Postoperative pain management practices and their effectiveness after major gynecological surgery: An observational study in a tertiary care hospital

Background and Aims: Despite advances in postoperative pain management, patients continue to experience moderate to severe pain. This study was designed to assess the strategy, effectiveness, and safety of postoperative pain management in patients undergoing major gynecological surgery.Material and Methods: This observational study included postoperative patients having major gynecological surgery from February 2016 to July 2016. Data collected on a predesigned data collection sheet included patient\u27s demographics, postoperative analgesia modality, patient satisfaction, acute pain service assessment of numeric rating scale (NRS), number of breakthrough pains, number of rescue boluses, time required for the pain relief after rescue analgesia, and any complication for 48 h.Results: Among 154 patients reviewed, postoperative analgesia was provided with patient-controlled intravenous analgesia in 91 (59.1%) patients, intravenous opioid infusion in 42 (27%), and epidural analgesia in 21 (13.6%) patients with no statistically significant difference in NRS between different analgesic modalities. On analysis of breakthrough pain, 103 (66.8%) patients experienced moderate pain at one time and 53 (51.4%) at two or more times postoperatively. There were 2 (0.6%) patients experiencing severe breakthrough pain due to gaps in service provision and inadequate patient\u27s knowledge. Moderate-to-severe pain perception was irrespective of type of incision and surgery. Vomiting was significantly higher (P = 0.049) in patients receiving opioids.Conclusion: Adequacy of postoperative pain is not solely dependent on drugs and techniques but on the overall organization of pain services. However, incidence of nausea and vomiting was significantly higher in patients receiving opioids

Audit of postoperative nausea and vomiting in paediatric day case surgery

OBJECTIVE: To assess the incidence of PONV, delay in discharge or unplanned admissions in paediatric surgical cases done at the Surgical Day Care Unit at Aga Khan University between January and July 2009. METHODS: All paediatric ASA 1-2 cases, from 6 months to 18 years of age undergoing day case surgeries at the Surgical day care unit were included in this retrospective audit. Data was collected on a designed form filled with information from preoperative, intraoperative and postoperative recovery forms. Any relevant data was also noted from nurses notes in recovery room and step down unit. Episodes of vomiting, delay in discharge, or unplanned admission due to PONV were documented. Data was analyzed on SPSS 14. RESULTS: Out of 163 patients only one patient (0.6%) had an episode of vomiting in the recovery room and two patients (1.2 %) had vomiting in the step down unit. There was no delay in discharge or unplanned admission due to PONV in paediatric day cases during the period of our audit. CONCLUSION: The incidence of postoperative vomiting in paediatric day cases at our day care unit does not justify polymodal prophylaxis as a protocol for PONV

Linking poverty and environment as causes of conflict: a case study of Pakistan

This paper presents a theoretical analysis of an International conflict i.e. East Pakistan Crisis, 1971, and reveals that un-equal development creates conflict in society. Natural resource scarcity and environmental degradation can also become a source of conflict, so marginalized and excluded people fight for their rights through non-peaceful means.This essay supports the theoretical approaches of poverty, environment, and conflict nexus and reveals that un-equal development and resources scarcity deepens the poverty and creates conflicts in the society, causing harm to the environment.The degraded environment deepens the poverty as environment and poverty are interlinked and poor has limited choices other than to degrade the environment for their survival.This vicious downward spiral link of poverty and degradation of environment requires working extensively for poverty alleviation to reverse the environmental decline

Measuring Training Effectiveness: A Case Study Of Public Sector Project Management In Pakistan

Many organizations do invest precious resources on training and development but without examining how training interventions could effectively contribute in the achievement of organizational objectives, eventually resources are wasted. To yield desired level of performance, it is an imperative that organizations effectively plan, implement and evaluate their training interventions. Several authors have studied the training and development practices but most the studies lack any operational framework for diagnosing the training and development system. This study used Kunder’s (1998) indicators of training ineffectiveness and developed a framework for measuring effectiveness of training and diagnosing problems at various stages of training and development. We developed a questionnaire based on framework and collected data from 115 project directors to measure training effectiveness in project organizations in Pakistan. The study had found that on overall basis training practices are ineffective. Results reveal that there is a poor mechanism of evaluation of training and use of evaluation results. The framework developed by this study can be used in other organizations to measure training effectiveness and diagnose problems at various stages of training cycle

An improved back propagation leaning algorithm using second order methods with gain parameter

Back Propagation (BP) algorithm is one of the oldest learning techniques used by Artificial Neural Networks (ANN). It has successfully been implemented in various practical problems. However, the algorithm still faces some drawbacks such as getting easily stuck at local minima and needs longer time to converge on an acceptable solution. Recently, the introduction of Second Order Methods has shown a significant improvement on the learning in BP but it still has some drawbacks such as slow convergence and complexity. To overcome these limitations, this research proposed a modified approach for BP by introducing the Conjugate Gradient and QuasiNewton which were Second Order methods together with ‘gain’ parameter. The performances of the proposed approach is evaluated in terms of lowest number of epochs, lowest CPU time and highest accuracy on five benchmark classification datasets such as Glass, Horse, 7Bit Parity, Indian Liver Patient and Lung Cancer. The results show that the proposed Second Order methods with ‘gain’ performed better than the BP algorithm

Safety and effectiveness of ultrasound guided peripheral nerve blocks: Audit at tertiary care hospital

Objective: To assess the safety and effectiveness of peripheral nerve blocks using ultrasound.Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of all patients who received peripheral nerve blocks as part of anaesthesia care between January 2015 and January 2017. The data included outcomes of peripheral nerve block effectiveness, complications and limb conditions after the block. Peripheral nerve block effectiveness was assessed by monitoring pain scores at rest and on movement, and the requirement of co-analgesia. Complications, like numbness, motor block, metallic taste, hypotension and respiratory depression, were also assessed. Data was analysed using SPSS 19.Results: There were 299 patients who received ultrasound-guided peripheral nerve blocks. The overall mean age was 44.57±16.64 years. Of the total, 140 (47%) received transversus abdominis plane block, followed by supraclavicular block 49(16.7%). The most common complication in the recovery room was numbness 19 (6.2%). Overall, 70% patients remained pain-free, while 16% had moderate pain on movement 12 hours postoperatively.Conclusions: Ultrasound-guided regional anaesthesia was found to provide effective analgesia during and after surgery. Nerve blocks proved to be safe when used with ultrasound

Evaluating the Perception and Awareness of Patients Regarding Ovarian Cysts in Peshawar, Pakistan

Purpose: To evaluate patients’ perception regarding ovarian cyst as well as their awareness of the symptoms and health management of the disease.Methods: A quantitative research approach was used to conduct this study. Patients were selected from the Gynecology wards, Hayatabad Medical Complex, Peshawar and a questionnaire was designed to evaluate the patients’ knowledge and awareness.Results: When women were asked if they had prior knowledge about the ovarian cyst, 37 (58.7 %) responded that they were first told by the  physician during their visit to the clinic or hospital while the patients  responded, “Still don’t know” are 22 (34.9 %). With respect to educational level of the patients, they seemed to be less aware of the disease. Their perception regarding the disease is that they had a “water filled” balloon or tumor.Conclusion: Prior to discharge of an ovarian cyst patient from the hospital, she should be counseled on the disease and successful treatment outcomes. Counseling of the patients may result in compliance with therapy, good quality of life and lower economic burden.Keywords: Ovarian cyst, Menstrual cycle, Awareness, Perception, Treatment outcome