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Background & objectives: Due to lack of appropriate statistical knowledge, published research articles contain various errors related to the design, analysis and interpretation of results in the area of biomedical research. If research contains statistical error, however, costly, it may be of no use and the purpose of the investigation gets defeated. Many biomedical research articles published in different peer reviewed journals may retain several statistical errors and flaws in them. This study aimed to examine the trend and status of application of statistics in biomedical research articles. Study design, sample size estimation and statistical measures are crucial components of a study. These points were evaluated in published original research articles to understand the use or misuse of statistical tools. Methods: Three hundred original research articles from the latest issues of selected 37 journals were reviewed. These journals were from the five internationally recognized publication groups (CLINICAL KEY, BMJ Group, WILEY, CAMBRIDGE and OXFORD) accessible through the online library of SGPGI, Lucknow, India. Results: Among articles assessed under present investigation, 85.3 per cent (n=256) were observational, and 14.7 per cent (n=44) were interventional studies. In 93 per cent (n=279) of research articles, sample size estimation was not reproducible. The simple random sampling was encountered rarely in biomedical studies even though none of the articles was adjusted by design effect and, only five articles had used randomized test. The testing of assumption of normality was mentioned in only four studies before applying parametric tests. Interpretation & conclusions: In order to present biomedical research results with reliable and precise estimates based on data, the role of engaging statistical experts need to be appreciated. Journals must have standard rules for reporting study design, sample size and data analysis tools. Careful attention is needed while applying any statistical procedure as, it will not only help readers to trust in the published articles, but also rely on the inferences the published articles draw.
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Background & objectives: The association between hyperglycaemia at admission, diabetes mellitus (DM) status and mortality in hospitalized SARS-CoV-2 infected patients is not clear. The purpose of this study was to determine the relationship between DM, at-admission hyperglycaemia and 28 day mortality in patients admitted with moderate-severe SARS-CoV-2 infection requiring intensive care. Methods: All consecutive moderate-to-severe patients with SARS-CoV-2 infection admitted to the intensive care units (ICUs) over six months were enrolled in this single-centre, retrospective study. The predicators for 28 day mortality were analysed from the independent variables including DM status and hyperglycaemia at-admission. Results: Four hundred and fifty two patients with SARS-CoV-2 were admitted to the ICU, with a mean age of 58.5±13.4 yr, 78.5 per cent being male, HbA1c of 7.2 per cent (6.3-8.8) and 63.7 per cent having DM. Overall, 28 day mortality was 48.9 per cent. In univariate analysis, mortality in diabetes patients was comparable with non-diabetes (47.9 vs. 50.6%, P=0.58), while it was significantly higher in hyperglycaemic group (60.4 vs. 35.8%, P<0.001). In multivariate Cox regression analysis, after adjusting for age, sex and comorbidities, hyperglycaemia at-admission was an independent risk factor of mortality [hazard ratio (HR) 1.45, 95% confidence interval (CI) (1.06-1.99), P<0.05]. Interpretation & conclusions: This study showed that the presence of hyperglycaemia at-admission in critically ill SARS-CoV-2 patients was an independent predictor of 28 day mortality. However, the findings may be susceptible to unmeasured confounding, and more research from prospective studies is required.
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RESUMO Objetivo: Examinar as características clínicas, o padrão de desmame e o desfecho de pacientes que necessitaram de ventilação mecânica por tempo prolongado em uma unidade de terapia intensiva em um país com recursos financeiros limitados. Métodos: Estudo prospectivo observacional em centro único, realizado na Índia, no qual todos os pacientes adultos que necessitaram de ventilação mecânica prolongada foram acompanhados quanto a duração e padrão do desmame, e à sobrevivência, tanto por ocasião da alta da unidade de terapia intensiva quanto após 12 meses. A definição de ventilação mecânica prolongada adotada foi a do consenso da National Association for Medical Direction of Respiratory Care. Resultados: Durante o período de 1 ano, 49 pacientes com média de idade de 49,7 anos receberam ventilação mecânica prolongada; 63% deles eram do sexo masculino e 84% tinham uma enfermidade de natureza clínica. As medianas dos escores APACHE II e SOFA quando da admissão foram, respectivamente, 17 e 9. O tempo mediano de ventilação foi 37 dias. A razão mais comum para início da ventilação foi insuficiência respiratória secundária à sepse (67%). O desmame foi iniciado em 39 (79,5%) pacientes, com sucesso em 34 deles (87%). A duração mediana do desmame foi de 14 (9,5 - 19) dias, e o tempo mediano de permanência na unidade de terapia intensiva foi 39 (32 - 58,5) dias. A duração do suporte com vasopressores e a necessidade de hemodiálise foram preditores independentes significantes de insucesso no desmame. No acompanhamento após 12 meses, 65% dos pacientes sobreviveram. Conclusão: Mais de um quarto dos pacientes com ventilação invasiva na unidade de terapia intensiva necessitaram de ventilação mecânica prolongada. Os desmames foram bem-sucedido em dois terços dos pacientes, e a maioria deles sobreviveu até o acompanhamento após 12 meses.
ABSTRACT Objective: This study aimed to examine the clinical characteristics, weaning pattern, and outcome of patients requiring prolonged mechanical ventilation in acute intensive care unit settings in a resource-limited country. Methods: This was a prospective single-center observational study in India, where all adult patients requiring prolonged ventilation were followed for weaning duration and pattern and for survival at both intensive care unit discharge and at 12 months. The definition of prolonged mechanical ventilation used was that of the National Association for Medical Direction of Respiratory Care. Results: During the one-year period, 49 patients with a mean age of 49.7 years had prolonged ventilation; 63% were male, and 84% had a medical illness. The median APACHE II and SOFA scores on admission were 17 and 9, respectively. The median number of ventilation days was 37. The most common reason for starting ventilation was respiratory failure secondary to sepsis (67%). Weaning was initiated in 39 (79.5%) patients, with success in 34 (87%). The median weaning duration was 14 (9.5 - 19) days, and the median length of intensive care unit stay was 39 (32 - 58.5) days. Duration of vasopressor support and need for hemodialysis were significant independent predictors of unsuccessful ventilator liberation. At the 12-month follow-up, 65% had survived. Conclusion: In acute intensive care units, more than one-fourth of patients with invasive ventilation required prolonged ventilation. Successful weaning was achieved in two-thirds of patients, and most survived at the 12-month follow-up.
Subject(s)
Humans , Male , Adult , Aged , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Ventilator Weaning/methods , Intensive Care Units , Patient Discharge , Respiratory Insufficiency/etiology , Time Factors , Survival Rate , Prospective Studies , Follow-Up Studies , Renal Dialysis , Outcome Assessment, Health Care , Sepsis/complications , APACHE , India , Length of Stay , Middle AgedABSTRACT
Background: Ever since HIV was first identified in India among sex workers in Chennai during 1986, HIV infections have been reported in all states and territories. The knowledge and attitudes of healthcare workers (HCWs) in relation to HIV infection is an important factor influencing the willingness and ability of people with HIV to access care, and the quality of the care they receive. Aims & Objective: To assess HIV-related knowledge and risk perception among a group of north Indian health care workers (HCW), and to identify predictors of willingness to provide care for patients with HIV infection. Material and Methods: A cross-sectional survey of 450 HCWs from tertiary health care centre was undertaken in March 2011. The information was collected on a semi structured, self-administered questionnaire. Information was gathered regarding demographic details, HIV-related knowledge, risk perception and previous experience caring for HIV-positive patients. Results: Most (95.7%) were aware of the routes of transmission. 4.1% HCWs wished that they should be allowed to refuse to care for people with HIV/AIDS. HCWs willingness to provide care for patients with HIV was strongly associated with having previously cared for patients with HIV (P = 0.001). Knowledge of HIV transmission and perception of risk were not associated with willingness to provide care (p<0.05). Conclusion: The knowledge of HCW was satisfactory. But periodic updates are required to enhance the knowledge of HCW. These include the development of programmes to promote occupational safety of HCWs and involving people with HIV in awareness training of HCWs.