National Journal of Health Sciences
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Informed Consent and Shared Decision Making in Women at a Tertiary Care Hospital
No full textIntroduction: Informed consent is an important aspect of ensuring good medical care and patient autonomy. In a developingcountry, the experience of women is often overlooked when deciding methods for obtaining consent. This study assesses the practice of takinginformed consent in a hospital setting and factors that affect decision-making for treatment methods among gynecology patients Pakistan.Materials and Methods: Women coming to the Hamdard University Hospital gynecology outpatient department or surgery were asked toparticipate in the study. The questionnarie asked about informed consent, cultural factors, and interaction between the doctor and the patient.The study was conducted for a duration of 5 months. Descriptive statistics were used to analyze the results.Results: 300 women participated in the study. While all women said that doctors asked for consent before examination, 30.7% said they werenot aware they could say no to being examined, 23% said the doctors did not explain the benefits or side effects of the medicines prescribed,and 22.7% were not told about alternative treatments. 91.7% said their husbands signed consent forms for them.Conclusion: This study highlights the need to improve the practice of taking informed consent in the country, as it involves educating thepatient about the intervention before obtaining consent. It is important that doctors keep in mind the cultural factors that influence decisionswhen obtaining consent and informing patients about their treatments and management
Correlation of ?CG Levels with Size of Gestational Sac in Patients of Ectopic Pregnancy Presenting to a Tertiary Care Health Facility
No full textAbstract: The objective of this study was to determine correlation of ?- HCG levels with size of gestational sac in patients of ectopic pregnancy presenting to a tertiary care health facility.Materials & Methods: This descriptive cross-sectional study was carried out in the Department of Obstetrics and Gynecology, district headquarter Hospital, Rawalpindi from Jan 2019 to Jan 2020. This study involved 100 pregnant women aged between 20-40 years diagnosed of ectopic pregnancy on transvaginal ultrasound. Serum ?hCG level was acquired in all these women while the size of gestational sac was measured on transvaginal ultrasound. Outcome variable was correlation between serum ?hCG level and size of gestational sac on transvaginal ultrasound which was noted and compared across various subgroups of patients based on age, gestational age, site of ectopic pregnancy and presence/absence of fetal cardiac activity.Results: The mean age of the patients was 29.3±6.1 years while the mean gestational age was 5.1±1.1 weeks. Serum ?hCG level ranged from 1647 mIU/mL to 18378 mIU/mL with a mean of 7968.4±4523.7 mIU/mL while the size of gestational sac on TVS ranged from 17 mm3 to 45 mm3 with a mean of 36.40±7.86 mm3. There was significantly strong positive correlation between serum ?hCG and size of gestational sac on TVS (r=0.659; p- value<0.001).Conclusion: There was significantly strong positive correlation between serum ?hCG and size of gestational sac on TVS (r=0.659;p-value<0.001)
Bickerstaff Brainstem Encephalitis. A Rare Entity in Children
No full textFisher and Bickerstaff, in the 1950s, reported some cases with distinctive features of ophthalmoplegia and ataxia. Bickerstaff’sBrainstem Encephalitis (BBE) is an uncommon nervous system disorder characterized by clinical signs and symptoms including acuteophthalmoplegia, ataxia, and impaired consciousness. In Bickerstaff brainstem encephalitis, hyperreflexia was noted which support of a centralpathology
Health Care Delivery System of Pakistan and Bangladesh: A Comparative Analysis
No full textHealth care delivery system is fair distribution, organization, and arrangement of health resources that serves best for any country’s population efficiently and effectively for the achievement of organizational goals. Health care services are the multiple services providing to an individual, families, and communities by health care providers who are skilled to prevent disease, promote health, cure illness for the purpose of maintaining and restoring good health. Human development and economic solidarity can be increased ultimately due to better health that labor of a country. Productive human capital resources and healthy labor force can be achieved by planned healthcare services by the government for its people. Worldwide, health regions contrasts from country to country, it depends on how much costs on health is been efficiently utilized.The primary contributors in health care services are private health sectors, donors, out of pocket expenditures in the most of developing countries which may increase human capital and economic growth of the country as, public health sectors remains deprived due to structural fragmentation, lack of resources, and functional inabilities. In this article we discuss about the healthcare delivery system of Pakistan versus Bangladesh such as organizational structure, analysis of both the healthcare systems, and some recommendations to improve healthcare reform and its application
Consultants & Trainees Active Participation in Multi-Disciplinary Team (MDT): Tumor Boards can Play a Major Role in the Achievement of their Academic Professional Development Goals
No full textWe wish to share with the readers of this scientific journal our experiences and observations regarding educational gains achieved by the consultant faculty and trainee postgraduate residents via active participation in multidisciplinary team (MDT) Tumor Boards. The rapid modernization of teaching methodologies is being observed in both postgraduate residents and faculty professional education learning processes. Contemporary literature is increasingly depicting academic work which is being directed towards the exploration of both educational and social determinants of health care [1]
An Exceptional Case of Cobalamin Deficiency that Presented with Extremely High Indirect Bilirubin Levels
No full textCobalamin deficiency anemia is a type of anemia that present with weakness, fatigue, icteric sclera and neuropathy. Main causes ofcobalamin deficiency are low intake or decreased absorption (gastric and intestinal causes). In present case, we report a 65-year-old male whopresented to the emergency department with signs and symptoms of cobalamin deficiency including bilateral peripheral neuropathy, icteric skinand sclera, and abdominal pain in right upper quadrant. He had low cobalamin and extremely high bilirubin levels (8mg/dL) in serum. Afterthe diagnosis of cobalamin deficiency established, 1mg daily cobalamin treatment initiated for five days which would follow weekly andmonthly intramuscular injections consequently. Hemolysis and other causes of elevated indirect bilirubin levels were excluded in differentialdiagnosis. Clinical and laboratory improvements were achieved after the treatment. In conclusion, physicians should kept in mind cobalamindeficiency even in subjects with unusual high levels of indirect bilirubin
Emergency Management of Metastatic Spinal Cord Compression
No full textMetastatic Spinal Cord Compression (MSCC) is one of the major forms of oncological emergencies. Other common emergency scenarios seen in cancer patients include Neutropenic Sepsis, Hypercalcemia and Superior Vena Cava Obstruction (SVCO). During this brief discussion of MSCC we will be going over the red flag symptoms a patient may present with common malignancies. We shall go through the points that are associated with and the multidisciplinary management of MSCC. A patient presenting to the emergency room with symptoms including recent onset back pain [1, 2], in the extremes of age (i.e. <20 or >55), with a history of weight loss, pyrexia, night sweats, sensory loss, leg weakness, constant pain at night and at rest and/or complains of urinary retention, fecal incontinence should have MSCC considered in differential diagnosis and appropriate work up should be considered
The Knowledge of Standard Precautions among Nurses in Public and Private Tertiary Care Hospital Lahore
No full textAbstract: Background: Nurses and other healthcare workers are at risk of occupational hazards in the healthcare setting. Nurses are prone to expose with blood born infection like HIV, HCV and Hb B. Proper implication of standard precaution effectively control the hospital acquired infection.Aims: To assess the Knowledge of standard precaution among nurses working at private and public hospital.Method: A cross sectional study was conducted among nurses in a tertiary care hospital at private and public sector. The duration of study was from February 2018 to May 2018. A self-structured questioner was used to obtain information from nurses. Data was analyzed using SPSS version 21 and the level of significance was at pvalue < 0.05.Results: Total respondent nurses were 201.Response rate rate was 98%. The results shows 42.3% of the participants in this study had poor knowledge, 40.3% have average knowledge, and 17.4% have good knowledge about the standard precaution. Total female participants were 169 (mean knowledge score was 14.14) and male participant 32 (mean knowledge score was 16.13). The results show significant difference between female verses male participant were (p = 0.03). Total private hospital participants are 99 mean knowledge score was 13.45 + 3.863 and public hospital nurses included 102 mean knowledge score is 14.66 + 3.167 that is greater than private hospital. There is significant difference between public versus private hospital (p = 0.17).Conclusion: As the result indicate poor knowledge of standard precaution among nurses at private and public hospital. it is suggested to provide training sessions on infection control with hands on workshops. This is also suggested infection control topics should add in Nursing curriculum and PNC should take initiate post basic one year Diploma in Infection Control
Prevention of Medication Errors in a Pakistani Hospital Because of Concurrent Evaluations and Interventions by Pharmacists
No full textObjective: The aim of this study is to document different pharmaceutical interventions that took place during dispensing throughComputerized Physician Order Entry (CPOE) to prevent medication errors at a multidisciplinary tertiary care hospital in Karachi, Pakistan.Method: Study Design: Systematic retrospective review of e-prescriptions received in inpatient pharmacy for dispensing in a multidisciplinary tertiary care hospital. Dispensing Setting: In order to decrease medication administration error, the hospital works on Unit Dose Dispensing System, all the orders are segregated by Health Management Information Software and appeared on inpatient pharmacist window for dispensing, the inpatient pharmacist then check all the medication order, if the pharmacist find any medication error or better alternative, the pharmacist contact the concerned physician and discuss about the error and suggest alternatives, if the physician find the suggestion beneficial for the patient then the order is intervened.Date Collection: These interventions were recorded by in-patient pharmacists from June 2014 till May 2015, which were then filled in a performa and categorized for potential of harm if not intervened.Result: A total of 1336 interventions are accepted during the study period. About 83.2% of the interventions were found to be minor or moderately harmful. Most significant intervention was related to dose correction (26.9%), followed by drug alternatives (therapeutic or brand alternative) (26.6%), wrong frequency of drug (20.7%), excessive duration (9.2%), drug duplication (6.2%), culture and sensitivity based drugs (2.3%), wrong choice of drug (1.9%), wrong route (0.7%), wrong dosage form (0.7%), Addition of drug (0.2%) and drug-drug interactions (0.1%).Conclusion: This study shows that concurrent evaluation of prescription by pharmacist decreases preventable medication errors which probably decrease health care cost and decrease patient hospital stay
Knowledge of Nurses in ENT Related Complications in Non-Dedicated Sub-Specialty Wards
No full textIntroduction: In our tertiary care hospital, we do not have a specialized ENT in-patient ward. All ENT patients are accommodatedin any of the surgical wards or medical wards. In the event of any complications, we were not sure as to how adept are the nurses in all the wards to handle different situations in ENT patients.Objective: To assess whether there is difference amongst nurses in terms of knowledge of potential ENT related complications and patient care between different wards and formal ENT training.Methodology: Nursing staff involved in routine care of adult patients in general ward and special care units were included in the study. A ten-point questionnaire was used to assess knowledge of nurses in ENT patient care. Participants were approached during the working day and were asked to fill out the questionnaire ‘on the spot’. Each questionnaire was checked and evaluated by two ENT residents and rated out of 10.Result: The average scores of nurses across the wards were not same and there was significant differences (p < 0.01); it was found that in ward b1 nurses scored higher marks compared to those from other wards. Trained nurses were evenly distributed in all wards and there were no association between the distributions of trained nurses across the wards. Positive correlation was observed between the scores and experience of ENT trained nurses.Conclusion: It is advisable to have dedicated ENT and subspecialty wards and provide formal nursing training with respect to managing ENT complications to ensure ultimate patient care