Geriatric patients\u27 expectations of their physicians: findings from a tertiary care hospital in Pakistan

Background: Geriatric health is a neglected and under-explored area internationally and in Pakistan. We aimed to ascertain the expectations of the geriatric Patients from their physicians and the factors associated with Patient satisfaction in this particular age bracket. Methods: A cross-sectional survey was carried out at a tertiary care teaching hospital in Karachi, Pakistan. Data collection was carried out via face-to-face interviews based on structured, pretested questionnaires. All consenting individuals aged 65 years or above were recruited into the study. Convenience sampling was used to draw the sample. The data was analyzed using SPSS version 16. Geriatric Patient\u27s expectations from physicians were elicited using a set of 11 questions that were graded on a scale of 1-3 where 1 = not important, 2 = important, 3 = very important. Results: Three hundred and eighty geriatric Patients were interviewed. The response rate of this study was 89.8%. The mean age of the respondents was 73.4 +/- 6.8 years. Two hundred and forty eight respondents (65.3%) were female. Diabetes mellitus (53.7%), hypertension (59.5%), arthritis (40.5%) and renal disease (32.1%) were common ailments among geriatric Patients. More than 50% of the Patients were visiting their physicians once every two to three months. Discussing treatment options and letting Patients make the final decision (79.2%), prescribing minimum possible medications (84.5%), physician\u27s holistic knowledge about the spectrum of care issues for geriatric Patients (79.2%), being given a realistic but optimistic picture of future health by physicians (85.5%) were ranked as very important expectations by Patients from their physicians. Cumulative household income (p = 0.005), most important health complaint (p = 0.01) and frequency of experiencing health complaint (p \u3c 0.001) emerged as independent predictors of the satisfaction of geriatric Patients from care provided by physicians. Conclusion: We have documented the expectations of the geriatric Patients from their physicians in a developing country. Physicians belonging to all disciplines should keep these expectations in mind during clinical encounters with geriatric Patients

Successful surgical embolectomy in acute massive bilateral pulmonary embolism

Acute massive pulmonary embolism is a life-threatening emergency that must be promptly diagnosed and managed. A 52-year-old man presented with progressively increasing dyspnoea for three days. He had a previous history of chronic obstructive pulmonary disease and was currently a heavy smoker. Examination revealed bilateral wheezing. Chest x-ray and electrocardiography showed non-specific changes. The patient was initially treated as a case of chronic obstructive pulmonary disease exacerbation secondary to pneumonia. However, despite optimum medical management, his oxygen saturation deteriorated. Emergent computed tomography scan of chest showed bilateral massive pulmonary emboli. As the patient\u27s haemodynamic status rapidly deteriorated, cardiothoracic surgery team was immediately consulted and the patient was taken to the operating room. Under cardiopulmonary bypass, bilateral open embolectomy was performed. Following surgical intervention, the patient made a remarkable recovery

Breaking bad news: exploring patient\u27s perspective and expectations

OBJECTIVE: To explore patient\u27s perspectives and expectations from physicians with respect to breaking of bad news. METHODS: A cross-sectional survey was carried out in the Community Health Centre of a tertiary care teaching hospital in Pakistan. All consenting individuals from 18 to 60 years of age were interviewed on the basis of a structured, pre-tested questionnaire. RESULTS: The response rate for this study was 91.3%. A total of 400 respondents completed the full interview. About 60% patients had a fairly accurate idea about the implications of the phrase bad news . A big proportion (44.1%) of people reported that bad news had been broken to them previously with incomplete details. From their personal experience, most respondents quoted disease diagnosis and chances of survival as most commonly encountered bad news. Diagnosis of cancer or its recurrence was stated as the most likely example of bad news (35.5%). A significant majority of respondents (40.5%) stated that it\u27s the patient\u27s absolute right to know bad news. A significant association for the relationship between both age as well as the gender of the respondents and type of emotional response expressed on hearing bad news (p = 0.000) was observed. CONCLUSION: This study documents the perceptions and expectations of patients from their physicians with regards to breaking of bad news. Most of the respondents wanted their doctors to be honest and upfront during the process

Knowledge, attitudes and practices regarding Gemstone therapeutics in a selected adult population in Pakistan

Background: Gemstones have been in use as part of alternative and complementary medicine for years. However, our understanding of the perceived healing powers of gemstones is limited. An extensive literature search revealed that there is a dearth of validated information on this subject. This study was therefore undertaken to explore the various aspects of the knowledge, attitudes, and practices of the public towards gemstone therapeutics. Methods: A survey was performed in the Community Health Centre of a tertiary care teaching hospital in Pakistan. Data collection was done via a face-to-face interview based on a structured, pre-tested questionnaire. Participants included all willing persons between 18-75 years of age approached prior to their appointments at the Community Health Centre. Results: The survey response rate was 86% (400/465). More than half (63%) of the study population was aware of the use of gemstone therapy. One hundred fifty-six individuals believed that gemstone use impacts health. Of this group, 39% believed that gemstone use increases physical strength. 62% believed that gemstone use is based on superstitious beliefs, whereas 28% opined that it is based on religious beliefs. 38% had used gemstones therapeutics formerly, while 24% were current users. Multiple logistic regression analysis revealed that age status and education status were significant (p \u3c 0.05) independent predictors for both awareness of gemstone therapy and the belief that gemstone use impacts health. The elderly (aged 51-61) were 5.9-times more likely to believe that gemstones had an impact on health than the younger population (aged 18-28 years). (Adjusted Odd\u27s Ratio = 5.9 [95% Confidence Interval = 2.9-11.9]). Conclusion: More than half of our sample population is aware of the use of the gemstones for their various effects. Willingness to use gemstones is associated with the beliefs about the impact of gemstone therapy on health. Friends and family seem to be the major role players influencing people\u27s willingness to use gemstones. CAM modalities should be recognized and considered as an important therapeutic option. We feel that gemstone therapy is a relatively unexplored area and more studies should, therefore, be conducted to gather more validated information on the subject

Giant unresectable lymphangioma of the trunk managed via intra-tumour injections of bleomycin

Surgical excision was once considered the mainstay of treatment for lymphangiomas. However, that paradigm is now changing with sclerotherapy emerging as a viable alternative. A 22-year-old girl presented with a mucopurulent and painful discharge from an extensive wound in the trunk. Chest roentogram showed a large soft tissue abnormality with multiple calcifications in the right upper abdomen and lower thorax. Magnetic resonance imaging revealed an extensive lobulated mass measuring 27 x 19 cm. Due to the extensive involvement of tissues, surgical excision did not appear to be a favourable option in this case. Local injections of bleomycin were successfully administered; resulting in complete regression of the lesion. There has been no recurrence at 2 years of follow up. Use of bleomycin sclerotherapy appears to be a safe and effective management strategy and obviates the need for primary surgery especially in extensive lymphangiomas

Gemella morbillorum endocarditis in a patient with a bicuspid aortic valve.

Infective endocarditis caused by Gemella morbillorum is a very rare occurrence and only a few cases have been reported in the literature so far. We describe a case of G. morbillorum endocarditis in a 31-year-old Pakistani woman who had a congenitally bicuspid aortic valve. She had also undergone repair of a large aortic aneurysm 1 year before this presentation. She presented to our institution with a 1.5-month history of fever, exertional dyspnea and generalized edema. A transthoracic echocardiogram showed two large, echogenic and mobile vegetations (7 x 15 mm and 8 x 10 mm) attached to the right coronary cusp and non-coronary cusp. Blood cultures of the Patient grew pan-sensitive G. morbillorum. The Patient fulfilled the Duke\u27s criteria for infective endocarditis. She was successfully treated with ceftriaxone and gentamycin therapy. At two years\u27 follow up she has remained well. This case represents a rare cause of infectious endocarditis that was successfully managed with medical treatment alone in a Patient with the predisposing risk factor of a bicuspid aortic valve

Two cases of primary laryngeal amyloidosis

The larynx is a rare site of involvement of amyloidosis. We report two cases of laryngeal amyloidosis. Both patients were middle aged females with history of persistent hoarseness. Fibreoptic laryngoscopy used for diagnosis in both and debulking of the tumour was performed. Histopathological examination confirmed the diagnosis of amyloidosis. Appropriate follow up is an important part of the long-term management of the disease

The Hirsch index - a play on numbers or a true appraisal of academic output?

Citation metrics have rapidly gained importance in today's landscape and are being increasingly utilized as a yardstick in making several important decisions regarding academic funding and appointments. The impact factor has traditionally been the metric most often employed in this regard. However, the emergence of the Hirsch index has provided an alternative to the impact factor. The h-index, despite its flaws, continues to gain acceptance and popularity in the medical community. Several medical journals have evaluated and endorsed the use of the h-index. However, it must be interpreted with all of its limitations in mind