Category: Statistics

Exp Physiol. 2026 Jun 19. doi: 10.1113/EP092753. Online ahead of print.

ABSTRACT

Traditionally, studies in experimental physiology have been conducted in small groups of human participants, animal models or cell lines. Identifying optimal study designs that achieve sufficient power for drawing proper statistical inferences to detect group level effects with small sample sizes has been challenging. Moreover, average effects derived from traditional group-level inference do not necessarily apply to individual participants. Here, we introduce N-of-1 trials as an innovative study design that can be used to draw valid statistical inference about the effects of interventions on individual participants and can be aggregated across multiple study participants to provide population-level inferences more efficiently than standard group randomized trials. N-of-1 trials have been used in healthcare settings since the late 1980s, but without large-scale adoption and with few applications in experimental physiology research settings. In this paper, we introduce the key components and design features of N-of-1 trials, describe statistical analysis and interpretations of the results, and describe some available digital tools to facilitate their use using examples from experimental physiology.

PMID:42318774 | DOI:10.1113/EP092753

Soft Matter. 2026 Jun 19. doi: 10.1039/d6sm00448b. Online ahead of print.

ABSTRACT

Chiral active Brownian particles (CABPs) are self-propelled agents with intrinsic rotational dynamics, giving rise to circular trajectories commonly observed in biological and synthetic microswimmers. Understanding how CABPs explore confined environments and locate targets is crucial for characterizing transport, search efficiency, and reaction processes in physical and biological systems. We study the escape dynamics of CABPs from one- and two-dimensional confined domains. In one dimension, we consider intervals with either two absorbing boundaries or a reflecting boundary on one side and an absorbing boundary on the other, and derive closed-form asymptotic solutions in the high-chirality regime, revealing the quantitative scaling of the mean first passage time (MFPT) as a function of particle rotation speed (chirality). In two dimensions, we analyze escape from a disk containing one absorbing arc or two symmetric absorbing arcs. By numerically solving the governing partial differential equations, we compute the MFPT for CABPs to escape the domains as a function of the particle’s initial orientation, self-propulsion speed, angular velocity, and domain geometry. Our results show that, depending on the parameters and geometry, the MFPT can exhibit non-monotonic behavior as a function of chirality. A minimal escape time exists at an intermediate value of chirality, where the rotational time scale balances the active swimming time scale, redirecting a particle towards the exit which would otherwise be blocked due to unfavorable initial orientation. Our work offers a comprehensive characterization of CABP escape dynamics in canonical confinements and identifies chirality as a key control parameter for transport and search in confined physical and biological systems.

PMID:42318759 | DOI:10.1039/d6sm00448b

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):534-539.

ABSTRACT

Background Breastfeeding self-efficacy predicts breastfeeding success. Studies shows that although mothers recognize its importance, many lack adequate knowledge of proper breastfeeding practices. Objective To assess breastfeeding self-efficacy and postnatal depressive symptoms and compare the breast-feeding efficacy score differences with selected variables and postnatal depressive symptoms among postnatal mothers. Method A cross- sectional study was conducted from 1st-28th August 2022 among 109 postnatal mothers in postnatal ward of Dhulikhel Hospital. The postnatal mothers were selected by convenience sampling method. Data collection was done by using structured questionnaire through interview method. Descriptive statistics (frequency, percentage, median and interquartile range) and inferential statistics (Mann Whitney U test and Kruskal Wallis test) were used. Result There was total 109 postnatal mothers. The median breastfeeding self-efficacy score was 55 with interquartile range 59 and 51. Nearly one fourth (21.1%) of postnatal mothers had presence of depressive symptoms. The mean overall Edinburgh Postnatal Depression Scale score was 9.37 (SD = 2.89; ranging from 1 to 18). The study showed higher breastfeeding score among age above 30 years, who received prenatal health information about breastfeeding, having previous experience of breastfeeding and who decided to breastfeed before childbirth. Conclusion The study showed that more than half of postnatal mothers had high median score of breastfeeding self-efficacy and nearly one fourth of postnatal mothers had presence of depressive symptoms. There was statistically significant difference between mothers’ age, received prenatal health information about breastfeeding, previous experience of breastfeeding and time of decision to breastfeed with breastfeeding self- efficacy score.

PMID:42318734

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):529-533.

ABSTRACT

Background Subarachnoid block (SAB) is a widely practiced regional anesthetic for lower limb surgeries. The patient position for subarachnoid block induction, either sitting or lateral decubitus, may affect hemodynamic stability and block quality. Objective To compare the incidence of hypotension and the onset times of block in these two positions. Method In this prospective single-center observational comparative study, 108 patients, who were scheduled to undergo elective lower limb surgery, were equally assigned to subarachnoid block in sitting position (SP) and Lateral decubitus position (LP) groups. An intrathecal dose of hyperbaric Bupivacaine 0.5% (15 mg) was given. Hemodynamic variables, onset of sensory and motor block, maximum level of sensory and motor block and any complications including hypotension and bradycardia were recorded and compared. Categorical variables were analyzed using the Chi-square test, and continuous variables were compared using the unpaired Student’s t-test. Result The incidence of hypotension was greater in sitting position group (20.41%) than in LP group (16.67%), but the difference was not statistically significant. Out of these, bradycardia was more frequent in sitting position (9.2%) as compared to lateral decubitus position (7.4%). The onset times of sensory and motor blocks in the lateral decubitus position group were significantly shorter (p < 0.05). Conclusion Lateral decubitus position results in superior early hemodynamic stability and shorter time to sensory and motor block onset as compared to sitting in subarachnoid block for elective lower limb surgeries.

PMID:42318733

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):523-528.

ABSTRACT

Background Ageing is a key demographic trend with universal implications, particularly in South Asia. In Nepal, the elderly people face socio-economic challenges such as poverty anddeclining family support. The old age allowance introduced in 1995 and gradually increased over time. Objective To assesses the relationship between old age allowance and fulfillment of fundamental needs among elderly people in Chandragiri Municipality. Method The analytical cross-sectional study was carried out in Chandragiri Municipality from 1st December 2023 to 30th May 2024. Simple random sampling technique was adopted. Participants were asked for socio-demographic information, socioeconomic information, and old age allowances by using a structured interview schedule. Data analysis included descriptive as well as inferential statistics. Thechisquare test wascarried outto assess relationship between old age allowances and fulfillment of fundamental needs. Result Out of 422 elderly individuals, 56.9% lacked an old age allowance, mostly due to age ineligibility (43.4%). Major demographics included 55.7% female, 69.2% Hindu, and 41.2% Janajati. While 54.5% reported adequate income, significant relationship was found between receiving an allowance and the fulfillment of fundamental needs (p = 0.001). Conclusion The study found that nearly half of the participants received old age allowances. It showed that there was relationship between old age allowances and fulfillment of fundamental needs. It is recommended that policymakers and local governments enhance the accessibility and inclusivity of the old age allowance program. Strengthening income sufficiency through supplementary programs or increasing the allowance amount could significantly alleviate financial inadequacies.

PMID:42318732

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):512-517.

ABSTRACT

Background The refractive error is an anomaly of the dioptric system of the eye in which rays of light are not focused on the retina. Objective To ascertain the pattern and prevalence of refractive error and visual impairment secondary to it in the pediatric population attending to ophthalmology department of Dhulikhel hospital. Method This was a hospital-based, prospective, cross-sectional study design. Presenting visual acuity, age of presentation, refractive status, best corrected visual acuity, and status of visual impairment were assessed in children ranging from 3-15 years presenting to the Ophthalmology department of Dhulikhel Hospital within the period of 6 months. They underwent assessment of visual acuity in different charts (as per their co-operation level) and cyclorefraction. History of use of spectacle was noted, and the children were categorized into different visual impairment categories as per their presenting visual acuity. Paired t-test was used to assess the improvement in visual acuity, post-refractive error correction. Result Out of 1,498 children examined during the study period, 116 (7.74%) had refractive error. Among these 60 (51.70%) were females and 56 (48.30%) were males. The mean age at presentation was 11.45±3.62 years. Astigmatism was the most common subtype seen in 45.26% (N=105 eyes), followed by Myopia (42.67%, N=99 eyes) and Hypermetropia (11.21%, N=26 eyes). Only 36.20% (N=42) of the pediatric population were using spectacle. 62.90% (N= 73 children) had some of visual impairment during their presentation. There was statistically significant improvement in visual acuity after refractive correction (paired t-test, P < 0.001). Conclusion Refractive errors were common among children with astigmatism having highest prevalence and majority presenting with visual impairment. Lack of awareness, infrequent ocular examination and lack of vision screening were the main causes for the late presentation. So, early detection through screening programs and timely management is recommended to enhance quality of life.

PMID:42318730

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):506-511.

ABSTRACT

Background Rehabilitation services are vital in improving the quality of life for people with disabilities in Nepal, where there is a prolonged effect of civil conflict and frequent natural disasters. To refer patients to rehabilitation specialists, health professionals should be equipped with knowledge and should have a positive attitude towards multidisciplinary rehabilitation. However, information on the knowledge, attitude, and practice (KAP) of health professionals in Nepal regarding multidisciplinary rehabilitation is limited. Objective To determine the level of knowledge, attitude, and practice of multidisciplinary rehabilitation among health professionals. Method A cross-sectional study was conducted across three hospitals in the Kavre district involving 118 various health professionals. A self-administered questionnaire was used to measure knowledge, attitude, and practice. Knowledge scores ranged from 0 to 24 (≤ 8: low, 9-16: moderate, > 16: high) and attitude scores from 0 to 20 (≤ 6: low, 7-14: moderate, > 14: high). Data were analyzed using SPSS version 26, employing descriptive statistics and non-parametric tests. Result The mean knowledge score was 17.77 ± 4.91, with 72% of participants demonstrating a high level of knowledge in multidisciplinary rehabilitation. The mean attitude score was 16.22 ± 3.23, with 74% rating high positive attitudes. Regarding practice, 50% of participants referred more than five patients to physiotherapists monthly, while 79.4% did not refer any patients to physiatrists monthly. Conclusion Health professionals in the Kavre district exhibit generally high knowledge and positive attitudes towards multidisciplinary rehabilitation. Nonetheless, referral patterns indicate underutilization of physiatrists and speech therapists, suggesting areas for targeted interventions to improve multidisciplinary rehabilitation services accessibility in Nepal.

PMID:42318729

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):493-498.

ABSTRACT

Background Laparoscopic Cholecystectomy is, a frequently performed surgery for symptomatic cholelithiasis. On various studies, in a significant proportion of patients developing gallstones, biliary infection has been noted. Objective To assess the bacteriological profile of bile and to determine antibiotic sensitivity pattern for preoperative prophylaxis in laparoscopic cholecystectomy patients. Method A prospective observational study was carried out from November 2021 to April 2022 at the Department of Surgery, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal after obtaining ethical approval from the Institutional Review Committee of Nepalese Army Institute of Health Sciences (Reg. No: 478) and informed written consent from each patient. A total of 123 patients undergoing for laparoscopic cholecystectomy were studied. About 5 ml of bile aspirated from gall bladder was collected in a sterile syringe and transported to laboratory for culture and sensitivity. Demographic characteristics, culture outcomes and postoperative parameters were collected using predesigned Performa. Statistical analysis was performed using Statistical Package for the Social Sciences software (SPSS). Result Bile culture was positive in 25 (20.33%) patients. The most predominant organisms were Gram negative bacteria. The most commonly isolated organisms were Escherichia coli, Pseudomonas spp and Klebsiella spp. On sensitivity profile, the isolates were most sensitive to antibiotics like: amikacin, gentamicin, clindamycin, meropenem, imipenem, linezolid and piperacillin plus tazobactum with resistance encountered against ampicillin. Conclusion Most common organisms isolated from bile culture were Gram negative. Aminoglycoside group of drugs was found to be most sensitive and can be used as first line drug for preoperative prophylaxis in patients undergoing laparoscopic cholecystectomy. It also highlights on the importance of understanding demographical and clinical aspects of patient’s profile along with bactibilia.

PMID:42318727

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):487-492.

ABSTRACT

Background Video-assisted teaching in the nursing field serves as a valuable and innovative tool to enhance the learning experience for students. When there is a demonstration technique available, video-based education can be a good replacement. As future nurses, nursing students need a comprehensive understanding of insulin therapy to effectively educate and empower patients in managing their condition. Objective To assess the effectiveness of a video-assisted teaching program in improving nursing students’ knowledge and skills in insulin therapy. Method A quasi-experimental study was conducted among B.Sc. Nursing students from two Kathmandu University-affiliated colleges from 22nd March to 25th May 2024. Eligible students were allocated into the intervention group (n1=62) received both traditional demonstration and 10-minute video instruction, while the control group (n2=55) received only traditional demonstration. Baseline demographic data, knowledge, and skills were collected using self-administered questionnaires and a checklist. After four weeks, post-intervention assessments were conducted. Ethical approval and written informed consent was obtained. Data were analyzed using SPSS version 20 with descriptive statistics and inferential tests including t-test, Mann-Whitney U-test and Wilcoxon signed-rank test. Result Knowledge and skill scores significantly increased in both groups (p value < 0.001). However, the intervention group demonstrated a significantly higher increase in knowledge and skill scores compared to the control group, with p-values of 0.026 and <0.001, respectively. Conclusion The study indicates that video-assisted teaching effectively enhances nursing students’ knowledge and skills in insulin administration. Nursing education programs in Nepal can integrate such tools to produce more competent and confident nurses.

PMID:42318726

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):471-476.

ABSTRACT

Background Internal jugular venous cannulation is required in many aspects for patients in intensive care, major surgeries, hemodialysis etc. Superficial cervical plexus block allows field of anesthesia to operate and secure the cannula in awake patient. Objective To study pain relief caused by superficial cervical plexus block of local anesthesia during the procedure of cannulation of internal jugular vein in patients requiring central venous cannulation. Method This prospective observational study was conducted from December 2023 to August 2024 at Dhulikhel Hospital, Kathmandu University Hospital. Sixty four awake patients with American Society of Anesthesia (ASA) I-III requiring central venous cannulation received ultrasound-guided Superficial cervical plexus block with 10 ml of 0.25% ropivacaine prior to internal jugular venous cannulation. Pain score (Verbal Pain Rating Scale) and hemodynamic changes (Heart rate, Mean Arterial Pressure, Spo2) were assessed at key procedural steps: during block, needle puncture, subcutaneous tunneling, catheter insertion, securing and suturing and five minutes post-procedure with any adverse effect and complication. Data were analysed using SPSS 22, student’s unpaired t-test was applied to the continue statistical data and chi square test to the categorical test considering significance p value <0.05. Result All cannulations were successful on the first attempt. Only 1 patient (1.56)% required additional analgesia due to moderate pain during tunneling. Mean pain scores were minimal at all other stages (≤ 1). Hemodynamic parameters remained stable throughout the procedure, with no significant complications observed. Conclusion Ultrasound guided superficial cervical plexus block provides effective analgesia at various stages of procedure avoiding the complications. This study recommends Superficial block as one of the analgesic technique during awake internal jugular venous cannulation to improve patient comfort and procedural safety.

PMID:42318723