Safe Practices Research Articles

Evaluating pediatric antimicrobial dosing of β-lactam antibiotics for upper respiratory tract infections in emergency and primary care settings.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Pediatric prescribing is often weight and indication specific and has been associated with high rates of error. The aim of this study was to evaluate outpatient β-lactam suspension dosing practices for pediatric upper respiratory tract infections (URIs), to characterize the rate of error and to describe common error types. This retrospective cohort study was conducted at a community health system with 2 emergency departments and 20 outpatient family medicine practices. Pediatric patients treated from these settings with oral suspension formulations of amoxicillin, amoxicillin/clavulanate, cefdinir, or cephalexin for streptococcal pharyngitis or otitis media between June 1, 2020, and May 31, 2023, were eligible for inclusion. Doses were evaluated against indication-specific best-practice guidelines and assessed for guideline concordance. Of the 200 patients evaluated, 100 were treated for streptococcal pharyngitis and 100 were treated for otitis media. Of the prescribed β-lactam doses, 32% were discordant with best-practice guideline recommendations. Dosing errors were more common for pharyngitis than for otitis media (47% vs 17%; P < 0.001). Overdosing was the most frequently observed error in pharyngitis prescriptions (93.6% of errors) and most commonly occurred in patients weighing more than the 20-kg weight associated with the dosing maximum (80.9% of overdosing errors). All patients receiving an inappropriate dose for otitis media were underdosed. Outpatient pediatric dosing errors for URI indications are common among both emergency medicine and family medicine prescribers. Patients weighing over the weight corresponding to the dosing maximum are at highest risk for error. Antimicrobial stewardship interventions targeting the point of prescribing are urgently needed to provide safe dosing practices for pediatric patients.

Practising Safe Care in Critical Care: A Reflexive Thematic Analysis.

AbstractAimTo explore the meaning of ‘safety’ as it applies to critical care nurses during daily care practice in the intensive care setting.DesignA qualitative study design was employed.MethodsThe study enlisted 18 critical care nurses and nurse leaders from three hospitals in Sweden. Interview data were collected in 2017 and in 2024. The data were examined using reflexive thematic content analysis.ResultsThe meaning of safety within critical care settings was illustrated by the themes ‘Sustaining a safety mindset’, ‘Fostering commitment to patient safety’, ‘Showing individual accountability and continuous learning’ and ‘Managing complexity while prioritising safety standards’. Safe care practice in daily practice also involved adaptability and resilience in response to changing circumstances or unexpected events, ensuring thoroughness and allowing for a return to regular routines when conditions permitted, thereby preventing incomplete care. Core competencies in safety encompassed both technical and non‐technical skills, such as the ability to assess and use technology, remain vigilant and thorough, plan ahead, prioritise and identify, and follow through on nursing interventions, all while working in a team and allocating sufficient time for patients.ConclusionSustaining a safe mindset over time is both challenging and essential. Further research should focus on how to foster a sustained safety mindset. A more proactive approach to learning may be achieved by reflecting on and discussing things that have worked well even in challenging circumstances.Implications for the Profession and/or Patient CareThis study enriches our understanding of practising safe care in intensive care. It furnishes the nursing profession with a deeper theoretical grasp of proactive safety efforts, encompassing various factors that can mitigate risks in a technologically advanced environment.

PKM PENYULUHAN DAN LATIHAN FISIOTERAPI PADA CEDERA ACL S CEDERA ACL DI SPORT CENTER RS AWAL BROS PEKANBAR)

The community service program titled "PKM: Physiotherapy Counseling and Training on ACL Injuries at Sport Center RS Awal Bros Pekanbaru" aimed to provide education and training for 20 athletes with anterior cruciate ligament (ACL) injuries. This program included sessions on injury prevention strategies, strengthening exercises, and post-injury rehabilitation techniques to enhance recovery and performance. Each participant received hands-on training from experienced physiotherapists, focusing on safe practices to prevent future injuries and improve mobility. The program's outcomes showed improvements in participants' understanding and ability to perform recommended exercises independently, reflecting the effectiveness of physiotherapy-based interventions in managing ACL injuries.

Street Venders' Food Safety Knowledge, Attitudes and Practices and Consumers' Preference About Street Food Marketing in Chennai City

Purpose-The purpose of a study on "Street Vendors' Food Safety Knowledge, Attitudes, and Practices and Consumers' Preference About Street Food Marketing" typically revolves around several key objectives.The study would typically aim to inform public health efforts, regulatory policies, and the support structures needed for street vendors to improve food safety while meeting consumer demand. Design/methodology/approach-This study adopts a descriptive cross-sectional design to gather information on the current knowledge, attitudes, and practices of street vendors related to food safety. It also examines consumer preferences regarding street food marketing and their perceptions of food safety.This study adopts a descriptive cross-sectional design to gather information on the current knowledge, attitudes, and practices of street vendors related to food safety.A sample of approximately 150 street vendors and 150 consumers will be targeted for this study, providing a representative overview of the practices and preferences in Chennai’s Street food sector. Findings-Food Safety Knowledge Gaps: Many street vendors in Chennai have limited formal knowledge about food safety, with gaps in understanding key areas such as personal hygiene, food handling, and the risks of cross-contamination.Inconsistent Attitudes and Practices: Vendors generally express positive attitudes toward maintaining hygiene, understanding its importance for consumer health and business success. Originality/value-Underserved Research Area: Street food vending is a significant part of the informal economy, particularly in developing regions, but often lacks sufficient formal research. This study explores an area where academic and policy-focused research may be limited, making it a fresh and critical investigation. Focus on Food Safety in Informal Settings: While food safety is well-documented in formal food industries, there is less research on how informal vendors manage food safety. This study provides original insights into how these vendors understand and practice food safety without formal training or resources.

Knowledge, attitudes and practices of the healthcare staff and students about disposal of unwanted medications: a systematic review

Abstract Introduction Improper disposal of medications poses a significant environmental risk on the ecosystems and human beings1. When medicines are discarded by flushing them down the toilet or throwing them in the household trash, their active components may leak into the water supply2. Aim This systematic review seeks to compile studies that examine healthcare professionals' and students' knowledge, attitudes, and practices (KAP) regarding medication disposal. It also aims to explore recommendations and barriers related to appropriate medication disposal. Methods A systematic review was conducted by adhering to guidelines outlined in Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and the Joanna Briggs Institute. The primary outcome is to measure the levels of the healthcare staff and students' knowledge, as well as their attitudes, and practices about disposal of unwanted medications. Authors included qualitative, quantitative, and mixed-method primary research studies. Participants included pharmacists, doctors, nurses, and both undergraduate and postgraduate medical, pharmacy, and nursing students due to their significant involvement with medication and its disposal in healthcare settings. Data extraction was conducted by four of the researchers independently. The study details were categorised into three main domains i.e., knowledge, attitude, and practice using the KAP model. Other relevant information was also extracted, thematically, such as challenges and recommendations. Ethical approval was not required as this systematic review used previously published data. Results 37 studies from 18 countries (21 from Asia, 7 from the US, 5 from Africa, and 2 each from the EU and South America) met the inclusion criteria. 86.5% (n=32) investigated participants' knowledge of medication disposal. Although there is a good level of awareness about the environmental impacts, there are significant gaps in knowledge regarding correct disposal methods, available services, guidelines, and training. 30 studies explored participants' attitudes toward medication disposal. The results indicate a generally positive attitude towards the need for environmentally safe disposal practices. 35 studies evaluated participants' practices in relation to medication disposal. Although there was generally a positive attitude and some understanding of appropriate disposal methods, majority of the participants do not follow the practice guidelines, especially outside healthcare settings. This inconsistency may be due to numerous factors such as inadequate practical training, limited resources, or unclear guidelines. Discussion/ Conclusion Overall, it was found that while healthcare staff and students have fair knowledge and positive attitudes toward medicine disposal, their actual practices are lacking. One significant challenge identified is the limited awareness about proper disposal methods coupled with a lack of established services or guidelines in many regions. Even in cases where take-back programs are available, they often face issues with accessibility. To tackle these challenges, it is suggested by the studies that governmental bodies should establish and enforce clear policies on medication disposal while also expanding educational initiatives to increase understanding among healthcare professionals and students about appropriate disposal methods. Furthermore, improving access to take-back programs is crucial for ensuring safe medication disposal and minimising potential environmental and health hazards.

Provincial distribution and factors associated with self-reported sexually transmitted infections and their symptoms among women in Sierra Leone

BackgroundSexually transmitted infections (STIs) are a significant public health concern worldwide. These infections can have severe consequences for women’s health, including pelvic inflammatory disease, infertility, and increased risk of HIV acquisition. Understanding the prevalence and factors associated with STIs among women in Sierra Leone is crucial to developing effective prevention and treatment strategies. This study investigated the provincial distribution and factors associated with self-reported STIs (SR-STIs) and STI symptoms among women in Sierra Leone.MethodsThe study used data from the 2019 Sierra Leone Demographic and Health Survey, comprising 13,965 women aged 15 to 49 who have ever had sex. Provincial variations in the prevalence of SR-STIs and STI symptoms were presented using a spatial map. A binary logistic regression analysis was performed to assess the factors associated with SR-STIs and STI symptoms among women in Sierra Leone. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe overall prevalence of SR-STIs and their symptoms was 21.6% [20.4, 22.9] among women in Sierra Leone. Higher odds of SR-STIs and their symptoms were associated with being aged 25–29 (aOR = 1.35, 95% CI = 1.10,1.66), 30–34 (aOR = 1.38, 95% CI = 1.09,1.74), 35–39 (aOR = 1.39, 95% CI = 1.10, 1.77), having tested for HIV (aOR = 1.16, 95% CI = 1.04, 1.29), and having multiple sexual partners (aOR = 2.25, 95% CI = 1.80, 2.83) compared to those in the reference category. Being in the rich wealth index (aOR = 1.32, 95% CI = 1.11, 1.57), living in the Northern (aOR = 2.43, 95% CI = 2.08, 2.83) and Northwestern province (aOR = 3.28, 95% CI = 2.81, 3.83), and being covered by health insurance (aOR = 3.19, 95% CI = 2.62, 3.88) were associated with higher odds of SR-STIs and their symptoms. Lower odds of SR-STIs and their symptoms were found among women with one (aOR = 0.81, 95% CI = 0.68, 0.96), two (aOR = 0.75, 95% CI = 0.61, 0.93), three (aOR = 0.66, 95% CI = 0.53, 0.83), and four or more children (aOR = 0.62, 95% CI = 0.49, 0.77], those residing in rural areas (aOR = 0.81, 95% CI = 0.69, 0.94), and women living in the Southern province (aOR = 0.67, 95% CI = 0.57, 0.80) compared to those in the reference category.ConclusionThe findings indicate that SR-STIs and their symptoms are prevalent among women in Sierra Leone. Our findings underscore the urgent need for targeted public health interventions to address the SR-STIs and their symptoms among women in Sierra Leone. The increased risk among women aged 25–39, those with multiple sexual partners and those from wealthier backgrounds, suggests that educational programmes focusing on safe sexual practices and STI prevention should be prioritized in urban and affluent areas. Additionally, the lower odds of SR-STIs among women with more children and those in rural regions indicate that family dynamics and geographic factors may offer protective benefits, which could be leveraged in public health messaging. Our findings highlight the importance of tailoring health services and outreach efforts to effectively reach and support vulnerable populations, ultimately aiming to reduce the incidence of SR-STIs.

An audit of the adherence to dosing and therapeutic monitoring of intravenous vancomycin in accordance with the trust’s antimicrobial guidelines

Abstract Introduction Inappropriate vancomycin dosing and monitoring have compromised patient safety, causing acute kidney injury and prolonged hospital stays. Misuse of antibiotics, like vancomycin, accelerates resistance, a global health threat. Following guidelines can prevent harm and curb the emergence of vancomycin-resistant enterococci and resistant Staphylococcus aureus1. Aim To assess the level of adherence to trust guidelines for the dosing and monitoring of intravenous vancomycin. Audit Standards Standard 1: Patients prescribed intravenous vancomycin should have documented indication Standard 2: Patients prescribed intravenous vancomycin should have correct loading dose Standard 3: Patients prescribed intravenous vancomycin should have correct maintenance dose Standard 4: Patients prescribed intravenous vancomycin should have trough levels taken at the right time Standard 5: Patients prescribed intravenous vancomycin should have doses accurately adjusted against trough level Results: Standard 6: Patients prescribed intravenous vancomycin should have all prescribed doses administered (i.e. no missed doses). Standard 7: Vancomycin prescriptions should be screened by a pharmacist. Methods This audit was approved by both the Trust Clinical Audit Committee and the Antimicrobial Stewardship Group. A retrospective audit using data extracted from EPMA. The data collected included: indication documented (Yes/No), correct loading dose? (Yes/No), missed doses? (Yes/No), correct maintenance dose? (Yes/No), correct first sampling? (Yes/No), correct subsequent sampling? (Yes/No), correct dose adjustments based on levels? (Yes/No) and prescription screened by a pharmacist? (Yes/No). Data was input into Microsoft Excel for analysis. The period covered was 01/12/2022 to 31/05/2023. Ethics approval was not required, as clinical audits do not require ethical review. The inclusion criterion was adult patients prescribed intravenous vancomycin. The exclusion criteria were patients in maternity, labour, and renal wards, due to different guidelines and ITU due to no EPMA. The population size was 243; sample size (n) =150 ensuring a 95% confidence level. Results In total, 150 patient drug charts were analysed, of which 96 % had their vancomycin indication documented. 65.3% of patients had the correct loading dose, 64.7% had the correct maintenance dose. 32.23% had the initial trough level done at the right time and 35% had correct subsequent trough levels measured. 44% had correct dose adjustments based on their trough levels and 57.33% had their prescriptions screened by a pharmacist. Discussion and conclusion None of the target compliance rates were met, highlighting significant issues with vancomycin dosing and therapeutic monitoring within the trust. Therapeutic drug monitoring (TDM) is crucial to ensure optimal patient outcomes2. Audit findings have been shared with the wider multidisciplinary team, education on TDM has taken place with junior pharmacists and digital prompts on EPMA have been included to help improve adherence. A limitation of this audit is its retrospective nature, useful for trend analysis but not for identifying causes. A prospective audit was not feasible due to staffing pressures. Conducting clinical audits are an important tool for assessing and ensuring safe clinical practice.

Psychedelic and MDMA-Related Adverse Effects—A Call for Action

This Viewpoint discusses the need to better understand potential risks associated with psychedelic and 3,4-methylenedioxymethamphetamine (MDMA) use to ensure safe and ethical practice and identifies 4 key research goals.

Safety Practices and Perceptions Among Laboratory Employees at a Tertiary Care Hospital

Safety Practices and Perceptions Among Laboratory Employees at a Tertiary Care Hospital

Ensuring Safe Practice by Late Career Physicians: Institutional Policies and Implementation Experiences.

Late career physicians (LCPs; physicians working beyond age 65 to 75 years) may be at higher risk for delivering unsafe care. To oversee LCPs, some health care organizations (HCOs) have adopted LCP policies requiring cognitive, physical, and practice performance screening assessments. Despite recent controversies, little is known about the content and implementation of such policies. To characterize key features of LCP policies and the perspectives of medical leaders responsible for policy development and implementation. Mixed-methods study using content analysis and key informant interviews. 29 U.S. HCOs with LCP policies active in 2020. 21 purposively sampled interviewees in physician leadership roles at 18 HCOs. Descriptive statistics of policy features and content analysis of interviews. Although policies had many commonalities-mandatory universal screening at a trigger age around 70 years, a strategy of screening followed by in-depth assessment of positive results, and commitment to patient safety as the key motive-they varied substantially in the testing required, funding, processes after a positive screening result, and decision making around concerning results. Policies prioritized institutional discretion in interpreting and responding to test results; many lacked clear language about appeals or other procedural protections for physicians. Leaders were generally satisfied with policies but reported preemptive retirements as physicians approached the screening age and cautioned that substantial investment in cultivating physicians' buy-in was required for successful rollout. Sampled policies and interviews may not be representative of all HCOs. The analysis excluded the experiences of HCOs that tried and failed to implement LCP screening. Policies about LCPs are considered successful by institutional leaders. Policy variations and early adopters' implementation experiences highlight opportunities to improve physician acceptance and program rigor. The Greenwall Foundation.

External drivers of changes in wildland firefighter safety policies and practices

Background Firefighter safety is a top priority in wildland fire response and management. Existing explanations emphasise how land management agency initiatives to change organisational culture, usually inspired by fatality incidents, contribute to changes both in formal safety policies and informal safety practices. Aims This paper identifies external factors that lead to changes in wildland firefighter safety policies and practices. Methods This paper uses qualitative data from a long-term ethnographic research project. Data include detailed fieldnotes, semi-structured interviews, and agency documents, which were systematically coded and thematically analysed. Key results In addition to the triggering effects of fatality incidents and agency initiatives to change organisational culture, external factors also directly impact the development of firefighter safety policies and practices. These include sociodemographic, material, political, and social-environmental factors. Conclusions Identifying and understanding the influence of multi-scalar external factors on firefighter safety is essential to improving safety outcomes and reducing firefighters’ exposure to hazards. Implications Attention to and recognition of external factors is valuable for fire managers and practitioners, whose work is influenced and constrained by meso- and macro-level factors. The framework presented in this paper would be useful in understanding other important aspects of wildland fire management.

ASSESSMENT OF NURSES' KNOWLEDGE REGARDING SAFE PATIENT LIFTING AND HANDLING IN TERTIARY CARE HOSPITALS

Safe patient handling is a critical aspect of nursing care, aimed at preventing musculoskeletal injuries among healthcare providers and ensuring patient safety. In Pakistan, nurses face challenges such as limited access to handling equipment and inconsistent training, increasing their risk of injury and affecting patient care quality. Objective: This study assesses nurses' knowledge of safe patient lifting and handling and explores demographic and professional factors influencing this knowledge. Methods: A cross-sectional study was conducted among 200 nurses at the Department of Nursing, Superior University, Lahore, using a self-structured questionnaire. The questionnaire comprised demographic and professional information, alongside a 15-item knowledge assessment on safe patient handling. Correct responses were scored, and the mean score was calculated to categorize knowledge as "good" or "poor." Data analysis was conducted using SPSS version 22.0, employing descriptive statistics and chi-square tests for associations, with p≤0.05 considered significant. Results: Of the 200 nurses surveyed, 56.0% demonstrated good knowledge of safe patient handling, while 44.0% exhibited poor knowledge. Significant associations were found between knowledge levels and gender, qualifications, work position, and department. Females and those with advanced qualifications had higher knowledge levels, while age and work experience showed no significant influence. Nurses who had received training reported higher knowledge, though the difference was not statistically significant (p=0.16). Conclusion: The findings indicate that a significant proportion of nurses lack adequate knowledge of safe patient handling, highlighting the need for enhanced training and resources. Targeted interventions considering demographic and professional variations can bridge knowledge gaps and promote safer handling practices, reducing occupational risks and improving patient care quality. Further studies are recommended to explore institutional policies and cultural factors that may impact the adoption of safe patient-handling practices in Pakistan.

Sun protection strategies of young children and their parents: A comparative, cross-sectional study from Türkiye

This study aimed to investigate the frequency of sun protection measures used by young children and their parents and evaluate the possible effect of parental knowledge and behavior on their children’s sun safety practices. A sun safety awareness test and a self-reported questionnaire survey regarding sun protection strategies, reasons and barriers for using these methods were conducted on parents of children aged 3-5 years between June and December 2023. One hundred fourty parents (median age: 35, female:male ratio=4:1) were included. Parents who sought advice from their physicians (14.0) had a higher median awareness score than those who did not (12.0) (p

Assessment of egg quality, food safety, and hygiene practices among commercial and non-commercial farms of Barwala district of Panchkula, Haryana

ABSTRACT Background: The aim of the present study was to assess the egg quality, food safety, and hygiene practices in egg production among commercial and non-commercial farms. Methods: A total of six, each commercial and non-commercial farm, were randomly selected form Barwala district, Panchkula, Haryana, for this study in 2019. A detailed interview on hygiene practices of farm workers was conducted. Egg samples were procured for external (N = 60) and internal (N = 24) egg quality determination. The swap samples (N = 24) were also analysed for bacterial contamination. Descriptive statistics were used for reporting the results, and Chi-square test was conducted for determining significant differences between commercial and non-commercial farms. Results: The egg yolk percentage (34.49%) and egg shell percentage (12.76) were higher among non-commercial farms. However, no significant external (P = 0.890) or internal (P = 0.367) egg quality difference was found between commercial and non-commercial farms. The biosecurity and disinfection management, daily waste disposal practice, fly and rodent control practice, farm activity record, and flock health monitoring were relatively better among commercial farms. There were no significant differences found in any of these assessments. The colony forming units (cfu) for salmonella and coliform were acceptable in three and four procured samples from commercial farms, respectively, whereas none were within acceptable levels among non-commercial farms. Conclusion: The internal egg quality, food safety, and hygiene practices were relatively better among commercial farms as compared to non-commercial farms. This requires further validation through a large sample-sized study.

Mitigating risks in hydrogen-powered transportation: A comprehensive risk assessment for hydrogen refuelling stations, vehicles, and garages

Hydrogen is increasingly seen as a viable alternative to fossil fuels in transportation, crucial to achieving net-zero energy goals. However, the rapid expansion of hydrogen-powered transportation is outpacing safety standards, posing significant risks due to limited operational experience, involvement of new actors and lack of targeted guidelines. This study addresses the urgent need for a tailored comprehensive risk assessment framework. Using Structured What-If (SWIFT) and bowtie barrier analysis, the research evaluates a hypothetical pilot project focusing on hydrogen refuelling stations, vehicles, and garages. The study identifies critical hazards and assesses the adequacy of current risk mitigation measures. Key findings reveal gaps in safety practices, leading to 41 actionable steps and 5 key activities to help new actors manage hydrogen risks effectively. By introducing novel safety guidelines, this research contributes to the development of safe hydrogen use and advances the understanding of hydrogen risks, ensuring its sustainable integration into transportation systems.

Role and Impact of Safety Leadership Culture in Promoting Safety Practices in Construction Sector of Pakistan

The construction industry offers employment to about one hundred eighty million people worldwide. The construction sector has grown and evolved to meet the demands of urbanization and industrialization, which are the foundation of the modern economy. Construction is still seen as a risky and difficult industry, with the most hazardous and vulnerable work environment, even with the industry's notable improvements. Pakistan's construction industry is known for its high level of risk, which makes strict safety procedures necessary to protect the health and safety of its workforce. This research seeks to understand the impact of safety leadership on safety practices and identify key factors influencing safety culture. In order to provide comprehensive insights, the research uses a mixed-methods approach that combines quantitative surveys and qualitative interviews. The validity and reliability of the results are ensured by thorough experimentations of the statistical methods such as reliability test, relative importance index (RII), and descriptive analysis tests. In order to effectively promote safety practices, management commitment, employee involvement, safety training, and good communication are essential. An in-depth examination of the relationship between management commitment and safety performance reveals how effective leadership and proactive participation improve safety results. The results shows that safety leadership is crucial to encourage safety procedures in Pakistan's construction sector by 68.81%, success factor for safety management by 65.42%, safety management practices by 64.32%, safety performance by 63.35%, barriers to effective safety management 62.47% and safety culture by 61.46%. Strengthening frameworks for regulations, promoting a safety-first culture, investing more in safety equipment, improving worker safety training, improving monitoring and evaluation mechanisms, fostering communication and collaboration, and addressing cultural barriers are just a few of the recommendations.

Phrenic nerve infiltration: a good practice to combine pulmonary expansion and pain control in patients with high-risk of prolonged air leak.

ObjectiveProlonged air leak (PAL) due to residual air space after lung resection is a main challenge. To date, few surgical options have been described to prevent this complication. The aim of this study is to investigate the safety and the efficacy of intra-operative phrenic nerve infiltration with long-acting anaesthetics in producing transient hemidiaphragm paralysis in patients at high risk for PAL, thus improving pulmonary expansion after surgery, and reducing air leaks, while controlling post-operative pain. MethodsBetween January 2021-2023, 65 consecutive patients at risk for PAL (defined in accordance with “2019 Society of Thoracic Surgery score-criteria of PAL”) who underwent lung resection (lobectomy or anatomical segmentectomy) for malignancy were prospectively included in the study. They have been randomly (1:2 ratio) assigned to receive (group A, 22 patients) intra-operative phrenic nerve infiltration with Ropivacaine 10 mg/ml in the peri-neurotic fat on the pericardium or not to receive intra-operative phrenic nerve infiltration (group B, 43 patients). Five patients of Group B have been excluded because they did not undergo anatomical resection. Data on pulmonary re-expansion, prolonged air leaks, pain at 24- and 72-hours post-surgery, referred shoulder pain, length of hospital stay, length of chest tube permanence, were collected and compared. ResultsHemidiaphragm elevation (p=0.006) and pulmonary expansion (p=0.000) were significantly higher in Group A. Patients in Group A showed lower pain at 24 and 72 hours compared to Group B (p=0.004). Shoulder pain (0.001) and prolonged air leak (0.000) were higher in Group B. Length of chest tube was longer in group B. No difference in hospital stay length was observed. ConclusionThis is the first study to investigate two combined effects of phrenic nerve anaesthetic infiltration (hemidiaphragm elevation and pain control), with potential enhancement of patient’s recovery after surgery. Intraoperative phrenic nerve infiltration in patients with risk for PAL appears a safe and effective clinical practice to improve pulmonary expansion in this set of patients, reducing post-operative air leak. This result is associated with an additional improvement in pain control, especially for shoulder pain.

Effective Compliance to Technical Regulations - Why is Compliance to the Orbital Debris Mitigation Rules So Poor?

Adherence to debris mitigation guidelines is critical for future robust space traffic management (STM). Debris mitigation guidelines are reviewed and their effectiveness at managing the space object population are contrasted against the means to comply with the guidelines. Specific concerns related to the deployment of large constellations are detailed to provide potential trade-offs for consideration in enhanced tracking systems to enable safe and efficient STM practices. The balance between reducing future debris deposition and minimizing the operational burden on satellites to maintain reliable operations are examined.

An Exploratory Study: Controversial Beliefs and Practices of Hijama Practitioners of Karachi, Pakistan

Background: Cultural and spiritual beliefs have preserved the use of traditional practices, including al hijama (wet cupping), which is widely recognized for its purported therapeutic value and historical significance. Despite its popularity, the practice often lacks formal training and is frequently administered by unqualified practitioners, leading to false beliefs and potentially unsafe practices. Objective: To investigate the scientific knowledge and beliefs of hijama practitioners of Karachi, Pakistan, with a focus on identifying misconceptions, variations in practice, and the influence of cultural and religious beliefs on the practice of hijama therapy. Methodology: A cross-sectional exploratory study was conducted involving 114 hijama practitioners from Karachi, who were recruited through various WhatsApp groups and enrolled in a seminar held in January 2023. The participants were required to complete a 37-item questionnaire covering their qualifications, practice methods, hygiene standards, and beliefs about the hijama therapy. Data were analyzed using spss version 20, employing mean, standard deviation, chi-square tests, and frequency distribution. Results: Most participants (97.4%) were female, with only 39.5% possessing a license to practice. Many practitioners (89.5%) were motivated by the religious significance of hijama. The knowledge regarding the scientific theories and mechanism of action of hijama therapy was known by 56.4%. Practices varied widely regarding hygiene, blade type, and cup placement. 38.1% did not consistently check for infectious diseases. Additionally, the practice of reciting Qur’anic verses was widespread, believed to enhance the therapy's effectiveness which shows strong religious connotation. Conclusion: The study reveals a substantial gap in formal training among hijama practitioners, leading to variations in practice and potential safety concerns. There is a pressing need for standardized training and regulations to ensure the safe and effective practice of hijama therapy. Further research is essential to establish evidence-based guidelines which improve the public and physician awareness towards this therapy’s risks and benefits.

UNDERSTANDING THE LEVEL OF KNOWLEDGE AMONG NURSES ABOUT FIRE SAFETY IN TERTIARY CARE HOSPITAL LAHORE

Fire safety in healthcare facilities is an important but frequently disregarded part of hospital administration and patient care. Despite substantial study on different aspects of healthcare delivery, there is still a significant gap in understanding and measuring fire safety knowledge and practices among healthcare personnel, particularly in Pakistan's tertiary care facilities. Objective: The purpose of this study was to assess the degree of fire safety knowledge among medical personnel at a tertiary care hospital in Lahore, Pakistan, to identify any shortcomings that may affect their capacity to respond effectively in the event of a fire. Methods: A cross sectional quantitative descriptive study was conducted at Public Tertiary care hospital in Lahore involving 202 nurses. A customized questionnaire was administered to assess the participant’s fire safety knowledge, selected through successive sampling. Data analysis was performed using SPSS version 22.0, categorizing knowledge level as poor, average and good. Results: 85% of survey participants were aware of fire response procedures. However, only 15% knew the fire department contact numbers, and 25% were unaware that foam or water extinguishers are ineffective against grease fires. Additionally, a significant proportion of participants struggled to correctly identify different types of fire extinguishers (65%) and fire categories (50%). The finding underscore the importance of comprehensive fire safety training to address significant knowledge gaps. Conclusions: Healthcare institutions should develop comprehensive fire safety training programs that extend beyond basic emergency protocols. Regular fire drills and simulations should be held to check staff members' understanding and reinforce fire safety procedures. Administrators should examine and update fire safety protocols on a regular basis to reflect new technology, legislation, and lessons learnt from previous events.