INTRODUCTION The COVID-19 pandemic has affected millions and resulted in a considerable strain on... more INTRODUCTION The COVID-19 pandemic has affected millions and resulted in a considerable strain on healthcare systems around the world. Intensive care units (ICUs) are reported to be affected the most because significant percentage of ICU patients requires respiratory support through mechanical ventilation (MV). This study examines the staffing levels and compliance with a ventilator care bundle in a single city in Pakistan. METHODS A cross-sectional survey of 14 ICUs including medical and surgical ICUs was conducted through a self-structured questionnaire including a standardized ventilator care bundle. We assessed the compliance of ICU staff to ventilator care bundle and calculated the correlation between staffing patterns with compliance to this bundle. RESULTS The unit response rate was 64% (7/11 hospitals). Across these seven hospitals, there were 14 functional ICUs (7 surgical and 7 medical). The Mean (SD) numbers of beds and ventilators were 8.14 (3.39) and 5.78 (3.68) while the average patient-to-nurse and patient-to-doctor ratio was 3: 1 and 5:1 respectively. The median ventilator care bundle compliance score was 26 (IQR = 21-28) out of 30, while in medical and surgical ICUs, median scores were 24 (IQR = 19-26) and 28 (IQR = 23-30) respectively. The perceived least compliant component was head elevation in ventilated patients. Correlation analysis revealed that 24 h a day, 7 days a week onsite cover of Advanced Cardiovascular Life Support certified staff was positively correlated with the ventilator care bundle score (rs = 0.654, p value = .011). Similarly, 24-h cover of senior ICU nurses was significantly correlated with the application of chlorhexidine oral care (rs = 0.676, p value = .008) while routine subglottic aspiration was correlated with the number of doctors (rs = 0.636, p value = .014). CONCLUSION Our study suggests that ICUs in Peshawar are not well staffed in comparison with international standards and the compliance of ICUs with the ventilator care bundle is suboptimal. We found only a few aspects of ventilator care bundle compliance were related to nursing and medical staffing levels. RELEVANCE TO CLINICAL PRACTICE Critical care staffs at most of the medical ICUs in Peshawar are not compliant with the standard guidelines for patients on mechanical ventilation. Moreover, the staffing levels at these ICUs are not in accordance with international standards. However, this study suggests that staffing levels may not be the only cause of non-compliance with standard mechanical ventilator guidelines. There is an urgent need to design and implement a program that can enhance and monitor the quality of nursing care provided to mechanically ventilated patients. Lastly, nurse staffing of ICUs in Pakistan must be increased to enable high quality care and more doctors should be trained in critical care.
The 2020–2021 global pandemic has brought significant changes to social and economic life. Compan... more The 2020–2021 global pandemic has brought significant changes to social and economic life. Companies must begin to rethink their business models and values to meet these new challenges. Given the process of intermediation, which has an indirect and catalytic impact, banks have a responsibility and opportunity to transform the economy by, for example, lending to projects that encourage decarbonization and/or green energy. The purpose of this paper is to examine the MagNet Hungarian Community Bank’s approach as a values-based bank in order to compare how the operation of the bank differs from that of traditional ones—even if these apply the Corporate Social Responsibility approach. The findings of an exploratory study of MagNet’s responsible and sustainable way of doing business can help other sectors and companies cope with the global crisis and be a part of the transition to an inclusive, fair, and decarbonised economy. The data for this study were collected using semi-structured in...
The paper portrays the development of green banking in Pakistan, the concept not much developed a... more The paper portrays the development of green banking in Pakistan, the concept not much developed and needs more attention of higher authorities due to globalization, intense competition in global markets and an increase in environmental issues across the country. Green banking practices may include eco-friendly light system, implementation of SolarPowered ATMs, Solar Power as an alternate source of Energy in Rural and remote branches and digitalization of the branches to reduce paperwork. The study suggests that banking sector is an important stakeholder in the Pakistan economy and can play a prominent role in reducing environmental problems. AsPakistan is currently facing high environmental risks,banks might contribute to reduce environmental issues by adopting green and sustainable banking practices such as the implementation of environmental standards for lending.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Jan 31, 2014
A psoas abscess is a condition with vague symptomatology that is associated with potentially life... more A psoas abscess is a condition with vague symptomatology that is associated with potentially life-threatening suppurative myositis of the iliopsoas muscular compartment. Immunocompromised patients run an increased risk of developing suppurative or chronic abscesses from acute foci. The presence of a solid-organ transplant, and the attendant need for immunosuppressant therapies and impaired renal provide additional factors that could contribute to the comorbidities of this condition.Here, we present a 61-year-old white man with a functioning renal transplant who developed a chronic psoas abscess associated with an appendicular sinus that required serial computed tomographic-guided drainages during 8 years. We highlight the difficulties and limitations of managing a psoas abscess. We conclude that a conservative approach toward managing a chronic psoas abscess may be associated with good long-term patient and graft functions, with minimal risk to the patient.
INTRODUCTION The COVID-19 pandemic has affected millions and resulted in a considerable strain on... more INTRODUCTION The COVID-19 pandemic has affected millions and resulted in a considerable strain on healthcare systems around the world. Intensive care units (ICUs) are reported to be affected the most because significant percentage of ICU patients requires respiratory support through mechanical ventilation (MV). This study examines the staffing levels and compliance with a ventilator care bundle in a single city in Pakistan. METHODS A cross-sectional survey of 14 ICUs including medical and surgical ICUs was conducted through a self-structured questionnaire including a standardized ventilator care bundle. We assessed the compliance of ICU staff to ventilator care bundle and calculated the correlation between staffing patterns with compliance to this bundle. RESULTS The unit response rate was 64% (7/11 hospitals). Across these seven hospitals, there were 14 functional ICUs (7 surgical and 7 medical). The Mean (SD) numbers of beds and ventilators were 8.14 (3.39) and 5.78 (3.68) while the average patient-to-nurse and patient-to-doctor ratio was 3: 1 and 5:1 respectively. The median ventilator care bundle compliance score was 26 (IQR = 21-28) out of 30, while in medical and surgical ICUs, median scores were 24 (IQR = 19-26) and 28 (IQR = 23-30) respectively. The perceived least compliant component was head elevation in ventilated patients. Correlation analysis revealed that 24 h a day, 7 days a week onsite cover of Advanced Cardiovascular Life Support certified staff was positively correlated with the ventilator care bundle score (rs = 0.654, p value = .011). Similarly, 24-h cover of senior ICU nurses was significantly correlated with the application of chlorhexidine oral care (rs = 0.676, p value = .008) while routine subglottic aspiration was correlated with the number of doctors (rs = 0.636, p value = .014). CONCLUSION Our study suggests that ICUs in Peshawar are not well staffed in comparison with international standards and the compliance of ICUs with the ventilator care bundle is suboptimal. We found only a few aspects of ventilator care bundle compliance were related to nursing and medical staffing levels. RELEVANCE TO CLINICAL PRACTICE Critical care staffs at most of the medical ICUs in Peshawar are not compliant with the standard guidelines for patients on mechanical ventilation. Moreover, the staffing levels at these ICUs are not in accordance with international standards. However, this study suggests that staffing levels may not be the only cause of non-compliance with standard mechanical ventilator guidelines. There is an urgent need to design and implement a program that can enhance and monitor the quality of nursing care provided to mechanically ventilated patients. Lastly, nurse staffing of ICUs in Pakistan must be increased to enable high quality care and more doctors should be trained in critical care.
The 2020–2021 global pandemic has brought significant changes to social and economic life. Compan... more The 2020–2021 global pandemic has brought significant changes to social and economic life. Companies must begin to rethink their business models and values to meet these new challenges. Given the process of intermediation, which has an indirect and catalytic impact, banks have a responsibility and opportunity to transform the economy by, for example, lending to projects that encourage decarbonization and/or green energy. The purpose of this paper is to examine the MagNet Hungarian Community Bank’s approach as a values-based bank in order to compare how the operation of the bank differs from that of traditional ones—even if these apply the Corporate Social Responsibility approach. The findings of an exploratory study of MagNet’s responsible and sustainable way of doing business can help other sectors and companies cope with the global crisis and be a part of the transition to an inclusive, fair, and decarbonised economy. The data for this study were collected using semi-structured in...
The paper portrays the development of green banking in Pakistan, the concept not much developed a... more The paper portrays the development of green banking in Pakistan, the concept not much developed and needs more attention of higher authorities due to globalization, intense competition in global markets and an increase in environmental issues across the country. Green banking practices may include eco-friendly light system, implementation of SolarPowered ATMs, Solar Power as an alternate source of Energy in Rural and remote branches and digitalization of the branches to reduce paperwork. The study suggests that banking sector is an important stakeholder in the Pakistan economy and can play a prominent role in reducing environmental problems. AsPakistan is currently facing high environmental risks,banks might contribute to reduce environmental issues by adopting green and sustainable banking practices such as the implementation of environmental standards for lending.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Jan 31, 2014
A psoas abscess is a condition with vague symptomatology that is associated with potentially life... more A psoas abscess is a condition with vague symptomatology that is associated with potentially life-threatening suppurative myositis of the iliopsoas muscular compartment. Immunocompromised patients run an increased risk of developing suppurative or chronic abscesses from acute foci. The presence of a solid-organ transplant, and the attendant need for immunosuppressant therapies and impaired renal provide additional factors that could contribute to the comorbidities of this condition.Here, we present a 61-year-old white man with a functioning renal transplant who developed a chronic psoas abscess associated with an appendicular sinus that required serial computed tomographic-guided drainages during 8 years. We highlight the difficulties and limitations of managing a psoas abscess. We conclude that a conservative approach toward managing a chronic psoas abscess may be associated with good long-term patient and graft functions, with minimal risk to the patient.
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