{"id":16166,"date":"2025-11-19T18:13:33","date_gmt":"2025-11-19T12:28:33","guid":{"rendered":"https:\/\/hthakuri.com.np\/blog\/2025\/11\/19\/%e0%a4%ac%e0%a4%be%e0%a4%b2-%e0%a4%b8%e0%a4%82%e0%a4%b0%e0%a4%95%e0%a5%8d%e0%a4%b7%e0%a4%a3-%e0%a4%ae%e0%a4%be-%e0%a4%b8%e0%a4%82%e0%a4%9a%e0%a4%be%e0%a4%b0-%e0%a4%b8%e0%a5%81%e0%a4%a7%e0%a4%be\/"},"modified":"2025-11-19T18:13:33","modified_gmt":"2025-11-19T12:28:33","slug":"%e0%a4%ac%e0%a4%be%e0%a4%b2-%e0%a4%b8%e0%a4%82%e0%a4%b0%e0%a4%95%e0%a5%8d%e0%a4%b7%e0%a4%a3-%e0%a4%ae%e0%a4%be-%e0%a4%b8%e0%a4%82%e0%a4%9a%e0%a4%be%e0%a4%b0-%e0%a4%b8%e0%a5%81%e0%a4%a7%e0%a4%be","status":"publish","type":"post","link":"https:\/\/hthakuri.com.np\/blog\/2025\/11\/19\/%e0%a4%ac%e0%a4%be%e0%a4%b2-%e0%a4%b8%e0%a4%82%e0%a4%b0%e0%a4%95%e0%a5%8d%e0%a4%b7%e0%a4%a3-%e0%a4%ae%e0%a4%be-%e0%a4%b8%e0%a4%82%e0%a4%9a%e0%a4%be%e0%a4%b0-%e0%a4%b8%e0%a5%81%e0%a4%a7%e0%a4%be\/","title":{"rendered":"\u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923 \u092e\u093e \u0938\u0902\u091a\u093e\u0930 \u0938\u0941\u0927\u093e\u0930"},"content":{"rendered":"<p><\/p>\n<div><span class=\"highwire-journal-article-marker-start\"\/><\/p>\n<div class=\"section\" id=\"sec-1\">\n<h2 class=\"\">\u0938\u093e\u0930\u093e\u0902\u0936<\/h2>\n<p id=\"p-1\">\u0938\u093e\u092e\u0941\u0926\u093e\u092f\u093f\u0915 \u0938\u0947\u091f\u093f\u0919\u092e\u093e \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923 \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u093e \u092e\u0942\u0932\u094d\u092f\u093e\u0919\u094d\u0915\u0928 (CPMA) \u092a\u091b\u093f \u0924\u0941\u0930\u0941\u0928\u094d\u0924\u0948 \u0938\u093e\u092e\u093e\u091c\u093f\u0915 \u0915\u093e\u0930\u094d\u092f\u0915\u0930\u094d\u0924\u093e (SW) \u0932\u093e\u0908 \u0926\u093f\u0907\u090f\u0915\u094b \u0905\u0938\u094d\u0925\u093e\u092f\u0940 \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923 \u092a\u0930\u093f\u0923\u093e\u092e \u0930\u093f\u092a\u094b\u0930\u094d\u091f (PCPOR) \u0915\u094b \u0915\u093e\u0930\u094d\u092f\u093e\u0928\u094d\u0935\u092f\u0928\u0964<\/p>\n<\/div>\n<div class=\"section\" id=\"sec-2\">\n<h2 class=\"\">\u0938\u092e\u0938\u094d\u092f\u093e<\/h2>\n<p id=\"p-2\">\u0917\u092e\u094d\u092d\u0940\u0930 \u0915\u0947\u0938 \u0938\u092e\u0940\u0915\u094d\u0937\u093e\u0939\u0930\u0942\u092e\u093e \u0938\u0942\u091a\u0928\u093e \u0938\u093e\u091d\u0947\u0926\u093e\u0930\u0940 \u0930 \u092a\u094d\u0930\u092d\u093e\u0935\u0915\u093e\u0930\u0940 \u0905\u0928\u094d\u0924\u0930-\u090f\u091c\u0947\u0928\u094d\u0938\u0940 \u0938\u091e\u094d\u091a\u093e\u0930\u092e\u093e \u0915\u092e\u0940\u0939\u0930\u0942 \u092c\u093e\u0930\u092e\u094d\u092c\u093e\u0930 \u0939\u093e\u0907\u0932\u093e\u0907\u091f \u0917\u0930\u093f\u0928\u094d\u091b\u0964 \u092a\u094d\u0930\u0915\u094d\u0930\u093f\u092f\u093e \u0930 \u092a\u094d\u0930\u0923\u093e\u0932\u0940 \u0935\u093f\u092b\u0932\u0924\u093e\u0939\u0930\u0942 \u092a\u094d\u0930\u093e\u092f\u0903 \u0939\u093e\u0907\u0932\u093e\u0907\u091f \u0917\u0930\u093f\u0928\u094d\u091b, \u091c\u0939\u093e\u0901 \u092a\u094d\u0930\u0915\u094d\u0930\u093f\u092f\u093e\u0939\u0930\u0942 \u0905\u0935\u0938\u094d\u0925\u093f\u0924 \u091b\u0928\u094d \u0924\u0930 \u092e\u093e\u0928\u0915\u0940\u0915\u0930\u0923\u0915\u094b \u0915\u092e\u0940 \u091b, \u091c\u0938\u0932\u0947 \u092a\u0947\u0936\u0947\u0935\u0930\u0939\u0930\u0942 \u092c\u0940\u091a \u092a\u094d\u0930\u092d\u093e\u0935\u0915\u093e\u0930\u0940 \u0938\u091e\u094d\u091a\u093e\u0930 \u0928\u093f\u092e\u094d\u0924\u094d\u092f\u093e\u0909\u0901\u091b\u0964 \u092f\u0938\u0932\u0947 \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923\u0915\u094b \u0932\u093e\u0917\u093f \u092e\u0939\u0924\u094d\u0924\u094d\u0935\u092a\u0942\u0930\u094d\u0923 \u0938\u092e\u092f\u092e\u0948 \u0928\u093f\u0930\u094d\u0923\u092f \u0932\u093f\u0928\u0947 \u0930 \u0938\u092e\u092f\u092e\u0948 \u0939\u0938\u094d\u0924\u0915\u094d\u0937\u0947\u092a\u0939\u0930\u0942\u0932\u093e\u0908 \u0928\u0915\u093e\u0930\u093e\u0924\u094d\u092e\u0915 \u0930\u0942\u092a\u092e\u093e \u0905\u0938\u0930 \u0917\u0930\u094d\u091b\u0964 \u092e\u0939\u0924\u094d\u0924\u094d\u0935\u092a\u0942\u0930\u094d\u0923 \u091c\u093e\u0928\u0915\u093e\u0930\u0940 \u092a\u094d\u0930\u093e\u092f\u0903 \u090f\u091c\u0947\u0928\u094d\u0938\u0940\u0939\u0930\u0942 \u092c\u0940\u091a \u0938\u093e\u091d\u093e \u0917\u0930\u093f\u090f\u0915\u094b \u0925\u093f\u092f\u094b, \u0924\u0930 \u092f\u094b \u092a\u0930\u094d\u092f\u093e\u092a\u094d\u0924 \u0930\u0942\u092a\u092e\u093e \u092c\u0941\u091d\u093f\u090f\u0915\u094b \u0925\u093f\u090f\u0928\u0964 \u0928\u0924\u093f\u091c\u093e\u0915\u094b \u0930\u0942\u092a\u092e\u093e, \u092f\u0938\u0915\u094b \u092e\u0939\u0924\u094d\u0924\u094d\u0935, \u0935\u093f\u0936\u0947\u0937 \u0917\u0930\u0940 \u092c\u091a\u094d\u091a\u093e\u0915\u094b \u0932\u093e\u0917\u093f \u0938\u092e\u094d\u092d\u093e\u0935\u093f\u0924 \u091c\u094b\u0916\u093f\u092e\u0939\u0930\u0942\u0915\u094b \u0938\u092e\u094d\u092c\u0928\u094d\u0927\u092e\u093e, \u092a\u0942\u0930\u094d\u0923 \u0930\u0942\u092a\u092e\u093e \u0938\u0930\u093e\u0939\u0928\u093e \u0917\u0930\u093f\u090f\u0915\u094b \u0925\u093f\u090f\u0928\u0964<a id=\"xref-ref-1-1\" class=\"xref-bibr\" href=\"#ref-1\">\u0967<\/a>\n<\/p>\n<\/div>\n<div class=\"section\" id=\"sec-3\">\n<h2 class=\"\">\u0932\u0915\u094d\u0937\u094d\u092f\u0939\u0930\u0942<\/h2>\n<p id=\"p-3\">\u0939\u093e\u092e\u094d\u0930\u094b \u0909\u0926\u094d\u0926\u0947\u0936\u094d\u092f CPMA \u0915\u094b \u0938\u092e\u092f\u092e\u093e \u092e\u0941\u0916\u094d\u092f \u0928\u093f\u0937\u094d\u0915\u0930\u094d\u0937 \u0930 \u0938\u093f\u092b\u093e\u0930\u093f\u0938\u0939\u0930\u0942\u0915\u094b \u0926\u094d\u0930\u0941\u0924 \u0915\u093e\u0917\u091c\u093e\u0924 \u092a\u094d\u0930\u0926\u093e\u0928 \u0917\u0930\u0947\u0930 \u0905\u0928\u094d\u0924\u0930-\u090f\u091c\u0947\u0928\u094d\u0938\u0940 \u0938\u0902\u091a\u093e\u0930\u0932\u093e\u0908 \u092c\u0922\u093e\u0909\u0928\u0941 \u0925\u093f\u092f\u094b\u0964 \u0939\u093e\u092e\u094d\u0930\u094b \u0926\u0943\u0937\u094d\u091f\u093f\u0915\u094b\u0923 \u0938\u094d\u092a\u0937\u094d\u091f \u0905\u0928\u094d\u0924\u0930-\u090f\u091c\u0947\u0928\u094d\u0938\u0940 \u0938\u0902\u091a\u093e\u0930 \u092a\u094d\u0930\u0935\u0930\u094d\u0926\u094d\u0927\u0928 \u0917\u0930\u094d\u0928 \u0905\u0938\u094d\u092a\u0937\u094d\u091f \u0928\u0924\u093f\u091c\u093e\u0939\u0930\u0942 \u0938\u0939\u093f\u0924 \u092e\u093e\u0930\u094d\u0917\u0926\u0930\u094d\u0936\u0928 \u0905\u0928\u0941\u0930\u0942\u092a \u092e\u093e\u0928\u0915\u0940\u0915\u0943\u0924 PCPOR \u091f\u0947\u092e\u094d\u092a\u094d\u0932\u0947\u091f \u0938\u093f\u0930\u094d\u091c\u0928\u093e \u0917\u0930\u094d\u0928\u0947 \u0930 \u092a\u093e\u0907\u0932\u091f \u0917\u0930\u094d\u0928\u0947 \u0925\u093f\u092f\u094b\u0964 \u0939\u093e\u092e\u0940\u0932\u0947 \u092f\u0938\u0932\u093e\u0908 \u0967\u0968 \u092e\u0939\u093f\u0928\u093e\u092d\u093f\u0924\u094d\u0930 \u0915\u093e\u0930\u094d\u092f\u093e\u0928\u094d\u0935\u092f\u0928 \u0917\u0930\u094d\u0928\u0947 \u0932\u0915\u094d\u0937\u094d\u092f \u0930\u093e\u0916\u0947\u0915\u093e \u091b\u094c\u0902\u0964 \u092a\u0942\u0930\u093e \u0917\u0930\u094d\u0928 \u0938\u091c\u093f\u0932\u094b \u0930 \u092a\u0942\u0930\u093e \u0917\u0930\u094d\u0928 \u0938\u092e\u092f \u0939\u093e\u092e\u094d\u0930\u094b \u092e\u0941\u0916\u094d\u092f \u092a\u0930\u093f\u0923\u093e\u092e \u0909\u092a\u093e\u092f\u0939\u0930\u0942 \u0925\u093f\u090f\u0964 PCPOR \u090f\u0915 \u0905\u0938\u094d\u0925\u093e\u092f\u0940 \u0915\u093e\u0917\u091c\u093e\u0924 \u0939\u094b \u0930 \u0905\u0928\u094d\u0924\u093f\u092e \u0930\u093f\u092a\u094b\u0930\u094d\u091f\u0915\u094b \u0928\u0924\u093f\u091c\u093e, 10 \u0915\u093e\u0930\u094d\u092f\u0926\u093f\u0935\u0938 \u092d\u093f\u0924\u094d\u0930 \u0921\u0947\u0932\u093f\u092d\u0930 \u0939\u0941\u0928\u094d\u091b, \u092f\u0938\u0932\u093e\u0908 \u0939\u091f\u093e\u0909\u0901\u091b\u0964<\/p>\n<\/div>\n<div class=\"section\" id=\"sec-4\">\n<h2 class=\"\">\u092a\u0930\u093f\u0935\u0930\u094d\u0924\u0928\u0915\u094b \u0932\u093e\u0917\u093f \u092e\u0941\u0926\u094d\u0926\u093e \u092c\u0928\u093e\u0909\u0901\u0926\u0948<\/h2>\n<p id=\"p-4\">\u0930\u094b\u092f\u0932 \u0915\u0932\u0947\u091c \u0905\u092b \u092a\u0947\u0921\u093f\u092f\u093e\u091f\u094d\u0930\u093f\u0915\u094d\u0938 \u090f\u0923\u094d\u0921 \u091a\u093e\u0907\u0932\u094d\u0921 \u0939\u0947\u0932\u094d\u0925 (RCPCH) \u0930 \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923 \u0935\u093f\u0936\u0947\u0937 \u0930\u0941\u091a\u093f \u0938\u092e\u0942\u0939\u0932\u0947 \u0905\u0915\u094d\u091f\u094b\u092c\u0930 \u0968\u0966\u0968\u0966 \u092e\u093e \u091c\u093e\u0930\u0940 \u0917\u0930\u0947\u0915\u094b CPMA \u0915\u093e \u0932\u093e\u0917\u093f \u0938\u093f\u092b\u093e\u0930\u093f\u0938 \u0917\u0930\u093f\u090f\u0915\u093e \u092c\u093e\u0932\u092c\u093e\u0932\u093f\u0915\u093e\u0939\u0930\u0942\u0915\u094b \u0935\u094d\u092f\u0935\u0938\u094d\u0925\u093e\u092a\u0928\u0915\u093e \u0932\u093e\u0917\u093f \u0930\u093e\u092e\u094d\u0930\u094b \u0905\u092d\u094d\u092f\u093e\u0938 \u0938\u0947\u0935\u093e \u0935\u093f\u0924\u0930\u0923 \u092e\u093e\u092a\u0926\u0923\u094d\u0921\u0939\u0930\u0942\u0932\u0947 \u092a\u0930\u093f\u0935\u0930\u094d\u0924\u0928 \u0930 \u0938\u0941\u0927\u093e\u0930\u0915\u094b \u0932\u093e\u0917\u093f \u092a\u094d\u0930\u0947\u0930\u0923\u093e \u092a\u094d\u0930\u0926\u093e\u0928 \u0917\u0930\u0947\u0915\u094b \u091b\u0964 \u092f\u0940 \u0926\u093f\u0936\u093e\u0928\u093f\u0930\u094d\u0926\u0947\u0936\u0939\u0930\u0942\u0915\u094b \u092e\u093e\u0928\u0915 8 CPMA \u092e\u093e \u0932\u093f\u0916\u093f\u0924 \u092a\u094d\u0930\u0924\u093f\u0915\u094d\u0930\u093f\u092f\u093e \u0930 \u092e\u0942\u0932\u094d\u092f\u093e\u0919\u094d\u0915\u0928 \u092a\u0930\u093f\u0923\u093e\u092e\u0939\u0930\u0942\u0915\u094b \u0926\u094d\u0930\u0941\u0924 \u0938\u091e\u094d\u091a\u093e\u0930\u092e\u093e \u0915\u0947\u0928\u094d\u0926\u094d\u0930\u093f\u0924 \u091b\u0964<a id=\"xref-ref-2-1\" class=\"xref-bibr\" href=\"#ref-2\">\u0968<\/a>\n<\/p>\n<p id=\"p-5\">\u0939\u093e\u092e\u0940\u0932\u0947 \u092e\u093e\u092a\u0926\u0923\u094d\u0921\u0939\u0930\u0942 \u0935\u093f\u0930\u0941\u0926\u094d\u0927 \u0935\u093f\u092d\u093e\u0917\u0940\u092f \u0938\u094d\u0935-\u092a\u0930\u0940\u0915\u094d\u0937\u0923 \u0917\u0930\u094d\u092f\u094c\u0902 \u0930 \u0928\u093f\u0937\u094d\u0915\u0930\u094d\u0937\u0939\u0930\u0942 \u0907\u092d\u0947\u0932\u093f\u0928\u093e \u0932\u0928\u094d\u0921\u0928 \u0938\u093e\u092e\u0941\u0926\u093e\u092f\u093f\u0915 \u092c\u093e\u0932 \u0930\u094b\u0917 \u091f\u094b\u0932\u0940\u0932\u093e\u0908 \u092a\u094d\u0930\u0938\u094d\u0924\u0941\u0924 \u0917\u0930\u094d\u092f\u094c\u0902\u0964 \u0939\u093e\u092e\u0940\u0932\u0947 CPMA \u092e\u093e \u092e\u094c\u0916\u093f\u0915 \u092a\u094d\u0930\u0924\u093f\u0915\u094d\u0930\u093f\u092f\u093e \u0938\u092e\u093e\u0935\u0947\u0936 \u0917\u0930\u0947\u0915\u094b\u0932\u0947, SW \u0932\u0947 \u0914\u092a\u091a\u093e\u0930\u093f\u0915 \u0932\u093f\u0916\u093f\u0924 \u092a\u094d\u0930\u0924\u093f\u0935\u0947\u0926\u0928\u0932\u093e\u0908 \u092a\u091b\u093f \u092a\u0920\u093e\u0909\u0928\u0915\u094b \u0932\u093e\u0917\u093f \u092a\u0930\u094d\u0916\u093f\u0930\u0939\u0947\u0915\u094b \u0939\u0941\u0928\u093e\u0932\u0947 \u092e\u093e\u0928\u0915 8 \u092a\u0942\u0930\u093e \u092d\u090f\u0915\u094b \u091b\u0948\u0928 \u092d\u0928\u0947\u0930 \u0939\u093e\u092e\u0940\u0932\u0947 \u0939\u093e\u0907\u0932\u093e\u0907\u091f \u0917\u0930\u094d\u092f\u094c\u0902\u0964<\/p>\n<\/div>\n<div class=\"section\" id=\"sec-5\">\n<h2 class=\"\">\u0924\u092a\u093e\u0908\u0902\u0915\u093e \u0938\u0941\u0927\u093e\u0930\u0939\u0930\u0942<\/h2>\n<p id=\"p-6\">\u0939\u093e\u092e\u0940\u0932\u0947 \u0939\u093e\u092e\u094d\u0930\u094b \u0917\u0941\u0923\u0938\u094d\u0924\u0930 \u0938\u0941\u0927\u093e\u0930 \u092a\u094d\u0930\u0935\u093f\u0927\u093f (<a id=\"xref-fig-1-1\" class=\"xref-fig\" href=\"#F1\">\u091a\u093f\u0924\u094d\u0930 \u0967<\/a>)\u0964<\/p>\n<div id=\"F1\" class=\"fig pos-float  odd\">\n<div class=\"highwire-figure\">\n<div class=\"fig-inline-img-wrapper\">\n<div class=\"fig-inline-img\"><span class=\"hw-responsive-img\"><img fetchpriority=\"high\" decoding=\"async\" class=\"highwire-fragment fragment-image lazyload\" alt=\"\u091a\u093f\u0924\u094d\u0930 \u0967\" src=\"https:\/\/ep.bmj.com\/content\/edpract\/110\/6\/260\/F1.medium.gif\" width=\"440\" height=\"175\"\/><img decoding=\"async\" class=\"highwire-fragment fragment-image\" alt=\"\u091a\u093f\u0924\u094d\u0930 \u0967\" src=\"https:\/\/ep.bmj.com\/content\/edpract\/110\/6\/260\/F1.medium.gif\" width=\"440\" height=\"175\"\/><\/span><\/div>\n<\/div>\n<\/div>\n<div xmlns:xhtml=\"http:\/\/www.w3.org\/1999\/xhtml\" class=\"fig-caption\"><span class=\"fig-label\">\u091a\u093f\u0924\u094d\u0930 \u0967<\/span> <\/p>\n<p id=\"p-7\" class=\"first-child\">\u092a\u0930\u093f\u092f\u094b\u091c\u0928\u093e \u0938\u092e\u092f\u0930\u0947\u0916\u093e\u0964 \u0938\u0940\u092a\u0940, \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923; CPSIG, \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923 \u0935\u093f\u0936\u0947\u0937 \u0930\u0941\u091a\u093f \u0938\u092e\u0942\u0939; PCPOR, \u0905\u0938\u094d\u0925\u093e\u092f\u0940 \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923 \u092a\u0930\u093f\u0923\u093e\u092e \u0930\u093f\u092a\u094b\u0930\u094d\u091f; RCPCH, \u092c\u093e\u0932 \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u093e \u0930 \u092c\u093e\u0932 \u0938\u094d\u0935\u093e\u0938\u094d\u0925\u094d\u092f \u0915\u094b \u0930\u094b\u092f\u0932 \u0915\u0932\u0947\u091c\u0964<\/p>\n<\/div>\n<\/div>\n<div id=\"F2\" class=\"fig pos-float  odd\">\n<div class=\"highwire-figure\">\n<div class=\"fig-inline-img-wrapper\">\n<div class=\"fig-inline-img\"><span class=\"hw-responsive-img\"><img decoding=\"async\" class=\"highwire-fragment fragment-image lazyload\" alt=\"\u091a\u093f\u0924\u094d\u0930 \u0968\" src=\"https:\/\/ep.bmj.com\/content\/edpract\/110\/6\/260\/F2.medium.gif\" width=\"440\" height=\"195\"\/><img loading=\"lazy\" decoding=\"async\" class=\"highwire-fragment fragment-image\" alt=\"\u091a\u093f\u0924\u094d\u0930 \u0968\" src=\"https:\/\/ep.bmj.com\/content\/edpract\/110\/6\/260\/F2.medium.gif\" width=\"440\" height=\"195\"\/><\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"fig-caption\"><span class=\"fig-label\">\u091a\u093f\u0924\u094d\u0930 \u0968<\/span> <\/p>\n<p id=\"p-8\" class=\"first-child\">\u0905\u0938\u094d\u0925\u093e\u092f\u0940 \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923 \u092a\u0930\u093f\u0923\u093e\u092e \u0930\u093f\u092a\u094b\u0930\u094d\u091f \u092b\u093e\u0930\u092e\u0915\u094b \u0938\u093e\u0925 \u092c\u0922\u0947\u0915\u094b \u0926\u0915\u094d\u0937\u0924\u093e \u0926\u0947\u0916\u093e\u0909\u0901\u0926\u0948 \u0938\u093e\u092e\u093e\u091c\u093f\u0915 \u0915\u093e\u0930\u094d\u092f\u0915\u0930\u094d\u0924\u093e \u092a\u094d\u0930\u0924\u093f\u0915\u094d\u0930\u093f\u092f\u093e\u0964<\/p>\n<\/div>\n<\/div>\n<p id=\"p-9\">\u092a\u093e\u0907\u0932\u091f PCPOR \u0938\u093f\u0930\u094d\u091c\u0928\u093e \u0917\u0930\u094d\u0928\u0941 \u0905\u0918\u093f \u0926\u0941\u0908 \u0915\u094d\u0937\u0947\u0924\u094d\u0930\u0939\u0930\u0942\u0915\u093e \u0928\u092e\u0942\u0928\u093e PCPOR \u0939\u0930\u0942 \u0938\u092e\u0940\u0915\u094d\u0937\u093e \u0930 \u0938\u094d\u091f\u094d\u0930\u093f\u092e\u0932\u093e\u0907\u0928 \u0917\u0930\u093f\u090f\u0915\u094b \u0925\u093f\u092f\u094b \u0932\u094d\u092f\u093e\u092e\u094d\u092c\u0947\u0925 \u0930 \u0938\u093e\u0909\u0925\u0935\u093e\u0930\u094d\u0915\u092e\u093e \u0938\u0941\u0930\u0915\u094d\u0937\u093f\u0924 \u0928\u0947\u0924\u0943\u0924\u094d\u0935\u0926\u094d\u0935\u093e\u0930\u093e, \u091c\u0938\u0932\u093e\u0908 \u092a\u093f\u092f\u0930-\u0938\u092e\u0940\u0915\u094d\u0937\u093e \u092e\u093e\u0930\u094d\u092b\u0924 \u0938\u0941\u0927\u093e\u0930 \u0930 \u0938\u094d\u092a\u0937\u094d\u091f \u0917\u0930\u093f\u090f\u0915\u094b \u0925\u093f\u092f\u094b\u0964<a id=\"xref-ref-3-1\" class=\"xref-bibr\" href=\"#ref-3\">\u0969<\/a> \u0939\u093e\u092e\u0940\u0932\u0947 \u092e\u0941\u0916\u094d\u092f \u092c\u093f\u0928\u094d\u0926\u0941\u0939\u0930\u0942\u092e\u093e \u0938\u0939\u0915\u0930\u094d\u092e\u0940\u0939\u0930\u0942\u0938\u0901\u0917 \u092a\u0930\u093e\u092e\u0930\u094d\u0936 \u0917\u0930\u094d\u200d\u092f\u094c\u0902, \u092f\u094b \u0938\u0941\u0928\u093f\u0936\u094d\u091a\u093f\u0924 \u0917\u0930\u094d\u0926\u0948 \u0915\u093f \u0939\u093e\u092e\u0940\u0932\u0947 CPMA \u0915\u094b \u0938\u092e\u092f\u092e\u093e PCPOR \u092a\u0942\u0930\u093e \u0917\u0930\u094d\u0928 \u0925\u092a \u0938\u092e\u092f\u0915\u094b \u0906\u0935\u0936\u094d\u092f\u0915\u0924\u093e \u0930 \u091c\u091f\u093f\u0932\u0924\u093e\u0939\u0930\u0942 \u0938\u092e\u094d\u092c\u0928\u094d\u0927\u0940 \u091a\u093f\u0928\u094d\u0924\u093e\u0939\u0930\u0942\u0932\u093e\u0908 \u0938\u092e\u094d\u092c\u094b\u0927\u0928 \u0917\u0930\u094d\u092f\u094c\u0902\u0964<\/p>\n<p id=\"p-10\">\u092a\u094d\u0930\u093e\u0930\u092e\u094d\u092d\u093f\u0915 PCPOR \u091f\u0947\u092e\u094d\u092a\u094d\u0932\u0947\u091f \u0967\u0966-\u0939\u092a\u094d\u0924\u093e\u0915\u094b \u0905\u0935\u0927\u093f\u092e\u093e \u092a\u094d\u0930\u092f\u094b\u0917 \u0917\u0930\u093f\u090f\u0915\u094b \u0925\u093f\u092f\u094b\u0964 \u092f\u0938 \u092a\u091b\u093f, \u0939\u093e\u092e\u0940\u0932\u0947 \u0905\u0928\u0932\u093e\u0907\u0928 \u0938\u0930\u094d\u0935\u0947\u0915\u094d\u0937\u0923 \u092a\u094d\u0930\u092f\u094b\u0917 \u0917\u0930\u0947\u0930 \u092c\u093e\u0932 \u0930\u094b\u0917 \u0935\u093f\u0936\u0947\u0937\u091c\u094d\u091e\u0939\u0930\u0942 \u0930 SWs \u092c\u093e\u091f \u092a\u094d\u0930\u0924\u093f\u0915\u094d\u0930\u093f\u092f\u093e \u0938\u0919\u094d\u0915\u0932\u0928 \u0917\u0930\u094d\u092f\u094c\u0902\u0964 13 SWs \u0930 26 \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u0915\u0939\u0930\u0942\u0932\u0947 \u0938\u0930\u094d\u0935\u0947\u0915\u094d\u0937\u0923 \u092a\u0942\u0930\u093e \u0917\u0930\u0947\u0964 56% \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u0915\u0939\u0930\u0942\u0932\u0947 \u092a\u093e\u092f\u0932\u091f \u0917\u0930\u093f\u090f\u0915\u094b PCPOR \u091f\u0947\u092e\u094d\u092a\u094d\u0932\u0947\u091f \u0909\u092a\u092f\u094b\u0917\u0940 \u092a\u093e\u090f\u0964 SW \u092a\u094d\u0930\u0924\u093f\u0915\u094d\u0930\u093f\u092f\u093e\u0932\u0947 1.72 \u0915\u094b \u0914\u0938\u0924 \u0938\u0939\u092f\u094b\u0917\u0940 \u0938\u094d\u0915\u094b\u0930 \u0938\u0902\u0915\u0947\u0924 \u0917\u0930\u094d\u200d\u092f\u094b (1-\u092c\u093e\u091f \u0927\u0947\u0930\u0948 \u0909\u092a\u092f\u094b\u0917\u0940 5-\u0909\u092a\u092f\u094b\u0917\u0940 \u0939\u094b\u0907\u0928) \u0932\u093e\u0908\u0915\u0930\u094d\u091f \u0938\u094d\u0915\u0947\u0932 \u092a\u094d\u0930\u092f\u094b\u0917 \u0917\u0930\u0947\u0930\u0964 91% SWs \u0932\u0947 \u0938\u0902\u0915\u0947\u0924 \u0917\u0930\u0947 \u0915\u093f PCPOR \u0932\u0947 CPMA \u092a\u094d\u0930\u0915\u094d\u0930\u093f\u092f\u093e\u0915\u094b \u092a\u094d\u0930\u092d\u093e\u0935\u0915\u093e\u0930\u093f\u0924\u093e\u092e\u093e \u0938\u0941\u0927\u093e\u0930 \u0917\u0930\u0947\u0915\u094b \u091b, \u0916\u0923\u094d\u0921 47 \u0938\u094b\u0927\u092a\u0941\u091b \u0930 \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923 \u0938\u092e\u094d\u092e\u0947\u0932\u0928\u0939\u0930\u0942 \u0938\u092e\u092f\u092e\u0948 \u092a\u0942\u0930\u093e \u0917\u0930\u094d\u0928 \u0938\u0915\u094d\u0937\u092e \u092a\u093e\u0930\u094d\u0926\u0948 (<a id=\"xref-fig-2-1\" class=\"xref-fig\" href=\"#F2\">\u091a\u093f\u0924\u094d\u0930 2<\/a>)\u0964 PCPOR \u0932\u0947 \u0906\u0935\u0936\u094d\u092f\u0915 \u0915\u093e\u0930\u094d\u092f\u0939\u0930\u0942\u0915\u094b \u0932\u093e\u0917\u093f \u0909\u092a\u092f\u094b\u0917\u0940 \u0930\u093f\u092e\u093e\u0907\u0928\u094d\u0921\u0930\u0915\u094b \u0930\u0942\u092a\u092e\u093e \u092a\u0928\u093f \u0915\u093e\u092e \u0917\u0930\u094d\u092f\u094b\u0964<\/p>\n<p id=\"p-11\">\u092e\u093e\u0925\u093f\u0915\u093e \u092a\u094d\u0930\u0924\u093f\u0915\u094d\u0930\u093f\u092f\u093e\u0939\u0930\u0942\u092c\u093e\u0930\u0947 \u091b\u0932\u092b\u0932 \u0917\u0930\u094d\u0928, \u091a\u093f\u0928\u094d\u0924\u093e\u0939\u0930\u0942 \u0938\u092e\u094d\u092c\u094b\u0927\u0928 \u0917\u0930\u094d\u0928 \u0930 \u092a\u094d\u0930\u092f\u094b\u0917 \u0917\u0930\u093f\u090f\u0915\u094b PCPOR \u092e\u093e \u092a\u0930\u093f\u0935\u0930\u094d\u0924\u0928\u0939\u0930\u0942\u092c\u093e\u0930\u0947 \u0938\u0939\u092e\u0924\u093f\u0915\u094b \u0926\u0943\u0937\u094d\u091f\u093f\u0915\u094b\u0923\u092e\u093e \u092a\u0941\u0917\u094d\u0928 \u090f\u0915 \u092b\u094b\u0915\u0938 \u0938\u092e\u0942\u0939\u0915\u094b \u0906\u092f\u094b\u091c\u0928\u093e \u0917\u0930\u093f\u090f\u0915\u094b \u0925\u093f\u092f\u094b\u0964 \u0938\u094d\u092a\u0937\u094d\u091f\u0924\u093e\u0915\u094b \u0935\u0930\u093f\u092a\u0930\u093f \u091b\u0932\u092b\u0932, \u0928\u093f\u0937\u094d\u0915\u0930\u094d\u0937 \u0930 \u092a\u0930\u093f\u0923\u093e\u092e\u0939\u0930\u0942\u0915\u094b \u0938\u0902\u091a\u093e\u0930\u0932\u093e\u0908 \u092a\u094d\u0930\u094b\u0924\u094d\u0938\u093e\u0939\u093f\u0924 \u0917\u0930\u093f\u092f\u094b\u0964 \u092f\u0938 \u092a\u094d\u0930\u0915\u094d\u0930\u093f\u092f\u093e\u092e\u093e, \u0939\u093e\u092e\u0940\u0932\u0947 \u0938\u092c\u0948 \u092a\u0930\u093f\u0935\u0930\u094d\u0924\u0928\u0939\u0930\u0942 RCPCH \u091a\u093e\u0907\u0932\u094d\u0921 \u092a\u094d\u0930\u094b\u091f\u0947\u0915\u094d\u0936\u0928 \u0915\u092e\u094d\u092a\u094d\u092f\u093e\u0928\u093f\u092f\u0928 (CPC) \u0915\u094b \u0905\u0927\u094d\u092f\u093e\u092f 6 \u092e\u093e \u0930\u093e\u0916\u093f\u090f\u0915\u093e \u0938\u093f\u0926\u094d\u0927\u093e\u0928\u094d\u0924\u0939\u0930\u0942\u0938\u0901\u0917 \u092e\u093f\u0932\u094d\u0926\u094b\u091c\u0941\u0932\u094d\u0926\u094b \u091b \u092d\u0928\u0940 \u0938\u0941\u0928\u093f\u0936\u094d\u091a\u093f\u0924 \u0917\u0930\u094d\u092f\u094c\u0902\u0964<a id=\"xref-ref-4-1\" class=\"xref-bibr\" href=\"#ref-4\">\u096a<\/a> \u090f\u0915 \u091f\u094b\u0932\u0940\u0915\u094b \u0930\u0942\u092a\u092e\u093e, \u0939\u093e\u092e\u0940\u0932\u0947 \u090f\u0915 PCPOR \u0938\u093f\u0930\u094d\u091c\u0928\u093e \u0917\u0930\u094d\u092f\u094c\u0902 \u091c\u0938\u0932\u0947 \u0939\u093e\u092e\u094d\u0930\u094b \u0932\u0915\u094d\u0937\u094d\u092f\u0939\u0930\u0942 \u0939\u093e\u0938\u093f\u0932 \u0917\u0930\u094d\u200d\u092f\u094b (<a id=\"xref-fig-3-1\" class=\"xref-fig\" href=\"#F3\">\u091a\u093f\u0924\u094d\u0930 3<\/a>)\u0964 \u0938\u0902\u092f\u0941\u0915\u094d\u0924 \u0938\u094d\u0935\u093e\u092e\u093f\u0924\u094d\u0935\u0932\u0947 \u092f\u0938\u0932\u093e\u0908 \u0915\u093e\u0930\u094d\u092f\u093e\u0928\u094d\u0935\u092f\u0928 \u0917\u0930\u094d\u0928 \u0907\u091a\u094d\u091b\u0941\u0915\u0924\u093e \u092c\u0922\u093e\u092f\u094b\u0964<\/p>\n<div id=\"F3\" class=\"fig pos-float  odd\">\n<div class=\"highwire-figure\">\n<div class=\"fig-inline-img-wrapper\">\n<div class=\"fig-inline-img\"><span class=\"hw-responsive-img\"><img loading=\"lazy\" decoding=\"async\" class=\"highwire-fragment fragment-image lazyload\" alt=\"\u091a\u093f\u0924\u094d\u0930 \u0969\" src=\"https:\/\/ep.bmj.com\/content\/edpract\/110\/6\/260\/F3.medium.gif\" width=\"289\" height=\"440\"\/><img loading=\"lazy\" decoding=\"async\" class=\"highwire-fragment fragment-image\" alt=\"\u091a\u093f\u0924\u094d\u0930 \u0969\" src=\"https:\/\/ep.bmj.com\/content\/edpract\/110\/6\/260\/F3.medium.gif\" width=\"289\" height=\"440\"\/><\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"fig-caption\"><span class=\"fig-label\">\u091a\u093f\u0924\u094d\u0930 \u0969<\/span> <\/p>\n<p id=\"p-12\" class=\"first-child\">(a) \u092a\u093e\u092f\u0932\u091f \u0930 (b) \u0905\u0928\u094d\u0924\u093f\u092e \u0905\u0938\u094d\u0925\u093e\u092f\u0940 \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923 \u092a\u0930\u093f\u0923\u093e\u092e \u0930\u093f\u092a\u094b\u0930\u094d\u091f \u092b\u093e\u0930\u092e\u0939\u0930\u0942\u0964<\/p>\n<\/div>\n<\/div>\n<p id=\"p-13\">PCPOR \u0932\u0947 \u0928\u093f\u0937\u094d\u0915\u0930\u094d\u0937\u0939\u0930\u0942\u0915\u094b \u092e\u0939\u0924\u094d\u0924\u094d\u0935\u0932\u093e\u0908 \u0905\u091d \u0930\u093e\u092e\u094d\u0930\u0930\u0940 \u092c\u0941\u091d\u094d\u0928\u0915\u094b \u0932\u093e\u0917\u093f \u091b\u0932\u092b\u0932\u0932\u093e\u0908 \u0928\u093f\u092e\u094d\u0924\u094b \u0926\u093f\u0928\u094d\u091b\u0964 \u0928\u0924\u093f\u091c\u093e \u0938\u094d\u0935\u0930\u0942\u092a, CPMA \u0928\u093f\u0937\u094d\u0915\u0930\u094d\u0937\u0939\u0930\u0942\u0915\u094b \u0905\u091d \u092a\u094d\u0930\u092d\u093e\u0935\u0915\u093e\u0930\u0940, \u0938\u094d\u092a\u0937\u094d\u091f \u0930 \u0938\u092e\u092f\u0938\u093e\u092a\u0947\u0915\u094d\u0937 \u0938\u0902\u091a\u093e\u0930 \u0939\u0941\u0928\u094d\u091b, SWs \u0932\u0947 \u0905\u0938\u094d\u0925\u093e\u092f\u0940 \u0928\u0924\u093f\u091c\u093e \u0930 \u0905\u092d\u093f\u0932\u0947\u0916\u093f\u0924 \u0938\u0930\u094b\u0915\u093e\u0930\u0939\u0930\u0942\u0915\u094b \u0938\u094d\u092a\u0937\u094d\u091f \u092c\u0941\u091d\u093e\u0907\u0915\u094b \u0938\u093e\u0925 CPMA \u091b\u094b\u0921\u094d\u091b\u0964 SW \u0932\u0947 \u092a\u094d\u0930\u0924\u093f\u0915\u094d\u0930\u093f\u092f\u093e \u0926\u093f\u090f\u0915\u093e \u091b\u0928\u094d \u0915\u093f \u092f\u094b \u0926\u0943\u0937\u094d\u091f\u093f\u0915\u094b\u0923 \u0924\u093f\u0928\u0940\u0939\u0930\u0942\u0915\u093e \u092a\u094d\u0930\u092c\u0928\u094d\u0927\u0915\u0939\u0930\u0942\u0938\u0901\u0917 \u091b\u0932\u092b\u0932, \u0938\u0941\u0930\u0915\u094d\u0937\u093e \u092f\u094b\u091c\u0928\u093e \u0930 \u092a\u094d\u0930\u0917\u0924\u093f \u0916\u0923\u094d\u0921 47 \u0905\u0928\u0941\u0938\u0928\u094d\u0927\u093e\u0928 \u0930 \u0938\u092e\u094d\u092e\u0947\u0932\u0928\u0939\u0930\u0942\u092e\u093e \u0909\u092a\u092f\u094b\u0917\u0940 \u091b\u0964<\/p>\n<p id=\"p-14\">\u092f\u0938\u0932\u093e\u0908 \u0935\u094d\u092f\u0935\u0939\u093e\u0930\u092e\u093e \u0907\u092e\u094d\u092c\u0947\u0921 \u0917\u0930\u094d\u0928, SW \u092a\u094d\u0930\u092c\u0928\u094d\u0927\u0915\u0939\u0930\u0942\u0932\u093e\u0908 CPMAs \u0915\u094b \u0938\u092e\u092f\u092e\u093e \u092f\u094b \u0905\u0928\u0941\u0930\u094b\u0927 \u0917\u0930\u094d\u0928 SW \u0932\u093e\u0908 \u0938\u0936\u0915\u094d\u0924 \u092c\u0928\u093e\u0909\u0928 \u092d\u0928\u093f\u092f\u094b\u0964 \u0939\u093e\u092e\u0940\u0932\u0947 \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u0915\u0939\u0930\u0942\u0932\u093e\u0908 \u0938\u092e\u094d\u091d\u093e\u0909\u0928\u0915\u094b \u0932\u093e\u0917\u093f CPMA \u0915\u094b\u0920\u093e\u092e\u093e \u092a\u094b\u0938\u094d\u091f\u0930 \u0930\u093e\u0916\u094d\u092f\u094c\u0902 \u0930 CPMA \u092a\u094d\u092f\u093e\u0915\u092e\u093e \u0905\u092c PCPOR \u0938\u092e\u093e\u0935\u0947\u0936 \u091b, \u091c\u0941\u0928 CPMA \u0915\u094b \u0938\u092e\u092f\u092e\u093e \u092a\u0942\u0930\u093e \u0917\u0930\u0940 SW \u0932\u093e\u0908 \u0909\u092a\u0932\u092c\u094d\u0927 \u0917\u0930\u093e\u0907\u0928\u094d\u091b\u0964 PCPOR \u0939\u093e\u092e\u094d\u0930\u094b CPMA \u092a\u094d\u0930\u0915\u094d\u0930\u093f\u092f\u093e\u0915\u094b \u090f\u0915 \u0938\u094d\u0925\u093e\u092a\u093f\u0924 \u092d\u093e\u0917 \u092d\u090f\u0915\u094b \u091b, \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u0915\u0939\u0930\u0942, \u092a\u094d\u0930\u0936\u093e\u0938\u0915 \u0915\u0930\u094d\u092e\u091a\u093e\u0930\u0940\u0939\u0930\u0942 \u0930 SWs \u0932\u0947 \u092f\u0938\u0932\u093e\u0908 \u092a\u0942\u0930\u094d\u0923 \u0930\u0942\u092a\u092e\u093e \u0905\u0901\u0917\u093e\u0932\u0947\u0915\u093e \u091b\u0928\u094d\u0964<\/p>\n<p id=\"p-15\">\u0939\u093e\u092e\u0940\u0932\u0947 \u0938\u094d\u0925\u093e\u092f\u093f\u0924\u094d\u0935 \u0930 \u0928\u093f\u0930\u0928\u094d\u0924\u0930 \u0938\u0902\u0932\u0917\u094d\u0928\u0924\u093e\u0915\u094b \u092e\u0942\u0932\u094d\u092f\u093e\u0919\u094d\u0915\u0928 \u0917\u0930\u094d\u0928 \u0928\u094b\u092d\u0947\u092e\u094d\u092c\u0930 2024 \u092e\u093e \u092b\u0932\u094b-\u0905\u092a \u0938\u0930\u094d\u0935\u0947\u0915\u094d\u0937\u0923 \u0917\u0930\u0947\u0915\u093e \u0925\u093f\u092f\u094c\u0902\u0964 \u0928\u0924\u093f\u091c\u093e\u0939\u0930\u0942\u0932\u0947 \u0926\u0947\u0916\u093e\u090f \u0915\u093f 94% \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u0915\u0939\u0930\u0942\u0932\u0947 PCPOR \u0938\u092c\u0948 \u0935\u093e \u0927\u0947\u0930\u0948\u091c\u0938\u094b \u0938\u092e\u092f \u092a\u094d\u0930\u092f\u094b\u0917 \u0917\u0930\u094d\u091b\u0928\u094d, 89.5% \u0932\u0947 \u092f\u0938\u0932\u093e\u0908 \u092a\u0942\u0930\u093e \u0917\u0930\u094d\u0928 \u0938\u091c\u093f\u0932\u094b \u0920\u093e\u0928\u094d\u091b\u0928\u094d (Likert \u0938\u094d\u0915\u0947\u0932 \u0938\u094d\u0915\u094b\u0930 2.15\/5) \u0930 79% \u0932\u0947 \u092f\u0938\u0932\u093e\u0908 \u0928\u093f\u0937\u094d\u0915\u0930\u094d\u0937, \u091a\u093f\u0928\u094d\u0924\u093e \u0930 \u0938\u093f\u092b\u093e\u0930\u093f\u0938\u0939\u0930\u0942 SWs \u0932\u093e\u0908 \u0938\u091e\u094d\u091a\u093e\u0930 \u0917\u0930\u094d\u0928 \u0938\u0939\u092f\u094b\u0917\u0940 \u0920\u093e\u0928\u094d\u091b\u0928\u094d\u0964<a id=\"xref-table-wrap-1-1\" class=\"xref-table\" href=\"#T1\">\u0924\u093e\u0932\u093f\u0915\u093e \u0967<\/a>)\u0964<\/p>\n<div id=\"T1\" class=\"table pos-float\">\n<div class=\"table-caption\"><span class=\"table-label\">\u0924\u093e\u0932\u093f\u0915\u093e \u0967<\/span> <\/p>\n<p id=\"p-16\" class=\"first-child\">\u092a\u093e\u092f\u0932\u091f PCPOR \u0915\u093e\u0930\u094d\u092f\u093e\u0928\u094d\u0935\u092f\u0928 \u092a\u091b\u093f \u0917\u0930\u093f\u090f\u0915\u094b \u092a\u094d\u0930\u093e\u0930\u092e\u094d\u092d\u093f\u0915 \u0938\u0930\u094d\u0935\u0947\u0915\u094d\u0937\u0923 \u0930 \u0926\u093f\u0917\u094b\u092a\u0928 \u092e\u0942\u0932\u094d\u092f\u093e\u0919\u094d\u0915\u0928\u092e\u093e 2 \u0935\u0930\u094d\u0937 \u092c\u0940\u091a\u0915\u094b \u0924\u0941\u0932\u0928\u093e<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"section\" id=\"sec-6\">\n<h2 class=\"\">\u0938\u093f\u0915\u094d\u0928\u0947 \u0930 \u0905\u0930\u094d\u0915\u094b \u091a\u0930\u0923\u0939\u0930\u0942<\/h2>\n<p id=\"p-19\">PCPOR CPMA \u092a\u0930\u093f\u0923\u093e\u092e\u0939\u0930\u0942\u0915\u094b \u0905\u0928\u094d\u0924\u0930-\u090f\u091c\u0947\u0928\u094d\u0938\u0940 \u0938\u0902\u091a\u093e\u0930 \u0938\u0941\u0927\u093e\u0930 \u0917\u0930\u094d\u0928 \u0938\u092b\u0932 \u092d\u090f\u0915\u094b \u091b\u0964 \u092f\u0938\u0932\u093e\u0908 \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u0915 \u0930 SWs \u0926\u094d\u0935\u093e\u0930\u093e \u0905\u0901\u0917\u093e\u0932\u0947\u0915\u094b \u091b \u0930 \u0926\u093f\u0917\u094b \u0924\u0930\u093f\u0915\u093e\u092e\u093e \u0938\u0947\u0935\u093e\u092e\u093e \u0938\u092e\u094d\u092e\u093f\u0932\u093f\u0924 \u0917\u0930\u093f\u090f\u0915\u094b \u091b\u0964<\/p>\n<p id=\"p-20\">\u092f\u0938 \u092a\u0930\u093f\u092f\u094b\u091c\u0928\u093e\u0915\u094b \u0938\u092b\u0932\u0924\u093e \u0927\u0947\u0930\u0948 \u0915\u093e\u0930\u0915\u0939\u0930\u0942\u0915\u094b \u0915\u093e\u0930\u0923 \u0939\u094b:<\/p>\n<ul class=\"list-unord \" id=\"list-1\">\n<li id=\"list-item-1\">\n<p id=\"p-21\">\u092a\u0930\u093f\u0935\u0930\u094d\u0924\u0928\u0915\u094b \u0932\u093e\u0917\u093f \u092e\u093e\u092e\u0932\u093e \u092c\u0928\u093e\u0909\u0928\u0915\u094b \u0932\u093e\u0917\u093f \u0932\u0947\u0916\u093e \u092a\u0930\u0940\u0915\u094d\u0937\u0923 \u092a\u094d\u0930\u092f\u094b\u0917 \u0917\u0930\u094d\u0926\u0948\u0964<\/p>\n<\/li>\n<li id=\"list-item-2\">\n<p id=\"p-22\">RCPCH \u0930\u093e\u092e\u094d\u0930\u094b \u0905\u092d\u094d\u092f\u093e\u0938 \u092e\u093e\u092a\u0926\u0923\u094d\u0921\u0939\u0930\u0942 \u092e\u093e\u0930\u094d\u092b\u0924 \u0906\u0935\u0936\u094d\u092f\u0915 \u0930\u0942\u092a\u092e\u093e \u092a\u0930\u093f\u0935\u0930\u094d\u0924\u0928 \u092a\u094d\u0930\u0935\u0930\u094d\u0926\u094d\u0927\u0928 \u0917\u0930\u094d\u0926\u0948\u0964<\/p>\n<\/li>\n<li id=\"list-item-3\">\n<p id=\"p-23\">\u0905\u0935\u0938\u094d\u0925\u093f\u0924 \u0938\u094d\u0930\u094b\u0924\u0939\u0930\u0942\u0915\u094b \u092a\u094d\u0930\u092f\u094b\u0917 \u0930 \u0928\u093f\u0930\u094d\u092e\u093e\u0923\u0964<\/p>\n<\/li>\n<li id=\"list-item-4\">\n<p id=\"p-24\">\u092e\u0941\u0916\u094d\u092f \u0938\u0930\u094b\u0915\u093e\u0930\u0935\u093e\u0932\u093e\u0939\u0930\u0942\u0932\u093e\u0908 \u092a\u094d\u0930\u0924\u093f\u0915\u094d\u0930\u093f\u092f\u093e\u092e\u093e \u092d\u093e\u0917 \u0932\u093f\u0928 \u0906\u092e\u0928\u094d\u0924\u094d\u0930\u093f\u0924 \u0917\u0930\u094d\u0926\u0948 \u0938\u093e\u091d\u093e \u0938\u094d\u0935\u093e\u092e\u093f\u0924\u094d\u0935 \u0930 \u092a\u0930\u093f\u0935\u0930\u094d\u0924\u0928\u0915\u094b \u0932\u093e\u0917\u093f \u0916\u0941\u0932\u093e\u092a\u0928\u0915\u094b \u092a\u0930\u093f\u0923\u093e\u092e\u0938\u094d\u0935\u0930\u0942\u092a\u0964<\/p>\n<\/li>\n<li id=\"list-item-5\">\n<p id=\"p-25\">RCPCH CPC \u0915\u094b \u0905\u0927\u094d\u092f\u093e\u092f 6 \u092e\u093e \u0938\u093f\u0926\u094d\u0927\u093e\u0928\u094d\u0924\u0939\u0930\u0942\u0932\u093e\u0908 \u0927\u094d\u092f\u093e\u0928\u092e\u093e \u0930\u093e\u0916\u094d\u0926\u0948 PCPOR \u0938\u093e\u0928\u094d\u0926\u0930\u094d\u092d\u093f\u0915 \u0930 \u0938\u0941\u0928\u0915\u094b \u092e\u093e\u092a\u0926\u0923\u094d\u0921\u0939\u0930\u0942\u0938\u0901\u0917 \u092e\u093f\u0932\u093e\u0907\u090f\u0915\u094b \u0938\u0941\u0928\u093f\u0936\u094d\u091a\u093f\u0924 \u0917\u0930\u094d\u092f\u094b\u0964<\/p>\n<\/li>\n<\/ul>\n<p id=\"p-26\">\u0915\u0947 \u092b\u0930\u0915 \u0924\u0930\u093f\u0915\u093e\u0932\u0947 \u0917\u0930\u094d\u0928 \u0938\u0915\u093f\u0928\u094d\u091b:<\/p>\n<ul class=\"list-unord \" id=\"list-2\">\n<li id=\"list-item-6\">\n<p id=\"p-27\">\u092b\u094b\u0915\u0938 \u0938\u092e\u0942\u0939 \u091b\u0932\u092b\u0932 \u0930 \u0938\u0939\u092f\u094b\u0917\u0915\u094b \u0932\u093e\u0917\u093f \u0909\u0924\u094d\u0915\u0943\u0937\u094d\u091f \u0925\u093f\u092f\u094b, \u0924\u0930 \u0909\u092a\u0938\u094d\u0925\u093f\u0924\u093f \u0905\u092a\u0947\u0915\u094d\u0937\u093e \u092d\u0928\u094d\u0926\u093e \u0915\u092e \u0925\u093f\u092f\u094b, \u0915\u092e \u0935\u093f\u091a\u093e\u0930 \u0935\u094d\u092f\u0915\u094d\u0924 \u0917\u0930\u093f\u090f\u0915\u094b \u0925\u093f\u092f\u094b\u0964 \u0926\u0941\u0908 \u092b\u094b\u0915\u0938 \u0938\u092e\u0942\u0939\u0939\u0930\u0942 \u0905\u0928\u0941\u0938\u0942\u091a\u0940 \u0917\u0930\u094d\u0928\u093e\u0932\u0947 \u0925\u092a \u0938\u0930\u094b\u0915\u093e\u0930\u0935\u093e\u0932\u093e\u0939\u0930\u0942\u092c\u093e\u091f \u0907\u0928\u092a\u0941\u091f \u0938\u0919\u094d\u0915\u0932\u0928 \u0917\u0930\u094d\u0928\u0947 \u0905\u0930\u094d\u0915\u094b \u0905\u0935\u0938\u0930 \u092a\u094d\u0930\u0926\u093e\u0928 \u0917\u0930\u094d\u0928 \u0938\u0915\u094d\u091b\u0964<\/p>\n<\/li>\n<li id=\"list-item-7\">\n<p id=\"p-28\">SW \u0938\u0930\u094d\u0935\u0947\u0915\u094d\u0937\u0923 \u092a\u094d\u0930\u0924\u093f\u0915\u094d\u0930\u093f\u092f\u093e\u0939\u0930\u0942 \u0905\u092a\u0947\u0915\u094d\u0937\u093e \u0917\u0930\u0947\u092d\u0928\u094d\u0926\u093e \u0915\u092e \u0925\u093f\u090f, \u0938\u0939\u092d\u093e\u0917\u093f\u0924\u093e\u0932\u093e\u0908 \u092a\u094d\u0930\u094b\u0924\u094d\u0938\u093e\u0939\u093f\u0924 \u0917\u0930\u094d\u0928 \u0925\u092a \u0907\u092e\u0947\u0932\u0939\u0930\u0942 \u091a\u093e\u0939\u093f\u0928\u094d\u091b\u0964 \u092e\u094c\u0916\u093f\u0915 \u092a\u094d\u0930\u0924\u093f\u0915\u094d\u0930\u093f\u092f\u093e \u0938\u0919\u094d\u0915\u0932\u0928 \u0917\u0930\u094d\u0928 \u0938\u093e\u0928\u094d\u0926\u0930\u094d\u092d\u093f\u0915 \u0938\u093e\u092e\u093e\u091c\u093f\u0915 \u0939\u0947\u0930\u091a\u093e\u0939 \u091f\u094b\u0932\u0940\u0939\u0930\u0942\u0915\u094b \u092d\u094d\u0930\u092e\u0923\u0932\u0947 \u0925\u092a \u092a\u094d\u0930\u0924\u093f\u0915\u094d\u0930\u093f\u092f\u093e\u0939\u0930\u0942 \u092a\u094d\u0930\u093e\u092a\u094d\u0924 \u0917\u0930\u094d\u0928 \u0938\u0915\u094d\u091b\u0964<\/p>\n<\/li>\n<\/ul>\n<p id=\"p-29\">\u0905\u0930\u094d\u0915\u094b \u091a\u0930\u0923\u0939\u0930\u0942:<\/p>\n<ul class=\"list-unord \" id=\"list-3\">\n<li id=\"list-item-8\">\n<p id=\"p-30\">\u092f\u094b \u092a\u0930\u093f\u092f\u094b\u091c\u0928\u093e \u0932\u0928\u094d\u0921\u0928\u092e\u093e Evelina QI \u0938\u092e\u094d\u092e\u0947\u0932\u0928, \u0938\u093e\u092e\u0941\u0926\u093e\u092f\u093f\u0915 \u092c\u093e\u0932 \u0938\u094d\u0935\u093e\u0938\u094d\u0925\u094d\u092f \u0935\u093e\u0930\u094d\u0937\u093f\u0915 \u0935\u0948\u091c\u094d\u091e\u093e\u0928\u093f\u0915 \u092c\u0948\u0920\u0915 \u0930 \u092c\u093e\u0930\u094d\u0938\u093f\u0932\u094b\u0928\u093e \u092e\u093e \u092c\u093e\u0932 \u0926\u0941\u0930\u094d\u0935\u094d\u092f\u0935\u0939\u093e\u0930 \u092c\u093e\u0932 \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u093e \u0915\u094b \u0905\u0928\u094d\u0924\u0930\u094d\u0930\u093e\u0937\u094d\u091f\u094d\u0930\u093f\u092f \u0938\u092e\u094d\u092e\u0947\u0932\u0928 \u092e\u093e \u092a\u094d\u0930\u0938\u094d\u0924\u0941\u0924 \u0917\u0930\u093f\u090f\u0915\u094b \u091b\u0964<\/p>\n<\/li>\n<li id=\"list-item-9\">\n<p id=\"p-31\">\u0905\u0928\u094d\u092f \u0930\u093e\u0937\u094d\u091f\u094d\u0930\u093f\u092f \u0938\u094d\u0935\u093e\u0938\u094d\u0925\u094d\u092f \u0938\u0947\u0935\u093e \u091f\u094d\u0930\u0938\u094d\u091f\u0939\u0930\u0942\u0932\u0947 \u0909\u0928\u0940\u0939\u0930\u0942\u0915\u094b \u0938\u0947\u0935\u093e\u092e\u093e \u0939\u093e\u092e\u094d\u0930\u094b \u0915\u093e\u092e \u0926\u094b\u0939\u094b\u0930\u094d\u092f\u093e\u0909\u0928 \u0939\u093e\u092e\u0940\u0932\u093e\u0908 \u0938\u092e\u094d\u092a\u0930\u094d\u0915 \u0917\u0930\u0947\u0915\u093e \u091b\u0928\u094d\u0964<\/p>\n<\/li>\n<li id=\"list-item-10\">\n<p id=\"p-32\">\u092a\u094d\u0930\u092d\u093e\u0935 \u0930 \u0938\u0902\u0932\u0917\u094d\u0928\u0924\u093e\u0915\u094b \u0925\u092a \u092e\u0942\u0932\u094d\u092f\u093e\u0919\u094d\u0915\u0928 \u0917\u0930\u094d\u0928 \u0930 \u092a\u0930\u093f\u0937\u094d\u0915\u0930\u0923\u0915\u094b \u0932\u093e\u0917\u093f \u0915\u0941\u0928\u0948 \u092a\u0928\u093f \u0925\u092a \u0938\u0941\u091d\u093e\u0935\u0939\u0930\u0942 \u0935\u093f\u091a\u093e\u0930 \u0917\u0930\u094d\u0928 \u0939\u093e\u092e\u0940\u0932\u0947 \u092b\u0932\u094b-\u0905\u092a \u0938\u0930\u094d\u0935\u0947\u0915\u094d\u0937\u0923 \u092a\u0942\u0930\u093e \u0917\u0930\u0947\u0915\u093e \u091b\u094c\u0902\u0964<\/p>\n<\/li>\n<li id=\"list-item-11\">\n<p id=\"p-33\">\u092a\u094d\u0930\u0915\u093e\u0936\u0928\u0915\u094b \u092e\u093e\u0927\u094d\u092f\u092e\u092c\u093e\u091f, \u0939\u093e\u092e\u0940 \u0935\u094d\u092f\u093e\u092a\u0915 \u0926\u0930\u094d\u0936\u0915\u0939\u0930\u0942\u0938\u0901\u0917 \u0930\u093e\u092e\u094d\u0930\u094b \u0905\u092d\u094d\u092f\u093e\u0938 \u0938\u093e\u091d\u093e \u0917\u0930\u094d\u0928\u0947 \u0906\u0936\u093e \u0917\u0930\u094d\u0926\u091b\u094c\u0902\u0964<\/p>\n<\/li>\n<\/ul>\n<\/div>\n<div class=\"section data-availability\" id=\"sec-7\">\n<h2 class=\"\">\u0921\u093e\u091f\u093e \u0909\u092a\u0932\u092c\u094d\u0927\u0924\u093e \u0915\u0925\u0928<\/h2>\n<p id=\"p-41\">\u0905\u0927\u094d\u092f\u092f\u0928\u0938\u0901\u0917 \u0938\u092e\u094d\u092c\u0928\u094d\u0927\u093f\u0924 \u0938\u092c\u0948 \u0921\u0947\u091f\u093e \u0932\u0947\u0916\u092e\u093e \u0938\u092e\u093e\u0935\u0947\u0936 \u0917\u0930\u093f\u090f\u0915\u094b \u091b \u0935\u093e \u092a\u0942\u0930\u0915 \u091c\u093e\u0928\u0915\u093e\u0930\u0940\u0915\u094b \u0930\u0942\u092a\u092e\u093e \u0905\u092a\u0932\u094b\u0921 \u0917\u0930\u093f\u090f\u0915\u094b \u091b\u0964<\/p>\n<\/div>\n<div class=\"section ethics-statement\" id=\"sec-8\">\n<h2 class=\"\">\u0928\u0948\u0924\u093f\u0915\u0924\u093e \u0915\u0925\u0928\u0939\u0930\u0942<\/h2>\n<div class=\"section\" id=\"sec-9\">\n<h3>\u092a\u094d\u0930\u0915\u093e\u0936\u0928\u0915\u094b \u0932\u093e\u0917\u093f \u092c\u093f\u0930\u093e\u092e\u0940\u0915\u094b \u0938\u0939\u092e\u0924\u093f<\/h3>\n<p id=\"p-42\" class=\"ethics-consent-to-publish\">\u0932\u093e\u0917\u0942 \u0939\u0941\u0901\u0926\u0948\u0928\u0964<\/p>\n<\/div>\n<div class=\"section\" id=\"sec-10\">\n<h3>\u0928\u0948\u0924\u093f\u0915\u0924\u093e \u0905\u0928\u0941\u092e\u094b\u0926\u0928<\/h3>\n<p id=\"p-43\" class=\"ethics-approval\">\u0932\u093e\u0917\u0942 \u0939\u0941\u0901\u0926\u0948\u0928\u0964<\/p>\n<\/div>\n<\/div>\n<div class=\"section ack\" id=\"ack-1\">\n<h2>\u0938\u094d\u0935\u0940\u0915\u0943\u0924\u093f\u0939\u0930\u0942<\/h2>\n<p id=\"p-34\">\u0939\u093e\u092e\u0940 GSTT \u0938\u093e\u092e\u0941\u0926\u093e\u092f\u093f\u0915 \u0938\u094d\u0935\u093e\u0938\u094d\u0925\u094d\u092f \u0938\u0947\u0935\u093e (Lambeth), Evelina \u0932\u0928\u094d\u0921\u0928 \u092e\u093e \u0938\u093e\u092e\u0941\u0926\u093e\u092f\u093f\u0915 \u092c\u093e\u0932 \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u093e \u091f\u094b\u0932\u0940 \u0930 Lambeth \u0930 Southwark \u092d\u0930\u093f\u0915\u093e \u0939\u093e\u092e\u094d\u0930\u093e \u0938\u093e\u092e\u093e\u091c\u093f\u0915 \u0939\u0947\u0930\u091a\u093e\u0939 \u0938\u093e\u091d\u0947\u0926\u093e\u0930\u0939\u0930\u0942\u0932\u093e\u0908 \u0924\u093f\u0928\u0940\u0939\u0930\u0942\u0915\u094b \u0905\u092e\u0942\u0932\u094d\u092f \u0938\u0939\u092f\u094b\u0917 \u0930 \u0938\u0939\u092f\u094b\u0917\u0915\u094b \u0932\u093e\u0917\u093f \u0921\u093e. Ayanda Jolobe (AJ), \u092a\u0942\u0930\u094d\u0935 \u0928\u093e\u092e\u093f\u0924 \u0921\u093e\u0915\u094d\u091f\u0930 \u092b\u0930 \u091a\u093e\u0907\u0932\u094d\u0921 \u092a\u094d\u0930\u094b\u091f\u0947\u0915\u094d\u0936\u0928 \u092a\u094d\u0930\u0924\u093f \u0915\u0943\u0924\u091c\u094d\u091e\u0924\u093e \u0935\u094d\u092f\u0915\u094d\u0924 \u0917\u0930\u094d\u0928 \u091a\u093e\u0939\u0928\u094d\u091b\u094c\u0902\u0964<\/p>\n<\/div>\n<p><span class=\"highwire-journal-article-marker-end\"\/><\/div>\n<p><a href=\"http:\/\/ep.bmj.com\/cgi\/content\/short\/110\/6\/260?rss=1\">Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0938\u093e\u0930\u093e\u0902\u0936 \u0938\u093e\u092e\u0941\u0926\u093e\u092f\u093f\u0915 \u0938\u0947\u091f\u093f\u0919\u092e\u093e \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923 \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u093e \u092e\u0942\u0932\u094d\u092f\u093e\u0919\u094d\u0915\u0928 (CPMA) \u092a\u091b\u093f \u0924\u0941\u0930\u0941\u0928\u094d\u0924\u0948 \u0938\u093e\u092e\u093e\u091c\u093f\u0915 \u0915\u093e\u0930\u094d\u092f\u0915\u0930\u094d\u0924\u093e (SW) \u0932\u093e\u0908 \u0926\u093f\u0907\u090f\u0915\u094b \u0905\u0938\u094d\u0925\u093e\u092f\u0940 \u092c\u093e\u0932 \u0938\u0902\u0930\u0915\u094d\u0937\u0923 \u092a\u0930\u093f\u0923\u093e\u092e \u0930\u093f\u092a\u094b\u0930\u094d\u091f [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":16157,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center 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