Hamdan Bin Mohammed College of Dental Medicine (HBMCDM)

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Does Hospital Teaching Status Affect the Outcomes of Patients Undergoing Anterior Cervical Discectomy and Fusion?
(2020) Akhras, Aya
Background: Teaching hospitals are responsible for the training and education of residents and have been centers of research and advancement in an era of evidence-based medicine. Several studies have reported conflicting findings regarding the effects of teaching status on the outcomes of patients. In the present study, we aimed to identify the differences in surgical outcomes among patients who had undergone anterior cervical discectomy and fusion (ACDF) between teaching and nonteaching hospitals. Methods: We queried the National Inpatient Sample for 2012e2015. We identified patients with cervical degenerative disease who had undergone single-level ACDF using the International Classification of Disease, 9th revision, diagnosis and procedure codes. One-to-one propensity score matching was conducted, using appropriate and clinically relevant variables. Stepwise multivariable logistic regression was performed to assess the effect of teaching status on the outcomes of interest. Finally, a marginal effect analysis was conducted to compare the differences in admission costs stratified by teaching status within each insurance type. Results: A total of 52,212 patients who had undergone elective ACDF from 2012 to 2015 were identified and matched, with 26,106 patients in each group. On multivariable regression, after adjusting for demographics and hospital characteristics, teaching hospitals were associated with greater odds of nonroutine discharge (odds ratio, 1.25; P < 0.001) and higher admission cost (coefficient, 414.31; P [ 0.002). However, teaching status was not associated with inpatient mortality or morbidity. The marginal effect analysis results indicated that privately insured patients incurred greater costs in nonteaching hospitals. Conclusion: Our results have shown that patients undergoing ACDF at nonteaching hospitals had a greater odds of routine discharge and higher admission costs compared with those at teaching hospitals but similar outcomes in terms of inpatient mortality and morbidity.
Investigating the Relationship Between Resilience, Stress-Coping Strategies, and Learning Approaches to Predict Academic Performance in Undergraduate Medical Students: Protocol for a Proof-of-Concept Study
(2019) Alsheikh-Ali, Alawi; Akhras, Aya; Hassan Khamis, Amar; ; Davis, David A
Background: The evolution of an undergraduate medical student into an adept physician is perpetual, demanding, and stressful. Several studies have indicated medical students have a higher predominance of mental health problems than other student groups of the same age, where medical education acts as a stressor and may lead to unfavorable consequences such as depression, burnout, somatic complaints, decrease in empathy, dismal thoughts about quitting medical school, self harm and suicidal ideation, and poor academic performance. It is imperative to determine the association between important psychoeducational variables and academic performance in the context of medical education to comprehend the response to academic stress. Objective: The aim of this proof-of-concept study is to determine the relationship between resilience, learning approaches, and stress-coping strategies and how they can collectively predict achievement in undergraduate medical students. The following research questions will be addressed: What is the correlation between the psychoeducational variables resilience, learning approaches, and stress-coping strategies? Can academic performance of undergraduate medical students be predicted through the construction of linear relationships between defined variables employing the principles of empirical modeling? Methods: Study population will consist of 234 students registered for the MBBS (Bachelor of Medicine, Bachelor of Surgery) at Mohammed Bin Rashid University of Medicine and Health Sciences distributed over 4 cohorts. Newly registered MBBS students will be excluded from the study. Various psychoeducational variables will be assessed using prevalidated questionnaires. For learning approaches assessment, the Approaches and Study Skills Inventory for Students questionnaire will be employed. Resilience and stress-coping strategies will be evaluated using the Wagnild-Young resilience scale and a coping strategies scale derived from Holahan and Moos’s Coping Strategies Scale, respectively. Independent variables (resilience, stress-coping strategies, and learning approaches) will be calculated. Scores will be tested for normality by using the Shapiro-Wilk test. An interitem correlational matrix of the dependent and independent variables to test pairwise correlation will be formed using Pearson bivariate correlation coefficients. Regression models will be used to answer our questions with type II analyses of variance in tests involving multiple predictors. Regression analyses will be checked for homogeneity of variance (Levine test) and normality of residuals and multicollinearity (variance inflation factor). Statistical significance will be set at 5% (alpha=.05). Effect sizes will be estimated with 95% CIs. Results: Psychoeducational instruments in the form of validated questionnaire have been identified in relation to the objectives. These questionnaires have been formatted for integration into Google forms such that they can be electronically distributed to the consenting participants. We submitted the proposal to MBRU institutional review board (IRB) for which exemption has been awarded (application ID: MBRU-IRB-2019-013). There is no funding in place for this study and no anticipated start date. Total duration of the proposed research is 12 months.

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