Medicine and Health Sciences Commons^™

Frequency Of Tension-Type Headache In Patients With Migraine: A Single-Center Cross-Sectional Study, Haris Majid Rajput, Zahid Hussain Mir, Muhammad Fateen Rashed, Fiza Batool Almosvi, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT Background and objective: Migraine is a common headache disorder characterized by recurrent episodes of moderate to severe headaches which are usually unilateral. Migraine is the second most common headache disorder after tension-type headache. The objective of this study was to determine the frequency of tension-type headache in patients with migraine. Methods: This cross-sectional study was carried out at Pakistan Institute of Medical Sciences, Islamabad for a period of six months between 1st July 2018 and 31st December 2018. This study enrolled patients above the age of 12 years that were diagnosed with “Migraine without aura” or “Migraine with aura”. …

Sensitivity Of A Preanaesthesia Screening And Triage Tool In Identifying High-Risk Patients Attending The Preanaesthesia Assessment Clinic In A Tertiary Referral Hospital In Sub-Saharan Africa: A Diagnostic Accuracy Study, Brian Misoi, Vitalis Mung’Ayi, Rajpreet Bal, Shamshudin Mohammedali

General Surgery, East Africa

Objectives: The use of preoperative triage questionnaires is an innovative way to mitigate the shortage of anaesthesiologists and to identify and refer high-risk patients early for evaluation. This study evaluates the diagnostic accuracy of one such questionnaire in identifying high-risk patients in a Sub-Saharan population.

Design: Diagnostic accuracy study

Setting: The study was conducted in a preanaesthesia assessment clinic in a tertiary referral hospital in SubSaharan Africa. Participants The study had a sample size of 128, including all patients above the age of 18 scheduled for elective surgery under any modality of anaesthesia other than local anaesthesia presenting to the …

Measuring The Patient Safety Culture At A Tertiary Care Hospital In Pakistan Using The Hospital Survey On Patient Safety Culture (Hsopsc), Fasih Ali Ahmed, Fozia Asif, Tahir Munir, Sohail Haleem, Zehra Feroze Ali, Asim Belgaumi, Hasnain Zafar, Asad Latif

Department of Anaesthesia

Background: Patient safety is a top priority for many healthcare organisations worldwide. However, most of the initiatives aimed at the measurement and improvement of patient safety culture have been undertaken in developed countries. The purpose of this study was to measure the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC).
Methods: The HSOPSC was used to measure the patient safety culture across 12 dimensions at Aga Khan University Hospital, Karachi. 2,959 individuals, who had been working at the hospital, were administered the HSOPSC in paper form between June and …

Machine Learning For Accurate Estimation Of Fetal Gestational Age Based On Ultrasound Images, Lok Hin Lee, Elizabeth Bradburn, Rachel Craik, Mohammad Yaqub, Shane A. Norris, Leila Cheikh Ismail, Eric O. Ohuma, Fernando C. Barros, Maria Carvalho, Shama Munim, Zulfiqar Ahmed Bhutta

Obstetrics and Gynaecology, East Africa

Accurate estimation of gestational age is an essential component of good obstetric care and informs clinical decision-making throughout pregnancy. As the date of the last menstrual period is often unknown or uncertain, ultrasound measurement of fetal size is currently the best method for estimating gestational age. The calculation assumes an average fetal size at each gestational age. The method is accurate in the first trimester, but less so in the second and third trimesters as growth deviates from the average and variation in fetal size increases. Consequently, fetal ultrasound late in pregnancy has a wide margin of error of at …

Pattern And Trends Of Helicobacter Pylori Genotypes In Gastric Cancer: A Kenyan 8-Year Study, Priscilla Njenga, Allan Njau, Zahir Moloo, Gunturu Revathi, Evariste Tshibangu, Yoshio Yamaoka

Pathology, East Africa

Background: Notable geographic and temporal variations in the prevalence and genotypes of Helicobacter pylori, in relation to gastric pathologies, have been observed; however, their significance and trends in African populations is scarcely described. The aim of this study, was to investigate the association of H. pylori and its respective CagA and vacuolating cytotoxin A (VacA) genotypes with gastric adenocarcinoma, and to describe the trends of H. pylori genotypes over an 8-year period (2012–2019).

Materials and methods: A total of 286 samples of gastric cancer cases and benign controls (one-to-one matching), from three main cities in Kenya, between …

Lipoprotein(A) In Atherosclerotic Cardiovascular Disease And Aortic Stenosis: A European Atherosclerosis Society Consensus Statement, Florian Kronenberg, Samia Mora, Erik S G Stroes, Brian Ference Ference Ference, Benoit J. Arsenault, Lars Berglund, Marc R. Dweck, Marlys Koschinsky, Gilles Lambert, Salim S. Virani

Office of the Provost

This 2022 European Atherosclerosis Society lipoprotein(a) [Lp(a)] consensus statement updates evidence for the role of Lp(a) in atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis, provides clinical guidance for testing and treating elevated Lp(a) levels, and considers its inclusion in global risk estimation. Epidemiologic and genetic studies involving hundreds of thousands of individuals strongly support a causal and continuous association between Lp(a) concentration and cardiovascular outcomes in different ethnicities; elevated Lp(a) is a risk factor even at very low levels of low-density lipoprotein cholesterol. High Lp(a) is associated with both microcalcification and macrocalcification of the aortic valve. Current findings do …

Emerging Therapeutic Strategies For Diffuse Intrinsic Pontine Glioma: A Systematic Review, Shahrukh Farrukh, Shagufta Habib, Amna Rafaqat, Zouina Sarfraz, Azza Sarfraz, Muzna Sarfraz, Karla Robles-Velasco, Miguel Felix, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Background: Of all central nervous systems tumors, 10-20% are located in the brainstem; diffuse intrinsic pontine glioma (DIPG) is diagnosed in 80% of them. With over five decades of clinical trial testing, there are no established therapeutic options for DIPG. This research article aims to collate recent clinical trial data and provide a landscape for the most promising therapies that have emerged in the past five years.
Methods: PubMed/MEDLINE, Web of Science, Scopus, and Cochrane were systematically searched using the following keywords: Diffuse intrinsic pontine glioma, Pontine, Glioma, Treatment, Therapy, Therapeutics, curative, and/or Management. Both adult and pediatric patients with …

Adapting International Clinical Trials During Covid-19 And Beyond, Kamala Thriemer, Kamala Thriemer, Mohammad Shafiul Alam, Bipin Adhikari, Rupam Tripura, Mohammad Sharif Hossain, Michael Christian, Najia Bano Ghanchi, Hellen Mnjala, Muhammad Asim

Department of Pathology and Laboratory Medicine

Background: The COVID-19 pandemic and resulting restrictions, particularly travel restrictions, have had significant impact on the conduct of global clinical trials. Our clinical trials programme, which relied on in-person visits for training, monitoring and capacity building across nine low- and middle-income countries, had to adapt to those unprecedented operational challenges. We report the adaptation of our working model with a focus on the operational areas of training, monitoring and cross-site collaboration.
The new working model: Adaptations include changing training strategies from in-person site visits with three or four team members to a multi-pronged virtual approach, with generic online training for …

The Clinical And Genetic Spectrum Of Autosomal-Recessive Tor1a-Related Disorders, Afshin Saffari, Tracy Lau, Homa Tajsharghi, Ehsan Ghayoor Karimiani, Ariana Kariminejad, Stephanie Efthymiou, Giovanni Zifarelli, Tipu Sultan, Mehran Beiraghi Toosi, Shahnaz Ibrahim

Department of Paediatrics and Child Health

In the field of rare diseases, progress in molecular diagnostics led to the recognition that variants linked to autosomal-dominant neurodegenerative diseases of later onset can, in the context of biallelic inheritance, cause devastating neurodevelopmental disorders and infantile or childhood-onset neurodegeneration. TOR1A-associated arthrogryposis multiplex congenita 5 (AMC5) is a rare neurodevelopmental disorder arising from biallelic variants in TOR1A, a gene that in the heterozygous state is associated to torsion dystonia-1 (DYT1 or DYT-TOR1A), an early-onset dystonia with reduced penetrance. While 15 individuals with TOR1A-AMC5 have been reported (less than 10 in detail), a systematic investigation of the full disease-associated spectrum has …

Socioecological Factors Linked With Pharmaceutical Incentive-Driven Prescribing In Pakistan, Muhammad Naveed Noor, Afifah Rahman-Shepherd, Amna Rehana Siddiqui, Wafa Aftab, Sadia Shakoor, Rumina Hasan, Mishal Khan

Department of Pathology and Laboratory Medicine

Pharmaceutical marketing through financial incentivisation to general practitioners (GPs) is a poorly studied health system problem in Pakistan. Pharmaceutical incentivisation is seen to be distorting GPs prescribing behaviour that can compromise the health and well-being of patients. We draw on a conceptual framework outlined in the ecological system theory to identify multiple factors linked with pharmaceutical incentivisation to GPs in Pakistan. We conducted qualitative interviews with 28 policy actors to seek their views on the health system dynamics, how they sustain pharmaceutical incentivisation and their effect on the quality of care. Our analysis revealed four interlinked factors operating at different …

Pulse Oximetry: Why Oxygen Saturation Is Still Not A Part Of Standard Pediatric Guidelines In Low-And-Middle-Income Countries (Lmics), Maheen Sheikh, Huzaifa Ahmad, Romesa Ibrahim, Muhammad Imran Nisar, Fyezah Jehan

Department of Paediatrics and Child Health

Background: With the high frequency of acute respiratory infections in children worldwide, particularly so in low-resource countries, the development of effective diagnostic support is crucial. While pulse oximetry has been found to be an acceptable method of hypoxemia detection, improving clinical decision making and efficient referral, many healthcare set ups in low- and middle-income countries have not been able to implement pulse oximetry into their practice.
Main body: A review of past pulse oximetry implementation attempts in low- and middle-income countries proposes the barriers and potential solutions for complete integration in the healthcare systems. The addition of pulse oximetry into …

Spontaneous Large Volume Hemothorax Managed With A Small-Bore Chest Tube, Moiz Salahuddin, Samia Ayub

Department of Medicine

A 67-year-old male with metastatic lung cancer presented with acute shortness of breath and increasing oxygen requirements. He had a decreasing hemoglobin for which he required red blood cell transfusions. His chest x-ray showed near complete white-out of the left lung. Bedside ultrasound (Handheld Sonostar C4PL) showed a large pleural effusion with swirling echogenic material suggestive of plankton sign. The pleural effusion was aspirated and showed frank blood, after which a small-bore chest tube (SBCT) was inserted. A total of 3200ml of blood was drained with the SBCT. There was complete clearance of the pleural space, and no further blood …

Capture Als: The Comprehensive Analysis Platform To Understand, Remedy And Eliminate Als, Vincent Picher-Martel, Claire Magnussen, Mathieu Blais, Tania M. Bubela, Samir Das, Annie Dionne, Alan C. Evans, Angela Genge, Russell Greiner, Yasser Iturria-Medina

Office of the Provost

The absence of disease modifying treatments for amyotrophic lateral sclerosis (ALS) is in large part a consequence of its complexity and heterogeneity. Deep clinical and biological phenotyping of people living with ALS would assist in the development of effective treatments and target specific biomarkers to monitor disease progression and inform on treatment efficacy. The objective of this paper is to present the Comprehensive Analysis Platform To Understand Remedy and Eliminate ALS (CAPTURE ALS), an open and translational platform for the scientific community currently in development. CAPTURE ALS is a Canadian-based platform designed to include participants' voices in its development and …

Prevalence Of Non-Alcoholic Fatty Liver Disease In Overweight And Obese Children Seeking Ambulatory Healthcare In Nairobi, Kenya, Anne Njeri Mburu, Ahmed Laving, William Macharia, Joyce Sande

Paediatrics and Child Health, East Africa

Background While linked to obesity and associated with an increased cardiovascular morbidity, non-alcoholic fatty liver disease (NAFLD) is an often-asymptomatic cause of chronic liver disease in children. Early detection provides opportunity for interventions to curb progression. Childhood obesity is on the rise in low/middle-income countries, but cause-specific mortality data associated with liver disease are scanty. Establishing the prevalence of NAFLD in overweight and obese Kenyan children would guide in public health policies aimed at early screening and intervention.

Objectives To investigate prevalence of NAFLD in overweight and obese children aged 6–18 years using liver ultrasonography.

Methodology This was a cross-sectional …

Comparison Of Premature, Extremely Premature, And Older Adults With Coronary Artery Disease In Pakistan, Waqas Ullah, Rehan Malik, Faiza Bashir, Mustafa Khan, Saud Khan, Mahboob Alam, Zainab Samad, Miguel C. Achirica, Salim S. Virani, Bashir Hanif

Section of Cardiology

No abstract provided.

The Efficacy Of Blended Learning In A Pediatric Spine Deformity Management Program In Sub-Saharan Africa, Alaaeldin Ahmad, Abdallah Abushehab, François Waterkeyn, Beverly Cheserem, Massimo Balsano, Christopher Bonfield, Hamisi Shabani, Juma Magogo, Bryson Mcharo, Costansia Bureta

General Surgery, East Africa

Introduction: Our study assessed the efficacy of blended learning, which combines in-person learning and e-learning, in a pediatric scoliosis training program through an international collaborative effort.

Methods: The course comprised two parts: the online portion, where participants reviewed educational materials for 3 weeks and met with faculty once/week for discussion, and the in-person session, where participants reviewed cases in a team-based approach and came to a consensus on treatment strategy, followed by discussion with an international expert. All participants completed a needs assessment (NA) and clinical quiz at three points: before the course, after the online session, and after the …

Clinical Risk Factors Of Adverse Outcomes Among Women With Covid-19 In The Pregnancy And Postpartum Period: A Sequential, Prospective Meta-Analysis, Emily R. Smith, Erin Oakley, Gargi Wable Grandner, Gordon Rukundo, Fouzia Farooq, Kacey Ferguson, Sasha Baumann, Kristina Adams Waldorf, Yalda Afshar, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: This sequential, prospective meta-analysis (sPMA) sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to: disease severity, maternal morbidities, neonatal mortality and morbidity, adverse birth outcomes.

Data sources: We prospectively invited study investigators to join the sPMA via professional research networks beginning in March 2020.

Study eligibility criteria: Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area.

Study appraisal and synthesis methods: We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and …

Generalisability Of Fetal Ultrasound Deep Learning Models To Low-Resource Imaging Settings In Five African Countries, Carla Sendra-Balcells, Víctor M. Campello, Jordina Torrents-Barrena, Yahya Ali Ahmed, Mustafa Elattar, Benard Ohene-Botwe, Pempho Nyangulu, William Stones, Sikolia Wanyonyi, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Most artificial intelligence (AI) research and innovations have concentrated in high-income countries, where imaging data, IT infrastructures and clinical expertise are plentiful. However, slower progress has been made in limited-resource environments where medical imaging is needed. For example, in Sub-Saharan Africa, the rate of perinatal mortality is very high due to limited access to antenatal screening. In these countries, AI models could be implemented to help clinicians acquire fetal ultrasound planes for the diagnosis of fetal abnormalities. So far, deep learning models have been proposed to identify standard fetal planes, but there is no evidence of their ability to generalise …

Improving Nursing Education Curriculum As A Tool For Strengthening The Nurse–Client Relationships In Maternal And Child Healthcare: Insights From A Human-Centered Design Study In Rural Tanzania, Kahabi Isangula, Eunice Pallangyo, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Background. There are growing evidence of poor nurse–client relationships in maternal and child health (MCH). The nursing curriculum forms an important entry point for strengthening such relationships, consequently improving client satisfaction with nurses' competencies, confidence in the formal healthcare system, healthcare-seeking practices, continuity with care, and MCH outcomes.

Objective. MCH nurses and clients were invited to design an intervention package (prototype) to improve nurse–client relationships using a human-centered design (HCD) approach.

Methods. A multi-step HCD approach was employed to first examine the contributors of poor nurse–client relationships using nine focus group discussions with nurses and clients and 12 key informant …

Preparedness, Resilience And Unmet Needs Of Informal Caregivers Of Advanced Cancer Patients In A Regional Mission Hospital In Kenya: Qualitative Study, Too Wesley, Faith Lelei, Mary Adam, Pete Halestrap

School of Nursing & Midwifery, East Africa

Background: Cancer is the third highest cause of death in Kenya. Eighty percent of cancer cases arrive at advanced stages, when there is nothing that can be done to cure them, and palliative care is the best alternative. Although the majority of end-of-life care in Kenya is provided at home, little is known about the caregivers’ preparedness, resilience and continued unmet needs. The goal of this qualitative study was to explore caregivers’ perceived preparedness, resilience and continued unmet needs in their caregiving role to patients with advanced stages of cancer.

Methods: A purposive sampling method was used to identify and …

Social Support And The Effects Of The Covid-19 Pandemic Among A Cohort Of People Living With Hiv (Plwh) In Western Kenya, Adel Mburia-Mwalili, Karla D. Wagner, Edith Kamaru Kwobah, Lukoye Atwoli, Maurice Aluda, Brianna Simmons, Jayne Lewis-Kulzer, Suzanne Goodrich, Kara Wools-Kaloustian, Jennifer L. Syvertsen

Internal Medicine, East Africa

As coronavirus disease (COVID-19) was declared a pandemic in 2020, countries around the world implemented various prevention strategies, such as banning of public and social gatherings, restriction in movement, etc. These efforts may have had a deleterious effect on already vulnerable populations, including people living with HIV (PLWH). PLWH were concerned about contracting COVID-19, the impact of COVID-19 on their social networks that provide social support, and the continued availability of antiretroviral medications during the pandemic. In addition, their mental health may have been exacerbated by the pandemic. The purpose of this study was to explore pandemic-related concerns among a …

Caesarean Section For Placenta Previa: A Retrospective Cohort Study Of Anaesthesia Techniques, Samina Ismail, Saima Rashid

Department of Anaesthesia

Objective: Placenta previa is associated with maternal and neonatal morbidity and mortality. This study aims to add to the limited literature from the developing world on the association of different anaesthetic techniques with blood loss, the need for blood transfusion, and maternal/ neonatal outcomes among women undergoing caesarean section with placenta previa.
Methods: This retrospective study was conducted at Aga University Hospital, Karachi, Pakistan. The patient population included parturients undergoing caesarean section for placenta previa from January 1, 2006, through December 31, 2019.
Results: Out of 276 consecutive cases of placenta previa progressing to caesarean section during the study period, …

Inspire : Vol 6, Issue 2, Department Of Medicine

INSPIRE – Department of Medicine Archives

• Message from the Chair
• Medicine at National and International Forums
• Pan Arab Union of Neurological Societies
• APPNA Merit HIV Awareness, Prevention and Education Project in Pakistan
• International Women Leaders Summit
• Early Career Researcher Training Grant – The Association of Commonwealth Universities
• Life Saving Training in Sindh under PLSP by AKU
• In-depth- featuring Dr Osman Faheem
• Featured Person: Dr. Saadia Farooqui | Senior Manager “You’ll never know how strong you are, until being strong is the only choice you have”
• Poem Section - If by Rudyard Kipling
• What are Academics Around the World Reading This Month?
• Publications

Patient-Level And System-Level Determinants Of Stroke Fatality Across 16 Large Hospitals In Ghana And Nigeria: A Prospective Cohort Study, Fred S. Sarfo, Onoja M. Akpa, Bruce Ovbiagele, Albert Akpalu, Kolawole Wahab, Reginald Obiako, Morenikeji Komolafe, Lukman Owolabi, Godwin Ogbole, Philip Adebayo

Internal Medicine, East Africa

Background: Every minute, six indigenous Africans develop new strokes. Patient-level and system-level contributors to early stroke fatality in this region are yet to be delineated. We aimed to identify and quantify the contributions of patient-level and system-level determinants of inpatient stroke fatality across 16 hospitals in Ghana and Nigeria.

Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicentre study involving 16 sites in Ghana and Nigeria. Cases include adults (aged ≥18 years) with clinical and radiological evidence of an acute stroke. Data on stroke services and resources available at each study site were collected and analysed as …

Does Mainstream Brca Testing Affect Surgical Decision-Making In Newly-Diagnosed Breast Cancer Patients?, Quratul Ain, Caroline Richardson, Miriam Mutebi, Angela George, Zoe Kemp, Jennifer E. Rusby

General Surgery, East Africa

Background: Germline pathogenic variants mutations) in the BRCA1 and BRCA2 genes cause an increased risk of breast cancer and ovarian cancer. Mainstream cancer genetic testing (MCG) was introduced for breast cancer patients in our unit in 2013. Non-geneticist clinicians have been trained to offer genetic testing during initial treatment planning. We assessed the impact of timely test results on surgical decision-making.

Methods: Women who had undergone mainstream genetic testing for breast cancer between September 2013 and September 2018 were identified from a prospective database. Surgical data were collected retrospectively.

Results: 580 eligible women had mainstream genetic testing. …

Monoclonal Antibodies, Gene Silencing And Gene Editing (Crispr) Therapies For The Treatment Of Hyperlipidemia-The Future Is Here, Melody Hermel, Madison Lieberman, Leandro Slipczuk, Jamal S. Rana, Salim S. Virani

Office of the Provost

Hyperlipidemia is a significant risk factor for atherosclerotic cardiovascular disease. Undertreatment of elevated lipids persists despite existing therapies. Here, we provide an update on monoclonal antibodies, gene silencing therapies, and gene editing techniques for the management of hyperlipidemia. The current era of cutting-edge pharmaceuticals targeting low density lipoprotein cholesterol, PCSK9, lipoprotein (a), angiopoietin-like 3, and apolipoprotein C3 are reviewed. We outline what is known, studies in progress, and futuristic goals. This review of available and upcoming biotechnological lipid therapies is presented for clinicians managing patients with familial hyperlipidemia, statin intolerance, hypertriglyceridemia, or elevated lipoprotein (a) levels.

Frequency Of Von Willebrand Disease And Its Types: Data From A Tertiary Care Hospital Of Karachi, Pakistan, Jyoti Mohan Lal, Anila Rashid, Natasha Ali

Department of Pathology and Laboratory Medicine

Introduction: von Willebrand disease is the most common inherited bleeding disorder. It is classified into 3 main types, type I and III are quantitative defects whereas type II is qualitative defect which is further sub-classified in to II-A, II-B, II-M, II-N. The aim of the present study is to see frequency and types of von Willebrand disease in a tertiary care hospital of Karachi, Pakistan.
Materials and methods: This retrospective cross-sectional study was conducted in the section of Hematology and Transfusion Medicine, Department of Pathology and Laboratory Medicine, the Aga Khan University hospital, Karachi, from May 2020 to April 2021 …

Protocol For Validation Of The Global Scales For Early Development (Gsed) For Children Under 3 Years Of Age In Seven Countries, Vanessa Cavallera, Gillian Lancaster, Melissa Gladstone, Maureen M. Black, Gareth Mccray, Ambreen Nizar, Salahuddin Ahmed, Muhammad Imran Nisar, Farzana Begum, Fyezah Jehan

Department of Paediatrics and Child Health

Introduction: Children's early development is affected by caregiving experiences, with lifelong health and well-being implications. Governments and civil societies need population-based measures to monitor children's early development and ensure that children receive the care needed to thrive. To this end, the WHO developed the Global Scales for Early Development (GSED) to measure children's early development up to 3 years of age. The GSED includes three measures for population and programmatic level measurement: (1) short form (SF) (caregiver report), (2) long form (LF) (direct administration) and (3) psychosocial form (PF) (caregiver report). The primary aim of this protocol is to validate …

A Qualitative Description Of Barriers To Visual Rehabilitation Experienced By Stroke Survivors With Visual Impairment In Alberta, Canada, Kiran Pohar Manhas, Katelyn Brehon, Jennis Jiang, Karim F. Damji, Fiona Costello

Department of Ophthalmology & Visual Sciences

Background: Post-stroke visual impairment (VI) is a common but under-recognized care challenge. Common manifestations of post-stroke VI include: diplopia, homonymous hemianopia, oscillopsia secondary to nystagmus, and visual inattention or neglect. In acute care settings, post-stroke VI recognition and treatment are often sub-optimal as emphasis is placed on survival. Stroke survivors with VI often face inconsistencies when accessing care out of hospital because variable availability and subsidization of visual rehabilitation. We sought to identify gaps in care experienced by stroke survivors with VI from stroke survivors' and care providers' perspectives.
Methods: We conducted a qualitative description study across 12 care sites …

"Women Are Again Unsafe": Preventing Violence And Poor Maternal Outcomes During Current Floods In Pakistan, Sarmad Muhammad Soomar, Abir Arefin, Salman Muhammad Soomar

School of Nursing & Midwifery

No abstract provided.