Knowledge and Attitude of ER and Intensive Care Unit Physicians toward Do-Not-Resuscitate in a Tertiary Care Center in Saudi Arabia: A Survey Study.
ABSTRACT: Only a few studies from Arab Muslim countries address do-not-resuscitate (DNR) practice. The knowledge of physicians about the existing policy and the attitude towards DNR were surveyed.The objective of this study is to identify the knowledge of the participants of the local DNR policy and barriers of addressing DNR including religious background.A questionnaire has been distributed to Emergency Room (ER) and Intensive Care Unit (ICU) physicians.A total of 112 physicians mostly Muslims (97.3%). About 108 (96.4%) were aware about the existence of DNR policy in our institute. 107 (95.5%) stated that DNR is not against Islamic. Only (13.4%) of the physicians have advance directives and (90.2%) answered they will request to be DNR if they have terminal illness. Lack of patients and families understanding (51.8%) and inadequate training (35.7%) were the two most important barriers for effective DNR discussion. Patients and families level of education (58.0%) and cultural factors (52.7%) were the main obstacles in initiating a DNR order.There is a lack of knowledge about DNR policy which makes the optimization of DNR process difficult. Most physicians wish DNR for themselves and their patients at the end of life, but only a few of them have advance directives. The most important barriers for initializing and discussing DNR were lack of patient understanding, level of education, and the culture of patients. Most of the Muslim physicians believe that DNR is not against Islamic rules. We suggest that the DNR concept should be a part of any training program.
Project description:BACKGROUND:In Islamic societies, issues related to sexual and reproductive health (SRH) are rarely discussed and considered sensitive subjects. This review aimed to identify any personal, religious, cultural, or structural barriers to SRH service and education among Muslim women worldwide. METHODS:A search for qualitative and quantitative studies was conducted on seven electronic databases. A narrative synthesis using thematic analysis was conducted. RESULTS:Fifty-nine studies were included from 22 countries: 19 qualitative, 38 quantitative and two mixed methods. Many Muslim women have poor SRH knowledge, and negative attitudes which influence their access to, and use of SRH services. Barriers to contraception use among Muslim women included a lack of basic reproductive knowledge, insufficient knowledge about contraception, misconceptions, and negative attitudes. Women had negative attitudes towards family planning for limiting the number of children but not for child spacing, which reflected religious views towards family planning. Religious and cultural beliefs were barriers to contraception use and access to SRH services and information. Family and the community have a significant impact on women's contraceptive use and access to SRH services. Husband and family opposition played a significant role in contraception access and use. Fear of stigmatization and being labelled as having pre-marital sexual relations among unmarried women acted as the main barrier to accessing contraception and seeking SRH information and services. CONCLUSION:The findings reveal that there are multiple levels of factors that influence Muslim women's SRH. Poor SRH knowledge and practices among Muslim women is complex matter that is affected by personal, community, cultural, religious factors and existing policies and regulations. All these factors overlap and are affected by each other. There is an urgent need for interventions addressing modifiable barriers to SRH education and services to improve knowledge, informed choice and access to services to facilitate better sexual and reproductive wellbeing for Muslim women. It is important to note that while this review aimed to report findings on Muslim women, we acknowledge that significant variations exist within every culture and religion.
Project description:Advance directives and end of life care are difficult discussions for both patients and health-care providers (HCPs). A HCP requires an accurate understanding of advanced directives to educate patients and their family members to allow them to make an appropriate decision. Misinterpretations of the do not resuscitate (DNR), do not intubate (DNI), and the Physicians Orders for Life-Sustaining Treatment (POLST) form result in ineffective communication and confusion between patients, family members, and HCPs.An anonymous, multiple choice online and paper survey was distributed to patients, family members of patients (PFMs), and HCPs from December 12, 2012 to March 6, 2013. Data regarding demographics, the accuracy of determining the correct definition of DNR and DNI, the familiarity of the POLST form and if a primary care physician had discussed advanced directives with the participants were collected.A total of 687 respondents participated in the survey. Patients and PFMs could not distinguish the definition of DNR (95% confidence interval [CI] [1.453-2.804]) or DNI (95% CI (1.216-2.334)) 52% of the time while HCPs 35% and 39% of the time (P < 0.0005). Regarding the POLST form, 86% of patients and PFMs and 50% of HCPs were not familiar with the POLST form. Sixty-nine percent of patients and family members reported that their primary care physician had not discussed advance directives with them. Twenty-four percent of patients and family members reported that they had previous health-care experience and this was associated with increased knowledge of the POLST form (P < 0.0005). An association was also seen between the type of HCP taking the survey and the ability to correctly identify the correct definition of DNR (P < 0.0005).Discussion of end of life care is difficult for patients and their family members. Often times multiple discussions are required in order to effectively communicate the definition of DNR, DNI, and the POLST form. Education of patients, family members, and HCPs is required to bridge the knowledge gap of advance directives.
Project description:INTRODUCTION:Turkey is constitutionally secular with a Muslim majority. There is no legal basis for limiting life-support at the end-of-life (EOL) in Turkey. We aimed to investigate the opinions and attitudes of intensive care unit (ICU) physicians regarding EOL decisions, for both their patients and themselves, and to evaluate if the physicians' demographic and professional variables predicted the attitudes of physicians toward EOL decisions. METHODS:An online survey was distributed to national critical care societies' members. Physicians' opinions were sought concerning legalization of EOL decisions for terminally ill patients or by patient-request regardless of prognosis. Participants physicians' views on who should make EOL decisions and when they should occur were determined. Participants were also asked if they would prefer cardiopulmonary resuscitation (CPR) and/or intubation/mechanical ventilation (MV) personally if they had terminal cancer. RESULTS:A total of 613 physicians responded. Religious beliefs had no effect on the physicians' acceptance of do-not-resuscitate (DNR) / do-not-intubate (DNI) orders for terminally ill patients, but atheism, was found to be an independent predictor of approval of DNR/DNI in cases of patient request (p<0.05). While medical experience (?6 years in the ICU) was the independent predictor for the physicians' approval of DNI decisions on patient demand, the volume of terminal patients in ICUs (between 10-50% per year) where they worked was an independent predictor of physicians' approval of DNI for terminal patients. When asked to choose personal options in an EOL scenario (including full code, only DNR, only DNI, both DNR and DNI, and undecided), younger physicians (30-39 years) were more likely to prefer the "only DNR" option compared with physicians aged 40-49 years (p<0.05) for themselves and age 30-39 was an independent predictor of individual preference for "only DNR" at the hypothetical EOL. Physicians from an ICU with <10% terminally ill patients were less likely to prefer "DNR" or "DNR and DNI" options for themselves at EOL compared with physicians who worked in ICUs with a higher (>50%) terminally ill patient ratio (p<0.05). CONCLUSION:Most ICU physicians did not want legalization of DNR and DNI orders, based solely on patient request. Even if EOL decision-making were legal in Turkey, this attitude may conflict with patient autonomy. The proportion of terminally ill patients in the ICU appears to affect physicians' attitudes to EOL decisions, both for their patients and by personal preference, an association which has not been previously reported.
Project description:How one defines death may vary. It is important for clinicians to recognize those aspects of a patient's religious beliefs that may directly influence medical care and how such practices may interface with local laws governing the determination of death. Debate continues about the validity and certainty of brain death criteria within Islamic traditions. A search of PubMed, Scopus, EMBASE, Web of Science, PsycNet, Sociological Abstracts, DIALOGUE ProQuest, Lexus Nexus, Google, and applicable religious texts was conducted to address the question of whether brain death is accepted as true death among Islamic scholars and clinicians and to discuss how divergent opinions may affect clinical care. The results of the literature review inform this discussion. Brain death has been acknowledged as representing true death by many Muslim scholars and medical organizations, including the Islamic Fiqh Academies of the Organization of the Islamic Conference and the Muslim World League, the Islamic Medical Association of North America, and other faith-based medical organizations as well as legal rulings by multiple Islamic nations. However, consensus in the Muslim world is not unanimous, and a sizable minority accepts death by cardiopulmonary criteria only.
Project description:To evaluate the impact of a 2008 Medicaid policy in Massachusetts (MA), regarding reimbursing physicians for providing fluoride varnish (FV) to eligible children in medical settings.Survey of a sample of primary care physicians in MA.Cross-sectional survey of a sample of physicians who provide care to MassHealth (MA Medicaid) enrolled-children.history of completed preventive dental skills training, and FV provision.oral health knowledge, FV-attitudes, and physician and practice characteristics.Overall, 19 percent of respondents had completed the training required to be eligible to bill for FV provision. Only 5 percent of physicians were providing FV. Most respondents (63 percent) were not familiar with the new policy, and only 25 percent felt that FV should be provided during well-child visits. Most physicians (60 percent) did not feel that the reimbursement rate of U.S.$26/application was sufficient; 17 percent said that they would not provide FV, regardless of payment. Most common barriers to FV provision were a lack of time and logistical challenges.Our findings suggest that simply reimbursing physicians for FV provision is insufficient to ensure provider participation. Success of this policy will likely require addressing several barriers identified.
Project description:The data presents an examination of Islamic ethical work behavior of Malay Muslim teachers in Brunei through religiosity and theory of planned behavior. The total number of participants was 370 Bruneian Malay Muslim teachers. The participants were sampled from two different types of school systems being non-religious schools and religious schools, with five schools each. By documenting information of the data, this data article presented the demographic characteristics of participants, and reliability and correlation of measures involved. Analyses of the data can provide insights into determinants and in predicting Islamic ethical work behavior. Furthermore, the data will be useful for researchers and policymakers that are interested in knowing the current situation of religiosity and behavior in the country. It can also be used as references in developing interventions, promoting and facilitating Islamic ethical work behavior in the workplace.
Project description:The rapid Arab-Islamic conquest during the early Middle Ages led to major political and cultural changes in the Mediterranean world. Although the early medieval Muslim presence in the Iberian Peninsula is now well documented, based in the evaluation of archeological and historical sources, the Muslim expansion in the area north of the Pyrenees has only been documented so far through textual sources or rare archaeological data. Our study provides the first archaeo-anthropological testimony of the Muslim establishment in South of France through the multidisciplinary analysis of three graves excavated at Nimes. First, we argue in favor of burials that followed Islamic rites and then note the presence of a community practicing Muslim traditions in Nimes. Second, the radiometric dates obtained from all three human skeletons (between the 7th and the 9th centuries AD) echo historical sources documenting an early Muslim presence in southern Gaul (i.e., the first half of 8th century AD). Finally, palaeogenomic analyses conducted on the human remains provide arguments in favor of a North African ancestry of the three individuals, at least considering the paternal lineages. Given all of these data, we propose that the skeletons from the Nimes burials belonged to Berbers integrated into the Umayyad army during the Arab expansion in North Africa. Our discovery not only discusses the first anthropological and genetic data concerning the Muslim occupation of the Visigothic territory of Septimania but also highlights the complexity of the relationship between the two communities during this period.
Project description:OBJECTIVE:The study aimed to explore the experience of male members of a rapidly grown community of Bangladeshi immigrants while accessing primary healthcare (PHC) services in Canada. DESIGN:A qualitative research was conducted among a sample of Bangladeshi immigrant men through a community-based participatory research approach. Focus group discussions were conducted to collect the qualitative data where thematic analysis was applied. SETTING:The focus group discussions were held in various community centres such as individual meeting rooms at public libraries, community halls and so on arranged in collaboration with community organisations while ensuring complete privacy. PARTICIPANT:Thirty-eight adults, Bangladeshi immigrant men, living in Calgary were selected for this study and participated in six different focus groups. The sample represents mostly married, educated, Muslim, Bangla speaking, aged over 25 years, full-time or self-employed and living in an urban centre in Canada >5 years. RESULT:The focus groups have highlighted long wait time as an important barrier. Long wait at the emergency room, difficulties to get access to general physicians when feeling sick, slow referral process and long wait at the clinic even after making an appointment impact their daily chores, work and access to care. Language is another important barrier that impedes effective communication between physicians and immigrant patients, thus the quality of care. Unfamiliarity with the healthcare system and lack of resources were also voiced that hinder access to healthcare for immigrant Bangladeshi men in Canada. However, no gender-specific barriers unique to men have been identified in this study. CONCLUSION:The barriers to accessing PHC services for Bangladeshi immigrant men are similar to that of other visible minority immigrants. It is important to recognise the extent of barriers across various immigrant groups to effectively shape public policy and improve access to PHC.
Project description:In order to minimize the possibility of unsuccessful dental extraction procedure due to dental anxiety, there are several approaches that can be used, including music intervention.The objective of this research was to investigate the effectiveness of classical and religious Islamic music on reducing dental anxiety.Two hundred and twenty-five muslim participants (105 males, 120 females) were recruited for this study and randomly assigned to three groups: classical music group, religious Islamic music group, and the group with no music intervention, equally in numbers. Participant's blood pressure (BP) and blood sample were taken prior to and after dental extraction to evaluate systolic and diastolic BP as well as nor-adrenaline plasma (NAP) level. All data were then analyzed by using t-test, ANOVA test, Mann-Whitney and Kruskawallis test.There was a decrease in NAP level in the religious music group (0.110 ng/mL) and the control group (0.013 ng/mL) when initial NAP level was compared to post extraction NAP level, whilst the classical music group showed an increase of 0.053 ng/mL. There were significant differences found between the religious Islamic music group and the classical music group (p = 0.041) as well as the control group (p = 0.028) for the difference between pre and post NAP level, of which the NAP level of the religious Islamic group participants were lower.Religious Islamic music was proven to be effective in reducing dental anxiety in Muslim participants compared to classical music. Despite, further evaluation in a more heterogenous population with various religious and cultural background is needed.
Project description:BACKGROUND:Over 1 million Canadians have class II or III obesity; however, access to weight-loss interventions for these patients remains limited. The purpose of our study was to identify the barriers to accessing medical and surgical weight-loss interventions from the perspectives of 3 groups: family physicians, patients who were referred for weight-loss intervention and patients who were not referred for weight-loss intervention. METHODS:Between November 2017 and May 2018, we conducted a qualitative exploratory research study using focus groups with family physicians and interviews with patients with class II or III obesity from 1 region in southern Ontario. We conducted a thematic analysis to identify emergent themes and used the barriers to change theory to classify the similarities and differences between the perspectives of family physicians, referred patients and nonreferred patients in first- and second-order barriers. RESULTS:Seventeen family physicians participated in 7 focus groups (1-4 participants/group), and we interviewed 8 referred patients and 7 nonreferred patients. We identified lack of resource supports, logistics and lack of knowledge about weight-loss interventions as first-order barriers to change, and lack of knowledge about root causes of obesity, lack of patient readiness for change and family physicians' perceptions about surgical weight loss as second-order barriers to change. Family physicians and patients had similar perceptions regarding lack of resource supports in the community, logistical issues, family physicians' lack of knowledge regarding weight-loss interventions, patients' lack of motivation and family physicians' perceptions of bariatric surgery as being high risk. They differed regarding the root cause of obesity, with family physicians attributing obesity to multiple extrinsic and intrinsic causes, whereas patients believed obesity was largely due to intrinsic causes alone. INTERPRETATION:It is important to address first- and second-order barriers to accessing weight-loss interventions through continuing professional development activities for family physicians to help ensure effective and timely treatment for patients with class II or III obesity and related comorbidities.