Reviewers\u27 responses to medical research articles

Objective: To document the reviewers\u27 responses in terms of reviewers\u27 demographic and professional characteristics, promptness of reply, and duration of reply to the request to review medical research articles for a general biomedical research journal.Study design: Cross-sectional, observational study.Place and duration of study: Department of Publications, College of Physicians and Surgeons Pakistan (CPSP), from October to December 2015.Methodology: Peer reviewed articles edited by a single staff editor were included. Editorials and correspondence were excluded. Manuscript category, discipline, and the total number of reviewers per manuscript were noted. Responses were divided into no response, regrets, and responded, i.e. provided with the review comments; and further sub-divided into timely response, i.e. within 21 days, or later. Total duration of response was counted in days from the date of dispatch to the date of receiving. Among those who provided a review, reviewers\u27 characteristics were noted as designation, institute affiliation, qualification, and gender. Number and percentages of the studied variables were determined. Chi-square test of proportions was used for comparing the proportions with significance at p\u3c0.05.Results: Reviewers for 50 articles including 28 original articles, 15 case reports, three letters to the editor, two short communications, and two new techniques, were evaluated. A total of 598 reviewers were contacted for those 50 articles; forming an average of 11.96 reviewers contacted and 2.2 responded per manuscript. Four hundred and seventy (78.59%) did not reply at all, 18 (3.01%) regretted, and 110 (18.39%) responded (79/110=71.81% timely, and 31/110=28.18% late). Earliest reply was received in one day and the delayed reply in 87 days. Maximum number of reviewers was 24 for a single original article (internal medicine) and 22 for a case report (cardiology). Significantly, more fellows, professors and females (p=0.004, p=0.002, and p=0.017, respectively) provided timely response.Conclusion: An overwhelming majority of the reviewers did not reply at all despite the incentives of CME credits and honorarium, adversely affecting the processing time. Majority of those who replied, were on time. Reasons for those who did not reply need to be explored

Increasing Awareness and Use of Iodised Salt in a Marginalised Community Setting in North-West Pakistan

Iodine deficiency is still prevalent in parts of Pakistan, despite the introduction of a national Iodine Deficiency Disorder Control Programme in 1994. The purpose of this study was to gain an understanding of the knowledge, attitudes and practice regarding the use of iodised salt in a brick kiln community, and to use this information to design an intervention to increase its consumption. A cross-sectional survey was used to assess the use of iodised salt and focus group discussions explored the attitudes and barriers to its use. Thematically analysed transcripts informed the design of a 4-month intervention. Iodised salt sales and urine iodine concentration (UIC) were monitored to assess the effectiveness of the intervention. At baseline, 2.6% of households reported use of iodised salt and barriers included its higher cost and belief about a negative impact on reproduction. During the intervention, sales of salt labelled as iodised increased by 45%, however this was not reflected in an increase in UIC. This study highlighted the positive impact of education and awareness raising on iodised salt consumption in a hard to reach, marginalised community. However, issues regarding adequate iodisation by local producers and appropriate storage also need to be urgently addressed at a provincial level

Sleeping pattern before thoracic surgery: A comparison of baseline and night before surgery

Background: Sleep deprivation is considered a stress factor in the perioperative period. There are several studies on sleep disturbance after surgery but very limited literature available on preoperative sleep patterns, predictors of sleep disturbance and its effect on surgical outcome.Methodology: Patients scheduled for thoracic surgery were asked to fill out a written Pittsburgh Sleep Quality Index (PSQI) questionnaire. The primary investigator explained this form to all the patients. This was filled out before premedication for subjective assessment of sleeping pattern at two different time point. Only those patients included who spent the previous night at home. Participants were asked to respond to the questions regarding their baseline sleeping pattern and compare it with last night.Results: Total eighty-three patients with a mean age of 47.83 ± 17.88 were included in the study. Overall mean PSQI scores were significantly higher (p-value \u3c 0.01) during the night before surgery (6.94 ± 2.115) when compared with baseline (3.88 ± 1.877). Sleep latency was also significantly affected when last night-1 (the night before admission) was compared with usual sleep latency. Twenty patients were unable to sleep more than 5 hrs at night before admission which was significant when compared with their last month status (20 vs 3). Logistic regression model demonstrated the age and Timing of surgery as a strong predictors of poor sleep (defined as PSQI ≥ 5).Conclusion: Quality of sleep was profoundly affected at night before thoracic surgery, mainly due to a significant change in sleep latency and sleep duration. Although age and Timing of surgery were strong predictors of poor sleep we were unable to find any association between quality of sleep and type of surgery

Immediate changes in hemodynamics and gas exchange after initiation of noninvasive ventilation in cardiac surgical patients

Introduction: Cardiac surgery is associated with pulmonary dysfunction and complications such as prolonged intubation and reintubation. Bilevel positive airway pressure (BiPAP) machine has been used in the clinical settings to improve oxygenation, reduce work of breathing, and avoid reintubation. The effect of BiPAP on cardiovascular parameters is not well established, and very few studies have targeted hemodynamic changes. The aim of the study was to assess the immediate effect of BiPAP on respiratory and hemodynamic parameters in post-cardiac surgery patients.Materials and methods: This quasi-experimental study was done on 33 adult cardiac surgery patients. Ethical review committee approval was sought and consent was taken. All patients who were in respiratory distress with respiratory rate of \u3e30/min and/or PaO2:FiO2 ratio of variables, PaO2:FiO2 ratio.Results: A total of 33 patients were included in the study. The average age of the patients was 60.97 ± 10.8, of which 23 (69.7%) were males and 10 (30.7%) females. BiPAP application leads to statistically significant improvement in ventilator parameters including SaO2 29 (87.7%), PaO2 29 (87.8%), PaCO2 21 (63.6%), and PaO2:FiO2 ratio in 27 (81.8%).Conclusion: Ventilatory parameters were significantly improved after BiPAP application in this study, but hemodynamic parameters showed no statistically significant change. BiPAP application was also able to decrease the need for reintubation in post-cardiac surgery patients

Clinical utility of a novel digitized clock drawing task

OBJECTIVE: The goal of this research was to examine the clinical utility of the digital Clock in the Box (dCIB), a novel digitized cognitive screening test. This was accomplished by (1) creating cutoff scores for the dCIB, (2) evaluating performance on the dCIB relative to established cognitive screening and standardized neuropsychological measures, and (3) determining the efficacy of the dCIB to screen for subtle cognitive deficits associated with poor vascular health. Metabolic Syndrome (MetS; clinical syndrome of three or more cardiovascular risk factors) is a rising health epidemic associated with an increased risk for cerebrovascular disease and vascular dementia. Early detection of subtle deficits associated with MetS may assist in regulation of disease progression and prevention of future vascular dementia. METHODS: A community-based sample of adults with no self-reported history of cognitive impairment was recruited for a cross-sectional study in which they completed a metabolic assessment, blood draw, and a brief neuropsychological battery consisting of the dCIB, the Mini-Mental State Exam (MMSE), and measures of executive function, memory, and attention. For part of the analysis, participants were separated into MetS (n=21) and non-MetS (n=42) groups based on current diagnostic criteria for MetS. RESULTS: Participants (N=63) were older (62.49 ± 9.16 years), educated (16.46 ± 2.76 years), and diverse with 44.4% female (n=28) and 28.6% non-White (n=18). Receiver operating characteristic (ROC) analysis and Youden’s J statistic determined the optimal cutoff value for the dCIB as 5.5 (dCIB score ≤ 6 indicating suspected impairment; dCIB score ≤ 5 indicating probable impairment). Performance on the dCIB (6.32 ± 2.32) was significantly correlated with the MMSE (28.19 ± 2.06); (Pearson’s r = 0.437, p = 0.000). The dCIB had better sensitivity (72.7%) but poorer specificity (65.4%) compared to the MMSE (sensitivity 45.5%; specificity 94.2%). Using regression modeling, the dCIB significantly predicted performance on measures of executive function, memory, and attention. In a sample stratified by vascular risk, the dCIB successfully differentiated MetS (5.33 ± 2.75) and non-MetS (6.81 ± 1.93) groups, with lower dCIB scores in the MetS group relative to the non-MetS group (F = 8.975, p = 0.004). CONCLUSION: The dCIB is a novel digitized clock drawing task designed to screen for cognitive impairment. Clinical utility for the dCIB was established by determining its test validity and demonstrating its sensitivity to detect subtle cognitive deficits in a sample with vascular risk. Because the dCIB is simple to administer and brief to complete, it may be an ideal option for routine cognitive screening in primary care settings