Social Security Hospital Research Articles

Burnout syndrome and occupational quality of life in healthcare workers of a tertiary care social security hospital: a gender-perspective analysis

Burnout syndrome and occupational quality of life in healthcare workers of a tertiary care social security hospital: a gender-perspective analysis

Patients’ sense of security from clinical factors in Iran: a cross-sectional study

BackgroundOne of the clinical responsibilities and goals of hospitals is to provide patients with comfort and security. The present study aims to assess patients’ sense of security among patients in Iranian hospitals.MethodsThe present research employed a cross-sectional design. The sample consisted of 830 patients visiting public, private, and social security hospitals in Mazandaran in the North of Iran. The required data were collected using a questionnaire developed by the researcher of this study.This questionnaire consisted of 4 dimensions:nursing, medical, advanced facilities and patient rights. The participants were selected using a proportional stratified random sampling method. Exploratory factor analysis, confirmatory factor analysis, descriptive statistics, and ANOVA were used for data analysis using SPSS version 22.ResultsThe mean scores of patients’ sense of security in social security, private, and public hospitals were 4.16 ± 0.89, 3.78 ± 0.67, and 3.60 ± 0.89, respectively. Medical factors with a mean and standard deviation of 3.92 ± 0.76, advanced facilities and equipment with 3.89 ± 0.89, nursing factors with 3.87 ± 0.73, and patient rights with 3.71 ± 0.90 were the highest to the lowest scores, respectively. The results showed that the type of hospital significantly affected the mean dimensions of security (p < 0.05).ConclusionsThe study revealed variations in the sense of securityacross the sampled hospitals. Particularly, the sense of security attributed to the patient rights factors was lower than other factors. Therefore, to enhance the sense of security for patients, it is recommended to focus on staff training and fostering a culturethat emphasizes obtaining informed consent, demonstrating respect for the patient, and introducing the medical team to the patient before initiating any treatment.

Managed Care After Discharge of COVID-19 Patients in North Iran

Background and Purpose: After-discharge follow-up is one of the branches of managed care used for information exchange, health education, early diagnosis of symptoms, symptom management, and high-quality aftercare services. The present study aims to elucidate the managed care of COVID-19 patients after discharge from hospitals affiliated with Mazandaran University of Medical Sciences, Mazandaran Province, Iran. Materials and Methods: The present cross-sectional study was conducted in 2019. The study sample included all COVID-19 patients discharged from public, private, and social security hospitals affiliated with Mazandaran University of Medical Sciences. The census method was used to recruit 14625 discharged patients. The data collection tool was based on the information registration form “Follow-up of the treatment process of discharged COVID-19 patients,” which was prepared in three sections (demographic, clinical characteristics, and follow-up of the treatment process) based on the opinions of 15 experts. Data analysis was carried out via the chi-square test in SPSS software, version 21. Results: The findings of the demographic section showed that 35.8% of COVID-19-related admissions were over 65 years old. Intensive care unit (ICU) admissions were necessary for 13% of cases, with the highest ICU admission rates among those aged 65 and above. Based on the findings of the clinical characteristics section, the most common underlying disease (46.7%) was diabetes, and the most common symptom upon admission was fever (higher than 38°C) (44.8%). Also, according to the findings of the “treatment follow-up” section, 7.04% of the discharged patients were readmitted, and 14.5% of patients infected their family members with COVID-19. Also, 57.82% adhered to the health and safety protocols and self-quarantine at home, which varied in different months. Conclusion: Follow-up after the discharge of COVID-19 patients as one of the branches of managed care increased the compliance with health principles and decreased the rate of COVID-19 infection of the patient’s family members and the readmission of patients. Therefore, appropriate follow-up after discharge is suggested as a low-cost method to shorten the recovery period of patients, prevent other family members from contracting this disease, and detect the worsening of disease symptoms among discharged patients.

Incidence of Unintended Intraoperative Awarness in Total Intravenous Anesthesia Using Modified Brice Scoring System as a Tool

Objective: Current study was planned to assess the incidence of awareness in patients undergoing general anesthesia (GA).&#x0D; Methodology: Cross sectional study was conducted at Sindh Employees Social Security Hospital Landhi Karachi from June 2021 to May 2022 in one-year duration. A total of 200 patients who underwent various surgical procedures, including septoplasty, endoscopic sinus surgery (FESS), mastoidectomy, laparoscopic procedures, all performed under general anesthesia. Primary variable of study was intraoperative awareness that was assessed by using Brice scoring system.&#x0D; Results: Modified Brice questions were asked to all of the patients. It was seen that 96.5% patients completely asleep for this operation. 9.5% patient’s memory about going to sleep and waking up. 8.0% patients had dream during the procedure. In our study, 9.5% patients were aware categorized as A, 36.0% patients were possible aware categorized as B and 54.5% patients had no awareness.&#x0D; Conclusion: The current study reveals a notably elevated incidence of intraoperative awareness in patient when compared to previous research, indicating a significant association between awareness and comorbidities among individuals undergoing surgery under general anesthesia.

The Relationship Between Effective Listening Skills and Job Satisfaction According to Organizational Health as a Mediator Variable among the Employees of Ahvaz Social Security Hospital: A Structural Equation Model

The present study was conducted to determine the relationship between effective listening skills and job satisfaction according to the mediatory role of organisational health among the employees of Ahvaz Social Security Hospital. The statistical population of the study consisted of the employees of Ahvaz Social Security Hospital, and the study sample included 230 of this population, who were selected by random sampling. The study tools included the Glenn and Pood Effective Listening Self-inventory, the Hoy and Feldman Organisational Health Scale, and the Minnesota Job Satisfaction Questionnaire (MSQ). The study hypotheses in the proposed conceptual model were tested in AMOS-23 and SPSS-23 using structural equation modelling. Based on the values of Pearson correlation coefficients and ( p &lt; .05), a positive and significant relationship between the main variables of the study was confirmed. In the case of model fit, normal chi-square test and other model fit statistics of NFI, RFI, IFI, TLI, and CFI were all close to or higher than 0.9. The main hypothesis of the study was proved by the structural equation modelling model through Amos software and all the fit indices of the model indicated the proper fit of the proposed model.

Relationship between Strategic Knowledge Management and Self-Management and Organizational

Background: Strategic knowledge management is widely recognized as a pivotal resource for the success of contemporary organizations. Self-management skills of managers are instrumental in fostering an organization’s growth and sustainability in the long run. The present study explores the relationship between strategic knowledge management and self-management and organizational development among managers in Social Security (Tamin-e Ejtemaei) Hospitals in the city of Isfahan.&#x0D; Methods: This was a practical, descriptive, and survey-based research with a correlational design, classified as field study. This study was conducted in 2022 on 117 managers of Tamin-e Ejtemae’i hospitals (Dr. Ali Shariati Hospital and Dr. Gharazi Hospital) in the city of Isfahan. Strategic knowledge management was measured using Lopez-Nicholas and Mariano-Cardenas questionnaire, self-management was evaluated through SMSQ questionnaire devised by Houghton and Neck, and organizational development was assessed using the Lok and Crawford questionnaire. The collected data underwent analysis using SPSS 26 software and the statistical methods applied Spearman’s rank correlation test, Tukey’s test and significance level was set at 0.05.&#x0D; Results: A significant correlation was observed between strategic knowledge management and self-management (P-value = 0.027), strategic knowledge management and organizational development (P-value = 0.000), and between organizational development and self-management (P-value = 0.000). Regarding organizational development, the highest average score was associated with relationships (a score of 20.5172); for strategic knowledge management, explicit knowledge received the highest average score (a score of 21.2632), and concerning self-management, personal goal setting obtained the highest average score (a score of 20.1810).&#x0D; Conclusion: Investing in strategic knowledge management, focusing on intellectual capacities, and increasing managers’ self-management improves performance and organizational development in hospitals.

Diagnostic accuracy study of globular sedimentation rate and C-reactive protein in patients with systemic lupus erythematosus and fever admitted to a Social Security hospital in Lima, Peru, 2010–2019

IntroductionIn patients with systemic lupus erythematosus (SLE) and fever, the causes are infection and/or activity. We assessed the diagnostic accuracy of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to discern these causes. MethodsWe reviewed medical records of patients with SLE and fever hospitalized from 2010 to 2019. Based on two categories of cause of fever (infection with-or-without activity versus activity alone), we computed ROC curves, areas under the curve (AUC) and best cut-off values for ESR, parameter ESR, CRP and ESR/CRP ratio. In addition, we calculated sensitivity, specificity, and predictive values. ResultsWe included 40 cases (34 women) with an average age of 35.5 years. The main cause of fever was the coexistence of infection and activity (17/40; 43%), followed by fever only due to activity (14/40; 35%). The most frequent infection was pneumonia (10/40; 25%) and the most common activity was renal (21/40; 53%). To diagnose “fever due to infection with-or-without activity”, compared to “fever only due to activity”, CRP had an AUC: 0.86 (95% CI: 0.75–0.97) with 5.4 mg/dl as the best cut-off value (Se: 76.9%; Sp: 85.7%; PPV: 90.9; NPV: 66.6%). To diagnose “fever due to activity only”, compared to “fever due to infection with or without activity”, the ESR/CRP ratio had an AUC: 0.83 (95% CI: 0.68–0.98) with 21.42 as the best cut-off value (Se: 78.6%; Sp: 84.6%; PPV: 73.3%; NPV: 88.0%). ConclusionCRP and ESR/CRP ratio, which are routine tests in these cases, are potentially useful in discerning causes of fever in SLE patients. These findings should be confirmed in future studies.

Relationship between Patient’s Satisfaction and level of emotional Intelligence in Nurses Working in Tertiary Care Hospital

Emotional intelligence is the ability to sense what is going on, to understand how it feels while in that circumstance, to effectively analyses and consider other people's thoughts and feelings, and to respond accordingly. It can be defined as the ability to correctly recognize one's own and others' emotions. Objectives: To determine the association between patients’ satisfaction and level of emotional intelligence (EI) in nurses working in medical and surgical department in tertiary care hospitals, Lahore. Methods: A correlational study design was used to carry on this study. This study was conducted at Mayo Hospital and Social Security Hospital Kot Lakh Pat Lahore. The duration of the study was six months from Jan, 2023 to June; 2023.The study participants were registered nurses (both male and female) and admit patients (both male and female) there. Purposive sampling technique was used n=265 participants were recruited. To assess the performance among nurses and patients, an observational checklist was used. Data of the study participants was entered in statistical software SPSS version 21.0 and was analyzed accordingly. Results: This study shows that there are statistically non-significant differences between patient’s satisfaction and emotional intelligence. The results revealed a non-significant association between nurses' emotional intelligence and patient’s satisfaction, as p-value is p=.381 which is non-significant. So, we reject the alternative hypothesis and accept the null hypothesis. Conclusions: It is concluded that nurse’s emotional intelligence has no relationship on patient’s satisfaction, Nurse’s emotional intelligence and its association with patient’s satisfaction, which results were non-significant.

The effect of family-centered empowerment program on self-efficacy and perceived stress in patients with acute coronary syndrome in yazd social security hospital

Objectives: One of the most common cardiovascular diseases is coronary heart disease. Key issues facing cardiovascular patients are their psychological problems and perceived stress. Stressful situations lower self-efficacy and increase dependence on others, including family members.The aim of this study was to investigate the effects of a family-centered empowerment program on self-efficacy and stress perceptions in acute coronary syndrome patients at Yazd Social Security Hospital.&#x0D; Methods: This education-oriented and semi-experimental study was conducted on patients with acute coronary syndrome referred to Yazd Shohadaye Kargar Hospital in 2018-2019. Eighty-four patients with acute coronary syndrome who were eligible to participate in the study were selected and randomly assigned to experimental and control groups by random assignment software.The experimental group underwent individual self-efficacy sessions and stress perception training in the presence of active family members, followed up by telephone, and held four group sessions every two weeks.&#x0D; Results: There was no statistically significant difference in pre-intervention self-efficacy mean scores between the experimental and control groups, but self-efficacy mean scores in the experimental group were higher immediately after the intervention and after two months interval than in the control group (p &lt;0.001). Also, there was no statistically significant difference between the perceived stress mean scores before the intervention in the experimental and control groups. But immediately after the intervention, the perceived stress mean score in the experimental group appeared to be higher than the control group (p &lt;0.001).&#x0D; Conclusions: Implementing a family-centered empowerment program can improve self-efficacy and reduce perceived stress in patients with acute coronary syndrome, lasting up to two months after the intervention. This affordable and low-cost intervention can thus be used to improve the health of acute coronary heart disease patients.

Frequency of Vitamin D Deficiency and associated Factors Among Pregnant Women Visiting Tertiary Care Hospital, Gujranwala, Pakistan

Objectives: To assess the frequency of deficiency of vitamin D and associated factor among gravid women following up at antenatal clinic of social security hospital, Gujranwala Method: It was a cross-sectional study carried out at antenatal clinic social security hospital, Gujranwala. Total 100 pregnant females who were on follow-up visits and gave consent were enrolled in this study through a non-probability purposive sampling technique. A semi-structured and pre-tested questionnaire with anthropometric measurements and blood sample for vitamin D levels assessment was used to collect data and analysis was performed through SPSS version 23 Results: Among one hundred participants, two participants had deficient levels, 41 had insufficient and 57 had sufficient levels of vitamin D. Study participants had mean age of 28.8 ± 4.23 years. Mean duration of marriage and gestational period were 6.49 ± 4.0 years and 30.49 ± 10.49 weeks respectively. The mean vitamin D level was 29.9 ± 8.1ng/ml. Complaints such as backache, leg cramps, fatigue, gravidity, parity and low systolic Blood pressure were significantly associated with insufficient/low vitamin D levels. Conclusion: Deficiency of vitamin D is high in study participants hence need based supplementation to gravid women is suggested.

A model of managerial competencies affecting the performance of social security hospitals in Tehran, Iran

A model of managerial competencies affecting the performance of social security hospitals in Tehran, Iran

Results and Feasibility of the Virtual Inspection of Clinical Trials During Pandemic of COVID-19 in Peru.

This study aimed to describe the results of inspection of clinical trials (CTs) and the feasibility of conducting inspections virtually in Peruvian Social Security hospitals during the pandemic of COVID-19. This study described 25 CTs that were inspected during August 2021-November 2021. The data for the variables were obtained from the CT inspection database of the Social Security Sub-directorate of Regulation and Management of Health Research which includes minutes and inspection reports. We describe the characteristics of the CT included and findings during the inspections using relative and absolute frequencies. Likewise, we evaluated the feasibility of virtual inspection through a self-administered questionnaire. According to the findings of the inspection, 60% of CTs were on biological products, and 60% were focused on infectiology. Additionally, 64% of CTs were implemented in Lima, 52% were conducted in level IV health facilities, and 72% were funded by the pharmaceutical sector. The lack of submission of requested documents (16/25) and inadequate access to the internet (9/15) and source documents (4/15) were the primary observations during the inspection. Regarding the feasibility of virtual supervisions, most interviewees rated their understanding of instruction form as "normal" and its content as "adequate." Similarly, in the virtual self-assessment matrix, a large proportion of interviewees rated comprehension as "normal" (7/15) and its content as "adequate" (13/15). The quality of the virtual supervision process was 8.6 ± 1.1 on a scale of 1-10. Discrepancies in records and failure to submit requested documents were the main observations. Most interviewees considered the material to be adequate and gave an overall good rating to the virtual inspection process.

Risk Factors of Intestinal Perforation Associated with Peritonitis

Perforation is known as an abnormal opening in an empty organ. It is copied from the Latin word perforatus, meaning “to bore through.” In western world the estimated frequency of intestinal perforation ranges from 0.6% to 4.9%. Objective: To find out the risk factors of intestinal perforation associated with peritonitis. Methods: It was a cross-sectional study and data was collected from February 2022 to July 2022. Data was collected from, DHQ Teaching Hospital Gujranwala and Social Security Hospital Multan chungi Lahore. Calculated sample size was 50 based on prevalence (0.68%) of intestinal perforation through an online sample size calculator (CI 95% and margin of error=0.09%). Patients of both genders with age limit of 10-60 years and patients presenting with perforation peritonitis were included in this study. Patients with Post-operative peritonitis and Immuno-compromised patients were excluded from study. Patient demographic information was collected. For demographic variables and risk factors of intestinal perforation descriptive analysis was used. Ethical approval has been obtained from concerned department and statistical analysis was done using SPSS version 24. Results: Out of 50 patients 38% were female and 62% were male. Major risk factors for intestinal perforation were Appendicitis (32%), Trauma (26%), Abdominal distension (24%) and Intestinal obstruction (20%). Conclusion: This study concludes that intestinal perforation is commonly seen between the age group of 21-30 years. Common risk factors of intestinal perforation are fever, appendicitis, trauma, abdominal distension, followed by intestinal obstruction, ascites and infection. The most commonly found perforation is duodenal perforation.

Evaluación de riesgos y mejora de la seguridad biológica y radiológica en la toma de radiografía torácica a pacientes con COVID-19

IntroductionHealth workers are at high risk of becoming infected with COVID-19. The objective of the study was to evaluate the risks and improve the biological and radiological safety measures for taking chest X-rays in patients with COVID-19 in a Social Security hospital in Utcubamba (Peru). Material and methodsQuasi-experimental intervention study type before and after without a control group, carried out between May and September 2020. A process map and an analysis of failure modes and effects (FMEA) of radiological care were prepared. The gravity (G), occurrence (O), and detectability (D) values ??were found and the risk priority number (RPN) was calculated for each failure mode (FM). FM with RPN ≥ 100 and G ≥ 7 were prioritized. Improvement actions were implemented based on the recommendations of recognized institutions and the O and D values ??were re-evaluated. ResultsThe process map consisted of 6 threads and 30 steps. 54 FM were identified, 37 of whom had RPN ≥ 100 and 48 had G ≥ 7. Most of the errors occurred during the examination 50% (27). After entering the recommendations, 23 FM had RPN ≥ 100. ConclusionsAlthough none of the measures applied through the FMEA made the failure mode impossible, they made it more detectable and less frequent and reduced the RPN for each failure mode; however, a periodic update of the process is necessary.

Association between nutritional risk, hospital stay and medical diagnosis among patients from a Peruvian social security hospital

Objective: To determine the association between nutritional risk, hospital stay and medical diagnosis among patients admitted at Centro Especializado de Rehabilitación Profesional (CERP) of Hospital Nacional Guillermo Almenara Irigoyen. Materials and methods: An observational retrospective longitudinal cohort study was conducted with inpatients between July 1, 2021 and February 27, 2022. The patients were followed up until they left the hospital (discharge). Individualsunder 18 years of age, pregnant or puerperal women, and those whose stay was less than 24 hours were excluded. The data of interest was collected from the patients’ medical records and diet cards. The main variable was the nutritional risk, which was detected using the Nutritional Risk Screening (NRS) 2002. The secondary variables were age group, sex, hospitalstay, main medical diagnosis, discharge condition and nutritional status. Data analysis was performed using the chi-square test to compare the qualitative or categorical variables, and the Student’s t-test and ANOVA for the quantitative variables. A value of p &lt; 0.05 was considered as statistically significant. Results: A total of 1,929 patients were included in the study. Nutritional risk prevalence accounted for 33.13 %. Patients with this condition showed the highest mortality rates (57.51 %). It was found that nutritional risk prevalence was related to a longer hospital stay (4.6 more days) (p &lt; 0.001), a diagnosis of constitutional thinness (48.67 %) (p &lt; 0.001) and themedical diagnosis, being oncology disorders the most associated ones (50.93 %). Conclusions: Nutritional risk is associated with disease progression, resulting in an increased hospital stay, mortality rate and therefore hospital costs. Early detection is important to provide adequate dietary interventions.

Comparison of Quality of life, Thyroid Hormones, and Blood Glucose in Active and Inactive Pregnant Women

Background and Objectives Pregnancy is one of the most important periods of a woman's life, which affects most body systems due to the extensive metabolic needs of pregnancy. This research aimed to compare quality of life, thyroid function, and blood glucose profile in active and inactive pregnant women. Subjects and Methods In the present study, 120 pregnant women were purposefully selected from the pregnant women who were referred to the women's Clinic of Amir al-Momenin and Social Security Hospital in Ahvaz, Khuzestan province, Iran, in 2022. The activity and inactivity of pregnant women were based on the Pregnancy Physical Activity Questionnaire (PPAQ). In addition, the participants completed the quality of life questionnaires (WHOQOL-BREF). To measure thyroid hormones and sugar profile, blood sampling was done in the Hospital Laboratory while fasting. The data were analyzed using multivariate analysis of variance and independent t-test. Results The results of the present research showed that active pregnant women had significantly higher quality of life and T3 and T4 hormones compared to inactive pregnant women. Furthermore, active pregnant women had significantly lower fasting blood glucose, two-hour blood glucose, and thyroid-stimulating hormone compared to inactive pregnant women. Conclusion Overall, the present study emphasizes the importance of the role of physical activity on the psychological and physiological variables of pregnant women and suggests exercise interventions in future research.

Evaluation of Hospitals on green hospital standards in Qazvin

Introduction: Hospitals may have an adverse effect on the environment. The World Health Organization (WHO) introduced the concept of Green Hospital to reduce these complications while also improving the environment. The purpose of this study was to assess how many hospitals in Qazvin met Green Hospital standards.Methods: This descriptive-observational study was carried out in all of the hospitals in Qazvin that were included in the study via the census sampling method. The standard green hospital questionnaire was used to collect data, which was completed with environmental experts through interviews and document observation. This questionnaire has 96 questions and is divided into eight dimensions: environmental, energy, hazardous materials, water, sewage, greenhouse gas emissions, external water consumption, material, and environmentally friendly purchasing management. Each question is graded on a three-point Likert scale ranging from 0 to 2.Results: This study included nine hospitals. Six were teaching/public (5 teaching hospitals and 1 Social Security Hospital), and three were public. The average ratio of active beds to approved beds was 90%, with private hospitals reaching more than 100% (131%). The mean achievement rates for the first through eighth dimensions were 70.08, 74.07, 74.07, 60.88, 40.87, 27.77, and 31.48, respectively. The overall mean score for meeting Green Hospital standards was 57.46%.Conclusions: Although hospitals achieved higher achievement rates in some dimensions, overall results showed low achievement rates. As a result, their managers and employees must learn how to prevent environmental degradation.

Comparison of Visual Outcomes between Phacoemulsification and Small Incision Cataract Surgery

Background: Globally, it is approximated that there are around 100 million cases of cataracts resulting in visual acuity of less than 6/60, and this number is expected to increase to approximately three to four times more for cases causing acuity of less than 6/18. Small incision cataract surgery is distinguished by its ability to provide early wound stability, reduce post-operative inflammation, eliminate suture-related complications, necessitate fewer post-operative visits, and have a milder impact on the corneal endothelium. This approach can be applied to all types of cataracts, unlike phacoemulsification, where careful case selection is particularly crucial, especially for less experienced surgeons. Objective: The objective of this study is to compare the visual outcome between Phacoemulsification and Small Incision Cataract surgery. Method: An experimental interventional study was conducted concurrently at Kulsoom Bai Valika Social Security Hospital and Sindh Govt. Qatar Hospital from January 2022 to January 2023. During this study, Phacoemulsification and Small Incision Cataract Surgery (SICS) procedures were performed. The research received approval from the relevant authorities at both hospitals. The study included a total of 200 participants, with one group undergoing SICS and the other group undergoing phacoemulsification, each consisting of 100 patients. To assess the relationship between the two procedures, a statistical analysis employing either the Chi-square or Fischer's test was conducted, and for LogMAR Mann-Whitney test with a P-value of 0.05 was deemed statistically significant. Results: The age difference between the two groups was found to be statistically insignificant, with a p-value of 0.158. The mean age for the SICS group was 54.96 ± 11 years, while the mean age for the Phacoemulsification group was 57.3 ± 12 years. In terms of gender distribution, the SICS group consisted of 47 females and 53 males out of 100 participants, while the Phacoemulsification group had 45 females and 55 males out of 100 participants. The results indicate that there was no significant difference in the mean best-corrected visual acuity (BCVA) between both groups, with a p-value of 0.36. In the Phacoemulsification and SICS groups, 86 and 83 patients out of 100, respectively, achieved a BCVA of 6/6-6/12 [LogMAR (0-0.3)]. Conclusion: The postoperative mean visual acuity in both the SICS and Phacoemulsification groups was found to be similar. Nevertheless, it's noteworthy that the SICS procedure offers significant cost-effectiveness and can be a viable option for cataract treatment, enabling economically disadvantaged patients to achieve excellent vision.

Comparison between Pipelle Sampling and Hysteroscopy Guided Biopsy in Histologic Evaluation of Endometrium in Tertiary Care Hospital in Pakistan

Introduction: Abnormal uterine bleeding is one of the commonest issues in perimenopausal age group. The proportion is 9-30% in reproductive age group. This extent rises to 70% in perimenopausal and postmenopausal women’s. Irregular uterine dying (AUB) warrants an intensive assessment in perimenopausal females and subsequently it’s vital to perform it in a cost-effective way with available resources. Objective: To compare the efficacy of Hysteroscopic guided biopsy and endometrial cytology To find out the efficacy of endometrial cytology in detecting different normal and abnormal endometrial patterns Study design &amp; Settings: It is a prospective comparative study conducted at Social Security Hospital, Multan Road, Lahore included patients 30 years and above with the chief complaints of abnormal uterine bleeding. Study Duration: 01 year January 2020 to December 2020 Sample: 100 patients Inclusion Exclusion Criteria: Females having symptoms of abnormal uterine bleeding and age above than 30 years are included in the study. The females who are pregnant and having infection or malignancy are excluded from the research Results: This Planned comparative hospital-based study was done in one hundred patients with abnormal uterine bleeding taken after the informed consent, inclusion and exclusion criteria. Endometrial thickness was assessed and all cases with &lt;5 mm thickness will be avoided from the study. Mean age of the patient was found 45 and standard deviation 7.43. Practical implication Conclusion: To get the endometrial sample by pipelle technique is a safe procedure. It has high specificity, sensitivity, positive and negative predictive values when compared to hysteroscopy. In this way, to obtain adequate endometrial sample, Pipelle biopsy should be considered as important way of investigation. Keywords: Abnormal uterine bleeding, Pipelle, Endometerial sampling, FIGO

Consumer Satisfaction in Social Security Hospital: A Case Study of Punjab Employees Social Security Institution Hospital, Rawalpindi.

In health care, consumer satisfaction is an important evaluation instrument to determine the quality of services. In recent years, the concept has assumed much greater significance particularly in market based health systems. Also, in World Health Organisation’s framework for health care assessment, the customer satisfaction is given due consideration. On the contrary, in developing countries particularly, the concept is one of the most ignored elements in evaluation of health care systems. Pakistan is also a case in point. Review of literature and general health management systems in the country suggests scarcity of information on consumer satisfaction as well as its neglect as a crucial element in health systems. This present study—which is cross-sectional—is designed on the ground that there is a need to incorporate consumer satisfaction in health care evaluation. This study, presents a scientific analysis of Punjab Employees Social Security Institution Hospital, Rawalpindi (PESSI) using the Patient Survey Questionnaire technique, the most universal approach used by international studies to evaluate consumer satisfaction with health services. Based on study results, generally, we conclude that consumers have expressed high level of satisfaction for various quality assessment scales. Despite these findings, it has also been noted that significant proportion of patients have also expressed medium as well as low satisfaction for certain scales. It tends to suggest that quality of services needs to be improved for specific items as well as certain scales including communication, general satisfaction, and interpersonal aspects for improvements in provision of certain services at the hospital. JEL classification: I11, I18, I38 Keywords: Customer Satisfaction, Quality, Healthcare, Evaluation