Conectar
by Fahad Saleem, Fazal ur Rehman Khilji, Sajjad Haider, Qaiser Iqbal, Baharudin Ibrahim, Fatiha Hana Shabaruddin, Mohammad Bashaar
Terrorism-related disasters (TRDs) continue to exert profound and recurring pressures on healthcare systems, particularly in vulnerable regions like Pakistan. Although pharmacists are increasingly recognized as an essential component of disaster management, there is a clear gap in the literature regarding their preparedness, experience, and specific roles in responding to TRDs particularly in low and middle-income countries. This study aimed to explore the preparedness, experiences, and response strategies of pharmacists managing TRDs at the Trauma Centre of Sandeman Provincial Hospital, Quetta, Pakistan. A qualitative design was adopted, guided by the Consolidated Criteria for Reporting Qualitative Research. Semi-structured, face-to-face interviews were conducted with pharmacists (n = 10) providing services at the Trauma Centre. Data were audio-recorded, transcribed verbatim, validated by participants, and analyzed using thematic content analysis. Analysis revealed five overarching themes: (1) pharmacists’ experiences with terrorism-related incidents and existing response mechanisms; (2) professional and personal responses to emergencies, reflecting both commitment and psychological burden; (3) preparedness challenges, including lack of disaster management training, limited awareness of policies and protocols, and inadequate understanding of triage and coordination; (4) barriers such as security risks, pharmacy curriculum deficiencies, insufficient experiential learning, and minimal involvement in planning and management activities; and (5) recommendations for strengthening capacity, including revising curricula, implementing structured training programs, conducting regular disaster drills, and expanding pharmacists’ roles in preparedness and response. Findings revealed a pronounced lack of formal training in disaster management, limited awareness of protocols and triage systems, and minimal involvement of pharmacists in planning and coordination activities. Despite strong professional commitment and frontline engagement, pharmacists’ contribution remain constrained by educational, structural, and policy-level shortcomings. The study highlights the urgent need for integrating disaster management into pharmacy curricula, implementing structured training programs and regular disaster drills, and expanding pharmacists’ roles within institutional and national disaster preparedness frameworks.The study aims to present recommendations for a revised Doctor of Pharmacy (Pharm-D) curriculum that aligns with regional needs and international standards of pharmacy education.
An exploratory qualitative study involving individual semistructured interviews. Data were collected and reported in accordance with Consolidated Criteria for Reporting of Qualitative Studies.
Face-to-face interviews were conducted in the respective offices of the experts and online interviews were conducted on Zoom and Google Meet.
Purposive and snowball sampling was used to recruit experts due to the eligibility criteria of including associate professors with a PhD, and snowball sampling facilitated the recruitment of experts from all provinces and internationally. Interviews were transcribed verbatim and data were analysed using an inductive thematic approach using NVivo V.15. All interviews were conducted in English.
The study engaged 49 experts from national and international settings with an age range of 25–60 years (median=43 years). The researchers came out with six themes and their subthemes from the data including: (a) understanding current Pharm-D curriculum in Pakistan, (b) inevitable changes required in the Pharm-D curriculum, (c) specific-subject based changes, (d) foundational steps to achieve the required changes, (e) barriers to the implementation of these changes and (f) impact of Pharm-D curriculum change.
The findings highlighted a clear need to revise the curriculum by incorporating enhanced clinical pharmacy content, integrated learning approaches, elective courses, interprofessional education, mandatory hospital and clinical placements, experiential learning through simulation-based methods and research components through a collaborative approach from policy makers and academic stakeholders.
To examine the associations between sleep quality and left ventricular hypertrophy (LVH) and their associations with haemodynamic and cardiometabolic risk factors among adults with hypertension in Pakistan.
A cross-sectional analytical study conducted from February to July 2025.
Conducted in three tertiary care hospitals in Sialkot, Pakistan representing both urban and rural populations.
A total of 405 participants aged ≥30 years, diagnosed with hypertension, were enrolled. Patients with primary sleep disorders, psychiatric illness, pregnancy or incomplete data were excluded.
Sleep quality was assessed using the Urdu version of the Pittsburgh Sleep Quality Index (PSQI) with a cut-off ≥5. Blood pressure was measured as the average of three seated readings. LVH was determined by echocardiography. Modified Poisson regression with robust SEs was applied to estimate adjusted prevalence ratios (aPRs) for factors associated with LVH and poor sleep, accounting for clustering by hospital.
LVH was present in 38.3% of participants, and 68.4% had poor sleep quality. In fully adjusted models for LVH, poor sleep quality was not independently associated with LVH (aPR 1.11; p=0.512).
Independent associates of LVH included:
Age (aPR=1.32; p
Systolic blood pressure (aPR=1.021 per mm Hg; p
Diastolic blood pressure (aPR=1.030 per mm Hg; p
Longer hypertension duration (aPR=1.47; p=0.002).
Overweight (aPR=0.77) and obesity (aPR=0.71) were inversely associated with LVH, consistent with the obesity paradox. Poor sleep quality was independently associated with smoking status, longer hypertension duration and higher blood pressure. Sensitivity analyses treating PSQI as a continuous variable (aPR=1.033 per point) suggested a modest dose–response relationship between more severe sleep impairment and LVH.
Elevated blood pressure, longer hypertension duration and smoking were significantly associated with LVH and poor sleep quality. Sleep quality was not an independent correlate of LVH, suggesting an indirect relationship mediated through haemodynamic factors.
This study aims to explore the impact of financial toxicity (FT) faced by cancer patients in Bahawalpur, Pakistan, identify their coping strategies and provide patient-driven recommendations to mitigate the FT.
A qualitative study design was used, and thematic analysis was employed to analyse the data.
Patients were selected from two tertiary care hospitals located in Bahawalpur, Pakistan.
Thirty patients were selected using a purposive and convenience sampling method. Data were collected between April and June 2024. Patients who provided consent, were 18 years or older and were receiving cancer treatment were included in the study.
Most participants were between 40 and 60 years old, and 66.6% were male. The study highlights severe FT, characterised by financial instability, psychological distress and family lifestyle disruptions. Patients employed various strategies, such as adjusting healthcare decisions, mobilising financial resources and seeking financial aid to cover treatment costs. Novel insights revealed the inadequacy of existing government health card programmes, which focus on direct medical expenses but fail to cover indirect costs, further exacerbating FT. Patients reported significant challenges in accessing government aid programmes due to administrative barriers. Participants highlighted the need for additional support mechanisms to address these gaps effectively, including enhanced accessibility, broadening financial assistance and integrated financial counselling.
This study is the first to explore FT in Pakistan’s healthcare system. It reveals gaps in support mechanisms and highlights the need for comprehensive policy interventions. Addressing these challenges holistically can improve patient outcomes and quality of life.
To explore the challenges and opportunities in clinical skills teaching and learning among faculty, final-year medical students and patients at a private medical university in Pakistan, within the context of a low- and middle-income country (LMIC) medical education system.
An exploratory descriptive qualitative design using inductive thematic analysis utilising in-depth interviews and focus group discussions, framed within a metaphorical lens.
A single private-sector tertiary care teaching hospital and affiliated undergraduate medical college in an urban setting in Pakistan.
A total of 48 participants were included in the study: 12 clinical faculty members representing various disciplines and levels of experience, 16 final-year medical students and 10 house officers and 10 patients from adult inpatient wards. Participants were purposively selected to ensure maximum variation in perspectives.
Six key metaphorical themes emerged, each reflecting both the challenges and opportunities within the clinical learning journey: (1) The Safety Harness—simulation as an opportunity for structured, risk-free skill development, yet limited by authenticity; (2) The Underwater Life—the irreplaceable but unpredictable nature of bedside learning in fostering empathy and communication; (3) The Stormy Seas—systemic and cultural barriers such as patient availability, gender constraints and limited faculty resources; (4) The Ship—students navigating self-development amid evolving expectations, digital distractions and shifting motivations; (5) The Engine Room Tools—balancing diverse teaching modalities while seeking optimal time distribution between simulation and bedside learning; and (6) The Guiding Compass—the pivotal role of clinical teachers as mentors and professional exemplars. Triangulated perspectives revealed that while structured simulation and bedside experiences complement one another, significant institutional, ethical and pedagogical challenges persist, many amplified by the realities of resource-limited LMIC settings.
This study underscores the complexities of clinical teaching and learning in an LMIC context, highlighting the need for a balanced, context-sensitive model that integrates simulation with authentic bedside exposure, supported by mentorship and reflective practice. Addressing structural and faculty-related barriers is essential to advancing equitable, patient-centred clinical education in resource-constrained environments.
The aim of this study was to document the process of the implementation and the perceived impact and sustainability of the Expansive Learning in Practice Model and its associated costs to inform future rollout.
A mixed-method rapid evaluation was conducted, comprising both qualitative and economic workstreams to document the implementation of the Expansive Learning in Practice Model and its associated costs. Semi-structured interviews (n = 44) were carried out with student nurses, student assessors, and staff involved in the delivery of the Model. The qualitative workstream utilised a rapid cycle evaluation approach, where data were collected and analysed in parallel, and preliminary findings were shared with stakeholders as the study was ongoing. The quantitative workstream relied on routinely collected data about non-staff-related costs, staff-related costs, and data on students' participation.
The main themes developed from the qualitative data included the organisation of the Expansive Learning Experiences, the supportive environment, the enhanced learning experience, and capacity building. Participants perceived that the model had a positive impact on student practice (including preparation and confidence) and on student nurse satisfaction. At the end of the programme, it is estimated that the programme will have cost about £523,572.
This model can be used as a framework for hospitals aiming to improve the learning experiences for student nurses. Improvements could be made by increasing staff buy-in and the streamlining of spoke opportunities. Future studies should focus on evaluating the long-term impact of the model, particularly the impact on generating student placement capacity. The evaluation also highlights the need for solutions for potential educational staff shortages, which could pose a risk to maintaining sufficient practice placement capacity for student nurses in healthcare settings.
Study participants perceived an improvement in student nurses' learning experiences and student nurse placement capacity as a result of the implementation of this model.
The relevant EQUATOR guidelines followed for reporting were the GRAMM guidelines (Good Reporting of a Mixed Methods Study).
The study centred around student nurse and staff experiences.
Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide, and detecting CAD in stable chest pain patients is challenging but crucial for early intervention. Strain and strain rate (S/SR) imaging offers a non-invasive method to assess myocardial function and detect coronary stenosis before symptoms occur. In this study, we aimed to demonstrate how effectively and accurately resting strain echocardiography can diagnose CAD.
We conducted a prospective diagnostic accuracy study of patients with chest pain who were referred for CT coronary angiography (CCTA).
Single-centre study conducted in the University Hospital of North Norway in Tromsø, Norway between 2016 and 2021.
A total of 510 patients with chest pain were included in the present study.
Echocardiography examination with S/SR imaging was performed.
Echocardiography findings were compared with CCTA and coronary angiography findings. A novel scoring model incorporating S/SR parameters was developed to assess diagnostic accuracy.
In this study, we showed that receiver operating characteristic curve analysis of early diastolic strain rate (SRe), systolic strain rate (SRs) and peak longitudinal strain (PLS) has high sensitivity and specificity with area under the curve (AUC) scores: SRe, 0.91; PLS, 0.81; SRs, 0.71 in identifying patients undergoing coronary artery bypass graft (CABG). However, these parameters showed lower sensitivity and specificity with AUC scores: SRe, 0.580; SRs, 0.539; PLS, 0.552 in detecting patients undergoing percutaneous coronary intervention (PCI).
Our study emphasises the potential of S/SR imaging in detecting CAD, particularly in high-risk CABG patients. However, its diagnostic utility in PCI patients is limited. Our study highlights the need for comprehensive approaches in coronary disease prediction.
Our research aimed to assess the feasibility of digital health in enhancing healthcare access in the semiurban areas of Karachi, Pakistan.
This qualitative descriptive study was employed at three villages in Gadap, Karachi, Pakistan, with varying socioeconomic contexts, using a feasibility framework. Ethical approval was provided by the Ethical Review Committee (ERC) of The Aga Khan University.
Through purposive sampling, demand and supply-side stakeholders (N=152) were invited to participate in the study, including community leaders, activists and members, representatives from non-governmental organisations, public and private sector healthcare providers, and digital healthcare providers and experts. Both inductive and deductive approaches were used for data analysis.
The assessment of feasible demand-side and supply-side factors would be extremely useful in the planning and implementation of a sustainable digital health programme.
Digital health is an acceptable and practically feasible option and is a potential solution to enhance healthcare access and equity, particularly in semiurban and rural remote areas, where healthcare access is limited. Digital healthcare should not replace inperson healthcare but should instead be offered in combination with it, preferably through a ‘Hub & Spoke Model’ facility. Few challenges exist in implementing digital health, including privacy, ethical issues, lack of evidence-based standards, inadequate training of healthcare providers, technological barriers and access to digital health services by vulnerable populations, such as the elderly, women, individuals who are illiterate and those of low-income class.
Our study concludes that digital healthcare is a dire need and is a potential solution to enhance healthcare access and equity, as it is acceptable and practically feasible. A mix of inperson and digital health consultation should be offered through a hub and spoke model. Few challenges to implementing digital health exist and should be addressed by tailoring digital health through co-creation and engaging all stakeholders.
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