Does the delivery of interprofessional education have an effect on stereotypical views of healthcare students in Qatar?

Interprofessional education (IPE) is an evolving educational approach for preparing healthcare professional students to provide patient care in a collaborative team atmosphere. One of the important outcomes to be achieved is understanding the stereotypical views of health professionals held by themselves and by others to eventually reduce negative and harmful stereotypes and to foster an environment of mutual respect and trust amongst healthcare professionals. The primary aim of this study was to investigate whether there is a change in healthcare students' stereotypical belief about the characteristics of healthcare professionals before and after an IPE activity focused on smoking cessation. The Student Stereotype Rating Questionnaire (SSRQ) was used to assess the students' stereotype ratings of their professions and other healthcare professions before and after the IPE activity. The ratings were made in relation to nine attributes. Sixty-eight students from five different majors (Medicine, Nursing, Pharmacy, Public Health, and Respiratory Therapy) participated in the IPE activity. All the students involved in the activity responded to both the pre and post surveys (response rate, 100%). The participating students' combined ratings revealed a significant change in the perspectives of medical, pharmacy, and respiratory therapy students in all of the nine attributes. While for public health students, differences were significant in two aspects: professional competence and practical skills. Three central themes emerged after the IPE session from the open-ended questions: roles and responsibilities, patient-centered care, and integrated healthcare team. Overall, the findings from this study suggest that stereotyping exists among different healthcare profession student groups in Qatar and that IPE can impact both hetero-stereotypes and auto-stereotypes. The positive change in perception following the IPE activity indicates the effectiveness and the value of these short duration IPE activities in negating stereotypical views.

Reflecting on the humanities, related to experiences of illness, with a creative exploration of metaphoric spaces.

Every patient has a story to tell, and every experienced physician has a bank of stories to recall. A patient's visit is not chance but a search for a cure, amelioration of state, advice, guidance, a prescription, or for seeking reassurance, comfort, and in some circumstances, permission to "be well". From the simplest tale to the most complex, narratives abound. Sometimes, the most intimate information shared with the physician confidante, go dark and deep, with a yearning to "tell all" after a period of suppression. Successful communication and rapport also depends on the carer's response, the degree of concentration, listening skills, body language, eye contact engagement, the patient relationship and empathy. How do we as physicians cope with emotion on both sides when it comes to listening to a narrated story, keeping matters in perspective, recognizing the effects of depression, grieving, anger, forgiveness, or the strength of the patient to be able to face their demons when cowardly acts of abuse have been committed. The professionalism of doctors should always be at the highest level, but individuals vary in their responses. A price may be paid with arising stress, unsolved patient problems, an increase in new ones, and the general challenge of coping. Time may not be the only enemy with modern day medical practice. Does narrative medicine have a place in reducing this dissonance, and will learning to share stories, as well as being a good listener, limit adverse outcomes?

Validity of self-reported vitamin D deficiency among midlife Arab women living in Qatar.

OBJECTIVES: This study evaluates the level of agreement between self-reported vitamin D deficiency and serum vitamin D measured within the previous calendar year. METHODS: In a study in which serum 25(OH)D levels were retrieved from electronic health records, 523 women were asked whether they considered themselves to have vitamin D deficiency. Serum vitamin D levels were categorized as vitamin D deficiency if serum 25(OH)D was <20 ng/ml and as insufficiency if <30 ng/ml. The kappa statistic was computed to assess the level of agreement between serum 25(OH)D level and self-report responses. RESULTS: Agreement between self-reported and measured 25(OH)D levels was poor. The kappa statistic was -0.041 when using a cutpoint of <20 ng/ml and -0.008 using the cutpoint of <30 ng/ml. Among women with levels ≥20 ng/ml, 82.4% believed that they were vitamin D deficient, while 13.3% who were below <20 ng/ml did not self-report deficiency. Among women who did not report vitamin D deficiency, 46.3% (37/80) had levels <20 ng/ml while 82.5% (66/80) had levels <30 ng/ml. CONCLUSIONS: These findings suggest that, although the prevalence of 25(OH)D <20 and <30 ng/ml was quite high (53.2% and 84.7%, respectively), there was little agreement between measured levels and self-report of vitamin D deficiency. This may be due to belief in this region that low levels of serum vitamin D is widespread. Better communication is needed between healthcare providers and patients regarding transmission of laboratory results.

Limited evidence of a threshold effect for increasing adiposity on risk of symptoms at midlife.

OBJECTIVE: To assess the nature of relationships between increasing body mass index (BMI) and the prevalence of midlife symptoms in a population with high adiposity. METHODS: In the cross-sectional Study of Women's Health in Qatar, 841 participants aged 40 to 60 years were recruited from nine primary health centers in Doha. Face-to-face interviews collected demographic, menopause, and symptom information. BMI (kg/m 2 ) was categorized as healthy, overweight, or class I, II, or III obesity. Multivariate logistic regression models were used to examine aches/stiffness in joints, trouble sleeping, shortness of breath, urinary incontinence, and hot flashes with BMI categories. Restricted cubic splines (RCSs) were used to estimate relationships between continuous BMI and each symptom and to conduct formal tests of nonlinearity. RESULTS: Mean BMI was 34.3 kg/m 2 (SD, 6.0 kg/m 2 ). Women with class II and III obesity had higher odds of reporting aches/stiffness than women with a healthy BMI, and the odds of reporting urinary incontinence were three times higher among women with class III obesity (odds ratio, 3.08; 95% confidence interval, 1.17-8.14). Using restricted cubic spline models, a significant nonlinear association ( P = 0.002) was observed between aches/stiffness and BMI with an apparent threshold of 38 kg/m 2 . Linear relationships were observed with BMI for urinary incontinence ( P < 0.001 for linear trend) and shortness of breath ( P = 0.005 for linear trend). Trouble sleeping and hot flashes were not associated with BMI. CONCLUSIONS: Even at very high levels of BMI, likelihood of urinary incontinence and shortness of breath increases with BMI. In contrast, likelihood of aches/stiffness has a nonlinear relationship with BMI, increasing to a threshold level.

Dry Eye Disease: Early Recognition with Guidance on Management and Treatment for Primary Care Family Physicians.

Primary care presentations of dry eye disease (DED) are common and pose a diagnostic challenge due to the variety of symptoms and the absence of certainty for family practitioners. While there are many published articles on the topic, the 2017 Tear Film and Ocular Surface Society Dry Eye Workshop was a landmark report in distinguishing multifactorial differences. Redefined terms clarified the DED disorder. The ocular surface-the tear/air interface-is the primary refractive component of the eye, which is why DED is so significant and impacts vision. There is a high prevalence of DED in the community, ranging from 5% to 30% of people across multiple studies. Elderly patients have up to 75% increased risk of DED and receive more intensive treatment than younger age groups. DED is also more common in women than men, occurring in 9.8% of postmenopausal women. The causes of DED span defective lacrimal apparatus and systemic disorders. Despite its prevalence, up to one-half of patients with confirmed DED do not receive proper alleviating treatment. Risk factors on functional and environmental bases follow. Tools to elicit a diagnosis more confidently are outlined using the Ocular Surface Disease Index (OSDI) and the Symptom Assessment in Dry Eye questionnaires (SANDE). Lacritin, lutein, vitamin A, and balanced nutrition are essential contributors to maintaining healthy eyes with appropriate management and treatment. The authors hope that this paper will prompt a more accurate and expedient diagnosis of DED in primary care practice and an earlier recognition of specialist referrals.

Dry eye disease (DED) poses a diagnostic challenge to primary care physicians. The condition involves the tear/air interface, at the corneal (ocular) surface, where light enters the eye. Any change in light refraction affects regular sight. Symptoms of DED include itching, grittiness, foreign body sensation, redness, excessive tearing, and visual blurring, the lattermost being the most common presentation. Ultimately, the untreated disease leads to continued discomfort and visual deficit, but when severe, it can result in blindness. Up to 30% of the population suffers from DED, with the elderly, particularly women, more affected. Unfortunately, up to 50% of those affected have inadequate treatment. Questionnaires help in diagnosis. Simple office tests can indicate the severity of eye problems. Technology with smartphone photography can take high-resolution images, which are useful in education and teaching. A multitude of conditions cause DED, including blepharitis, an infection of the eyelids. Environmental risks also abound. Proper nutrition is essential in maintaining eye health. Intermittent eye symptoms are likely to be underrated by the public, by purchasing over-the-counter products such as artificial tears rather than seeking a proper medical check. Newer prescription medications are now available for DED relief before advancing to debility requiring specialist treatment. Dry Eye Disease: Early Recognition with Guidance on Management and Treatment for Primary CareFamily Physicians (MP4 95031 kb).

Schistosomiasis: Still a Cause of Significant Morbidity and Mortality.

Tropical diseases remain severe threats to global health with acute or chronic debility. Public health issues are regularly monitored and reported by the WHO. Conditions with high prevalence and virulence such as Schistosomiasis or Malaria still need active treatment. Advances over the decades in the treatment and management of Schistosomiasis have reduced morbidity and mortality in patients. However, poverty, adverse environments, lack of education and awareness, with parasites and vectors that can thrive if uncontrolled, remain issues for the successful global eradication of Schistosomiasis. From the disease's discovery in 1850, the author relates historical details to its current status. Several countries previously affected, including Japan and Tunisia, have eliminated the disease while others seek the same goal. Africa remains the most severely affected continent with vulnerable women and children, although the infection persists in South America and the Far East of Asia as well. Realistic improvements for continuing health conditions are vogue and emphasized for those at risk or afflicted by the infection, illustrating success models of concerted efforts of extirpation. Constant proximity to infected water, with a parasite host, are hurdles in reducing exposure. Effective medication for acute treatment is available, and prophylaxis by vaccination is promising. Where endemic Schistosomiasis is prevalent, significant morbidity and mortality have far-reaching complications in multiple human organ systems, including irreversible pulmonary hypertension, renal, genitourinary, central nervous system conditions, and neoplasia. Two hundred and thirty million people are estimated to have contracted Schistosomiasis globally, with up to 700 million still at risk of infection, and 200,000 deaths occur annually. The disease may be more prevalent than thought after newer tests have shown increased sensitivity to pathological antigens. The author discusses infectivity risks, investigations, prognosis, treatment, and management, as well as morbidity and mortality.

Diabetic muscle infarction: often misdiagnosed and mismanaged.

A patient with type 2 diabetes, retinopathy, neuropathy, and nephropathy presented with severe right distal thigh pain, which awoke him from sleep. He was diagnosed with musculoskeletal pain and discharged home. Two days later, the severity of pain increased in his right thigh and, subsequently, he developed pain in the proximal lateral aspect of his left thigh, for which he returned to hospital. He had elevated creatine kinase and myoglobin levels. An ultrasound of the right thigh identified a loss of definition of the normal muscular striations and subcutaneous edema. On MRI, the axial STIR image demonstrated extensive T2 hyperintensity in the right vastus medialis and left vastus lateralis, consistent with the diagnosis of diabetic muscle infarction (DMI). This presentation emphasizes the need for a thorough patient history and physical examination, and the importance of directed imaging for the prompt diagnosis of DMI.

Medical issues in flight and updating the emergency medical kit.

Airline travel is more affordable than ever and likely safer than ever too. Within half a day, a passenger can be on the other side of the world. However, medical care in-flight has been an issue for those with medical conditions and for those who fall sick during a journey. While airlines have the advice of multiple recognized organizations on needs and standards of care, in-flight emergencies occur at various levels. An emergency medical kit (EMK) together with trained cabin crew can be very effective at resolving the minor problems that arise and reducing the risk of escalation. On occasion, an overhead plea may be announced for additional medical expertise. Having the right content in a medical kit is more important in modern day travel, coupled with advances in equipment and passenger expectations. The authors address current issues of illness and other relevant conditions and suggest a content enhancement for an onboard EMK.

Delivering Tobacco Cessation Content in the Middle East Through Interprofessional Learning.

Objective. To explore the attitudes of pharmacy, pharmacy technician, medical, and public health students before and after an IPE activity that focused on smoking cessation in the Middle East. Methods. A pre-post intervention research design using the Readiness for Interprofessional Learning Scale (RIPLS) was used for this study. The tool contained 20 items, categorized under the following subscales: teamwork and collaboration, professional identity, and patient-centeredness. Results. A total of 47 out of 50 students from four different health disciplines in Qatar (medicine, pharmacy, pharmacy technician, and public health) who participated in the activity completed a pre- and post-intervention pre-validated questionnaire (94% response rate). Total attitude scores were calculated for all the 20 items along with attitudinal scores of the three domains. Most of the students reported having a positive attitude toward IPE; the number of students having a positive attitude toward IPE increased after the IPE session. The overall median (IQR) score increased from 82 (16) before the session to 84 (15) after the session. Students from different disciplines did not vary in their attitude scores. Conclusion. Health care professional students in Qatar perceived IPE positively, believing that it enhanced their communication skills, collaboration and appreciation of professional roles. This study has implication on developing effective methods to implement IPE in various health professional education curricula.

Rare mutation in the SLC26A3 transporter causes life-long diarrhoea with metabolic alkalosis.

SLC26A3, a chloride/bicarbonate transporter mainly expressed in the intestines, plays a pivotal role in chloride absorption. We present a 23-year-old woman with a history of congenital chloride diarrhoea (CCD) and renal transplant who was admitted for rehydration and treatment of acute kidney injury after she presented with an acute diarrhoeal episode. Laboratory investigations confirmed metabolic alkalosis and severe hypochloraemia, consistent with her underlying CCD. This contrasts with most other forms of diarrhoea, which are normally associated with metabolic acidosis. Genetic testing was offered and revealed a homozygous non-sense mutation in SLC26A3 (Gly-187-Stop). This loss-of-function mutation results in bicarbonate retention in the blood and chloride loss into the intestinal lumen. Symptomatic management with daily NaCl and KCl oral syrups was supplemented with omeprazole therapy. The loss of her own kidneys is most likely due to crystal-induced nephropathy secondary to chronic volume contraction and chloride depletion. This case summarises the pathophysiology and management of CCD.

Patient opinion of the doctor-patient relationship in a public hospital in Qatar.

OBJECTIVE: To analyze the factors associated with the level of satisfaction of outpatients in their relationship with their doctor at the largest public hospital in Qatar. METHODS: This study was a cross-sectional survey of attitudes. Researchers surveyed 626 outpatients at Hamad General Hospital in Doha, Qatar from September 2009 to January 2010 using a novel questionnaire assessing satisfaction with patients' interaction(s) with their doctor (spent time with patient, took case seriously, maintained confidentiality, and the overall quality of visit). RESULTS: Mean responses on 4 Likert scale items (one to 5) were as follows: "spent enough time with patient" = 4.39; "doctor took case seriously" = 4.57; "satisfaction with doctor-patient confidentiality" = 4.71; "overall quality of visit" = 4.46. Age, gender, citizenship, level of education, and number of visits did not significantly impact the level of satisfaction. For 73.1% of patients, the physician's qualification was the most important factor in choosing a doctor. Of those surveyed, 40.7% of men and 28.1% of women preferred to see a doctor of their own gender. A positive correlation between perceived communication and satisfaction with the doctor-patient encounter was established. CONCLUSION: This study found that patients in the Out-Patient Department at Hamad Hospital were highly satisfied with their relationships with their doctors, and physician qualification was the most significant factor in choosing a doctor. A significant number of males and females preferred a physician of their own gender. Communication difficulty correlated with lower satisfaction.