34 research outputs found

    COMPARISON OF DOCUMENTED PATIENT CARE BEFORE AND AFTER IMPLEMENTATION OF END OF LIFE CARE PATHWAY FOR TERMINALLY ILL PATIENTS AT SHAUKAT KHANUM MEMORIAL CANCER HOSPITAL AND RESEARCH CENTRE

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    Purpose: Shaukat Khanum Memorial Cancer Hospital and Research Cancer primarily deals with cancer patients and has various departments which provide best-integrated lifesaving care. However, when patients who have been given all possible medical and oncological treatment still progress their disease, they are then referred for best supportive care to palliative care department. The aim of this paper was to audit documented care for palliative patients before and after implementation of end of life care (ELC) pathway.Materials and Methods: We used a retrospective method to audit 45 terminally ill patients over a period of 3 months. Then, a re-audit was done over a period of 3 months and data were collected for patients who were started on SKM-ELC pathway.Results: Results show that the implementation of ELC pathway, 67% of the patients were not prescribed PRN medications for symptom control, 20% of the patients were not reviewed for the need of assisted nutrition and for 20% of the patient’s primary team were not even notified that the patient is dying. After the ELC pathway implementation, it was found that 100% of patients were reviewed for PRN medications and assisted nutrition. Oncologists were timely notified that the patient is dying.Conclusion: In summary, we can say that implantation of ELC pathway has significantly improved documented patients care in all aspects.Key words: Cancer, care for dying, end of life care, goals of care pathwa

    Word by word labelling of Romanized Sindhi text by using online python tool

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    Sindhi is one of the most ancient languages in the world and it has its own written and spoken scripts. After the rigorous study it was found that a lot of research work has been done in different languages, but word by word labelling of Sindhi language had not been done yet. In this research study, word labelling was done on 100 sentences of Romanized Sindhi texts using Python online tool. The dataset was collected from different sources which include Sindhi newspaper, blogs and social media webpages. From this dataset, a rule-based model has been applied for the Parts-of-Speech (POS) tagging of the Romanized Sindhi sentences. A total of 624 words of Romanized Sindhi texts were tested and successfully tagged by the SindhiNLP tool in which 482 words were tagged as nouns and pronouns, 92 words tagged as verbs and 50 words tagged as determinants

    Comparison of Percentage Depth Doses with the Published Data for Co-60 Radiotherapy Machine at a Regional Cancer Hospital

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    In external beam radiation therapy, the percentage depth dose (PDD) is a main factor for estimation of patient’s dose and dose distribution in target volume, therefore its accurate estimation is important. The purpose of this article is to compare PDDs with the published PDDs of different authors along central axis at different depths and field sizes for cobalt-60 (Co-60) radiotherapy machine at a regional cancer hospital Pakistan. A dedicated water phantom was used for estimation of PDDs at different depths and different field sizes, for Theratron phoenix Co-60 machine. It was observed that for 10×10 cm2 filed size of Co-60 beam mean percent variation in measured PDDs and published PDDs by different authors was -0.29% to 1.13%, which was within acceptable limit of ± 2%. However, for one author who used semi-empirical equation for PDDs calculation, the mean percent variation between measured PDDs and that of the author was -3.23%, 4.69% and 5.88% for 10×10 cm2, 25×25 cm2 and 30×30 cm2 field sizes of Co-60 beam respectively, which were within acceptable limit of   ±10%. A noticeable increase in PDDs was observed with increase of the field size at given depth which shows obvious contribution of secondary scattered radiation. Also measured PDDs were well matched with that of published PDDs of most of the authors i.e. ± 2%, but the measured PDDs were moderately matched with that of PDDs for only one author for some field sizes and some depths i.e. ±10%, which need to be rectified by taking more such data.

    Prevalence of Marital Conflicts among Women Diagnosed with Postpartum Depression

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    The present research was on the prevalence of marital conflicts among women having postpartum depression and from general population. The sample was of 100 women, including 50 women having postpartum depression and 50 from general population. The data was collected after one week of child birth. The hypothesis was “the marital conflicts will be higher in women with postpartum depression than women from general population”. The hypothesis was tested by using chi-square test, highly significant results revealed that postpartum depression negatively effect the marital relation. Similarly, women with postpartum depression revealed difficulty in understanding themselves and they blamed themselves comparing them with women without postpartum depression. Women with postpartum depression blamed themselves when things went wrong and created troubles for themselves

    Chemical composition and pharmacological bio-efficacy of Parrotiopsis jacquemontiana (Decne) Rehder for anticancer activity

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    Consistent STAT3 (Single transducer and activator of transcription 3) activation is observed in many tumors and promotes malignant cell transformation. In the present investigation, we evaluated the anticancer effects of Parrotiopsis jacquemontiana methanol fraction (PJM) on STAT3 inhibition in HCCLM3 and MDA-MB 231 cells. PJM suppressed the activation of upstream kinases i.e. JAK-1/2 (Janus kinase-1/2), and c-Src (Proto-oncogene tyrosine-protein kinase c-Src), and upregulated the expression levels of PIAS-1/3 (Protein Inhibitor of Activated STATs-1/3), SHP-1/2 (Src-homology region 2 domain-containing phosphatase-1/2), and PTP-1β (Protein tyrosine phosphatase 1 β) which negatively regulate STAT3 signaling pathway. PJM also decreased the levels of protein products conferring to various oncogenes, which in turn repressed the proliferation, migration, invasion, and induced apoptosis in cancer cell lines. The growth inhibitory effects of PJM on cell-cycle and metastasis were correlated with decreased expression levels of CyclinD1, CyclinE, MMP-2 (Matrix metalloproteinases-2), and MMP-9 (Matrix metalloproteinases-9). Induction of apoptosis was indicated by the cleavage and subsequent activation of Caspases (Cysteine-dependent Aspartate-directed Proteases) i.e. caspase-3, 7, 8, 9, and PARP (Poly (ADP-ribose) polymerase) as well as through the down-regulation of anti-apoptotic proteins. These apoptotic effects of PJM were preceded by inhibition of STAT3 cell-signaling pathway. STAT3 was needed for PJM-induced apoptosis, and inhibition of STAT3 via pharmacological inhibitor (Stattic; SC-203282) abolished the apoptotic effects. Conclusively, our results demonstrate the capability of PJM to inhibit cancer cell-proliferation and induce apoptosis by suppressing STAT3 via upregulation of STAT3 inhibitors and pro-apoptotic proteins whereas the down-regulation of upstream kinases and anti-apoptotic protein expression. In future, one-step advance studies of PHM regarding its role in metastatic inhibition, immune response modulation for reducing tumor, and inducing apoptosis in suitable animal models would be an interesting and promising research area

    Applying a mixed-method approach to improve on-the-job learning and job satisfaction in a cohort of interns at a university hospital

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    Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern\u27s work-based learning and satisfaction in a university hospital setting.Methods: Using Kern\u27s six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome the identified gaps. In phase 2 (2014-2016) the impact of these developmental strategies was assessed.Results: A total of 65 interns, 30 residents, and 22 faculty members participated in phase I, while 71 interns participated in phase II. The reformation of orientation sessions, including practical exposure and content of sessions, opportunities to enhance hands-on experience and supervision in inpatient areas, operating rooms, supervision by fellows, supervision for hands-on procedures, career counseling, and mentorship, led to significant improvement in satisfaction. It was identified that the lack of hands-on opportunities can be overcome by surgical skills-based workshops. These reforms led to an overall rise in intern satisfaction (50% vs 75.4%, p=0.02).Conclusion: Periodic restructuring of an existing program helps to improve the work-based learning experience and overall satisfaction among interns. This not only maximizes learning but also eases interns into their postgraduate life and workload subsequently enabling them to become more competent and well-rounded health practitioners

    Burden of ileal perforations among surgical patients admitted in tertiary care hospitals of three Asian countries: Surveillance of enteric fever in Asia project (SEAP), september 2016-september 2019

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    Background: Typhoid fever is caused by Salmonella enterica subspecies enterica serovar Typhi (S. Typhi) and can lead to systemic illness and complications. We aimed to characterize typhoid-related ileal perforation in the context of the population-based Surveillance of Enteric Fever in Asia Project (SEAP) in Bangladesh, Nepal and Pakistan.Methods: Between September 2016 and September 2019, all cases of nontraumatic ileal perforation with a clinical diagnosis of typhoid were enrolled from 4 tertiary care hospitals in Karachi, 2 pediatric hospitals in Bangladesh, and 2 hospitals in Nepal. Sociodemographic data were collected from patients or their caregivers, and clinical and outcome data were retrieved from medical records. Tissue samples were collected for histopathology and blood cultures where available.Results: Of the 249 enrolled cases, 2 from Bangladesh, 5 from Nepal and 242 from Pakistan. In Pakistan, most of the cases were in the 0-15 (117/242; 48%) and 16-30 (89/242; 37%) age groups. In all countries, males were most affected: Pakistan 74.9% (180/242), Nepal 80% (4/5), and Bangladesh 100% (2/2). Blood culture was done on 76 cases; 8 (11%) were positive for S. Typhi, and all were extensively drug resistant (XDR) S. Typhi. Tissue cultures was done on 86 patients; 3 (3%) were positive for S. Typhi, and all were XDR S. Typhi, out of 86 samples tested for histopathology 4 (5%) revealed ileal perforation with necrosis. Culture or histopathology confirmed total 15 (11%) enteric fever cases with ileal perforation are similar to the clinically diagnosed cases. There were 16/242 (7%) deaths from Pakistan. Cases of ileal perforation who survived were more likely to have sought care before visiting the sentinel hospital (P = .009), visited any hospital for treatment (P = .013) compared to those who survived.Conclusions: Although surveillance differed substantially by country, one reason for the higher number of ileal perforation cases in Pakistan could be the circulation of XDR strain of S. Typhi in Karachi

    Antimicrobial resistance in typhoidal salmonella: Surveillance for enteric fever in Asia project, 2016-2019

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    Background: Clinicians have limited therapeutic options for enteric as a result of increasing antimicrobial resistance, and therefore typhoid vaccination is recommended as a preventive measure. As a part of the Surveillance for Enteric Fever in Asia Project (SEAP), we investigated the extent measured the burden of antimicrobial resistance (AMR) among confirmed enteric fever cases in Bangladesh, Nepal, and Pakistan.Methods: From September 2016-September 2019, SEAP recruited study participants of all age groups from its outpatient, inpatient, hospital laboratory, laboratory network, and surgical sites who had a diagnosis of febrile illness that was either suspected or blood culture confirmed for enteric fever. Antimicrobial resistance of isolates was determined by disc diffusion using Clinical and Laboratory Standard Institute cut-off points. We reported the frequency of multidrug resistance (MDR)(resistance to ampicillin, cotrimoxazole, and chloramphenicol), extensive drug resistance (XDR) (MDR plus non-susceptible to fluoroquinolone and any 3rd generation cephalosporins), and fluoroquinolone (FQ) and azithromycin non-susceptibility.Results: We enrolled 8,705 blood culture confirmed enteric fever cases: 4,873 (56%) from Bangladesh, 1,602 (18%) from Nepal and 2,230 (26%) from Pakistan. Of these, 7,591 (87%) were Salmonella Typhi and 1114 (13%) were S. Paratyphi. MDR S. Typhi was identified in 17% (701/4065) of isolates in Bangladesh, and 1% (19/1342) in Nepal. In Pakistan, 16 % (331/2084) of S. Typhi isolates were MDR, and 64% (1319/2074) were XDR. FQ nonsusceptibility among S. Typhi isolates was 98% in Bangladesh, 87% in Nepal, and 95% in Pakistan. Azithromycin non-susceptibility was detected in 77 (2%) in Bangladesh, 9 (.67%) in Nepal and 9 (.59%) isolates in Pakistan. In Pakistan, three (2%) S. Paratyphi isolates were MDR; no MDR S. Paratyphi was reported from Bangladesh or Nepal.Conclusions: Although AMR against S. Paratyphi was low across the three countries, there was widespread drug resistance among S. Typhi, including FQ non-susceptibility and the emergence of XDR S. Typhi in Pakistan, limiting treatment options. As typhoid conjugate vaccine (TCV) is rolled out, surveillance should continue to monitor changes in AMR to inform policies and to monitor drug resistance in S. Paratyphi, for which there is no vaccine

    Population Enumeration and Household Utilization Survey Methods in the Enterics for Global Health (EFGH): Shigella Surveillance Study

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    Background: Accurate estimation of diarrhea incidence from facility-based surveillance requires estimating the population at risk and accounting for case patients who do not seek care. The Enterics for Global Health (EFGH) Shigella surveillance study will characterize population denominators and healthcare-seeking behavior proportions to calculate incidence rates of Shigella diarrhea in children aged 6–35 months across 7 sites in Africa, Asia, and Latin America. Methods: The Enterics for Global Health (EFGH) Shigella surveillance study will use a hybrid surveillance design, supplementing facility-based surveillance with population-based surveys to estimate population size and the proportion of children with diarrhea brought for care at EFGH health facilities. Continuous data collection over a 24 month period captures seasonality and ensures representative sampling of the population at risk during the period of facility-based enrollments. Study catchment areas are broken into randomized clusters, each sized to be feasibly enumerated by individual field teams. Conclusions: The methods presented herein aim to minimize the challenges associated with hybrid surveillance, such as poor parity between survey area coverage and facility coverage, population fluctuations, seasonal variability, and adjustments to care-seeking behavior

    Emotional Intelligence, Motivation and Dysfunctional Attitude among Patients with Substance Use: Cognitive Behavior Therapy

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    he study explores the significant predictive relationship between emotional intelligence, motivation, and dysfunctional attitude among substance use patients with the role of cognitive behavior therapy. The sample was comprised of 150 addictive patients. Among 150 patients, 40 were selected for intervention. The sample was divided into two groups of 20 each in the experimental and controlled groups. Participants were selected using a purposive sampling technique from Poly Clinic Jhelum, Punjab, Pakistan. To estimate the constructs following scales were used Trait Emotional Intelligence Questionnaire-Short Form Scale, Situational Motivation Scale, Dysfunctional Attitude Scale Short Form and Drug Abuse Screening Test all in Urdu. Patients with a high level of dysfunctional attitude were selected for intervention. For each participant, 12 sessions were planned. The statistical calculations were done using Statistical Package for Social Sciences(V-26). Regression analysis confirmed that emotional intelligence and motivation is a significant predictors of dysfunctional attitudes in substance used patients [R²=.066; F (2, 147) = 5.198, p<.01] with 6.6% explained variation in the dysfunctional attitude due to emotional intelligence and motivation. The effectiveness of cognitive behavior therapy was also evident with the experimental groups mean score of emotional intelligence (M=78.6, M = 169.00), motivation (M=58.1, M = 92.10) and dysfunctional attitude (M=61.1, M = 26.00) pre and posttest scores. It indicates that Cognitive Behavior Therapy was effective in the treatment of drug addicts to deal with lower levels of motivation and emotional intelligence as well as higher dysfunctional attitudes. For emotional intelligence, results showed that there is change in mean score of experimental groups (M=78.6, M = 169.00) For motivation, results showed that there is change in mean score of experimental groups (M=58.1, M = 92.10). For dysfunctional attitude, results showed that there is change in mean score of experimental groups (M=61.1, M = 26.00) which indicate that Cognitive Behavior Therapy was effective in treatment of drug addicts to deal with lower levels of motivation and emotional intelligence as well as higher dysfunctional attitude
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