Firdous Jahan

Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management

Fibromyalgia Syndrome (FMS) is a chronic condition causing pain, stiffness, and tenderness of the muscles, tendons, and joints. It is also characterized by restless sleep, tiredness, fatigue, anxiety, depression, and disturbances in bowel functions. The etiology of fibromyalgia remains unknown, but recent advances and discoveries have helped to unravel some of the mysteries of this disease. Research highlights some of the biochemical, metabolic, and immunoregulatory abnormalities associated with fibromyalgia. Management of FMS at the present time is very difficult as it has multiple etiological factors and psychological predispositions; however, a patient centered approach is essential to handle this problem.

Understanding the context of balanced scorecard implementation: a hospital-based case study in pakistan

BackgroundAs a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital.MethodsFour clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs and reporting of performance based on the BSC during administrative meetings. Pettigrew and Whipps context (why), process (how) and content (what) framework of strategic change was used to guide data collection and analysis. Data collection methods included quantitative tools (a validated culture assessment questionnaire) and qualitative approaches including key informant interviews and participant observation.ResultsMethod triangulation provided common and contrasting results between the four units. A participatory culture, supportive leadership, financial and non-financial incentives, the presentation of clear direction by integrating support for the BSC in policies, resources, and routine activities emerged as desirable attributes for BSC implementation. The two units that lagged behind were more involved in direct inpatient care and carried a considerable clinical workload. Role clarification and consensus about the purpose and benefits of the BSC were noted as key strategies for overcoming implementation challenges in two clinical units that were relatively ahead in BSC implementation. It was noted that, rather than seeking to replace existing information systems, initiatives such as the BSC could be readily adopted if they are built on existing infrastructures and data networks.ConclusionVariable levels of the BSC implementation were observed in this study. Those intending to apply the BSC in other hospital settings need to ensure a participatory culture, clear institutional mandate, appropriate leadership support, proper reward and recognition system, and sensitization to BSC benefits.

Culture and quality care perceptions in a Pakistani hospital

PURPOSE Organizational culture is a determinant for quality improvement. This paper aims to assess organizational culture in a hospital setting, understand its relationship with perceptions about quality of care and identify areas for improvement. DESIGN/METHODOLOGY/APPROACH The paper is based on a cross-sectional survey in a large clinical department that used two validated questionnaires. The first contained 20 items addressing perceptions of cultural typology (64 respondents). The second one assessed staff views on quality improvement implementation (48 faculty) in three domains: leadership, information and analysis and human resource utilization (employee satisfaction). FINDINGS All four cultural types received scoring, from a mean of 17.5 (group), 13.7 (developmental), 31.2 (rational) to 37.2 (hierarchical). The latter was the dominant cultural type. Group (participatory) and developmental (open) culture types had significant positive correlation with optimistic perceptions about leadership (r = 0.48 and 0.55 respectively, p < 0.00). Hierarchical (bureaucratic) culture was significantly negatively correlated with domains; leadership (r = -0.61,p < 0.00), information and analysis (-0.50, p < 0.00) and employee satisfaction (r = -0.55, p < 0.00). Responses reveal a need for leadership to better utilize suggestions for improving quality of care, strengthening the process of information analysis and encouraging reward and recognition for employees. RESEARCH LIMITATIONS/IMPLICATIONS It is likely that, by adopting a participatory and open culture, staff views about organizational leadership will improve and employee satisfaction will be enhanced. This finding has implications for quality care implementation in other hospital settings. ORIGINALITY/VALUE The paper bridges an important gap in the literature by addressing the relationship between culture and quality care perceptions in a Pakistani hospital. As such a new and informative perspective is added.

Perception of Stress, Anxiety , Depression and Coping Strategies among Medical Students at Oman Medical College

Objective: To explore the stress sources, prevalence of anxiety and depression and coping strategies among preclinical and clinical under graduate medical students. Methods: A cross sectional study was conducted on Oman Medical College Students of pre-clinical and clinical years. Data was collected using Medical Student Stressor Questionnaire (MSSQ), Hospital Anxiety and Depression scale (HAD) and COPE questionnaire. Statistical analysis was performed using SPSS (IBM SPSS Statistics 20.0). Results: A total of 288 participants were enrolled in which 123 were pre-clinical and 165 were clinical medical students. Nearly two thirds (78.1%) of students were aged between 20-24 years. Among all 87.5% (252) were females and 12.5% (36) were males. Collective score of academic stress factors in the pre-clinical group was not statistically different (p = 0.865) to the clinical group. There was no significant difference (P: 0.826; 95% CI: -3.511-2.804) in the mean score of preclinical and clinical group regarding Social Stress factors. Coping strategies to control stress score in the pre-clinical group was statistically significantly (p < 0.001) higher than the clinical group. Conclusion: The higher level of stress is associated with poor academic performance, large content of study material, exam and time constraints. Coping strategies in students were mainly better time management, emotional support, talking to family members/friends helps and good sleep relaxes them to control stress.

Recognition of Core Elements of Medical Professionalism among Medical Students and Faculty Members

OBJECTIVES Medical students and future physicians have chosen to pursue a profession that requires personal integrity, compassion and a constant awareness of the commitment made by them. Professionalism includes personal behaviors, knowledge, and competency. It includes the attitudes and values one holds and that run through the profession as a whole. Medical students learn professionalism during the course by either direct teaching or experiential learning. We conducted this study to estimate the self-reported level of practice of the core elements of professionalism by medical students and medical faculty and compared the two groups. METHODS One-hundred and nine students and 83 faculty members of Oman Medical College completed a professionalism questionnaire. The survey questions related to core elements of professionalism and were grouped under professional knowledge, professional skills, professional attitude, and qualities essential for professionalism. RESULTS The response rate was 65.6% (109 of 166) among students and 75.5% (83 of 110) from faculty members. Response to the questions on professional skills between the student and faculty group was significantly different (p < 0.001). Similarly, there was a significant difference in the responses related to professional attitude between the student and faculty group (p < 0.001). Students and faculty members have a significant difference in opinion regarding up to date knowledge of basic and clinical sciences and clinical competency (p = 0.024). Similarly, significant differences in opinion regarding up to date knowledge of basic and clinical sciences and clinical competency in clinical and basic sciences faculty members (p = 0.001). Students identified good communication skills (82.6%), and faculty staff identified up to date professional knowledge (62.7%) as the most important aspect of professionalism. CONCLUSIONS Both students and teaching faculty agreed that the top most professional elements are up to date knowledge, good communication skills, and teamwork. Hence, it is important that faculty members encourage their students to improve their professional skills and attitude.

Role of Complementary and Alternative Medicine in Controlling Dyslipidemia

This special issue focuses on the role of complementary and alternative medicine (CAM) in controlling dyslipidemia. Complementary and alternative medicine (CAM), also known as nonconventional medicine, includes a wide and heterogeneous array of health care practices (such as herbal medicine, acupuncture, yoga, meditation, and homeopathic medicine) that are not part of a health care system. The popularity of CAM has dramatically increased in many developed countries since the 1990s. This could be attributed to the aging of population, prevalence of chronic diseases, and concern about the adverse reaction of chemical drugs. All these aspects have contributed greatly to the worldwide popularity of CAM. In the United States, consumers spend over

Evaluation of Nutritional Status in Relation to the Cognitive Performance of Medical Students at Oman Medical College

34 billion per year on CAM therapies spent outside the conventional health care financing system. This out-of-pocket expenditure is evidence of the belief that CAM therapies have benefits that outweigh their costs. CAM is generally more popular in most developed countries, especially in North America, Europe, and Australia. According to the 2007 National Health Interview Survey on more than 32,800 Americans, 38.2% of adults and 12% of children used some form of CAM within the previous 12 months. Dyslipidemia is an independent preventable risk factor of coronary heart disease and has been shown to increase the risk of cardiovascular mortality manyfold. Therefore, the study on various indicators and risk factors of dyslipidemia appears to be significant for future health outcomes. It is critically important to recognize the need for treatment of dyslipidemia and to institute necessary therapies to reduce the long-term risks of disease recurrence or modify the metabolic derangements that promote atherosclerosis. Drugs used in dyslipidemia may cause adverse effects if used for longer duration. Therefore patients use CAM to reduce lipids without any major side effect. The exact reasons for the popularity of CAM are complex; as they change with time and space, they vary from individual to individual and from therapy to therapy. In general, there are a broad range of positive motivations to the present popularity of CAM. Although the use and expenditure of CAM have been increased radically, the potential role of CAM in modern clinical practice and health care system seems to be limited. As the efficacy and safety have been the major concerns in the recognition of CAM and integrating it into the conventional medicine, hence, there is an urgent need to provide evidence regarding the merits of the numerous techniques of CAM. The best way to achieve this is through rigorous research. Since then, in CAM, simple answers or broad generalizations are not possible. Each of the numerous techniques has to be evaluated separately. It is necessary to bring the practice of CAM in line with evidence. The wide dissemination of its findings is also important to include CAM into the modern clinical practice. Studies have reported that CAM can be ineffective for a specific condition, but still they could be used as they do not harm the patients. Some argue that CAM should be used regardless of the results of placebo-controlled clinical trials, particularly when its use is not associated with serious risks. The main purpose of this issue is to illustrate the inevitability of researches in the field of CAM to integrate it into the modern clinical practice. Altogether, 14 manuscripts were submitted for publication, out of which 11 manuscripts got accepted. The articles in this issue represent a wide range of therapeutic approaches of CAM in preventing dyslipidemia. This special issue includes a review that discusses the progress and perspective of studies on dyslipidemia with single Chinese herb and its monomers or effective extracts during the past 10 years. The review concludes that traditional Chinese medicine (TCM) has some beneficial effects on the treatment of patients with dyslipidemia and has less adverse effects as compared to chemical agents. However, future clinical trials are needed to be confirmed about the effects of TCM. This edition also includes a randomized, double-blind, placebo-controlled clinical trial on 50 hyperlipidemic patients. The results of this trial show that daily consumption of the fruit extract of Vaccinium arctostaphylos significantly reduces the serum levels of total cholesterol, LDL-C, and triglyceride (TG) and oxidative stress in hyperlipidemic patients. Therefore, this extract could be considered as a potential agent for treatment of dyslipidemia. Another study in this issue is on Chaihu-Shugan-San (CSS), an ancient classical formula composed of seven Chinese herbs, which found that integrated recipe might work as a significant anti-inflammatory effect in Kupffer cells. In addition, another study conducted by Han et al. on the molecular docking of echinocystic acid (EA) (isolated from G. sinensis fruits) and the effects of it on the possible targets in in vitro rat liver microsomes has been added. This review also includes a research paper which concluded that preventive acupuncture and moxibustion can significantly decrease the plasma TG and LDL, increase the plasma HDL, and prevent fat accumulation during climacteric period in rats. Moreover, a paper included is on intestinal transportations of main chemical compositions of Polygoni Multiflori Radix (PMR, originated from the root of Polygonum multiflorum Thunb.). This has been used in the treatment of hyperlipidemia in some countries for centuries. Another paper using the same herb PMR has been added to this special issue which discusses the mechanisms of the water extracts of Polygoni Multiflori Radix (PMR) and its processed products (PMRP) on liver lipid metabolism. Moreover, another paper was included in this review on propolis, which is a brownish resinous material collected by worker bees from the leaf buds of numerous plants that have strong pharmacological and biological properties. Another study analyzed the effects of acupuncture on interleukin, IL-17expression in fat excess liver on adult mice, and provided some basic evidences that the inflammatory damage of hyperlipidemic fatty liver could be restricted through acupuncture. A study in this review investigates the beneficial effects of ethanol extract of Gastrodia elata Blume (EGB) on lipid metabolism and endothelial dysfunction in a high-fructose (HF) diet animal model.

Poor glycaemic control is the major factor associated with increased frequency of gastrointestinal symptoms in patients with diabetes mellitus.

Objective: Dietary assessment to describe eating practices and asses the nutritional status of students in relation to the cognitive performance of students by Mini-Mental State Examination. Methods: A cross-sectional study was conducted using a food frequency questionnaire, Mini mental state examination, anthropometric measurements, and blood analysis for measuring hemoglobin(Hb) and glucose levels. Third year medical students of Oman medical college Sohar campus (Sample size, N=80) were involved in this study. Statistical Analysis was done using the food frequency, MMSE and blood analysis data to study the dietary patterns, nutrition status and cognitive performance of the students. Results: The data revealed low intake of legumes, eggs and red meat (mutton/beef), hence low protein intake by majority of students. 47.5% of the students consumed only two meals in a day. 20.9% of the students were underweight, 13.4% were overweight and 9% were obese. Physical inactivity was present in 51.2% of the students. Low hemoglobin (Hb<12mg/dl) and low glucose level (<3.9mmol/L) was observed in 32% and 28.7% of study sample respectively. Low MMSE score among 11.6% subjects indicated mild cognitive impairment. A significant correlation existed between MMSE and glucose level (p<0.05). Conclusion: A strategy is required to monitor the nutrition of young Omani adults in order to improve health status and prevent deficiency diseases. There is an urgent requirement to promote healthy food choices and lifestyle among medical students.