Care Protocols Research Articles

Development and Feasibility Evaluation of a Family-Centred Neonatal End-of-Life Care Protocol.

To develop a family-centred end-of-life care protocol and evaluate its feasibility. The draft protocol was created by integrating literature review results and existing protocols and interviewing bereaved parents. A Delphi study and an experts' review were conducted to refine the draft, followed by feasibility testing with neonatal intensive care unit nurses. A 71-item protocol based on an integrated end-of-life care model and the family-centred care concept was developed, comprising three sections: principal guidelines, communication during end-of-life care and five substeps (4, 17 and 71 items, respectively) according to changes in an infant's condition. The feasibility was confirmed by an increase in competency and a positive attitude towards infant end-of-life care participants who completed the protocol education. The protocol was feasible and improved nurses' competency and attitude in providing end-of-life care for infants and parents requiring support due to the loss of their infants. It can positively impact the well-being of parents who have experienced the loss of their infants in neonatal intensive care units and enhance family-centred care within the units. Application of the family-cantered end-of-life care could support infants' dying process and improve bereaved parents' quality of life in neonatal intensive care units. This study increased neonatal end-of-life nursing needs' awareness among nurses and parents during bereavement. It offered preliminary evidence regarding the feasibility of a neonatal end-of-life care protocol developed in this study. AGREE Reporting Checklist 2016. We interviewed bereaved parents to develop the draft protocol and involved neonatal care experts for the Delphi study and neonatal nurses (who would use the protocol) as feasibility test subjects. This was a doctoral dissertation and did not require protocol registration as the feasibility test involved a single neonatal intensive care unit.

Impact of daily music on comfort scores in preterm infants: a randomized controlled trial.

Premature birth heightens neurodevelopmental risks, theorized to partly stem from altered sensory inputs and disrupted sleep patterns. Modifying the acoustic milieu through music intervention (MI) offers promise to improve neonatal comfort, reduce sleep disturbances, and stabilize physiological parameters. This study explores the impact of non-pharmacological MI on these health indicators within the Neonatal Intensive Care Unit (NICU). A single-blinded RCT was conducted. Premature infants (34 > GA > 29 wks) were randomly assigned to either receive 8 min of daily MI or placebo for up to 15 days. Validated behavioral comfort scores were visually obtained by a blinded observer before and after intervention. Additionally, physiological signs (HR, RR, SatO2) were recorded. Differences between the groups were analyzed using χ² tests and t-tests. In total 56 preterm infants were included. After intervention, comfort levels increased significantly in the MI compared to placebo group (p = 0.000). Neonates receiving MI transitioned from wakefulness to a state of sleep significantly more compared to placebo (p = 0.002). Physiological parameters remained stable. This study adds to existing literature demonstrating that a music intervention in a NICU setting can enhance comfort and sleep of premature infants without adversely affecting physiological parameters. The study demonstrates that music interventions (MI) in a Neonatal Intensive Care Unit (NICU) setting can significantly increase comfort levels and positively impact the sleep of premature infants without negatively impacting their physiological parameters. This research increases evidence for non-pharmacological interventions, specifically music, as beneficial for the well-being of premature infants in NICU settings. It replicates and expands upon previous methodological designs, providing more robust evidence of MI's positive effects on this vulnerable population. The positive outcomes of music intervention could influence hospital policies by integrating non-pharmacological practices into standard neonatal care protocols to enhance developmental support for premature infants.

Anesthesia-related Complications in General Surgery: Strategies for Prevention and Management

Background: Anesthesia-related complications in general surgery remain a significant concern despite advances in anesthetic techniques. These complications can lead to increased morbidity and mortality if not effectively managed. This study aimed to evaluate the incidence, prevention, and management of anesthesia-related complications in a tertiary care hospital in Bangladesh. Methods: A prospective observational study was conducted on 60 patients who underwent general surgery at the Department of Anesthesia, Analgesia, and Intensive Care Medicine, BSMMU, Dhaka, from 2022 to 2023. Demographic data, anesthesia-related complications, preventive measures, and management strategies were recorded and analyzed. Results: Cardiovascular complications were the most common, with hypotension in 11.7% and arrhythmias in 6.7% of patients. Respiratory complications, including hypoxemia and bronchospasm, occurred in 13.3% and 5% of cases, respectively. Neurological complications, such as postoperative delirium, were observed in 10% of patients. Preventive strategies, including fluid preloading, bronchodilators, and antiemetic prophylaxis, were effective in reducing the incidence of complications. All cases of hypotension, hypoxemia, postoperative nausea and vomiting (PONV), and arrhythmias were successfully managed with standard interventions, achieving a 100% success rate. Conclusion: This study demonstrates that anesthesia-related complications can be effectively managed through vigilant perioperative care and established management protocols. Cardiovascular and respiratory complications were the most common, and prompt interventions such as fluid resuscitation, oxygen therapy, and pharmacological treatment ensured favorable outcomes. Future studies with larger sample sizes and multicenter settings are recommended to further validate these findings and optimize anesthesia practices in diverse healthcare environments.

Prevalence and Risk Factors of Postpartum Depression in Palestinian Women in the Hebron Governorate, Palestine

Background Despite the increased interest from researchers in Postpartum depression (PPD) globally, related studies are limited in Palestine and do not provide a comprehensive understanding of PPD. Objective We examined the factors that determine post-partum depression among Palestinian mothers in Hebron governorate. Methods A cross-sectional study was conducted in 122 governmental primary healthcare clinics in Hebron Governorate. A convenient sampling method was used to collect data from 435 using a self-administered questionnaire using the Edinburg Postnatal Depression Scale. Results The mean EPDS scale score was 10.56 (SD 5.273), and 36.1% had a score of ≥13, indicating moderate-to-severe depression symptoms. The study results revealed that psychosocial factors were significantly associated with PPDS and play a crucial role in the development of PPD, such as the history of depression, being exposed to domestic violence before and during pregnancy, poor husband support, unplanned pregnancy, fear of infant’s gender, and in addition to anemia than other factors. Conclusion A high prevalence of PPD was found among Palestinian women in this study. The study proposes screening women for trauma or domestic violence and assessing their social support, inquiring about pregnancy intention, and discussing family planning. Delivering iron supplements to pregnant or postpartum anemic women is important. Women who have a history of depression, domestic abuse, or lack social support should receive psychological and medical treatment. Mental health services must be included in the after-birth care protocol to train primary health clinic staff to recognize and treat PPD.

Suspected intracranial hypertension in COVID-19 patients with severe respiratory failure.

COVID-19 patients may exhibit neurological symptoms due to direct viral damage, systemic inflammatory syndrome, or treatment side effects. Mechanical ventilation in patients with severe respiratory failure often requires sedation and neuromuscular blockade, hindering thorough clinical examinations. This study aimed to investigate neurological involvement through clinical and noninvasive techniques and to detect signs of intracranial hypertension in these patients. We conducted a prospective observational study on mechanically ventilated COVID-19 adult patients admitted to our ICU, following standard of care protocols for ventilation and permissive hypercapnia. Data were collected at three time points: admission day (T1), day seven (T7), and day fourteen (T14). At each time point, patients underwent multimodal noninvasive neurological monitoring, including clinical examination, pupillary reactivity, transcranial color doppler of the middle cerebral artery (MCA), and optic nerve sheath diameter (ONSD) assessed via ultrasound (US). Head computer tomography (CT) was performed at T1 and T14. A limited subset of patients had a follow-up examination six months after ICU discharge. Seventy-nine patients were recruited; most were under deep sedation and neuromuscular blockade at T1. Pupillary size, symmetry, and reactivity were normal, as was the MCA mean velocity. However, ONSD, assessed by both US and CT, appeared enlarged, suggesting raised intracranial pressure (ICP). In a subgroup of 12 patients, increased minute ventilation was associated with a significant decrease in US-ONSD, corresponding to a drop in paCO2. At follow-up, twelve patients showed no long-term neurological sequelae, and US-ONSD was decreased in all of them. In this cohort, enlarged ONSD was detected during non-invasive neurological monitoring, suggesting a raised ICP, with hypercapnia playing a prominent role. Further studies are needed to explore ONSD behavior in other samples of mechanically ventilated, hypercapnic patients.

Tratamento de urgência de abcesso periapical agudo em evolução: Relato de um caso clínico

During emergency care, when the patient has pain, it is one of the main duties of the dental surgeon to promote pain relief to the patient. Acute apical abscess (AGA) is one of the most common causes found in urgent care. They are odontogenic infections, consisting mainly of anaerobic microorganisms, which lead to pain and/or edema, and have the potential to diffuse through the cortical bone, with eventual lethal consequences. The present study aims to describe the case report of drainage of an evolved acute periapical abscess and its respective treatment at the Primary Care Clinic II (CAB II) of the Faculty of Dentistry of Pernambuco - University of Pernambuco (FOP/UPE). Where the patient complained of spontaneous, pulsatile, localized pain and edema. Endodontic intervention is essential for immediate symptom relief, and there is no consensus in the literature that establishes a care protocol in these cases. Even though there is no requirement for standardization of the protocol for emergency care, we conclude that it is of great importance to conduct a procedure that performs the drainage of the abscess to avoid systemic compromise.

Multidisciplinary team training in postpartum hemorrhage: impact on the use of blood products.

Compare the number of puerperal women submitted to blood transfusion before and after the implementation of a care protocol for postpartum hemorrhage (PPH) with multidisciplinary team training. Cross-sectional study in a university hospital, analyzing births from 2015 to 2019, compared the use of blood products before and after the adoption of a PPH protocol with multidisciplinary training. Between 2015 and 2019, there were 17,731 births, with 299 (1.7%) postpartum women receiving blood products and 278 postpartum women were considered for this analysis, 128 (0.7%) at Time 1 and 150 (0.8%) at Time 2. After the multiprofessional team training (T2), there was a difference in the complete use of the PPH protocol (use of oxytocin, misoprostol and tranexamic acid) (T1 = 5.1% x T2 = 49.5%, p≤0.0001). An individual categorized analysis revealed that, in the T2 period, there was lower use of blood component units per patient compared to T1 (Mann-Whitney, p=0.006). It should be noted that at T1 and T2, 54% and 24% respectively received two units of blood products. It is important to highlight that after the multidisciplinary team training for the PPH protocol, the goal of zero maternal death due to hemorrhage was reached. The adoption of a specific protocol for PPH, combined with the training of a multidisciplinary team, had an impact on the ability to identify women at high risk of hemorrhage, resulting in a decrease in the use of blood components.

HARNESSING PHYTOTHERAPY: EXPLORING ALTERNATIVE TREATMENTS FOR MALE INFERTILITY

Purpose: The multifaceted nature of male infertility requires innovative approaches, leading researchers to explore the potential of phytotherapy to improve reproductive health. Phytotherapy offers a promising prospect for individuals seeking alternative treatments for male infertility, harnessing the natural therapeutic properties of plant-based compounds. The aim of this work is to investigate the efficacy and mechanisms of action of phytotherapy as a promising alternative treatment for male infertility. Through a comprehensive review of existing literature and clinical trials, this research aims to elucidate the potential benefits of phytotherapeutic interventions in improving sperm quality, enhancing reproductive parameters and addressing the underlying causes of male infertility. Methodology. We conducted a comprehensive literature search using electronic databases including PubMed, Scopus, Web of Science and Google Scholar. The search was conducted from 1970 to 2024, with no language restrictions. The following keywords and combinations of keywords were used: “phytotherapy”, “male infertility”, “herbal medicine”, “plant extracts”, “natural remedies” and “herbal supplements”. In addition, relevant articles were identified through manual searches of the reference lists of the retrieved trials and review articles. Articles were included if they met the following criteria: (1) original research articles, systematic reviews, meta-analyses and clinical trials investigating the efficacy of phytotherapy in the treatment of male infertility; (2) studies reporting outcomes related to sperm quality, reproductive hormones, semen parameters or fertility outcomes; (3) human studies involving adult men diagnosed with infertility or subfertility; (4) studies published in peer-reviewed journals. Scientific novelty. While conventional treatments for male infertility often focus on hormonal therapies, surgery or assisted reproductive techniques, this manuscript highlights the potential of phytotherapy as an alternative approach. By exploring natural remedies derived from medicinal plants, this manuscript offers new insights into complementary strategies for the treatment of male infertility. The emphasis on alternative treatments reflects a growing interest in holistic and integrative approaches to reproductive medicine. In addition to discussing the broader concept of phytotherapy, this manuscript examines the efficacy of specific phytochemicals in the treatment of male infertility. By focusing on individual compounds and their pharmacological effects, this manuscript advances our understanding of the bioactive constituents responsible for the therapeutic effects of medicinal plants. This targeted approach allows for a more nuanced evaluation of phytotherapeutic interventions and facilitates the identification of potential drug candidates. Conclusions. The use of various medicinal plants with benefits for male reproductive health was discussed, including Tribulus terrestris, Apium graveolens, Withania somnifera, Cornus mas, Fumaria parviflora, Phoenix dactylifera and many others, was discussed. The mechanisms by which these herbal remedies may exert their effects on sperm quality, reproductive hormones and overall fertility were also demonstrated. The role of plants as adjunctive therapies to address underlying conditions associated with male infertility, such as oxidative stress, inflammation and hormonal imbalances, was discussed. Although promising, clinical evidence for the efficacy of herbal treatments for male infertility remains limited, highlighting the need for further well-designed clinical trials and studies. Nevertheless, the integration of medicinal plants into comprehensive fertility care protocols offers a promising avenue for improving male reproductive health outcomes and warrants further exploration.

Large Language Models in Biomedical and Health Informatics: A Review with Bibliometric Analysis.

Large language models (LLMs) have rapidly become important tools in Biomedical and Health Informatics (BHI), potentially enabling new ways to analyze data, treat patients, and conduct research. This study aims to provide a comprehensive overview of LLM applications in BHI, highlighting their transformative potential and addressing the associated ethical and practical challenges. We reviewed 1698 research articles from January 2022 to December 2023, categorizing them by research themes and diagnostic categories. Additionally, we conducted network analysis to map scholarly collaborations and research dynamics. Our findings reveal a substantial increase in the potential applications of LLMs to a variety of BHI tasks, including clinical decision support, patient interaction, and medical document analysis. Notably, LLMs are expected to be instrumental in enhancing the accuracy of diagnostic tools and patient care protocols. The network analysis highlights dense and dynamically evolving collaborations across institutions, underscoring the interdisciplinary nature of LLM research in BHI. A significant trend was the application of LLMs in managing specific disease categories, such as mental health and neurological disorders, demonstrating their potential to influence personalized medicine and public health strategies. LLMs hold promising potential to further transform biomedical research and healthcare delivery. While promising, the ethical implications and challenges of model validation call for rigorous scrutiny to optimize their benefits in clinical settings. This survey serves as a resource for stakeholders in healthcare, including researchers, clinicians, and policymakers, to understand the current state and future potential of LLMs in BHI.

Alvimopan for postoperative ileus following abdominal surgery: a systematic review.

Postoperative ileus (POI) is a common complication following abdominal surgery, often leading to extended hospital stays and a higher risk of post-operative complications, leading to poorer patient outcomes. Alvimopan, a peripherally acting µ-opioid receptor antagonist, has been shown to aid in the recovery of normal bowel function after surgery. While its benefits are well-established in open abdominal surgeries, its efficacy in laparoscopic procedures had not been conclusively determined. However, recent clinical trials involving laparoscopic surgeries have since been conducted. This review aims to reassess the efficacy of Alvimopan by incorporating findings from these new studies, potentially providing further insight into its clinical benefits. A comprehensive search of PubMed, Google Scholar, EMBASE, and the Cochrane Library was conducted. Studies were included based on the PICO framework, focusing on Alvimopan's impact on postoperative gastrointestinal recovery. Primary outcomes were time to gastrointestinal function recovery (GI-3) and hospital stay duration. Ten studies met the inclusion criteria, with seven focusing on the use of Alvimopan in open abdominal surgeries and three in laparoscopic procedures. Collectively, these studies involved 18,822 patients undergoing various types of abdominal Administration of Alvimopan 6mg accelerated gastrointestinal function recovery by an average of 14h (Hazard ratio: 1.62, p = 0.002) and reduced hospital stays by 5.2h (Hazard ratio: 1.52, p = 0.04) compared to placebo. Similarly, Alvimopan 12mg reduced GI-3 recovery time by 13.5h (Hazard ratio: 1.58, p = 0.02) and hospital stay duration by 6.2h (Hazard ratio: 1.46, p = 0.018). Alvimopan shows promise in reducing POI and hospital stay durations following abdominal surgeries. The incorporation of the recent studies in laparoscopic abdominal procedures further supports these findings. Integrating Alvimopan into perioperative care protocols may enhance patient outcomes and help lower healthcare costs.

ThP2.8 - Reducing postoperative length of stay after thyroidectomy through a standardised multidisciplinary postoperative care protocol does not compromise patient safety

Abstract Aims Our unit had a significantly longer length of stay after thyroid surgery. We introduced change of practice through a standardised multidisciplinary postoperative care protocol. We analyse the effect of the protocol on postoperative length of stay and any impacts on patient safety. Methods A multidisciplinary protocol was implemented and embedded into clinical practice. Data was collected prospectively on consecutive patients undergoing thyroid surgery. Outcomes with reference to adverse events, length of stay and readmissions were audited. Comparisons were made with unit's pre-protocol data and national figures published in BAETS (British Association of Endocrine and thyroid Surgeons) audit report. Results A total of 78 patients underwent 37 total thyroidectomies and 41 lobectomies. Three (8.3%) of the total thyroidectomies had transient hypocalcaemia but none were permanent. None had voice changes or recurrent laryngeal nerve palsy. Three patients were reviewed few days after discharge with mild hypocalcaemia symptoms treated with calcium supplements. One was re-admitted 5 days post discharge with wound infection. Twenty-seven (75%) were discharged on 1st postoperative day as opposed to 0% pre-protocol (BAETS audit report 66%). Thirty-seven (90%) of lobectomies were discharged on 1st postoperative day (Units pre-protocol 42%, BAETS audit 81%). There was no postoperative bleed or hypocalcaemia. One patient with a large recurrent retrosternal goitre had transient recurrent laryngeal nerve palsy that recovered subsequently. There were no readmissions or adverse events directly related to early discharge. Conclusion A well embedded dedicated postoperative care protocol can significantly reduce postoperative hospital stay after thyroid surgery without compromising patient safety.

Indonesian dentists' views on providing oral health care for older adults

BackgroundWith demographic changes in aging populations, dentists require special care protocols to treat older adults with diverse and complex oral health needs and problems. Knowledge, positive attitudes, and sufficient practice experience are essential components for promptly treating older adults. However, many dentists encounter multiple barriers influencing their willingness to provide care for older adults. This study assessed Indonesian dentists' knowledge, attitudes, and practices (KAP) in providing oral health care (OHC) for older adults, including their willingness and barriers.MethodsA cross‐sectional survey was conducted with 392 dentists employing an online questionnaire between April and June 2022. The respondents' KAP was categorised utilising a modified Blooms' cut‐off point of ≥60%. Data were analysed using descriptive statistics, the x2 test, and logistic regression.ResultsMost dentists demonstrated adequate knowledge (62.2%), a positive attitude (95.4%), sufficient practice experience (91.6%), and a high willingness (98%) to provide OHC services for older adults. However, 91.4% encountered barriers primarily related to interpersonal communication, disease complexity and polypharmacy, and patient functional status. Significant associations were found between dentists' attitudes toward practices and willingness to attend geriatric dentistry training with knowledge.ConclusionImplementation of continuing professional development (CPD) in geriatric dentistry, the inclusion of geriatric dentistry into the undergraduate curriculum, and enhancing clinic accessibility for older adults may improve dentists' preparedness and benefit the future provision of OHC for older adults in Indonesia.

Polycystic Ovary Syndrome: A Comprehensive Exploration of Diagnosis Experience in Saudi Women.

Background/Objectives: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age, characterized by symptoms such as menstrual irregularities, hyperandrogenism, and polycystic ovaries. This study aimed to explore the diagnostic experiences of women with PCOS in Saudi Arabia, evaluating the timeline to diagnosis, the adequacy of information provided, and overall patient satisfaction with the healthcare process. Methods: A cross-sectional online survey was conducted with 1182 women diagnosed with PCOS across Saudi Arabia. The survey collected data on sociodemographic characteristics, the timeline from symptom onset to diagnosis, the number of healthcare visits required for diagnosis, and satisfaction with the information and support provided during the diagnostic process. Statistical analyses, including linear regression, were performed to identify factors influencing patient satisfaction. Results: The study found that 43.2% of participants sought medical attention within a year of symptom onset, yet significant delays in diagnosis were common, with 28.6% of women waiting six months or more after seeking medical care. Only 42.7% of women reported receiving adequate information at diagnosis, and satisfaction levels varied across different aspects of care. Key predictors of lower satisfaction included marital status and longer time since diagnosis, while quicker diagnosis and more healthcare visits before diagnosis positively influenced satisfaction. Conclusions: The findings highlight critical gaps in the diagnostic process and patient education for PCOS in Saudi Arabia. The widespread dissatisfaction with the information provided underscores the need for improved patient-centered care, comprehensive education, and standardized diagnostic protocols. Addressing these issues could enhance patient satisfaction and lead to better management of PCOS, both in Saudi Arabia and globally.

The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical Ventilation

Respiratory infection is the most common nosocomial infection found in intensive care units (ICUs). Dental plaques and oral mucosa can be colonized by respiratory pathogens within a few days after tracheal intubation. Oral care plays an important role in reducing the incidence of ventilator-associated infections.Aim of the study. To evaluate clinical effectiveness of the original oral care protocol in ICU patients on invasive mechanical ventilation (IMV).Materials and Methods. A multicenter, open-label, randomized, prospective, controlled study was conducted in 55 surgical ICU patients on long-term mechanical ventilation. Oral care for patients in the study group (group 1, N=30) included brushing with disposable toothbrushes and rinsing with an aqueous solution of 0.05% chlorhexidine digluconate three times daily. In the control group (group 2, N=25), patients' oral care was performed twice a day using sterile cotton swabs soaked in 0.05% aqueous chlorhexidine digluconate solution. The results were statistically processed using IBM SPSS Statistics 21. The relative risk (RR) of events was calculated with a 95% confidence interval (95% CI). The 95% CIs for event density parameters such as incidence rate (IR) and incidence rate ratio (IRR) were calculated using the exact Poisson test.Results. The incidence of ventilator-associated pneumonia (VAP) was 13.6 cases [95% CI: 4.4; 31.7] per 1,000 ventilation days in group 1 and 23.6 cases [95% CI: 7.7; 55] per 1,000 ventilation days in group 2. The incidence of VAP was 1.74 times lower [95% CI: 0.4, 7.54] in group 1 vs. group 2 (P=0.398). The identity of oral and tracheal flora on day 7 was 20% in group 1 and 50% in group 2, RR=0.4, 95% CI: 0.165–0.973, P=0.037. Serum C-reactive protein levels were significantly lower in group 1 on day 7 of ventilation compared to group 2 (P=0.04).Conclusion. The original oral care protocol, based on toothbrushing 3 times daily with a set of disposable toothbrushes and 0.05% aqueous solution of chlorhexidine digluconate, is associated with a tendency to lower VAP incidence per 1000 days of ventilation, significantly lower similarity between oral and tracheal flora, and lower serum C-reactive protein levels on day 7 of IMV. Further research on various aspects of oral care in ICU patients is needed, especially in the absence of complete clinical guidelines and clearly effective strategies for the prevention of ventilator-associated infections.

Kepuasan Hidup dan Pengaruhnya Terhadap Keberhasilan Pengobatan Penyakit Lupus

This study examines the relationship between life satisfaction and the effectiveness of systemic lupus erythematosus (SLE) treatment through a systematic review and meta-analysis of 32 studies (N=8,746) published between 2018 and 2023. The analysis reveals a moderate negative correlation between life satisfaction and lupus disease activity (r=-0.38, 95% CI: -0.44 to -0.32, p<0.001). More specifically, the data demonstrate a strong positive correlation between life satisfaction and quality of life in the context of health (r=0.52, 95% CI: 0.47-0.57, p<0.001) and a moderate positive correlation with medication adherence (r=0.34, 95% CI: 0.28-0.40, p<0.001). Longitudinal analysis (n=6 studies) shows that early improvements in life satisfaction are significantly predictive of reductions in lupus disease activity (?=-0.24, p<0.001) and enhancements in quality of life (?=0.29, p<0.001) over six months to 2 years. Meta-regression analysis further identifies age (?=0.008, p=0.03) and disease duration (?=0.015, p=0.01) as significant moderators of the effect of life satisfaction on SLE treatment outcomes. These findings extend previous research by Diener and Chan (2011) on well-being and health and by Mok et al. (2019) on depression in SLE by emphasizing the specific role of life satisfaction in SLE management. The novelty of this study lies in its focus on life satisfaction rather than solely negative risk factors, highlighting the potential for life satisfaction-based interventions in the management of SLE. This research supports the integration of life satisfaction assessments and psychosocial interventions into standard SLE care protocols, offering new insights into the psychoimmunological approach to SLE treatment.

Best practices guidelines in the postoperative management of patients who underwent cervical and lumbar fusions.

There is a lack of standardization in spine surgery in particular, as relates to postoperative care for the most common spine procedures such as cervical and lumbar fusions. The goal of this study was to develop a standardized postoperative treatment protocol for common spine procedures such as cervical and lumbar fusion to reduce unnecessary visits, imaging studies, and create a standard for all spine surgeons to adhere while maintaining quality. We developed a best practices protocol (BPP) for postoperative spine care for anterior cervical diskectomy and fusion (ACDF) and posterior lumbar interbody fusion (PLIF). We compared outcome to retrospective controls (pre-BPP) and a national database [Quality Outcomes Database (QOD)/American Spine Registry (ASR)]. Pre-BPP retrospective controls (n=1,010) were compared to patients enrolled in BPP (n=750). BPP reduced postoperative visits (POV) from 2,201 to 1,061 (52%). Total additional imaging studies computed tomography (CT) and magnetic resonance imaging (MRI) beyond standard X-ray were reduced from 192 studies to 57 (70%); 53% for lumbar fusion and 67% for cervical fusion. Comparing pre-BPP to BPP groups for complications, the number of adverse events was reduced by 52% overall; 45% for lumbar fusion, and 62% for cervical fusion. A subset of BPP patients (n=450) with available data were compared to a national registry QOD and ASR where lumbar and cervical fusion patients showed comparable less lengths of stay, lower 3-month complication rates and lower readmission rates. This is one of the first studies to standardize postoperative spine care as a first step towards creating uniformly accepted models for value-based care (VBC) in spine surgery.

Decreasing the rate of incontinence-associated dermatitis in intensive care units: A quality improvement project

PurposePatients in the intensive care unit (ICU) are at a high risk of developing incontinence-associated dermatitis (IAD), the incidence and severity of which are positively related to pressure injuries, thus affecting nursing quality indicators. This quality improvement project aimed to decrease the severity and incidence of IAD, with a focus on enhancing awareness among nursing staff. DesignThis 36-month project was implemented via the Plan-Do-Study-Act (PDSA) model. Subjectsand setting: Included staff members worked in the ICUs (central and emergency ICUs) at a Grade A tertiary hospital in Suzhou (South of Jiangsu), China. MethodsThe quality improvement project included three main procedures: (1) formulating and implementing a modified prevention and treatment nursing protocol for early structured skin care with perineum ventilation, formulating a guidance sheet for incontinence nursing care; (2) organizing training and assessments of theories and skills, including three special sections on incontinence care training (theoretical knowledge, project process, video watching), skills training for nursing staff, and an incontinence nursing workshop to engage and evaluate all staff; (3) annual analysis and discussion of nursing quality control. ResultsFollowing project completion, there was a decrease in the overall incidence of IAD. Moreover, ICU nurses may attach more importance/awareness to IAD. ConclusionsThis project successfully reduced the incidence of IAD among ICU patients.

535. AUDITING THE PATIENTS OUTCOMES AFTER SURGERY FOR ESOPHAGEAL AND GASTRIC CARDIA CANCER WITHIN THE 18 YEARS PERIOD. SINGLE CENTER EXPERIENCE

Abstract Background Malignant tumor of the esophagus and gastroesophageal junction is a long-term survival limiting disease. Although over the years there has been a significant shift in the quality of surgical care, oncological approach and treatment protocols, despite it is still disease with a very poor prognosis. Methods Evaluation of a retrospective database of consecutive patients at our surgical departement from 2005 to 2022. We divided these 18 years into three periods A (2005 – 2010), B (2011 – 2016) and C (2017 – 2022) in which we evaluated overall survival, morbidity, anastomotic complications, 30- and 90-day mortality and number of removed nodes. The difference in the number of patients with adneocarcinoma was between periods A and C, higher by almost 30%, squamous cell carcinoma without an increase. Results During the observed period, radical surgery was performed on 1252 patients, 881 patients with adenocarcinoma (70.37%) and 316 patients with squamous cell carcinoma (25.24%) and 4.39% (n=55) with another histological type. The period A N=384 (2005 – 2010), period B N=405 (2011 – 2016) and C N=463 (2017 – 2022). Between periods A and C, we recorded an increase in frequency of adenocarcinoma by almost 30%, squamous cell carcinoma without any increase. 62.3% of patients (N=780) underwent neoadjuvant oncological treatment. The indication for its performance was the clinical TNM classification (cT2 and more or cN+), histological type, general condition of the patient and as well patients age. We indicated for chemoradiotherapy 271 patients (21.65%), CHT 491 (39.22%) RT only in 17 patients and 472 (37.7%) patients designated for surgery without any other treatment. • 5-year survival in the entire group was 37.20% (Graph No 1) and median survival was 974 days for adenocarcinoma and 909 days for squamous cell carcinoma. • 30-day mortality for the entire monitored period was 1.92% (24 out of 1252) and 90-day mortality was 5.27% (66 out of 1252). • Other results are in the attached table. Conclusion During the observed period, it is clear that the quality indicators of surgical resection are improving, as well as the 30- and 90-day mortality, but this trend is not clearly manifested in the length of survival.

The management of liver disease in people with congenital bleeding disorders: guidance from European Association for Haemophilia and Allied Disorders, European Haemophilia Consortium, ISTH, and World Federation of Hemophilia

People with bleeding disorders (PWBD) have been exposed to the risk of developing chronic viral hepatitis and cirrhosis after replacement therapy. Today, the advent of new pharmacologic strategies for the control of hemostasis and the efficacious antiviral therapies against hepatitis C virus and hepatitis B virus have significantly reduced this risk. However, the real success for liver health in this clinical setting is based on other risk factors, such as the severity of liver disease at the time of hepatitis B virus/hepatitis C virus antiviral therapy and the exposure to highly prevalent factors of chronic liver damage (eg, metabolic dysfunction and/or alcohol) that can cause a residual risk of complications such as hepatocellular carcinoma, portal hypertension, and liver insufficiency. With this background, a group of experts selected among hepatologists, PWBD treaters, and patient representatives produced this practical multisociety guidance for the protection of liver health and the prevention and management of liver complications in PWBD based on the most updated protocols of care.

The Nexus of Aging and Substance Use: A Scoping Review of Therapeutic Modalities for Geriatric Substance Use Disorders.

The insidious grip of substance use disorders (SUDs) manifests as a ubiquitous public health crisis, indiscriminately affecting individuals across the spectrum of age, gender, and socioeconomic status. While advancements in treatment offer a glimmer of hope, millions continue to grapple with the debilitating physical, psychological, and social consequences of addiction, particularly those involving alcohol and opioids. This crisis is further exacerbated by the alarming rise of SUDs among older adults. As the global population undergoes a process of demographic senescence, the escalating prevalence of SUDs in this demographic underscores the urgent need for nuanced interventions.This review explores the therapeutic landscape for managing SUDs in older adults, evaluating pharmacological and non-pharmacological treatment modalities.A detailed literature search was conducted using databases like PubMed, Google Scholar, and Scopus, and studies were selected based on their relevance to therapeutic interventions for older adults with SUDs, encompassing pharmacological and non-pharmacological modalities. The synthesized results provide an extensive overview of contemporary therapeutic approaches. The findings indicate that pharmacological interventions demonstrate varied effectiveness in managing opioid and alcohol use disorders, with each drug offering distinct benefits and limitations regarding safety, tolerability, and patient adherence. Non-pharmacological interventions provide critical psychological and social support, often requiring adaptations to meet elderly patients' needs effectively. Integrated care models, which combine pharmacological and non-pharmacological treatments, emerge as the most effective approach, addressing the comprehensive needs of elderly patients by leveraging multidisciplinary teams, centralized service access, and coordinated, patient-centered care. Implementing these models, however, requires overcoming significant resource and coordination challenges. Indeed, the confluence of a burgeoning geriatric population and escalating rates of SUDs necessitates the development and implementation of granular and integrated care protocols specifically designed for older adults. By employing such a targeted approach, optimism can be cultivated and the quality of life enhanced for this vulnerable and often overlooked segment of society. This ensures the fight against addiction extends its reach, leaving no one behind.