Tag: statistics

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):749-754. doi: 10.55519/JAMC-04-14131.

ABSTRACT

BACKGROUND: Amphetamine use disorder (AUD) is a public health concern on a global scale and is a rising epidemic in Pakistan. Cognitive Behavioural Therapy (CBT) is a well-established treatment for substance use disorders, but its efficacy may be dependent on what is known as socio demographic and behavioural variables. The aims of this study are to provide evaluation of efficacy of CBT for AUD in Pakistani population and to find whether the presence of factors like education, job, duration of addiction, residence, age, family support, smoking and alcohol intake may affect treatment outcomes.

METHODS: A quasi-experimental design was applied with 100 participants recruited from outpatient treatment centers and rehabilitation centers in Pakistan. A culturally adapted CBT program was delivered to 50 participants along with treatment as usual and standard treatment as usual (TAU) was given to control group with 50 participants. Addiction Severity, anxiety, depression, psychological wellbeing, quality of life, as well as relapse rates were measured using pre-test and post-test assessments. Descriptive statistics, paired t-tests, ANOVA, multiple regression and survival analysis were completed to analyze the data.

RESULTS: The frequency of amphetamine use from pre to post change from 5.8 to 2.3 days per week (p<0.001) and ASI, addiction severity index scores from pre to post change from 30.2 to 18.7 (p<0.001) was significant in the CBT group. On the behavioural as well as on the psychological measures, improvements were observed, as evidenced by a decrease in the BDI from 22.4 to 14.1 (p<0.001) and a decrease in the GAD-7 from 18.5 to 11.3 (p<0.001). Significantly higher Quality of Life (WHOQOL-BREF) scores improved from 45.3 to 62.0 (p<0.001). But the TAU group also got better, just not as much as the CBT group. Positive associations were found with socio-demographic factors (such as higher education, stable employment and strong family support) and negative associations with unemployment, longer duration of addiction and regular alcohol intake.

CONCLUSIONS: Both the effectiveness of CBT and its suitability to reduce amphetamine use, enhance psychological wellbeing, and improve quality of life among individuals with AUD in Pakistan were demonstrated. The significance of incorporating social demographic factors, and behavioural factors in the development of CBT interventions to ensure maximal treatment effect is underscored.

PMID:40121636 | DOI:10.55519/JAMC-04-14131

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):734-737. doi: 10.55519/JAMC-04-13574.

ABSTRACT

BACKGROUND: The aim was to assess the clinical outcome of non-anatomic rotator-cuff repair in large tears not amenable to anatomic repair and to assess the preoperative factors that affect the result of such repairs. A retrospective case-series at Ghurki Trust Teaching Hospital, Lahore. Twenty-seven cases that underwent non-anatomic rotator-cuff repair at GTTH over the last 5 years and met inclusion criteria were assessed over a three-month study period (from 01/10/2023 to 31/12/2023).

METHODS: Outcome was assessed in terms of improvement in pain as per visual-analog-scale (VAS), UCLA, as well as Constant score. Furthermore, patients’ satisfaction was also assessed to measure subjective efficacy of the procedure.

RESULTS: Most commonly cases of rotator cuff tear present with pain, weakness, and restriction of shoulder range of motion. Pain improved significantly (p<0.001) from preoperative score of 3.68 to 1.45. Analysis of the objective assessment showed statistically significant (p=001) improvement in Constant score from a preoperative average score of 63.63 to a postoperative average of 77.27, with significant improvement (p=0.05) in each individual scoring criteria as well. The other scoring studied: UCLA also improved significantly (p=0.001) from 25.36 to 30.18. Despite this, on subjective assessment 40.9% of the sample was very satisfied and 27.3% were satisfied with the outcome.

CONCLUSIONS: Non-anatomic repair is very effective at treating the presenting complaints of the rotator cuff tear patients. Thus, alongside good clinical outcome, patient satisfaction can be predicted after the procedure.

PMID:40121633 | DOI:10.55519/JAMC-04-13574

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):730-733. doi: 10.55519/JAMC-04-13720.

ABSTRACT

BACKGROUND: Accurate and comprehensive documentation during emergency admissions is crucial for ensuring patient safety. This is especially important in high-risk environments such as neurosurgery. Traditional freehand clerking methods often result in incomplete or inconsistent records, potentially compromising patient care. This study aimed to evaluate the impact of introducing a structured surgical clerking proforma on the quality of emergency admission clerking in a tertiary care neurosurgery unit.

METHODS: A three-phase comparative audit was conducted, comprising an initial audit of traditional clerking methods (Cycle 1), the implementation of a surgical clerking proforma, and a subsequent re-audit using the proforma (Cycle 2). Data were collected retrospectively from 40 patient records in Cycle 1 and prospectively from 30 patient records in Cycle 2. The completeness of documentation was assessed across 31 key parameters, and statistical significance was determined using paired t-tests on simulated data.

RESULTS: The introduction of the surgical clerking proforma resulted in significant improvements in documentation completeness, particularly for parameters such as the Consultant Responsible and Reviewing Doctor, which saw increases of 30% and 32.5%, respectively (p<0.05). These improvements underscore the effectiveness of the proforma in standardizing and enhancing the reliability of clinical documentation.

CONCLUSIONS: The structured surgical clerking proforma significantly improved the quality of emergency admission documentation in the neurosurgery unit. The findings support the broader adoption of such proformas across various medical specialties to enhance the accuracy, consistency, and reliability of clinical records, ultimately contributing to improved patient care and safety.

PMID:40121632 | DOI:10.55519/JAMC-04-13720

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):726-729. doi: 10.55519/JAMC-04-13758.

ABSTRACT

BACKGROUND: Diabetes mellitus is a disease with many possible complications like macrovascular, i.e., stroke, coronary artery disease, peripheral artery disease, and microvascular, i.e., retinopathy, neuropathy and nephropathy. Many studies have been done in past to find the frequencies of these complications and their association with sociodemographic determinants of diabetic patients, but there was limited data available in our setup. This study was carried out to determine the frequency of micro and macrovascular complications of diabetic patients and their association with socioeconomic determinants at Ayub Teaching Hospital, Abbottabad.

METHODS: This cross-sectional study was carried out at Ayub Teaching Hospital, Abbottabad, Pakistan, from July 2022 till December 2023 on 113 diabetic patients. The data was collected on micro and macrovascular complications of diabetes on a pre-designed structured proforma and analyzed by means of SPSS-23.

RESULTS: The most common macrovascular complication was coronary artery disease 10 (8.8%) while neuropathy 35 (31%) was the most common microvascular complication. Among macrovascular complications stroke was associated significantly with age (p=0.01) and duration of diabetes (p=0.032). Among microvascular complications neuropathy was associated with gender (p=0.047), nephropathy with smoking (p=0.02) and retinopathy with both gender (p=0.019) and smoking (p=0.017).

CONCLUSIONS: In this study there was significant association between, gender with neuropathy and retinopathy, smoking with nephropathy and retinopathy, stroke with age and duration of diabetes.

PMID:40121631 | DOI:10.55519/JAMC-04-13758

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):698-701. doi: 10.55519/JAMC-04-12375.

ABSTRACT

BACKGROUND: This audit primarily assesses compliance with the British Thoracic Society guidelines (BTS) for oxygen prescriptions in the Respiratory Department at King’s Mill Hospital. The results of this audit aim to guide the strategies to improve the oxygen prescription practices in the Trust.

METHODS: We collected the data on oxygen prescriptions, from the electronic prescribing system, of all the patients admitted in the three respiratory wards of King’s Mill Hospital over the period of one week. This data was then recorded and analysed using Audit management and Tracking© (AMAT).

RESULTS: The overall compliance score to BTS guidelines for oxygen prescription was 12.2%. Out of the 152 patients, only 8 (5%) had oxygen therapy prescribed and a target oxygen saturation range was identified. No patient had an identifiable oxygen delivery method on their prescription.

CONCLUSIONS: The current practices of oxygen prescription at the respiratory department of King’s Mill Hospital are suboptimal. These findings highlight the risk of serious potential consequences and the opportunity to implement safe prescribing measures for oxygen, like other prescribed medications.

PMID:40121625 | DOI:10.55519/JAMC-04-12375

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):686-691. doi: 10.55519/JAMC-04-13550.

ABSTRACT

BACKGROUND: Admission for heart failure poses a significant risk of readmission. Evaluating readmission rates in settings lacking chronic disease management programs could provide valuable insights to advocate for the establishment of such services.

METHODS: This study focused on patients admitted to the Cardiology Department of Ayub Medical Teaching Institute with acute decompensated heart failure. After excluding patients based on exclusion criteria, demographic and clinical data were recorded, including symptoms, signs, discharge medications, and readmission status within 6 months. Patients not readmitted were contacted via telephone at 1, 3, and 6 months. Readmission rates and time to first readmission or death were documented.

RESULTS: A total of 222 patients were enrolled, with 60% being males. All patients exhibited pulmonary congestion, with 85% classified as NYHA Class III or IV. Comorbidities included hypertension (59%), history of myocardial infarction (45.49%), and diabetes (38.28%). Within 6 months, 21% of patients were readmitted, and 13% died before readmission, resulting in an overall death or readmission rate of 34% at 6 months. No significant differences were observed between readmitted and non-readmitted patients regarding sex, age, creatinine levels, haemoglobin levels, sodium levels, or ejection fraction. Utilization of guideline-directed medical treatment was low.

CONCLUSION: The high rate of readmission or death among patients admitted with acute decompensated heart failure underscores the necessity for implementing multidisciplinary care to closely monitor these patients.

PMID:40121623 | DOI:10.55519/JAMC-04-13550

Health Rep. 2025 Mar 19;36(3):17-28. doi: 10.25318/82-003-x202500200002-eng.

ABSTRACT

BACKGROUND: Ambulatory care sensitive conditions (ACSCs) are illnesses that can be effectively treated and managed in primary care settings. Hospitalizations for ACSCs are therefore considered avoidable and may indicate poor access to quality primary care. This study examined trends in avoidable hospitalizations in Canada among racialized groups.

DATA AND METHODS: The 2016 Canadian Census Health and Environment Cohort was used to estimate annual age-standardized hospitalization rates (ASHRs) for ACSCs among people aged 10 to 74 from 2016/2017 to 2021/2022. ASHRs were disaggregated by sex and racialized group. Rate ratios (RRs) and 95% confidence intervals (CIs) were calculated to assess relative inequality. Logistic regression models were run, adjusting for age, sex, immigrant status, household income, and education.

RESULTS: Across all study years, the odds of avoidable hospitalizations were significantly higher among males, Black people, and non-immigrants, and significantly lower among Chinese people and people in the category “other racialized groups not included elsewhere.” In 2020/2021, during the COVID-19 pandemic, RRs for Black females compared with non-racialized females decreased (2019/2020: RR=1.12, 95% CI=1.07 to 1.61; 2020/2021: RR=0.99, 95% CI=0.94 to 1.04), while they significantly increased for Black males compared with non-racialized males (2019/2020: RR=1.30, 95% CI=1.25 to 1.35; 2020/2021: RR=1.63, 95% CI=1.41 to 1.88).

INTERPRETATION: This study reveals inequalities in avoidable hospitalizations in Canada, pronounced for the Black population compared with the non-racialized population, especially during the pandemic (2020/2021 and 2021/2022). Future studies examining the factors driving these inequalities (e.g., access to primary care, most prevalent conditions, geography) may inform targeted interventions.

PMID:40121621 | DOI:10.25318/82-003-x202500200002-eng

Clin Pharmacokinet. 2025 Mar 23. doi: 10.1007/s40262-025-01500-9. Online ahead of print.

ABSTRACT

OBJECTIVES: The volume kinetics of a commercially available colloid fluid, Gelofusine, have not been studied previously.

METHODS: Intravenous Gelofusine 10 mL/kg was infused over 30 min in 15 patients undergoing vascular surgery. Of the 15 patients, 14 were classified as American Society of Anesthesiologists (ASA) class III status. The distribution and elimination of the infused volume was calculated with mixed-model kinetics based on 280 measurements of the hemoglobin-derived plasma dilution (19 per patient) collected over 180 min.

RESULTS: The expanded central fluid space volume (V_c, the plasma) amounted to 2.16 L (95% confidence interval [CI] 1.06-2.35) at baseline. The maximum volume expansion of V_c was 706 mL (95% CI 599-812) after infusing Gelofusine 800 mL. Elimination occurred with a half-life of 115 min (95% CI 110-124). Noradrenaline was infused in eight of the 15 patients, leading to a dose-dependent reduction in elimination half-life. For example, an infusion rate of 3 µg/min decreased the half-life to 60 min (- 48%). Distribution of the infused volume to the extravascular space was small (15%), and redistribution to the plasma was accelerated by noradrenaline. Mean arterial pressure and urinary creatinine were not statistically significant covariates, and the model was not strengthened by considering the urine output. Infusion protocols aiming to achieve steady state plasma volume expansion during surgery can begin with a fast infusion over 20 min, then decreasing the rate by 80%.

CONCLUSION: The kinetics of Gelofusine was predictable in patients of American Society of Anesthesiologists class III status undergoing vascular surgery, with the fluid expanding the vascular space and the half-life shortened by noradrenaline.

TRIAL REGISTRATION: Retrospectively registered with ClinicalTrials.gov NCT06474052, June 24, 2024.

PMID:40121598 | DOI:10.1007/s40262-025-01500-9

Epilepsia Open. 2025 Mar 22. doi: 10.1002/epi4.70021. Online ahead of print.

ABSTRACT

OBJECTIVE: Investigate real-world outcomes in drug-resistant epilepsy (DRE) patients treated with cenobamate as adjunctive treatment to other antiseizure medications (ASMs) within the Early Access Programs (EAP) in Germany, France, and the United Kingdom.

METHODS: DRE adults with uncontrolled focal-onset seizures were included from 19 hospitals participating in the EAP in this retrospective study. Data were sourced from clinical records. Participants were evaluated at baseline, 1 months, and 3 months from cenobamate start, and 3, 6, and 12 months after maintenance. The primary effectiveness endpoint was the 50% responder rate, defined as the reduction in seizure frequency ≥50%.

RESULTS: Data were collected from 298 patients who received at least one dose of cenobamate; efficacy was evaluated on 216 patients with seizure data available. At baseline, the median epilepsy duration was 22.2 years, and 41.9% of patients had previous epilepsy surgery, including vagus nerve stimulation, with a median of nine previously failed ASMs. The median number of seizures/month was 8.8. After 3 months of maintenance, the 50% responder rate (primary endpoint) was 49.3%; the median percentage seizure reduction from baseline was 49.1%. A total of 100%, ≥90%, and ≥75% seizures reduction were reported in 13.6%, 20.0%, and 33.6% of patients, respectively. Both the responder rate and the median percentage seizure reduction steadily increased during the observation period. At 6-month maintenance, the seizure-free rate was 24.2%. The retention rate assessed by Kaplan-Meier decreased from 96.6% at 1-month cenobamate start to 69.7% at 12-month maintenance. Adverse Drug Reactions (ADRs) to cenobamate occurred in 30.9% of patients, with asthenia, dizziness, and somnolence being the most frequent; the majority were mild-to-moderate and resolved during the observation period; three patients (1.0%) experienced a total of seven serious ADRs, all during titration.

SIGNIFICANCE: In this study, cenobamate demonstrated to be an effective option for people with uncontrolled epilepsy even after multiple failed ASMs or failure of epilepsy surgery.

PLAIN LANGUAGE SUMMARY: This study involved patients with drug-resistant epilepsy, who had continued seizures despite using at least two antiseizure medications (ASMs). Patients received cenobamate (Ontozry) as epilepsy treatment during the Early Access Program (EAP) in France, Germany, and the United Kingdom. An EAP allows patients to receive promising new drugs under clinical supervision before they are commercially available. After 6 months from cenobamate start, 49.3% of patients had their seizures cut by half or more, and 13.6% became seizure-free. A total of 30.9% of patients had an undesirable reaction to cenobamate, mostly mild-to-moderate and resolved; the most frequent were asthenia, dizziness, and somnolence.

PMID:40119878 | DOI:10.1002/epi4.70021

Epilepsia. 2025 Mar 22. doi: 10.1111/epi.18380. Online ahead of print.

ABSTRACT

We compared the efficacy of lacosamide to other frequently used second-line anti-seizure medications (ASMs) for adult status epilepticus (SE) by conducting a retrospective analysis of an institutional SE registry between January 2013 and December 2022. Clinical outcomes assessed at discharge were categorized as return to baseline, new disability, or death; we also considered SE termination after the second-line ASM and the need for mechanical ventilation. Potential confounders included the Status Epilepticus Severity Score (STESS), sex, adequacy of initial SE treatment, treatment delay, and potentially fatal etiology. Over 10 years, 961 adult SE episodes were analyzed; 868 were treated with the following second-line ASMs: 413 levetiracetam (47.6%), 110 valproate (12.7%), and 75 lacosamide (8.6%), as well as lower rates of 18 other ASMs including benzodiazepines (not further analyzed). Univariable analysis identified STESS, treatment delay, and adequacy of initial SE treatment as potential confounders. On multivariable analysis adjusting for these variables, patients with episodes treated with second-line lacosamide, levetiracetam, or valproate demonstrated statistically equivalent rates of seizure cessation, need for mechanical ventilation, and clinical outcomes at hospital discharge. We conclude that lacosamide appears to represent a reasonable alternative to levetiracetam and valproate, and warrants consideration for inclusion in future randomized controlled trials for control of SE.

PMID:40119876 | DOI:10.1111/epi.18380