Statistics in the Operating Room: A Cardiovascular Surgeon's Guide to Numbers That Matter

Pediatric cardiac surgery demands meticulous technique, but optimal outcomes hinge on translating data into actionable insights. This editorial bridges the gap between scalpel and statistical jargon, empowering surgeons to decipher common tests. Descriptive statistics paint portraits of patient cohorts, while hypothesis testing discerns real differences from chance. Regression analysis unveils hidden relationships, predicting outcomes based on complex interplays of variables. Survival analysis tracks the delicate dance of time and survival, informing therapeutic strategies. By embracing statistical fluency, surgeons become architects of personalized care, tailoring interventions to mitigate risks and maximize the precious gift of a beating heart.

Identification of Predominant Learning Approaches in Medical Students using ASSIST in An Indian Medical School: A Cross-sectional Survey

Introduction: Approaches to study and learning may either improve or attenuate educational outcomes. Medical educators, therefore need to monitor the various approaches adopted by students in pursuit of their learning. This can be achieved using Approaches to Study and Skills Inventory for Students (ASSIST). Aim: To find predominant learning approach amongst medical students in a western Indian medical school. Materials and Methods: A cross-sectional observational study was conducted at second year MBBS students in September 2015, at the private medical college of Pramukhswami Medical College, Gujarat, India for documenting details about their understanding about learning and its concepts, different learning approaches and preferences for different types of courses and teachings adopted by students in their daily academic routine. Descriptive analysis was carried out finding frequency (n) and percentages (%) and Independent sample t-test was applied to compare the scores of quantitative data between the sub groups. Analysis was done using the software Statistics and Data Science (STATA) version 14.2. Results: Out of 100 students, 75 participated (38 females and 37 males). Results displayed the frequency scores of ASSIST and its three sections. Under first section i.e., “what is learning” and “what are concept”, there was no significant difference (p-value >0.05) in mean (Standard Deviation) scores. While in second section on “Approaches of learning” maximum students used Strategic Approach (SA) (79.82±8.97), followed by Deep Approach (DA) (64.39±6.01) and then surface approach (50.10±9.87). There was a positive correlation between deep and strategic learning approach (r=+0.44) whereas deep and surface approach showed negative relation (r=-0.23). In addition, surface approach had negative relation with SA (r=-0.21). In regards to the preferences for different types of course and teaching, there was no significant difference (p>0.05). Conclusion: Knowledge of student’s ‘approaches to learning’, ‘conceptions of learning’ and ‘preference towards different types of teaching styles can help optimise the quality of student learning, as well can support teaching and assessment methods used by educators.

Blood Component Transfusion in Tertiary Care Neonatal Intensive Care Unit and Neonatal Intermediate Care Unit: An Audit

Background Neonates admitted in a tertiary neonatal intensive care unit (NICU) require multiple blood transfusions because of extended NICU stay and repeated sampling. The rookie organ systems and miniature blood volumes in the neonate call for regular audits in neonatal blood transfusion practice. Sharing component usage data with the blood bank will prepare them to store components according to demand, thus limiting wastage of components as well as make banks ready to face a shortage in case of ramped up requirements. Objective Auditing neonatal blood transfusion indications and identifying the most commonly used component. Methodology This retrospective cohort study was conducted by the department of pediatrics over 22 months from February 20, 2017, to December 30, 2018. Any preterm and term neonates admitted to the NICU and Neonatal Intermediate Care Unit (NIMC) and receiving any transfusion, i.e., fresh frozen plasma (FFP), red cell concentrate (RCC), platelets, and exchange transfusion were included in our study. We collected data from the medical records of NICU and NIMC admitted patients receiving blood component transfusions from 2011 to 2016. Patients were categorized according to the classification of neonatal conditions by the International Classification of Diseases 11th Revision (ICD-11). There were no exclusion criteria. A descriptive statistical analysis was done, and a Chi-square test was applied. Results Out of 340 neonates, 249 (73.2%) were low birth weight, 139 (40.9%) were small for gestational age (SGA), and 277 (81.5%) neonates required transfusion during the first week of life. The majority of neonates require multiple transfusions. Fourteen(4.12%) neonates required up to 10 transfusions, two neonates required up to 22 transfusions, and 58 neonates required more than five blood transfusions. The majority required transfusion due to neonatal sepsis, Disseminated intravascular coagulopathy, low birth weight, respiratory distress syndrome, and unconjugated hyperbilirubinemia. Thirty-seven point eighty-two percent (37.82%) transfusions were fresh frozen plasma, 31.34% transfusions were red cell concentrate, 28.14% transfusions were platelet concentrate, and 2.70% were whole blood. Out of 340 neonates, 317 survived and were discharged. Conclusion The most commonly transfused component was fresh frozen plasma, the indication was neonatal sepsis, and the group was preterm. Whole blood is still being used and needs to be stopped.

Direct Cost of Critical Illness Associated Healthcare Expenditures among Children Admitted in Pediatric Intensive Care Unit in Rural India

OBJECTIVE

To assess the direct costs involved in treatment of children receiving intensive care in a university-affiliated teaching hospital and its associated implications on the children's families, in rural India.

METHODS

It was a prospective observational study for cost-analysis using questionnaire based interviews and billing records data collection for admissions to the PICU over 27 consecutive months (January 2010 through March 2012).

RESULTS

A total of 784 children were admitted to the unit during the assessment period. Full details of 633 children were included for analysis. The average length of stay was 6.16 d, average hospital expenditure was US$185.67, average hospital expenses per day was US$44.00, average pharmacy expenditure was US$109.67 and average pharmacy expenditure per day was US$20.62 per patient. Children who were ventilated had approximately 61 % more expense per day as compared to non-ventilated ones. Boys and those with health insurance reported higher length of stay. Linear hierarchical regression with backward LR model showed that mechanical ventilation, multiple organ dysfunction, length of stay and insurance cover were the variables significantly affecting the final expenses.

CONCLUSIONS

There is a high direct expenditure incurred by families of children receiving intensive care when seen in perspective of high rates of extreme poverty in rural India. These high expenditures make critical care unaffordable to majority of the population lacking insurance cover in resource limited regions with limited universal health coverage, which ultimately leads to suboptimal care and high childhood mortality. It is highly imperative for the governments and global health organizations to be sensitive towards this issue and to plan strategies for the same across different nations.

Xanthelasma Palpebrarum with Arcus Cornea: A Clinical and Biochemical Study

Background:

Xanthelasma palpebrarum (XP) is characterized by sharply demarcated yellowish flat plaques on upper and lower eyelids. It is commonly seen in women with a peak incidence at 30–50 years. It is also considered as the cutaneous marker of underlying atherosclerosis along with the disturbed lipid metabolism. XP and corneal arcus are associated with increased levels of serum cholesterol and low-density lipoprotein (LDL) cholesterol.

Aims and Objectives:

To study the clinical pattern of XP, its relationship with lipid profile and association with arcus cornea.

Materials and Methods:

This study was conducted at Department of Dermatology and Opthalmology, between August 2013 and January 2015. Patients with clinical diagnosis of XP who visited skin outpatient department and willing to undergo lipid profile test and eye examination were included in the study. Data regarding demographics, clinical findings, family history, and past history were noted along with the lipid profile details. Data of age-matched healthy controls were taken for comparison. The clinical profile of the participants was presented using frequency and proportions. Gender wise analysis comparing the lipid profile in cases with XP and without XP was done using independent sample t-test.

Results:

Total 49 patients of XP, 81.6% were females. Maximum, 35% patients were among 50–60 years of age and 69.4% were homemakers by occupation. The average lipid values were-cholesterol 210.57 mg%, triglyceride 123.06 mg%. LDL 142.79 mg% and VLDL 30.95 mg% among patients of XP. Arcus cornea was found in 20% cases of XP.

Conclusions:

Patients of XP requires proper investigation at the onset and regular follow-up thereafter for any altered lipid profile and early diagnosis of coronary artery disease.

Social, Psychological and Financial Burden on Caregivers of Children with Chronic Illness: A Cross-sectional Study

OBJECTIVES

To explore social, psychological and financial burden on caregivers of chronically diseased children.

METHODS

Participants were recruited from ambulatory and hospital areas in pediatrics department following informed consent. Parents who were caregivers of children 18 y or below in age with chronic illness were included. Socio-demographic details were collected using a semi structured questionnaire, adapted from Family Burden Interview Schedule (FBIS). The psychological well-being of caregivers was assessed using Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7). Descriptive analysis and ANOVA was done for comparing mean scores of responses to analyze financial, psychological and social burden across different diagnosis.

RESULTS

A total of 204 (89 females:115 males) participated. Only 27% were receiving some benefits from government or hospital side. No depressive symptoms were reported by 25% caregivers, while 37% reported mild and 38% moderate to severe depressive symptoms. No anxiety symptoms were reported by 33%, while 50% reported mild and 17% moderate to severe anxiety symptoms. No association was seen between gender of the caregiver and depressive or anxiety symptoms. Significantly higher financial and social burden was seen in cerebral palsy and cancer groups vis-a-vis other diseases, being least in thalassemia. Disruption of routine life was highest in cancer group caregivers followed by those in cerebral palsy group.

CONCLUSIONS

Most caregivers reported moderate depressive symptoms and mild to moderate anxiety symptoms. Cerebral palsy caused more social and financial burden on family vis-a-vis thalassemia. Social and financial burden on families of remaining diseases was comparable.

Characteristics of Postpartum Depression in Anand District, Gujarat, India

Characteristics of postpartum depression (PPD) in Anand District, Gujarat, India. PPD affects 1 in 10 women in the developed world. It has been implicated as an independent factor with adverse effect on child health, and health care-seeking behavior of mothers. We sought to find the prevalence of PPD in our hospital by including mothers who registered and delivered live babies at our hospital. Basic demographic information related to pregnancy was acquired from mothers and Edinburgh Postnatal Depression Scale (EPDS), pre-translated and validated in Gujarati language, was administered. Current study observed prevalence of PPD as 48.5% using cutoff score of 10.5 for classifying depression in Gujarati women. Factors associated with depression after multivariable logistic regression were: age of mother, modified Kuppuswami category (MKC) score, family type, violence from husband, gravida, para and sex of infant. PPD has higher prevalence in our study vis-a-vis Western countries. This may be because of early administration of EPDS.

Pain in children: knowledge and perceptions of the nursing staff at a rural tertiary care teaching hospital in India

OBJECTIVES

To assess the knowledge and perception regarding pain amongst nursing staff and to determine whether varying clinical exposure to painful procedures in children had any association with their perception of pain.

METHODS

A consensually validated questionnaire containing combination of questions from basic (must know) and advanced (nice to know) areas of knowledge about nursing pediatric patients and questions related to nurses' perception about pain in pediatric patients was administered to the eligible nursing staff at a Rural Tertiary Care Hospital in Western India. The responses to the questionnaire were analyzed using descriptive statistics and the comparisons were made by applying chi-square test.

RESULTS

Three Hundred and Fifty one usable questionnaires (83.37 %) out of 421 were returned. The knowledge of the nurses in general regarding pain was observed to be poor. Only 60 % of all the nurses had complete knowledge of all the basic questions asked. Only 3.1 % had answered all of the five advanced questions correctly, while 96.9 % of the nurses had answered one or more questions incorrectly.

CONCLUSIONS

The deficit in knowledge and shortcomings in perception of nursing staff needs to be addressed and steps need to be taken to improve the nurse's knowledge and modify beliefs and attitude of the nursing staff towards the pain of the pediatric patients.