ABSTRACT
Objective: to study the perceptions of medical students about factors responsible for physicians' migration
Study Design: cross-sectional survey
Place and Duration of Study: Dow Medical College and Civil Hospital, Karachi, from April to May 2015
Methodology: a self-administered structured questionnaire was used including demographic details, attitudes about push and pull factors of migration, and reasons for migrating or not migrating abroad. Final year students and interns were included. Likert scale from 1 to 4 [1=strongly disagree to 4=strongly agree] was used to assess attitudes. Data was analyzed by SPSS version 16
Results: a total of 240 medical students, mostly females [n=181, 75%] [60% final year and 40% interns], participated in the study. Majority wished to go abroad [n=127; 54%] with United States being the favorite destination [n=80; 66.1%] and internal medicine fields being the preferred choice for specialization [n=126; 54%]. The major pull factors were better quality of postgraduate education abroad [n=110; 48.2%] and economic prospects [80; 35.2%]; while the push factors were a weak healthcare system [n=219; 94.3%], inadequate salary structure [n=205; 88.3%], insecurity [n=219; 93.9%] and increasing religious intolerance in Pakistan [n=183; 78.5%]
Conclusion: this survey highlights the continuing trend of physician migration from Pakistan owing to interplay of various push and pull factors. Majority of our medical students wish to migrate, mainly due to low salaries, poor job structure, and insecurity. Urgent interventions are required to reverse this trend of medical brain-drain
ABSTRACT
Objective: the object of this study was whether the intubating conditions and the haemodynamic responses to intubation and laryngoscopy without neuromuscular block were better as compared to that, following suxamethonium
Material and Methods: a prospective study was conducted on patients who were undergoing Adeno Tonsillectomy. This study was performed Khyber Teaching Hospital, Peshawar over a period of one year [1995 to 1996]. 100 patients of both sexes were selected which were undergoing adenotonsillectomy. Their ages were between 8 to 12 years. The patients with potentially difficult intubation and those who were sensitive to the drugs used were excluded from the study. Patients were divided in two groups of 50 patients each. In-group A induction was done with propofol and suxamethonium and in group-B induction was achieved with propofol and fentanyl
Results: after collecting and comparing the data in both the groups the result showed no statistically significant difference in the two groups except limb movements and coughing. In-group A [suxamethonium] 99% cases had acceptable intubation and Laryngoscopy while the conditions were unacceptable in 1% cases. There was a slight cough in 10% cases and slight limb movements in 15% cases while in-group B [fentanyl] 87% cases had acceptable intubation and Laryngoscopy while 13% had unacceptable intubating condition. Severe cough was present in 5% cases while moderate limb movements were present in 20% cases. As far as haemodynamic, variables were concerned heart rate and MAP shooted. High in-group A [Table] while in-group B there was slight decrease in both the variables. [Table]
Conclusion: intubation with fentanyl and propofol has the advantage of less hemodynamic changes and attenuation of physiological responses to endotracheal intubation. Side effects of suxamethonium are also avoided. These studies need further evaluation concerning the doses of different agents and their proper timing. It is hoped that in future, that we might get rid of the bad aspects of the drugs used in-group B [fentanyl-propofol] like coughing, limb movements, high cost and non-availability of the product in market