Does empowerment matter? Perceptions of nursing leaders in Pakistan through qualitative approach.

Background: In a patriarchal society like Pakistan, where women are oppressed, women dominating professions like nursing is mostly seen as disempowered and requires considerable struggle to achieve its due recognition and respect. Aim: This study aims to explore the experiences of empowerment among the nursing leaders of Pakistan. Methods: This study uses a qualitative descriptive design. Total of twelve Pakistani Nursing leaders were interviewed using semi-structured interview guideline to explore their experiences of empowerment. Results: The study findings revealed five major categories which include: status of a nurse, nursing profession, power relationships, value-belief system, and leadership and management. Conclusions: Nurses’ empowerment is essential for enhancing the image and status of nursing profession in Pakistan. The study identified various personal and professional factors affecting nurses’ empowerment in the country and suggests various strategies, such as access to higher nursing education, development of enhanced nursing leadership competencies and understanding of power and politics of the organization, through which nurses can achieve empowerment

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Family ethnographic approach to explore the causes of suicide among married women of 20-40 years in Chitral, Khberpakhtunkhawa, Pakistan

The study was conducted to discover the factors that contribute to the suicide among married women in Chitral, through exploring the experiences of 24 immediate family members of six women who had committed suicide during the last one year. A qualitative study using the family ethnographic approach was employed. The data was collected between Aprils - July, 2016, largely through semi-structured in depth interviews and observation in the homes of participants. The study was conducted in district Chitral KPK, PakistanParticipants: 24 immediate family members of 6 women who were dead because of suicide were interviewed and observed. The key findings revealed that poverty and domestic violence were the key themes for committing suicide among married women. The sub themes were: lack in education ; psychological and physical problem (depression) ; lack of parental support; poor spousal relationship; lack of supportive structure; socio-cultural values /gender norms ; high expectations from women; and lack of supportive legislation in the area. Implications for practice: The findings of this study will offer guidelines for planning structured interventional research, poverty alleviation and suicide prevention programs. Moreover, the study findings will be useful to develop structured social and legal support system at individual, community and societal level

Medical education and training: responding to community needs.

At its inception in 1987, the Aga Khan University introduced the idea of community-based medical education in Pakistan, at a time when this model was being introduced and adapted internationally. Human resource development has been a major objective in the Department of Community Health Sciences (CHS). CHS has contributed to developing a medical curriculum that addresses the health needs of the community at large. This paper narrates the department\u27s experience in working directly with under-served communities, leading to the development of specialized courses and degree programs. CHS emphasizes operational research and development of managerial skills among front-line public health professionals, in both the public and private sectors. Training is provided by people from diverse backgrounds, such as public health, community development, social sciences, law, epidemiology, economy, biostatistics, demography, theater, and film. The lessons we have learned show that the mode of training depends on the overall objectives of the program, the clients and the setting. However, in the spirit of the participatory approach, the recipients of the training must be involved during all stages so as to ensure the sustainability of the training program. Training must focus on the communities at the grass roots level or community based organizations, where the communities identify their own capacity and needs. Wide dissemination of training materials, courses and manuals is also useful to replicate successful experience

Computational analysis of magnetized Casson liquid stretching flow adjacent to a porous medium with Joule heating, stratification, multiple slip and chemical reaction aspects

This article aims to investigate the characteristics of thermo-solutal magnetohydrodynamic (MHD) non-Newtonian smart coating boundary layer flow of a stretching substrate adjacent to a porous medium, considering the influence of chemical reactions and thermal radiation subject to a transverse static magnetic field. A non-Darcy drag force model is deployed to capture both Darcy bulk drag and inertial Forchheimer (quadratic) drag effects. A diffusion flux model is deployed for radiative heat transfer. The Casson viscoplastic model has been utilized to simulate rheological characteristics. Due to polymeric slip effects, three slip phenomena are included at the wall (hydrodynamic, thermal and concentration) in the formulation. Furthermore, viscous dissipation and Ohmic heating (Joule dissipation) are also included. Robust scaling similarity variables are deployed to transform the governing partial differential equations into ordinary differential equations. Subsequently, the emerging dimensionless coupled nonlinear boundary value problem is solved utilizing the Bvp4c method in MATLAB version 2022. This numerical approach allows for a logical parametric examination of all key control parameters on the transport phenomena, enabling a comprehensive understanding of the system behavior. Validation with previous studies is included. Detailed graphical and tabular computations are included for velocity, temperature, concentration, skin friction, Nusselt number and Sherwood number, for the influence of Darcian parameter, Forchheimer inertial parameter, mixed convection, velocity (momentum) slip, magnetic number, Casson parameter, nonlinear thermal convection parameter, nonlinear concentration convection parameter, radiation parameter, thermal stratification parameter, Prandtl number, heat source/sink parameter, Eckert number, thermal slip parameter, Schmidt number, chemical reaction, solutal stratification parameter and solutal slip parameter. Detailed interpretation of the physics associated with these multiple effects is included. Flow deceleration is observed with increment in Darcy parameter, Forchheimer parameter, Hartmann number, Casson parameter and momentum slip whereas flow acceleration is computed with increasing mixed convection parameter. Temperatures are accentuated with elevation in Rosseland radiative parameter, magnetic parameter, thermal stratification parameter, heat source parameter and Eckert (dissipation) number, whereas it is depleted with thermal slip (jump) parameter, heat sink, Prandtl number and mixed convection parameter. An increment in Schmidt number, first order homogenous chemical reaction parameter, solutal stratification parameter and mass slip parameters induce a reduction in concentration magnitudes and species boundary layer thickness. Skin friction is elevated with Darcian parameter. Nusselt number is boosted with mixed convection parameter whereas it is suppressed with radiation parameter, magnetic number, Casson parameter, thermal stratification parameter and thermal slip parameter. Sherwood number is observed to decay with increment in solutal stratification parameter and solutal slip parameter whereas it is enhanced with Schmidt number and chemical reaction parameters. The simulations provide further insight into the transport characteristics of electromagnetic viscoplastic coating material manufacturing

Exploring women and traditional birth attendants\u27 perceptions and experiences of stillbirths in district Thatta, Sindh, Pakistan: A qualitative study

Background: Pakistan reports the highest stillbirth rate in the world at 43 per thousand births with more than three-quarters occurring in rural areas. The Global Network for Women\u27s and Children\u27s Health maintains a Maternal and Newborn Health Registry (MNHR) in 14 study clusters of district Thatta, Sindh Pakistan. For the last 10 years, the MNHR has recorded a high stillbirths rate with a slow decline. This exploratory study was designed to understand the perspectives of women and traditional birth attendants regarding the high occurrence of stillbirth in Thatta district.Methods: We used an exploratory qualitative study design by conducting in-depth interviews (IDIs) and focus group discussions (FGDs) using semi-structured interview guide with rural women (FGDs = 4; n = 29) and traditional birth attendants (FGDs = 4; n = 14) who were permanent residents of Thatta. In addition, in-depth interviews were conducted with women who had experienced a stillbirth (IDIs = 4). This study presents perceptions and experiences of women and TBAs regarding high rate of stillbirth in Thatta district, Karachi.Results: Women showed reluctance to receive skilled/ standard care when in need due to apprehensions towards operative delivery, poor attitude of skilled health care providers, and poor quality of care as service delivery factors. High cost of care, far distance to facility, lack of transport and need of an escort from the family or village to visit a health facility were additional important factors for not seeking care resulting in stillbirth. The easy availability of unskilled provider in the form of traditional birth attendant is then preferred over a skilled health care provider. TBAs shared their husband or family members restrict them to visit or consult a doctor during pregnancy. According to TBAs after delivering a macerated fetus, women are given herbs to remove infection from woman\u27s body and uterus. Further women are advised to conceive soon so that they get rid of infections.Conclusion: Women of this rural community carry lots of apprehension against skilled medical care and as a result follow traditional practices. Conscious efforts are required to increase the awareness of women to develop positive health seeking behavior during pregnancy, delivery and the post-partum period. Alongside, provision of respectful maternity care needs to be emphasized especially at public health facilities

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease