Perceptions of patients on doctors' and nurses' non-verbal communication in Lahore, Pakistan: a phenomenological study

Objective: The study identifies and determines the frequency and types of non-verbal behaviours of doctors and nurses as perceived by patients and elucidates their effect on healthcare delivery

Study Design: Descriptive study

Place and Duration of the Study: The study is conducted in outpatient departments of Red Crescent Hospital, Dina Nath and Fatima Memorial Hospital, Lahore, Pakistan, for a period of 2 weeks

Patients and Methods: Semi-structured Interviews of 40 patients [20 from each hospital] coming for their appointments are conducted and analysed by Heidegger's Phenomenological principles. Purposive sampling method is used to recruit the volunteer patients from various socio-economic strata in this study

Results: The findings revealed that majority of the patients [80 percent=32] perceived non-verbal behaviours of the professionals spontaneously. The most frequent behaviours affecting healthcare delivery were facial expressions and the tone of voice. It was found that age, class and education are the factors that affect patients' perceptions. In total fourteen kinds of non-verbal behaviours were perceived by the patients amounting to 139 repetitions. The researchers have analysed only those non-verbal cues in the study that were found most frequently

Conclusion: Non-verbal communication plays a significant role for the development of interpersonal relationship between doctors, nurses and patients. As many messages are transmitted paralinguistically, the health professionals must be trained to understand and gauge their own non-verbal cues towards the patients

Comparison of power point presentation, transparency overhead projector [TOHP] and black board for undergraduate medical teaching

Use of technology in modern education is inevitable. Nowadays the most common ways of lecture delivery include PowerPoint presentation, transparency overhead projector [TOHP] and black board [chalk and talk] methods. Limited researches are available to compare the effectiveness of these teaching tools in public sector universities of Pakistan. Our Objective was to compare the students' perception regarding these three teaching tools in Dow Medical College Karachi. A cross sectional, questionnaire based study. This study was conducted at Dow Medical College, Karachi from April to September 2010. A cross sectional, questionnaire based, study was done. Questionnaire consists of MCQs, grading and open ended questions. A sample size of 314 subjects was taken including students from all current batches in Dow Medical College, Karachi. Information was collected to compare different features among Power Point presentation, transparency overhead projector [TOHP] and black board [chalk and talk] tools. Our study depicted that student overall preferred the use of PowerPoint presentation in lectures than blackboard and overhead projector. The students have a more favorable response towards PowerPoint presentation than Blackboard and Transparency for better inclusion of content, understanding of text and figures, use of examples and illustrations and for summarizing the lecture. [p=<0.001]. On the other hand, they preferred blackboard over Power Point presentations and transparency for facilitation of interaction between teacher and students, coping with teaching speed and stressing on important and relevant points. [p=<0.001]. The result also indicated that the students considered blackboard and PowerPoint presentation equally effective than transparency to develop interest in learning and to grasp the contents. [p=<0.001]. Our study concluded that PowerPoint presentation and Black Board teachings are equally important and should be used as an instruction tool for their respective aspects of learning. One teaching modality is not enough to cope up with student's level of understanding and thus a combination of modern and traditional style of teaching should be incorporated

update on ABO and RhD prevalence in Pakistan

To document RhD blood groups frequency in Pakistani population. Retrospective. Shifa International Hospital, January 2012 to August 2012. The subject population included healthy donors, in patients, out patients and referred patients to our hospital for blood grouping from January 2007 through December 2011. They were analyzed by ABO standardized grouping protocol, and frequency of each group was recorded. A total of the 47,289 subjects were analyzed and the commonest blood group obtained was B [34.8%] followed by O [31.1%], A [24.2%] and AB [9.9%]. 91.4% of the tested population was RhD positive [91.4%], while only 8.6% were negative for RhD antigen. Our study demonstrates a low RhD negative and universal donor [O negative] population, which emphasizes the need for national RhD negative donor profiling and development of mechanisms for provision of these blood groups during emergency

Chromosomal study for prognostic grouping in chronic lymphocytic leukemia

To determine the frequency of various cytogenetic aberrations in newly diagnosed chronic lymphocytic leukemia [CLL] patients, and their detection rate by cytogenetic and fluorescent In situ hybridization [FISH] technique separately. A case series. Clinical and Molecular Cytogenetics Laboratories, University of California, Los Angeles, USA, from November 2007 to July 2008. Analysis was made on 100 diagnosed chronic lymphocytic leukemia patients. Cytogenetics and FISH technique were performed on blood or bone marrow samples. Nineteen out of 100 cases [19%] showed karyotype abnormalities; whereas 55 showed abnormalities using the CLL - specific FISH probes. The most frequent abnormality detected by standard Cytogenetics was trisomy 12. The most common abnormality detected by FISH was a deletion of 13q14 [40 out of 55 cases; 72% of the abnormal]. For prognostic grouping of CLL patients, FISH must always be requested which may even replace standard karyotyping. These chromosomal markers help in choosing the therapeutic options

Frequency of aspirin resistance in patients with coronory artery disease in Pakistan

Aspirin resistance is an emerging clinical entity. However the data available on aspirin resistance in Asian population is scarce. This study was initiated to prospectively evaluate the frequency of aspirin resistance in patients with stable coronary artery disease [CAD] in Pakistan. A cross sectional prospective study was conducted in cardiology and hematology departments at Shifa International Hospital, Islamabad from January to December 2007. Two hundred and fifty patients were enrolled from cardiology out patient department having met the specific inclusion criteria. Details were entered on a pre-designed questionnaire and aspirin response assay was performed on IMPACT-R [Dia Med AG 1785 Cressier Morat, Switzerland]. Data was analyzed using SPSS V12. Aspirin resistance was observed in 12% of patients. 73.2% of study population were male and 26.8% were female, with a mean age of 57.2 years. There was no significant correlation of aspirin resistance with traditional risk factors like Diabetes Mellitus [DM], Hypertension or Dyslipidemia. 84% of Aspirin non responders were taking 75mg per day and 16% were on 150mg per day. A positive trend was noted between aspirin resistance and cigarette smoking. Aspirin resistance is a real phenomenon in Pakistani population with an estimated frequency of 12%. Large scale prospective randomized trials with long term follow up are needed to assess the impact of different doses and the clinical significance of this biochemical entity

Efficacy and safety of total dose infusion of low molecular weight iron dextran in the treatment of iron deficiency anemia during pregnancy

To determine the efficacy and safety of Total Dose Infusion [TDI] of low molecular weight iron dextran for the treatment of iron deficiency anemia compared to oral iron replacement during pregnancy through improvement in hemoglobin [Hb] after intervention. Non-randomized control trial. Section of Gynaecology and Obstetrics, Shifa International Hospital and Shifa Community Health Centre, Islamabad during January 2005 to January 2006. A group of 100 pregnant women with gestational age greater than 12 weeks with confirmed diagnosis of iron deficiency anemia attending the antenatal clinics were enrolled in this study. Total dose iron infusion of low molecular iron dextran was given to these patients after calculating iron deficit, in a monitored in-patient setting. Control comprised of a second group of 50 pregnant females matched for age, parity and baseline hemoglobin, tolerant to oral iron supplementation [ferrous sulphate 200 mg three times a day] attending the antenatal clinics during the same period. Post-treatment hemoglobin levels of study group as well as the oral control group were determined between 3 to 4 weeks. In the intervention group, mean pre-infusion hemoglobin level was 8.57 +/- 0.9 gm/dl [range 5-10.5gm/dl] and mean post-infusion Hb was 11.0 +/- 1.1 [range 8.4-14. 3 gm/dl]. In control group, mean pre-oral intake Hb level was 9.5 +/- 0.9 gm/dl [range 7-1 0.5 gm/dl] and mean post-oral intake Hb was 10.2 +/- 1.2 gm/dl [range 6.4-1 2.8 gm/dl]. Mean increase of Hb in intervention group was 2.43 gm/dl [95% Cl 2.4 - 3.8] and for controls it was 0.7 gm/dl [95% Cl 0.6-2.3]. Flushing and palpitations were observed in 4% of interventional group patients and none in the control group. No significant adverse reactions were observed in either group. We conclude that the total parenteral iron replacement with low molecular weight iron dextran is an effective and safe method for the treatment of iron deficiency anemia in a selected group of pregnant women

Non-secretory myeloma: a rare variant of multiple myeloma

The spectrum of plasma cell neoplasm represents indolent conditions like Monoclonal Gammopathy of Undetermined Significance [MGUS] to more aggressive multiple myeloma and plasma cell leukemia. Non-secretory myeloma comprises less than 01% of this spectrum where serum protein electrophoresis and quantitative immunoglobulins remain essentially normal. We are presenting a case report of this rare variant involving the sternum of an adult male

Imatinib-related bone marrow aplasia after complete cytogenetic response in chronic myeloid leukemia

Imatinib mesylate is a BCR-ABL tyrosine kinase inhibitor used in the management of chronic myeloid leukemia. It is a safe and well-tolerated agent with a few manageable side effects. We are reporting a case of imatinib-related fatal bone marrow aplasia after complete cytogenetic response

Treatable disease causing untreatable harm: anemia in school going childern

Prevalence of anemia in Pakistan is high. Magnitude of anemia is well studied in pregnant woman and infants in Pakistan, but we do not have enough data on school age children. The aim of this study was to find the frequency of anemia in apparently healthy primary school age population in Islamabad and its suburban area. All children between the ages of 5 and 14 years attending participating non-formulary schools in Islamabad and its suburbs were enrolled in the study. Children attending these schools belong to low to lower middle socioeconomic status. Hemoglobin level was determined in all subjects and a level <11.5 gm/dl was considered as anemia. A total of 319 children were enrolled. Eighty-seven [27%] children were found to be anemic. Mean hemoglobin concentration was 12.1 gm/dl. There was no significant difference between mean hemoglobin concentrations of males vs. female children. Anemia is a significant problem in our apparently health school going children of low to lower middle class. We suggest that primary school age children must be screened for anemia and treated