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

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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, pre-tested 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's 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.</p> <p>Results</p> <p>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's 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 < 0.001) emerged as independent predictors of the satisfaction of geriatric patients from care provided by physicians.</p> <p>Conclusion</p> <p>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.</p

Arctic Holocene proxy climate database &ndash; New approaches to assessing geochronological accuracy and encoding climate variables

We present a systematic compilation of previously published Holocene proxy climate records from the Arctic. We identified 170 sites from north of 58° N latitude where proxy time series extend back at least to 6 cal ka (all ages in this article are in calendar years before present - BP), are resolved at submillennial scale (at least one value every 400 ± 200 years) and have age models constrained by at least one age every 3000 years. In addition to conventional metadata for each proxy record (location, proxy type, reference), we include two novel parameters that add functionality to the database. First, "climate interpretation" is a series of fields that logically describe the specific climate variable(s) represented by the proxy record. It encodes the proxy-climate relation reported by authors of the original studies into a structured format to facilitate comparison with climate model outputs. Second, "geochronology accuracy score" (chron score) is a numerical rating that reflects the overall accuracy of 14C-based age models from lake and marine sediments. Chron scores were calculated using the original author-reported 14C ages, which are included in this database. The database contains 320 records (some sites include multiple records) from six regions covering the circumpolar Arctic: Fennoscandia is the most densely sampled region (31% of the records), whereas only five records from the Russian Arctic met the criteria for inclusion. The database contains proxy records from lake sediment (60%), marine sediment (32%), glacier ice (5%), and other sources. Most (61%) reflect temperature (mainly summer warmth) and are primarily based on pollen, chironomid, or diatom assemblages. Many (15%) reflect some aspect of hydroclimate as inferred from changes in stable isotopes, pollen and diatom assemblages, humification index in peat, and changes in equilibrium-line altitude of glaciers. This comprehensive database can be used in future studies to investigate the spatio-temporal pattern of Arctic Holocene climate changes and their causes. The Arctic Holocene data set is available from NOAA Paleoclimatology. © Author(s) 2014

Climate-driven regime shifts in the biological communities of arctic lakes

Fifty-five paleolimnological records from lakes in the circumpolar Arctic reveal widespread species changes and ecological reorganizations in algae and invertebrate communities since approximately anno Domini 1850. The remoteness of these sites, coupled with the ecological characteristics of taxa involved, indicate that changes are primarily driven by climate warming through lengthening of the summer growing season and related limnological changes. The widespread distribution and similar character of these changes indicate that the opportunity to study arctic ecosystems unaffected by human influences may have disappeared. © 2005 by The National Academy of Sciences of the USA

Aquatic ecosystem changes in a global biodiversity hotspot: Evidence from the Albertine Rift, central Africa

10.1111/jbi.13643Journal of Biogeography4692098-211

Paleolimnological evidence of the effects on lakes of energy and mass transfer from climate and humans

The premise of this article is that climate effects on lakes can be quantified most effectively by the integration of process-oriented limnological studies with paleolimnological research, particularly when both disciplines operate within a common conceptual framework. To this end, the energy (E)–mass (m) flux framework (Em flux) is developed and applied to selected retrospective studies to demonstrate that climate variability regulates lake structure and function over diverse temporal and spatial scales through four main pathways: rapid direct transfer of E to the lake surface by irradiance, heat, and wind; slow indirect effects of E via changes in terrestrial development and subsequent m subsidies to lakes; direct influx of m as precipitation, particles, and solutes from the atmosphere; and indirect influx of water, suspended particles, and dissolved substances from the catchment. Sedimentary analyses are used to illustrate the unique effects of each pathway on lakes but suggest that interactions among mechanisms are complex and depend on the landscape position of lakes, catchment characteristics, the range of temporal variation of individual pathways, ontogenetic changes in lake basins, and the selective effects of humans on m transfers. In particular, preliminary synthesis suggests that m influx can overwhelm the direct effects of E transfer to lakes, especially when anthropogenic activities alter m subsidies from catchments

Imaging use for low back pain by Ontario primary care clinicians: protocol for a mixed methods study – the Back ON study

Abstract Background At any one time, one in every five Canadians has low back pain (LBP), and LBP is one of the most common health problems in primary care. Guidelines recommend that imaging not be routinely performed in patients presenting with LBP without signs or symptoms indicating a potential pathological cause. Yet imaging rates remain high for many patients who present without such indications. Inappropriate imaging can lead to inappropriate treatments, results in worse health outcomes and causes harm from unnecessary radiation. There is a need to understand the extent of, and factors contributing to, inappropriate imaging for LBP, and to develop effective strategies that target modifiable barriers and facilitators. The primary study objectives are to determine: 1) The rate of, and factors associated with, inappropriate lumbar spine imaging (x-ray, CT scan and MRI) for people with non-specific LBP presenting to primary care clinicians in Ontario; 2) The barriers and facilitators to reduce inappropriate imaging for LBP in primary care settings. Methods The project will comprise an inception cohort study and a concurrent qualitative study. For the cohort study, we will recruit 175 primary care clinicians (50 each from physiotherapy and chiropractic; 75 from family medicine), and 3750 patients with a new episode of LBP who present to these clinicians. Clinicians will collect data in the clinic, and each participant will be tracked for 12 months using Ontario health administrative and self-reported data to measure diagnostic imaging use and other health outcomes. We will assess characteristics of the clinicians, patients and encounters to identify variables associated with inappropriate imaging. In the qualitative study we will conduct in-depth interviews with primary care clinicians and patients. Discussion This will be the first Canadian study to accurately document the extent of the overuse of imaging for LBP, and the first worldwide to include data from the main healthcare professions offering primary care for people with LBP. This study will provide robust information about rates of inappropriate imaging for LBP, along with factors associated with, and an understanding of, potential reasons for inappropriate imaging

Arctic Holocene proxy climate database &ndash; New approaches to assessing geochronological accuracy and encoding climate variables

We present a systematic compilation of previously published Holocene proxy climate records from the Arctic. We identified 170 sites from north of 58° N latitude where proxy time series extend back at least to 6 cal ka (all ages in this article are in calendar years before present - BP), are resolved at submillennial scale (at least one value every 400 ± 200 years) and have age models constrained by at least one age every 3000 years. In addition to conventional metadata for each proxy record (location, proxy type, reference), we include two novel parameters that add functionality to the database. First, "climate interpretation" is a series of fields that logically describe the specific climate variable(s) represented by the proxy record. It encodes the proxy-climate relation reported by authors of the original studies into a structured format to facilitate comparison with climate model outputs. Second, "geochronology accuracy score" (chron score) is a numerical rating that reflects the overall accuracy of 14C-based age models from lake and marine sediments. Chron scores were calculated using the original author-reported 14C ages, which are included in this database. The database contains 320 records (some sites include multiple records) from six regions covering the circumpolar Arctic: Fennoscandia is the most densely sampled region (31% of the records), whereas only five records from the Russian Arctic met the criteria for inclusion. The database contains proxy records from lake sediment (60%), marine sediment (32%), glacier ice (5%), and other sources. Most (61%) reflect temperature (mainly summer warmth) and are primarily based on pollen, chironomid, or diatom assemblages. Many (15%) reflect some aspect of hydroclimate as inferred from changes in stable isotopes, pollen and diatom assemblages, humification index in peat, and changes in equilibrium-line altitude of glaciers. This comprehensive database can be used in future studies to investigate the spatio-temporal pattern of Arctic Holocene climate changes and their causes. The Arctic Holocene data set is available from NOAA Paleoclimatology. © Author(s) 2014

Symbiosis insights through metagenomic analysis of a microbial consortium

Symbioses between bacteria and eukaryotes are ubiquitous, yet our understanding of the interactions driving these associations is hampered by our inability to cultivate most host-associated microbes. Here we use a metagenomic approach to describe four co-occurring symbionts from the marine oligochaete Olavius algarvensis, a worm lacking a mouth, gut and nephridia. Shotgun sequencing and metabolic pathway reconstruction revealed that the symbionts are sulphur-oxidizing and sulphate-reducing bacteria, all of which are capable of carbon fixation, thus providing the host with multiple sources of nutrition. Molecular evidence for the uptake and recycling of worm waste products by the symbionts suggests how the worm could eliminate its excretory system, an adaptation unique among annelid worms. We propose a model that describes how the versatile metabolism within this symbiotic consortium provides the host with an optimal energy supply as it shuttles between the upper oxic and lower anoxic coastal sediments that it inhabits