Category: Nevin Manimala

Healthc Inform Res. 2023 Apr;29(2):174-185. doi: 10.4258/hir.2023.29.2.174. Epub 2023 Apr 30.

ABSTRACT

OBJECTIVES: Large amounts of healthcare data are now generated via patient health records, records of diagnosis and treatment, smart devices, and wearables. Extracting insights from such data can transform healthcare from a traditional, symptom-driven practice into precisely personalized medicine. Dialysis treatments generate a vast amount of data, with more than 100 parameters that must be regulated for ideal treatment outcomes. When complications occur, understanding electrolyte parameters and predicting their outcomes to deliver the optimal dialysis dosing for each patient is a challenge. This study focused on refining dialysis dosing by utilizing emerging data from the growing number of dialysis patients to improve patients’ quality of life and well-being.

METHODS: Exploratory data analysis and data prediction approaches were performed to gather insights from patients’ vital electrolytes on how to improve the patients’ dialysis dosing. Four predictive models were constructed to predict electrolyte levels through various dialysis parameters.

RESULTS: The decision tree model showed excellent performance and more accurate results than the support vector machine, linear regression, and neural network models.

CONCLUSIONS: The predictive models identified that pre-dialysis blood urea nitrogen, pre-weight, dry weight, anticoagulation, and sex had the most significant effects on electrolyte concentrations. Such models could fine-tune dialysis dosing levels for the growing number of dialysis patients to improve each patient’s quality of life, life expectancy, and well-being, and to reduce costs, efforts, and time consumption for both patients and physicians. The study’s results need to be validated on a larger scale.

PMID:37190742 | DOI:10.4258/hir.2023.29.2.174

Healthc Inform Res. 2023 Apr;29(2):168-173. doi: 10.4258/hir.2023.29.2.168. Epub 2023 Apr 30.

ABSTRACT

OBJECTIVES: Since protecting patients’ privacy is a major concern in clinical research, there has been a growing need for privacy-preserving data analysis platforms. For this purpose, a federated learning (FL) method based on the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) was implemented, and its feasibility was demonstrated.

METHODS: We implemented an FL platform on FeederNet, which is a distributed clinical data analysis platform based on the OMOP CDM in Korea. We trained it through an artificial neural network (ANN) using data from patients who received steroid prescriptions or injections, with the aim of predicting the occurrence of side effects depending on the prescribed dose. The ANN was trained using the FL platform with the OMOP CDMs of Kyung Hee University Medical Center (KHMC) and Ajou University Hospital (AUH).

RESULTS: The area under the receiver operating characteristic curves (AUROCs) for predicting bone fracture, osteonecrosis, and osteoporosis using only data from each hospital were 0.8426, 0.6920, and 0.7727 for KHMC and 0.7891, 0.7049, and 0.7544 for AUH, respectively. In contrast, when using FL, the corresponding AUROCs were 0.8260, 0.7001, and 0.7928 for KHMC and 0.7912, 0.8076, and 0.7441 for AUH, respectively. In particular, FL led to a 14% improvement in performance for osteonecrosis at AUH.

CONCLUSIONS: FL can be performed with the OMOP CDM, and FL often shows better performance than using only a single institution’s data. Therefore, research using OMOP CDM has been expanded from statistical analysis to machine learning so that researchers can conduct more diverse research.

PMID:37190741 | DOI:10.4258/hir.2023.29.2.168

J Coll Physicians Surg Pak. 2023 Apr;33(4):477-478. doi: 10.29271/jcpsp.2023.04.477.

ABSTRACT

This cross-sectional study aimed to describe the frequency of psychological sequelae of COVID-19 in healthcare workers (HCWs) conducted at The Aga University Hospital, from May to July 2020. The data collection was done online using a demographics questionnaire, concern of COVID-19 scale, Generalised Anxiety Disorder, and Impact of event scale. A total of 560 responses were received. Nearly 25% of participants had moderate to severe anxiety or psychological distress due to COVID-19. Female responders reported more anxiety compared to males. (p= 0.001. The doctors and nurses reported significant psychological distress (p=0.046). The participants with moderate to severe anxiety and psychological distress reported statistically significant high levels of concern of the following: inadequate protective measures, contracting and spreading COVID-19, medical violence, and deteriorating quality of patient interaction due to COVID-19. The COVID-19 pandemic has highlighted areas of development for occupational healthcare policy development in Pakistan. Implementation of contextualised solutions, especially psychosocial determinants is necessary to mitigate the invisible mental health burden and its impact on HCWs in Pakistan. Key Words: Occupational mental health, Pakistan, Anxiety, Depression.

PMID:37190726 | DOI:10.29271/jcpsp.2023.04.477

J Coll Physicians Surg Pak. 2023 Apr;33(4):460-464. doi: 10.29271/jcpsp.2023.04.460.

ABSTRACT

OBJECTIVE: To evaluate the efficacy and complications of subgaleal drain placement after two burr-holes evacuation of chronic subdural hematoma (CSDH).

STUDY DESIGN: Descriptive study.

PLACE AND DURATION OF STUDY: The Neurosurgical unit of the Lady Reading Hospital, Peshawar, from April to November 2021.

METHODOLOGY: Sixty-four consecutive patients diagnosed with surgically significant unilateral chronic subdural hematoma were prospectively included after obtaining informed consent. All the patients underwent two burr-holes craniectomies and evacuation, followed by subgaleal drain placement. Patient demographics, pre- and postoperative clinical information including hematoma resolution and complications were collected.

RESULTS: This study included 44 (69%) males and 20 (31%) females with a mean age of 70.1 ± 8 years. The most common presenting symptoms were headaches (70%) and confusion (68%). Eighteen patients (28%) were taking warfarin or other anticoagulants, whereas, 23 patients (36%) were taking antiplatelet medications at the time of presentation. Thirty-six (56.3%) patients had a history of head trauma. Warfarin use was statistically significant in the patients with no history of head injury. Fifty-five patients (85%) showed no significant recurrence on the 2 week postoperative computed tomography (CT) scan. None of the patients had intraparenchymal hematoma or contusion of iatrogenic origin on postoperative CT scans.

CONCLUSION: Subgaleal drain placement after two burr-holes craniectomy led to high-resolution rates. However, no parenchymal injuries were attributed to the procedure.

KEY WORDS: Chronic subdural hematoma, Subdural drain, Subperiosteal drain, Burr-hole craniostomy.

PMID:37190722 | DOI:10.29271/jcpsp.2023.04.460

J Coll Physicians Surg Pak. 2023 Apr;33(4):427-432. doi: 10.29271/jcpsp.2023.04.427.

ABSTRACT

OBJECTIVE: To use carotid intimal medial thickness as a marker of early atherosclerosis in patients with rheumatoid arthritis.

STUDY DESIGN: Cross-sectional descriptive study. Place and Duration of the Study: Rheumatology Unit of Federal Government Polyclinic Hospital, Islamabad, from 1st June 2019 till 30th January 2022.

METHODOLOGY: The study included 190 patients divided equally into cases of rheumatoid arthritis and healthy control groups. Carotid intimal medial thickness was measured using the carotid doppler ultrasound. The mean values of both the study groups were evaluated using the independent sample t-tests. Different statistical tests for correlation were also used where appropriate.

RESULTS: This study included a total of 190 patients, 95 each in case and control groups. There were 15 (15.8%) males and 80 (84.2%) females with mean age of 43.5±12.8 years among cases, while 27 (28.4%) males and 68 (71.6%) females with mean age of 43.1±10.1 years in the control group. A significantly higher number of cases had a carotid intima-media thickness of more than 0.6 mm as compared to controls (43.2% vs. 25.3%, p=0.009). Cases with seropositive status were 1.98 times more likely to have higher carotid intima-medial thickness compared with controls.

CONCLUSION: Carotid intima-media thickness measurement is important as a surrogate marker of atherosclerotic process in patients with rheumatoid arthritis.

KEY WORDS: Rheumatoid arthritis (RA), Carotid intimal medial thickness (CIMT), Atherosclerosis, Cardiovascular disease (CVD).

PMID:37190716 | DOI:10.29271/jcpsp.2023.04.427

J Coll Physicians Surg Pak. 2023 Apr;33(4):416-420. doi: 10.29271/jcpsp.2023.04.416.

ABSTRACT

OBJECTIVE: To investigate the effect of subclinical hyperthyroidism on voice quality using acoustic analysis.

STUDY DESIGN: Cross-sectional comparative study. Place and Duration of the Study: Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, Turkey, from January to June 2020.

METHODOLOGY: A total of 115 participants, with 60 patients with subclinical hyperthyroidism and 55 healthy volunteers, were evaluated and compared. Healthy volunteers with similar age and gender distributions were also evaluated and compared. Acoustic variables including average fundamental frequency (F0), relative average perturbation (RAP), jitter, shimmer, noise-to-harmonic ratio (NHR), and voice turbulence index (VTI) were measured and recorded.

RESULTS: In the patient group, acoustic voice analysis results were obtained for F0 224.97%, jitter 0.85%, RAP 0.51%, shimmer 3.16%, NHR 0.12 dB, and VTI 0.047, respectively. In the control group, these respective values were 219.60%; 0.74%; 0.46%; 3.11%; 0.12 dB; and 0.045, respectively. There was no statistically significant difference between the groups (p>0.05).

CONCLUSION: Subclinical hyperthyroidism does not cause a significant change in voice quality.

KEY WORDS: Acoustic analysis, Subclinical hyperthyroidism, Voice, Frequency.

PMID:37190714 | DOI:10.29271/jcpsp.2023.04.416

J Coll Physicians Surg Pak. 2023 Apr;33(4):406-410. doi: 10.29271/jcpsp.2023.04.406.

ABSTRACT

OBJECTIVE: To determine the frequency of skin manifestations found in end-stage renal disease (ESRD) patients undergoing dialysis, while assessing their effect on the quality of lives of the same patients.

STUDY DESIGN: Descriptive cross-sectional study. Place and Duration of the Study: Benazir Bhutto Hospital, Holy Family Hospital, and Hussain Lakhani Hospital, from 12th December 2021 to 13th October 2022.

METHODOLOGY: Seventy-three Patients undergoing hemodialysis were enrolled in the study. Skin manifestations were defined as “cutaneous signs and symptoms related to ESRD unrelated to the symptoms resulting from any primary dermatological disorder or other systemic diseases”. Data on the skin manifestations of their disease and their effect on patients’ quality of life were collected by using a 2-part questionnaire. The first part consisted of demographic details along with the type of skin disorders faced by the patient and the second part of the questionnaire comprised of the dermatology life quality index (DLQI). The data were entered and analysed using the statistical package for social sciences (SPSS) version 23.0.

RESULTS: Xerosis and pruritus were most commonly reported (83.7%), followed by nail changes (18.6%) and skin discolouration (16.3%). The median duration of dialysis was 36 (1-180) months and there was no significant increase in skin symptoms with the increase in the duration of dialysis (p=0.082). The median DLQI score was 3 (range:0-10) A significantly higher number of females (n=14) reported associated mental discomfort with their skin symptoms of pruritis as compared to males (n=5, p=0.008).

CONCLUSION: Cutaneous manifestations have variable effects on the quality of life of ESRD patients. Adopting a multidisciplinary approach early in the management may help to minimise the mental discomfort of these patients and bring an improvement in their quality of life.

KEY WORDS: End-stage renal disease (ESRD), Hemodialysis, Skin manifestations, Pruritus, Quality of life.

PMID:37190712 | DOI:10.29271/jcpsp.2023.04.406

Eur J Hosp Pharm. 2023 May 15:ejhpharm-2023-003680. doi: 10.1136/ejhpharm-2023-003680. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to assess the impact of pharmacist interventions on injectable chemotherapy prescription and the safety of early prescription practice in an adult daily care unit.

METHODS: Prescription errors were recorded before and after implementing corrective measures. Errors identified from the pre-intervention period (i) were analysed to identify areas for improvement. During the post-intervention period (ii) we compared the errors in anticipated prescription (AP) with those in real-time prescriptions (RTP). We performed Chi-square statistical tests (α=0.05).

RESULTS: Before implementing corrective measures (i), 377 errors were recorded (ie, 3.02% of prescriptions). After the implementation of corrective measures (ii), there was a significant decrease in errors, with 94 errors recorded (ie, 1.20% of prescriptions). The error rate in AP and RTP groups was 1.34% and 1.02%, respectively, without a significant difference between the two groups.

CONCLUSIONS: This study highlights the importance of prescription review, as well as collaboration between pharmacists and physicians, in reducing prescription errors, whether these prescriptions were anticipated or not.

PMID:37188505 | DOI:10.1136/ejhpharm-2023-003680

BMJ Open Qual. 2023 May;12(2):e002058. doi: 10.1136/bmjoq-2022-002058.

ABSTRACT

AIM: Aim of this study was to describe and analyse associations of incidents and their improvement actions in hospital setting.

METHODS: It was a retrospective document analysis of incident reporting systems’ reports registered during 2018-2019 in two Estonian regional hospitals. Data were extracted, organised, quantified and analysed by statistical methods.

RESULTS: In total, 1973 incident reports were analysed. The most commonly reported incidents were related to patient violent or self-harming behaviour (n=587), followed by patient accidents (n=379), and 40% of all incidents were non-harm incidents (n=782). Improvement actions were documented in 83% (n=1643) of all the reports and they were focused on (1) direct patient care, (2) staff-related actions; (3) equipment and general protocols and (4) environment and organisational issues. Improvement actions were mostly associated with medication and transfusion treatment and targeted to staff. The second often associated improvement actions were related to patient accidents and were mostly focused on that particular patient’s further care. Improvement actions were mostly planned for incidents with moderate and mild harm, and for incidents involving children and adolescents.

CONCLUSION: Patient safety incidents-related improvement actions need to be considered as a strategy for long-term development in patient safety in organisations. It is vital for patient safety that the planned changes related to the reporting will be documented and implemented more visibly. As a result, it will boost the confidence in managers’ work and strengthens all staff’s commitment to patient safety initiatives in an organisation.

PMID:37188481 | DOI:10.1136/bmjoq-2022-002058

BMJ Open. 2023 May 15;13(5):e070869. doi: 10.1136/bmjopen-2022-070869.

ABSTRACT

INTRODUCTION: Sustained viral suppression, an indicator of long-term treatment success and mortality reduction, is one of four strategic areas of the ‘Ending the HIV Epidemic’ federal campaign launched in 2019. Under-represented populations, like racial or ethnic minority populations, sexual and gender minority groups, and socioeconomically disadvantaged populations, are disproportionately affected by HIV and experience a more striking virological failure. The COVID-19 pandemic might magnify the risk of incomplete viral suppression among under-represented people living with HIV (PLWH) due to interruptions in healthcare access and other worsened socioeconomic and environmental conditions. However, biomedical research rarely includes under-represented populations, resulting in biased algorithms. This proposal targets a broadly defined under-represented HIV population. It aims to develop a personalised viral suppression prediction model using machine learning (ML) techniques by incorporating multilevel factors using All of Us (AoU) data.

METHODS AND ANALYSIS: This cohort study will use data from the AoU research programme, which aims to recruit a broad, diverse group of US populations historically under-represented in biomedical research. The programme harmonises data from multiple sources on an ongoing basis. It has recruited ~4800 PLWH with a series of self-reported survey data (eg, Lifestyle, Healthcare Access, COVID-19 Participant Experience) and relevant longitudinal electronic health records data. We will examine the change in viral suppression and develop personalised viral suppression prediction due to the impact of the COVID-19 pandemic using ML techniques, such as tree-based classifiers (classification and regression trees, random forest, decision tree and eXtreme Gradient Boosting), support vector machine, naïve Bayes and long short-term memory.

ETHICS AND DISSEMINATION: The institutional review board approved the study at the University of South Carolina (Pro00124806) as a Non-Human Subject study. Findings will be published in peer-reviewed journals and disseminated at national and international conferences and through social media.

PMID:37188476 | DOI:10.1136/bmjopen-2022-070869