S H Waqar - Academia.edu (original) (raw)

Papers by S H Waqar

The Lancet

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as ind... more Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45•6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84•5 (95% CI 84•1-84•9), which varied between HIC (88•5 [89•0-88•0]), MIC (81•8 [82•5-81•1]), and LIC (66•8 [64•9-68•7]) settings. In the third phase, 1217 (74•6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51•4%) were from HIC, 538 (44•2%) from MIC, and 54 (4•4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3•6% (95% CI 3•0-4•1; p<0•0001) increase in SVR. This was consistent in HIC (4•8% [4•1-5•5]; p<0•0001), MIC (2•8 [2•0-3•7]; p<0•0001), and LIC (3•8 [1•3-6•7%]; p<0•0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.

Pakistan Journal of Medical Sciences

Objectives: To review the strategies for controlling COVID-19 transmission among doctors involved... more Objectives: To review the strategies for controlling COVID-19 transmission among doctors involved in aerosol generating procedures. Methods: A cross-sectional study was conducted in Pakistan Institute of Medical Sciences, Islamabad from September to November 2020, using a 21-itemed initially piloted self-administered questionnaire designed on Google forms. It was shared with doctors involved in Aerosol generating medical procedures (AGMPs) by using social media applications. After the data was collected, it was analyzed using SPSS version 21. Results: A total of 136 doctors participated in the study that included 59 female and 77 male participants. Our 67 (49.3%) participants screened their patients for signs and symptoms of COVID-19 before a routine checkup. The most common disinfectant used for reusable medical equipment by 62 (45.6%) respondents was alcohol swab, 57 (41.9%) did not disinfect reusable equipment and 17 (12.5%) used Dettol water spray. Conclusion: Majority of the do...

Background: It is well known that early appropriate referrals of critically ill patients to an IC... more Background: It is well known that early appropriate referrals of critically ill patients to an ICU can significantly reduce the mortality. At the same time, improper admissions to ICU limits bed availability that adversely affects ICU functioning. Objective: To determine the patterns of admissions and outcome in Medical and Surgical Intensive care Units.Material & Methods: A retrospective review of all patients admitted in medical and surgical ICU of Pakistan Institute of Medical Sciences, Islamabad from 2014 to 2016 was done. Data was collected from admission registers and patients’ files. Data was analyzed using SPSS software version 20.0. Chi-square test was applied and P-value < 0.05 was considered significant.Results: Study recruited data of 1652 patients admitted to intensive care unit of PIMS hospital. There were 769(46.5%) males and 883(53.5%) females. Among all the patients, 503(30.4%) were admitted to medical intensive care unit while 1149(69.6%) were admitted to surgic...

Rawal Medical Journal, 2018

Objective: To assess the influence of fainting episodes on career intensions in medical students ... more Objective: To assess the influence of fainting episodes on career intensions in medical students and to determine the risk factors of fainting, the preventive measures taken and effectiveness of these preventive measures. Methodology: This cross-sectional quantitative questionnaire-based study was conducted from October 2016 to December 2016 at Federal Medical & Dental College, Islamabad, Pakistan. Medical students were randomly selected from private and public medical colleges of Islamabad and Rawalpindi. Results: A total of 170 students participated in the study. Amongst them 107(62.9%) were females and 63(37.1%) were males. 56(32.9%) respondents experienced fainting or its prodormal symptoms in operation theater (OT). Out of these 56, 48(85.7%) experienced fainting only in operating environment while 8(14.28%) experienced fainting outside OT as well. The predisposing factors for fainting was bleeding for 18(10.5%), incision for 8(4.7%), blades & scalpel for 4(2.3%), use of surgic...

Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University, Apr 28, 2020

DOAJ (DOAJ: Directory of Open Access Journals), Oct 31, 2020

Objective: Routine drainage after laparoscopic cholecystectomy is a debatable issue. This study i... more Objective: Routine drainage after laparoscopic cholecystectomy is a debatable issue. This study is aimed to compare post-operative complications in patients undergoing laparoscopic cholecystectomy with and without drainage. Study Design: Randomized Controlled Trial.

Pakistan Armed Forces Medical Journal, 2020

Objective: To assess the patient satisfaction of health care services offered at the telemedicine... more Objective: To assess the patient satisfaction of health care services offered at the telemedicine center at SZABMU, Islamabad during COVID-19 Pandemic. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medical Education/Tele-medicine Centre SZABMU Islamabad, from Mar 2020 to Apr 2020. Methodology: Data of all calls was collected on a pre-piloted closed-ended questionnaires Important parameters were included demographic details, Corona score and other co-morbidities. COVID-19 related calls were divided into three categories 1, 2, 3 based on the severity of symptoms and advised accordingly. Non COVID-19 related calls were referred to concerned specialties. Results: Total numbers of calls were 765 with majority 578 (75.6%), male callers. 230 (30%) callers were between 20 to 30 years of age. Only 3 (0.5%) of callers were asked to consult the hospital immediately because they had high Corona score. 734 (96%) of callers were satisfied with tele-consultation a...

Background: Surgical site infections are important cause of mo rbidity and mortality in admitted ... more Background: Surgical site infections are important cause of mo rbidity and mortality in admitted patients world ov er. Objectives: To determine the pattern of surgical site infectio ns in General Surgical ward of a tertiary care hosp ital. Study type, settings and duration: Analytical cross-sectional study conducted at Depar tment of General Surgery, Pakistan Institute of Medical Sciences, Islamabad f or two years from January 2010 to December 2011. Subjects and Methods: All cases were admitted in surgical ward with vario us surgical problems either as elective or emergency cases who developed wound infection later were included in the study. Cases of wound infecti on operated elsewhere, diabetic foot, and abscesses were exclud ed. Data collected included age, gender, primary di agnosis, mode of admission, comorbid factors, type and duration of s urgery, expertise of the surgeon, use of antibiotic s and hospital stay. After operation, wound was examined for evidence of infection fro...

Objective: To assess the changing practices of surgical procedures for Breast Cancer over the las... more Objective: To assess the changing practices of surgical procedures for Breast Cancer over the last decade in a tertiary care general surgical department Pakistan Institute of Medical Sciences (PIMS), Islamabad. Study Design: Retrospective Comparative Study Place and Duration of the Study: Records of Breast cancer patients, who were operated in main operation theatre of PIMS Islamabad in 1999/2000 and 2009/2010 Materials and Methods: Records of Breast cancer patients, who were operated in main operation theatre of PIMS Islamabad in 1999/2000 and 2009/2010, were studied retrospectively. Comparative analysis of different primary surgical procedures was undertaken and measured against the international surgical oncology guidelines for the surgical management of breast cancer. Results: 418 patients’ records were analyzed. Over the last decade we observed a dramatic increase in incidence of surgical procedures for breast cancer (about two-fold increase), a move to less invasive surgical t...

Rawal Medical Journal, 2013

Objective: To evaluate our experience with laparoscopic total extra-peritoneal (TEP) inguinal her... more Objective: To evaluate our experience with laparoscopic total extra-peritoneal (TEP) inguinal herniorrhaphy in terms of full recovery, return to work, complications and recurrence rate. Duration: From 1st January 2007 to 31st December 2010. Setting: Surgical Unit III, Department of General Surgery, Pakistan Institute of Medical Sciences Islamabad. Patients and Methods: We retrospectively studied a consecutive series of patients who underwent laparoscopic TEP repair of inguinal hernia at our unit. The study consisted of fifty eight patients and total extra-peritoneal (TEP) approach was used in all patients. Results: All 58 patients were male with a mean age of 46 years (range 25 to 67 years) at the time of operation. During the study period, 69 laparoscopic inguinal hernia repairs were performed in 58 patients. Bilateral hernia repair was done in 11 patients (19%). Of the 69 procedures; seven repairs (12%) were done for recurrent hernias. In 20% of the patients the procedure was comp...

Pakistan Armed Forces Medical Journal, 2019

Objective: To find out the perceptions of postgraduate students regarding inclusion of clinical a... more Objective: To find out the perceptions of postgraduate students regarding inclusion of clinical audit in the training programme. Study Design: Mixed method sequential study. Place and Duration of Study: Combined Military Hospital Lahore, from Apr to Nov 2018. Material and Methods: In the first phase, quantitative research question addressed the perceptions of postgraduate students regarding inclusion of clinical audit in the training programme through a questionnaire. A total of fifty postgraduate students participated in the study. In the second phase, focus group discussions (FGD) were carried out from thirty-five students divided into five equal groups across different disciplines to explorethese perceptions in depth. Results: The quantitative analysis of results revealed that significantly large percentage of students considered clinical audit, audit project and relevant clinical governance domains to be of high relevance to the postgraduate training programmes. The key themes e...

Pakistan Armed Forces Medical Journal, 2016

Objective: To explore the perceptions about direct observation of procedural skills (DOPS) as wor... more Objective: To explore the perceptions about direct observation of procedural skills (DOPS) as workplace based assessment (WBA) tool among postgraduate students in general surgery. Study Design: Sequential mixed method study. Place and Duration of Study: The study was conducted in department of general surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan Institute of Medical Sciences (SZABMU, PIMS), Islamabad from April 2015 to June 2015. Material and Methods: An 18-item questionnaire was used as quantitative data collection tool that gave the numerical description of the trends, attitudes or opinions of the participants. Survey was followed by focus group discussion that was used as a tool of qualitative methods to enquire perceptions and explore the attitudes. Results: All forty eight postgraduate students in general surgery were approached and questionnaire response rate was 100% (48/48). Fifty four percent of trainees had awareness about DOPS. Assessments were not ap...

Journal of Postgraduate Medical Institute, 2018

Objective: To present our experience about the surgical management and short-to-mid-term outcome ... more Objective: To present our experience about the surgical management and short-to-mid-term outcome of patients with colorectal cancer with an emphasis on the implications for our local population. Methodology: This was a descriptive study conducted between July 2010 to June 2015. We included adult patients with a diagnosis of colorectal cancer who were managed surgically and they were followed-up post-operatively for up to 12 months. Patients demographics, clinical features, radiological and pathological staging, surgical intervention performed, early postoperative complications, mortality and recurrence data was obtained. Results: A total of 81 patients were studied with a mean age of 50.25 ±4.71 years. The average follow up duration was 6.56 ±2.76 months. Among the 67 cases of adenocarcinoma, 15 (22.4%) were grade 1 tumours, 24 (35.8%) were grade 2 tumours while 28 (41.8%) were grade 3 tumours. Adenocarcinoma most frequently presented during Stage C1 (n =23, 34.3%) which was followe...

Objective: Analysis of various cases admitted to surgical unit of Pakistan Institute of Medical S... more Objective: Analysis of various cases admitted to surgical unit of Pakistan Institute of Medical Sciences (PIMS), Islamabad. Patients and Methods: This cross-sectional study was conducted from Jan 2016 – Dec 2016 at Department of General Surgery, PIMS Islamabad. The record of all the cases admitted in Surgical Unit II during the year 2016 was reviewed. All data was collected on a specially designed performa that included basic information of patients like demographics characters, mode of admission i.e. emergency, outpatient department, referred or transferred from another unit, management i.e. operation or conservative treatment, the outcome of management i.e. discharge, referred or death, and the presence of co-morbidities. Data was recorded and analyzed by using SPSS version 20. Results: Total number of admissions during the study period was 822, out of these 54.3% (n=447) were males and 45.60% (n=375) were females. The mean age of the patients was 35.9. The Record showed that 33.0...

Background: Postoperative wound infection continues to be a major complication for patients under... more Background: Postoperative wound infection continues to be a major complication for patients undergoing operative procedures, and remains a cause of concern for surgeons. Objective: The aim of this study was to determine spectrum of microorganisms in postoperative wound infections in general surgical wards at Pakistan Institute of Medical Sciences, Islamabad. Methodology: This prospective observational study was conducted by the Surgical Unit III, PIMS, Islamabad, from July 2012 to June 2014. Data of the patients developing postoperative wound infection of various types were collected and analyzed. Data included clinical features, primary diagnosis, and type of surgery performed, timing when evidence of wound infection was observed, the causative microorganism, and their antibiotic sensitivity pattern. Results: During the study period, 1621 patients were admitted to the surgical ward; out of which 1375 underwent surgery. Among them, 136 patients developed wound infections, giving an ...

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005

A rare case of mesenteric lipoma was presented to us as acute abdomen. His abdominal x-ray showed... more A rare case of mesenteric lipoma was presented to us as acute abdomen. His abdominal x-ray showed dilated small gut. Ultrasonography of abdomen revealed dilated small gut loops and minimal amount of free fluid in the peritoneal cavity. On exploration, most of the small gut was gangrenous and tightly twisted twice around its mesentery that contained a lump which was confirmed as lipoma on histopathology.

Journal of Ayub Medical College, Abbottabad : JAMC

Ingrown toe nail is common problem presenting to the surgeon. Partial Nail avulsion only results ... more Ingrown toe nail is common problem presenting to the surgeon. Partial Nail avulsion only results in recurrence of the ingrown toe nail. The aim of this study was too see the effect of phenolization in preventing recurrence after partial nail avulsion. This was a randomized controlled trial carried out at Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad. This study included 100 patients (50 in each group) with ingrown toe nail presented from November 2009 to October 2010. This study compared the application of phenol after partial avulsion with partial avulsion alone in the treatment of ingrown toe nail. Sixty-nine percent of the patients were males and 31 % were female. The mean age in both groups was 18 years. Patient in the partial nail avulsion with application of phenol group had less pain as compared to patient with partial nail avulsion group only. Our study has shown that patient in phenol group had less post operative infection, spike formation and re...