Autonomy and paternalism in shared decision-making in a Saudi Arabian tertiary hospital: A cross-sectional study.

Medical paternalism has long been a common medical practice. However, patient autonomy in healthcare has been recently adopted by doctors and patients alike. This study explored whether doctors and patients in a tertiary care hospital in Saudi Arabia preferred autonomy or paternalism in shared decision-making. A total of 118 participants (51 patients requiring total knee replacement, owing to stages 3-4 of osteoarthritis, and 67 doctors) from the Eastern province, Saudi Arabia. responded to a 17-question category-based questionnaire involving four scales of autonomy. Descriptive statistics and chi-square test results revealed that in this hospital, patients preferred a paternalistic approach toward their medical care along with a full disclosure of the risks related to surgical procedures. We recommend health education regarding the specific autonomy subscales (doctor knows best, patient should decide, right to non-participation, and obligatory risk information), and the implementation of protocols that protect patients' rights and enhance personal autonomy.

Subspecialization in Family Medicine: Opinions, Preferences, and Practices of Family Physicians in Saudi Arabia.

OBJECTIVE: In recent years, family medicine (FM) has shown many changes, including the development of sub-specialization. This study aimed to explore the opinions, preferences, and practices of Saudi family physicians with regard to sub-specialization within family practice. METHODS: This cross-sectional study was conducted from January to May 2018. Data were collected from 561 Saudi FM board-certified physicians and family medicine residents from all over SA via personal emails using a self-administered questionnaire consisting of questions aimed at examining participants' opinions, preferences, and practices with regard to sub-specialization in family practice. RESULTS: Only 48 family doctors (20.2%) had the qualification of subspecialist. Diabetology was the most common clinical subspecialty. The majority of participants agreed with the statements in favor of sub-specialization in FM. About 73% approved of the idea of sub-specialization in FM, while 89% thought that sub-specialization would provide a source of expertise within the FM context. The most stated reasons to go for FM subspecialties were to earn more experience (65.1%), gain some sense of control of huge knowledge and skills of FM (53.7%), and earning extra money (47.8%). CONCLUSIONS: This study revealed that majority of certified family physicians and FM residents in SA have positive attitude towards sub-specialization in FM and support the idea of sub-specialization to be practiced within the context of FM.

Study designs and statistical methods in the Journal of Family and Community Medicine: 1994-2010.

INTRODUCTION: The Journal of Family and Community Medicine (JFCM) is the official peer reviewed scientific publication of the Saudi Society of Family and Community Medicine. Unlike many peer medical journals, the contents of JFCM, have never been analyzed. The objective of this study was to perform an analysis of the contents of the JFCM over a 16-year period to discern the study designs and statistical methods used with a view to improving future contents of the journal. MATERIALS AND METHODS: All volumes of the JFCM, from 1 January 1994 to 31 December 2010 were hand searched for research articles. All papers identified as original articles were selected. For every article, the study designs and the statistical methods used were recorded. Articles were then classified according to their statistical methods and study designs. The frequency of study designs was calculated as a simple percentage of the total number of articles, while the frequency of statistical methods was calculated as a percentage of articles that used those statistical methods. RESULTS: A total of 229 articles were analyzed. Of these, 66 (28.8%) either reported no statistics or reported simple summaries. The cross-sectional design was used in 175 (76.4%) of all analyzed articles. Statistical methods were used in 163 (71.2%) articles. Chi-squared test was used in 111 (68.1%) articles, and t-test used in 48 (29.4%) articles. Other common statistical tests were: Regression, which was used in 35 (21.5%) articles, ANOVA used in 23 (14.1%) articles, and odds ratio and relative risk tests which were used in 22 (13.5%) articles. CONCLUSIONS: The JFCM has a wide range of study designs and statistical methods. However, no article on experimental studies has been published in the JFCM since its inception.

Clinical effect of Metformin in children and adolescents with type 2 diabetes mellitus: a systematic review and meta-analysis.

To assess the clinical value and of metformin as mono-therapy versus other treatments for type 2 diabetes mellitus in children and adolescents. Major electronic databases, the reference lists of relevant articles and databases of ongoing trials were searched. Authors of reviews and metformin manufacturers were contacted in order to obtain more references and reports of unpublished trials. The methodological quality of these reports, included randomised controlled trials (RCTs) was assessed using the National Health System Centre for Reviews and Dissemination (NHS CRD) checklist. The search identified 1,825 studies. Three RCTs met the inclusion criteria. Two RCTs had been completed and one was still ongoing. In the metformin group there were significant reductions of mean change of HBA1c from baseline. It reduced by -0.71% (P = 0.0002) and in the other trial the result was reduced by -1.10 (95% CI: -1.19 to -1.01). In addition, more patients (48.1%) in the metformin group achieved good glycaemic control (<7%) at week 24. The mean changes in FPG from baseline were significantly (P < 0.05) different in the metformin group (-16.6%, for week 18 and week 24 20.6%. In the second trial there was a significant (P < 0.001) reduction in the adjusted mean of FPG from baseline in the metformin group, while there was an increase in the placebo group ( -42.9 mg/dl vs. +21.4mg/dl) with mean difference of -64.80 in favour of the metformin group. For BMI, significant (P < 0.001) differences were seen at week 12 and week 24 (0.07 and 0.55 kg(2)) for metformin and glimepiride respectively. There was no significant difference between the placebo and metformin in the other trials. For lipid value there was a significant decrease in LDL levels in the metformin group. No significant changes were found in the other lipid parameters after adjusting. There were more adverse events in the metformin group but they were not statistically significant. There was a limited but not convincing evidence to suggest that metformin can improve the glycaemic control in children and adolescent with type 2 diabetes compared with other interventions. This is may be the result of the limited number, poor quality and short duration of the included trials.

Outbreak of food borne Salmonella among guests of a wedding ceremony: The role of cultural factors.

OBJECTIVE: In response to a large number of cases of gastroenteritis reporting to Sulyyel hospital, an outbreak investigation was conducted to identify its source, to assess its extent and to make recommendations on the prevention of such outbreaks in the future. MATERIAL AND METHODS: A CASE WAS DEFINED AS ANY INDIVIDUAL WHO DEVELOPED DIARRHEA WITH ANY OF THE FOLLOWING SYMPTOMS: Abdominal pain, fever or vomiting within three days of eating at the wedding ceremony. A retrospective cohort study was conducted to identify food items and circumstances responsible for this outbreak. RESULTS: A total of 283 individuals were interviewed, 88 of whom developed gastroenteritis, most commonly manifested by diarrhea (100%), abdominal pain (94.3%) and fever (86.4%). The majority of persons interviewed were Saudis (89.1%) and 21.6% were males. The median incubation period was 20.6 ± 2.77 hours and the epidemic curve suggested a common point source outbreak. Out of 9 food items and drinks served at the wedding ceremony, 3 food items were significantly associated with illness: meat ranked first (RR=16.7, 95% CI=2.37-115.8), followed by rice (RR=13.6 95% CI=1.95-93.61), and restaurant made sweets (RR=1.9, 95% CI=1.35-2.58). Out of 62 stool samples collected from cases, 40 (64.5 %) grew Salmonella group C non-typhoid. CONCLUSION: Salmonella was considered the causative agent of this food-borne outbreak. Meat and rice served at the wedding party were the food items incriminated. Time, temperature misuse, inadequate heat treatment, and unhygienic handling were the most important factors causing this outbreak.

Knowledge of diabetes risk factors and preventive measures among attendees of a primary care center in eastern Saudi Arabia.

BACKGROUND AND OBJECTIVE: Few studies have been conducted in Saudi Arabia to assess the level of awareness and knowledge of the population about diabetes mellitus (DM) risk factors and preventative measures. The objective of this study was to measure this knowledge among attendees of a primary care center in eastern Saudi Arabia. METHODS: A sample of 300 male and female Saudis aged 18 years and older from the catchment area of the Aqrabya Primary Care Center were randomly selected for this cross-sectional survey. Data were collected through a structured face-to-face interview using a pre-piloted Arabic instrument. Regression analysis was used to identify the predictors of knowledge. RESULTS: The 288 participants interviewed included 100 males and 188 females. The mean (SD) age was 44.7 (12.6) years for males and 33.8 (12.4) years for females. Fewer than 50% of participants knew about DM risk factors and preventive measures. In a regression model that included age, sex and education, education had a statistically significant positive association with knowledge of risk factors (odds ratio 12.5, 95% CI 6.26-25.2, P<.001) and preventive measures (odds ratio 7.6, 95% CI 4.01-14.2, P<.001), and age had a statistically significant negative association with knowledge of DM risk factors (odds ratio 0.377, 95% CI 0.207-0.685, P=.001) and prevention (odds ratio 0.407, 95% CI 0.231-0.717, P=.001). The main risk factor stated by participants was obesity (35.8%), while the main preventive measure mentioned was weight reduction (37.9%). CONCLUSION: Attendees had poor knowledge of DM risk factors and preventive measures. The level of education and age were important predictors of knowledge. Programs for health education of the community about DM risk factors and preventive measures are needed.