Evaluation of FamMed essentials: a blended-learning program for capacity building of general practitioners in Pakistan.

BACKGROUND: To provide access to primary care and universal health coverage, Pakistan requires 60,000 trained family physicians by 2030. At present, most primary care is provided by general practitioners (GPs) who do not have any post-graduate training. Empowering GPs through competency-based programs, that strengthen their knowledge and skills, may be a cost-effective strategy for improving healthcare quality. We describe the development and evaluation of FamMed Essentials, a modular, blended-learning program to improve clinical knowledge and skills of GPs. METHODS: This is a mixed method study. We used the CIPP (content, input, process and product) framework for course development and evaluation. We describe the steps used in content development, strategies for teaching and assessments, and evaluation of strengths and weaknesses of the program. In depth focus group discussions were conducted to gather insight on participants' and faculty's perceptions regarding the program's effectiveness. RESULTS: Of the 137 participants who have completed the program, 72% were women and 49% had been practicing for more than five years. We saw a significant improvement in knowledge across all modules (p = < 0.001) and perceived confidence in clinical skills (p = < 0.001). An objective assessment showed participants' competence in patient management. Participants reported a high level of satisfaction (4.4 ± 0.83 on a 5-point Likert Scale). Focus group discussions revealed a positive impact on clinical practice. Flexibility and use of different teaching and learning strategies were additional strengths. In addition, participants reported an interest in further training. Power outages were highlighted as a major challenge. CONCLUSION: In resource-constrained health systems, a modular, blended-learning, competency-based program is helpful to upgrade GPs knowledge without impacting their busy schedules. Accreditation of such programs and provision of a career trajectory for the trained GPs are pivotal to expansion of such initiatives.

Patients' profile, clinical presentations and histopathological features of colo-rectal cancer in Al Hassa region, Saudi Arabia.

BACKGROUND: Patients' demographics, presenting clinical and histopathological features for colo-rectal cancer (CRC) are important factors for patients' outcome and disease prognosis. This study aimed to describe the pattern of CRC in terms of patients' demographics, main presenting symptoms and histopathological features in Al Hassa region of Saudi Arabia. SUBJECTS AND METHODS: A retrospective hospital records-based study which included reviewing of patients' records diagnosed with CRC at three general hospitals in Al Hassa region, Saudi Arabia. A compilation form was designed to collect information regarding socio-demographics, age at diagnosis; referral sites and the main presentations at CRC diagnosis. sites and the main presentations at CRC diagnosis. Histopathological reports were reviewed to delineate the main cytopathologic features, prominent cytological characteristics, the presence of predisposing pathology, and disease stage. RESULTS: Of the 142 cases with CRC, 15.5% and 33.1% were affected before 40 and 50 years of age respectively. Emergency rooms were main referral sites for CRC cases (31.0%). Right colon was affected in 16.9% while left colonic lesions accounted for 62.7%. Intestinal obstruction was the main presentations (41.5%), and 26.1% presented with symptoms indicating distant metastatic lesions. Adenocarcinoma was the predominant pathological lesions (86.6%). Metastatic CRC was diagnosed in 62.7%. Duke's staging showed that 22.5% and 40.1% of lesions were classified into C and D categories respectively. CONCLUSION: Saudi patients with CRC present late with distant metastasis, and advanced disease stage. A sizeable proportion of patients developed the lesions at relatively young age. Screening recommendations should be enacted and revised in response to current change with younger age of affection.

Pattern, prevalence, and perceived personal barriers toward physical activity among adult Saudis in Al-Hassa, KSA.

OBJECTIVES: To determine patterns of physical activity (PA) along domains of work-transport-leisure among adult Saudis, sociodemographic correlates of PA and perceived personal barriers to leisure-time-related physical inactivity in Al-Hassa, KSA. METHODS: A cross-sectional study in which 2176 adult Saudis attending urban and rural Primary Health centers were selected using multistage proportionate sampling method. Participants were personally interviewed to gather information regarding sociodemographics, PA pattern using Global Physical Activity Questionnaire (GPAQ), and perceived barriers toward recreation-related PA. Analysis was carried out along GPAQ protocol. RESULTS: Median total physical activity was 2304 METs-minutes/week. Fifty-two percent of subjects were sufficiently active meeting the minimum recommendations when considering total PA and 21% of the subjects were sufficiently active in leisure-time-related activity with ≥ 5 days of any combination of walking, moderate or vigorous-intensity activities with a total of at least 600 METs-minutes/week. Regression analyses showed that females, higher educational and occupational status were negative predictors to total and leisure-related PA. Barriers perceived toward leisure-related PA included weather, traditions, lack of facilities and time. CONCLUSION: A low PA pattern along the 3 domains of PA may impose a reflection toward more sedentary life style in Saudi Arabia.

Factors determining outcome of acute renal failure patients.

OBJECTIVE: Acute Renal Failure (ARF) is a common medical problem. Delay in diagnosis is associated with increased mortality. Variety of conditions can lead to ARF. Many factors can influence the outcome of ARF. This study was done to find the predictive factors related to outcome of ARF. METHODS: One hundred adult patients of acute renal failure admitted to Ziauddin Hospital were studied. Certain factors related to outcome of ARF were identified and analyzed. RESULTS: Among such factors oliguria, levels of urea, creatinine and potassium were found significant poor prognostic predictors on univariate analysis as far as outcome of treatment modality is concerned. The multivariate analysis revealed that the presence of oliguria is the only significant independent predictor (P<0.001) for good outcome with dialysis. CONCLUSION: Oliguria was found to be the major predictor of non recovery of renal function.