The Workload Pressures Experienced by Nurses at Public Sector Hospitals, Peshawar

OBJECTIVE The study's objective was to assess that nurses working in in-patient wards were under workload stress. METHODOLOGY Descriptive observational research on nurses working in the in-patient ward of a public sector hospital in Peshawar was undertaken in November 2020. Workload Indicators of Staffing Need (WISN), a tool established by the World Health Organization (WHO) to anticipate the number of health staff needed to cope with workload pressure, was used to determine nurses' workload. To ensure the successful implementation of the WISN methodology, three tiers of committees were developed, including steering, technical, and expert committees. Data were also analyzed using the tool. RESULTS Nurses in the hospital's in-patient unit work 1966 hours per year. Health service activities, support, and other activities account for 47.92%, 33.33%, and 18.75% of all nurses' time, respectively, during this time. Four nurses were working in the hospital during the research study; however, WISN estimated that three nurses were needed to cope with the ward's workload pressure, and one nurse was overstaffed at the time. The WISN ratio calculated was 1.33. CONCLUSIONS The study concluded that there was no workload pressure on nurses (negative), and the ward had an extra nurse who could be accommodated in any other department with greater demand

Healthcare Professionals’ Compliance with the Standard Management Guidelines towards the Use of Biological Disease-Modifying Anti-Rheumatic Drugs in Rheumatoid Arthritis Patients

Treatment of rheumatoid arthritis (RA) is complicated, with numerous aspects influencing decision-making, including disease severity, comorbidities, and patient preferences. The present study aimed to evaluate healthcare professionals’ (HCPs) knowledge of biological disease-modifying anti-rheumatic drugs (bDMARDs) and their compliance with the standard management guidelines for assuring optimal RA therapy. The cross-sectional, survey-based study was performed in various healthcare and academic settings in Karachi, Pakistan to probe HCPs’ knowledge of bDMARDs and their compliance with the European League against Rheumatism (EULAR) recommendations for the management of RA patients. Overall, n = 413 questionnaires were included in our study (response rate: 82.6%). The physicians were further well-informed about the indications (n = 276, 91.3%, p = 0.001) and monitoring requirements (n = 258, 85.4%, p = 0.004). The pharmacists were more knowledgeable about the drug targets (n = 96, 86.4%, p = 0.029) and their mechanisms of action (n = 80, 72.0%, p = 0.013). Male respondents as compared with females (41.3% vs. 35.6%, p = 0.04), and physicians as compared with pharmacists (40.7% vs. 37.8%, p = 0.012), were more confident in using bDMARDs than conventional treatment in RA patients. Our findings show that the respondents were familiar with the attributes of bDMARDs and the standard management guidelines for RA care. Our results may be relevant in creating new methods, guidelines, and treatments to enhance RA treatment adherence, satisfaction, and health outcomes

Acceptance of COVID-19 vaccine in Pakistan: A nationwide cross-sectional study

Introduction: The coronavirus disease 2019 (COVID-19) vaccine is available across various countries worldwide, with public-private partnerships ensuring all individuals are vaccinated through a phased approach. Irrespective of the geographical spread, several myths pertaining to the COVID-19 vaccine have stemmed, ultimately limiting the national administration of vaccines and rollouts. This study assessed the acceptance of the COVID-19 vaccine among the general public in Pakistan.Methods: A pre-validated questionnaire was administered from January 2021 to February 2021 to assess the public attitude and acceptance of the COVID-19 vaccine. Logistic regression analyses were run to identify factors associated with the acceptance among the population.Results: A total of 936 responses were elicited, where 15% perceived their risk of being infected at 20-30% with an overall 70% agreeing to be vaccinated if recommended. Multivariate analysis identified higher acceptance in the male gender, healthcare workers, and students. Of all, 66% respondents chose healthcare workers and public officials, whereas 15.6% chose scientific literature, and 12.9% chose social media as the most reliable source of COVID-19 information.Conclusion: Given the relatively greater trust in healthcare providers for information regarding COVID-19, healthcare workers ought to be on the frontline for vaccine campaigns and public outreach efforts, with governmental efforts in addition to the promotion of scientific materials for population-level understanding

ASSESSING STAFF REQUIREMENTS AND WORKLOAD PRESSURE AMONG DOCTORS WORKING IN OBSTETRICS & GYNECOLOGY DEPARTMENT OF A PUBLIC SECTOR HOSPITAL IN PAKISTAN USING THE WORLD HEALTH ORGANIZATION’S WORKLOAD INDICATORS OF STAFFING NEEDS

OBJECTIVE: To assess the doctors’ requirement/workload pressure in Department of Obstetrics and Gynecology (DObGyn) of a public sector hospital for effective planning and management of human resources. METHODS: World Health Organization's Workload Indicators of Staffing Needs (WISN) tool was used in assessing the staffing requirements for doctors working in the DObGyn of a public sector hospital Khyber Pakhtunkhwa, Pakistan. Information on working conditions and staffing was acquired by reviewing relevant documents and interviewing key informants. We obtained workload statistics from the hospital from January 1 to December 31, 2015. We assisted a senior technical expert working group in identifying workload components and activity standards, as well as validating both. RESULTS: The average working time needed by the doctors to perform ‘health service activities' was 1952 hours, for which 32 doctors are needed, while there are 36 doctors in the department. ‘Support activities’ accounted for about a fifth of the doctors' annual working hours (-category allowance standards=18.54%), for which 7 doctors were additionally needed. The ‘additional activities' required 3566 hours for which 2 additional doctors were needed. To perform all the three activities, there was a total need of 41 doctors. The workload pressure was also found to be high (WISN ratio: 0.87) on doctors. CONCLUSION: The health services, support and additional activities take up about significant part of the doctors’ time annually. This may require recruitment of a low-cost skill-mix of healthcare personnel to cope with the current workload and/or a health system thinking perspective to reduce the workload indirectly

Pediatricians’ Compliance to the Clinical Management Guidelines for Community-Acquired Pneumonia in Infants and Young Children in Pakistan

Community-acquired pneumonia (CAP) is among the most commonly prevailing acute infections in children that may require hospitalization. Inconsistencies among suggested care and actual management practices are usually observed, which raises the need to assess local clinical practices. The current study was conducted to evaluate pediatricians’ compliance with the standard clinical practice guidelines and their antibiotic-prescribing behavior for the management of CAP in children. Methods: A descriptive cross-sectional study was conducted using a self-administered questionnaire; which was provided to pediatricians by the researchers. Statistical analysis was performed with SPSS 25 Statistics; χ2 tests (or Fisher-exact tests) with the p-value set at Results: The overall response rate was 59.2%. Male respondents were (n = 101; 42.6%), and the respondents (n = 163; 68.7%) were under 30 years of age. Amoxicillin (n = 122; 51.5%) was considered as the most commonly used first-line treatment for non-severe pneumonia, whereas a smaller proportion (n = 81; 34.2%) of respondents selected amoxicillin–clavulanate. Likewise, amoxicillin (n = 100; 42.2%) was the most popular choice for non-severe pneumonia in hospitalized children; however, if children had used antibiotics earlier to admission, respondents showed an inclination to prescribe a macrolide (n = 95; 40.0%) or second-generation cephalosporin (n = 90; 37.9%). More than 90% responded that children n = 71; 29.9%), improving antibiotic prescribing (n = 59; 24.8%), and using the appropriate dose of antimicrobials (n = 29; 12.2%) were considered the major factors by the respondents to reduce antimicrobials resistance. Conclusions: The selection of antibiotics and diagnostic approach was as per the recommendations, but indication, duration of treatment, and hospitalization still can be further improved

Frequency of Naturally Occurring Maxillary Midline Diastema (mmd) and its Association with Enlarged Labial Frenulum in Students of Public Medical College Mardan, Pakistan

OBJECTIVE: The study was conducted to determine the prevalence of naturally occurring maxillary midline diastema (MMD) in students of public sector medical college in Mardan, Pakistan and its association with enlarged labial frenulum. METHODOLOGY: The cross-sectional study was conducted in Mardan where students were assessed to determine MMD. Sample size was 150 (males 76%, n= 114; females 24%, n= 36). Ethical consideration was followed, and data was analyzed using SPSS version 17 for descriptive statistics. RESULTS: Only 20% (n= 30) male students were having MMD while out of these only 20% (n= 6) were having enlarged labial frenulum. No MMD was found in female students CONCLUSION: The maxillary midline diastema is more pronounced in male students and the authors decline the observation based on their findings that major contributing factor in MMD is because of enlarged labial frenulum

Breaking the barriers: addressing dental students bullying by medical counterparts and promoting a collaborative learning environment

The study question on the bullying of dental students by their medical counterparts is of the utmost significance due to the policy implications and the necessity for additional research. Despite anecdotal evidence showing instances of competitiveness and exploitation between dental and medical students, there is an absence of comprehensive studies on the incidence and impact of bullying specifically targeted against dental students. This research gap is concerning since bullying has a negative impact on people’s mental health, academic success, and professional development. This review provides an in-depth study of the matter, allowing the policymakers better understand the scope and dynamics of bullying among medical and dental students, to enable them develop specialized policies and programs to address the problem

PHYSICIANS' APPREHENSIONS IN MANAGING A FEBRILE CHILD

  Objectives: Fever in children under the age of 5 years can be a diagnostic challenge for pediatricians and primary care physicians since it is often complicated to recognize the rationale. In this study, we intend to ascertain their understanding, attitudes and misapprehensions concerning fever in children.Methods: This transversal study was conducted from March to August 2014 by adopting a pre-validated questionnaire. The study population comprised of physicians working in different public and private sector hospitals and clinics of Karachi. Descriptive statistics was employed to acquire the response of respondents to questionnaire items. Kruskal-Wallis H test was executed to evaluate the association of gender, position, experience and institution of physicians with their responses.Results: The response rate for filling the questionnaire was 71%. More than 97% considered fever risky for a child, 92.25% considered that neurological disorders, seizures and fatality are problems associated with fever. More than 95% opined that when the fever increases then the possibility of febrile convulsions increases. High fever was considered as a sign of severe bacterial infection by majority (90.14%) of participants. Many (79%) opined that the body temperature of above 38°C must absolutely be treated in spite of the causal pathology. Majority of the physicians recommended physical methods such as baths (90.14%), cold application, (82.39%) and rubbing the body with alcohol (28.87%) to be utilized in reducing fever.Conclusion: The study revealed that there were misapprehensions about fever and its associated problems. This demands the execution of educational intervention employing international guiding principles concerning the appropriate management of the febrile child.Keywords: Fever, Physicians, Febrile child, Pakistan