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  • 1
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    Online Resource
    Availability and use of Automated External Defibrillators in Karachi, Pakistan: a cross-sectional study
    Pakistan Medical Association ; 2022
    In:  Journal of the Pakistan Medical Association ( 2022-02-23)
    Details
    In: Journal of the Pakistan Medical Association, Pakistan Medical Association, ( 2022-02-23)
    Abstract: Objective: To assess the availability and use of automated external defibrillators in various public and private establishments, and to assess knowledge, attitude and practices related to its use. Methods: The telephone-based survey was conducted from March to August 2019 in Karachi after approval from the ethics review committee of the Aga Khan University, Karachi, and comprised public and private establishments identified through purposive sampling based on the standard requirements for automated external defibrillators installation. Data was collected using a predesigned questionnaire which was pilot-tested for reliability and validity. Data was analysed using SPSS 23. Results: Of the 53 establishments, 32(60.4%) were private and 21(39.6%) were public. Overall, 9(17%) establishments were aware of automated external defibrillators and 1(1.9%) had an automated external defibrillator on the premises. Also, 25(47.2%) establishments believed that having an automated external defibrillator on the premises would be useful, while 25(47.2%) were undecided. Besides, 22(41.5%) establishments said they would consider installing an automated external defibrillator on the premises, while 24(45.3%) were undecided. Finally, 37(69.8%) establishments expressed a positive desire to get trained in giving basic life support. Conclusion: There was a need for a city-wide automated external defibrillator placement project for a reduction in mortality due to out-of-hospital cardiac arrest. Key Words: Defibrillator, Resuscitation, Training, Bystanders.
    Type of Medium: Online Resource
    ISSN: 0030-9982
    URL: Article
    DOI: 10.47391/JPMA.4447
    Language: Unknown
    Publisher: Pakistan Medical Association
    Publication Date: 2022
    detail.hit.zdb_id: 2128872-0
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  • 2
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    Online Resource
    Global geographic and gender disparities in stem cell-related surgical research: bibliometric review of the top 200 most-cited articles
    Pakistan Medical Association ; 2023
    In:  Journal of the Pakistan Medical Association Vol. 73, No. 2 ( 2023-01-25)
    Details
    In: Journal of the Pakistan Medical Association, Pakistan Medical Association, Vol. 73, No. 2 ( 2023-01-25)
    Abstract: Objective: The study aimed to identify geographic and gender disparities in the quality, academic impact, and media attention of the top-cited articles related to stem cell-related surgical research. Methods: The following data was extracted for the top 200 most-cited articles (2011-2021): article- (including citation metrics and country of publication), journal- (including impact factor), and author-level (including corresponding author gender) variables. Article Altmetric Attention Score (AAS), a measure of mass mainstream and social media attention, was also recorded. Results: Most articles originated from high-income countries (HICs: 175 [87.5%]), with only 7 (3.5%) from lower-middle-income countries. Articles from non-HIC were published in journals with significantly lower impact factors (6.66 [3.75-9.46] vs. 23.2 [7.3-32.5]; p 〈 0.001) and AAS (7 [3-14.5] vs. 30 [11-83] ; p 〈 0.001). Only 44 (22%) of articles were authored by a female corresponding author, Continued..
    Type of Medium: Online Resource
    ISSN: 0030-9982
    URL: Article
    DOI: 10.47391/JPMA.AKUS-17
    Language: Unknown
    Publisher: Pakistan Medical Association
    Publication Date: 2023
    detail.hit.zdb_id: 2128872-0
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  • 3
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    Online Resource
    FRI515 GRADE-Adolopment Of Hyperthyroidism Treatment Guidelines For A Pakistani Context
    The Endocrine Society ; 2023
    In:  Journal of the Endocrine Society Vol. 7, No. Supplement_1 ( 2023-10-05)
    Details
    In: Journal of the Endocrine Society, The Endocrine Society, Vol. 7, No. Supplement_1 ( 2023-10-05)
    Abstract: Disclosure: A. Pervez: None. R. Martins: None. A. Aziz: None. S. Raja: None. N. Islam: None. A. Ahmed: None. A. Sheikh: None. S. Furqan: None. N. Ram: None. A. Rizwan: None. N. Rizvi: None. M. Mustafa: None. S. Aamdani: None. B. Ayub: None. M.Q. Masood: None. A. Haider: None. S. Nadeem: None. Background: Hyperthyroidism is a common endocrinological disorder in Pakistan. The prevalence of hyperthyroidism here is four times higher than the United States. Most high-quality hyperthyroidism clinical practice guidelines (CPGs) originate from high-income countries. Due to resource constraints, de novo local guideline creation is restricted in lower-middle income countries which adopt internationally created CPGs lacking a local context. Thus, we aimed to produce a comprehensive evidence-based CPG for the management of adult outpatient hyperthyroidism patients in Pakistan. Methods: An adaptation of the GRADE-ADOLOPMENT process was followed in collaboration with the GRADE working group. Adolopment describes a combination of adoption (verbatim use), adaptation (contextual modifications), and de novo development, thus leveraging the benefits of pre-existing high-quality CPGs while ensuring local appropriateness. The 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis was selected as the source CPG by a panel of local endocrinology experts. Recommendations from the source CPG were either adopted, excluded, or adapted. Adaptation was done using the evidence-to-decision framework. Results: The source CPG included a total of 124 recommendations, of which 71 were adopted as is. 49 recommendations were excluded due to reasons including but not limited to unavailability of drugs, inapplicability to the existing health-care system of Pakistan or different target audience. 4 recommendations were carried forward for adaptation, 2 of these remained unchanged after collection of local contextual data and consensus between the local endocrinologists. 2 recommendations were modified from the source CPG. The first recommended using ALT only instead of a full liver function test amongst patients experiencing symptoms of hepatotoxicity while being treated with anti-thyroid drugs. The second pertained to thyroid status testing post-treatment by radioactive iodine therapy for Graves’ Disease with only FT4 instead of a full thyroid profile. Both adaptations centered around the judicious use of laboratory investigations to reduce costs of hyperthyroidism management. Conclusion: Our CPG for the management of hyperthyroidism in Pakistan consists of 75 recommendations, of which two recommendations have context-specific adaptations that prioritize patients’ finances during hyperthyroidism management and limit the overuse of laboratory testing in a resource-constrained setting. Our revised methodology is a resource-efficient method for developing CPGs with a local context. We aim to publish and disseminate this CPG to improve hyperthyroidism care provision in Pakistan. Future research must investigate the cost-effectiveness and risk-benefit ratio of these modified recommendations. Presentation: Friday, June 16, 2023
    Type of Medium: Online Resource
    ISSN: 2472-1972
    URL: Article
    DOI: 10.1210/jendso/bvad114.1860
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2023
    detail.hit.zdb_id: 2881023-5
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  • 4
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    Online Resource
    Evaluation of data analytics workshop using RStudio amongst medical students in Pakistan
    Pakistan Medical Association ; 2022
    In:  Journal of the Pakistan Medical Association Vol. 73, No. 1 ( 2022-12-15), p. 222-224
    Details
    In: Journal of the Pakistan Medical Association, Pakistan Medical Association, Vol. 73, No. 1 ( 2022-12-15), p. 222-224
    Abstract: A quasi-experimental study was conducted at the Aga Khan University, Karachi, Pakistan, to evaluate the outcomes of a series of workshops on 25 medical students’ statistical knowledge and acceptance of RStudio. The knowledge in each of the five sessions was assessed using pre- and post- knowledge-based quizzes. In addition, the Student's Attitude Towards Statistics (SATS-36) and the Technology Acceptance Model were used. Data analysis on RStudio revealed a statistically significant improvement in knowledge in all five sessions (p 〈 0.05). SATS-36 showed statistically significant improvement in Cognitive Competence (p 〈 0.001). RStudio had commendable acceptance with relatively high scores of Attitudes (behavioural intention, median = 6.00 [5.20-7.00]) and Utility (perceived usefulness, median = 5.20 [4.10-6.20] ). In conclusion, medical students had improved statistical knowledge and acceptance towards the novel statistical tool. Hence, further studies must evaluate the effectiveness of RStudio when integrated as part of the medical curriculum. Keywords: RStudio; Technology acceptance; Peer learning; Statistics.
    Type of Medium: Online Resource
    ISSN: 0030-9982
    URL: Article
    DOI: 10.47391/JPMA.6450
    Language: Unknown
    Publisher: Pakistan Medical Association
    Publication Date: 2022
    detail.hit.zdb_id: 2128872-0
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  • 5
    Online Resource
    Online Resource
    Risk factors for intensive care unit admission and mortality among adult meningitis patients
    Pakistan Medical Association ; 2022
    In:  Journal of the Pakistan Medical Association ( 2022-02-12)
    Details
    In: Journal of the Pakistan Medical Association, Pakistan Medical Association, ( 2022-02-12)
    Abstract: Objectives: To assess the risk factors for intensive care unit admission and inpatient all-cause mortality among adult meningitis patients. Method: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data between July 2010 and June 2019 of patients of either gender aged 18 years diagnosed with bacterial, viral or tuberculous meningitis. Multivariable logistic regression analyses were used to explore independent predictors of inpatient mortality and intensive care unit admission. Data was analysed using SPSS 24. Results: Of the 929 patients with suspected meningitis, 506(54.5%) had confirmatory diagnosis. Of them, 303(59.9%) were males. The overall median age of the sample was 47.0 years (interquartile range: 33.0 years). The most common aetiology was bacterial meningitis 324(64%), followed by viral meningitis 141(27.9%). Incidence of inpatient mortality was 53(10.5%), while 75(14.8%) patients required intensive care unit admission. Tuberculous aetiology, intensive care unit admission, concurrent encephalitis, hydrocephalus, inpatient neurosurgery, and longer length of hospital stay were predictors of mortality (p 〈 0.05). Non-indication of blood culture was found to be associated with reduced risk of mortality (p 〈 0.05). For intensive care unit admission, diabetes mellitus, presentation with seizure, imaging suggestive of meningitis, and inpatient neurosurgery were associated with higher risk of admission, while hypertension, presentation with headache, viral aetiology and non-indication of blood culture reduced the risk (p 〈 0.05). Conclusion: Adult meningitis patients tend to have poor expected outcomes, and their management strategies should be planned accordingly. Key Words: Meningitis, Mortality, Intensive care units, Critical care, Risk factors.
    Type of Medium: Online Resource
    ISSN: 0030-9982
    URL: Article
    DOI: 10.47391/JPMA.4482
    Language: Unknown
    Publisher: Pakistan Medical Association
    Publication Date: 2022
    detail.hit.zdb_id: 2128872-0
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  • 6
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    Online Resource
    PREDICTING DEVELOPMENT OF CRITICAL ILLNESS IN PATIENTS WITH COVID-19 PRESENTING TO A TERTIARY CARE HOSPITAL IN A DEVELOPING COUNTRY
    Ayub Medical College, Abbottabad Pakistan ; 2022
    In:  Journal of Ayub Medical College Abbottabad Vol. 34, No. 2 ( 2022-03-03)
    Details
    In: Journal of Ayub Medical College Abbottabad, Ayub Medical College, Abbottabad Pakistan, Vol. 34, No. 2 ( 2022-03-03)
    Abstract: Background: With the increasing number of COVID-19 patients and limited resources available to accommodate them, there is a need for risk stratification tools to ensure better utilization of resources. Methods: We conducted a retrospective observational cohort study in patients discharged from the COVID designated areas of a large tertiary care hospital in Karachi, Pakistan from the 1st of May to the 31st of July, 2020. 581 patients were included and the COVID GRAM score was calculated at the time of admission and patients developing critical disease as per COVID GRAM study criteria (need of intensive care unit admission, invasive ventilation or death) after 24 hours of admission were noted. Results: The mean age of the study population was 56.3±14.8 years. Patients that developed critical illness (as per COVID GRAM study criteria) beyond 24 hours after admission had higher COVID GRAM scores at admission versus those that did not (183.2±80.7 versus 130.3±42.6). The Area under the Receiver Operator Curve for the COVID gram score to predict critical illness in the study population was 0.802 (95% confidence interval, 0.753–0.850). On binary logistic multivariable regression analysis, the COVID GRAM and SOFA scores on admission and need of ICU admission during hospitalization were significant predictors of mortality 24 hours after admission. Conclusions: The COVID GRAM score is a useful risk assessment tool and can be used for appropriate allocation and prioritization of resources where they are most needed.
    Type of Medium: Online Resource
    ISSN: 1819-2718 , 1025-9589
    URL: Article
    DOI: 10.55519/JAMC-02-8926
    Language: Unknown
    Publisher: Ayub Medical College, Abbottabad Pakistan
    Publication Date: 2022
    detail.hit.zdb_id: 2143079-2
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  • 7
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    Online Resource
    The impact of community medical camps on medical students and graduates’ education
    Pakistan Medical Association ; 2023
    In:  Journal of the Pakistan Medical Association Vol. 73, No. 6 ( 2023-05-15), p. 1183-1191
    Details
    In: Journal of the Pakistan Medical Association, Pakistan Medical Association, Vol. 73, No. 6 ( 2023-05-15), p. 1183-1191
    Abstract: Objectives: To investigate the impact of volunteering at community medical camps on medical students’ and graduates’ clinical and soft skills, knowledge of community health, and future career goals. Method: The cross-sectional pilot study was conducted at the Aga Khan University Hospital, Karachi from July to October 2020, and comprised medical students or trainees who had attended at least one medical camp in a community-based setting organised by any of the two non-governmental organisations who collaborated in the study. Responses were obtained through a self-reported online survey from the participants. Data was analyzed using SPSS 25. Results: Of the 52 subjects, there were 25(48.9%) males and 27(51.9%) females with overall mean age 25.4±3.8 years. Majority of the participants 35(67.3%) had attended a private first-tier medical school while 17(32.7%) had attended other local medical schools. Overall, 40(76.9%) subjects reported improved community knowledge, , 44(84.6%) had experiential learning and confidence in outpatient management, and 49(94%) had improved soft skills. Besides,  21(40.4%) participants agreed to have been influenced to pursue a career in primary care, and 25(48.1%) reported a direct impact on their choice of career specialty. Compared to males, females reported improved more awareness and alertness (p=0.016), increased confidence approaching communities (p=0.032), and increased compassion towards patient care (p=0.047). Conclusions: Community-based medical camps had an overall positive impact on volunteering medical students. Key Words: Community medical camps, Community health service, Medical education, Service-learning.
    Type of Medium: Online Resource
    ISSN: 0030-9982
    URL: Article
    DOI: 10.47391/JPMA.5731
    Language: Unknown
    Publisher: Pakistan Medical Association
    Publication Date: 2023
    detail.hit.zdb_id: 2128872-0
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  • 8
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    Radial artery coronary bypass grafting: Surgical outcomes of an unexplored innovation in a developing country
    Pakistan Medical Association ; 2022
    In:  Journal of the Pakistan Medical Association Vol. 72, No. 01 ( 2022-02-08)
    Details
    In: Journal of the Pakistan Medical Association, Pakistan Medical Association, Vol. 72, No. 01 ( 2022-02-08)
    Abstract: Objective: To explore postoperative outcomes, particularly prolonged length of hospital stay, in radial arterycoronary artery bypass graft patients in a tertiary-care setting.Methods: The pilot prospective cohort study was conducted at the Aga Khan University Hospital, Karachi, fromSeptember 2019 to September 2020, and comprised adult patients of either gender due to undergo coronary arterybypass grafting for coronary artery disease involving two or more vessels. The subjects approached for the use oftheir radial artery as a conduit. Prolonged length of hospital stay was defined as postoperative stay 〉 9 days.Multivariable logistic regression was used to identify independent predictors of the length of hospital stay. Data wasanalysed using SPSS 21.Results: Of the 97 patients, 84(86.6%) were males. The overall mean age of the sample was 58.33±8.34 years. Meanlength of hospital stay was 8.10±2.37 days, and 23(23.7%) patients had prolonged stay. Higher age was a significantpredictor of prolonged hospital stay (p 〈 0.05). Besides, 23(23.7%) patients developed acute kidney injury. There wasno incidence of wound, infection or deep venous thrombosis, while 1(1.03%) patient had to be reopened due toexcessive postoperative bleeding, and it represented the lone mortality.Conclusion: Patient age was found to be a significant predictor of prolonged hospital stay in patients undergoingradial artery coronary artery bypass graft, while almost a quarter of the sample was affected by acute kidney injury.Keywords: Coronary artery bypass graft, Radial artery, Prolonged length of stay, Acute kidney injury, Ejectionfraction. Continuous...
    Type of Medium: Online Resource
    ISSN: 0030-9982
    URL: Article
    DOI: 10.47391/JPMA.AKU-22
    Language: Unknown
    Publisher: Pakistan Medical Association
    Publication Date: 2022
    detail.hit.zdb_id: 2128872-0
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  • 9
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    Online Resource
    In a digitally connected world through Likes, Hashtags and Followers — Advancing surgical research through a social media: A narrative review
    Pakistan Medical Association ; 2022
    In:  Journal of the Pakistan Medical Association Vol. 72, No. 01 ( 2022-02-08)
    Details
    In: Journal of the Pakistan Medical Association, Pakistan Medical Association, Vol. 72, No. 01 ( 2022-02-08)
    Abstract: In this era of modern information technology, the world is now digitally connected through various platforms on social media, which has also changed the way medical professionals work, communicate and learn. The use of social media in surgery is expanding, and it is now becoming an essential tool for surgical training, research and networking. Articles, journal clubs and surgical conferences are within reach of everyone regardless of geographical location worldwide. Electronic publicationshave now resoundingly replaced printed editions of journals. Collaborative research through social media platforms helps collect diverse data, enhancing the research's global generalisability. The current narrative review was planned to discuss the importance of social media in advancing surgical research and the use of different social media applications in the context ofpromoting and disseminating surgical research alongside its evolving ethical challenges. Continuous...
    Type of Medium: Online Resource
    ISSN: 0030-9982
    URL: Article
    DOI: 10.47391/JPMA.AKU-14
    Language: Unknown
    Publisher: Pakistan Medical Association
    Publication Date: 2022
    detail.hit.zdb_id: 2128872-0
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  • 10
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    The environment under the knife: A review of current Eco-surgical strategies and recommendations for Pakistan
    Pakistan Medical Association ; 2022
    In:  Journal of the Pakistan Medical Association Vol. 72, No. 01 ( 2022-02-08)
    Details
    In: Journal of the Pakistan Medical Association, Pakistan Medical Association, Vol. 72, No. 01 ( 2022-02-08)
    Abstract: The healthcare sector at its core is based on the fundamentals belief to do no harm and bring about betterment in the lives of the people. Paradoxically, hospitals are one of the leading contributors to pollution, greenhouse gas (GHG) emissions and toxic waste material worldwide. Surgical care delivery is quite resource intensive, consuming significant amount of energy and equipment as well as producing large quantities of waste. With climate change being a global priority, it is crucial that hospitals re-evaluate the environmental impact of such practices. The current review was planned to identify areas of improvement in surgical care in terms of sustainability, as well as describe efficient and innovative strategies for hospitals in Pakistan to lessen their impacton the environment. Continuous...
    Type of Medium: Online Resource
    ISSN: 0030-9982
    URL: Article
    DOI: 10.47391/JPMA.AKU-23
    Language: Unknown
    Publisher: Pakistan Medical Association
    Publication Date: 2022
    detail.hit.zdb_id: 2128872-0
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