Effectiveness of training on de-escalation of violence and management of aggressive behavior faced by health care providers in a public sector hospital of Karachi

Background and Objective: Considering high burden of violence against healthcare workers in Pakistan APPNA Institute of Public Health developed a training to prevent reactive violence among healthcare providers. The purpose of this training was to equip healthcare providers with skills essential to control aggressive behaviors and prevent verbal and non-verbal violence in workplace settings. This study assesses the effectiveness of training in prevention, de-escalation and management of violence in healthcare settings

Methods: A quasi-experimental study was conducted in October, 2016 using mixed method concurrent embedded design. The study assessed effectiveness of de-escalation trainings among health care providers working in emergency and gynecology and obstetrics departments of two teaching hospitals in Karachi. Quantitative assessment was done through structured interviews and qualitative through Focus Group Discussions. Healthcare providers` confidence in coping with patient aggression was also measured using a standard validated tool"

Results: The overall self-perceived mean score of Confidence in Coping with Patient Aggression Instrument "[CCPAI]" scale was significantly higher in intervention group [Mean= 27.49, SD=3.53] as compared to control group [Mean= 23.92, SD=4.52] [p<0.001]. No statistically significant difference was observed between intervention and control groups with regard to frequency of violence faced by HCPs post training and major perpetrators of violence

Conclusion: De-escalation of violence training was effective in improving confidence of healthcare providers in coping with patient aggression

Breaking bad news: a contextual model for pakistan

Objectives: The purpose of the study was to identify the sequence of violence that ensues after breaking bad news and develop a contextual model of breaking bad news and develop a model contextual for Pakistan

Methods: A qualitative exploratory study was conducted using Six FGDs and 14 IDIs with healthcare providers working in the emergency and the obstetrics and gynecology departments of tertiary care hospitals of Karachi, Pakistan. Data was transcribed and analyzed to identify emerging themes and subthemes using thematic content analysis

Results: Impatience or lack of tolerance, lack of respect towards healthcare providers, unrealistic expectations from healthcare facility or healthcare staff were identified as main reasons that provoked violence after breaking bad news. A conceptual five step model was developed to guide communication of bad news by the health care providers. On initial testing the model was found to be effective in deescalation of violence

Conclusion: Communication of bad news requires application of specific approaches to deal with contextual challenges for reducing violence against healthcare

potential effect of technology and distractions on undergraduate students'concentration

Background and Objectives: In the present era, it is difficult to keep the concentration of college students at its maximum potential during the class time, as there are many distractions that negatively impact students' concentration and prevent optimal learning. Technologies such as laptops and cell phones have invaded the classroom, raising considerable concerns about their effects on college students' attention in the classroom. Despite these concerns, no research has been done in Saudi Arabia on the effects of technology and other types of classroom distractions on students' concentration. In the current study, we have attempted to identify students' perceptions of major distractions in the classroom based on seventeen internally [self-produced] and twenty-four externally produced classroom situations

Methods: The students participating in this study rated the degree to which each distraction interferes with their concentration on the class materials and their ability to learn. Data were collected through surveys of 265 students ]66 and 199 students from medical and basic classes, respectively], including 97 females and 168 males 17-23 years of age from the academic years 2010 to 2014. A validated self-administered questionnaire was handed to the students in the classroom

The students were asked to report and rate the classroom distraction produced by 24 external internal distracters [Table-ll], on a 5-point scale

Results: The results revealed that ringing cell phones in the class were the most commonly reported electronic external distractor for 68% of students, and 21% of them reported being extremely distracted by this noise. Having an instructor who is difficult to understand was the most commonly reported external behavioral distractor for 75% of students, and 48% of them rated this as extremely distracting. Students talking in class were the most self-produced distractor for 72% of students; negatively impacting their concentration and ability to learn, and 42% of them rated it as an extreme distractor. Wearing clothing with unusual words, drinking and eating in the classroom were minimally distracting colleagues. Overall, distractions [internal and external] were more significant for fifth-year students than the other years at a p-value< 0.001

Conclusion: Students believed that laptop and cell phone use in the classroom can effect their concentration and ability to learn. The students also felt that inappropriate behavior is a major distraction for students as well, and thus necessitates monitoring and improvement

Evaluation of off-service rotations at National Guard Health Affairs: results from a perception survey of off-service residents

"Off-service" clinical rotations are part of the necessary requirements for many residency training programs. Because these rotations are off-service, little attention is given to their structure and quality of training. This often leads to suboptimal educational experience for the residents on these rotations. The aim of this study was to assess medical residents' perceptions, opinions, and levels of satisfaction with their "off-service" rotations at a major residency training site in Saudi Arabia. It was also to evaluate the reliability and validity of a questionnaire used for quality assurance in these rotations. Improved reliability and validity of this questionnaire may help to improve the educational experience of residents in their "off-service" rotations. A close-ended questionnaire was developed, Pilot tested and distributed to 110 off-service residents in training programs of different specializations at King Fahad Naitonal Guard Hospital and King Abdulziz Medical City, Riyadh, Saudi Arabia, between September 2011 and December 2011. A total of 80 out of 110 residents completed and returned the questionnaire. Only 33% of these residents had a clear set of goals and educational learning objectives before the beginning of their off-service rotations to direct their training. Surgical specializations had low satisfaction mean scores of 57.2 [11.9] compared to emergency medicine, which had 70.7 [16.2], P value [0.03]. The reliability of the questionnaire was Cronbach's alpha 0.57. The factor analysis yielded a 4-factor solution [educational environment, educational balance, educational goals and objectives, and learning ability]; thus, accounting for 51% variance in the data. Our data suggest that there were significant weaknesses in the curriculum for off-service clinical rotations in KAMC and that residents were not completely satisfied with their training

Association of menopause with osteopenia and osteoporosis: results from population based study done in Karachi

To assess the association of osteopenia and osteoporosis with menopause and compare the health seeking behaviour of women related to menopause in different strata of society. A cross-sectional study. Three different socioeconomic strata of Karachi from May till August 2004. A sample of 925 women, over 35 years of age, was selected from 16 clusters of 250 households [50 houses in each cluster]. All apparently healthy women having age between 35 and 50 years were selected in the cluster houses. Those who were not willing to be the part of the study or giving history of taking treatment for any disease for more than 4 weeks were excluded. In-depth interviews were conducted at their houses by the fourth year medical students trained and supervised by the senior faculty of the Medical College. T-scores were calculated to get BMD [Bone Mineral Density] for all the subjects through heel ultrasound. A total of 287 women were found to be experiencing menopause. The mean age of menopause was 47.8 + 4.7 years. Out of those 287 women, 135 [47%] wanted their menses to continue and 235 [82%] had consulted a physician after menopause. There was a significantly lower score of BMD of postmenopausal women [mean = -1.833 + 0.65] compared to pre-menopausal women [mean = -1.597 + 0.60, p=0.016]. Out of the 925 women interviewed, 53% had consulted a physician for various symptoms related to menopause. The symptoms experienced by pre-menopausal women included lack of sleep [25%], fear of becoming sterile [13%] and urinary incontinence [18%]. The average age of menopause was found to be similar to other studies of the country. Lower bone mineral density was found in greater proportion among older females. Majority needed intervention inclusive of awareness through health education and medication

Assesment of risk factors of osteoporosis

To assess the risk factors of osteoporosis. Descriptive study. OPD of Abbasi Shaheed Hospital, KMDC Basic health unit and Zubaida medical centre from August 2005 to November 2005. 231 persons of either sex were included in the study. Pattern of life style and dietary intake was studied using a questionnaire. Bone mineral density [BMD] was measured using quantitative ultrasound. Weight in kg was recorded. Males below 60 years and females below 40 years of age were excluded from the study. Also persons with incomplete information were excluded from the study. Out of 231 persons, 179 were females and 52 were males. Mean weight in males was 67.40+12.8 kg and in females 64.04+13.1 kg. A significantly high proportion of persons [71.3%] living in joint families had osteopenia or osteoporosis [p<0.031], compared to persons in nuclear families [60.4%]. There was no significant relationship between BMD and profession [p=0.563], sex [p=0.463], intake of calcium [p-=0.664], observing veil [p=0.789] and exposure to sunlight [p=0.356]. In our study, significantly higher percentage of persons living in joint families had osteopenia or osteoporosis. However, no statistically significant association was found between BMD and dietary intake pattern, early marriage, observing veil or exposure to sunlight in our study

Opinion of medical students regarding problem based learing

To assess the process of problem-based learning [PBL] as perceived by the medical students and their opinions regarding the process. A cross-sectional study was conducted at Karachi Medical and Dental College. One hundred and four medical students of fourth year MBBS [52 each of batch 2004 and 2005] were selected for their responses and feedback on problem-based learning in small groups. Data was collected through a closed-ended questionnaire. Seventy nine percent [82 out of 104] of medical students liked the PBL sessions. Overall 85% of students were motivated towards self learning while liking for PBL was 82%. Activation of prior knowledge was observed by 83% students. Students supported problem-based learning [PBL] as an effective method of learning. Majority of students were motivated towards self- learning. They were convinced that PBL helped them in building up communication skills, interpersonal relationship and problem solving capacity

Cost of DOTS for tuberculous patients

To determine the cost of DOTS [directly observed therapy short course] incurred by the patients. A hospital based cross-sectional study was conducted at Nazimabad Chest Clinic and Ojha Center for Chest Diseases from January 2005 to July 2005. Two hundred and twenty tuberculous patients with acid-fast bacilli positive in their sputum were analyzed. Variables for cost were assessed with respect to money and time. Most of the tuberculous patients [68%] registered during the data collection period were females. Thirty seven percent of the patients belonged to families with 8-10 family members living under one roof. The expense of direct cost for two months treatment was Rs. 3060-3600 [if patient was not buying the anti-tuberculous drugs]. Most of the patients who were on DOTS spent more than 4 hours per day in obtaining the therapy. The disease was found to be common in poor families [75% of patients had total monthly income less than Rs. 2000]. Tuberculosis was common in poor and large-sized families. Time consumption on travel for DOTS was a deterrent for compliance. DOTS coverage should be modified to reduce time and financial cost for the patients

Evaluation of academic performance by dental graduates of Karachi medical and dental college: In lieu of their selection criteria for professional education

Creditable selection of candidates in the professional colleges is of crucial importance in producing capable and talented doctors to deliver good service to the people. KMDC selects its candidates on the bases of an admission test conducted by Institute of Business Administration [I BA] with weightage given to Intermediate [HSC] and Matric [SSC]. Evidence shows that academic achievements of professional graduates can not be predicted on the basis of their preprofessional records hence it has been suggested that innovative methods should be evolved for selecting the most suitable professionals. Aims: The purpose of this study is to look at the ability of the pre-professional records and the admission test to predict the academic performance of dental graduates. Results of professional exams of first four dental batches [n=80] of Karachi Medical and Dental College were retrieved and their academic records in Higher secondary, Secondary school and IBA test were also taken. The descriptive statistics show that average score of first BDS batch for IBA is 59.0 while for batch 4th it is 71.04. Whereas the average professional marks of batch 1 is 356.9 to that of 346.81 of batch 4. There is negative correlation between IBA and final prof results with R=-.048 [P<.510], -.340 [P<.152],.163 [P<.079] and -.198 [P<.033] respectively for each batch. There is no significant difference in final professional marks between the four batches with F=1.991 [P<.193] for higher IBA scores. It was concluded that there is no significant positive correlation between IBA Test score and the final professional results in all four batches of dental graduates of Karachi Medical and Dental College. The IBA score was improved in the subsequent batches without influencing the professional scores

Knowledge attitude and practice in families of tuberculous patients

To find out knowledge, attitude and practices in families of tuberculous patients [KAP survey]. Hospital based KAP survey conducted on 250 individuals, in four chest clinics and Ojha Institute of Chest Diseases at Karachi. Out of 201 individuals 60.2% of the respondents had fair and 39.8% had poor knowledge, 27.4% had favourable, 67.6% had unfavourable and 5% had bad attitude, while 1% had good, 32.3% had fair and 66.7% had bad practice. The study showed poor knowledge, bad attitude and bad practices among TB patients. There is a need for extensive health education through most commonly used mass media to increase awareness of the people regarding tuberculosis

Risk factors associated with anaemia children six month to five years of age residing in a squatter settlement of Karachi

The commonest form of malnutrition in Pakistan is protein energy malnutrition followed by iron deficiency anaemia. This cross sectional study was done in a squatter settlement of Karachi to find out the risk factors associated with anaemia and prevalence of anaemia in children 6-60 months of age. The prevalence of anemia was found to be 77.9% [n=947]. For detailed interviews, 321 children were selected through systematic random sampling. Highly significant association of anaemia were found with present history of Pica [P < 0.000], diarrhea [P< .006] and weight of the child [P< 03]. In the past history beyond 3 months, significant associations were found with Pica [P< .007], growth retardation [P< .01] repeated infections [P< .01], chronic diarrhoeas [P< .000]. Our results show that if an underweight child with pica and frequent black stool gives a history of repeated infections and/or chronic diarrhea, then iron deficiency anaemia should be strongly suspected and iron therapy can be initiated with caution in these patients. Community prescription of iron and/or fortification with staple foods should be considered in high risk groups through utilization of community health workers

Anemia in children: part I Can simple observations by primary care provider help in diagnosis?

The commonest and reliable method of diagnosing anaemia is by determining haemoglobin levels, which is an invasive technique. This cross-sectional study aims to detect the validity of diagnosing anaemia by simple non-invasive clinical techniques. This study screened 951 children [6-60 months] residing in a squatter settlement of Karachi. Every child was first labelled anaemic or normal by a clinical scoring system and then his/her haemoglobin was tested by finger prick method on a Hemocue. Mean age was 31.1 +/- 15.3 months [n=945] and median was 32 months. The prevalence of anaemia by Hemocue was 78% [Anaemia=Hb<11gms percent] and by clinical examinations 68%. Conjunctivae alone had the highest sensitivity [74%] and nails alone highest specificity [96%]. Nails alone had the highest positive predictive value and conjunctivae alone highest negative predictive value [43.2%]. Combinations of conjunctivae with either nails, palm or tongue yielded the highest validity. The results indicate that in PHC settings with no laboratory facilities, anaemia can be detected by pallor of conjunctivae associated with pallor of either nails, palm or tongue