1
|
Jin L, Han Y, Dong J, Wang H, Dong Y, Wang W, Li Y. The role of payment sources in the continuation of rehabilitation therapy in tertiary hospitals for patients with traumatic spinal cord injury: a study in Southwest China. Ann Med 2024; 56:2333890. [PMID: 38557236 PMCID: PMC10986431 DOI: 10.1080/07853890.2024.2333890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Medical security support for rehabilitation therapy in China is different from that in other countries. We investigated whether the discharge plan to continue rehabilitation therapy in tertiary hospitals for patients after traumatic spinal cord injury (TSCI) was influenced by payment sources or other conditions. This was a cross-sectional, observational study. Information was collected on the general condition, caregiver, types of payment sources for continued rehabilitation, American Spinal Injury Association Impairment Scale (AIS) scores, and discharge plans. In total, 135 patients with TSCI (107 male, mean age 41.00 ± 13.73 years, mean spinal cord injury duration 238.43 ± 345.54 days) were enrolled. Medical insurance (43%) and out-of-pocket payments (27.4%) were the primary payment sources. Although most patients were beyond the acute phase, 40% continued rehabilitation therapy at other tertiary hospitals. The caregiver, payment sources, injury level, AIS level, and complete urinary tract infection (UTI) were different due to discharge plans (p > .05). Patients seemingly consider a higher AIS level and co-UTI as the requirement for tertiary hospital therapy. In non-medical insurance payment source patients, the discharge plan also differed due to the AIS level and co-UTI (p > .05). However, in medical insurance patients, the discharge plan differed only in terms of TSCI duration (p > .05). The restricted duration of medical coverage restricted the continuation of rehabilitation therapy and influenced the discharge plan of most patients with TSCI.
Collapse
Affiliation(s)
- Lihua Jin
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yongqian Han
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Juchuan Dong
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haonan Wang
- Department of Rehabilitation Medicine, Kunming Medical University, Kunming, China
- Department of Burn and Plastic Medicine, The Fourth Medical Center of the Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yifei Dong
- Department of Rehabilitation Medicine, Kunming Medical University, Kunming, China
| | - Wenyuan Wang
- Department of Rehabilitation Medicine, Kunming Medical University, Kunming, China
| | - Yongmei Li
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| |
Collapse
|
2
|
Weiner DM, Kumar P, Varadhan R, Sweren R, Kim N, Rozati S. Outcomes of extracorporeal photopheresis in a diverse cohort of patients with cutaneous T-cell lymphoma: a retrospective study at a tertiary care hospital. J DERMATOL TREAT 2024; 35:2312250. [PMID: 38331434 DOI: 10.1080/09546634.2024.2312250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- David M Weiner
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Priyanka Kumar
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ravi Varadhan
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ronald Sweren
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Noori Kim
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sima Rozati
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
3
|
Maghembe RS, Magulye MAK, Eilu E, Sekyanzi S, Makaranga A, Mwesigwa S, Katagirya E. A sophisticated virulence repertoire and colistin resistance of Citrobacter freundii ST150 from a patient with sepsis admitted to ICU in a tertiary care hospital in Uganda, East Africa: Insight from genomic and molecular docking analyses. Infect Genet Evol 2024; 120:105591. [PMID: 38604286 DOI: 10.1016/j.meegid.2024.105591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
Sepsis and multidrug resistance comprise a complex of factors attributable to mortality among intensive care unit (ICU) patients globally. Pathogens implicated in sepsis are diverse, and their virulence and drug resistance remain elusive. From a tertiary care hospital ICU in Uganda, we isolated a Citrobacter freundii strain RSM030 from a patient with sepsis and phenotypically tested it against a panel of 16 antibiotics including imipenem levofloxacin, cotrimoxazole and colistin, among others. We sequenced the organism's genome and integrated multilocus sequencing (MLST), PathogenFinder with Virulence Factor analyzer (VFanalyzer) to establish its pathogenic relevance. Thereafter, we combined antiSMASH and PRISM genome mining with molecular docking to predict biosynthetic gene clusters (BGCs), pathways, toxin structures and their potential targets in-silico. Finally, we coupled ResFinder with comprehensive antibiotic resistance database (CARD) to scrutinize the genomic antimicrobial resistance profile of the isolate. From PathogenFinder and MLST, this organism was confirmed to be a human pathogen (p = 0.843), sequence type (ST)150, whose virulence is determined by chromosomal type III secretion system (T3SS) (the injectosome) and plasmid-encoded type IV secretion system (T4SS), the enterobactin biosynthetic gene cluster and biofilm formation through the pgaABCD operon. Pathway and molecular docking analyses revealed that the shikimate pathway can generate a toxin targeting multiple host proteins including spectrin, detector of cytokinesis protein 2 (Dock2) and plasmalemma vesicle-associated protein (PLVAP), potentially distorting the host cell integrity. From phenotypic antibiotic testing, we found indeterminate results for amoxicillin/clavulanate and levofloxacin, with resistance to cotrimoxazole and colistin. Detailed genome analysis revealed chromosomal beta lactam resistance genes, i.e. blaCMY-79, blaCMY-116 and blaTEM-1B, along with multiple mutations of the lipopolysaccharide modifying operon genes PmrA/PmrB, pmrD, mgrA/mgrB and PhoP/PhoQ, conferring colistin resistance. From these findings, we infer that Citrobacter freundii strain RSM030 is implicated in sepsis and resistance to standard antibiotics, including colistin, the last resort.
Collapse
Affiliation(s)
- Reuben S Maghembe
- Biological and Marine Sciences Unit, Faculty of Natural and Applied Sciences, Marian University College, P. O. Box 47, Bagamoyo, Tanzania; Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda; Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University, Wester Campus, Ishaka, Uganda.; Microbiology Section, Department of Biological Sciences, University of Botswana, Private Bag 0704, Gaborone, Botswana.
| | - Maximilian A K Magulye
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Emmanuel Eilu
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University, Wester Campus, Ishaka, Uganda
| | - Simon Sekyanzi
- Department of Medical Microbiology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Abdalah Makaranga
- Biological and Marine Sciences Unit, Faculty of Natural and Applied Sciences, Marian University College, P. O. Box 47, Bagamoyo, Tanzania
| | - Savannah Mwesigwa
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Eric Katagirya
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| |
Collapse
|
4
|
Patel I, Hall LA, Osei-Bordom D, Hodson J, Bartlett D, Chatzizacharias N, Dasari BVM, Marudanayagam R, Raza SS, Roberts KJ, Sutcliffe RP. Risk factors for failure to rescue after hepatectomy in a high-volume UK tertiary referral center. Surgery 2024; 175:1329-1336. [PMID: 38383242 DOI: 10.1016/j.surg.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Mortality after severe complications after hepatectomy (failure to rescue) is strongly linked to center volume. The aim of this study was to evaluate the risk factors for failure to rescue after hepatectomy in a high-volume center. METHODS Retrospective study of 1,826 consecutive patients who underwent hepatectomy from 2011 to 2018. The primary outcome was a 90-day failure to rescue, defined as death within 90 days posthepatectomy after a severe (Clavien-Dindo grade 3+) complication. Risk factors for 90-day failure to rescue were evaluated using a multivariable binary logistic regression model. RESULTS The cohort had a median age of 65.3 years, and 56.6% of patients were male. The commonest indication for hepatectomy was colorectal metastasis (58.9%), and 46.9% of patients underwent major or extra-major hepatectomy. Severe complications developed in 209 patients (11.4%), for whom the 30- and 90-day failure to rescue rates were 17.0% and 35.4%, respectively. On multivariable analysis, increasing age (P = .006) and modified Frailty Index (P = .044), complication type (medical or combined medical/surgical versus surgical; P < .001), and body mass index (P = .018) were found to be significant independent predictors of 90-day failure to rescue. CONCLUSION Older and frail patients who experience medical complications are particularly at risk of failure to rescue after hepatectomy. These results may inform preoperative counseling and may help to identify candidates for prehabilitation. Further study is needed to assess whether failure to rescue rates could be reduced by perioperative interventions.
Collapse
Affiliation(s)
- Ishaan Patel
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Lewis A Hall
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK; Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, UK
| | | | - James Hodson
- Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, UK
| | | | | | | | | | - Syed S Raza
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | | |
Collapse
|
5
|
Solanki S, Dogra S, Gupta PK, Peters NJ, Malik MA, Mahajan JK. Randomized controlled trial to evaluate the rate of successful neonatal endotracheal intubation performed with a stylet versus without a stylet. Paediatr Anaesth 2024; 34:448-453. [PMID: 38305632 DOI: 10.1111/pan.14845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Neonates in intensive care units often require endotracheal intubation and mechanical ventilation. During this intubation procedure, a stylet is frequently used along with an endotracheal tube. Despite the widespread use of a stylet, it is still not known whether its use increases the intubation success rate. This study examined the association between stylet use and the intubation success rate in surgical neonates. METHODOLOGY This single-center study was conducted between December 2021 and December 2022 in the Neonatal surgical intensive care unit of a tertiary care center in Northern India. Infants were randomized to have the endotracheal intubation procedure performed using either an endotracheal tube alone or with a stylet. The primary outcome of the study was to assess the successful first-attempt neonatal endotracheal intubation rate with and without using a stylet. Apart from the rate of successful intubation, the duration of the intubation and complications during the intubation procedures as measured by bradycardia, desaturation episodes, and local trauma were also recorded. Both groups were thus compared on above mentioned outcomes. RESULTS The total number of neonates enrolled were 200, and the overall success rate (81% in the stylet group vs. 73% in the non-stylet group) was not statistically significant. Intubation time was however less, when stylet was used (16.2 ± 4.3 vs. 17.5 ± 5.0 s, p = .046). When the endotracheal tube size was 3 or less, the success rate was substantially higher in the stylet group (80%) than the non-stylet group (63%), p = .03. No statistical difference was recorded for bleeding and local trauma, though the esophageal intubation rate was higher when intubation was attempted without the stylet. CONCLUSION Endotracheal intubation using a stylet did not significantly improve the success rate of the procedure, however, intubation time significantly varied between groups and in different conditions. The rigidity and curvature provided by the stylet may facilitate the process of intubation when smaller caliber endotracheal tubes are used.
Collapse
Affiliation(s)
| | - Shivani Dogra
- Department of Paediatric Surgery, PGIMER, Chandigarh, India
| | - Pramod K Gupta
- Department of Paediatric Surgery, PGIMER, Chandigarh, India
| | - Nitin J Peters
- Department of Paediatric Surgery, PGIMER, Chandigarh, India
| | - Muneer A Malik
- Department of Paediatric Surgery, PGIMER, Chandigarh, India
| | - J K Mahajan
- Department of Paediatric Surgery, PGIMER, Chandigarh, India
| |
Collapse
|
6
|
Shmoury AH, Hanna W, Zakhour J, Zahreddine NK, Kanj SS. Epidemiology and microbiology of catheter-associated urinary tract infections: A 14-year surveillance study at a tertiary care center in Lebanon. J Infect Public Health 2024; 17:825-832. [PMID: 38537577 DOI: 10.1016/j.jiph.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the most common device-associated healthcare-acquired infections and pose a significant burden on patients and healthcare systems worldwide. However, there is a paucity of data on CAUTI epidemiology and microbiology in the Middle East and North Africa (MENA) region, including Lebanon. METHODS This 14-year retrospective cohort study was conducted at a tertiary care center in Lebanon. It analyzed data on all adult patients diagnosed with CAUTI between January 2009 and December 2022 in intensive care units (ICUs) and between June 2011 and December 2022 in regular units. Incidence rates, urinary catheter utilization ratios, and microbiological profiles were collected and analyzed. RESULTS A total of 620 CAUTI cases were identified during the study period. The overall CAUTI rate was 2.4 per 1000 catheter-days, with higher rates in ICUs (3.2 per 1000 catheter-days) compared to regular units (1.4 per 1000 catheter-days). No significant changes in the rates were noted despite implementing many interventions. The most common pathogens were Gram-negative bacteria, with Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae being predominant. Multidrug-resistant organisms represented 48% of all isolates. Enterobacterales were largely extended-spectrum β-lactamase (ESBL) producing, and most Acinetobacter baumannii isolates showed multidrug resistance. CONCLUSIONS This study provides important insights into CAUTI epidemiology and microbiology in a tertiary care center in Lebanon, addressing the knowledge gap in this area in the MENA region. Despite implementing prevention measures, CAUTI rates remained stable over the 14-year period. The findings highlight the need for continuous improvement in infection prevention practices, diagnostic stewardship, and antimicrobial stewardship, especially given the rising threat of antimicrobial resistance. These results can serve as a guide for the development of targeted preventive strategies to reduce the burden of CAUTIs, particularly in low- and middle-income countries where antimicrobial resistance is a major issue.
Collapse
Affiliation(s)
- Abdel Hadi Shmoury
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wael Hanna
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Johnny Zakhour
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Kara Zahreddine
- Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon; Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
| |
Collapse
|
7
|
Broekhoven AGC, Ostyn T, van Melkebeke L, Verspaget HW, van der Merwe S, Verbeek J, Coenraad MJ, Roskams TA, Nevens F. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59:577-583. [PMID: 38306114 DOI: 10.1080/00365521.2024.2309527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES Alcoholic hepatitis (AH) is a frequent precipitating event for the development of acute-on-chronic liver failure (ACLF), a syndrome characterised by organ failures due to immune dysfunction. The histological features of this complication are not well characterized. We investigated whether ACLF has specific histological characteristics. METHODS Prospective cohort study in consecutive adult patients admitted between 03-2008 and 04-2021 to a tertiary referral centre with suspected AH. Diagnosis of AH was based on clinical presentation and confirmed by transjugular liver biopsy. All biopsies were assessed by a dedicated liver pathologist, blinded for clinical data and outcome. Diagnosis of ACLF was based on EASL-CLIF criteria. Histological and clinical characteristics of patients with and without ACLF at baseline were compared. RESULTS 184 patients with biopsy-proven AH were enrolled. Median time from hospital admission to transjugular biopsy was 4.5 days (IQR 2-8). At baseline, ACLF was present in 73 patients (39.7%). Out of the 110 patients without ACLF at baseline, 30 (27.3%) developed ACLF within 28 days (median 7.5 days (IQR 2-20)). At baseline, ductular bilirubinostasis (DB) was the only histological feature significantly more frequently present in patients with ACLF compared to patients without ACLF (50.7% vs. 30.6%, p = 0.003). No clear association between histological features and the development of ACLF later on could be demonstrated. CONCLUSIONS In this well-defined cohort of patients with biopsy-proven AH, DB was associated with the presence of ACLF. This finding fits with the pathophysiology of this syndrome, which is characterized by systemic inflammation and an increased risk of infections.
Collapse
Affiliation(s)
- Annelotte G C Broekhoven
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tessa Ostyn
- Department of Imaging and Pathology, Translational Cell and Tissue Research, KU Leuven, Leuven, Belgium
| | - Lukas van Melkebeke
- Department of Gastroenterology and Hepatology, University Hospitals, Leuven, Belgium
- Laboratory of Hepatology, KU Leuven, Leuven, Belgium
| | - Hein W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Schalk van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals, Leuven, Belgium
- Laboratory of Hepatology, KU Leuven, Leuven, Belgium
| | - Jef Verbeek
- Department of Gastroenterology and Hepatology, University Hospitals, Leuven, Belgium
- Laboratory of Hepatology, KU Leuven, Leuven, Belgium
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tania A Roskams
- Department of Imaging and Pathology, Translational Cell and Tissue Research, KU Leuven, Leuven, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals, Leuven, Belgium
- Laboratory of Hepatology, KU Leuven, Leuven, Belgium
| |
Collapse
|
8
|
Patel PS, Desai ND, Shah SH, Shah SN. Lived Experiences of Bereaved Family Members During COVID-19 Pandemic in a Tertiary Care Hospital With Special Reference to Imposed Restrictive COVID Guidelines-a Qualitative Study. Omega (Westport) 2024; 89:404-420. [PMID: 35184587 PMCID: PMC8863921 DOI: 10.1177/00302228221075207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to understand the experiences of bereaved family members in view of restrictive COVID guidelines using qualitative approach. 10 Hindu, Gujarati bereaved family members who lost their loved ones during the first wave were interviewed telephonically after a month of their loss. Findings were difficulty in proper communication during hospitalization, disrupted end-of-life and funeral rituals and accepting harsh realities related to the changes imposed by using content analysis. Most of the family members felt that there was a need of staying with the patients. Telephonic mode of communication was not sufficient for them and created doubts related to death. Most of them felt remorseful as they were not able to see or bring their loved one home during their last moments and felt deprived of the traditional rituals. Also, they had to deal with their grief by themselves.
Collapse
Affiliation(s)
- Preet S Patel
- Department of Psychiatry,
GMERS Medical College Gotri
Vadodara, Vadodara, India
| | - Nimisha D. Desai
- Department of Psychiatry,
GMERS Medical College Gotri
Vadodara, Vadodara, India
| | - Sandip H. Shah
- Department of Psychiatry,
GMERS Medical College Gotri
Vadodara, Vadodara, India
| | - Saurabh N. Shah
- Department of Psychiatry,
GMERS Medical College Gotri
Vadodara, Vadodara, India
| |
Collapse
|
9
|
Broccard SP, Edwards MA, Brennan ER, Spaulding AC, DeLeon MF, Mishra N, Casler JD, Colibaseanu DT. Room for Improvement: The Impact of Guideline-Recommended Extended Thromboprophylaxis in Patients Undergoing Abdominal Surgery for Colorectal and Anal Cancer at a Tertiary Referral Center. Dis Colon Rectum 2024; 67:714-722. [PMID: 38335005 DOI: 10.1097/dcr.0000000000003158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Venous thromboembolism occurs in approximately 2% of patients undergoing abdominal and pelvic surgery for cancers of the colon, rectum, and anus and is considered preventable. The American Society of Colon and Rectal Surgeons recommends extended prophylaxis in high-risk patients, but there is low adherence to the guidelines. OBJECTIVE This study aims to analyze the impact of venous thromboembolism risk-guided prophylaxis in patients undergoing elective abdominal and pelvic surgeries for colorectal and anal cancers from 2016 to 2021. DESIGN This was a retrospective analysis. SETTING The study was conducted at a multisite tertiary referral academic health care system. PATIENTS Patients who underwent elective abdominal or pelvic surgery for colon, rectal, or anal cancer. MAIN OUTCOME MEASURES Receipt of Caprini-guided venous thromboembolism prophylaxis, 90-day postoperative rate of deep vein thrombosis, pulmonary embolism, venous thromboembolism, and bleeding events. RESULTS A total of 3504 patients underwent elective operations, of whom 2224 (63%) received appropriate thromboprophylaxis in the inpatient setting. In the postdischarged cohort of 2769 patients, only 2% received appropriate thromboprophylaxis and no thromboembolic events were observed. In the group receiving inappropriate thromboprophylaxis, at 90 days postdischarge, the deep vein thrombosis, pulmonary embolism, and venous thromboembolism rates were 0.60%, 0.40%, and 0.88%, respectively. Postoperative bleeding was not different between the 2 groups. LIMITATIONS Limitations to our study include its retrospective nature, use of aggregated electronic medical records, and single health care system experience. CONCLUSION Most patients in our health care system undergoing abdominal or pelvic surgery for cancers of the colon, rectum, and anus were discharged without appropriate Caprini-guided venous thromboembolism prophylaxis. Risk-guided prophylaxis was associated with decreased rates of inhospital and postdischarge venous thromboembolism without increased bleeding complications. See Video Abstract . MARGEN DE MEJORA EL IMPACTO DE LA TROMBOPROFILAXIS RECOMENDADA POR LAS DIRECTRICES EN PACIENTES SOMETIDOS A CIRUGA ABDOMINAL POR CNCER COLORRECTAL Y ANAL EN UN CENTRO DE REFERENCIA TERCIARIO ANTECEDENTES:El tromboembolismo venoso ocurre en aproximadamente el 2% de los pacientes sometidos a cirugía abdominal y pélvica por cánceres de colon, recto y ano, y se considera prevenible. La Sociedad Estadounidense de Cirujanos de Colon y Recto recomienda una profilaxis prolongada en pacientes de alto riesgo, pero el cumplimiento de las directrices es bajo.OBJETIVO:Este estudio tiene como objetivo analizar el impacto de la profilaxis guiada por el riesgo de tromboembolismo venoso (TEV) en pacientes sometidos a cirugías abdominales y pélvicas electivas por cáncer colorrectal y anal entre 2016 y 2021.DISEÑO:Este fue un análisis retrospectivo.AJUSTE:El estudio se llevó a cabo en un sistema de salud académico de referencia terciaria de múltiples sitios.PACIENTES:Pacientes sometidos a cirugía abdominal o pélvica electiva por cáncer de colon, recto o ano.PRINCIPALES MEDIDAS DE RESULTADO:Recepción de profilaxis de tromboembolismo venoso guiada por Caprini, tasa postoperatoria de 90 días de trombosis venosa profunda, embolia pulmonar, tromboembolismo venoso y eventos de sangrado.RESULTADOS:Un total de 3.504 pacientes se sometieron a operaciones electivas, de los cuales 2.224 (63%) recibieron tromboprofilaxis adecuada en el ámbito hospitalario. En el cohorte de 2.769 pacientes después del alta, solo el 2% recibió tromboprofilaxis adecuada en la que no se observaron eventos tromboembólicos. En el grupo que recibió tromboprofilaxis inadecuada, a los 90 días después del alta, las tasas de trombosis venosa profunda, embolia pulmonar y tromboembolia venosa fueron del 0,60%, 0,40% y 0,88%, respectivamente. El sangrado posoperatorio no fue diferente entre los dos grupos.LIMITACIONES:Las limitaciones de nuestro estudio incluyen su naturaleza retrospectiva, el uso de registros médicos electrónicos agregados y la experiencia de un solo sistema de atención médica.CONCLUSIÓN:La mayoría de los pacientes en nuestro sistema de salud sometidos a cirugía abdominal o pélvica por cánceres de colon, recto y ano fueron dados de alta sin una profilaxis adecuada de TEV guiada por Caprini. La profilaxis guiada por el riesgo se asoció con menores tasas de tromboembolismo venoso hospitalario y dado de alta sin un aumento de las complicaciones de sangrado. (Traducción-Dr. Aurian Garcia Gonzalez ).
Collapse
Affiliation(s)
| | - Michael A Edwards
- Division of Advanced GI and Bariatric Surgery, Mayo Clinic, Jacksonville, Florida
| | - Emily R Brennan
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center, Mayo Clinic, Jacksonville, Florida
| | - Aaron C Spaulding
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center, Mayo Clinic, Jacksonville, Florida
| | - Michelle F DeLeon
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida
| | - Nitin Mishra
- Division of Colon and Rectal Surgery, Mayo Clinic, Phoenix, Arizona
| | - John D Casler
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona
| | - Dorin T Colibaseanu
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center, Mayo Clinic, Jacksonville, Florida
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
10
|
Porte J, Hennequin C, Krizch D, Vercellino L, Guillerm S, Thieblemont C, Quéro L. Extranodal nasal-type NK/T lymphoma treated with chemotherapy and radiotherapy: case series from a European tertiary referral center and review of the literature. Strahlenther Onkol 2024; 200:434-443. [PMID: 37945929 DOI: 10.1007/s00066-023-02165-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Extranodal nasal-type NK/T-cell lymphoma (ENKTL) is very rare in western countries and few data are available regarding the prognosis and the outcome of patients treated for this disease. We aimed to evaluate the prognosis, the pattern and risk factors of disease failure after combined therapy and also performed a review of the literature. PATIENTS AND METHODS We retrospectively analyzed 20 patients with (ENKTL) who underwent L‑Asparaginase based chemotherapy followed by (chemo-) radiotherapy between 2010 and 2020 in our center. Data on clinical characteristics and irradiation were collected. Failure patterns were recorded as local (tumor site), regional (regional lymph nodes) or distant failure (metastasis and/or nonregional lymph nodes). RESULTS During a median follow-up period of 46 months, disease failure was observed in 8 patients (40%). The 3‑year progression-free survival (PFS) and overall survival (OS) rates were 62.5 and 83.0%, respectively. The failure patterns were local (n = 6, 30%), regional (n = 3, 15%) and distant (n = 4, 20%). Among patients with local failure, all failures occurred within the radiation fields (100%). Univariate analysis showed that bilateral regional lymph node involvement (p = 0.0002), initial circulating EBV viral load ≥ 3.5 log (p = 0.03) and no negativation of EBV PCR after induction CT (p = 0.0497) were independent predictors of PFS. CONCLUSION Patients with bilateral lymph node involvement and/or high EBV viral load have a significant recurrence rate despite multimodal therapy. These results need to be confirmed by larger studies. Given the high rate of local recurrence within radiotherapy fields, the value of dose escalation should be considered. Patients at risk of relapse should be included in dedicated trials.
Collapse
Affiliation(s)
- Judith Porte
- Radiation Oncology department, AP-HP, Hopital Saint Louis, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | - Christophe Hennequin
- Radiation Oncology department, AP-HP, Hopital Saint Louis, 1, Avenue Claude Vellefaux, 75010, Paris, France
- UMR/CEA, Immuno-Hematology Research Unit (SRHI), Université Paris Cité, Paris, France
| | - Daphné Krizch
- Hematology department, AP-HP, Hopital Saint Louis, Paris, France
| | - Laetitia Vercellino
- Nuclear Medicine Department, Hopital Saint Louis AP-HP, Paris, France
- INSERM, UMR_S942 MASCOT, Université Paris Cité, Paris, France
| | - Sophie Guillerm
- Radiation Oncology department, AP-HP, Hopital Saint Louis, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | - Catherine Thieblemont
- Hematology department, AP-HP, Hopital Saint Louis, Paris, France
- INSERM U728, Universite Paris Cite, Paris, France
| | - Laurent Quéro
- Radiation Oncology department, AP-HP, Hopital Saint Louis, 1, Avenue Claude Vellefaux, 75010, Paris, France.
- INSERM U1160, Universite Paris Cite, Paris, France.
| |
Collapse
|
11
|
Stephens IJB, Murphy B, Burns L, McCawley N, McNamara DA, Burke JP. Contemporary perioperative outcomes after total abdominal colectomy for ulcerative colitis in a tertiary referral centre. Eur J Gastroenterol Hepatol 2024; 36:578-583. [PMID: 38489595 DOI: 10.1097/meg.0000000000002755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Colectomy for ulcerative colitis (UC) is common despite therapeutic advances. Post-operative morbidity and mortality demonstrate an association between hospital volumes and outcomes. This single-centre retrospective study examines outcomes after emergency colectomy for UC. METHODS Patient demographics, perioperative variables and outcomes were collected in Beaumont Hospital between 2010 and 2023. Univariant analysis was used to assess relationships between perioperative variables and morbidity and length of stay (LOS). RESULTS A total of 115 patients underwent total abdominal colectomy with end ileostomy for UC, 8.7 (±3.8) per annum. Indications were refractory acute severe colitis (88.7%), toxic megacolon (6.1%), perforation (4.3%), or obstruction (0.9%). Over 80% of cases were performed laparoscopically. Pre-operative steroid (93%) and biologic (77.4%) use was common. Median post-operative LOS was 8 days (interquartile range 6-12). There were no 30-day mortalities, and 30-day post-operative morbidity was 38.3%. There was no association between time to colectomy ( P = 0.85) or biologic use ( P = 0.24) and morbidity. Increasing age was associated with prolonged LOS ( P = 0.01). Laparoscopic approach (7 vs. 12 days P =0.01, 36.8% vs. 45% P = 0.66) was associated with reduced LOS and morbidity. CONCLUSION This study highlights contemporary outcomes after emergency colectomy for UC at a specialist high-volume, tertiary referral centre, and superior outcomes after laparoscopic surgery in the biologic era.
Collapse
Affiliation(s)
- Ian J B Stephens
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | | | | | | | | | | |
Collapse
|
12
|
Santhosh S, Vimalraj S, Kalpana MM. Quality of life following a maternal near-miss event during the COVID-19 pandemic at a tertiary care center in South India. Int J Gynaecol Obstet 2024; 165:823-829. [PMID: 38186373 DOI: 10.1002/ijgo.15340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/27/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To assess the quality of life (QoL) in women following a maternal near-miss event and to assess the women's attitude towards future fertility and their contraceptive choices. METHODS A cross-sectional observational study was conducted in Government Medical College, Kozhikode, India among women who had experienced a near-miss event (n = 50) between January 1, 2020 and May 31, 2021 during the peak of the COVID-19 pandemic. The QoL was assessed using the WHO Quality of Life, BREF Version, questionnaire, which was administered to the consenting participants over phone. Information regarding desire for future fertility, contraceptive choices, and urogenital symptoms was also collected. A comparison between the short-term and long-term effects on the QoL was also done. RESULTS A maternal near-miss event was not found to adversely affect the overall quality of life in the present study. The scores in all the four domains-physical, psychological, social relationships, and environmental-suggested good QoL, although greater variability in values were observed in the physical and psychological domains. The influence in these two domains was more pronounced following a perinatal loss and following prolonged physical morbidities. There was no difference in short- and long-term QoL following a maternal near miss (MNM). The MNM did not influence the contraceptive choices and there was no subsequent pelvic floor dysfunction in most women. CONCLUSION MNM was not found to adversely affect the overall subsequent QoL in the present study. There was no difference in short- and long-term QoL following a MNM. Studies carried out over a longer period of time with a control group would yield more information.
Collapse
Affiliation(s)
- Smitha Santhosh
- Department of Obstetrics and Gynaecology, Government Medical College, Kozhikode, Kerala, India
| | - Sajala Vimalraj
- Department of Obstetrics and Gynaecology, Government Medical College, Kozhikode, Kerala, India
| | - M M Kalpana
- Department of Obstetrics and Gynaecology, Government Medical College, Kozhikode, Kerala, India
| |
Collapse
|
13
|
Haliyur R, Sinha AK, Andrews CA, Musch DC, Conrady CD, Zacks DN, Huvard MJ. NO EFFECT OF REAL-WORLD UNIVERSAL FACE MASKING ON POST-INTRAVITREAL INJECTION ENDOPHTHALMITIS RATE AT A SINGLE TERTIARY ACADEMIC CENTER. Retina 2024; 44:916-922. [PMID: 38207176 DOI: 10.1097/iae.0000000000004043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE To determine whether universal masking during COVID-19 altered rate and outcomes of postinjection endophthalmitis. METHODS Retrospective, single-site, comparative, cohort study. Eyes diagnosed with endophthalmitis within 4 weeks of intravitreal injection at the University of Michigan from August 1, 2012, to November 15, 2022, were identified. Cases were considered "masking" between March 15, 2020, and November 15, 2022. Endophthalmitis rate, visual acuity, and microbial spectrum were investigated. RESULTS There were 20 postinjection endophthalmitis cases out of 72,194 injections (0.028%; one in 3,571 injections) premasking and 10 of 38,962 with universal masking (0.026%; one in 3,846 injections; odds ratio 0.9; 95% [confidence interval]: 0.4-2.0). Referral from the community was unchanged with 32 cases referred premasking (0.35 cases/month) and 10 cases with masking (0.31 cases/month). Presenting mean the logarithm of the minimum angle of resolution visual acuity with masking of all postinjection endophthalmitis cases trended worse (2.35 ± 0.40) compared with premasking (2.09 ± 0.48; P = 0.05) with light perception visual acuity more common with masking (31.6% vs. 10.9%, P = 0.06). There was no delay in time from procedure to initial treatment ( P = 0.36), no difference in the rate of initial treatment with tap and inject (T/I), and similar positive-culture rates ( P = 0.77) between the cohorts. Visual acuity after 30 days of follow-up was clinically unchanged (∼20/500 vs. 20/400; P = 0.59). CONCLUSION Universal masking had no effect on postinjection endophthalmitis rate or on the rate of culture-positive cases. Although presenting visual acuity appeared worse with masking, this was not statistically significant, and current treatment paradigms resulted in similar visual outcomes.
Collapse
Affiliation(s)
- Rachana Haliyur
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Alina K Sinha
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Chris A Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Christopher D Conrady
- Departments of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Omaha, Nebraska; and
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Michael J Huvard
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
14
|
Seixas DR, Trindade IEK, Yamashita RP, Silva ASCD, Araújo BMAM, Maia SÉDS, Fukushiro AP. Effect of Orthognathic Surgery on Breathing in Patients with Cleft lip and Palate: 20-Year Experience at a Tertiary Hospital in Brazil. Cleft Palate Craniofac J 2024; 61:808-817. [PMID: 36517969 DOI: 10.1177/10556656221145311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To verify the effect of orthognathic surgery (OS) on nasal dimensions and its correlation with respiratory symptoms in patients operated on over the past 20 years. DESIGN Retrospective study. SETTING Tertiary level craniofacial hospital. PARTICIPANTS 535 patients with CLP previously repaired, without syndromes, age over 18, who performed OS between 2000 and 2019 and rhinomanometric evaluation pre and post OS. INTERVENTIONS Maxillary advancement isolated and combined with turbinectomy and/or mandibular osteotomy. MAIN OUTCOME MEASURES Minimum nasal cross-sectional area (CSA) assessed by posterior (PR) and anterior rhinomanometry (AR), nasopharyngeal cross-sectional area (NCSA) verified by modified AR, and self-perceived respiratory symptoms through a questionnaire. RESULTS After OS, there was a significant increase in CSA assessed by PR (p < .001) and AR (p < .001), while there was no significant difference in NCSA (p = 0.319). Regarding respiratory symptoms after OS, 26.3% showed improvement in nasal obstruction, 28.5% in oronasal breathing, 18.5% in snoring, and 5.2% in respiratory obstruction during sleep. However, a weak correlation between increased CSA and improvement of symptoms was observed. In the first decade, lower values of CSA (p < .001) and NCSA (p < .001) were observed compared to the second decade. Both periods showed a significant increase in CSA (p < .001). CONCLUSIONS Nasal dimensions and breathing symptoms were improved by OS when combined with turbinectomy. Comparing the results of patients operated on between two different decades, patients had more favorable conditions for breathing in the most recent decade of care. However, this was not statistically correlated with the improvement in patient symptoms in this study.
Collapse
Affiliation(s)
- Déborah Rocha Seixas
- Postgraduate Program in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, 17012-900, Brazil
| | - Inge Elly Kiemle Trindade
- Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, 17012-900, Brazil
| | - Renata Paciello Yamashita
- Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, 17012-900, Brazil
| | | | | | - Sergio Éberson da Silva Maia
- Postgraduate Program in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, 17012-900, Brazil
| | - Ana Paula Fukushiro
- Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, 17012-900, Brazil
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, 17012-900, Brazil
| |
Collapse
|
15
|
Hongaiah D, Kattepur AK, George EV, Mahadev M A, Kenkere D, Dasappa A. Free flap reconstruction at a rural-based tertiary medical college hospital: Barriers and outcomes. J Surg Oncol 2024; 129:1159-1164. [PMID: 38414222 DOI: 10.1002/jso.27607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/10/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND AND OBJECTIVES In a rural-based setting, providing optimal treatment is often difficult owing to the limited resources and financial constraints being rampant in cancer care delivery. Oncological resections often result in large, complex defects requiring free flap reconstruction to achieve cosmetic and/or functional goals. This article focuses on our experience of starting and promoting microvascular reconstruction in a rural tertiary medical college hospital. METHODS Retrospective observational study of patients undergoing free flap reconstruction for oncological indications was included. Standard oncological principles were followed for cancer extirpation. Free flap reconstruction was done using loupes of 4× magnification. Flap-related outcomes and barriers in doing free flap reconstruction were analysed. RESULTS A total of 56 patients were included. The most common free flap undertaken was free anterolateral thigh flap in 21 (37.5%) patients. The mean duration of reconstruction was 438 min. Re-exploration was undertaken in 17 patients (30.4%). Nonsalvageable flap loss was 19.64%. Adjuvant treatment was administered in all patients as per oncological indications, albeit with some delay in 12.5%. Barriers to reconstruction were noted in the pre-, intra- and postoperative periods. CONCLUSION Reconstruction with free flaps is feasible in a resource-constrained setup with careful planning and a multidisciplinary team approach to overcome the barriers.
Collapse
Affiliation(s)
- Deepak Hongaiah
- Department of Plastic and Reconstructive Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
| | - Abhay K Kattepur
- Department of Surgical Oncology, R.L. Jalappa Institute of Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
| | - Eldo V George
- Department of Plastic and Reconstructive Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
| | - Abhishek Mahadev M
- Department of Surgical Oncology, R.L. Jalappa Institute of Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
| | - Deepika Kenkere
- Department of Dental and Oro-Maxillofacial Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
| | - Aswathappa Dasappa
- Department of Surgical Oncology, R.L. Jalappa Institute of Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
| |
Collapse
|
16
|
Kim A, Geller D, Min H, Miyazaki B, Raymond J, Vidmar AP, Zipursky R, Chao LC. Decline in case rates of youth onset type 2 diabetes in year three of the COVID-19 pandemic. J Pediatr Endocrinol Metab 2024; 37:360-362. [PMID: 38410000 DOI: 10.1515/jpem-2023-0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVES To determine changes in case rates of youth onset type 2 diabetes in the three years following the COVID-19 pandemic. METHODS A single-center, retrospective medical record review was conducted for patients newly diagnosed with T2D between 3/1/18 and 2/28/23 at a pediatric tertiary care center. The number of patients referred to CHLA with a T2D diagnosis date between 3/1/2020 and 2/28/2023 was compared to historical rates between 3/1/2018 and 2/29/2020. χ2 or Fisher's exact test was used to compare categorical variables between each year and 2019. RESULTS Compared to prepandemic baseline (3/1/19-2/29/20, 11.8±3.7 cases/month), there was a significant increase in new T2D monthly case rates in pandemic year 1 (3/1/20-2/28/21, 20.1±6.0 cases/month, 171 %, p=0.005) and pandemic year 2 (3/1/21-2/28/22, 25.9±8.9 cases/month, 221 %, p=0.002). Case rates declined in pandemic year 3 to 14.5±4.1 cases/month (3/1/22-2/28/23, p=0.43). Compared to prepandemic year 1, the frequency of DKA at diagnosis was higher in pandemic year 1 (13.3 vs. 5.0 %, p=0.009). The DKA rate in pandemic years 2 (6.8 %) and 3 (3.4 %) were comparable to prepandemic year 1 (p=0.53 and 0.58, respectively). CONCLUSIONS Youth onset type 2 diabetes cases and DKA rates in year 3 of the pandemic have returned to prepandemic level.
Collapse
Affiliation(s)
- Ahlee Kim
- Division of Endocrinology, Department of Pediatrics, 5150 Children's Hospital Los Angeles , Los Angeles, CA, USA
- 5150 Keck School of Medicine of University of Southern California , Los Angeles, CA, USA
| | - David Geller
- Division of Endocrinology, Department of Pediatrics, 5150 Children's Hospital Los Angeles , Los Angeles, CA, USA
- 5150 Keck School of Medicine of University of Southern California , Los Angeles, CA, USA
| | - Hyojin Min
- Division of Endocrinology, Department of Pediatrics, 5150 Children's Hospital Los Angeles , Los Angeles, CA, USA
| | - Brian Miyazaki
- Division of Endocrinology, Department of Pediatrics, 5150 Children's Hospital Los Angeles , Los Angeles, CA, USA
- 5150 Keck School of Medicine of University of Southern California , Los Angeles, CA, USA
| | - Jennifer Raymond
- Division of Endocrinology, Department of Pediatrics, 5150 Children's Hospital Los Angeles , Los Angeles, CA, USA
- 5150 Keck School of Medicine of University of Southern California , Los Angeles, CA, USA
| | - Alaina P Vidmar
- Division of Endocrinology, Department of Pediatrics, 5150 Children's Hospital Los Angeles , Los Angeles, CA, USA
- 5150 Keck School of Medicine of University of Southern California , Los Angeles, CA, USA
| | - Rachel Zipursky
- Division of Endocrinology, Department of Pediatrics, 5150 Children's Hospital Los Angeles , Los Angeles, CA, USA
| | - Lily C Chao
- Division of Endocrinology, Department of Pediatrics, 5150 Children's Hospital Los Angeles , Los Angeles, CA, USA
- 5150 Keck School of Medicine of University of Southern California , Los Angeles, CA, USA
| |
Collapse
|
17
|
Zheng G, Cai J, Deng H, Yang H, Xiong W, Chen E, Bai H, He J. Development of a risk prediction model for subsequent infection after colonization with carbapenem-resistant Enterobacterales: a retrospective cohort study. Antimicrob Resist Infect Control 2024; 13:46. [PMID: 38659068 DOI: 10.1186/s13756-024-01394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 03/31/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Colonization of carbapenem-resistant Enterobacterale (CRE) is considered as one of vital preconditions for infection, with corresponding high morbidity and mortality. It is important to construct a reliable prediction model for those CRE carriers with high risk of infection. METHODS A retrospective cohort study was conducted in two Chinese tertiary hospitals for patients with CRE colonization from 2011 to 2021. Univariable analysis and the Fine-Gray sub-distribution hazard model were utilized to identify potential predictors for CRE-colonized infection, while death was the competing event. A nomogram was established to predict 30-day and 60-day risk of CRE-colonized infection. RESULTS 879 eligible patients were enrolled in our study and divided into training (n = 761) and validation (n = 118) group, respectively. There were 196 (25.8%) patients suffered from subsequent CRE infection. The median duration of subsequent infection after identification of CRE colonization was 20 (interquartile range [IQR], 14-32) days. Multisite colonization, polymicrobial colonization, catheterization and receiving albumin after colonization, concomitant respiratory diseases, receiving carbapenems and antimicrobial combination therapy before CRE colonization within 90 days were included in final model. Model discrimination and calibration were acceptable for predicting the probability of 60-day CRE-colonized infection in both training (area under the curve [AUC], 74.7) and validation dataset (AUC, 81.1). Decision-curve analysis revealed a significantly better net benefit in current model. Our prediction model is freely available online at https://ken-zheng.shinyapps.io/PredictingModelofCREcolonizedInfection/ . CONCLUSIONS Our nomogram has a good predictive performance and could contribute to early identification of CRE carriers with a high-risk of subsequent infection, although external validation would be required.
Collapse
Affiliation(s)
- Guanhao Zheng
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Jiaqi Cai
- Department of Clinical Laboratory, Kunshan Hospital, Nanjing University of Chinese Medicine, Kunshan, China
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Han Deng
- Department of International Medical Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Haoyu Yang
- Department of Pharmacy, Handan First Hospital, Handan, China
| | - Wenling Xiong
- Department of Infection Management, Chongqing University Cancer Hospital, Chongqing, China
| | - Erzhen Chen
- Department of Emergency Intensive Care Unit, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hao Bai
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China.
| | - Juan He
- Department of Pharmacy, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
18
|
Hughes S, Srenathan H, Lynch M, Leeman H. Multicentre experience from tertiary skin cancer units on the role of sentinel lymph node biopsy in patients with pT1b melanoma. Clin Exp Dermatol 2024; 49:519-521. [PMID: 38112606 DOI: 10.1093/ced/llad450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/02/2024] [Indexed: 12/21/2023]
Abstract
Multicentre experience from tertiary skin cancer units on the role of sentinel lymph node biopsy in patients with pT1b melanoma.
Collapse
Affiliation(s)
- Sam Hughes
- Department of Dermatology
- St John's Institute of Dermatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Hareni Srenathan
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
| | - Magnus Lynch
- St John's Institute of Dermatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Hayley Leeman
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
| |
Collapse
|
19
|
Zheng Q, Zeng Z, Tang X, Ma L. Impact of an ICU bed capacity optimisation method on the average length of stay and average cost of hospitalisation following implementation of China's open policy with respect to COVID-19: a difference-in-differences analysis based on information management system data from a tertiary hospital in southwest China. BMJ Open 2024; 14:e078069. [PMID: 38643008 PMCID: PMC11033667 DOI: 10.1136/bmjopen-2023-078069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/27/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVES Following the implementation of China's open policy with respect to COVID-19 on 7 December 2022, the influx of patients with infectious diseases has surged rapidly, necessitating hospitals to adopt temporary requisition and modification of ward beds to optimise hospital bed capacity and alleviate the burden of overcrowded patients. This study aims to investigate the effect of an intensive care unit (ICU) bed capacity optimisation method on the average length of stay (ALS) and average cost of hospitalisation (ACH) after the open policy of COVID-19 in China. DESIGN AND SETTING A difference-in-differences (DID) approach is employed to analyse and compare the ALS and ACH of patients in four modified ICUs and eight non-modified ICUs within a tertiary hospital located in southwest China. The analysis spans 2 months before and after the open policy, specifically from 5 October 2022 to 6 December 2022, and 7 December 2022 to 6 February 2023. PARTICIPANTS We used the daily data extracted from the hospital's information management system for a total of 5944 patients admitted by the outpatient and emergency access during the 2-month periods before and after the release of the open policy in China. RESULTS The findings indicate that the ICU bed optimisation method implemented by the tertiary hospital led to a significant reduction in ALS (HR -0.6764, 95% CI -1.0328 to -0.3201, p=0.000) and ACH (HR -0.2336, 95% CI -0.4741 to -0.0068, p=0.057) among ICU patients after implementation of the open policy. These results were robust across various sensitivity analyses. However, the effect of the optimisation method exhibits heterogeneity among patients admitted through the outpatient and emergency channels. CONCLUSIONS This study corroborates a significant positive impact of ICU bed optimisation in mitigating the shortage of medical resources following an epidemic outbreak. The findings hold theoretical and practical implications for identifying effective emergency coordination strategies in managing hospital bed resources during sudden public health emergency events. These insights contribute to the advancement of resource management practices and the promotion of experiences in dealing with public health emergencies.
Collapse
Affiliation(s)
- Qingyan Zheng
- School of Business, Sichuan Unversity, Chengdu, China
- The Hong Kong Polytechnic University, Hong Kong, China
| | - Zhongyi Zeng
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiumei Tang
- School of Business, Sichuan Unversity, Chengdu, China
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Li Ma
- School of Business, Sichuan Unversity, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
20
|
Al-Sarar D, Moussa IM, Alhetheel A. Antibiotic susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated at tertiary care hospital in Riyadh, Saudi Arabia. Medicine (Baltimore) 2024; 103:e37860. [PMID: 38640320 PMCID: PMC11029994 DOI: 10.1097/md.0000000000037860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024] Open
Abstract
Staphylococcus aureus is an important human pathogen that has a major impact on public health. The objective of the present work was to determine the prevalence and the pattern of antibiotic susceptibility in S aureus (MRSA) isolates from the King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. The isolates were collected from different body sites of infection and the antibiotic susceptibility was confirmed on the Vitek 2 system. A total of 371 MRSA isolates from clinical samples were received over a 12-month period from January 2021 to December 2021. The results showed that infection was predominant among males (55.8%) and most of the isolates occurred in the older age groups, with a mean age of 43.7 years and an age span from <1 to 89 years old. The majority (34.5%) recovered from wound infection followed by (14.6%) from blood. We have observed peaks of MRSA infections during the autumn, especially in September and November. All MRSA isolates were resistant to Amoxicillin + clavulanic acid, Ampicillin, Imipenem, Oxacillin, Cloxacillin, and Penicillin while all isolates were sensitive to Daptomycin and Nitrofurantoin. Furthermore, Vancomycin was resistant in (0.3%) of MRSA isolates, and (2.9%) was resistant to Linezolid. The current study concluded that MRSA strains had developed resistance toward 24 tested antibiotics, including the previous effective drugs vancomycin and linezolid. Therefore, there is an urgent need for continuous review of infection control practices to prevent any further spread of resistant strains.
Collapse
Affiliation(s)
- Dalia Al-Sarar
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Ihab M. Moussa
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Abdulkarim Alhetheel
- Department of Pathology, College of Medicine and University Hospitals, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
21
|
Hala S, Malaikah M, Huang J, Bahitham W, Fallatah O, Zakri S, Antony CP, Alshehri M, Ghazzali RN, Ben-Rached F, Alsahafi A, Alsaedi A, AlAhmadi G, Kaaki M, Alazmi M, AlhajHussein B, Yaseen M, Zowawi HM, Alghoribi MF, Althaqafi AO, Al-Amri A, Moradigaravand D, Pain A. The emergence of highly resistant and hypervirulent Klebsiella pneumoniae CC14 clone in a tertiary hospital over 8 years. Genome Med 2024; 16:58. [PMID: 38637822 PMCID: PMC11025284 DOI: 10.1186/s13073-024-01332-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Klebsiella pneumoniae is a major bacterial and opportunistic human pathogen, increasingly recognized as a healthcare burden globally. The convergence of resistance and virulence in K. pneumoniae strains has led to the formation of hypervirulent and multidrug-resistant strains with dual risk, limiting treatment options. K. pneumoniae clones are known to emerge locally and spread globally. Therefore, an understanding of the dynamics and evolution of the emerging strains in hospitals is warranted to prevent future outbreaks. METHODS In this study, we conducted an in-depth genomic analysis on a large-scale collection of 328 multidrug-resistant (MDR) K. pneumoniae strains recovered from 239 patients from a single major hospital in the western coastal city of Jeddah in Saudi Arabia from 2014 through 2022. We employed a broad range of phylogenetic and phylodynamic methods to understand the evolution of the predominant clones on epidemiological time scales, virulence and resistance determinants, and their dynamics. We also integrated the genomic data with detailed electronic health record (EHR) data for the patients to understand the clinical implications of the resistance and virulence of different strains. RESULTS We discovered a diverse population underlying the infections, with most strains belonging to Clonal Complex 14 (CC14) exhibiting dominance. Specifically, we observed the emergence and continuous expansion of strains belonging to the dominant ST2096 in the CC14 clade across hospital wards in recent years. These strains acquired resistance mutations against colistin and extended spectrum β-lactamase (ESBL) and carbapenemase genes, namely blaOXA-48 and blaOXA-232, located on three distinct plasmids, on epidemiological time scales. Strains of ST2096 exhibited a high virulence level with the presence of the siderophore aerobactin (iuc) locus situated on the same mosaic plasmid as the ESBL gene. Integration of ST2096 with EHR data confirmed the significant link between colonization by ST2096 and the diagnosis of sepsis and elevated in-hospital mortality (p-value < 0.05). CONCLUSIONS Overall, these results demonstrate the clinical significance of ST2096 clones and illustrate the rapid evolution of an emerging hypervirulent and MDR K. pneumoniae in a clinical setting.
Collapse
Affiliation(s)
- Sharif Hala
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Mohammed Malaikah
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia
- Laboratory of Infectious Disease Epidemiology, Biological and Environmental Science and Engineering (BESE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Jiayi Huang
- Laboratory of Infectious Disease Epidemiology, Biological and Environmental Science and Engineering (BESE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
- KAUST Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Wesam Bahitham
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Omniya Fallatah
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Samer Zakri
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Chakkiath Paul Antony
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, 001-0020, Japan
| | - Mohammed Alshehri
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Raeece Naeem Ghazzali
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia
| | - Fathia Ben-Rached
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia
| | - Abdullah Alsahafi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Asim Alsaedi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Ghadeer AlAhmadi
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Mai Kaaki
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Meshari Alazmi
- KAUST Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
- College of Computer Science and Engineering, University of Hail, Hail, Saudi Arabia
| | - Baraa AlhajHussein
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Muhammad Yaseen
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Hosam M Zowawi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
- The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia
| | - Majed F Alghoribi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Abdulhakeem O Althaqafi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Abdulfattah Al-Amri
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Danesh Moradigaravand
- Laboratory of Infectious Disease Epidemiology, Biological and Environmental Science and Engineering (BESE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia.
- KAUST Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia.
| | - Arnab Pain
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia.
- The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia.
| |
Collapse
|
22
|
Pehlivanli A, Akkan Eren S, Sengul S, Basgut B, Erturk S, Ozcelikay AT. Determination of drug-related problems according to PAIR criteria in dialysis patients: a cross-sectional study in tertiary care hospital. BMC Pharmacol Toxicol 2024; 25:28. [PMID: 38637817 PMCID: PMC11025200 DOI: 10.1186/s40360-024-00754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Dialysis patients are at high risk for drug-related problems (DRPs), which have significant consequences for their morbidity, mortality, and quality of life. Improved clinical outcomes can be achieved by preventing, identifying, and resolving these problems. METHODS This is a retrospective observational study. In this study, the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) was validated for use in Turkish. Validation consisted of three stages: translation back-translation with expert panel evaluation, reliability analysis using the test-retest method, and conceptual validity with both Pharmaceutical Care Network Europe (PCNE) and PAIR used to determine DRPs prevalence. RESULTS In total, 104 patients (mean ± SD age, 54.1 ± 15.8 years; 53.8% male) were included in the study. An expert panel evaluated the items in the criterion based on their intelligibility, service of purpose, differentiation, and cultural suitability during the translation stage. Content validity index (CVI) score was found to be 0.95. The reliability analysis was performed by applying the test-retest method and calculating correlation coefficient on 30 randomly selected patients one month later. Correlation coefficient (p) was found to be 0.8. To evaluate conceptual validity, 104 patients' pharmacotherapy plans were assessed using both the PAIR and PCNE criteria. The prevalence of DRPs according to PAIR criteria (100.0%) and PCNE (73.1%) were statistically significantly different (p < 0.001). CONCLUSIONS As a result, PAIR criteria can identify clinically relevant DRPs in patients with CKD and is a new, validated tool to be used in Turkey, but may not be adequate for patients receiving dialysis. Therefore, it needs to be reviewed and updated for dialysis patients.
Collapse
Affiliation(s)
- Aysel Pehlivanli
- Faculty of Pharmacy, Department of Pharmacology, Baskent University, Ankara, Turkey.
- Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara University, Ankara, Turkey.
| | - Sayeste Akkan Eren
- Department of Nephrology, Ankara University, School of Medicine, Ankara, Turkey
| | - Sule Sengul
- Department of Nephrology, Ankara University, School of Medicine, Ankara, Turkey
| | - Bilgen Basgut
- Faculty of Pharmacy, Department of Pharmacology, Baskent University, Ankara, Turkey
| | - Sehsuvar Erturk
- Department of Nephrology, Ankara University, School of Medicine, Ankara, Turkey
| | - A Tanju Ozcelikay
- Faculty of Pharmacy, Department of Pharmacology, Ankara University, Ankara, Turkey
| |
Collapse
|
23
|
San Román Llorens JJ, Fernández-Gurria M, Artaechevarria Artieda J, Alejandre Alba N, García Sandoval B, Jiménez-Alfaro Morote I. Efficacy, safety and cost-effectiveness of 5-fluorouracil versus interferon α-2b as adjuvant therapy after surgery in ocular surface squamous neoplasia in a southern European tertiary hospital. Int Ophthalmol 2024; 44:184. [PMID: 38630143 DOI: 10.1007/s10792-024-03105-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To analyze the efficacy, safety and cost-effectiveness of adjuvant therapy with 5-fluorouracil (5-FU) compared to interferon α-2b (IFNα-2b) after surgery in ocular surface squamous neoplasia (OSSN). METHODS Retrospective study that included patients diagnosed with OSSN, who underwent surgical excision followed by adjuvant therapy with IFN α-2b (Group A) or 5-FU (Group B), in a tertial referral hospital. Clinical data collected included: demographics, risk factors, appearance, size and location of the lesions, slit-lamp examination, anterior segment optical coherence tomography, iconography and histological classification of subtypes of OSSN. Costs derived from surgery and adjuvant therapy were noted. Resolution of the lesion, recurrences and adverse events were studied. Cost-effectiveness analysis was performed with the incremental cost-effectiveness index (CEI). RESULTS 54 cases of 54 patients were included, with a mean age of 74.4 years (range 28-109). 30 were male (55.6%), and predominantly Caucasian (79.6%). The main risk factor was prolonged sun exposure (79.6%). Leukoplakic appearance (48.1%), location in bulbar conjunctiva (48.2%) and T3 (46.3%) stage were the most common clinical features. Histologically, the percentage of CIN I, CIN II, CIN III and SCC were 25.9%, 29.6%, 40.7% and 3.7%, respectively. Complete resolution was obtained in 74.1% and tolerance was overall positive. The cost was significantly higher for IFNα (1025€ ± 130.68€) compared to 5-FU (165.57€ ± 45.85 €) (p 0.001). The CEI was - 247.14€. CONCLUSIONS Both 5-FU and IFN α-2b are effective and present a good security profile as adjuvant therapies after surgery in OSSN. Although presenting slightly more ocular complications, 5-FU can be considered more cost-effective than IFN α-2b.
Collapse
Affiliation(s)
- José Javier San Román Llorens
- University Hospital Fundación Jiménez Diaz, Avenida Reyes Católicos 2, 28040, Madrid, Spain.
- Ruber Juan Bravo Hospital, Madrid, Spain.
| | - Marta Fernández-Gurria
- University Hospital Fundación Jiménez Diaz, Avenida Reyes Católicos 2, 28040, Madrid, Spain
| | | | - Nicolas Alejandre Alba
- University Hospital Fundación Jiménez Diaz, Avenida Reyes Católicos 2, 28040, Madrid, Spain
| | - Blanca García Sandoval
- University Hospital Fundación Jiménez Diaz, Avenida Reyes Católicos 2, 28040, Madrid, Spain
- Ruber Juan Bravo Hospital, Madrid, Spain
| | - Ignacio Jiménez-Alfaro Morote
- University Hospital Fundación Jiménez Diaz, Avenida Reyes Católicos 2, 28040, Madrid, Spain
- Ruber Juan Bravo Hospital, Madrid, Spain
| |
Collapse
|
24
|
Alzyoud R, Alsuweiti M, Maaitah H, Aladaileh B, Noubani M, Nsour H. Inborn Errors of Immunity in Jordan: First Report from a Tertiary Referral Center. J Clin Immunol 2024; 44:101. [PMID: 38630413 DOI: 10.1007/s10875-024-01709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Inborn errors of immunity (IEI) are a heterogeneous group of diseases with variable clinical phenotypes. This study was conducted to describe the epidemiology, clinical presentations, treatment, and outcome of IEI in Jordanian children. METHODS A retrospective data analysis was conducted for children under 15 years diagnosed with IEI from the pediatric Allergy, Immunology, and Rheumatology Division-based registry at Queen Rania Children's Hospital, Amman, Jordan, between 2010 and 2022. RESULTS A total of 467 patients, 263 (56.3%) males and 204 (43.7%) females, were diagnosed with IEI. The mean age at symptom onset was 18 months (1 week to 144 months), a positive family history of IEI was reported in 43.5%, and the consanguinity rate was 47.9%. The most common IEI category was immunodeficiencies affecting cellular and humoral immunity at 33.2%, followed by predominantly antibody deficiencies at 16.9%. The overall median diagnostic delay (range) was 6 (0-135) months; patients with a positive family history of IEI had a statistically significant shorter diagnostic delay. Pulmonary and gastrointestinal clinical features were the most common at 55.2% and 45.6%, respectively. The overall mortality was 33.2%; the highest rate was reported in severe combined immunodeficiency at 56.2%. CONCLUSIONS The high minimal estimated IEI prevalence at 16.2/100,000 Jordanian children compared to the regional and worldwide data, with the diversities in clinical presentation and distribution of IEI categories in our cohort point to unique features of IEI in Jordanian children, call for national registry establishment, regional and international collaborative networks.
Collapse
Affiliation(s)
- Raed Alzyoud
- Pediatric Allergy, Immunology, and Rheumatology Division, Queen Rania Children's Hospital, Jordanian Royal Medical Service, Amman, Jordan.
| | - Motasem Alsuweiti
- Pediatric Allergy, Immunology, and Rheumatology Division, Queen Rania Children's Hospital, Jordanian Royal Medical Service, Amman, Jordan
| | - Heba Maaitah
- Pediatric Allergy, Immunology, and Rheumatology Division, Queen Rania Children's Hospital, Jordanian Royal Medical Service, Amman, Jordan
| | - Boshra Aladaileh
- Pediatric Allergy, Immunology, and Rheumatology Division, Queen Rania Children's Hospital, Jordanian Royal Medical Service, Amman, Jordan
| | - Mohammed Noubani
- Pediatric Allergy, Immunology, and Rheumatology Division, Queen Rania Children's Hospital, Jordanian Royal Medical Service, Amman, Jordan
| | - Hamazh Nsour
- Pediatric Allergy, Immunology, and Rheumatology Division, Queen Rania Children's Hospital, Jordanian Royal Medical Service, Amman, Jordan
| |
Collapse
|
25
|
Ang BW, Fernandez L. A prospective study on direct out-of-pocket expenses of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in a Philippine tertiary care center. BMC Pulm Med 2024; 24:184. [PMID: 38632584 PMCID: PMC11022336 DOI: 10.1186/s12890-024-03011-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a frequent cause of morbidity and mortality in the Philippines and majority of the economic burden lies in hospitalizations during an exacerbation. Despite coverage of hospitalization cost with the national health insurance system (Phil-Health) for COPD exacerbations, patients often pay out-of-pocket. This study aimed to determine the demographic characteristics of COPD admissions at a Philippine tertiary care center, Philippine General Hospital, and assess mean cost of hospitalization, and identify predictors of prolonged hospitalization and cost > 20,000 Philippine pesos (Php). A prospective cross-sectional study was conducted for 6 months by chart review. Patients were categorized as charity service patients, that is, with no charged professional fees and free medications and private service patients who pay for their health care services. A total of 43 COPD admissions were included. The average daily cost of hospitalization (at peso-dollar rate of 56) for service patients was at $ 75.89 compared to private service patients at $ 285.71. Demographic characteristics and type of accommodation were not significant predictors of prolonged hospital stay nor hospitalization cost of ≥ $ 357. Accommodation cost and professional fees accounted for majority or 61.6% of the overall cost for private patients, while medications and diagnostic tests were the major or 76.01% contributor to the overall cost for charity patients. Despite existence of Phil-health, in-patient coverage for COPD remain insufficient. Measures for maximizing COPD control in the out-patient setting could potentially reduce total cost for this disease.
Collapse
Affiliation(s)
- Blake Warren Ang
- Division of Pulmonary Medicine, University of the Philippines? Philippine General Hospital, Manila, Philippines.
| | - Lenora Fernandez
- Division of Pulmonary Medicine, University of the Philippines? Philippine General Hospital, Manila, Philippines
| |
Collapse
|
26
|
Soomro MY, Khan SR, Muhammad H, Ahmad S, Zehra N, Ali I, Samar MR, Hameed A, Moosajee M, Rashid YA. Exploring treatment outcomes in Stage II-III rectal cancer patients undergoing neoadjuvant therapy at a tertiary care center in Pakistan: a comprehensive analysis of pathological outcomes. BMC Cancer 2024; 24:479. [PMID: 38627736 PMCID: PMC11020334 DOI: 10.1186/s12885-024-12241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Rectal cancer treatment has transformed in recent years, with neoadjuvant treatment (NT) and total neoadjuvant treatment (TNT) aiming to enhance pathological responses. This pioneering study in our country delves into rectal cancer management, offering crucial insights by examining pathological outcomes in patients treated with the NT and TNT approach, shaping the evolving landscape. METHODS In this retrospective-cohort study spanning January 2017 to December 2022 at a tertiary care hospital in Pakistan, ethical approval was obtained to examine outcomes of two treatments. Patients were divided into TNT (chemoradiation and pre-surgery 5 FU-based chemotherapy) and NT (chemoradiation, surgery, and subsequent 5 FU-based chemotherapy). The primary end-point was response rates-no response, pathological complete response (pCR), near complete response (near CR), and partial response (PR). The Chi-Square Test for Independence assessed the association between treatment response and type (TNT or NT). Data analysis used STATA MP 64; significance was set at p < 0.05 for all two-tailed tests. RESULTS We analyzed 77 patients, 60 underwent standard neoadjuvant chemoradiation, and 17 followed the total neoadjuvant approach. Predominantly male, most were > 65 with ECOG 0-1. The TNT group showed higher response rates (76% vs 62%, p = 0.039), with 40.38% achieving pCR. In the overall population, pCR and near-CR were similar (27.2% vs 26%), while PR were 14%. Treatment characteristics correlated significantly with chemotherapy type, concurrent chemoradiation, LVI, PNI, and T, N, M staging (p < 0.05). Median overall survival was not reached, and mean survival was 89.1 months (CI: 95.0 to 83.3). Side effects varied, with notable differences in neuropathy, diarrhea, oral mucositis, and thrombocytopenia between NT and TNT groups. CONCLUSION Our study adds to evidence favoring neoadjuvant approaches in managing rectal cancer in pakistan. Demonstrating a favorable pcr rate, ongoing research with extended follow-up is essential, given the dynamic landscape of rectal cancer treatment for improved patient outcomes.
Collapse
Affiliation(s)
| | - Saqib Raza Khan
- Aga Khan University Hospital, Karachi, Pakistan.
- Department of Medical Oncology, Section of Oncology, Aga Khan University Hospital, Karachi, Pakistan.
| | | | - Sujjawal Ahmad
- Aga Khan University Centre for Regenerative Medicine and Stem Cell Research, Karachi, Pakistan
| | | | - Insia Ali
- Aga Khan University Hospital, Karachi, Pakistan
| | | | - Arif Hameed
- Aga Khan University Hospital, Karachi, Pakistan
| | | | | |
Collapse
|
27
|
Lompo P, Heroes AS, Ouédraogo K, Okitale P, Wakpo A, Kalema J, Lunguya O, Tinto H, Affolabi D, Sangaré L, Jacobs J. Knowledge, awareness, and risk practices related to bacterial contamination of antiseptics, disinfectants, and hand hygiene products among healthcare workers in sub-saharan Africa: a cross-sectional survey in three tertiary care hospitals (Benin, Burkina Faso, and DR Congo). Antimicrob Resist Infect Control 2024; 13:44. [PMID: 38627805 PMCID: PMC11020199 DOI: 10.1186/s13756-024-01396-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/01/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Antiseptics, disinfectants, and hand hygiene products can be contaminated with bacteria and cause healthcare-associated infections, which are underreported from low- and middle-income countries. To better understand the user-related risk factors, we conducted a knowledge, awareness, and practice survey among hospital staff in sub-Saharan Africa. METHODS Self-administered questionnaire distributed among healthcare workers in three tertiary care hospitals (Burkina Faso, Benin, Democratic Republic of the Congo). RESULTS 617 healthcare workers (85.3% (para)medical and 14.7% auxiliary staff) participated. Less than half (45.5%) had been trained in Infection Prevention & Control (IPC), and only 15.7% were trained < 1 year ago. Near two-thirds (64.2%) preferred liquid soap for hand hygiene, versus 33.1% for alcohol-based hand rub (ABHR). Most (58.3%) expressed confidence in the locally available products. Knowledge of product categories, storage conditions and shelf-life was inadequate: eosin was considered as an antiseptic (47.5% of (para)medical staff), the shelf life and storage conditions (non-transparent container) of freshly prepared chlorine 0.5% were known by only 42.6% and 34.8% of participants, respectively. Approximately one-third of participants approved using tap water for preparation of chlorine 0.5% and liquid soap. Most participants (> 80%) disapproved recycling soft-drink bottles as liquid soap containers. Nearly two-thirds (65.0%) declared that bacteria may be resistant to and survive in ABHR, versus 51.0% and 37.4% for povidone iodine and chlorine 0.5%, respectively. Depicted risk practices (n = 4) were ignored by 30 to 40% of participants: they included touching the rim or content of stock containers with compresses or small containers, storing of cotton balls soaked in an antiseptic, and hand-touching the spout of pump dispenser. Filling containers by topping-up was considered good practice by 18.3% of participants. Half (52.1%) of participants acknowledged indefinite reuse of containers. Besides small differences, the findings were similar across the study sites and professional groups. Among IPC-trained staff, proportions recognizing all 4 risk practices were higher compared to non-trained staff (35.9% versus 23.8%, p < 0.0001). CONCLUSIONS The present findings can guide tailored training and IPC implementation at the healthcare facility and national levels, and sensitize stakeholders' and funders' interest.
Collapse
Affiliation(s)
- Palpouguini Lompo
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Ouagadougou, 11 BP 218, Burkina Faso.
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000, Belgium.
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22, Box 5401, Leuven, 3000, Belgium.
| | - Anne-Sophie Heroes
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22, Box 5401, Leuven, 3000, Belgium
| | - Kadija Ouédraogo
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Ouagadougou, 11 BP 218, Burkina Faso
| | - Patient Okitale
- Département de Microbiologie, Cliniques Universitaires de Kinshasa, BP 127, Kinshasa, Congo
| | - Abel Wakpo
- Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, 01 BP 386, Benin
| | - Jocelyne Kalema
- Département de Microbiologie, Cliniques Universitaires de Kinshasa, BP 127, Kinshasa, Congo
- Département de Microbiologie, National Institute of Biomedical Research, Av. De la Démocratie N°5345, Kinshasa, Congo
| | - Octavie Lunguya
- Département de Microbiologie, Cliniques Universitaires de Kinshasa, BP 127, Kinshasa, Congo
- Département de Microbiologie, National Institute of Biomedical Research, Av. De la Démocratie N°5345, Kinshasa, Congo
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Ouagadougou, 11 BP 218, Burkina Faso
| | - Dissou Affolabi
- Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, 01 BP 386, Benin
| | - Lassana Sangaré
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, 03 BP 7022, Burkina Faso
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22, Box 5401, Leuven, 3000, Belgium
| |
Collapse
|
28
|
Feng W, Zhang B, Fan L, Song A, Hou J, Die X, Liu W, Wang Y, Guo Z. Clinical characteristics and influence of postoperative Hirschsprung-associated enterocolitis: retrospective study at a tertiary children's hospital. Pediatr Surg Int 2024; 40:106. [PMID: 38613719 DOI: 10.1007/s00383-024-05688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE To explore the influence of postoperative Hirschsprung-associated enterocolitis (post-HAEC) on long-term outcomes and to identify risk factors of post-HAEC. METHODS The medical records of 304 eligible patients diagnosed with Hirschsprung's disease (HSCR) were reviewed. We analyzed the clinical characteristics of post-HAEC and its influence on long-term outcomes. Furthermore, risk factors for early and recurrent HAEC were identified separately. RESULTS The overall incidence of post-HAEC was 29.9% (91/304). We categorized early HAEC as occurring within postoperative 3 months (n = 39) and recurrent HAEC as occurring ≥ 3 episodes within postoperative 6 months (n = 25). Patients with early HAEC were more likely to experience worse nutritional status, defecation function, and quality of life compared to those with late or no episodes (P < 0.05). Similarly, the adverse influences of recurrent HAEC on these outcomes were also significant (P < 0.05). The risk factors for early HAEC included preoperative undernutrition, long-segment HSCR, and postoperative Grade 3-4 complications within 30 days. For recurrent HAEC, risk factors were preoperative malnutrition, non-parental caregivers, long-segment HSCR, and postoperative Grade 3-4 complications within 30 days. CONCLUSION Classification of post-HAEC based on the first episode time and frequency was necessary. The earlier or more frequent episodes of post-HAEC have detrimental influences on long-term outcomes. Furthermore, risk factors for early and recurrent HAEC were different.
Collapse
Affiliation(s)
- Wei Feng
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Bobin Zhang
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Linxiao Fan
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Aohua Song
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Jinping Hou
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Xiaohong Die
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Wei Liu
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Yi Wang
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Zhenhua Guo
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
| |
Collapse
|
29
|
Chau EYW, Bakar AA, Zamhot AB, Zaini IZ, Binti Adanan SN, Sabardin DMB. An observational study on the impact of overcrowding towards door-to-antibiotic time among sepsis patients presented to emergency department of a tertiary academic hospital. BMC Emerg Med 2024; 24:58. [PMID: 38609924 PMCID: PMC11015690 DOI: 10.1186/s12873-024-00973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The latest Surviving Sepsis Campaign 2021 recommends early antibiotics administration. However, Emergency Department (ED) overcrowding can delay sepsis management. This study aimed to determine the effect of ED overcrowding towards the management and outcome of sepsis patients presented to ED. METHODS This was an observational study conducted among sepsis patients presented to ED of a tertiary university hospital from 18th January 2021 until 28th February 2021. ED overcrowding status was determined using the National Emergency Department Overcrowding Score (NEDOCS) scoring system. Sepsis patients were identified using Sequential Organ Failure Assessment (SOFA) scores and their door-to-antibiotic time (DTA) were recorded. Patient outcomes were hospital length of stay (LOS) and in-hospital mortality. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 26. P-value of less than 0.05 for a two-sided test was considered statistically significant. RESULTS Total of 170 patients were recruited. Among them, 33 patients presented with septic shock and only 15% (n = 5) received antibiotics within one hour. Of 137 sepsis patients without shock, 58.4% (n = 80) received antibiotics within three hours. We found no significant association between ED overcrowding with DTA time (p = 0.989) and LOS (p = 0.403). However, in-hospital mortality increased two times during overcrowded ED (95% CI 1-4; p = 0.041). CONCLUSION ED overcrowding has no significant impact on DTA and LOS which are crucial indicators of sepsis care quality but it increases overall mortality outcome. Further research is needed to explore other factors such as lack of resources, delay in initiating fluid resuscitation or vasopressor so as to improve sepsis patient care during ED overcrowding.
Collapse
Affiliation(s)
- Evelyn Yi Wen Chau
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Afliza Abu Bakar
- Department of Emergency Medicine, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Aireen Binti Zamhot
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ida Zarina Zaini
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | |
Collapse
|
30
|
Liu J, Hu MH, Bai X, Zhao Y, Cui CH, Wang Y, Shi XY, Niu ZB. Analysis of the influencing factors of the scientific fitness literacy of nurses in the context of exercise and medicine integration. BMC Med Educ 2024; 24:404. [PMID: 38605290 PMCID: PMC11010280 DOI: 10.1186/s12909-024-05378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/31/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The present study aims to explore the influencing factors of the scientific fitness literacy of nurses and provide a strategic basis for literacy improvement. METHODS A questionnaire on the influencing factors of scientific fitness literacy of nurses was designed by the group conducting the present study; the questionnaire was based on the socioecology model and the questionnaire preparation method. The general data questionnaire and the questionnaire on the influencing factors of scientific fitness literacy of nurses were adopted to investigate nurses in tertiary hospitals in order to analyze and discuss the influencing factors of their scientific fitness literacy. RESULTS (1) The questionnaire on the influencing factors of the scientific fitness literacy of nurses comprised five dimensions and 36 items. The overall item-content validity index was 0.833-1.000, the scale-content validity index was 0.974, and the overall Cronbach's α coefficient was 0.955; (2) the results of the pairwise Pearson correlation analysis showed that all five dimensions were positively correlated with the scientific fitness literacy of nurses; and (3) the results of the multiple linear regression analysis revealed that five dimensions, as well as the existence of exercise habits in daily life, had a significant impact on the scientific fitness literacy of nurses (P < 0.001). CONCLUSION The factors influencing the scientific fitness literacy of nurses involved all levels of the socioecological system. The methods of improving the awareness of the scientific fitness of nurses and providing opportunities for scientific fitness activities via the hospital played a critical role in literacy improvement. However, the lack of professional guidance and an atmosphere promoting scientific fitness might hinder literacy improvement.
Collapse
Affiliation(s)
- Juan Liu
- Department of Rehabilitation Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Man-Hui Hu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Xuan Bai
- Development Planning Office, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Yu Zhao
- Hebei University Health Science Center, Baoding, Hebei, 071000, China
| | - Cai-Hong Cui
- Department of Rehabilitation Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Yan Wang
- College of Nursing, Hebei University, No.342, Yuhua East Road, LianChi District, Baoding City, Hebei Province, 071000, China.
| | - Xiao-Yang Shi
- College of Nursing, Hebei University, No.342, Yuhua East Road, LianChi District, Baoding City, Hebei Province, 071000, China.
| | - Zong-Bao Niu
- Department of Ultrasound Diagnosis, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| |
Collapse
|
31
|
Alphonce B, Meda J, Nyundo A. Incidence and predictors of post-stroke cognitive impairment among patients admitted with first stroke at tertiary hospitals in Dodoma, Tanzania: A prospective cohort study. PLoS One 2024; 19:e0287952. [PMID: 38598466 PMCID: PMC11006170 DOI: 10.1371/journal.pone.0287952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/01/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Stroke survivors develop cognitive impairment, which significantly impacts their quality of life, their families, and the community as a whole but not given attention. This study aims to determine the incidence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to a tertiary hospital in Dodoma, Tanzania. METHODOLOGY A prospective cohort study was conducted at tertiary hospitals in the Dodoma region, central Tanzania. A sample size of 158 participants with the first stroke confirmed by CT/MRI brain aged ≥ 18 years met the criteria. At baseline, social-demographic, cardiovascular risks and stroke characteristics were acquired, and then at 30 days, participants were evaluated for cognitive functioning using Montreal Cognitive Assessment (MoCA). Key confounders for cognitive impairment, such as depression and apathy, were evaluated using the Personal Health Questionnaire (PHQ-9) and Apathy Evaluation Scale (AES), respectively. Descriptive statistics were used to summarise data; continuous data were reported as Mean (SD) or Median (IQR), and categorical data were summarised using proportions and frequencies. Univariate and multivariable logistic regression analysis was used to determine predictors of PSCI. RESULTS The median age of the 158 participants was 58.7 years; 57.6% of them were female, and 80.4% of them met the required criteria for post-stroke cognitive impairment. After multivariable logistic regression, left hemisphere stroke (AOR: 5.798, CI: 1.030-32.623, p = 0.046), a unit cm3 increase in infarct volume (AOR: 1.064, 95% CI: 1.018-1.113, p = 0.007), and apathy symptoms (AOR: 12.259, CI: 1.112-89.173, p = 0.041) had a significant association with PSCI. CONCLUSION The study revealed a significant prevalence of PSCI; early intervention targeting stroke survivors at risk may improve their outcomes. Future research in the field will serve to dictate policies and initiatives.
Collapse
Affiliation(s)
- Baraka Alphonce
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - John Meda
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Cardiology, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - Azan Nyundo
- Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
- Department of Psychiatry and Mental Health, School of Medicine, The University Dodoma, Dodoma, Tanzania
| |
Collapse
|
32
|
Yue LH, Wang LY, Guo JL, Li WL, Zhang JW. An investigation into the present status and influencing factors of nurse retention in grade-a tertiary general hospitals in Shanxi Province within the framework of the magnet hospital concept. BMC Health Serv Res 2024; 24:452. [PMID: 38600558 PMCID: PMC11007957 DOI: 10.1186/s12913-024-10945-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/02/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The attrition of nursing staff significantly contributes to the shortage of healthcare professionals. This study entailed an examination of the propensity of nurses to sustain employment within Grade-A tertiary general hospitals and the various influencing factors. METHODS A total of 2,457 nurses from three grade-A tertiary general hospitals were surveyed. The survey instruments included a general information questionnaire, a scale measuring their willingness to continue working, and a Chinese version of the Magnet Hospital Factor scale. RESULTS The scores of the willingness to continue working scale and the Magnet Hospital Factor scale were 21.53 ± 4.52 and 145.46 ± 25.82, respectively. There were statistically significant differences in the scores of willingness of nurses to continue working across various factors, including the department, age, marital status, family location, length of service as nurses, professional title, position, and employment type, upon comparison (P < 0.001). The correlation analysis showed that there was a positive correlation between the willingness of nurses to continue working and the magnet hospital factors, with a correlation coefficient of 0.523 (P < 0.01). Regression analysis showed that department, length of service as nurses, professional title, position, average monthly income, number of night shifts, medical care relationship, educational support, and nursing manager support among the magnet hospital factors were important predictors of willingness to continue working (P < 0.001). CONCLUSION The willingness of nurses to continue working in grade-A tertiary general hospitals in Shanxi Province was determined to be at an upper-middle level. The magnet status of grade-A tertiary general hospitals needs to be improved, and there are many factors that influenced willingness of nurses to continue working. To cultivate a more favorable environment and bolster nurse recruitment and retention, all healthcare institutions should strive to establish a magnet nursing environment, thereby fostering the robust development of the nursing team.
Collapse
Affiliation(s)
- Li-Hong Yue
- Department of Infection, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
| | - Lin-Ying Wang
- Department of Nursing, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, No.99 of Longcheng Street, Xiaodian District, 030032, Taiyuan, China
| | - Jin-Li Guo
- Department of Nursing, Second Hospital of Shanxi Medical University, 030001, Taiyuan, China
| | - Wan-Ling Li
- Department of Nursing, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, No.99 of Longcheng Street, Xiaodian District, 030032, Taiyuan, China.
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 of Jiefang Avenue, Qiaokou District, 430030, Wuhan, China.
| | - Jian-Wei Zhang
- Department of Infection, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
| |
Collapse
|
33
|
Zhang Y, Huang Y, Xi X. Association of the barriers of pharmaceutical care perceived by clinical pharmacists and occupational stress in tertiary hospitals of China. Front Public Health 2024; 12:1342565. [PMID: 38655521 PMCID: PMC11035884 DOI: 10.3389/fpubh.2024.1342565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Objective As an important member of the healthcare team, clinical pharmacists' occupational stress will lead to a decline in the quality of pharmaceutical care. According to person-environment fit theory, barriers of pharmaceutical care perceived by clinical pharmacists may be a potential factor influencing occupational stress. This study aimed to assess the association between the specific barriers of pharmaceutical care perceived by clinical pharmacists and their occupational stress in China. Method A field-based questionnaire survey of tertiary hospitals was conducted in 31 provincial administrative regions in mainland China using a multi-stage stratified sampling method. Data on occupational stress, barriers of pharmaceutical care perceived by clinical pharmacists and other factors of job stress were collected using the Brief Job Stress Questionnaire and a self-administered instrument. The instruments have undergone multiple rounds of pilot investigations, and their reliability is acceptable. Ordinary least squares regression was used to evaluate the association of the perceived barriers and other factors with their occupational stress. Result A total of 625 clinical pharmacists from 311 tertiary hospitals in China (response rate = 84%) participated. Perceived resource dimension barriers (p = 0.00) and self-improvement dimension barriers (p = 0.01) were associated with increased occupational stress of the participants. In addition, clinical pharmacists with senior professional titles and engaged in neurology and ICU have higher occupational stress. Conclusion By removing barriers to pharmacists' resources and self-improvement, it is possible to better meet the work needs of clinical pharmacists and may effectively reduce occupational stress, thereby improving the quality of pharmaceutical services.
Collapse
Affiliation(s)
| | | | - Xiaoyu Xi
- National Medical Products Administration Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, Nanjing, China
| |
Collapse
|
34
|
Reese M, Eichelmann AK, Nowacki TM, Pascher A, Sporn JC. The role of cytoreductive surgery and HIPEC for the treatment of primary and secondary peritoneal malignancies-experience from a tertiary care center in Germany. Langenbecks Arch Surg 2024; 409:113. [PMID: 38589714 DOI: 10.1007/s00423-024-03309-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Peritoneal surface malignancies (PSM) are commonly known to have a dismal prognosis. Over the past decades, novel techniques such as cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and pressurized intraperitoneal aerosol chemotherapy (PIPAC) have been introduced for the treatment of PSM which could improve the overall survival and quality of life of patients with PSM. The decision to proceed with CRS and HIPEC is often challenging due the complexity of the disease, the extent of the procedure, associated side effects, and potential risks. Here, we present our experience with CRS and HIPEC to add to the ongoing discussion about eligibility criteria, technical approach, and expected outcomes and contribute to the evolution of this powerful and promising tool in the multidisciplinary treatment of patients with primary and secondary PSM. METHODS A single-center retrospective chart review was conducted and included a total of 40 patients treated with CRS and HIPEC from April 2020 to September 2022 at the University Hospital Münster Department of Surgery. All patients had histologically confirmed primary or secondary peritoneal malignancies of various primary origins. RESULTS Our study included 22 patients with peritoneal metastases from gastric cancer (55%), 8 with pseudomyxoma peritonei (20%), 4 with mesothelioma of the peritoneum (10%), and 6 patients with PSM originating from other primary tumor locations. Median PCI at time of cytoreduction was 4 (0-25). Completeness of cytoreduction score was 0 in 37 patients (92.5%), 1 in two patients (5%), and 2 in one patient (2.5%). Median overall survival across all patients was 3.69 years. CONCLUSION Complete cytoreduction during CRS and HIPEC can be achieved for patients with low PCI, for patients with high PCI in low-grade malignancies, and even for patients with initially high PCI in high-grade malignancies following a significant reduction of cancer burden due to extensive preoperative treatment with PIPAC and systemic chemotherapy.
Collapse
Affiliation(s)
- Mikko Reese
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Ann-Kathrin Eichelmann
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Tobias M Nowacki
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, 48149, Germany
- Department of Gastroenterology, UKM Marienhospital Steinfurt, Mauritiusstr. 5, Steinfurt, 48565, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Judith C Sporn
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany.
| |
Collapse
|
35
|
Okomo U, Gon G, Darboe S, Sey ICM, Nkereuwem O, Leigh L, Camara N, Makalo L, Keita A, Dancer SJ, Graham W, Aiken AM. Assessing the impact of a cleaning programme on environmental hygiene in labour and neonatal wards: an exploratory study in The Gambia. Antimicrob Resist Infect Control 2024; 13:36. [PMID: 38589973 PMCID: PMC11003010 DOI: 10.1186/s13756-024-01393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/31/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Effective surface cleaning in hospitals is crucial to prevent the transmission of pathogens. However, hospitals in low- and middle-income countries face cleaning challenges due to limited resources and inadequate training. METHODS We assessed the effectiveness of a modified TEACH CLEAN programme for trainers in reducing surface microbiological contamination in the newborn unit of a tertiary referral hospital in The Gambia. We utilised a quasi-experimental design and compared data against those from the labour ward. Direct observations of cleaning practices and key informant interviews were also conducted to clarify the programme's impact. RESULTS Between July and September 2021 (pre-intervention) and October and December 2021 (post-intervention), weekly surface sampling was performed in the newborn unit and labour ward. The training package was delivered in October 2021, after which their surface microbiological contamination deteriorated in both clinical settings. While some cleaning standards improved, critical aspects such as using fresh cleaning cloths and the one-swipe method did not. Interviews with senior departmental and hospital management staff revealed ongoing challenges in the health system that hindered the ability to improve cleaning practices, including COVID-19, understaffing, disruptions to water supply and shortages of cleaning materials. CONCLUSIONS Keeping a hospital clean is fundamental to good care, but training hospital cleaning staff in this low-income country neonatal unit failed to reduce surface contamination levels. Further qualitative investigation revealed multiple external factors that challenged any possible impact of the cleaning programme. Further work is needed to address barriers to hospital cleaning in low-income hospitals.
Collapse
Affiliation(s)
- Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Atlantic Boulevard, Fajara, The Gambia.
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK.
| | - Giorgia Gon
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Saffiatou Darboe
- Research Microbiology Laboratory, MRC Unit The Gambia at LSHTM, Fajara, The Gambia
- AMR Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Isatou C M Sey
- Research Microbiology Laboratory, MRC Unit The Gambia at LSHTM, Fajara, The Gambia
| | - Oluwatosin Nkereuwem
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Atlantic Boulevard, Fajara, The Gambia
| | - Lamin Leigh
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Nfamara Camara
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Atlantic Boulevard, Fajara, The Gambia
| | - Lamin Makalo
- Department of Paediatrics, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Abdoulie Keita
- Department of Obstetrics and Gynaecology, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Stephanie J Dancer
- Department of Microbiology, NHS Lanarkshire and School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Wendy Graham
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Alexander M Aiken
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
36
|
Molina JD, Amigo F, Vilagut G, Mortier P, Muñoz-Ruiperez C, Rodrigo Holgado I, Juanes González A, Combarro Ripoll CE, Alonso J, Rubio G. Impact of COVID-19 first wave on the mental health of healthcare workers in a Front-Line Spanish Tertiary Hospital: lessons learned. Sci Rep 2024; 14:8149. [PMID: 38589491 PMCID: PMC11001893 DOI: 10.1038/s41598-024-58884-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 04/04/2024] [Indexed: 04/10/2024] Open
Abstract
Healthcare workers (HCWs) were at high risk of experiencing psychological distress during COVID-19 pandemic. The objective of this study was to evaluate the impact on HCWs' mental health in a Spanish hospital. Cross-sectional study of HCW, active between May and June 2020. A web-based survey assessed probable current mental disorders (major depressive disorder [PHQ-8 ≥ 10], generalized anxiety disorder [GAD-7 ≥ 10], panic attacks, post-traumatic stress disorder [PTSD; PLC-5 ≥ 7], or substance use disorder [CAGE-AID ≥ 2]). The Sheehan Disability Scale (SDS) was used to assess severe impairment and items taken from the modified self-report version of the Columbia Suicide Severity Rating Scale (C-SSRS) assessed suicidal thoughts and behaviors. A total of 870 HCWs completed the survey. Most frequent probable mental disorders were major depressive disorder (33.6%), generalized anxiety disorder (25.5%), panic attacks (26.9%), PTSD (27.2%), and substance use disorder (5.0%). Being female, having aged 18-29 years, being an auxiliary nurse, direct exposure to COVID-19-infected patients, and pre-pandemic lifetime mental disorders were positively associated with mental issues. Hospital HCWs presented a high prevalence of symptoms of mental disorders, especially depression, PTSD, panic attacks, and anxiety. Younger individuals and those with lifetime mental disorders have been more vulnerable to experiencing them.
Collapse
Affiliation(s)
- Juan D Molina
- Centro de Investigación Biomédica en Red (CIBER) Salud Mental, Madrid, Spain.
- Villaverde Mental Health Center, Clinical Management Area of Psychiatry and Mental Health, Psychiatric Service, Hospital Universitario, 12 de Octubre, Av. de Córdoba S.N, Madrid, Spain.
- Research Institute Hospital 12 de Octubre (I + 12), Madrid, Spain.
- Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Franco Amigo
- Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gemma Vilagut
- Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Philippe Mortier
- Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carmen Muñoz-Ruiperez
- Occupational Medicine and Occupational Risk Prevention Service, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Irene Rodrigo Holgado
- Clinic Psychologist, COVID-19 Assistance Project, 12 de Octubre University Hospital, Madrid, Spain
| | - Alba Juanes González
- Psychiatrist, COVID-19 Assistance Project, Consultation-Liaison Psychiatry Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Carolina Elisa Combarro Ripoll
- Psychiatrist, COVID-19 Assistance Project, Consultation-Liaison Psychiatry Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Jordi Alonso
- Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Gabriel Rubio
- Villaverde Mental Health Center, Clinical Management Area of Psychiatry and Mental Health, Psychiatric Service, Hospital Universitario, 12 de Octubre, Av. de Córdoba S.N, Madrid, Spain
- Research Institute Hospital 12 de Octubre (I + 12), Madrid, Spain
- Department of Psychiatry, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Addictive Disorders Network, Redes Temáticas de Investigación Cooperativa (RETICS) (Thematic Networks of Cooperative Research in Health), Carlos III Health Institute, Ministerio de Ciencia e Innovación (MICINN) and Federación Española de Enfermedades Raras (FEDER), Madrid, Spain
| |
Collapse
|
37
|
Shen Y, Hu S, Bao S, Tu M. Clinical characteristics of snakebite patients attending a tertiary hospital in Hangzhou, southeast China. Trans R Soc Trop Med Hyg 2024; 118:287-292. [PMID: 38073610 DOI: 10.1093/trstmh/trad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/01/2023] [Accepted: 11/24/2023] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Venomous snakebite is a neglected yet an important public health problem in China, and few studies have focused on them so far. The aim of this study is to investigate clinical characteristics of snakebites patients in a tertiary hospital in Hangzhou, southeast China. METHODS A total of 416 snakebite cases were included in this retrospective study. The data were collected from the medical records including demographics, clinical manifestations, management and outcomes. RESULTS Of the 416 patients with venomous snakebites, 248 were male, and the average age was 54.6 years. The majority of cases occurred in rural in May to September. Out of all the venomous bites, Gloydius brevicaudus accounted for the highest percentage (55.3%). Hands were the most vulnerable site to snakebites (47.4%). Patients had clinical manifestations of pain (100%), swelling (100%), wound necrosis (25.7%), hemorrhagic blister (18.3%), and blister (8.7%). Three hundred and ninety-two patients received antivenom administration, and most were treated within six hours after bites. Twenty-six patients received surgical treatments, and 90 patients developed venom-induced consumption coagulopathy. No deaths have occurred in this study. CONCLUSION Hangzhou is one of the regions with high affecting of snakebites in China. The results of this study will increase the understanding of the clinical characteristics of venomous snakebites in Hangzhou area.
Collapse
Affiliation(s)
- Yuchen Shen
- Department of Dermatology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Sipin Hu
- Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Shuhua Bao
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Mengyun Tu
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| |
Collapse
|
38
|
Hofbauer S, Horka L, Seidenberg S, Da Mutten R, Regli L, Serra C, Beuschlein F, Erlic Z. Metabolic and inflammatory parameters in relation to baseline characterization and treatment outcome in patients with prolactinoma: insights from a retrospective cohort study at a single tertiary center. Front Endocrinol (Lausanne) 2024; 15:1363939. [PMID: 38645431 PMCID: PMC11026551 DOI: 10.3389/fendo.2024.1363939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Background Prolactinomas (PRLs) are prevalent pituitary adenomas associated with metabolic changes and increased cardiovascular morbidity. This study examined clinical, endocrine, metabolic, and inflammatory profiles in PRL patients, aiming to identify potential prognostic markers. Methods The study comprised data from 59 PRL patients gathered in a registry at the University Hospital of Zurich. Diagnostic criteria included MRI findings and elevated serum prolactin levels. We assessed baseline and follow-up clinical demographics, metabolic markers, serum inflammation-based scores, and endocrine parameters. Treatment outcomes were evaluated based on prolactin normalization, tumor shrinkage, and cabergoline dosage. Results The PRL cohort exhibited a higher prevalence of overweight/obesity, prediabetes/diabetes mellitus, and dyslipidemia compared to the general population. Significant correlations were found between PRL characteristics and BMI, HbA1c, and fT4 levels. Follow-up data indicated decreases in tumor size, tumor volume, prolactin levels, and LDL-cholesterol, alongside increases in fT4 and sex hormones levels. No significant associations were observed between baseline parameters and tumor shrinkage at follow-up. A positive association was noted between PRL size/volume and the time to achieve prolactin normalization, and a negative association with baseline fT4 levels. Conclusion This study underscores the metabolic significance of PRL, with notable correlations between PRL parameters and metabolic indices. However, inflammatory markers were not significantly correlated with patient stratification or outcome prediction. These findings highlight the necessity for standardized follow-up protocols and further research into the metabolic pathogenesis in PRL patients.
Collapse
Affiliation(s)
- Susanna Hofbauer
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - Laura Horka
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - Samuel Seidenberg
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - Raffaele Da Mutten
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - Felix Beuschlein
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - Zoran Erlic
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| |
Collapse
|
39
|
Tegegne GA, Rade BK, Yismaw AE, Taye W, Mengistie BA. Predictors of successful trial of labor after cesarean section (TOLAC) in women with one prior transverse cesarean section at Tertiary Hospitals in northwest Ethiopia: a multicenter study. BMC Pregnancy Childbirth 2024; 24:240. [PMID: 38580911 PMCID: PMC10996235 DOI: 10.1186/s12884-024-06432-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/18/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Trials of labor after cesarean section is the preferred strategy to decrease the cesarean delivery rate and reducing complications associated with multiple cesarean sections. The success rate of trials of labor after cesarean section and associated factors have not been well documented in Ethiopia. Hence, this study was aimed to determine the success rate and factors associated with the trial of labor after one cesarean section in five Comprehensive Specialized Hospitals located in northwest Ethiopia. METHODS An institutional-based cross-sectional study was conducted among 437 women who came for the trial of labor from December 1, 2021, to March 30, 2022. All women who fulfilled the eligibility criteria were included to this study. Data was collected using structured and pre-tested questionnaire. Then, the data was entered into Epi Data 4.6 software and exported to SPSS version 26 for analysis. To identify the variables influencing the outcome variable, bivariable and multivariable logistic regression analyses were conducted. The model's fitness was checked using the Hosmer-Lemeshow goodness of fit test, and an adjusted odds ratio with a 95% confidence interval was used to declare the predictors that are significantly associated with TOLAC. RESULTS The success rate of the trial of labor after one cesarean section was 56.3% (95% CI, 51.3%, 61.2%). Maternal age ≥ 35 years (AOR: 3.3, 95% CI 1.2, 9.3), the fetal station at admission ≤ zero (AOR: 5. 6, 95% CI 3.3, 9.5), vaginal delivery before cesarean section (AOR: 1.9, 95% CI 1.2, 3.2), and successful vaginal birth after cesarean delivery (AOR 2.2, 95% CI 1.2, 4.1) were found to have a significant association with the success rate of trial of labor after cesarean section. CONCLUSIONS In this study, the success rate of the trial of labor after a cesarean section was low as compared to the ACOG guideline and other studies in different countries. Therefore, the clinicians ought to offer counsel during antenatal and intrapartum period, encourage the women to make informed decision on the mode of delivery, and the practitioners need to follow fetal and maternal conditions strictly to minimize adverse birth outcomes.
Collapse
Affiliation(s)
| | - Bayew Kelkay Rade
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Engida Yismaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Worku Taye
- Department of Midwifery, Debremarkos Referral Hospital, Debremarkos, Ethiopia
| | - Berihun Agegn Mengistie
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| |
Collapse
|
40
|
Arjuhn R, Jeeva S, Vijayasree TN. CLO24-078: Hippocampal Optimization and Dosimetric Analysis on Feasibility of Hippocampal Sparing in Primary Gliomas-A Retrospective Dosimetric Study in a Tertiary Care Center. J Natl Compr Canc Netw 2024; 22:CLO24-078. [PMID: 38579759 DOI: 10.6004/jnccn.2023.7210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
- R Arjuhn
- 1Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - S Jeeva
- 1Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - T N Vijayasree
- 1Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| |
Collapse
|
41
|
Le VT, Do PT, Nguyen VD, Nguyen Dao LT. Transforaminal pulsed radiofrequency and epidural steroid injection on chronic lumbar radiculopathy: A prospective observational study from a tertiary care hospital in Vietnam. PLoS One 2024; 19:e0292042. [PMID: 38573929 PMCID: PMC10994338 DOI: 10.1371/journal.pone.0292042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 09/12/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Lumbosacral radicular syndrome (LRS) is probably the most frequent neuropathic pain syndrome, exaggerating medical and economy burden on developing countries, such as Vietnam. As a result, the urgence to find an approach which is both affordable and effective always puts great demand on medical researchers. OBJECTIVES Evaluate the effectiveness of transforaminal pulsed radiofrequency (PRF) stimulation on the dorsal root ganglion (DRG) and epidural steroid injection (ESI) in management of chronic lumbosacral radiculopathy. METHODS Seventy-six patients with chronic radicular pain were performed transforaminal PRF + ESI by neurosurgeons. Demographic characteristics and surgical outcomes were recorded on admission, pre-procedural and post-procedural for 1-month, 3-month, 6-month and 12-month follow-up. Primary outcome was measured by using Visual Analogue Scale (VAS), Oswestry disability index (ODI) and Straight Leg Raising Test (SLRT). Secondary outcome was subjectively collected based on short assessment of patients' satisfaction (SAPS). RESULTS Patients who received transforaminal PRF and ESI showed significant improvements on all three evaluation tools (VAS, ODI, SLRT), compared to that before treatment (p<0.001). Pain relief was achievable and long-lasting, which met patients' expectation. No significant complications were observed for 12 months follow-up. CONCLUSION Transforaminal PRF combined with ESI in management of lumbosacral radiculopathy should be a good method of choice for its effectiveness and safety in management of pain.
Collapse
Affiliation(s)
- Viet-Thang Le
- Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Phuoc Trong Do
- Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Vu Duc Nguyen
- Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam
| | | |
Collapse
|
42
|
Franconi I, Rizzato C, Ghelardi E, Lupetti A. Hospital distribution, seasonality, time trends and antifungal susceptibility profiles of all Aspergillus species isolated from clinical samples from 2015 to 2022 in a tertiary care hospital. BMC Microbiol 2024; 24:111. [PMID: 38570761 PMCID: PMC10988875 DOI: 10.1186/s12866-024-03267-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 03/19/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Aspergillus species cause a variety of serious clinical conditions with increasing trend in antifungal resistance. The present study aimed at evaluating hospital epidemiology and antifungal susceptibility of all isolates recorded in our clinical database since its implementation. METHODS Data on date of isolation, biological samples, patients' age and sex, clinical settings, and antifungal susceptibility tests for all Aspergillus spp. isolated from 2015 to 2022 were extracted from the clinical database. Score test for trend of odds, non-parametric Mann Kendall trend test and logistic regression analysis were used to analyze prevalence, incidence, and seasonality of Aspergillus spp. isolates. RESULTS A total of 1126 Aspergillus spp. isolates were evaluated. A. fumigatus was the most prevalent (44.1%) followed by A. niger (22.3%), A. flavus (17.7%) and A. terreus (10.6%). A. niger prevalence increased over time in intensive care units (p-trend = 0.0051). Overall, 16 (1.5%) were not susceptible to one azole compound, and 108 (10.9%) to amphotericin B, with A. niger showing the highest percentage (21.9%). The risk of detecting A. fumigatus was higher in June, (OR = 2.14, 95% CI [1.16; 3.98] p = 0.016) and reduced during September (OR = 0.48, 95% CI [0.27; 0.87] p = 0.015) and October as compared to January (OR = 0.39, 95% CI [0.21; 0.70] p = 0.002. A. niger showed a reduced risk of isolation from all clinical samples in the month of June as compared to January (OR = 0.34, 95% CI [0.14; 0.79] p = 0.012). Seasonal trend for A. flavus showed a higher risk of detection in September (OR = 2.7, 95% CI [1.18; 6.18] p = 0.019), October (OR = 2.32, 95% CI [1.01; 5.35] p = 0.048) and November (OR = 2.42, 95% CI [1.01; 5.79] p = 0.047) as compared to January. CONCLUSIONS This is the first study to analyze, at once, data regarding prevalence, time trends, seasonality, species distribution and antifungal susceptibility profiles of all Aspergillus spp. isolates over a 8-year period in a tertiary care center. Surprisingly no increase in azole resistance was observed over time.
Collapse
Affiliation(s)
- Iacopo Franconi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 37-39, 56127, Pisa, Italy
- Mycology Unit, Pisa University Hospital, Pisa, Italy
| | | | - Emilia Ghelardi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 37-39, 56127, Pisa, Italy
- Mycology Unit, Pisa University Hospital, Pisa, Italy
| | - Antonella Lupetti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 37-39, 56127, Pisa, Italy.
- Mycology Unit, Pisa University Hospital, Pisa, Italy.
| |
Collapse
|
43
|
K. L, Ganjekar S, K. S. M, H. S. V, Philip M, G. S, Rajaram D, Acharya S, Vaiphei K, A. R. S. Study on awareness and management based health action using video intervention (SAMBHAV) for postpartum depression among mothers attending immunisation clinic in a tertiary medical college hospital: Study protocol. PLoS One 2024; 19:e0301357. [PMID: 38568902 PMCID: PMC10990171 DOI: 10.1371/journal.pone.0301357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Pregnancy exerts a detrimental effect on women's mental health. Maternal mental health is considered as one of the public health concerns as it impacts the health of both mother and the child. One in five people in developing countries experience serious mental health issues during pregnancy and after giving birth. In India, postpartum depression (PPD) affects 22% of women, according to a research by WHO. The available data on mental health literacy among women, showed that only 50.7% of the postpartum mothers who were attending paediatric tertiary care centres had adequate knowledge about PPD. It is crucial to diagnose early and adequately manage postpartum depression to avoid long-term consequences. It is also essential to seek help and utilise the available resources and services to avoid worsening of the condition and to aid in the recovery. This demonstrates the need to promote awareness, improve help seeking, reduce stigma and treatment gap associated with PPD through educational video intervention specific to cultural context and beliefs. MATERIALS AND METHODS This is a quasi-experimental study without a control group that attempts to improve the awareness among the mothers about postpartum depression to understand better about the condition and also its management through video intervention. The video intervention will be developed in regional language specific to the cultural context of the setting. The video script will be finalised from the findings of the available literature and also through focus group discussion among mothers and health care professionals which will be analysed qualitatively using thematic identification. The study will use a standardized Postpartum Depression Literacy Scale (PoDLIS) which will be quantitatively analysed using paired t test before and after the intervention. Repeated measures of ANOVA will also be used to analyse the changes in literacy scale scores with respect to socio demographic variables. The mothers will also be screened for PPD using Patient Health Questionnaire 9 (PHQ 9) and feedback will be collected and analysed to find the overall usefulness of video. DISCUSSION If it becomes apparent that this video intervention is successful in raising awareness of PPD among postpartum mothers and reducing stigma, it can be used to aid early identification of mothers with PPD which can result in early management and improved health outcome for both mothers and children. The major goals of the video intervention are to raise awareness, lessen stigma, and prevent PPD through strong family support, adopting healthy lifestyles, having access to information, practising self-care, and enhancing help-seeking. TRIAL REGISTRATION The trial is registered under the Clinical Trial Registry- India (CTRI) (CTRI/2023/03/050836). The current study adheres to the SPIRIT Guidelines [See S1 Checklist: SPIRIT Guidelines].
Collapse
Affiliation(s)
- Latha K.
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Meena K. S.
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Virupaksha H. S.
- Department of Psychiatry, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Suman G.
- Department of Community Medicine, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Dinesh Rajaram
- Department of Community Medicine, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Swathi Acharya
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Kimneihat Vaiphei
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Somshekhar A. R.
- Department of Pediatrics, Ramaiah Medical College, Bengaluru, Karnataka, India
| |
Collapse
|
44
|
Srivastva S, Chakravarty J, Kushwaha AK. Prevalence of HIV Drug Resistance Mutations among Treatment-Naive People Living with HIV in a Tertiary Care Center in India. Am J Trop Med Hyg 2024; 110:713-718. [PMID: 38442417 PMCID: PMC10993842 DOI: 10.4269/ajtmh.23-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 11/28/2023] [Indexed: 03/07/2024] Open
Abstract
India has the third-largest number of people living with HIV (PLHIV) in the world. A national program provides free access to standard uniform antiretroviral therapy. However, the program is not monitored by comprehensive drug resistance surveys. The aim of this study was to determine the prevalence of HIV drug resistance mutations (DRMs) among treatment-naive PLHIV in a large antiretroviral treatment center of the national program. This cross-sectional study was done in 2017 and involved 200 consecutive treatment-naive PLHIV. A target fragment of 1,306 bp in the reverse transcriptase and protease regions was amplified. Identification of mutations and drug resistance interpretation was done by HIV Genotypic Resistance Interpretation and International Antiviral Society-USA list. Sequencing was successful in 177 samples. The majority (98.8%; 175/177) belonged to subtype C. Nineteen of 177 patients (10.7%; 95% CI: 6.2%-15.3%) had at least one major DRM. The prevalence of non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations was 10.2% (18/177). The most frequent mutations were E138A/K, A98G, K103N, V179D, and K101H/E. The prevalence of nucleoside reverse transcriptase inhibitor (NRTI) mutations was 1.1% (2/177). None of the samples had major protease inhibitor resistance mutations. The prevalence of NNRTI mutations in this study was >10%, crossing the threshold recommended by the WHO to change the NNRTI-based first-line regimen to non-NNRTI based. In 2021, the national program replaced efavirenz with dolutegravir in the first-line regimen of tenofovir, lamivudine, and efavirenz. As the majority (64%) of PLHIV in India are accessing free ART from the national program, this study highlights the need for regular nationally representative drug resistance surveys for optimizing antiretroviral regimens in the program.
Collapse
Affiliation(s)
- Shweta Srivastva
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Jaya Chakravarty
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Anurag Kumar Kushwaha
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| |
Collapse
|
45
|
Kassam N, Ngunga M, Varwani M, Msunza M, Jeilan M. Acute coronary syndrome patterns in the Young: risk factor profile and in-hospital outcomes in a tertiary referral hospital in Kenya. BMC Cardiovasc Disord 2024; 24:192. [PMID: 38570757 PMCID: PMC10988889 DOI: 10.1186/s12872-024-03832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Acute coronary syndrome (ACS) accounts for coronary artery disease (CAD) -related morbidity and mortality. There has been growing concern about the rising incidence of ACS among young individuals globally both in developed and developing countries, including Sub-Saharan Africa. This group's phenotypic characteristics; risk factors and clinical outcomes are not well described. contextual and regional studies are necessary to understand the magnitude of ACS among young Individuals and help highlight challenges and opportunities for improved ACS outcomes in the region. The study aimed to describe the demographic and clinical characteristics of young individuals hospitalized with ACS and report on in-hospital outcomes. METHODOLOGY This single-center retrospective study was conducted at the Aga Khan University Hospital, Nairobi. Medical records of all young individuals hospitalized with ACS from 30th June 2020 to 1st May 2023 were reviewed. We defined young individuals as 50 years or below. Categorical variables were reported as frequencies and proportions, and compared with Pearson chi- square or Fisher's exact tests. Continuous variables were reported as means or medians and compared with independent t-tests or Mann-Whitney U tests. P- value < 0.05 was considered statistically significant. RESULTS Among 506 patients hospitalized with ACS, (n = 138,27.2%) were aged 50 years and below. The study population was male (n = 107, 79.9%) and African(n = 82,61.2%) predominant with a median age of 46.5 years (IQR 41.0-50.0). Hypertension (n = 101,75.4%) was noted in most study participants. More than half of the cohort were smokers (n = 69,51.5%) having a family history of premature ASCVD(n = 70,52.2%) and were on lipid-lowering therapy(n = 68,50.7%) prior to presentation. ST-segment-elevation myocardial infarction (STEMI) was the most common clinical manifestation of ACS (n = 77, 57.5%). Of the significant coronary artery disease (n = 75,56.0%), the majority of the individuals had single vessel disease (n = 60, 80%) with a predilection of left anterior deciding artery(n = 47,62.6%). The Main cause of ACS was atherosclerosis (n = 41,54.6%). The mean left ventricular ejection fraction was 46.0 (± 12.4). The in-hospital mortality was (n = 2, 1.5%). CONCLUSION This study highlights that young individuals contribute to a relatively large proportion of patients presenting with ACS at our center. The most common presentation was STEMI. The principal cause was atherosclerosis. The findings of this study highlight the importance of developing systems of care that enable the early detection of CAD. Traditional cardiovascular risk factors were prevalent and modifiable, thus targets of intervention.
Collapse
Affiliation(s)
- Nadeem Kassam
- Department of cardiology, Aga Khan University Kenya, P.O. Box 30270 - 00100, Nairobi, Kenya.
| | - Mzee Ngunga
- Department of cardiology, Aga Khan University Kenya, P.O. Box 30270 - 00100, Nairobi, Kenya
| | - Mohamed Varwani
- Department of cardiology, Aga Khan University Kenya, P.O. Box 30270 - 00100, Nairobi, Kenya
| | - Miriam Msunza
- Department of cardiology, Aga Khan University Kenya, P.O. Box 30270 - 00100, Nairobi, Kenya
| | - Mohamed Jeilan
- Department of cardiology, Aga Khan University Kenya, P.O. Box 30270 - 00100, Nairobi, Kenya
| |
Collapse
|
46
|
Yan X, Jia J, Zheng W, Yuan X, Wang J, Zhang L, Li G. Gestational weight gain and pregnancy outcomes in Chinese women with type 2 diabetes mellitus: evidence from a tertiary hospital in Beijing. Front Endocrinol (Lausanne) 2024; 15:1348382. [PMID: 38628589 PMCID: PMC11018921 DOI: 10.3389/fendo.2024.1348382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
Objective To examine the effects of gestational weight gain on pregnancy outcomes and determine the optimal range of weight gain during pregnancy for Chinese women with type 2 diabetes mellitus. Methods This retrospective cohort study included 691 Chinese women with type 2 diabetes mellitus from 2012 to 2020. The study utilized a statistical-based approach to determine the optimal range of gestational weight gain. Additionally, multivariate logistic regression analysis was conducted to assess the impact of gestational weight gain on pregnancy outcomes. Results (1) In the obese subgroup, gestational weight gain below the recommendations was associated with decreased risks of large for gestational age (adjusted odds ratio [aOR] 0.19; 95% confidence interval [CI] 0.06-0.60) and macrosomia (aOR 0.18; 95% CI 0.05-0.69). In the normal weight subgroup, gestational weight gain below the recommendations of the Institute of Medicine was associated with decreased risks of preeclampsia (aOR 0.18; 95% CI 0.04-0.82) and neonatal hypoglycemia (aOR 0.38; 95% CI 0.15-0.97). (2) In the normal weight subgroup, gestational weight gain above the recommendations of the Institute of Medicine was associated with an increased risk of large for gestational age (aOR 4.56; 95% CI 1.54-13.46). In the obese subgroup, gestational weight gain above the recommendations was associated with an increased risk of preeclampsia (aOR 2.74; 95% CI 1.02, 7.38). (3) The optimal ranges of gestational weight gain, based on our study, were 9-16 kg for underweight women, 9.5-14 kg for normal weight women, 6.5-12 kg for overweight women, and 3-10 kg for obese women. (4) Using the optimal range of gestational weight gain identified in our study seemed to provide better prediction of adverse pregnancy outcomes. Conclusion For Chinese women with type 2 diabetes, inappropriate gestational weight gain is associated with adverse pregnancy outcomes, and the optimal range of gestational weight gain may differ from the Institute of Medicine recommendations.
Collapse
|
47
|
Hellinger A, Hörscher D, Biber FC, Haasenritter J, Jost K, Kreuzer T, Müller HH, Wächtershäuser EM, Weber J, Weise C, Opitz E. [Safety of patient care on an interprofessional training ward in visceral surgery]. Chirurgie (Heidelb) 2024; 95:299-306. [PMID: 38319344 DOI: 10.1007/s00104-024-02034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Interprofessional training wards (ITW) are increasingly being integrated into teaching and training concepts in visceral surgery clinics. OBJECTIVE How safe is patient care on an ITW in visceral surgery? MATERIAL AND METHODS Data collection took place from November 2021 to December 2022. In this nonrandomized prospective evaluation study the frequency and severity of adverse events (AE) in 3 groups of 100 patients each in a tertiary referral center hospital for visceral surgery were investigated. The groups consisted of patients on the ITW and on the conventional ward before and after implementation of the ITW. The Global Trigger Tool (GTT) was used to search for AE. Simultaneously, a survey of the treatment was conducted according to the Picker method to measure patient reported outcome. RESULTS Baseline characteristics and clinical outcome parameters of the patients in the three groups were comparable. The GTT analysis found 74 nonpreventable and 5 preventable AE in 63 (21%) of the patients and 12 AE occurred before the hospital stay. During the hospital stay 50 AE occurred in the operating theater and 17 on the conventional ward. None of the five preventable AE (in 1.7% of the patients) was caused by the treatment on the ITW. Patients rated the safety on the ITW better than in 90% of the hospitals included in the Picker benchmark cohort and as good as on the normal ward. CONCLUSION The GTT-based data as well as from the patients' point of view show that patient care on a carefully implemented ITW in visceral surgery is safe.
Collapse
Affiliation(s)
- A Hellinger
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland.
| | - D Hörscher
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - F C Biber
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - J Haasenritter
- Institut für Allgemeinmedizin, Philipps-Universität Marburg, Marburg, Deutschland
| | - K Jost
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - T Kreuzer
- Studiendekanat des Fachbereichs Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| | - H-H Müller
- Institut für Medizinische Bioinformatik und Biostatistik, Philipps-Universität Marburg, Marburg, Deutschland
| | - E M Wächtershäuser
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - J Weber
- Apotheke, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Fulda, Deutschland
| | - C Weise
- Medizinische Klinik III - Nephrologie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Fulda, Deutschland
| | - E Opitz
- Studiendekanat des Fachbereichs Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| |
Collapse
|
48
|
AlJohi A, Alohali A, Alsaeed S, Sakkijah HM, Obeid DA. Outcome of pregnant women admitted to critical care unit with confirmed severe COVID-19: A center experience. Saudi Med J 2024; 45:379-386. [PMID: 38657988 DOI: 10.15537/smj.2024.45.4.20240022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To explore the traits and risk factors of pregnant women admitted to intensive care units (ICUs) with COVID-19. Moreover, the study classifies outcomes based on differing levels of required respiratory support during their intensive care stay. METHODS This retrospective and descriptive study included all pregnant women with COVID-19 admitted to the adult critical care unit at a specialized tertiary hospital in Riyadh, Saudi Arabia. Between January 2020 and December 2022. A total of 38 pregnant women were identified and were eligible for our study. RESULTS The mean age of the patients was 32.9 (19-45) years, and the average Acute Physiology and Chronic Health Evaluation IV (APACHI IV) score was 49.9 (21-106). Approximately 60.5% of the patients suffered from superimposed infections during their ICU stay. Approximately 81.6% patients were delivered by C-section, 33 of the newborns survived, and 5 died. The crude mortality rate among pregnant women in our cohort was 15.8%. Patients treated with high-flow nasal cannula (HFNC) were mostly discharged or delivered normally, while the mechanical ventilation (MV) and extracorporeal membrane oxygenation groups mostly underwent C-sections. Most of the surviving newborns were on HFNC and MV. Patients with multiple infections had the longest ICU stay and had the highest risk of death. CONCLUSION The results of this study highlight the characteristics of pregnant women admitted to the ICU at a specialized tertiary healthcare center in Saudi Arabia. The APACHI IV scores accurately predicted patient's mortality, duration of MV, and length of ICU stay. In our study, we shared our experience of managing severe COVID-19 infections in pregnant patients.
Collapse
Affiliation(s)
- Amani AlJohi
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Alohali
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Saffanah Alsaeed
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Hussam M Sakkijah
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Dalia A Obeid
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
49
|
Sarkar MAM, Arefin MS, Khan MMR, Saha M, Alam MR, Ghosh CK, Ahmed DS, Masud MH, Roy PK. Demographic and Clinical Characteristics of Functional Dyspepsia and Its Subtypes in Adult Patients: An Experience from a Tertiary Care Centre in Bangladesh. Mymensingh Med J 2024; 33:426-432. [PMID: 38557521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Functional dyspepsia (FD) is a common gastrointestinal problem in the world. The Rome III consensus subdivided functional dyspepsia into two groups: meal-related postprandial distress syndrome (PDS) and meal-unrelated epigastric pain syndrome (EPS). Limited data are available regarding FD in Bangladesh. The aim of this study was to investigate the demographic and clinical characteristics of FD and its sub-types. This cross-sectional study was conducted in which we recruited patients who attended the outpatient department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Bangladesh from March 2017 to February 2018. Patients fulfilling Rome III FD criteria and a negative upper GIT endoscopy were included for this study. The patients were then subdivided into 'pure' PDS (i.e. meeting criteria for PDS without EPS symptoms), 'pure' EPS (i.e., meeting criteria for EPS without PDS symptoms), and overlapping PDS-EPS (i.e., symptoms of both PDS and EPS) groups. Total of 368 FD patients (56.0% females, mean age 32.8±8.6 years, BMI: 22.0±2.7), were included in this study. Out of them, 112(30.4%) patients (57.2% females, mean age 33.9±9.3 years, BMI: 22.0±2.7) fulfilled criteria of pure EPS and 64(17.4%) patients (68.8% females, mean age 33.2±7.8 years, BMI: 22.1±2.4) fulfilled criteria of pure PDS. However, the majority of patients [192(52.2%), 52.1% females, mean age 32.0±8.4 years, BMI: 21.9±2.8] had symptoms of overlapping EPS-PDS. More than 40% of patients in our study presented with 3 or more of the four key symptoms of FD. A longer duration of presenting symptoms was seen among patients with overlapping EPS-PDS in comparison to pure EPS and pure PDS (p<0.001). A significant overlap of symptoms of both EPS and PDS was noticed among patients with FD. The value of dividing functional dyspepsia into the subgroups of PDS and EPS is thus questionable. Further research and modification of the diagnostic criteria for FD subtypes are necessary.
Collapse
Affiliation(s)
- M A M Sarkar
- Dr Md Abdul Mumit Sarkar, Resident, Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail:
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Rees NOT, Schimansky S, Bizley G, Kobayter L. Real-world experience of implementing the MOLES score in a virtual choroidal naevi clinic at a tertiary referral centre. Eye (Lond) 2024; 38:1183-1188. [PMID: 38057559 PMCID: PMC11009328 DOI: 10.1038/s41433-023-02864-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION The MOLES score has been validated to clinically differentiate choroidal naevi from melanomas by ocular oncologists and community optometrists. However, its utility in a virtual choroidal naevi clinic at a tertiary eye hospital without specialist ocular oncology services has not yet been evaluated. METHODS A retrospective case review of 385 choroidal lesions in the virtual choroidal naevus clinic at Bristol Eye Hospital during January-March 2020 and April-August 2021 was performed. Choroidal lesions were assessed using the TFSOM-UHHD risk factor index and MOLES score, respectively. For both study periods, clinical outcome and adherence data were analysed. RESULTS Choroidal lesions scored higher with the TFSOM-UHHD index (median 2) compared to the MOLES score (median 0; p < 0.001). Median required follow-up duration was 2 years for lesions assessed with the TFSOM-UHHD index, and 0 years for those graded with the MOLES score. Overall, 215 patients were appropriately discharged to community optometrists based on their MOLES score. Imaging requirements for the TFSOM-UHHD index and MOLES score protocols were met in 69.1% and 94.8% of cases, respectively. CONCLUSION The MOLES score was easily implemented in a virtual choroidal naevus clinic, with good adherence. It increased clinic capacity by facilitating appropriate discharges of low-risk naevi to community monitoring, allowing finite and specialist hospital-based services to monitor higher-risk naevi more closely.
Collapse
Affiliation(s)
- Nicholas O T Rees
- Medical Retina Service, Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, United Kingdom.
| | - Sarah Schimansky
- Medical Retina Service, Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, United Kingdom
| | - Gemma Bizley
- Medical Retina Service, Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, United Kingdom
| | - Lina Kobayter
- Medical Retina Service, Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, United Kingdom
| |
Collapse
|