Bridging distances and saving costs: insights from a pilot project of telerheumatology in a rural area of Pakistan.

Enhancing access to healthcare remains a formidable challenge in rural regions of low- and lower-middle-income countries. Amid evolving healthcare challenges, telerheumatology provides opportunities to bridge gaps and expand access to rheumatology care, particularly in remote areas. We describe a pilot telerheumatology program and its cost-, time-, and travel-saving potential in a remote rural setting in northern Pakistan. The telerheumatology program commenced at the Pakistan Institute of Medical Sciences Islamabad, providing services through video consultations to a basic health unit in the Gilgit-Baltistan region. Patients visiting from the Gilgit-Baltistan region willing to participate were recruited in the program. Demographics and logistical metrics were recorded in a dedicated registry. A total of 533 consultations were carried out from April 2022 to April 2023. The majority of the patients were female (318/533, 59.7%). The median age of patients was 50 ± 15.7 years. The average wait time for consultation was 20 ± 13 min. The average travel time to reach telecentre was 59 ± 53 min. The average travel cost to reach telecentre was 379 ± 780 PKR (1.85 ± 3.81 USD). The average duration of consultation was 15 ± 5 min. The most common diagnosis for consultation was knee osteoarthritis (237, 44.5%), chronic low back pain (118, 22.1%), and rheumatoid arthritis (42, 7.9%). On average, patients saved 787 ± 29 km of distance, 15 ± 1 h of traveling, and 6702 ± 535 PKR (33 ± 3 USD) that would have been required to travel to our tertiary care hospital. Telerheumatology substantially reduced travel time, distance, and cost for patients. It has the potential to deliver outpatient rheumatology consultation in an economically efficient manner, effectively breaking geographical barriers and expanding access to essential services for patients in remote areas.

Classification of Arrhythmia in Heartbeat Detection Using Deep Learning.

The electrocardiogram (ECG) is one of the most widely used diagnostic instruments in medicine and healthcare. Deep learning methods have shown promise in healthcare prediction challenges involving ECG data. This paper aims to apply deep learning techniques on the publicly available dataset to classify arrhythmia. We have used two kinds of the dataset in our research paper. One dataset is the MIT-BIH arrhythmia database, with a sampling frequency of 125 Hz with 1,09,446 ECG beats. The classes included in this first dataset are N, S, V, F, and Q. The second database is PTB Diagnostic ECG Database. The second database has two classes. The techniques used in these two datasets are the CNN model, CNN + LSTM, and CNN + LSTM + Attention Model. 80% of the data is used for the training, and the remaining 20% is used for testing. The result achieved by using these three techniques shows the accuracy of 99.12% for the CNN model, 99.3% for CNN + LSTM, and 99.29% for CNN + LSTM + Attention Model.

Compliance to timely vaccination in an Expanded Program on Immunization center of Pakistan.

The importance of childhood immunization in prevention of highly fatal diseases and disability cannot be overemphasized. Pakistan has a national Expanded Program on Immunization but the compliance is far below the international benchmark for achieving a herd immunity. Monitoring the compliance to timely receipt of vaccinations is crucial to establishing and preventing disease and disability associated risk in children. There is little or no evidence that reports the timeliness of the vaccinations according to the EPI schedule in Peshawar. The primary objective of the study was to evaluate rate of Fully Immunized Children and to report compliance to the timeliness of vaccine specific schedule during the study period in the EPI center in the capital city of Peshawar, Khyber Pakhtunkhwa province of Pakistan. We collected consecutive retrospective data of the infants enrolled from June 2014 to December 2015 in one EPI center for our study. Out of the total 157 (n) children, fully immunized children (FIC) were 62 (39.5%) and only 19 (12.1%) were FIC with timely visits. Dropouts increased with successive vaccinations with highest for Measles 1 (42%). On-time vaccinations decreased over time, while the proportion of children receiving vaccination outside the ideal window period reaches as high as 46%. The study reports a low compliance to EPI schedule, and also highlights that immunization coverage is not a good indicator of age appropriate vaccinations.

Public health education and health system needs in Pakistan: a mixed methods study.

BACKGROUND: Pakistan has recently observed a significant growth in public health education programmes. Little is known about the structure of these programmes nor whether they are adequately responsive to national health system needs. AIMS: We reviewed existing public health degree programmes in Pakistan along with an exploration of the national public health market and health system needs. METHODS: A mixed-methods study was conducted between January 2015 and March 2016. Seventeen public health degree programmes were reviewed for programmatic and instructional attributes. Thirteen key-informant interviews were conducted to explore health system needs and challenges related to public health workforce. RESULTS: We found substantial variation in public health academic programmes in terms of offered courses, credit hours, number of faculty and tuition costs. About 70% of public health degree programmes were generic (i.e. with no specific concentration track) and only 18% offered practicums. Overall median tuition cost in 2016 was US$ 10 350. During key-informant interviews, emerged themes for challenges included lack of practical public health skills, limited knowledge of latest theoretical principles, poor communication skills and insufficient IT orientation. Identified themes about knowledge and skills areas to address future public health challenges of Pakistan included system thinking mind set, healthcare IT skills, and leadership and management skills. CONCLUSIONS: Public health education in Pakistan falls short of meeting current national challenges. Pakistan needs a national public health accreditation body for regulating education, harmonizing global standards to local context and developing relevant career pathways.

Diagnostic accuracy of Focused Assessment with Sonography for Trauma for blunt abdominal trauma in the Eastern Region of Saudi Arabia.

OBJECTIVES: To determine the diagnostic accuracy of  Focused Assessment with Sonography for Trauma (FAST) in blunt abdominal trauma caused by motor vehicle accidents at our Hospital in Dhahran city. METHODS: This descriptive, observational study was conducted in the Radiology Department at King Fahad Military Medical Complex   Dhahran, Saudi Arabia between September 2016 and September 2017.  All adult patients (n=105) involved in motor vehicle accidents with blunt abdominal injury on presentation were retrospectively reviewed for FAST and CT scans for detection of free fluid. Focused assessment with sonography for trauma studies were conducted or supervised by senior registrar of general surgery (trauma team leader). Computed tomography findings were reviewed by 2 experienced radiologists. High and low-grade solid abdominal visceral (liver, spleen, kidney) injuries were identified on CT scans. Focused assessment with sonography for trauma and CT scan findings were identified as 'positive' and 'negative' for presence and absence of free fluid respectively. Outcomes of FAST were presented on a 2x2 contingency table. RESULTS: Sensitivity of FAST in detecting intraperitoneal free fluid was calculated as 76.1% (95% confidence interval [CI], 64.14-85.69%), specificity 84.2% (95% CI, 68.75-93.98%) and accuracy 79% (95% CI, 70.01-86.38%). Focused assessment with sonography for trauma detected free fluid in most cases of high-grade solid visceral injuries. Nearly half of true-negative cases were having low grade visceral or other injuries. CONCLUSION: Focused assessment with sonography for trauma is an important tool in initial assessment of suspected blunt abdominal injury patients with high sensitivity and specificity. A negative FAST does not exclude low grade solid visceral or other injuries.

Introducing a structured prescription form improves the quality of handwritten prescriptions in limited resource setting of developing countries.

INTRODUCTION: Incomplete or illegible prescriptions can lead to serious errors in administration of the prescribed medication, which can become hazardous. OBJECTIVE: Our aim is to determine if a structured prescription form can improve the quality of handwritten prescription in terms of completeness and legibility. METHODS: We conducted a prospective, non-randomized, time series study of quality of written prescriptions of general practitioners at a tertiary teaching hospital in Peshawar, Pakistan. The study involved an intervention, composed of the introduction of a pre-printed structured prescription form. The data were collected within 4 weeks including a 2-week pre-intervention phase and 2-week post-intervention phase. Completeness, quality of prescriptions and legibility were compared before and after the intervention of the pre-printed structured prescription form. RESULTS: A total of 463 prescriptions were obtained (260 in the pre-intervention phase and 203 in the post-intervention phase). Between pre-intervention phase and post-intervention phase, the Pakistan Medical and Dental Council registration number presence in prescriptions improved from 73.1% to 100% (P < 0.0005). The presence of prescriber's signature improved from 92.7% to 99% (P = 0.001). Drug duration was not missing in 99.5% in post-intervention phase as compared with 90.4% in pre-intervention phase (P < 0.0005). Prescriptions with no legibility problems improved from 76.2% to 94.1% (P < 0.0005). Although not statistically significant, prescriptions in which drug dosage was not missing improved from 85% to 90.6% (P = 0.07). LIMITATIONS: We have a limited single-center study. A larger study in multiple settings is needed to develop adequate evidence for such interventions. Subjective nature of prescription legibility can also be considered as a limitation. CONCLUSION: Structuring a prescription form alone may improve certain aspects of quality of written prescription in terms of completeness and legibility.

Schizophrenia diagnosis and treatment by general practitioners: A cross-sectional study in district Peshawar, Pakistan.

OBJECTIVE: To assess the knowledge and practices of general practitioners about diagnosis and treatment of schizophrenia and determine their association with clinical exposure to such cases in practice. METHODS: The cross-sectional study was conducted in Peshawar from August 2009 to December 2011 at the clinics of general practitioners enrolled with the provincial Health Regulation Authority. All the listed GPs were contacted and those consenting to participate were included. A semi-structured questionnaire was used to assess their knowledge and practices related to diagnosis and treatment of schizophrenia. They were categorised as having Good Knowledge/Practice, in this regard, when they responded to >60% of the questions correctly. RESULTS: Of the 135 general practitioners contacted, 114(84.5%) agreed to participate and represented the study sample. Of them, 61(53.5%) physicians did not treat any diagnosed case while 15(13.2%) treated more than 10(8.8%) annually. Only 6(5.3%) practitioners spent more than 30 minutes, while 22(19.3%) spent less than 10 minutes per patient. Besides, 14(12.3%) practitioners had good knowledge about schizophrenia diagnosis and treatment, while 100(87.7%) had poor or no knowledge. Similarly, 32(28.1%) practitioners had good practice skills regarding schizophrenia compared to 82(71.9%) having poor practice skills or no practice regarding schizophrenia. General practitioners who were not treating any patients with schizophrenia had lower knowledge and practice scores compared to those who were treating one or more patients with schizophrenia annually (p<0.001 each). CONCLUSIONS: The knowledge and practice skills of general physicians were below average by medical standards regarding schizophrenia diagnosis and treatment.

Prescription patterns of general practitioners in peshawar, pakistan.

OBJECTIVES: To find out prescription patterns of general practitioners in Peshawar. METHODS: Cross-sectional survey of drug prescriptions was done at six major hospitals and pharmacies of Peshawar between April and May 2011. A total of 1097 prescriptions that included 3640 drugs, were analyzed to assess completeness, average number of drugs, prescription frequency of various drug classes, and number of brands prescribed. RESULTS: No prescription contained all essential components of a prescription. Legibility was poor in 58.5% prescriptions. Physician's name and registration number were not mentioned in 89% and 98.2% prescriptions respectively. Over 78% prescriptions did not have diagnosis or indication mentioned. Dosage, duration of use, signature of physician and directions for taking drugs were not written in 63.8%, 55.4%, 18.5% and 10.9% of prescriptions respectively. On average each prescription included 3.32 drugs. Most frequently prescribed drug classes included analgesics (61.7%), anti-infective agents (57.2%), multi-vitamins (37.8%) and gastrointestinal drugs (34.4%). We found 206, 130, 105 and 101 different brands of anti-infective agents, gastrointestinal drugs, analgesics and multivitamins being prescribed. CONCLUSION: We observed a high number of average drugs per prescription mostly using brand names, and over-prescription of analgesics, antimicrobials, multivitamins and anti-ulcer drugs. Quality of written prescriptions was poor in terms of completeness.

Assessment of health services on relevant primary health care principles in internally displaced people of pakistan based on sphere standards and indicators.

SPHERE based assessment of internally displaced persons camp was done to assess health services on relevant primary health care principles using a cross-sectional survey in Jalozai Camp, Pakistan. Most of the households (74%, n=87) had access to health education addressing issues to protect and promote their health which was provided at household level (83%, n=72), community level (44%, n=38) and health centre level (13%, n=11). All the health facilities were culturally and socially acceptable in terms of language, separate waiting rooms, presence of female health providers and language translators. A referral system was in place which provided free transport in (67%, n=2) health facilities to tertiary care hospitals. Health services provided were culturally and socially acceptable and efforts on health education were also appreciable, except that no health education or intervention was done on HIV AIDS. Referral should be made to referral facilities within the districts instead of directly to tertiary care hospitals.