Browsing by Author "Benamer, Hani TS"

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Clinical learning environments across two different healthcare settings using the undergraduate clinical education environment measure
(2023) Benamer, Hani TS; Alsuwaidi, Laila; Khan, Nusrat; Lakshmanan, Jeyaseelan; Ho, Samuel B.; Kellett, Catherine; Alsheikh-Ali, Alawi; Stanley, Adrian G
Background: The clinical placements of our medical students are almost equally distributed across private and public sectors. This study aims to assess medical students’ perceptions of their Clinical learning Environment (CLE) across these two different healthcare settings, using the Undergraduate Clinical Education Environment Measure (UCEEM). Methods: 76 undergraduate medical students (Year 5 and 6), were invited to participate. Data were collected using an online UCEEM with additional questions related to demographics and case load exposure. The UCEEM consists of two overarching domains of experiential learning and social participation, with four subdomains of learning opportunities, preparedness, workplace interaction, and inclusion. Results: 38 questionnaires were received. Of 225 responses to the individual UCEEM items, 51 (22.6%) scored a mean of ≥4 (range 4-4.5, representing strong areas), 31 (13.7%) scored a mean of ≤3 (range 2.1-3, needing attention) and 143 (63.6%) scored a mean of 3.1–3.9 (areas that could be improved). The majority (63%) of the case load exposure responses scored a mean of ≥4 (range 4-4.5). Compared to the private sittings, there is a significant reduction in total UCEEM (p=0.008), preparedness for student entry (p=0.003), and overarching dimension of social participation (p=0.000) scores for the public sector. Similarly, both workplace interaction patterns and student inclusion and equal treatment scored significantly lower for the public sector (p=0.000 and p=0.011 respectively). Two out of three case load exposure items scored significantly higher for the public sector (p=0.000). Discussion: The students’ CLE perceptions were generally positive. The lower UCEEM ratings in the public sector items were related to student entry preparedness, workplace interactions, student inclusiveness and workforce equity of treatment. In contrast the students were exposed to more variety and larger number of patients in the public sector. These differences indicated some significantly different learning environments between the two sectors.
First Two-Year Observational Exploratory Real Life Clinical Phenotyping, and Societal Impact Study of Parkinson's Disease in Emiratis and Expatriate Population of United Arab Emirates 2019–2021: The EmPark Study
(2022-08) Loney, Tom; Benamer, Hani TS
Background: Phenotypic differences in Parkinson’s Disease (PD) among locals (Emiratis) and Expatriates (Expats) living in United Arab Emirates have not been described and could be important to unravel local aspects of clinical heterogenicity of PD pointing towards genetic and epigenetic variations. Objective: To investigate the range and nature of motor and nonmotor clinical presentations of PD and its impact on time to diagnosis, local service provisions, and quality of life in Emiratis and Expats in UAE, as well as address the presence of current unmet needs on relation to care and etiopathogenesis of PD related to possible genetic and epigenetic factors. Methods: a cross-sectional one point in time prospective, observational real-life study of 171 patients recruited from PD and Neurology clinics across United Arab Emirates from 2019–2021. Primary outcomes were sociodemographic data, motor and nonmotor symptoms (NMS), including cognition and sleep, and quality of life (QOL) assessments, Results: A total of 171 PD patients (52 Emiratis 119 Expats) were included with mean age (Emiratis 48.5 (13.1) Expats 64.15 (13.1)) and mean disease duration (Emiratis 4.8 (3.2) Expats 6.1 (2.9)). In the Emiratis, there was a significant mean delay in initiating treatment after diagnosis (Emiratis 1.2 (0.9) Expats 1.6 (1.1)), while from a clinical phenotyping aspect, there is a high percentage of akinesia 25 (48.1) or tremor dominant (22 (42.3)) phenotypes as opposed to mixed subtype 67 (56.3) in Expat cohorts; double tremor dominant, especially Emirati females (25%), had a predominant lower limb onset PD. Both Emirati (27.9 (24.0)) and Expat 29.4 (15.6) showed moderate NMS burden and the NMS profile is dominated by Sleep, Fatigue, Mood, Emotional well-being 3.0 (1.1) and Social Stigma 3.5 (0.9) aspects of PDQ8 SI measurements are predicted worse QOL in Emiratis, while lack of social support 2.3 (1.3) impaired QOL in Expat population. Awareness for advanced therapies was low and only 25% of Emiratis were aware of deep brain surgery (DBS), compared to 69% Expats. Only 2% of Emiratis, compared to 32% of Expats, heard of Apomorphine infusion (CSAI), and no (0%) Emiratis were aware of intrajejunal levodopa infusion (IJLI), compared to 13% of expats. Conclusion: Our pilot data suggest clinical phenotypic differences in presentation of PD in Emiratis population of UAE compared to expats. Worryingly, the data also show delayed treatment initiation, as well as widespread lack of knowledge of advanced therapies in the Emirati population.
Hiccups, Hypersalivation, Hallucinations in Parkinson’s Disease: New Insights, Mechanisms, Pathophysiology, and Management
(2023) Benamer, Hani TS
Abstract: Parkinson’s disease (PD) is a chronic, progressive neurological disorder and the second most common neurodegenerative condition. We report three common but overlooked symptoms in PD—hiccups, hypersalivation, and hallucinations—in terms of their prevalence, pathophysiology, and up-to-date evidence-based treatment strategies. Whilst all these three symptoms do occur in many other neurological and non-neurological conditions, early recognition and treatment are paramount. Whilst hiccups affect 3% of healthy people, their rate of occurrence is higher (20%) in patients with PD. Hypersalivation (Sialorrhea) is another common neurological manifestation of many neurological and other neurodegenerative conditions such as motor neuron disease (MND), with a median prevalence rate of 56% (range: 32–74%). A 42% prevalence of sialorrhea is also reported in sub-optimally treated patients with PD. Hallucinations, especially visual hallucinations, are commonly reported, with a prevalence of 32–63% in PD, and a 55–78% prevalence is noted in patients with dementia with Lewy bodies (DLB), followed by tactile hallucinations, which are indicated by a sensation of crawling bugs or imaginary creatures across the skin surface. Whilst mainstay and primary management strategies for all these three symptoms are carried out through history taking, it is also essential to identify and treat possible potential triggers such as infection, minimise or avoid causative (such as drug-induced) factors, and especially carry out patient education before considering more definitive treatment strategies, such as botulinum toxin therapies for hypersalivation, to improve the quality of life of patients. This original review paper aims to provide a comprehensive overview of the disease mechanisms, pathophysiology, and management of hiccups, hypersalivation, and hallucinations in Parkinson’s disease.
The relationship of online pre-recorded neurology mini-lectures to medical student assessment: a pilot study
(2023) Benamer, Hani TS; Stanley, Adrian G
Introduction: eLearning has become an essential part of medical education. However, there is a lack of published research on student engagement with online pre-recorded mini-lectures and its relation to assessment. The aim of this pilot study is to explore the relationship between newly introduced neurology pre-recorded mini-lectures and undergraduate medical students engagement and assessment. This may encourage the wider use of mini-lectures in undergraduate medical curricula. Methods: The engagement of medical students with 48 online pre-recorded neurology mini-lectures was assessed through a Learning Management System. To measure engagement, data was stratified according to the number of watched/downloaded mini-lectures. A point system was used (out of 5): −1 point=watching/downloading 0–10 mini-lectures, 2 points=watching/downloading 11–20 mini-lectures, 3 points=watching/downloading 21–30 minilectures, 4 points=watching/downloading 31–40 mini-lectures and, 5 points=watching/downloading 41–48 minilectures. The students’ engagement was correlated with their neurology assessments [Objective Structured Clinical Examination (OSCE), and knowledge-based assessment 10 Multiple Choice Questions (MCQs) and one 10-mark Short Answer Question, (SAQ)], internal medicine grade and annual grade point average (GPA) using the Pearson correlation coefficient. Results: The mean engagement of 34, Year 5, medical students is 3.9/5. There is a significant positive correlation between engagement and internal medicine grade (r=0.35, p=0.044). There is a moderate correlation between engagement and neurology OSCE (r=0.23), annual Year 5 GPA (r=0.23), neurology knowledge-based score (r=0.22) and composite neurology knowledge/OSCE (r=0.27). The knowledge-based assessment included SAQ and MCQs: there was a moderate correlation with SAQ (r=0.30), but a weak negative correlation with the MCQs (r =-0.11). Subgroups analysis comparing the top- and low- or non- engaging students made these weaker correlations stronger. Conclusion: This pilot study indicates a high rate of engagement with an online pre-recorded mini-lectures resource and evidence of moderate correlation between engagement and assessment. Online pre-recorded mini-lectures should be used more in delivering the curriculum contents of the clinical clerkships. Further studies are needed to evaluate the relation and the impact of the mini-lectures on assessment.