Invited Editorial

Crossroad between camel bites and crocodile bite

The Degree of Schools Principals Practicing Innovation and its Relation with the Teachers’ Professional Development

The study aims to know the degree of schools principals practicing innovation and its relationship with the teachers’ professional development; the population of the study is consisted of all male and female teachers numbering to 415 teachers; the sample of the study is consisted of 205 male and female teachers from members of the study population.To achieve the goals of the study two questionnaires were developed in order to collect information to define the degree of the schools principles practicing innovation and its relation with the teachers’ professional development; the first questionnaire contained the degree of the schools principles practicing innovation; the first questionnaire is consisted of 24 paragraphs, the second questionnaire contains the measurement of the degree of the teacher’s practicing professional development which is consisted of 37 paragraphs whom their validity and consistency are checked.The study concluded that the degree of schools principals practicing innovation and its relation with the teachers’ professional development in the three domains was great arranged in accordance with the study domains as follows: encouraging of innovative ideas, promoting of schooling environment and solving of innovative problems. The study results showed as well that the degree of schools teachers’ professional development was great according to the teachers’ point of view.The result of the study revealed a positive correlation of statistical significance at the level (α≤0.05) among the averages of schools teachers estimations in the domains of schools principals practicing innovation and their estimations of the teachers professional development.In the light of the results the study recommended the work to meet the required new training for the schools principals; to conduct the field studies on the effectiveness of the training programs provided to the schools principals and to the teachers and to increase the appropriate material and nominal motivations for the innovators of them. Keywords: Innovation, Professional Development, Schools Principal

High incidence of acute full-thickness rotator cuff tears. A population-based prospective study in a Swedish Community.

Background and purpose - Epidemiological studies of full-thickness rotator cuff tears (FTRCTs) have mainly investigated degenerative lesions. We estimated the population-based incidence of acute FTRCT using a new diagnostic model. Patients and methods - During the period November 2010 through October 2012, we prospectively studied all patients aged 18-75 years with acute onset of pain after shoulder trauma, with limited active abduction, and with normal conventional radiographs. 259 consecutive patients met these inclusion criteria. The patients had a median age of 51 (18-75) years. 65% were males. The patients were divided into 3 groups according to the clinical findings: group I, suspected FTRCT; group II, other specific diagnoses; and group III, sprain. Semi-acute MRI was performed in all patients in group I and in patients in group III who did not recover functionally. Results - We identified 60 patients with FTRCTs. The estimated annual incidence of MRI-verified acute FTRCT was 16 (95% CI: 11-23) per 105 inhabitants for the population aged 18-75 years and 25 (CI: 18-36) per 105 inhabitants for the population aged 40-75 years. The prevalence of acute FTRCT in the study group was 60/259 (23%, CI: 18-28). The tears were usually large and affected more than 1 tendon in 36 of these 60 patients. The subscapularis was involved in 38 of the 60 patients. Interpretation - Acute FTRCTs are common shoulder injuries, especially in men. They are usually large and often involve the subscapularis tendon

Bowel injury following gynecological laparoscopic surgery

Background: Bowel injury remains a serious complication of gynecological laparoscopic surgery. We aimed to review the literature on this topic, combined with personal experiences, so as to give recommendations on how to avoid and manage this complication.Methods: We performed a narrative review on bowel injury following gynecological laparoscopic surgery using PubMed covering prevention, diagnosis, and management. Search terms used were laparoscopy, gynaecology, injury, bowel, prevention, treatment.Results: Important principles of prevention include proper pre-operative evaluation and increased laparoscopic surgical skills and knowledge. High clinical suspicion is crucial for early diagnosis. Diagnostic workup of suspected cases includes serial abdominal examination, measuring inflammatory markers, and performing imaging studies including abdominal ultrasound and CT scan. When bowel injury is recognized during the first laparoscopic procedure then laparoscopic primary suturing could be tried although laparotomy may be needed. When diagnosis is delayed, then laparotomy is the treatment of choice. The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on bowel injury needs to be further assessed.Conclusion: Early recognition of bowel injury is crucial for a favorable clinical outcome. A combined collaboration between gynecologists and general surgeons is important for timely and proper decisions to be made.Keywords: Laparoscopy, gynaecology, injury, bowel, prevention, treatmen

An interactive problem-solving approach to teach traumatology for medical students

<p>Abstract</p> <p>Aim</p> <p>We aimed to evaluate an interactive problem-solving approach for teaching traumatology from perspectives of students and consider its implications on Faculty development.</p> <p>Methods</p> <p>A two hour problem-solving, interactive tutorial on traumatology was structured to cover main topics in trauma management. The tutorial was based on real cases covering specific topics and objectives. Seven tutorials (5-9 students in each) were given by the same tutor with the same format for fourth and fifth year medical students in Auckland and UAE Universities (n = 50). A 16 item questionnaire, on a 7 point Likert-type scale, focusing on educational tools, tutor-based skills, and student-centered skills were answered by the students followed by open ended comments.</p> <p>Results</p> <p>The tutorials were highly ranked by the students. The mean values of educational tools was the highest followed by tutor-centered skills and finally student-centered skills. There was a significant increase of the rating of studied attributes over time (F = 3.9, p = 0.004, ANOVA). Students' open ended comments were highly supportive of the interactive problem-solving approach for teaching traumatology.</p> <p>Conclusions</p> <p>The interactive problem-solving approach for tutorials can be an effective enjoyable alternative or supplement to traditional instruction for teaching traumatology to medical students. Training for this approach should be encouraged for Faculty development.</p

Distraction-related road traffic collisions

Objectives: We aimed to prospectively study distraction-related road traffic collision injuries, their contributory factors, severity, and outcome.Methods: Data were prospectively collected on all hospitalized road traffic collision trauma patients in Al-Ain City who were drivers at the collision time over one and half years. Driver’s inattentive behaviors preceding the collision were collected by interviewing the admitted drivers.Results: There were 444 drivers, 330 of them were fully oriented patients, out of them only 44 (13%) were distracted. Nineteen (5.8%) drivers were distracted by using mobile phones, 12 (3.6%) were pre-occupied with deep thinking, six (1.8%) were talking with other passengers, four (1.2%) were picking things in the vehicle, and three (0.9%) were using entertainment systems. The maximum distraction occurred during the time of 6 am - 12 noon when the traffic was crowded. There were no significant differences between distracted and non-distracted drivers in demographical and physiological factors, injured regions, and outcomes.Conclusion: Distraction of alert drivers causes 13% of road traffic collisions in Al-Ain city. About 40 percent of the distracted drivers involved in road traffic collisions (RTC) were using mobile phones. Our study supports the ban of use of cell phones while driving.Keywords: Distraction, prevention, road traffic collision, mobile phon

The biomechanics of lower limb injuries in frontal-impact road traffic collisions

Aim: We aimed to review the biomechanics of lower limb injuries caused by frontal-impact road traffic collisions.Methods: In this narrative review, we identified articles through pubmed, Scopus and Science Direct search engines for the period of 1990-2014. Search terms included: “biomechanics”, “lower limb injury”, “hip injury”, “knee injury”, “foot and ankle injury” and “frontal impact collision”. We studied factors affecting the anatomical site, frequency and severity of the injuries.Results: The most common reported mechanisms of injury were: the impaction of the knee with the dashboard resulting in acetabular fracture or posterior hip dislocation; and toepan intrusion in combination with forceful application of the brake resulting in foot and ankle fractures. The probability of an occupant sustaining significant injury to the hip is increased in taller males, and being out of position during the collision. The probability of an occupant sustaining a fracture to the foot and ankle is increased in shorter female occupants with a large overlap impact or a near oblique collision.Conclusion: Understanding the biomechanics of frontal-impact road traffic collisions is useful in alerting clinicians to the potential lower limb injuries sustained in these collisions.Keywords: Biomechanics, frontal-impact collisions, lower limb injury, knee, thigh and hip injury, lower leg, foot and ankle injury

Care of terminally-ill patients: an opinion survey among critical care healthcare providers in the Middle East

Background: Modern medicine has allowed physicians to support the dying terminally-ill patient with artificial means. However, a common dilemma faced by physicians in general, and intensivist in particular is when to limit or withdraw aggressive intervention.Objective: To study the effect of training background and seniority on Do-not to resuscitate (DNR) decisions in the Middle East.Methods: Anonymous questionnaire sent to members of the Pan Arab Society of Critical Care.Results: The response rate was 46.2%. Most of the responders were Muslim (86%) and consultants (70.9%). Majority of the responders were trained in western countries. Religion played a major role in 59.3% for making the DNR decision. DNR was considered equivalent to comfort care by 39.5%. In a futile case scenario, Do Not Escalate Therapy was preferred (54.7%). The likelihood of a patient, once labeled DNR, being clinically neglected was a concern among 46.5%. Admission of DNR patients to the ICU was acceptable for 47.7%. Almost one-half of the responders (46.5%) wanted physicians to have the ultimate authority in the DNR decision. Training background was a significant factor affecting the interpretation of the term no code DNR (P&lt; 0.008).Conclusion: Training background and level of seniority in critical care provider does not impact opinion on most of end of life issues related to care of terminally-ill patients. However, DNR is considered equivalent to comfort care among majority of Middle Eastern trained physicians.Keywords: Do-not resuscitate, Islam, care of terminally-ill, opinion, trainingAfrican Health Sciences 2013; 13(4): 893 - 89

Surgeon-performed sonographic findings in a traumatic trans-anal rectal perforation

Early diagnosis and active management of trans-anal rectal injuries is essential for a favorable outcome. Intraperitoneal free air (IFA) is usually diagnosed by an erect Chest X-ray. Point-of-care ultrasound has been recently used to detect IFA. We report a 45-year-old male who presented to the Emergency Department with lower abdominal peritonitis. Surgeon-performed portable point-of-care ultrasound as an extension of the abdominal examination revealed an inflamed omentum with hypoechoic stranding, thickened non compressible small bowel, and free fluid in the pelvis. A transverse abdominal section of the right upper quadrant showed free intraperitoneal air. Rectal examination revealed a longitudinal rectal tear. Laparotomy has confirmed the sonographic findings. There was a 12 cm intraperitoneal tear of the anterior wall of the rectum which was necrotic. This case clearly demonstrates that portable point-of-care ultrasound gives very useful detailed information even when performed by a non radiologist. Surgeons should be encouraged to use point-of-care ultrasound after appropriate training