Measurement of off-centre ratios (OCRs) is a requirement for the commissioning of cyberknife. The fixed source to axis distance (SAD) technique is required for the measurement of OCRs which is time-consuming and tedious. The fixed source to surface distance (SSD) technique, on the other hand, is easy to set up and requires less time. The OCRs have been measured with SAD and SSD setup and compared to assess the difference between each other.

The research is carried out on an Accuracy cyberknife M6, installed at NORI Cancer Hospital Islamabad. The OCRs are measured with Sun Nuclear ‘EDGE’ diode detector on a Sun Nuclear SNC 3D dosimetry system. The OCRs were measured for 12 cones and at three depths. Each OCR measured with the SAD setup is compared with the corresponding OCR measured with SSD setup using % dose distance and distance to agreement (2%/0·2mm).

For the within-the-beam and out-of-the beam regions, both OCRs are matching with each other. The percentage difference is in the order of less than 1% while the distance-to-agreement results in 100% matching for all cones and all depths. For the penumbra region, the percentage difference is higher than the other two regions. The maximum percentage difference is 2·96%. Generally, the percentage difference is higher for small cones and for OCRs measured at larger depths.

The OCRs on a cyberknife system measured with a fixed SSD setup and fixed SAD setup coincide within an acceptable limit and can be measured with both setups with similar accuracy.

This research assessed healthcare workers' vaccination practices for influenza, hepatitis, and pneumonia, as well as their desire to get COVID-19 vaccine when accessible, and investigated their 7C psychological antecedents (confidence, complacency, collective responsibility, compliance, calculation, constraints and conspiracy). Stress variables and vaccination intention for COVID-19 were also compared to see whether psychological stress had a meditative impact on the relationship.

An analytical cross-sectional survey was conducted among health care professionals including nurses and doctors of tertiary care hospitals of Rawalpindi. Data were collected from February to April 2021 to get the COVID-19 vaccination when it became available, and looked into their 7C mental forebears (confidence, complacency, collective responsibility, compliance, calculation, constraints and conspiracy). A total of 642 health care professionals voluntarily participated in our research. Demographic Details, questions like pneumonia vaccination, hepatitis vaccination, influenza vaccination and 7C questions were asked. Data were entered and analysed through SPSS 26.0 and Python. Correlation, linear and non linear regression, and mediation analysis were applied.

The immunization rates for influenza, hepatitis, and pneumonia vaccines, as well as the percentage of those who received COVID-19 vaccination, were 43.4%, 65.2%, 42.8%, and 39.7%, respectively. Hepatitis vaccination was significantly associated with the 7C model, influenza vaccination with conspiracy, whereas pneumonia was significantly associated with compliance. confidence (r = 0.11), complacency (r = −0.19), constraints (r = −0.20), calculation (r = 0.08), collective responsibility (r = 0.18), and compliance (r = 0.19) were significantly corelated with the COVID-19 Vaccine Intention. Contrary to direct effect, the indirect effect of patient contact frequency (β = −0.01, ρ<0.05) and terrified of contracting virus (β = −0.05, ρ<0.05) via psychological stress on COVID-19 Vaccination intention were significant depicting full mediation.

For herd immunity, the probability for COVID-19 vaccination uptake among healthcare professionals was less than optimal. The 7C structures may help predict immunization against influenza, hepatitis, and pneumonia, but not vaccination against COVID-19.

COVID-19 imposed lockdowns have impacted the mental health of medical students worldwide. However, the relationship of social anxiety disorder with psychological distress during the pandemic has not been studied. The objective of this study was to assess the association of social anxiety disorder and physical activity with psychological distress in medical students during COVID-19 imposed lockdown.

256 medical students (M/F: 144/112) took part in this online cross-sectional survey conducted in September 2020 during a government imposed lockdown. Kessler-10 (K10) questionnaire, social interaction anxiety scale (SIAS) and international physical activity questionnaire (IPAQ) - short form were used to assess psychological distress, social anxiety and physical activity, respectively. Data were analysed using SPSS v25, with application of multivariate logistic regression to assess association of various factors with psychological distress.

Out of 256 medical students, 73 (28.5%) had severe psychological distress and 105 (41.0%) had mild to moderate distress. A logistic regression model to assess the effect of social anxiety disorder, level of physical activity and gender with the likelihood of having severe psychological distress was statistically significant (p < 0.001) with overall accuracy of 73.8%. The risk of developing severe psychological distress was higher among females [OR 2.13 (95% CI 1.17–3.87), p = 0.013] and those with social anxiety disorder [OR 4.56 (95% CI 2.27–9.16), p < 0.001]. Low physical activity was not a significant risk factor for psychological distress [OR 0.88 (95% CI 0.35–2.23), p = 0.794].

This study shows that COVID-19 imposed lockdown has adversely affected the mental health of medical students. Female students and those with social anxiety disorder are at more risk of developing severe psychological distress.

Among various factors that determine an individual's self-esteem, parenting styles play a very significant role in this regard. Certain parenting styles that are practiced around the globe include authoritarian, authoritative and permissive parenting. The study aimed to investigate the co-relation between parenting styles and self-esteem among medical students.

A cross-sectional study was conducted among the MBBS students of Rawalpindi Medical University, Rawalpindi from December 2020 to March 2021. 255 students took part in this study. An online survey was prepared by using Parental Authority Questionnaire-Short Version and Rosenberg Self-Esteem Scale and students were asked to fill it. Simple Random sampling technique was applied. SPSS version 26.0 was used to enter and analyze data. Pearson Correlation, Logistic regression and Hierarchal regression analysis were applied.

Out of 230, 60% of the sample population experienced authoritative, 29% experienced authoritarian whereas 11% experienced permissive style of parenting. Authoritative (r = 0.283, p < 0.001) and authoritarian (r = -0.227, p < 0.001) parenting styles were significantly correlated with self-esteem. Authoritarian parenting style (AOR = 2.20, 95% CI: 1.17, 4.14) was significantly associated with self-esteem of the participants compared to authoritative parenting style.

Results indicated that authoritative parenting was only parenting style that correlates positively with self-esteem which suggest authoritative parenting is the optimum parenting style in Pakistani culture.

The aim of this study was to assess the legibility as well as components of a prescription prescribed by doctors in tertiary care hospitals of Rawalpindi, Pakistan.

An analytical cross-sectional study was conducted in pharmacies of two allied hospitals of Rawalpindi Medical University. Data were collected using stratified randomized sampling. A total of 661 prescriptions were selected and analysed for legibility by three experts. SPSS version 26.00 and Graph Pad Prism were used to enter and analyze the data. Descriptive statistics, correlational model and multinomial logistic regression were applied.

A total of 1982 drugs were prescribed in 661 prescriptions. A total of 46.0% prescriptions were classified in grade 2 and 32.1% in grade 3. On average, 55.74% prescriptions were found to be complete. On average, prescriber's information, patient's information and medication details were present in 72.64%, 57.25%, and 36.73% prescriptions, respectively. Grade 1 (AOR = 0.62), grade 2 (AOR = 0.83), and grade 3 (AOR = 0.85) prescriptions had less odds of being complete compared to grade 4 prescriptions.

Majority of the prescriptions prescribed at tertiary care hospitals were barely legible and also quite a number of prescriptions were incomplete.

Nurses and paramedics by being the frontline workers of the health-care profession need to be equipped with the relevant knowledge, skills, and protective gears against different forms of infection, including coronavirus disease 2019 (COVID-19). Although the governments and concerned stakeholders have provided personal protective equipment (PPE), training and information to protect the health-care professionals; however, until now the scientific literature has virtually not reported the impact of PPE availability, training, and practices on the COVID-19 sero-prevalence among the nurses and paramedics. This study aimed to assess the impact of PPE availability, training, and practices on COVID-19 sero-prevalence among nurses and paramedics in teaching hospitals of Peshawar, Pakistan.

A cross-sectional survey was conducted with a total of 133 nurses and paramedics as subjects of the study.

A univariate analysis was done for 4 variables. The findings indicate that the health-care professionals (nurses and paramedics) who have received PPE on time at the start of COVID-19 emergence have fewer chances of contracting the COVID-19 infection (odds ratio = 0.96); while the odds for PPE supplies was 0.73, and the odds of hand hygiene training was 0.95.

The study concluded that the availability of the PPE, COVID-19–related training, and compliance with World Health Organization recommended practices against COVID-19 were instrumental in protection against the infection and its spread.

We aimed to investigate knowledge, attitudes, and practices regarding the new coronavirus in a sample of the general Pakistani population.

This survey was carried out through The University of Faisalabad (TUF), Pakistan, between February 2020 and April 2020. The questionnaire was circulated on various online platforms to gather information. The data were analyzed on SPSS-22.

Out of 2121 respondents (13.7% were male, and 86.3% were females), 7.4% were married, 4.5% had a high income, and 5.8% had fewer family members. Coronavirus disease (COVID-19) knowledge scores were significantly low in the < 21 years age group as compared to the 21 to 25 years age group (P < 0.001) and > 25 years age group (P < 0.001). The males, married community, high income people, and few family members groups had significantly higher coronavirus knowledge than their respective groups (P = 0.033; P = 0.001; P < 0.001; P = 0.042, respectively).

Our findings suggest that the knowledge score among our study population was not up to the mark. However, a positive correlation between the correct knowledge and appropriate attitude and practice was found among study participants. Older age groups and the high income group were associated with adequate knowledge scores.

Cognitive behaviour therapy (CBT), self-help and guided self-help interventions have been found to be efficacious and cost effective for victims of trauma, but there are limited data from low- and middle-income countries on culturally adapted interventions for trauma.

To investigate the feasibility and acceptability of culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan.

This randomized controlled trial (RCT) recruited 50 participants from shelter homes in Karachi and randomized them to two equal groups. The intervention group received GSH in nine sessions over 12 weeks. The control group was a waitlist control. The primary outcomes were feasibility and acceptability. Secondary outcomes included Impact of Event Scale-Revised (IES-R), Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHO DAS 2). Assessments were carried out at baseline and at 12 weeks.

Out of 60 clients who met DSM-5 criteria for post-traumatic stress disorder (PTSD), 56 (93.3%) agreed to participate in the study. Retention to the intervention group was excellent, with 92% (23/25) attending more than six sessions. Statistically significant differences were noted post-intervention in secondary outcomes in favour of the intervention.

A trial of CatCBT GSH was feasible and the intervention was acceptable to Pakistani women who had experienced domestic violence. Furthermore, it may be helpful in improving symptoms of PTSD, depression, anxiety and overall functioning in this population. The results provide a rationale for a larger, confirmatory RCT of CatCBT GSH.

The waiting room in psychiatric services can provide an ideal setting for offering evidence-based psychological interventions that can be delivered through electronic media. Currently, there is no intervention available that have been developed or tested in mental health.

This proof-of-concept study aimed to evaluate a pilot design of RESOLVE (Relaxation Exercise, SOLving problem and cognitiVe Errors) to test the procedure and obtain outcome data to inform future, definitive trials (trial registration at Clinicaltrials.gov NCT02536924, REB Number: PSIY-477-15).

Forty participants were enrolled and equally randomised to the intervention, RESOLVE plus treatment as usual arm (TAU), or to a control group (TAU only). Those in the intervention group watched RESOLVE in a room adjacent to the waiting area. Participants in the control received routine care. Outcome measures included the Hospital Anxiety and Depression Scale; the Clinical Outcomes in Routine Evaluations outcome measure; and the World Health Organization Disability Assessment Schedule. These measures were performed by a masked assessor at baseline and at 6-week follow-up. Additionally, we measured the number of contacts with mental health services during the prior 4 weeks. Both intention-to-treat and per protocol analyses were performed.

The study proved feasible. We were able to recruit the required number of participants. There was a statistically significant improvement in depression (P < 0.001), anxiety (P < 0.001), general psychopathology (P < 0.001) and disability (P = 0.0361) in favour of the intervention group. People in the intervention group were less likely to contact the service (P = 0.012) post-intervention.

Findings provide preliminary evidence that evidence-based psychosocial interventions can be delivered through electronic media in a waiting-room setting. The outcome data from this study will be used for future definitive trials.

None.

To systematically review the literature on barriers to the use of clozapine and identify any interventions for optimizing clozapine use in treatment-resistant schizophrenia. Journal databases were searched from 1972 to March 2018. The following search terms were used: treatment-resistant schizophrenia, clozapine, barriers, use, prescription rates, implementation, clozaril and prescribing practices. Following a review of the literature, 15 papers were included in the review.

The major barriers that were identified included mandatory blood testing, fear of serious side-effects and lack of adherence by the patients, difficulty in identifying suitable patients, service fragmentation, and inadequate training in or exposure to using clozapine.

In view of consistent evidence across the studies on inadequate knowledge and skills as a significant barrier, we suggest that a certification requiring competence in initiating and managing side-effects of clozapine becomes a mandatory requirement in training programmes.

None.

The purpose of this study was to analyse the comparison of intensity-modulated radiation therapy quality assurance (IMRT QA) using Gafchromic® EBT3 film, Electronic portal imaging device (EPID) and MapCHECK®2.

Pretreatment authentication is the main apprehension in advanced radiation therapy treatment plans such as IMRT.

A total of 20 patients were planned on Eclipse treatment planning system using 6 and 15 MV separately.

Gamma index of EBT3 film results shows the following average passing rates: 97% for 6 MV and 96·6% for 15 MV using criteria of ±5% of 3 mm, ±3% of 3 mm and ±3% of 2 mm for brain. However, by using ±5% of 3 mm and ±3% of 3 mm criteria, the average passing rates were 95·4% on 6 MV and 95·2% on 15 MV for prostate. For EPID, the results show the average passing rates as 97·8% for 6 MV and 97·2% for 15 MV in for brain. In cases in which ±5% of 3 mm and ±3% of 3 mm were used, the average passing rates were 96·6% for 6 MVand 96·1% for 15 MV for prostate. MapCHECK®2 results show average passing rates of 96·4% for 6 and 96·2% for 15 MV, respectively, for brain using criteria of ±5% of 3 mm, ±3% of 3 mm and ±3% of 2 mm, whereas for ±5% of 3 mm and ±3% of 3 mm the average rates are 95·2% for 6 and 94·7% for 15 MV in prostate.

The EPID results are better than the other methods, and hence EPID can be used effectively for IMRT pretreatment verifications.

To determine the feasibility of an anthropomorphic breast polyurethane-based three-dimensional (3D) dosimeter with cavity to measure dose distributions and skin dose for a commercial strut-based applicator strut-adjusted volume implant (SAVI™) 6–1.

An anthropomorphic breast 3D dosimeter was created with a cavity to accommodate the SAVI™ strut-based device. 2 Gy was prescribed to the breast dosimeter having D95 to planning target volume evaluation (PTV_EVAL) while limiting 125% of the prescribed dose to the skin. Independent dose distribution verification was performed with GAFCHROMIC® EBT2 film. The dose distribution from the 3D dosimeter was compared to the distributions from commercial brachytherapy treatment planning system (TPS) and film. Point skin doses, line profiles and dose–volume histogram (DVHs) for the skin and PTV_EVAL were compared.

The maximum difference in skin dose for TPS and the 3D dosimeter was 4% whereas 41% between the TPS and EBT2 film. The maximum dose difference for line profiles between TPS, 3D dosimeter, and film was 4·1%. DVHs of skin and PTV_EVAL for TPS and 3D dosimeter differed by a maximum of 4% at 5 mm depth and skin differed by a maximum 1·5% between TPS and 3D dosimeter. The criterion for gamma analysis comparison was 92·5% at ±5%±3 mm criterion. The TPS demonstrated at least ±5% comparability in predicting dose to the skin, PTV_EVAL and normal breast tissue.

3D anthropomorphic polyurethane dosimeter with cavity gives comparable results to the TPS dose predictions and GAFCHROMIC® EBT2 film results in the context of HDR brachytherapy.