Prescribing practices of Hormone Therapy for Menopausal females by OBGYN of Pakistan.

Objectives: To assess the prescribing practice of obstetricians and gynecologists (OBGYN) regarding Menopausal Hormone therapy (MHT) for menopausal females and assess the knowledge regarding indications for prescribing MHT and identify the barriers to HRT. Methods: This was a cross-sectional study conducted from May 2021 to December 2021. The participants were OBGYN experts (MCPS, FCPS, MRCOG) and senior experts. The tool was formulated after looking at contemporary literature and then validated by experts for face, content and construct validity. It was piloted and hence fourth given to study participants after approval by IRB of JSMU. Data was analyzed by SPSS version 22. Mean and Standard Deviation of categories in Likert scale were calculated. Results: Majority of the participant gynecologists prescribed HRT for Hot flushes and vaginal dryness having the highest mean scores nearing 4 on a Likert scale of (1-5). The prescription for other menopausal symptoms was observed to be less. The highest score for category of women in whom hormone therapy is specifically justified was "Premature ovarian failure" (4.37) followed by "Hysterectomy with bilateral oophorectomy before the age of 50" (4.23). Conclusion: Pakistani gynecologists are more cautious in their management strategies concerning MHT. Most of the gynecologists showed good and up to date information while prescribing MHT however knowledge for preventing fractures, alleviating anxiety/depression and weight gain was less among the gynecologist of Pakistan. We recommend refresher courses and online webinars for updated information on menopause and its management.

Mapping Institutional Interventions to Mitigate Suicides: A Study of Causes and Prevention.

Suicide is an extreme, tragic act and an important subject for social inquiry. It is the rising public health issue prevalent in the Himalayan range of Pakistan. The young and educated population is more prone to suicide instead of using this prime phase of age productively. Unfortunately, the suicide problem remains unaddressed, the causes remain undefined, solutions are not in the works, and in situations when others play a part in driving someone to commit suicide, no one is being held accountable. This study is aimed at uncovering the root causes of suicide and proposing some preventive measures to mitigate the problem. Our team studied three years' worth of data (2017-2019) on suicides from the office of Human Rights Commission of Pakistan, Chitral. In addition, we conducted semi-structured interviews of different stakeholders, including family members, neighbors, lawyers, and police personnel. The findings revealed that extended family pressures, the power dynamic between sustainers and dependents, family conflicts, and inheritance cases were the major causes of the domestic violence that preceded suicide attempts. Mental health issues, forced marriages, academic competitions, and flawed litigation processes were also among the leading causes of suicide. Awareness through education and religious sermons, strengthening healthcare organizations, restructuring family systems, establishing police complaint centers, effective prosecution processes, and imparting lifesaving skills have been identified as measures to prevent suicide. This study has theoretical and practical implications, as it adds certain novel variables regarding the causes and solutions of suicide to the existing body of literature and guides public authorities to strengthen institutions to intervene effectively.

Effect of health education on awareness and practices of breast self examination among females attending a charitable hospital at North Karachi.

OBJECTIVE: To assess the effectiveness of health education as an intervention to promote breast self-examination in a low-resource setting. METHODS: The quasi-experimental study was conducted from January to August 2018 in Karachi after approval by the Jinnah Sindh Medical University, and comprised women from a low resource locality and dividing them into intervention group A and control group B. Demographic data was collected using a pretested questionnaire filled through interviews. Subsequently, group A received health education regarding carcinoma of breast, importance of breast self-examination and monthly motivation through cell phone to perform self-examination. The questionnaire was again filled after 6 months of intervention. Data was analysed using SPSS 20. Group B was given the same health education sessions after the completion of the study. RESULTS: Of the 172 subjects, there were 86(50%) in each of the two groups. In terms of demographic data, the groups were similar (p>0.05). After the intervention, group A showed significant (p<0.001) improvement in knowledge and practice of breast self-examination. There was no change in group B (p>0.05). Being in the intervention group (p=0.001) and level of education (p=0.018) showed positive and negative associations with selfexamination practice. Upon adjusting for age, marital status, family history and education, group A (p=0.001) remained significant, while the level of education (p=0.116) became non-significant. CONCLUSIONS: Designed health promotion programmes with monthly reminders through cell phone improved knowledge and practice of breast self-examination.

Exploring Reproductive Health Impact of COVID 19 pandemic: In Depth Interviews with key stakeholders in Pakistan.

OBJECTIVE: To explore the effects of COVID 19 on reproductive and child health services and gender relations. METHODS: This is a Qualitative Exploratory Research. Due to lockdown, setting was online interviews on Zoom. Sampling was purposive. Five in-depth interviews were conducted in June 2020 followed by compilation of results and manuscript writing in July and August 2020. RESULTS: Maternal Neonatal morbidity and mortality will rise as part of collateral damage of C19. As all routine services of maternity care, family planning, post abortion care and vaccination were also in lockdown. Baby boom, unwanted pregnancies, unsafe abortions and violence against women will be the secondary consequences of C19. CONCLUSION: Some critical services should never stop which include maternal and neonatal essential services. MNCH service continuity has to be maintained to optimize maternal neonatal health, prevent unwanted pregnancy and abortion. With appropriate standard operating procedures, and protective equipments, health facilities need to open. LHWs and community mobilisers with PPEs should continue services.

Mixed method survey to assess the problems and propose solutions for implementation of CME/CPD in Sindh, Pakistan.

OBJECTIVES: To determine the type of CME/CPD sessions attended by doctors, identify the problems with implementation of CME/CPD program and propose possible solutions for successful implementation of CME/CPD Program. METHODS: This was a concurrent triangulation mixed method study. Quantitative questionnaires were filled by faculty and physicians from different specialties. The qualitative component had both focus groups and in depth interviews conducted with different professional bodies (PMA), faculty JSMU, College of Family Physicians. This study was done in 2016-2017. RESULTS: More than half of the participants (53.6%) reported that CPD/CME should be mandatory. Doctors who had graduated from outside Karachi were significantly less likely to report CPD/CME to be mandatory as compared to graduates from Karachi (p=0.004).Top three factors which influenced HCP's to attend CPD/CME included career progression (65.1%), interest (54.7%) and knowledge gap (50.5%). The most common perceived barriers were lack of study leave, cost and work-life imbalance. The implementation issues expressed by different stakeholders included lack of doctor's interest, busy clinical schedule and poor accessibility. CONCLUSION: Mostly medical practioners believe that CPD program is an important step toward enabling physicians to demonstrate their competency and professionalism to themselves and others. The PM&DC has to take practical steps to evaluate the cognitive, clinical, and humanistic attributes of certified doctors.

A needs assessment for faculty development at two medical colleges of Dow University of Health Sciences, Karachi.

OBJECTIVE: To identify the perceptions of the faculty about their current level of pedagogical skills and their desire to improve these skills in future. METHODS: This cross-sectional study was conducted at two medical colleges of Dow University of Health Sciences, Karachi from March 1, 2015 to April 30, 2015. A re-validated questionnaire was used comprising three parts; 1) Demographic details, 2) Fifteen educational domains each having 2 statements, first indicating minimum knowledge of domain and second showing maximum. Each statement had two 9-point anchored scales, first indicating current knowledge and second, desired knowledge of the faculty. 3) Factors which are important considerations for attending educational workshops. The data was analyzed by statistical software SPSS 17. RESULTS: The response rate was 54%. The mean age of faculty was 43.42 ± 8.41, largest proportion being assistant professors (85; 47%). For all educational domains, faculty perceived their knowledge to be moderately high (Mean = 5.9 +/- 1.8 to 6.8 +/- 1.7 and Median: 6 to 7). However, they desired to improve their pedagogical skills further in all domains (Mean = 8.2 +/- 1.1 to 8.4 +/- 1.1, Median: 9), p-values < 0.001. Nearly 95% teachers are willing to attend faculty development workshops. CONCLUSION: Our faculty perceives their current pedagogical skills to be moderately high. However, they would like to improve these skills to a higher level in all educational domains.

Simulation based medical education; teaching normal delivery on intermediate fidelity simulator to medical students.

OBJECTIVE: To assess the effectiveness of medium fidelity simulator in teaching normal vaginal delivery to medical students. METHODS: The quasi-experimental study was conducted at the professional development centre of the Jinnah Sindh Medical University, Karachi, from June to December 2015, and comprised medical students. Third-year medical students were included. They were divided into two groups. Group A was taught normal delivery through traditional PowerPoint and group B through simulator. The instruments used for assessing knowledge were pre-test and post-test, for skills of labour/delivery checklist of performance was used, and perception forms were filled to evaluate workshops/learning environment by students. RESULTS: Of the 76 participants, there were 36(47.4%) in group A and 40(52.6%) in group B. The overall mean age of the participants was 20.86±0.76 years in group B and 20.60±0.95 years in group A (p=0.19). The mean grade point average of the participants was 2.89±0.47 in group A and 2.87±0.48 in group B (p=0.81).Group B performed much better in skill of delivery having a mean score of 8.91±3.20compared to group A which had mean of 5.67±1.84 (p<0.01). CONCLUSIONS: Simulation-based skill learning showed significantly better results.

Comparison of Cognitive Professionalism in Residents of Public and Private Hospitals of Karachi.

OBJECTIVE: To evaluate and compare the cognitive professionalism in resident medical officers (RMOs) of public and private hospitals of Karachi. STUDY DESIGN: Across-sectional survey. PLACE AND DURATION OF STUDY: Civil Hospital and Ziauddin Medical University Clifton Campus, Karachi, from August to December 2014. METHODOLOGY: This survey was conducted in one public and one private medical college. All residents from Gynecology and Obstetrics, Medicine and Surgery departments were included with non-probability purposive sampling. Avalidated tool (Barry Challenges to Professionalism questionnaire) was used to assess professionalism, containing six challenges to professionalism (acceptance of gifts, conflict of interest, confidentiality, physician impairment, sexual harassment, and honesty) with multiple-choice responses. Data was analyzed with SPSS version 17 and chi-square test was used for determining significant difference between public and private institutes. RESULTS: Forty-three residents from both the places responded. The frequency of acceptable answers to the six scenarios ranged from 0% to 55.8%. Acceptable responses were more from private-sector institute residents than public-sector residents, but no statistical significant difference was seen. CONCLUSION: Most residents did not provide appropriate responses to professional challenges. The postgraduate training programs are very stringent on medical knowledge and skills. However, it is needed to address formally professional attitudes and behaviors and include them as a competency in the training program.

Patient safety: Perceptions of Medical Students of Dow Medical College, Karachi.

OBJECTIVE: To assess medical students' perceptions about patient safety issues before the teaching of "patient safety" can be recommended. METHODS: The cross-sectional survey was undertaken at the Dow Medical College and Civil Hospital, Karachi, in September, 2013. Data collection tool was a structured questionnaire administered to medical students. The main outcome measures were students' perceptions about patient safety issues and their attitude towards teaching of patient safety curriculum. RESULTS: There were 229 medical students in the study with a response rate of 100%. Overall, 129(57%) students agreed that medical errors were inevitable, but 106 (46.9) thought competent physicians do not make errors. While 167(74%) students said medical errors should be reported, 204(90%) thought reporting systems do not reduce future errors. Besides, 90(40%) students thought only physicians can determine the causes of error and nearly 177(78%)% said physicians should not tolerate uncertainty in patient care. Overall, 217(96%) agreed that patient safety is an important topic; 210(93%) agreed that it should be part of medical curriculum; 197(87%) said they would like to learn how to disclose medical errors to patients and 203(90%) to faculty members. CONCLUSIONS: A significant knowledge gap existed among medical students regarding patient safety issues. The teaching of 'patient safety' was highly supported by students and needs to be included in medical curriculum on an urgent basis.