Service Quality Of Diagnostic Fine Needle Aspiration Cytology In A Tertiary Care Hospital Of Lahore (Process Measure As Patient's Perspective).

BACKGROUND: Quality of any service is the most important aspect for the manufacturer as well as the consumer. The primary objective of any nation's health system is to provide supreme quality health care services to its patients. The objective of this study was to assess the quality of diagnostic fine needle aspiration cytology service in a tertiary care hospital. As Patient's perspectives provide valuable information on quality of process, therefore, patient's perception in terms of satisfaction with the service was measured. METHODS: In this cross sectional analytical study, 291 patients undergoing fine needle aspiration cytology in Mayo Hospital were selected by systematic sampling technique. Information regarding satisfaction of patients with four dimensions of service quality process, namely "procedure, sterilization, conduct and competency of doctor" was collected through interview on questionnaire. The questionnaire was developed on SERVQUAL model, a measurement tool, for quality assessment of services provided to patients. All items were assessed on 2- point likert scale (0=dissatisfied, 1=satisfied). Frequencies and percentages of satisfied and dissatisfied patients were recorded for each item and all items in each dimension were scored. If the percentage of sum of all item scores of a dimension was ≥60, the dimension was 'good quality'. Whereas <60% was 'poor quality' dimension. Data was analysed using epi-info-3.5.1. Fisher test was applied to check statistical significance. (p-value <0.05). RESULTS: Out of the 4 dimensions of service quality process, Procedure (48.8%), Sterilization (51.5%) and practitioner conduct (50.9%) were perceived as 'poor' by the patients. Only practitioner competency (67.4%) was perceived as 'good'. Comparison of dimensions of service quality scoring with overall level of patient satisfaction revealed that all 4 dimensions were significantly related to patient dissatisfaction (p<.05). CONCLUSIONS: The study suggests that service quality of therapeutic and diagnostic procedures in public hospitals should be routinely monitored from the patients' point of view as most aspects of service quality in public hospitals of Pakistan, require improvements. In this manner patient's satisfaction regarding use of services in public hospitals can be made better.

Insulin Sensitivity To Trace Metals (Chromium, Manganese) In Type 2 Diabetic Patients And Non Diabetic Individuals.

BACKGROUND: Diabetes mellitus constitutes one of the most important problems in developing and non-developing countries. The purpose of the study to estimate the concentrations of Chromium and Manganese in diabetic and non-diabetic population of Hazara division. The cross sectional comparative study was carried out on one hundred blood samples of Type 2 Diabetic patients collected non-randomly from Ayub Teaching Hospital and one hundred normal healthy controls from Women Medical College Abbottabad from September 2014 to April 2015. METHODS: The study included two hundred subjects. Among them 100 were diabetic and 100 non diabetic respectively. The blood samples were collected from Ayub Medical College, Abbottabad. The serum Chromium and Manganese levels were determined by Atomic Absorption spectrophotometer. RESULTS: Serum Chromium and Manganese levels were decreased in diabetic and increased in non-diabetic patients. CONCLUSIONS: Low serum level of Chromium and manganese were found in diabetic patients as compare to non-diabetic individuals.

Appetite Regulation In Relation To Energy Provision.

BACKGROUND: Appetite control is a very complex process which influences the short term feeding behaviour and a long term adaptive process that responds to the energy input. Appetite control and food intake is influenced by a combination of behavioural, psychological and neuro-endocrine influences. METHODS: For identification of articles search engines of the databases EMBASE, OVID, Pub med and MEDLINE were used for papers published from 2002 to 2015 in English language. RESULTS: The higher endogenous peptide YY (PYY) and cholecystokinin (CCK) and lower ghrelin levels are not always associated with subjective feelings of fullness or hunger and a decreased energy intake which highlights the fact that appetite control and food intake is a very intricate process. CONCLUSIONS: When food is ingested, numerous physiological, hormonal, social and psychological processes are triggered in an intricate manner. Therefore, it can be said that ghrelin, PYY and CCK are just few pieces, which contributes to the process of appetite control and energy intake.

Diabetes mellitus among tuberculosis patients in a tertiary care hospital of Lahore.

BACKGROUND: Diabetes is an important risk factor for Tuberculosis (TB) that might affect disease presentation and treatment response but has hitherto been neglected by the clinicians. There is inadequate data on the prevalence of diabetes mellitus (DM) among TB patients in Pakistan. This study was conducted to determine the frequency of TB patients having DM. METHODS: In this cross-sectional study, 158 TB patients admitted in Gulab Devi hospital were selected by systematic random sampling technique and data were collected using a pretested questionnaire. All patients underwent anthropometric measurements and baseline investigations. Diabetes was confirmed by determining fasting blood sugar level using cut-off value of 126 mg/dl. Data was entered in Epi-Data-6 and analyzed using Epi-Info. RESULTS: Among 158 patients of tuberculosis, 41 (25.9%) were found to be diabetic, out of which 9 (5.69%) were newly diagnosed with diabetes. Moreover 96 (60.8%) patients were 35-55 years of age. Male patients were 97 (61.4%). Most of the patients belonged to the rural area 118 (74.7%) while 115 (72.8%) patients were illiterate and 139 (88%) had monthly income less than 7000 PKR. CONCLUSION: The study concludes that among tuberculosis patients with diabetes mellitus, about 5.69% were newly diagnosed during the course of investigation. This raises the concern that importance is not being given to routine screening of tuberculosis patients for diabetes by the clinicians. Health professionals should be updated about the link between diabetes and TB.

The health workforce crisis in Pakistan: a critical review and the way forward.

Today, the developing world suffers due to the health "workforce crisis." The World Health Report 2006 uses this term to study the current scenario in the developing countries. Human resource planning is a critical activity within the broader sectoral planning, especially when it comes to the health sector. Pakistan faces an acute shortage of different cadres of healthcare workers, which is bound to escalate further because of the high population growth rate, inequitable distribution and out-migration of the healthcare workforce. In the wake of ongoing reforms in the health sector of Pakistan, it is suggested that for the strengthening of health systems, there ought to be a serious thought process involved for developing a human resource plan for the health sector that responds to the needs of the population and the disease burden. A national strategy is imperative to retain, train and incentivize the health workforce.

Assessment of nutritional status of 1-5 year old children in an urban union council of Abbottabad.

BACKGROUND: Malnutrition is one the major public health problem in developing countries. In Pakistan more than 38% of the children are under weight and stunted. The current study is being done to access the nutrition status of children of 6 months to 5 years in District Abbottabad. The objectives of the study were to determine the macronutrient deficiency both acute and chronic in children 1-5 years of age, and recommend appropriate interventions. METHODS: A cross-sectional descriptive survey was conducted in an urban Union Council (UC) of District Abbottabad, with a sample size of 100, selected through simple random sampling. For data collection a questionnaire was designed. RESULTS: According to height for age Z-score, out of 100 children studied, 80 were normal while 17 were stunted and 3 were severely stunted. According to weight (see text) Z-score, 79 children were normal, 11 were underweight and 10 were severely underweight. According to weight for height Z-score. 83 children were normal while 13 were wasted and 4 were severely wasted. CONCLUSION: Macronutrient deficiency is prevalent in our children. Macronutrient and micronutrient deficiencies can also occur concomitantly. The nutritional deficiency affects our children since their embryonic lives. The nutritional deficiency makes children vulnerable to contract diarrhoeal diseases, acute respiratory infections and other infections that further compound the situation.