Hospitals Of Lahore Research Articles

Expression of hormone receptors and human epidermal growth Factor2/Neu in female breast cancer patients

Overexpression of HER2/neu and estrogen receptors (ER) and/or progesterone receptors (PR) are reported to be inversely associated with breast cancer (BC). The relationship between hormone receptors and HER2/neu is attenuated by age and numerous other clinical factors. Here, we examined the link between hormone receptors and HER-2/neu in terms of an additional variable, such as the histological grades of breast tumors in women. A total of 240 breast cancer samples were obtained from the Department of Histopathology at the University of Lahore Teaching Hospital in Lahore, Punjab. Immunohistochemistry (IHC) was used to examine the expression of hormone receptors and HER-2/neu. Using the χ2 and fisher exact test, the association between hormone receptors and HER-2/neu in various age groups and histological grades was investigated. Patients that were included in this study had ages between 30 and 90 years, with a mean age of 51.89 ± 12.01 years, and were mostly having grade 1 tumors. The most prevalent type of breast cancer was invasive ductal carcinoma (95.83%). It was found that the ER, PR, and HER-2/neu were more expressive in older (above 45) and grade 1 tumors as compared to younger (≤45) and higher-grade tumor patients. HER-2 was negatively correlated with hormonal receptors in women aged >45 years old with grade-1 tumors. Hormonal receptor (ER/PR) expression is associated with HER-2/neu expression not only in older age (>45) but also in grade 1 tumors. This correlation between HER2/neu and hormone receptors that improves with age and tumor grade is useful for predicting outcomes and, likely, for guiding therapy choices.

Molecular characterization of rotavirus indicates predominance of G9P[4] genotype among children with acute gastroenteritis: First report after vaccine introduction in Pakistan

AbstractGlobally, Group A rotavirus (RVA) is the leading cause of acute gastroenteritis in children under 5 years old, with Pakistan having the highest rates of RVA‐related morbidity and mortality. The current study aims to determine the genetic diversity of rotavirus and evaluate the impact of Rotarix‐vaccine introduction on disease epidemiology in Pakistan. A total of 4749 children, hospitalized with acute gastroenteritis between 2018 and 2020, were tested at four hospitals in Lahore and Karachi. Of the total, 19.3% (918/4749) cases were tested positive for RVA antigen, with the positivity rate varying annually (2018 = 22.7%, 2019 = 14.4%, 2020 = 20.9%). Among RVA‐positive children, 66.3% were under 1 year of age. Genotyping of 662 enzyme‐linked immuno sorbent assay‐positive samples revealed the predominant genotype as G9P[4] (21.4%), followed by G1P[8] (18.9%), G3P[8] (11.4%), G12P[6] (8.7%), G2P[4] (5.7%), G2P[6] (4.8%), and 10.8% had mixed genotypes. Among vaccinated children, genotypes G9P[4] and G12P[6] were more frequently detected, whereas a decline in G2P[4] was observed. Phylogenetic analysis confirmed the continued circulation of indigenous genotypes detected earlier in the country except G9 and P[6] strains. Our findings highlight the predominance of G9P[4] genotype after the vaccine introduction thus emphasizing continual surveillance to monitor the disease burden, viral diversity, and their impact on control of rotavirus gastroenteritis in children.

Health Belief, Perceived Control, and Quality of Life in Rheumatoid Arthritis Patients

This current research study examined the relationship between health belief, perceived control, and quality of life in rheumatoid arthritis patients. It was hypothesized that there was likely to be a significant relationship between health belief, perceived control, and quality of life in rheumatoid arthritis patients. A sample of 130 participants comprising both male and female patients (M=65; F=63) was taken from different hospitals in Lahore. This study employed a quantitative correlational research design. Non-probability purposive sampling was used for the selection of participants. A questionnaire comprising of Demographic Information Sheet, Consent Form, Questionnaire for Arthritis Dialogue (Laure et al., 2019), Sense of Control Scale (Lachman & Weaver, 1998), and Rheumatoid Arthritis Quality of Life (RAQOL) was used to collect responses from the participants. The results were generated using the Independent Samples t-test, Pearson Product-Moment Correlation, Multiple hierarchal Regression, and Moderation. The study findings revealed that all the study variables are correlated to each other. Health belief was positively correlated with quality of life while perceived control positively correlated with quality of life. There were no significant gender differences across the study variables. This research study provides direction for future research and the development of targeted interventions to optimize the care and quality of life for individuals living with rheumatoid arthritis.

Assessment of Workplace Difficulties Faced by Nurses Working in Public Sector Hospitals of Lahore

Nursing is recognized as a stressful profession, with adverse effects on both personal health and professional performance. However, there is a scarcity of data on stress prevalence among nurses in developing countries like Pakistan. Objective: To assess stress prevalence and contributing factors among nurses in government hospitals, informing interventions to improve their work environment and well-being. Methods: This descriptive cross-sectional survey collected data from Mayo Hospital, Lady Atchison Hospital, and Said Mitha Hospital in Lahore. A structured questionnaire assessed demographic information and perceptions across four domains: Occupational Stress, Job Satisfaction, Workplace Violence, and Workplace Harassment. Likert scale items were analyzed using SPSS version 26.0, with logistic regression examining factors associated with job satisfaction. Results: Findings reveal significant concerns regarding occupational stress, job satisfaction, workplace violence, and harassment among nurses. While nurses express satisfaction with certain aspects of their job, including opportunities to utilize their abilities and relations between management and staff, concerns arise regarding workload, recognition, pay rates, and workplace violence and harassment. Logistic regression analysis indicates that age, educational qualifications, marital status, experience duration, and department insignificantly influence job satisfaction among nurses in public sector hospitals. Conclusions: These findings emphasize the urgent need to address the challenges faced by nurses to enhance their well-being and maintain a positive work environment conducive to high-quality patient care.

Effects of Aerobic Exercise on Blood Pressure and Sleep Quality in Hypertensive Postmenopausal Female

Background: Menopause is a significant phase in a woman's life, marked by hormonal changes that can lead to various health issues, including hypertension and sleep disturbances. Managing these conditions is crucial for improving the quality of life in postmenopausal women. Objective: This study aimed to evaluate the combined effects of aerobic exercise and anti-hypertensive medication on blood pressure and sleep quality in hypertensive postmenopausal women. Methods: This randomized controlled trial, registered at ClinicalTrials.gov (NCT05306929), was conducted at Al Mustafa Maternity Hospital in Lahore over six months. Forty-six hypertensive postmenopausal women aged 45-65 were selected using convenience sampling and randomized into two groups. Group A (n=23) received anti-hypertensive medication plus 30 minutes of moderate-intensity aerobic exercise five days a week for eight weeks. Group B (n=23) received only anti-hypertensive medication. Blood pressure was measured using an aneroid sphygmomanometer, and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at baseline, and after 4 and 8 weeks. Data were analyzed using SPSS 25, employing the Shapiro-Wilk test, Friedman test, and Mann-Whitney test. Results: Group A showed significant reductions in systolic blood pressure (SBP) from 153.29 ± 11.56 mmHg at baseline to 135.05 ± 10.25 mmHg at 4 weeks, and 125.29 ± 8.15 mmHg at 8 weeks (p<0.001). Diastolic blood pressure (DBP) decreased from 92.96 ± 4.55 mmHg at baseline to 84.76 ± 4.58 mmHg at 4 weeks, and 80.62 ± 3.85 mmHg at 8 weeks (p<0.001). In contrast, Group B showed less pronounced reductions in SBP and DBP. PSQI scores in Group A improved from 10.95 ± 4.85 at baseline to 9.14 ± 4.56 at 4 weeks, and 7.52 ± 4.12 at 8 weeks. However, the difference in sleep quality between the two groups was not statistically significant (p>0.05). Conclusion: Aerobic exercise combined with anti-hypertensive medication significantly reduced blood pressure in hypertensive postmenopausal women compared to medication alone. Although sleep quality improved in both groups, the differences were not significant. These findings suggest that incorporating aerobic exercise into the treatment regimen for hypertensive postmenopausal women can enhance cardiovascular health.

Evaluation of Knowledge among Nurses about Pressure Ulcer in a Tertiary Care Hospital, Lahore

Background: Pressure ulcers are a prevalent issue in healthcare settings, leading to significant morbidity and increased healthcare costs. Nurses play a crucial role in the prevention and management of these conditions, yet gaps in knowledge can affect patient outcomes. The study aimed to assess the knowledge of nurses at a tertiary care hospital in Lahore, Pakistan, a setting where pressure ulcer management is critical yet understudied. Objective: This study aimed to evaluate the current level of knowledge among nurses regarding pressure ulcer prevention and management, and to identify any significant differences in knowledge across various critical care settings within the hospital. Methods: A cross-sectional descriptive study was conducted at Shalamar Hospital, Lahore, involving 125 staff nurses and nursing interns selected via simple random sampling. Participants were required to have at least six months of experience in general wards. Data were collected using a validated questionnaire, assessing knowledge of pressure ulcer management. Ethical approval was obtained from the Shalamar College of Nursing's ethical committee. Data analysis was performed using SPSS version 25 and Microsoft Excel, applying descriptive and inferential statistics, including the Chi-square test, with a significance level set at p<0.05. Results: The study revealed that 68.8% (86/125) of nurses had average knowledge, 29.6% (37/125) demonstrated good knowledge, and only 1.6% (2/125) exhibited poor knowledge regarding pressure ulcer management. Notably, nurses in the Surgical Intensive Care Unit (SICU) and High Dependency Unit (HDU) displayed the highest levels of knowledge, whereas those in the Medical Intensive Care Unit (MICU), Cardiac Care Unit (CCU), and Emergency Room (ER) had comparatively lower knowledge levels. Conclusion: The majority of nurses at Shalamar Hospital possessed an average level of knowledge concerning pressure ulcer management. There is a critical need for targeted educational interventions to enhance knowledge and practices, particularly in units where nurses showed lower knowledge levels. Improving nurse education in pressure ulcer management could significantly impact the quality of patient care and reduce the prevalence of these injuries.

To Assess Knowledge and Practice among Nurses Regarding Prevention of Catheter-Associated Urinary Tract Infection

Background:Catheter-associated urinary tract infections (CAUTIs) are a common healthcare-associated infection among patients with indwelling urinary catheters. The role of nursing staff is crucial in preventing these infections through proper knowledge and practices. Objective:To assess the knowledge and practices among nurses regarding the prevention of catheter-associated urinary tract infections in a tertiary hospital in Lahore, Pakistan. Methods:This descriptive cross-sectional study was conducted among 164 nurses from various departments, including medical, surgical, and gynecological units. Nurses with more than one year of experience were included, while student nurses and head nurses not directly involved in patient care were excluded. Data were collected through a survey assessing knowledge and practices related to CAUTIs. The sample size was determined using Solvin's formula. Ethical approval was obtained, and participants gave informed consent. The data were analyzed using IBM SPSS Statistics Version 25.0 for descriptive statistics, including frequencies and percentages. Results:The majority of participants were female (85.4%), and most were aged between 31 and 35 years (50%). About 51.2% of the nurses had 6 to 10 years of experience, and 46.2% had received prior information or training on catheter-related urinary tract infections. The majority of participants (92.8%) knew that CAUTIs result from prolonged catheter use, and 95.7% were aware that aseptic technique with sterile equipment is crucial for catheter insertion. However, only 67.4% used a sterile technique for insertion, and 79.3% did not perform daily catheter care. The overall knowledge level was low for 29.3% of participants, moderate for 43.5%, and high for 16.3%, while the practice level was poor for 52.2% and good for 37%. Conclusion:Nurses demonstrated moderate knowledge but poor practices in preventing catheter-related urinary tract infections, indicating the need for targeted interventions and educational programs to bridge the gap and enhance patient care.

Role of Home Based Educational Intervention on Illness Perception and Health Services Utilization among Chronic Obstructive Pulmonary Disease Patients

Background: Chronic Obstructive Pulmonary Disease (COPD) remains a significant public health challenge globally, particularly affecting middle-aged and older adults. Effective management of COPD requires not only clinical interventions but also patient-centric educational programs that enhance illness perception and encourage appropriate health services utilization. Objective: This study aimed to evaluate the effectiveness of a home-based educational intervention in improving illness perception and health services utilization among COPD patients. Methods: A quasi-experimental study was conducted at the Pulmonology Out-Patient Department of a public hospital in Lahore. From an initial screening of 200 participants, 130 met the inclusion criteria based on their illness perception scores. Following random sampling, 84 participants were enrolled and divided into control and intervention groups. The intervention group received a structured educational program on COPD management. Data on demographics, illness perception, and health services utilization were collected pre and post-intervention. Statistical analyses were performed using SPSS version 25, employing t-tests to compare the outcomes between the groups. Results: The study consisted predominantly of participants aged 30-60 years, with the majority (57.1%) in the 30-40 year age group. Post-intervention, the illness perception in the intervention group showed a significant improvement, with the mean score increasing from 54.24 ± 5.905 to 75.24 ± 7.564 (t = -14.183, p < 0.000). Health services utilization also saw a notable enhancement in the intervention group, with the mean score rising from 12.38 ± 1.396 to 20.07 ± 2.202 (t = -19.117, p < 0.000). Conclusion: The home-based educational intervention significantly improved both the illness perception and health services utilization among COPD patients. Such interventions can be pivotal in managing COPD effectively, reducing hospital readmissions, and promoting self-management.

Lipid Peroxidation and Detection of Pro-Inflammatory Variables in Rheumatoid Arthritis- A Comprehensive Analysis of Malondialdehyde and Isoprostanes in Synovial Fluids and SERA

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease marked by systemic inflammation and joint destruction produced mostly by oxidative stress and lipid peroxidation. Analyzing markers for these processes is critical to understanding the etiology of RA. Objectives: The goal of this study is to assess the importance of the lipid peroxidation indicators malondialdehyde (MDA) and isoprostanes in RA synovial fluids and sera in indicating oxidative stress, as well as their potential diagnostic use. Methodology: We carried up cross-sectional analytical study with 60 participants, evenly divided between RA patients and healthy controls of the same age and gender. Malondialdehyde levels were measured spectrophotometrically using the thiobarbituric acid reactive substances (TBARS) method, and isoprostanes were quantified using commercially available ELISA kits. The samples were obtained at the Arif Clinical and Diagnostic Centre and examined in the biochemical labs of Rashid Latif Hospital in Lahore. Results: The study found that RA patients had significantly higher levels of MDA and isoprostanes in their serum (MDA: 1.95±0.094 µmol/ml; Isoprostanes: 12.26±5.26 pg/ml) and synovial fluid (MDA: 3.26±0.65 µmol/ml; Isoprostanes: 34.26±4.26 pg/ml) compared to controls (MDA: 0.95±0.019 µmol/ml; Synovial Fluid MDA: 0.019±0.0016). Conclusion: Elevated levels of MDA and isoprostanes in RA patients highlight their significance as oxidative stress indicators, representing the continuous inflammatory process and probable joint damage in RA. These findings lend credence to the diagnostic and prognostic value of lipid peroxidation products in the treatment of RA.

Knowledge and Perception of Soft Skills Among Medical Students and Postgraduate Residents at Services Hospital Lahore

Background and Objectives: Soft skills have emerged as a novel focal area for health care practitioners. Objective of this study was to assess the perception of medical students and postgraduate residents regarding soft skills and the need of incorporating these skills into the curriculum.Methods: This cross-sectional descriptive study was conducted at the Services Institute of Medical Sciences and Services Hospital in Lahore from January 1st to March 31st, 2023. A total of 192 participants, divided into two groups on the basis of their academic and clinical experience(Group 1 medical students final year and group 2 postgraduate residents of SHL (1st year) were included in the study after informed consent. Participants were given a pre-designed, validated questionnaire to record their details and assess their soft skills.Results: Postgraduate doctors were more effective at educating and motivating patients regarding treatment plans (84.4% vs. 15.6%, p < 0.0001), problem solving in critical situations (83.3% vs. 16.7%, p = 0.0001), and managing ethical conflicts (82.3% vs. 17.7%, p < 0.0001) compared to medical students. Doctors reported being taught communication skills (88.5% vs. 67.7%, p = 0.0005), critical thinking and problem- solving skills (81.3% vs. 31.3%, p=0.0001), time management skills (89.6% vs. 10.4%, p = 0.0001), and leadership skills (77.1% vs. 57.3%, p = 0.0035) more than medical students. A higher proportion of doctors had been assessed by their supervisors on communication skills (71.9% vs. 41.7%, p = 0.00003), critical thinking and problem-solving skills (49.0% vs. 27.1%, p = 0.0018), and leadership skills (74.0% vs. 33.3%, p = 0.0001) compared to medical students.Conclusion: Postgraduate doctors exhibit stronger aptitude in essential soft skills as compared to medical students therefore efforts should be made to integrate soft skills in healthcare educational program for better patient care and prepare medical students and residents for the multifaceted challenges they will face in their career.Key words: soft skills, perception, curriculum.

Knowledge and Practice Regarding Breast Self-Examination (BSE) among Nursing Students Working in A Tertiary Care Hospital Lahore, Pakistan: An Observational Descriptive Cross Sectional Study

Background: Breast self-examination (BSE) is a simple, quick, and cost-free method crucial for the early detection of breast cancer, which significantly reduces morbidity and mortality. Health Sciences students, particularly those in nursing, are ideally positioned to serve as role models and educators on this practice. Objective: The objective of this study was to assess the knowledge and practice of BSE among nursing students at a tertiary care hospital in Lahore, with a view to identifying gaps that could be addressed through targeted educational programs. Methods: This observational descriptive cross-sectional study engaged nursing students from various academic levels at a tertiary care hospital in Lahore. Participants were selected through convenience sampling. Adherence to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was ensured. Data were collected via a self-administered structured questionnaire and analyzed using SPSS software version 26, focusing on frequencies and percentages of categorical variables. Results: Of the participants, 63.76% demonstrated a high level of knowledge about BSE, scoring ≥75%. In contrast, 36.23% scored below 75%, indicating a low level of knowledge. Practice of BSE was limited, with only 47% (n=65) of the participants engaging in the practice, and the majority, 53% (n=73), not practicing at all. Conclusion: Although nursing students show a good understanding of BSE, a significant gap exists between their knowledge and actual practice. This discrepancy highlights the need for enhanced educational interventions to encourage regular BSE practice, which is essential for the effectiveness of breast cancer screening and early detection efforts.

Functional and Radiological Outcomes of Distal Femur Fractures treated with Less Invasive Stabilization System versus Dynamic Condylar Screw

Introduction: Fractures in the distal femur are quite rare, comprising around 0.4% of all fractures and 3% of femoral fractures. Managing distal femur fractures has been a subject of debate, but recent developments favor indirect reduction and minimally invasive approaches. The objective is to find a harmonious equilibrium between the mechanical stability of the fractured segments and their biological viability. Given their elevated complication rate, achieving optimal restoration of functional anatomy and ensuring stable fixation is imperative for prompt recovery from distal femoral fractures. Comparison of less invasive stabilization system versus dynamic condylar screw fixation in treatment of distal femur fractures is subject of ongoing debate as to which one is better. Aims and Objectives: To compare the functional and radiological outcomes of distal femur fractures treated with less invasive stabilization system versus dynamic condylar screw fixation. Place and Duration of study: A randomized clinical trial was conducted in the Orthopedic Department of Sheikh Zayed Hospital, Lahore, from July 2, 2020, to January 1, 2021. Material and Methods: A randomized clinical trial was conducted at Sheikh Zayed Hospital in Lahore over a six-month duration. In total 104 patients who fulfilled the inclusion criteria were admitted to the Orthopedic Department via Emergency and OPD. Demographic data and medical histories were taken. The sample size consisted of 52 patients in each group, with random allocation to either the LISS (A) or DCS (B) groups determined by a lottery method. Follow-up appointments were scheduled for all patients at one month, three months, and six months post-surgery. Radiological outcome was evaluated at each follow-up visit while functional outcome assessed at sixth monthly follow up. Data analysis was performed using the SPSS: version 22, considering p ? 0.05 as significant. Results: Frequency of functional outcome was i.e. excellent (32.7%), good (14.4%), fair (2.9%) in group A and excellent (27.9%), good (31.7%), fair (7.7%) in group B (p-value>0.05). Mean fusion time was 18.67±3.04 in group A and 19.62±4.36 in group B (p-value>0.05). Conclusion: Our findings indicate no substantial distinction between the two groups. Using DCS or LISS, both methods yield favorable outcomes with negligible complications in the management of distal femoral fractures. Both systems effectively reduce soft tissue injury.

Prevalence of Low Back Pain in Pregnant Females

Background: Low back pain (LBP) during pregnancy is a common condition that affects a significant number of women, impacting their daily activities and overall quality of life. Various studies have documented the prevalence and severity of LBP among pregnant women, highlighting the need for more focused healthcare strategies. Objective: The aim of this study was to assess the prevalence, onset, and severity of LBP in pregnant women, and to evaluate the impact of LBP on their daily activities, with a view to enhancing prenatal care and management approaches. Methods: A cross-sectional study was conducted over six months at two hospitals in Lahore, involving 181 pregnant women selected through non-probability convenience sampling. Data were collected using the Oswestry Low Back Pain Disability Questionnaire and the Numeric Pain Index Scale. Statistical analysis was performed using SPSS version 25, focusing on descriptive statistics to calculate means, standard deviations, and prevalence percentages. Ethical considerations followed the Helsinki Declaration guidelines, with informed consent obtained from all participants. Results: The prevalence of LBP among the participants was 76.8%. The pain onset was most frequently reported in the second trimester (38.1% of cases). Severity assessments revealed 36.5% of participants experienced moderate pain and 40.3% severe pain. LBP significantly impaired daily functions, with many women reporting difficulties in walking, sitting, and engaging in other routine activities. Conclusion: LBP is highly prevalent among pregnant women and begins primarily in the second trimester, with a considerable impact on daily activities. This study emphasizes the necessity for routine prenatal assessment and targeted interventions to manage LBP, which could improve pregnancy outcomes and maternal health.

Assessment of level of Burnout among Health Professionals in Lahore, Pakistan

Objectives: The prime objective of this study is to access the level of burnout among healthcare professionals using BAT tool. Also, the association of job satisfaction and workload factors is tested with burnout. Study Design and setting: A cross-sectional multi-centered study in Lahore during the month of August 2022 to Jan 2023. The data was collected from healthcare professionals in three tertiary care hospitals in Lahore. Methodology: The data was collected from clinicians and staff nurses. The required sample size was calculated as 172. Data was collected using Burnout Assessment Tool (BAT) proposed by Schaufeli (2020). BAT was initially proposed with 33 items. BAT-S was the proposed 33-item version with four core dimensions and two secondary dimensions. The average score for each dimension was calculated and interpreted as given by Schaufeli in user manual for BAT-S. Results: Exhaustion was high among 55.8% of the participants. Mental distance was high among 34.3% of the participants whereas it was normal among 46.5%. Nearly 90% of the participants were satisfied from their jobs, committed to their jobs and accept responsibilities. Job satisfaction was significantly associated with burnout level. Lack of organizational influence and poor internal communication were statistically significantly related with level of burnout. Conclusion: The study was conducted to highlight the level of burnout among healthcare professionals. We found that very high level of burnout was observed in cognitive impairment followed by emotional impairment. The average level of burnout was more common among participants with job satisfaction and good internal communication.

A comparison of port-site infiltration with bupivacaine alone vs. bupivacaine plus dexemedetomidine after diagnostic staging laparoscopy.

To compare the effects of bupivacaine alone and in combination with dexmedetomidine following staging laparoscopies. This triple-blinded, prospective study was conducted from June to September 2021 at a tertiary care cancer hospital in Lahore, Pakistan, and comprised adult patients having American Society of Anaesthesiologists grade I-III, weighing >30kg and undergoing diagnostic staging laparoscopy. The subjects were randomised into two equal groups. Group A received 6ml of 2mg/kg bupivacaine at each of the four laparoscopic port sites before skin closure, while group B additionally received 2μg/kg dexmedetomidine. The presence and severity of pain were recorded and assessed at 15 min, 1, 2 and 4 hours as well as at the time of discharge from the post-anaesthesia care unit. The time to first request for rescue analgesia, total morphine consumption, and the occurrence of any side effects during their stay were also recorded. Data was analysed using SPSS 23. Of the 30 patients, 15(50%) were in group A; 10(66.6%) males and 5(33.3%) females with mean age 43.27±7.59 years. There were 15(50%) patients in group B; 12(80%) males and 3(20%) females with mean age 41.36±12.42 years (p>0.05). Of the total, 29(96.66%) patients were classified as American Society of Anaesthesiologists grade II, and 1(3.33%) patient in group A was grade III. There was no significant difference between the groups in any of the outcome measures assessed (p>0.05), and none of the patients experienced any side effect throughout the post-operative stay. The combination of dexmedetomidine and bupivacaine had no significant improvement in pain relief compared to bupivacaine alone.

Virtual patients versus standardized patients for improving clinical reasoning skills in ophthalmology residents. A randomized controlled trial

BackgroundHistory taking and clinical reasoning are important skills that require knowledge, cognition and meta-cognition. It is important that a trainee must experience multiple encounters with different patients to practice these skills. However, patient safety is also important, and trainees are not allowed to handle critically ill patients. To address this issue, a randomized controlled trial was conducted to determine the effectiveness of using Virtual Patients (VP) versus Standardized Patients (SP) in acquiring clinical reasoning skills in ophthalmology postgraduate residents.MethodsPostgraduate residents from two hospitals in Lahore, Pakistan, were randomized to either the VP group or the SP group and were exposed to clinical reasoning exercise via the VP or SP for 30 min after the pretest. This was followed by a posttest. One month after this activity, a follow-up posttest was conducted. The data were collected and analysed using IBM-SPSS version 25. Repeated measures ANOVA was used to track the effect of learning skills over time.ResultsThe mean age of the residents was 28.5 ± 3 years. The male to female ratio was 1:1.1. For the SP group, the mean scores were 12.6 ± 3.08, 16.39 ± 3.01 and 15.39 ± 2.95, and for the VP group, the mean scores were 12.7 ± 3.84, 16.30 ± 3.19 and 15.65 ± 3.18 for the pretest, posttest and follow-up posttest, respectively (p value < 0.00). However, the difference between the VP and SP groups was not statistically significant (p = 0.896). Moreover, there was no statistically significant difference between the VP and SP groups regarding the retention of clinical reasoning ability. In terms of learning gain, compared with the VP group, the SP group had a score of 51.46% immediately after clinical reasoning exercise as compared to VP group, in which it was 49.1%. After one month, it was 38.01 in SP and 40.12% in VP group.ConclusionVPs can be used for learning clinical reasoning skills in postgraduate ophthalmology residents in a safe environment. These devices can be used repeatedly without any risk to the real patient. Although similarly useful, SP is limited by its nonavailability for repeated exercises.

Nurses Knowledge and Attitude Regarding Infection Control Practices

Background: Infection control practices are crucial in minimizing the risk of healthcare-associated infections (HAIs) in hospital settings. Adequate knowledge and positive attitudes among nurses towards these practices are essential for effective implementation and patient safety. Objective: This study aimed to evaluate the knowledge and attitudes of nurses regarding infection control practices at a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted involving 150 registered nurses from various departments including ICU, ER, and pediatric wards. Participants were selected using a convenient sampling technique. Data were collected via a validated questionnaire assessing knowledge and attitudes toward infection control practices. Descriptive statistics, frequency distributions, and reliability analysis (Cronbach’s Alpha) were performed using SPSS version 25. Results: The study revealed that 47.3% (71/150) of nurses had excellent knowledge, 22.0% (33/150) had good knowledge, and 30.7% (46/150) had poor knowledge about infection control. Regarding attitudes, 94.7% (142/150) of nurses exhibited a positive attitude towards infection control measures. The majority of participants were young, with 97.3% (146/150) between the ages of 21-30. Experience levels varied, with 81.3% (122/150) having between 1 to 3 years of experience. Conclusion: The findings indicate that while there is a good level of knowledge and a very positive attitude towards infection control among nurses, continuous education and training are needed to address gaps in knowledge and ensure high standards of practice are maintained.

Knowledge and Practices of Nurses Regarding Aseptic Techniques for Infection Prevention in Operating Room at Tertiary Care Hospital

Background: Surgical site infections (SSIs) remain a significant concern in operating rooms, largely influenced by the adherence to aseptic techniques by healthcare professionals. Despite the critical role of operating room nurses in preventing these infections, gaps in knowledge and practice persist, affecting the overall quality of patient care in tertiary healthcare settings. Objective: This study aimed to assess the knowledge and practices of operating room nurses regarding aseptic techniques for infection prevention in tertiary care hospitals. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital in Lahore, involving 130 operating room nurses with over a year of service. The study employed purposive sampling to administer a validated questionnaire assessing demographic data, knowledge, and practices related to aseptic techniques. Data were collected from January to March 2023 and analyzed using SPSS version 25, employing descriptive and inferential statistics to explore the relationship between demographic factors and knowledge/practices of aseptic techniques. Results: The study found that 60% of nurses were aware that a gown is considered sterile in specified areas, and 54.6% understood the contamination risks of dropped sterile packages. Approximately 62.3% recognized the importance of maintaining a safe distance during procedures. Despite these knowledge indicators, 94% of nurses routinely practiced sterile techniques, and 91% adhered to proper handwashing protocols. However, the overall level of knowledge concerning aseptic techniques was low, with significant gaps that could potentially impact patient safety. Conclusion: The study highlights a discrepancy between the knowledge and practices of operating room nurses regarding aseptic techniques, indicating a critical need for enhanced training and continuous education to bridge these gaps and improve infection control measures in surgical settings.

Knowledge, Attitude and Practice of Nurses Regarding Therapeutic Communication at Tertiary Care Hospital

Background: Effective communication in healthcare settings is pivotal for enhancing patient outcomes and fostering a cooperative environment between patients and healthcare providers. Therapeutic communication specifically plays a crucial role in establishing a rapport between nurses and patients, which can significantly impact the quality of care provided. Objective: The study aimed to evaluate the knowledge, attitudes, and practices of nurses regarding therapeutic communication within tertiary care hospitals in Lahore, identifying areas for potential improvement. Methods: A descriptive cross-sectional study was conducted over nine months using a validated questionnaire to assess the knowledge, attitudes, and practices of nurses. A total of 154 nurses were randomly selected using Slovin’s formula for sample size determination. Data collection involved demographic and professional experience details, followed by specific questions on therapeutic communication. The Statistical Package for the Social Sciences (SPSS) Version 25.0 was utilized for data analysis, employing descriptive and inferential statistics to interpret the data. Results: The results showed that 33.1% of nurses exhibited low knowledge levels, 39.0% moderate, and 27.9% high knowledge about therapeutic communication. Regarding attitudes, 57.1% of nurses displayed a positive attitude while 42.9% had a negative attitude towards therapeutic communication. In practice, 61.7% of nurses demonstrated good practice of therapeutic communication, whereas 38.3% displayed poor practices. Conclusion: The study concluded that while there is a moderate understanding and positive attitude towards therapeutic communication among nurses, significant portions still require further training and improvement. Enhanced educational programs focusing on therapeutic communication could bridge existing knowledge gaps and refine practices, thereby improving patient care outcomes.

ASSESSMENT OF SURGICAL TREATMENT STRATEGIES OF IATROGENIC GIANT FEMORAL ARTERY PSEUDOANEURYSMS

Iatrogenic giant femoral artery pseudoaneurysms pose significant clinical challenges, necessitating prompt intervention to prevent complications. Despite advancements in endovascular techniques, optimal surgical strategies remain unclear. This study aimed to evaluate surgical treatment's technical and clinical outcomes for these pseudoaneurysms. Objective: To assess the technical success and clinical outcomes following surgical repair of iatrogenic giant femoral artery pseudoaneurysms. Methods: This retrospective cohort study was conducted at a tertiary care hospital in Lahore, Pakistan between July 2022 and July 2023. A total of 60 patients diagnosed with iatrogenic giant femoral artery pseudoaneurysms underwent surgical repair. It was followed up for one, three, and six months using Duplex ultrasound and CT angiography. Data were analyzed to evaluate surgical techniques, technical success rates, and postoperative outcomes. Statistical analysis was performed using descriptive statistics and chi-square tests. Results: All patients (n=60) underwent successful surgical repair with various techniques: primary repair (n=30), repair with vein patch angioplasty (n=15), interposition reversed saphenous vein graft (n=10), and interposition synthetic Dacron graft (n=5). Technical success was achieved in 100% of cases, with no limb loss or intraoperative/postoperative mortality. The presenting symptoms were resolved in all patients, with one case of postoperative groin wound infection being effectively managed with antibiotics and debridement. Conclusion: Open surgical repair of femoral pseudoaneurysms demonstrates excellent technical feasibility and serves as a first-line treatment for iatrogenic giant femoral artery pseudoaneurysm-associated complications. These findings support surgical intervention as a practical approach to managing these challenging cases.