RESUMO
Earlier in its course, SARS-CoV-2 was primarily identified to cause an acute respiratory illness in adults, the elderly and immunocompromised, while children were known to be afflicted with milder symptoms. However, since mid-April of 2020, latent effects of the virus have begun emerging in children and adolescents, which is characterised by a multisystem hyperinflammatory state; thus, the term Multisystem Inflammatory Syndrome in Children (MIS-C) was introduced by the WHO and CDC. The syndrome manifests itself approximately 4 weeks after COVID-19 infection, with symptoms mimicking Kawasaki Disease and Kawasaki Disease Shock Syndrome. Demographically, MIS-C peaks in children aged 5 to 14 years, with clusters in Europe, North and Latin America seen, later followed by Asia. Although the exact pathophysiology behind the syndrome is unknown, recent studies have proposed a post-infectious immune aetiology, which explains the increased levels of immunoglobulins seen in affected patients. Patient presentation includes, but is not limited to, persistent fever, rash, gastrointestinal symptoms and cardiac complications including myocarditis. These patients also have raised inflammatory markers including C reactive protein, ferritin and interleukin-6. In poorly controlled patients, the syndrome can lead to multiorgan failure and death. The mainstay of treatment includes the use of intravenous immunoglobulins, steroids, immune modulators and aspirin. Adjunct therapy includes the use of low molecular weight heparin or warfarin for long term anticoagulation. Currently very little is known about the syndrome, highlighting the need for awareness amongst healthcare workers and parents. Moreover, with increased cases of COVID-19 as a result of the second wave, it is essential to keep MIS-C in mind when attending patients with a past history of COVID-19 exposure or infection. Additionally, once these patients have been identified and treated, strict follow-up must be done in order carry out long term studies, and to identify possible sequelae and complications.
RESUMO
BACKGROUND: In recent times, the assessment of patient satisfaction has become an essential tool for measuring the effectiveness of healthcare delivery. However, not a lot of work has been done in Pakistan, even less so in comparing it across different hospital systems in the country. This research aims to fill that gap and be the first to compare satisfaction levels in a military and public hospital. OBJECTIVE: To assess patient satisfaction in different hospital systems of Pakistan and compare their outcomes. METHODS: A cross-sectional study was undertaken between October 2019 and April 2020 among 376 patients; 193 from Combined Military Hospital, Lahore (CMH) and 183 from Jinnah Hospital, Lahore. The questionnaire used for the study was the Short-Form Patient Satisfaction Questionnaire - 18, and convenience sampling was used to select participants. Data was entered and analysed on Statistical Product and Service Solutions (SPSS) version 21 (IBM Corp., Armonk, NY). RESULTS: The majority of participants were male (71.2%), entitled to free healthcare (58.4%), and employed (59.7%). It was found that CMH Lahore scored better in all seven domains of patient satisfaction (p<0.03 individually), with significant differences in six: general satisfaction, interpersonal manner, communication, financial aspects, time spent with the doctors, and accessibility and convenience. Overall, waiting times and entitlement to free healthcare were established to be major determinants of satisfaction, with CMH having shorter waiting times and providing free treatment to a larger number of patients. The mode waiting time in CMH was 1 - 15 minutes (44.9%) as compared to 15 - 30 minutes (50.9%) in Jinnah Hospital. Additionally, 78.2% of patients were entitled to free healthcare in CMH, compared to 35.5% in Jinnah Hospital. Conclusion: Patient satisfaction was found to be significantly better in CMH in six out of seven domains studied. Further work needs to be done in its assessment, as well as in its role in healthcare policies.
