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Although physical therapy services are a part of the Essential Package of Health Services in Pakistan, they do not receive their due importance. This qualitative study aimed to explore the in-depth insights regarding the factors that influence the provision of physical therapy services in public sector hospitals of Karachi, Pakistan using the WHO’s health systems framework.
Exploratory qualitative study.
Three public sector hospitals located in Karachi, Pakistan were selected for this study. In-depth interviews were conducted with a total of 12 physical therapists working in the outpatient departments of the selected hospitals.
Findings were categorised into six major themes within the health systems framework, shedding light on various factors influencing the quality of care provided to the patients. These encompass issues such as inappropriate facility infrastructure, limited staff availability and competency, challenges with equipment adequacy and functionality, insufficient financial support, low staff incentivisation and the absence of a regulatory council.
The findings exhibited that the physical therapy services are constrained by various factors at the public sector hospitals in Pakistan. Improvement is recommended at various levels to increase the adequate staffing, financial support, provide the necessary equipment and ensure its functionality. The development of the regulatory council for physical therapy services is the need of the time to address the above solutions.
by Elham Zakeri Zafarghandi, Vincent Jacquemet
BackgroundTransmural propagation and endoepicardial delays in activation observed in patients with atrial fibrillation are hypothesized to be associated with structural remodeling and endoepicardial dissociation. We aim to explore in a computational model how the distribution of delays and the rate of endo- and epicardial breakthrough activation patterns are affected by fibrosis and heterogeneous layer dissociation.
MethodsA bilayer interconnected cable model of the left atrium was used to simulate a total of 4,800 episodes of atrial fibrillation on 960 different arrhythmogenic substrates with up to 30% epicardium-only diffuse fibrosis. Endoepicardial connections were heterogeneously distributed following random spatial patterns (characteristic length scale from 1.6 to 11.4 mm). Intermediate nodes were introduced in the transmural connections to enable the simulation of weaker coupling. This heterogeneous interlayer dissociation divided the atrial bilayer into connected and disconnected regions (from 27 to 48,000 connected regions). Activation time series were extracted in both layers to compute endoepicardial delays and detect breakthrough patterns.
ResultsBecause of epicardial fibrosis, fibrillatory waves were driven by the endocardium, which generated endoepicardial delays. The delays in the connected regions (up to 10 ms, but generally 15 ms) and promoted the occurrence of breakthroughs. These breakthroughs had short lifespan ( 0.1 breakthrough/cycle/cm2).
ConclusionHeterogeneous endoepicardial dissociation aggravates activation delays and increases the prevalence of epicardial breakthroughs.
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