Diabetes-related Knowledge, Medication Adherence, and Health-related Quality of Life: A Correlation Analysis.

CONTEXT: Even though positive treatment outcomes for type 2 diabetes mellitus (T2DM) are linked to disease knowledge and adherence to medications, inadequate knowledge, poor adherence, and resistance to lifestyle modifications are still common among patients. This situation has been a continuing dilemma for patients and healthcare providers, and these factors negatively affect the health-related quality of life (HRQoL) of patients. OBJECTIVE: The current study intended to evaluate the correlations between diabetes-related knowledge, medication adherence, and HRQoL among T2DM patients in Pakistan. DESIGN: The study was designed as a questionnaire-based, cross-sectional descriptive analysis, with participants being selected using a prevalence-based sampling method. SETTING: The study was conducted at four different healthcare institutes namely Sandeman Provincial Hospital, Bolan Medical Complex Hospital, Al-Khair Hospital and Sajid Hospital, Quetta city, Pakistan. PARTICIPANTS: Participants were 300 patients with T2DM who were receiving treatment at public and private healthcare institutes in Quetta, Pakistan. OUTCOME MEASURES: In addition to collection of demographics, the Urdu version of Michigan Diabetes Knowledge Test (MDKT-U), the Drug Attitude Inventory (DAI-10), and the EuroQol EQ-5D were used to assess diabetes-related knowledge, medication adherence and HRQoL, respectively. The relationships among the 3 variables were determined using the Spearmen rho correlation coefficient, and the results were interpreted using Cohen' criteria. SPSS v.20 was used for data analysis, and P < .05 was considered significant for all analysis. RESULTS: The mean diabetes-related knowledge score was 5.83 ± 1.92, indicating participants' lack of knowledge of T2DM. Moderate adherence was reported, with a mean adherence score of 4.94 ± 2.72. Additionally, the mean EQ-5D score was 0.48±0.36, and the mean Visual Analogue Score (VAS) was 54.58 ± 20.28, highlighting poor HRQoL. The Spearman's rho correlation coefficient indicated significant, moderate correlations among all variables (P < .05; r = 0.053-0.231). CONCLUSIONS: The study found limited diabetes-related knowledge, moderate medication adherence, and poor HRQoL among patients with T2DM in Pakistan. Nevertheless, a positive significant correlation revealed that a directly proportional change in one study variable can improve the others.

Translation and validation study of Quality of Life Questionnaire for Physiological Pregnancy at Sandeman Provincial Hospital, Quetta, Pakistan.

OBJECTIVE: To examine the psychometric properties of the Urdu version of Quality of Life Questionnaire for Physiological Pregnancy. METHODS: The cross-sectional study was conducted from August 1 to October 31, 2020, at the Obstetrics and Gynaecology department of Sandeman Provincial Hospital, Quetta, Pakistan. The Quality of Life Questionnaire for Physiological Pregnancy was translated into Urdu by using a forward-backward procedure. The test-retest reliability was assessed through Cronbach's alpha reliability analysis. The validity of the translated questionnaire was constructed by using exploratory factor analysis through principal axis factoring extraction and Oblique rotation with Kaiser Normalisation. The constructs were retained based on extracted communalities. Data was analysed using SPSS v 21. RESULTS: The Urdu version of the questionnaire exhibited acceptable test-retest alpha values of 0.780 and 0.812 at two-time points, with an overall value of 0.790. All items showed good stability with intraclass correlation coefficient values of >0.80. The Kaiser-Meyer-Olkin measure for factor analysis was 0.812. Barlett's Test of Sphericity was significant (p<0.05). Three factors explaining the variance were extracted and the loading values for all nine constructs were acceptable (>0.40). All items of the translated version were retained, proving the validity of the Urdu version of the questionnaire. CONCLUSIONS: The translated version of Quality of Life Questionnaire for Physiological Pregnancy was found to be a valid and reliable instrument for the assessment of quality of life for pregnant women in regions where Urdu is the prime language of communication.

Knowledge and practice of adolescent females about menstruation and menstruation hygiene visiting a public healthcare institute of Quetta, Pakistan.

BACKGROUND: The current study is aimed to assess menstruation-related knowledge and practices of adolescent females visiting a public health care institute of Quetta city, Pakistan. METHODS: A questionnaire-based cross-sectional survey was conducted. Nine hundred and twenty three female adolescents attending general out-patient departments of Mohtarma Shaheed Benazir Bhutto Hospital Quetta, Balochistan, was approached for data collection. Based on the objectives of the study, descriptive analysis was conducted and SPSS v. 21.0 was used for the data analysis. RESULTS: Demographic characteristics revealed that the mean age of the respondents was 15 years. Mothers' (67%) were the main source of menstruation-related information. Majority (77.7%) of our respondents never had a class or session regarding menstruation-related education in their schools. About (44%) knew that menstruation is a physiological phenomenon while 60.2% knew that menstrual blood comes from the vagina. Nearly 40% of our study respondents missed their schools because of menarche. The use of absorbent material was frequent (90%) among the adolescent females and (68.7%) used commercially available sanitary napkins/pads. Although majority of the respondents (58.2%) were not taking baths during menstruation, 80.5% do cleaned their genitalia with water during menstruation. CONCLUSION: Female adolescents of our study had certain misconception regarding menstruation because of poor access to health-related education. Education can be provided at healthcare facilities, residential area as well as religious centers. Adolescent reproductive health should be included in the school curriculum; this will influence general reproductive health of females.

Religious Cliché and Stigma: A Brief Response to Overlooked Barriers in COVID-19 Management.

For decades, religion has provided explanations and answers to existential questions and queries that can emerge during a pandemic. This characteristic of religion has helped communities in finding answers and meanings to their confusions. During a pandemic, healthcare professionals are often unprepared in answering the patients' religious beliefs regarding the diseases. Moreover, patients are faced with religious clichés and stigma that results because of religious beliefs and practices. To overcome the religious stigma, a deeper understanding of religious beliefs and values is required so that a perception or practice change can take place. Therefore, the inclusion and collaboration of spiritual leaders with healthcare professionals are needed to ensure a holistic understanding and overcome the stigma that can shape as a barrier for reaching an optimal therapeutic outcome.

Development of a rapid resolution HPLC method for the quantitative determination of sitagliptin in Human plasma.

A new high performance liquid chromatography (HPLC) method for the quantitative determination of sitagliptin in human plasma was developed and validated for pharmacokinetics study. The plasma was spiked with the internal standard (Salbutamol, IS), extracted with trichloro acetic acid. The extracted analyte was injected into a Symmetry® ODS C18 column (250mm×4.5mm, 5m) and the flourometric detector was operated at 267nm for excitation and 575nm for emission. The mobile phase consisting of Potassium dihydrogen phosphate buffer pH (4.9)-Acetonitrile-Methanol (30:50:20 v/v) at flow rate of 1.0mL/min. The method showed high specificity. Calibration curves of the peak area ratio of each analyte/IS versus sitagliptin concentration were linear in the range of 0.122-31.25µg/mL (r>0.989) for plasma and 0.012-25ug/ml for QC solution(r>0.995). The lower limit of quantification (LLOQ) was 0.122µg/mL in plasma and 0.012 in QC solution. The intraday and interday coefficient of variation was lower than 10%. The accuracy (relative recovery) at three levels was 100.95%, 101.03% and 97.79% respectively. The extraction recovery was 97.6%, 92.2% and 91.96% at the concentrations of 6.25, 25 and 100µg/mL, respectively. Short term and long term, freeze thaw stability of standard solutions and plasma samples were satisfactory. The optimized HPLC method was validated and proved to be specific, robust and accurate for determination of Sitagliptin in human plasma.

Profile and predictors of health related quality of life among type II diabetes mellitus patients in Quetta city, Pakistan.

BACKGROUND: This study aims to assess the profile and predictors of Health-Related Quality of Life (HRQoL) in Type II Diabetes Mellitus (T2DM) patients in Quetta, Pakistan. METHODS: The study was designed as a questionnaire based, cross sectional analysis. 300 Type II diabetic patients attending public and private hospitals were targeted for data collection. In addition to demographic and disease related information, Euroqol Quality of Life was used to measure HRQoL. Moreover, Drug Attitude Inventory and Michigan Diabetes Knowledge Test were used to assess medication adherence and diabetes related knowledge respectively. Treatment satisfaction was assessed by patient's experience towards health care professionals and available facilities. Descriptive statistics were used to elaborate patients' demographic and disease related characteristics. Binary logistic regression was used to predict factors independently associated with HRQoL. SPSS v. 20 was used for data analysis and p < 0.05 was taken as significant. RESULTS: Patients in the current study reported poor HRQoL with a mean score of 0.48 ± 0.36. Age, duration of disease, number of prescribed drugs, medication adherence and treatment satisfaction were significantly associated (p < 0.05) with HRQoL in the cross tabulation analysis. The significant variables were entered into the model that showed significant goodness of fit with highly significant Omnibus Test of Model Coefficient (Chi-square = 12.983, p = 0.030, df = 4). Medication adherence was reported as a significant predictor of HRQoL with an increase of one adherence score was associated with improvement of HRQoL by a factor of 1.75 provided other variables remain constant. CONCLUSION: The study presents a model that is associated with HRQoL with patient with T2DM, where medication adherence shaped as a predictor of HRQoL. Healthcare professionals should pay special attention on patients' medication taking behavior and should put their efforts in explaining the benefits of the medication adherence to the patients.

Frequency and predictors of anxiety and depression among pregnant women attending tertiary healthcare institutes of Quetta City, Pakistan.

BACKGROUND: Anxiety and depression (A&D) are commonly reported among pregnant women from all over the world; however, there is a paucity of workable data from the developing countries including Pakistan. The current study, therefore, aims to find out the frequency and predictors of A&D among pregnant women attending a tertiary healthcare institutes in the city of Quetta, in the Balochistan province, Pakistan. METHODS: A questionnaire based, cross-sectional survey was conducted. The pre-validated Hospital Anxiety and Depression Scale (HADS) were used to assess the frequency of A&D among study respondents. Anxiety and depression scores were calculated via standard scoring procedures while logistic regression was used to identify the predictors of A&D. SPSS v. 20 was used for data analysis and p < 0.05 was taken as significant. RESULTS: Seven hundred and fifty pregnant women responded to the survey. The majority of the respondents belonged to age group of 26-35 year (424, 56.4%) and had no formal education (283, 37.6%). Furthermore, 612 (81.4%) of the respondents were unemployed and had urban residencies (651, 86.6%). The mean anxiety score was 10.08 ± 2.52; the mean depression score was 9.51 ± 2.55 and the total HADS score was 19.23 ± 3.91 indicating moderate A&D among the current cohort. Logistic regression analysis reported significant goodness of fit (Chi square = 17.63, p = 0.030, DF = 3), indicating that the model was advisable. Among all variables, age had a significant association when compared with HADS scores [adjusted OR (odds ratios) = 1.23, 95% CI = 1.13-1.62, p < 0.001]. CONCLUSION: Moderate A&D was reported among the study respondents. Furthermore, age was highlighted as a predictor of A&D. The evidence from this study provides a motion of support programs for anxious and depressed pregnant women. The benefits of implementing good mental health in antenatal care have long-lasting benefits for both mother and infant. Therefore, there is a need to incorporate A&D screening in the existing antenatal programs.

Treatment Outcomes of Severe Acute Malnutrition and Its Determinants Among Paediatric Patients in Quetta City, Pakistan.

Purpose: Severe acute malnutrition (SAM) is the most prevalent reason for admission to a paediatric unit, and it is a leading cause of mortality in many countries, including Pakistan. This study aimed to assess treatment outcomes and associated factors among children aged 6-59 months with severe acute malnutrition. Patients and Methods: A retrospective cohort study was conducted at the Outpatient Therapeutic Feeding Program Centre established at the Sheikh Khalifa bin Zayed Al Nahyan Medical Complex Quetta. Out of 225 patients' records, data from 182 (80.8%) records were analysed based on the inclusion criteria. The SAM logbook was used as a source of data. Predictors of treatment outcomes were identified by applying a regression model with p<0.05 taken as significant. Results: One hundred and twenty (65.9%) of the children were diagnosed with SAM, while the remaining 34.1% had Moderate Acute Malnutrition. Ninety-five (52.2%) children were included in the marasmus, while 47.8% were included in the Kwashiorkor cohort. The recovery rate was 68.6%; 22.5% were non-responsive, 11% defaulted on the program, and 3.5% died during management. The multivariate logistic regression identified the presence of diarrhea and the use of amoxicillin as significant prognosticators of treatment outcomes. Consequently, the odds of recovery on SAM among children with diarrhea [AOR = 0.60, 95% CI: (0.35-0.75)] were lower than those without diarrhea. Likewise, children on PO amoxicillin had higher chances of recovery [AOR = 2.45, 95% CI: (2.21-4.68)]. Conclusion: This study found that the recovery rate among children treated for SAM was poor based on the established Sphere Standard recommendation. In addition to community-based educational campaigns, capacity enhancement of OTP and frequent monitoring of services as well as program evaluation based on the management protocol is recommended to reduce the frequency of SAM among children.

Hospital Pharmacists' Viewpoint on Quality Use of Antibiotics and Resistance: A Qualitative Exploration from a Tertiary Care Hospital of Quetta City, Pakistan.

Suboptimal antibiotics use and the development of antibiotic resistance is a universal calamity. The theoretical model of therapeutic efficacy correlates quality use of antibiotics with healthcare practitioners' understanding of antibiotic use and resistance. Keeping this phenomenon in mind, we aimed to evaluate hospital pharmacists' understanding of antibiotic use and resistance at a public healthcare institute in Quetta city, Pakistan. This was a qualitative study that employed a semi-structured interview guide for data extraction. The phenomenology-based approach commissioned in-depth, face-to-face interviews with hospital pharmacists stationed at the surgical unit of Sandeman Provincial Hospital, Quetta. The interviews were audio taped followed by transcribed verbatim and were then analyzed for thematic contents by the standard content analysis framework. Although the saturation was reached after the 10th interview, we conducted two additional interviews for definite validation. Content analysis revealed five major themes: (1) Defining antibiotics, quality use of antibiotics and resistance, (2) antibiotic use: awareness and concern, (3) antimicrobial resistance: awareness and concern, (4) responding to antibiotic use and resistance, and (5) barriers to quality use of antibiotics and prevention of antibiotic resistance. The knowledge of quality use of antibiotics and resistance was promising, and the respondents were eager to address the drastic situation. The respondents were aware of the critical situation and provided valuable insights that can offer valued input while promoting the quality use of antibiotics in a developing country. The current study managed to identify an adequate understanding of antibiotic use and resistance among hospital pharmacists. Additionally, prospective concerns and possible predictors of antibiotic resistance were also highlighted. The current findings must be disseminated to the policymakers and prescribers to take prompt restorative actions to address antibiotic use and the development of antibiotic resistance in a developing country like Pakistan.

Translation, Validation, and Psychometric Evaluation of the Diabetes Quality-of-Life Brief Clinical Inventory: The Urdu Version.

Purpose: The study is aimed to examine the psychometric properties of the Urdu version of the Diabetes Quality-of-Life Brief Clinical Inventory. Methods: We adopted the forward-backward procedure to translate the Diabetes Quality-of-Life Brief Clinical Inventory (DQoL-BCI) into the Urdu language (lingua franca of Pakistan). The intraclass correlation (ICC) confirmed the consistency of retaining the items, and Cronbach's alpha established the test-re-test reliability. The confirmatory factor analysis (principal axis factoring extraction and oblique rotation with Kaiser normalization) validated the DQoL-BCI in Urdu. Results: A two-time point with an interval of 2 weeks was used, and the Urdu version of DQoL-BCI was piloted accordingly. The 15-item translated version (DQoL-BCI-U) exhibited a satisfactory Cronbach's value of 0.866 (test) at week 1 and 0.850 at week 3 (re-test). Using the one-way random model with single measurements, the ICC for all 15 items exhibited coefficient values of >0.80. The Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's Test of Sphericity revealed relationships of the data and suitability of CFA (0.899, p<0.05). Seven factors explaining the total variance of 69% were extracted. With acceptable communalities, all 15 items of DQoL-BCI-U were retained. Conclusion: The study concludes that the translated version of DQoL-BCI-U is a valid instrument in regions, where Urdu is a communal language of communication and can examine quality-of-life issues during the typical patient-provider encounter.

Disposal practices of unused and expired pharmaceuticals among the general public in Quetta city, Pakistan.

OBJECTIVE: Although community practices towards disposal of expired and unused medications vary globally, the phenomenon is neglected specifically in developing countries. We, therefore, aimed to assess the disposal practices of unused and expired pharmaceuticals among the general public in Quetta city, Pakistan. METHODS: A questionnaire-based, cross-sectional survey was conducted among 830 respondents in Quetta city, Pakistan. A pre-validated, structured questionnaire was used for data collection. Data were coded and analyzed by Statistical Package for Social Science (SPSS) version 26. Both descriptive and inferential statistics were sued and p<0.05 was taken as significant. RESULTS: Almost 87% of the respondents had unused medicines at their homes and reusing the medications was the purpose of medicine storage (50%). Medicines were mostly kept in refrigerators (36.0%) followed by bedrooms (28.8%). Fifty percent of the respondents never checked the expiry date before using the medications. The procedure to dispose of nearly expired or expired medicines was unknown to 88% of the respondents and for those reasons, medicines were disposed either in household trash or flushed in the toilet or sink. Interestingly, medicines were kept at home even after being expired by 27% of the respondents. Income was associated with reason of storing medicines (p = 0.004; φc = 0.402) while educational status had significant associations with storage of medications (p = 0.002; φc = 0.399), reading about storage instructions (p = 0.008; φc = 0.452) and checking expiry date before purchasing and using the medicines (p = 0.007; φc = 0.114 and p = 0.001; φc = 0.100) respectively. CONCLUSION: Improper storage and disposal of unused and expired medications is a common practice among study respondents and raised serious concerns. Findings of the current study call upon immediate development and implementation of the strategies to promote awareness and strengthen the pharmaceutical waste management program at the societal level.

Doctors' adherence to guidelines recommendations and glycaemic control in diabetic patients in Quetta, Pakistan: Findings from an observational study.

Background: Poor control of diabetes mellitus (DM) is partly attributed to doctors' poor adherence to guidelines. Objective: To evaluate doctors' adherence to pharmacotherapeutic recommendations of DM management guidelines and factors associated with guidelines adherence and glycaemic control. Methods: This prospective observational study included 30 doctors who were treating DM patients in their private clinics in Quetta, Pakistan. On visit 1, a total of 600 prescriptions written by 30 enrolled doctors (20 patients per doctor) were noted along with patients' sociodemographic and clinical characteristics. American Diabetes Association guidelines was used as a reference. The prescriptions noted were judged for guidelines compliance. Of 600 enrolled patients, 450 patients (15 patients per doctor) were followed for one more visit and included in final analysis. Glycated hemoglobin (HbA1c) level noted one visit 2 was related with the respective prescription on visit 1. Data were analyzed by SPSS (version 23). A p-value <0.05 was considered statistically significant. Results: Patients received a median of two antidiabetic drugs (range: 1-5). A total of 73.1% patients were on polytherapy. Metformin was the most frequently prescribed (88.4%) antidiabetic followed by gliptins (46.2%). A total of 41.6% prescriptions were judged guidelines compliant. In multivariate binary logistic regressions (MVBLR) analysis, chronic kidney disease (CKD) (OR = 0.422) and polytherapy (OR = 0.367) had statistically significant negative associations (p-value <0.05) with guidelines' compliant prescriptions. The group of doctors comprised of specialists and consultants wrote significantly (p-value = 0.004) high number of guidelines adherent prescriptions (mean rank = 20.25) than the group comprised of medical officers (mean rank = 11.34). On visit 2, only 39.5% patients were on goal glycemic levels. In MVBLR analysis, suffering from dyslipidemia (OR = 0.134) and CKD (OR = 0.111), receiving sulfonylurea (OR = 0.156) and guidelines' compliant prescription (OR = 4.195) were significantly (p-value <0 .05) associated with glycemic control. Conclusion: Although guidelines compliant prescriptions produced better glycemic control, but doctors' adherence to guidelines and glycemic control were poor. Polytherapy and CKD emerged as risk factors for guidelines divergent prescriptions. Dyslipidemia, CKD and reception of sulfonylureas had negative association with glycemic control.

Physicians' Response and Preparedness of Terrorism-Related Disaster Events in Quetta City, Pakistan: A Qualitative Inquiry.

Background: Besides catastrophes, infrastructural damages, and psychosocial distress, terrorism also imposes an unexpected burden on healthcare services. Considerably, adequately-prepared and responsive healthcare professionals affirms effective management of terrorism-related incidences. Accordingly, the present study aimed to evaluate physicians' preparedness and response toward terrorism-related disaster events in Quetta city, Pakistan. Methods: A qualitative design was adopted. Physicians practicing at the Trauma Center of Sandeman Provincial Hospital (SPH), Quetta, were approached for the study. We conducted in-depth interviews; all interviews were audio-taped, transcribed verbatim, and analyzed for thematic contents by a standard content analysis framework. Results: Fifteen physicians were interviewed. The saturation was achieved at the 13th interview however we conducted another two to validate the saturation. The thematic content analysis revealed five themes and 11 subthemes. All physicians have experienced, responded to, and managed terrorism-related disaster events. They were prepared professionally and psychologically in dealing with a terrorism-related disaster. Physicians identified lack of disaster-related curricula and training, absence of a standardized protocol, recurrence of the disaster, and hostile behavior of victim's attendants during an emergency as critical barriers to effective terrorism-related disaster management. Among limitations, all respondents mentioned workspace, and resources as a foremost constraint while managing a terrorism-related disaster event. Conclusion: Although physicians understood the abilities and had the required competencies to mitigate a terrorism-related disaster, lack of workspace and resources were identified as a potential barrier to effective disaster management. Based on the results, we propose reconsideration and integration of the medical curriculum, particularly for terrorism-related disaster management, collaboration, and communication among various stakeholders to manage terrorism-related disaster events competently.

Medication Errors and Type 2 Diabetes Management: A Qualitative Exploration of Physicians' Perceptions, Experiences and Expectations From Quetta City, Pakistan.

Background: Type 2 Diabetes-related medication errors are frequently reported from the hospitals and consequently are of major concern. However, such reports are insufficient when developing healthcare settings are pursued in literature. Keeping this inadequacy in mind, we therefore aimed to explore physicians' perceptions, experiences and expectations of medication errors when managing patients with Type 2 Diabetes Mellitus. Methods: A qualitative design was adopted. By using a semi-structured interview guide through the phenomenology-based approach, in-depth, face-to-face interviews were conducted. Physicians practicing at the medicine ward of Sandeman Provincial Hospital, Quetta, were purposively approached for the study. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Results: Although the saturation was reached at the 13th interview, we conducted additional two interviews to ensure the saturation. Fifteen physicians were interviewed, and thematic content analysis revealed six themes and nine subthemes. Mixed conceptualization and characterization of medication errors were identified. Medication errors were encountered by all physicians however poor understanding of the system, deficiency of logistics and materials were rated as barriers in reporting medication errors. Among contributors of medication errors, physicians themselves as well as dispensing and patient-related factors were identified. Physicians suggested targeted training sessions on medication error-related guidelines and reporting system. Parallel, establishment of an independent unit, involving the pharmacists, and strict supervision of paramedics to minimize medication errors was also acknowledged during data analysis. Conclusion: With a longer life expectancy and a trend of growing population, the incidences of medication errors are also expected to increase. Our study highlighted prescribing, dispensing and administration phases as contributing factors of medication errors. Although, physicians had poor understanding of medication errors and reporting system, they believed getting insights on guidelines and reporting system is essential. A review of admission and discharge reconciliation must be prioritized and a culture of teamwork, communication and learning from mistakes is needed.

Depression, Anxiety, and Stress Among Nurses During the COVID-19 Wave III: Results of a Cross-Sectional Assessment.

PURPOSE: The current study was aimed to evaluate depression, anxiety, and stress among nurses during the COVID-19 (wave III) at a public hospital in Quetta city, Pakistan. PARTICIPANTS AND METHODS: By using the validated Depression, Anxiety and Stress Scale - 21, three hundred and twenty-five nurses practicing at the Sandeman Provincial Hospital, Quetta were approached for data collection. Through SPSS, both descriptive and inferential statistics were used during data analysis. Chi-square test was used to assess the goodness-of-fit between observed values and demographic variables. The factors that were significantly associated with depression, anxiety, and stress were further assessed by binary logistic regression analysis. The statistical significance was set at 0.05. RESULTS: Out of the 325 nurses, 297 participated in the study with a response rate of 91.3%. Mild depression and stress were reported in the current cohort of nurses (6.00 ± 5.30 and 8.01 ± 4.47), respectively. The mean anxiety score was 6.68 ± 4.86 indicating moderate anxiety among the study respondents. Marital status, working department, and job experience were significantly associated with depression, anxiety, and stress with moderate effect size (>0.3). The logistic regression reported department in which nurses were stationed (adjusted OR = 2.54, 95% CI = 1.118-1.415, p < 0.001) and job experience (adjusted OR = 1.004, 95% CI = 1.001-1.215, p = 0.002) as significant predictors of depression, anxiety and stress. Nurses working in the corona ward were more likely to develop depression, anxiety and stress by a factor of 2.54 and married nurses with a factor of 1.004 provided controlling other confounding factors. CONCLUSION: Moderate depression, anxiety, and stress were observed among nurses and it calls for hospital management to consider interventions for all nurses irrespective of their present working departments. Facilitating continuous and comprehensive support mechanisms aimed at protecting nurses' mental health is of great importance during pandemics. The findings of the study have some clear suggestions for mental health advocacy among nurses that are essential for improving the quality of services and patients' safety.

Effectiveness of Shorter Treatment Regimen in Multidrug-Resistant Tuberculosis Patients in Pakistan: A Multicenter Retrospective Record Review.

In Pakistan, the treatment of multidrug-resistant tuberculosis (MDR-TB) with a shorter treatment regimen (STR), that is, 4-6 months of amikacin, moxifloxacin (Mfx), ethionamide, clofazimine (Cfz), pyrazinamide (Z), ethambutol (E), and high-dose isoniazid, followed by 5 months of Mfx, Cfz, Z, and E, was initiated in 2018. However, there is a lack of information about its effectiveness in Pakistani healthcare settings. Therefore, this retrospective record review of MDR-TB patients treated with STR at eight treatment sites in Pakistan aimed to fill this gap. Data were analyzed using SPSS 23. Multivariate binary logistic regression (MVBLR) analysis was conducted to find factors associated with death and treatment failure, and lost to follow-up (LTFU). A P-value < 0.05 was considered statistically significant. Of 912 MDR-TB patients enrolled at the study sites, only 313 (34.3%) eligible patients were treated with STR and included in the current study. Of them, a total of 250 (79.9%) were cured, 12 (3.8%) completed treated, 31 (9.9%) died, 16 (5.1%) were LTFU, and four (1.3%) were declared as treatment failures. The overall treatment success rate was 83.7%. In MVBLR analysis, patients' age of 41-60 (odds ratio [OR] = 4.9, P-value = 0.020) and > 60 years (OR = 3.6, P-value = 0.035), being underweight (OR = 2.7, P-value = 0.042), and previous TB treatment (OR = 0.4, P-value = 0.042) had statistically significant association with death and treatment failure, whereas patients' age of > 60 years (OR = 5.4, P-value = 0.040) and previous TB treatment (OR = 0.2, P-value = 0.008) had statistically significant association with LTFU. The treatment success rate of STR was encouraging. However, to further improve the treatment outcomes, special attention should be paid to the patients with identified risk factors.

Profile and Predictors of Maternal Quality of Life During Physiological Pregnancy: A Cross-Sectional Analysis.

BACKGROUND: Quality of Life (QoL) and its determinants are significant in all stages of life, including pregnancy. The physical and emotional changes during pregnancy affect the QoL of pregnant women, affecting both maternal and infant health. Hence, assessing the QoL of pregnant women is gaining interest in literature. We, therefore, aimed to describe the QoL of pregnant women during physiological pregnancy and to identify its associated predictors in women attending a public healthcare institute of Quetta city, Pakistan. METHODS: A cross-sectional study was conducted at the Obstetrics and Gynecology Department of Sandeman Provincial Hospital Quetta city, Pakistan. The respondents were asked to answer the Urdu (lingua franca of Pakistan) version of the Quality of Life Questionnaire for Physiological Pregnancy. Data were coded and analyzed by SPPS v 21. The Kolmogorov-Smirnov test was used to establish normality of the data and non-parametric tests were used accordingly. Quality of Life was assessed as proposed by the developers. The Chi-square test was used to identify significant associations and linear regression was used to identify the predictors of QoL. For all analyses, p < 0.05 was taken significantly. RESULTS: Four hundred and three pregnant women participated in the study with a response rate of 98%. The mean QoL score was 19.85 ± 4.89 indicating very good QoL in the current cohort. The Chi-Square analysis reported a significant association between age, education, occupation, income, marital status, and trimester. Education was reported as a positive predictor for QoL (p = 0.006, ß = 2.157). On the other hand, trimester was reported as a negative predictor of QoL (p = 0.013, ß = -1.123). CONCLUSION: Improving the QoL among pregnant women requires better identification of their difficulties and guidance. The current study highlighted educational status and trimester as the predictors of QoL in pregnant women. Health care professionals and policymakers should consider the identified factors while designing therapeutic plans and interventions for pregnant women.

Exploring Nurses' Perception of Antibiotic Use and Resistance: A Qualitative Inquiry.

PURPOSE: Quality use of antibiotics and the development of antibiotic resistance is a global catastrophe. In the conceptual context, the phenomenon is correlated with the healthcare practitioners' understanding of antibiotic use and resistance. Therefore, the study aimed to highlight nurses' perception of antibiotic use and resistance at a public healthcare institute in Quetta City, Pakistan. RESPONDENTS AND METHODS: By using a semi-structured interview guide through the phenomenology-based approach, in-depth, face-to-face interviews were conducted. Nurses practicing at the surgical and medical units of Sandeman Provincial Hospital (SPH), Quetta, were approached for the study. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. RESULTS: Although the saturation was reached after the 13th interview, an additional two were interviewed for absolute validation. Content analysis revealed five major themes: (1) defining antibiotics and antibiotic resistance, (2) antibiotic use: awareness and concern, (3) antimicrobial resistance: awareness and concern, (4) responding to antibiotic use and resistance, and (5) barriers to quality use of antibiotics and prevention of antibiotic resistance. Even though the understanding of nurses regarding antibiotic use and resistance was promising, certain apprehensions were also observed. The respondents were aware of the critical situation and provided valuable insights that can offer significant input while promoting the quality use of antibiotics in a developing country. CONCLUSION: While the perception towards antibiotics appeared positive, potential areas of concern and contributing factors regarding antibiotic resistance were also identified. Importantly, nurses too highlighted possible solutions to address the issue of irrational antibiotic use and the development of antibiotic resistance.

"Expecting the Unexpected:" Nurses' Response and Preparedness of Terrorism-Related Disaster Events in Quetta City, Pakistan.

Background: In addition to the psychiatric and societal misery, terrorism places an exceptional burden while delivering healthcare services. Accordingly, a responsive and well-prepared healthcare system ensures effective management of terrorism-related events. Within this context, with a strong historic grounding in addressing situations of societal crisis nurses are well-placed in contributing to the global arena of humanitarian policy and social research. Therefore, assessing their response and preparedness is vital in effective management of a terrorism-related disaster. For that very reason, we aimed to evaluate nurses' preparedness and response toward terrorism-related disaster events in Quetta city, Pakistan. Methods: A qualitative design was adopted to explore nurses' response and preparedness of terrorism-related disaster events. By using a semi-structured interview guide through the phenomenology-based approach, in-depth, face-to-face interviews were conducted. Nurses practicing at the Trauma Center of Sandeman Provincial Hospital (SPH), Quetta, were approached for the study. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Results: Fifteen nurses were interviewed and thematic content analysis revealed five themes. All nurses have experienced, responded to, and managed terrorism-related disaster events. They were prepared both professionally and psychologically in dealing with a terrorism-related disaster. Among limitations, space and workforce were highlighted by almost all the respondents. Lack of disaster-related curricula, absence of a protocol, recurrence of the disaster, and hostile behavior of victim's attendants during an emergency were highlighted as a key barrier toward terrorism-related disaster management. Conclusion: The skills and expertise needed to address a terrorism-related disaster are well-understood by the nurses but are lacking for various reasons. In addition to the review and adaption of the nursing curriculum specifically for terrorism-related disaster management, collaboration and dialogue between various stakeholders is required to efficiently manage terrorism-related disaster events.