Impact of wellness indicators on intellectual dimensions of medical teachers of Karachi: Findings from cross sectional study.

OBJECTIVE: To measure impact of social, spiritual, occupational, physical, financial and emotional wellness on intellectual wellness of medical teachers. METHODS: The cross-sectional study was conducted at 8 medical universities in the Sindh province of Pakistan from January 2012 to December 2014, and comprised faculty members. Using a self-administered questionnaire, teachers' responses on physical, emotional, social, spiritual, intellectual, occupational and financial spokes of the wellness wheel that were graded on a 4-point Likert scale. Generalised linear models were executed to find the best predictive scores for intellectual wellness. RESULTS: Out of 300 subjects approached, 261(87%) returned the questionnaire fully completed. Of them, 86(33%) were males and 175(67%) were females. Occupational wellness followed by spiritual, financial and emotional wellness depicted significantly high correlation with IW (p<0.05). Adjusted analysis revealed significant effects of spiritual, financial and occupational wellness (p<0.05). Findings of Models 1 and 2 suggested that holding the effect of other wellness subscales, intellectual wellness increased up to 0.485 score and 0.245 score due to occupational and spiritual wellness (p<0.05) respectively, while financial wellness was not significant (p>0.05). In the final model, occupational wellness effect increased to 0.504 score and spiritual wellness effect projected to 0.273 score for intellectual wellness (p<0.05). CONCLUSIONS: Amongst all the spokes of the wellness wheel, occupational, financial, social, emotional and spiritual wellness improved mental capabilities of medical teachers to overcome the challenges for acquiring intellectual wellness. However, wellness at workplace played the major role in enhancing intellectual proficiencies.

Effect of diabetic counseling based on conversation map as compared to routine counseling on diabetes management self-efficacy and diabetic distress among patients with diabetes in Pakistan: a randomized controlled trial (study protocol).

BACKGROUND: Novel interactive and pictorial health education tool named Diabetes Conversation Map (DCM) might be effective for the improvement of diabetes management self-efficacy (DMSE) and diabetes distress (DD) among diabetic patients in lower middle-income setting. This study protocol will assess the effectiveness of DCM as compared to routine care (RC) to improve DMSE, decrease DD and glycated hemoglobin (HbA1c) among patients with type 2 diabetes (T2DM). METHODS: This will be two arms randomized controlled trial, conducted at national institute of diabetes and endocrinology (NIDE) in Karachi, Pakistan. A sample of 120 T2DM patients of age 30-60 years with suboptimal diabetes control will be screened through eligibility criteria and DD screening tool. Patients who fulfill the eligibility criteria and have diabetes distress will be randomized into interventional and control arm. The intervention arm will receive four education sessions (40 min each) using DCM for 4 weeks duration of enrollment. Controlled arm will receive RC. DMSE and DD will be measured using the validated Likert tools at baseline and after 3 months of enrollment. Latest results of HbA1c will be retrieved from the respective medical record files at baseline and 3 months. Change in DMSE, DD scores and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment will be compared. Multivariable linear regression will be conducted to adjust for any potential confounders. DISCUSSION: In a study in UK, 70% of the patients with diabetes reported DCM had helped them in controlling their diabetes and recommended this method to teach other patients with diabetes also. In China, a study found that patients with diabetes who received DCM based education had significantly lower DD and significantly higher diabetes empowerment score after six months of the intervention as compared to the traditional counselling. A cross sectional study conducted in Pakistan also demonstrated that teaching based on DCM was useful in improving the knowledge, attitude and practices of patients with T2DM. Besides, no other study has evaluated the effectiveness of these novel tools for DMSE and diabetes distress DD in well-designed, sufficiently powered clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03747471 . Date of registration: Nov 20. 2018. Version and Date of Protocol: Version 1, IRB Approval date 28 June 2018.

Embryo quality in intracytoplasmic sperm injection: A quasi experimental design in Pakistan.

OBJECTIVE: To assess the role of good-quality embryos in acquiring pregnancy after intracytoplasmic sperm injection and to predict factors required for development of embryos. METHODS: The quasi-experimental study was conducted from June 2010 to August 2012 at Islamabad Clinic Serving Infertile Couples and comprised infertile females who received long-term gonadotropin agonist protocol for intracytoplasmic sperm injection. Basal estradiol and antral follicle count was measured at baseline, while estradiol, progesterone and interleukin levels with pre-ovulatory follicle count were evaluated on the ovulation induction day. Follicular output rate was measured as ratio of pre-ovulatory follicle count to antral follicle count. The quality of embryos was graded as good, fair and poor on the third day after the injection. Linear regression was employed to determine unadjusted and adjusted estimate of effect of different factors on good-quality embryo. RESULTS: There were282 subjects with a mean age of 32.1±4.7 years (range: 23-41 years). There was an inverse correlation of body mass index with good-quality embryo (r=-0.131). In adjusted analyses, basal estradiol and progesterone on the ovulation induction day showed negative effect (95% confidence interval: -1.42 - -1.01), while estradiol and interleukin measured positive effect on quality of embryo (p<0.05). Follicular output rate was highly positively correlated with good quality embryo (p<0.05).. CONCLUSIONS: Females with low body mass index produced good-quality embryos. A high follicular output rate with production of estradiol and interleukin complemented good-quality embryos.

Perceptions of nursing students of educational environment at a private undergraduate School of Nursing in Karachi.

OBJECTIVE: To assess educational environment at a nursing school.. METHODS: The cross-sectional survey was carried out from May to October 2016 at Aga Khan University School of Nursing and Midwifery, Karachi, using the Dundee Ready Educational Environment Measure tool. The scores were obtained by merging five sub-scales of the inventory. The average scores of the scale and sub-scales were compared in terms of age, year of study, and living status using Mann-Whitney U test, and among years of study by Kruskal Wallis test.. RESULTS: Of the 442 students, 228(51.6%) had age below 20 years. Overall, 131(29.1%) subjects were in the first year, 152(33.8%) second year, 91(20.2%) third year and 76(16.9%) fourth year. The average Dundee Ready Educational Environment Measure score was 129.92±19.97 with reliability of 88.9%. Students aged 20 years and less had more positive perceptions than students over 20 years (p<0.0001). Students living in hostel secured higher scores (p<0.0001). First year nursing students attained significant highest scores in all sub-scales compared to the rest (p<0.0001). CONCLUSIONS: Scores reveal better perception from younger nursing students, as well as those living in the hostel and those who were in their initial years of nursing education.

Self-reported academic performance in relation to health behaviours among Bahria University students.

OBJECTIVE: To find an association between self-reported academic performance with different socio-demographic factors, health behaviours and mental health amongst university students. METHODS: This cross-sectional study was conducted at Bahria University, Karachi, from January 2012 to December 2013, and comprised university students of different disciplines. An anonymous, self-reported questionnaire was distributed among the subjects. Convenient sampling technique was used. Demographic information, including age, gender and field of study, were obtained. Depresion was evaluated via Centre for Epidemiological Studies Depression Scale. SPSS 22 was used to analyse data. RESULTS: Of the 813 respondents, 334(41.1%) were males and 479(58.9%) females. The mean age was 19.9±1.8 years. Overall, 126(15.5%) subjects reported excellent, 242(29.8%) very good, 310(38.1%) good, 100(12.3%) satisfactory and 35(4.3%) not satisfactory academic performance. Residential status of students played a significant role on their academic performance (p=0.011). Breakfast eating behaviour depicted a significant association with the academic performance (p=0.04).The proportion of unsatisfactory academic performances among students having severe sleep disorder was the highest, followed by mild/moderate (p=0.01). The depression scale's item 'troubling in mind' was highly associated with academic performance (p<0.05). CONCLUSIONS: A constructive association existed among healthy behaviours and academic performance. .

Impact of social interdependence on emotional well-being of medical students.

OBJECTIVE: To observe the effect of social interdependence on emotional well-being in medical students. METHODS: This cross-sectional study was conducted in Karachi from June 2013 to January 2014 and comprised first-year medical students of 5 private and 3 public-sector colleges. Students of both genders aged 19-24 years were included. Quantitative aspects of social and emotional wellness were evaluated using a structured questionnaire from the wellness wheel on a four-point Likert's scale (score ranging from 0 to 3). Two focus group discussions were conducted in each medical college from the qualitative aspect. RESULTS: Of the 736 participants, 526(71.47%) were females and 210(28.53%) were males. Males reported significantly less inclination towards exhibiting fairness, solving problems, teaching batch fellows and attending group discussion (p<0.05). They were significantly least anxious with less frequency of helping others during emotional outbursts (p<0.05). Females had higher frequency of close friends and self-improvement (p<0.05). The scores of social wellness were significantly better in females compared to males (p<0.001) while there was no significant difference in emotional wellness on the basis of gender (p>0.05). Social communication and help was highly positively correlated with self-content in students (p<0.05). CONCLUSIONS: The medical students of Karachi had good social and emotional well-being.

A comparison between wellness awareness among medical students.

OBJECTIVE: To assess and compare the dimensions of spiritual wellness as elements of quality care in medical students of private and public medical universities. METHODS: The cross-sectional study was carried out at private and public medical universities in Karachi from November 2013 to January 2015.Students from both genders and all ethnic groups19-23 years of age were included. The responses of spiritual wellness were obtained and evaluated on a four-point Likert's scale; score ranging from 0-3. Data was analysed using Predictive Analysis Software version 18. RESULTS: Out of 736 students, 286 (38.9%) were from public medical universities and 450 (61.1%) were from private-sector institutions. Students of both types of universities were aware of the concept of spiritual wellness but the level of awareness needed scaling up. Public-sector students had a stronger will, were more physically and mentally alert, more compassionate, empathetic and enthusiastic about their relationship with patients than their private-sector counterparts (p<0.05). They used spiritual wellness as a coping strategy to deal with difficult situations through religious activities. Though attentive listening was a predominant feature in both groups, the use of communication skills required particular attention to improve the element of compassionate care. CONCLUSIONS: Empowerment of spiritual wellness is more likely to enable medical students to be more compassionate towards their patients and strengthen doctor-patient relationship.

Intellectual wellness in medical university teachers: Gender based comparison.

A cross section, questionnaire based study was carried out from January 2012 till December 2014 to compare intellectual wellness (IW) awareness on the basis of gender in teachers of basic sciences at medical universities of Karachi, Pakistan. Data was collected from 3 public and 5 private medical universities of Karachi, Pakistan. Questionnaire was tailored from "Wellness Wheel" and responses were aggregated for eight questions in the dimension of IW to obtain aggregate IW score. Reliability of the questionnaire was measured using Cronbach's alpha. The average intellectual score was 24.99 ± 3.93 with a minimum score of 8 and maximum 32.The frequency of keeping informed about research updates was significantly higher in males (p = 0.043) that emphasized significantly better IW awareness of male medical teachers involved in teaching of medical sciences in both public and private medical universities of Pakistan.

Dream of a conducive learning environment: One DREEM for all medical students!

OBJECTIVE: To compare students' response assessed by Dundee Ready Educational Environment Measure on the basis of the year of study, gender and pre-medical educational background. METHODS: This cross-sectional study was carried out at the Aga Khan University Medical College, Karachi, Pakistan, from June 2014 to March 2015, and comprised medical students. The average scores of Dundee Ready Educational Environment Measure scales and subscales were compared between gender and educational background. Responses were also compared on the basis of year of study. RESULTS: Of the 416 participants, 184 (44%) were males and 232 (56%) were females. There were 100 (24%) students in the first year, 90 (21.6%) in second, 92 (22.1%) in third, 91 (21.9%) in fourth and 43 (10.3%) in the fifth year. The mean Dundee Ready Educational Environment Measure score was 125.7±16.8. The mean score of females and students with higher secondary school background was significantly better as compared to males and students in British General Certificate of Education background, respectively (p<0.0001, p=0.017). Female medical students were satisfied with the atmosphere of teaching and learning (p<0.0001; p=0.011). Year-wise comparison showed significantly better Dundee Ready Educational Environment Measure score responses by fourth-year students (p<0.0001). CONCLUSIONS: Assessment by Dundee Ready Educational Environment Measure endorsed approval of conducive learning environment with reference to atmosphere, teaching, learning, sense of well-being, academic self-perception and achievement by all medical students.

Perceptions of medical students regarding dimensions of environmental wellness.

OBJECTIVE: To explore the status of awareness on environmental wellness in medical students of Karachi. METHODS: The cross-sectional questionnaire-based survey was carried out at Bahria University Medical & Dental College, Karachi, from January 2009 to July 2013, and comprised randomly selected medical students. The response options were; never, sometimes, mostly and always (numbered 0-4) and these were analyzed in terms of frequency, proportion and percentages by Predictive analysis software version18. RESULTS: Out of 800 questionnaires distributed, 736(92%) were received fully completed. There were 210(28.5%) male and 526(71.5%) female respondents, with a male-to-female ratio of 1:2.5. Female medical students were more serious in taking care of their environment tasks (p< 0.0001). They knew their responsibility to preserve environment and consciously tried to conserve energy more than the male students (p=0.034). The proportions of admitting disposal of garbage in dustbins was found more in females than males (p< 0.0005). Though 486(66%) participants were interested in knowing about environmental problems, females tended to be more in liking greenery in their place of residence (p< 0.0005) and lived in harmony with nature and universe (p< 0.001). CONCLUSIONS: Medical students were aware of the concept of environmental wellness, but female medical students had a better perception and were a step ahead in its realization.

Students' perception of educational environment at Aga Khan University Medical College, Karachi, Pakistan.

OBJECTIVE: To assess educational environment in Aga Khan University Medical College (AKUMC) by Dundee Ready Educational Environmental Measure (DREEM) scale. METHODS: A cross-sectional survey of students at the AKUMC with simple random sampling was carried out from June 2014 till March 2015. Responses in five subscales were used to calculate DREEM scores. RESULTS: The average DREEM score was 125.77±16.8 with a reliability of 91.3%. With regards to subscales, on the 12-item students' perceptions of learning (PoL) subscale, the maximum score was 48; 11 items of students' perceptions of teachers (PoT) had a maximum score of 44; students' academic self-perceptions (ASP) identified by 8 items showed maximum score of 32; students' perceptions of atmosphere (PoA) with 12 items obtained maximum score 48 and students' social self-perceptions (SSP) subscale of 7 items had a maximum score of 28. CONCLUSION: Students perceived a positive learning environment at AKUMC Karachi.

Risk assessment for obstructive sleep apnea and anxiety in a Pakistani population with coronary artery disease.

PURPOSE: Previous studies in the western world have reported the possible association of obstructive sleep apnea (OSA) with anxiety and cardiovascular diseases. However, the data from developing countries such as Pakistan remains scarce in this regard. The main aim of this study was to investigate the prevalence of coronary artery disease (CAD) patients who are at high risk of OSA and to determine the association between the risk of OSA and levels of anxiety. METHODS: The sample population consisted of 400 participants including 200 patients, who had been previously diagnosed with CAD, and 200 healthy controls. The 200 CAD patients were approached for inclusion in the study on their follow-ups after their acute symptoms had subsided. The patients were interviewed after a mean time period of 13 weeks post event. All patients with lung disease or respiratory infection were excluded from the study. The risk of OSA was determined using Berlin questionnaire, while the levels of anxiety were measured by Beck anxiety inventory scale (BAI). RESULTS: More than half (n = 104) of the CAD patients were at high risk of OSA while majority (n = 168) of the healthy controls were at low risk. The high risk of OSA was significantly (P < 0.0001) more prevalent in CAD patients compared with controls. It was also observed that the patients who were at high risk of OSA, among both cases and controls, had significantly (P values <0.001) higher levels of anxiety. CONCLUSION: A significant proportion of CAD patients are at high risk of OSA in our region. Moreover, OSA is also associated with greater levels of anxiety in both healthy people and CAD patients.

Producing financially literate medical graduates -- a national need for a brighter Pakistan.

OBJECTIVE: To compare the awareness of financial wellness between male and female medical students. METHODS: The cross-sectional questionnaire-based survey was conducted from February to December 2011 and comprised first year medical students belonging to different medical colleges of Karachi. Students from both genders, aged 19-24 years, belonging to all ethnic groups willing to participate were included. A close-ended questionnaire evaluated aspects of financial wellness, using four-point Likert's scale: never, sometimes, mostly, and always from 0 to 4. Besides, factor analysis was performed to investigate common financial wellness among the participants. RESULTS: Of the total 800 students approached, complete responses were received from 736(92%); 210(28.5%) boys and 526(71.5%) girls. The mean financial wellness score of boys was 8.60±3.04 and that of the girls was 7.61±3.12 (p<0.0005). Greater number of boys 93(44%) set both short- and long-term financial goals compared to 180(36%) girls (p=0.03). Besides, 218(42%) girls confined themselves to the budget compared to 81(39%) boys (p>0.05). More boys 71(34%) were spendthrift (p<0.0001) and 57(27%) preferred to keep their savings in bank accounts compared to the girls (p<0.0001). Overall, boys were better in financial security wellness compared to the girls (p=0.001). CONCLUSIONS: Male medical students exhibited awareness of financial wellness better than girls.

Effect of endometrial thickness on pregnancy outcome after intracytoplasmic sperm injection.

OBJECTIVE: To identify cut-off value of endometrial thickness required for implantation of embryo after intracytoplasmic sperm injection. METHODS: The auasi-experimental study was conducted from July 2011 to June 2012 at an assisted reproductive clinic in Islamabad. Down-regulation of ovaries, controlled ovarian stimulation, oocyte pick-up, in vitro fertilisation, blastocyst transfer and confirmation of pregnancy with beta human chorionic gonadotropin more than 5mIU/ml. Patients were categorised into two groups on the basis of endometrial thickness < 8mm and >8mm.On ovulation induction, before human chorionic gonadotropin injection, endometrial thickness was measured by trans-vaginal scan. Receiver operating curve was used to define groups on the basis of endometrial thickness cut-off value for pregnancy. The groups were compared in terms of the number of retrieved, mature and fertilised oocytes along with oocyte maturity, fertilisation and implantation rates by chi square test. RESULTS: There were 282 females; 116(41%) in Group A with endometrial thickness < 8mm, and 166(59%) in Group B with endometrial thickness >8mm. In group A, 6(5%) and in Group B, 95(57.2%) patients had a positive pregnancy test. The number of mature, fertilised oocytes and cleaved embryos was significantly high in Group B (p=0.01; p=0.001; p=0.001respectively). Increase in endometrial thickness enhanced chances of oocyte maturity, fertilisation, cleavage and implantation (p< 0.0001 each). CONCLUSIONS: Endometrial thickness of 8mm was associated with a positive pregnancy outcome after intracytoplasmic sperm injection. Implantation of embryo was facilitated by better oocyte parameters, oocyte maturity, fertilisation and its cleavage in females who exhibited endometrial thickness above the cut-off value.

Financial wellness awareness: A step closer to achieve Millennium Development Goals for Pakistan.

OBJECTIVE: To explore financial wellness (FW) awareness amongst public and private sector medical college students of Karachi. METHODS: A cross sectional questionnaire based survey was conducted on medical students from 3 public and 5 private sector medical colleges of Karachi from February 2011 to December 2011. All ethnic groups having age range of 18-23 years were included. A questionnaire tailored from wellness wheel evaluated the responses of FW on a four point Likert's scale ranging from 0-3(never, sometimes, mostly, and always). Factor analysis explored common FW factors among both public and private sector medical college (MC) students. RESULTS: Private MC Students were better in terms of making short and long terms financial goals compared to students in public sector. The students of public MC were more focused to make and restricting to given budgets (p=0.05). The FW element of keeping savings in bank account was responded more by private MC candidates (P < 0.0001) but was spent thrift as well (P < 0.0001). Factor analysis revealed two factors; 'Financial Security Wellness' which was better in Private MC Students (p=0.001) and 'Care towards Expenses Wellness" in which results were not significant. CONCLUSION: Both groups of medical college students lacked FW awareness element in terms of caring towards financial expenses. The awareness of importance of financial security was practiced better by private MC students in terms of making short and long term financial goals and keeping savings in bank accounts. They were however deficient in the knowledge of making and restricting themselves to budgets.

Frequency and predictors of non-compliance to dietary recommendations among hypertensive patients.

Compliance to dietary recommendations among hypertensive people is a major health care issue. Non-compliance can nullify the effects of even the most scientific and optimum treatment plan. The main aim of this study was to determine the frequency and predictors of non-adherence in our region. We also investigated the possible factors based on patient opinions that could increase compliance. A sample of 400 adult patients, diagnosed with hypertension for at least 3 years, who visited Civil Hospital during the time period April-June 2013 were included in this cross sectional study. Patient data and opinions were collected by two trained interviewers using a pre-coded questionnaire. Compliance was assessed based on patients self report. More than three quarters (n = 310, 77.5%) of the hypertensive patients were non-compliant. More than one social gathering in a week, peer-influence, no friends to follow the recommended diet plan and lack of believe regarding diet as an effective measure to control blood pressure were found to be the significant predictors of non-compliance (P values <0.0001). Counseling was thought to be the most effective way by the patients to increase adherence. Non-compliance to dietary recommendations is a major problem prevalent especially in Pakistan. There is an urgent need for doctors and nurses to counsel their patients effectively to prevent future morbidities and mortalities because of non-compliance.

Skeletonization technique in coronary artery bypass graft surgery reduces the postoperative pain intensity and disability index.

BACKGROUND AND AIM: Benefits of the skeletonized internal thoracic artery (ITA) include increased graft flow, increased graft length, and reduced incidence of sternal complications. We conducted a randomized, double-blinded comparison of skeletonized versus pedicled ITA to assess the differences in pain intensity and extent of disability between the two types of harvesting procedures at one and three months follow-up. METHODS: A total of 50 patients were included in our study. Twenty-five patients had undergone skeletonized grafting while the other half had undergone pedicled grafting. The patients were evaluated for their pain at one and three months postoperatively. Extent of disability was measured via Pain Disability Index and intensity of pain was measured via Visual Analogue Scale (VAS). The patients were also questioned about the details of their pain using Short Form McGill Pain Questionnaire. RESULTS: In the first month, the mean pain intensity measured through VAS was 30.4 ± 4.0 and 55.0 ± 5.7 mm in skeletonized and pedicle group, respectively. The pedicled group had significantly higher scores measured by all three scales at both one- and three-month intervals (p-values < 0.0001). CONCLUSIONS: Our results indicate that skeletonization of ITA significantly reduces postcoronary artery bypass graft surgery pain at both one- and three-month intervals. Long-term clinical trials involving larger sample sizes should be conducted to fully confirm the benefits of the skeletonization technique.

Intellectual wellness awareness: a neglected area in medical universities of Pakistan.

OBJECTIVE: To compare the presence of intellectual wellness awareness in students of public and private sector medical colleges in a metropolitan city. METHODS: The cross-sectional questionnaire-based survey was conducted from March to November 2011 at Bahria University Medical and Dental College, Karachi, and overall covered five private and 3 public sector medical colleges of the city.The study randomly selected 800 medical students.The responses - never, sometimes, mostly and always (numbered 0-4)--were analysed in terms of frequency, proportion and percentages using Predictive Analysis Software version 18. RESULTS: Of the 800 forms distributed, 736 (92%) completed forms were analysed. Among the respondents, 526 (71.5%) were females. Besides, 450 (61%) belonged to private medical colleges and 236 (39) were from public medical colleges. The participants of private medical colleges had taken part in intellectual discussions actively compared to those from public colleges (p < 0.001). Habit of reading books to acquire knowledge was found in 126 (44%) private college students compared to 149 (33%) in public colleges (p < 0.004). The importance of creative mental activities (p = 0.954) and current information about local and international affairs (p < 0.564) was deficient in both sets of students. CONCLUSION: Students of private medical colleges were better in terms of presence of intellectual wellness awareness, took active participation in class discussions, had good reading habits and carefully selected television programmes and movies.

Inpatient satisfaction at tertiary care public hospitals of a metropolitan city of Pakistan.

OBJECTIVE: To determine the satisfaction of in-patients towards quality of service provision and environment of public-sector hospitals. METHODS: The cross-sectional study was conducted in four major public-sector hospitals of Karachi from December 2010 to February 2012. The questionnaire, besides the demographic details, also had 5-point Likert scale questions regarding satisfaction of patients with doctors, staff, administration and the hospital environment. SPSS 20 was used for statistical analysis and results were expressed as frequencies with percentages. RESULTS: Of the 710 subjects in the study, 475(67%) agreed that their doctors checked them with concentration and care. Staff was reported as being kind natured and well-mannered by 423(59.6%) and 451(63.5%) patients respectively. However, 414(58.3%) were not pleased with the sanitary condition of the hospital. Only 225(31.7%) got comfortable beds, while 498(70.14%) patients found bugs in beds. In terms of overall satisfaction 452(63.7%) were satisfied with the staff, 463(65.2%) with doctors, and 385(54.2%) with the hospital environment. CONCLUSION: Patients were relatively satisfied with the staff, but sanitary conditions and hospital environment were a concern for majority of the patients.

Sex distribution in clinical trials of radiologic contrast agents: A 27-year review.

PURPOSE: Clinical trials play a pivotal role in assessing the safety and efficacy of medical therapies. Addressing sex distribution among enrollees in clinical trials of radiologic contrast agents is essential for ensuring the generalizability of trial outcomes. Previous research has highlighted the influence of demographic factors, particularly sex, on treatment responses, emphasizing the need for equitable representation in clinical trials. Our study aim was to determine the sex distribution of enrollees in clinical trials of radiologic contrast agents. METHODS: Our retrospective study included a total of 65 clinical trials conducted between 1990 and 2017 identified on clinicaltrials.gov after a comprehensive review including searching individually for all FDA approved contrast agents. Data collected included the year of FDA approval, the number of participants, sex distribution, trial location, trial phase, and study type. Inter-rater validation ensured data accuracy. RESULTS: Our analysis revealed fluctuations in sex distribution of trial enrollees. Enrollment of males exceeded females in most years, with a shift towards a more equitable representation in recent trials. Trials conducted in the United States had a higher rate of enrollment by females. Phase I trials had the most balanced representation, whereas Phase IV trials had the highest sex disparity. CONCLUSION: Across all trials, females made up 47.3 % of enrollees [3316 out of 7016 total enrollees]. Enrollment of males exceeded females in 44 of the 65 trials studied, females outnumbered males in 19 trials, and enrollment was equal between the sexes in 2 trials. While the sex distribution observed across all trials represents an equitable representation of enrollees, the wide variance of sex distribution at the level of individual trials has the potential to limit the generalizability of results.