ABSTRACT Objective: To explore the factors contributing to late diagnosis of breast cancer in female population of Punjab, Pakistan. Methodology: Descriptive qualitative study with phenomenological approach was used. The study was carried out in University of Health Sciences, Lahore in collaboration with breast cancer clinics/departments of the Jinnah Hospital, Lahore, Sir Ganga Ram Hospital Lahore and Mayo Hospital Lahore. 15 Females diagnosed more than 4 months after appearance of symptoms of breast cancer were recruited using purposive sampling until saturation of data. Data collected through in depth semi structured face to face interviews was tape-recorded, transcribed and then analysed using thematic analysis framework method. Results: Personal/psychological factors, Sociocultural and Health care system related factors were identified as main themes emerged from data. Lack of knowledge, religious believes, use of Alternative medicine, socioeconomic status cultural myths and poorly facilitated health care facility were the most influential determinants of delay among breast cancer patients. Conclusion: Diagnosis delay is very significant health problem in women with breast cancer linked with multiple determinants. However, educating women for recognition of symptoms and reinforcement to pursue for earlier medical consultation will be helpful in reducing breast cancer diagnosis delay in the country. Key terms: Breast Cancer, Metastasis, Delayed Diagnosis, Prognosis, Advance Stage.
Background: Hemodialysis patients experienced a number of issues that led to early session termination, decreased waste removal, and ultimately decreased dialysis effectiveness. The dialysis unit's nursing staff struggles to care for these patients. An updated practice guideline is needed to provide the proper interventions to lower complications and improve patient outcomes. Long-term maintenance hemodialysis has also changed the way that patients with end-stage renal failure are treated, reducing the risk of death. Objective: To assess the effect of guidelines based practice on dialysis complications in patients on permanent hemodialysis. Methodology: A single group quasi experimental conducted in Sheikh Zayed Hospital Lahore Punjab Pakistan from 1 June to 15 August 2022, data was collected Through the use of a self-structured tool from 30 people receiving hemodialysis for at least six months. The validity and reliability of the tool were initially assessed. A systematic instruction workshop was offered to care providers following the pre data, and the previously described criteria were reassess. Result: According to this study, there were 60% men and 40% female, had age between 30 to 39 (43.3%) and mostly 70% belong to urban area. The McNemar test evaluated the reduction between the pre- and post-dialysis fatigue, headache, vomiting, nausea, breathlessness and cramps with statistical significance (P<0.05). Practical implication: Patients receiving hemodialysis must need a complete nursing care in order to reduce dialysis induced complications. Conclusion: The significant reduction of dialysis complication after conducted dialysis on guideline base; it is recommended that dialysis be performed in accordance with the most recent clinical guidelines to improve hemodialysis procedures and boost hemodialysis efficacy. Keywords: Hemodialysis, Guidelines based practice and Dialysis Complications
Some hospital emergency departments (EDs) suffer from prolonged patient wait times, which decreases hospital productivity. The factors influencing normal ED patient wait times are therefore crucial for hospital administrators to be aware of. An emergency severity index (ESI) and patient flow model for emergency departments were both tested in this causal comparison study, which was founded in the academic framework for business process optimization. Through the use of computer-generated reports, archival data records for one week from the ED of the Bahria International Hospital in Lahore, Pakistan were censused for an ED REU model for patient flow. The results of quantitative descriptive investigation showed that the patient flow model had a considerable temporal effect. The ability to decrease patient wait times while enhancing patient happiness and health outcomes is one of the social change implications. A quantitative study would produce data that would assist medical staff by shortening the wait times for patients.
Background: The rapid increase of caesarean sections has become the major public health problem. Caesarean section ratio is increasing day by day worldwide without knowing the factors with limited explanation that influence the rising trend without medical indications. Aims: To explore the driving factors which lead to the Caesarean Section and to evaluate the maternal choice without medical indication for Caesarean Section. Methodology: A Phenomenological qualitative approach was used with a semi structured open ended questionnaire. Sample size of ten pregnant women with a third trimester was used in this study. There was an individual in-depth interview with a time duration of 30-40 minutes. Purposive sampling technique was used in this study. Content analysis was done by using the Nvivo-10 software. Result: Participants were recruited from the urban and rural area. Interview session was 30-40 minutes which was convenient to the participant. All the interviews were audio tapes recorded. Interpretative Phenomenological analysis revealed five major themes which are: mother personal beliefs for caesarean section, lack of knowledge to make an informed choice, cultural and social influence, fear of labour pain, non-supportive behaviour of staff and management of health care system were made from these interviews. However, critical knowledge gaps were also observed among study obstetricians, particularly with regards to the indications for and timing of elective caesarean sections. Practical implication: The maternal choice of caesarean section without medical indications and the factors influencing the women decision-making process were complex. Therefore, these findings suggest that healthcare policy makers should attend to the factors that influence maternal choice about caesarean section and promote the normal vaginal birth among women. Conclusion: This study identifies the personal beliefs of mothers are the major factors for taking decisions regarding caesarean section. Furthermore, relative’s consultation with mother’s decision-making become the main influencer to conduct the caesarean section. There is the dire need to involve the relatives during the mother's antenatal period to support them to make the timely and right decision regarding the mode of birth. Keywords: Caesarean Section, Decision-Making, Influence, Factors, SVD, Pregnant Women
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