What method of contact works best for recruiting participants in a study: lessons for health care researchers?

Objectives: To assess the various recruitment strategies used by medical researchers and their response rates. Methods: The observational study, part of a larger retrospective cohort, was done at the Aga Khan University Hospital, Karachi, Pakistan, from May 2008-December 2010, covering a period from 1999 to 2005. We used a multi-mode contact approach for including participants in the study. This comprised an invitational letter that described the study sent along with a mail-back, postage-paid envelope and multiple phone calls for recruitment of participants. The response to each mode was noted and described as frequency and percentage. Results: There were 1335 participants eligible for recruitment in the study. Of them, 1247 (93.4%) were sent mailouts to which only 84 (6.7%) responded. Besides, 1133 participants,whose phone numbers were available, were called. Overall, the number of people that we were able to contact was low. The response to postage paid mail was very poor whereas the majority of participants were contacted via phone calls. Out of such participants, 257 (19.25%) agreed to participate at the very first call and our results suggest that more than three calls made very little contribution to the consent rate. CONCLUSION: Recruiting subjects from contact information available in the medical records may not be the best method. Multiple and innovative approaches are required for approaching potential participants and requesting them to participate in a study

Titanium Cage Fixation in Thoracic and Thoraco-lumbar Anterior Inter-body Fusion

nner by inter body fusion. Study Design:  Prospective Study. Material and Method:  The study was conducted at the department of neurosurgery Lahore general hospital Lahore. Results:  Thirty cases were included during period two years. All cases operated for decompression, fusion and instrumentation, cages of titanium mesh were used. Neurological status of the patients assessed before and after operation. Twenty eight (93.3%) cases improved neurologically. Two (6.7%) did not improved. There were three infected cases which were treated and improved in the long run. Conclusion:  By using anterior interbody fusion (AIF) with cage we can mobilize the patient early. Improvement of the neurological status is excellent. Per operative infection rate is very low. Deformity can be corrected with more accuracy. Key Words:  Anterior cervical corpectomy, anterior dorsal inter body fusion, anterior, posterior and lateral, computed tommography, magnetic resonance imaging

Accounting Discretion, Loan Loss Provision in Financial Distress: Evidence from Commercial Banks

This study explores the association between earning management practices and financial distress in commercial banks. Earning management is measured through discretionary loan loss provisions and non-discretionary loan loss provisions. Modified Altman’s Z-score has been used as a proxy for financial distress. Panel regression with fixed and random effect has been employed for empirical analysis. The study finds a significant positive association between DLLP, NDLLP and financial distress in terms of the Altman Z-score. In the case of NDLLP, liquidity reduces the probability of financial distress. Whereas, a bank’s SIZE, LEVG and AQ enhance the likelihood of financial distress. The robustness tests were applied to find the association between NDLLP and FD using logistic regression to validate baseline estimates results of the random effect model. The findings of this study have implications for the policymakers, regulators and internal stakeholders to devise effective regulatory measures for well-informed investment decisions

Neurological health profile in pakistan – A health systems based needs assessment

The aims of our study were to develop a neurological health profile in Pakistan from a health systems perspective, ascertain the readiness of neurology with regards to Sustainable Development Goals, and proffer recommendations for policy advocacy and planning in neurology

Nyereségmenedzsment és pénzügyi nehézségek kialakulásának valószínűsége a bankoknál – Bizonyítékok a pakisztáni kereskedelmi bankoktól

A tanulmány a pénzügyi nehézségek (financial distress, FD) és a diszkrecionális elhatárolások alkalmazása közti kapcsolatot hivatott vizsgálni, húsz, a Pakisztáni Értéktőzsdén (Pakistan Stock Exchange, PSX) jegyzett pakisztáni kereskedelmi bank nyereségmenedzsment-gyakorlata alapján. A tanulmány a 2010–2015-ös évek adatait használja fel. A pénzügyi nehézségek felmérésére Altman-féle Z-mutató került alkalmazásra. A Z-mutató értékét a bankok veszélyeztetett és nem veszélyeztetett csoportokba való kategorizálására is alkalmazzák. Emellett a nyereségmenedzsment nem diszkrecionális (non-discretionary accruals, NDA) és diszkrecionális elhatárolások (discretionary accruals, DA) szerint került kategorizálásra. A változók közti kapcsolat tanulmányozására logisztikai megközelítés került alkalmazásra. A megállapítások mutatják, hogy a bankok nem diszkrecionális és diszkrecionális elhatárolások útján kezelik pénzügyi nehézségeiket. Jelen kutatási tanulmány hasznos betekintést kínál a befektetők, könyvvizsgálók és szabályozó hatóságok számára, mivel azonosítja a vezetés által a szigorú szabályozások ellenére alkalmazott intézkedéseket

Comparative trends in ischemic heart disease admissions, presentation and outcomes due to the COVID-19 pandemic: First insights from a tertiary medical center in Pakistan

Introduction: COVID-19 has manifested a striking disarray in healthcare access and provision, particularly amongst patients presenting with life-threatening ischemic heart disease (IHD). The paucity of data from low-middle income countries has limited our understanding of the consequential burden in the developing world. We aim to compare volumes, presentations, management strategies, and outcomes of IHD amongst patients presenting in the same calendar months before and during the COVID-19 pandemic.Methods: We conducted a retrospective cross-sectional analysis at the Aga Khan University Hospital, one of the premier tertiary care centres in Pakistan. Data were collected on all adult patients (\u3e18 years) who were admitted with IHD (acute coronary syndrome (ACS) and stable angina) from March 1 to June 30, 2019 (pre-COVID) and March 1 to June 30, 2020 (during-COVID), respectively. Group differences for continuous variables were evaluated using student t-test or Mann-Whitney U test. The chi-squared test or Fisher test was used for categorical variables. Values of p less than 0.05 were considered statistically significant. P-value trend calculation and graphical visualization were done using STATA (StataCorp, College Station, TX).Results: Data were assimilated on 1019 patients, with 706 (69.3%) and 313 (30.7%) patients presenting in each respective group (pre-COVID and during-COVID). Current smoking status (p=0.019), admission source (p\u3c0.001), month of admission (p\u3c0.001), proportions ACS (p\u3c0.001), non-ST-elevation-myocardial-infarction (NSTEMI; p\u3c0.001), unstable angina (p=0.025) and medical management (p=0.002) showed significant differences between the two groups, with a sharp decline in the during-COVID group. Monthly trend analysis of ACS patients showed the most significant differences in admissions (p=0.001), geographic region (intra-district vs intracity vs outside city) (p\u3c0.001), time of admission (p=0.038), NSTEMI (p=0.002) and medical management (p=0.001).Conclusion: These data showcase stark declines in ACS admissions, diagnostic procedures (angiography) and revascularization interventions (angioplasty and coronary artery bypass graft surgery, CABG) in a developing country where resources and research are already inadequate. This study paves the way for further investigations downstream on the short- and long-term consequences of untreated IHD and reluctance in health-seeking behaviour

Hearing loss prevalence and years lived with disability, 1990–2019: findings from the Global Burden of Disease Study 2019

Background Hearing loss affects access to spoken language, which can affect cognition and development, and can negatively affect social wellbeing. We present updated estimates from the Global Burden of Disease (GBD) study on the prevalence of hearing loss in 2019, as well as the condition's associated disability. Methods We did systematic reviews of population-representative surveys on hearing loss prevalence from 1990 to 2019. We fitted nested meta-regression models for severity-specific prevalence, accounting for hearing aid coverage, cause, and the presence of tinnitus. We also forecasted the prevalence of hearing loss until 2050. Findings An estimated 1·57 billion (95% uncertainty interval 1·51–1·64) people globally had hearing loss in 2019, accounting for one in five people (20·3% [19·5–21·1]). Of these, 403·3 million (357·3–449·5) people had hearing loss that was moderate or higher in severity after adjusting for hearing aid use, and 430·4 million (381·7–479·6) without adjustment. The largest number of people with moderate-to-complete hearing loss resided in the Western Pacific region (127·1 million people [112·3–142·6]). Of all people with a hearing impairment, 62·1% (60·2–63·9) were older than 50 years. The Healthcare Access and Quality (HAQ) Index explained 65·8% of the variation in national age-standardised rates of years lived with disability, because countries with a low HAQ Index had higher rates of years lived with disability. By 2050, a projected 2·45 billion (2·35–2·56) people will have hearing loss, a 56·1% (47·3–65·2) increase from 2019, despite stable age-standardised prevalence. Interpretation As populations age, the number of people with hearing loss will increase. Interventions such as childhood screening, hearing aids, effective management of otitis media and meningitis, and cochlear implants have the potential to ameliorate this burden. Because the burden of moderate-to-complete hearing loss is concentrated in countries with low health-care quality and access, stronger health-care provision mechanisms are needed to reduce the burden of unaddressed hearing loss in these settings

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

COVID-19 Entwined the Dynamic Relationship between Stock Returns and Macroeconomic Variables

This study examines the dynamic relationship between macroeconomic variables and stock prices in Pakistan in the COVID-19 pandemic scenario. For this purpose, monthly data has been taken from Jan 2019 to June 2021 and divided into Pre-COVID, COVID and overall periods. Data have been retrieved from various sources including Statistical Reviews & Bulletins of State Bank of Pakistan, Karachi Stock Exchange and Pakistan Economic Survey. To assess the relationship between economic variables and stock prices, Cointegration, Granger-causality and Impulse Repose Function Tests have been applied on three data series. The results of the study reveal that there is a long-term equilibrium relationship between all economic variables and stock prices in the Pre-COVID period. However, most of the economic variables do not have such a relationship during the COVID period and the pattern of the relationship is almost the same in the overall period. Even the short-run dynamic relationship between economic variables and stock returns is affected by the pandemic. The results show that economic variables affect stock returns differently in the COVID situation than in the Pre-COVID scenario and it also affects the short-run relationship in the overall period. This research study provides imminent findings on the linkage between macroeconomic variables and stock prices in the Pakistani context. It helps investors and regulators in customizing their decisions and macroeconomic regulations respectively to improve the financial and economic stability of the country in the wake of the pandemic.&nbsp