Government Sector Hospitals Research Articles

Frequency of Immunisation Status, Complications and Outcome in Children Admitted with Measles in Public and Private Sector Hospitals of Karachi

Objective: To assess the immunisation status, frequency of complications and the outcome in chil- dren admitted with measles in public and private sector hospitals of Karachi.
 Methods: In this cross-sectional study a total of 382 patients admitted with measles, of either sex from 3 months to 13 years, who presented from March 2016 to March 2017 were included. A total of 265 (69.3%) children were from Ziauddin University Hospital (ZU) and 117 (30.6%) from Abbasi Shaheed Hospital (AS). Non-probability convenient sampling technique was used. Those with con- genital anomalies and chronic medical illnesses were excluded from the study. Detailed history and physical examination was done, and findings entered in a Proforma. Immunisation status of the pa- tients was recorded. All the patients were observed for complications like encephalitis, pneumonia, diarrhea, otitis media, epiglottis, febrile fits and corneal ulcers. Statistical analysis was done using SPSS version 22. Categorical values were compared by chi-square test, p-value of <0.05 was con- sidered significant.
 Results: A total of 382 were patients admitted with measles, 265 (69.3%) from Ziauddin University hospital and 117 (30.6%) from Abbasi Shaheed Hospital. Overall, 57.4% were completely vaccinated in ZU vs. 32.5% in AS. Despite being completely vaccinated, children in ZU; 152/265 (80%) and in AS; 38/117 (30.6%) had complications with a statistically significant (p<0.0001) difference between private and government sector hospitals. Predominantly, in both hospitals pneumonia was common followed by gastroenteritis. Overall mortality was 13/382 (3.4%) in both hospitals combined.
 Conclusion: A sizeable number of children admitted with measles in both private and government hospitals were unvaccinated. A significant number developed measles despite receiving two doses of vaccine. Frequency of complications was higher in private versus government hospitals. Mortality from measles was high (3.4%) especially in the unvaccinated.

Awareness about Knowledge, Attitude and Practice of Medical Ethics pertaining to Patient Care, among Male and Female Physicians Working in a Public Sector Hospital of Karachi, Pakistan - A Cross-Sectional Survey

The aim of the study is to assess the knowledge, attitudes and practices of medical ethics among male and female healthcare professionals in a public sector hospital in Karachi, Pakistan. A structured questionnaire about knowledge of medical ethics and its role in the everyday decision making in the hospital was developed, tested and distributed among residents, consultant physicians at the Abbasi Shaheed Hospital, a tertiary care teaching hospital, during June and August 2016. The paper analyzed 70 responses from doctors at various level of training comprising residents and consultants. Each question had sub parts and hence was scored accordingly. The participants encountered ethical decision making situations in a diverse regularity, varying from ‘daily’ to ‘annually’. Interestingly, 9% of the doctors were not aware of the primary contents of the Hippocratic Oath, and 89% of these were junior doctors. Details of Nuremberg Code and Helsinki Code were known only to 4% of the total sample. Female physicians had a stronger opinion as compared to male physicians regarding practice of ethics. This included topics such as complying with the consent for procedures, treating violent/non-compliant patients, listening to the patient’s wishes, autonomy and above all the attribute of maintaining confidentiality. A significant difference in the level of knowledge between diverse cadres of physicians was noted. Physicians who had cleared their qualifying and/or licensing exams exams in first attempt scored higher than those who did not. The female participants have 1.65 times the odds of having a higher knowledge about medical ethics, than male participants, keeping all other variables constant. The study highlights the need to strengthen the professional knowledge regarding medical ethics issues, among the health care workforce in public sector hospitals of the developing world. In our data, female physicians working in the government sector hospitals in Karachi, demonstrate a higher knowledge about medical ethics, than male participants, keeping all other variables constant.

Prospective surveillance of device-associated health care–associated infection in an intensive care unit of a tertiary care hospital in New Delhi, India

Surveillance of health care-associated infections (HAIs) plays a key role in the hospital infection control program and reduction of HAIs. In India, most of the surveillance of HAIs is reported from private sector hospitals that do not depict the situation of government sector hospitals. Other studies do not confirm with the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) surveillance criterion, or deal with ventilator-associated pneumonia (VAP) instead of ventilator-associated event (VAE). The aim of this study was to identify the incidences of 3 device-associated HAIs (DA-HAIs) (VAE, central line-associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) by active surveillance using CDC's NHSN surveillance criteria and to identify the pathogens associated with these DA-HAIs. This was a prospective surveillance study (January 2015-December 2016) conducted in an intensive care unit (ICU) of a large, tertiary care, government hospital situated in Delhi, India. Targeted surveillance was done as per the CDC's NHSN 2016 surveillance criteria. There were 343 patients admitted to the ICU that were included in the study. The surveillance data was reported over 3,755 patient days. A DA-HAIs attack rate of 20.1 per 100 admissions and incidence of 18.3 per 1,000 patient days was observed. The duration of use for each device for patients with DA-HAIs was significantly longer than for patients without DA-HAIs. The device utilization ratios of central line, ventilator, and urinary catheters were 0.57, 0.85, and 0.72, respectively. The crude excess length of stay for patients with DA-HAI was 13 days, and crude excess mortality rate was 11.8%. VAE, CLABSI, and CAUTI rates were 11.8, 7.4, and 9.7 per 1,000 device days, respectively. Among 69 DA-HAIs reported, pathogens could be identified for 49 DA-HAI cases. Klebsiella spp was the most common organism isolated, accounting 28.5% for all DA-HAI cases, followed by Enterococcus spp (24.4%). The most common organisms causing VAE, CAUTI, and CLABSI were Acinetobacter (6/15, 40%), Enterococcus spp (11/31, 35.4%), and Candida spp (5/19, 26.3%), respectively. Most of the gram-negative organisms were carbapenem resistant; however, none of the isolates were colistin resistant. To reduce the risk of infection in hospitalized patients, DA-HAI surveillance is of primary importance because it effectively describes and addresses the importance and characteristics of the threatening situation created by DA-HAIs. The present surveillance shows high rates of ICU-onset DA-HAIs and high resistance patterns of organisms causing HAIs, representing a major risk to patient safety.

Validation of a modified early warning score-linked Situation-Background-Assessment-Recommendation communication tool: A mixed methods study.

To develop and validate a modified Situation-Background-Assessment-Recommendation communication tool incorporating components of the Cape Town modified early warning score vital signs chart for reporting early signs of clinical deterioration. Reporting early signs of physiological and clinical deterioration could prevent "failure to rescue" or unexpected intensive care admission, cardiac arrest or death. A structured communication tool incorporating physiological and clinical parameters allows nurses to provide pertinent information about a deteriorating patient in a logical order. Mixed methods instrument development and validation. We used a sequential three-phase method: cognitive interviews, content validation and inter-rater reliability testing to validate a self-designed communication tool. Participants were purposively selected expert nurses and doctors in government sector hospitals in Cape Town. Cognitive interviews with five experts prompted most changes to the communication tool: 15/42 (35.71%) items were modified. Content validation of a revised tool was high by a predetermined ≥70% of 18 experts: 4/49 (8.2%) items were modified. Inter-rater reliability testing by two nurses indicated substantial to full agreement (Cohen's kappa .61-1) on 37/45 (82%) items. The one item achieving slight agreement (Cohen's kappa .20) indicated a difference in clinical judgement. The high overall percentage agreement (82%) suggests that the modified items are sound. Overall, 45 items remained on the validated tool. The first modified early warning score-linked Situation-Background-Assessment-Recommendation communication tool developed in South Africa was found to be valid and reliable in a local context. Nurses in South Africa can use the validated tool to provide doctors with pertinent information about a deteriorating patient in a logical order to prevent a serious adverse event. Our findings provide a reference for other African countries to develop and validate communication tools for reporting early signs of clinical deterioration.

Association of help-seeking behavior with depression and anxiety disorders among gastroenterological patients in Saudi Arabia

Background/Aims:There is a high prevalence of depression and anxiety disorders among gastroenterological outpatients. Relatively few studies have been done on the help-seeking behavior among those who suffer from gastrointestinal symptoms with or without psychiatric disorders. We aimed to characterize the help-seeking behavior of gastroenterological outpatients and to evaluate if this behavior is linked to the presence of depression and anxiety.Patients and Methods:A cross-sectional study was carried out in gastroenterology clinics in four hospitals in Riyadh between February and September 2013. A self-administrated questionnaire was developed and administered to patients. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) questionnaires were used to diagnose depression and anxiety, respectively.Results:A total of 440 patients completed the study questionnaire. The average age was 36.0 ± 12.8 years and 69% of the patients were males. Complaints included abdominal pain (58%), heartburn (29%), diarrhea or constipation (25%), appetite or weight changes (22%), and nausea or vomiting (16%). Depression was diagnosed in 36%, while anxiety was diagnosed in 28% of the patients. The first intervention was use of medications (68%) and undergoing endoscopy (16%), while few patients initially used herbs or Islamic incantation (7.5%). This first intervention was done primarily (59%) in private sector hospitals rather than government sector hospitals (36%). The rates of depression and anxiety in our patients were higher among those who suffered from multiple complaints for longer durations and with less satisfaction with the offered services.Conclusion:Depression and anxiety are common comorbidities in gastroenterological outpatient population, especially those who have a chronic course of multiple gastrointestinal complaints.

Laparoscopic vs Open Total Mesorectal Excision for Rectal Cancer: A Clinical Comparative Study in a Government Sector Hospital

Aims and objectives: To assess feasibility, advantages, oncological safety, cost-effectiveness and short-term results of laparoscopic vs open total mesorectal excision (TME) for rectal cancer in a government sector hospital. Patients and methods: This comparative nonrandomized retrospective study analyzes the data of 70 patients with rectal cancer treated with low anterior resection (LAR) or abdominoperineal resection (APR) from May 2007 to June 2012. Of these 40 patients underwent laparoscopic TME and 30 underwent open TME. Both the groups were comparable. Results: Laparoscopic surgery took longer to perform (200 vs 150 min), but was accompanied by less blood loss (200 vs 800 ml) and fewer postoperative complications. Enteric function recovered sooner after laparoscopy than open surgery.Hospital stay was shorter for patients who underwent a laparoscopic surgery (7 vs 10 days). The mean number of harvested lymph nodes was greater in the laparoscopic group than in the open group (12 ± 3 vs 9 ± 2). Mean follow-up time was 30 months (range: 28-32 months). No local recurrence was found. Conclusion: This study shows that laparoscopic TME for rectal cancer is a safe and feasible technique with some short-term benefits over open TME.

Laparoscopic vs Open Total Mesorectal Excision for Rectal Cancer: A Clinical Comparative Study in a Government Sector Hospital

Laparoscopic vs Open Total Mesorectal Excision for Rectal Cancer: A Clinical Comparative Study in a Government Sector Hospital

Breast imaging reports for malignant lesions: are we maintaining recommended BI-RADS® lexicon standards?

BackgroundThe purpose of this study was to evaluate mammography reports for diagnosed breast cancer cases in major government and private centers in Karachi, Pakistan, with respect to concordance with the Breast Imaging Reports And Data System (BI-RADS®) lexicon.MethodsA prospective, descriptive, multicenter study was conducted in the radiology sections of the Aga Khan University Hospital, Pakistan Naval Station Shifa Hospital, Advanced Radiology Clinic, Karachi Institute of Radiotherapy and Nuclear Medicine, and Civil Hospital Karachi between May and October 2010 after approval from the ethical review committee of Aga Khan University. Mammograms reported as BI-RADS category 4 and 5 were included in the study. Mammograms reported as BI-RADS category 0, 1, 2 and 3 were excluded. Fifty reports were collected from each center. Data were collected about the clinical indication, breast density, location and description of the lesion, calcification, and comments on axillary lymph nodes. This description was compared with the BI-RADS lexicon.ResultsThe mean age of the patients was 50 ± 12 years. The clinical indication, breast parenchymal density, lesion location, and presence of calcification were better described by the private centers, while description of lymph node status was better stated by the government centers. This difference was statistically significant, except for lesion description. The description of masses by the two reporting groups was comparable.ConclusionMammographic reporting of malignant breast lesions in the private sector is more in line with the BI-RADS lexicon, as compared with government sector hospitals in Karachi, Pakistan. Lymph node documentation was better in government sector reports.

Molecular and epidemiological characterisation of clinical isolates of carbapenem-resistant Acinetobacter baumannii from public and private sector intensive care units in Karachi, Pakistan

The purpose of this study was to identify molecular and epidemiological characteristics of hospital-acquired carbapenem-resistant Acinetobacter baumannii (CRAB) from two different intensive care unit (ICU) settings in Karachi, Pakistan. A cross-sectional study was performed in the adult ICUs of a private sector tertiary care hospital (PS-ICU) and of a government sector hospital (GS-ICU) between November 2007 and August 2008. Deduplicated CRAB isolates from clinical specimens were examined for carbapenemase and class 1 integrase genes. Isolates were typed using sequence-based multiplex polymerase chain reaction, pulsed-field gel electrophoresis (PFGE) and variable number tandem repeat (VNTR). A total of 50 patients (33from PS-ICU and 17 from GS-ICU) were recruited. There were statistically significant differences between patients in the two ICUs in terms of mean age, comorbidities, the presence of central venous pressure lines, urinary catheters, and average length of stay. bla(OxA-23-like) acquired-oxacillinase genes were found in 47/50 isolates. Class 1 integrase genes were found in 50% (25/50) of the organisms. The majority of isolates belonged to strains of European clones I andII. PFGE typing grouped the isolates into eight distinct clusters, three of which were found in both hospitals. Most of the isolates within each PFGE cluster shared identical or highly similar VNTR profiles, suggesting close epidemiological association. Irrespective of differences in risk factors and infection control policies and practices, the extent of clonality among CRAB isolates was very similar in both ICU settings.

Laparoscopic Surgery for Rectal Carcinoma-An Experience of 20 Cases in a Government Sector Hospital

Objective: To assess feasibility, advantages, oncological safety, costeffectiveness and long term results of laparoscopic surgery for rectalcancer in a government sector hospital.Method: From January 2005 to May 2007, 20 patients of operablecancer rectum were subjected to laparoscopic curative resection. Surgicaltechnique, postoperative morbidity and clinical results were reviewedin close follow-up for median period of 20 months (12 wks to 30months).Results: Fourteen patients underwent LAPR and 6 patients LAR.Median age was 39 years. Median operating time for Lap APR was296 minutes, initial 7 cases taking an average of 368 minutes, whilesubsequent 7 cases average operating time was 232.5 minutes. In LapAR, average duration of surgery was 356 minutes, first 4 cases taking400 minutes while for last 2 cases, and mean operating time was300 min.There was no intraoperative complication in either group. Allpatients mobilized on POD: (1) Incidence of PONV was significantlyless. Oral feeds were routinely started on POD, (2) Incidence of woundinfection was also reduced (2/20). Hospital stay on an average was 11days as ours being a government sector hospital, patients weredischarged only after drain removal and thus stay was slightlyprolonged. Of the 20 patients, 17 were diagnosed to be Adenocarcinoma,2 with Malignant Melanoma and 1 with GIST. Two patients ofmalignant melanoma developed locoregional recurrence and 2 patientsdeveloped distant metastasis after approximately 1 year. No incidenceof port metastasis in any patient.Conclusion: Laparoscopic colorectal surgery is safe, feasible and meetsoncologic requirements of radicality. Pattern of local recurrence anddistant metastasis is similar to open surgery. Lap surgery has a steeperlearning curve. Cost of treatment decreased by use of Ligaclips forintracorporeal vascular control and extracorporeal division of gutwhenever possible.

Gender differences among discrimination & stigma experienced by depressive patients in Pakistan.

Objective:This study aims to examine Gender Difference in the level of Discrimination and Stigma experienced by people diagnosed with Major Depressive Disorder in Pakistan. It was hypothesized that Women diagnosed with Depression are likely to be experiencing more Discrimination and Internalized Stigma in comparison to Men.Methods:This is a Cross Sectional Study. Thirty eight patients diagnosed with Major Depressive Disorder recruited from different Government Sector Hospitals of Lahore; were approached after obtaining informed consent. Discrimination and Stigma were measured through Discrimination and Stigma Scale and Internalized Stigma of Mental Illness Inventory respectively.Results:Both Men and Women experience considerably high level of associated Stigma and Discrimination due to their Mental Illness. However, Women in comparison to Men experience significantly greater level of Internalized Stigma especially in domains of Discrimination Experience and Social Withdrawal.Conclusion:The findings of this study highlight the fact that people with Depression can be more benefited with psychological treatment if dealing with Stigma and Discrimination is also addressed in Intervention Plans.