Khalid Al-Umran

Medical ethics and tomorrow's physicians: an aspect of coverage in the formal curriculum

Medical ethics has created contentious issues and requires reforms in medical education such as renewed emphasis on formal instruction. The aim here was to review the current status of bioethics teaching in medical schools, determine Saudi students’ perception of its coverage in the formal curriculum and make recommendations. Using a self-administered questionnaire in a cross-sectional study, undergraduate students’ opinion about medical ethics coverage was obtained. Fourteen clinical departments and 201 students were studied. Only 46% of respondents were satisfied with the current coverage of ethical issues in the formal curriculum; 23% were unaware of the value of the subject. Students’ approval rate was highest in Neurology and Psychiatry (70%). The study confirmed inadequate formal instruction on medical ethics in a developing country. Five recommendations are made. At admission, students’ integrity and character should be assessed. Bioethics should be taught in clinical settings. In the Islamic world, medical curricula should include the Islamic code of medical ethics. Peers, nurses and patients should evaluate graduates’ performance in ethics at the bedside. Evidence-based assessment and continuous quality improvement are required to maintain the requisite standard.

Volatile substance abuse among school students of eastern Saudi Arabia.

A questionnaire-based cross-sectional epidemiological survey of volatile solvent (VS) abuse in a representative sample of 1778 male Saudi students drawn from nine intermediate and nine secondary schools in three urban areas in Eastern Saudi Arabia showed a prevalence rate of 5.3%. The majority (52%) started their abuse between 112 to 14 years of age and the involvement was mostly once (45%) or occasionally (44%), while daily abuse was rare (11%). Predominantly (63%), the behavior lasted less than a month and solitary abuse prevailed (54%). The commonly abused substances were petrol (27%) and glue (23%). VS abuse was significantly associated with family troubles, truancy and smoking, but neither correlated with socioeconomic status, family structure nor with scholastic achievement. Preventive measures are suggested.

Neonatal hip instability in Saudi Arabia: Results and cost effectiveness.

The benefits of screening hips at birth for congenital dislocation have been repeatedly confirmed but doubts have been raised about the need for splinting all positive cases. Experience from an ongoing screening program, now in operation for over 11 years, is presented particularly with reference to cost benefit of screening and early surgical intervention. Of 30,651 live born babies screened for congenital dislocation of the hip (CDH) employing Barlow and Ortolani maneuvers, 132 were found to be positive, giving an incidence of two to six per 1000 liver births, averaging 4.3/1000 for the period. The implications of epidemiologic and clinical observations and of management have been discussed. The cost of screening and of surgical management of cases that would not have stabilized without intervention. Cost effectiveness of a screening program for CDH was observed from this 11 year study, fully justifying a sustained program apart from the human misery an overlooked diagnosis may cause.

Changes in plasma creatinine in first 72 hours of life

Editor—Recently, Miall et al 1 have reported a rapid rise in serum creatinine in the first 48 hours of life in neonates. But we have noticed in our clinical day to day practice that this rise is transient and may not be clinically significant. To confirm this, we looked at the initial serum creatinine levels on a stable group of term neonates admitted to the neonatal intensive care of King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. Neonates with congenital anomalies, perinatal asphyxia, and those requiring ventilatory support were excluded. The serum creatinine levels were measured together with electrolytes …

Congenital diaphragmatic hernia: Update on regional experience.

A consecutive series of 34 patients with congenital diaphragmatic hernia are reported from a tertiary neonatal care unit in the Eastern Province. All the patients presented within the first 24 hours of life with left-sided defect. The overall mortality (56%) and postoperatiVE mortality (44%) are comparable with reports from other centers. The outcome of treatment correlated well with the age on presentation, the size of the defect, and preoperative blood gas results. Our approach to management has been modified lately, in the light of recent experience from other centers. The surgery is delayed until the neonate is stabilized with biochemical values of PaCO2 = 45 torr or less; pH = 7.2 or higher; and PaO2 = 50 torr or more. This management policy did not adversely affect overall survival. The problem encountered with patient transfer and the need for continued improvement in the organization of regionalized care are highlighted.

Evaluation of newborn care in the Kingdom of Saudi Arabia: a first step toward regionalization of perinatal care.

The newborn care facilities, policies, and patient load in the perinatal care centers (PNCCs) in Saudi Arabia were assessed in 1985 as a first step toward providing data that would be needed in for...

Impact of a medical education unit on assessment practices

an attachment to the faculty listserv. We also individually e-mailed faculty members with clarifying information. Evaluation of results and impact We received 39 out of 125 possible responses to the questionnaire and e-mail inquiry. This enabled us to identify a group of eight of the 39 faculty members who appeared to already be using innovative assessment methods spontaneously. They reported the use of portfolios, role-play activities, student self-assessment, 360-degree evaluation, formative assessment, cognitive tests integrating basic and clinical science, direct observation of student activities and behaviour with checklists, and peer assessment approaches. These faculty members were therefore regarded as ‘found pilots’ who could act as agents of change to assist in aligning the assessment system with the new curriculum. Focusing on and investing further in this group is assumed to be an attractive and effective strategy for the dissemination and systematisation of innovative assessment methods throughout the faculty. This might therefore allow the successful aligning of assessment strategies with the new curriculum objectives and have a positive impact on the institution’s educational activities.

Pediatric liver disease in the eastern province of Saudi Arabia: A clinicopathological study.

This prospective study analyzes the clinical features and histopathological findings in liver biopsies of pediatric patients presenting to the hospital with liver disease during a 10 year period. Only those patients in whom liver biopsy was performed for a tissue diagnosis were included. Fifty patients were investigated, all below the age of 12 years, of whom 36 were male and 14 female. Thirty-two were of neonatal-infantile group, 11 had a diagnosis of neonatal giant cell he hepatitis of infections origin and an intact biliary tree. Two had septic shock and one had leishmaniasis. The remaining 18 patients of the neonatal-infantile group constituted five case of glycogen storage disease, six of infantile obstructive cholangiopathy (biliary atreasia), four of fatty change and one each of congenital hepatic fibrosis, neuroblastoma and nonspecific reactive hepatitis. The eighteen older children had the following diagnoses: thalassemia in five, sickle cell disease in four, two each of Reye syndrome and hepatoblastoma. The remaining were one each of glycogen storage disease, Rotor syndrome, cirrhosis, fatty change and non-Hodgkin lymphoma (NHL). These findings are presented and discussed.