Preoperative informed consent: is it truly informed?

Pre-operative informed consent is an important aspect of surgery, yet there has been no formal training regarding it in Pakistan. This study was done to assess the preoperative informed consent practice. After taking informed permission, a questionnaire was filled in during an interview with 350 patients, who have undergone elective surgical procedures under routine practice conditions from July to October 2010. All the patients were asked a set of standard questions which related to the information they were provided before the operation as a part of standard informed consent practice. Most i.e. 307 [87.7%] patients were informed about their condition but very few 12 [3.4%] were briefed regarding complications. Only 17 [4.9%] patients said they knew about the risks and complications of proposed anesthesia. One hundred thirty-eight [39.4%] patients said that they were allowed to ask questions while giving consent. Most of the time 196 [56%] consent was taken one day before surgery but in few 2 [0.6%] instances it was taken on the morning of surgery and on operation table in some cases 3 [0.9%] as reported by patients. The consent form was signed by the patients themselves in only 204 [58.3%] cases and by their relatives in the rest. About half the number of patients 171 [48.9%] interviewed were satisfied from the information they received as informed consent process. This study highlights the poor quality of patient knowledge about surgical procedures and the inadequate information provided

Psychological problems of children in general paediatric settings

Chronic physical illnesses appear to be a significant risk factor for emotional and behavioral difficulties. The aim of present study was to determine the frequency of emotional and behavioral problems in children in general pediatric setting and to try to identify any risk factors which can predispose a child to develop psychological problems. This was a pilot study conducted in the Pediatric unit of a tertiary teaching hospital in Lahore during March -May 2006. Following parental consent, hundred children consecutively admitted in the unit, who were between the ages of four to twelve and not critically ill were included in the study. Demographic details and information about risk factors were collected. Strengths and difficulties Questionnaire was also administered. Among our sample, SDQ scores of 40% children were in abnormal range. Children with physical illnesses of more than one month were at higher risk of emotional and behavioral problems. [P value less than 0.05]. Among risk factors, family history of psychiatric illness, and epilepsy, history of epilepsy in the child as well as presence of learning disability reached statistical significant results. None of these children were identified or referred for psychological assessment. Emotional and behavioral difficulties commonly first present in Pediatric medical settings but often are not detected and therefore not treated. Pediatricians need to acquire skills in assessing and treating primary developmental and behavioral disorders, and in preventing and managing secondary emotional difficulties, which can arise because of major physical illness. Better liaison is also required between pediatricians and psychiatrists to improve early detection and treatment of psychiatric problems in children

pattern of diseases in a surgical unit at a tertiary care public hospital of Karachi

Objective: To study the pattern of diseases in patients admitted in a surgical unit of tertiary care public hospital in Karachi

Design: Descriptive retrospective analysis of patients admitted from January 1, 2004 to June 30, 2004

Setting: Surgical Unit IV, Civil Hospital, Karachi

Results: A total of 501 patients, 284 [56.7%] males and 217 [43.3%] females were admitted during a six months period in Surgical Unit IV of Civil Hospital, Karachi. Out of these 296 [59.1%] patients were admitted through OPD, 190 [37.9%] came from emergency and 15 [3%] from other units. The majority of patients i.e. 114 [22.8%] had gastrointestinal related diseases followed by hernia 94 [18.8%], hepatobiliary diseases 69 [13.8%], ano-rectal diseases 37 [7.4%], abscesses 35 [7%], trauma 28 [5.6%], thyroid diseases 20 [4%], testicular and scrotal related problems 19 [3.7%], breast diseases 17 [3.4%] and tetanus patients 10 [2%]. Diabetes mellitus was the commonest associated disease seen in 60 [12%] patients. Four hundred forty-one [88%] patients were discharged after successful treatment while 10 [2.2%] expired during the study period

Conclusion: This study revealed that the commonest cause of admission was gastrointestinal related problems including acute abdomen, followed by hernias and hepato-biliary diseases, while diabetes mellitus was the most common associated disease