Biological and Clinical Sciences Research Journal

A Quality Improvement Project on Evaluating factors for Cancellation of Ophthalmic surgery.

Fri, 31 Jan 2025 00:00:00 +0000

Ongoing challenges with surgery cancellations impose pressure on the healthcare system, necessitating systematic reforms to enhance efficiency, resource allocation, and patient care. Consequently, this audit aimed to assess the extent of cancelled cases and identify the underlying causes for their cancellation in a tertiary care hospital. Objective: To assess the frequency of cancelled surgical cases and identify the contributing factors in a tertiary care hospital. Methods: This study was carried out from January 1, 2023, to December 31, 2023, over two sessions. During this timeframe, a comprehensive census was conducted of all cases on the operating theatre (OT) list. Data from both sessions were collected using a structured proforma and analysed with SPSS version 23. Results: 81 (11.80%) cancellations were recorded from the total cases on the OT list. The median age with the interquartile range was 27 (52.5) years. In the first cycle, 17 (43.6%) of the cancellations occurred due to medical reasons, 15 (38.5%) did not show up, 1 (2.6%) experienced a change in plan, and no case was cancelled due to equipment malfunction. In the second cycle, out of the cancelled cases, approximately 17 (40.5%) were due to medical reasons, 6 (14.3%) did not show up, 08 (19%) experienced a change in plan, and 2 (4.8%) was due to equipment failure, with a statistically significant difference noted between the reasons in the first and second cycles (p=0.01). Conclusion: This study indicates that many of the factors contributing to the cancellation of surgeries are preventable, and adhering to guidelines can substantially decrease the number of cancelled cases.

Work Stress, Burnout, and Patient Satisfaction Towards Nurses Working in Medicare Hospital, Multan

Robina Ghazanfar, Hafsa Noreen, Nuzhat Sher, Adeel Nouman — Fri, 31 Jan 2025 00:00:00 +0000

Nurse burnout and work-related stress are critical factors that can influence patient care quality. Understanding their impact on patient satisfaction, particularly in high-pressure settings like emergency departments, is essential for improving healthcare outcomes. Objective: To assess the association between burnout and work stress in nurses with patient satisfaction in the emergency department. Methodology: A cross-sectional study was conducted in the Emergency Department of Medicare Hospital, Multan, from December 2023 to December 2024. A total of 100 nurses working in the emergency department for at least 1 year were included in the study. Study data was collected through questionnaires. A 22-item Nursing Stress Scale was used to assess work stress through incidences in the workspace. A 16-item Maslach Burnout Inventory-General Services Scale was used to evaluate burnout in nurses. The questionnaire was divided into three sections: emotional exhaustion, cynicism, and personal effectiveness. Patient satisfaction was measured on a 12-item La Mónica-Oberst Patient Satisfaction Scale presented to emergency department patients after 1-2 days of admission. Results: No significant associations were observed between demographic and professional parameters, stress, burnout, and patient satisfaction. The mean satisfaction score was 4.71 ± 0.93, showing an adequate positive perception among patients. The mean nurse stress score was 0.99 ± 0.10, emotional exhaustion score was 2.02 ± 0.28, cynicism score was 1.49 ± 0.21, and personal effectiveness score was 5.08 ± 0.30, indicating low stress, exhaustion, and cynicism which lead to high performance. Only 5% of the nurses experienced burnout, which was associated with stress experienced at work. However, patient satisfaction was not associated with burnout or stress levels of nurses. Conclusion: Stress and burnout parameters of nurses were not significantly associated with patient satisfaction. However, further research is needed in this field.

Effectiveness of Knotless Suture as A Wound Closure Agent for Impacted Third Molar

Naresh Kumar, Anwar Ali, Tivishna Bai, Kiran ., Gobind Ram, Roma . — Fri, 31 Jan 2025 00:00:00 +0000

Impacted third molar extraction is a common surgical procedure performed by oral and maxillofacial surgeons, often requiring effective wound closure techniques. Conventional sutures have been widely used; however, knotless sutures have emerged as an alternative method, potentially offering faster wound closure and reduced post-operative complications. This study evaluates the effectiveness of knotless sutures as a wound closure agent compared to conventional sutures in impacted third-molar surgeries in the Pakistani population. Objective: To compare the outcomes of knotless sutures versus conventional sutures regarding wound closure time and post-operative swelling in impacted third-molar surgeries. Methods: A randomized controlled trial was conducted at the Department of Oral & Maxillofacial Surgery, Dr. Ishrat Ul Ebad Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan. 72 patients undergoing impacted third molar extraction were randomly allocated into Group A (knotless sutures) and Group B (conventional sutures), with 36 patients in each group. Primary outcomes included wound closure time (measured in minutes) and post-operative swelling (measured in millimeters) at 1-hour and 72-hour intervals. Data were analyzed using SPSS version 23, and statistical significance was set at p≤0.05. Results: The mean age of participants was 26.14 ± 4.66 years in Group A and 24.50 ± 4.39 years in Group B. Mean wound closure time in Group A was significantly lower (2.78 ± 0.90 minutes) compared to Group B (4.47 ± 1.30 minutes, p=0.0001). Swelling at 1 hour post-operatively was significantly lower in Group A (42.69 ± 4.82 mm) than in Group B (46.22 ± 4.46 mm, p=0.002). Similarly, at 72 hours, swelling was lower in Group A (34.75 ± 4.80 mm) compared to Group B (40.80 ± 6.56 mm, p=0.0001). Conclusion: Knotless sutures improved wound closure efficiency and reduced post-operative swelling compared to conventional sutures in impacted third-molar surgeries. These findings support adopting knotless suturing techniques in oral surgical procedures to enhance clinical outcomes and patient comfort.

Frequency of Factors Leading To Intrapartum Perineal Tears in Primigravida

Mah Rukh, Umaiyma Farhad, Sadia Khan, Sanam Shafiq, Sidra Faiz, Saira khan — Fri, 31 Jan 2025 00:00:00 +0000

Intrapartum perineal tears are common complications during childbirth, particularly in primigravida women. Several factors, including episiotomy, vacuum-assisted delivery, and fetal macrosomia, influence the occurrence of these tears. This study aimed to evaluate the frequency and associated factors leading to intrapartum perineal tears in primigravida women in a hospital setting in Peshawar, Pakistan. Objective: To evaluate the frequency and associated factors leading to intrapartum perineal tears in primigravida women in a hospital setting in Peshawar, Pakistan Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Hayatabad Medical Complex, Peshawar, from 15th January 2021 to 15th July 2021. A total of 123 primigravida women with singleton pregnancies were included in the study. The sample size was calculated using the WHO sample size calculator with a 95% confidence interval and a 7% margin of error. Participants were selected using non-probability consecutive sampling. Demographic data and information on episiotomy, vacuum delivery, and macrosomia were collected through a structured proforma. Data were analyzed using SPSS version 22, and descriptive statistics and chi-square tests were used to identify associations. Results: The mean age of participants was 27.1 ± 2.45 years, with a mean gestational age of 38.6 ± 1.28 weeks and a mean weight of 68.5 ± 5.97 kg. Episiotomy was performed in 21.1% of cases, vacuum delivery in 29.3%, and macrosomia was observed in 32.5% of the participants. Stratification of episiotomy, vacuum delivery, and macrosomia by age, gestational age, and weight revealed no significant associations (p-value >0.05). The episiotomy rate was higher in women weighing ≤70 kg (24.7%) and those aged 18–30 years (23.7%). Vacuum delivery was more common in younger women (29.7%) and in those weighing >70 kg (36.7%). Conclusion: Episiotomy, vacuum delivery, and macrosomia were identified as key factors associated with intrapartum perineal tears in primigravida women. The findings suggest that variations in obstetric practices, maternal weight, and fetal characteristics play a significant role in the incidence of perineal tears. Further studies are needed to standardize practices such as episiotomy and vacuum extraction and to assess their impact on perineal trauma in diverse populations.

Comparison of Surgical Site Infection in Diabetic vs. non-diabetic Patients Operated Electively in the Surgical Unit of MTI-Lady Reading Hospital Peshawar

Fri, 31 Jan 2025 00:00:00 +0000

Surgical site infections (SSIs) are a major cause of postoperative morbidity, prolonged hospital stays, and increased healthcare costs. Patients with diabetes mellitus are at a higher risk of developing SSIs due to impaired immune responses and delayed wound healing. Understanding the impact of diabetes on SSIs in elective surgeries is crucial for improving perioperative care and patient outcomes. Objective: To compare the incidence of surgical site infections (SSIs) between diabetic and non-diabetic patients undergoing elective surgeries in a surgical unit and to evaluate associated factors influencing infection rates. Methods: This comparative cross-sectional study included 70 patients aged 25 years and above, divided equally into two groups: 35 diabetic patients (Group A) and 35 non-diabetic patients (Group B). The patients underwent elective, open and laparoscopy surgeries with similar perioperative care protocols, including standardised antibiotic prophylaxis. SSIs were identified based on clinical criteria, including purulent discharge, erythema, swelling, fever, and elevated white blood cell counts. Patients were followed for 30 days postoperatively to record infection outcomes. Results: The incidence of SSIs was notably higher in diabetic patients, with 42.9% (n=15) developing infections, compared to 17.1% (n=6) in non-diabetic patients (p<0.05). Demographic characteristics, including age and BMI, were comparable between the two groups. Comorbidities such as obesity and hypertension were more prevalent in diabetic patients, potentially contributing to the increased risk of SSIs. Among the surgical approaches, laparoscopic procedures were more common in both groups, yet the infection rates remained disproportionately higher in the diabetic cohort. Conclusion: Diabetes is a significant independent risk factor for SSIs, even in elective surgical procedures. The findings underscore the need for optimised glycemic control, management of comorbid conditions, and stringent perioperative infection prevention measures to improve surgical outcomes in diabetic patients.

Knowledge and Attitudes of Nursing Students About Opioids and Overdose Crisis

Madiha Zarif, Hafsa Sattar, Arooj Fatima, Adeel Nouman — Fri, 31 Jan 2025 00:00:00 +0000

Adequate knowledge and positive attitudes toward opioids are crucial for nursing students to provide effective pain management while minimizing the risk of opioid misuse. Understanding students’ perspectives on opioid use and overdose can help improve nursing education and patient care. Objective: To assess the knowledge and attitudes of nursing students regarding opioids and opioid overdose. Methodology: This cross-sectional study was conducted at Medicare Hospital of Nursing, Multan, from December 2023 to December 2024. A total of 100 full-time nursing students were selected. Data were collected through a 34-item questionnaire assessing demographic characteristics, knowledge, attitudes toward opioids and overdose, experience with pain management, and satisfaction with opioid policies. Responses were recorded on a Likert scale ranging from 0 (strongly disagree) to 5 (strongly agree). Statistical analysis was performed to compare knowledge and attitude scores across different academic years. Results: The mean knowledge score increased significantly with the student's educational progression, from 11.2 ± 2.76 in first-year students to 17.1 ± 2.58 in fourth-year students (f(df3) = 21.34, p<0.001). Attitudes toward opioids were negative in 50% of students overall, but this percentage declined with academic advancement: 82% of first-year, 60% of second-year, 44.5% of third-year, and 40% of fourth-year students had negative attitudes. Conclusion: Nursing students demonstrated satisfactory knowledge and a moderate attitude toward opioids, with both improving as they progressed through their academic years. However, curriculum enhancement and hands-on clinical experiences are essential to refine their understanding further and promote better patient care.

Effectiveness of Intralesional Steroid Injections in Peyronie’s Disease

Fri, 31 Jan 2025 00:00:00 +0000

Peyronie’s disease (PD) is a progressive fibrotic disorder characterised by penile curvature, plaque formation, pain, and erectile dysfunction, significantly impacting patients' quality of life. Various treatment modalities, including intralesional steroid injections, have been explored to manage PD, but their efficacy remains a subject of investigation. Objective: This observational study aimed to evaluate the effectiveness of intralesional steroid injections in treating Peyronie’s disease. Methods: This observational study was conducted from January 2023 to December 2024, involving 101 male patients aged between 20 and 65. All patients were diagnosed with Peyronie’s disease based on clinical evaluation and medical history. Participants were treated with intralesional steroid injections administered every four weeks for a total of three sessions. Pre- and post-treatment assessments included measurements of penile curvature, plaque size, erectile function using the International Index of Erectile Function (IIEF), and pain levels using a visual analogue scale (VAS). The primary outcomes were changes in penile curvature, erectile function, plaque size and pain relief, with follow-up evaluations conducted after each treatment cycle. Results: Out of the 101 patients, 75.2% experienced improvements in penile curvature, and 61.4% showed a reduction in plaque size. Additionally, 64.4% of participants reported pain relief, and 77.2% exhibited improvements in erectile function, as measured by the IIEF score. Conclusion: Intralesional steroid injections were found to be effective in reducing penile curvature, plaque size, and pain, as well as improving erectile function in patients with Peyronie’s disease.

Surgical Site Infections is the Concerning Issue in Pakistan: A Review Article

Fri, 31 Jan 2025 00:00:00 +0000

Surgical Site Infections (SSIs) are a significant healthcare-associated infection, particularly in low- and middle-income countries (LMICs) like Pakistan. This review article evaluates the incidence, prevalence, risk factors and role of medical devices in surgical site infections. A literature review was conducted to assess the incidence, risk factors, and preventive strategies for SSIs. Studies comparing povidone-iodine (PI) and chlorhexidine gluconate (CHG) for skin antisepsis, normothermia and data on the effectiveness of sterile surgical attire and negative pressure wound therapy were analysed. SSI rates in LMICs range from 8-30%, compared to 1-4% in high-income countries. Risk factors include patient-related variables (e.g., malnutrition, immunosuppression), surgical factors (e.g., contamination, poor sterilisation), and physiological factors (e.g., postoperative hypoxia). CHG combined with alcohol-based preparations is more effective than PI. Maintaining normothermia, proper sterilisation, and using disposable medical equipment can reduce SSI rates. Preventive strategies include training on CHG use, mandatory disposable sterile drapes and gowns, adherence to AST and AORN guidelines for surgical attire, and continuous education for perioperative staff. Implementing comprehensive CHG combined with alcohol-based preparations, normothermia, negative pressure wound therapy, ongoing education programs, and robust preventive strategies are essential to reduce SSIs, especially in LMICs, improving patient outcomes and healthcare sustainability.