Knowledge, Attitude, and Practices of Mid-Level Providers regarding Post Abortion Care in Sindh, Pakistan

Background: In Pakistan, half of all pregnancies are unintended (4.2 million per year); out of which 2.2 million end in induced abortions. Almost 700,000 women seek medical treatment for post abortion complications every year. This necessitates access to quality Post-Abortion Care (PAC) services from skilled providers in Pakistan. Purpose: This study aimed to assess the knowledge, attitude and practices of Mid-Level Providers (MLPs) regarding PAC services in Sindh, Pakistan. Method: The study utilized a cross-sectional design. Convenience sampling was used to recruit 116 MLPs, including Nurse Midwives (NM), Lady Health Visitors (LHVs), and Community Midwives (CMWs) from different parts of Sindh. Data were collected using a self-administered questionnaire. Data were analyzed using SPSS version 19.Key Findings: The participants comprised 47% NMs, 35% LHVs, and 18% CMWs. The median age of the participants was 30 years. Nearly half of the participants (45%) worked in their own private practices. The remainder were almost evenly divided into those working in primary health care centres and those in secondary care hospitals. The mean score on the knowledge component was 8.9±2.2, from a maximum total of 16. Almost all (98%) the participants had heard about PAC. However, only 29% were aware of the need for a community and service provider partnership as a key element of PAC. Most (81%) of the participants knew about counseling compared with 54% who knew about Manual Vacuum Aspiration (MVA) and 46% about misoprostol. The mean score on the attitude component was 14.9±2.0, from a maximum total of 21. Various gaps were identified in the practices of MLPs regarding PAC counseling, referral linkages, and in addressing reproductive and health issues.Conclusion: The findings highlighted the need for providing comprehensive training and mentorship to the groups of midwives about PAC and building strong networks to enable improved referral processes. Moreover, it is crucial to expand this study at a national level to identify the gaps and to plan strategies to promote safe PAC services

Enhancement of knowledge and skills of community midwives in Sindh, Pakistan

With a maternal mortality rate of 276 deaths per 100,000 live births, Pakistan is one of the countries with a large share in the percentage of world’s maternal mortality. As an intervention for the Millennium Development Goals (MDG) 4 and 5, the World Health Organization (WHO) strongly suggests that skilled care before, during, and after childbirth can save the lives of women and newborn babies. One of the interventions to ensure care to mothers and babies by skilled care providers is the capacity building training of Community Midwives (CMWs) aiming to improve their midwifery competency. One such training intervention was organized in Hyderabad, in the Sindh Province of Pakistan. Forty two CMWs who had graduated from ten districts across Sindh participated in the training; they were divided into 3 cohorts. The training aimed to review the midwifery knowledge and skills of CMWs; introduce them to evidence-based midwifery practices and the concept of respectful maternity care; strengthen their financial management skills, to enable them establish and sustain their birth centers independently; and, most importantly to provide hands on practice under the mentorship of clinicians. The training started with a pre-training assessment, to assess the participants’ previous knowledge and skills along with a learning needs assessment to facilitate self -directed learning. At the end of 5 weeks, a post training assessment was conducted to analyze the outcomes of this training. The post-assessment showed an increase in CMWs’ knowledge and skills, and they shared that the training had made them more competent and confident. This training was a significant effort to enhance CMWs’ development, as it was the first of its kind in the country. Through this training, the CMWs were able to review the important midwifery concepts and skills. Moreover, the CMWs recommended internship in the community with a mentor, after their graduation, and inclusion of management of birthing centers through coverage of entrepreneurial skills in the curriculum

Evaluation of antibiotic use in pediatric intensive care unit of a developing country

Background: Pediatric Intensive Care Unit (PICU) patients are often prescribed antibiotics with a low threshold in comparison to patients elsewhere. Irrational antibiotics use can lead to rapid emergence of drug resistance, so surveillance of their use is important.Objectives: To evaluate the use of antibiotics in relation to bacteriological findings in PICU of a Tertiary Hospital.Methods: Retrospective review of medical records of all children (age 1 month-16 years) admitted in our closed multidisciplinary-cardiothoracic PICU from January to June 2013 was performed, after approval from Ethical Review Committee. For each antibiotic, indication (prophylactic, empiric, therapeutic) and duration of use were recorded. All diagnoses of infections were recorded according to diagnostic criteria of IPSCC 2005. Results are presented as frequency and percentages and median with inter quartile range using SPSS version 19.Results: All of the total 240 patients admitted in PICU during the study period received antibiotics: 43% (n = 104) prophylactically, 42% (n = 102) empirically, and 15% (n = 15) therapeutically. Median number of antibiotic use per patient in PICU was 3, with range of 1-7. 25% received 1 antibiotic, 23% received 2 antibiotics, 29% received 3 antibiotics, and rest received ≥4 antibiotics. Most commonly used antibiotics were cefazolin, meropenem, vancomycin and ceftriaxone, and most frequently used combination was meropenem and vancomycin. In majority of the cases, (70%) empiric antibiotic combinations were stopped in 72 h.Conclusion: This is the first report of antibiotics use in PICU from our country, which shows that antibiotics are prescribed universally in our PICU. Strategies to assess the need for antibiotic use are needed

Implementation of a Bachelor’s in midwifery programme in Pakistan: Reflections of Midwifery Faculty

Introduction/Objective: There is an international consensus on the significant role of competent midwives in improving maternal and newborn health indicators. Midwives and midwifery education in the developing world including Pakistan have lagged behind in being part of higher education. To enhance the quality of maternal and newborn services through competency based higher education in midwifery, the first Bachelors of Science in Midwifery (BScM) programme was introduced in Pakistan. As part of a larger study about establishing this programme, this paper focuses on the reflective logs of midwifery faculty members who initiated this new programme in Pakistan. Method: The team of faculty members involved in the planning and execution of the programme were asked to record their reflections throughout the process of planning the programme to facilitating students in the first cohort. These reflections were collected at the time of the graduation of first cohort in 2014 and content analysis was applied to identify major themes emerging from the reflections. Findings: Major themes which emerged were: a) Scaling up of faculty competence, b) Utilizing student diversity as strength, c) Supporting students’ transition and adjustments in the programme d) Scaffolding students’ learning e) Helping students acquire clinical competencies. Overall, the team regarded the experience as unique and enriching for both students and faculty. The first Bachelors in Midwifery demanded a great deal of theoretical and clinical proficiency from faculty. Rigorous planning, networking with international midwifery experts, continuous faculty development, facilitating student learning through scaffolding, and incorporating periodic feedback from students were found to be the major strengths of the programme. Conclusion: The Bachelor of Midwifery programme in Pakistan has given new hope to the profession. The lessons learned and some of the practical recommendations may prove useful to other institutions and South Asian countries intending to initiate similar programmes

The Problem-Based Learning Approach towards Developing Soft Skills: A Systematic Review

In this paper, we review systematically the role of problem-based learning (PBL) in developing soft skills in Technical and Vocational Education and Training (TVET) and other fields of studies. The Systematic Literature Review (SLR) includes the most recent empirical, review, and conceptual studies from TVET and other multiple fields of studies including medicine, humanities, and engineering between the years of 2001 and 2016 collected from four databases. A qualitative method was used to accomplish the systematic review. After the collection of articles, the selected studies were analyzed through thematic analysis. From this review, we concluded that PBL as an instructional approach has a significant role in the development of soft skills among students of various disciplines including TVET; empirical evidence is predominantly conclusive in identifying the acquisitions of various soft skills including communication skills, conflict resolution skills, leadership skills, and interpersonal skills, and finally, several factors might influence the relationship of PBL and soft skills such as duration and process of PBL instruction, role of facilitator, and awareness and training of learners. Moreover, there are fewer number of empirical studies on the role and effects of PBL approach to developing soft skills in TVET

A Two-Tier Framework Based on GoogLeNet and YOLOv3 Models for Tumor Detection in MRI

Medical Image Analysis (MIA) is one of the active research areas in computer vision, where brain tumor detection is the most investigated domain among researchers due to its deadly nature. Brain tumor detection in magnetic resonance imaging (MRI) assists radiologists for better analysis about the exact size and location of the tumor. However, the existing systems may not efficiently classify the human brain tumors with significantly higher accuracies. In addition, smart and easily implementable approaches are unavailable in 2D and 3D medical images, which is the main problem in detecting the tumor. In this paper, we investigate various deep learning models for the detection and localization of the tumor in MRI. A novel two-tier framework is proposed where the first tire classifies normal and tumor MRI followed by tumor regions localization in the second tire. Furthermore, in this paper, we introduce a well-annotated dataset comprised of tumor and normal images. The experimental results demonstrate the effectiveness of the proposed framework by achieving 97% accuracy using GoogLeNet on the proposed dataset for classification and 83% for localization tasks after fine-tuning the pre-trained you only look once (YOLO) v3 model

Un estudio sobre el uso de combinaciones de palabras en estudiantes de administración

Previous studies have reported lack of collocational competence and difficulties among English as a second language (ESL) learners. However, collocation is crucial in second language acquisition. This research examined the receptive and productive knowledge of collocations among the business students of COMSATS University Islamabad Vehari Campus who studied ESL. It also investigated the gap in the use of collocations at a receptive and productive level. The sample included 61 males and 39 females out of the total sample size of 100. Employing a quantitative approach, we gathered the data through a questionnaire and two collocations tests, and we analysed them via SPSS version 20. The overall result of the collocation test indicated that 66.4% of the respondents had the correct answer at the receptive level compared with only 33.7% at the productive level. Moreover, the statistical result presented a great gap in the ability to utilise collocations at the productive and receptive levels. This result also affirmed that despite their ability to understand the collocations, the students had difficulties in identifying proper English collocations confidently. Local and native language experiences might be one of the reasons that caught the students from being more confident in identifying the English collocations.Previos estudios han informado de la falta de competencia en la ubicación y las dificultades entre los estudiantes de inglés como segunda lengua (ESL). Sin embargo, las combinaciones de palabras son cruciales en la adquisición de un segundo idioma. Esta investigación examinó el conocimiento receptivo y productivo de las combinaciones de palabras entre los estudiantes de administración de la Universidad COMSATS de Islamabad (Campus de Vehari) que estudiaron ESL. También investigó la brecha en el uso de estas combinaciones a nivel receptivo y productivo. La muestra incluyó 61 hombres y 39 mujeres, de un total de 100. Empleando un enfoque cuantitativo, recopilamos los datos mediante un cuestionario y dos pruebas de colocaciones, y los analizamos por medio del programa SPSS versión 20. El resultado general de la prueba de colocación indicó que el 66,4 % de los encuestados tenía la respuesta correcta a nivel receptivo y solo el 33,7 % a nivel productivo. Además, el resultado estadístico presentó una gran brecha en la capacidad de utilizar combinaciones de palabras en los niveles productivo y receptivo. Este resultado también afirmó que, a pesar de su capacidad para comprender las combinaciones de palabras, los estudiantes tenían dificultades para identificar con seguridad (...

Compare the Level of Satisfaction Among Smart Phone and Traditional Hearing Aids Users

Hearing is crucial for human life, it undertakes a important job in dissertation and linguistic development, which is the fundamental device for the advancement of human correspondence. People with hearing impedance may endure extreme misfortune in their social, mental and proficient lives, dread, misery, disengagement and further more family strains as a result of the absence of consideration influencing those with hearing disorders.  Objective: To compare the level of Satisfaction between smart phone hearing aids and traditional hearing aids users.  Methods: Cross-sectional study was conducted among Hearing aids users with smart phone hearing aids and traditional hearing aids using purposive sampling technique .SADL (Satisfaction with amplification in daily life) was used to measure the satisfaction level between smart phone hearing aids users and traditional hearing aids users.100 applicants by moderate to severe senserineural hearing loss of age range from 18 years to 35 years recommended for hearing aids fitting were included in this research by their consent. Data for this research was collected from Sialkot, Lahore, Narowal, Gujranwala, Pakistan. The data of 100 participants were analyzed through SPSS version 25.O and P-value less than 0.05was considered significant.  Results: A total number of 100 participants were included under which there were 50 males and 50 females.. Out of 100, 53(53%) participants belong to age group of (26+35) years and 47(47%) participants belong to age group of (18+26) years. The participants who were using traditional hearing aids, there the level of satisfaction was 48.0±3.915 and the level of satisfaction in the participants who were using smart phone hearing aids was 53.95±4.17. Smart phone hearing aids users were more satisfied than traditional hearing aids users. Conclusion: It was concluded that smart phone hearing aids users have more satisfaction level as compare to traditional hearing aids users. Keywords: Audiologist, Audible range, Hearing loss, Smart phone Hearing aids, Traditional hearing aids. DOI: 10.7176/JHMN/69-05 Publication date: December 31st 201

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI