Grading reflective essays: the reliability of a newly developed tool- GRE-9.

BACKGROUND: The main objective of this study is the development of a short reliable easy-to-use assessment tool in the aim of providing feedback to the reflective writings of medical students and residents. METHODS: This study took place in a major tertiary academic medical center in Beirut, Lebanon. Seventy-seven reflective essays written by 18 residents in the department of Family Medicine at the American University of Beirut Medical Center (AUBMC) were graded by 3 raters using the newly developed scale to assess the scale reliability. Following a comprehensive search and analysis of the literature, and based on their experience in reflective grading, the authors developed a concise 9-item scale to grade reflective essays through repeated cycles of development and analysis as well as the determination of the inter-rater reliability (IRR) using intra-class correlation coefficients (ICC) and Krippendorff's Alpha. RESULTS: The inter-rater reliability of the new scale ranges from moderate to substantial with ICC of 0.78, 95% CI 0.64-0.86, p < 0.01 and Krippendorff's Alpha was 0.49. CONCLUSIONS: The newly developed scale, GRE-9, is a short, concise, easy-to-use reliable grading tool for reflective essays that has demonstrated moderate to substantial inter-rater reliability. This will enable raters to objectively grade reflective essays and provide informed feedback to residents and students.

Psychological Distress among Syrian Refugee Women and a Control Group in an Urban Settlement in Beirut- a Pilot Study.

The Syrian conflict has created approximately five million refugees. Of these, more than one million have settled in Lebanon. This project aimed to determine the prevalence of psychological distress (PD) amongst Syrian refugee mothers compared to a control group of local mothers living in the same informal urban settlement in Beirut. A convenient sample was selected from a primary care center. The General Health Questionnaire-12 items (GHQ-12) was administered to determine PD amongst women who were pregnant within 2 years of the study. Data was analyzed using SPSS. Sixty women were enrolled; 35 were Syrian refugees. All women had PD. The mean GHQ-12 scores were 7.5 and 7.2 for the control and Syrian refugee mothers, respectively. When asked about stressors, 91.7% of the women stated poverty. Syrian refugee women had similar PD as women who were not displaced and did not experience direct war related hostilities.

Oesophageal ulcer due to a herbal remedy.

Herbal-induced oesophageal lesions are rare. We report the case of an 85-year-old male who presented with cough and odynophagia. An upper endoscopy showed white deposit under the proximal oesophageal sphincter. Biopsy of the lesion revealed an oesophageal ulcer with adherent plant material and ruled-out candidiasis. At this point, the patient divulged self-preparation of an herbal remedy consisting of Aloe Vera pulp, whisky, honey, ginger and turmeric. Aloe Vera, ginger and turmeric are commonly used to sooth some gastroenterological symptoms in Complementary and Alternative Medicine. Incorrect extraction of Aloe Vera pulp and adding honey to it transformed the recipe into a sticky paste that may have injured the oesophageal mucosa. Follow-up showed that the cough and odynophagia subsided after discontinuing this herbal remedy.

Resistance exercise-induced rhabdomyolysis: Need for immediate intervention and proper counselling.

BACKGROUND: Rhabdomyolysis results from damage to skeletal muscle. Improper resistance training may result in rhabdomyolysis, which can cause acute kidney injury, serious metabolic abnormalities, compartmental syndrome and even death. Proper counselling for athletes may prevent this condition. OBJECTIVE: We present two patients with unilateral swelling after resistance exercise. The workup revealed rhabdomyolysis. We highlight the importance of counselling to prevent rhabdomyolysis secondary to resistance exercise. DISCUSSION: Trainers and primary care physicians need to be educated about the main features of rhabdomyolysis and urgently refer trainees suspected of having this condition. Treatment consists mainly of hydration and correction of metabolic abnormalities. Primary care physicians need to counsel patients on ways to prevent rhabdomyolysis. Trainers and primary care physicians should instruct novice trainees who are performing resistance exercise to start low and gradually increase the load. Training with loads of 60-70% of one repetition maximum for 8-12 repetitions and use of one to three sets per exercise is recommended.

Evidence for exercise training in the management of hypertension in adults.

UNLABELLED: OBJECTIVE To provide recommendations on exercise training as part of the management of hypertension in adults.Quality of evidence Evidence was found through a systematic search of PubMed, MEDLINE, EMBASE, Agency for Healthcare Research and Quality evidence-based reports, Bandolier, Clinical Evidence, the Institute for Clinical Systems Improvement guidelines, the National Guideline Clearinghouse database, UpToDate,and the Cochrane Database of Systematic Reviews (part of Ovid Evidence Based Medicine Reviews) for articles published from January 1973 to September 2013. Study types were limited to meta-analyses, randomized controlled trials, clinical trials, and reviews. MAIN MESSAGE: Exercise exerts an antiinflammatoryaction through the sympathetic nervous system and the hypothalamic-pituitary adrenal axis, and has direct effects on blood pressure. The resulting physiologic effects are classified as acute, postexercise, and chronic. Current treatment guidelines emphasize the role of nonpharmacologic interventions, including physical activity, in the management of mild to moderate hypertension. CONCLUSION: Moderate intensity aerobic exercise has been proven to prevent hypertension and to help in the management of stage 1 hypertension. Dynamic resistance exercises, if done properly, contribute to lowering both systolic and diastolic blood pressures. There is insufficient evidence about the safety and efficacy of isometric resistance training to recommend it.

Impact of a Multifaceted Intervention Among Primary Care Physicians on Sickness Certification.

INTRODUCTION: Sickness absence remains a major challenge globally. Primary care physicians often find it challenging to deny patients' requests for sick leaves, making the gatekeeping role uneasy among doctors. METHODS: Twenty-one PCPs participated in this non-randomized intervention study. The educational intervention consisted of an interactive presentation, a 20-minute video screening, and 3 text message reminders. The average number for sickness certificates (SCs), sickness absence rate per patient, and causes for sickness absence spells were measured one year before and one year after the intervention. RESULTS: The average number of SC one year before and after the intervention was 0.44 and 0.47, respectively. The sickness absence rate was 0.63% one year before and 0.75% one year after the intervention with no statistical significance. The mean number of sickness absence days did not significantly change. Causes for sickness absence spells significantly increased for diarrhea and back pain but decreased for upper respiratory infections with no statistical significance. DISCUSSION: Implementation of a multifaceted intervention to train PCPs on the process of sickness certification did not affect the sickness absence rate. Further research is needed to assess the knowledge and understanding of physicians' sickness certification process and the underlying factors that govern it to better develop tailored and effective interventions.

Communication skills in a Lebanese medical school: from movie theaters to medical classrooms.

BACKGROUND: Communication skills are widely taught in US medical schools, but in Lebanon, such teaching is in its infancy. METHODS: At the American University of Beirut, we piloted a communication skills teaching package using video scenarios in Arabic. A total of 150 second-year medical students addressed eight communication issues in a 3-hour multi-method workshop that included watching and discussing video clips and role-playing. RESULTS: Students evaluated the sessions positively for relevancy, quality of video clips, teaching methods, and usefulness for future practice. CONCLUSIONS: This interactive, role-playing workshop proved highly acceptable to Arab students and has been permanently incorporated into the curriculum.

Predictors of psychological distress in Lebanese hostages of war.

A cross-sectional study addressed the experience of Lebanese hostages of war in Lebanon. It specifically assessed the prevalence of general distress and its relationship to captivity-related factors and selected psychosocial variables. Trained field researchers using standard measurements interviewed 118 Lebanese hostages released from Khiam prison, an Israeli detention center in Lebanon. Questionnaires administered included the GHQ-12 and the Harvard Trauma Questionnaire. Individuals were detained for 3.4 years on average, and 86% were tortured. Psychological distress was present in 42.1% of the sample compared to 27.8% among the control group. In the multivariate analysis, the significant predictors for distress were: years of education and increase in religiosity after release. In conclusion, even after 2 years of release, more than one-third of the Lebanese hostages released from Khiam prison were found to have psychological distress. Caregivers need to pay special attention to the mental health of hostages of war. The paper discusses the meaning and implications of the factors predicting resilience and vulnerability in this particular population.

Impact of a 3-day OSCE workshop on Iraqi physicians.

BACKGROUND AND OBJECTIVES: Following a severe hardship for the past 4 decades, the Iraqi Ministry of Health initiated many activities to enhance the knowledge and skills of health professionals. The American University of Beirut was approached to deliver a workshop to update the skills of Iraqi physicians in constructing an Objective Structured Clinical Examination (OSCE). METHODS: This is a descriptive study of the 3-day workshop delivered to Iraqi physicians as train the trainer. The participants were given reading material and participated in interactive hands-on exercises. Performance was determined by direct observation of participants performing a mock OSCE. Pretests and posttests were conducted to assess change in knowledge. RESULTS: The participants demonstrated a significant improvement in their mean score of the posttest in comparison to pretest (8.6 versus 6.4, respectively). Moreover, they revealed mastery of the OSCE in the final mock OSCE activity. The participants highly evaluated the workshop and were positive in their future ability to conduct an OSCE. CONCLUSIONS: Adopting an interactive hands-on workshop to train the trainer is feasible and appears to be effective.