METHODS: The review study was conducted from December 2017, to May 2018. An online search was conducted in international and local health databases using appropriate search keywords as well as scanning reference lists of related articles. Literature published after year 2000 that reported epidemiological, demographic, clinical and socioeconomic data of Pakistani rheumatoid arthritis patients was included. Meta-analysis was performed where possible. This systematic review was registered on the international prospective register of systematic reviews PROSPERO (CRD42018090582).
RESULTS: Of the 334 research articles found, 29 (8.7%) were selected. Patients were mostly females, but no study explored impact of disease on household and family role functioning of rheumatoid arthritis-affected women in Pakistan. Most patients were uneducated (55%) and unemployed; had low disease knowledge (N = 149, 74.5%) and poor adherence to disease-modifying anti-rheumatic drugs (N = 23, 23%). Point prevalence of rheumatoid arthritis reported from Karachi was high at 26.9%. Moderate disease activity, i.e., 4.5}0.7 and mild functional disability (N = 66, 51.6%) were seen in RA patients. Almost half (N = 799, 46.9%) had comorbidities. Almost a fifth proportion of RA patients had dyslipidaemia as a comorbidity (N = 134, 16.77%) and higher cardiovascular risk score as modifiable risk factor. Undiagnosed depression (N = 134, 58.3%) and low bone mineral density (N = 93, 40.6%) were reported in RA patients. Direct monthly treatment cost of disease was significantly high considering patients' socio-economic status, i.e., USD 16.47 - 100.68. Most commonly used drug was methotrexate.
CONCLUSIONS: There is a paucity of data on Pakistani rheumatoid arthritis patients' demographic and socio-economic parameters, especially the gender element.
METHODS/DESIGN: This is a randomized, single-blind, two-arm, controlled trial in patients with rheumatoid arthritis visiting outpatient rheumatology clinics in Karachi, Pakistan. We will enroll patients with established diagnosis of rheumatoid arthritis over 3 months. The patients would be randomized through a computer-generated list into the control group, i.e., usual care or into the intervention group, i.e., pharmaceutical care, in a ratio of 1:1, after providing signed written consent. The study will take place in two patient-visits over the course of 3 months. Patients in the intervention group would receive intervention from the pharmacist while those in the control group will receive usual care. Primary outcomes include change in mean score from baseline (week 0) and at follow up (week 12) in disease knowledge, adherence to medications and rehabilitation/physical therapy. The secondary outcomes include change in the mean direct cost of treatment, HRQoL and patient satisfaction with pharmacist counselling.
DISCUSSION: This is a novel study that evaluates the role of the pharmacist in improving treatment outcomes in patients with rheumatoid arthritis. The results of this trial could set the foundation for future delivery of care for this patient population in Pakistan. The results of this trial would be published in a peer-reviewed journal.
TRIAL REGISTRATION: ClinicalTrials.gov, NCT03827148 . Registered on February 2019.
METHODS: After translating the original English version into Chinese (GMAS-C) following the forward-backward translation and expert review procedure, we conducted a pilot study among 10 chronic disease patients. Each patient took about 10 min to complete the scale and was asked about the difficulty of understanding or filling the scale. Then a total of 312 patients aged 18 years or older with chronic illness were selected from the outpatient departments of two tertiary hospitals and a community center in Tianjin from April 2019 to May 2020 by convenience sampling. Cronbach's α coefficient, item-total correlation and test-retest reliability were used to evaluate the scale reliability; expert evaluation method was used to evaluate the content validity of the scale; and exploratory factor analysis, confirmatory factor analysis, and known group validity were used to evaluate the construct validity of the scale.
RESULTS: As a result of the adaptation process, the GMAS-C's structure was determined. It included 3 dimensions and 11 items and was reliable and valid for Chinese patients with chronic diseases. Total Cronbach's α coefficient of the scale was 0.781 and test-retest reliability coefficient was 0.883 after two weeks. The item-level content validity indexes (CVIs) were ≥ 0.78 for all items. A Kaiser-Meyer-Olkin test and Bartlett' test of sphericity test indicated that the sample met the requirements of factor analysis. Exploratory factor analysis extracted three factors with eigenvalue >1, and 60% of the total variance was explained by three-factor solution. Confirmatory factor analysis showed acceptable fit indices (χ2/df = 1.58, IFI = 0.96, TLI = 0.94, CFI = 0.96 and RMSEA = 0.05).
CONCLUSIONS: The GMAS-C demonstrates satisfactory reliability and validity. This scale can be a clinically useful tool to identify the levels of medication adherence and possible barriers for adherence of the medication regime in patients with chronic diseases.
METHODS: A qualitative study was conducted in a tertiary care hospital in Karachi in September 2017, using grounded theory and inductive approach. Interviews were conducted using a checklist in Urdu language from patients of chronic illnesses determined based on medicines dispensed from the out-patient pharmacy in hospital. Interviews were recorded, transcribed verbatim, translated in English and validated. The translated quotations were analysed using a qualitative analysis software, and thematic analysis was conducted. Codes were generated and analysed by semantic linkages and network analysis using ATLAS.ti qualitative research software.
RESULTS: Of the 16 patients interviewed, 8(50%) were males and 8(50%) were females. Barriers to medication adherence identified were patient behaviour (intentional and un-intentional non-adherence), comorbidity and pill burden, cost-related non-adherence, and low patient knowledge. The last barrier was associated with the rest.
CONCLUSIONS: Counselling has the potential to increase patient knowledge regarding medication use, and active pharmacist-physician collaboration can improve medication adherence..
METHODS: A prospective 1-year study was conducted in rheumatology clinics of tertiary care hospitals of Karachi, Pakistan. Cost-of-illness methodology was used and all patient data related to costs of rheumatologist visits, physical therapy sessions, medications, assistive devices and laboratory investigations were obtained directly in printed hardcopies from patient electronic databases using their medical record numbers. Transportation cost was calculated from patient-reported log books. Data were analyzed through IBM SPSS version 23. Patients were asked to sign a written consent and the study was ethically approved.
RESULTS: The mean age of patients (N = 358) was 48 years. Most patients (73.7%) were female, married (86%) and had basic education (71.8%). Average cost of rheumatologist visits was PKR 11 510.61 (USD: 72.05) while it was PKR 66 947.37 (USD: 419.07) for physical therapy sessions. On average, medicines and medical devices costs were estimated at PKR 10 104.23 (USD: 63.25) and PKR 7848.48 (USD: 49.13) respectively. Cost attributed to diagnostic and laboratory charges was PKR 1962.12 (USD: 12.28) and travel expense was PKR 6541 (USD: 40.95). The direct expenditure associated with managing RA was PKR 37 558 (USD: 235.1). All costs were reported per annum.
CONCLUSION: Patient with RA in Pakistan pay a considerable amount of their income for managing their condition. Most patients have no provision for insurance which is a need considering the nature of the disease and associated productivity loss that would significantly lower income as the disease progresses.
Materials and Methods: This is a cross-sectional study and the response along with demographic details was collected through a validated questionnaire; the results were analyzed by using a validated data collection tool. The results were concluded based on good, moderate, and poor responses, which were evaluated through data analysis by using the Statistical Package for the Social Sciences software version 20.0., SPSS Inc., Chicago, III, USA. A value of P < 0.05 was considered statistically significant.
Results: In total, 182 (44.4%) of male and 228 (55.6%) of female respondents were selected for this study. Studies showed that a greater knowledge level was observed among female respondents (15.55 ± 2.7, P < 0.001). The selected Chinese population had relatively good knowledge (i.e., 15.63, P = 0.006). People practicing Buddhism had also good knowledge. Rural population had lesser family income and showed a good practice pattern and understanding (P = 0.006). The positive attitude was identified among women ( P < 0.001) with a mean score of 15.55 ± 2.7. Postgraduate participants were found to have diverse results with SD ± 6.23, and 77.1% had a good attitude. A statistically significant association was observed between religion and attitude of respondents (P < 0.001).
Conclusion: Although a better practice was noticed in Malaysian population, more awareness is required and knowledge should be disseminated among the population to improve the overall health and quality of life in Malaysia.
OBJECTIVES: To describe and summarize the assessment of knowledge and perceptions about CVD risk and preventive approaches among patients with T2DM.
METHODS: A scoping review methodology was adopted, and three scientific databases, Google Scholar, Science Direct, and PubMed were searched using predefined search terms. A multistage screening process that considered relevancy, publication year (2009-2019), English language, and article type (original research) was followed. We formulated research questions focused on the assessment of levels of knowledge and perceptions of the illness relevant to CVD prevention and the identification of associated patients' characteristics.
RESULTS: A total of 16 studies were included. Patients were not confident to identify CVD risk and other clinical consequences that may occur in the prognostic pathway of T2DM. Furthermore, patients were less likely to identify all CV risk factors indicating a lack of understanding of the multi-- factorial contribution of CVD risk. Patients' beliefs about medications were correlated with their level of adherence to medications for CVD prevention. Many knowledge gaps were identified, including the basic disease expectations at the time of diagnosis, identification of individuals' CVD risk factors, and management aspects. Knowledge and perceptions were affected by patients' demographic characteristics, e.g., educational level, race, age, and area of residence.
CONCLUSION: There are knowledge gaps concerning the understanding of CVD risk among patients with T2DM. The findings necessitate educational initiatives to boost CVD prevention among patients with T2DM. Furthermore, these should be individualized based on patients' characteristics, knowledge gaps, disease duration, and estimated CVD risk.
OBJECTIVE: This study investigated direct costs attributed to rehabilitation treatment of poliomyelitis among Pakistani patients and reported its duration along with the socioeconomic status of poliomyelitis survivors.
CONCLUSION: The cost of poliomyelitis rehabilitation in Pakistan is high; it has an economic effect on the lives of patients and their families. Despite good education, polio survivors in Pakistan appear to have low socioeconomic status, lower chances of employment and marriage, as well as fewer children. Further research is recommended to explore the burden of disease on society, i.e., indirect costs and suffering.
OBJECTIVE: The present systematic review aimed to investigate the potential role of home visits in improving outcomes among adult patients with asthma.
METHODS: The systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An extensive literature search was conducted using databases such as PubMed, ProQuest, CINAHL, The Cochrane Library, PsycINFO, and Google Scholar from inception to June 2019. The studies included were randomized controlled trials, which reported asthma outcomes in adult patients.
RESULTS: The literature search yielded 8331 publications, of which 63 studies were selected for full-text review, and of these studies, 9 studies with a total of 2011 patients were included in the final analysis. The included randomized controlled trials reported quality of life, asthma symptoms, exacerbations, health care utilization, and pulmonary function. Improvements in asthma outcomes were observed predominantly in quality of life. The effects on asthma symptom control were inconsistent. The evidence on the impact of home visits in asthma exacerbations and health care utilization was rather limited. There were no significant differences observed between intervention versus control arms in terms of pulmonary function; however, 1 study reported significant improvements in peak expiratory flow rate.
CONCLUSIONS: Home visits may serve as an adjuvant activity that complements the existing health care system-based initiatives. It may be concluded that home visits have the potential to improve outcomes in adult patients with asthma; however, the randomized controlled trials reviewed in the present systematic review reported several limitations that warrant further investigation.
METHODS: A month-long study was conducted in patients attending physical therapy sessions at clinics in two tertiary care hospitals in Karachi, Pakistan. It was done using block randomization technique. Sample size was calculated based on item-to-respondent ratio of 1:20. The GRAS was developed and validated using content validity, factor analyses, known group validity, and sensitivity analysis. Receiver operator curve analysis was used to determine cut-off value. Reliability and internal consistency were measured using test-retest method. Data was analyzed through IBM SPSS version 23. The study was ethically approved (IRB-NOV:15).
RESULTS: A total of 300 responses were gathered. The response rate was 92%. The final version of GRAS contained 8 items and had a content validity index of 0.89. Sampling adequacy was satisfactory, (KMO 0.7, Bartlett's test p-value 0.95 while absolute fit index of root mean square of error of approximation was
MATERIAL AND METHODS: A total of 300 elderly Malay participants (age ≥ 65 years) with CKD, attending the Hospital University Sains Malaysia were included in the study. Demographic data and history were also recorded. Serum creatinine was assayed by Chemistry Analyzer Model Architect-C8000 (Jaffe method). While serum cystatin C was examined by Human cystatin C ELISA kit (Sigma-Aldrich) using Thermo Scientific Varioskan Flash ELISA reader.
RESULTS: Out of 300 study participants, 169 (56.3%) were females. Mean age of patients was 67.6 ± 6.7 years. 64 male (64.6%) and 35 female (35.4%) patients were between 70 and 79 years. When estimated by MDRD equation, the prevalence of CKD stage 3 (defined as eGFR = 30 - 59 mL/min/1.73m2) was 27.7%, while based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, it was 28%, 36.3%, and 36.3%, respectively. The prevalence of CKD stage 4 (defined as eGFR = 15 - 29 mL/min/1.73m2) when estimated by MDRD was 37.6%, whereas based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, it was 36.3%, 46.4%, and 46.4%, respectively. CKD stage 5 (defined as eGFR < 15 mL/min/1.73m2) when estimated by the MDRD equation was 34.7%. While based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, the prevalence of CKD stage 5 was 35.7%, 17.3%, and 17.3%, respectively.
CONCLUSION: The staging of CKD is different between the creatinine- and cystatin C-based equations. Creatinine-based equations classify patients as having CKD stage 5 twice as often as cystatin C-based equations.
METHODS: The translation of the English version of the valid 10-item TAI questionnaire into BM was followed by subjecting it to a series of tests establishing factorial, concurrent and known group validities. Concurrent validity was assessed through Spearman's rank correlation coefficient against pharmacy refill-based adherence scores. Known group validity was assessed by cross-tabulation against asthma symptom control and using chi-square test. The internal consistency of the test scale was determined by a test-retest method using Cronbach's alpha (α) value and intraclass correlation coefficients.
RESULTS: A total of 120 adult asthma patients participated in the study. A 2-factor structure was obtained and confirmed with acceptable fit indices; CFI, NFI, IFI, TLI >0.9 and, RMSEA was 0.08. The reliability of the scale was 0.871. The test-retest reliability coefficient for the total sum score was 0.832 (p 85%.
CONCLUSIONS: The scale successfully translated into BM and validated. The 10-item TAI-BM appears fit for use in testing inhaler adherence of Malaysian patients with asthma.
METHODS: A novel research instrument known as the rheumatoid arthritis knowledge assessment scale (RAKAS) which consisted of 13 items, was formulated by a rheumatology panel and used for this study. This study was conducted in rheumatology clinics of three tertiary care hospitals in Karachi, Pakistan. The study was conducted in March-April 2018. Patients were recruited using a randomized computer-generated list of appointments. Sample size was calculated based on item-to-respondent ratio of 1:15. The validities, factor structure, sensitivity, reliability and internal consistency of RAKAS were assessed. The study was approved by the institutional Ethics Committee.
RESULTS: A total of 263 patients responded to the study. Content validity was 0.93 and response rate was 89.6%. Factor analysis revealed a 3-factor structure. Fit indices, namely normed fit index (NFI), Tucker Lewis index (TLI), comparative fit index (CFI) and root mean square of error approximation (RMSEA) were calculated with satisfactory results, that is, NFI, TLI and CFI > 0.9, and RMSEA 19 and difficulty index <0.95. Sensitivity and specificity of RAKAS were above 90%. The tool established construct and known group validities.
CONCLUSION: A novel tool to document disease knowledge in patients with RA was formulated and validated.