Care Protocols Research Articles

POST-OPERATIVE PROTOCOL FOR BRAIN TUMOR SURGERY IN INTENSIVE CARE UNIT: A LITERATURE REVIEW

Background: Brain tumors represent a diverse group of neoplasms arising from intracranial tissues, posing significant clinical challenges and impacting public health globally. With primary brain tumors having an annual incidence of around 14 per 100,000 individuals and secondary brain tumors being even more prevalent, the burden on healthcare systems is substantial. Postoperative care, particularly in the intensive care unit (ICU), plays a crucial role in monitoring patients for early detection of complications and maintaining neurological and systemic homeostasis. This study aims to serve a literature review to examine post operative management in brain surgery operation in the ICU in literatures. Result and Discussion: Protocols for ICU management post-brain tumor surgery are essential, with factors such as patient status, surgical site, and anticipated postoperative needs guiding decisions regarding ICU admission and monitoring. Neuroprotective strategies encompass physiological and pharmacological interventions aimed at mitigating adverse outcomes, with a multifaceted approach necessary for optimal neuroprotection. Conclusion: A comprehensive understanding of the surgical and postoperative management of brain tumors along with the implementation of evidence-based protocols for ICU care are essential to improve patient outcomes and minimize complications. Continued advancements in surgical techniques, neuroprotective strategies, and critical care management are crucial in addressing the complex challenges posed by brain tumors and enhancing the quality of care for affected patients.

The impact of frailty on clinical outcomes of older patients undergoing enhanced recovery after lumbar fusion surgery: a prospective cohort study.

Frailty is recognized as a surrogate for physiological age and has been established as a valid and independent predictor of postoperative morbidity, mortality, and complications. Enhanced recovery after surgery (ERAS) can enhance surgical safety by minimizing stress responses in frail patients, enabling surgeons to discharge patients earlier. However, the question of whether and to what extent the frailty impacts the post-ERAS outcomes in older patients remains. An evidence-based ERAS program was implemented in our center from January 2019. This is a prospective cohort study of patients aged ≥75 years who underwent open transforaminal lumbar interbody fusion (TLIF) for degenerative spine disease from April 2019 to October 2021. Frailty was assessed with the Fried frailty scale (FP scale), and patients were categorized as non/prefrail (FP 0-2) or frail (FP ≥ 3). The preoperative variables, operative data, postoperative outcomes, and follow-up information were compared between the two groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for 90-day major complications and prolonged length of hospital stay after surgery. A total of 245 patients (age of 79.8±3.4 year) who had a preoperative FP score recorded and underwent scheduled TLIF surgery were included in the final analysis. Comparisons between nonfrail and prefrail/frail patients revealed no significant difference in age, sex, and surgery-related variables. Even after adjusting for multiple comparisons, the association between Fried frailty and ADL-dependency, IADL-dependency, and malnutrition remained significant. Preoperative frailty was associated with increased rates of postoperative adverse events. A higher CCI grade was an independent predictor for 90-day major complications, while Fried frailty and MNA-SF scores <12 were predictive of poor postoperative recovery. Frail older patients had more adverse post-ERAS outcomes after TLIF compared to non/prefrail older patients. Continued research and multidisciplinary collaboration will be essential to refine and optimize protocols for surgical care in frail older adults.

Impact of misdiagnosis on the treatment and prognosis of acute aortic syndrome

Abstract Funding Acknowledgements None. Introduction Acute aortic syndrome (AAS) embraces a spectrum of pathologies with relatively low prevalence but associated with high mortality. The clinical presentation of AAS is highly variable and the differential diagnosis with other much more common diseases such as myocardial infarction (AMI) or pulmonary embolism (PE) is often difficult to achieve. AAS detection requires a high index of suspicion and the delay in diagnosis is associated with increased morbidity and mortality. Purpose The aim of this study is to characterize the diagnostic approach to AAS patients in the emergency department (ED) and to study the impact of the initial diagnostic suspicion on the treatment and prognosis of patients with AAS. Methods The "Aorta Code" is an inter-hospital and interdisciplinary care protocol for the management of patients with AAS in a 4-Hospital network. Patients with AAS were prospectively and consecutively collected from 2019 to 2022. The sample was classified into two groups according to whether the initial suspicion was AAA or another clinical entity. The diagnosis of AAS was established by computed tomography in all patients. Time, clinical, treatment and prognostic variables were analyzed. Results A total of 113 patients with AAS were included. Of them, only 38% (34) were initially suspected of having an AAS (Figure). AMI and PE were the initial diagnosis in 34% of patients (Figure). There were no significant differences in age, history of hypertension or other cardiovascular risk factors between the groups (table). Anterior chest pain was more frequent in the "AAS-suspicion" group. The diagnostic time delay was longer in patients with initial misdiagnosis (table). Patients with type A AAS with initial misdiagnosis underwent surgery in a lower proportion (table). Although the differences were not significant, patients with initial misdiagnosis had more postoperative complications and higher mortality. Conclusion It is essential to maintain a high index of diagnostic suspicion for AAS in the ED. Initial misdiagnosis is associated with a delayed diagnosis, delayed surgical treatment and a lower rate of surgery. In addition, although it is a small sample size, this group of patients had more postoperative complications and higher mortality.

An interventional cross-sectional study of electrolyte levels in newborns with hyperbilirubinemia before and after phototherapy in a tertiary care hospital in central India

Introduction This study protocol outlines a comprehensive investigation into the impact of phototherapy on electrolyte levels in newborns with hyperbilirubinemia. With a focus on neonates admitted to the Neonatal Intensive Care Unit (NICU) at Jawaharlal Nehru Medical College and AVBR Hospital, Sawangi, Wardha, Central India, the research aims to contribute valuable insights into the physiological changes associated with this common neonatal condition. The study’s introduction highlights the rationale, significance, and gaps in current knowledge, emphasising the need for a detailed exploration of electrolyte dynamics before and after phototherapy. Method The methodology involves a descriptive, interventional cross-sectional design with a calculated sample size of 264 neonates. Standardised protocols for data collection, including serum electrolyte analysis and urine-specific gravity assessment, will be employed. Inclusion and exclusion criteria are clearly defined to ensure a homogenous study population. Statistical analyses, utilising R Studio 4.3.1 will encompass descriptive statistics, comparative analysis, correlation analysis, and multivariate analysis to explore the nuanced relationships between variables. Rigorous ethical considerations and transparency in reporting will guide the data collection process. Expected Result Anticipated outcomes include a nuanced understanding of changes in serum electrolyte levels following phototherapy and the correlation of these changes with the treatment duration. The study is poised to shed light on the impact of gestational age and birth weight on electrolyte responses. Through rigorous statistical analysis, the research aims to provide evidence-based insights that can inform neonatal care protocols. The anticipated findings hold the potential to influence clinical practices, enhancing the quality of care provided to newborns with hyperbilirubinemia undergoing phototherapy.

Comparison of Sensitivity, Specificity, and Accuracy of ISS, RTS, and TRISS Instruments in Predicting Mortality of Trauma Patients

This study aims to compare the effectiveness of three trauma scoring systems—Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS)—in predicting mortality among trauma patients at Inche Abdoel Moeis Regional General Hospital Samarinda's emergency room. Trauma assessment tools are crucial for reducing mortality rates and enhancing patient outcomes. While ISS focuses on anatomical factors, RTS integrates physiological parameters, and TRISS combines both for a comprehensive evaluation. Previous research suggests their effectiveness in mortality prediction, albeit with variations in performance. The absence of a dedicated trauma assessment system at the hospital underscores the urgency of this research. By evaluating the performance of ISS, RTS, and TRISS, this study aims to inform clinical practice and enhance trauma patient management, ultimately reducing mortality rates and improving outcomes in the emergency room setting. The study's methodology involves retrospective analysis of trauma patient data, including demographics, injury characteristics, and outcomes. Statistical analysis will compare the performance of the three scoring systems in predicting mortality with implications for trauma care protocols and resource allocation. Results will contribute to evidence-based decision-making in emergency room settings, facilitating more accurate triage and treatment strategies for trauma patients.

Incidence of Ischemic Heart Disease (IHD) in Smokeless Tobacco/Naswar Users Versus Non-Users Following Coronary Interventions

Background: Ischemic heart disease (IHD) is a significant health concern globally, with various risk factors affecting the outcomes of therapeutic interventions like percutaneous coronary interventions (PCIs) and coronary artery bypass grafting (CABG). The use of smokeless tobacco products such as SLT (snus, loose snuff) and Naswar is prevalent in South Asia and poses additional risks due to its cardiovascular implications. Objective: This study aims to assess the impact of smokeless tobacco (SLT/Naswar) use on the incidence of IHD following coronary interventions, highlighting the need for tailored healthcare strategies to address this modifiable risk factor. Methods: A prospective observational study was conducted from July 1, 2023, to January 1, 2024, involving 200 participants aged 18 to 80 years diagnosed with IHD. Data collection involved structured interviews and comprehensive reviews of health records. Statistical analyses included Chi-square tests and logistic regression to evaluate the association between SLT/Naswar usage and IHD incidence post-intervention, with SPSS software utilized for all computations. Results: Among the participants, 40.5% were users of SLT/Naswar. Post-coronary intervention, SLT/Naswar users showed a 66% incidence rate of IHD compared to 48% in non-users, with a statistically significant difference (P=0.032). Successful intervention rates were 62% in SLT/Naswar users versus 78% in non-users. Complication rates such as re-stenosis were higher in SLT/Naswar users (29% vs. 16%). Conclusion: The study demonstrates that SLT/Naswar use significantly impacts the outcomes of coronary interventions, with a higher incidence of IHD and complications among users. These findings underscore the importance of integrating smokeless tobacco cessation programs into cardiovascular care protocols.

Quality of work life for health professions in Colombia’s adult critical care: An integrative analysis

BackgroundHealth professionals in Colombian and many parts of the world, in some cases, work in precarious conditions and intend to migrate to other countries in search of better living conditions for themselves and their families, which results in inadequate distribution worldwide and in the quality of care throughout the health system, which can ultimately influence the quality of life of patients in their health-disease processes.PurposeDescribe in depth what quality of life at work is like for the health workforce in adult critical care (ACC).MethodsThis is an investigation of convergent parallel mixed methods approach that are integrated by means of a matrix in terms of convergence, divergence, and complementarity. Two methods are used: a transversal analytical method in which three instruments were applied to 209 participants to study the relationship between Quality of Life at Work, exposure to psychosocial risks, compassion fatigue and the intention to rotate; other than from the experiences narrated by 10 Human Talent in Health explore organizational practices in critical care.ResultsThe dimension of quality of work life with the greatest dissatisfied was the management of free time (77%), the most compromised psychosocial risk was the pace of work (84%). They have high compassion satisfaction (67%) and there is an intention to migrate to another country (66%). The narrative results in discrimination/harassment as normalized practices and faceless spirituality. The integration of mixed methods shows convergence between the use of the instrument that measures quality of life at work and the narratives of the participants, complementarity with the other instruments, and divergence regarding the intention to rotate to another health institution.ConclusionThe positive trend that converges with the two approaches is that of safety at work and well-being achieved through work, embodied in the constant updating of technology and care protocols, experience time, balance between salary and work effort, staffing and supplies, and disconnection with work.

Nutritional Strategies to Mitigate Complications and Improve Long-Term Functionality of Autologous Arteriovenous Fistula Post Ultrasound and DSA Guided Balloon Dilation

This prospective cohort study evaluated the efficacy of omega-3 fatty acid supplementation on arteriovenous fistula patency and systemic inflammation in 220 hemodialysis patients undergoing ultrasound and digital subtraction angiography-guided balloon dilation. The participants were randomized into an intervention group receiving 2,000 mg of omega-3 fatty acids daily and a placebo group. The primary outcome measures were arteriovenous fistula patency at 12- and 24-months post-dilation, while secondary outcomes included thrombosis incidence, changes in inflammatory markers (c-reactive protein and interleukin-6), lipid profiles, and health-related quality of life (HRQoL). Results indicated a significant improvement in arteriovenous fistula patency in the omega-3 group at 24 months (80.9 vs. 68.2%, P &lt; 0.05). Additionally, there was a significant reduction in thrombosis rates (7.3 vs. 16.4%, P &lt; 0.05) and inflammatory markers (c-reactive protein and interleukin-6) in the omega-3 group compared to the placebo. Lipid profile analysis showed a decrease in total cholesterol and low-density lipoprotein levels with omega-3 supplementation, with significant changes at 12 months (P &lt; 0.05). HRQoL scores also improved significantly in the omega-3 group at both 12 and 24 months (P &lt; 0.05). These findings suggest that omega-3 fatty acids can enhance arteriovenous fistula functionality and reduce cardiovascular risk factors in hemodialysis patients. And its integration into standard care protocols for patients with arteriovenous fistulas would improve long-term outcomes.

The Performance of Processing and Protocol Management Carried Out By the Care Organization as A Team

The textual production identifies actions aimed at health services with the help of care protocols with an emphasis on improving population care, the content aimed to analyze the access of the population network to the health system featuring strategic points that integrate structuring theory in the care provided. The theoretical foundation is shaped in current and retrospective productions, establishing a coherent study whose documents used are from reliable sources. The result confirms that there are different actions in the management of assistance policies and that the users of the process involuntarily regularize the relevance of the complexity documented by sectoral interests, where the dominant action filed for use refers to important and confidential data. The gaps in public policies are of great relevance and indicate that the effort is paramount in health care, but the concentration on archived data will avoid future disruptions in the administrative and collaborative sector.

Perioperative oxygen administration for adults undergoing major noncardiac surgery: a narrative review.

Perioperative oxygen administration, a topic under continuous research and debate in anesthesiology, strives to optimize tissue oxygenation while minimizing the risks associated with hyperoxia and hypoxia. This review provides a thorough overview of the current evidence on the application of perioperative oxygen in adult patients undergoing major noncardiac surgery. The review begins by describing the physiological reasoning for supplemental oxygen during the perioperative period and its potential benefits while also focusing on potential hyperoxia risks. This review critically appraises the existing literature on perioperative oxygen administration, encompassing recent clinical trials and meta-analyses, to elucidate its effect on postoperative results. Future research should concentrate on illuminating the optimal oxygen administration strategies to improve patient outcomes and fine-tune perioperative care protocols for adults undergoing major noncardiac surgery. By compiling and analyzing available evidence, this review aims to provide clinicians and researchers with comprehensive knowledge on the role of perioperative oxygen administration in major noncardiac surgery, ultimately guiding clinical practice and future research endeavors.

Intrathecal Analgesia Versus Thoracic Epidural Analgesia for Thoracic Surgery

Introduction: Thoracic surgery is associated with severe postoperative pain involving parietal, visceral, and projected components. Potent analgesia at rest and during movement over an extended period is crucial. Thoracic epidural analgesia is considered the gold standard, but intrathecal analgesia may represent a promising alternative. This study aimed to evaluate the ability of intrathecal analgesia to provide comparable pain relief to thoracic epidural analgesia for thoracic surgery. Methods: This prospective, descriptive study was conducted over 12 months. Adult patients undergoing elective thoracic surgery were included after obtaining written informed consent. Patients were randomly allocated to receive either thoracic epidural analgesia (Epidural group, n=40) with a loading dose of 10 ml 0.1% bupivacaine + 10 mcg sufentanil followed by continuous infusion, or intrathecal analgesia (Intrathecal group, n=23) with a single injection of 500 mcg morphine + 10 mcg sufentanil. Standardized general anesthesia and postoperative care protocols were applied. Primary outcomes included intraoperative hemodynamics, postoperative pain scores (NRS 0-10), rescue analgesic requirements, patient satisfaction, and adverse effects. Results: The incidence of intraoperative hypotension was higher in the Epidural group (30% vs 8.7%, p=0.04). Postoperative pain scores were initially lower in the Intrathecal group, but the difference was not significant beyond 18 hours. Rescue morphine requirements were significantly higher in the Epidural group during the first 12 postoperative hours. Overall patient satisfaction was higher in the Intrathecal group (82.6% vs 62.5%, p=0.03). The incidence of nausea/vomiting and pruritus was significantly higher in the Intrathecal group. Discussion: Thoracic epidural analgesia was associated with a higher risk of intraoperative hypotension, likely due to the extended sympathetic blockade. Intrathecal analgesia provided superior early postoperative ....

Risk Factors and Clinical Outcomes of Asymptomatic Bacteriuria in Pregnant Women: A Comprehensive Analysis.

Background Asymptomatic bacteriuria (ASB) in pregnant women poses risks to maternal and neonatal health. Understanding its prevalence and associated risk factors is crucial for effective management. This study aimed to determine the prevalence of ASB among pregnant women and identify associated risk factors. Methodology A cross-sectional study involving 294 pregnant women was conducted. ASB prevalence was determined, and bivariate analysis was performed to identify associated risk factors. Logistic regression analysis was employed to assess the significance of identified risk factors. Results The overall prevalence of ASB was 17.34%. Bivariate analysis revealedassociations between ASB and maternal age (p > 0.05), socioeconomic status (p < 0.001), previous urinary tract infection (UTI) history (p < 0.001), diabetes mellitus (p = 0.00204), and anemia (p = 0.522). Multivariate logistic regression confirmed significant associations of ASB with maternal age (p = 0.008), parity (p = 0.001), previous UTI (p < 0.001), and diabetes mellitus (p < 0.001). Conclusion This study underscores the importance of screening for ASB during prenatal care, particularly among pregnant women with advanced maternal age, higher parity, previous urinary tract infection (UTI) history, and diabetes mellitus. Tailored screening strategies and prompt treatment can mitigate the risks associated with untreated ASB, improving maternal and neonatal outcomes. Healthcare providers should integrate these findings into routine antenatal care protocols to optimize maternal and fetal health.

Antenatal Care: A Comparative Review of Guidelines.

Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best possible perinatal outcomes. The aim of this study was to review and compare the most recently published guidelines on antenatal care. A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Public Health Agency of Canada, the World Health Organization, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists regarding antenatal care was conducted. There is a consensus among the reviewed guidelines regarding the necessary appointments during the antenatal period, the proper timing for induction of labor, the number and frequency of laboratory examinations for the assessment of mother's well-being, and management strategies for common physiological problems during pregnancy, such as nausea and vomiting, heartburn, pelvic pain, leg cramps, and symptomatic vaginal discharge. In addition, special consideration should be given for mental health issues and timely referral to a specialist, reassurance of complete maternal vaccination, counseling for safe use of medical agents, and advice for cessation of substance, alcohol, and tobacco use during pregnancy. Controversy surrounds clinical evaluation during the antenatal period, particularly when it comes to the routine use of an oral glucose tolerance test and symphysis-fundal height measurement for assessing fetal growth, whereas routine cardiotocography and fetal movement counting are suggested practices only by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Of note, recommendations on nutritional interventions and supplementation are offered only by Public Health Agency of Canada and World Health Organization, with some minor discrepancies in the optimal dosage. Antenatal care remains a critical factor in achieving positive outcomes, but there are variations depending on the socioeconomic status of each country. Therefore, the establishment of consistent international protocols for optimal antenatal care is of utmost importance. This can help provide safe guidance for healthcare providers and, consequently, improve both maternal and fetal outcomes.

Beyond standard treatment: A qualitative descriptive study of cancer patients' perceptions of hypnotherapy in cancer care

Background and purposeCancer remains a leading cause of death in Australia. The number of new cancer cases diagnosed each year is expected to surpass 200,000 by 2033. This marks a significant increase from about 88,000 cases in 2000 to an estimated 165,000 cases in 2023. Despite advancements in treatment, emotional and psychological challenges in cancer care are often overlooked. This study focuses on hypnotherapy, a complementary therapy recognized for its efficacy for physical and emotional symptoms, yet underutilized in Australian cancer care. The research aims to explore patients' perceptions of hypnotherapy and identify barriers to its integration, contributing to the development of holistic, patient-centered cancer care models. Materials and methodsA qualitative study employing semi-structured interviews was conducted with 14 adult cancer patients (breast, lung, and colorectal) undergoing active treatment, selected through convenience sampling. The interviews were carried out from May 2022 to August 2023, focusing on participants' experiences and attitudes toward hypnotherapy among other complementary and alternative medicine (CAM) therapies. Thematic analysis using Braun and Clarke's six-step framework was applied to the data. ResultsFive themes were developed following analysis: 1) emotional roller coaster of cancer diagnosis, 2) participants’ perspectives on hypnotherapy among other CAM modalities, 3) hypnotherapy as a psychological vs physiological support, 4) fringe benefits of hypnosis, and 5) the main hurdles: cost and lack of information. Participants expressed a diverse range of experiences and attitudes towards hypnotherapy and CAM, with a strong emphasis on the need for emotional support in cancer care. Although hypnotherapy was recognized for its potential to address both emotional and physical symptoms, its predominant use was for emotional well-being. Participants also highlighted the importance of attitudes and endorsements from healthcare providers in their decision-making process about CAM therapies. ConclusionThe study findings emphasize the need for a more integrative and patient-centered approach in cancer care that includes hypnotherapy as a non-pharmacological intervention for physical and particularly emotional support. Healthcare providers should be aware of the potential value of hypnotherapy and consider patient preferences in their recommendations. In addition, addressing the identified barriers could improve the accessibility and integration of hypnotherapy into cancer care protocols in Australia.

Review article: Evaluation and care of the critically ill patient with cirrhosis.

The increase in prevalence of liver disease globally will lead to a substantial incremental burden on intensive care requirements. While liver transplantation offers a potential life-saving intervention, not all patients are eligible due to limitations such as organ availability, resource constraints, ongoing sepsis or multiple organ failures. Consequently, the focus of critical care of patients with advanced and decompensated cirrhosis turns to liver-centric intensive care protocols, to mitigate the high mortality in such patients. Provide an updated and comprehensive understanding of cirrhosis management in critical care, and which includes emergency care, secondary organ failure management (mechanical ventilation, renal replacement therapy, haemodynamic support and intensive care nutrition), use of innovative liver support systems, infection control, liver transplantation and palliative and end-of life care. We conducted a structured bibliographic search on PubMed, sourcing articles published up to 31 March 2024, to cover topics addressed. We considered data from observational studies, recommendations of society guidelines, systematic reviews, and meta-analyses, randomised controlled trials, and incorporated our clinical expertise in liver critical care. Critical care management of the patient with cirrhosis has evolved over time while mortality remains high despite aggressive management with liver transplantation serving as a crucial but not universally available resource. Implementation of organ support therapies, intensive care protocols, nutrition, palliative care and end-of-life discussions and decisions are an integral part of critical care of the patient with cirrhosis. A multi-disciplinary approach towards critical care management is likely to yield better outcomes.

Ecology of emergency care in lower-tier healthcare providers in Ghana: an empirical data-driven Bayesian network analytical approach.

Thehealthcare landscape in Ghana is primarily composed of lower-tier providers, which serve asthe initial point of contact for most medical emergencies. This study aimed to assess the emergency care preparedness and readiness of primary healthcare providers using a robustevaluation approach.A multicentre retrospective cross-sectional study was conductedon 460 healthcare facilities using the standardised Health Facilities Emergency Preparedness Assessment Tool (HeFEPAT). Data were analysed via Bayesian Belief network.Emergency preparedness was associated with facility location, type, ownership, and in-charge personnel.Over 70% of facilities lacked specialised emergency/critical care personnel. Although 65% of in-charges reported protocol knowledge, only 7.8% could execute cardiopulmonary resuscitation. 90% of facilities lacked onsite defibrillators, and over 80% had no cerebrovascular accident medications. Road traffic accident protocols were largely unavailable, with an estimated53% probability of lacking such protocols. Private-owned facilities were more likely to lack protocols for road traffic accidents (76% vs 20% probability) and general acute care (62% vs 32%)compared to government-owned facilities.Significant gaps in emergency preparedness were identified across the studied health facilities, indicating limited capacity to manage critical situations effectively. Urgent investments in emergency medicine training, essential resources, and evidence-based protocols are needed. Standardised emergency preparedness assessments should be implemented for accreditation and quality improvement. Further research can inform the development of national guidelines and targeted interventions to strengthen emergency response capacities.

The Effects of Medical Clowning on the Quality of Life (QoL)on the Patients in on Co-Pediatric Daycare Wards

This study investigate the effects of Medical Clowning on the quality of life (QoL)on the patients in onco-pediatric daycare wards. A total of 35 participants aged 8-15 years were recruited from an onco-pediatric ward. Validated tools, including the Pediatric Quality of Life Inventory (PedsQL) and thematic coding, were utilized to assess QOL respectively. Statistical analysis, including frequency distribution for quantitatively analyzing the scores of quality of life and further using thematic coding to form respective codes done conducting semi structured interviews on the patients and their guardians were employed to analyze the data. The findings revealed significant improvements in the pediatric quality of life following medical clowning therapy. The frequency distribution for scoring quantitative data for quality of life, thematic coding for qualitatively analysis and forming 8 different themes, to assess the effectiveness of medical clowning therapy was used. The findings indicated a significant positive impact of medical clowning on improving pediatric quality of life. These results highlight the therapeutic benefits of medical clowning interventions in pediatric oncology care, emphasizing their role in enhancing patient well-being and promoting a supportive treatment environment. Furthermore, the findings underscore the importance of interdisciplinary collaboration and policy support in integrating medical clowning into comprehensive pediatric oncology care protocols. Overall, this study contributes valuable insights into the effectiveness of medical clowning as a psychosocial intervention in pediatric oncology settings, providing evidence to support its integration into standard care protocols. Moving forward, further research is needed to explore the long-term effects of medical clowning interventions and optimize their implementation in clinical practice.

Detection of Arrhythmias Using Smartwatches-A Systematic Literature Review.

Smartwatches represent one of the most widely adopted technological innovations among wearable devices. Their evolution has equipped them with an increasing array of features, including the capability to record an electrocardiogram. This functionality allows users to detect potential arrhythmias, enabling prompt intervention or monitoring of existing arrhythmias, such as atrial fibrillation. In our research, we aimed to compile case reports, case series, and cohort studies from the Web of Science, PubMed, Scopus, and Embase databases published until 1 August 2023. The search employed keywords such as "Smart Watch", "Apple Watch", "Samsung Gear", "Samsung Galaxy Watch", "Google Pixel Watch", "Fitbit", "Huawei Watch", "Withings", "Garmin", "Atrial Fibrillation", "Supraventricular Tachycardia", "Cardiac Arrhythmia", "Ventricular Tachycardia", "Atrioventricular Nodal Reentrant Tachycardia", "Atrioventricular Reentrant Tachycardia", "Heart Block", "Atrial Flutter", "Ectopic Atrial Tachycardia", and "Bradyarrhythmia." We obtained a total of 758 results, from which we selected 57 articles, including 33 case reports and case series, as well as 24 cohort studies. Most of the scientific works focused on atrial fibrillation, which is often detected using Apple Watches. Nevertheless, we also included articles investigating arrhythmias with the potential for circulatory collapse without immediate intervention. This systematic literature review provides a comprehensive overview of the current state of research on arrhythmia detection using smartwatches. Through further research, it may be possible to develop a care protocol that integrates arrhythmias recorded by smartwatches, allowing for timely access to appropriate medical care for patients. Additionally, continuous monitoring of existing arrhythmias using smartwatches could facilitate the assessment of the effectiveness of prescribed therapies.

A comprehensive analysis of twin births: clinical characteristics, morbidity trends, and risk determinants

Background: Twin births are often associated with increased risks and complications compared to singleton births. This study aims to analyze the clinical profile, morbidity pattern, and risk factors associated with twin births, focusing on maternal characteristics, neonatal outcomes, and the prevalence of conditions such as low birth weight (LBW) and preterm births. Methods: This hospital-based observational study was conducted at a tertiary care center, involving 25 mothers who had given birth to twins and their 50 neonates. The study assessed maternal age, antenatal care, parity, medical history, and neonatal outcomes including birth weight, gestational age, respiratory and cardiac parameters, and overall health status. Data were collected through medical records and direct observations in the neonatal intensive care unit. Results: The majority of mothers (64%) were aged between 21-30 years, with a mean age of 24.8 years. A significant proportion (92%) had regular antenatal visits, and 96% were multiparous. The majority of neonates (68%) were aged ≤12 hours at assessment, with a near-equal distribution between very low birth weight (VLBW) and LBW. Preterm births were common, affecting 84% of the neonates. Respiratory challenges were evident, with 62% of neonates having SpO2 levels below 94%. The mortality rate among the neonates was 32%. Conclusions: The study highlights the high-risk nature of twin pregnancies, characterized by a significant prevalence of LBW, VLBW, and preterm births. The findings emphasize the need for enhanced prenatal care and specialized neonatal interventions. The high mortality rate among neonates indicates the critical need for targeted strategies to improve neonatal outcomes in twin pregnancies. These insights are crucial for informing clinical practices and developing comprehensive care protocols for managing twin pregnancies and their associated risks.

Umbilical Cord Care - Impact of National Recommendations

Objectives −To analyze the current umbilical cord (UC) care practice in Slovenia and to evaluate the impact of national UC care recommendations by comparing the UC care practice before and after their introduction.Materials and Methods − A questionnaire covering the complete UC care was sent to medical nurses and midwifes involved in UC care in primary-level pediatric centers, health visiting and parent education services (outpatient group) and secondary and tertiary-level pediatric centers (inpatient care group) in Slovenia. Three different clinical conditions of the newborn’s umbilicus, i.e. healthy umbilicus (HU), umbilicus at risk (RU) and unhealthy umbilicus (UU) were used. The inpatient and outpatient groups and UC care in 2013 and 2021 were compared.Results − The sample included 396 respondents from all Slovenian regions. The odds for using UC care protocol in 2021 were 2.6 times higher compared to 2013 (P&lt;0.001). The UC care of HU changed: the dry UC care became less frequent (P&lt;0,001), the use of normal saline solution increased and the use of ethanol solution decreased (P&lt;0.001). The use of ethanol solution for UU decreased (P&lt;0.001) and the use of octenidine increased more than 200 times (P&lt;0.001). Conclusions − The implementation of national recommendations significantly influenced the UC care in Slovenia. The current UC care practice is more unified and consistent with international recommendations. The adjusted UC care, depending on the clinical condition of the newborn’s umbilicus, puts additional value to these recommendations. Further refinements of the UC care protocol should emphasize the use of dry UC care.