Health Care Centers Research Articles

Histopathological evaluation of the placenta: Clues of intra-uterine fetal demise

Intrauterine fetal demise (IUFD) is a distressful event with lasting impact and risk of recurrence. However, in majority of cases, the cause remains unexplained. The aim of the present study is to evaluate the histomorphological features of placenta, the findings associated with commonly known etiologies of IUFD and other clues provided by it in establishing the cause of IUFD.: A prospective, observational study was conducted at a tertiary healthcare center in North India for a period of 3.5 years. A total of 104 placental specimen from IUFD cases were received and evaluated microscopically by 3 histopathologists. Data was tabulated and analyzed.: Majority cases of IUFD were seen in multigravida women (52.8%) in the age group of 25 to 30 years. We found that inflammatory lesions in 46.1% cases, maternal vascular malformation (MVM) in 25% cases, fetal vascular malformation in (FVM) in 16.3%, combined MVM and FVM in 2.9% while 9.7% cases were idiopathic. Presence of fibrotic villi, intervillous fibrin deposition, chorioamnionitis and calcification were the most common findings. Pregnancy induced hypertension was the most common maternal cause of IUFD identified (20.3%), while congenital anomalies were the most common fetal (72.1%) and placenta previa was the most common placental cause (33.3%). A comprehensive placental histopathological evaluation can provide clues regarding the causation and progression of IUFD, allowing clinicians to initiate early management and prevent recurrence. Patient education regarding the same may also motivate the patient to seek early and proper antenatal care in subsequent pregnancies.

Engaging Low-Wage Workers in Health and Well-Being Survey Research: Strategies From 5 Occupational Studies

Without perspectives of low-wage workers in studies of worker health and well-being, researchers cannot comprehensively assess occupational health and health equity impacts of workplace exposures and interventions. Researchers and practitioners have noted particular challenges in engaging low-wage workers in worksite-based health survey research, yet little scholarship has described strategies for improving their engagement and response rates. To fill this gap, we present case examples from 5 occupational studies conducted between 2020 and 2024 in industries including health care, food service, and fulfillment centers. For each case, we describe how we identified barriers to worker engagement in surveys, explain specific strategies we used to address those barriers, and assess the effectiveness of these actions. Then, summarizing across case examples, we offer practical recommendations to researchers surveying low-wage populations, highlighting that high-touch recruitment, building trust with workers and managers, and obtaining manager support to take surveys during work time (for worksite-based studies) are critical for obtaining reliable, representative data. Our work contributes to broader discussions on improving survey response rates in vulnerable worker populations and aims to support future researchers undertaking similar efforts. ( Am J Public Health. Published online ahead of print November 14, 2024:e1–e8. https://doi.org/10.2105/AJPH.2024.307875 )

Analysis of Underlying Factors in Financial Neglect and Abuse in Older Adults: A Qualitative Content Analysis

Objectives: To analyze underlying factors in financial neglect and abuse to enhance understanding and inform interventions that can protect the financial well-being of older adults. Design: A qualitative content analysis approach. Setting(s): Borujen, Shahrekord, Iran. Participants: A sample of 15 older adults (8 females and 7 males) aged 60 and above was selected through a purposeful sampling method from healthcare centres in Borujen, based on specific inclusion criteria. Outcome measures: Data were collected through semi-structured, in-depth individual face-to-face interviews. Results: The findings displayed one overarching category, which is lost property, along with four subcategories, including forced reluctance to pursue the recovery of lent money, deprivation of financial independence, distress due to an inability to recover lent money, and children’s financial evasions in repaying the lent money. Collectively, these factors contributed to older adults perceiving their property as lost. Conclusions: Addressing the burden imposed by financial neglect and abuse necessitates coordinated efforts from authorities, ensuring that policymakers and planners in the fields of health and aging implement concrete measures to raise awareness among families, older adults, and service providers regarding elder abuse. Ultimately, these efforts should aim to improve the quality of life for older adults.

Abstract B011: Circulating tumor DNA profiling in colorectal cancer to detect guideline-based targeted mutations at a Quebec health care center

Abstract Liquid biopsy is an emerging tool in oncology, providing minimally invasive detection of tumor- specific DNA in body fluids, known as circulating tumor DNA (ctDNA). Colorectal cancer (CRC) has shown a high rate of shedding of ctDNA, making it a promising prognostic and possibly predictive biomarker in the personalized management of patients with CRC. Therefore, the half-life of ctDNA in circulation is estimated to be between 16 minutes and several hours, indicating a need for rapid processing. This study aimed to explore the concordance between the mutational profiles in tumor tissue and ctDNA from plasma obtained using EDTA tubes as well as the correlation between ctDNA and disease stage, to evaluate the potential of implementing liquid biopsy testing in CRC cases, following biobank standards. In this retrospective cohort, 58 patients with CRC stage T1 to T4 were enrolled at the Research Institute McGill University Health Centre (RI-MUHC). Tumor tissue was obtained through surgical resection or biopsies of formalin-fixed paraffin-embedded tissue, and blood samples were drawn pre-surgery using EDTA tubes. Cell-free DNA (cfDNA) was extracted from 1-2mL plasma samples using QIAamp Circulating Nucleic Acids. Next-Generation Sequencing using a 52-gene (AmpliSeq for Illumina Focus Panel) was performed to identify the tumor mutations and subsequently droplet digital PCR (ddPCR) was performed to identify the plasma mutations. Among the 58 patients, the mean age was 62 years (range 29-86), and 29 were women. Forty- one patients had left-sided tumor. At least 1 tumor-specific mutation was detected in all tissue tumor samples. Overall, the most frequently identified mutations in this cohort were: BRAF V600E (22.4%), KRAS G12D (12.1%), KRAS G12V and KRAS G13D (8.6%). Cell-free DNA was obtained from 32 patients and showed a mean concentration of 975 ng/mL (range 400- 1,995) for stage T1, 584 ng/mL (range 228-1,300) for stage T2, 1,127 ng/mL (range 249-4,160) for stage T3 and 2,083 ng/mL (range 860-3,680) for stage T4. ddPCR revealed mutation concordance between ctDNA and matched tumor tissue of 28.1%. When tumors were stratified by stage, the concordance was 0% (n=0/3) in patients with T1 tumors, 16.7% (n=1/6) in patients with T2 tumors, 25% (n=5/20) in patients with T3 tumors and 100% (3/3) in patients with T4 tumors. This study showed that ctDNA detection of mutations has excellent concordance in stage T4 tumors, highlighting the potential of ctDNA in advanced stage disease. However, in T1-3 tumor stages the concordance was low, showing the importance of preanalytical steps such as the use of cell-free DNA preservative tubes for sensitive and accurate detection of ctDNA in patients with earlier stage disease. Citation Format: Monyse de Nobrega, Kyle Dickinson, Saba Alsaddah, Alexandra Bartolomucci, Tadhg Ferrier, Anne Mahalia Olivier Mahalia Olivier, Mina Farag, Gertuda Evaristo, Sophie Camilleri-Broet, Andrea Gomez, Thupten Tsering, Lawrence Lee, Pierre Olivier Fiset, Julia V. Burnier. Circulating tumor DNA profiling in colorectal cancer to detect guideline-based targeted mutations at a Quebec health care center [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr B011.

The effect of interhospital transfer on pediatric burn injury mortality in a resource‐limited setting

AbstractIntroductionThe World Health Organization's burn mortality estimate is 180,000 annually. Ninety‐five percent of all mortality caused by fire‐related burns worldwide occurs in low‐ and middle‐income countries (LMICs). Prior studies have shown that transfer status (direct transfer from an injury scene to a trauma center vs. indirect transfer from another health facility) affects patient outcomes. We evaluated the effect of interhospital transfer on burn mortality.MethodsWe analyzed a burn database of pediatric patients admitted to the Kamuzu Central Hospital (KCH) burn unit in Lilongwe, Malawi. We performed a bivariate analysis based on their transfer status and mortality and a logistic regression analysis to determine the effect of transfer status on mortality after burn injury.ResultsA total of 2301 patients were analyzed, with 1095 (47.6%) being in the transfer cohort from referring hospitals. The median age was 3 years (IQR 1–4). The transfer cohort had more patients presenting to the hospital more than 48 h after injury. Upon multivariate logistic regression, controlling for pertinent variables, including time to presentation, burn‐injured patients in the transfer cohort had increased odds of mortality (OR 2.26, 95% CI 1.22–4.19, and p = 0.01) compared to patients who were not transferred. The predictive probabilities of burn mortality by TBSA showed significant differences in mortality based on transfer status at TBSA between 20% and 80%.ConclusionEnsuring district hospitals and other primary health care centers in resource‐limited settings are sufficiently equipped to provide initial burn resuscitation and care may decrease mortality rates associated with transferred patients.

Impact of Hyaneb in the management of severe acute bronchiolitis in pediatric patients: a single-center retrospective study

Abstract Background To determine the impact of Hyaneb (7% hypertonic saline and 0.1% hyaluronic acid) on severe acute bronchiolitis management in pediatric patients. The aim of this study is to evaluate the possible benefits and safety of Hyaneb in managing severe acute bronchiolitis. Methods This retrospective observational study was conducted in a tertiary healthcare center. The investigation included patients aged < 2 years who were admitted to the pediatric intensive care unit (PICU) of the Clínico San Carlos Hospital. Patients were excluded if they had a radiological diagnosis of pneumothorax on admission, infection by other microorganisms, bronchiolitis for > 5 days, need for respiratory or hemodynamic support with extracorporeal techniques, or known allergies or intolerance to any Hyaneb compounds. We evaluated the potential benefit and safety of using Hyaneb in severe acute bronchiolitis between 2019 and 2020 by comparing two groups of patients: one that received Hyaneb and the other that did not. Results A total of 49 children were included in the study, and 51.7% received Hyaneb. The median age was 1 month (interquartile range [IQR] 1.5–2.0), and the median weight was 4.7 ± 1.3 kg. Patient history included premature birth in 10% of the sample population. The results were not significant for the length of stay in the PICU and the respiratory support score (p = 0.114 and p = 0.06, respectively). However, there was a significant difference (p = 0.047) in the use of adrenaline rescue between the groups. These data were no longer significant when adjusted for age, Wood Downes scale, and weight (p = 0.056). Conclusions Using nebulized Hyaneb seems safe in patients less than a month old and weighing less than 5 kg. A reduction in PICU stay or respiratory support length could not be confirmed.

Study protocol of the ALMA-CKD trial; an electronic triggering decision-support system to improve the detection, recognition, and management of patients with chronic kidney disease in primary care

Abstract Background Chronic kidney disease (CKD) is a global health problem affected by under-recognition and under-treatment in primary care settings. Electronic clinical decision support (CDS) triggering systems have the potential to improve detection and management of people with CKD by assisting clinicians in adhering to guideline recommendations. We aimed to test whether an electronic CDS triggering system would improve the detection, recognition, and management of patients with CKD in primary care. Method/Design This is a pragmatic cluster-randomized controlled trial where 66 primary healthcare centers from the Stockholm Region, Sweden were randomized 1:1 to receive either a new expanded CDS-triggering system offering kidney-specific advice or to continue with their current CDS-triggering system. The expanded CDS system reminds and provides practical facilitators of the processes of CKD screening, recognition with a diagnosis, management and referral to specialist care. The trial duration is 24 months and it is embedded into the Stockholm CREAtinine measurements (SCREAM) project, a repository of healthcare data from the region, which minimizes disturbances with healthcare praxis due to the trial and makes it fully pragmatic. The primary outcomes are the number of eligible patients screened for creatinine and albuminuria once annually and the re-testing of these labs within 6 months in patients with abnormal eGFR or albuminuria. Secondary outcomes are the proportions of issued clinical diagnoses among those fulfilling criteria, proportions of patients with significant albuminuria receiving prescribed nephroprotective medications, proportions of accepted referrals to nephrologist care among those fulfilling criteria and proportion of referrals for ultrasound of the kidneys. Discussion Prior pragmatic trials of CDS-systems in CKD has shown an improvement in quality indicators primarily in patients already diagnosed with CKD. This study expands this evidence by focusing on the process of screening, identification, monitoring and diagnostic work-up. Conclusion This pragmatic trial will assess the value of CDS for improved adherence to CKD guidelines in primary care. Clinicaltrials.gov registration: NCT06386172, submitted 2024-04-23.

A Qualitative Method To Assess a History of Cerebral Malaria in Malian Children

The investigation of factors associated with susceptibility to severe malaria is best achieved using case-control studies. The presence of a history of severe malaria in controls could affect the quality of their phenotype and study findings and hence should be rigorously determined. Here, we assessed the performance of a qualitative questionnaire to identify a history of cerebral malaria in controls in a case-control study of severe malaria in Mali. We evaluated the archived medical records of 220 children diagnosed with severe diseases at health care centers in rural and urban settings in Mali from 2018 to 2019. Parents of enrolled children were then identified and interviewed using a structured questionnaire by an investigator blinded to the diagnosis. The diagnosis derived from the interview was then compared with the diagnosis from the medical records as the reference diagnosis. The sensitivity and specificity of the questionnaire to detect cerebral malaria in history were, respectively, 84% and 76%. The questionnaire was concordant with the medical record diagnosis in 60% (95% CI: 50–71%) of cases. For other clinical phenotypes of malaria (severe malaria anemia, uncomplicated malaria, and severe malaria anemia concurrent with cerebral malaria), sensitivity and specificity ranged from 42% to 85% and 88% to 96%, respectively. Positive and negative predictive values were, respectively, 75% and 85%. The questionnaire demonstrated suitable sensitivity and specificity to identify cerebral malaria in a participant’s history. In sub-Saharan Africa, a region with suboptimal medical record archives, such a tool could be used in case-control studies of severe malaria to select controls.

Healthcare and Pharmacy Staffs' Experiences on Medication Management for Migrants—A Qualitative Exploratory Case Study in Primary Health Care

ABSTRACTAimTo explore what healthcare staff and staff in pharmacies experiences, as challenges, and possibilities in handling and use medications by foreign‐born persons or their relatives, and how necessary information is exchanged between different units in the healthcare chain to prevent medication errors.DesignA qualitative explorative single‐unit case study in a primary healthcare centre, with connected home care and pharmacies in an immigrant‐dense area.MethodsIndividual semi‐structured interviews with 17 respondents, including pharmacists, physicians and registered nurses, were conducted between May and December 2022, in Sweden. Inductive qualitative content analysis was applied.ResultsSix categories were identified: limited knowledge about medications, lack of knowledge about the Swedish system for medication prescriptions and pharmacy regulations, insufficient time to develop trusting relations, communication to support medication management, tools for facilitating safe use of medications and problems in exchange of information in the healthcare chain.ConclusionGood communication is both a challenge and a prerequisite for safe medication management by well‐informed patients. To ensure patient safety, it is crucial to establish ways to communicate with patients about their medications, regardless of their language skills. Improving communication within the healthcare chain is essential to prevent medication errors.Implication for the Profession and Patient CareUnderstanding the complexity of medication management and preventing medication errors requires staff to communicate effectively with patients at all steps in the healthcare chain to identify their informational and educational needs.ImpactThis study provides a comprehensive understanding of the importance of communication within the healthcare chain, including prescribing physicians, nurses, pharmacists and patients, to prevent medication errors.Reporting MethodCOREQ checklist.Patient or Public ContributionThis study focused on staff at a healthcare centre and two pharmacies.

Lymph node yield independently predicts local recurrence in papillary thyroid cancer

AbstractBackgroundLymph node yield (LNY) is a validated quality control parameter in colorectal cancer surgery, with >12 nodes reflecting an adequate oncological resection. No formal guidelines exist in the context of central and lateral compartment lymph node dissection for papillary thyroid cancer (PTC). This study aimed to investigate the association between LNY and regional recurrence in PTC patients, and to define a threshold LNY that indicates adequate compartmental lymphadenectomy.MethodsA retrospective analysis of patient data (1992–2022) was conducted using “The University of Sydney Endocrine Surgery Unit” database. Patients undergoing either prophylactic or therapeutic dissection of the central compartment or therapeutic dissection of the lateral compartment for PTC were included. Multivariate logistic regression analysis was performed to examine the relationship between nodal yield and local recurrence.ResultsOn multivariate analysis, a central LNY ≤3 was an independent adverse prognostic factor for central recurrence (odds ratios [OR] 2.19, 95% confidence intervals [CI] 1.15–4.17, and p = 0.018) and a lateral LNY ≤20 was independently predictive of lateral recurrence (OR 2.45, 95% CI 1.24–5.31, and p = 0.007).ConclusionsThis study highlights the association between LNY and local recurrence in PTC. Our findings suggest that minimum LNY thresholds (>3 for central and >20 for lateral) may serve as indicators of adequate dissection. Further research should validate these findings across healthcare centers.

Integrating digital behavioural therapy for insomnia into primary care: A feasibility mixed‐methods study

SummaryDigital cognitive behavioural therapy for insomnia has been developed to increase capacity and scalability for patients with insomnia, but implementation in primary care remains limited. The aim of the trial was to evaluate the implementation of digital insomnia therapy into primary care practice for patients with insomnia. We conducted a single‐arm feasibility trial of digital behavioural therapy for insomnia (SleepFix) providing sleep restriction therapy with insomnia patients in primary care. Healthcare professionals (comprising General Practitioners, community pharmacists and nurses) were enrolled into the trial and, when deemed clinically appropriate, prescribed SleepFix to patients with insomnia. The primary outcome was uptake assessed by the number of downloads of SleepFix. Interviews with primary care healthcare professionals explored their attitudes towards implementing/using insomnia digital therapeutics in clinical practice, and patients about their experiences with SleepFix. Insomnia symptoms, mood and sleep quality were measured before and after the trial. This trial was prospectively registered (ACTRN12620000055909). Thirty healthcare professionals and 105 patients were enrolled into the trial. Fourteen healthcare professionals administered at least one insomnia digital therapeutic prescription between November 2021 and March 2022. Fifty patients downloaded and used SleepFix (47.6% uptake). In post‐trial interviews, healthcare professionals felt they could incorporate digital sleep health into clinical practice and patients found SleepFix acceptable. There were significant improvements in insomnia symptoms, mood and sleep quality at week 6 (all p < 0.05). This trial shows a real‐world implementation of a digital insomnia therapy into primary care that could provide a framework for prescribing digital sleep interventions.

INNV-38. 3 DAYS-ON-1 DAY-OFF FRACTIONATED USE PROTOCOL FOR IMPROVED COMPLIANCE AND PREVENTATIVE SKIN SAFETY FOR USE OF TUMOR TREATING FIELDS: PRACTICE IMPROVEMENT STRATEGY IN NEURO-ONCOLOGY

Abstract BACKGROUND Compassionate care delivery requires that providers understand patient values and adopt practices aimed to improve the quality of extended survival. Many brain tumor clinical trials measure survival outcomes based on therapeutic interventions, but often fail to anticipate patient noncompliance and the provider’s ability to communicate the plan. Tumor Treating Fields (TTFields) is an FDA-approved locoregional, noninvasive therapy worn on the scalp to treat glioblastoma (GBM). When worn, TTFields therapy disrupts cancer cell viability and delays tumor progression but is complicated by mild-moderate skin irritation and real-world inconvenience of the unclear recommendation to wear the device an average of “≥18 hours/day or 75% of the time”. We simplified the physician instructions to encourage patient compliance and skin safety on TTFields. METHODS Adults with GBM were provided an easy-to-follow flow chart and advised across multiple centers to follow the 3-days-on (72 hours) and 1-day-off (16–24 hours) TTFields therapy use schedule and given skin-specific wound prevention guidance (cleansing selenium-based shampoo and reparative skin-barrier moisturizing) during the ‘off day’. We evaluated the ease to explain the 3-on-1-off schedule, patient adherence, and the presence and severity of skin AEs during follow-up visits. REAL-WORLD PRACTICE OUTCOMES Seventy-six patients received TTFields therapy using the 3-on-1-off protocol between 2015 and 2021 at two US healthcare centers. The median age was 57 years (range 25–81). The mean time on TTFields therapy was 73 weeks. Skin AEs occurred in 5% of patients on the 3-on-1-off protocol, as compared to 16% and 52% reported on EF-11 (NCT00379470) and EF-14 (NCT00916409) GBM studies, respectively. Majority of AEs were mild, and no patients discontinued TTFields therapy or modified electrode placement due to skin AEs while on the 3-on-1-off protocol. CONCLUSION We report real-world data confirming a practice improvement for patient compliance using a novel 3-on-1-off protocol which minimizes skin AEs and treatment interruptions to improves patient outcomes. An ounce of prevention is worth a pound of cure.

Depression in geriatrics: a systematic review and meta-analysis of prevalence and risk factors in Egypt

Abstract Background Depression is the most common psychiatric disorder in older adults, even though it is commonly misdiagnosed and undertreated, leading to exacerbations of preexisting medical conditions and even a higher mortality rate. In the present systematic review with meta-analysis, we quantify the magnitude of depression and its associated risk factors among the older adult population in Egypt. Methods A thorough literature search was performed from 2010 up to October 2023. The results were presented as proportions or risk difference with a 95% confidence interval (CI) calculated using the random effects model. A sensitivity analysis was performed to examine the robustness of the results. Results Our study included 14 articles with 5857 older adults published between 2011 and 2023. All the included studies assessed depression in geriatrics using the Geriatric Depression Scale. Of the 14 studies, 5 were for community-dwelling older adults, 3 were for older adults attending primary health care (PHC) centers, 2 were for hospitalized older adults, 3 were for residing in geriatric homes, and one for residing in geriatric homes, hospitalized older adults, and community-dwelling older adults. The overall prevalence of depression among Egyptian geriatrics was 64.6%. The pooled prevalence of depression was 59.6%, 67.0%, 67.0%, and 62.0% for community-dwelling older adults, older adults people attending PHC, hospitalized older adults, and older adults residing in geriatric homes, respectively. Older adults with chronic illness, female sex, and low-income elders and elders who were not employed had a higher risk for depression with pooled risk differences of 34.9%, 17.8%, 23.8%, and 15.1% (P < 0.05), respectively. In contrast, there was no significant difference in risk for depression in the older adults residing in urban areas compared to rural areas, the older adults aged + 70 compared to those less than 70, individuals with low levels of education or who are illiterate compared with those with higher levels of education and the older adults who live alone compared with those living with family. Conclusion More than half of the older adults in Egypt suffer from depressive symptoms. Chronic diseases, female sex, unemployment, and low-income inequality are the most significant factors contributing to depression among Egypt’s older adults.

Understanding the connection and relation between sleep and depression in a tertiary health-care center: Insights from a cross-sectional study

Abstract Background: There is a bidirectional relationship between sleep disturbance and depression, with which a new hypothesis could be generated, that is, sleep disturbance can be a prodromal event rather than a symptom of depression. Many long-term studies have identified insomnia as a risk factor for the onset or recurrence of depression in young, middle-aged, and older people and it can also increase the risk of self-harm and suicide, which can also exacerbate the medical comorbidity conditions and also increase the substance intake. Materials and Methods: Those patients attending the psychiatry outpatient department of tertiary Health-care center for 6 months were considered. Those patients who were diagnosed with depression as per the International Classification of Diseases-11 depression criteria were taken after getting proper informed consent from them. Then, those patients who satisfied the inclusion criteria were taken into the study and evaluated with self-structured pro forma including details regarding the sociodemographic profile, Hamilton Depression Rating Scale, and Insomnia Severity Index Scale to assess the severity of depression and sleep disturbance. Results: The prevalence of sleep disturbance in depressive individuals was found to be 78% (140). The significance was established between the severity of depression and the severity of insomnia (P<0.001), along with sleep duration (P<0.001), insomnia type (P=0.002), benzodiazepine usage (P<0.001) and self-harm ideas/attempts (P<0.001). Conclusion: Sleep is considered a major aspect of holistic care, as it may have an impact on the severity, frequency and duration of depression and its remission along with quality of life and mortality rate.

Proton pump inhibitors in inpatients: Are we getting it right? A retrospective analysis

Background: Proton pump inhibitors (PPIs) are commonly prescribed to hospitalized patients, but many of these prescriptions may not be based on evidence-based indications. It’s important to understand that inappropriate prescribing of PPIs can lead to unnecessary medications and financial burdens. Unfortunately, there are not many recent studies exploring how often PPIs are prescribed and if they are being prescribed appropriately. Objective: The study aimed to assess the appropriateness of PPIs use among hospitalized patients. It evaluated the indications for PPIs use and determined whether the use of PPIs in hospitalized patients is justified or not. Setting: The study was conducted at Hamad General Hospital, a tertiary academic healthcare center in the state of Qatar. Methods: A retrospective observational study with 201 subjects, was conducted in general internal medicine wards at a tertiary hospital. Physician documentation and inpatient and outpatient medication prescriptions were analyzed for PPIs exposure. Main outcome measures: The appropriateness of exposure to PPIs is determined based on international recommendations. Results: Of 533 hospitalized patients who were not critically ill, 201 (37.7%) were prescribed PPIs. The study found that 65.2% of the patients had no valid indication for PPIs exposure. Furthermore, 18% of patients were inappropriately prescribed stress ulcer prophylaxis with PPIs even though they had a low risk for the development of ulcer disease. After discharge, 82.6% of patients were prescribed PPIs, with the most common indication (43%) being gastrointestinal ulcer prophylaxis. Conclusion: This study sheds light on the issue of overutilization of PPIs, specifically in non-critically ill hospitalized patients. It highlights the unnecessary continuation of PPI prescriptions at discharge and emphasizes the importance of physicians reevaluating PPI prescriptions periodically to ensure they are still necessary and discontinuing them when possible to avoid unwanted consequences.

Pregnant women and healthcare workers’ perceptions on tuberculosis and screening: a cross-sectional study in Indonesia

Abstract Background There is a scarcity of studies regarding the obstacles in tuberculosis (TB) screening in pregnant women. This study aimed to assess the perceptions of TB as a disease and TB screening among pregnant women and healthcare workers, describe pregnant women's perceptions on specific TB screening methods and explore associations between the perceptions of TB with the intention to have TB screening by pregnant women. Methods A cross-sectional study was conducted at six primary healthcare centres in Yogyakarta Municipality, Indonesia among 240 pregnant women and 126 healthcare workers interviewed with a structured questionnaire about their perceptions. Perceptions were analysed as percentages and associated factors were tested by multivariable logistic regression. Results Most pregnant women and healthcare workers supported TB screening in pregnant women based on their perceptions of the susceptibility to or severity of TB and the benefits and risks of TB screening. Women who perceived the high susceptibility of TB disease and the benefits of TB screening were significantly more likely to have high intentions to accept TB screening in the future. Conclusions Pregnant women's perceptions of TB and TB screening influenced their intention to be screened; however, appropriate testing methods for universal TB screening in pregnant women in areas with a high prevalence of TB require further studies.

Challenges in delivery of Bhutanese Traditional Medicine (Sowa Rigpa) services at Primary Healthcare Centres in Bhutan

Bhutanese Traditional Medicine (Sowa Rigpa) and allopathic medicine are integrated and state-funded in the three-tier healthcare system of Bhutan. Bhutanese Traditional Medicine services are available in all three levels of the healthcare system offering a range of services, from consultations to therapies and drug dispensations. Except for the National Traditional Medicine Hospital in Thimphu, all the centres across the country offer only outpatient services. Out of 81 traditional medicine centres, 55 centres are located at the primary level, serving people in different geographical areas of the country. Despite an increasing number of patients availing the traditional medicine services, the facilities at the primary level continue to face several challenges. The challenges include delayed and disruptive medicine supply chain, lack of an effective and systematic patient referral system, misconceptions and lack of awareness of traditional medicine services and inadequate infrastructure. All of these impede the provision of traditional medicine services in the communities. We recommend a technology-based drug delivery system in addition to resilient production centres, an effective patient referral system in traditional medicine practice by leveraging on the guideline and electronic patient information system, advocacies in the communities to dispel the myths and misconceptions regarding the Bhutanese Traditional Medicine, and adequate and architecturally smart infrastructure. Implementing these solutions could enhance access and utilization of traditional medicine services, leveraging the best use of this important component of the healthcare system.

Service Quality and Brand Switching Behaviour in Private Healthcare Centres in Uyo, Nigeria

The study centered on service quality and brand switching behaviour in private healthcare centres inUyo, Nigeria. Three objectives, research questions and research hypotheses were formulated for the study. The population of the study was 210, while the sample size was 138, as determined using Taro Yamane sample size determination technique. Survey research design was used in the study. Using simple linear regression analysis, results from the analysis showed that availability of healthcare personnel and time spent by patients has positive and significant effects on patients’ switching behaviour in private healthcare centers in Uyo, Nigeria. It was concluded that service quality has positive and significant effect on patients witching behaviour in the studied healthcare centres in Uyo, Nigeria. The researcher recommended that management of the studied healthcare centers in Uyo metropolis should improve their working conditions as this will help guarantee the availability of healthcare personnel. Also, time spent by patients should equally be reduced across all units as this will help healthcare personnel to cope with their workloads, leading to negative patients switching behaviours.

External evaluation of intravenous vancomycin population pharmacokinetic models in adults receiving high‐flux intermittent haemodialysis

AimsPatients undergoing haemodialysis (HD) are at greater risk of methicillin‐resistant Staphylococcus aureus infections requiring intravenous vancomycin. Close vancomycin therapeutic drug monitoring is warranted in HD patients as renal clearance is the primary elimination pathway. Clinically, population pharmacokinetics (popPK) model‐informed dosing is commonly used. This study aimed to perform an external evaluation of published vancomycin popPK models developed for adults undergoing high‐flux intermittent HD, and to create a dosing nomogram derived from the model that performed best.MethodsA literature review was conducted through PubMed and EMBASE to identify relevant popPK models. an external dataset was collected retrospectively from patients of 2 healthcare centres in Quebec, Canada. Selected models were implemented in NONMEM (v7.5; ICON Development Solutions). Predictive performance was assessed through prediction and simulation‐based diagnostics.ResultsIn total, 2386 vancomycin concentrations were collected from 274 patients and 476 antibiotic courses. Four vancomycin popPK models were selected for evaluation. None of the models demonstrated overall satisfactory or clinically acceptable predictive performance. Nonetheless, Bae et al.’s model performed best with a median prediction error of 16.25% and median absolute prediction error of 34.66%. Different predictive performance was also observed for vancomycin concentrations from samples collected during and between HD sessions.ConclusionAll evaluated models presented poor overall predictive performance. Further studies are required, through existing popPK model parameter re‐estimation or new model development, to adequately describe vancomycin pharmacokinetics for our high‐flux intermittent HD patient cohort.

Assessing Dietary Habits of Saudi Patients With Type 2 Diabetes at Primary Healthcare Centers in Jeddah, Saudi Arabia

Assessing Dietary Habits of Saudi Patients With Type 2 Diabetes at Primary Healthcare Centers in Jeddah, Saudi Arabia