The use of politeness strategies by pharmacy students while obtaining information from patients during OSCES consultations

Introduction

Objective Structured Clinical Examinations (OSCEs) assess students’ application of clinical and communication skills, and can include discussing patient behaviours (e.g., diet, or medication adherence). Politeness Theory (PT) defines potentially sensitive elements of such interactions as Face Threatening Acts (FTAs) and proposes a framework of mitigating Politeness Strategies (PS). Accordingly, asking a behavioural question, e.g. ‘have you been taking your medicines?’, interferes both with the person’s face need to be autonomous and face need to be ‘liked’, by imposing a response and risk of judgement, respectively. Contrastingly, fact-finding questions (e.g. ‘what is your name?’) are arguably less face threatening because they don’t hinge on patient behaviours. Asking a question directly without attempting to minimize its impact on face needs is usually considered devoid of PS (labelled within PT as a ‘Bald on record’ approach), whereas for example hedging (e.g. using ‘perhaps’), showing deference (e.g. ‘please’) and being indirect (e.g. ‘would you happen to know’) involve PS. Not meeting patient face needs can create tension, cause distress and, in turn, decrease the effectiveness of an interaction. We hypothesised students would use PS more frequently when asking questions relating to patient behaviours (i.e. involving obvious FTAs) compared to standard non-behavioural questions, in order to maintain patient face.

Aim

To identify behavioural and non-behavioural questions asked by pharmacy students and any PS used within recorded OSCEs, and test differences between question types and use of PS.

Methods

This study employed PT to identify any conversational PS used by students. Following institutional ethical approval, a total of 19 OSCE video recordings of 10 students performing Healthy Living Assessments (HLA) and Responding to Symptoms (RTS) scenarios were transcribed using ELAN software ((Version 6.4). Student speech activities were coded as behavioural or non-behavioural questions. PS used by students were classified as absent (i.e. ‘Bald on record’) or using at least one PS. We looked for associations between categories of questions (behavioural or non-behavioural) and use of PS (absent or present) using the Chi-square test.

Results

In most cases, pharmacy students used the ‘Bald on record’ approach to obtain information; 63 % for behavioural questions, e.g. “what is your alcohol intake?” or “do you smoke cigarettes?”, and 60% for non-behavioural questions, e.g. “do you have any food or drug allergies?”. PS were also used, but with lower frequency; 37% for behavioural questions, e.g. by asking the patient’s permission politely “is it okay to ask you some questions about your lifestyle...?”, and 40% for non-behavioural questions, e.g. “may I ask you how old are you?”. The Chi-square test (χ 2=1.98, df=1, p=0.73) showed no significant relationship between the face threatening nature of a question and the use of PS.

Discussion/Conclusion

Pharmacy students asked behavioural questions similar to how they asked non-behavioural questions, and may be unaware that behavioural (vs. non-behavioural) questions are potentially more face threatening to patients. Enhancing pharmacy students’ awareness of patient face needs and PS is a novel approach, which could be explored further when teaching about consultations with its impact tested in future research.

References

1. Brown P, Levinson SC. Politeness: some universals in language usage. vol 4. Cambridge University Press; 1987.

2. Have P. Doing conversation analysis. 2nd ed. Introducing qualitative methods. Sage; 2007.

Denial attitude towards COVID-19 among general population in Saudi Arabia

Introduction

During the current crisis of COVID 19, recent studies evident that it has a huge impact on public mental health and individuals’ behavior.

Objectives

Our study aimed to estimate the prevalence of high denial attitude towards the emerging pandemic of COVID 19 among the general population of Saudi Arabia.

Methods

A cross-sectional online survey was conducted from April 3, 2020 to May 5, 2020. All participants (N= 1817) were asked to complete an online questionnaire survey that included socio-demographic and other variables, and Denial Attitude Questionnaire towards COVID-19 pandemic (DAQ-COVID-19).

Results

High denial attitude was prevalent among 728 (40.1 %) of the participants. It was associated with old age, being married, having low educational level, working in a non-medical professions, do not have a past history of infectious diseases, spending less than one hour following COVID-19 news, satisfied with the government procedures for COVID-19, and highly depressed and anxious respondents, where p-values were 0.001, 0.019, <0.001, 0.027, <0.001, <0.001, 0.004, 0.008, and 0.026; respectively.

Conclusions

About two out of five participants had high denial attitude. To our knowledge, the current study is the first study that tries to evaluate a high denial attitude during the initial COVID 19 outbreaks, especially in Saudi Arabia. However, further exploration in this field is needed. We suggest conducting such a study at the end of the current pandemic or in the second wave of the outbreak

Screening for Middle East respiratory syndrome coronavirus infection in hospital patients and their healthcare worker and family contacts: a prospective descriptive study

The Saudi Arabian Ministry of Health implemented a pro-active surveillance programme for Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV). We report MERS-CoV data from 5065 Kingdom of Saudi Arabia individuals who were screened for MERS-CoV over a 12-month period. From 1 October 2012 to 30 September 2013, demographic and clinical data were prospectively collected from all laboratory forms received at the Saudi Arabian Virology reference laboratory. Data were analysed by referral type, age, gender, and MERS-CoV real-time PCR test results. Five thousand and 65 individuals were screened for MER-CoV: hospitalized patients with suspected MERS-CoV infection (n = 2908, 57.4%), healthcare worker (HCW) contacts (n = 1695; 33.5%), and family contacts of laboratory-confirmed MERS cases (n = 462; 9.1%). Eleven per cent of persons tested were children (<17 years of age). There were 108 cases (99 adults and nine children) of MERS-CoV infection detected during the 12-month period (108/5065, 2% case detection rate). Of 108 cases, 45 were females (six children and 39 adults) and 63 were males (three children and 60 adults). Of the 99 adults with MERS-CoV infection, 70 were hospitalized patients, 19 were HCW contacts, and ten were family contacts. There were no significant increases in MERS-CoV detection rates over the 12-month period: 2.6% (19/731) in July 2013, 1.7% (19/1100) in August 2013, and 1.69% (21/1238) in September 2013. Male patients had a significantly higher MERS-CoV infection rate (63/2318, 2.7%) than females (45/2747, 1.6%) (p 0.013). MERS-CoV rates remain at low levels, with no significant increase over time. Pro-active surveillance for MERS-CoV in newly diagnosed patients and their contacts will continue.

Bacillus Calmette-Guerin lymphadenitis: a 6-year experience in two Saudi hospitals

BACKGROUND

The World Health Organization (WHO) has recommended Bacillus Calmette-Guerin (BCG) vaccination as a part of the global expanded program for immunization. Although the BCG vaccine is usually a safe vaccine, a number of complications with lymphadenitis being the most common complication, can occur.

AIM

We evaluated the frequency, the clinical presentation and treatment modalities of lymphadenitis after BCG vaccine in Saudi children.

RESULTS

A total of 145 patients with BCG lymphadenitis presented between January 2005 and December 2010. In the majority (103) of the cases, the lymphadenitis involved ipsilateral left axillary nodes. Other sites of involvement included the left supraclavicular lymph nodes in 26 (18%) patients, and both the left axillary and supraclavicular lymph nodes were involved in 7 cases (4.8%). A total of 75 patients (65%) were given antituberculous medication. Eight (27%) patients had positive acid-fast bacilli and positive cultures for Mycobacterium bovis.

CONCLUSION

In light of the findings of this study, it would be advisable to administer the BCG vaccine in Saudi Arabia at a time later than at birth, as the younger children are commonly affected.

Importance of screening household members of acute brucellosis cases in endemic areas

Isolated reports of brucellosis among family members have been documented. The aim of this study is to determine if active serological screening of the households' members of acute brucellosis cases will detect additional unrecognized cases. From May 2000 to October 2001, patients with acute brucellosis were enrolled and their household members were serologically screened for brucellosis using the Standard Agglutination Test (SAT). Fifty-five index cases with acute brucellosis and 404 household members were enrolled. The majority of index cases (48%) were young adults, and 79% were illiterate. Ownership of animals and ingestion of unpasteurized raw milk were reported by 45 and 75% of the index cases respectively. Of the 55 families screened, 23 (42%) had two family members or more with serological evidence of brucellosis and 32 (58%) had only the index case. Households of > or = 5 members and a history of raw-milk ingestion by family members were risk factors associated with the seropositives (P < 0.05). Of the 404 household members screened, 53 (13%) were seropositive; of these 39 (74%) were symptomatic, and 9 (35%) had brucella bacteraemia. Symptomatic seropositives tended to have bacteraemia and higher brucella antibody titres compared to asymptomatic seropositives (P < or = 0.05). Screening family members of an index case of acute brucellosis will detect additional cases.