Search

Plantar Fasciitis is among the major causes of heel pain. Mechanical stress of plantar aponeurosis usually causes inflammation thus result in problem with weight bearing and difficulty in walking. Pain often exacerbates and may stick at for months with unremitting activity, limiting the activities of daily living and the functional status. The objective of the study was to compare the effects of low level laser and ultrasound therapy in patients for pain and their functional status presents with plantar fasciitis. This study was a Quasi-experimental trial and conducted at Physical therapy Center for Arthritis & Rehabilitation Excellence (PT CARE), Gulberg III Lahore. The study completed in the time duration of six months (Aug 2019 – Jan 2020). Consecutive sampling technique was used to collect the data. A sample size of `total 28 patients were taken in this study; patients were divided into two groups. Conventional Physiotherapy protocol was given to both groups as baseline treatment. (Group A patients were treated with low level laser protocol whereas Group B was treated with ultrasound therapy protocol). Functional Foot Index (FFI) score was used to ask some questions related to patients symptoms and daily activities and to measure the intensity of pain Numeric Pain Rating Scale (NPRS) was used. All participants of the study filled the FFI & NPRS score and Numeric pain rating scale on day 1 in first cycle as pretreatment values and at the end of 5th session and 10th session as first and second cycles as post treatment values respectively. Data was analyzed on SPSS 21.The means of pre-treatment NPRS in group A was 7.78 and in group B means of pre-treatment NPRS was 7.35 with p value

This study aimed to test the psychometric properties of the Urdu version of the Safety Attitudes Questionnaire for inpatient settings in Pakistan.The SAQ short form (inpatient version) was translated with the back-translation technique into Urdu. The SAQ-Urdu was administered in three teaching hospitals in Pakistan to a sample of 483 front line healthcare personnel from August 2016 through December 2017. Confirmatory factor analysis was performed to test the factor structure of the responses. Cronbach's alphas and correlation coefficients were computed. Mean and percentage agreement scores for items were reported.The response rate was 75%. Goodness-of-fit indices from the confirmatory factor analysis showed a reasonable model fit (χ2=213.27, df=125, p0.001; CFI 0.94, RMSEA 0.044). Cronbach's alphas of survey factors (teamwork climate, safety climate, job satisfaction, perceptions of management, and working conditions) ranged from 0.71 to 0.87. In terms of mean percentage agreement scores, substantial variability was found at the clinical unit level.The Urdu version of the SAQ showed satisfactory internal psychometric properties. The attitudes around patient safety considerably vary and indicate a need for improvement.

Pakistan has recently observed a significant growth in public health education programmes. Little is known about the structure of these programmes nor whether they are adequately responsive to national health system needs.We reviewed existing public health degree programmes in Pakistan along with an exploration of the national public health market and health system needs.A mixed-methods study was conducted between January 2015 and March 2016. Seventeen public health degree programmes were reviewed for programmatic and instructional attributes. Thirteen key-informant interviews were conducted to explore health system needs and challenges related to public health workforce.We found substantial variation in public health academic programmes in terms of offered courses, credit hours, number of faculty and tuition costs. About 70% of public health degree programmes were generic (i.e. with no specific concentration track) and only 18% offered practicums. Overall median tuition cost in 2016 was US$ 10 350. During key-informant interviews, emerged themes for challenges included lack of practical public health skills, limited knowledge of latest theoretical principles, poor communication skills and insufficient IT orientation. Identified themes about knowledge and skills areas to address future public health challenges of Pakistan included system thinking mind set, healthcare IT skills, and leadership and management skills.Public health education in Pakistan falls short of meeting current national challenges. Pakistan needs a national public health accreditation body for regulating education, harmonizing global standards to local context and developing relevant career pathways.تعليم الصحة العامة واحتياجات النظام الصحي بباكستان: دراسة باتباع مزيج من الطرق.محمد فضل ذيشان، عثمان رضا، سعيد أنور، دردانة خان، عامر عباس، نويد صادق، عميرقاضي.شهدت باكستان مؤخرا نموًّا كبيرًا في برامج التعليم في الصحة العامة. إن المعلومات قليلة حول بنية برامج التعليم في الصحة العامة وما إذا كانت استجابتها كافية لتلبية احتياجات النظام الصحي الوطني.استعرضنا البرامج الموجودة حاليًّا لمنح الشهادات الدراسية في الصحة العامة في باكستان إلى جانب استكشاف سوق الصحة العامة واحتياجات النظام الصحي على الصعيد الوطني.أجرينا دراسة بمزيج من الطرق في الفترة بين يناير/كانون الثاني 2015 ومارس/آذار 2016. استعرضنا المواصفات البرنامجية والتلقينية في 17 برنامجًا يمنح شهادة في الصحة العامة. أجرينا 13 مقابلة مع أشخاص ذوي أهمية رئيسية كمصادر للمعلومات لاستكشاف احتياجات النظام الصحي والتحديات ذات الصلة بالقوى العاملة في الصحة العامة.وجدنا اختلافًا كبيرًا بين البرامج الأكاديمية في مجال الصحة العامة من حيثُ الدورات التعليمية التي تقدمها والساعات المعتمدة التي تحتسبها وعدد أعضاء هيئة التدريس فيها والرسوم الدراسية التي تطلبها. واتضح لنا أن حوالي 70 % البرامج التي تمنح شهادات في الصحة العامة كانت عامة (أي أنها لا تركِّز على مسار تخصصي) ، وأن نسبة التدريب العملي الذي تقدمه لا يزيد على 18 % فقط. وكان متوسط تكلفة رسوم التعليم في عام 2016 مقدرة بالدولارات الأمريكية 10350. أثناء المقابلات مع الأشخاص ذوي الأهمية الرئيسية كمصادر للمعلومات اتضح لنا مواضيع التحديات ومنها الافتقار إلى المهارات العملية في مجال الصحة العامة، والمعرفة المحدودة النطاق بأحدث المبادئ النظرية، وتدني مستوى مهارات الاتصال، وعدم كفاية التوجه نحو تكنولوجيا المعلومات. وحددنا المواضيع التي تدور حول مجالات المعلومات والمهارات اللازمة لمواجهة التحديات المستقبلية في مجال الصحة العامة في باكستان ومنها توجيه الذهن نحو التفكير بالنظام، ومهارات تكنولوجيا المعلومات في الرعاية الصحية، ومهارات القيادة ومهارات الإدارة.لا يلبي التعليم في مجال الصحة العامة في باكستان مقتضيات التحديات الوطنية الحالية. تحتاج باكستان إلى هيئة اعتماد وطنية في الصحة العامة لتنظيم التعليم، ومواءمة المعايير العالمية مع السياق المحلي وتطوير مسارات المستقبل المهني ذات الصلة.Enseignement en santé publique et besoins du système de santé au Pakistan : étude à méthodologie mixte.Le Pakistan connaît depuis peu une forte augmentation du nombre de ses programmes d’enseignement en santé publique. La structure de ces programmes et leur adéquation aux besoins du système de santé national restent méconnues.Nous avons examiné les programmes en santé publique diplômants qui existent actuellement au Pakistan et nous avons étudié le marché national pour ce domaine ainsi que les besoins du système de santé.Une étude à méthodologie mixte a été réalisée entre janvier 2015 et mars 2016. Dix-sept programmes en santé publique diplômants ont été passés en revue afin de déterminer leurs caractéristiques programmatiques et pédagogiques. Treize entretiens avec des informateurs clés ont été menés afin d’analyser les besoins du système de santé et les problèmes des personnels dans le secteur de la santé publique.Nous avons constaté des différences considérables entre les filières académiques en santé publique, tant sur le plan des cours proposés que des heures d’étude, des effectifs du corps enseignant et des frais de scolarité. Environ 70 % des programmes diplômants en santé publique étaient génériques (c’est-à-dire sans filière spécialisée) et seuls 18 % proposaient des stages pratiques. La valeur médiane des frais de scolarité généraux (en 2016) s’élevait à 10 350 dollars US. Au cours des entretiens avec les informateurs clés, les problématiques soulevées comprenaient le manque de compétences pratiques en matière de santé publique, les connaissances limitées concernant les derniers principes théoriques, les faibles compétences en communication et l’orientation insuffisante vers les moyens informatisés. Les thématiques identifiées dans les domaines des connaissances et des compétences nécessaires afin de relever les défis futurs du Pakistan en matière de santé publique comprenaient une approche intellectuelle systémique, des compétences informatiques axées sur les soins de santé et des aptitudes en leadership et en gestion.L’enseignement en santé publique au Pakistan n’est pas à la hauteur des difficultés auxquelles le pays fait face à l’heure actuelle. Le Pakistan a besoin d’un organisme d’accréditation national en santé publique capable de réglementer l’enseignement, d’harmoniser les normes mondiales en fonction du contexte local et de développer des filières professionnelles pertinentes.

Hospital waste management (HWM) rules in Pakistan were issued in 2005. Despite a decade of enactment, adherence to HWM 2005 rules has been inconsistent and systematic assessment of adherence using a World Health Organization (WHO)-recommended questionnaire has not been done in all teaching hospitals of Peshawar District.This study assessed the adherence to HWM 2005 rules by tertiary care teaching hospitals of Peshawar District with respect to HWM personnel, policy and practices.Pretested structured questionnaires based on WHO recommendations were used to survey all teaching hospitals of Peshawar District from January to March 2015. Data were also collected on HWM infrastructure and processes from 1 randomly selected medical, surgical, paediatric, and obstetrics/gynaecology unit in each hospital. Besides descriptive statistics, public and private hospitals were compared using Fisher's exact and Wilcoxon rank-sum tests.Most surveyed hospitals lacked formal HWM plans (70%), written procedures (80%), related job descriptions (80%) or records (90%). Many hospitals neither had trained HWM supervisors (56%) nor did they organize formal HWM trainings for new staff (40%). None of the hospitals followed waste segregation and colour coding. When compared to national HWM 2005 rules, multiple gaps in appropriate transportation, storage and disposal were found with no statistically significant difference between public and private hospitals.Serious gaps in adherence to HWM 2005 rules exist in surveyed hospitals. With recent devolution of environmental function, the Government of Khyber Pakhtunkhwa should enact provincial HWM rules (and ensure their implementation) to facilitate effective HWM practice across provincial healthcare facilities.ممارسات وتنفيذ القواعد الوطنية لإدارة نفاقات المستشفيات لعام 2005 في باكستان.محمد فضل ذيشان، أحمد العباد، عبد العزيز، افتاب سبحاني، آصف شاه، طاهر خان، هداية الله، عمير قاضي.صدرت قواعد إدارة نفايات المستشفيات في باكستان في عام 2005. وعلى الرغم من مرور عقد على سن هذه القواعد، ظل الامتثال لها يفتقر إلى الاتساق، ولم يُر أي تقييم منهجي للامتثال باستخدام استبيان موصى به من منظمة الصحة العالمية في جميع المستشفيات التعليمية في منطقة بيشاور.عمدت هذه الدراسة إلى تقييم الامتثال لقواعد إدارة نفايات المستشفيات لعام 2005 في مستشفيات الرعاية الثلاثية التعليمية في منطقة بيشاور بالنسبة للمختصين بإدارة نفايات المستشفيات وسياساتها وممارساتها.استُخدمت استبيانات منظمّة ومجرّبة سلفاً استناداً إلى توصيات منظمة الصحة العالمية لمسح جميع المستشفيات التعليمية في منطقة بيشاور في الفترة من يناير إلى مارس 2015. وجمعت بيانات أيضا بشأن البنية التحتية لإدارة نفايات المستشفيات وعملياتها من وحدة واحدة من كل من أقسام الباطنة، الجراحة، طب الأطفال، النساء والولادة اختيرت عشوائياً في كل مستشفى. وبالإضافة إلى الإحصاءات الوصفية، أجريت مقارنة بين مستشفيات عامة وخاصة باستخدام اختبار فيشر الدقيق واختبار ويلكوكسون لحساب مجموع الرتب.افتقرت معظم المستشفيات الخاضعة للاستقصاء لأي خطط رسمية لإدارة نفايات المستشفيات (70 %) أو إجراءات مكتوبة (80 %) أو توصيف للوظائف ذات الصلة (80 %) أو سجلات (90 %). ولم يقدم كثير من المستشفيات أي تدريب للمشرفين (56 %) ولا تنظيم دورات تدريبية رسمية بشأن إدارة نفايات المستشفيات للموظفين الجدد (40 %). ولم تلتزم أي من المستشفيات بفصل النفايات والترميز اللوني. وعند مقارنة هذه القواعد بالقواعد الوطنية لإدارة نفايات المستشفيات لعام 2005 ، ظهرت عدة فجوات تتصل بالنقل والتخزين والتخلص الملائم مع عدم ظهور أي فرق ذي دلالة إحصائية بين المستشفيات العامة والخاصة.توجد فجوات خطيرة في الامتثال لقواعد إدارة نفايات المستشفيات لعام 2005 في المستشفيات الخاضعة للمسح. وبعد إلغاء الوظيفة البيئية مؤخراً، ينبغي لحكومة خيبر باختونخوا سن قواعد لإدارة نفايات المستشفيات على مستوى المقاطعات (وكفالة تنفيذها) لتيسير ممارسة إدارة نفايات المستشفيات بفعالية في جميع مرافق الرعاية الصحية على مستوى المقاطعات.Pratiques et application des réglementations nationales en matière de gestion des déchets hospitaliers 2005 : étude de cas au Pakistan.Les réglementations en matière de gestion des déchets hospitaliers au Pakistan ont été publiées en 2005. Dix ans après leur adoption, l’observation des réglementations de 2005 en matière de gestion des déchets hospitaliers demeure incohérente, et une évaluation systématique de la conformité à l’aide d’un questionnaire recommandé par l'Organistation mondiale de la Santé (OMS) n’a pas été effectuée dans tous les hôpitaux universitaires du district de Peshawar (Khyber Pakhtunkhwa).La présente étude a évalué l’observation des réglementations de 2005 en matière de gestion des déchets hospitaliers par les hôpitaux universitaires de soins tertiaires dans le district de Peshawar eu égard au personnel, aux politiques et aux pratiques de gestion des déchets hospitaliers.Des questionnaires structurés prétestés reposant sur les recommandations de l’OMS ont été utilisés pour enquêter dans tous les hôpitaux universitaires du district de Peshawar entre janvier et mars 2015. Des données ont également été recueillies sur les infrastructures et les processus de gestion des déchets hospitaliers auprès de départements de médecine, de chirurgie, de pédiatrie, de gynécologie/d’obstétrique sélectionnés de façon aléatoire dans chaque hôpital. Outre les statistiques descriptives, les hôpitaux publics et privés ont été comparés à l’aide du test exact de Fisher et du test des rangs signés de Wilcoxon.La plupart des hôpitaux enquêtés n'avaient pas de plans officiels (70 %), de procédures écrites (80 %), de descriptifs de postes associés (80 %) ou de dossiers (90 %) pour la gestion des déchets hospitaliers. De nombreux hôpitaux n’avaient pas formé de responsables en gestion des déchets hospitaliers (56 %), ou organisé de formations officielles dans le domaine pour les nouveaux membres du personnel (40 %). Aucun des hôpitaux ne procédait à un tri des déchets ou n’appliquait le code couleurs. Eu égard aux réglementations nationales en matière de gestion des déchets hospitaliers, des lacunes multiples en matière de transports, d’entreposage et d’élimination appropriés ont été révélées, sans différences significatives entre les hôpitaux publics et privés.Il existe de sérieuses lacunes concernant le respect des réglementations de 2005 en matière de gestion des déchets hospitaliers dans les hôpitaux ayant fait l’objet de l’enquête. Au vu de la décentralisation récente de la gestion environnementale, le gouvernement de Khyber Pakhtunkhwa devrait adopter des réglementations en matière de gestion des déchets hospitaliers à l’échelle de la province (et garantir leur application) afin de faciliter la mise en place de pratiques efficaces de gestion des déchets hospitaliers au sein des établissements de soins de santé dans la province.

Introduction Incomplete or illegible prescriptions can lead to serious errors in administration of the prescribed medication, which can become hazardous. Objective Our aim is to determine if a structured prescription form can improve the quality of handwritten prescription in terms of completeness and legibility. Methods We conducted a prospective, non-randomized, time series study of quality of written prescriptions of general practitioners at a tertiary teaching hospital in Peshawar, Pakistan. The study involved an intervention, composed of the introduction of a pre-printed structured prescription form. The data were collected within 4 weeks including a 2-week pre-intervention phase and 2-week post-intervention phase. Completeness, quality of prescriptions and legibility were compared before and after the intervention of the pre-printed structured prescription form. Results A total of 463 prescriptions were obtained (260 in the pre-intervention phase and 203 in the post-intervention phase). Between pre-intervention phase and post-intervention phase, the Pakistan Medical and Dental Council registration number presence in prescriptions improved from 73.1% to 100% (P

To investigate personality disorders in medical students appearing for medical school entrance exam.The cross-sectional study was conducted at Peshawar Medical College from August 2015 to May 2016, and comprised all the students who undertook medical school entrance examination of the College. They were asked to fill screening questionnaire of international personality disorder examination, based on International Classification of Disease version-10. Demographic information was collected from the application form. After screening of all the medical students during the entrance exam, detailed interview was taken from the students who were invited for admission interview. The data was analyzed using SPSS 20.There were 1334 subjects with a mean age of 18.91.41 years. Of the total, 745(55.8%) were male students. The most common personality traits were anankastic 1170(88%), schizoid 932(70%) and dependent 705(53%). Of the total, 322(24%) students were called for interview. The mean age of the interview sample was 18.91.03 years and 189 (58.7%) of them were females. Definite personality disorders in order of frequency were dependent 3(0.93%), schizoid 2(0.62%) and anankastic 1(0.31%). There was a significant correlation of female gender with histrionics, anxious, dependent and borderline personality disorder (p0.05). There was a significant correlation between academic performance and dissocial, impulsive and borderline personality disorder separately (p0.05).Anankastic, schizoid and dependent personality traits and disorders were the commonest on screening and detailed interview.

OBJECTIVES To assess the surgical informed consent (SIC) practices for obstetric and gynaecological (OB-GYN) procedures at different hospitals in Pakistan. METHODS Study was conducted in five hospitals (three public and two private) of Peshawar, Pakistan. A pretested structured tablet-based questionnaire was administered from October 2016 through January 2017 among post-op OB-GYN patients. RESULTS About 27% of the patients (significantly more in private hospitals, P = 0.001) did not remember a formal consent administration. Most patients (80%) felt they had no choice about signing the consent. About 65% (mostly in public as compared with private hospitals) mentioned that they would have signed it regardless of the specifics in it (P

Background Appalachian residents have a higher overall cancer burden than the rest of the United States because of the unique features of the region. Treatment delays vary widely within Appalachia, with colorectal cancer patients undergoing median treatment delays of 5 days in Kentucky compared to 9 days for patients in Pennsylvania, Ohio, and North Carolina combined. Objective This study identified the source of this disparity in treatment delay using statistical decomposition techniques. Methodology This study used linked 2006 to 2008 cancer registry and Medicare claims data for the Appalachian counties of Kentucky, Pennsylvania, Ohio, and North Carolina to estimate a 2-part model of treatment delay. An Oaxaca Decomposition of the 2-part model revealed the contribution of the individual determinants to the disparity in delay between Kentucky counties and the remaining 3 states. Results The Oaxaca Decomposition revealed that the higher percentage of patients treated at for-profit facilities in Kentucky proved the key contributor to the observed disparity. In Kentucky, 22.3% patients began their treatment at a for-profit facility compared to 1.4% in the remaining states. Patients initiating treatment at for-profit facilities explained 79% of the observed difference in immediate treatment (

The importance of childhood immunization in prevention of highly fatal diseases and disability cannot be overemphasized. Pakistan has a national Expanded Program on Immunization but the compliance is far below the international benchmark for achieving a herd immunity. Monitoring the compliance to timely receipt of vaccinations is crucial to establishing and preventing disease and disability associated risk in children. There is little or no evidence that reports the timeliness of the vaccinations according to the EPI schedule in Peshawar. The primary objective of the study was to evaluate rate of Fully Immunized Children and to report compliance to the timeliness of vaccine specific schedule during the study period in the EPI center in the capital city of Peshawar, Khyber Pakhtunkhwa province of Pakistan. We collected consecutive retrospective data of the infants enrolled from June 2014 to December 2015 in one EPI center for our study. Out of the total 157 (n) children, fully immunized children (FIC) were 62 (39.5%) and only 19 (12.1%) were FIC with timely visits. Dropouts increased with successive vaccinations with highest for Measles 1 (42%). On-time vaccinations decreased over time, while the proportion of children receiving vaccination outside the ideal window period reaches as high as 46%. The study reports a low compliance to EPI schedule, and also highlights that immunization coverage is not a good indicator of age appropriate vaccinations.

Context Method mix-the percentage distribution of contraceptive users in a given country, by method-is one measure that reflects the availability of a range of contraceptive methods. A skewed method mix-one in which 50% or more of contraceptive users rely on a single method-could be cause for concern as a sign of insufficiency of alternative methods or provider bias. Shifts in method mix are important to individual countries, donors and scholars studying contraceptive dynamics. Methods To determine current patterns and recent changes in method mix, we examined 109 low- and middle-income countries. A variety of statistical methods were used to test four factors as correlates of skewed method mix: geographic region, family planning program effort index, modern contraceptive prevalence rate and human development index. An assessment of changes in reliance on female and male sterilization, the IUD, the implant and the injectable was conducted for countries with available data. Results Of the 109 countries included in this analysis, 30% had a skewed method mix-a modest decrease from 35% in a 2006 analysis. Only geographic region showed any correlation with method skew, but it was only marginally significant. The proportion of users relying on female sterilization, male sterilization or the IUD decreased in far more countries than it increased; the pattern was reversed for the injectable. Conclusion Method mix skew is not a definitive indicator of lack of contraceptive choice or provider bias; it may instead reflect cultural preferences. In countries with a skewed method mix, investigation is warranted to identify the cause.

Incomplete or illegible prescriptions can lead to serious errors in administration of the prescribed medication, which can become hazardous.Our aim is to determine if a structured prescription form can improve the quality of handwritten prescription in terms of completeness and legibility.We conducted a prospective, non-randomized, time series study of quality of written prescriptions of general practitioners at a tertiary teaching hospital in Peshawar, Pakistan. The study involved an intervention, composed of the introduction of a pre-printed structured prescription form. The data were collected within 4 weeks including a 2-week pre-intervention phase and 2-week post-intervention phase. Completeness, quality of prescriptions and legibility were compared before and after the intervention of the pre-printed structured prescription form.A total of 463 prescriptions were obtained (260 in the pre-intervention phase and 203 in the post-intervention phase). Between pre-intervention phase and post-intervention phase, the Pakistan Medical and Dental Council registration number presence in prescriptions improved from 73.1% to 100% (P 0.0005). The presence of prescriber's signature improved from 92.7% to 99% (P = 0.001). Drug duration was not missing in 99.5% in post-intervention phase as compared with 90.4% in pre-intervention phase (P 0.0005). Prescriptions with no legibility problems improved from 76.2% to 94.1% (P 0.0005). Although not statistically significant, prescriptions in which drug dosage was not missing improved from 85% to 90.6% (P = 0.07).We have a limited single-center study. A larger study in multiple settings is needed to develop adequate evidence for such interventions. Subjective nature of prescription legibility can also be considered as a limitation.Structuring a prescription form alone may improve certain aspects of quality of written prescription in terms of completeness and legibility.

Appalachian residents have a higher overall cancer burden than the rest of the United States because of the unique features of the region. Treatment delays vary widely within Appalachia, with colorectal cancer patients undergoing median treatment delays of 5 days in Kentucky compared to 9 days for patients in Pennsylvania, Ohio, and North Carolina combined.This study identified the source of this disparity in treatment delay using statistical decomposition techniques.This study used linked 2006 to 2008 cancer registry and Medicare claims data for the Appalachian counties of Kentucky, Pennsylvania, Ohio, and North Carolina to estimate a 2-part model of treatment delay. An Oaxaca Decomposition of the 2-part model revealed the contribution of the individual determinants to the disparity in delay between Kentucky counties and the remaining 3 states.The Oaxaca Decomposition revealed that the higher percentage of patients treated at for-profit facilities in Kentucky proved the key contributor to the observed disparity. In Kentucky, 22.3% patients began their treatment at a for-profit facility compared to 1.4% in the remaining states. Patients initiating treatment at for-profit facilities explained 79% of the observed difference in immediate treatment (2 days after diagnosis) and 72% of Kentucky's advantage in log days to treatment.The unique role of for-profit facilities led to reduced treatment delay for colorectal cancer patients in Kentucky. However, it remains unknown whether for-profit hospitals' more rapid treatment converts to better health outcomes for colorectal cancer patients.