Presentation, Treatment and Long-Term Outcomes of a Multidisciplinary Acute Atrial Fibrillation Pathway: A 12-Month Follow-Up Study.

AIM: Atrial fibrillation/flutter (AF/AFL) is associated with high rates of emergency department (ED) visits and acute hospitalisation. A recently established multidisciplinary acute AF treatment pathway seeks to avoid hospital admissions by early discharge of haemodynamically stable, low risk patients from the ED with next-working-day return to a ward-based AF clinic for further assessment. We conducted a preliminary analysis of the clinical outcomes of this pathway. METHODS: We retrospectively reviewed clinical records of all patients assessed at the AF clinic at Christchurch Hospital, New Zealand, over a 12-month period. Data related to presentation, patient characteristics, treatment, and 12-month outcomes were analysed. RESULTS: A total of 143 patients (median age 65, interquartile range: 57-74 years, 59% male, 87% European) were assessed. Of these, 87 (60.8%) presented with their first episode of AF/AFL. Spontaneous cardioversion occurred in 41% at ED discharge, and this increased to 73% at AF clinic review. Electrical cardioversion was subsequently performed in 16 patients (11.2%), and 16 (11.2%) ultimately required hospital admission (eight to facilitate electrical cardioversion). At a median of 1 day, 83.9% were discharged from the AF clinic in sinus rhythm. During 12-month follow-up, there were 25 AF-related hospitalisations (20 patients, 14%) and one patient underwent electrical cardioversion; additionally, one patient had had a stroke and eight had bleeding complications giving a combined outcome rate of 6.3%. CONCLUSION: Utilising a rate-control strategy with ED discharge and early return to a dedicated AF clinic can safely prevent the majority of hospitalisations, avert unnecessary procedures, and facilitate longitudinal care.

Coronavirus Disease 2019 Infection in Children With Sickle Cell Disease: Case Series From Oman.

BACKGROUND: In March 2020, WHO announced Coronavirus Disease 2019 (COVID-19) outbreak a global pandemic. During this pandemic, patients with sickle cell disease (SCD) have been placed in the "high-risk" category of the population. Although there are numerous publications describing COVID-19 in adult patients, pediatric data are still limited. OBSERVATION: Herein, we report case series of 5 sickle cell disease Omani children who got infected with COVID-19; illustrating their different ways of presentation, management and highlighting the outcomes. CONCLUSION: Although SCD patients are considered as a high-risk group, all of the observed patients, and whose cases are reported here, have recovered. A large scale of SCD cases should be studied to reach more conclusive results.

Different Types of Syncope Presenting to Clinic: Do We Miss Cardiac Syncope?

BACKGROUND: In the outpatient setting, differentiation of cardiac syncope (CS) from other more common forms of syncope is difficult, particularly in the elderly. We examined the frequency of the different types of syncope in a clinic population and estimated missed CS cases. METHODS: We retrospectively examined the relevant data for patients assessed in our Christchurch Hospital syncope clinic over a 5-year study period (1 January 2011-31 December 2015). Patients who were later found to have cardiac syncope (and were not initially diagnosed in our clinic) were counted as "missed" cases. RESULTS: Eight hundred thirty-nine (839) patients (median age 57, interquartile range: 35-73 years, 56% female) were assessed during the study period. Vasovagal syncope (VVS) was the most frequent diagnosis (42.8%) followed by drug-related postural hypotension (DRPH) (26.6%). Cardiac syncope was initially diagnosed in only 3.1%. Of 30 CS patients initially assessed in syncope clinic who later required pacing, 18 (2.1%) were missed CS. In this group, 12-lead electrocardiograph (ECG) was normal in 50% and the majority (n=10) were tilt-positive. The 2.5-year mortality was 5.7% (n=48) including three sudden unexpected cardiac deaths. CONCLUSION: Vasovagal syncope and DRPH were by far the most frequent diagnoses. Cardiac syncope was less frequent because patients were selected mainly from an outpatient population, not the emergency department. In a small number of patients, CS was missed for the following reasons: (1) coexistence of cardiac conduction system disease with VVS and DRPH in the elderly, and (2) insensitivity of 12-lead ECG, in-hospital telemetry and out-of-hospital Holter monitoring for detecting conduction system disease early in its development.

Global Surgery: A 30-Year Bibliometric Analysis (1987-2017).

INTRODUCTION: There has been a growing interest in addressing the surgical disease burden in low- and middle-income countries (LMICs). Assessing the current state of global surgery research activity is an important step in identifying gaps in knowledge and directing research efforts towards important unaddressed issues. The aim of this bibliometric analysis was to identify trends in the publication of global surgical research over the last 30 years. METHODS: Scopus® was searched for global surgical publications (1987-2017). Results were hand-screened, and data were collected for included articles. Bibliometric data were extracted from Scopus® and Journal Citation Reports. Country-level economic and population data were obtained from the World Bank. Descriptive statistics were used to summarise data and identify significant trends. RESULTS: A total of 1623 articles were identified. The volume of scientific production on global surgery increased from 14 publications in 1987 to 149 in 2017. Similarly, the number of articles published open access increased from four in 1987 to 68 in 2017. Observational studies accounted for 88.7% of the included studies. The three most common specialties were obstetrics and gynaecology 260 (16.0%), general surgery 256 (15.8%), and paediatric surgery 196 (12.1%). Over two times as many authors were affiliated to an LMIC institution than to a high-income country (HIC) institution (6628, 71.5% vs 2481, 28.5%, P < 0.001). A total of 965 studies (59.5%) were conducted entirely by LMIC authors, and 534 (32.9%) by collaborations between HICs and LMICs. CONCLUSION: The quantity of research in global surgery has substantially increased over the past 30 years. Authors from LMICs seemed the most proactive in addressing the global surgical disease burden. Increasing the funding for interventional studies, and therefore the quality of evidence in surgery, has the potential for greater impact for patients in LMICs.

Publication in a medical student journal predicts short- and long-term academic success: a matched-cohort study.

BACKGROUND: Medical student journals play a critical role in promoting academic research and publishing amongst medical students, but their impact on students' future academic achievements has not been examined. We aimed to evaluate the short- and long-term effects of publication in the New Zealand Medical Student Journal (NZMSJ) through examining rates of post-graduation publication, completion of higher academic degrees, and pursuing an academic career. METHODS: Student-authored original research publications in the NZMSJ during the period 2004-2011 were retrospectively identified. Gender-, university- and graduation year-matched controls were identified from publicly available databases in a 2:1 ratio (two controls for each student authors). Date of graduation, current clinical scope of practice, completion of higher academic degrees, and attainment of an academic position for both groups were obtained from Google searches, New Zealand graduate databases, online lists of registered doctors in New Zealand and Australia, and author affiliation information from published articles. Pre- and post-graduation PubMed®-indexed publications were identified using standardised search criteria. RESULTS: Fifty publications authored by 49 unique students were identified. The median follow-up period after graduation was 7.0 years (range 2-12 years). Compared with controls, student-authors were significantly more likely to publish in PubMed®-indexed journals (OR 3.09, p = 0.001), obtain a PhD (OR 9.21, p = 0.004) or any higher degree (OR 2.63, p = 0.007), and attain academic positions (OR 2.90, p = 0.047) following graduation. CONCLUSION: Publication in a medical student journal is associated with future academic achievement and contributes to develop a clinical academic workforce. Future work should aim to explore motivators and barriers associated with these findings.

Dissemination of results from medical student public health research training and factors associated with publication.

PURPOSE: To examine factors associated with successful publications resulting from mandatory public health research training attachment, the Trainee Intern Health Care Evaluation (TIHE) projects, at the University of Otago, Dunedin School of Medicine, New Zealand. METHODS: A total of 227 TIHE projects completed during the period from January 1985 to December 2013 were included in the study. In February 2016, Medline and Google Scholar databases were searched independently by both authors for publications using predefined search criteria. RESULTS: Overall, 25 (11.1%) out of 227 projects resulted in 19 articles, 3 conference presentations/abstracts and 4 cited report abstracts. Nineteen (8.4%) projects resulted in 22 peer-reviewed journal publications, the majority of which were original articles (86.4%). The number of projects commissioned by a client was independently associated with the likelihood of publication, conference abstract or citation of the project report (OR 1.40; P<0.01, 95% CI 1.14 to 1.71). The number of authors and the number of non-student authors were positively associated with publication in higher impact journals, while student first-authored articles were more likely to be published in lower impact journals. Projects completed in more recent years were more likely to be published. CONCLUSIONS: Mandatory medical student research experiences promote tangible research output. These findings may help to influence policy around the introduction of required medical school research and facilitate encouraging academic careers among medical students. Future research could focus on examining how different student-related, supervisor-related and programme-related factors influence publication rates from mandatory medical student research attachments.

Impact of Reported Beta-Lactam Allergy on Inpatient Outcomes: A Multicenter Prospective Cohort Study.

BACKGROUND: Reported allergy to beta-lactam antibiotics is common and often leads to unnecessary avoidance in patients who could tolerate these antibiotics. We prospectively evaluated the impact of these reported allergies on clinical outcomes. METHODS: We conducted a trainee-led prospective cohort study to determine the burden and clinical impact of reported beta-lactam allergy on patients seen by infectious diseases consultation services at 3 academic hospitals. The primary outcome was a composite measure of readmission for the same infection, acute kidney injury, Clostridium difficile infection, or drug-related adverse reactions requiring discontinuation. Predictors of interest were history of beta-lactam allergy and receipt of preferred beta-lactam therapy. RESULTS: Among 507 patients, 95 (19%) reported beta-lactam allergy; preferred therapy was a beta-lactam in 72 (76%). When beta-lactam therapy was preferred, 25 (35%) did not receive preferred therapy due to their report of allergy even though 13 (52%) reported non-severe prior reactions. After adjustment for confounders, patients who did not receive preferred beta-lactam therapy were at greater risk of adverse events (adjusted odds ratio [aOR], 3.1; 95% confidence interval [CI], 1.28-7.89) compared with those without reported allergy. In contrast, patients who received preferred beta-lactam therapy had a similar risk of adverse events compared with patients not reporting allergy (aOR, 1.33; 95% CI, .62-2.87). CONCLUSIONS: Avoidance of preferred beta-lactam therapy in patients who report allergy is associated with an increased risk of adverse events. Development of inpatient programs aimed at accurately identifying beta-lactam allergies to safely promote beta-lactam administration among these patients is warranted.

Poststroke Anxiety and Depression: Findings from Saudi Arabia.

BACKGROUND: Anxiety and depression are the two most frequent neuropsychiatric manifestations of stroke. In Saudi Arabia, there is a general lack of research into anxiety and depression in stroke patients when compared with physical complications. METHODS: We assessed the prevalence of anxiety and depression in 76 stroke patients from Saudi Arabia using the Hospital Anxiety and Depression Scale (HADS). RESULTS: In this study, 18.4% and 23.7% of the patients met the HADS criteria for moderate or severe anxiety and depression, respectively. Female gender was the only significant predictive factor associated with both anxiety (P = .03) and depression (P = .04), where longer duration since stroke was only associated with anxiety (P = .02) but not depression (P = .25). CONCLUSIONS: These results suggest that anxiety and depression are commonplace in Saudi patients with stroke, a finding that has implications for clinical practice and future research.

Targeted study to evaluate the cardiovascular risk factor status among patients and efficacy of statins in attaining goal lipid levels in a regional hospital in Sultanate of Oman.

BACKGROUND AND OBJECTIVE: Elevated LDL (Low Density Lipoprotein) cholesterol is a major cause of Coronary Heart Disease (CHD) and LDL lowering therapy reduces the risk for CHD. The study was conducted with the aim of assessing the prescribing pattern of statins based on cardiovascular risk factor category, pattern of lipid monitoring followed among the patients and extent of attainment of goal Low Density Lipoprotein (LDL-C) observed among the patients. METHODS: A group of patient files (among those on statin agent during the year 2011) from the Department of Medicine in Nizwa Hospital were selected for targeted evaluation on the risk factor status of patients and efficacy of statins in attaining goal lipid levels. Goal LDL-C levels were estimated for each patient depending on their risk factor status. Subsequent follow ups of the patients were reviewed from the patient files and accordingly the attainment and maintenance of goal-LDL-C in the patients were evaluated. RESULTS: A total of 183 patients were identified. Mean age of the evaluated patients was 63.6 ± 11.58 years. Evaluating the status of patients on the presence of risk factors, majority (63.9%) of them had presence of CHD. Simvastatin was the most commonly used agent and titration of dose was done in only 3.3% of patients. Mean LDL-C level of the patient before initiation of treatment was 3.74 ± 1.9 mmol/L. Only in 59 (32.2 %) of the total evaluated 183 patients, there was evidence of attaining goal-LDL-C levels. Among them, there was evidence of maintenance of goal LDL-C in 16 (27.1%) of the patients. CONCLUSION: Statins were used less frequently for primary prevention of CHD. Absence of lipid monitoring; base line and follow up in a good number of patients as well as lack of dose titration among the patients were observed. Importance of adequate lipid monitoring and follow up to ensure attainment of goal LDL-C needs to be stressed to serve the objective of use of statins; primary and secondary prevention of CHD.

An educational forum to engage infectious diseases and microbiology residents in resource stewardship modelled after the Choosing Wisely campaign.

BACKGROUND: Rising costs present a major threat to the sustainability of health care delivery. Resource stewardship is increasingly becoming an expected competency of physicians. The Choosing Wisely framework was used to introduce resource stewardship at a national educational retreat for infectious disease and microbiology residents. METHODS: During the 2014 Annual Canadian Infectious Disease and Microbiology Resident Retreat in Toronto, Ontario, infectious disease (n=50) and microbiology (n=17) residents representing 11 Canadian universities from six provinces, were invited to participate in a modified Delphi panel. Participants were asked, in advance of the retreat, to submit up to five practices that infectious disease and microbiology specialists should not routinely perform due to lack of proven benefit(s) and/or potential harm to patients. Submissions were discussed in small and large group forums using an iterative approach involving electronic polling until consensus was reached for five practices. A finalized list was created for both educational purposes and for residents to consider enacting; however, it was not intended to replace formal society-endorsed statements. A follow-up survey at two-months was conducted. RESULTS: Consensus was reached by the residents regarding five low-value practices within the purview of infectious diseases and microbiology physicians. After the retreat, 20 participants (32%) completed the follow-up survey. The majority of respondents (75%) believed that the session was at least as relevant as other sessions they attended at the retreat, including 95% indicating that at least some of the material discussed was new to them. Since returning to their home institutions, nine (45%) respondents have incorporated what they learned into their daily practice; four (20%) reported that they have considered initiating a project related to the session; and one (5%) reported having initiated a project. CONCLUSIONS: The present educational forum demonstrated that trainees can become actively engaged in the identification and discussion of low-value practices. Embedding residence training programs with resource stewardship education will be necessary to improve the value of care offered by the future members of our profession.

HISTORIQUE: Les coûts croissants représentent une menace importante pour la pérennité des soins de santé. De plus en plus, on s'attend que les médecins aient les compétences nécessaires pour gérer les ressources. Lors d'une journée de réflexion nationale pour les résidents en infectiologie et en microbiologie, la gestion des ressources a été abordée conformément au cadre Choosing Wisely. MÉTHODOLOGIE: Pendant la journée de réflexion canadienne annuelle de 2014 pour les résidents en infectiologie et en microbiologie tenue à Toronto, en Ontario, des résidents en infectiologie (n=50) et en microbiologie (n=17) représentant 11 universités canadiennes réparties dans six provinces ont été invités à participer à un groupe Delphi modifié. Avant la journée de réflexion, ils ont été invités à soumettre jusqu'à cinq pratiques que les spécialistes de l'infectiologie ou de la microbiologie ne devraient pas effectuer systématiquement parce que leurs avantages ne sont pas démontrés ou qu'elles comportent des risques potentiels pour les patients. Ils ont examiné ces pratiques lors de forums en petits et grands groupes selon une méthode itérative par sondage électronique, jusqu'à atteindre un consensus pour cinq pratiques. Une liste définitive a été créée pour des besoins d'éducation et pour que les résidents envisagent de la respecter. Cette liste ne visait toutefois pas à remplacer les documents officiels approuvés par la Société. Un sondage de suivi a été effectué au bout de deux mois. RÉSULTATS: Les résidents sont parvenus à un consensus sur cinq pratiques de faible valeur qui relèvent des médecins en infectiologie et en microbiologie. Après la journée de réflexion, 20 participants (32 %) ont rempli le sondage de suivi. La majorité d'entre eux (75 %) trouvaient que cette séance était au moins aussi pertinente que les autres séances auxquelles ils avaient assisté pendant la journée de réflexion, et 95 % ont indiqué qu'au moins une partie de ce qui avait été abordé était nouveau pour eux. Depuis leur retour au sein de leur établissement, neuf (45 %) répondants avaient intégré ce qu'ils avaient appris à leur pratique, quatre (20 %) ont déclaré avoir envisagé un projet lié à la séance et un (5 %) a affirmé avoir lancé un projet. CONCLUSIONS: Le présent forum d'éducation a démontré que les résidents peuvent s'investir pour cerner les pratiques de faible valeur et en discuter. Il faudra intégrer la gérance de l'éducation aux programmes de résidence pour améliorer la valeur des soins offerts par les futurs membres de notre profession.

Microbiological and Antimicrobial Susceptibility Pattern of Asymptomatic Bacteriuria in Pregnant Women Attending SQUH.

Objectives: Our research aimed to study the microbiology and antimicrobial resistance in asymptomatic bacteriuria (ASB) among Omani pregnant women. Methods: We conducted a retrospective study that included data from 196 Omani pregnant women with ASB who received care at Sultan Qaboos University Hospital from 2010-2019. Data were obtained from the patients' electronic medical records including demographics, clinical details, isolated organisms, antimicrobial susceptibility results, and prescribed antibiotics. Results: ASB was detected in 56.1% of cases during the third trimester. Klebsiella pneumoniae(32.1%) was the most frequently isolated organism, followed by Escherichia coli (29.6%). Twenty-one (10.7%) isolates were extended-spectrum beta-lactamase (ESBL)-producing organisms. The overall microbiological susceptibility pattern showed that organisms have a high susceptibility rate to nitrofurantoin reaching 82.8%, followed to a lesser extent by cefuroxime and augmentin. The susceptibility of E. coli and K. pneumoniae to cefuroxime was 74.1% and 71.4%, respectively. Only 52.4% of all isolated ESBL-producing organisms were susceptible to nitrofurantoin. Conclusions: K. pneumoniae and E. coli were the most frequently isolated bacteria in ASB, representing 60.7% of total isolates. A high prevalence of ESBL-producing organisms, 10.7% of the total isolates, was observed. Cefuroxime is an appropriate empirical antibacterial therapy for ASB and urinary tract infection in pregnant women. Nitrofurantoin should be considered for empirical antibiotic therapy in settings of high prevalence of ESBL-producing organisms.

Patient perceptions of barriers to attending annual diabetes review and foot assessment in general practice: a qualitative study.

Introduction Regular diabetic foot checks, at least annually, are important for early identification of risk factors and prevention of ulceration and amputation. To ensure this, most general practices in Aotearoa New Zealand (NZ) offer free annual diabetes reviews (ADRs) which include a comprehensive foot evaluation. However, attendance rates at these ADRs are low. Aim To explore patients' perspectives on the barriers to attending ADRs and foot checks. Methods Semi-structured interviews with people with type 2 diabetes who were overdue their ADR (n = 13; 7 women, 6 Maori) from two urban practices were conducted. Interviews were audio recorded and transcribed verbatim and then analysed using an inductive thematic analysis approach. Results We identified three key themes demonstrating barriers to attendance: healthcare-associated factors (suboptimal clinician-patient relationship, not having a consistent general practitioner (GP)); patient-related factors (co-morbid health conditions, issues surrounding identity, and logistical issues); and systemic factors (COVID-19 pandemic, travel distance to the practice, unawareness of available foot care services). Participants' feedback focused on patient-centred approaches for improvements to service delivery, for example using online educational materials, and utilising culturally appropriate models of health including Te Whare Tapa Wha and Whanau Ora approach. Discussion We identified several barriers to attendance, some of which are potentially modifiable. Addressing modifiable barriers and incorporating suggestions made by participants may improve access to the ADR and reduce non-attendance. Further participatory action research could explore these insights in ways that facilitate tino rangatiratanga (self-determination) and palpable action.

How far has diabetes-related foot disease research progressed in Australia? A bibliometric review (1970-2023).

BACKGROUND: Diabetes-related foot disease (DFD) is a leading cause of the Australian and global disease burdens and requires proportionate volumes of research to address. Bibliometric analyses are rigorous methods for exploring total research publications in a field to help identify volume trends, gaps and emerging areas of need. This bibliometric review aimed to explore the volume, authors, institutions, journals, collaborating countries, research types and funding sources of Australian publications investigating DFD over 50 years. METHODS: A systematic search of the Scopus® database was conducted by two independent authors to identify all Australian DFD literature published between 1970 and 2023. Bibliometric meta-data were extracted from Scopus®, analyzed in Biblioshiny, an R Statistical Software interface, and publication volumes, authors, institutions, journals and collaborative countries were described. Publications were also categorised for research type and funding source. RESULTS: Overall, 332 eligible publications were included. Publication volume increased steadily over time, with largest volumes (78%) and a 7-fold increase over the last decade. Mean co-authors per publication was 5.6, mean journal impact factor was 2.9 and median citation was 9 (IQR2-24). Most frequent authors were Peter Lazzarini (14%), Vivienne Chuter (8%) and Jonathon Golledge (7%). Most frequent institutions affiliated were Queensland University Technology (33%), University Sydney (30%) and James Cook University (25%). Most frequent journals published in were Journal Foot and Ankle Research (17%), Diabetic Medicine (7%), Journal Diabetes and its Complications (4%) and International Wound Journal (4%). Most frequent collaborating countries were the United Kingdom (9%), the Netherlands (6%) and the United States (5%). Leading research types were etiology (38%), treatment evaluation (25%) and health services research (13%). Leading funding sources were no funding (60%), internal institution (16%) and industry/philanthropic/international (10%). CONCLUSIONS: Australian DFD research increased steadily until more dramatic increases were seen over the past decade. Most research received no funding and mainly investigated etiology, existing treatments or health services. Australian DFD researchers appear to be very productive, particularly in recent times, despite minimal funding indicating their resilience. However, if the field is to continue to rapidly grow and address the very large national DFD burden, much more research funding is needed in Australia, especially targeting prevention and clinical trials of new treatments in DFD.

Level of and factors associated with foot self-care among people with diabetes in Idlib Province of Northwest Syria: A cross-sectional study.

Background and aims: Diabetic foot and lower limb problems are among the most neglected complications during the Syrian armed conflict due to the absence of a functioning health infrastructure, including early detection and timely management of limb-threatening wounds. This study aimed to determine self-reported diabetes-related foot disease (DRFD), adherence to recommended foot self-care (FSC) practices, and associated factors among people with diabetes in war-torn Northwest Syria (NWS). Methods: This was a cross-sectional study conducted at six primary care clinics in Idlib, NWS, between March 27 and April 17, 2022, utilizing the validated interviewer-administered Diabetes Foot Disease and Foot Care Questionnaire. Data on demographic characteristics, DRFD, and FSC practices were collected. FSC score was determined by adding the points from all 12 FSC items, with a maximum score of 48, and were categorized into very poor (≤12), poor (13-24), moderate (25-36), and good (37-48). A convenience sample of 331 consecutive Syrians, aged ≥18 years, with diabetes, were invited. Multiple linear regression was used to identify variables associated with FSC practices. Results: A total of 328 patients completed the questionnaire (response rate: 99.1%). The overall FSC score was average (mean total score 27.24, SD 7.03). Over one-third (37.8%) had a very poor/poor score, 50.3% had an average score, and 11.9% had a good score. Household income/month of ≥51 USD (ß = 2.6, 95% confidence interval [95% CI]:1.06-4.1, p = 0.001) and diabetes duration of ≥10 years (ß = 1.8, 95% Cl: 0.2-3.4, p = 0.027) significantly predicted better FSC practice. Conclusion: A significant proportion of participants had inadequate adoption FSC behaviors. Higher socioeconomic status was associated with better FSC practices. Future research should evaluate diabetic foot education and professional foot care in this population.

Types and sociodemographic correlates of complementary and alternative medicine (CAM) use among people with epilepsy in Oman.

Nonpharmacological treatment strategies that originate from sociocultural teachings and are beyond the scope of allopathic medicine are commonly used among people with epilepsy (PWE) in many parts of the world. The present study explored the types and sociodemographic correlates of complementary and alternative medicine (CAM) use among PWE in Oman among attendees of a neurological unit at a tertiary care center. Data on the types of CAM were gathered from telephone interviews. The relevant demographic and clinical characteristics of the participants were obtained from electronic medical records. Of the total of 101 participants, 73.3% were CAM users. The majority of these participants have not disclosed their CAM use to their allopathic health-care providers. The most common types of CAM reported were those falling under the 'mind-body' type (incantations and fumigation) and biologically based (herbal concoctions) or a combination of them. Compared to non-CAM users, a significant and greater proportion of CAM users attributed the etiology of their illness to nonbiomedical factors such as 'evil eyes' (P=0.04). The multivariate logistic regression model indicated that the use of CAM was highly associated with age of <30years (OR=3.09; 95% CI: 1.10, 5.46), unemployment (OR=2.04; 95% CI: 1.15, 6.39), having basic school education (OR=2.21; 95% CI: 0.83, 5.18), low family income (OR=1.52; 95% CI: 0.91, 2.11), and the presence of hypersalivation (OR=2.20; 95% CI: 1.01, 4.39). Further studies are needed to harmonize these two healing practices. On the whole, this study indicates that among attendees of tertiary care utilization, CAM is common among PWE in Oman. The most utilized type of CAM falls under the umbrella of mind-body practice.