The case for building residential facilities [Sarais'] for patient visitors. If not now, when?

Objective: To gather the opinion of attendants accompanying admitted patients in CMH Lahore about their satisfaction with existing eating and sleeping arrangements

Study Design: Cross sectional survey

Place and Duration of Study: Combined Military Hospital Lahore Pakistan, from Jul to Aug 2016

Material and Methods: For this descriptive observational study attendants of patients admitted in the hospital for more than 24 hours were administered a questionnaire. Only one family member per patient was surveyed

Results: Three hundred attendants were interviewed for the study of which 162 were males. One hundred and twenty eight 128 [42.7 percent] came from within the city. One hundred and eighty seven [62.3 percent] intended to stay with the patients till the time they were discharged. A total of 185 [61.7 percent] patients had only one attendant whereas 59 [19 percent] of patients had no attendants available. Two hundred and thirty one [77 percent] attendants were blood relatives. The hospital canteen served food to 140 [46.7 percent] attendants. Only 25 [4.3 percent] attendants were satisfied with their existing eating arrangements. One hundred and seventy eight [59.3 percent] of attendants slept inside the hospital wards whereas 54 [18 percent] slept within hospital premises. One third of them were satisfied with their sleeping arrangements whereas the remaining desired more comfortable residential facilities or [Sarais] which were affiliated with the hospital. Sixty four [52 percent] attendants experienced difficulties in affording their boarding and lodging expenses

Conclusion: Patients and families bear the emotional and financial cost of illness. Findings suggest that attendants are not satisfied with their existing sleeping

Non-invasive investigations in heroin users and non-users - a case control study

Objective: To compare heroin users with their age and gender matched relatives as regards non-invasive investigations like chest x-ray, electrocardiography [ECG] and 2D-echocardiography

Study Design: Case control study

Place and Duration of Study: Armed Forces Institute of Cardiology-National Institute of Heart Diseases, Rawalpindi, from Feb 2010 to Jul 2010

Material and Methods: Sixty one heroin users [cases] and their 100 non-substance abuser age and gender matched relatives [controls] were included through non-probability consecutive sampling. Chest x-ray [CXR], 12-lead electrocardiography [ECG] and two-dimensional echocardiography [2D-ECHO] were done of each one and the result was interpreted by respected consultants. The data were analyzed on SPSS version 15. Descriptive statistics of mean and standard deviation [SD] were described for quantitative variables while frequency and percentages for qualitative variables. Independent samples t-test compared quantitative variables while for qualitative variables chi-square test was used. Ninety five percent confidence intervals were calculated for all variables

Results: Statistically significant differences were noted between cases and controls as regards chest X-ray. A total of 10% cases had findings consistent with tuberculosis [TB] as compared to 3% controls [p=0.045]. There was however no cardiac abnormality in any study subject. Significant 12-lead ECG findings other than normal were noticed in 12 [19.7%] heroin users as compared to 10 [10%] controls [p=0.083]. In 12 lead ECG, the predominant finding was t wave inversion in leads AVF and III. According to 2D-echocardiography [2D-echo] reports, 15 [24.6%] heroin users [cases] and 17 [17%] controls had abnormal findings [p=0.242]. We report no vegetations on any cardiac valve

Conclusion: On radiological and cardiac parameters, heroin users are a different population as compared to the non-heroin users. The knowledge about variations on non-invasive investigations not only helps the healthcare workers to optimize treatment regarding rehabilitation but also facilitate diagnosis and treatment

Staff surgeon utilization pattern at combined military hospital Lahore

Objective: The study was conducted to highlight the sickness absenteeism pattern among the doctors and nurses of Combined Military Hospital, Lahore in the year 2014

Study Design: Cross sectional descriptive study

Place and Duration of Study: Combined Military Hospital [CMH] Lahore, 1 year from Jan 2014 to Dec 2014

Patients and Methods: Sick-in-Quarter [SIQ] reports of doctors and nurses were collected from the SIQ register of Combined Military Hospital, Lahore for the duration of 1 year. This data was categorized based on gender, rank, causes and duration of illness. Frequencies of Sickness absenteeism of the health care providers based on these categories were noted and analyzed through SPSS 20

Results: A total of 670 SIQ's were issued to health care professionals at CMH Lahore in 2014. Of these, 164 [24.5%] were issued to males and 506 [75.5%] were issued to females. Out of these 316 [47.2%] were doctors and 354 [52.8%] were nurses [p<0.001]. Maximum absenteeism was caused by respiratory diseases 176 [26.28%]. Monday showed the highest predominance of sick reports with 166 [24.8%]. Most SIQ's were issued in April 90 [13.4%] while a low number of SIQs were issued in February 20 [3%]

Conclusion: Sickness absenteeism was highly prevalent, and was higher among nurses than doctors. Respiratory diseases were the leading cause of sickness absenteeism among the doctors and nurses. Measures are needed to sustain the health of doctors and nurses to improve the overall patient care

Burnout among female nursing students

Objective: To determine the frequency of burnout among Pakistani military female nursing students and to find out its association with demographic factors and common stressors during training

Study Design: Cross-sectional analytical study

Place and Duration of Study: This study was carried out at Combined Military Hospital [CMH] Lahore and CMH Lahore Medical and Dental College from Mar to Apr 2015

Material and Methods: Sample consisted of 84 female nursing students. Since it was a relatively small sample and participants were easily accessible so all 84 students available at the time of study were included. Mashlach Burnout Inventory [MBI] [which included 20 questions] was used to measure emotional exhaustion, and burnout. The questionnaire also elicited information about socio-demographic characteristics and various perceived stressors during their training. Data analysis was performed by using SPSS version 20.0

Results: On the MBI, 66 [78.6%] nurses showed mild emotional exhaustion, 17 [20.2%] showed moderate emotional exhaustion and only 1 [1.2%] showed high emotional exhaustion. Similarly no burnout was found in 29 [34.5%] nurses; whereas mild burnout was found in 30 [35.7%], moderate burnout in 19 [22.6%], severe burnout in 5 [6%], and only one nurse student [1.2%] showed extreme burnout. No significant association was found between various stressors and burnout [p>0.05]

Conclusion: There is low level of burnout in female military nursing students in this study. This is a favorable finding and may be considered helpful in increasing productivity, performance and quality of patient care

Experience of Fontan surgery at Armed Forces Institute of Cardiology /National Institute of Heart Diseases [AFIC-NIHD]

To assess the overall outcome and success of Fontan surgery at our institute. AFIC-NIHD Rawalpindi. 01 September 2005 to 31 March 2010. For this retrospective study, institute's cardiac surgery database was used. Patients of single ventricle physiology, who had normal Left Ventricular End-diastolic Pressure and pulmonary artery pressures, were included. Data was analyzed using SPSS version 16. A total of 34 Fontan procedures were done. The mean age at operation was 4.83 +/- 1.37 years. There were 22 [64.7%] males and 12 [35.3%] females. Twenty five [73.5%] had a staged Fontan [successful previous Bidirectional Glenn's shunt, BDG]. Nine [26.5%] were primary Fontan procedures [no successful previous Bidirectional Glenn's shunt, BDG]. Thirty two [94.8%] were Extra Cardiac Conduit Fontan [ECCF] and 2[5.8%] were Intra Cardiac Fontan. Mean Bypass time was 132.65 +/- 48.44 minutes. Aorta was cross clamped in intracardiac Fontan and its mean time was 43.31 +/- 5.85minutes. Fenestration was employed in 14 [41.2%] patients. Mean pre-operative oxygen saturations were 77.41 +/- 10.27%, which significantly increased to 93.94 +/- 3.96% post-operatively [p<0.001]. In-hospital mortality was 2 [5.8%]. Fontan surgery has acceptable morbidity and mortality in our set up

Nephropyelolithiasis: clinical presentation and management At CMH, Multan

To determine the prevalence, clinical presentation, management and the role of diets, drugs and other factors in the development of nephropyelolithiasis. Cross sectional analytical study conducted from June 1998 to December 2000. Department of Surgery, Combined Military Hospital, Multan.All patients who were admitted with renal stone disease.Data of all the patients with nephrolithiasis was collected by a closed questionnaire and analyzed Treatment consisted of emergency relief of pain as well as definitive treatment for stone removal. All surgeries were open due to non availability of minimally invasive procedures. High risk patients for recurrent stones were identified and underwent assessment of their metabolic profile. Precautionary methods and drugs were also used in high risk recurrent stone formers.A total of 38000 cases were treated by the surgical department during the study period, out of which 700 cases were of nephropyelolithiasis; thus making a prevalence of 1 in 54.28 patients. Amongst these 469 [67%] were male and 231 [33%] female, with a mean age of 40 years [ +/- 30]. Most i.e. 546 [78%] patients presented with renal colic, while 154[22%] had dull lumbar ache. About 450 [64.2%] patients were given emergency treatment and discharged, but 104 [14.8%] did not improve and had to be admitted Amongst the investigations Intravenous Urography showed a sensitivity of 99% and was the best available imaging technique. Expectant treatment for small stones [<4mm] was successful in 14 [2%] patients, whereas 300 [42.85%] patients consented for surgery and under went nephropyelolithotomy, with partial nephrectomy in 50 [7.14%] cases. In 150 patients the stone was sent for chemical analysis which showed calcium oxalate to be the predominant variety. The evaluation for the risk factors, as well as urine and serum metabolic examination confirmed that 100 [14.7%] patients had secondary causes of stone formation.Nephropyelolithiasis can cause morbidity ranging from renal colic to renal failure, which can be treated by timely intervention. The patient should be counselled on the importance of early recognition, early reporting to hospital, and adopting preventive and prophylactic measures