Hand hygiene; perceptions of medical students

WHO Guidelines recommends [My five moments for hand hygiene] for prevention of HCAI. To assess the knowledge and practices of medical students about HCAI and hand hygiene. Lahore Medical and Dental College [LMDC], Lahore. Four weeks, in January and February, 2012. Descriptive cross-sectional study was conducted using WHO'S [Hand Hygiene Knowledge Questionnaire], among MBBS students from 3rd to final years, 2012. Data was entered and cleaned in SPSS 19 and presented in tables and graphs. Descriptive statistics was used in the forms of numbers and percentages. Among 227 respondents, 63% were female, 67% were 20 to 22 years old, 38% were from 3rd year, 40% from 4th year and 22% from final year, 61% never received hand hygiene training and 67% never used hand rubs. Few students named unclean hands as main route [42%] and source of HCAI [21%]. Hand hygiene was preferred before touching patients [76%] and after body fluid exposure [70%]. It was perceived to be rapid [63%], effective [66%], cause of skin dryness [57%] and it was supposed to be used concomitantly with hand washing [74%], before abdomen palpation [48%], giving injection [31%], after removing gloves [22%] and making patient's bed [31%]. Damaged skin [92%], artificial fingernails [78%] and jewelry [53%] were perceived to increase hand contamination. There were serious gaps in knowledge of proper hand cleaning techniques and their importance in prevention of health HCAI. Hand hygiene, must be part of curriculum and training of all health care providers

Stress in medical educators

Workplace or occupational stress are harmful physical and emotional responses that occur when there is an apparent mismatch between what doctors are trained for and what they are required to do. Data on workplace stress experienced by medical educators is scarce. To asses stress in medical educators and its job related predictors. Lahore Medical and Dental College [LMDC], Lahore and its affiliated Ghurki Trust Teaching Hospital [GTTH]. Three months, between January and March 2009. A cross sectional survey was conducted. A structured questionnaire for background information and Workplace Stress Scale [WSS] were the data collection tools to survey 11 0 medical educators. Data was recorded and analyzed in SPSS 16. Chi Square test with p

Reasons for selection of nursing profession in Pakistan

Nursing is the backbone of health care delivery system. There are various factors which influence the choice of selecting nursing as profession. [1] To find out the socio demographic profile of nurses working at Ghurki Trust Teaching Hospital [GTTH] Lahore. [2] To explore the reasons for selection of this profession. A cross sectional descriptive study. From October 2009 to January 2010. GTTH, Lahore. All the nurses working in Ghurki Trust Teaching Hospital, Lahore are included in this study and their responses are obtained with a self administered questionnaire. A total of 77 nurses participated in our study. The age distribution of these nurses has shown that a large number of nurses, 49 [63.6%] belonged to age group between 20 to 30 years. There were 26 [33.8%] nurses who had done B. Sc nursing. About 72 nurses [93.5%] have monthly income more than Rs.10.000. Majority of them, 48 [62.3%] are unmarried. 41 [53.2%] of the nurses selected this profession due to their own personal interest, 15 nurses [19.5%] selected this profession due to their parental influence. 12 nurses [15.6%] selected this profession for serving humanity. 9[11.7%] selected this profession to support their family. Approximately 25 nurses [32.5%] said that there are other family members working in the same profession. It was noted that out of these 25 nurses, 10 [40%] had their sisters in the same profession. Nursing forms the backbone of health care delivery system of a country. Decision makers in health sector need to understand that human resource development. Particularly nursing requires revolutionary changes. As public health policy makers, it is imperative that we investigate the reasons for selection of nursing profession to attract and retain these important partners in health care provision

Medical education: views and recommendations by final year MBBS students of a private medical college in Lahore

To obtain the views and recommendations of final year MBBS medical students of Lahore Medical and Dental College, Lahore about various aspects of the current medical education. Cross-sectional survey. Lahore Medical and Dental College, Lahore in October and November 2007. Preformed close ended structured questionnaire regarding medical teaching and evaluation methods and recommendations was used to collect the data from students of final year MBBS [n=120] at Lahore Medical and Dental College. SPSS 15 program was used for analysis. Data was presented as frequency percentages. A majority of the students [79%] thought that multimedia was the most effective teaching tool, [54%] students viewed 45 minutes as ideal lecture duration. Measures suggested to improve the examination results were regular tests [54%], improved lecture content [32%] and regular tutorials [10%]. MCQ's were the mode of examination questions preferred by 62% of students. Recommendations given by students for improving the current medical education were better teaching [26%] followed by increased motivation in students 54 [16%] and more hands-on training/practical field work [12%]. Medical students in this study preferred multimedia, lecture duration less than 45 minutes and MCQ's as their preferred mode of evaluation. Students recommended increased emphasis on better lectures, increasing learning motivation in students and more hands on training/practical field work to improve current medical teaching

Congenital heart disease: knowledge and myths in parents attending cardiology department of children hospital and institute of child health, Lahore

To assess the parental knowledge and myths related to etiology of congenital heart disease. A cross sectional descriptive study. Out patient department, indoor and echocardiography rooms of Children Hospital and Institute of Child Health [CH and ICH] Lahore, in two weeks of October, 2007. Convenient sampling technique was used to recruit 299 children between 1 month and 14 years of age, suffering from congenital heart disease. Cases of rheumatic fever and associated congestive cardiac failure were excluded from the study group. A structured questionnaire was used to interview parents of the study group. Descriptive statistics was determined in terms of percentages. Out of total 299 patients included in this study, 132 were in the age group of 1 -5 years [44%], with the mean age 1.86 years +/- 0.886 SD. 200 were males [67%] and 99 were females [33%]. The respondents included 71% mothers and 27% fathers. Ventricular septal defect [VSD] was the most common disease encountered in 128 children [43%], Regarding the causes of congenital cardiac defects, parents blamed cousin marriage [41%], inheritance [26%], increased maternal age [16%], maternal smoking [16%] and paternal smoking [39%]. Other responses included evil spirits, moon and sun eclipses and bad wishes/evil I eye. 57% of the respondents said that there is no relationship between gender and congenital cardiac malformation and 85% respondents believed that there is no relation with the food taken in pregnancy and subsequent cardiac defects. High Salt intake was considered as an associated factor by 47 [15%] of the respondents. Naming the cause of cardiac malformations, 41% of the parents said drugs taken in pregnancy, 13% of the respondents blamed alcohol, cocaine and opium intake. Among parents, 73% were aware of the fact that maternal health is important for disease causation in neonates but could not name any particular disease. The parents of those children, who have congenital malformation, have different myths and fallacies associated with disease causation. Adequate health education strategies should be adopted towards mass dissemination of information in the community about this important issue

Bullying of medical students

To assess the frequency and forms of bullying experienced by medical students, and the associated factors. Cross-sectional questionnaire-based survey. The study was conducted at a private Medical College of Lahore, from January to February 2010. All the students of first and fourth year classes were included in the study with voluntary and anonymous participation. Self administered-questionnaires were given to the students which were completed by them in the presence of the surveyor. A modified version of the British Medical Associations [BMA] medical student's welfare and education survey form was used for data collection. The data was recorded and analyzed using the statistical package for social sciences version 16.0. Data was described in the form of frequencies and percentages. Chi-square test and Fisher exact test were used to test statistical significance between categorical variables at p

Factors affecting medical specialty preferences and associated gender differences in fourth year MBBS students

To Identify factors affecting medical specialty preferences and associated gender differences in Fourth Year MBBS students. This was a Cross-sectional survey conducted on fourth year MBBS students of Lahore Medical and Dental College through a Preformed Structured questionnaire by non probability sampling technique. The student were told that the survey was voluntary and were given a choice of refusal but fortunately all the students in the class participated in the survey [n=120]. Data was collected during January 2009. Data was analyzed using SFSS v. 16.0. Descriptive statistics were computed, and the relationship between specialty preference and categorical variables [gender, reasons for choosing a particular specialty] were evaluated using Pearson Chi square test. A calculated p value of

Selection of medical profession by first year medical students

The factors which influence medical students' selection of specific medical specialties have been analyzed by a number of studies in the literature. However, very few studies have been carried out to ascertain the factors which influence students selection of the medical profession itself. The literature review did not identify any such study conducted in Pakistan, therefore this particular venture was undertaken. To establish a baseline of factors that affect student's decision in selecting medical profession and to determine if there was a significant difference in factor by gender. Lahore Medical and Dental College, between January and February 2009. The present study was a cross-sectional survey in which the first year MBBS class of Lahore Medical and Dental College, comprising ninety students were part of the study. Data was collected using a pre-formed structured questionnaire, which was pretested before adoption of the final version. The collected data was analyzed using version 16 of the statistical package for social sciences [SPSS]. Data is presented in the form of tables and figures. It is described in the form of frequencies and percentages. Inferential statistics were done using Fisher Exact test at 5% level, Among 90 respondents, 58 [64%] were females, 74 [82%] were between 18-20 years of age, 81 [90%] had their residence in Pakistan, 57 [63%] of the respondents' fathers and 26 [29%] of their mothers had attained postgraduate education. Of the respondents' parents, 29 [32%] of the fathers and 12 [14%] of the mothers belonged to the medical profession. All students taking two attempts at FSc/A-level/American high examination also took two attempts at the entry test to a medical college [p<0.001]. A large proportion 10 [59%], of students who attempted the entry test twice had fathers who were doctors. The popular reasons for selection of medical profession by the respondents included personal interest [89%], parental wish [58%] and a desire to serve humanity [41%]. Among the respondents 100% males had a personal interest in medical profession in contrast to 83% female respondents [p=0.012], 100% male respondents were influenced by parental wish compared to 34% females [p<0.001], 100% males in contrast to 9% females identified humanitarian concern [p<0.001] as factors influencing selection of medical profession. The prestigious status of the profession, parents being doctors, financial incentives, better career opportunities and a better chance to go abroad were the factors identified by only the male respondents as compared to the female respondents in influencing their choice of medical field [p<0.05]. The overall frequent choices for selection of medical profession included personal interest in the profession, parental wish and a desire to serve humanity. Whereas, parents being in the same profession, financial incentives, better career opportunities and the prestige associated with the profession were identified as motivating factors by only the male respondents

Seroprevalence of transfusion transmissible infections [TTIS] in blood donors

To find out the seroprevalence of HIV, Hepatitis B, C virus and Trepenoma Pallidum among the healthy blood donors, at Ghurki Trust Teaching Hospital, Lahore. Descriptive study. Blood Bank of GTTH, Lahore, from 1st January to 31st December 2008. All healthy blood donors reporting to blood bank in the specified study period were screened for HIV, Hepatitis B, C and Syphilis. A total of 6659 donors were screened, out of these 512 donors [7.69%] were seropositive for Hepatitis C, 113 [1.70%] were sero positive for Hepatitis B, 35 [0.5%] were seropositive for syphilis and only 3 [0.05%] had shown seropositivity for HIV. Transfusion transmissible infections are a major threat associated with unscreened blood donations. In Pakistan the prevalence of Hepatitis B and C is very high in occult form. Selection of healthy blood donors and public awareness programs targeting local community will be an important measure to stop its transmission through blood transfusion

Smoking patterns

To determine the smoking patterns of medical students of 4th year MBBS. A cross-sectional survey. Lahore Medical and Dental College [LMDC], Lahore, Pakistan. From November to December 2006. The 50 medical students of 4th year MBBS, who were current smokers. A structured questionnaire was used to collect the data. Descriptive statistics was determined in terms of percentages. In present study, 48% students started smoking between 14-17 years of age, 34% started to smoke between ages 18-21 years and 18% of them had been smoking for past 4-6 yrs. Main reason to commence smoking included curiosity [27%], need to look glamorous [22%], peer pressure [16%] and stress relieving [10%]. When probed about numbers of cigarettes smoked daily, the response of majority was that 32% of students admitted to smoking 1 -5 cigarettes, similar number admitted to smoking 6-10 cigarettes, and 30% of students smoked more than 20 cigarettes. Among the respondents, 41% had a brother who was a smoker and 37% had a father who was a smoker. More than half the respondents [58%] said that their parents were unaware of their smoking habit. Regarding awareness about the medical hazards of smoking, 31% of students named cancer, 29% mentioned heart disease, 18% were familiar with COPD and only 7% referred to stroke. The main concerns of respondents regarding smoking were fear of being discovered by their parents [22%], psychological dependence [20%] and physical dependence [18%]. Only 50% of students tried to quit smoking, using hypnosis and substitutes like nicotine gum and nicotine patches. Tobacco smoking among medical students is alarming. These findings not only raise concerns for the future health of our medical students but also their credibility and effectiveness as health promoters for population at large

Tuberculosis; awareness about spread and control

To assess the awareness about spread and control of Tuberculosis amongst people presenting at Ghurki Trust Hospital, Lahore. A cross-sectional survey. Lahore Medical and Dental College [LMDC], Lahore. From November and December 2006. A cross-sectional survey was conducted among people presenting at Ghurki Trust Hospital, Lahore, between November and December 2006. A structured questionnaire was used to collect the data. Descriptive statistics were determined in terms of percentages. In the present study, 82% respondents did not know the correct mode of transmission of tuberculosis. Correct modes of transmission including coughing, sneezing, spitting and breathing air were mentioned only by 18%. A large proportion of respondents [76%] knew that tuberculosis presents as cough lasting more than three [3] weeks and having prolonged fever [68%]. Fifty percent of respondents said that government health facilities are the best places for the treatment of TB. Twenty three percent [23%] of respondent mentioned use of medicine as a method of management and treatment. Improving sanitation and nutrition was mentioned to prevent and control TB by respondents in almost equal percentage [20% and 18%]. Poor knowledge and misconceptions concerning tuberculosis are rampant in Pakistani patients. Poor knowledge of TB patients concerning their disease may contribute to the high burden of TB disease in the country

Weaning; knowledge and practices

To evaluate the awareness and practices regarding weaning in lactating mothers of infants. A cross sectional descriptive study. At pediatrics OPD in Ghurki Trust Teaching Hopsital, Lahore. From October to December 2007. A non probability convenience sampling was done to collect data from 50 mothers who were attending out patient department along with their infants on a pre-formed questionnaire. After gathering, data was analyzed and presented in the form of tables and graphs. In the present study, 66% mothers were in the age group of 20-29 years, all were house wives, 34% were matriculate and 72% lived in joint family system Mean age of weaning was 4-6 months in more than 64% of the sample. Among the women interviewed, 44% used home-made weaning diets, 30% used mixture of homemade and commercially prepared diets, while 16% used only commercially prepared diets. Breast feeding was continued during and after weaning, by 64% of respondents along with weaning diets. Mothers need to be educated about the importance of weaning, the recommended age of weaning and about the types of weaning food. This can be achieved by using lady health workers and lady health visitors and the mass media. Importance of breast feeding with weaning diet should be emphasized upon

Assessment of socio-economic status of patients

To determine whether or not doctors assess the socio-economic status of their patients in order to customize treatment and improve compliance. A cross-sectional Jinnah Hospital and Shalimar Hospital Lahore. From March to June 2005 Ninety-three patients were included from each of the two randomly selected tertiary care hospitals [one public, one private] of Lahore. Doctor-patient encounters were observed. No assessment was made for 134/186[72%] patients. 51/186[27.4%] received an inadequate assessment. Only 01/186[0.5%] patient received a thorough assessment of his socioeconomic status. Doctors in the private hospital made better effort to assess the socioeconomic background of the patient [albeit inadequately], compared to those in the public hospital [p: < 0.0001]. Doctors should be regular and meticulous in patients' socioeconomic status assessment

Diabetes mellitus; awareness among individuals attending out patient department of Ghurki trust teaching hospital

To assess the awareness of diabetes in individuals attending Out Patient Department of Ghurki Trust Teaching Hospital. Descriptive study design. Out Patients Department, Ghurki Teaching Hospital, Lahore. The study was conducted among a sample of 50 individuals, recruited by convenience sampling technique. Data was collected, by administering a structured questionnaire, during a two week period in December 2006. Data was presented in the form of tables and graphs. General Awareness of Diabetes Mellitus in the participants of our study was poor. Only 16% recognized it as a disease of the pancreas while 50% considered it to be a disease of other systems. Majority of the respondents [78%] had no idea about the types of the disease. When asked about the communicability of diabetes, 76% considered it to be non-communicable, 10% thought it to be communicable. Among the respondents, 78% thought diabetes is inheritable. When asked about its prevention, 54% considered avoiding sugar as the best way to prevent diabetes, while only 9% believed weight reduction to be important. Regarding the management of diabetes, 40% of respondents considered medication, 27% thought of diet modification as a better way, 18% considered exercise, while only 6% named weight reduction. The participants of the present study lacked awareness of types of diabetes, its mode of inheritance, its prevention and management

Prevalence, predictors and determinants of depression in women of the reproductive age group

The purpose of this study was to find out prevalence, predictors and determinants of depression in women of reproductive age. The study was conducted in a peri-urban locality of Lahore. Among 186 respondents, 114 were less than 30 years of-age [61%], 117 were Christians [62%] and 124 were educated [67%], 65 lived in nuclear family system [35%], with 148 women having 5 to 10 family members [79%], 174 were housewives [94%], 154 husbands were in regular employment [83%] and 107 women had family income of less than Rs. 5000 [58%]. Among the study group, 123 women were married [66%], 19 were pregnant [15%] and 61 women had 3-4 children [50%]. The present study prevalence of depression was 25%. Emotional and physical complaints like sadness, crying, irritability, loss of interest in life, sleeplessness, inability to work, tiredness, health worries, disappointment, self blaming, poor appetite and weight loss, were more in depressed respondents than non-depressed women [p = < 0.001]. Among age group > 30 years, 33% women were depressed compared to 19% in age group < 30 years [p = 0.03]. Among uneducated respondents 35% were depressed in contrast to 19% of educated women [p = 0.02]. In nuclear family type, 35% respondents were depressed compared to 20% living in mixed family system [p = 0.03]. Among women with 3-4 children, 38% had depression in contrast with 19% with 1-2 children [p = 0.02]. The study concluded that depression in reproductive age women is not uncommon. Its emotional and physical predictors and socio-demographic determinants must be kept in mind while identifying its risk factors and planning its management

Immunization status; assessment of children between 1 - 3 years coming to OPD of children hospital and institute of child health, Lahore

To assess the immunization status of children between 1-3 years of age coming to the Children Hospital and Institute of Child Health, Lahore. Descriptive study. The study was conducted at OPD of Children Hospital and Institute of Child Health, Lahore. The data was collected in two weeks in December, 2006. Information was gathered from parents about the immunization status of 50 children and awareness of parents of these children about the vaccine preventable diseases, using a pre-tested questionnaire comprising of close ended questions. The results were presented in the form of tables and graphs. The data was collected for 28 male children [56%] and 22 female children [44%]. According to parents, 29 children [58%] were delivered at hospitals, whereas, 21 children [42%] were born at home. Maximum immunization was done at Government hospitals [47%]. About 40% of the children had their first immunization at the time of birth. Only 17% of the parents could easily recall vaccination of their children against polio, about 14% of parents could name pertussis, 13% of parents named tuberculosis, about 12% of parents could name hepatitis and measles, diphtheria was known to only 7% of parents and tetanus was named about 5% of parents. Among the parents, 18% could not answer this question. Nearly all the children [98%] had taken polio drops at home. The best source of information about immunization program was declared to be the health care providers [33%], mass media [23%], mother/mother in law [19%], and other family members [17%]. The present study concludes that 99% of children coming to OPD of Children Hospital were immunized for Polio, despite the lack of awareness among parents about vaccination against other communicable diseases. The best source of information about immunization was the health care providers, mass media and family members

Prevention of hepatitis B; knowledge and practice among first year MBBS students

To assess the knowledge and practice of first year MBBS students, for the prevention of Hepatitis B. Descriptive study. The study was conducted at Lahore Medical and Dental College. Lahore. The data was collected in two weeks in December, 2006. A total of 50 students were recruited using a non probability random sampling technique, through the lottery method. A pre-tested structured questionnaire was administered to collect information about the knowledge and practice of students about the prevention of hepatitis B. Data was presented in the form of simple tables and graphs. Out of 50 students, majority [96%] responded that it was a disease of liver. Regarding knowledge about the communicability of Hepatitis B, 78% said it was communicable, 19% assumed that it was water borne. Other responses included spread via blood transfusion [28%], through use of injection [21%], close physical contact [8%] and un-hygienic conditions [18%]. For prevention of Hepatitis B, the more common responses were, provision of clean water [24%], improvement in hygiene [27%], restriction to single sex partner [6%], avoidance of sharing syringes and needles [19%], screening blood before transfusion [9%] and vaccination [15%]. The high risk group was identified as the poor people living in unhygienic conditions [34%], surgeons [32%], barbers [12%], Intravenous drug users [8%], recipient of blood transfusion [6%] and uneducated people [6%]. Only 1 respondent [2%] said that sex workers could be at risk of getting this disease. When inquired about their vaccination status, 66% of students admitted to have been vaccinated against Hepatitis B, while 34% of have not been vaccinated. The present study concludes that there is lack of awareness among the medical students entering into the profession about the hazards of Hepatitis B, its routes of spread and its modes of prevention. Similarly, all the students were not vaccinated against Hepatitis B, which made the m very vulnerable to this disease

Critical appraisal of rural health centers in Tehsil Sialkot by using the HMIS reports

Since July 1991, the Federal Ministry for Health and Provincial Health Departments with the support of international agencies is in the process of replacing the routine reporting system of the government managed First Level Care Facilities [FLCFs] with a more comprehensive Health Management Information System [HMIS]. A descriptive study was conducted to appraise the level of information generated by two FLCFs through the HMIS reports The reports were evaluated for malaria tuberculosis priority listing diseases and maternal health related issues, addressed routinely at the rural health centers. In the year 2000, it was observed that new cases of fever at RHC Khalian were reported to be 1069 and 243 slides [23%] were prepared to diagnose malarial parasites. In comparison, Kotli Loharan reported 275 cases of fever and prepared 253 slides. Total 46 cases of cough were reported by RHC Khalian and no smear was done for acid fast bacilli. In RHC Kotli Loharan, 14 cases of cough were reported and only 6 smears were done. RHC Khalian registered 21% of the expected pregnancies, assisted only 5% of the expected deliveries and provided postnatal care [PNC] to 30% of women. In comparison, RHC Kotli Loharan, registered 66% of pregnancies, out of these, 27% were attended at the time of delivery and 79% were given PNC. At RHC Khalian, 16% of the total cases reported were diarrhoeal cases while in RHC Kotli Loharan, these cases were only 7% of total reported cases of ill health. It is concluded that the HMIS reports generated at the two RHCs have proved to be an important tool in assessing the quality and quantity of services provided at FLCFs. This is only true if the HMIS reports are filled properly and timely feedback is provided to these facilities