The Influence of Customer Orientation on Customer Relationship in Telecom Services

In this study, an effort has been made to disclose the influence of customer orientation on customer retention. It has also revealed that customer orientation influences on customer satisfaction and customer trust and their ultimate effect on customer Retention. Primary data was collected through questionnaire survey.290 questionnaires were distributed out of which 219 were received and supposed for analysis purpose, 75.51% which is considered as a serious response rate of our respondents. Customer orientation has positive effect on customer satisfaction as well as on customer trust, which shows significant relationship of customer orientation on customer satisfaction and customer trust. Moreover, satisfaction and trust of customer has effect on customer retention. Satisfaction of customer has negative effect due to one or more reason, whereas, customer trust has positive and significant effect on customer retention. Customer orientated organizations earn more profit and can control customer retention. Findings of this study can also be used to control the customer retention. While customer orientation is under discussion then it has two major factors i.e. customer satisfaction and customer trust, organizations should more focus on these factors. Sometime when customer retention takes place even focusing these factors then current competitor’s strategies can also be kept in mind. This study is done in a developing country where there is a very tough competition among service providers to enhance their market share. The focus of this research is to control the switching customer, which is the one of the important problems facing by the service providers

Undergraduate clerkship in emergency medicine: experience from Pakistan.

Although Emergency Medicine (EM) is an integral part of undergraduate medical curriculum in many countries, it has not been included formally in the MBBS curriculum in Pakistan. Medical graduates are supposed to be able to handle common as well as life threatening emergencies but little has been done to ensure the process to achieve this competence. The development of an undergraduate EM curriculum is important but challenging task. Implementation of standard curriculum will ensure that medical graduates have gained competence in assessing and managing acutely ill patients and dealing with common emergencies. This paper shares the features of an undergraduate EM clerkship which can be used as a template by other medical institutions

Differences in risk-adjusted outcome of road traffic injuries in urban tertiary care centers of Pakistan

Objective: To assess the differences in road injury survival in three tertiary care hospitals in an urban setting.Methods: The study was conducted in and comprised all road traffic injury victims presenting to the three state-run tertiary care centres in Karachi from September 2006 to October 2009. Patients\u27 age, gender, mode, and delay in arrival, severity of injury were noted. Data was stratified by hospital of presentation. A logistic regression model was developed and probability of survival was assessed after adjusting for various risk factors, including patient characteristics and injury severity.Results: There were 93,657victims in the study, but complete information was missing in 6,458(6.89%) study subjects, including survival information. Overall, 83,837(89.5%) were males; 64,269(74%) were aged between 16 and 45 years; 84,016(95%) had injury severity score of ?15; and overall survival was 84,141(96.5%).Conclusions: Significant differences existed in risk-adjusted survival of road injury victims presenting to public hospitals of Karachi. These differences pointed to variations in the process of care, and highlighted opportunities for improvement

Attitude of Medical Students Towards Psychiatry in a Tertiary Care Hospital

Background: Dearth of psychiatrist specialists is evident worldwide. Awareness of undergraduate students towards mental illness has an important role in affecting the quality of care the patient receives and in choosing  psychiatry as a career . Decision to specialize in psychiatry based on many factors, however attitude of undergraduates towards career choice play most important role in this aspect. Objective: This study aims to explore attitude and towards psychiatry among medical undergraduates in tertiary care hospital and factors influencing this decision. Methodology: It was Descriptive cross sectional study done at Nishtar medical University, tertiary care hospital of Multan Pakistan from July to December 2019. The total 384 students from first to final year were enrolled by non probability convenient sampling technique. Participation was voluntary and ensured that response would be kept anonymous. ATP-30 (Attitude towards Psychiatry)   a 30 item self- administered questionnaire was used to measure the attitude of medical students. Data collected on a pre defined questionnaire was analyzed using SPSS version 23. Results pertaining to rates were reported as frequencies and percentages. Result: 47.4% of study respondents were male and 52.6 % were female. 52.3% of our study respondents strongly agree that psychiatry was respected branch of medicine and 56.7% strongly agree that psychiatry should be an important part of medical curriculum. 19.4% of study respondents consider it in the list of the carrier choice while majority didn’t think that it should be in their career list options. Conclusion: Majority of students shows positive attitude. Mostly found it as respected and essential field of medicine. However insufficient knowledge and awareness can also be observed in responses pertaining to available treatment and advancement in the field. There is a need to revise the curriculum and clinical rotation schedule to raise interest of students  regarding  mental health issues of their community and ease their decision in choosing it as a career. Keywords: Attitude, Undergraduate medical students, Psychiatry, Multan, Pakistan DOI: 10.7176/JMPB/63-06 Publication date: January 31st 202

Development and pilot implementation of a locally developed Trauma Registry: lessons learnt in a low-income country

Background Trauma registries (TRs) play an integral role in the assessment of trauma care quality. TRs are still uncommon in developing countries owing to awareness and cost. We present a case study of development and pilot implementation of “Karachi Trauma Registry” (KITR), using existing medical records at a tertiary-care hospital of Karachi, Pakistan to present results of initial data and describe its process of implementation. Methods KITR is a locally developed, customized, electronic trauma registry based on open source software designed by local software developers in Karachi. Data for KITR was collected from November 2010 to January 2011. All patients presenting to the Emergency Department (ED) of the Aga Khan University Hospital (AKUH) with a diagnosis of injury as defined in ICD-9 CM were included. There was no direct contact with patients or health care providers for data collection. Basic demographics, injury details, event detail, injury severity and outcome were recorded. Data was entered in the KITR and reports were generated. Results Complete data of 542 patients were entered and analysed. The mean age of patients was 27 years, and 72.5% were males. About 87% of patients had sustained blunt injury. Falls and motor vehicle crashes were the most common mechanisms of injury. Head and face, followed by the extremities, were the most frequently injured anatomical regions. The mean Injury Severity Score (ISS) was 4.99 and there were 8 deaths. The most common missing variables in the medical records were ethnicity, ED notification prior to transfer, and pre-hospital IV fluids. Average time to review each chart was 14.5 minutes and entry into the electronic registry required 15 minutes. Conclusion Using existing medical records, we were able to enter data on most variables including mechanism of injuries, burden of severe injuries and quality indicators such as length of stay in ED, injury to arrival delay, as well as generate injury severity and survival probability but missed information such as ethnicity, ED notification. To make the data collection process more effective, we propose provider based data collection or making a standardized data collection tool a part of medical records

Knowledge about osteoporosis among healthy women attending a tertiary care hospital

INTRODUCTION: To determinate the knowledge on osteoporosis-risk factors and disease in three age groups of Pakistani women.METHODS: In this exploratory cross-sectional study, an osteoporosis knowledge assessment questionnaire (OKAT) was used to collect data and it was delivered through a face-to-face interview. Questions were asked about symptoms of osteoporosis, knowledge of risk factors, preventive factors and treatment. A convenience sample (n =320) comprising of three groups of healthy women aged 25-35 years, 36-45 years, and over 45 years was taken. The scoring range was 0 to 20. Among-group comparisions of means were analyzed by two-way ANOVA. To determine the overall influence of osteoporosis-risk factors, the multivariate analysis was used.RESULTS: The knowledge on osteoporosis in younger women was very poor compared to relatively older females. However, women belonging to higher socioeconomic status and better education had slightly more knowledge about osteoporosis compared to those with a low education level, regardless of age.CONCLUSION: The majority of women had modest knowledge on osteoporosis. Younger women were at increased risk for low bone mass and premature osteoporosis

How vital are the vital signs? a multi-center observational study from emergency departments of Pakistan.

BACKGROUND: Vital signs play a critical role in prioritizing patients in emergency departments (EDs), and are the foundation of most triage methods and disposition decisions. This study was conducted to determine the frequency of vital signs documentation anytime during emergency department treatment and to explore if abnormal vital signs were associated with the likelihood of admission for a set of common presenting complaints. METHODS: Data were collected over a four-month period from the EDs of seven urban tertiary care hospitals in Pakistan. The variables included age, sex, hospital type (government run vs. private), presenting complaint, ED vital signs, and final disposition. Patients who were \u3e12 years of age were included in the analysis. The data were analyzed to describe the proportion of patients with documented vitals signs, which was then crossed-tabulated with top the ten presenting complaints to identify high-acuity patients and correlation with their admission status. RESULTS: A total of 274,436 patients were captured in the Pakistan National Emergency Department Surveillance (Pak-NEDS), out of which 259,288 patients were included in our study. Vital signs information was available for 90,569 (34.9%) patients and the most commonly recorded vitals sign was pulse (25.7%). Important information such as level of consciousness was missing in the majority of patients with head injuries. Based on available information, only 13.3% with chest pain, 12.8% with fever and 12.8% patients with diarrhea could be classified as high-acuity. In addition, hospital admission rates were two- to four-times higher among patients with abnormal vital signs, compared with those with normal vital signs. CONCLUSION: Most patients seen in the EDs in Pakistan did not have any documented vital signs during their visit. Where available, the presence of abnormal vital signs were associated with higher chances of admission to the hospital for the most common presenting symptoms

A successful model of road traffic injury surveillance in a developing country: Process and lessons learnt

Background: Road Traffic Injuries (RTIs) are one of the leading causes of death and disability worldwide with 90% of global mortality concentrated in the low and middle income countries. RTI surveillance is recommended to define the burden, identify high risk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This paper shares the experience of setting up an urban RTI surveillance program in the emergency departments of five major hospitals in Karachi, Pakistan.Method: We describe the process of establishing a surveillance system including assembling a multi-institution research group, developing a data collection methodology, carrying out data collection and analysis and dissemination of information to the relevant stakeholders. In the absence of a road safety agency, the surveillance system required developing individual partnerships with industry, police, city government, media and many other stakeholders. Impact of the surveillance is demonstrated by some initiatives in the local trauma system and improvements in road design to effect hazard reduction.Conclusion: We demonstrated that a functional RTI surveillance program can be established, and effectively managed in a developing country, despite lack of infrastructure and limitation of resources. Data utilization in the absence of well defined road safety infrastructure within the government is a challenge. More effective actions are hampered by the limited capacity in the transport and health sectors to do in-depth analysis through road safety audits and trauma registries

Microscopic Discectomy Outcomes in Lumbar Disc Herniation Patients

Background: Radiculopathy due to herniated lumbar disc is one of the most common determinant of sciatica. Most patients with sciatica respond well to non-surgical treatment. Surgery is performed when there is an established neurological deficit or when conservative management is not successful in achieving positive results in pain.Objective: To evaluate the frequency of good outcomes regarding pain relief after lumbar microscopic discectomy in adult patients presenting with radiculopathy.Material and Methods: Current study includes 80 patients, both male and female between 20-70 years and admitted for herniated lumbar disc surgery. Microscopic discectomy was performed in all these patients. Outcome variable was frequency of good outcome in terms of post-operative pain ? 4/10. Informed consent in written was obtained from the individual patient.Results: In 73 (91.3%) cases good outcome was observed. No substantial difference was noticed in the frequency of good outcome according to the duration of herniated disc (p = 0.960), pre-operative pain score (p = 0.499), age (p = 0.851) and gender (p = 0.703).Conclusion: Good outcome was observed in 91.3% patients presenting with herniated lumbar disc undergoing microscopic discectomy regardless of patient’s age, gender, pre-operative pain and duration of disc herniation