Perception towards multidisciplinary team approach in stroke rehabilitation: a qualitative study

Objective: To determine perception of rehabilitation professionals working as multidisciplinary team members with stroke patients

Study Design: Qualitative study design

Place and Duration of Study: Isra Institute of Rehabilitation Sciences [IIRS], Isra University, Islamabad Campus from Nov 2015 to Feb 2016

Material and Methods: This qualitative study utilized focus group discussion with sample of six rehabilitation professionals. These professionals included physiotherapist, rehabilitation specialist, nurses, speech and language therapist, psychologist and occupational therapist with minimum two year work experience in multidisciplinary team. Two focus group were conducted which were audio and video recorded. Data was transcribed and thematic analyzed were drawn manually. Data verification was done with the help of two separate coders

Results: Attitude of professional was very much important while developing multidisciplinary team approach for quality Care. Team skills of each member of multidisciplinary team must be very much evident. Inter professional and interdepartmental communication and collaboration is needed while developing multidisciplinary team approach. Appropriate resources and procedures. Skill mix in team, Climate of the team, Individual personal characteristics, Clear vision, Quality and outcome of care, Understanding of the roles, proper communication, respect and dignity are the key characteristics emerged from focus group discussion

Conclusion: Attitude of professional was categorized very important while developing multidisciplinary team approach for quality Care. Inter professional and interdepartmental communication and collaboration was highlighted for developing multidisciplinary team approach. Appropriate resources and procedures, Skill mix in team, Climate of the team, Individual personal characteristics, Clear vision, Quality and outcome of care, Understanding of the roles, proper communication and respect and dignity was the key characteristics emerged from focus group discussion

Prevalence of anxiety and depression among doctors; the unscreened and undiagnosed clientele in Lahore, Pakistan

Objectives: To analyze prevalence of anxiety and depression among doctors serving in a tertiary care hospital in Lahore, with a study of impact of relevant demographic features

Methods: A cross sectional study was conducted at Combined Military Hospital, Lahore, from February 2014 to Jan 2015. Participants were doctors serving in subject hospital for at least six months duration. Standardized Hospital Anxiety Depression Score [HADS] inventory was selected as inventory. Formal approval from hospital ethical committee and written informed consent from participants were obtained. Demographic characteristics of participants were recorded as independent variables; anxiety and depression scores being outcome variables. Data analysis was done via descriptive statistics [SPSS-20], qualitative data expressed as frequencies, percentages; quantitative as mean +/- standard deviation[SD]. Cross tabulation was done via chi-square, p-value < 0.05 considered as significant

Results: Out of 203 volunteers, 97[47.78%] responded. Score of anxiety was 7.04 +/- 4.470, maximum being 19, scores of depression was 4.94 +/- 3.605, maximum score being 15. Mild to moderate anxiety and depression were revealed in 33[34%] and 24[24.8%] respectively, while 7[7.2%] and 1[1.0%] had severe anxiety and depression respectively. There was strong positive relation between anxiety and depression[p<0.001]. There was significant impact of service years on depression[p-0.011] and gender on anxiety[p-0.002],9[17.31%] males and 24[53.33%] females had mild to moderate anxiety while 4[7.69%] males and 3[6.66%] females revealed severe anxiety and other variables did not reveal significant impact on HADS scores

Conclusion: Doctors showed high grades of anxiety and depression. They must be promptly screened and managed at all medical institutions

Trends of contraception among ladies of local population in Pakistan; why, how, when and what?

Objective: To analyze trends of use of methods of contraception along with study of impact of various demographic and social factors on contraception in Peshawar, Pakistan

Methods: A cross-sectional descriptive study with random purposive sampling was conducted at Combined Military Hospital Peshawar, from Mar 2015-Nov 2015. Self-designed questionnaire with demographic details and questions pertinent to contraceptive practices was utilized as study instrument. Females reporting to concerned hospital for contraceptive advice and prescription were distributed with questionnaire and written informed consent form. Formal approval was taken from ethical committee of hospital. Data was analyzed via descriptive analysis [SPSS-21], qualitative data was expressed as frequencies and percentages; quantitative as mean +/- standard deviation [SD]. Main outcome variable i-e contraceptive device used; was cross-tabulated with independent variables

Results: Response rate was 53.2% [n-426]. Usage of contraceptive device was as follows; 51.2% Nil, 9.4% barriers, 22.3% oral/injectable hormones, 13.4% IUCDs, 3.8% sterilization. There was a strong relationship between type of contraceptives used and age [p<0.001], client's education [p<0.001], husband's education [p<0.001], number of children [p<0.001], religion [p0.013], socioeconomic class [p<0.001], and religious beliefs about use of contraceptives [p<0.001]. More Muslims considered contraception irreligious than non-Muslims [p 0.02]. There was no significant impact of husbands' pressure to not to use contraceptives on type of contraception practised [p 0.114]

Conclusion: Contraceptive devices are under-utilized in the study participants. Multidisciplinary approach should be applied to enhance client education, awareness and counseling to utilize these devices more appropriately and regularly

Results of comparative study of fractures fixed with DCP and nailing

The treatment methods of the fractures of humerus are treated in many ways. Interlocking nails and plates have both stood the test of time but the present study looks at both methods scientifically. Prospective, comparative study. This study was carried out at Ghazi Medical College, D.G.Khan from 07.01.2013 to25.02.2015. A total of 40 patients were included in the study. It was a, study of two groups of patients of fractures of humerus treated with dynamic compression plate versus with interlocking nails. Fractures in both groups healed uneventfully without significant complications. Both modes of treatment can be recommended for the treatment of fractures of the shaft of Humerus with minimal chances of complications

Job satisfaction among doctors, a multi-faceted subject studied at a tertiary care hospital in Lahore

Objective: To study the level of job satisfaction among doctors serving in a tertiary care hospital in Lahore and ascertain its co-relation with multiple demographic variables which had a profound impact. Methods: This cross sectional study with non-probability purposive sampling was conducted at Combined Military Hospital, Lahore, from February 2014 to November 2014. Subjects were doctors serving in that hospital for minimum six months duration. Pre-formed questionnaires were distributed to volunteers [average filling time was 3 ½ to 7 minutes]. Multiple demographic features were independent variables. Outcome variable was job satisfaction. Statistical analysis was done via descriptive statistics [SPSS 20], data expressed as mean +/- standard deviation [SD]. Results: Out of 263 doctors serving in hospital, 203 [77.91%] volunteered to participate; response rate by depositing the filled forms was 47.78% [97 doctors]. Amongst the respondents, 10 [10.3%] doctors had below average job satisfaction, 32[33.0%], 21[21.6%], 21[21.6%] and 13[13.3%] had average, above average, well above average and outstanding job satisfaction respectively. There was significant relation between job satisfaction and age group of the doctors [p 0.025], education [p 0.015], service years [p 0.013] income per month [p<0.001]. There was no significant impact of gender [p 0.540], marital status [p 0.087], number of children [p 0.153], current employment [p 0.71], nature of job [p 0.204], working hours [p 0.089], additional duties [p 0.421] and socioeconomic class [p 0.104] on outcome variable. Conclusion: A significant number of doctors was found discontented with their job, which may consequently impact their yield/ performance. The job satisfaction can be substantially improved if these contributory factors are aptly addressed at all tiers

rapidly developing cataract in idiopathic hypoparathyroidism: a case report

Rapidly developing cataract in idiopathic hypoparathyroidism is rare. Here we report, a case of cataract which developed rapidly and was associated with idiopathic hypoparathyroidism in a 20- year-old female patient. The case is being reported for its rarity and early diagnosis which was presented in a tertiary care hospital. For cases like these, prompt treatment is essential which may result in prevention of complications like vision loss. As per literature research via pubmed.com, this is the first case report of rapidly developing cataract in a patient of idiopathic hypoparathyroidism in Pakistan

To compare lipid changes in glycemic controlled type 2 [NIDDM] and glycemic uncontroled type 2 [NIDDM] patients

Today diabetes is a global problem. Insulin play an inportant role in the lipid and lipoprotein metabolism. Glycemic control improves and may even normalize triglyceride and HDL cholesterol level in diabetic petients, therefore one could speculate the improvement of glycemic control beneficidly influence LDL phenolype. The degree of hyperglycemia was assesed by means of measmement of fasting blood glucose and glycosylated heamoglobin [Haemoglobin A[1c]. To compare the lipid profile in good glycemic controlled NIDDM type 2 with glycemic uncontrolled NIDDM type 2 and matched controls. Comparative study. This study was conducted at BMSI, JPMC, Karachi from June 2007 to December 2007. Total 120 subject of either sex, age were included with set criteria in study and were distributed in to three groups. Group A controls, Group B glycemic controlled type 2 NIDDM using oral hypoglycemic drugs regularly - Group C glycemic uncontrolled type 2 NIDDM using oral hypoglycemic drugs regularly. Lipid, lipoprotein and fasting serum sugar and HbA[1c] were analyzed. Highly significantly increase in total cholestrol, triglycerides and LDL cholestrol, while significantly decrease in HDL cholestrol in glycemic uncontrolled type 2 NIDDM . Fasting serum glucose level and HbA[1c] are useful diagnostic index for glycemic controlled and uncontrolled type 2 NIDDM - patient with glycemic uncontrolled type 2 NIDDM have greater disbances in lipid and lypoprotein metabolism which leads to atherosclerosis which futher results in coronary, cerebral and peripheral vascular occlusion

Early spica cast in children femoral shaft fractures

To find out the advantages of early spica cast as a treatment for isolated, uncomplicated femoral shaft fracture in children. Descriptive Study. This study was carried out in the Department of Orthopaedics, DHQ Hospital, Dera Ghazi Khan ospital DeraGhazi Khan from April 2009 to December 2010. A total of 30 patients were included in the study. All patients under the age of 12 years, who presented during the study period with femoral shaft fracture were included in the study. A total of 30 children with femoral fractures were treated with early spica cast. Age ranged from 2 year to 11 years. Male to female ratio was 2.75:1. Majority of children were under 5 years. In most of the children spica cast was applied on the day of presentation within few hours and were sent home on the same day. Twenty one children were followed till removal of spica cast. Period of immobilization in spica cast ranged from 4 weeks to 7 weeks with average of 5.73 weeks. Common problems related to spica cast were soakage and breakage of spica which occurred in 9[42.85%] children. At the time of cast removal shortening ranged from 0.5cm to 2.5 cm in 15 out of 21 [71.42%] children: Early spica cast is simple, effective and definite method of treatment with minmal complications and acceptable results in paediatric age group. It allows rapid return of child to family environment, thus avoiding prolonged separation from parents

comparative study of cross and parallel Kirschner-wires fixation in Gartland type-III supracondylar fracture of humerus in children

To compare the anatomical and functional results of open reduction and internal fixation of supracondylar fracture of humerus in children with parallel and cross K-wire fixation and to determine the best method of fixation, preventing complications. A comparative study. This study was conducted in Orthopaedics department, District Head Quarter Hospital Dera Ghazi Khan from March 2011 to September 2011. Forty consecutive patients from 4 to 10 years of age [mean age of 6.4 years] with Gartland type-III supracondylar fractures of humerus, received in the emergency department were included in the study. In this study, patients from 4 to 10 years of age were included. Their mean age was 6.4 years. Their age distribution is shown in Graph-1. Highest numbers of patients were from 6 to 7 years of age. Those were 17 [42.5%]. The mean age of the patients in which fracture was fixed by parallel Kirschner wires, was 6.2 years and the mean age of the patients in which fracture was fixed by cross Kirschner wires, was 6.6 years. On the basis of above mentioned findings and review of the available literature, the conclusion of this study is that cross Kirschner wires configuration is more safer and stronger mode of fixing all Gartland type-III supracondylar fracture of humerus in children

Outcome of 7-S, TQM technique for healthcare waste management

To assess the present waste management system of healthcare facilities [HCFs] attached with Shalamar Hospital, Lahore by applying the 7-S technique of Total Quality Management [TQM] and to find out the outcome after imparting training. Interventional quasi-experimental study. The Shalamar Hospital, Lahore, Punjab, Pakistan, November, 2009 to November, 2010. Mckinsey's 7-S, technique of TQM was applied to assess the 220 HCFs from Lahore, Gujranwala and Sheikhupura districts for segregation, collection, transportation and disposal [SCTD] of hospital waste. Direct interview method was applied. Trainings were provided in each institution. After one year action period, the status of four areas of concern was compared before and after training. The parameters studied were segregation, collection, transportation and disposal systems in the 220 HCFs. Each of these were further elaborated by strategy, structure, system, staff, skill, style and stakeholder/shared value factors. Standard error of difference of proportion was applied to assess significance using 95% confidence level. There was marked improvement in all these areas ranging from 20% to 77% following a training program of 3 months. In case of disposal of the waste strategy, structure and system an increase of 60%, 65% and 75% was observed after training. The 7-S technique played a vital role in assessing the hospital waste management system. Training for the healthcare workers played a significant role in healthcare facilities

Proposed model for healthcare waste management

The objective of this manuscript is to propose a Healthcare Waste Management [HWM] model for the safe disposal of healthcare waste which should be comprehensive, environment friendly and in an integrated form. This descriptive analytical study was done and based upon the factors associated with the poor handling of healthcare waste at Shalamar Hospital Lahore from November, 2008 to December, 2010 in healthcare facilities [HCFs] situated in Punjab, Pakistan, a model has been proposed. Five stages for the management of the waste [a] Planning the outline, [b] Implementation of action plan, [c] Classifying job descriptions, [d] disposal method and [e] Skill Development have been evolved. This model can be applied in any healthcare facility situated in Pakistan

Frequency of hydrocephalus in postoperative cases of myelomeningocele. Need of ventriculoperitoneal shunt?

To assess the frequency of hydrocephalus in postoperative cases of myelomeningocele and the need of ventriculoperitoneal shunt placement. Descriptive study CMH Rawalpindi from Sep 2008 to Nov 2009. Forty patients of either sex with myelomeningocele were included. These patients did not have hydrocephalus at the time of presentation. They were operated upon for myelomeningocele. Postoperative follow up was carried out at 1, 2 and 3 months to look for the development of hydrocephalus. Data was analyzed using SPSS version 17. Out of forty patients 22 [55%] were males and 18 [45%] were females. The age ranged from newborn to 10 months. Thirty five [87.5%] patients had lumbosacral myelomeningocele, 2 [5%] patients thoracic, 2[5%] patients cervical while one patient [2.5%] presented with both cervical and lumbosacral myelomeningocele. Postoperatively 21 [52.5%] patients developed hydrocephalus which were subsequently confirmed on CT scan head and were then subjected to ventriculoperitoneal shunting. High frequency of hydrocephalus was observed in postoperative cases of myelomeningocele and patients presenting with one entity must be looked for the other. Postoperative cases of myelomeningocele should be regularly followed for the evidence of hydrocephalus

Prevalence of obesity among the school-going children of lahore and associated factors

To determine the prevalence of obesity among the school- going children [6[th] and 7[th] grade] of Lahore and ascertain the associated factors. A descriptive study with sample size of 293 children conducted over a period of four months in two private sector schools of Lahore. Information was gathered by the help of a pre designed questionnaire after getting formal consent from parents. Children included in the study were healthy with no reported chronic illness. Body weight was measured in minimal clothing using a weight scale; body height was measured in erect posture without shoes using a stadiometer. Obesity, underweight and overweight were defined by plotting BMI against age [in months and years] on WHO BMI-for-age [5-19 years [percentiles]] charts. Out of 293 children 11.9% were obese [more than 97[th] percentile] while 21.8% were overweight [85[th]-97[th] percentile]. Among obese children 74.3% were found to watch TV for 1-2 hours daily while 25.7% watch TV for 3-4 hours. 48.6% of obese children did not participate in any field sports while 34.3% have less than 3 hours participation in field sports. Among parents of obese children, 60% were found to have little or no influence on their children's food intake at school whereas 22.9% parents of obese children never advise them against eating junk food. Parents think that ban on advertisements promoting unhealthy foods [75.1%] and use of popular media characters in promoting healthy foods [83.6%] and exercise can help in preventing obesity in children. This study shows that high prevalence of obesity and overweight among children in private schools has direct relationship with decreased physical activity and other factors like watching TV, role of media and lack of diet control by parents

Studies on the chemical composition of kohl stone by x-ray diffractometer

Use of Kohl [Surma] creates toxicity or protects eye, is one of the most controversial topic of modern medicines. However, modern researches show that kohl forms a thin film on the eye lens thus avoiding the direct contract of harmful UV radiation and glare of sun with lens. Black and shining particles of galena in kohl shield the eyes from glare and reflection of sun and thus protect them from harmful effect of UV radiation emerging from the sun. Based on these findings and other properties of kohl, it was decided to undertake this study to ascertain it's chemical composition and to correlate these properties scientifically. In the present study, kohl stone obtained from Madina [Saudi Arabia] was analyzed to ascertain it's chemical composition. The chemical analysis and X-ray diffractometer results obtained, showed that the main component of kohl stone is galena [PbS]

Managing the healthcare solid waste in selected districts of Punjab, Pakistan

Hospital and other health care facilities [HCFs] are known to generate lot of waste for which its management is a matter of considerable public health and environmental concern. The study was undertaken to describe the current practices, gaps and quantify the load of health care solid waste. Out of one hundred and fifty health care facilities [HCFs] in Punjab, the largest province of Pakistan, a sample of fifteen [HCFs] was taken from a few selected Districts, to include six large hospitals and nine without indoor facilities. Only 40% of studied institutions had some program to dispose-off the waste. Even these programs were deficient in many areas and could hardly be considered as scientific. One third of institutional personnel interviewed had proper awareness or existence of a training program. Only one institution had some concept of taking safety steps from infectious materials. The process of solid waste collection, storing, transporting and final disposal was highly inefficient in almost all the institutions. No regulatory body or system of waste was in place in any of the hospitals. There was no allocated budget in 27% of the hospitals for covering the cost of waste disposal. An average of 0.3 kg/bed/day of solid unsafe waste demands a systematic program of its disposal, failing which serious environmental hazards would develop for within and surroundings communities

Acute anal fissure; effect of topical glyceryl trinitrate [GTN] on its management

To evaluate the role of topical glyceryl trinitrate [0.2% GTN] on the clinical features of acute anal fissure. A prospective, open label therapeutic trial was carried out at Combined Military Hospital, Kharian Cantonment during one calendar year. All adult males and females presenting with acute anal fissure were included. Patients with chronic anal fissure, associated pathology [hemorrhoids, fistula in ano], age < 15 years, previous surgery of anal canal were excluded. The diagnosis was based upon history and physical examination. A detailed history was taken regarding their symptoms like painful defecation, bleeding per rectum, constipation and itching. Then the patients were examined to look for anal fissure, associated mucus discharge and sphincter tone and recorded in the proforma. 0.2% topical GTN ointment was prescribed twice daily for local application in the anal canal with the help of cotton pledget on a stick [soaked completely in ointment]. The duration of treatment was four weeks and their symptomatology and healing of anal fissure was assessed weekly. A total of 40 patients were treated in this study. Age varied between 22 - 51 years. 36 patients [90%] were male while only 4 patients [10%] were females. Painful defecation [100%], bleeding PR [87.5%] constipation [50%], and itching [40%] were the main complaints. Posterior fissure was seen in 85%, anterior fissure in 12.5%, while both anterior and posterior fissures were seen in 2.5% of patients. Out of 40 patients 21 had complete healing of anal fissure while 03 patients recovered partially. Thus the healing rate was 60%. Topical glyceryl trinitrate is an effective treatment modality for acute anal fissure

Antimicrobial sensitivity pattern of urine isolates from asymptomatic bacteriuria during pregnancy

Screening women for asymptomatic bacteriuria [ASB] on the first antenatal visit is a part of standard obstetric care. Treating women with ASB decreases the chances of maternal and f0etal complications. This study was conducted to find out the spectrum of urine pathogens and their drug susceptibility pattern for ASB during pregnancy. The study was conducted in the Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre Karachi, from September 2001 to March 2002. Two hundred and ninety women, apparently normal with confirmed pregnancy, were registered. A voided midstream urine specimen was collected and cultured. A significant growth i.e. >/= 105 organisms/ml was identified with Analytical Profile Index 20 tests for identification of Enterobacteraceae [API-2o-E] and for Gram positive cocci by other standard methods. The prevalence of ASB was found 6.2%. Antimicrobial sensitivity was determined by disc diffusion Kirby Bauyer method after matching the turbidity with 0.5 McFarland's standard. Most of the recommended drugs were found to have encouraging results, however, Escherichia coli showed 66.67% resistance to ampicillins and sulphonamides. Enterobacters showed 100% resistance to ampicillins, cephalosporins and nitrofurantoin. Staphylococcus saprophyticus showed 66.67% resistance to ampicillins and sulphonamides. It was concluded that detection of ASB during pregnancy and appropriate use of antimicrobials is only possible after culture of urine. Empirical anti-microbial therapy cannot be relied upon because of possible risk of resistance

Mortality rate in adult tetanus patients in district D. I. Khan, NWFP - Pakistan

This study was conduct to know about the real and present situation in our set up where tetanus still remains an important cause of morbidity and mortality despite free availability of a safe and effective vaccine. The study was conducted in medical unit of DHQ teaching hospital D. I. Khan over a period of four years. A total of 150 cases of tetanus were studied with 120 patients being males and 30 females. Diagnosis of tetanus was based on clinical examination. The patients were given conventional therapy for tetanus and comparison was made with other studies. Among these 150 patients of tetanus, 29 [19.3%] patient died, 22 being males and 7 females. Mortality rate in adult patients with tetanus is lower than reported in most other studies

Impact of class attendance upon examination results of students in basic medical sciences

A number of studies have shown the impact of attending the classes during the session on examination results of students. Students with good lecture attendance show good results while those with poor lecture attendance are at risk for poor performance in the examinations. In this study we wanted to test this in students of basic medical sciences in our set up. All the students in Basic Medical Sciences of Gomal Medical College, D.I. Khan, Pakistan, during the session 1999-2000 were enrolled for this study. Performance of these students in one of their three annual term tests, which covered duration of studies for four months, from February 2000 to May 2000, was analyzed. Students were grouped into two, Group-A with =75% attendance and Group-B with <75% attendance. The frequency of failure in the two groups was compared using the chi square test. Results of the term test showed that the percentage of failure in students of Group-B with less than 75%, attendance was significantly higher when compared to Group-A with equal or more than 75% attendance. Our results supported the previous studies showing that attendance in the classes during teaching sessions had a direct impact on performance of students in the examinations. Students with good attendance show good results while those with poor attendance are at risk for poor performance during examinations in basic medical sciences