Improving Care in Accident and Emergency Departments in Pakistan

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Introduction: Emergency departments (EDs) are perceived as 24/7 portals where a rapid and efficient diagnosis, urgent attention, primary care, and inpatient admission is provided for stabilizing seriously ill and wounded patients.

Objectives: The main objective of the study is to analysed the improving care in accident and emergency departments.

Material and methods: This analytical study was conducted in DHQ hospital, Sahiwal during 2020 to 2021. For this 5 hospitals were selected for the determination of improving care in accident and EDs. All hospitals were visited one by one and collect the data for the determination of mode of clinics and improving care. Number of patients and number of doctors were also counted. Results: Analysis of results was performed by comparing the data of hospitals with international standards. Patient case notes were checked for compliance with RCP 12 point generic medical record keeping standards on 5 point scale to stratify the level of compliance. Hospitals where case notes fulfilled all the 12 standards were placed at point 5. EDs safety scores were measured on 4 point scale and different hospitals were categorized according to grades A, B, C, D and F.

Conclusion: It is concluded that the emergency service would be provided largely by doctors in middle grade or career grade posts supported by nurse practitioners, general practitioners, and senior house officers working under much closer supervision than at present.

Association between Antiphospholipid Antibodies (APLA) and Preeclampsia (PE) in Females Presenting for Antenatal Check-Up

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Introduction: APLA have been associated with a number of obstetric complications however their  role  in  the  pathogenesis  of  preeclampsia  has  remained  an  issue  of controversy. There is a lack of information on APLA in pre-eclamptic women.

Objective: To assess the association between antiphospholipid antibodies (APLA) and preeclampsia (PE) in females presenting for antenatal check-up.

Materials and Methods: This Case Control study was conducted in Services Institute of Lahore. After approval from hospital ethical committee, 200 females, fulfilling the inclusion criteria were included in the study from OPD of Department of Obstetrics & Gynecology. Informed consent was obtained. Demographic information was also recorded. The females were divided in two groups on the basis of presence or absence of PE i.e. cases and controls.

Results: The mean age of the patients among cases was 27.60±4.96 years the minimum age was 20 years and maximum was 35 years whereas among controls the mean age of the patients was  27.94±4.13 years the minimum age was 20 years and maximum was 35 years .The mean gestational age among cases was 27.46± 4.72 weeks the minimum gestational age was 20 weeks and maximum was 35 weeks on the other side the mean gestational age among controls was 27.25± 4.74 weeks the minimum gestational age was 20 weeks the maximum was 35 weeks. There was significant association between preeclampsia and APLA as the p-value was significant (p-value=0.007).

Conclusion: Results of this study showed a significant association and significant risk between APLA and preeclampsia. Therefore a routine assay of APLA in women at  risk  of  preeclampsia should be done. However  APLA  testing  should  be  considered  in  women  with  early  onset  severe  preeclampsia,  especially  when  additional  clinical features of APS are present.

The Participation Model of Kampung KB in Prevention of COVID-19 in Banyumas Regency, Indonesia

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Family Panning Village, known as “Kampung KB”, is a social institution at the Neighborhood Council level in villages formed by the Government in 2017. The purpose of this institution is to improve the quality of families living in those areas, including the health aspect. The managers were social workers in those areas. This research aims to investigate the participation of this institution in preventing the COVID-19 pandemic in Banyumas Regency, which cases are pretty high. The research informants included 82 participants from family planning village core administrators in 8 villages and one subdistrict in 4 districts of Banyumas Regency, Indonesia.  The data were collected using online interviews through WhatsApp groups belonging to informants in each village/subdistrict, followed by in-depth interviews conducted in those groups. The qualitative data were then analyzed using an interactive model.  Results of this study show that some villagers in three family planning villages identified with positive COVID-19, yet not all village core administrators knew about those cases. Most family planning villages had no special preventive programs. However, in those family planning villages and the surrounding areas with some villagers identified with positive COVID-19, the core village administrators will perform some preventive efforts more intensively in the forms of news socialization related to COVID-19 through Whatsapp groups of family welfare empowerment, neighborhood association, and neighborhood council groups. In addition, some family planning village core administrators organized the local villagers to help one elderly whose child was intensively treated at a hospital because of identified with positive COVID-19. It shows that the family planning villages may be optimized to improve the local family conditions and strengthen social solidarity.

 

The Strategic Management of Mosque-Based Education

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As in the early days of Islam, mosques are not only places of worship but also places of empowerment and Islamic education for Muslims. As an Islamic educational institution, fostering personality attitudes, and the center of civilization for the people, mosques should be managed with modern, professional and accountable organizational management, following the management stages, in order to facilitate the service function for mosque congregations. Among these stages is to develop a good plan, which contains the formulation of actions to achieve the results according to the goals set, namely a decision on what to do in the future. This study uses a descriptive method with the aim of describing various phenomena that exist in the research location. The data collection techniques are through observation, interviews and documentation studies. The results showed that the planning of strategic management for mosque-based education used several strategies to develop, prosper the mosque, with the formulation starting with the development of the vision and mission, identifying various opportunities and threats as well as strengths and weaknesses faced by the al-Mukarromah mosque, determining the good goals for the mosque in short-term, medium-term and long-term goals, and determine alternative strategies and specific strategies to achieve.

Finding the Therapeutic Role of miRNAs in Hepatocellular Carcinoma (HCC)

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Hepatocellular carcinoma (HCC) has become the second most common cause of cancer-related death worldwide, with approximately 782,500 new cases and 745,500 deaths occurring in the global during 2012. The main objective of the study is to find the therapeutic role of miRNAs in Hepatocellular Carcinoma (HCC). This study was conducted using a systematic search on Google scholar, Pubmed and Web of science published until 20th June 2020. The cited references of retrieved articles and previous reviews were also manually checked to identify any additional eligible studies. MiRNAs perform their tumor suppressor functions through downregulating oncogene expression. Increasing evidence suggests that miRNAs are essential for the regulation of liver development, regeneration, and metabolic functions. It is concluded that deregulation of miRNAs significantly contributes to the development of HCC. miRNAs mainly functions to down regulate the expression of targeted genes. However, they may have other yet unknown functions including the activation of gene transcription.

 

Adherence to Contraceptive Use Guidelines and Preconception Advice in a Diabetes Clinic

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Background: Women with diabetes have more complications during pregnancy. Contraceptive advice to prevent unplanned pregnancy is of utmost importance for them. Maintenance of strict glycaemic control is essential to have a positive outcome in pregnancy and proper care. Preconception care and counselling to help pregnancy planning is thus essential.

Aim: To assess whether proper education regarding importance of contraceptive use, preconception care and advice is being imparted to female diabetics according to NICE guidelines

Method: This is a proposed monocentric retrospective clinical audit to evaluate adherence of a diabetes clinic to NICE guidelines regarding education and advice on contraceptive use and preconception care. The three criteria being assessed include documentation of patient’s intentions regarding contraceptive use and pregnancy at each visit with the diabetes care team; offering patients intending to get pregnant a structured education programme as soon as possible; and preconception care and advice being imparted to patients wanting to try for pregnancy before discontinuing contraception. Two patient cohorts, each consisting of 50 patients who meet the inclusion and exclusion parameters for the respective criteria will be made. Data collection will be done by the diabetologist, the diabetes specialist nurse and the practice nurse at St. June’s Diabetes Clinic. Data will be collected by accessing previous records of patients from 01 January 2021 to 31 December 2021. Data will be compiled as a percentage and compared with the standard.

Conclusion: Improved patient-staff communication is the key point to improve compliance with NICE guidelines regarding these standards.

Exploring the Significance of Elevated Antinuclear Antibodies in Medically Critically Ill Patients

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Antinuclear antibodies (ANA) and a type of antibodies that are produced against macromolecules in cell nuclei or the cytoplasm. Indirect immunofluorescence is the most widely method to detect ANA with additional solid phase assays also being available. All the patient admitted to the ICU and had their ANA levels drawn at the SMDC within the past three years (Jan 2017 to Dec 2019) were included in the study.  In patient with multiple hospitalizations, the most recent one was considered for the study. ANA levels were detected using immunofluorescence assay technique. Between Jan 2017 and Dec 2019, 600 patients had their ANA levels drawn, out of which 78 were positive and 522 were negative. Out of the ANA positive patients, 14 (17 percent) had the values to 1:40, 29 (35 percent) had values to 1:80, 14 (17 percent) had values to 1:160, 8 (9.7 percent) had values to 1: 320, 11 (13.2 percent) had values to 1:640, 4 (4.8 percent) had values to 1:1280, 2 (2.4 percent) had values greater than >1:1280. It is concluded that in patients with RA, important differences exist between those who are ANA‐positive and ANA‐negative in terms of time to fulfillment of RA criteria and time to DMARD initiation as well as choice of initial pharmacotherapy.

A Correlational Study on Glycemic Index and Glycemic Load of Foods Consumed by Adolescents in Relation to Their Nutritional Status

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Background: A cross sectional study with random sampling over 442 adolescent of 14 to 19 years age studying in Govt & Private Schools in Mansehra was done  to assess nutritional status by selective anthropometric measurements.

Methods: Food frequency questionnaires were distributed among the students and nutritional assessment was done by selective anthropometric measurements. Descriptive data and correlation was measured by latest SPSS.

Results: Among 450 students of 14 to 19 years 442 students responded the study including (53%) male and (47%) female students, 205 girls participated in the study, 286 (64.7%) participants showed interest in daily exercise while 156 (35.3 %) participants showed no interest in exercise. out of 442 (100%) students 66 (14.9%), were on diet while 376 (85.1%) were not on diet. Out of (100%) students (25.5%), perceived diet impact on nutritional status while (73.7%) perceived no impact on nutritional status, minimum weight of the participants was 41 kg with maximum 84 kg and a mean of 57.25 kg.while (σ) of the Data was 9.74 minimum height was 132 cm and maximum was 185 cm with a mean of 162.97 cm; (σ) was 9.56 of the participant.

Conclusion: Z- Scores and Glycemic loads had correlation with p values 0.5 but with 2 **. There was very strong correlation between waist hip ratio and Glycemic loads of foods and p values 0.36 with 2** in Pearson correlation and p values 0.00 in 2-tailed showed strong correlation.

Influence of Adequacy of Financial Resources on Quality of Education in Public Day Secondary Schools in Embu County, Kenya

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This paper is conceptualized on the existing researches which propound that financial resources are fundamental enablers to an educational system or learning institution in providing quality education. The study sought to examine the influence of adequacy of financial resources on quality of education in public day secondary schools in Embu County, Kenya. The study drew on correlational research design. Using stratified random sampling and purposeful sampling 35 principals, 97 teachers and 384 students were sampled-all drawn from 35 public day secondary schools. The tools of data collection were questionnaires, interview schedule and observation checklist. The findings of the study revealed that the government was the main financier of public day secondary education and the parents were expected to meet the costs of transport, lunch, uniform and stationery for their children. The main challenge with finances from the government was late and untimely disbursement of funds. The study also found that the occupations of a majority of parents were those of low economic status and as such they had difficulties in meeting educational expenses of their children. The study established that the relationship between adequacy of financial resources and quality of education was statistically significant. The study recommends that the government should include the lunch levy in the student’s capitation. The study also recommends for introduction of free bicycle to school scheme by the government to improve on punctuality and also save on time spend on the way to school and increase the time for personal study. The study further recommends for termly stipend for uniform and stationery to the very needy cases.

Influence of Information Technology (IT) on Corporate Social Responsibility (CSR) and Good Corporate Governance (GCG) on Financial Performance

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With all its conveniences and benefits, the use of information technology is expected to help companies carry out their duties and improve their performance; the use of information technology to communicate has a positive influence on coordination. In this study, a re-examination of several companies in Bandung was carried out to correct the weaknesses of previous studies. This research uses quantitative research by using statistical or computational mathematics. The sample in this study is a manufacturing company listed on the Indonesia Stock Exchange (IDX) in the 2016– 2020 period. The researcher determines the model in this study using the purposive sampling technique, selecting the specific criteria. Where the manufacturing population is 178 companies. The analytical tool used in this research is Path Analysis. The results of the descriptive study show that in general information technology, the role of IT in CSR and GCG on the company’s financial performance is considered good. Furthermore, based on the results of hypothesis testing, it is known that information technology has a significant effect on the company’s financial performance and simultaneously has a substantial impact on its economic performance.