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Problems in Physician-Patient Communication: What do our Students See and Hear? A Qualitative Study with a Pragmatic Approach 医患沟通中的问题:我们的学生看到和听到了什么?用语用方法进行质的研究
IF 0.4 Pub Date : 2022-08-04 DOI: 10.21649/akemu.v28i2.5097
Ayesha Younas, R. Khan, Rahila Yasmeen, U. Mahboob, A. Ansar
Background: Efficient communication with patients is an indispensable necessity for physicians of the 21 century. Over the past decades, much work has been done nationally and internationally to instill this essential skill in undergraduate students and medical graduates are now formally trained to become better communicators. However, deficiencies persist and medical students of today still observe various issues when they observe physician- patient communication interactions in their training. Objective: To understand perceptions of undergraduate medical students about the difficulties in Physician-Patient communication (PPC) & take suggestions on how to overcome them. Methods: A qualitative study design was employed, with data collection through three focus group discussions with medical students studying in Wah medical college, Pakistan in October 2019. Thematic data analysis was done using Atlas-ti 8 software. A pragmatic approach was used to understand student perceptions about difficulties in PPC. Conclusion: The various issues regarding the problems in physician patient communication portray a realistic picture of our current communication practices. Various factors have been identified in this study and, the most practical solution to these problems lies in the effective teaching of behavioral sciences.
背景:对21世纪的医生来说,与患者进行有效的沟通是必不可少的。在过去的几十年里,国内外已经做了很多工作,向本科生灌输这一基本技能,现在医学毕业生正在接受正式培训,成为更好的沟通者。然而,缺陷仍然存在,今天的医学生在他们的培训中观察医患沟通互动时仍然观察到各种问题。目的:了解医学生对医患沟通困难的看法,并提出解决医患沟通困难的建议。方法:采用定性研究设计,于2019年10月对巴基斯坦华医学院的医学生进行三次焦点小组讨论,收集数据。采用Atlas-ti - 8软件进行专题数据分析。采用务实的方法来了解学生对PPC困难的看法。结论:关于医患沟通问题的各种问题描绘了我们当前沟通实践的现实图景。在本研究中发现了各种各样的因素,而解决这些问题的最实际的办法在于有效的行为科学教学。
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引用次数: 0
Prevalence of ST-Segment Elevation Myocardial Infarction (STEMI) in Pakistan and the Role of Primary Percutaneous Coronary Intervention (PPCI) 巴基斯坦st段抬高型心肌梗死(STEMI)患病率及首次经皮冠状动脉介入治疗(PPCI)的作用
IF 0.4 Pub Date : 2022-08-04 DOI: 10.21649/akemu.v28i2.5119
Shahzaib Ahmad, Anum Sohail, Muhammad Abubakar Shahid Chishti, T. Azeem
There are various strategies used for treating ST-segment elevated myocardial infarction (STEMI). Among those approaches, Primary percutaneous coronary intervention (PPCI) is the current treatment of choice for STEMI as it reperfuses the ischaemic cardiac tissue with fewer reported adverse events and a better survival rate. Although thrombolytic therapy is still used for STEMI in approximation, the benefits of PPCI outweigh thrombolytic therapy as thrombolytic therapy is associated with higher bleeding events and higher morbidity. The barriers in implementing a PPCI program and regional differences arise due to limited technologies, lack of proper training of first responders, lack of public awareness, and transport facilities and finances. Therefore, treatment varies between different regions of countries and even between different countries, including Pakistan. PPCI should be used in a timely manner as delayed use of this intervention can significantly reduce the benefits. We lack a coordinated approach to the delivery of this system in Pakistan; mainly, the paramedical staff is not fully familiarised and trained for making a definite diagnosis and lacks referral portals. We need a comprehensive approach and program to identify factors that cause a delay in providing PPCI to STEMI patients and to eliminate the factors responsible for the delay. This will help in improving the survival rate morbidity in STEMI patients.
治疗st段抬高型心肌梗死(STEMI)有多种策略。在这些方法中,原发性经皮冠状动脉介入治疗(PPCI)是目前STEMI的首选治疗方法,因为它可以对缺血的心脏组织进行再灌注,报道的不良事件较少,生存率更高。尽管目前STEMI仍近似采用溶栓治疗,但PPCI的益处大于溶栓治疗,因为溶栓治疗与更高的出血事件和更高的发病率相关。实施PPCI计划的障碍和地区差异是由于技术有限、缺乏对急救人员的适当培训、缺乏公众意识以及交通设施和资金。因此,各国不同地区,甚至包括巴基斯坦在内的不同国家之间的待遇也不尽相同。PPCI应及时使用,因为延迟使用该干预措施会显著降低获益。我们缺乏在巴基斯坦提供这一系统的协调方法;主要是,辅助医务人员没有完全熟悉并接受过作出明确诊断的培训,也缺乏转诊门户。我们需要一个综合的方法和计划来确定导致向STEMI患者提供PPCI延迟的因素,并消除导致延迟的因素。这将有助于提高STEMI患者的生存率和发病率。
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引用次数: 0
Type 2 Diabetes Mellitus(T2DM) in Pakistan: Prevalence, Trends and Management Strategies 巴基斯坦2型糖尿病(T2DM):患病率、趋势和管理策略
IF 0.4 Pub Date : 2022-08-04 DOI: 10.21649/akemu.v28i2.5117
Ramisha Aslam, Sam K Suhail, Rabeea Sajid, Bilal Bin Younis
The rising incidence of diabetes has become one of the major health problems worldwide. It is especially overburdening low-income countries like Pakistan which ranks 4th in diabetes prevalence. The purpose of this review article is to analyze the current approach to diabetes management in Pakistan and to highlight its deficiencies. It also discusses the future strategies that can help Pakistan to reduce the rising disease burden. Information was collected from the publications which were searched on 'Google scholar' and 'PubMed'. The latest data provided by IDF has shown diabetes prevalence in Pakistan to be 17.1% in 2019; 148% higher than previous reporting. The major obstacles in the effective management of diabetes are lack of resources, societal barriers and patient related issues. In order to reduce the load of diabetes, combined efforts of government, health care professionals and patients are required. In future, diabetes education of the patients as well as HealthCare providers, use of telemedicine for the management of chronic diseases and concept of precision medicine can be applied to decrease diabetes burden in Pakistan.
糖尿病发病率的上升已成为世界范围内的主要健康问题之一。尤其是像巴基斯坦这样的低收入国家,它的糖尿病患病率排名第四。这篇综述文章的目的是分析目前巴基斯坦糖尿病管理的方法,并强调其不足之处。报告还讨论了能够帮助巴基斯坦减轻日益增加的疾病负担的未来战略。信息收集自在“b谷歌scholar”和“PubMed”上搜索的出版物。IDF提供的最新数据显示,2019年巴基斯坦的糖尿病患病率为17.1%;比之前的报告高出148%。有效管理糖尿病的主要障碍是缺乏资源、社会障碍和患者相关问题。为了减轻糖尿病的负担,需要政府、卫生保健专业人员和患者的共同努力。今后,可以通过对患者和医疗保健提供者进行糖尿病教育、使用远程医疗管理慢性病和精准医疗概念来减少巴基斯坦的糖尿病负担。
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引用次数: 0
Intranasal Dexmedetomidine as Sedative for Non-Invasive Pediatric Diagnostic Procedures Outside Operating Room 右美托咪定鼻内作为非侵入性儿科手术诊断程序的镇静剂
IF 0.4 Pub Date : 2022-08-04 DOI: 10.21649/akemu.v28i2.5083
A. Akhtar, M. Ijaz, Adeel Bashir, A. Khan
Background: Children often require sedation for long non-invasive diagnostic procedures. Dexmedetomidine is a highly selective alpha 2-adrenoceptor agonist with sedative, anxiolytic and analgesic properties. It mimics natural sleep and allows patients to easily arouse with minimal effects on respiration and airway patency. Objective: To assess the successful completion of pediatric non-invasive diagnostic procedures with intranasal dexmedetomidine as a sedative agent. Methods: Seventy-nine subjects of age six months to twelve years scheduled for non-invasive diagnostic procedures were included. Dexmedetomidine (4 mcg/kg) was administered intranasally 25 minutes before the scheduled time of procedure. A sedation score of two or above as per the MICHIGAN sedation scale was considered satisfactory for starting the procedure. Results: Seventy-four (95%) out of the seventy-nine subjects were successfully sedated with Intranasal dexmedetomidine (p
背景:儿童在长时间的非侵入性诊断过程中经常需要镇静。右美托咪定是一种高选择性α 2-肾上腺素能受体激动剂,具有镇静、抗焦虑和镇痛作用。它模仿自然睡眠,使患者很容易醒来,对呼吸和气道通畅的影响最小。目的:评估以右美托咪定为鼻内镇静剂的儿童无创诊断程序的成功完成情况。方法:纳入79名年龄在6个月至12岁的受试者,计划进行非侵入性诊断程序。右美托咪定(4微克/千克)在预定手术时间前25分钟经鼻给药。根据密歇根镇静量表,镇静评分达到2分或以上被认为是令人满意的开始手术。结果:79名受试者中有74名(95%)成功使用鼻内右美托咪定镇静(p
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引用次数: 0
The Sehat Ghar: An Innovation to Improve Primary Healthcare in Rural Punjab Sehat Ghar:改进旁遮普农村初级保健的创新
IF 0.4 Pub Date : 2022-08-04 DOI: 10.21649/akemu.v28i2.5123
M. A. Bhatti, Muhammad Asad Azhar, Zohaib Hassan, Muhammad Ammar Agha, Syed Fahad Qadir Bukhari, Wajdan Aftab
An effective healthcare sector essentially relies on a strong primary healthcare system. The primary healthcare system governs all major aspects of preventive healthcare and family planning services including immunization, hygiene, communicable disease prevention, sanitation, etc. In addition to this, a major bottleneck limiting the quality of healthcare at secondary and tertiary health facilities is the very high patient footfall that these hospitals. The primary healthcare facilities are designed to be the first tier of facility that a patient falls onto, and hence is either treated there or referred to higher level facilities by screening and limiting patient flow to next levels. Supporting this tier hence helps reduce burden on secondary and tertiary facilities of patients that could have been treated at primary facilities and hence exponentially improve the quality of health services in these lager hospitals. The document discusses some of the major issues faced by the primary healthcare sector in Punjab. These issues were studied and analyzed in detail at South Punjab Health Department, which is an arm of the provincial health department governing 11 districts of Southern Punjab – districts where socio-economic conditions are generally much poorer than the rest of Punjab. This document discusses the initiative of Sehat Ghar, its model, potential to ensure basic health services delivery to the local population and its direct & indirect contribution to tackle major issues of primary healthcare in Punjab.
一个有效的卫生保健部门基本上依赖于一个强大的初级卫生保健系统。初级保健系统管理预防保健和计划生育服务的所有主要方面,包括免疫、卫生、传染病预防、环境卫生等。除此之外,限制二级和三级保健设施保健质量的一个主要瓶颈是这些医院的病人人数非常高。初级卫生保健设施被设计为患者就诊的第一层设施,因此要么在那里接受治疗,要么通过筛查和限制患者流向下一层而转到更高级别的设施。因此,支持这一层次有助于减轻本来可以在初级设施治疗的病人对二级和三级设施的负担,从而大大提高这些大医院的保健服务质量。该文件讨论了旁遮普省初级保健部门面临的一些主要问题。南旁遮普省卫生厅对这些问题进行了详细的研究和分析,该卫生厅是省卫生厅的一个分支机构,负责管理旁遮普省南部的11个地区,这些地区的社会经济条件通常比旁遮普省其他地区差得多。本文件讨论了Sehat Ghar倡议、其模式、确保向当地人口提供基本保健服务的潜力及其对解决旁遮普初级保健主要问题的直接和间接贡献。
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引用次数: 0
Solving problems in Blood transfusion with efficient technology 用高效的技术解决输血中的问题
IF 0.4 Pub Date : 2022-08-04 DOI: 10.21649/akemu.v28i2.5115
Bushra Khalid, Dure Najaf, Bisma Tahir, Abdul Bari Khan
Blood transfusion is a life-sustaining procedure. But there are several hurdles in safe blood administration which can cause transfusion transmitted infections (TTI) and acute transfusion reactions and even death. Besides, human errors anywhere in the transfusion chain add fuel to the fire. Blood borne Infections like Hepatitis B and Hepatitis C are highly prevalent in Pakistan affecting about 7.4% of the general population. Among acute transfusion reactions, Febrile nonhemolytic reaction and the allergic reaction are the most common. Moreover, a variety of human errors and near-miss events in transfusion have been reported in the past. Technology has played an important contribution in upgrading the quality of life and healthcare. The main goal of this review is to point out the problems in blood transfusion and to hint at possible solutions with the use of Technology. In addition to following the WHO strategies for safe blood transfusion, blood safety can be ensured by incorporating haemovigilance systems, pathogen reduction technologies and certain approaches to reduce the risk of bacterial contamination. Human errors can be halted via a Management Information System called “Blood Bank Management Information System (BBMIS)” which can recognize and arrest such errors simultaneously.
输血是维持生命的手段。但是在安全血液管理方面存在一些障碍,这些障碍可能导致输血传播感染(TTI)和急性输血反应,甚至死亡。此外,输血链中任何地方的人为错误都是火上浇油。乙型肝炎和丙型肝炎等血源性感染在巴基斯坦非常普遍,约占总人口的7.4%。在急性输血反应中,以发热性非溶血性反应和过敏反应最为常见。此外,过去曾报道过各种人为失误和输血未遂事件。技术在提高生活质量和医疗保健方面发挥了重要作用。本文的主要目的是指出输血中存在的问题,并提示可能的解决方法。除了遵循世卫组织安全输血战略外,还可以通过纳入血液警戒系统、减少病原体技术和某些减少细菌污染风险的方法来确保血液安全。通过一个叫做“血库管理信息系统(BBMIS)”的管理信息系统,可以同时识别和制止人为错误。
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引用次数: 0
A Case Report of Fibrolamellar Hepatocellular Carcinoma in a Young Adult 青壮年纤维层状肝细胞癌1例报告
IF 0.4 Pub Date : 2022-08-04 DOI: 10.21649/akemu.v28i2.5095
M. Atiq, M. Haroon, Muhammad Imran Khan, A. Ammar, Wardah Khalid, F. Hanif
Among the four histopathological variants of hepatocellular carcinoma, Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare variant of hepatocellular carcinoma (HCC). It occurs in less than 1 % cases of hepatocellular carcinoma with distinct features as compared to classical HCC. It differs from typical HCC in terms of epidemiology, etiology, clinical presentation and prognosis. In this case report we are going to present a case of fibrolamellar variety of HCC in a 20-year young male with no history of previous liver disease and no characteristics features on Computed Tomography (CT) scan when compared with typical HCC. After discussing in multidisciplinary meeting, he underwent non anatomical liver resection which remained uneventful. Histopathology of the biopsy sample revealed FLHCC. No neoadjuvant therapy was given. Patient was kept on 1 year follow-up and no recurrence or metastasis occurred.
在肝细胞癌的四种组织病理学变异中,纤维层状肝细胞癌(FLHCC)是一种罕见的肝细胞癌(HCC)变异。它发生在少于1%的肝细胞癌病例中,与经典HCC相比具有明显的特征。它在流行病学、病因学、临床表现和预后方面与典型HCC不同。在本病例报告中,我们将报告一例20岁年轻男性的纤维板层型HCC,与典型HCC相比,他没有既往肝脏疾病史,计算机断层扫描(CT)扫描没有特征。在多学科会议上讨论后,他接受了非解剖性肝切除术,手术顺利。活检样本的组织病理学显示为FLHCC。未给予新辅助治疗。患者随访1年,未发生复发和转移。
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引用次数: 0
Digital Health and Future of Healthcare in Pakistan 巴基斯坦的数字健康和医疗保健的未来
IF 0.4 Pub Date : 2022-08-04 DOI: 10.21649/akemu.v28i2.5120
Wara Naeem, H. A. Nadeem, Ayesha Javed, Waqas Ahmed
In today's fast paced world, the use of Information Technology (IT) in dispensing quality healthcare forms a cornerstone for the development of any health system. While the standard of Medical Education and training is quickly gaining impetus within Pakistan, we are severely lacking in use of digital platforms and electronic records to aid the process of healthcare delivery. There's no dearth of talent in Pakistan; in the field of Medicine or IT. However, there is a considerable lack in the understanding of how IT can revolutionize healthcare delivery. We see that there is an urgent need for the governmental institutions and the private sector medical institutions to recognize the importance of digital health in making medical practice more effective, efficient and error proof; so that Pakistan can shake off the burden of a centuries old and obsolete system of healthcare delivery. Here, we propose our roadmap vision for development of digital health systems in Pakistan and propose basic initiatives that must be taken at the grass roots level to expedite this process.
在当今快节奏的世界中,信息技术(IT)在分配高质量医疗保健方面的使用构成了任何卫生系统发展的基石。虽然巴基斯坦的医学教育和培训标准正在迅速提高,但我们严重缺乏使用数字平台和电子记录来帮助提供医疗保健的过程。巴基斯坦并不缺乏人才;在医学或IT领域。然而,人们对IT如何彻底改变医疗保健服务的理解相当缺乏。我们看到,政府机构和私营医疗机构迫切需要认识到数字健康在提高医疗实践效果、效率和防错方面的重要性;这样巴基斯坦就可以摆脱几个世纪以来陈旧的医疗保健系统的负担。在此,我们提出了巴基斯坦数字卫生系统发展的路线图愿景,并提出了必须在基层采取的基本举措,以加快这一进程。
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引用次数: 0
Advanced Endoscopy Training in UK –what's in there for Pakistan? 英国的高级内窥镜检查培训-巴基斯坦的培训内容是什么?
IF 0.4 Pub Date : 2022-08-04 DOI: 10.21649/akemu.v28i2.5114
Emaan Munir, Tehreem Saleemi, Haris Mahmood, Farooq Khan
Gastrointestinal endoscopy revolutionized the diagnostic as well as therapeutic paradigms of many gastrointestinal diseases. Advanced endoscopy procedures like ERCP and EUS have gained paramount importance in recent times. Structured training in basic as well as advanced endoscopy techniques is essential to boost the confidence of the trainee and ensure positive patient outcomes. This review article used the databases, published literature, and a large number of research journals to find out the latest data on the standards of advanced endoscopy training to improve patient care. To excel in the field of endoscopy, studies have established that an endoscopy trainee should be assessed based on his skill and expertise; not based on a particular number of procedures. The endoscopists must benchmark their performance against their peers to assess their competency. The training of endoscopists should be on real patients, in addition to practice on simulators. Also, training programs and curricula should be well structured. With advanced endoscopy being established across the world in patient-care, it is the need of the hour to establish standards and mechanisms for endoscopy training in Pakistan. The UK systems can offer a roadmap to achieve this goal.
胃肠道内窥镜检查彻底改变了许多胃肠道疾病的诊断和治疗模式。先进的内窥镜检查程序,如ERCP和EUS,在最近的时间已经获得了至关重要的意义。在基本和先进的内窥镜技术的结构化培训是必不可少的,以提高学员的信心,并确保积极的病人的结果。这篇综述文章利用数据库、已发表的文献和大量的研究期刊来寻找先进内窥镜培训标准的最新数据,以改善患者的护理。为了在内窥镜领域脱颖而出,研究表明内窥镜培训生应该根据他的技能和专业知识进行评估;而不是基于特定数量的程序。内窥镜医生必须将他们的表现与同行进行比较,以评估他们的能力。内窥镜医师的培训除了在模拟器上练习外,还应该在真实的病人身上进行。此外,培训计划和课程应该有良好的结构。随着先进的内窥镜检查在世界各地的患者护理中得到建立,在巴基斯坦建立内窥镜检查培训的标准和机制是当务之急。英国的系统可以为实现这一目标提供路线图。
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引用次数: 0
A Case Report of Scar Endometrioma, A Rare Entity 瘢痕性子宫内膜异位瘤1例
IF 0.4 Pub Date : 2022-08-04 DOI: 10.21649/akemu.v28i2.5101
Javeria Mushtaq, T. Wasim, Jamshaid Feroze
Scar endometriosis is an uncommon entity. Its diagnosis is often delayed because it often resembles to several surgical conditions and dermatological diseases. It is almost always iatrogenic in origin. Here we are discussing a 38 old year old women who presented with scar endometriosis after Lower Segment Caesarean Section (LSCS).
瘢痕性子宫内膜异位症是一种罕见的疾病。它的诊断经常被推迟,因为它经常类似于几种外科疾病和皮肤病。它几乎总是医源性的。我们在这里讨论一位38岁的女性,她在剖宫产术后出现瘢痕性子宫内膜异位症。
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引用次数: 0
期刊
Annals of King Edward Medical University Lahore Pakistan
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