Tag: statistics

J Contin Educ Health Prof. 2023 Jan 1;43(1):4-11. doi: 10.1097/CEH.0000000000000485.

ABSTRACT

INTRODUCTION: Patients seeking treatment for complex conditions require coordinated care from interprofessional clinicians. Collaborative engagement in an interprofessional community of practice is crucial to the collective competence of a team and the provision of high-quality, safe health care leading to improved patient outcomes. The objective of this descriptive, cross-sectional study was to describe interprofessional communication, coordination, and collaboration of participants in an integrated practice unit that was structured to include weekly case conferences as part of routine practice.

METHODS: Data were collected from October 2019 to February 2020. Web-based surveys were administered to a convenience sample that included 33 questions and followed the CHERRIES checklist for reporting results. Items focused on team knowledge, impact on patient care, and communication, and conference focus and effectiveness. Descriptive and survey item analysis included frequency, percentage, means and standard deviation, Chi-square, and Pearson correlation analysis. Patient outcome data were collected via a Patient Global Impression of Improvement scale and were analyzed using a paired sample t test.

RESULTS: Survey respondents (n = 161) included clinicians and administrative staff. Results demonstrated that interprofessional case conferences improved the collective competence of the team, including team knowledge and communication. Participants viewed case conferences as a means to enhance care delivery quality, value, safety, and equity. In the study period, there was also a statistically significant improvement between the patient’s first follow-up and last visits.

CONCLUSION: Survey respondents indicated that case conferences were an effective means to deliver high-quality, patient-centered care through interprofessional collaboration and education.

PMID:36849427 | DOI:10.1097/CEH.0000000000000485

J Ayub Med Coll Abbottabad. 2023 Feb-Mar;35(1):133-136. doi: 10.55519/JAMC-01-10932.

ABSTRACT

BACKGROUND: Cryotherapy is a common destructive treatment modality for treating plantar warts that results in blistering and scarring. Mitomycin an antitumor drug with antiviral property is a safe, better and a promising option for treating plantar warts. Objective was to compare efficacy of cryotherapy and mitomycin microneedling in the management of plantar warts. It was a randomized controlled trial conducted at the Skin Department CMH Abbottabad from 1st May to 31st December 2021.

METHODS: The study included 60 patients with plantar warts. Each group with 30 patients. Random tables were used to determine the distribution of patients within each group. Group A received mitomycin microneedling (1u/ml) repeated every 3 weeks. Group B was prescribed liquid nitrogen cryotherapy. The freeze-thaw cycle was 20 secs and repeated every 2 weeks. Both groups were treated for 4 months duration. For analysis of data, SPSS version 21.0 was used. Efficacy was compared by the application of Chi-square test between the two groups. p<0.05 was considered statistically significant.

RESULTS: Mitomycin microneedling completely cured 76.7% of patients, while cryotherapy was effective for only 56.7%. Complete remission was observed after two to three sessions of mitomycin microneedling while average of 4 sessions of cryotherapy were required for complete remission. In general, microneedling with mitomycin had better tolerance, pain being the commonest adverse effect.

CONCLUSIONS: Plantar warts can be effectively treated with mitomycin microneedling. Treatment of plantar warts with this method is more effective, requires fewer sessions, and may take less time to complete.

PMID:36849393 | DOI:10.55519/JAMC-01-10932

J Ayub Med Coll Abbottabad. 2023 Feb-Mar;35(1):127-132. doi: 10.55519/JAMC-01-11451.

ABSTRACT

BACKGROUND: One of the most frequent diseases among male gender is benign prostatic hyperplasia. Transurethral resection of the prostate (TURP) is a minimally invasive procedure for resection of prostate through endoscopic technique. Recently there was a debate on role of saddle block in TURP. There we aimed to determine the effectiveness of spinal anaesthesia versus saddle block in terms of hemodynamic stability and vasoprbessor requirement in TURP.

METHODS: This open label randomized control trial was performed at Hamdard University Hospital, Karachi, Pakistan, during 1st October, 2021 to 31st March, 2022. Male patients of age 45-65 years requiring TURP, with well controlled diabetes and hypertension of ASA grade I-II were included into the study and randomly assigned into two study groups. Patients’ parameters including blood pressure, heart rate, mean arterial pressure and oxygen saturation (SPO2) were measured at baseline and intraoperative at every fifth minute interval till surgery completion. Patients’ other parameters including age, surgery duration and comorbidity were also recorded.

RESULTS: Total 60 patients with 30 patients in each group were enrolled into the study. Maximum fall in systolic blood pressure, diastolic blood pressure, pulse rate and mean arterial pressure from baseline was significantly lower in patients receiving saddle block anaesthesia than spinal anaesthesia. Maximum fall in SPO2 was not significantly different among two study groups. Maximum fall in all parameters excluding SPO2 was significant between two groups for initial 20 minutes of the procedure. No statistically significant maximum fall was seen for all of the parameters beyond 20 minutes of the procedure. Vasopressor consumption was significantly lower in saddle block group than spinal anaesthesia.

CONCLUSIONS: Application of saddle block anaesthesia is effective for TURP procedure with controlled hemodynamic status than spinal anaesthesia. Moreover, saddle block requires less vasopressor consumption than spinal anaesthesia technique.

PMID:36849392 | DOI:10.55519/JAMC-01-11451

J Ayub Med Coll Abbottabad. 2023 Feb-Mar;35(1):123-126. doi: 10.55519/JAMC-01-11092.

ABSTRACT

BACKGROUND: Coccydynia is also known as coccygodynia or coccygeal neuralgia. Coccyx is a triangular bone located within the vertebral column. The cause of coccydynia is unknown in the literature; however, it is found to be common among obese individuals, particularly females. The probability of women having coccydynia is five times higher than among men, which may result from larger pressure during pregnancy and child delivery. It is treated well with ganglion impar block. The aim of our study was to assess pain relief after Ganglion Impair Block with subsequent improvement in quality of life.

METHODS: A single-arm study was done in the department of Pain Medicine, Fauji Foundation Hospital, Rawalpindi from July 2021 to June 2022. A total of 50 patients with ≥3 months’ coccygeal pain of either gender aged between 20-60 years unresponsive to analgesics & anti-inflammatory medications with no laboratory abnormalities were included. Fluoroscopic guided trans-sacro‑coccygeal ganglion impair block was done with alcohol neurolysis. The patients were observed for 1 hour in the recovery room to record post-intervention complications that may occur like hypotension, bradycardia, signs, and symptoms of cardiotoxicity or neurotoxicity etc. and evaluated for pain scores on the basis of the numeric rating scale (NRS). Data collected was analyzed using the statistical package for social scientists (SPSS) version 21. The quantitative data, i.e., age and NRS score were analyzed using mean and standard deviation and compared between pre and post-intervention periods.

RESULTS: The data from 50 patients who completed the follow-up period were used for analysis. The average age of the patients was 42.9±8.39 years, with a range of 38-60 years. Based on the data obtained, 30% of the patients experienced trauma (that is falling on the coccyx region). The mean score from NRS before intervention was 7.80±0.16 which decreased to 0.96±0.35, respectively, and this difference was statistically significant (p-value, <0.001).

CONCLUSIONS: Ganglion Impar neurolysis is highly effective in the treatment of chronic coccydynia.

PMID:36849391 | DOI:10.55519/JAMC-01-11092

J Ayub Med Coll Abbottabad. 2023 Feb-Mar;35(1):80-83. doi: 10.55519/JAMC-01-11188.

ABSTRACT

BACKGROUND: In 2019 novel coronavirus was discovered in Wuhan, China and declared pandemic by world health organization. The disease caused by this virus called coronavirus disease 2019 (COVID-19). Among the corona family the actual virus responsible for COVID-19 is Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). Objective of the study was to determine the pattern of blood parameters in corona virus disease (COVID-19) positive cases and the association of these parameters with severity of COVID-19.

METHODS: This cross-sectional descriptive study was conducted on 105 participants who were confirmed positive by SARS-CoV-2 through real-time reverse transcriptase PCR, both genders, and Pakistani nationals. The participants who were below 18 years age and missing data were excluded. Haemoglobin (Hb), total leukocyte count (TLC), neutrophil, lymphocyte, monocyte, basophil and eosinophil counts were calculated. Comparison of blood parameters was done among various severity classes of COVID-19 by running one way ANOVA. The level of significance was p≤0.05.

RESULTS: The mean age of the participants was 50.6±6.26 years. Males were 78 (74.29%) and females were 27 (25.71%). In critical type COVID-19 the mean haemoglobin was least (10.21±1.07 g/dl) and highest in mild cases (15.76±1.16 g/dl) and these differences were highly statistically significant (p<0.001). TLC was highest in critical COVID cases (15.90±0.51×103 /μl) followed by moderate (12.44±0.65×103/μl). Similarly, neutrophil count was highest in critical (89±2.1) followed by severe (86±1.12).

CONCLUSIONS: There is significant decrease in mean haemoglobin level and platelet count but increase in TLC in patients infected from COVID-19.

PMID:36849382 | DOI:10.55519/JAMC-01-11188

J Ayub Med Coll Abbottabad. 2023 Feb-Mar;35(1):76-79. doi: 10.55519/JAMC-01-11149.

ABSTRACT

BACKGROUND: Cataract surgery has become one of the most common surgeries in the world with one in every four surgeries performed being a cataract extraction and the numbers are expected to increase by 16 percent in the USA alone by 2024 as compared to the current statistics. The aim of the study is to analyze the visual outcomes of intraocular lens implants for various visual ranges.

METHODS: This non-comparative interventional study was conducted at the Ophthalmology department of Al Ehsan Eye Hospital from Jan to Dec 2021. It included patients who underwent uneventful phacoemulsification with an intraocular lens implant and analysis of the visual outcomes for uncorrected distance (UDVA), uncorrected intermediate distance (UIVA), and uncorrected near distance (UNVA).

RESULTS: Independent sample t-test was applied to observe the mean values of recorded far vision on the 1stday, 1 week, and 1 month after the trifocal intraocular lens implantation. It showed a significant difference with a p-value of 0.00 on 1st day, 1 week, and 1 month after was 0.3±0.1, 0.17±0.09, and 0.14±0.08 respectively. Mean improvement in near vision after 1 month was N6 with S.D 1.03 and in intermediate vision was N8±1.4 respectively.

CONCLUSIONS: Trifocal Intraocular lens implantation offers an improved vision for near, intermediate, and distant visual ranges without the need for correction.

PMID:36849381 | DOI:10.55519/JAMC-01-11149

J Ayub Med Coll Abbottabad. 2023 Feb-Mar;35(1):68-75. doi: 10.55519/JAMC-01-11069.

ABSTRACT

BACKGROUND: Prone positioning improves ventilation-perfusion mismatch, distribution of gravitational gradient in pleural pressure, and oxygen saturation significantly in patients with Covid pneumonia. We aimed to find out the efficacy of eight hours per day of intermittent selfprone positioning for seven days in patients affected with COVID-19 pneumonia/ ARDS.

METHODS: This Randomized Clinical Trial was conducted in the Covid isolation wards of Ayub Teaching Hospital, Abbottabad. Patients suffering from COVID-19 pneumonia/ ARDS were enrolled with permuted block randomization into a control and an experimental group each consisting of 36 patients. Parameters of Pneumonia Severity Index (PSI) score along with other sociodemographic data was noted on a preformed structured questionnaire. Death was confirmed by requesting the death certificate of patients on the 90th day of enrolment. Data Analysis was done with SPSS Version 25. Tests of significance were applied to calculate the difference in the patients of the two groups with respect to respiratory physiology and survival.

RESULTS: The mean age of the patients was 63.79±15.26 years. A total of 25 (32.9%) male and 47 (61.8%) female patients were enrolled. Statistically significant improvement was found in the respiratory physiology of the patients at 7th and 14th DOA between the groups. Pearson Chi-Square test of significance showed a difference in mortality between the two groups at 14th DOA (pvalue=0.011) but not at 90th DOA (p-value=0.478). Log Rank (Mantel-Cox) test of significance, applied on the Kaplan Meier curve and showed no statistically significant difference among the groups based on the survival of the patients. (p-value=0.349).

CONCLUSIONS: Early transient improvement in respiratory physiology and mortality does occur with 8 hours of self-prone positioning for seven days but there is no effect on the 90-day survival of the patients. Thus, the impact of the manoeuvre on improving survival needs to be explored with studies having an application of the manoeuvre for a longer duration and period.

PMID:36849380 | DOI:10.55519/JAMC-01-11069

J Ayub Med Coll Abbottabad. 2023 Feb-Mar;35(1):50-53.

ABSTRACT

BACKGROUND: Vesical calculi refer to stones in the urinary bladder. The causes of bladder stones include bladder outlet obstruction, neurogenic voiding dysfunction, infection, or foreign bodies. Very rarely, these vesical calculi may reach very large sizes and the largest dimension can sometimes reach 13 centimetres.

METHODS: This descriptive cross-sectional study was conducted from 1ST May 2019 to 31st October, 2019 at Institute of Kidney Diseases, Urology Department, Hayatabad Peshawar. 164 patients with vesical stone were included in study. Ultrasound-KUB was used for diagnosis of vesical stone and after informed consent, and they underwent transurethral nephroscopic lithotripsy via the pneumatic Swiss Lithoclast.

RESULTS: Frequency of stone clearance was 96.34%. No statistically significant association of stone clearance was observed with age, gender, number of stones or max dimension of largest stone in the bladder (p>0.05).

CONCLUSIONS: Transurethral nephroscopic pneumatic lithotripsy via pneumatic Swiss Lithoclast is safe and effective procedure for treatment of large vesical stones. However, this being the first such study in adults, more data is needed to confirm these findings.

PMID:36849376

J Ayub Med Coll Abbottabad. 2023 Feb-Mar;35(1):32-36. doi: 10.55519/JAMC-01-10605.

ABSTRACT

BACKGROUND: Distal radius fracture is one of the most common injuries presented to emergency department and can be presented in any age group. In young patients the most common cause is Road Traffic Accident (RTA), while old patient history of fall is the most common cause. Different surgical options are available to treat this injury. This study aims to compare the outcome of volar buttress plate vs across wrist external fixator for Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C2/C3 fracture of the distal radius.

METHODS: A retrospective comparative study between July 2020 to June 2021 at Ghurki Trust Teaching Hospital was done and a total of 50 patients who underwent surgical intervention for AO C2/C3 fracture of the distal Radius, were included. The follow-up period was 12 weeks. QuickDASH score was used to find out patient’s functional outcomes. Functional outcome was analyzed between the two groups using Mann-Whitney U test, using SPSS version 21.

RESULTS: There was no significant statistical difference between the functional outcome of patients with distal radius fracture treated with across wrist external fixator vs volar buttress plate, in term of QuickDASH score. Furthermore, age and gender also were having no effect on functional outcome in our population.

CONCLUSIONS: Across wrist external fixator is a reasonable option for AO C2/C3 type fractures of the distal radius with comparable results with volar buttress plate. It is the procedure of choice in high volume tertiary care hospitals like Gurki Trust Teaching hospital as it saves time, have similar functional outcome score, no need to re-open for removal of implant, less chances of tendon rupture as compared to volar buttress plate for distal radius fracture.

PMID:36849373 | DOI:10.55519/JAMC-01-10605

J Ayub Med Coll Abbottabad. 2023 Feb-Mar;35(1):3-6. doi: 10.55519/JAMC-01-11512.

ABSTRACT

BACKGROUND: Strabismus is a common disease entity in paediatric age group usually requiring surgical intervention under general anaesthesia and Oculocardiac reflex is the most dangerous complications intraoperatively. Various anaesthetic options have been evaluated to mitigate this complication. The objective of this study was to assess the efficacy of sub-tenon’s block in paediatric strabismus surgery in terms of reduction in oculocardiac reflex.

METHODS: This prospective Randomized control trial was conducted at Department of ophthalmology, MTI, Hayatabad Medical complex, Peshawar over a period of six months from 1st July to 31st December 2021. A total of 124, were equally divided in subtenon’s group (Group A) and placebo group (Group B). Intraoperatively, patients were assessed for Bradycardia and development of OCR. Data including demographics, intraoperative BP, HR and OCR development were noted and analysed with SPSS version 22.

RESULTS: The total number of patients were 124, 62 in each group with a mean age of 9.45±1.61. Sixty-six (53.22%) patients were males and 58 (46.87%) patients were females. At 10-, 20- and 30-minutes interval, the SBP and DBP has no significant difference. At 10, 20, 30 minutes interval, the HR differed significantly (79.33±7.36 vs 66.65±6.83 (p˂0.05), 79.78±7.63 vs 66.57±7.06 (p˂0.05), 79.80±7.78 vs 66.52±7.01 (p˂0.05), respectively. Intraoperative OCR was recorded in 13 (21%) patients in sub-tenon’s (Group A) versus 56 (90.30%) patients in placebo (Group B) with statistically significant difference between the two (p<0.05).

CONCLUSION: Sub-tenon’s injection of bupivacaine reduces the incidence of Bradycardia and OCR in squint surgery patients after general anaesthesia induction and usage is recommended in routine.

PMID:36849367 | DOI:10.55519/JAMC-01-11512