Family Medicine Commons^™

Barriers, Challenges And Way Forward For Implementation Of Person Centered Care Model Of Patient And Physician Consultation: A Survey Of Patients’ Perspective From Eastern Mediterranean Countries, Waris Qidwai, Kashmira Nanji, Tawfik A M Khoja, Salman Rawaf, Nabil Yasin Al Kurashi, Faisal Alnasir, Mohammed Ali Al Shafaee, Mariam Al Shetti, Muntazar Bashir, Nagwa Eid Sobhy Saad, Sanaa Alkaisi, Wafa Halasa, Huda Al Duwaisan, Amal Al- Ali

Department of Family Medicine

Background: Person-Centered Care (PCC) is now considered a mandatory approach in Patient-Physician consultation. The aim of the study was to identify patients’ perception regarding barriers and possible remedies for implementation of PCC in Eastern Mediterranean Region (EMR).
Methods: A cross-sectional multi-country study was conducted in six countries of EMR during May 2014 to October 2014. Expert Family Physicians from each country were identified and asked to participate in the study. The Family Physicians then recruited Patients from their own clinics (>18 years). Data analysis was performed on SPSS 19 and results are reported in the form of …

Psychosocial Risk Factors For Acute Myocardial Infarction: Results Of A Case-Control Study In A Teaching Hospital At Karachi, Pakistan, Kiran Abdul Sattar, Waris Qidwai, Kashmira Nanji

Department of Family Medicine

Objective: To determine psychosocial risk factors for acute myocardial infarction at a teaching hospital in Karachi. Methods: One hundred and fifty three cases were recruited from cardiology clinics and 153 controls from internal medicine and family medicine clinics of Aga Khan University Hospital, Karachi, through non-probability sampling using a structured questionnaire. Cases were those who were diagnosed with acute myocardial infarction for the first time in past month. Controls were selected from family medicine and internal medicine clinics of the same hospital and included patients above the age of 40 years without acute myocardial infarction. Associations between psychosocial risk …

Experiences Of Parents Caring For Infants With Rare Scalp Mass As Identified Through A Disease-Specific Blog, Miranda Worthen, Tara Leonard, Thomas Blair, Nalin Gupta

Faculty Publications

Background: Delayed subaponeurotic fluid collection (DSFC) is a self-limited disorder of unknown etiology characterized by a benign, fluid-filled mass in the subaponeurotic layer of an infant's scalp. While a few case series describe DSFC, the experiences of families whose infants develop this condition have not previously been reported.Methods: We used a disease-specific blog to evaluate the experiences of 69 families affected by DSFC. We identified self-reported clinical features of DSFC and qualitatively analyzed the families' experiences with obtaining a diagnosis and care for their infants.Results: Infants presented in several clinical settings, and multiple diagnostic procedures were administered, including ultrasound (46%), …

Can Trained Field Community Workers Identify Stroke Using A Stroke Symptom Questionnaire As Well As Neurologists? Adaptation And Validation Of A Community Worker Administered Stroke Symptom Questionnaire In A Peri-Urban Pakistani Community., Maria Khan,, Ayeesha Kamran Kamal, Muhammad S. Ilyas, Muhammad Islam, Iqbal Azam Syed, Azam Virk,, Alia Nasir, Hasan Rehman,, Anita Arif,, Muhammad Jan,, Anjum Akhtar,, Minaz Mawani, Junaid Abdul Razzak,, Omrana Pasha

Department of Medicine

Background: Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by Community Health Workers (CHWs) are required to identify stroke in the community in a resource strapped region such as this.

Methods: The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire for Verifying Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community dwelling subjects using purposive sampling. Each CHW collected data independently which was validated by a vascular neurologist who …

Improving Community Case Management Of Diarrhoea And Pneumonia In District Badin, Pakistan Through A Cluster Randomised Study--The Nigraan Trial Protocol, Fauziah Rabbani, Aftab A. Ali Mukhi, Shagufta Perveen, Xaher Gul, Saleem Iqbal Perwaiz, Shamim Ahmed Qazi, Iqbal Azam Syed, Khalid Hussain Shaikh, Wafa Aftab

Community Health Sciences

BACKGROUND:

Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan's Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community casemanagement (CCM) of childhood pneumonia and diarrhoea will improve.

METHODS/DESIGN:

NIGRAAN …

Vaccine Effectiveness And Risk Factors Associated With Measles Among Children Presenting To The Hospitals Of Karachi, Pakistan., Aysha Zahidie, Saba Wasim, Zafar Fatmi

Community Health Sciences

OBJECTIVE:

To determine the risk factors regarding guardian's practices associated with development of Measles and also find out effectiveness of Measles vaccine among children less than 12 years of age presenting to the hospitals of Karachi.

STUDY DESIGN:

Matched case control study.

PLACE AND DURATION OF STUDY:

Multicenter surveillance was conducted in 11 public and private sector hospitals of Karachi from January 2011 to September 2012 in consultation with World Health Organization Measles Surveillance Cell.

METHODOLOGY:

Cases were children aged less than 12 years with Measles presenting to the hospitals. Controls for cases were enrolled from the same hospitals without …

Effects Of Polypharmacy On Adverse Drug Reactions Among Geriatric Outpatients At A Tertiary Care Hospital In Karachi: A Prospective Cohort Study., Bilal Ahmed, Kashmira Nanji, Rakshinda Mujeeb, Muhammad Junaid Patel

Department of Medicine

Background: Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, ‘‘concurrent use of five or more different prescription medication’’. Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center.

Methods: A hospital based prospective cohort study was conducted at ambulatory care clinics of Aga Khan University …

Epidemiology, Determinants And Dynamics Of Cholera In Pakistan: Gaps And Prospects For Future Research., Maliha Naseer, Tanzil Jamali

Community Health Sciences

Cholera is one of the notifiable endemic diseases in Pakistan, but the reporting of cholera cases is still unsatisfactory. Most of the diagnosed cases are never reported to the relevant authorities. In the year 1993 - 2005, the country did not report any single case of cholera to the WHO. The objectives of this review were to understand the epidemiology and to identify the possible determinants of cholera infection in Pakistan. Medscape, Medline, PakMedinet and PubMed, was searched, using key words, epidemiology and determinants of cholera infection in Pakistan during 1995 - 2010. Morbidity and mortality due to cholera infection …

Training A Workforce For Primary Care, K. Van Sickle, A. Beecham, Jodi Polaha

ETSU Faculty Works

No abstract provided.

Factors Associated With Intimate Partner Violence Against Women In A Mega City Of South-Asia: Multi-Centre Cross-Sectional Study, Niloufer S. Ali, Farzana N. Ali, Ali K. Khuwaja, Kashmira Nanji

Department of Family Medicine

Objectives: To assess the proportion of women subjected to intimate partner violence and the associated factors, and to identify the attitudes of women towards the use of violence by their husbands. Design: Cross-sectional study.
Setting: Family practice clinics at a teaching hospital in Karachi, Pakistan.
Participants: A total of 520 women aged between 16 and 60 years were consecutively approached to participate in the study and interviewed by trained data collectors. Overall, 401 completed questionnaires were available for analysis. Multivariate logistic regression analysis was used to identify the association of various factors of interest.
Results: In all, 35% of …

Clinical, Lifestyle, Socioeconomic Determinants And Rate Of Asymptomatic Intracranial Atherosclerosis In Stroke Free Pakistanis., Ayeesha Kamran Kamal, Farzin Majeed, Omrana Pasha, Hasan Rehman, Muhammad Islam, Iqbal Azam Syed, Muhammad Saleem Ilyas, Munawar Hussain, Kamran Masood, Bilal Ahmed, Sumaira Nazir, Zafar Sajjad, Scott E. Kasner

Department of Medicine

Background: Intracranial Atherosclerotic Disease (ICAD) is the most frequent etiology of stroke with high prevalence among Asians. Despite this, early determinants of ICAD have not been described from this region.

Methods: The study is an analytical prospective cross-sectional study of 200 adults from Radiology Departments of two diagnostic centers in Karachi. Eligible participants confirmed the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS) and underwent an interview covering medical, socio demographic, lifestyle and anthropometric evaluation using locally validated and standardized definitions. Magnetic Resonance Images (MRI) were centrally reviewed to detect ICAD using the criterion used …

Rural Parents’ Perceived Stigma Of Seeking Mental Health Services For Their Children: Development And Evaluation Of A New Instrument, Stacey L. William, Jodi Polaha

ETSU Faculty Works

The purpose of our research was to examine the validity of score interpretations of an instrument developed to measure parents’ perceptions of stigma about seeking mental health services for their children. The validity of the score interpretations of the instrument was tested in 2 studies. Study 1 employed confirmatory factor analysis (CFA), using a split half approach, and construct and criterion validity on data from the entire sample of parents in rural Appalachia whose children were experiencing psychosocial concerns (N = 347), while Study 2 employed CFA, construct and criterion validity, and predictive validity of the scores on data from …

Unique Interdisciplinary Public Health Model Doubles Latent Tuberculosis Infection Treatment Completion Of Refugee Patients In A Large Metropolitan Area, Christine O'Leary, Pharmd, Kevin Scott, Md, Marc Altshuler, Md, Karen Kitagawa-James, Rn, Bsn, Maria Hervada-Paige, Mss

Department of Family & Community Medicine Presentations and Grand Rounds

Background and Purpose:

The Jefferson Center for Refugee Health (JCRH), a component of Jefferson Family Medicine Associates (JFMA), is the first and largest single provider of refugee health in Philadelphia; over 1,000 refugee primary care visits are provided annually. Refugee patients are disproportionately affected by latent tuberculosis infection (LTBI) compared to the general population of the United States; and though treatment of LTBI is highly effective at reducing conversion to active tuberculosis (TB), completion rates among the foreign-born are reported to be less than 50%. To establish baseline LTBI incidence and treatment completion rates for our refugee population, the JCRH …

An Update On Breast Cancer Screening And Prevention., Maria Syl D. De La Cruz, Mona Sarfaty, Richard C Wender

Department of Family & Community Medicine Faculty Papers

The goal of this article is to provide clinical guidance on breast cancer screening and prevention in primary care. The discussion highlights the importance of risk assessment, including screening options and risk-reduction strategies, for women at average and high risk. We review recommendations for breast cancer screening, evaluate current evidence on primary prevention, examine current practice patterns, and consider the impact of recent changes within health care.

Prevalence, Determinants, And Management Of Chronic Kidney Disease In Karachi, Pakistan - A Community Based Cross-Sectional Study., Saleem Jessani, Rasool Bux, Tazeen Jafar

Community Health Sciences

BACKGROUND:

Chronic kidney disease (CKD) is increasing being recognized as a global public health problem. However, there is dearth of information on the prevalence, determinants, and management of CKD from low- and middle-income countries. The objectives of the study were to determine the 1) prevalence of CKD; 2) socio-demographic and clinical factors associated with CKD; and 3) the existing management of these patients with regards to blood pressure control, and use of antihypertensive medications.

METHODS:

We conducted a cross-sectional study on 2873 participants aged ≥ 40 years in 12 representative communities in Karachi, Pakistan. The primary outcome was clinically significant …

Predictors Of Marital Satisfaction In Couples That Include A Physician Partner, Glenda F. Stockwell, Ivy A. Click, Jessee D. Gilreath, Erin Elizabeth Harris

ETSU Faculty Works

It is estimated that the divorce rate for marriages in which at least one party is a physician is 10-20% higher than the general population. Predicting the variables that contribute to marital satisfaction, identifying the skills associated with those behaviors and developing a residency curriculum to teach the skills to resident physicians is the focus of this study. Intimacy, conflict resolution and emotional expressiveness have all been identified as important aspects of marital satisfaction. We will determine how each of these variables contributes to marital satisfaction using multilevel logistic regression. The results will be used to develop a skills based …

Cancer Screening 2014, Richard C. Wender, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Presentation celebrating 40th reunion symposium for the Department of Family and Community Medicine at Thomas Jefferson University Hospital.

Presentation outline includes:

Breast, Colon, Lung and Prostate Cancer

Learning objective: Apply new cancer screening guidelines to primary care physicians

Validation Of A Food Frequency Questionnaire For Assessing Macronutrient And Calcium Intake In Adult Pakistani Population, Romaina Iqbal, Mohammad Ali Haroon, Farhan Javed Dar, Mujtaba Bilgirami, Gulshan Bano, Aysha Habib Khan

Community Health Sciences

Objective: To develop and validate a food frequency table (FFQ) for use in urban Pakistani population.
Study design: A validation study.
Place and duration of study: The Aga Khan University, Karachi, from June to November 2008.
Methodology: Healthy adult females, aged ³ 18 years who consented to be included in the study were inducted, while males, unhealthy females, aged below 18 years or who did not consent were excluded. The FFQ was administered once while 4, 24 hours recalls spread over a period of one year were administered as the reference method. Daily intakes for energy, protein, fat, and calcium …

Challenging Situations In Family Centered Rounds: Making The Best Out Of Worst Case Scenarios, Priti Bhansali, Kerry Moss, Christiane Corriveau, Geeta Singhal, Robert Kavanagh, Jeffrey Simmons

E-Learning Modules

This resource is a workshop intended for both seasoned and novice health care providers who are interested in becoming prepared for challenging scenarios that may be encountered during FCR. Case scenarios of challenging situations relating to discussing sensitive topics, correcting errors, and teaching learners in front of both parents and patients are presented. Tangible opportunities to role model communication skills, efficiency, and teaching skills for trainees are highlighted. The session will conclude with a question and answer session with a multi-specialty panel to share experiences and strategies for addressing the unexpected during FCR. By the end of the workshop, participants …

Can Clinical Decision Support Improve Medication Safety In The Ambulatory Setting?, B. Keber

Journal Articles

No abstract provided.