Public Sector Tertiary Care Hospital Research Articles

Development of Acceptable Quality Dose (AQD) and image quality-related diagnostic reference levels for common computed tomography investigations in a tertiary care public sector hospital of Khyber Pakhtunkhwa, Pakistan.

To describe the first experience of patient dose optimization in developing AQD, SSDE and image quality-related DRLs for common CT examinations in the adult age group using the concept of AQD. The recent published IQSC from 0 to 4 were used by radiologists for the assessment of image quality. The entire data were collected for five types (brain CT, chest CT, chest HRCT, abdomen KUB CT and abdomen + pelvic CT) CT investigations based on anatomic region (head, chest and abdomen + pelvic). The entire datasets of 264 patients were categorized into three groups based on their weights: group-1 (41-60kg), group-2 (61-80kg) and group-3 (81-100kg). Only score-3 images were considered to assess median and 75th percentile values of CTDIvol and DLP to obtain AQDs and DRLs, respectively. Following the practical training of four radiologists on image quality scoring criteria for CT images, 264 (92%) out of 288 patient images were clinically acceptable as per IQSC for the study. The AQD (median) values in terms of CTDIvol for the mentioned weight groups were 25.8, 2.7, and 30.6mGy, while the median DLP values for these groups were 496, 510 and 557 mGycm, respectively, for brain CT. The 75th percentile values in terms of CTDIvol were 30.2, 35.3 and 36.2mGy, while in terms of DLP, they were 583, 619 and 781 mGycm for brain CT, respectively. Similar results are presented for the above-mentioned procedures, as well as in terms of SSDE. The first ever experience in obtaining AQD, SSDE and DRLs values for specific CT procedures couples image quality with dose indices, showing comparable values with other relevant studies. Hence, it will provide a baseline for comparison within the facility for future studies and facilitate dose optimization for other facilities aiming for improvement.

Exploring antibiotic safety: A prospective observational study from a tertiary care public sector hospital

BackgroundAntibiotics are the most commonly used drugs to treat bacterial infections; however, these life-saving drugs can also cause adverse drug reactions. In several pharmacovigilance studies, adverse drug reactions are a cause of prolonged hospitalization. The development of hypersensitivity reactions even after a negative skin test and patch test makes antibiotic-associated adverse reactions unpredictable. Owing to the scarcity of data on antibiotic desensitization, these drugs are important for pharmacovigilance. Most of the previous studies conducted were retrospective and lacked data regarding the duration of adverse drug reactions. AimThis study aimed to examine adverse drug reactions associated with antibiotics and to provide knowledge on the duration of these reactions. MethodA prospective observational study was conducted on patients receiving antibiotics at a tertiary care hospital. The patients were followed until discharge, and causality and severity assessments were performed. Descriptive statistical analyses were performed to summarize the data. ResultsThe study results show the median duration of adverse drug reactions was two days, with an interquartile range of two to four days. Most (21,3%) of the reactions were caused by cephalosporins. The majority (44.7%) of the reactions were skin and subcutaneous tissue disorders. The majority (78.7%) of the reactions were moderately severe and were not responsible for prolonged hospital stay. ConclusionThe patients receiving antibiotics require close monitoring for early detection and management of adverse reactions to reduce the duration of hospital stay and the duration of adverse drug reactions.

Feasibility of a nurse-led, mHealth-assisted, and team-based collaborative care model for heart failure care in India: Findings from a multi-stakeholder qualitative study

Background Heart failure (HF) management is often challenging due to poor adherence to GDMT and self-care. Continuous monitoring of patients by a dedicated care manager may enhance adherence to self-care and treatment and prevent hospitalisations. For the adoption and acceptance of a collaborative care model (CCM) for HF management in Indian settings, understanding the perspectives of all stakeholders regarding its various components and feasibility is needed. Therefore, we aimed to obtain perceptions of potential challenges to care and suggestions on multiple components of the proposed CCM in managing HF and its feasibility. Methods In-depth interviews were done among HF patients, caregivers, nurses, and cardiologists from private, co-operative, and public sector tertiary care hospital settings that cater to HF patients in Kerala, India. An in-depth interview guide was used to elicit the data. Data were analysed using Python QualCoder version 2.2. We used a framework method for the analysis of data. Results A total of 22 in-depth interviews were conducted. We found that the existing care for HF in many settings was inadequate for continuous engagement with the patients. Non-adherence to treatment and other self-care measures, was noted as a major challenge to HF care. Healthcare providers and patients felt nurses were better at leading collaborative care. However, various barriers, including technical and technological, and the apprehensions of nurses in leading the CCM were identified. The stakeholders also identified the mHealth-assisted CCM as a potential tool to save money. The stakeholders also appreciated the role of nurses in creating confidence in patients. Conclusions A nurse-led, mHealth-assisted, and team-based collaborative care was recognised as an excellent step to improve patient adherence. Effective implementation of it could reduce hospitalisations and improve patients' ability to manage their HF symptoms.

Clinico-Epidemiological Profile, Trends, and Health-Related Outcomes of Snakebite Victims: A One-Year Prospective Study from Eastern India.

Snakebite envenomation is a significant life-threatening public health problem in Southeast Asia (SEA). In this region, India reported the largest number of snakebite deaths from 2000 to 2019 (1.2 million), with an average of 58,000 deaths yearly. This prospective observational study was carried out among snakebite victims at the emergency department (ED) of a tertiary care public sector hospital in eastern India. A total of 145 cases of venomous snakebite were investigated. More than half (n = 81, 56%) of the snakebite victims were between 17 to 45 years. Most of the snakebite victims were male (68%) and were farmers (53%) by occupation. The majority of snakebites occurred during the daytime (76%) and while outdoors (67%). Most victims sustained a bite on the lower extremity (71%). The peak incidence of snakebites occurred from June to September (69%). Three-quarters of all patients were unaware of the required first aid measures following a snakebite. Among the 145 venomous snakebites, 48 were presumptively identified as the Indian cobra, 32 by the Indian krait, 56 by the Russel's viper, and 9 by saw-scaled viper. The mean duration from the snakebite to the onset of systemic effects in the Indian cobra was 52 ± 14.28 min, 66 ± 18.35 min in the Indian krait, 42 ± 13.47 min in Russel's viper, and 48 ± 16.38 min in saw-scaled viper. Respiratory failure was the commonly observed complication following an elapid envenomation. The mortality rate was 2.1% among the patients treated with antivenom. Snakebite is considered an occupational hazard in India, commonly affecting the young population in their productive period. The peak incidence was during monsoon season, and the majority had neurotoxic envenomation following an elapid bite (55%) that contributed to the increased mortality and morbidity among young adults. Of the 145 patients, the majority (84%) recovered fully with treatment; 16% of the victims developed morbidity viz cellulitis, respiratory failure, acute renal failure, compartment syndrome, local tissue necrosis, intracerebral hemorrhage, and disseminated intravascular coagulation. Appropriate first aid measures and timely medical intervention can significantly improve the treatment outcome following snakebites.

Examining Barriers and Perceptions in Reporting Medication Administration Errors among Nurses at the Tertiary Care Hospitals in Peshawar Pakistan

Medication administration is vital for patient safety, yet medication errors can lead to life-threatening situations and increased mortality rates. Nurses, being essential members of the healthcare team, are constantly present with patients and regularly tasked with drug administration, facing a significant burden of medication errors compared to other healthcare providers. Objectives: To explore the barriers and perceptions of nurses' regarding medication errors reporting in public sector tertiary care hospitals. Methods: A convenient sample of 209 staff nurses participated in this cross-sectional survey from June to October 2022. A three-part questionnaire was used to gather information on the general characteristics of nurses, the causes of medication errors, and the justifications for not reporting them. Results: The Pharmacy supplies inappropriate doses to this unit with a mean of (2.53 ± 1.28) and an insufficient number of staff nurses in each working shift (4.23 ± 0.76) were the two least and most significant contributing factors to medication errors. Additionally, the two most and least significant factors for not reporting medication errors were that nurses may be held accountable if the patient suffered harm (3.94 ± 1.16) and that nurses did not agree with the hospital's definition of a medication error (2.33 ± 1.26) on average. Conclusions: The main causes of drug mistakes and failure to reveal them were nursing and management issues. Moreover, attempt to establish a blame-free culture to motivate reporting errors.

Need for the dedicated emergency department in health care services; Postgraduate doctors’ perspective.

Objective: To explore the perspectives of post graduate residents working on emergency floor about the need of dedicated emergency department in healthcare department. Study Design: Qualitative Exploratory study. Setting: Allied Hospital, Faisalabad (AHF), Pakistan A Tertiary Care Public Sector Hospital in Punjab. Period: January 10, 2024, to January 30th, 2024. Material & Methods: Post-graduate residents of surgery and medicine department were included in study and interviews were conducted after taking their consent till the data saturation. Total 18 interviews were recorded and then transcribed. Thematic narrative analysis was performed. Results: Out of 18 participants, 14 (77.7%) were males while 4(22.2%) were females. From surgical floor, 8 Residents participated in the study out of which 1 (12.5%) was female and 7 (87.5%) were males while 10 residents participated from medical floor out of which 3 (30%) were females and 7(70%) were males. Theme 1: The problems faced on the emergency floor: All the participants agreed that the working condition of emergency floor is quite hectic and stressful. With sub themes (1a) Over-burdened emergency of tertiary care centers: 1b) Faulty Referral system: (1c) Patient interactions: (1d) Lack of facilities: (1e) Guidance & facilitation center: Theme 2: Dedicated Emergency Department: The Participants when asked about their suggestions regarding improvement of working condition at emergency floor, they all had a clear idea of establishment of a dedicated emergency department with specially trained and recruited staff for this purpose. With subthemes (2a) Filtration clinics: (2b) Rotational Duties: (2c) Proper Training: (2d) Public Awareness. Conclusion: The emergency departments in tertiary hospitals should be a separate department with dedicated staff, proper triage system and adequate facilities to deal with the critical patients.

Patients Satisfaction Towards Quality of Nursing Care at a Public Sector Tertiary Care Hospital Karachi

Care is seen as a significant element of health amenities. The most anticipated health outcomes are achieved by providing treatments that are effective, efficient, and cost-effective. Objective: To assess the level of patient’s satisfaction towards the quality of nursing care at a public sector tertiary care hospital in Karachi. Methods: This cross-sectional study was accompanied by 312 patients admitted to public sector hospital. Non-probability purposive sampling technique was used for data collection. Those patients who have been admitted for more than three days in various departments. Data were collected after approval Institutional Review Committee (IRC) of the Dow Institute of Nursing and Midwifery (DIONAM) and the Ethical Review Committee (ERC) of the National Institute of Cardiovascular Disease (NICVD). Data were analyzed on SPSS-version 25.0. Frequency and percentage were measured from categorical data. An Independent t-test was run to find out the relationship of patient’s satisfaction and with demographic characteristics of the study participants. Written informed consent was obtained from all participants. Results: The findings highlighted that the majority (55%) of the study participants were male and 79% were married. Furthermore, the highest satisfaction level (90.7) was found in the domain of nurse’s communication, and the lowest level of satisfaction score 81.8% found in the discharge domain. Moreover, the overall patient’s satisfaction score of all domains was 93.3%. Conclusions: The findings of this study concluded that the majority of the admitted patients strongly agreed with the quality of nursing care. Furthermore, the nurse’s communication domain showed a higher level of satisfaction among all domains.

Factors Associated with Knowledge about Gestational Diabetes Mellitus among Women Attending Antenatal Clinics in Riyadh, Saudi Arabia

Abstract Background: Gestational diabetes mellitus (GDM) is an increasing public health problem worldwide. Measuring the level of knowledge in a population at high risk for GDM will highlight the gaps and help in designing appropriate interventions. The objective of this study was to measure the knowledge about GDM and to identify the factors associated with it among pregnant women in Riyadh city, Saudi Arabia. Methodology: A cross-sectional study was conducted with pregnant women seeking antenatal care services in two of the public sector tertiary care hospitals in Riyadh city. The study was performed using a self-administrated predesigned questionnaire. Collected data were analyzed using SPSS program. Results: More than 40% of the participants had poor knowledge about GDM complications, diagnosis and management. Women with lack of exercise [adjusted odds ratio 3.3 (95% CI 1.8, 6.1)]; having past histroy of GDM [3.2 (1.8, 5.7); primigravida [2.9 (1.6, 5.1)]; information on GDM received from doctors [2.0 (1.2, 3.4)] and those with low education level [1.8 (1.1, 2.9)] were more likely to have poor knowledge about GDM. Whereas, women with positive family history were 60 times more likely to have good knowledge about GDM. Conclusion: Primigravida mothers and those with low education level should receive specific information and awareness regarding GDM. Healthy lifestyle is important for the prevention and improvement in the diagnosis and management of GDM among pregnant women in Riyadh.

Metabolic storage disorders at a tertiary care hospital, Pakistan

OBJECTIVE: To determine the clinical spectrum of metabolic storage disorders presenting to a public sector tertiary care hospital in Karachi, Pakistan. METHODOLOGY: This retrospective, cross-sectional study was conducted at the Department of Pediatrics, Dr RKMP Civil Hospital Karachi, in 2021. We reviewed the medical records of patients from January 2015 to December 2020. We included all pediatric patients admitted with suspicion of metabolic storage disorders based on two or more: visceromegaly, developmental delay, regression of milestones, fits without fever, family history of similar illness, and family history of expiry of children due to unknown reasons. Patients of malaria, enteric fever, epilepsy and cerebral palsy were excluded. We noted the demographic and clinical variables and applied descriptive statistics using SPSS version 22. RESULTS: Out of n=140 suspected children, n=40 (28.5%) patients were diagnosed with metabolic storage disorder. Among these, 26 (65%) were Lysosomal, and 14 (35%) were Glycogen storage disorders (LSDs and GSDs). The most common clinical feature of LSDs was faltering growth in 23 (88.4%), while for GSDs, it was abdominal distention and hepatomegaly in 100% of patients. Mucopolysaccharidoses were the most common type of LSD identified in 9(34.6%). Interestingly, family history of similar illness was not a standard feature (19.2% for LSDs and 7% for GSDs). CONCLUSION: Metabolic storage disorders are an emerging concern to pediatric health in our population. Physicians need to keep a high index of suspicion for patients with faltering growth and visceromegaly, with or without a significant family history. KEYWORDS: Glycogen storage diseases; Lysosomal storage diseases; Metabolic diseases; Inborn errors of metabolism; Hepatomegaly; Genetic diseases

Emotional Intelligence and Psychological Adjustment among Doctors and Nurses in a Tertiary Care Hospital in Rawalpindi-Pakistan: A Cross Sectional Study

Objective: This study aimed to determine the relationship between EI and the quality of nursing care from the viewpoint of nurses and patients. Methods: This cross-sectional study was conducted at a public sector tertiary care hospital in Rawalpindi, Pakistan, over 6 months from November 2019 to April 2020. The convenience sampling technique was employed. The study groups were qualified practising doctors and nurses including nursing assistants and paramedics. Study groups were provided with a self-administered questionnaire that was filled out after getting consent from the study participants. Data analysis was done by entering it into SPSS version 22. The relationship between emotional intelligence and psychological adjustments among the two groups was assessed by applying an independent T-test. Results: The current study explored that doctors were emotionally intelligent and psychologically well-adjusted as compared to nurses. Females were more emotionally intelligent than males; however, males were better adjusted psychologically. Years of experience had no significant results between both groups, while there was a positive correlation between the department of practice and psychological well-being. Conclusions: It shows that harmonious work environments and friendly interpersonal relationships positively affect the well-being of HCWs and patients. What this indicates is a need to bring about changes within work environments to produce friendly interpersonal relationships and a positive impact on the well-being of HCWs and patients. Keywords: Emotional intelligence, Psychological adjustments, Nursing staff

FIFTEEN YEARS’ EXPERIENCE IN PEDIATRIC ENDOSCOPIC PROCEDURES AT THE ENDOSCOPIC SUITE OF A TERTIARY CARE HOSPITAL

G.I. endoscopy is a highly efficient diagnostic and therapeutic tool now increasingly used in the pediatric population. Our country needs pediatric endoscopic data due to a lack of pediatric gastroenterologists and dedicated pediatric facilities; only a few facilities available in private setups are out of reach of the general population. Hence, this pediatric endoscopic audit was performed to analyze the indications, findings, and complications of all endoscopy procedures in a pediatric population referred to the endoscopy suite of a public sector tertiary care hospital. Data from all pediatric patients who underwent endoscopy from January 2006 to December 2020 was retrospectively reviewed for endoscopy indications, findings, and complications. Three thousand eight hundred seventy pediatric patients (age 0 -18 years) were analyzed. The mean age of the study population was 12.75 years, and the male-to-female ratio was 1.04:1. One thousand seven hundred seventy-nine patients underwent EGD, 1639 had colonoscopy, and 452 had ERCP. The most common indication for EGD was found to be epigastric pain (29.7%), the most common finding was gastritis (21.4%), and the complication rate for all upper G.I. endoscopic procedures was found to be 0.5%. The most common indication for colonoscopy was per rectal bleeding (69%), the most common finding was polyp (29.7%), and the complication rate was 0.9%. The most common indication for ERCP was found to be jaundice secondary to biliary obstruction (57.5%), the most common finding was bile duct stone (30%), and the complication rate was 5.6%. The overall incidence of adverse events was low and was found to be 0.7% in all of the 3870 procedures.

Impact of COVID-19 Pandemic on the Quality of Life of Nurses Working in the Public Sector Tertiary Care Hospitals of Karachi

COVID-19 has a substantial influence related to the quality of life of nurses by increasing the number of patients, which increases the work burden and stress level. Objective: To determine the impact of the COVID-19 pandemic on the quality of life of nurses working in the public sector tertiary care hospitals of Karachi. Methods: Present an analytical cross-sectional study design was employed to determine the quality of life of working by using a non-probability convenient sampling technique to recruit 240 nurses. The quality of life of nurses was assessed by using the McGill Quality of Life (QoL) revised questionnaire. Results were considered significant at p-value of ≤0.05. Results: Out of a total of 240 nurses, most of them 135 (56.2%) were male, 177(73.88%) married, 128, 53.3% Post RN qualification, and 99 (41.2%) 6 to 10 years of working experience. The mean+SD of the overall QoL of nurses was 6.56+2.53. Based on multiple logistic regression analysis, males had 2.79 times better QOL during the COVID-19 pandemic as compared to females (ORadj=2.79, 95% CI: 1.05 - 7.45, p= 0.04). Similarly, married persons had 3.06 times better QOL during the COVID-19 pandemic as compared to others (ORadj=3.06, 95% CI: 2.14 – 3.34, p= 0.003). Conclusions: It is concluded that the COVID-19 pandemic has a significant effect on all aspects of the physical, psychological, existential and social quality of life of nurses working in the public sector tertiary care hospitals of Karachi, Pakistan

Comparison of Emergency Severity Index Version 4 and Modified Pediatric Early Warning Score as Triage Models in the Pediatric Emergency of a Tertiary Care Public Sector Hospital

Comparison of Emergency Severity Index Version 4 and Modified Pediatric Early Warning Score as Triage Models in the Pediatric Emergency of a Tertiary Care Public Sector Hospital

Refining the provider payment system of India’s government-funded health insurance programme: an econometric analysis

ObjectivesReimbursement rates in national health insurance schemes are frequently weighted to account for differences in the costs of service provision. To determine weights for a differential case-based payment system under...

An Experience from Public Sector tertiary care Hospital:Secondary data analysis of Dengue patients from 2013-2022

Background: This study aims to identify patient number trends in three tertiary care hospitals affiliated with Rawalpindi Medical University by conducting a secondary data analysis of past hospital records. Methods: A retrospective study, spanning from 2013 to 2022, was undertaken in three tertiary care hospitals (Holy Family Hospital, District Head Quarters Hospital, and Benazir Bhutto Hospital) affiliated with Rawalpindi Medical University. The analysis included data on outpatient department (OPD) visits, admission rates, confirmed cases, morbidity and mortality variables related to Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), fatalities, expiries %, and the predominant Dengue virus genotype. Statistical analysis utilized SPSS version 25.0. Results: The records encompassed 299,101 OPD patients in the three allied hospitals. Over the past decade, an epidemic occurred in 2019, witnessing a surge—87,680 OPD cases, 14,879 admissions, and 11,942 confirmed cases. A second peak in the current year saw 32,940 cases. Maximum fatalities occurred in 2021 (0.68%), followed by 2013 (0.57%). Dominant Dengue serotype was DEN-2, except in 2022, which showed both DEN-1 (40%) and DEN-2 (60%). Conclusion: Trend analysis of dengue cases from 2013 to 2022 revealed a peak in 2019, followed by the current year (2022), indicating a significant increase. The rise during the current epidemic, coupled with a new serotype (DEN-1), may be linked to human migration due to recent floods, population displacement, and virus evolution, evident in increased cases with different serotypes.

Point prevalence probing of antimicrobial prescription patterns from a developing country

ABSTRACT Background Irrational use of antibiotics intensifies resistance and jeopardizes advances made in modern medicine. We aimed to conduct a baseline gap analysis survey on antibiotic prescription practices across Pakistan. Research Design and Methods This multi-centered cross-sectional survey was conducted at six public sector tertiary care hospitals from February 2021 to March 2021. Data related to various variables including hospital infrastructure, policies and practices, monitoring and feedback, and epidemiological, clinical, and antibiotic prescription for surveyed patients was collected using World Health Organization (WHO) Point Prevalence Survey (PPS) methodology. Results In a survey of 837 inpatients, 78.5% were prescribed antibiotics. Most commonly prescribed antimicrobial was ceftriaxone (21.7%), followed by metronidazole (17.3%), cefoperazone-sulbactam (8.4%), amoxicillin-clavulanate (6.3%), and piperacillin/tazobactam (5.9%). Surgical prophylaxis (36.7%) and community-acquired infections (24.7%) were the main reasons for antibiotic prescriptions. Single antibiotics were given to 46.7% of patients, 39.9% received a combination of two antibiotics, and 12.5% were prescribed three or more antibiotics. Among six hospitals surveyed, two had drug and therapeutic committees, three had infection prevention and control committees, and one had an antibiotic formulary. Conclusion Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasize the importance of expanding antimicrobial stewardship programs among hospitals. Mentoring clinical teams could help rationalize antimicrobial use.

Healthcare-associated infections among neonates and children in Pakistan: findings and the implications from a point prevalence survey

Health-care associated infections (HAIs) increase morbidity, mortality and costs. The overall prevalence of HAIs is greater in low and middle income countries due to poor resources and infrastructure, with the incidence of HAIs greater among neonates and children. There is a need to understand the current situation in Pakistan including key drivers to improve future care. Point prevalence survey (PPS) of HAIs in the children wards of 19 public sector secondary and tertiary care hospitals of Pakistan and associated key drivers. 1147 children were included in the PPS. 35.7% were neonates with 32.8% aged >1 to 5 years. 35.2% were admitted in the ICU. Peripheral, central venous and urinary catheters were present in 48%, 2.9% and 5.6% of the patients respectively. 161 HAIs from various pathogens were observed in 153 cases, giving a prevalence of 13.3%. The majority of HAIs were caused by S. aureus (31.7%) followed by K. pneumoniae (22.9%) and E. coli (17.4%). Blood stream infections were identified in 42 cases followed by lower respiratory tract infections in 35. Increased length of hospital stays and being admitted to the ICU, "rapidly fatal" patients under the McCabe and Jackson criteria, central and peripheral catheterization, and invasive mechanical ventilation were associated with higher HAIs (p < 0.001). 99.7% HAIs patients fully recovered and were discharged from the hospital. There is a high prevalence of HAIs among neonates and children admitted to health facilities in Pakistan. Infection prevention and control measures should be implemented to help prevent future HAIs.

Blood Donors Hemovigilance in Public Sector Tertiary Care Hospitals of Peshawar

Hemovigilance of blood donors is an integral part of blood transfusion system, conferring to lessen the blood donation complications and enhancing the safety of blood donors. Objective: To determine the prevalence, severity, and associated factors of acute hemovigilance reactions in the blood donors of public sector tertiary care hospital bank banks in Peshawar. Methods: A multi-centered, cross-sectional approach was applied on blood donors` population selected via random proportionate sampling, visiting 6 Public sector tertiary care hospitals in Peshawar. Adverse reactions were reported on national guidelines reporting form during and after the blood donation. Results: Out of 420 blood donors selected via random proportionate sampling of total blood donors` population, prevalence of acute adverse hemovigilance reaction was 8.57% while no adverse reactions occurred in 91.43% of the blood donors. The most frequent hemovigilance reaction was vasovagal reactions (5.2%). All the reactions were of mild to moderate severity with no life threatening hemovigilance reactions. Conclusions: The overall prevalence rate was 8.57% of all healthy blood donors` which strengthens the fact that adverse reactions are avoidable complication of blood donations among the voluntary and replacement blood donors, and can be prevented with centralized hemovigilance data base for a sustainable base of voluntary blood donors.

Public sector rehabilitation services for physical disabilities in tertiary care hospitals of Karachi, Pakistan: A qualitative study

BackgroundAround the globe there are 2.4 billion people in need of rehabilitation. Disability and rehabilitation have not gained much importance in the public health arena, possibly due to limited research and awareness regarding the significance of rehabilitation. This study aimed to provide an in-depth understanding of the barriers and facilitators to the provision and utilization of rehabilitation services in public sector tertiary care hospitals of Karachi, Pakistan. MethodologyThis qualitative exploratory study was conducted from August to September 2015 in two tertiary care hospitals of Karachi. The criterion for hospital selection included the availability of functional rehabilitation services. Twenty-four key informant interviews were conducted with health professionals, including doctors, physiotherapists, occupational therapists, prosthetists, orthotists, as well as patients and caregivers. Qualitative content analysis was performed using a consensual qualitative research approach. Responses from key informant interviews were coded into free nodes and then categorized into themes. ResultsTwo themes emerged from the data: constraints to the provision of rehabilitation services, and barriers to the utilization of rehabilitation services. Basic infrastructure was available at both study sites; however, a lack of structured guidelines for referring patients to these services, a lack of information-sharing and guidance to the patients, and a limited supply of equipment (treatment modalities) hampered the provision of services. The barriers to rehabilitation services included cost pertaining to transport, environmental barriers, lack of support from the employer, and strain on and lack of support from caregivers. ConclusionRehabilitation services require attention and investment in research and allocation of funds to strengthen the service delivery system. Hospitals, alongside the department of health, need to develop a strategic plan to set future directions and standards of available rehabilitation services.

Prescription Audit of the Outpatient Department of an Ophthalmic Tertiary Care Public Sector Hospital

Abstract Introduction: Prescription audit is a type of vigilance activity, which is beneficial in clinical practice in terms of reducing the burden of disease because of medication errors. The aim of the audit was to study the prescribing practices of the outpatient department of an ophthalmic tertiary care public sector hospital. The objectives were to assess the drug use pattern and to recommend suggestions, if any, to improve the prescribing practices. This was a prospective, cross-sectional descriptive study. Materials and Methods: A study was conducted over a period of 1 month (February) to audit the ophthalmic prescriptions received at free generic pharmacy of the tertiary hospital. Data was collected using a predetermined sample size (625) and random sampling strategy. Audit of prescriptions was done and WHO drug prescription and usage indicators were analyzed. Statistical Analysis Used: The data was analyzed using Microsoft Excel 2010 and Strata 11. Results: Out of randomly selected 625 prescriptions, patient identification details were not properly mentioned in 23% of prescriptions. Some errors were, missing name in 8 (1.28%), missing age in 68 (10.88%), and missing gender in 65 (10.4%) prescriptions. Regarding drug prescription indicators, the doses and correct strength of drug was mentioned in 7 (1.12%) prescriptions and the route of administration of drug was not written in 17 (2.72%) prescriptions. Out of the total 1543 drugs prescribed, only 134 (8.68%) drugs were prescribed in generic form. One hundred (6.48%) drugs were prescribed from the WHO Essential Drug Formulary (EDF), 115 (7.45%) drugs were prescribed from the National EDF, and a total of 129 (8.36%) drugs were prescribed in the form of fixed-drug combinations. An average of 2.47 ± 1.51 drugs were prescribed per patient. Polypharmacy was not significant as more than five drugs were prescribed in only 4% of prescriptions. Conclusions: Prescription writing errors were common which include incorrect mention of patient details, route of administration, and correct dose and strength of drugs. Awareness against polypharmacy was high. Efforts should be taken to promote the usage of generic form of drugs. Standardization of prescription writing and regular conduct of audits is the way forward.