Awareness of the process of informed consent among family practice patients in Karachi

Objective: To study the awareness of \u27Informed Consent\u27, among patients presenting to Family Physicians. Methods: A cross-sectional study was carried out at the Community Health Centre, Aga Khan University Hospital, Karachi in July 2002. Written Consent was taken and confidentially was assured Results: Out of the 100 patients interviewed, 80 agreed to participate in the study, forty-four men and thirty-six women. Approximately half the participants (45%) were graduates and 40% had less than five years of school education. The awareness of the process of \u27informed consent\u27 was observed in only 20% of the respondents, all in the educational category of graduates. Conclusion: A lack of awareness of informed consent was observed in patients attending the Community Health Centre, Aga Khan University, despite stringent institutional policies, which are adequately followed. To improve awareness, \u27Health Education Programs\u27 for the population are required with media support. Readability of written consent forms should be of class V level or less to give advantage to the less educated classes in the society. Local languages should be utilized for written and verbal consent. Public health programs should also be aimed at educating physicians, nurses and paramedics. Provisions should be made to legalise the process of taking consent (JPMA 54:398;2004)

Project DIANA - Converging and Integrating IP and ATM for real-time applications

The evolution of IP and ATM share some common drivers. Both of them are addressing efficient network resource utilisation. In order to evaluate the options and combinations offered by these technologies the DIANA project is looking into the areas where ATM and IP both overlap and complete each other, that is QoS interworking between ATM and IP. This is achieved by investigating RSVP-over-ATM approach. This solution is compared with two IP level approaches: Differentiated Services and Scalable Resource Reservation Protocol (SRP)

Genetic characterization of human coxsackievirus A6 variants associated with atypical hand, foot and mouth disease: a potential role of recombination in emergence and pathogenicity

Human coxsackievirus A6 (CVA6) is an enterically transmitted enterovirus. Until recently, CVA6 infections were considered as being of minor clinical significance, and only rarely aetiologically linked with hand, foot and mouth disease (HFMD) associated with other species A enteroviruses (particularly EV71 and CVA16). From 2008 onwards, however, CVA6 infections have been associated with several outbreaks worldwide of atypical HFMD (aHFMD) accompanied by a varicelliform rash. We recently reported CVA6-associated eczema herpeticum occurring predominantly in children and young adults in Edinburgh in January and February 2014. To investigate genetic determinants of novel clinical phenotypes of CVA6, we genetically characterized and analysed CVA6 variants associated with eczema herpeticum in Edinburgh in 2014 and those with aHFMD in CAV isolates collected from 2008. A total of eight recombinant forms (RFs) have circulated worldwide over the past 10 years, with the particularly recent appearance of RF-H associated with eczema herpeticum cases in Edinburgh in 2014. Comparison of phylogenies and divergence of complete genome sequences of CVA6 identified recombination breakpoints in 2A-2C, within VP3, and between 5' untranslated region and VP1. A Bayesian temporal reconstruction of CVA6 evolution since 2004 provided estimates of dates and the actual recombination events that generated more recently appearing recombination groups (RF-E, -F, -G and -H). Associations were observed between recombination groups and clinical presentations of herpangina, aHFMD and eczema herpeticum, but not with VP1 or other structural genes. These observations provided evidence that NS gene regions may potentially contribute to clinical phenotypes and outcomes of CVA6 infection

Implications for the practice of a patient expectation and satisfaction survey, at a teaching hospital in Karachi, Pakistan

Objective: To study the expectations and satisfaction of patients visiting Family Practice Clinics, at the Aga Khan University Hospital, in Karachi, Pakistan. Methodology: A cross sectional survey of 316 patients was carried out. A questionnaire, based on the study objectives was developed and administered. The participating patient signed a consent form, after assurance of confidentiality was provided. Data on the demographic profile of the patients was collected.Results: The mean age was 33.81 years, with 105 (33.2%) women, and 211 (66.8%) men. The majority were married, with education above intermediate level and were in private or government service or were housewives. The median for the patient waiting time was 30 minutes, against an expectation of 12.69 minutes. Reading newspaper, watching television, reading magazine, reading Quran and listening to music were quoted as ways to lessen the burden of waiting to see a physician. The average consultation time with the physician was 13.89 minutes, against an expectation of 16.37 minutes. Patient expectation in terms of listening by the doctor with patience, explanation of the diagnosis and treatment, prescription of medicines, ordering of investigations and specialist referral has been documented. Objections to the presence of medical student, nursing student, resident doctor, nurse and an observer, in the consultation room have also been documented. Reasons quoted for the objection include issues of privacy/confidentiality, lack of justification, discomfort, and interference with the consultation process. The expected average cost for doctor’s consultation was Pakistani Rs. 124, while 196 (61.8%) of the respondents were satisfied with the consultation based on Rs. 70. Conclusion: We have collected important information to improve the services offered at our Family Practice clinics (JPMA 53:122;2003)

Sormien jännevammat

Vertaisarvioitu.Sormien jännevammat syntyvät lävistävien tai sulkeisten vammojen seurauksena. Kliininen tutkimus ja tarvittaessa natiiviröntgenkuvaus riittävät usein diagnosointiin. Jännevammoihin voi liittyä jänteen kiinnityskohdan avulsio- eli repeämismurtuma. Avoimiin vammoihin liittyy usein hermo- ja verisuonivammoja. Sulkeiset ojentajajännevammat hoidetaan yleensä lastoilla. Vasarasormen (mallet finger) lastahoito voidaan toteuttaa perusterveydenhuollossa. Avoimet ja muut kirurgisesti korjattavat jännevammat kuuluvat käsikirurgiseen yksikköön. Hyvän toiminnallisen tuloksen saavuttaminen edellyttää leikkauksen jälkeistä kuntoutusta ja potilaan sitoutumista siihen.Peer reviewe

Physician assisted suicide perceptions among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan

Objective: To study the perceptions on physician assisted suicide, among patients presenting to family physicians, at a teaching hospital in Karachi, Pakistan. Method: The study was carried out at the Community Health Center of The Aga Khan University Hospital, Karachi, between December 1999 and May 2000. The principal and co-investigators filled a pre-coded and pre­tested questionnaire consisting of important demographic characteristics and bio-medical ethics issues. A system of convenience sampling was used and a written consent was taken from respondents over the age of 16 years, who agreed to participate. The data were managed by using the Epi Info (version 6.0) program. Results: Four hundred twenty respondents were interviewed against an estimated sample size of 385. Majority (88%) were males between 25 and 34 years of age, and were self employed or in private service. Overall 9%respondents were advocated of physician assisted suicide. advocates was 9%. Those who advocated the Physician assisted suicide were more likely to be female, elderly, married and educated amongst the total respondents. Those who support Physician assisted suicide were less likely to attach divine qualities to physicians and were more bold, courageous and tolerant towards broader biomedical ethics issues. Conclusion: We have found a substantial acceptability to the idea of Physician assisted suicide in a Muslim society and have identified characteristics of those who support it (JPMA 51 :233;2001)

The way forward to public health in Gulf Cooperation Council (GCC) countries: a need for public health systems and law

Introduction: Public health systems in the Gulf Cooperation Council (GCC) Countries are not well established. The existing systems do not match with the current health challenges and with the use of innovative technology in healthcare (diagnosis, treatment or rehabilitation). This paper is intended to give an overview of the public health situation in these countries. It discusses the need for effective and integrated system of public health laws that plays important role in addressing high priorities in public health. Conclusion: The GCC countries have the infrastructure for estab¬lishing a national public health system. However it needs an effective integrated and organized mechanism to shape this system; based on acceptable guidelines and criteria in such a way that they are institutional and capable of meeting the population needs. This system should be cost- effective and investment in health sector should be looked upon as a sustained investment in human and societal development. Despite the great efforts exerted and achievements made, there are great challenges ahead that can be overcome by exhibiting a strong political will and having a united approach of all stakeholders