Knowledge and perception of hand hygiene among health care workers of a tertiary care military hospital: a descriptive study

Objective: To determine the knowledge and perception of doctors and paramedical staff about hand hygiene of a tertiary care military hospital

Study Design: Cross sectional descriptive study

Place and Duration of Study: Study was conducted at tertiary care military hospital, from Aug 2016 to Jan 2017

Material and Methods: The sample size 196 was calculated using World Health Organization sample size calculator. Permission from administrative authorities was taken. Purposive sampling technique was used. World Health Organization's knowledge and perception structured self-administered questionnaire was used with minor amendments for the data collection. The percentage's in knowledge and perception domain of >75 Percent determined good, 50-75 Percent fair and <50 Percent poor

Results: There were 88 [45 Percent] paramedical staff, 49 [25 Percent] doctors and 59 [30 Percent] nurses while overall 103 [52.5 Percent] were male and 93[47.5 Percent] female. The age of 160 [81.5 Percent] study participants ranged 21-40 years. The overall mean score of knowledge was 64.1 Percent and perception 72.5 Percent. The paramedical staff presented with lowest mean score in knowledge 60.6 Percent and perception 74.9 Percent. While doctors scored highest 64.6 Percent in knowledge domain and nurses scored highest in perception domain 82.2 Percent. There was no statistical significant difference of knowledge and perception of hand hygiene between and within doctors, nurses and paramedical staff knowledge [p-value 0.799 and p-value 0.515 respectively]

Conclusion: The overall knowledge and perception of study participants about hand hygiene was fair. However, doctorsand nurses' perception of hand hygiene was good

Usability of hospital management system in clinical work physician's perspective

Objective: To assess effectiveness of hospital management system in clinical work in military hospitals: physicians' perspective

Study Design: Descriptive cross sectional study

Place and Duration of Study: Military hospitals of Rawalpindi, from Apr 2013 to Jun 2014

Material and Methods: Sample selected through convenient non probability sampling. Sixty-one [61] physicians in clinical work: 23 [38%] specialists and 38 [62%], Health Care Administrators [HCAs] were included in the study. Tools used were questionnaire, interviews, think aloud protocol, log book analysis and chart reviews

Results: More than 50% of respondents agreed that hospital management system in clinical setting lacks appropriate attributes. System is not customized to the needs of each specialty and doesn't support the continuity of care. It does not support evidence based decision making since it lacks clinical decision support system. Majority of physicians expect their clinical HMS to provide better support for collecting statistics for research. Most respondents agreed that HMS often diverts attention away from the patients and physicians [worked around] the system due to number of cofounders like lack of time, increased number of patients. Chart review revealed majority did not add alerts

Conclusion: This study has highlighted a significant number of usability issues which are on one hand lessening the effectiveness and efficiency of this system; while at the other hand leading to user frustration. These findings call for usability evaluations at all levels and the subsequent redesign of HMS application leading to a usercentered design which is effective in providing physicians with key functionalities which support physician's tasks and improve patient care

Birth preparedness and complication readiness: a cross sectional survey from expectant mothers visiting a rural health center

Objective: To assess level of awareness of expectant mothers about their birth preparedness and complication readiness [BPACR]

Study Design: Descriptive cross sectional study

Place and Duration of Study: It was a descriptive cross sectional study conducted at a Rural Health Center, Mandra over period of six months, from Sep 2016 to Feb 2017

Material and Methods: Three hundred and twenty pregnant women of rural area of residence in their third trimester [29-40 wks] were approached using non probability convenient sampling. They were interviewed by using a structured questionnaire after taking informed consent. SPSS version 20 was used for data entry and analysis. A p-value <0.05 was considered statistically significant

Results: The mean age of the participants was 29.02 +/- 6.403 years. All the 320 participants were from rural area of residence. The knowledge of elements of BPACR was highest [7 out of 8] in only 26 [8.1%] women followed by 6 elements in 47 [14.7%], 5 elements in 78 [24.4%], 4 elements in 83 [25.9%]. There was significant number of females who had poor knowledge of only 3 elements 69 [21.6%]. Overall 45% of pregnant women knew 5 or more elements were well prepared while 55% were less prepared regarding birth and related complications. Participants' education and husbands' monthly income was found to be significantly associated with birth preparedness and complication readiness knowledge [p-value<0.05]

Conclusion: The majority of expectant mothers were well prepared for the birth and were also aware of the danger signs of pregnancy. Antenatal visits were taken by majority of the participants. However arrangements for transportation, financial support and blood donor identification were not satisfactory

Comparison of quality of life of cancer patients undergoing chemotherapy in a tertiary care hospital, Rawalpindi

Objective: To compare the Quality of Life [QOL] of cancer patients at different chemotherapy [CT] cycles

Study Design: Cross sectional analytical

Place and Duration of Study: Tertiary Care Hospital, Rawalpindi

Material and Methods: Study was conducted in a Tertiary Care Hospital in Rawalpindi. Non-probability purposive sampling technique was used to select a sample of 50 cancer patients undergoing chemotherapy. The patients were grouped in two on the basis of number of chemotherapy cycles, those having 2 CT cycles. After taking informed consent the data was collected using the European Quality of Life Questionnaire [EORTC QLQ-C30] to measure QOL in the patients. Data was entered and analyzed using SPSS version 21. Baseline distinctiveness [demographic and HRQOL] was summarized by descriptive statistics. Mean and standard deviation of individual items in the two scales was calculated in two groups and statistical inference was drawn using Independent T test between the two groups, p value of

Results: The study sample comprised of 31 males and 19 females. Mean age of participants was 43.88 +/- 12.72 [Range 18-70] with the most common age group being 41-50 years. There was a male preponderance [63%] and majority 36% were doing house hold work. Among the 50 subjects, 32% were suffering from lung carcinoma, 26% had genitourinary cancer, 24% had cancer of the oral cavity while 18% had carcinoma breast. As per the QOL scoring, in the Global Health Scale [GHS] the four items of symptom scale that is fatigue [p=0.02], nausea [p=0.00], pain [p=0.01] and appetite loss [0.03] attained a significant difference. Nevertheless, a significant difference was found between the level of QOL in patients with 2 cycles [p< 0.001]. In the functional scale items only role functioning was significant

Conclusion: This study suggests that the quality of life is related to chemotherapy cycles. Although QOL scoring system did not show significant improvement in all areas of our study, but the obtained results indicated a significant association between QOL and number of CT cycles in cancer patients

prevalence of post traumatic growth among troops in post deployment phase

Objective: To determine the prevalence of post-traumatic growth [PTG] and its association with socio demographic factors among a cohort of troops in post deployment phase

Study Design: Descriptive cross sectional

Place and Duration of Study: A Military battalion in Lahore from Jan-April 2015, one year after deployment in the combat area

Material and Methods: A sample of 296 combat troops was selected using non-probability convenient sampling technique. After taking informed written consent the data was collected using Urdu version of psychometric tool Post Traumatic Growth Inventory [PTGI]. Data was entered and analyzed SPSS version 20

Results: The mean age of the respondents was 29 +/- 6.2 years. Married and unmarried were 214 [72.3%] and 82 [27.7%] respectively. The mean years of service of the troops were 11. In our study the majority of troops 279[94.3%] exhibited greater degree of positive growth [75] ,15 [5.1%] had moderate degree of positive growth [74-51] while only 2[0.7%] had no post traumatic growth[<50]. There was a significant negative correlation of PTG with the age [p < 0.01] and a significant association of Ethnicity with PTG [p=0.03]. However there was no significant association of PTG with marital status [p= 0.06], education [/7=0.52], income [p=0.71], rank [p= 0.96] and years of service [p= 0.49] at 95% confidence level

Conclusion: It was concluded that there was a high prevalence of resilience as PTG in majority of troops one year after deployment in a combat area

Knowledge, attitude and self-reported hand washing practice among healthcare staff of military hospital, Rawalpindi

Hand washing can be regarded as one of the most effective and important hygiene promotion programmes for community as well as hospital based settings. A cross sectional survey was carried out at Military Hospital, Rawalpindi, over 03 months from September to November 2012. The survey was conducted to assess the knowledge, attitude and self-reported hand washing practice among healthcare staff [nurses] working in family OPD and ward. Data was entered and analyzed in SPSS 16. Descriptive statistics was used in the form of numbers and percentages. It was believed by 95% of staff that handwashing can reduce infection rates in hospitals. Among the respondents, 24.2% expressed strong dissent on washing hands only with water, however, 22.5% considered it enough. Patients never [50%], sometimes [21.7%], seldom [19.2%], often [9.2%] asked health care staff about hand washing. Staff reported their practice of hand washing before touching patients as often [32.5%], sometimes [37.5%], seldom [20.8%] and never [9.2%]

Association of vitamin d deficiency with tuberculosis in adult patients reporting to a tertiary care hospital of Rawalpindi

To compare the mean vitamin D levels in pulmonary tuberculosis patients and healthy controls and to find out the frequency and association of vitamin D deficiency in patients with tuberculosis. Study Design: Case control study. Pulmonology department, Military Hospital Rawalpindi from Jan 2013 to Dec 2013. Patients and Methods: Fifty two incident outdoor pulmonary tuberculosis patients were selected with 52 age and gender matched controls. Tuberculosis was diagnosed by the sputum examination through gene Xpert technique from National Institute of Health [NIH], Islamabad. Serum 25-hydroxvitamin D level <50 nmol/1 [electrochemiluminescene assay] was taken as vitamin D deficiency. Mean vitamin D was much lower [20.688 +/- 14.065 nmol/1] in cases as compared to the controls [57.917 +/- 18.197 nmol/1] which was statistically significant [p<0.001]. Forty nine [94%] cases and 18 [34.6%] controls were found to be vitamin D deficient. [Odd's Ratio = 3.8, 95% CI = 2.423-5.999, p>0.00l]. Sensitive tuberculosis patients had mean vit D levels of 18.55 +/- 9.99 nmol/1 while multi-drug resistant tuberculosis patients had the mean serum vitamin D levels of 22.38 +/- 16.60 nmol/1 but the difference was statistically insignificant [p > 0.05]. Significant vitamin D deficiency was seen in newly diagnosed TB patients. It was found that vitamin D deficiency is associated with tuberculosis, but its causal role has not been established

Proportion of exposure of passive smoking in teenage group and symptoms precipitated after exposure to second hand smoke

Exposure of passive smoking and second hand smoke [SHS] exposure in teenage group results in precipitation of several symptoms. Five hundred teenagers between ages of 13 - 19 studying in Army Public School and College Westridge, Rawalpindi, were selected for descriptive cross-sectional study from September 2012 till February 2013. Out of the total 500, 279 [55.8%] were exposed to passive smoking while 221 [44.2%] were not exposed to passive smoking. Out of the exposed 279 [55.8%] students, males were 132 [47.3%] and females were 147 [52.7%] with mean age of 15.06 +/- 1.805 years. After exposure to SHS, multiple responses were observed. Statistical significant association was found between symptoms precipitation and exposure to SHS. Nose irritation was present in 84, while 195 did not complain of it [p = 0.002]. Allergic symptoms were precipitated with SHS in 42, while not in 21 students [p < 0.001]. Asthma attack was precipitated in 38, while 241 did not experience precipitation of asthma attack [p < 0.001]. More cough was present in 168, while not in 111 students [p = 0.037]. Nausea was present in 41, while not in 238 [p < 0.001]. Nose irritation was seen in 84 and not in 195 students [p = 0.002]. More than half of the teenagers had exposure to passive smoking. Statistical significant association was found between passive smoking exposure and precipitation of symptoms

Patient safety: a survey of knowledge of general practitioners in Karachi

To study the knowledge of General Practitioners on Patient's Safety. Descriptive cross sectional study. Malir district, Karachi, from Feb 2012 to April 2012. Responses to a closed ended questionnaire by general practitioners [GPs] was recorded using non probability convenient sampling. The variables were derived from aspects of patient safety issues. The questionnaire used 11 potential risk factors to explore GP's views on patient safety. A total of 68 GPs responded out of the total 150 GPs running their private clinics or filter clinics of private hospitals in the Malir district area. The risk factors most frequently judged as a threat to patient safety were a poor doctor-patient relationship, insufficient continuing education on the part of the GP and a patient age based guidelines and patient privacy in the reception/ waiting room were not perceived as risk factors by most of the GPs. GPs in the present study judged a broader range of factors than in previously published research on patient safety in primary care, including a poor doctor-patient relationship, to pose a potential threat to patient safety. Other risk factors such as infection prevention, deviation from guidelines and incident reporting were judged to be less relevant than considered conventionally

Association of blood lipid and glucose levels with carotid intima media thickness

To measure the differences in CIMT across groups based upon normal and higher levels of fasting glucose and lipids. This cross sectional study was carried out between January to June 2011 at department of radiology and pathology, PNS Rahat hospital Karachi. From a target population of patients presenting for fasting blood glucose measurement, a total 0f 201 subjects were short listed and consented after various exclusion. These patients were sampled for glucose and lipids after brief clinical evaluation. Later subjects underwent CIMT measurement in radiology department. Age showed moderate positive correlation with CIMT readings [r=0.493, p=0.000], while BMI[r=0.038, p=0.636], fasting blood glucose [r=0.038, p=0.646], triglyceride [r=0.179, p=0.029], and total cholesterol [r=0.221, p=0.007] showed lesser correlations. Patients with hyperglycemia had higher CIMT [[Group-1, Normolycemia, FBG 5.5mmol/L= 0.7180 +/- 0.147cm][p=0.028]]. Mean CIMT values among subjects with hypertriglyceridemia and hypercholesterolemia were higher than patients with normal triglycerides and cholesterol [[triglyceride:p=0.040] [total cholesterol: p=0.055]]. The carotid intima medial layers were found to be thicker in subjects having higher blood levels of fasting blood glucose, triglycerides and total cholesterol

Primary amoebic meningo encephalitis- a case study

Primary amoebic meningoencephalitis [PAM] mimicks acute bacterial meningitis in presentation. However because it is very rare as compared to pyogenic meningitis, physicians may miss the diagnosis initially. Recent exposure to diving, swimming or splashing in warm fresh water should suggest the possibility of amoebic meningoencephalitis, and prompt examination of the cerebrospinal fluid [CSF] for N. Fowleri. Timely diagnosis requires a high index of suspicion in any individual presenting with acute onset of meningitis-like symptoms. We present a fatal case of PAM masquerading as an acute upper respiratory infection but a quick transition to pyogenic meningitis, and encephalitis

Prevalence of vitamin d deficiency in orthopedic practice-a study in Karachi

To study the prevalence of vit D deficiency in Karachi by evaluating the levels of vit D in patients reporting to an orthopaedic out patients department[OPD] with complaints of persistent backache or generalized aches and pains. Cross sectional descriptive study. From Aug 2008 to May 2009 in orthopaedic OPD of Pakistan Steel Mills Hospital Karachi. A non probability convenience sample was taken from 334 patients referred to orthopaedic specialist by primary care physicians for persistent backache and or generalized aches and pains, minimum for the last 6 months. A total 89 patients were included keeping in view the exclusion criteria. X-ray lumbosacral spine, and serum Vitamin D levels were advised in all cases. The normal range is 40-100ng/ml. Value of 20-39ng/ml was taken as mild deficiency,5-19 ng/ml was considered as moderate and <5ng/ml was noted as severe deficiency. There were 73 [82%] females and 16[18%] males. Mean Vitamin D3 level estimated in the study population was 7.76 ng/ml [SD= 3.50]. Mean age was 40.2 years +/- 10.75. Serum Vitamin D3 levels were checked and found to be moderately low in 75% of cases checked. Vitamin D deficiency constitutes a common reason of morbidity in Pakistan and deserves to be considered in the common differential diagnosis of backache and unexplained aches and pains.

Noise induced hearing loss- profile in military service

To describe the morbidity profile of soldiers being managed for disability due to sensorineural deafness as a result of noise induced hearing loss [NIHL] in military service. A descriptive study Department of statistics CMH Malir Cantt. Records of soldiers reporting for NIHL in CMH Malir Cantt during the period i.e January 2004 - January 2009 were included. All cases of sensorineural deafness either diagnosed for the first time or reporting in ENT OPD of CMH Malir Cantt for re-evaluation during the period i.e January 2004-January 2009 were included. The records of 70 such servicemen were available in statistics department of the hospital and were analysed to determine the profile of history and physical findings in all cases managed for sensorineural deafness. The total sample of cases studied included 70 servicemen. Their mean age group was 35.3 years, between 38-42 years of age while most vulnerable age group was between 33-37 years. A total of 41.4% of individuals had 10-15 years of service before this handicap was documented .While 47.1% accepted feeling this problem for 11-15 years, the period of observation in low medical category/handicap was less than 5 years in 54.3% of cases. As the most affected trades with max number of disabled soldiers, artillery and infantry had 40% each of all affected cases. Rinne's test was positive in 90% of them. Weber's test was lateralized to left ear indicating sensorinerual deafness in right ear in at least 82% of cases.PTA tests were conducted separately for both ears to determine the degree of hearing range loss. There was moderate hearing loss in the frequency range of 60-90 db in both ears in 47.1% of cases with hearing defect and severe hearing loss in range of >90 db in Right ear in 30.0% cases and in 15.7% of left ears checked. Noise induced hearing loss among relatively young [under 40 years of age] and otherwise healthy soldiers with around 5-10 years of service is a phenomenon that needs further research as an occupational health problem and all out efforts to reduce the incidence of this irreversible though preventable disease

Effects of obesity on pregnancy and its outcome

The objective of study was to find out adverse effects of obesity on pregnancy. A case - control study comparing outcome of pregnancy in obese women with a control group of non obese. Obstetrics unit of Military Hospital Rawalpindi from 20th December 2004 to March 2006. The study included 100 obese ladies with body mass index [BMI] 28-35 and 100 non obese ladies with BMI 18-25. Pregnancy in obese women associated with increased risk of complications. These women had a higher frequency of pregnancy-induced hypertension [RR 1.75; 95% CI 1.08 - 2.81] and gestational diabetes mellitus [RR 3.0; 95% CI 1.13 - 7.94], a higher cesarean section rate [RR 1.78; 95% CI 1.91 - 2.67], increase in postpartum hemorrhage [RR 3.50; 95% CI 1.19 - 10.27] and higher babies weight [RR 2.83; 95% CI 1.50 - 5.15]. This study concluded that obese woman were at high risk of antepartum, intrapartum and postpartum complications with an increased risk of operative delivery

Frequency of hepatitis B and C in young male recruits from rural Pakistan

To know the frequency of HBV and HCV amongst male recruits. Cross-sectional descriptive study. Pathology laboratory CMH Malir Cantt over a period of six months [June to December 2005]. Recruits from rural areas of all provinces of Pakistan reporting to Pathology laboratory CMH Malir Cantt for screening of HBV and HCV before enrollment in army. During the period of this study a total of 3320 recruits were screened for hepatitis B and C viral infections. Overall Seropositivity of anti HCV was found to be 3.2% while 4.5% of recruits tested positive for HBsAg. Province wise distribution showed Sindh had the highest frequency of HCV positive cases i.e 6.4% though Punjab had almost equal values of HBV and HCV of around 4%. While 2.7% of those from NWFP tested positive for HBsAg and 1.4% of them for Anti-HCV. Balochistan and Northern areas had no more than 0.5% of HBsAg positive cases while there was no hepatitis C positive candidate from these areas. This study indicates that young healthy, recruits from all the four provinces revealed an overall 4.5% frequency of HBsAg carriers and 3.2% of the screened population

Health education - the neglected front: a study of health awareness among young females of Karachi

Objective of the study was to assess the knowledge, attitude and practice of primary healthcare amongst young females attending primary healthcare centers in Karachi East. This Cross- sectional study was carried out at Primary health care centers in Malir Cantt from April 2006 to September 2006. Out of a total 1800 households of lower grade government employees a convenient sample of 300 females aged 25-35 years, married 8-10 years and attending various health care centers in Malir Cantt for at least five years were included in the study. A closed ended structured questionnaire was administered to the study participants and filled in by the interviewers themselves. Descriptive diferrential statistics [frequency and confidence interval] were calculated. The results of the study regarding Breast feeding and nutrition section showed that only 11% mothers started breast feed within 2 hours of delivery while 87% of them discarded colostrums as useless during initial breast wash. Bottle feeding and weaning was initiated within 4 months of baby's age in 73% and 86% of the respondents respectively. Thirty five percent respondents had some idea of hand washing as an important hygiene practice and 21% considered Oral rehydration salt [ORS] as an effective treatment of diarrhea in children and merely 9% knew about constitution of home based ORS. There were more than 3 children in 64% of families and 73% had narrow child spacing of less than 2 years. Only 17% had successfully used any contraceptive for full 2 years. Anti- anemic prescription was offered to 92% of antenatal women and only 31% complied with its usage. Only 32% mothers possessed complete and up-to-date EPI vaccination cards of their wards