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  1. Tuang GJ, Nik Hussin NR, Zainal Abidin ZA
    Fam Med Community Health, 2019;7(3):e000137.
    PMID: 32148716 DOI: 10.1136/fmch-2019-000137
    Unilateral rhinorrhoea in the paediatric age group could be an alarming sign that warrants a clinician attention. These patients are routinely brought to see general practitioner as parents may not be aware of the urgency to intervene surgically. Herein we describe a case of a toddler who presented initially to a general practitioner with unilateral nasal discharge. He was subsequently referred to the otorhinolaryngology department for unresolved rhinitis. The child was examined, and the diagnosis of an embedded foreign body was made. X-ray of the paranasal sinus unveiled an embedded button battery. An emergency endoscopic retrieval of the button battery was performed under general anaesthesia. Unfortunately, the case was complicated with a huge septal perforation.
  2. Firdaus A, Efendi F, Hadisuyatmana S, Aurizki GE, Abdullah KL
    Fam Med Community Health, 2019;7(3):e000144.
    PMID: 32148718 DOI: 10.1136/fmch-2019-000144
    Objective: The aim of this study was to analyse the factors associated with the intention of Indonesian nursing students to work in rural areas.

    Design: This was a cross-sectional study. The instrument used was a self-developed questionnaire consisting of 13 questions. The data were analysed using the χ2 statistics test and binary logistic regression with a level of significance <0.05.

    Setting: The study was conducted at a public nursing school located in urban Surabaya, East Java, Indonesia, in December 2017.

    Participants: A total of 714 nursing students from four different programmes were involved.

    Results: This study found that almost 60% of nursing students were reluctant to work in rural areas. Of the three variables which were significant in the χ2 analysis, only two were significant following the logistic regression test, namely the class programmes of undergraduate regulars (OR=2.274; 95% CI 1.326 to 3.900), profession regulars (OR=2.262; 95% CI 1.110 to 4.607) and rural place of origin (OR=1.405; 95% CI 1.036 to 1.906).

    Conclusion: The education programme and place of origin were associated with the intention of nursing students to work in rural areas. Therefore, the recruitment of prospective nurses should consider these factors by considering the local context.

  3. Saleem Z, Hassali MA, Hashmi FK, Godman B, Saleem F
    Fam Med Community Health, 2019;7(3):e000138.
    PMID: 32148717 DOI: 10.1136/fmch-2019-000138
    Background: There are concerns with the extent of dispensing of antibiotics among community pharmacists in Pakistan often without a prescription adding to antimicrobial resistance (AMR) rates.

    Objective: To explore the determinants of AMR and the pattern of antimicrobial dispensing among community pharmacists.

    Design: In this qualitative study design, a semistructured interview guide was developed based on an in-depth review of published papers. Audio-recorded interviews with transcripts were analysed by thematic content analysis.

    Setting: Interviews were conducted among community pharmacists in Lahore, Pakistan.

    Participants: In order to obtain individual points of view, in-depth face-to-face interviews with purposively selected pharmacists were conducted.

    Results: A total of 12 pharmacists were interviewed for the study. After analysis, four major themes emerged: (1) knowledge and perception of community pharmacists about antimicrobials, (2) antimicrobial dispensing practices of community pharmacists, (3) determinants of AMR, (4) potential interventions to control AMR. Most of the pharmacists have limited knowledge about AMR, antimicrobial stewardship programmes and related guidelines. However, all the pharmacists strongly agreed that different appropriate actions should be taken in order to rationalise future antimicrobial use.

    Conclusion: The results indicated that irrational antimicrobial dispensing and use is common among community pharmacists in Pakistan owing to lack of knowledge. The community pharmacists perceived that behaviour of patients and the societal environment contributed to irrational antimicrobial use and subsequent development of AMR. They suggested a need for a multidisciplinary framework in order to improve future antimicrobial use and reduce AMR in Pakistan.

  4. Chan SC, Ganeson JV, Ong JT, Sugathan S
    Fam Med Community Health, 2020;8(1):e000188.
    PMID: 32201548 DOI: 10.1136/fmch-2019-000188
    Objective: To explore the perception of medical students from a private medical college in Perak, Malaysia, on primary care practice and induce the factors influencing their perception and willingness to consider primary care as a career pathway.

    Design: Qualitative study using focus group discussions. Participants' responses were audio recorded, transcribed, grouped under various domains and listed out and analysed.

    Setting: A private medical college in Perak state, Malaysia.

    Participants: Forty-six medical students from years 2 to 5 were included. Eight focus groups were formed with two focus groups from each academic year (six students each in seven groups and four students in one group). Students were informed through their respective student leader of each year and received a participant information sheet and an informed consent form which were completed and returned if they decided to participate in the focus group discussions.

    Results: The participants had different levels of understanding of primary care depending on their level of exposure to primary care. Senior students with more exposure had a better understanding about primary care and its services. Attractive factors towards choosing primary care as a career included short working hours with a more balanced family and social life, being able to treat patients as a whole with continuity of care and closer relationship with patients. Unattractive factors included routine, unchallenging and boring practice, poor salary, work overload and administrative work in government clinics, being less recognised by other specialties; and the poor perception by other doctors that those pursuing primary care were not 'brilliant enough' for more 'sophisticated disciplines like surgery or paediatrics'.

    Conclusion: This study showed that the medical students' level of exposure to primary care played a crucial role in determining their understanding of primary care practice and their choice of career in primary care. Issues to be addressed include remuneration, workload and the prejudice against primary care as a career pathway. Suggestions included introducing early exposure to fun and challenging primary care postings in the medical curriculum and producing well trained, skilled and enthusiastic role models.

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