Disclosure of Medical error

With the advancement of medical sciences, lives are being prolonged and practice of medicine is considered an art and no longer as science. ‘To Err is Human Report’ has been released and gives data of medical errors in United States which opened people’s eyes but there is grieving need that health professional in Pakistan also report the medical errors. Medical errors are common, costly, and often preventable. This could only happen when health professional are trained and made aware to report the errors. Evidences shows that full and honest disclosure of error and restitution are factors that may lead to significant improvement in responsibility of medical cases

A literature review about effectiveness of massage therapy for cancer pain.

This literature review explores the effectiveness of massage therapy to reduce cancer pain. As part of the review, systematic literature search was carried out on various electronic databases and specialised journals. Included are 19 research-based articles and 8 review articles. The review suggests that cancer has become a common health problem in the world and most of the cancer patients are going through intense and unbearable pain. Studies have reported that most of the cancer patients\u27 pain reduced with therapeutic massage. Seventy-three per cent of cancer patients use massage therapy in the USA. Few studies are available in the context of the developing world related to massage therapy and we could not find any study in the Pakistani context. There is a need to conduct an interventional study about the effectiveness of massage therapy to control cancer pain in developing countries such as Pakistan

Interaction and cognitive engagement in online discussions in professional development leadership and management course at a private nursing institution

In the Post RN BScN curriculum, one of the courses “Professional Development and Leadership (PDLM)” was offered as blended mode for the first time. In order to explore the students’ interactions and Cognitive Engagement (CE) in Online Discussion Forums (ODFs), the research team conducted a retrospective study for the first time at a private nursing institution of Karachi-Pakistan. The study was conducted by utilizing the retrospective qualitative paradigm of discourse analysis to understand student’s CE in ODFs. The study has addressed the following one main and three subsidiary research questions: How do threaded discussions (in the part of online forums) enable or hinder the student’s level of cognitive engagement in a blended learning course (PDLM course)? All the course enrollees were invited to participate in the study; 24 of 81 students provided the written consent to participate in the study. The participants of the research study were both males and females; of which males were (20.8%) whereas females were (79.2%). However, only (92.3%) of the participants’ completed the Online Monkey Survey tool for demographic details. The data was collected after the university’s ethical review committee’s clearance. The scripts of ODFs from two online modules (named as Module A & B) were used for this study, which were triangulated through Focus Group Discussions (FGDs). The researcher used discourse analysis to explore the interrelations between words and the context in which the words are used. This assisted in establishing the links to determine the patterns of interaction and the levels of CE of the learners. Levels and categories of CE defined by Zhu (2006) were used as a guideline for discourse analysis of the discussion forums of two modules. Categories were assigned various levels to understand the specific kinds of interactions as explained within the selected analytical framework. The categories and levels include question type I and II, statements type I-VI, reflection type I and II, mentoring and scaffolding. It is observed from the results that majority of the participants used statements type I which is responding to the direct questions, whereas, seeking clarifications (either question type I or II) was not much observed. Mentoring and Scaffolding are higher levels of CE, however, only less number of responses observed in both the modules A and B. Moreover, study participants reported high level of engagement with the positive role of faculty facilitation and felt more comfortable in participating through a virtual learning environment. It was recommended to set netiquettes, to have sound training to those learners whose ICT skills need improvement and to consider in-depth key informant interviews with each research participant soon after they posted a comment on ODF, will bring more insight in understanding CE

Women experiences of using external breast prosthesis after mastectomy.

Objective: The aim of this study was to identify the experiences of breast cancer patients using external breast prostheses (EBP) in the context of the Pakistani society. Methods: A qualitative descriptive exploratory design was used in the study. In-depth individual interviews were conducted with 15 postmastectomy women using EBP. A semi-structured interview guide with open-ended questions was used for the interviews. The analysis of the data was organized into four categories according to the study questions including reasons for using EBP, feeling about EBP, challenges for using EBP, and coping with lost breast. Each category was further divided into subcategories. Results: Women used EBP because they felt strange, incomplete, and embarrassed in front of other people, due to the asymmetrical shape of the chest after mastectomy. They faced several challenges with regard to obtaining and using the EBP. While EBP was used as an alternative of their lost breast, they experienced sadness and embarrassment. They found it challenging to take care of the EBP and were required to make changes in their lifestyle. However, they accepted living with their lost breast, either through rationalization, family support, or faith and prayers, which helped them to cope. Conclusions: The study findings have given insight into some real experiences of mastectomy patients. Mastectomy not only affects women\u27s physical health but also their psychological health, as a result of which they become reluctant to socialize. Using EBP can help them to improve their body image and body posture. Health-care providers\u27 support is very important to the families of the patients specifically where patients are very shy to openly seek information due to cultural constraints

Cultural practices of rearing preterm infants: A qualitative study in a tertiary care hospital, Karachi, Pakistan

The research work explores the cultural practices of feeding and hygiene of preterm infants in the Pakistani context. A Qualitative descriptive-exploratory design has been used. Purposive sampling was utilized to recruit 17 mothers, who met inclusion criteria from a largest government tertiary care hospital in Karachi, Pakistan. The semi-structured interview was used to collect the data, which lasted for approximately 45-60 minutes. Thematic analysis was conducted to analyze the key findings of the study. Welcoming newborn with \u27honey\u27 and herbal remedies were reported as a common ritual among mothers. Findings revealed differences in the time period of initial bath given to the preterm, ranges from 3 days to 1 month. These custom variations of rearing preterm have its own meaning in the prescribed culture; however, these customs are the insights to explore more on its effects on infants\u27 health. This study provides useful insights into several practices of cultures, which serve as the determinants of infants\u27 nutrition and health status. It provides an insight to the health care professionals to provide quality care to preterm infants

Exploring lived experiences of married Pakistani women post-mastectomy

Objective: This qualitative descriptive exploratory study aimed to explore the lived experiences of married Pakistani women, 2 years post-mastectomy.Methods: Twelve participants were recruited through purposive sampling from outpatient oncology clinic from a tertiary care hospital in Pakistan. Interviews were audio-taped and transcribed, and then themes and sub-themes were identified.Results: Women verbalized a range of their experiences throughout the span from diagnosis to mastectomy. One over arching theme, quality of life and four main themes and their subthemes emerged from the data. Following are the themes; from history to diagnosis, worries, coping strategies, and recommendations.Conclusions: The study findings revealed that effective coping strategies were beneficial for these women, as these women coped well after being diagnosed with breast cancer. Strong recommendations were made by the participants for the formulation of support groups, which could help them reduce their anxiety through information exchange

Prenatal allostatic load and preterm birth: A systematic review

Objective: Allostatic load refers to cumulative neuroendocrine burden and has been postulated to mediate and moderate physiological and psychological stress-related responses. This may have important implications for the risk of preterm birth. This systematic review examines the evidence on the association between prenatal allostatic load and preterm birth. Data sources: A comprehensive search of seven electronic databases was conducted from inception to August 23, 2022 to identify all English-language observational and mixed methods studies examining allostatic load and preterm birth with no year or geographic restrictions. Study eligibility criteria: Studies were included if they measured allostatic load, evaluated as the cumulative effect of any combination of more than one allostatic load biomarker, during pregnancy. Studies must have observed preterm birth, defined as \u3c 37 weeks\u27 gestational age, as a primary or secondary outcome of interest. Study appraisal and synthesis methods: The Quality In Prognosis Studies tool was used to evaluate risk of bias within included studies. A narrative synthesis was conducted to explore potential associations between allostatic load and preterm birth, and sources of heterogeneity. Results: Three prospective cohort studies were identified and revealed mixed evidence for an association between allostatic load and preterm birth. One study reported a statistically significant association while the other two studies reported little to no evidence for an association. Heterogeneity in when and how allostatic load was measured, limitations in study design and cohort socio-demographics may have contributed to the mixed evidence. Conclusions: This review provides insight into key individual-, community-, and study-level characteristics that may influence the association between allostatic load and preterm birth. Knowledge gaps are identified as foci for future research, including heterogeneity in allostatic load biomarkers and allostatic load index algorithms as well as pregnancy-specific considerations for allostatic load measurement. Further investigation of the allostatic load framework in the context of perinatal mental health is needed to advance understandings of maternal, infant, and child health

Perceived stress may mediate the relationship between antenatal depressive symptoms and preterm birth: A pilot observational cohort study

Background: Screening for changes in pregnancy-related anxiety and depressive symptoms during pregnancy may further our understanding of the relationship between these two variables and preterm birth.Objectives: To determine whether changes in pregnancy-related anxiety and depressive symptoms during pregnancy influence the risk of preterm birth among Pakistani women; explore whether perceived stress moderates or mediates this relationship, and examine the relationship between the various components of pregnancy-related anxiety and preterm birth.Methods: A prospective cohort study design was used to recruit a diverse sample of 300 low-risk pregnant women from four centers of Aga Khan Hospital for Women and Children in Karachi, Pakistan. Changes in pregnancy-related anxiety and depressive symptoms during pregnancy were tested. Multiple logistic regression analysis was used to determine a predictive model for preterm birth. We then determined if the influence of perceived stress could moderate or mediate the effect of depressive symptoms on preterm birth.Results: Changes in pregnancy-related anxiety (OR = 1.1, CI 0.97-1.17, p = 0.167) and depressive symptoms (OR = 0.9, CI 0.85-1.03, p = 0.179) were insignificant as predictors of preterm birth after adjusting for the effects of maternal education and family type. When perceived stress was added into the model, we found that changes in depressive symptoms became marginally significant after adjusting for covariates (OR = 0.9, CI 0.82-1.01, p = 0.082). After adjusting for the mediation effect of change in perceived stress, the effect of change in depressive symptoms on preterm birth were marginally significant after adjusting for covariates. Among six different dimensions of pregnancy-related anxiety, mother\u27s concerns about fetal health showed a trend towards being predictive of preterm birth (OR = 1.3, CI 0.97-1.72, p = 0.078).Conclusions: There may be a relationship between perceived stress and antenatal depressive symptoms and preterm birth. This is the first study of its kind to be conducted in Pakistan. Further research is required to validate these results

Ethnic disparity and exposure to supplements rather than adverse childhood experiences linked to preterm birth in Pakistani women

Background: Adverse childhood experiences (ACEs) are associated with prenatal mental health and negative pregnancy outcomes in high income countries, but whether the same association exists in Pakistan, a low- to middle-income (LMI) country, remains unclear. Methods: Secondary data analyses of a prospective longitudinal cohort study examining biopsychosocial measures of 300 pregnant women at four sites in Karachi, Pakistan. A predictive multiple logistic regression model for preterm birth (PTB; i.e., \u3c37 weeks’ gestation) was developed from variables significantly (P \u3c 0.05) or marginally (P \u3c 0.10) associated with PTB in the bivariate analyses. Results: Of the 300 women, 263 (88%) returned for delivery and were included in the current analyses. The PTB rate was 11.1%. We found no association between ACE and PTB. Mother\u27s education (P = 0.011), mother\u27s ethnicity (P = 0.010), medications during pregnancy (P = 0.006), age at birth of first child or current age if primiparous (P = 0.049) and age at marriage (P = 0.091) emerged as significant in bivariate analyses. Mother\u27s ethnicity and taking medications remained predictive of PTB in the multivariate model. Limitations: Findings are limited by the relatively small sample size which precludes direct testing for possible interactive effects. Conclusions: In sum, pathways to PTB for women in LMI countries may differ from those observed in highincome countries and may need to be modelled differently to include behavioural response to emotional distress and socio-cultural contexts

Foreign body aspiration: a life-threatening situation.

Foreign body aspiration is a life-threatening event, especially in children. In Pakistan, foreign body aspiration in children with betel nuts is a common emergency in the perioperative area. Health awareness of parents, teachers, caretakers, and health care providers can play a significant role in reducing the risk of this life-threatening event. This article describes a case report of a 2½ year old boy who presented in the perioperative area with a betel nut aspiration