A dilemma of patients: poor quality administration of tertiary care hospitals: a cross-sectional study

Introduction

The study focuses on healthcare delivery standards in Pakistan's tertiary care hospitals. Poor accountability and a lack of financial and human resources are the main contributing factors to a hospital's substandard performance and low patient satisfaction rates. Feedback surveillance forms are the Achilles tendon in the quality improvement of a facility, and this practice is, unfortunately, not widely practiced in the hospitals of Pakistan. Through this paper and experience, the authors hope to shed light on the need for regular feedback surveys and implementing their results to improve healthcare quality.

Settings and Design

A prospective, observational study of seven tertiary care hospitals in Pakistan.

Materials and Methods

The data was collected using a survey form. Each survey form was filled out by a team comprising three public health professionals who observed the hospital and its functioning without interfering with its workings. The questionnaire was developed with the help of Tools for Assessing the Operationality of District Health Systems: Health Facility Questionnaire designated in the respective facilities. The analysis was then draughted as a qualitative narrative review. Finally, the review was broken down into an assessment of the hospital's outpatient clinic setting, inpatient department, emergency department and other departments.

Results

The survey was conducted at seven public sector hospitals in three major cities of Pakistan. The survey focused on administrative and nonmedical parameters of healthcare facilities. Overall, the hospitals of Lahore and Islamabad lacked mass casualty apparatus and cleanliness, and staff behaviour can be improved. The hospitals in Rawalpindi have mass casualty apparatuses in place. However, they need improvement in accessibility services and hygiene and staff attitude.

Conclusions

The survey showed that all the hospitals had good access and accessibility, and the directions were clearly marked for the visitors. The hospital staff is knowledgeable about the hospital, but their behaviour needs to be improved. Also, the quality of the cleanliness and waiting areas is fair but needs improvements. Finally, regular cheques via regular feedback and quality assessments can improve healthcare delivery.

Immunoassay Urine Drug Testing among Patients Receiving Opioids at a Safety-Net Palliative Medicine Clinic

BACKGROUND

Few studies have examined the use of immunoassay urine drug testing of cancer patients in palliative care clinics.

OBJECTIVES

We examined the frequency of immunoassay urine drug test (UDT) abnormalities and the factors associated with aberrancy at a safety-net hospital palliative medicine clinic.

METHODS

A retrospective review of the electronic medical records of consecutive eligible patients seen at the outpatient palliative medicine clinic in a resource-limited safety-net hospital system was conducted between 1 September 2015 and 31 December 2020. We collected longitudinal data on patient demographics, UDT findings, and potential predictors of aberrant results.

RESULTS

Of the 913 patients in the study, 500 (55%) underwent UDT testing, with 455 (50%) having the testing within the first three visits. Among those tested within the first three visits, 125 (27%) had aberrant UDT results; 44 (35%) of these 125 patients were positive for cocaine. In a multivariable regression model analysis of predictors for aberrant UDT within the first three visits, non-Hispanic White race (odds ratio (OR) = 2.13; 95% confidence interval (CI): 1.03-4.38; p = 0.04), history of illicit drug use (OR = 3.57; CI: 1.78-7.13; p < 0.001), and history of marijuana use (OR = 7.05; CI: 3.85-12.91; p < 0.001) were independent predictors of an aberrant UDT finding.

CONCLUSION

Despite limitations of immunoassay UDT, it was able to detect aberrant drug-taking behaviors in a significant number of patients seen at a safety-net hospital palliative care clinic, including cocaine use. These findings support universal UDT monitoring and utility of immunoassay-based UDT in resource-limited settings.

Healthcare provider perceptions and reported practices regarding opioid prescription for patients with chronic pain

PURPOSE

Data indicates that clinicians might be under-prescribing opioids for patients with chronic cancer pain, and this could impact adequate chronic pain management. Few studies have sought to understand healthcare provider (HCP) perceptions and practices regarding the prescription of opioids for chronic pain. We assessed HCP perceptions and practices regarding opioid prescription for patients with chronic pain since the onset of the COVID-19 pandemic.

METHODS

An anonymous cross-sectional survey was conducted among 186 HCPs who attended an opioid educational event in April 2021 and 2022.

RESULTS

61/143(44%) opioid prescribers reported reluctance to prescribe opioids for chronic pain. In a multivariate logistic model, younger participants (log OR -0.04, 95% CI: -0.085, -0.004; p = 0.033) and pain medicine clinicians (log OR -1.89, CI: -3.931, -0.286; p = 0.034) were less reluctant, whereas providers who worry about non-medical opioid use (NMOU) were more reluctant to prescribe opioids (log OR 1.58 95% CI: 0.77-2.43; p < 0.001). 53/143(37%) respondents had experienced increased challenges regarding opioid dispensing at pharmacies, and 84/179(47%) reported similar experience by their patients. 54/178(30%) HCPs were aware of opioid-related harmful incidents to patients or their families, including incidents attributed to opioid misuse by a household or family member.

CONCLUSION

A significant number of opioid prescribers were reluctant to prescribe opioids for patients with chronic pain. Many reported challenges regarding dispensing of opioids at the pharmacies. These may be unintended consequences of policies to address the opioid crisis. Future measures should focus on addressing regulatory barriers without undermining the gains already made to combat the opioid crisis.

Four-Dimensional-Printed Microrobots and Their Applications: A Review

Owing to their small size, microrobots have many potential applications. In addition, four-dimensional (4D) printing facilitates reversible shape transformation over time or upon the application of stimuli. By combining the concept of microrobots and 4D printing, it may be possible to realize more sophisticated next-generation microrobot designs that can be actuated by applying various stimuli, and also demonstrates profound implications for various applications, including drug delivery, cells delivery, soft robotics, object release and others. Herein, recent advances in 4D-printed microrobots are reviewed, including strategies for facilitating shape transformations, diverse types of external stimuli, and medical and nonmedical applications of microrobots. Finally, to conclude the paper, the challenges and the prospects of 4D-printed microrobots are highlighted.

Interdisciplinary intervention for the management of nonmedical opioid use among patients with cancer pain

BACKGROUND

Few studies have assessed interventions aimed at managing nonmedical opioid use (NMOU) behavior among patients with cancer. The authors developed the Compassionate High-Alert Team (CHAT) intervention to manage patients receiving opioids for cancer pain who demonstrate NMOU behavior. The objective of this study was to determine the change in frequency of NMOU behaviors, pain intensity, and opioid requirements among those who received the intervention.

METHODS

A total of 130 patients receiving opioids for cancer pain that had documented evidence of NMOU and received the CHAT intervention were reviewed. Demographic and clinical information such as NMOU behaviors, pain scores, and morphine equivalent daily dose at baseline, 3, and 6 months post-intervention was obtained.

RESULTS

NMOU behaviors significantly decreased from a median (interquartile range) of 2 (1-3) at baseline to 0 (0-1) at both 3 and 6 months post-intervention (p < .001). A total of 45 of 75 (60%) and 31 of 50 (62%) of CHAT recipients achieved complete response to the intervention at 3 and 6 months, respectively. Higher baseline number of NMOU behaviors was independently associated with patient response to the intervention (odds ratio [OR], 1.97; 95% confidence interval [CI],1.09-4.28, p = .049 at 3 months; OR, 2.5; 95% CI, 1.20-6.47, p = .03 at 6 months). The median pain score decreased from 7 at baseline to 6 at both 3 and 6 months (p = .01). Morphine equivalent daily dose did not significantly change during that same period (143 mg/day vs. 139 mg/day, p = .13).

CONCLUSIONS

Most patients who received the CHAT intervention improved in their NMOU behaviors and pain intensity scores 3 and 6 months post-intervention. These preliminary findings support the efficacy of CHAT in managing patients receiving opioids for cancer pain who demonstrate NMOU behavior.

Health Care Provider Attitudes, Beliefs, and Perceived Confidence in Managing Patients With Cancer Pain and Nonmedical Opioid Use

CONTEXT

Health care provider education is an effective strategy to improve knowledge and competencies in opioid-prescribing practices. However, there are very few studies regarding this among providers of patients with cancer pain and nonmedical opioid use (NMOU). The aim of our study was to assess participants' attitudes, beliefs, and self-perceived confidence in caring for patients with cancer pain and NMOU before and after attending an opioid educational seminar on the use and nonmedical use of opioids in patients with cancer.

METHODS

An anonymous cross-sectional survey was conducted among health care providers who attended an opioid educational event in April 2018 and May 2019.

RESULTS

The overall response rate was 63% (129 of 206). Approximately 72% of participants had concerns about NMOU in patients with cancer, 69% felt that such patients are frequently underdetected, and 63% felt that cancer pain is frequently undertreated. At baseline, only 23% reported adequate knowledge and 35% reported confidence in caring for patients with cancer with NMOU-related issues. Among those who completed both the preseminar and postseminar surveys, these numbers improved significantly at the end of the seminar (26% vs. 71% and 43% vs. 84%, respectively; all P < 0.001).

CONCLUSION

Most health care providers expressed concerns about underdetection of NMOU and undertreatment of pain among patients with cancer. Many self-reported knowledge and confidence deficits in caring for patients with cancer with NMOU. Seminar participation was associated with an increase in the number of participants with self-perceived knowledge and confidence. Future studies are needed to ascertain the impact of such opioid educational events on patient care practices.

Ventilation use in nonmedical settings during COVID-19: Cleaning protocol, maintenance, and recommendations

Coronavirus disease 2019, otherwise referred to as COVID-19, started in China and quickly became a worldwide pandemic. Beginning in March 2020, nonessential businesses in the United States were closed, and many communities were under shelter-in-place orders. As of May 2020, some business sectors started reopening, even amidst concerns of worker health as the pandemic continued. In addition to physical distancing, cleaning and disinfection routines, and using face coverings, building ventilation can also be an important risk mitigation measure for controlling exposure to SARS-CoV-2 indoors. A number of studies to date, however, have focused on ventilation in medical facilities (e.g. hospitals) as the risk of transmission of SARS-CoV-2 is higher there (because of the close proximity of workers to patients who have the disease and their treatment procedures). Few studies have focused on ventilation use in nonmedical settings (e.g. office buildings and school classrooms), despite the large population of workers and community members in these facilities. In this article, we review the role that building ventilation can play in minimizing the risk of SARS-CoV-2 transmission in nonmedical environments and some recommended protocols to follow for its proper use, including cleaning and maintaining mechanical ventilation systems for businesses, schools, and homes.

Self-Medication Among King Khalid University Students, Saudi Arabia

Purpose

This study objective was to explore the pattern of self-medications among King Khalid University students, Saudi Arabia.

Patients and methods

A cross-sectional study was conducted over five months among King Khalid University students, Abha, Saudi Arabia.

Results

Among all the study participants, nearly 98.7% were practicing self-medication. Headache (75.9%), cough and cold (52.5%), and fever (35.6%) and body pain (24.6%) were the most reported symptoms. Use of painkillers (91.6%) was significantly predominant among the medical students, whereas non-medical students used antibiotics (35.4%).Time saving (64.2%), mild symptom (51.7%) and quick relief (36.9%) were the reasons behind seeking self-medication in this study.

Conclusion

Self-medications was common in King Khalid University. Educational programs are highly recommended.

Self Injection of Topical Skin Preparation by Patient Seeking Facial Volume Enhancement: A Case Report

A 25-year-old man seeking increased prominence of the cheeks self-injected a topical skin preparation containing hyaluronic acid into his malar soft tissues. Labeling and marketing of the product, which highlighted the hyaluronic acid as one of the ingredients, might have contributed to his misunderstanding of the intended use for the product. Additionally, a popular medical-based talk show and numerous videos online contributed to the errant belief that self-administration was a viable option. Complications from the injection of nonpharmaceutical substances of this type and implications for treatment in clinical practice are discussed.

Bullying among medical and nonmedical students at a university in Eastern Saudi Arabia

BACKGROUND

Many medical students, junior doctors, and other health-care professionals have been affected by the negative experience of bullying. Research is scarce on bullying experienced by medical and nonmedical students in Saudi Arabia unlike what is found in Western countries. It is unclear whether being a nonmedical student modifies the risk of being bullied.

MATERIALS AND METHODS

A cross-sectional study included 400 university students using convenient sampling. The sample comprised 295 students who responded and were stratified into medical (n = 176) and nonmedical (n = 119) groups. Statistical Package for the Social Sciences (SPSS) version 22.0 was used to analyze our data. Normality was measured using the Kolmogorov-Smirnov test. Statistical significance was tested using chi-square test for categorical variables, and t-test for continuous variables.

RESULTS

Almost half of the respondents were found to have experienced some bullying, victimization, or other harassment during their medical education. The most common forms of bullying were verbal abuse and undue pressure to produce work (43.8%; n = 77). Nonmedical students experienced more bullying than medical students and were more likely to be female, single, and younger in age. The number of medical students subjected to sexual harassment (1.7%; n = 3) was higher than nonmedical students (0.8%; n = 1). Physical violence was more towards nonmedical (4.2%; n = 5) than medical students (1.1%, n = 2). The rates of bullying continue to be associated with anxiety and depression.

CONCLUSIONS

Our data suggest similar bullying rates in the developed world but higher than previously reported in a Saudi study. Bullying or harassment affects both medical and nonmedical students and is associated with high levels of anxiety and depression.

Patterns of self-medication among medical and nonmedical University students in Jordan

Background and objective

Self-medication practice involves consumption of medicines by one's own initiative or on the consultation of others without the guidance of a physician. Self-medication and use of over-the-counter drugs are prevalent worldwide public health concerns. University students of medical and nonmedical disciplines may have different levels of health education. This study evaluated the prevalence and patterns of self-medication and the attitudes toward this practice among medical and nonmedical university students in Jordan.

Methods

A descriptive cross-sectional study was conducted in 504 students (medical: 248 and nonmedical: 256). The students were invited to complete a questionnaire that included questions primarily related to patterns of physician visits, self-medication practice, symptoms provoking self-medication, and sources of advice.

Results

Self-medication was highly prevalent and comparable between medical and nonmedical students (~96%). Headache (81.9%), cold (58.3%), and flu (53%) were the frequent symptoms provoking self-medication among students. Self-medication for headache (86.7% vs 77.3%) and tooth pain (53.1% vs 27%) was significantly higher among medical vs nonmedical students, respectively. Self-treatment with painkillers (82.3% vs 73%) or antiallergy (11.3% vs 5.9%) drugs was significantly higher among medical students, while the use of anti-flu decongestants (47.6% vs 60.2%) was lower compared to nonmedical students, respectively. Nonmedical vs medical students were significantly more dependent on friends (14.8% vs 7.7%) and own experience (7.4% vs 2.4%) as a source of self-medication advice.

Conclusion

Self-medication is common among Jordanian university students of medical and nonmedical disciplines. This practice, if used irrationally, may constitute a health problem that needs awareness and interventions by health care regulators in Jordan. Future studies are warranted to examine the impact of self-medication on students' health.

Nonmedical Use of Prescription Stimulants Among US High School Students to Help Study: Results From a National Survey

OBJECTIVE

Mixed findings exist regarding extent and efficacy of nonmedical use of prescription stimulants (NMUPS) for study enhancement (SE). This national study of US high school seniors examined NMUPS for SE and addressed risk/benefit questions: To what extent are students reporting NMUPS specifically for SE, and do these individuals demonstrate fewer problem behaviors and superior academic performance?

METHOD

Total of 15 098 US students surveyed (2009-2015) and divided into 4 subgroups: (1) no past-year NMUPS (nonusers), (2) past-year NMUPS to help study (NMUPS-SE only), (3) past-year NMUPS for study/nonstudy motives (NMUPS-SE+ other), and (4) past-year NMUPS for nonstudy motives (NMUPS-nonSE only). Student characteristics (eg, grade point average [GPA]) and substance-related problems (eg, binge drinking) compared between subgroups.

RESULTS

Among students who reported past-year NMUPS (n = 781), 7.4% reported NMUPS-SE only, 40.9% NMUPS-SE+ other, and 51.7% NMUPS-nonSE only. Odds of binge drinking, cigarette smoking, marijuana, and opioid nonmedical use significantly higher among all NMUPS subgroups. GPAs significantly lower among subgroups reporting NMUPS nonstudy motives; did not differ between NMUPS-SE only and nonusers.

CONCLUSIONS

7% of US high school seniors engaged in NMUPS for SE only (0.4% total population). Findings indicate greater substance-related problems without superior academic performance among NMUPS-SE subgroups.

Dose-response relationship between functional pain interference and nonmedical analgesic use: Findings from a nationally representative Canadian survey

Background

Despite the epidemic of nonmedical analgesic use (NMAU) in North America, there is a scarcity of research quantifying the effect of pain on NMAU.

Aims

This study sought to investigate the relationship between NMAU and functional pain interference, defined as the perceived level of interference in performing activities of daily living due to pain, in a population-based sample of the general Canadian population.

Methods

Data from the 2012 Canadian Community Health Survey (CCHS)–Mental Health, a nationally representative cross-sectional survey, were used to conduct bivariable and multivariable logistic regression analyses.

Results

The weighted prevalences of pain and NMAU were 20.6% and 6.6%, respectively. After adjusting for age, sex, education, culture/race, and chronic mental health diagnosis, a dose–response relationship was observed between higher functional pain interference and increased odds of NMAU, ranging from 1.61 (95% confidence interval [CI], 1.22–2.12) to 2.98 (95% CI, 2.21–4.01) from the lowest to the highest levels of functional pain interference. Elevated odds of NMAU were also observed among younger respondents aged 20–29 years and 15–19 years, respondents with a chronic mental illness diagnosis, and males. Secondary analyses revealed that the dose–response relationship between greater function pain interference and increased odds of NMAU persisted within subgroups with and without mental illness, as well as within subgroups aged 40 to 69.

Conclusions

These findings highlight the potential role of pain on increasing NMAU and the need for targeted strategies to reduce harms of NMAU among high-risk subgroups such as young adults.

Noninvasive and alternative management of chronic low back pain (efficacy and outcomes)

OBJECTIVES

The goal of this article is to provide a thorough literature review of available noninvasive and alternative treatment options for chronic low back pain. In particular, the efficacy of each therapy is evaluated and pertinent outcomes are described.

MATERIALS AND METHODS

A comprehensive search for available literature was done through PubMed and Cochrane data base for topics discussed in this paper.

RESULTS

Relevant current and past references were reviewed and presented to reflect the efficacy of each therapy and related outcomes.

CONCLUSIONS

There are a wide variety of noninvasive and alternative therapies for the treatment of chronic low back pain. Those with the strongest evidence in the literature for good efficacy and outcomes include exercise therapy with supervised physical therapy, multidisciplinary biopsychosocial rehabilitation, and acupuncture. Therapies with fair evidence or moderately supported by literature include yoga, back schools, thermal modalities, acupressure, and cognitive-behavioral therapy. Those therapies with poor evidence or little to no literature support include manipulation, transcutaneous electrical nerve stimulation, low-level laser therapy, reflexology, biofeedback, progressive relaxation, hypnosis, and aromatherapy. Providers delivering care for patients with chronic low back pain must carefully evaluate these available treatment options related to their efficacy or lack thereof as well as relevant outcomes.

Adolescent Nonmedical Use of Prescription Pain Relievers, Stimulants, and Depressants, and Suicide Risk

BACKGROUND

Although the link between drug abuse and suicide risk is established, few studies have examined the relationship between the nonmedical use of prescription drugs (NMUPD) and suicide risk, particularly among adolescents.

OBJECTIVES

To explore the relationship between NMUPD and suicide risk among 4,148 adolescents in grades 9-12 enrolled in five public high schools.

METHODS

Logistic regression models were constructed for the nonmedical use of prescription pain relievers, depressants, stimulants, and a composite measure for any NMUPD. Models were estimated before and after controlling for key covariates.

RESULTS

About 21% of respondents reported lifetime NMUPD. After covariate adjustment, students who had reported any NMUPD were between 1.7 and 2.3 times more likely to report suicidal ideation, but not a suicide attempt (p < .0001). When stratified by sex and drug, nonmedical use of pain relievers, stimulants, and depressants were significantly associated with greater odds of suicidal ideation and behavior for both males and females (p < .05). However, NMUPD of pain relievers were not associated with greater odds of suicide attempts for males or females or among males who reported nonmedical use of stimulants. Nonmedical use of depressants was associated with greater odds of suicide attempts for both males and females (OR = 1.61 and 2.25, respectively) and among females who reported nonmedical use of stimulants (OR = 2.06, p < .01).

CONCLUSIONS/IMPORTANCE

Results suggest that some adolescents may be inappropriately self-medicating psychological distress with prescription medications or NMUPD may promote suicide risk, especially for males and females who use depressants and females who use stimulants.

A survey of chiropractic academic affiliations within the department of veterans affairs health care system

PURPOSE

With the recent implementation of chiropractic into the Department of Veterans Affairs (VA) Health Care System, chiropractic institutions nationwide now share common educational ground with many of the nation's medical schools and other educational institutions. Chiropractic students may undergo clinical training within VA medical facilities that have affiliation agreements with chiropractic institutions. The purpose of this study was to gain a greater understanding of the current state of chiropractic academic affiliations within the VA.

METHODS

Survey method was utilized to obtain information about the program design and operation of VA chiropractic academic affiliations.

RESULTS

Chiropractic academic affiliations have been established within four VA medical facilities in association with three chiropractic colleges. There was considerable variation in staffing and internship duration among the locations.

CONCLUSION

The four existing chiropractic academic affiliations were dissimilar in terms of their design and operation with different strengths and program characteristics identified. Additional study is indicated to determine the impact that program variation has on the clinical care and educational functions of VA chiropractic academic affiliations.

Department of defense chiropractic internships: a survey of internship participants and nonparticipants

OBJECTIVE

Department of Defense (DoD) chiropractic internships first began in July of 2001. At the time of this study, 30 New York Chiropractic College student interns had completed part of their clinical education within chiropractic clinics at either the National Naval Medical Center or Naval Hospital Camp Lejeune. The purpose of this study was to evaluate and compare the careers of DoD chiropractic internship participants with comparable nonparticipants in terms of demographics, professional activities, income, and satisfaction.

METHODS

Survey research was employed to gather data from DoD chiropractic internship participants and comparable nonparticipants. Statistical analysis was carried out to determine significant differences with a nominal significance level set as.05.

RESULTS

There were no statistically significant differences in demographics, professional activities, income, or career satisfaction between the 21 DoD chiropractic internship participants (70% response rate) and 35 internship nonparticipants (35% response rate).

CONCLUSIONS

This study utilized practice parameters as a form of feedback for a comparative analysis of DoD chiropractic internship participants and nonparticipants and found no significant differences between these groups. Limitations of the study may have influenced the results. Opportunities for chiropractic students to train within these settings remains limited and should be further explored, as should additional research into this component of chiropractic clinical education.