23 research outputs found
What constitutes responsiveness of physicians: A qualitative study in rural Bangladesh
Responsiveness entails the social actions by health providers to meet the legitimate expectations
of patients. It plays a critical role in ensuring continuity and effectiveness of care
within people centered health systems. Given the lack of contextualized research on
responsiveness, we qualitatively explored the perceptions of outpatient users and providers
regarding what constitute responsiveness in rural Bangladesh. An exploratory study was
undertaken in Chuadanga, a southwestern Bangladeshi District, involving in-depth interviews
of physicians (n = 17) and users (n = 7), focus group discussions with users (n = 4),
and observations of patient provider interactions (three weeks). Analysis was guided by a
conceptual framework of responsiveness, which includes friendliness, respecting, informing
and guiding, gaining trust and optimizing benefits. In terms of friendliness, patients expected
physicians to greet them before starting consultations; even though physicians considered
this unusual. Patients also expected physicians to hold social talks during consultations,
which was uncommon. With regards to respect patients expected physicians to refrain from
disrespecting them in various ways; but also by showing respect explicitly. Patients also had
expectations related to informing and guiding: they desired explanation on at least the diagnosis,
seriousness of illness, treatment and preventive steps. In gaining trust, patients
expected that physicians would refrain from illegal or unethical activities related to patients,
e.g., demanding money against free services, bringing patients in own private clinics by brokers
(dalals), colluding with diagnostic centers, accepting gifts from pharmaceutical representatives.
In terms of optimizing benefits: patients expected that physicians should be
financially sensitive and consider individual need of patients. There were multiple dimensions
of responsiveness- for some, stakeholders had a consensus; context was an important
factor to understand them. This being an exploratory study, further research is
recommended to validate the nuances of the findings. It can be a guideline for responsiveness
practices, and a tipping point for future research
Serum amyloid A (SAA): a novel biomarker for uterine serous papillary cancer
BACKGROUND: Uterine serous papillary carcinoma (USPC) is a biologically aggressive variant of endometrial cancer. We investigated
the expression of Serum Amyloid A (SAA) and evaluated its potential as a serum biomarker in USPC patients.
METHODS: SAA gene and protein expression levels were evaluated in USPC and normal endometrial tissues (NEC) by real-time PCR,
immunohistochemistry (IHC), flow cytometry and by a sensitive bead-based immunoassay. SAA concentration in 123 serum samples
from 51 healthy women, 42 women with benign diseases, and 30 USPC patients were also studied.
RESULTS: SAA gene expression levels were significantly higher in USPC when compared with NEC (mean copy number by
RT\u2013PCR\ubc162 vs 2.21; P\ubc0.0002). IHC revealed diffuse cytoplasmic SAA protein staining in USPC tissues. High intracellular levels
of SAA were identified in primary USPC cell lines evaluated by flow cytometry and SAA was found to be actively secreted in vitro.
SAA concentrations (mgml 1) had a median (95% CIs) of 6.0 (4.0\u20138.9) in normal healthy females and 6.0 (4.2\u20138.1) in patients with
benign disease (P\ubc0.92). In contrast, SAA values in the serum of USPC patients had a median (95% CI) of 15.6 (9.2\u201356.2),
significantly higher than those in the healthy group (P\ubc0.0005) and benign group (P\ubc0.0006). Receiver operating characteristics
(ROC) analysis of serum SAA to classify advanced- and early-stage USPC yielded an area under the ROC curve of 0.837
(P\ubc0.0024).
CONCLUSION: SAA is not only a liver-secreted protein but is also a USPC cell product. SAA may represent a novel biomarker for
USPC to assist in staging patients preoperatively, and to monitor early-disease recurrence and response to therapy