SACM - United Kingdom
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Item Restricted Treatment Strategies for Delayed Cerebral Ischaemia After Subarachnoid Haemorrhage: A Systematic Review(Queen Mary University of London, 1431-07-18) Alanazi, Abdullah; Zolfaghari, ParjamABSTRACT Delayed cerebral ischaemia (DCI) is a devastating complication which may occur after aneurysmal subarachnoid haemorrhage (SAH). It significantly increases mortality among SAH patients and leads to poor functional outcomes. Due to uncertainty among researchers and healthcare professionals regarding the pathophysiology and clinical diagnosis of DCI, no sufficient treatment model has been proposed. Aims and Objectives: The aim of this study is to address the literature gap in the current recommendations on the treatment for DCI. In doing so, we aim to bring to light potential avenues for novel therapies, which have not yet been addressed by treatment models, and to inform directions for future research. Methodology: Three electronic databases (Pubmed, Medline, and Embase) were systematically searched for randomised control trials (RCT) and retrospective cohort studies that addressed various treatment methods of DCI. These included data on the use of statins, endovascular rescue therapy (ERT), calcium antagonists and vasodilators, assessing their efficacy and safety profile. Studies were included on the basis of predetermined inclusion criteria. Primary and secondary outcomes included mortality rate, ICU and hospital length of stay, incidence of vasospasm, and adverse events for each treatment modality. Results: A total of nine studies were included: 3 RCT and 6 retrospective cohort studies. No study reported a significant increase in adverse events, indicating that the included treatments are safe to use. A significant improvement in the severity of vasospasm was reported after the given treatment modalities; however, changes in functional outcome (Glasgow Coma Scale, Glasgow Outcome Scale, modified Rankin Scale) were not significant. Only the studies on statins included the length of hospital stay as a measure, which also showed insignificant results. Adjunct therapy of ERT with nimodipine appears to improve functional outcomes compared to single therapies. Conclusion: There is currently insufficient evidence for the addition of milrinone and statins to the current guidelines. However, adjuvant therapies show promise and more combinations should therefore be explored in the future. Keywords: Delayed cerebral ischaemia, cerebral vasospasm, aneurysmal subarachnoid haemorrhage, treatment, statins, endovascular rescue therapy, balloon angioplasty, nimodipine, milrinone37 0Item Restricted How Much Patient-Centred Care (PCC) is Taught to Medical Students in Saudi Arabia: A Case Study of the University of Tabuk Medical Curriculum(Saudi Digital Library, 2023-08-30) Alanazi, Abdullah; Agius, StevenBackground: Medical education’s role is to equip medical students with competencies to meet the patients’ needs. The CanMEDs framework presents key competency areas of medical practice that a typical medical curriculum should incorporate. The SaudiMeds competency framework was established to achieve the purpose of the CanMEDs framework in Saudi medical schools. As a result, meeting these competencies is meant to enhance the provision of patient-centered care (PCC). However, the extent of incorporation of PCC in Saudi medical curriculum has not been fully explored. Aims: To determine how much PCC content is taught to medical students at the University of Tabuk by mapping the common PCC domain to the MBBS program Methods: This study applied the sequential exploratory mixed-methods design as the qualitative data on the curriculum content was explored widely and then corroborated with the survey findings. Using the case study approach, the study explored how much PCC is taught to medical students at the University of Tabuk. Data was obtained from the MBBS program specification document, course modules for the six academic years, and self-administered questionnaire. Manifest content analysis approach was used to locate 27 PCC domains in the MBBS program learning outcomes (knowledge, skills and values), course learning outcomes, and teaching/learning strategies. Curriculum mapping was done to create links between the PCC domains and the MBBS program documents retrieved from the university. The higher the number of links, the greater the extent of teaching PCC to the university’s medical students. Results: All the 27 PCC domains are incorporated into the MBBS program at the University of Tabuk. The questionnaire results corroborated this finding. Problem-based learning (PBL) and case-based learning (CBL) dominate the teaching/learning strategies used at the university. The study also revealed that PCC is highly concentrated in the clinical years than in the preclinical years. Discussion: There is congruency between the MBBS program at the University of Tabuk and SaudiMeds/CanMeds) frameworks. Since the university’s mission is to churn out competent graduates to serve the community, strict adherence to PCC concepts will contribute positively to the attainment of this mission. In conclusion, there is a positive trend in the incorporation of PCC in the medical curriculum, which should be a norm nationally.14 0