Evolution of technology in teaching: Blackboard and beyond in Medical Education.

TEACHING AND LEARNING: the passing of knowledge from one generation to another - has been in existence from the earliest times of human civilization. It began in 1801, with a large piece of slate hung on the wall in a school in Scotland to provide information to a large audience at one time. In the US by mid-19th century, every class room had a blackboard to teach students. The modern version of the blackboard is either green or brown board. This was introduced in late 1960s. The whiteboards came into use during the late 1980s. Projected aids have been used since 1420. The various devices used are the epidiascope, slide projector, overhead projector for transparencies and the micro projector. An instrument to project images from a horizontal surface onto a vertical screen was invented in the 1870s. By the 1960s, transparencies were in use in classrooms. The 'Hyalotype', a transparent image of a photograph using actual black and white photographs on a glass slide that could be projected was invented in 1851. By 1916, the German company Agfa started producing colored lantern slides. The first version of PowerPoint was released by Microsoft in the year 1990. Cell phones, palmtops, and handheld computers; tablets, laptops, and media players are included under mobile learning devices. With the evolution of technology, students achieved competence and interested in interactive learning. The education industry has moved from distance learning to e-learning and finally to m-learning as knowledge expanded exponentially and the demand escalated. While using teaching aids with advanced technology, we must not forget the lessons from the past, striking a balance between embracing new methods of teaching and learning while upholding the timeless principles of education. The newer educational technology can be part of a comprehensive system for lifelong education. CONCLUSION: Use of technology in education has come a long way since the earliest times of human civilization. While embarking on aids with advanced technology, we need to take full cognizance of the lessons from the past, striking a balance between embracing new methods of teaching and learning while holding on to the timeless principles of education. Thus, the newer educational technology can be effective tools of teaching and learning in this rapidly changing technological world and be part of a comprehensive system for lifelong education. ACKNOWLEDGEMENTS: The authors wish to acknowledge Prof. Raja Bandaranayake for his valuable suggestions and editing this manuscript.

Herbal Medicines Use During Pregnancy: A Review from the Middle East.

The prevalence of the herbal medicines use is on the rise across the world, especially amongst pregnant women. The scenario in the Middle Eastern region was reviewed to explore the prevalence, usage pattern, motivation, and attitude towards use of herbal medicine by pregnant women. Literature published up to December 2012 showed the prevalence of herbal medicine use varied between 22.3-82.3%, implying a rising trend in the utilization of herbal medicine during pregnancy. The most common herbs used were peppermint, ginger, thyme, chamomile, sage, aniseed, fenugreek, and green tea. The most common reasons for use included the treatment of gastrointestinal disorders and cold and flu symptoms. The majority of women used these products during their first trimester, and did not reveal this information to their physician. Most women were advised by family and friends to use herbal medicines and believed they were more effective and had fewer side effects than modern medicine especially during pregnancy. In conclusion, the use of herbal medicine is prevalent among pregnant women in the Middle Eastern region and healthcare providers need to seek information pertaining to their use.

Cigarette Alternatives: Are they Safe?

In spite of limited data regarding the safety or effectiveness of electronic cigarette introduced into the market as a healthier alternative to tobacco smoking, its popularity has increased enormously. E-cigarettes have penetrated the market rapidly owing to the elaborate marketing network and attractive marketing strategies. Stated advantages include the claim that they help quit smoking and produce less exposure than conventional smoking. The list of disadvantages is even more elaborate. While the majority of the studies supporting health claims and efficacy for quitting smoking are not scientifically sound, they are also challenged by studies providing contradictory results. Owing to the limited evidence on the potential advantages and disadvantages of e-cigarettes, the debate on their safety continues.

Use of antihypertensive medications in patients with type -2 diabetes in Ajman, UAE.

Optimal reduction in blood pressure with antihypertensive agents helps to prevent microvascular and macrovascular complications of diabetes. The objective of the study was to evaluate the current utilization pattern of antihypertensive medications among patients with diabetes and coexistent hypertension as per the JNC seventh report guidelines. A Cross-sectional survey was conducted among patients with diabetes attending outpatient department of Internal Medicine at a hospital at Ajman. Medical records of patients were used to obtain diagnostic, demographic and drug use information. Univariate analysis was performed using Chi-square and t- test followed by logistic regression to compute independent predictors. Of 132 patients with diabetes, uncomplicated hypertension (HTN) was coexistent in 81% (107/132) of patients. Males constituted 49.5% (53/107) of the total. Mean (SD) age of patients with HTN was 55.1(10.1) years higher than those without HTN 49.6 (9.9) years (P<0.01). Higher number of patients with HTN had duration of diabetes<5 years than those>5 years (P=0.04). While adjusting the significant factors, only duration of diabetes was statistically significant (adjusted OR=1.06; CI 95% (1.003-1.116) P= 0.03 among patients with HTN. 63.6% (68/107) prescriptions contained one drug antihypertensive drug, 27.1 % (29/107) two drugs and 7.4% (8/107) no anti-hypertensive drug were prescribed. Angiotensin converting enzyme inhibitors/ Angiotensin receptor blockers (ACEI/ARBs) followed by diuretics were commonly prescribed drugs. ARBs with diuretics were the most frequent two drug combinations. The antihypertensive utilization pattern was similar in both gender and age groups. Results represent the current prescribing trend for anti-hypertensive agents among patients with diabetes that is in accordance with JNC-7 recommendations.

Prevalence of Allergies among University Students: A Study from Ajman, United Arab Emirates.

Aim. Urbanization and globalization in the Middle East have resulted in drastic environmental changes and increased allergens present in the environment. This study aimed to assess the prevalence of allergies among undergraduate students from a university. Material and Methods. This cross-sectional survey was carried out among undergraduate students of a University at Ajman, UAE. A self-administered questionnaire was used as research instrument for data collection. The demographic data and the allergy characteristics were collected and analyzed using SPSS version 19. Descriptive and inferential statistics were performed. Results. A total of 255 students (33.3% males; 66.7% females) were included. Commonest allergies among the students were allergic conjunctivitis (104 (40.8%)), allergic dermatitis (89 (34.9%)), and eczema (38 (14.9%)). Family history of allergies was strongly associated with occurrence of allergic conjunctivitis and allergic dermatitis. In about 58 (22%) of the students, dust was the most common triggering factor for allergies. Allergies associated with pollen, food, and drugs were less frequent. The distribution of allergies based on gender revealed female preponderance in all types of allergies. Students with allergies reported interference with their daily activities, and academic, social, and extracurricular activities. Conclusions. Allergic conjunctivitis and allergic dermatitis were the frequent allergies reported. Adequate preventive strategies can crumb the prevalence of allergies.

Patients' Adherence to Anti-Diabetic Medications in a Hospital at Ajman, UAE.

BACKGROUND: Anti-diabetic medications are integral for glycemic control in diabetes. Non-adherence to drugs can alter blood glucose levels, resulting in complications. Adherence to anti-diabetic medications reported by patients and the factors associated with medication adherence among adult patients with diabetes mellitus were explored. METHODS: This cross-sectional study was carried out among patients with type II diabetes mellitus attending the Internal Medicine Department of a hospital in the United Arab Emirates. Consecutive patients were selected, and data regarding their medication adherence were collected using a questionnaire. Data analysis was carried out using SPSS-20. The chi-square test was performed to examine the associations between categorical variables; a two-sided P Value < 0.05 was considered significant. RESULTS: A total of 132 patients participated in the study (63 males; 69 females). The mean age (standard deviation) of the respondents was 54 years (SD 10.2). The self-reported adherence rate to anti-diabetic drugs was 84%. The most common reason for non-adherence was forgetfulness, and the adherence rate was similar in both genders. Patients with Bachelor's and Master's degree reported greater adherence rate to anti-diabetic medication in comparison to the secondary school educated. CONCLUSION: The self-reported adherence rate to anti-diabetic medications was 84%, and forgetfulness was the most common reason for non-adherence. Future studies on strategies to improve adherence rate should be considered.

Patterns of antimicrobial therapy in acute tonsillitis: A cross-sectional hospital-based study from UAE.

BACKGROUND: Diseases of the ear, nose and throat (ENT) are associated with significant impairment of the daily life and a major cause for absenteeism from work. AIM: The study determined antimicrobial prescription pattern in patients with acute tonsillitis. MATERIALS AND METHODS: A cross-sectional study was carried out among all the patients attending the ENT department with acute tonsillitis. Data were retrieved from the medical records using a proforma. Statistical analysis was carried out using SPSS.19. RESULTS: Total of 238 patients included (Males 138; females 100). About 96% of total drugs were prescribed by generic name. Median number of drugs prescribed was four (range 1-7). Eighty eight percent of prescriptions contained antimicrobials, (78.5%) analgesics and (57.9%) antipyretics. Amoxicillin / Clavulanic acid (24.8%) and Ceftriaxone (12.2%) were the most commonly prescribed antimicrobials. Parenteral route was preferred in 41.6%. About 23.7% of the patients on Amoxicillin / Clavulanic acid had received the drug as intravenous injection. Culture and sensitivity tests were carried out in 106 (44.5%) of the cases. Antimicrobials were changed / added after the culture and sensitivity test in 25 patients. CONCLUSION: Study findings highlighted rational practices in drug prescribing. Therapeutic guidelines based on current sensitivity pattern optimize the use of antimicrobial agents.

A review of computer assisted learning in medical undergraduates.

Laboratory based practical classes, have been the corner stone of undergraduate pharmacology learning. Ethical issues with the use of animals and rapid development of information technology has led to newer trends in teaching and learning such as computer assisted learning. Computer assisted learning (CAL) software includes computer based packages, focusing on interactive instruction in a specific subject area, collection of animal experiments that encourage students to understand concepts in pharmacology. CAL offers a number of advantages to both students and teachers; most important being meeting the learning objectives. Few disadvantages and pitfalls to implementation in medical schools are also associated with CAL sessions. This article reviews the trend of CAL in pharmacology, advantages, disadvantages and pitfalls to the implementation of CAL.

Dokha: an emerging public health issue as a form of tobacco smoking in the middle East.

BACKGROUND: Tobacco use is one of the leading causes of preventable death across the world today and the smoking rates among men in the Arab world are amongst the highest in the world. Smoking of dokha, a traditional Arab tobacco is common in some of the Middle East countries such as the United Arab Emirates and Iran. This review focuses on the prevalence, pattern and health effects of dokha use in the Middle East. For this purpose an electronic search was performed in the following databases and websites: MEDLINE, EMBASE, Proquest and Google scholar up to December 2012. The search strategy was based on Internet search for the synonyms of dohka or midwakh. From the results of the review it emerged that younger people are the most common users of dokha. Hence effective outreach health education programs, targeting adolescents, especially school students before they take up the habit of smoking, may thus curb the emergence of the problem.

Nurses opinion on the attributes of polypharmacy in patient safety.

Nurses play a functional role in preventing drug related problems. They need to be aware of the dangers of polypharmacy while reviewing patient medications. We studied the nurses' opinion on the diverse effects of polypharmacy in the hospital setting. Nurses working in a tertiary care teaching hospital participated in this cross-sectional study, conducted over 3 months, by responding to a self-administered questionnaire. Chi-square test was used to analyze association between socio-demographic characteristics and items in the study. A value of P<0.05 was considered statistically significant. Increased drug interactions scored the highest (98.1%), followed by increased adverse drug effects (81.9%), and increase in financial burden (69.5%) among the negative effects of polypharmacy. 61% of the respondents felt that polypharmacy increased therapeutic effect in polypathology. No difference was observed in the opinion between male and female nurses or among varying nursing experience. Nurses with 5-10 years of experience opined increase in non-compliance to prescribed medication regimen and increase in financial burden also as negative attributes. Nurses pointed out both positive and negative implications of polypharmacy. Training programs such as continuing nursing education and workshops can be planned to translate this knowledge into practice in their routine nursing practice.

Evaluation of efficacy and safety of gabapentin, duloxetine, and pregabalin in patients with painful diabetic peripheral neuropathy.

AIM: To compare the efficacy and safety of gabapentin (GBP), duloxetine (DLX), and pregabalin (PGB) in patients with painful diabetic peripheral neuropathy (DPNP). METHODS: A prospective, randomized, open label, 12-week study was conducted. A total of 152 patients with history of pain attributed to DPNP with a minimum 40-mm score on visual analogue scale (VAS) were randomized to receive GBP, DLX, or PGB. The primary efficacy measure was pain severity as measured on 11 point VAS. Secondary efficacy measures included sleep interference score, Patient Global Impression of Change (PGIC), and Clinical Global Impression of Change (CGIC). Assessment of safety was done by recording the occurrence of adverse drug reactions. Data was analyzed using descriptive statistics, Chi square test, analysis of variance (ANOVA), and repeated measures ANOVA. RESULTS: Of total 152 patients, 50 patients received GBP, DLX each while 52 received PGB. A significant reduction in pain score (VAS), sleep interference score, PGIC, and CGIC was seen in all the three treatment groups across time (P<0.05) with no statistically significant difference between the groups. There was a significant interaction between the time and treatment groups (P<0.001) for pain score (VAS), sleep interference score, and PGIC. The improvement in pain scores (VAS) and sleep interference score was higher with PGB compared to DLX and GBP. Adverse drug reactions were mild and occurred in 9.2% of all cases. CONCLUSIONS: Monotherapy with GBP, DLX, or PGB Produced a clinically and subjectively meaningful pain relief in patients with DPNP with onset of pain relief being faster and superior with PGB.

Reporting of adverse drug reactions: an exploratory study among nurses in a teaching hospital, Ajman, United Arab Emirates.

BACKGROUND AND THE PURPOSE OF THE STUDY: Adverse drug reactions (ADRs) are important public health problem associated with morbidity, mortality and financial burden on the society. Nurses play important role in medication safety surveillance through the spontaneous voluntary reporting of ADRs. Nurses' knowledge, attitude and practice towards ADR reporting and factors affecting reporting was assessed in the study. METHODS: All nurses working in a tertiary care hospital, Ajman, UAE participated in this cross-sectional survey. A self administered questionnaire of four domains (knowledge, attitude, practice, factors affecting reporting) was distributed among nurses after obtaining informed consent. The knowledge and attitude components were assigned score of one for correct response. Data was analyzed using SPSS (version 19). Mann-Whitney U test was used to compare knowledge and attitude scores between subgroups; Spearman's correlation for any relationship between knowledge and attitude. RESULTS: Of the total participants, females constituted 92.3%; average duration of clinical experience 6.5 ± 3.3 years; mean age 28.9 ± 4.1 years. Median score for knowledge components of ADR reporting was 11(total score: 17) and for attitude components was 4(total score: 8). No difference noted in knowledge and attitude scores between gender, age group, educational qualification. A positive correlation between knowledge and attitude components was observed (r = 0.38). ADRs are important cause for morbidity and mortality was reported by (54.9%). 49.5% were aware of Pharmacovigilance centers'. Uncertainty of ADRs (49.5%); concern that the report may be wrong (46.2%) and inadequate knowledge of ADR reporting procedure were the major barriers to reporting. Training in ADR reporting as the key measure to improve reporting was suggested by (86.8%). MAJOR CONCLUSION: The results of the study strongly point out the need for interventional program among nurses focusing on the importance of ADR reporting and reporting procedure to encourage their active, voluntary participation in drug safety surveillance.

Utilization patterns of central nervous system drugs: A cross-sectional study among the critically ill patients.

INTRODUCTION: Critically ill patients often receive central nervous system drugs due to primary disorder or complications secondary to multiorgan failure. The aim of the study was to evaluate the current utilization pattern of central nervous system drugs among patients in the medical intensive care unit. MATERIALS AND METHODS: A prospective observational study carried out over a period of 1 year. The relevant data on drug prescription of each patient was collected from the inpatient case record. Drugs were classified into different groups based on WHO-ATC classification. The demographic data, clinical data, and utilization of different classes of drugs as well as individual drugs were analyzed. RESULTS: A total of 325 consecutive patients were included for the analysis; 211 (65%) patients were males; 146 patients (45%) were above 55 years of age. Encephalopathy [63(19.38%)] and stroke [62(19%)] were the common central nervous system diagnoses. In a total of 1237 drugs, 68% of the drugs were prescribed by trade name. Midazolam (N05CD08) 142 (43.69%), morphine (N02AA01) 201 (61.84%), and atracurium (M03AC04) 82 (25.23%) were the most commonly used sedative, analgesic, and neuromuscular blocker, respectively. Phenytoin (N03AB02) 151 (46.46%) had maximum representation among antiepileptic agents. CONCLUSIONS: Utilization of drugs from multiple central nervous system drug classes was noticed. Rational use of drugs can be encouraged by prescription by brand name.