IntroductionBurnout is defined as a prolonged state of physical and psychological exhaustion. Doctors, due to the demanding nature of their job, are susceptible to facing burnout, which has far reaching implications on their productivity and motivation. It affects the quality of care they provide to patients, thus eroding the doctor–patient relationship which embodies patient centeredness and autonomy. The study aims at addressing the stressors leading to burnout and its effect on the doctor–patient relationship.MethodsA descriptive, cross-sectional study design with convenience (non-probability) sampling technique was employed in six major hospitals of Lahore, Pakistan. A total of 600 doctors were approached for the study which included house officers or “HOs” (recent graduates doing their 1 year long internship) and post-graduate trainees or “PGRs” (residents for 4–5 years in their specialties). Burnout was measured using the Copenhagen Burnout Inventor (CBI) while attitudes towards the doctor–patient relationship was measured using the Patient Practitioner Orientation Scale (PPOS), which measures two components of the relationship: power sharing and patient caring. Pearson correlation and linear regression analysis were used to analyze the data via SPSS v.21.ResultsA total of 515 doctors consented to take part in the study (response rate 85.83%). The final sample consisted of 487 doctors. The burnout score was not associated with the total and caring domain scores of PPOS (P > 0.05). However, it was associated with the power sharing sub-scale of PPOS. Multiple linear regression analysis yielded a significant model, by virtue of which CBI scores were positively associated with factors such as female gender, feeling of burn out, scoring high on sharing domain of PPOS and a lack of personal control while CBI scores were negatively associated with private medical college education, having a significant other, accommodation away from home and a sense of never ending competition. Burnout levels varied significantly between house officers and post graduate trainees. Twenty-three percent of the participants (mostly house officers) had high/very high burnout levels on the CBI (Kristenson’s burnout scoring). Both groups showed significant differences with respect to working hours, smoking status and income.ConclusionAlthough burnout showed no significant association with total and caring domain scores of PPOS (scale used to assess doctor–patient relationship), it showed a significant association with the power sharing domain of PPOS suggesting some impact on the overall delivery of patient care. Thus, it necessitates the monitoring of stressors in order to provide an atmosphere where patient autonomy can be practiced.

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Objectives: To see the effects of Intra-Vitreal Diclofenac injection (IVD) in refractory Diabetic Macular Edema (DME). Study Design: Quasi-experimental study. Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan from Sep 2019 to Feb 2020. Methodology: Patients included in the study having Clinically Significant Macular Edema (CSME) with Central Macular Thickness (CMT) of more than 300 microns not responding to three consecutive Intravitreal injections of Bevacizumab (IVB).Intravitreal Diclofenac injection (500μg/0.1 ml) was given by the same retina fellow with the same protocol across all patients.Each patient was evaluated based on Central Macular Thickness (CMT) before intravitreal Diclofenac injection and on followup visits one week and one month after injection. Results: A total of 30 patients (30 eyes) were included in the study. Out of these, 11 were females, and 19 were males. The mean age of the patients was 57.87±4.424 years. Mean Central Macular Thickness (CMT) before injection was 439.67±110.45µm, after one week 398.47±110.55µm and 384.87±119.11µm after one month of intra-vitreal Diclofenac injection. Pre and post-injection central macular thickness (µm), which was clinically significant (p-value <0.001). Conclusion: Intravitreal Diclofenac injection (IVD) is effective in diabetic macular oedema, not responding to intravitreal antiVEGF (IVB) injections.

Small and medium enterprises (SMEs), entrepreneurship, and crude oil are important contrib- utors to the economic growth of several countries. Crude oil revenue facilitated the develop- ment of other economic sectors including SMEs in many countries and became a blessing for economic stability. However, in some countries or regions, it attracted most of the labour, capital, and government support at the cost of other economic sectors and became a curse. This study investigates the relationship between crude oil prices and small business entrepre- neurship activities in the province of Alberta. The Ordinary Least Square (OLS) models, along with some other statistical tools, are used to analyze the data for the period 1988-2018. Our findings reveal a positive relationship between crude oil prices and the number of small busi- nesses in Alberta and Canada, which is consistent with the natural resources blessing hypoth- esis. However, some labour-intensive and low-wage small business sectors were found to be negatively associated with crude oil prices. Moreover, the population growth and market in- terest rate hampered small business entrepreneurial activities, while GDP growth promoted them. Some implications are provided at the end of the study to diversify the economy of Alberta through promoting small business entrepreneurial activities.