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Objectives: The purpose of the study was to identify the sequence of violence that ensues after breaking bad news and develop a contextual model of breaking bad news and develop a model contextual for Pakistan
Methods: A qualitative exploratory study was conducted using Six FGDs and 14 IDIs with healthcare providers working in the emergency and the obstetrics and gynecology departments of tertiary care hospitals of Karachi, Pakistan. Data was transcribed and analyzed to identify emerging themes and subthemes using thematic content analysis
Results: Impatience or lack of tolerance, lack of respect towards healthcare providers, unrealistic expectations from healthcare facility or healthcare staff were identified as main reasons that provoked violence after breaking bad news. A conceptual five step model was developed to guide communication of bad news by the health care providers. On initial testing the model was found to be effective in deescalation of violence
Conclusion: Communication of bad news requires application of specific approaches to deal with contextual challenges for reducing violence against healthcare
ABSTRACT
Background and Objective: Considering high burden of violence against healthcare workers in Pakistan APPNA Institute of Public Health developed a training to prevent reactive violence among healthcare providers. The purpose of this training was to equip healthcare providers with skills essential to control aggressive behaviors and prevent verbal and non-verbal violence in workplace settings. This study assesses the effectiveness of training in prevention, de-escalation and management of violence in healthcare settings
Methods: A quasi-experimental study was conducted in October, 2016 using mixed method concurrent embedded design. The study assessed effectiveness of de-escalation trainings among health care providers working in emergency and gynecology and obstetrics departments of two teaching hospitals in Karachi. Quantitative assessment was done through structured interviews and qualitative through Focus Group Discussions. Healthcare providers` confidence in coping with patient aggression was also measured using a standard validated tool"
Results: The overall self-perceived mean score of Confidence in Coping with Patient Aggression Instrument "[CCPAI]" scale was significantly higher in intervention group [Mean= 27.49, SD=3.53] as compared to control group [Mean= 23.92, SD=4.52] [p<0.001]. No statistically significant difference was observed between intervention and control groups with regard to frequency of violence faced by HCPs post training and major perpetrators of violence
Conclusion: De-escalation of violence training was effective in improving confidence of healthcare providers in coping with patient aggression
ABSTRACT
Background and Objective: The findings of the Health Care in Danger project in Karachi suggests that there is presence of behavioral negligence among vehicle operators on roads in regards to giving way to ambulances. A mass media campaign was conducted to raise people's awareness on the importance of giving way to ambulances. The main objective of this study was to determine the effectiveness of the campaign on increasing the proportion of vehicles that give way to ambulances
Methods: This was a quasi-experimental study that was based on before and after design. Three observation surveys were carried out in different areas of the city in Karachi, Pakistan before, during and after the campaign by trained observers who recorded their findings on a checklist. Each observation was carried out at three different times of the day for at least two days on each road. The relationship of the media campaign with regards to a vehicle giving space to an ambulance was calculated by means of odds ratios and 95% confidence intervals using multivariate logistic regression
Results: Overall, 245 observations were included in the analysis. Traffic congestion and negligence/resistance, by vehicles operators who were in front of the ambulance, were the two main reasons why ambulances were not given way. Other reasons include: sudden stops by minibuses and in the process causing obstruction, ambulances not rushing through to alert vehicle operators to give way and traffic interruption by VIP movement. After adjustment for site, time of day, type of ambulance and number of cars in front of the ambulance, vehicles during [OR=2.13, 95% CI=1.22-3.71, p=0.007] and after the campaign [OR=1.73, 95% CI=1.02-2.95, p=0.042] were significantly more likely give space to ambulances
Conclusion: Mass media campaigns can play a significant role in changing the negligent behavior of people, especially when the campaign conveys a humanitarian message such as: giving way to ambulances can save lives
ABSTRACT
Macrodystrophia lipomatosa is a rare presentation and only few cases are reported in scientific literature. We report a case of Macrodystrophia lipomatosa in a 7 year young girl from a tertiary care hospital Mumbai. Case presentation: A 7 year old female was presented to outpatient department with progressive enlargement of right lower limb with increase in size of right great toe since birth. On clinical examination there was non tender fluctuant soft tissue swelling with good functional limb. Scannogram showed reduction of the medial compartment of right knee joint and the right lower limb length was slightly longer compared to the left side with presence of soft tissue swelling on medial distal thigh and knee region. MRI showed un-encapsulated subcutaneous fatty tissue involving the entire right lower limb along its medial aspect up to the great toe with fatty infiltration of the vastus medialis muscle suggestive of macrodystrophia lipomatosa. Arterial and venous colour Doppler study of right lower limb was normal. Conclusion: Macrodystrophia lipomatosa is a rare congenital, non hereditary condition with localized macrodactyly and proliferation of mesenchymal element and marked increase in fibroadipose tissue. X-ray and MRI are investigation of choice. Doppler study shows normal vascularity.
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Ulnar nerve compression at guyon’s canal is rare and very few cases have been reported in literature. It can be missed due to its rarity. Symptoms vary from pain and paresthesia to wasting and significant loss of muscle strength, with significant deformities of the hand. The diagnosis is made by detailed history and examination, electromyography, nerve conduction velocity test, ultrasound and magnetic resonance imaging. Early decompression of nerve is treatment of choice. Here we are presenting a case of compression of ulnar nerve in guyon’s canal due to ganglionic cyst.
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Objective: To assess the perceptions regarding basal bolus insulin injections and the changes in blood glucose levels and glycosylated hemoglobin [HbA1c] before and after 3 months of such treatment in diabetic patients. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Endocrinology, Liaquat National Hospital, Karachi, from December 2014 to March 2015
Methodology: A total of 222 diabetic patients started on basal bolus insulin injection were enrolled and asked to answer 17 questions. Those with complications of diabetes were excluded. Fasting blood glucose [FBS], random blood glucose [RBS] and HbA1c levels were checked initially, and after 3 months of getting basal bolus insulin. Paired t-test and chi-square test were used for determining p-value with significance at p < 0.05
Results: Majority [n=217, 97.7%] of the patients were previously taking other insulins. Before starting this treatment, the mean FBS was 260.5 +/- 52.2 mg/dl, RBS was 385.5 +/- 47.61 mg/dl and HbA1c was 12.76 +/- 1.92%. After 3 months of treatment, FBS improved to 117.9 +/- 14.2 mg/dl, RBS was 156.7 +/- 17.09 mg/dl and HbA1c was 7.72 +/- 4.41% [p < 0.001]. Two hundred and sixteen [97.3%] patients believed that basal bolus insulin was started as their diabetes worsened; 157 [70.70%] thought that their blood glucose control would improve with the use of this form of insulin. One hundred and ninety four [87.4%] had fear of needle injections. Perceptions regarding hypoglycemia with this form of insulin were observed in 157 [70.7%]. One hundred and twenty seven [84.1%] of the females and 51 [71.8%] of the males thought that the basal bolus insulin regimen was too expensive [p=0.032]
Conclusion: There were many misconceptions in patients who were started on basal bolus insulin. Marked improvement in blood glucose levels and HbA1c were observed after the use of this regimen
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Perception , Insulin/analogs & derivatives , Injections , Recombinant Proteins , Glycated Hemoglobin , Blood Glucose , Surveys and QuestionnairesABSTRACT
Background: A retrospective study was conducted in the department of orthopaedic surgery in a tertiary care hospital of western Maharashtra. Methods: Data of all the patients with fracture of distal end radius with or without ulna fracture who were admitted in our centre over a period of 4 years were recorded from case files, casuality admission register and operative records. A total of 204 patients were included in our study and mode of treatment was compared among the various available treatment modality such as cast/slab; percutation fixation with k-wire, external fixation & plate osteosynthesis. Results: Out of the total number of cases (n=204) for fracture distal end radius, nearly 10% case were managed with cast (n=21), 22% with percutaneous fixation with k-wire (n=45), 23.5% with external fixature (n=48), 19% with both external fixator and k-wire (n=38) and 25% with plate osteosynthesis (n=52). Hence when we assess the modality of treatment of distal end radius year wise from 2011 to 2014, the incidence of surgery by plate osteosynthesis has increased over a span of period. Conclusion: Retrospective study conducted at our tertiary care hospital concludes that incidence of plating for distal end radius fracture has increased over a period of time as compared to cast, percutaneous k -wire fixation and external fixator.
ABSTRACT
Bioabsorbable materials are more commonly used now days in orthopaedic surgeries. Bioabsorbable implants for fracture fixation, and meniscal repair. These implants provide the advantages of gradual load transfer to the healing tissue, reduced need for implant removal, and radiolucency, which facilitates postoperative radiographic evaluation and no hinderance in second surgery. These also carries disadvantages like, more expensive, having less strength than metals, tissue reactions including mild fluid accumulation, painful erythematous fluctuating papule, sterile sinus tract formation, osteolysis, synovitis, and hypertrophic fibrous encapsulation. We advocate more researches to be carried out for the best suitability of these materials in orthopaedic surgeries.
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To determine the effect of mobile phone intervention on HbA1c in type-2 Diabetes Mellitus [DM] patients living in rural areas of Pakistan. Randomized controlled trial. Department of Endocrinology, Liaquat National Hospital, Karachi, from December 2013 to June 2014. A total of 440 patients in intervention and control groups were enrolled. All patients between 18 - 70 years of age, residing in rural areas of Pakistan, HbA1c >/= 8.0% and having personal functional mobile phone were included. The intervention group patients were called directly on mobile phone after every 15 days for a period of 4 months. They were asked about the self- monitoring blood glucose, intake of medications, physical activity, healthy eating and were physically examined after 4 months. However, the control group was examined initially and after 4 months physically in the clinic and there were no mobile phone contacts with these patients. Patients in intervention group showed improvement [p < 0.001] in following diet plan from 17.3% at baseline to 43.6% at endline, however, the control group showed insignificant increase [p=0.522] from 13.6% at baseline to 15.9% at endline. Intervention group [RR = 2.71, 95% CI = 1.18 - 6.40] showed significant positive association with normalization of HbA1c levels. The relationship was adjusted for age, gender, socio-economic status, ethnicity, education, hypertension, medication, BMI, diet, LDL levels and physical activity. Dietary restriction and low LDL levels also showed significant associations with reduced HbA1c levels on multivariate analysis. Mobile phone technology in rural areas of Pakistan was helpful in lowering HbA1c levels in intervention group through direct communication with the diabetic patients. Lowering LDL and following diabetic diet plan can reduce HbA1c in these patients and help in preventing future complications
Subject(s)
Humans , Male , Female , Diabetes Mellitus/prevention & control , Rural Population , Randomized Controlled Trials as TopicABSTRACT
Objective: To assess the clinical presentations and short-term outcomes of patients with thyroiditis presenting to a tertiary care hospital in Karachi, Pakistan
Study Design: Case series
Place and Duration of Study: Department of Endocrinology, Liaquat National Hospital, Karachi, from June 2014 to February 2015
Methodology: Patients between 18 and 70 years of age with acute onset of thyroiditis confirmed on thyroid scan or clinical judgment presenting to the outpatient services were included in the study. Pregnant females, psychiatric patients and patients having other chronic illnesses were excluded from the study
Results: A total of 26 patients with thyroiditis attended the endocrine clinic. Mean age of patients was 41.2 +/- 11.12 years. There were 18 [69.2%] females. Clinical presentations were fever [65.4%], tender neck [23.1%], goiter [19.2%], localized tenderness in neck and palpable lymph nodes [26.9%]. Major symptoms reported were: sore throat [69.2%], weight loss [38.5%], upper respiratory tract infection, thyroid pain, tremor, sweating and fever of unknown origin in 26.9% cases. All the patients had raised Erythrocyte Sedimentation Rate [ESR]. Low Thyroid Stimulating Hormone [TSH] < 0.4 mlU/L was seen in 88.5% and 57.7% had raised Free T4 > 1.8 ng/dL. Complete recovery was seen in 88.5% patients while 11.5% had early hypothyroidism
Conclusion: Fever and sore throat were the main presenting features of thyroiditis patients. ESR was raised in all patients. A majority of patients had complete recovery with appropriate management; however, few cases developed hypothyroidism
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To assess the quality of postgraduate fellowship training and to determine the differences in the quality of postgraduate fellowship training in public and private teaching hospitals of Karachi. It was a cross sectional survey conducted in four public and private sector hospitals of Karachi from January to March 2012. A total of 246 postgraduate fellowship trainees were interviewed. A standardized questionnaire adopted from CPSP guidelines on postgraduate training standards was developed. Postgraduate fellowship trainees [PG's] were selected on the basis of convenient non-probability sampling technique. Fisher's exact test and chi-square test were used to find differences in quality of postgraduate training. The mean duty hours per week was highest in private sector hospitals i.e., 72.1 as compared to government sector hospital which was 58.3 [P-value <0.01]. Of the respondents, 66.0% of PG's in private hospitals agreed that they have a structured study program as compare to 46.5% in public hospitals [P-value <0.001]. Only 38.1% of PG's in public hospitals agreed that they spent appropriate amount of time with their family and friends as compare to 1.8% of PG's in private hospitals [P-value <0.001]. No significant difference was found in quality of supervision in both public sector and private sector hospitals. The attributes of different aspects of training were different in public and private sector hospitals. So significant room exists for improvement in the quality of postgraduate medical training as indicated by the less than desirable proportion of trainees being satisfied with different aspects of training
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To determine the factors related to tobacco smoking among students of grade 6-10 in an urban setting in Sindh, Pakistan. Cross-sectional survey. The study was conducted in public and private schools of Hyderabad, Sindh, Pakistan, from January 2008 to June 2009. A sample of 501 students from grade 6-10 were selected through simple random sampling and probability proportional to size. Students answered to a pre-tested questionnaire on sociodemography and tobacco use. Descriptive statistics were used to determine frequency distribution. About 9% of the students were smoking some form of tobacco. Ten percent had tried cigarette smoking and about 80% and 61% were chewing Areca nuts and 'Paan' [concoction of Areca nuts, tobacco, hydrated lime, herbs and spices wrapped in betel leaf. Being old, male gender, peer influence, personal attitude toward future smoking, chewing 'Gutka' [concoction of tobacco, Areca nuts and hydrated lime] and having a more educated mother was associated with greater frequency of smoking any form of tobacco. High frequency of tobacco smoking, the attitude toward tobacco consumption and a very high consumption of Areca nuts and other chewable tobacco products by the children warrants urgent action in order to control the tobacco epidemic in Pakistan
ABSTRACT
To estimate the proportion of children 1-4 years of age vaccinated in the first year of their life and determine socio-demographic factors associated with vaccination in the rural sub-district Khairpur, Sindh, Pakistan. Cross-sectional study. The study was conducted in 9 Union Councils of sub-district Gambat, district Khairpur, Sindh, from August to October 2008. A questionnaire based representative multi-stage cluster survey was conducted. A total of 549 children aged 1-4 years were assessed for coverage and predictors of vaccination. Univariate and multivariate analysis was done using logistic regression to determine the unadjusted and adjusted relationship between socio-demographic predictor and outcome [vaccination status]. The coverage for complete vaccination was 71.9% [95%CI=68.1%-75.7%]. Educational level of mother [p=0.042], father [p=0.001] and child birth at hospital [p=0.006] were significantly associated with the vaccination status. Mother's educational level of intermediate and above was the strongest predictor [OR=12.19, 95%CI=1.57-94.3] for vaccination. Education of parents, particularly mother's education was important determinant of vaccination status of the children. In addition, distance from taluka health facility and misconception of parents were among the main reasons of not getting the children vaccinated. There is a need to educate the parents especially mothers about the importance of vaccination and organize EPI services at Basic Health Unit level to improve the vaccination coverage in rural areas of Pakistan