Planning for a patient's postdischarge needs care does not begin on the day when decision is made to release the patient from the hospital. It is generally accepted that discharge planning should start before admission (for a planned admission) or at the time of admission (for an unplanned admission). A combination of individual factors, most notably age, medical factors such as presence of multiple pathology, and organizational factors such as lack of alternative forms of care facilities put patients at risk of delayed discharge. Moreover, lack of nurses' participation also contributes toward the delaying of discharge. In this article, the author provides strategies to improve nurses' participation in discharge planning and discusses the importance of involving patients and their caretakers in decision making.

OBJECTIVES To determine the frequency of depression in caregivers of stroke patients at a tertiary care teaching hospital in Karachi Pakistan.  METHODS A cross-sectional study was conducted among caregivers of stroke, who were recruited from the Aga Khan University Hospital Karachi Pakistan, between January 2018 to October 2018. Data was collected through the Urdu Hamilton rating scale for depression (HAM-D-U) and it was analyzed using descriptive and inferential statistics.  RESULTS A total of 136 caregivers participated in the study. Among them, 44.1 % were male and 55.9% were female. The mean age of caregivers was 45.38 ± 10.33 years. Using the HAM-D-U scale, depression was present in 64 (47.1%) caregivers. Out of them (n=64), 46 (33.8%) caregivers had mild depression whereas 18 (13.2%) had moderate depression. Depression was found to have a significant relationship with the age of the patient (p=0.002), education level of caregiver (p= 0.012), employment status of caregiver (p=0.012), being a sole caregiver (p=0.039), and monthly family income (p=0.016).  CONCLUSIONS Caring for patients with neurological disorders is highly challenging and demanding. The need for this role may arise unexpectedly in one’s life; leaving little space for adjustment and coping. Depression itself can be very paralyzing for the sufferer especially if moderate to severe in intensity. Depression in stroke caregivers can be missed as patients are the center of a clinical visit. Hence, strategies should be designed and reinforced to screen patients and caregivers for depression along with a pathway for an easy and timely referral.

Background: Physical violence is considered as a routine matter and is a neglected issue in the heavily populated society of Pakistan. The study aimed to estimate the physical violence and its associated factors among married women living in the district Multan, a city of Southern Punjab, Pakistan. Methods: A Cross-Sectional study was conducted among 375 married women living in the community of six towns of Multan. The data was collected from March 2013 to May 2013, through a questionnaire, based on the World Health Organization Multi-country Study on Women's Health and Life Experiences of Violence against Women. A univariate and multivariate analyses were recorded. Results: Out of 375 women surveyed, 62.93% reported physical violence. In the univariate analysis, women's age (28-60 years), women's occupation (non-professional,) and family categories, (combined/extended) were found to be significant, at 95% confidence interval (CI). In multivariate analysis, women's employment status, as non-earning (OR; 0.57CI:0.33, 0.98) was significant in last year, and in life time multivariate analysis, husband's nonprofessional status (OR; 1.06; CI: 0.635 1, 0.793) and women's non-earning status (OR; 0.57; CI: 0.33, 0.98) became significant. The combined family system (OR; 1.795, CI: 1.120, 2.878) was found to be significant in multivariate analyses. Conclusion: Physical violence of different forms is considered as a social and cultural norm by intimate partner. There is a pressing need for appropriate mechanisms particularly in primary health care, to identify and deal with physical violence

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Introduction Suicide is a major public health problem in Pakistan, accounting to approximately 19,331 deaths every year. Many are due to consumption of acutely toxic pesticides; however, there is a lack of national suicide data, limiting knowledge and potential for intervention. In this paper, we aimed to review the literature on pesticide self-poisoning in Pakistan to identify the most problematic pesticides in relation to national pesticide regulations. Methods Information on the currently registered and banned pesticides was obtained from Ministry of National Food Security and Research while data on pesticide import and use was extracted from FAOSTAT. We searched the following sources for articles and research papers on poisoning in Pakistan: Cumulative Index to Nursing and Allied Health (CINAHL), Google Scholar, Applied Social Sciences Index and Abstracts (ASSIA), Excerpta Medica (EMBASE), National Library of Medicine’s MEDLINE (PUBMED), PS102YCHINFO and Pakmedinet.com using the search terms ‘self-poisoning’, ‘deliberate self-harm’, ‘suicide’, ‘methods and means of suicide’, ‘organophosphate’, ‘wheat pill’, ‘aluminium phosphide’, ‘acute poisoning’, OR ‘pesticides’, AND ‘Pakistan’. Results As of May 2021, 382 pesticide active ingredients (substances) were registered in Pakistan, of which five were WHO hazard class Ia (extremely hazardous) and 17 WHO hazard class Ib (highly hazardous). Twenty-six pesticides, four formulations, and seven non-registered pesticides had been banned, of which two were WHO class Ia and five Ib. We identified 106 hospital-level studies of poisoning conducted in Pakistan, of which 23 did not mention self-poisoning cases and one reported no suicidal poisoning cases. We found no community or forensic medicine studies. Of 52,323 poisoning cases identified in these papers, 24,546 [47%] were due to pesticides. The most commonly identified pesticide classes were organophosphorus (OP) insecticides (13,816 cases, 56%) and the fumigant aluminium phosphide (3 g 56% tablets, often termed ‘wheat pills’; 686 cases, 2.7%). Few studies identified the particular pesticides involved or the resulting case fatality. Conclusion We found pesticide poisoning to be a major cause of poisoning in Pakistan, with OP insecticides and the fumigant aluminium phosphide the main pesticides identified. Withdrawal of Class I pesticides (as proposed to occur nationally in 2022) and high concentration aluminium phosphide tablets should rapidly reduce suicidal deaths by reducing the case fatality for low-intention poisoning cases. National cause of death data and forensic toxicology laboratory data identifying the pesticides responsible for deaths will be important to assess impacts of the proposed national ban.