Emotional intelligence weakly predicts academic success in medical programs: a multilevel meta-analysis and systematic review.

BACKGROUND: Emotional intelligence (EI) is a predictive factor of academic success in undergraduate Doctor of Medicine (MD) programs. Although some research suggests a positive association between EI and academic success in MD programs, other research reports neither an association nor a negative correlation between the two variables. The current study aimed to resolve these contradictory findings by conducting a systematic review and a meta-analysis using research from 2005 to 2022. METHODS: Data were analyzed using a multilevel modeling approach to (a) estimate the overall relationship between EI and academic success in MD programs and (b) determine whether the mean effect size varies according to country (United States vs. non-United States countries), age, EI test, EI task nature (ability-based vs. trait-based), EI subscales, and academic performance criteria (grade point average vs. examinations). RESULTS: Findings from 20 studies (m = 105; N = 4,227) indicated a positive correlation between EI and academic success (r = .13, 95% CI [.08, - .27], p < .01). Moderator analyses indicated that the mean effect size significantly varied according to EI tests and EI subscales. Moreover, three-level multiple regression analyses showed that between-study variance explained 29.5% of the variability in the mean effect size, whereas within-study variance explained 33.5% of the variability in the mean effect. CONCLUSIONS: Overall, the current findings show that EI is significantly, albeit weakly, related to academic success in MD programs. Medical researchers and practitioners can therefore focus on integrating EI-related skills into the MD curriculum or target them through professional development training and programs.

Women's contribution to medicine in Bahrain: leadership and workforce.

BACKGROUND: Women make up a significant proportion of workforce in healthcare. However, they remain underrepresented in leadership positions relating to healthcare for a multitude of reasons: balancing personal and work duties, favoritism toward men, lack of support from colleagues and mentors, as well as other factors. This study aims to recognize the contribution made by women in the Bahraini healthcare sector by determining the gender distribution in Bahrain's medical schools, government hospitals, Ministry of Health, and National Health Regulatory Authority. METHODS: Data were collected from the Bahraini Ministry of Health, National Health Regulatory Authority, Salmaniya Medical Complex, King Hamad University Hospital, Bahrain Defence Force Royal Medical Services, the College of Medicine and Medical Sciences in the Arabian Gulf University, and the Royal College of Surgeons in Ireland-Bahrain. Only physicians who held a Bachelor of Medicine and Surgery and a valid license to practice from NHRA were eligible to participate. Descriptive statistics were used to derive the frequencies and percentages of physicians with the following leadership positions: (1) top administrative positions (e.g., Chief executive officer); (2) heads of departments; (3) heads of committees; and (4) academic positions (e.g., Professor). Data were also collected from the two medical schools in Bahrain to see the trend in female enrollment into medical schools since 2004. RESULTS: The results of the study indicated that leadership positions were mostly held by males in Bahrain (59.4% vs. 40.6%). However, Bahraini males and females equally dominated academic positions. Male physicians also dominated surgical specialties; however, female Bahraini physicians slightly surpassed male Bahraini physicians at the specialist and consultant levels (female to male: 11.9% vs. 10.4% and 33.2% vs. 30.4%, respectively). Furthermore, more females were reported to have general licenses. A trend analysis since 2004 showed that female medical students' representation was higher than males over the years. CONCLUSIONS: This study highlights the increasing trend of women's participation and contribution to medicine in Bahrain. The data indicated continued growth in the number of female medical students and physicians. As such, it is likely that females will have a bigger impact on healthcare in the future with potential to hold more leadership positions in Bahrain.

Child and adolescent psychiatry training and services in the Middle East region: a current status assessment.

Mental health is a key component of health, yet appropriate care is limited. Evidence concerning child and adolescent mental health has predominantly come from western countries, while the Middle East region, with a large youth population, has reported very little on it. This original, cross-sectional study of child and adolescent psychiatry in the Middle East provides an assessment of current postgraduate programs, services and what is needed to build workforce capacity. Academic psychiatrists from 16 Middle East countries were invited to form a Consortium to map current postgraduate training as one of the determinants of available child and adolescent psychiatry services, identify gaps in the distribution of child and adolescent psychiatrists, and propose potential steps to improve access to child and adolescent mental health care. The study collected data from 15 of the 16 countries invited (no data provided from Yemen). The study revealed underdeveloped child and adolescent psychiatry academic systems throughout the region. Despite recognition of the specialty in a majority of the countries (11/15), only six countries had established a designated child and adolescent psychiatry training program. The overall shortage of child and adolescent mental health specialists varied, yet all Consortium members reported a need for additional child and adolescent psychiatry specialists and allied professionals. Lack of child and adolescent psychiatry specialized programs in place throughout the region has evidently contributed to the shortage of qualified child and adolescent mental health workforce in the Middle East.

Eating disorders risk among medical students: a global systematic review and meta-analysis.

PURPOSE: Medical students appear to be a high-risk group to develop psychological problems including eating disorders (ED). The prevalence estimates of ED risk vary greatly between studies. This systematic review and meta-analysis was done to estimate the prevalence of ED risk among medical students. METHODS: An electronic search of EMBASE, MEDLINE, ProQuest and Google Scholar was conducted. Studies that reported the prevalence of ED risk among medical students and were published in English peer-reviewed journals between 1982 and 2017 were included. Information about study characteristics and the prevalence of ED risk were extracted by four investigators. Each article was reviewed independently by at least two investigators. Estimates were pooled using random-effects meta-analysis using the DerSimonian-Laird method. The main outcome of interest was the prevalence of ED risk in medical students. RESULTS: The prevalence of ED risk among medical students was extracted from nineteen cross-sectional studies across nine countries (total participants n = 5722). The overall pooled prevalence rate of ED risk was 10.4% (497/5722 students, 95% CI 7.8-13.0%), with statistically significant evidence between-study heterogeneity (Q = 295, τ2 = 0.003, I2 = 94.0%, P < 0.001). Prevalence estimates between studies ranged from 2.2 to 29.1%. CONCLUSION: In this systematic review and meta-analysis, the summary prevalence of ED risk among medical students was 10.4%. Further research is needed to identify and prevent ED in this population. Studies are also needed to investigate concurrent pathologies associated with ED risk. LEVEL OF EVIDENCE: Level I, systematic review and meta-analysis.

Hepatic Cyst Compressing The Right Atrial and Ventricular Inflow Tract: An Uncommon Cardiac Complication.

Commonly reported complications of hepatic cysts are spontaneous hemorrhage, rupture into the peritoneal cavity, infection and compression of the biliary tree however cardiac complications are not commonly reported. We are presenting a case of a large liver cyst presenting with right atrial and ventricular inflow tract impingement resulting in cardiac symptoms. A 68 year-old Hispanic female presented with one month of fatigue and shortness of breath after household work and walking less than one block, right upper quadrant pain and weight loss. She had history of multiple hepatic cysts for more than 12 years, well-controlled diabetes and hypertension. Examination of the heart revealed tachycardia with regular heart sounds. There were no murmurs. She had tenderness in her right upper quadrant on palpation and an enlarged smooth liver. Rest of physical examination was unremarkable. CT scan of the abdomen showed multiple non-enhancing liver cysts in both lobes, with the largest measuring 12 x 15 x 17 cm which was significantly increased from her baseline of 7 x 8 x 10 cm in 2003. Echocardiogram showed normal left ventricular ejection fraction, grade 1 diastolic dysfunction and a hepatic cyst impinging RA and RV inflow tract. She had successful laparoscopic enucleation of liver cyst and subsequent relief from tachycardia, fatigue and shortness of breath. In conclusion, this case illustrates that hepatic cysts may become symptomatic after remaining quiescent for an extended period. They may present with unusual symptoms and clinicians should be mindful of rare complications, such as in this case.

A One-Two Punch: Hydralazine-Induced Liver Injury in a Recovering Ischemic Hepatitis.

A 77-year-old woman presented to the emergency department with a 2-day history of nausea and vomiting. Her medical history included diabetes mellitus, hypertension, atrial fibrillation, dilated cardiomyopathy, and coronary artery disease. Her home medications included aspirin, clopidogrel, warfarin, digoxin, metoprolol, losartan, simvastatin, isosorbide dinitrate, furosemide, and spironolactone. Initial physical examination showed blood pressure of 170/80 mm Hg with a heart rate of 69 beats per minute, otherwise unremarkable. Initial laboratory workup was significant for INR of 3.6, with slightly elevated troponin I and creatinine of 0.06 ng/mL and 1.4 mg/dL, respectively. The patient was admitted to the medicine floor. However, a few hours later, her atrial fibrillation went into rapid ventricular response, associated with hypotension. Cardiac enzymes began to trend up along with worsening of her renal function tests and hepatic enzymes. Her INR remained supratherapeutic despite holding coumadin and giving vitamin K. The patient was transferred to the medical intensive care unit for closer monitoring. During day 1 of the medical intensive care unit stay, losartan, simvastatin, and diuretics were held, whereas aspirin, clopidogrel, and isosorbide dinitrate were continued. In the following 2 days, there was worsening of tissue perfusion, and laboratory workup showed AST 514 IU/L, ALT 391 IU/L, INR >9, creatinine 3.8 mg/dL, and troponin I 0.19 ng/mL; therefore, digoxin was also held. Once the patient achieved hemodynamic stability, she was started on hydralazine. On day 4, renal function, cardiac, and hepatic enzymes improved significantly. However, 24 hours later, transaminases began to trend up again reaching a maximum of AST and ALT of 359 and 525 IU/L, respectively. Other possible causes were ruled out because her viral hepatitis markers, antihistone antibody, antinuclear antibody, and anti-double-stranded DNA were all negative. After thorough review of all medications, hydralazine was held with subsequent improvement in transaminases. The patient was seen a month later after her discharge, and all her laboratory workup improved to baseline.

Sarcopenia and associated risk factors in oncology outpatients in specialized cancer centers in Saudi Arabia: a cross-sectional study.

Sarcopenia is a comorbidity associated with cancer, which takes advantage of a patient's deteriorating state and decreases the survival rate. Thus, early detection of sarcopenia could improve oncology outpatient prognosis, treatment, and general quality of life. Objective: To measure the prevalence of probable sarcopenia and the associated risk factors in patients with cancer. Methods: This is a cross-sectional study. A total of 324 cancer patients were screened for sarcopenia using a simple questionnaire to rapidly diagnose sarcopenia [SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls)] and a hand grip dynamometer tool. The study was conducted from 1 January 2021 till 28 February 2021, in the outpatient department of Princess Noorah Oncology Center. Results: Among 324 cancer patients receiving active chemotherapy treatment, 28.4% screened positive for sarcopenia (SARC-F score ≥4). Moreover, 23.45% were identified as probable cases [SARC-F score ≥4 and a low hand grip strength (HGS)] of sarcopenia, according to the European Working Group on Sarcopenia in Older People consensus 2 (EWGSOP2) case-finding algorithm, which is sufficient to initiate a management plan. Conclusions: One-quarter of the cancer patients had probable sarcopenia at our institution. Sarcopenia risk was independently associated with patient age, and the risk of sarcopenia was low among patients with higher albumin concentrations. Screening cancer patients for sarcopenia using the SARC-F questionnaire and HGS may offer a useful strategy to mitigate the risk of unfavorable consequences that may occur during cancer treatment.

Validation of Physical Examination Perceived Self-Efficacy Instrument for Undergraduate Nursing Students.

BACKGROUND: Numerous studies have revealed that nursing students perceive lack of confidence as one of the key barriers to performing physical examination; however, it is not empirically measured. This study aimed to test the psychometric properties of the Physical Examination Perceived Self-Efficacy Instrument. METHOD: The study included three phases: in Phase 1, 51 items were constructed; in Phase 2, 7 field experts rated items for relevancy; and in Phase 3, the instrument was piloted to a convenience sample of 238 students. RESULTS: The analysis yielded six factors with a factor loading >0.40. The corrected item-total correlation ranged from 0.6 to 0.87. Cronbach's alpha ranged from .84 to .98. The interscale correlation of the instrument was statistically significant (p < .001). CONCLUSION: We found that the instrument is a psychometrically robust measure of self-efficacy of performing physical examination. The instrument could provide a better understanding of the association between perceived self-efficacy and students' academic performance. [J Nurs Educ. 2022;61(1):36-40.].

Saudi Expert Consensus-Based Autism Spectrum Disorder Statement: From Screening to Management.

BACKGROUND: There is a large gap between the needs of individuals diagnosed with autism spectrum disorder (ASD) and the currently available services in Saudi Arabia. Services are often difficult to access, inconsistent in quality, incomplete, unsatisfactory, and costly. As such, there is a national need for expert consensus on the appropriate standards for the assessment and management of children on the autism spectrum. METHODOLOGY: A guideline development group (GDC) was formed by professionals representing all related specialties and institutions involved in the management of individuals on the autism spectrum in Saudi Arabia. They met on a regular basis over 21 months. The guideline development process consisted of five steps starting from reviewing existing guidelines and ending with discussing and writing this manuscript. A formal voting process was utilized and recommendations were discussed until a consensus was reached. RESULTS: There was consensus on the following: A specialized diagnostic assessment needs to be carried out by an experienced multidisciplinary team for children referred to assess for ASD. They should be assessed for medical etiology, their behavioral history carefully reviewed, and symptoms directly observed. Longitudinal assessments are encouraged to reflect the effects of symptoms on the individual's ability to function while with their family, among peers, and in school settings. An additional formal assessment of language, cognitive, and adaptive abilities as well as sensory status is essential to complete the diagnostic process. Interventions should be individualized, developmentally appropriate, and intensive, with performance data relevant to intervention goals to evaluate and adjust interventions. Target symptoms must be identified to address and develop monitoring systems to track change. CONCLUSION: ASD is a complex condition with widely varying clinical manifestations, thus requiring evaluation and intervention by a range of professionals working in coordination. Behavioral and environmental interventions are the key to optimal outcomes, in conjunction with medications when indicated for specific symptoms. Parental involvement in interventions is vital to sustaining therapeutic gains.

The risk of eating disorders among children and adolescents with attention deficit hyperactivity disorder: Results of a matched cohort study.

BACKGROUND AND OBJECTIVES: There are some studies on the association between attention deficit and hyperactivity disorder (ADHD) and the risk of eating disorders (ED). Only few have examined the risk of ED among children and adolescents with ADHD. Previous research which included subjects with ADHD with other comorbidities used inadequate controls and did not focus on the type of ADHD or the role of pharmacological treatment. METHODS: This matched cohort study was conducted in the Child/Adolescents Psychiatry Unit (CAPU), Bahrain. Using the CAPU diagnostic frameworks, 70 subjects with ADHD were recruited and matched with their corresponding age- and sex- healthy controls at 1:2 ratio (70 cases:140 controls). The participants were children or adolescents aged between 8 and 19 years old. A brief interview was used to collect socio-demographic information and anthropometrics. The risk of ED was estimated using the eating attitude test -26 (EAT-2). Data were analyzed using cohort analysis. RESULTS: A total of 31.43% of the subjects with ADHD were screened using EAT-26 and found to be 'at risk' for ED, compared to 12.14% of the controls (OR 3.31, 95% CI 1.62-6.78). The prevalence of ED among female cases with ADHD was slightly higher than males (33.33% and 30.77%, respectively). Body weight or body mass index was a statistically significant explanatory factor for the risk of ED. CONCLUSIONS: The present study shows that children and adolescents with ADHD have a three-fold increased risk of ED compared to healthy controls. This research raised the recommendation that children and adolescents with ADHD should be screened for disordered eating patterns.

Reliability and Validity of the Arabic Version of the EORTC QLQ-C30 and QLQ-BR23 Questionnaires.

OBJECTIVE: To evaluate the psychometric properties of the Arabic version of the EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires. MATERIALS AND METHODS: A cross-sectional study was carried out. A total of 337 subjects were recruited from the Oncology Centre in Bahrain and 239 consented to participation. The European Organization for Research and Treatment-QOL questionnaire and breast cancer-specific module (EORTC QLQ-C30 and QLQ-BR23) were used to measure the HRQOL among women with breast cancer. All statistical tests were performed using SPSS Version 20. The reliability of the EORTC QLQ-C30 and QLQ-BR23 questionnaires was examined using Cronbach's alpha test. The construct validity of both questionnaires was tested using the exploratory factor analysis. RESULTS: Exploratory factor analysis results of EORTC QLQ-C30 showed that Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was 0.878 and Bartlett's Test of Sphericity is <0.001. The extracted four-factor model explained 51.52% of the total variance. Relating to EORTC-QLQ-BR23, the KMO value was 0.735 and Bartlett's Test of Sphericity showed a significance of p<0.001 and extracted a three-factor model which explained a total variance of 46.05%. The Cronbach's alpha coefficient results for EORTC QLQ-C30 and QLQ BR-23 were 0.927and 0.844 respectively which reflects high internal consistency. CONCLUSION: The EORTC QLQ-C30 and QLQ-BR23 questionnaires are feasible and promising instruments to measure the levels of HRQOL among Arabic-speaking women with breast cancer in future studies with some suggested modifications in some of the domains or items.

"I have chicken fat in my urine!" A case of Candida tropicalis induced emphysematous pyelitis.

A patient with uncontrolled diabetes mellitus presented with fever and flank pain. A computed tomography scan showed free air within both collecting systems. A diagnosis of emphysematous pyelitis was made after other alternative diagnoses were ruled out. Urine culture grew Candida tropicalis. The emphysematous pyelitis resolved with conservative management using antifungal therapy.

The clinical and molecular significance of C4d staining patterns in renal allografts.

BACKGROUND: We investigated the clinical and molecular significance of minimal peritubular capillary (PTC) and isolated glomerular C4d+ staining using microarrays. METHODS: Two hundred fifty-five clinically indicated transplant biopsies were included in the analyses. C4d staining was performed on paraffin sections using a polyclonal rabbit anti-C4d antibody. Gene expression profiles in a subset of patients were studied using Affymetrix HuGene 1.0ST arrays. RESULTS: Immunohistochemistry for C4d of 255 biopsies showed 51% C4d negative, 4% minimal PTC C4d+, 15% focal or diffuse PTC C4d+, and 31% isolated glomerular C4d+ biopsies. Patients with minimal and focal/diffuse PTC C4d+ staining had higher frequency of donor-specific anti-HLA antibodies (DSA) (67% and 82%) and antibody mediated rejection (AMR) (66% and 89%) when compared with C4d-negative biopsies (25% and 19%, respectively) (P<0.001). The glomerulitis, interstitial inflammation, and peritubular capillaritis scores were also significantly higher in minimal (0.88, 1.25, and 1.5) and focal/diffuse PTC C4d+ biopsies (0.65, 1.41, and 1.5), compared with C4d-negative biopsies (0.25, 079, and 0.34), respectively. There were no differences in the DSA frequency, AMR rate, or Banff scores between isolated glomerular C4d+ and C4d-negative patients. Although both minimal and focal/diffuse C4d+ biopsies showed increased expression of genes related to the immune response, interferon-gamma and rejection-induced, cytotoxic T cell and constitutive macrophage-associated pathogenesis-based transcripts, there was no activation of immune-response-related genes in isolated glomerular C4d+ biopsies. CONCLUSION: Minimal PTC C4d+ staining but not isolated glomerular C4d+ staining is associated with AMR, circulating DSAs and immune-response-related gene activation.

A Comparison Study of Communication Skills Between General Surgery and General Practice Residents on First-time Patient Visits.

BACKGROUND: There is little published research about differences in doctor-patient communication of different specialties. Accordingly, we compared doctor-patient communication skills in two different specialties, general surgery (GS) and general practice (GP). METHODS: Twenty residents from the Bahrain Defence Force Hospital (10 men and 10 women; mean age 28 years; 10 GS and 10 GP) participated in 200 patient first visit consultations. The consultations were video-recorded and analysed by four trained observers using the MAAS Global scale. RESULTS: 1) Internal consistency reliability of the MAAS Global (> 0.91) and Ep(2) = 0.84 for raters was high, 2) GP residents spent more time (12 minutes) than GS residents (7 minutes), in the visits, 3) There were several differences on the MAAS Global items between GP and GS residents (GS > GP, p < 0.05 on history taking, diagnosis and medical aspects; GP > GS, p < 0.05 on information giving), and 4) The present participants performed well compared to normative samples as well as to criterion-referenced cut-off scores. The general level of communication skills in both specialties, however, was 'unsatisfactory' and 'doubtful', as it is for normative samples. CONCLUSION: Excellent doctor-patient communication is essential but does not appear to receive the amount of attention that it deserves in practice settings. There are some differences between specialties as well as unsatisfactory communication skills for both specialties, since residents from both programs spent less time than recommended on each consultation. Our findings emphasize the need to improve the communication skills of physicians and surgeons in general.