Field Guide to the Difficult Patient Interview

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Medical Tourism Abroad : A new challenge to Oman’s health system - Al Dakhilya region experience

Objectives: This study aimed to understand why people seek medical advice abroad given the trouble and expense this entails. The types of medical problems for which treatment abroad was sought, preferred destinations and satisfaction with the treatment were explored. A secondary aim was to give feedback to stakeholders in the health care system on how to handle this issue and meet the needs of the community. Methods: 45 patients who had recently travelled abroad for treatment were asked to complete a questionnaire or were interviewed by telephone. Results: 40 questionnaires were received. 68% of the respondents were male. Orthopaedic diseases were the most common conditions leading patients to seek treatment abroad. Thailand was the most popular destination followed by India (50% and 30% respectively). 85% of respondents went abroad for treatment only, 10% for treatment and tourism and 2.5% were healthy, but travelled abroad for a checkup. Interestingly, 15% of the participants went abroad without first seeking medical care locally. Out of those initially treated in Oman, 38.2% had no specific diagnosis and 38.2% had received treatment, but it was not effective. 73% of respondents obtained information on treatment abroad from a friend. The Internet and medical tourism offices were the least used sources of information. 15% of the patients experienced complications after their treatment abroad. Conclusion: Various facts about medical treatment abroad need to be disseminated to the public. This will necessitate greater effort in public health promotion and education. 

The Effectiveness of Teaching and Evaluating A written Expression Using A package of Modern Digital Applications in Developing the Written Expression Skills of Tenth-Grade Students

ملخص: هدفت الدراسة إلى التحقق من فاعلية تدريس التعبير الكتابي وتقويمه باستخدام حزمة من التطبيقات الرقمية الحديثة الداعمة لمنصة جوجل كلاس روم (Google Classroom) في تنمية مهارات التعبير الكتابي لدى طلبة الصف العاشر، وقد شمل مجتمع الدراسة جميع طلبة الصف العاشر الأساسي في المدارس الحكومية بسلطنة عمان خلال العام الدراسي 2020/2021، البالغ عددهم (49042) طالبًا وطالبةً موزعين على مدارس السلطنة؛ حيث تكونت العينة من (124) طالبًا وطالبةً ( 62 من الذكور و62 من الإناث)، اختيروا من  أربع (4) مدارس بطريقة قصدية (مدرستين للذكور ومدرستين للإناث)، واعتمدت الدراسة الحالية على المنهج التجريبي ذي التصميم شبه التجريبي ذي المجموعتين التجريبية والضابطة؛ إذ اتُّبعت في المجموعة التجريبية الاستراتيجية المقترحة لتدريس التعبير وتقويمه، وأما المجموعة الضابطة فقد سار تدريس وتقويم التعبير الكتابي فيها وفق الطريقة التقليدية. وتوصلت نتائج الدراسة إلى ارتفاع متوسط درجات المجموعة التجريبية مقارنة بمتوسط المجموعة الضابطة في التطبيق للاختبار البعدي لمهارات التعبير الكتابي في المهارات الرئيسة الثلاث (المضمون، واللغة والأسلوب، والشكل والتنظيم)، وأظهرت النتائج وجود فروق ذات دلالة إحصائية عند مستوى(0.05≥α) بين متوسطي درجات المجموعتين التجريبية والضابطة في التطبيق للاختبار البعدي لمهارات التعبير الكتابي يعزى إلى طريقة التدريس. كما أوضحت نتائج الدراسة عدم وجود فروق ذات دلالة إحصائية بين طلبة الصف العاشر الأساسي في مستوى كل من مهارتي المضمون واللغة والأسلوب تعزى إلى الجنس، كذلك أظهرت النتائج وجود فروق ذات دلالة إحصائية بين طلبة الصف العاشر الأساسي في مستوى مهارة الشكل والتنظيم تعزى إلى الجنس ولصالح الإناث. وكشفت النتائج عن عدم وجود فروق ذات دلالة إحصائية بين طلبة الصف العاشر الأساسي في مستوى مهارات التعبير الكتابي مجتمعة معا يعزى إلى التفاعل بين طريقة التدريس والجنس. وأوضحت نتائج تحليل التباين الثنائي وجود فرق ذي دلالة إحصائية بين طلبة الصف العاشر الأساسي في مستوى مهارات التعبير الكتابي مجتمعة يعزى إلى طريقة التدريس والجنس.Abstract: The study aimed to investigate the effectiveness of teaching and evaluating written expression using a package of modern digital applications that support the Google Classroom platform to develop the writing skills of students in tenth grade.The study included all tenth-grade students in government schools in the Sultanate of Oman during the academic year 2020/2021, totaling 49,042 male and female students distributed among schools in the country. The sample consisted of 124 male and female students, 62 males and 62 females selected purposively from four schools (two schools for males and two for females). The current study followed the experimental method with a quasi-experimental design consisting of two experimental and control groups. The experimental group was taught and evaluated using the proposed strategy for teaching and evaluating written expression, while the control group was taught and evaluated using the traditional method. The results of the study showed a statistically significant increase in the average scores of the experimental group compared to the control group in the post-application test of the written expression skills in the three primary skills (content, language and style, and form and organization), and the results showed that there are statistically significant differences at the level of (0.05≥α) between the average scores of the experimental and control groups in the application of the post-test of written expression skills attributed to the teaching method. The results of the study also showed that there were no statistically significant differences between tenth grade students in the level of "content and language & style" skills attributed to gender, while the results showed that there were statistically significant differences among tenth grade students in the level of "form and organization" skill attributed to gender and in favor of females. Furthermore, the results revealed no statistically significant differences among tenth-grade students in the overall level of writing expression skills, attributed to the interaction between the teaching method and gender. However, the results of the Two-way analysis of variance indicated statistically significant differences in the performance of tenth-grade students in overall skills, attributed to both gender and teaching method

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Assessing the presence of pharmaceuticals in soil and plants irrigated with treated wastewater in Oman

Abstract Purpose This study conducted to assess the presence of pharmaceuticals in soils and crops irrigated with treated wastewater in Oman. The study was aimed to evaluate the potential of plant uptake of four commonly used pharmaceuticals in Oman: amoxicillin, sulfamethoxazole, trimethoprim and ibuprofen by radish (Raphanus raphanistrum subsp. sativius) in soil culture. Methods Radish (Raphanus raphanistrum) was selected as a test crop. Liquid chromatography mass spectrometry/mass spectrometry (LC–MS/MS) instrument was used to measure concentrations of pharmaceuticals. Groundwater and treated wastewater were used for irrigation. Additionally, there were two spiked treatments; high-spiked concentration (5 mg/l) and low-spiked concentration (1 mg/l). Results Results of the study showed that trimethoprim and ibuprofen were not detected in any samples of soil and plant. Sulfamethoxazole accumulated in radish roots for low- and high-spiked treatments. Amoxicillin accumulated in roots with low-spiked- as well as high-spiked treatments. Radish showed the ability to translocate some of the selected pharmaceuticals from soil irrigated with treated wastewater if they are present in sufficient concentrations. Conclusions Radish showed positive uptake of some selected pharmaceuticals from soil irrigated with treated wastewater with spiked (both high and low) concentration of pharmaceuticals and has the ability to accumulate them in the roots. Pharmaceutical usage and disposal must be given attention to prevent their occurrences in the environment. Furthermore, treated wastewater must be given attention, as it is an important source of water in Oman, which suffers from water shortages

Antibiotics in wastewaters: a review with focus on Oman

Abstract The occurrence of antibiotics in treated wastewater effluent has been a concern worldwide for various reasons: most importantly development of antibiotics resistance by bacteria and other microorganism, impact of antibiotics on animal life in surface water and likely consequences on humans if treated wastewater is used for drinking water supply through the process of managed aquifer recharge (MAR). Another potential area of concern is the uptake of these antibiotics by crops irrigated by treated wastewater. In Oman, wastewater treatment and reuse is pursued vigorously as a government policy. Treated wastewater is used for crop irrigation following government regulations, MAR is being contemplated and practiced in small scale and release of such waters in the ocean takes place from time to time. Some tests have been conducted on the wastewater effluent around the world to verify and detect the concentration of antibiotics in wastewater effluent. In the Sultanate of Oman, very little research has been performed on the occurrence of antibiotics in treated wastewater, removal efficiencies of treatment processes and development of antibiotics resistance. It is expected that wastewater reuse will increase substantially due to expansion of sewerage network in the capital city as well as many other cities and towns. As such, it is imperative that research be undertaken to find out various issues related to commonly used antibiotics such as ciprofloxacin, norfloxacin, erythromycin, linezolid, penicillin, ampicillin, chloramphenicol, streptomycin, minocycline, tetracycline and sulfamethoxazole in Oman and their ultimate fate through the treatment process. In addition, the development of guidelines is crucial in amounts of antibiotics acceptably occurring in treated wastewater effluent and if they could be suitable for agriculture without causing any harm. A review of the available literature and data are provided in this article. Research needs have been identified

The effect of municipal sewage sludge on the quality of soil and crops

Abstract Purpose To examine the effects of the application of composted sewage sludge fertilizer (commercially sold as Kala compost) and inorganic (NPK) fertilizers on soil quality and on two crops (radish and beans) irrigated using groundwater and sewage treated wastewater (TWW) for irrigation by measuring heavy metals in the soil and plants and other parameters such as crops yield, TOC in soil, chlorophyll index and total nitrogen. Methods The field experiments were conducted in an open area in Agricultural Experimental Study at Sultan Qaboos University campus, Oman. In this research, “green beans and white radish” were examined under the application of Kala and NPK fertilizers. The experimental design was a randomized complete block with four replicates. Results The results showed that the yield, TOC and chlorophyll contents of green beans and white radish increased when soil was amended with Kala compost compared to NPK. Chemical analysis of soil and the two crops did not show any risk of heavy metal accumulation. Conclusions Considering that the experiment was a short duration one, there is a need for more continuous long-term experiments (at least 5 years) that will improve the understanding on the effects of composted sewage sludge on soil fertility and crop yield to contribute to the development of sustainable agricultural practices in an arid environment of Oman