Quality of primary care from the patient perspective in Saudi Arabia : a multi-level study.

Objectives: To assess primary care performance for measures of patients’ experience in Community-based Primary Care (CPC) and Employer-based Primary Care (EPC) systems in Saudi Arabia, to examine variations in performance across the two systems, and to explore factors at both the individual-level and the organizational-level that explain variations in primary care performance. Design and Methods: This is an observational and cross-sectional study, using comparative design and survey research methods. The newly revised and re-translated Arabic version of the Primary Care Assessment Survey (PCAS) was used to measure patients’ experience of primary care. PCAS operationalizes the IOM definition of primary care, which identified core domains of primary care as accessibility of care, continuity of care, comprehensiveness of care, coordination of care, interpersonal treatment, communication, and community orientation. A two-stage cluster, matched sampling was employed to select 16 primary care centers (eight CPC and eight EPC centers) in Riyadh, the capital and largest city (population \u3e 5.5 million) in Saudi Arabia. A systematic random sampling was employed to collect primary survey data from 612 adult patients visiting the selected primary care centers. Results: After adjusting for differences in the patient-mix and taking into account the multi-level structure of data by means of multi-level modeling, EPC performed statistically significantly better than CPC in interpersonal care (Mean EPC = 68.3, 95% CI [± 6.3] vs. Mean CPC = 59.5, 95% CI [± 5.9], p = 0.024, Effect Size (d) = 0.36) and communication (Mean EPC = 69.8, 95% CI [± 4.9] vs. Mean CPC = 64.4, 95% CI [± 5.5], p = 0.035, d =0.22), in addition to the total quality score (Total PCAS EPC = 60.4, 95% CI [± 2.9 ] vs. Total PCAS CPC = 56.1, 95% [± 3.3], p = 0.009, d =0.31). CPC performed statistically significantly better than EPC in community orientation (Mean CPC = 47.8, 95% [± 5.7] vs. Mean EPC = 35.5, 95% [± 6.2], p = 0.003, d =0.50) and accessibility of care (Mean CPC = 67.4, 95% [± 5.7] vs. Mean EPC = 63.5, 95% [± 4.5], p = 0.025, d=0.23). There were no significant differences between CPC and EPC in coordination of care (p= 0.098), comprehensiveness of care (p = 0.208), and visit-based continuity of care (p = 0.354). Patient-level (compositional) variables explained a significant proportion (R2 = 0.14) of the observed level-one (within-centers) variations in measures of patients’ experience. Those variables include gender, self-perceived health status, and patient-reported co-morbidity. Female patients, reporting poor health, and reporting chronic conditions are each statistically significantly associated with lower ratings of patients’ experience of care. Organizational-level (contextual) variables explained a significant proportion (R2 = 0.78) of the observed level-two (between-centers) variations in measures of patients’ experience. Those organizational variables include practice type and proportions of family physicians in a center. EPC centers and those centers with higher proportions of family physicians are each statistically significantly associated with better patients’ experience. Finally, aspects of care that were statistically significantly associated with better patients’ experience include knowing the name of the physician and being with the same physician for longer durations. Conclusion: Enhancing continuity and quality of patient-physician relationships may improve the overall patients’ experience of care. Healthcare systems in Saudi Arabia might embrace the Bio-Psycho-Social model to foster a culture of health and caring. Effective, community-oriented primary care systems have the potential to re-orient health systems’ from a sole focus on sickness and disease, to include additional approaches for prevention and wellness at the societal level. Positive indicators of health, at both the individual and community levels, are needed to better align existing healthcare systems with this goal, mission and vision to improve population health

Association of Subpubic Angle Measurement with Age and Gender in a Group of Adult Sudanese Patients

Background: The measurement of the subpubic angle (SPA) has been used for determining gender with a high degree of accuracy in various ethnic groups. This measurement can also be helpful in forensic and physical anthropology. The aim of this study was to compare the SPA in different adult age groups (males and females) and to use the SPA to estimate the demarking point (DP) for the determination of gender. Methods: This study included 158 subjects – 59 male and 99 female. The SPA was measured electronically using antero-posterior pelvis X-rays. Measurements were taken retrospectively using the Picture Archiving and Communication System.  SPA measurements were compared between the male and female participants  in different adult age groups. To determine the gender, the DP was calculated from the means of SPA in male and female participants.   Results: A comparison of the means of SPA between males and females showed that females (134.94 ± 15.33º)  had wider SPA than males (105.88 ± 10.33) with a significant difference (P = 0.012). While a DP > 126.5 is most likely indicative of a female pelvis, a DP < 104.3 is indicative of a male pelvis. The accuracy levels based on the measured DP of participants in this study were 45.8% and 69.7% for males and females, respectively. Besides, with regards to age, the mean values for different age groups in males and females were statistically insignificant (P-values were 0.21 and 0.75, respectively).   Conclusions: According to the obtained results, the variations in the measurements of the SPA from pelvic X-rays can be used to determine gender. The calculated SPA range and DP were found to predict female gender with higher accuracy. Age was not associated with any notable differences in SPA measurements. Keywords: subpubic angle, pelvis, Sudanese, sex differences&nbsp

A Comparative Questionnaire-based Study on Learning Styles and Studying Resources among Undergraduate Medical Students in Public and Private Universities

Background: Learning styles are circumstances beneath which learners most expeditiously and successfully understand, process, store, and recall what they are attempting to learn. The main goal of the current study was to compare different methods of study and learning style predilections amongst undergraduate MBBS students who attend public and private universities. Methods: The current study was a descriptive cross-sectional research. Data collected were obtained through a questionnaire filled by second- and third-year students in Omdurman Islamic University - OIU (public) and University of Medical Sciences and Technology – UMST (private) using systematic random sampling. Using the SPSS version 23 software, the data were analyzed and Chi-square test was used to test the significance considering the α (alpha) level of significance as 0.05. Results: The application of the Chi-square test showed that there is no relation between the a method of study used and the students’ grades (P = 0.333). The most preferred learning style in OIU was found to be Aural (60.0%), while in UMST it was read/write (57.9%). The most preferred source of studying used in OIU was found to be extracourses (private courses given outside the university), whereas in UMST it was found to be the teachers’ slides. Conclusion: The most preferred learning style for public university was found to be aural while for private university it was found to read/write. This factor must be taken into consideration while teaching sessions are being conducted. Interestingly, there was no statistical association between the study methodology and students’ grades

Presentation of Invasive Fungal Rhinosinusitis in Sudanese Children: A Report of Four Cases

Fungal rhinosinusitis (FS) is considered as a disease spectrum that ranges from allergic fungal sinusitis (AFS) and chronic fungal rhinosinusitis (CFS) to invasive fungal rhinosinusitis (IFS) invading the orbit, Dura, and intra-cranium. Fungal rhinosinusitis is a common disease in Sudan. Objective: To present four rare cases of InvasiveFungal Rhinosinusitis in Sudanese children presented with orbital extension. Patients and Method: The authors have reported four cases of children in the age range of 9–11 years, two girls and two boys; they were presented with invasive fungal rhinosinusitis in Africa ENT hospital (Sudan) during the period from September 2015 to August 2017. Patients’ diagnosis was made by endoscopic examination, CT, and MRI,and it was confirmed by tissue biopsy. Results: Patients’ age range was 9–11 years, two girls and two boys. The unilateral disease was the commonest type. An orbital extension was detected in all cases on CT and MRI. No intracranial extension was detected. Aspergillus flavus was the most responsible agent detected in all the fourcases. Conclusion: Fungal rhinosinusitis (FS) is a common disease in adult Sudanese patients but rarely affects children. It is mainly caused by Aspergillus species. The disease is extensive and can be associated with orbital and intracranial complications

An optimal path selection using lion optimization routing protocol for mobile ad-hoc network

MANET is a set of nodes that communicate with each other directly or indirectly. The nodes in MANET can be moved freely. The dynamic nature of the network makes several challenges. One of the challenges in routing is to transfer the data from the start node (source) to the end node (destination). Routing suffers from several metrics such as power-consuming, delay, packet delivery ratio, etc. This paper proposed a new protocol called the Lion Optimization Routing protocol (LORP) based on the lion algorithm and AODV protocol. This protocol uses the Lion Optimization Algorithm to select the optimal path. Firstly, we use lion optimization to select the optimal path using the LOA maximization algorithm depending on three main metrics Power Efficiency, Throughput, and Packet Delivery Ratio. Secondly, we use the LOA minimization algorithm to select the optimal path using two metrics Delay and Short Path. In LOA Maximization algorithm metrics calculated and choose the max path value. The result of this protocol is compared with AODV, DSR, and ANTHOCNET