Objectives: To determine the knowledge, attitudes, and practices regarding diagnosis and treatment of sexually transmitted infections (STIs) among specialists-that is, dermatologists, gynaecologists and urologists, and general practitioners (GPs) in Karachi, Pakistan. Methods: Interviewers administered structured questionnaires to doctors conducting outpatient clinics at tertiary hospitals and/or private clinics in Karachi. All private clinics within a 10 km radius of the Aga Khan University, and all tertiary hospitals having more than 100 inpatient beds were included in the study. Results: 100 doctors (54 specialists and 46 GPs) responded. 80 doctors reported seeing at least one STI patient/month. The most commonly diagnosed STI the doctors reported was urethritis/ cervicitis syndrome. 50% of the doctors knew the recommended antibiotics for gonorrhoea though only 46% of these knew the correct dosage. Specialists were three times more likely to recognise the clinical presentation of herpes and twice as likely to treat chlamydia, syphilis, and herpes with appropriate antimicrobials than GPs. 85% of the doctors advised their STI patients regarding condom usage; 36% thought that STI patients had loose sexual morals; 43% believed STI patients were drug addicts. Over 90% of the physicians were willing to attend educational sessions and follow a national STI treatment protocol. Conclusion: Doctors in Karachi, especially GPs, are deficient in appropriately managing and counselling STI patients. Among the specialists, urologists and dermatologists were more likely to manage STIs correctly than gynaecologists. Karachi doctors should be educated in the correct management and counselling of STIs to prevent further spread of STIs including AIDS. (Sex Transm Inf 2000;76:383-385)
The current healthcare system in the United States (US) is characterized by high costs and poor patient outcomes. A value-based healthcare system, centered on providing the highest quality of care for the lowest cost, is the country’s chosen solution for its healthcare crisis. As the US transitions to a value-based model, a new definition of health is necessary to clearly define what constitutes a healthy state. However, such a definition is impossible to develop without a proper understanding of what “health” actually means. To truly understand its meaning, one must have a thorough historical understanding of the changes in the concept of health and how it has evolved to reflect the beliefs and scientific understanding of each time period. Thus, this review summarizes the changes in the definition of health over time in order to provide a context for the definition needed today. We then propose a new definition of health that is specifically tailored to providers working in the era of value-based care.
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