How do patients perceive and expect quality of surgery, diagnostics, and emergency services in tertiary care hospitals? an evidence of gap analysis from Pakistan

Objectives: Service quality is one of the important gears to appraise services and determine the gray areas that need improvement. In countries with a resource-poor health system, the first step of measuring quality is yet to be taken. This study seeks to inform policy makers in developing contextual service quality models by identifying service quality gaps in tertiary care teaching hospitals using patients' perspective. Methods: A cross-sectional study was performed using multistage cluster sampling, and a modified version of the SERVQUAL [SERV-service, QUAL-quality] instrument was administered to determine patient's expectations and perceptions. A total of 817 completed questionnaires were obtained from patients and/or their attendants using convenience sampling

Results: Data analysis revealed statistically significant negative quality gaps between expectations and perceptions of tangibility, reliability, empathy, assurance, responsiveness, and communication. The difference in mean expectation and perception for responsiveness across the sexes was significant [p < 0.003;p < 0.037, respectively] as well as in perception of communication [p < 0.026]. Other dimensions and overall hospital expected and perceived quality were independent of sex. Educational status showed significant difference in expectation and perception in responsiveness [p < 0.005], but the perception of each dimension was significantly different in different educational categories [assurance:p < 0.001; empathy:p < 0.001; reliability:p < 0.001; tangibility:p < 0.001; responsiveness:p < 0.001; communication:p < 0.001; and for overall service quality:p < 0.001]. Age and service departments showed no relationship with any of the perceived or expected dimension of service quality of hospitals

Conclusions: Tertiary care hospitals failed to meet patients' expectations in all major areas of service quality, posing a question of how hospitals implement and evaluate their quality assurance policy

Age of menarche in relation to socioeconomic status, BMI, physical activity and stress among high school girls

Over the past 50 years, the average age of onset of menarche has significantly declined and found to be a risk factor for breast cancer

Objectives: The research objective is to assess the effect of socioeconomic status, BMI, physical activity and stress on the age of menarche of school girls of urban and peri-urban communities in Lahore

Methods: This cross-sectional study estimated the age at menarche and investigated its relationship with socioeconomic status, BMI, physical activity and stress. It was carried out in 2 schools of peri-urban and urban communities of Lahore, selected through convenience sampling. The data was collected from adolescent girls [aged 13-17 years] from grades 9 and 10 through self-constructed questionnaire. All 199 adolescent girls experiencing menstruation were enrolled in the study

Results: The estimated average age at menarche was 12.66 +/- 1.12 years collectively and 12.92il.21 and 12.37 +/- 1.59 in girls of peri-urban and urban schools respectively. Mean age of menarche was not significantly different in categories of BMI, levels of physical activity and stress but showed statistically significant difference in categories of socio-economic status

Conclusion: It was concluded that mean age of menarche is influenced by socio-economic status

Risk factors of oral cancer in Lahore, Pakistan: a case control design

Increase in incidence of oral cancers associated with tobacco and smokeless tobacco products in South Asian countries, especially in Pakistan, is creating an alarming situation

Objectives: Study investigated the association of tobacco, smokeless tobacco and alcohol with oral cancer

Methods: A case control design was used. 118 cases of oral cancer were selected from hospital, matched with 354 controls during April to June 2015. Case to control ratio was 1:3

Results: Mean age of cases was 48.9I +/- 13.24 years, 77.1% being males and 22.9% females. Most of the participants belonged to low socioeconomic status. The association of pan with oral cancer was very significant [p<0.05, OR= 9.755, 95% CI 5.7-16.5]. However, 62/118 cases were non-chewers and developed oral cancer. Pan chewing showed the strongest risk for oral cancer. We also found an increased risk for oral cancer in the consumption of Niswar [p<0.05, OR- 3.941, 95% CI 1.6-9.8], gutka [p<0.05, OR- 4.133, 95% CI 3.5-4.9], supari/chalia [p<0.05, OR-3.291, 95% CI 1.6-6.7] and alcohol [p<0.05, OR-4.789, 95%C1: 1.7-13.6]. Cigarette Smoking habit was present in both case and controls [p>0.05, OR- 1.291, 95% CI 0.8-1.9] indicating the cultural habit prevalent in Pakistan

Conclusion: Our study thus proved strong association between these predisposing factors and the development of oral cancer and the strength of association found to be stronger than in other studies

Faculty development ---- looking through different lenses

To understand how the faculty and students perceive the needs, barriers and possible solutions for instructional, professional and organizational development of faculty in context of a medical school. Mixed method sequential study. Shaikh Khalifa Bin Zayed Al-Nahyan Medical College [SKZMC] Lahore from September 2013 to March 2014. Five-point Likert scale, focus group discussions [FGDs] and in-depth, face-to-face interviews [IDI] were used to collect data. Using convenience sampling, 2lfaculty members for Likert scale forms,lO for FGD and 12 for ID1 were selected along with93 students for Likert scale and20 students for 2 FGDs. Scale data summarized using mean +/- SD and categorized using median score. Thematic analysis was done on interview and focus group data and findings were triangulated. Triangulation showed lack of motivation, poor time management, deficiencies in curriculum understanding and alignment with instruction and assessment, unawareness of innovative instruction and assessment tools, lack of feedback use and reflection, poor learning environment, and almost no rewards and recogrution of excellence in teaching. Weak institutional leadership and unsupportive administration were impediments too. Enhanced motivation by incentives, rewards and institutional support along with a robust faculty development program, training faculty and improving instructional, professional and organizational structure were identified as context specific solutions to address the needs and barriers. Innovative instructional training, development of research, leadership and scholarship, with organizational restructuring and support, are the main elements for faculty development in this specific context

Assessment of process measures of quality of care through client flow analysis

Background: Quality of health care services is emerging as a field with multifaceted approach. Measuring the quality is tricky and needs standards. Many global standards are in place but still the contextual applications of standards need research on the measurable aspects of the quality of care

Material and Methods: A cross-sectional study was conducted at general medical out patient departments of two tertiary care hospitals of Lahore, one from the public sector and the other from the private sector selected using multi-stage sampling. 93 patients were selected from each hospital. Process measures of quality of care delivered in medical out patient departments were assessed using client flow analysis technique, performed by trained personnel

Results: Access to the hospital OPD, waiting time outside the consultant room, physical environment of the OPD and provision of relevant information to the patient were observed for adherence to standards and statistical association found with the patient satisfaction on these aspects

Conclusion: The process measures must be assessed in order to evaluate the quality of care in a specific service or hospital as patient satisfaction [outcome measure] alone is not enough to judge the quality of care

Training of non-physician practitioners to identify and refer diabetic patients

To improve the practices of non-physician practitioners on early diagnosis and referral of patients with diabetes mellitus. Study will be conducted in a peri-urban village community in Lahore, Pakistan, during 2007 - 2008. Quasi - experimental study, one group before and after design was used to document the effect of training of non-physician practitioners on improving their diabetic patient identification practices and referral to the hospital for diagnostic and treatment facilities. Fasting blood glucose test was used to identify hyperglycaemics out of those referred by the NPPs. Patient referral was increased by 48.44% after training. Identification of hyperglycaemic patients on the basis of signs and symptoms was 47% before and 48% after training and the difference between two proportions was not significant. increased number of referral showed motivation of NPPs towards the task however more prolonged and structured training program is required to utilize their services in community as part of our health care delivery system

Abortion prevalence and socio-demographic differentials

This study was performed to estimate the prevalence of abortions and to evaluate its association with the socio-demographic factors in an urban slum. The data was collected based on recall obstetric history fromi86 females through systematic r and om sampling from 01.04.2001 to 30.06.2001. It was found that the abortion rate was 419.35/1000 women of reproductive age group. Abortion ratio was 109.39/1000 live births. There was strong association of induced abortion with non-Muslim family, working of female and illiteracy of husb and. On the other h and gravidity 5 or above [increasing gravidity] was statistically associated with total abortions. It was concluded that there is an unmet need for controlling unwanted pregnancies and promoting birth spacing among Pakistani women. Some important social and demographic factors determine the abortion behavior in Pakistan