Urgency index and time management in a work environment

Objective: The objective of this study was to identify the urgency patterns and the effect of time management

Study Design: A survey based descriptive study

Place and Duration of Study: Army Medical College, Rawalpindi Pakistan, from June to August 2015

Material and Methods: Through random sampling, sample size was limited to 50 respondents. Questionnaire was introduced after the informed consent to the management and faculty of the Army Medical College. It was divided into section of demographic data and and data regarding the awareness about time management and practices of effective time management in the organization. Second section composed of the urgency index questions and calculations of the total score. Third section was the Steve Covey Time Management Grid to categorize activities into four quadrants. The time management matrix technique [TMMT] was constructed by Steve Covey to focus on the control of personal actions rather than purely scheduling time

Results: Twenty eight [56%] males and 22 [44%] females participated in the study with mean age of 43.54 +/- 7.58. Four [8%] were single and 46 [92%] were married. Mean working experience of the participants was 17.55 +/- 7.36. Categories of the participants into low urgency and high urgency index after calculation of the scores reflected that most of the participants irrespective of the gender or length of the work experience were suffering from high urgency patterns of life style

Conclusion: Most of the participants were suffering from high urgency patterns of life style. Urgent tasks have short-term penalties while important tasks are those with objective-oriented consequences

Disease patterns among hajj pilgrims attending medical facilities of pakistan Hajj medical mission 2016 [1437 hijri]

Objective: The purpose of this study was to determine the frequency of different diseases among Pakistani Hajj pilgrims attending the medical facilities of Pakistan Hajj Medical Mission during Hajj 2016 [1437 hijri]. Study Design: A descriptive cross sectional study. Place and Duration of Study: Pakistan Hajj Medical Mission hospitals and dispensaries at Makkah Mukkarrmah, Medina Munawwarah and Jeddah, from 10[th] Aug 2016 to 5[th] Oct 2016

Material and Methods: All Pakistani Hajj pilgrims reporting to various Pakistan Hajj Medical Mission Hospitals and dispensaries at Makkah, Medina and Jeddah were included in the study. A universal sample of all patients reporting to the Hajj medical mission [A total of 184,496 OPD visits] was used. The patient were initially assessed in Emergency Reception[ER] by medical officers and then referred to respective specialists if required. A specially designed proforma having information regarding name, age, disease and its duration was prepared and filled for each patient separately. A second hospital/dispensary visit of the Hajj pilgrim was considered separately on a new proforma. SPSS version 17 was used to analyze the data

Results: There were a total of 184,496 OPD [Out Patient Department] visits by Pakistani Hajj pilgrims during the study period. Age of the patients ranged from 20-96 years, 74.5% [n=137, 449] were male and 25.5% [n=47047] were female. Number of patients suffering from various diseases and their percentage in order of frequency was; respiratory diseases 29% [n=53187], musculoskeletal disorders 18% [n=33838], gastrointestinal diseases 15% [n=26696], Ear Nose and Throat [ENT] diseases 8% [n=14448], skin disorders 6% [n=10937], eye disease 3% [n=4530], mouth and dental diseases 3% [n=6101], wounds, fractures and burns 3% [n=6186], cardiovascular diseases 2% [n=4433], gynecological disorders 2% [n=4357], infectious disease 1% [n=1055], minor surgeries <1% [n=620], psychiatric disorders <1% [n=40] and other miscellaneous complaints 5% [n=9889]

Conclusion: Respiratory illness was the commonest disease among Pakistani Hajj Pilgrims while musculoskeletal and gastrointestinal complaints were also high. This study helps to identify the common diseases encountered during Hajj Medical Mission and may aid in the better preparedness of such missions in future

Refining elements of medical professionalism in the undergraduate medical students

Objective: To assess the perception of professionalism in the students of Army Medical College

Study Design: A survey based descriptive study

Material and Methods: In the first phase of the study, experts were selected from various fields in medicine through email and their opinion was sought about the most important key elements of professionalism. On the basis of response, in the second phase, weighting of the elements were selected and re-forwarded to the experts for their confirmation. In the third phase, a survey of 1st year and final year was conducted amongst the students about their knowledge, perception and importance of selected element

Results: The first version of the professionalism assessment scale [PAS] consisted of 35 items. The experts also suggested 10 additional elements of professionalism other than proposed by the researchers. Based on their percentages, 33 out of the 45 items were excluded, so the second version of the PAS contained 12 items. When the mean scores of the different elements were compared among the responses of first year and the final year students, three elements i.e. integrity, teamwork and ethics were found to be significant

Conclusion: Professionalism assessment scale [PAS] can be used for the assessment of perception of professionalism among undergraduate medical students

Outcomes of Primary Unilateral Cheiloplasty in Same-Day Surgical Settings

BACKGROUND: Financial, clinical, and psychological considerations have made same-day surgery an attractive option for a variety of procedures. This article aimed to analyse the postoperative results of same-day primary unilateral cleft nasolabial repair. METHODS: This study was performed from 2011 to 2014. Unilateral cleft lip patients fulfilling the inclusion criteria were preoperatively classified as mild, moderate, and severe. All patients underwent same-day surgery and were discharged after satisfying the appropriate clinical criteria, receiving thorough counselling, and the establishment of a means of communication by phone. Postoperative outcomes were assessed and stratified according to preoperative severity and the type of repair. RESULTS: A total of 423 primary unilateral cleft lip patients were included. Fisher's anatomical subunit approximation technique was the most common procedure, followed by Noordhoff's technique. The postoperative outcome was good in 89.8% of cases, fair in 9.9% of cases, and poor in 0.2% of cases. The complication rate was 1.18% (n=5), and no instances of mortality were observed. The average hospital stay was 7.5 hours, leading to a cost reduction of 19% in comparison with patients who stayed overnight for observation. CONCLUSIONS: Mild unilateral cleft lip was the most common deformity for which Fisher's anatomical subunit approximation technique was performed in most of the cases, with satisfactory postoperative outcomes. Refinements in the cleft rhinoplasty techniques over the course of the study improved the results regarding cleft nasal symmetry. Single-day primary unilateral cleft cheiloplasty was found to be a cost-effective procedure that did not pose an additional risk of complications.

Development and validation of HPLC analytical method for Nepafenac in ophthalmic dosage form [suspension]

The aim of the present study was to develop and validate an analytical method for the estimation of nepafenac as a raw material as well as in dosage form [suspension] by using reverse phase high performance liquid chromatographic [RP-HPLC]

The target was to obtain an easy, rapid, reproducible as well as a rugged method. The HPLC system that was used in the proposed study was LC-20AD liquid chromatograph equipped with SPD-20A UV-VIS detector

The separation was performed on CIS column which was attached with loop 20ul. Elution was done at ambient temperature with a mobile phase consisting of acetonitrile: Water [40: 60v/v] at a flow rate of Iml/min and at a wavelength of 254 nm. The proposed method was validated as per the ICH guidelines. The retention time for nepafenac was 7.49 minutes [% CV=0.0076]

The percentage coefficient variation [CV] of six consecutive peak areas of injections was 0.34% with tailing factor 1.76. The peak area responses were linear within the concentration range of 0.078-20.0ug/ml (R[2]=0.9993]

The sensitivity of the method could be evaluated by limits of detection [LOD] [0.0195ug/ml] d limits of quantitation [LOQ] [0.039ug/ml]

Nepafenac drug is s in its diluent that could see by intra-day [% CV I =0.45-1.96] and inter-day variation [%CV=0.173-1.898%]

The accuracy and recovery results of 80%, 100% and 120% were 97.40% to 102.10% with % CV of 0.3201% to 1.3496%. The robustness and ruggedness of the method are significantly broader and is reproducible. It could be used as a more convenient, efficient, easy and time saving method for the analysis of drug in raw material as well as in dosage form [ophthalmic suspension]

Surgical management and outcome analysis of extradural hematoma at combined military hospital Rawalpindi

The aim of this study is to see the frequency of extradural hematomas [EDH] at neurosurgical centre CMH Rawalpindi. Descriptive study. Department of Neurosurgery CMH Rawalpindi over a period of 2 years [Jan 2001 to Jan 2003]. All patients with head injury reporting to trauma center CMH Rawalpindi from 2001 to 2003 were reviewed. Using non-probability convenient sampling, patients with closed head trauma were included in the study. A total of 1215 patients were reviewed during the study period. Maximum patients were under 12 years of age. Extradural haematoma was found in 23 [2%] patients. Out of 23 patients, 18 [78%] were males and 5 [22%] were females, the male to female ratio was 3.5:1. Alteration of consciousness was the most common presentation [61%]. Location of EDH was temporoparietal in majority of patients. Bilateral EDH was found in 1 patient only. At 6 months follow up, good recovery was observed in 15 [65%] patients. Level of consciousness at the time of surgery is the single most important decisive factor in the outcome hence early diagnosis and surgical intervention is essential

Recurrent laryngeal nerve injury; a risk in thyroid surgery

Aim of this study was to find out the frequency of recurrent laryngeal nerve injury in different types of thyroid surgery. An experimental study. The study was carried out at Combined Military Hospital, Rawalpindi from January 2001 to July 2002. Seventy two patients were included in this study. Case selection was done by non probability convenient sampling from surgical out patient department. Age of patients ranged between 15 years to 73 years. Mean age was 36.5 years with maximum prevalence in the range of 31-40 years [31.5%] Male to female ratio was 1:1.7. All patients were evaluated clinically and were advised preoperative routine investigation. All patients had voice analysis along with indirect laryngoscopic examination preoperatively. The commonest presenting complaint in 72 patients was lump front of neck in 69 [95.8%] patients, 48[66.7%] patients were having nontoxic goiter, 15 [20.8%] patients were having toxic goiter and 9 [12.5%] patients were having malignant goiter. Out of all thyroidectomies performed 48 [66.7%] were sub total, 18 [25%] lobectomy with Isthmusectomy, 5 [6.9%] were near total and 1 [1.4%] was total thyroidectomy. Temporary recurrent laryngeal nerve injury occurred in 2 [2.8%] cases. Permanent injuries to recurrent laryngeal nerve occurred in 2 [2.8%] cases, one patient had vocal cord paralysis and other developed vocal cord paresis which improved partially with time. Recurrent laryngeal nerve injury is a potentially dangerous and a serious complication of thyroid surgery. The overall percentage of injury to recurrent laryngeal nerve in thyroid surgery in this study was 4 [5.6%] cases

Management of multilevel lumbar disc herniation

To identify and document more then one level symptomatic lumbar disc herniation and to find its frequency presentation and outcome. Descriptive study Combined Military Hospital Rawalpindi from 2001 to 2002. A total number of 260 male patients were selected from out patient department over a period of 1 year. After clinical evaluation, confirmation was done by nonenhanced Electro-resonance imaging [MRI] of the lumbar spine. All the patients with multilevel disc herniation on MRI underwent never conductions [NCS] electromyography [EMG] studies. All the patients were males. Maximum number of patients was between 32 - 40 years of age; mean age was 35 with a standard deviation of 2. 48 belonged to military setup and 82 were civilians. Out of all, 14 had multilevel lumbar disc herniations, the frequency being 5.8 in our study. All the patients with multilevel disc herniations underwent surgery. Only 4 patients had multilevel discectomy where 10 had discectomy at single level. Mortality was nil and there were no postoperative neurological deficits. All the patients were back to work at 6 weeks. Data was analyzed using the descriptive SPSS package. The identification of symptomatic multilevel disc herniation is extremely important in order to manage the patients with multilevel disc herniation as single level discectomy in such patients will not ameliorate the symptoms and may require another difficult surgery

Peripheral vascular trauma an experience of two years

The incidence of vascular trauma has increased considerably during last 40 years. The study was carried out to describe the causes of injury, presentations, surgical approaches, outcome and complication of vascular trauma of the upper and lower limbs. This was a descriptive study. Surgical Department CMH Kharian, in which this study lasted from Oct 1997 to Oct 1999. In the study, 30 patients were operated for peripheral vascular injuries. Diagnosis was made by physical examination and hand Doppler alone. Primary vascular repair was carried out where possible; if not interposition vein graft was placed. Early liberal fasciotomy was considered as and when required. Patients with isolated venous trauma and patients with obviously unsalvageable lower extremity injury requiring primary amputation were excluded from the study. The limb salvage rate was 93.3%. A total no of 30 patients were included in this study. Out of these 24 [80%] were males and 6 [20%] were females, all were young adults with age ranging from 14 to 52 years, a mean age of 22 years and a standard deviation of. Gun shot wound [GSW] constituted the major cause of trauma and was present in 18 [60%] Patients, road traffic accident [RTA] in 6 [20%] patients and stab wound in 6 [20%] patients which are comparable to international studies. Primary end-to-end anastomosis was done in 20 [66.07%] patients and graft interposition was done in 10 [33.3%] patients. Vein graft was used in 20 [66.07%] patients lateral repair was done in 7 [23.3%] patients while in 3 [10%] patients ligation was performed. Early complications included bleeding in 2 [6.7%], thrombosis in 4 [13.3%] and wound infection in 3 [10%] patients respectively. Late complications are amputation in 2 [6.7%] patients and muscle ischaemia in 2 [6.7%] patients. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present. Early fasciotomy is warranted if there is any suspicion of occurrence of compartment syndrome

Pneumothorax: a review of 146 adult cases admitted at a university teaching hospital in Pakistan

OBJECTIVE: There is a lack of data on the etiology and outcome of pneumothorax among the Pakistani population. Our aim was to review the etiology, clinical course, management and outcome of patients presenting with pneumothorax. PATIENTS AND METHODS: All adult cases with pneumothorax admitted to a University Teaching Hospital in Karachi, between January 1992 and June 1996, were reviewed and analyzed. A total of 146 patients were reviewed. Their mean age was 46.3 years [SD +/- 17.8 years] with a male to female ratio of 3.7:1. Secondary pneumothorax was the commonest type seen [45%], followed by traumatic [21%], iatrogenic [18%] and primary [16%]. Tuberculosis [47%] and COPD [45%] were most common lung diseases associated with secondary pneumothorax. Pneumothorax secondary to TB presented at an earlier age than that with COPD [49.6 vs. 60.1 years]. Similarly, patients with primary pneumothorax were significantly younger than patients with secondary pneumothorax [42.3 vs. 51.7 years]. Rib fracture was the most common cause of traumatic pneumothorax. Coronary artery bypass grafting, transthoracic fine needle aspiration and neck vein cannulations were the leading iatrogenic causes. The commonest symptoms of pneumothorax were dyspnea [68%] and chest pain [40%]. Most cases [81%] were successfully managed by intercostal tube drainage. In our study population, secondary pneumothorax was the commonest variety seen. TB was the commonest cause of secondary pneumothorax, closely followed by COPD. Nearly 40% of pneumothorax were either traumatic or iatrogenic. Intercostal tube drainage remains the treatment of choice for pneumothorax