwait during the years 2001 to 2005; [2] project the future demand of AHPs, with special reference to the supply of Kuwaiti AHPs during the years 2006 to 2020. Local and international data on demand and supply of AHPs were retrieved. Data on the actual population and supply of AHPs during the years 2001 to 2005 were used to project the future demand of AHPs during the period 2006 to 2020. Population projections were derived using an exponential average annual population growth rate. The future need for AHPs was projected using the population ratio during 2001 to 2005, of one AHP to 358 population [equivalent to 2.7909 AHPs to 1000 population]. The projected number of Kuwaiti AHPs at a given year was calculated by incrementing the number of Kuwaiti AHPs of the previous year by 8.82%, the average annual growth rate of Kuwaiti AHPs during 2001 to 2005. Projections for the demand of AHPs were also computed based on the Australian ratio of 7.3 AHPs: 1000 population [equivalent to one AHP to 137 population]. The average annual growth rate of 8.82% for Kuwaiti AHPs indicates that the number of Kuwaiti AHPs is increasing. Of the total demand of AHPs in year 2005, Kuwaiti AHPs constituted 48.2%, mostly employed by the Ministry of Health. Assuming that the 2005 AHPs to population ratio will continue to be the same and no new AHP specialties will be introduced, it is projected that the number of Kuwaiti AHPs will be equal to the number of non-Kuwaiti AHPs by year 2007. By year 2018 Kuwaiti AHPs will constitute the majority in the profession. However, the number of Kuwaiti AHPs available is unlikely to meet the total demand if the health authorities were to improve the AHPs: population ratio to the values in affluent countries such as Australia by establishing the needed AHP specialties that do not exist in Kuwait at present. There is a gap between the projected numbers of AHPs in Kuwait and affluent countries such as Australia due to the numerous non-existing AHPs specialties. There is a need to introduce new AHP specialties for the improvement of patients' health care. The education authorities in Kuwait, namely the Faculty of Allied Health Sciences and the Public Authority for Applied Education have the responsibility to introduce innovative allied health training programs similar to those existing in the developed countries. Also, more scholars for new allied health technologists should be supported by the Ministry of Higher Education

Clinical experiences of intern doctors in Kuwait: implications of assessment practices for internship training

This study reviewed the clinical conditions encountered by interns during their specialty rotations and the pattern of assessment ratings of their performances of clinical skills. Trainers used a checklist and a set of Interaction Cards to assess the performances in six clinical domains of 45 interns in the 2002/03 cohort during and at end of rotations over a one year period. Analysis of 4868 assessments revealed that the clinical conditions seen during training matched the health problems of Kuwait adequately. The majority of the ratings were close to upper end in a rating scale of 1 to 5, with 66 percent in the 5 - excellent category. During their rotations interns encountered clinical conditions common in Kuwait. There was leniency in assessment. Feedback to trainers on the ratings given and workshops in clinical assessment would improve assessment in internship training

Speciality choices of women doctors in Kuwait

Objectives To identify the medical specialties that were selected by women medical graduates for postgraduate training and the distribution of the specialties among the trainees. Methods Data maintained on women medical graduate registering for postgraduate training provided or monitored by the Kuwait Institute for Medical Specialization during 1974 to 1998 were reviewed. Results Of the 603 subjects, 543 [90%] were Kuwaiti nationals. They had obtained the basic degree in medicine from many universities in the region, with 358 [59.4%] having graduated from Kuwait University. The specialties of Pediatrics [18.2%], Family Medicine [15%], Obstetrics and Gynecology [13.6%] and Medicine [11.6%] ranked higher than the others among the choices for training as Assistant Registrar. 166 [32%] received training abroad on state-funded scholarships, 93 [56%] opting for the United Kingdom and Ireland. 120 [19.9%] had obtained a Diploma or a Master's degree in the chosen specialties. 152 [25.2%] qualified with Memberships/Fellowships from Royal Colleges in UK and Ireland or Board Certificates from North America or institutions in other countries. Conclusion Pediatrics, Family Medicine and Obstetrics and Gynecology are preferred for specialist training by women medical graduates in Kuwait. Surgery does not appear as an attractive choice. The findings are similar to observations made in previous investigations in other countries. The socio-cultural factors exiting in the society may act as an additional incentive for women doctors to select specialties that offer 'controllable life styles