Improvement in the pattern of advice of investigations following rationalization campaign

To assess the magnitude of change in advising pattern of laboratory and radiological investigations during and after campaign emphasizing rational use of these tests. Comparative cross sectional study. Combined Military Hospital Peshawar, Twenty seven months. The laboratory investigation analysis were Blood Glucose, Thyroid Function Tests, Liver Function Tests [LFT], Renal Function Tests [RFT] and Cardiac Markers and radiological tests were X-Rays Chest, Skull, Wrist and Plain Abdomen, Obstetric Ultra Sound [USG] and CT Scan. The awareness was done by Lectures, handouts, feedback advice on test reports and personal communications to the Medical Officers, Nursing Officers and Paramedical Staff. The data was analyzed through Quarterly Returns, records of laboratory and radiology retrieved from Hospital Information System and departmental registers. In some laboratory investigations there was a significant improvement in the advisory pattern e.g. blood glucose fasting instead of random, ALT instead of whole LFT, electrolytes not included in every RFT and abolishing of AST and LDH from cardiac marker profile and TSH only as screening test. In Radiology there was improvement in the rationality of X-Ray chest, X-Ray skull, X-Rays wrist and obstetric USG. CT scan data could not be compared because CT Scan equipment became out of order during the study. There was also reduction in expenses incurred on irrational investigations. A dynamic ongoing process of awareness and realization campaign for medical professionals is required in any public sector medical institute for cultivating a culture of rational use of investigations

Knowledge, attitudes and practice of diabetes mellitus amongst postgraduate trainees and undergraduate medical students: a multi-centric questionnaire - based survey

To assess the knowledge, attitude and practice of Diabetes Mellitus [DM] amongst doctors and medical students. This is a questionnaire based survey that was carried out at Army Medical College Rawalpindi and Armed Forces Institute of Pathology, Rawalpindi, from Jul 2001 to Jul 2009. A questionnaire was designed comprising 20 questions examining knowledge [7 questions], attitude [6 questions] and practice [7 questions] about the etiology, types, diagnostic criteria and treatment of DM. The questionnaire was distributed amongst 219 Post-Graduate Trainees [PGT] including doctors attending courses of various specialties and General Duty Medical Officers [GDMOs] attending basic medical administration courses and 279 Under-Graduate Medical Students [UGS]. The questionnaire was required to be filled within 20 minutes during routine classes of instruction. These students were not informed about this quiz prior to these sessions. Students were instructed not to show their identity on the questionnaire except their specialty. On the basis of Mean Score i.e. mean of correct answers, there was no significant difference amongst various groups [p=0.46]; however, PGT of General Medicine, Paediatrics and sub-specialties of Pathology obtained the highest Mean Score. Similarly Mean Score of UGS of two medical colleges were not significantly different [p = 0.34]. Questions regarding knowledge were answered best by all groups followed by questions on attitude and practice. In our doctors and medical students knowledge is fairly evidence based but practice and attitude need improvement

Acute pancreatitis; evaluation of modified glasgow scoring system [IMRIE]

To determine whether in our setup the Modified Glasgow Scoring System is still an accurate marker for the assessment of severity in acute pancreatitis. Observational study. Surgical Unit, CMH Peshawar. January 2005 to January 2008. It is an observational study of 50 male and female patients between ages of 1 5-75 years [Mean 43.3]. Male to female ratio was 1:1.3. They were graded mild, moderate and severe using the 8 variables / markers of Modified Glasgow Scoring System. Exclusion from this study were the patients with acute pancreatitis who were treated at the same institution but not admitted to the surgical ICU, those admitted after inter institutional transfer for tertiary care and patients admitted as sick transfer from other hospitals after 24 hours. On the basis of variables in the Modified Glasgow scoring system [Imrie], 18 patients were predicted with the severe outcome, but only 15 [83%] cases had an actual severe outcome. Whereas 3 cases [17%] did not follow the prediction and behaved as moderate pancreatitis. Similarly, 16 cases predicted as moderate pancreatitis, 14 [88%] followed the prediction and only 2 [12%] cases behaved as mild cases.16 cases were predicted mild, but 13 [81%] followed the prediction and only 3 [19%] switched to moderately severe group. Thus the overall accuracy of Modified Glasgow Scoring System was found in 42 [84%] cases. Bililary pathology remained the main aetiological factor. Two of the variables were significantly deranged in severe cases. These were age over 50 [4 cases], and WBC count > 20x 10[9]/l [12 cases]. Hospital stay varied between 4-21 days [Mean 9 days]. Conclusion: The Modified Glasgow Scoring System remains a valid predicting system for the outcome in patients with acute pancreatitis. It is simple, easy to apply with good predictive value and can be used in all hospital settings

Pattern of harmful practices towards the newborn in a Pakistani community

To assess the pattern of harmful practices which can affect the neonatal mortality in our community. It was a cross-sectional study based on recall of child birth and rearing events by the respondents. Place and Duration of the Study: The study was carried out in Union Council 45 [UC 45] of Rawalpindi District, which had a population of 25000 people with mostly low income families living on either side of Nalla Lai. The survey was carried out 20th July to 20th September 2006. One hundred mothers were interviewed. A questionnaire was used to identify these practices in an urban setting. It was found that many harmful neonatal practices were prevalent in the study population most common being the powder sprinkling on the baby [94%], removal of vernix caseosa [81%], pre-lacteal feeding [79%], unhygienic cord practices [74%], and application of contaminated Surma [73%]. Moreover mothers are mostly unaware of the consequences of their practices, however, they were found receptive and eager to know whether their practices were beneficial or not. The study highlights that many harmful neonatal practices are prevalent in the society. Larger study is required to determine the quantum effect of traditional harmful neonatal practices to the newborn mortality in order to prioritize our actions and develop strategies

EDTA contamination in laboratory specimens-effect of an awareness campaign

To measure the effects of awareness campaign on the frequency of EDTA contamination. A cohort study. The study was carried out in Combined Military Hospital, Peshawar, from October to December 2008. A cohort of 200 doctors, nurses and paramedical staff involved in sample collection for laboratory investigations were selected for this three phased study. In all samples with plasma potassium level>6.0 mmol/L, plasma Ca++ was measured for one month before, during and after a campaign of correct filling order of sample tubes for two weeks. Renal function test and LDH were also measured to rule out chronic renal failure and in-vitro haemolysis, respectively. Fisher's exact test was used for comparison of frequency of hyperkalemia. There was a significant decrease [75%, p<0.01] in the cases of spurious hyperkalaemia and hypocalcaemia. EDTA contamination is a common and important source of pre-analytical error which can be prevented to some extent by education of medical and nursing staff

Radial nerve injuries; presenting as wrist drop-analysis of 100 patients

To highlight etiological factors leading to radial nerve injury resulting in wrist drop, with particular reference to iatrogenic causes. Retrospection and Descriptive. One hundred patients of all ages and both sexes with wrist drop. Data of clinical assessment after detailed history and examination as well as electro diagnostic studies was recorded on pre-designed assessment proforma. The outcome was charted down for frequency of etiology of the wrist drop. Rehabilitation Medicine Department of Combined Military Hospital [CMH] Multan and Armed Forces Institute of Rehabilitation Medicine [AFIRM]. The major cause of injury was splinter/gun shot injury 31%, mis-placed injection at mid-arm 21%fracture of humerus was 21%, compression neuropathy 16%, and stab wound 11% caused wrist drop. Electro-physiological studies revealed that 85% patients had injury to radial nerve at mid-arm, 9% had injury to posterior interosseous nerve while 4% had injury to superficial branch of radial nerve and only 2% had normal study. Electrodiagnostic studies also revealed that majority of the patients suffered from axonotmesis [44%] and neurapraxia [38%], whereas [16%] were neurotmesis. The most common cause of radial nerve injury is trauma. It is also found that the frequency of radial nerve palsy due to iatrogenic causes is quite high. In addition to the clinical examination, the nerve conduction studies and electromyography proved to be the better investigation technique in the assessment of the location, severity and extent of the peripheral nerve injury and subsequently guides in starting the proper treatment option due to early referral of patient to the concerned fields

Awareness of AIDS related public health facts in medical students: a survey in a medical college of Rawalpindi - Pakistan

The incidence of HIV infection is rising and Pakistan is considered a high-risk country. The key intervention to this threat, at present, is increased awareness of the population. This study was designed to assess awareness of medical students about HIV infection It was a cross sectional survey conducted on students of a Medical College of Rawalpindi in December 2005. A semi-structured questionnaire was used to assess awareness levels. A total of 648 students responded. Out of these 242 [37.35%] were males and 406 [62.65%] were females. A total of 595 [91.8%] students agreed that AIDS is a national threat. Six hundred and twenty five [96.4%] students were sure about HIV transmission modes. Four hundred and twenty eight [66%] students considered close contact safe, 544 [84%] knew that sharing swimming pools was not a risk and 511[78.9%] students knew that mosquitoes have no role in HIV transmission. A total of 321 [79.1%] female students were aware that condoms acted as barrier to HIV transmission compared to 217 [89.7%] males, [p < 0.05]. Cumulative awareness on AIDS was 83.9%, and observed difference between groups' overall level of awareness was not significant [p > 0.5]. Although students demonstrated a high level of knowledge concerning AIDS and HIV, considerable misconceptions were also noted. A need was felt to enhance awareness programs among students in medical colleges on AIDS

Frequency of osteoporosis and its associated risk factors in postmenopausal women in clinical practice at Rawalpindi

To find out the frequency of osteoporosis and it's associated risk factors in postmenopausal women in clinical practice at Rawalpindi. A descriptive cross-sectional study. A total of 105 postmenopausal women from 45 to 70 years of age from outpatient clinical of Military Hospital Rawalpindi were included in this study. The risk factors assessment questionnaire was used to obtain information. Bone mineral density was measured by densitometry Sahara Clinical - Sonometer [Hologic Inc]. All the data of the study was analyzed by using SPSS-12. The study showed that out of total 105 postmenopausal women who underwent the BMD [bone mineral density] assessment, 16.1% had osteoporosis and 34.2% osteopenia. The bone mineral density decreased with advancing age and duration of menopause. The frequency of osteoporosis was more common in women who had more numbers of children, less educated and not doing daily exercise. The majority of women had general musculosketal pain consumed in balanced diet and belonged to low socioeconomic background. It is conduced that frequency of osteoporosis and osteopenia is16% and 34% in postmenopausal women in clinics at Rawalpindi. The osteoporosis is associated with advanced age, duration of menopause, parity, exercise and poor diet in our medical setup