Prevalence of Burnout among Physicians at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

Introduction: Physician burnout in armed forces involves emotional exhaustion, depersonalization and a sense of declined personal accomplishment. This can have an adverse effect on quality patient care, the healthcare team and can cost physician health in both in-training physicians and practicing physicians. The causative factors include excessive long work shifts, inefficient work systems and clerical burdens, professional home conflicts, lack of departmental support, limited work force and poor leadership culture. Objectives: This study aims at measuring the prevalence of burnout in physicians working in King Salman armed forces hospital Saudi Arabia and studying possible related socio-demographic variables. Methods: A cross sectional study was conducted between April and May 2015 among physicians. A self‑administered questionnaire was used that includes questions on socio demographic characteristics, sources of stress and burnout of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) in this study. Student’s T-test and chi square tests were used for analysis. Results: Majority were males 74.8% aged more than 35 years with the prevalence rate of 14.2%. The analyzed variables associated with emotional exhaustion, the following factors significantly affected the EE with P value<0.05, exercise, alternate shift duty, work over load, quality of life, satisfaction with work and specialty. As for the significant factors associated with DP, shift duty, work overload, quality of life perception and specialty were found to have P value less than 0.05. Conclusion: Burnout is prevalent among physicians; we identified variables significantly associated with Emotional exhaustion (EE), Depersonalization (DP) and Personal accomplishment (PA). However, further research is recommended to study other predictors not mentioned in the current study and all health policy makers must work jointly in designing and implement effective remedial measures for physician burnout.

Will Musculoskeletal Conditions of Shoulder Affect the Hand Function and Hand-Eye Coordination? A Cross-Sectional Analysis

Objective: To analyze the Hand Function (HF) and Hand-Eye Coordination (HEC) among subjects with shoulder conditions resulting in pain and disability. Methodology: In these cross-sectional 47 subjects with selected shoulder pathology between 30 to 60 years participated. Shoulder pathology was measured in terms of pain and disability using the SPADI scale. These values were correlated with Purdue pegboard and Balloon tossing task and Wall Ball Bounce task. Results: Spearman rank correlation analysis of SPADI pain component revealed that there was a negative correlation with HF (R= -0.596, p<0.001), but there was significant correlation with HEC1 (R= -0.260, p= 0.078) and HEC2 (R= -0.217, p= -0.144). Though there was no correlation a negative relationship was observed between the variables. In the correlation of SPADI disability component there was a perfect negative correlation with HF (R= -0.870, p<0.001), with HEC1 (R= -0.588, p<0.001) and HEC2 (R= -0.541, p<0.001). Conclusion: This study concludes that shoulder pain negatively influences the Hand Function, whereas the shoulder disability negatively influences both Hand Function and Hand-Eye Coordination. The therapist should consider assessing and treating HF and HEC in patients with shoulder pain and disability in the future.

Collaborative Learning Aspect for Training Hip and Knee Joint Anatomy

One of the prerequisites required for an efficient diagnosis in a medical practice is to have a strong command of both functional and clinical anatomy. In this study we introduce a new collaborative approach in the effective teaching of the knee and hip joint. In the present teaching model, anatomist, orthopedists and physical therapists present the anatomy of the hip and knee joint in small groups. Courses for the hip and knee joint were scheduled during the early stages of the medical curriculum. Students of nursing and physical therapy were grouped together to sensitize for the importance of a collaborative effort. The study results clearly demonstrate that nursing students and physical therapy students appreciated this teaching approach. The collaborative approach further proved to be a suitable method to teach both functional and clinical anatomy of the hip and knee joint. Aside from this training, a collaborative approach between medical students and physical therapy students was also successful for healthcare organization.

Constrictive Pericarditis as the First Presentation of Systemic Lupus Erythematosus

Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by multi-organ damage mediated by immune complexes and autoantibodies. It often presents with patients being non-specifically unwell and there is a wide range of differential diagnoses, one of which includes chronic infections such as Tuberculosis (TB). Exudative pericarditis is a relatively common feature in SLE and is present in up to 62% of patients on autopsy, although only a quarter of patients are symptomatic; constrictive pericarditis is a very rare feature of SLE. We report a 49 year old gentleman who was diagnosed with SLE which presented with features of constrictive pericarditis following an extensive period of investigations for TB.

Rheumatology - A Qualitative Review of Community and Hospital Based Delivery Models

Over recent years the increasing pressures on hospital based services has raised the question as to whether more clinical facilities can be provided in the community. Accordingly, commissioning groups have focused much of their energy towards research into whether this shift in healthcare models is feasible, cost-effective and satisfactory to both patients and healthcare providers. Specialties which lend themselves towards the possibility of community based models of care include those that manage patients with chronic but stable diseases and Rheumatology, in particular, has been a focus of such research.

Efficacy of Etanercept with Jaw - Training for Rheumatoid Arthritis with Firstly Temporomandibular Joint Symptoms: A Case Report

Some patients with Rheumatoid Arthritis suffer with Temporomandibular Disorders (TMD). A 36-year-old Asian female presented to our hospital with Temporomandibular Joint (TMJ) symptoms, including pain. The maximum self-opening distance was 23 mm at first visit. As symptoms were worse in the morning and also started occurring in other joints, rheumatologists were consulted. The rheumatologists prescribed Etanercept (ETN), a tumor necrosis factor inhibitor which is commonly used in the early stages of Rheumatoid Arthritis (RA). The use of ETN together with conservative therapy for the TMJ improved the symptoms in the affected joints. No therapy for TMJ symptoms in RA patients has yet been established. However, the findings of this case suggest that the usage of biological products from the early stage of RA and jaw-training may be possible to manage TMJ symptoms.

Delayed Radiographic Presentation of IgG4 Vasculitis

Immunoglobulin G4 (IgG4) related disease is a systemic inflammatory process that affects multiple organs and can commonly present with large vessel vasculitis. We present an interesting case of a patient with delayed manifestation of IgG4 related vasculitis on radiographic imaging.