BackgroundCommunity health workers (CHWs) are currently deployed in improving access to palliative care in a limited number of low-income or middle-income countries (LMICs). This review therefore aimed to document evidence from LMICs regarding (1) where and how CHWs are currently deployed in palliative care delivery, (2) the methods used to train and support CHWs in this domain, (3) the evidence surrounding the costs attached with deploying CHWs in palliative care provision and (4) challenges and barriers to this approach.MethodsWe conducted a systematic scoping review of the literature, adhering to established guidelines. 11 major databases were searched for literature published between 1978 and 2019, as well as the grey literature.Findings13 original studies were included, all of which were conducted in sub-Saharan African countries (n=10) or in India (n=3). Ten described a role for CHWs in adult palliative care services, while three described paediatric services. Roles for CHWs include raising awareness and identifying individuals requiring palliative care in the community, therapeutic management for pain, holistic home-based care and visitation, and provision of psychological support and spiritual guidance. Reports on training context, duration and outcomes were variable. No studies conducted a formal cost analysis. Challenges to this approach include training design and sustainability; CHW recruitment, retention and support; and stigma surrounding palliative care.ConclusionDespite relatively limited existing evidence, CHWs have important roles in the delivery of palliative care services in LMIC settings. There is a need for a greater number of studies from different geographical contexts to further explore the effectiveness of this approach.

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Objective: The aim of this study was to compare the outcome of dexamethasone and methylprednisolone among patients suffering with COVID-19 pneumonia. Study Design: Quantitative Retrospective Comparative study. Setting: Department of Medicine, Allied Hospital, Faisalabad. Period: February to September 2021. Material & Methods: Data included archival record of 120 diagnosed cases of COVID-19 pneumonia during July 2020 to December 2020. Data was retrospectively collected by researchers using a predesigned study proforma and analyzed through SPSS software 25.0. Results: Out of 120 reported cases of COVID-19 pneumonia, 76 (63.3%) were males, and 44(36.7%) were females (p= 0.097). There were 67 patients (55.8%) prescribed with dexamethasone treatment (Group A) and 53 patients (44.2%) with methylprednisolone treatment (Group B). Mean duration of hospital stay was 3.48 + 3.0 days in Group A and 3.45 + 3.0 days in Group B. Six patients were lost for follow-up Out of 114 patients, 63 patients (55.26%) had mortality within 30 days of study while 51 patients (44.74%) survived. Conclusion: There is no statistical difference in the outcomes of COVID-19 pneumonia when treated with dexamethasone as compared to methylprednisolone in terms of outcome related to duration of hospitalization, need for ICU admission and reported mortality within 30 days. More studies are warranted with larger sample size.

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