The Urdu Version Of The Safety Attitude Questionnaire (Saq) For Inpatient Settings In Pakistan: Psychometric Properties And Baseline Data.

BACKGROUND: This study aimed to test the psychometric properties of the Urdu version of the Safety Attitudes Questionnaire for inpatient settings in Pakistan. METHODS: The SAQ short form (inpatient version) was translated with the back-translation technique into Urdu. The SAQ-Urdu was administered in three teaching hospitals in Pakistan to a sample of 483 front line healthcare personnel from August 2016 through December 2017. Confirmatory factor analysis was performed to test the factor structure of the responses. Cronbach's alphas and correlation coefficients were computed. Mean and percentage agreement scores for items were reported. RESULTS: The response rate was 75%. Goodness-of-fit indices from the confirmatory factor analysis showed a reasonable model fit (χ2=213.27, df=125, p<0.001; CFI 0.94, RMSEA 0.044). Cronbach's alphas of survey factors (teamwork climate, safety climate, job satisfaction, perceptions of management, and working conditions) ranged from 0.71 to 0.87. In terms of mean percentage agreement scores, substantial variability was found at the clinical unit level. CONCLUSIONS: The Urdu version of the SAQ showed satisfactory internal psychometric properties. The attitudes around patient safety considerably vary and indicate a need for improvement.

Compliance to timely vaccination in an Expanded Program on Immunization center of Pakistan.

The importance of childhood immunization in prevention of highly fatal diseases and disability cannot be overemphasized. Pakistan has a national Expanded Program on Immunization but the compliance is far below the international benchmark for achieving a herd immunity. Monitoring the compliance to timely receipt of vaccinations is crucial to establishing and preventing disease and disability associated risk in children. There is little or no evidence that reports the timeliness of the vaccinations according to the EPI schedule in Peshawar. The primary objective of the study was to evaluate rate of Fully Immunized Children and to report compliance to the timeliness of vaccine specific schedule during the study period in the EPI center in the capital city of Peshawar, Khyber Pakhtunkhwa province of Pakistan. We collected consecutive retrospective data of the infants enrolled from June 2014 to December 2015 in one EPI center for our study. Out of the total 157 (n) children, fully immunized children (FIC) were 62 (39.5%) and only 19 (12.1%) were FIC with timely visits. Dropouts increased with successive vaccinations with highest for Measles 1 (42%). On-time vaccinations decreased over time, while the proportion of children receiving vaccination outside the ideal window period reaches as high as 46%. The study reports a low compliance to EPI schedule, and also highlights that immunization coverage is not a good indicator of age appropriate vaccinations.

Public health education and health system needs in Pakistan: a mixed methods study.

BACKGROUND: Pakistan has recently observed a significant growth in public health education programmes. Little is known about the structure of these programmes nor whether they are adequately responsive to national health system needs. AIMS: We reviewed existing public health degree programmes in Pakistan along with an exploration of the national public health market and health system needs. METHODS: A mixed-methods study was conducted between January 2015 and March 2016. Seventeen public health degree programmes were reviewed for programmatic and instructional attributes. Thirteen key-informant interviews were conducted to explore health system needs and challenges related to public health workforce. RESULTS: We found substantial variation in public health academic programmes in terms of offered courses, credit hours, number of faculty and tuition costs. About 70% of public health degree programmes were generic (i.e. with no specific concentration track) and only 18% offered practicums. Overall median tuition cost in 2016 was US$ 10 350. During key-informant interviews, emerged themes for challenges included lack of practical public health skills, limited knowledge of latest theoretical principles, poor communication skills and insufficient IT orientation. Identified themes about knowledge and skills areas to address future public health challenges of Pakistan included system thinking mind set, healthcare IT skills, and leadership and management skills. CONCLUSIONS: Public health education in Pakistan falls short of meeting current national challenges. Pakistan needs a national public health accreditation body for regulating education, harmonizing global standards to local context and developing relevant career pathways.

Assessment of personality disorders in students appearing for medical school entrance examination.

OBJECTIVE: : To investigate personality disorders in medical students appearing for medical school entrance exam. METHODS: The cross-sectional study was conducted at Peshawar Medical College from August 2015 to May 2016, and comprised all the students who undertook medical school entrance examination of the College. They were asked to fill screening questionnaire of international personality disorder examination, based on International Classification of Disease version-10. Demographic information was collected from the application form. After screening of all the medical students during the entrance exam, detailed interview was taken from the students who were invited for admission interview. The data was analyzed using SPSS 20. RESULTS: There were 1334 subjects with a mean age of 18.91.41 years. Of the total, 745(55.8%) were male students. The most common personality traits were anankastic 1170(88%), schizoid 932(70%) and dependent 705(53%). Of the total, 322(24%) students were called for interview. The mean age of the interview sample was 18.91.03 years and 189 (58.7%) of them were females. Definite personality disorders in order of frequency were dependent 3(0.93%), schizoid 2(0.62%) and anankastic 1(0.31%). There was a significant correlation of female gender with histrionics, anxious, dependent and borderline personality disorder (p<0.05). There was a significant correlation between academic performance and dissocial, impulsive and borderline personality disorder separately (p<0.05). CONCLUSIONS: Anankastic, schizoid and dependent personality traits and disorders were the commonest on screening and detailed interview.

Practice and enforcement of national Hospital Waste Management 2005 rules in Pakistan.

BACKGROUND: Hospital waste management (HWM) rules in Pakistan were issued in 2005. Despite a decade of enactment, adherence to HWM 2005 rules has been inconsistent and systematic assessment of adherence using a World Health Organization (WHO)-recommended questionnaire has not been done in all teaching hospitals of Peshawar District. AIMS: This study assessed the adherence to HWM 2005 rules by tertiary care teaching hospitals of Peshawar District with respect to HWM personnel, policy and practices. METHODS: Pretested structured questionnaires based on WHO recommendations were used to survey all teaching hospitals of Peshawar District from January to March 2015. Data were also collected on HWM infrastructure and processes from 1 randomly selected medical, surgical, paediatric, and obstetrics/gynaecology unit in each hospital. Besides descriptive statistics, public and private hospitals were compared using Fisher's exact and Wilcoxon rank-sum tests. RESULTS: Most surveyed hospitals lacked formal HWM plans (70%), written procedures (80%), related job descriptions (80%) or records (90%). Many hospitals neither had trained HWM supervisors (56%) nor did they organize formal HWM trainings for new staff (40%). None of the hospitals followed waste segregation and colour coding. When compared to national HWM 2005 rules, multiple gaps in appropriate transportation, storage and disposal were found with no statistically significant difference between public and private hospitals. CONCLUSIONS: Serious gaps in adherence to HWM 2005 rules exist in surveyed hospitals. With recent devolution of environmental function, the Government of Khyber Pakhtunkhwa should enact provincial HWM rules (and ensure their implementation) to facilitate effective HWM practice across provincial healthcare facilities.

Introducing a structured prescription form improves the quality of handwritten prescriptions in limited resource setting of developing countries.

INTRODUCTION: Incomplete or illegible prescriptions can lead to serious errors in administration of the prescribed medication, which can become hazardous. OBJECTIVE: Our aim is to determine if a structured prescription form can improve the quality of handwritten prescription in terms of completeness and legibility. METHODS: We conducted a prospective, non-randomized, time series study of quality of written prescriptions of general practitioners at a tertiary teaching hospital in Peshawar, Pakistan. The study involved an intervention, composed of the introduction of a pre-printed structured prescription form. The data were collected within 4 weeks including a 2-week pre-intervention phase and 2-week post-intervention phase. Completeness, quality of prescriptions and legibility were compared before and after the intervention of the pre-printed structured prescription form. RESULTS: A total of 463 prescriptions were obtained (260 in the pre-intervention phase and 203 in the post-intervention phase). Between pre-intervention phase and post-intervention phase, the Pakistan Medical and Dental Council registration number presence in prescriptions improved from 73.1% to 100% (P < 0.0005). The presence of prescriber's signature improved from 92.7% to 99% (P = 0.001). Drug duration was not missing in 99.5% in post-intervention phase as compared with 90.4% in pre-intervention phase (P < 0.0005). Prescriptions with no legibility problems improved from 76.2% to 94.1% (P < 0.0005). Although not statistically significant, prescriptions in which drug dosage was not missing improved from 85% to 90.6% (P = 0.07). LIMITATIONS: We have a limited single-center study. A larger study in multiple settings is needed to develop adequate evidence for such interventions. Subjective nature of prescription legibility can also be considered as a limitation. CONCLUSION: Structuring a prescription form alone may improve certain aspects of quality of written prescription in terms of completeness and legibility.

Disparities in Colorectal Cancer Treatment Delay Within Appalachia--The Role of For-Profit Hospitals.

BACKGROUND: Appalachian residents have a higher overall cancer burden than the rest of the United States because of the unique features of the region. Treatment delays vary widely within Appalachia, with colorectal cancer patients undergoing median treatment delays of 5 days in Kentucky compared to 9 days for patients in Pennsylvania, Ohio, and North Carolina combined. OBJECTIVE: This study identified the source of this disparity in treatment delay using statistical decomposition techniques. METHODOLOGY: This study used linked 2006 to 2008 cancer registry and Medicare claims data for the Appalachian counties of Kentucky, Pennsylvania, Ohio, and North Carolina to estimate a 2-part model of treatment delay. An Oaxaca Decomposition of the 2-part model revealed the contribution of the individual determinants to the disparity in delay between Kentucky counties and the remaining 3 states. RESULTS: The Oaxaca Decomposition revealed that the higher percentage of patients treated at for-profit facilities in Kentucky proved the key contributor to the observed disparity. In Kentucky, 22.3% patients began their treatment at a for-profit facility compared to 1.4% in the remaining states. Patients initiating treatment at for-profit facilities explained 79% of the observed difference in immediate treatment (<2 days after diagnosis) and 72% of Kentucky's advantage in log days to treatment. CONCLUSIONS: The unique role of for-profit facilities led to reduced treatment delay for colorectal cancer patients in Kentucky. However, it remains unknown whether for-profit hospitals' more rapid treatment converts to better health outcomes for colorectal cancer patients.