Strategies Physicians Apply to Value-Based Patient Care for Quality Reimbursement

Low-quality value-based patient care negatively impacts physicians’ ability to maintain private solo practices. Physicians who lack strategies to apply value-based patient care may lose their ability to stay in a private solo practice. Grounded in the complex adaptive system theory, the purpose of this qualitative multiple case study was to explore strategies used by private solo physicians that provided value-based patient care. Participants were four physicians in solo private practice who successfully applied value-based patient care to maintain their private solo practice. Data were collected from semistructured interviews and organizational documents and analyzed using thematic analysis. Three themes emerged: (a) electronic medical record fitness with the physician, (b) sharing of workload to reduce burnout, and (c) choosing the right outsourced billing service. A key recommendation for solo practitioners is to select an EMR system to achieve value-based patient care and correct payer reimbursement. The implications for positive social change include the potential for physicians to improve healthcare delivery to benefit the health, dignity, and quality of life for local citizens

Body mass index or body fat! which is a better obesity scale for Pakistani population?

Ojective: To compare two methods of classifying obesity based on body mass index and body fat percentage.Methods: The cross-sectional study was conducted from November 2012 to August 2013 at Jinnah Postgraduate Medical Centre, Karachi. Male and female volunteers between the ages 15-65 years were selected using simple random sampling. They were classified into different groups for body mass index and body fat percentage measured through bioelectrical impedance scale. The subjects were sub-grouped into underweight, normal weight, overweight and obese. SPSS 11 was used for statistical analysis.Results: The mean age of the 828 healthy volunteers was 25.67±10.10 years. A total of 552 (66.6%) subjects had a higher body fatpercentage and were misclassified by body mass index. Only 276 (33.3%) subjects had body fat percentage values corresponding to the body mass index classification. The difference in terms of categorising obesity was highly significant (p\u3c0.001). Both body mass index and body fat percentage showed positive correlation with age (r=0.144; p=0.001) (r=0.261; p=0.001) and weight (r=0.578; p=0.001) (r=0.444; p=0.001) respectively. Moreover body fat percentage showed a significant positive association with gender (r=0.109; p=0.027) whereas BMI did not.Conclusions: Body fat percentage should be incorporated for a better understanding as well as categorising of obesity

A Study of Social Development of Children at Elementary Level

The aim of the present study is to find out the social development of children at elementary level. This study was descriptive in nature and survey type research technique was used to investigate the “Social Development (SD)” of children at basic level.  All the teachers, parents and students of private and government schools of specific district were the population of the study. The convenient sampling strategy was used for sample selection. The sample size of the research was 100 students, 50 teachers and 50 parents. The quantitative approaches were used for data collection. The questionnaire was used as research instrument. The instrument of the study was “social development of children questionnaire” having seven sub scales. After the data collection, the data was entered in SPSS.  The data was analyzed by using frequency analysis, descriptive analysis, mean analysis and percentage analysis. The study concluded that children at elementary level have friendly relationship with their family members. The children take part in social activities. The study, recommended that the teachers should motivate the students to come to school regularly. The teachers should recognize the abilities of everyone without having any limited view in mind. The parents should give importance to their children’s opinions

African women writers and the politics of gender

This thesis examines the work of a group of African women writers who have emerged over the last forty years. While figures such as Chinua Achebe, Ben Okri and Wole Soyinka are likely to be the chief focus of discussions of African writing, female authors have been at the forefront of fictional interrogations of identity formation and history. In the work of authors such as Mariama Bâ (Senegal), Buchi Emecheta (Nigeria), Chimamanda Ngozi Adichie (Nigeria), Tsitsi Dangarembga (Zimbabwe), and Leila Aboulela (Sudan), there is a clear attempt to subvert the tradition of male writing where the female characters are often relegated to the margins of the culture, and confined to the domestic, private sphere. This body of work has already generated a significant number of critical responses, including readings that draw on gender politics and colonialism; but it is still very much a minor literature, and most mainstream western feminism has not sufficiently processed it. The purpose of this thesis is threefold. First, it draws together some of the most important and influential African women writers of the post-war period and looks at their work, separately and together, in terms of a series of themes and issues, including marriage, family, polygamy, religion, childhood, and education. Second, it demonstrates how African literature produced by women writers is explicitly and polemically engaged with urgent political issues that have both local and global resonance: the veil, Islamophobia and a distinctively African brand of feminist critique. Third, it revisits Fredric Jameson’s claim that all third-world texts are ‘national allegories’ and considers these novels by African women in relation to Jameson’s claim, arguing that their work has complicated Jameson’s assumptions

Clinical skills in undergraduate program and Curricular change – does it make a difference?

Background Clinical Skills Laboratory (CSL) was established at Foundation University Medical College (FUMC) in year 2009 with the introduction of integrated modular teaching program. A structured integrated curriculum was introduced from the Class of year 2013 for learning of clinical skills at CSL. This study was conducted to evaluate the effect of introducing the new curriculum on student’s performance in CSL. Methods A comparative analytical study was conducted. The OSCE scores of group A (Class of year 2011) were compared with group B (Class of 2013). Data collection tool was institutional checklist. The OSCE stations were of General Physical Examination (GPE), history taking, systemic examination of Gastrointestinal tract and communication skills. Reliability of the scores was estimated through Cronbach α. Mean scores of the two groups were compared using the independent sample t test and Mann Whitney U-test. Chi-square test was used to compare variables (years, gender and educational background). Comparison of student scores at different components of OSCE using Analysis of Variance (ANOVA) was done.   Results Reliability of scores was 0.65 for group B and 0.52 for group A. comparison of overall scores of the two groups reflected improved performance in the group B (p 0.001). Comparison of scores at different components of OSCE using ANOVA also reflected better performance of group B (p<0.01). OSCE scores of both the groups were also correlated for gender and educational background. No difference was found in the two groups on the basis of gender and educational background. Conclusion To enhance the value of clinical skills training and to make it more effective, skill lab curriculum must be structured and integrated within the undergraduate curriculum. Key words;Clinical skills laboratory, undergraduate integrated curriculum, clinical skills training&nbsp

KCNQ1 rs2237895 polymorphism is associated with Gestational Diabetes in Pakistani Women

Background and Objective: Genetic studies on gestational diabetes (GDM) are relatively scarce; moreover, limited data is available for KCNQ1 polymorphism in Pakistani pregnant women. We aimed to determine the frequency of KCNQ1 rs2237895 in GDM and normal pregnant controls and its association with GDM-related phenotypes.Methods: A total of 637 pregnant females (429 controls and 208 cases) in their second trimester were classified according to the International Association of the Diabetes and Pregnancy Study criteria in this study. Their blood samples were genotyped for KCNQ1 SNP rs2237895 using PCR-RFLP method and sequencing. Fasting and two hour-post glucose load blood levels, serum HbA1c, insulin, and anthropometric assessment was performed.: Pearson\u27s Chi Square test, Mann- Whitney U test, and regression analyses were performed. A p-value of \u3c 0.05 was considered significant.Results: The variant genotyped was in Hardy-Weinberg equilibrium (p \u3e 0.05). The rs2237895 showed an association with GDM (OR 2.281; 1.388-3.746: p \u3c 0.001) and remained significant after multiple adjustments for age and body mass index (OR 2.068; 1.430-2.997: p=0.005). The C allele showed positive association with insulin level, and HOMA-IR in study subjects.Conclusions: This study identifies that KCNQ1 rs2237895 polymorphisms might be associated with risk of GDM in Pakistani population and that it is related to higher glucose levels and insulin resistance. Further large scale studies are required to consolidate on the functional aspect of this polymorphism

Diagnostic Accuracy Of Barium Swallow For Dysphagia, Keeping Rigid Esophagoscopy As The Gold Standard

Objective: To determine the diagnostic accuracy of Barium Swallow in detection of patients presenting with dysphagia. Study Design: Cross-sectional validation study. Study Setting & Duration: Department of Otorhinolaryngology, Head & Neck Surgery, District Headquarter Hospital Rawalpindi from 01-09- 2022 to 01-03-2023. Materials and Methods: Approval of the study was obtained from the Hospital Ethical Committee. A total of 111 patients both male and female patients were selected. The patients suffering from dysphagia as per operational definitions and who have reported for work-up to the Department of ENT, District Headquarters Hospital, Rawalpindi, and fulfill the complete inclusion and exclusion criteria, were selected. Informed consent was obtained from all the patients. Patients were selected by consecutive non-probability sampling technique. The data was analyzed using SPSS 24. Results: A total of 111 patients were included in this study. The mean age of these patients was 50.79 ± 13.01 years, ranging from 28 to 70 years. The frequency distribution of females 70.27 % was found to be more than that of males 29.73 %. Majority of patients' barium swallow (74.77%) revealed pathologies, while only a small percentage of patients (25.23%) had normal barium swallow. Most of patients (87.39%) had pathologies found during rigid esophagoscopy, while just a small number (12.61%) had normal rigid esophagoscopy. Comparing both investigating tools, esophagoscopy discovered 87.39% of pathologies while Barium swallow detected 74.77%, indicating that esophagoscopy was a more accurate procedure. Patients had esophageal web 55 (25.2%) on barium swallow and 69 (62.2%) on the Rigid esophagoscopy. Barium Swallow had esophageal stricture 28 (52.2) and no Pathology was detected in 28 (25.2 %) patients. As well as Rigid esophagoscopy had esophageal growth13 (11.7), esophageal stricture 15 (13.5), and no Pathology was detected in 14 (12.6 %). Rigid esophagoscopy is more efficient in detecting esophageal pathology than Barium Swallow. In Barium swallows most patients had esophageal web 55 (25.2%) than the esophageal stricture 28 (52.2) and no pathology was detected 28 (25.2). In rigid esophagoscopy most patients had esophageal web 69 (62.2%) than the esophageal growth13 (11.7), esophageal stricture 15 (13.5) and no pathology detected 14 (12.6). Conclusion: A range of diseases are associated with dysphagia can be found in patients. Two often used diagnostic methods are barium swallow and rigid esophagoscopy. Both Barium swallow and Rigid esophagoscopy are successful in the diagnosis of esophageal cancer. The use of a Rigid esophagoscopy is still a gold standard diagnostic and therapeutic tool for upper aerodigestive tract pathologies

Comparison Of Isoconazole Nitrate Versus Nystatin For The Treatment Of Otomycosis

Objective: To compare the efficacy and local adverse effects of Isoconazole Nitrate versus Nystatin for the treatment of patients having Otomycosis  Sudy Design: Group experimental study. Study Setting & Duration: Department of Otolaryngology, Head & Neck Surgery at Rawalpindi Teaching Hospital, Rawalpindi.  Duration of study was 6 months after approval by Ethical Committee from Feb 2023 to july 2023 Materials and Methods: Total of 64 patients were selected.  The study participants were individuals who, according to operational definitions had Otomycosis and who had presented for evaluation at the Department of Otolaryngology Rawalpindi teaching Hospital, Rawalpindi. They also met all inclusion and exclusion criteria requirements and these requirements were strictly adhered to in order to control confounders and bias. Isoconazole nitrate ointment was used to treat patients in Group A and Nystatin ointment was used to treat instances in Group B.  Patients were chosen by randomization using lottery method. SPSS 28 was used to determine the frequencies in the data. Results: 64 individuals (32 cases in each group) were chosen for the study by the ENT outpatient clinic. Out of which 33 (51.6%) being female and 31 (48.1) being male. The age ranged from 12 to 80 years, with a mean age of 44.29 ±19.13. After two weeks, there was a substantial improvement in 25 (39.06%) of the group A patients (p=0.08), a moderate improvement in 7 (10.9%), and a minor improvement in 5 (7.81%) patients (p=0.37) while in group B exhibited a substantial improvement in just 19 (10.9%) (p=0.08), a moderate improvement in 9 (39.0%) (p=0.38), and a small improvement in 7 (42.19%) (p=0.37). After four weeks 21 (32.81%) in Group B showed insignificant improvement, while 26 (40.63%) in Group A exhibited better improvement than Group B. The treatment for group A, which included isoconazole nitrate, was substantially more successful than the Nystatin treatment for group B. Isoconazole was found insignificantly more effective than   (p=0.08). The  majority of patients in both groups didn't notice any adverse  . Conclusion: Nystatin was shown to be significantly less efficacious than isoconazole nitrate ointment in treating otomycosis

Gestational diabetes mellitus and the predisposing factors

Objective: To evaluate the occurrence of gestational diabetes mellitus and its association with demographic and anthropometric variables in pregnant women.Methods: This cross-sectional study was conducted at the Aga Khan University Hospital, Abbasi Shaheed Hospital and Memon Hospital in Karachi, from February 2014 to December 2015, and comprised pregnant women who were screened by 75-g 2-hour oral glucose tolerance test, (24-28 weeks of gestation) and classified as per the criteria of the International Association of Diabetes and Pregnancy Study Group. Weight, body mass index and serum glycated haemoglobin levels were measured. Women with pre-gestational diabetes were excluded. SPSS 21 was used for data analysis.Results: Of the 1,210 participants, 208(17.2%) had gestational diabetes, while 1,002(82.8%) did not have the condition. Gestational diabetes was associated with advancing age, deranged glycated haemoglobin, elevated body mass index at booking (p0.05).Conclusions: Pre-existing adiposity and presence of strong family history rendered a considerable number of pregnant women to suffer from gestational diabetes

Factors Leading To Early Versus Late Presentation In Patients With Neck Masses

Abstract Objective: To compare the factors that lead to early versus late presentation in patients with neck masses Study Design: Group Comparative Study. Study Setting & Duration: Department of Otorhinolaryngology and Head &Neck Surgery at Rawalpindi Teaching Hospital from 01-9-2022 to 01-03-2023. Methods: Approval of the study was obtained from the hospital's ethical committee. A total of 64 patients (32 in each group) were placed in two Groups A &  B. Group A included patients who presented early and Group B included patients who presented late. Both male and female patients were selected. In this study patients suffering from neck masses who have reported for work-up to the Department of ENT, Rawalpindi Teaching Hospital, and fulfil the complete inclusion and exclusion criteria were included. Patients were selected via consecutive nonprobability sampling. The data were analyzed for frequencies by SPSS 24. Results: A total of 64 patients were included in this study. The mean age of these patients was 48.67 ± 9.74 years, ranging from 25 to 70 years. The Frequency distribution of males at 65.63 % was found to be more than that of females at 34.36 %. In the majority of patients, the size of mass more than 1.5 cm (51.56%) revealed malignancy, while only a small percentage of patients (48.44%) had less than 1.5 cm neck mass. The majority of patients (93.75%) with addiction presented late, while just a small number (6.25%) had early presentation. The majority of patients (51.56%) with frequent visits to  Quacks /Hakeem per year were presented late. Regarding socioeconomic status, the majority of patients (28) from upper-class families presented early, compared to (11) patients from middle-class families who presented late, and all (21) patients from lower-class families who presented late. The education level reveals that the majority of patients (31), who were educated, attended a school for more than a year, but only up to ten (matriculate or similar) years, or advanced literacy: got a college- or university-level education, and they displayed early presentation. The 30 uneducated patients, who never attended an educational institution, or attended for less than one year, presented late. 31 patients had frequent visits to health care professionals and were presented early, 30 patients had fewer visits to health care professionals present late with advanced disease.  Conclusion: The majority of patients who were drug and alcohol addicts were presented late with advanced disease. Middle-class families, lower-class families, uneducated patients, and patients who did not see a healthcare provider four or more times per year, make up the majority of visits to Quacks and Hakeem each year and are presented late with advanced disease as compared to the group of patients who belong to upper class, were literate with no history of drug or alcohol addiction and have frequent visits to health care professionals. Both groups were considered to be significant (p=0.00) based on the probability ratio. This study helped to identify the role of various suspected risk factors for late presentation in head and neck cancers in an attempt to reinforce or negate their importance which will help to guide the formation of screening protocols thereby improving morbidity, and mortality and reducing financial costs.