Background
Low back pain (LBP) resides as a most common type of symptom pointing towards lumber radiculopathy. It is defined as burning sharp leg pain that originates from the back and goes all the ...way down your legs and extends into the toes and foot. Lumbosacral radiculopathy is caused by pathology of the intervertebral disk or associated structures. Different dimensional traction has been used to treat lumbar radiculopathy. This study aimed to compare the effects of 3-dimensional and 2-dimensional lumbar traction on pain and functional disability in patients with lumbar radiculopathy. The randomized clinical trial study of 4 weeks was carried out at the Lifeline Health Care Imaging and Pain Center and the Hamza Hospital Lahore. Twenty-six subjects were included in the clinical trial and divided into two groups after randomization. Group A received three-dimensional lumbar traction with traction force 50% of total body weight on Spine MT 3D traction machine, and group B received two-dimensional lumbar traction with traction force 50% of total body weight. Pre- and post-values of NPRS and ODI were noted.
Results
Parametric tests were used during statistical analysis because data was normally distributed. NPRS pre- and posttreatment values showed significant results with
p
-value < 0.05. ODI pre- and post-values were also obvious with
p
-value < 0.05. Independent sample
T
-test was used to assess across the group comparison, suggesting that both groups showed significant improvements of NPRS and ODI post-treatment with
p
-value (< 0.001).
Conclusion
The study concluded that 3D traction significantly reduced pain levels and improved functional impairment more effectively than 2D traction in patients with lumbar radiculopathy.
Trial registration
Trial was registered with ClinicalTrials.gov:
NCT05356689
.
The rehabilitation services including physical therapy, occupational therapy, speech and language therapy is an essential part of the healthcare system, which is required to enhance patients' quality ...of life. These services need a streamlined support system, which is required from the funding sources that significantly impact the efficacy. The accessibility, affordability, and quality of healthcare services are significantly influenced by healthcare finance and its utilization, which involves revenue generation and reimbursement processes to budgetary supervision and allocation of resources. Effective resource allocation is made possible by sound financial management, which minimizes undue usage and maximizes the use of existing resources in underfunded healthcare systems like Pakistan, where there is a greater need for funds for rehabilitation. Despite their value in the budget, rehabilitation services frequently receive a smaller portion of the healthcare budget. There is a need to focus on several funding sources, such as commercial insurance plans, public sector grants, out-of-pocket costs for patients and families, and the functions of foreign aid and charitable donations. The possible ways can be increasing insurance coverage for rehabilitation services, increasing public sector investment and encouraging increased cooperation between public and private sector parties. Ultimately, the healthcare system and the rehabilitative services can be improved for future prevention of disability and evidence-based health policies that maximize available resources and high-quality healthcare. This review offers a thorough analysis of and describes the current state of rehabilitation financing in Pakistan. In addition, it also provides considerable evaluation of barriers and suggested solutions in managing the finances required for running a viable rehabilitation system. Keywords: Budgets; Funds; Funding Resources; Finance; Healthcare System; Hospitals; Patients; Rehabilitation Citation: Waheed A, Shah S, Mahmood T. Managing barriers to resource allocation for the rehabilitation services in Pakistan: a review article. Anaesth. pain intensive care 2024;28(4):776−782; DOI: 10.35975/apic.v28i4.2528 Received: July 08, 2024; Reviewed: July 12, 2024; Accepted: July 26, 2024
•Distal radial access shows promise over the traditional proximal radial access approach.•Distal radial access has a lower rate of radial artery occlusion than proximal radial access.•Distal radial ...access has a shorter time to hemostasis than proximal radial access.•Crossover rates and multiple puncture attempts were higher in distal radial access than proximal radial access.
Radial artery occlusion (RAO) is a major impediment to reintervention in patients who underwent proximal transradial access (p-TRA) for coronary catheterization. Distal transradial access (d-TRA) at the level of snuffbox distal to the radial artery bifurcation is a novel alternative to p-TRA. We conducted an updated meta-analysis of all available randomized controlled trials (RCTs) to compare the incidence of RAO between p-TRA and d-TRA, along with access site–related complications. PubMed, Web of Science, and Google Scholar were searched for RCTs published since 2017 to October 2023 comparing d-TRA and p-TRA for coronary angiography and/or intervention. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals were calculated using the random-effects model for procedural and clinical outcomes for the 2 approaches. A total of 18 RCTs with 8,205 patients (d-TRA n = 4,096, p-TRA n = 4,109) were included. The risk of RAO (RR 0.31, 0.21 to 0.46, p ≤0.001) and time to hemostasis (minutes) (MD −51.18, −70.62 to −31.73, p <0.001) was significantly lower in the d-TRA group. Crossover rates (RR 2.39, 1.71 to 3.32, p <0.001), access time (minutes) (MD 0.93, 0.50 to 1.37, p <0.001), procedural pain (MD 0.46, 0.13 to 0.79, p = 0.006), and multiple puncture attempts (RR 2.13, 1.10 to 4.11, p = 0.03) were significantly higher in the d-TRA group. The use of d-TRA for coronary angiography and/or intervention is associated with a lower risk of RAO at the forearm and may preserve p-TRA site for reintervention in selective patients by reducing the incidence of RAO
Comparison of safety outcomes in patients who underwent coronary access for diagnostic/therapeutic interventions by way of distal versus proximal transradial access.
Note: the subgroup analysis is not detailed within this visual abstract. Continuous outcomes are reported using the standard mean difference (SMD) to ensure the forest plots are clearly visible and interpretable. Display omitted
Postnatal depression (PND) is a global public health problem. There is a high prevalence of PND amongst ethnic minority women and major ethnic inequalities in mental health care in the U.K. Language ...and cultural barriers pose a significant challenge for access to timely treatment and interventions for British South Asian (BSA) women with PND.
The study, carried out in Manchester and Lancashire, England, was a two-arm single-blind exploratory randomised controlled trial. BSA women (N = 83) having a baby <12 months were randomised either to the group receiving the culturally adapted Positive Health Programme (PHP) (n = 42) or to the group receiving treatment as usual (TAU) (n = 41). Follow-up assessments were at 3 months (end of intervention) and 6 months after randomisation.
Using an intention to treat analysis, there was no significant difference between PHP intervention and TAU groups in depression measured using Hamilton Depression Rating Scale both at 3 and 6 months follow up. Using modified intention to treat analysis, women who attended four or more sessions showed significant reduction in depression in the PHP group compared to the TAU group and the greater number of sessions attended was associated with greater reductions in depression scores.
The sample was relatively small and the study was conducted in one geographical area in Northwest England; hence, these results may not be generalizable to other regions and populations.
The recruitment and trial retention figures highlighted the ability of the research team to engage with BSA women, having implications in planning services for this group.
Clinicaltrials.govNCT01838889.
•There is a high prevalence of Postnatal Depression amongst ethnic minority women, and major ethnic inequalities in mental health care in the UK.•One of the first exploratory Randomised Controlled Trials designed to examine the psychological needs of British South Asian women with Postnatal Depression.•The study demonstrated the acceptability of participants being able to engage in a culturally sensitive group Cognitive Behavioural Therapy intervention, the Positive Health Programme (PHP) in British South Asian women•Several factors such as using native language, culturally aware therapists and facilitators, childcare facilities and transport assistance helped the study to better engage and retain participants in this trial.•This study is an important step to improve current knowledge on conducting research with a hard to engage group who is at an elevated risk of maternal mental health difficulties.
Morbidly adherent placenta in the absence of risk factors is a rare entity in primigravida, and its conservative management becomes important in such patients to preserve future fertility. We report ...a case where a primigravida was discovered accidentally having placenta increta while her caesarean section was being performed due to foetal distress (grade 2 meconium). There was unexpected delay in delivery of the placenta. It was managed conservatively by performing a bilateral uterine artery ligation and methotrexate post operatively. On weekly follow-ups serum beta Human Chorionic Gonadotropin(bHCG) levels were done as well as and two weekly ultrasounds. Conservative management of morbidly adherent placenta can be considered in primigravidas where there is a great need to preser ve fer tility and avoid hysterectomy.
To compare the duration of 3rd stage of labour and blood-loss in patients with and without placental cord blood drainage following normal vaginal delivery.
The quasi-experimental study was conducted ...at the Services Hospital, Lahore, Pakistan, from October4, 2015, to April 4, 2016, and comprised pregnant women aged 18-40 years with any parity having gestation >36 weeks and haemoglobin >7.0gm. The subjects were divided into two groups. In one group, routine active management of third stage of labour was done and placental end of the umbilical cord was left open to drain blood in a kidney tray till flow ceased. In the other group, the placental end of the cord was left clamped and spontaneous expulsion was carried out by controlled cord traction. Data was analysed using SPSS 22.
Of the 200 females, 100(50%) were in each of the two groups. The overall mean age was 29.22}6.84 years. The mean baseline haemoglobin in placental cord drainage group was 11.48}0.89 and that in the control group was 11.40 } 0.91 (p>0.05). The mean duration of third stage of labour in placental cord drainage group was 5.67}1.81 hours and in control group it was 8.44}2.50 hours (p<0.001). The mean blood-loss in placental cord drainage group was 174.69}13.69mlcompared to 196.25}15.06ml in the control group (p<0.001).
In the management of the third stage of labour with the cord drainage method, results showed significant reduction in postpartum blood-loss and the duration of the third stage in normal vaginal birth patients.
Abstract Background In the United Kingdom, ethnic minority group's particularly British South Asian women have higher rates of depression than their white counterparts. Despite this they remain under ...represented in mental health trials. Whilst the US legislation mandates the inclusion of ethnic minorities into research, there are no similar initiatives in the UK. Barriers in recruiting these hard to reach ethnic groups are cited as major reasons behind this under representation. Once these barriers are encountered it becomes a challenge for the researchers to overcome them. As there is paucity of research in this specific area through this paper we want to share our strategies in recruiting British South Asians thus encouraging other researchers to consider ethnic minority inclusion into research. Methods Our published systematic review on the barriers to recruitment of ethnic minority participants into mental health research developed a typology of thirty three ethnic recruitment barriers described under five themes. We aimed to find strategies to overcome these barriers from five depression trials for British South Asians conducted by our research group. Firstly we extracted data on recruitment strategies from the published papers. Later researchers involved in these five trials formed a working group to add to these extracted strategies. Finally these strategies were matched to the individual barriers described in the typology. Results Multiple recruitment strategies were described by the researchers. These strategies were matched to all but two recruitment barriers related to psychopathology/substance misuse by the participants and paucity of healthcare related resources. Multiple strategies were found to be effective against each barrier and appropriate ones could be selected by the researchers after considering available resources at hand. Conclusions Findings from this paper have implications for the design of recruitment strategies for hard to recruit ethnic minority groups to health care research. There is need for wider training and support of researchers to give them the skills to recruit these ethnic groups. Further development and evaluation of these strategies will lead to increased recruitment accruals.
