Department Patients Research Articles

The causes of bacterial bloodstream infections and antimicrobial resistance patterns in children attending a secondary care hospital in Bhaktapur, Nepal, 2017-2022: a retrospective study.

Data on antimicrobial resistance (AMR) among children in Nepal are limited. Here we have characterized the causes of bacterial bloodstream infections (BSIs), antimicrobial resistance patterns and the mechanisms of β-lactamase production in Enterobacterales among children attending outpatient and inpatient departments of a secondary care paediatric hospital in Nepal. We retrospectively collected demographic and clinical data of culture-proven bacterial BSIs between January 2017 and December 2022 among children <18 years attending a 50-bedded paediatric hospital. Stored isolates were subcultured for antimicrobial susceptibility testing against commonly used antimicrobials. Enterobacterales displaying non-susceptibility to β-lactams were phenotypically and genotypically investigated for ESBLs, plasmid-mediated AmpC (pAmpC) β-lactamases and carbapenemases. A total of 377 significant bacteria were isolated from 27 366 blood cultures. Among 91 neonates with a BSI, Klebsiella pneumoniae (n = 39, 42.4%), Pseudomonas aeruginosa (n = 15, 16.3%) and Acinetobacter baumannii complex (n = 13, 14.1%) were most common. In the non-neonates, 275/285 (96.5%) infections were community-acquired including Staphylococcus aureus (n = 89, 32.4%), Salmonella Typhi (n = 54, 19.6%) and Streptococcus pneumoniae (n = 32, 11.6%). Among the 98 S. aureus, 29 (29.6%) were methicillin-resistant Staphylococcus aureus. K. pneumoniae and Escherichia coli demonstrated non-susceptibility to extended-spectrum cephalosporins and carbapenems in both community and hospital-acquired cases. For E. coli and K. pneumoniae, blaCTX-M (45/46), blaEBC (7/10) and blaOXA-48 (5/6) were common among their respective groups. We determined significant levels of AMR among children attending a secondary care paediatric hospital with BSI in Nepal. Nationwide surveillance and implementation of antimicrobial stewardship policies are needed to combat the challenge imposed by AMR.

Bi-objective scheduling of physical therapy treatments with coupled operations for inpatients in rehabilitation departments

In recent years, the field of physical therapy has experienced significant growth, particularly due to the impact of the Covid-19 pandemic. However, the capacity of rehabilitation services remains inadequate. This current study deals with scheduling physical therapies with coupled operations and multiple resources in rehabilitation departments, considering bi-objective optimization by minimizing both makespan and waiting time. Based on detailed analysis of practical operations, a mixed integer linear programming model is formulated. For small-size instances, optimal solutions can be obtained using software such as Gurobi. To handle large instances, a compound NSGA-II algorithm (CNSGA-II) is proposed. CNSGA-II consists of First-NSGA-II and Second-NSGA-II, which are associated with patient sequences and their respective treatments. Furthermore, practical heuristics are used to improve the initial solutions for CNSGA-II. The results of a real-work instance show that makespan is reduced by approximately 8.0%–10.8% and the maximum waiting time is reduced by about 26.4%–30.0%, comparing to the Queue Length Priority Algorithm commonly used in practice. The proposed CNSGA-II is further assessed using randomly generated instances and compared to MOEA/D and NSGA-II based on HV and IGD metrics. The results indicate the superior performance and effectiveness of the proposed CNSGA-II algorithm.

Fear of violence and working department influences physical aggression level among nurses in northwest Ethiopia government health facilities

PurposeViolence is recognized as an extreme expression of aggressive behavior and physical violence is most recognized type among victims. Patients always come to the hospitals looking for a cure, remedy, or assurance; however, incompatibility of demand and service often results in violent incidents that become statuesque in health facilities. This study aims to investigate physical violence and associated factors among nurses in health facilities in Gondar town, Ethiopia. MethodThe study was an institutional-based cross-sectional study among nurses in Gondar town from April to May 2017. Data were collected using a pretested modified version of the standard [ILO/ICN/WHO/PSI] questionnaire by trained data collectors among 339 nurses across health facilities. Multivariable logistic regression analysis with 95% confidence interval (CI) was used to identify the factors significantly associated with physical violence at p-value ≤0.05. ResultOver one fourth (28.9%) [95% CI: (24.8, 33.9)] of nurses were victims of violence in the past 12 months. Level of verbal abuse (AOR = 2.35; 95%CI, 1.26–4.40), working in emergency (AOR = 4.58; 95%CI, 1.47–14.30) and inpatient (AOR = 3.33; 95%CI, 1.15–9.66)departments; having moderate (AOR = 0.41; 95%CI, 0.18–0.90),high (AOR = 0.41; 95%CI, 0.18–0.90), optimal (AOR = 0.41; 95%CI, 0.18–0.90) level of concern of violence were significantly associated with physical violence. ConclusionThis study underlines findings nurses are at high-risk of physical violence and it is ranked second highest only to psychiatric and trauma facilities in Gondar town. Exposure to verbal abuse, working in emergency and inpatient departments and perceived level of concern are the precursors of experiencing physical violence. Therefore, investing time and capital in training like restraining and de-escalation, structural measures that deter the assailants are important.

A cross-sectional study of the relationship between premenstrual syndrome and missed nursing care among female nursing staff

PurposePremenstrual syndrome (PMS) is a cyclical psychosomatic disorder prevalent among women of reproductive age. However, research on the potential impact of PMS on routine nursing schedules and activities is limited. This study aims to identify the prevalence of PMS among female nursing staff and to examine the relationship between PMS and missed nursing care (MNC). MethodBetween November 1, 2022, and April 30, 2023, this study was conducted among female nursing staff working in nine inpatient departments at Sun Yat-sen University Cancer Center. This study used a cross-sectional design. The participants were recruited through convenience sampling. Data were collected using the standardized Menstrual Distress Questionnaire, the Oncology Missed Nursing Care self-rating scale, and a sociodemographic questionnaire. One-way analysis of variance, Fisher's least significant difference test for post-hoc comparisons, and Spearman's correlation coefficient were utilized for data analysis. A trend test was also performed to explore patterns in the severity of PMS and MNC over time. ResultsWe collected a total of 224 questionnaires, with 154 (68.7%) female nursing staff reporting PMS. The most common symptoms were low back pain (91.1%), abdominal discomfort (90.6%), cold hands and feet (87.1%), and lethargy (87.1%). Moreover, 91.5% of the 224 female nursing staff reported at least one MNC activity. The nursing activities most frequently missed or left incomplete were liquid intake and output monitoring as ordered (43.3%), medication administration within 30 min before or after the scheduled time (43.3%), and electrocardiogram monitoring as ordered (42.9%). “Abdominal discomfort” from the Menstrual Distress Questionnaire was significantly correlated with the majority of MNC activities (p < 0.001). ConclusionsThis study provides evidence for a strong association between PMS and MNC among female nursing staff, suggesting that administrators should take the premenstrual conditions of female nursing staff into consideration. It is necessary to provide appropriate understanding and support to mitigate the impact on patient care and safety.

Sexual dysfunction, marital relationship, and subjective quality of life among women with schizophrenia: Analytical case-control study.

Women with schizophrenia have a high risk of adverse sexual health outcomes. The chronic course of schizophrenia draws attention to assessing the quality of life and marital relationships of patients with schizophrenia. However, there is a crunch of data in the Indian setting. This study aimed to investigate the prevalence of sexual dysfunctions (SDs) and determine the marital relationship and quality of life among women with schizophrenia. The study followed an analytical case-control design. The study was conducted at the inpatient psychiatric department of one of the apex tertiary healthcare centers located at the foothills of the Northern Himalayas. The study purposively included 136 participants (68 cases and 68 controls). The control group included healthy women aged 18-45 currently staying with sexual partners. Data were collected using pretested and standardized self-report questionnaires. The median age of the case group was 36 (interquartile range (IQR), 29-42) years, while that of the control group was 29 (IQR 26-34) years. The prevalence of SD was significantly higher (P = 0.001) in cases (95.3%) than in controls (73.4%). Compared to healthy controls, women with schizophrenia have a significantly higher rate of SD in sexual desire (P = 0.001), getting arousal (P < 0.001), lubrication (P < 0.001), achieving orgasm (P < 0.001), and sexual satisfaction (P < 0.001) (except pain). In addition, the marital relationship was better managed (P < 0.001) in healthy controls compared with cases. The healthy control group significantly expressed a better quality of life in physical (P < 0.001), psychological (P < 0.001), and maintaining social (P < 0.001) relationships (except environment domains). In multivariable logistic regression analysis, employment status significantly predicted SDs (odds ratio (OR), 25.78; 95% confidence interval (CI), 2.09, 318.10; P < 0.05) in participants. The prevalence of SD is significantly high among female participants. Hence, treating physicians should pay attention to sexual function during the screening and treatment of patients with schizophrenia.

Inpatient experience and influencing factors at Ho Chi Minh city Blood Transfusion and Hematology hospital in 2022

Objective: Policymakers and healthcare managers globally are increasingly focused on collecting Patient Experience (PE) Data to identify information and issues that require improvement for enhancing service quality. For several years, the Ho Chi Minh City Blood Transfusion and Hematology Hospital has prioritized improving patient experience and satisfaction with its services. Methods: A cross-sectional study incorporating both quantitative and qualitative approaches. Quantitative data were gathered from 250 patients or their main caregivers in six inpatient departments. Quantitative data analysis employed descriptive statistics and non-parametric tests. Qualitative information was obtained through six in-depth interviews with customers (patients and their family members) and seven in-depth interviews with medical staff (hospital leader, 02 clinical department leaders, 02 doctors, and 02 nurses). Results: The overall Patient Experience (PE) score was 8.5 (median) on a 10-point scale. PED at admission: the waiting time for admission to the inpatient department had the lowest rate of positive experiences (48.8%). Internal Audit on Facilities and Utilities serving patients: the criterion for positive experiences regarding hospital quietness had the lowest rate (65.2%). Internal Audit on the attitude and spirit of service by medical staff, medical examination and treatment activities, and hospital fee payment: all criteria received a fairly high positive evaluation rate of over 86%. Internal accounts before discharge: over 12% of respondents reported difficulties in hospital discharge payment. Factors influencing Internal Revenue Service: Positive factors included the correct application of medical examination and treatment regulations according to the Ministry of Health, administrative procedure reform, new facilities and equipment, training on codes of conduct, and appropriate treatment method selection according to the diagnosis. Negative factors included an incomplete call center for medical examination and treatment, long waiting times for admission to the inpatient department and medical examination, and a lack of methods for patients to pay hospital fees directly in the department or treatment room. Conclusions: The hospital's overall PED score is 8.5 points. Develop a plan to adjust the process to reduce waiting time for admission from the medical examination department and discharge time; Increase medical human resources to support patient fee collection directly in the treatment department/room. Keywords: Patient experience, inpatients, patients, hematology blood transfusion.

Inverted U-shaped relationship between Barthel Index Score and falls in Chinese non-bedridden patients: a cross-sectional study

ABSTRACT Background Performing activities of daily living comprise an important risk factor for falls among non-bedridden stroke inpatients in rehabilitation departments. Objectives To explore the correlation between Barthel Index score and the occurrence of falls in non-bedridden stroke rehabilitation inpatients. Methods In this cross-sectional study, information of patients grouped as non-bedridden patients by the Longshi Scale was collected. Results A total of 3097 patients were included in this study, with a fall incidence of 10.43%. After adjusting covariates, the total score of Barthel Index and falls in non-bedridden inpatients after stroke presented an inverted U-shaped curve relationship, in which inflection point was 60. The effect sizes on the left and right sides of infection point were 1.02 (95%CI 1.00–1.04) and 0.97 (95%CI 0.96–0.99), respectively. Conclusions Non-bedridden stroke patients with moderate activities of daily living (ADL) capacity may be at particularly increased risk of falls in rehabilitation departments.

Hygienic aspects of general medicine ward operation: problems and solutions

The existing problems in the field of healthcare and prevention create new challenges and difficulties in various parts of the national public health system. Today, there is an effective set of new sanitary rules and regulations important for competent organization and stable functioning of general medicine wards. In 2023, this set is SanPiN 2.1.3678-20, developed to ensure safe and effective work in medical facilities. There are special bodies tasked with controlling compliance with the standards, including Rospotrebnadzor. The COVID-19 pandemic revealed a number of problems in the organization of work of inpatient departments, which required revision of the ways of rendering medical assistance. This article considers current sanitary and hygienic aspects of organization of operations at a general medicine ward, as well as the approaches to infection prevention in the context of medical care.

An update on the access to inpatient rehabilitation facilities across Tunisia in 2023.

Considering the growing global need and the complexity of health conditions, an intensive rehabilitation in inpatient departments is fundamental. Yet, in Tunisia, the distribution of Inpatient Rehabilitation Facilities is not illustrated. To perform an update concerning the rehabilitation's beds-ratio /1000 Tunisian-inhabitants in 2023. Data were collected from the Tunisian Ministry of Health, the Eastern Mediterranean Regional Office, and the National Institute of Statistics websites. The findings revealed a total number of rehabilitations' beds 132 among a total of 20000 hospital beds with a rehabilitations' beds-ratio equal to 0.01/1000 inhabitants. Only three Inpatient Rehabilitation Facilities were identified in Tunisia covering the Greater Tunis, North East, and Center east districts. There was inequity of distribution since the beds ratio is 1.07/1000 in the North east, 0.02/1000 in the Greater Tunis and 0 in the North West and the South of Tunisia. This update highlighted the alarmingly low rehabilitation's beds-ratio in Tunisia, coupled to a significant regional disparity. Increasing beds in the existing Inpatient Rehabilitation Facilities and extending outpatient rehabilitation departments with inpatient units might be considered urgent solutions.

Epidemiology and economic burden of Von Hippel-Lindau Disease-associated central nervous system hemangioblastomas and pancreatic neuroendocrine tumors in the United States

BackgroundTo date, real-world evidence around the clinical and economic burden related to von Hippel-Lindau (VHL) disease is limited. Therefore, this study characterized the prevalence, healthcare resource utilization (HRU), and economic burden of von Hippel-Lindau–associated central nervous system hemangioblastoma (VHL-CNS-Hb) and pancreatic neuroendocrine tumors (VHL-pNET) in the United States (US).MethodsPatients with VHL-CNS-Hb or VHL-pNET were identified from Optum’s de-identified Clinformatics® Data Mart Database (2007–2020) and matched 1:5 to control patients without VHL disease or CNS-Hb/pNET. Prevalence rates of VHL-CNS-Hb and VHL-pNET (standardized by age and sex) in 2019 were estimated. HRU and healthcare costs (2020 US dollars) were compared between the VHL-CNS-Hb/VHL-pNET and control cohorts.ResultsIn 2019, US prevalence rates of VHL-CNS-Hb and VHL-pNET were estimated to be 1.12 cases per 100,000 (3,678 patients) and 0.12 cases per 100,000 (389 patients), respectively. Patients with VHL-CNS-Hb (N = 220) had more inpatient, outpatient, and emergency department visits and $49,645 higher annual healthcare costs than controls (N = 1,100). Patients with VHL-pNET (N = 20) had more inpatient and outpatient visits and $56,580 higher annual healthcare costs than controls (N = 100). Costs associated with surgical removal of CNS-Hb and pNET were particularly high.ConclusionsIn this retrospective, claims-based study, both VHL-CNS-Hb and VHL-pNET were associated with substantial HRU and healthcare costs, particularly tumor reduction surgery–related costs. These findings provide important insight for healthcare payers regarding the expected real-world costs that enrollees with VHL-CNS-Hb and VHL-pNET may incur over the course of their disease.

Proposing the "Continuum of UTI" for a Nuanced Approach to Diagnosis and Management of Urinary Tract Infections.

Patients with suspected UTIs are categorized into 3 clinical phenotypes based on current guidelines: no UTI, asymptomatic bacteriuria (ASB), or UTI. However, all patients may not fit neatly into these groups. Our objective was to characterize clinical presentations of patients who receive urine tests using the "continuum of UTI" approach. This was a retrospective cohort study of a random sample of adult noncatheterized inpatient and emergency department encounters with paired urinalysis and urine cultures from 5 hospitals in 3 states between January 01, 2017, and December 31, 2019. Trained abstractors collected clinical (eg, symptom) and demographic data. A focus group discussion with multidisciplinary experts was conducted to define the continuum of UTI, a 5-level classification scheme that includes 2 new categories: lower urinary tract symptoms/other urologic symptoms and bacteriuria of unclear significance. The newly defined continuum of UTI categories were compared to the current UTI classification scheme. Of 220,531 encounters, 3392 randomly selected encounters were reviewed. Based on the current classification scheme, 32.1% (n = 704) had ASB and 53% (n = 1614) did not have a UTI. When applying the continuum of UTI categories, 68% of patients (n = 478) with ASB were reclassified as bacteriuria of unclear significance and 29% of patients (n = 467) with "no UTI" were reclassified to lower urinary tract symptoms/other urologic symptoms. Our data suggest the need to reframe our conceptual model of UTI vs ASB to reflect the full spectrum of clinical presentations, acknowledge the diagnostic uncertainty faced by frontline clinicians, and promote a nuanced approach to diagnosis and management of UTIs.

Opioid stewardship program implementation in rural and critical access hospitals in Arizona.

The objective of this study is to examine rural hospitals' status in implementing opioid stewardship program (OSP) elements and assess differences in implementation in emergency department (ED) and acute inpatient departments. Health administrator survey to identify the number and type of OSP elements that each hospital has implemented. Arizona critical access hospitals (CAHs). ED and acute inpatient department heads at 17 Arizona CAHs (total of 34 assessments). Implementation of 11 OSP elements, by department (ED vs inpatient) and prevention orientation (primary vs tertiary). The percentage of implemented elements ranged from 35 to 94 percent in EDs and 24 to 88 percent in acute care departments. Reviewing the prescription drug monitoring program database and offering alternatives to opioids were the most frequently implemented. Assessing opioid use disorder (OUD) and prescribing naloxone were among the least. The number of implemented elements tended to be uniform across departments. We found that CAHs implemented, on average, 67 percent of elements that prevent unnecessary opioid use and 54 percent of elements that treat OUD. Some OSP elements were in place in nearly every Arizona CAH, while others were present in only a quarter or a third of hospitals. To improve, more attention is needed to define and standardize OSPs. Equal priority should be given to preventing unnecessary opioid initiation and treating opioid misuse or OUD, as well as quality control strategies that provide an opportunity for continuous improvement.

Bacteriological Trends of Chronic Mucosal Otitis Media in a Tertiary Care Hospital in the Northern Region of Bangladesh

Background: Chronic otitis media (COM) is a disease of multiple etiology caused by bacteria and its importance lies in its chronicity and awful complications. The microbiological study shows the growth of a lot of organisms, frequently multiple and those differ based on geographical variation, patient population, climate, and many other factors. Objective: To evaluate current bacteriological trends of ear infections in patients with chronic otitis media which will be beneficial for appropriate treatment as well as for reducing complications. The study also focuses on rapid diagnosis by exploring other factors like age and sex-wise distribution, socioeconomic status, distribution of patients according to the type of dwelling, and bathing habits of patients. Methods: This cross-sectional, observational study was conducted in the Department of ENT and Head-Neck Surgery, Rangpur Medical College Hospital in Rangpur, a northern district of Bangladesh, over 6 months on a total of 80 patients who had attended outpatient and inpatient departments. Aural swab was taken from the discharging ears which were inoculated on blood agar and MacConkey’s agar media. The organism pattern was then tabled based on the culture reports. Results: The most common bacteria causing COM was Pseudomonas aeruginosa in (45.0%) followed by Staph. aureus (27.5%), mixed isolates in 8.75%, E. coli in 5%, Proteus in 3.75%, S. pneumoniae in 2.5%, and Klebsiella in 1.25%. Conclusion: The study proved to be useful for clinicians in management of COM and its complications. Early and effective microbiological diagnosis and intervention is the best solution. From this study, it is observed that Pseudomonas aeruginosa is the commonest pathogen for bacterial ear disease followed by S. Aureus. Mugda Med Coll J. 2023; 6(2): 83-87

Improving TB detection among children in routine clinical care through intensified case finding in facility-based child health entry points and decentralized management: A before-and-after study in Nine Sub-Saharan African Countries.

In 2022, an estimated 1.25 million children <15 years of age developed tuberculosis (TB) worldwide, but >50% remained undiagnosed or unreported. WHO recently recommended integrated and decentralized models of care as an approach to improve access to TB services for children, but evidence remains limited. The Catalyzing Paediatric TB Innovation project (CaP-TB) implemented a multi-pronged intervention to improve TB case finding in children in nine sub-Saharan African countries. The intervention introduced systematic TB screening in different facility-based child-health entry-points, decentralisation of TB diagnosis and management, improved sample collection with access to Xpert® MTB/RIF or MTB/RIF Ultra testing, and implementation of contact investigation. Pre-intervention records were compared with those during intervention to assess effect on paediatric TB cascade of care. The intervention screened 1 991 401 children <15 years of age for TB across 144 health care facilities. The monthly paediatric TB case detection rate increased significantly during intervention versus pre-intervention (+46.0%, 95% CI 36.2-55.8%; p<0.0001), with variability across countries. The increase was greater in the <5 years old compared to the 5-14 years old (+53.4%, 95% CI 35.2-71.9%; p<0.0001 versus +39.9%, 95% CI 27.6-52.2%; p<0.0001). Relative contribution of lower-tier facilities to total case detection rate increased from 37% (71.8/191.8) pre-intervention to 50% (139.9/280.2) during intervention. The majority (89.5%) of children with TB were identified through facility-based intensified case-finding and primarily accessed care through outpatient and inpatient departments. In this multi-country study implemented under real-life conditions, the implementation of integrated and decentralized interventions increased paediatric TB case detection. The increase was driven by lower-tier facilities that serve as the primary point of healthcare contact for most patients. The effect was greater in children < 5 years compared to 5-14 years old, representing an important achievement as the TB detection gap is higher in this subpopulation. (Study number NCT03948698).

Organizational Citizenship Behavior to Improve Nurse Performance in the Inpatient Department at Ibnu Sina Hospital Makassar

Organizational Citizenship Behavior to Improve Nurse Performance in the Inpatient Department at Ibnu Sina Hospital Makassar

A Systematic Review and Meta-Analysis: Child and Adolescent Healthcare Utilization for Eating Disorders During the COVID-19 Pandemic

To conduct a meta-analysis documenting healthcare service utilization rates for pediatric (age<19 years) eating disorders during compared to before the COVID-19 pandemic. PsycINFO, MEDLINE, Embase, and Web of Science Core Collection were searched for studies published up to May 19, 2023. Studies with pediatric visits to primary care, inpatient, outpatient, and emergency department for eating disorders before and during the pandemic were included. This preregistered review (PROSPERO CRD42023413392) was reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analyzed with random-effects meta-analyses. A total of 52 studies reporting >148,000 child and adolescent eating disorder-related visits to >300 health settings across 15 countries were included (mean age, 12.7 years; SD= 4.1 years; 87% girls). There was strong evidence of an increase in healthcare use for eating disorders during the pandemic (rate ratio [RR]= 1.54, 95% CI= 1.38-1.71). Moderator analysis revealed larger rate increases among girls (RR= 1.48, 95% CI= 1.28-1.71) compared to boys (RR= 1.24, 95% CI= 1.06-1.45) and for adolescents (age≥12 to 19 years) (RR= 1.53, 95% CI= 1.29-1.81) compared to children (RR= 0.87, 95% CI= 0.53-1.43). Moderator analysis demonstrated strong evidence of increased use of emergency department (RR= 1.70, 95% CI= 1.48-1.97), inpatient (RR= 1.56, 95% CI= 1.33-1.84), and outpatient (RR= 1.62, 95% CI= 1.35-1.95) services, as well as strong evidence of increased rates of anorexia nervosa (RR= 1.48, 95% CI= 1.24-1.75). Healthcare use for pediatric eating disorders increased substantially during the COVID-19 pandemic, particularly among girls and adolescents. It is important to continue to monitor whether changes in healthcare use associated with acute pediatric mental distress are sustained beyond the COVID-19 pandemic. Risk factors for eating disorders for youth during the COVID-19 pandemic; https://www.crd.york.ac.uk/; CRD42023413392. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

The opioid public health crisis in Texas: Characterizing real-world healthcare resource utilization and economic burden in different clinical settings.

Given the national opioid public health crisis, this study aimed to characterize the real-world healthcare resource utilization pattern and to quantify the economic burden associated with opioid misuse in Texas. A retrospective cross-sectional study was conducted using Texas state-wide Inpatient, Outpatient, and Emergency Department (ED) administrative data. International Classification of Diseases, 10th Revision (ICD-10-CM) codes related to opioid abuse, adverse effects, dependence, and poisoning identified opioid-related clinical encounters. High-sensitivity and high-specificity definition criteria were used to capture the range of opioid-related clinical encounters. Descriptive statistics were applied to evaluate the resource utilization and economic burden in different clinical settings and by different types of opioid misuse. Multivariable logistic regression models were applied to identify the association with patients' characteristics. The high-sensitivity definition identified three to six times more opioid-related clinical encounters related as compared to the high-specificity definition (31,901 vs 10,423 outpatient visits and 47,021 vs 7,444 inpatient visits). A greater proportion of these patients were aged 18-44, White, non-Hispanic, living in metro areas, and uninsured as compared to all-cause visits. EDs were heavily utilized with the outpatient visits predominantly through the ED (>90 percent) and between 49 and 78 percent of inpatient hospitalizations admitted through ED. The multivariable association between patient characteristics and opioid-related clinical encounters varied with clinical settings and the two definitions. High-sensitivity opioid-related clinical encounters were generally associated with higher charges as compared to high-specificity encounters. The total healthcare charge related to opioid misuse in 2016 was estimated to be USD 0.27 billion using the high-specificity definition and USD 2.6 billion using the high-sensitivity definition. Findings indicate opioid-related clinical encounters impose significant clinical and economic burdens in Texas. Study findings can help healthcare policymakers, professionals, and clinicians better classify opioid use disorder as a major but underreported condition in Texas.

Burnout among GU oncologists and associated factors: BUCARE survey.

293 Background: The growing number of patients with genitourinary (GU) cancers coupled with complexity of their treatments could create an increasing burden on GU oncologists. The Bureau for Cancer Research (BUCARE) assessed the prevalence of burnout among GU oncologists. Methods: This is a cross-sectional survey study conducted online among practicing surgical, medical and radiation oncologists from Kazakhstan, Russia, Uzbekistan, Azerbaijan, Georgia, Kyrgyzstan, Tajikistan, and Israel. The primary outcome is burnout experience assessed through the Maslach Burnout Inventory. Association between respondents’ characteristics and presence of burnout was tested using X-test. Results: From April to August 2023,a total of 674 GU oncologists completed the questionnaire. The characteristics of respondents are 50% female, 45% medical oncologists, 35% surgeons, 15% radiation oncologists, working in outpatient (35%) and inpatient (65%) departments. Ninety-two percent of responders are interested in their daily work and 83.7% have a great interest in further professional development. However, 71.5% (482 of 674) had symptoms of burnout (high emotional exhaustion and/or depersonalization scores) and 60.8% of respondents describe readiness to seek psychological support. 172 (25.5%) and 401 (59.5%) participants reported that they do not have enough time to communicate with their family at all or partially, respectively. Significant drivers of burnout identified in multivariable regression modeling include ≥20 patients per day (odds ratio [OR] = 15.1; P&lt;0.001) and ≥10 working hours per day (OR=10.4; P&lt;0.001). Male gender (OR=0.1; P&lt;0.001) and specialization in radiation oncology (OR=0.19; P&lt;0.01) are associated with lower odds of burnout. Conclusions: Two-thirds of surveyed GU oncologists met predefined standardized criteria for burnout. Expanding the staff of GU oncologists and reducing the daily workload may improve the emotional state of these physicians. Special attention must be paid to the work environment of female providers as well as surgical and medical oncologists to decrease the rate of burnout.

Nurses retrospective view on nursing education: A repeated cross-sectional study over three decades

BackgroundAs the healthcare landscape undergoes transformative shifts due to factors like ageing demographics, technological innovations, rapid global dissemination of infectious diseases, and imperatives for accessible, cost-effective care, a pressing need emerges for the contemporisation of nursing education. Notably, there is a paucity of research delving into nurses’ introspective evaluations of their educational experiences after their immersion in professional settings. ObjectiveThis study aimed to examine nurses’ evaluations of their educational background over 30 years and identify relationships between their assessments and their demographic. DesignThe study embraced a recurrent cross-sectional survey methodology, encompassing three distinct quantitative cross-sectional evaluations conducted in the years 1999, 2009, and 2021. Context/participantsThe cohort for this inquiry consisted of nurses stationed in Estonian general hospitals and inpatient departments of developmental plan institutions, each with at least one year of professional experience. Cumulatively, 832 nurses were engaged across three sequential evaluations: Study I (n = 463), Study II (n = 198), and Study III (n = 171). MethodsData procurement was executed via a structured survey, with subsequent analytical procedures encompassing descriptive and correlational methodologies. ResultsA discernible augmentation in the educational calibre of nurses was observed with each successive evaluation. This escalation concomitated enhanced positive assessments in areas like evidence-informed education, skill development, and autonomous operational capabilities. Yet, a critical appraisal persisted concerning their competencies in navigating complex patient interactions and addressing socio-religious dilemmas. ConclusionsThe merit of this investigation lies in its illumination of nursing education's evolution, as perceived retrospectively by nurses who have operationalized their academic learnings in real-world scenarios. Their vantage point, inherently informed by practice, uniquely positions them to earmark avenues of refinement. This exploration paves the way for enrichments in nursing education, spotlighting the imperative of equipping nurses to adeptly manage intricate situations.

Staged operation in the surgical treatment of granulomatous lobular mastitis.

Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast condition characterized by an unclear etiology and an undefined therapeutic approach. Surgical intervention is considered an alternative modality for managing GLM. Staged operation is the predominant and characteristic surgical approach in the treatment of GLM in our center; therefore, we evaluated the efficacy of staged operative techniques in this cohort study. We retrospectively reviewed 212 patients with GLM who underwent staged operation between August 2020 and July 2022 in the inpatient department of our institute. Their clinical history information, clinic complaints, treatment details, surgical outcomes, follow-up results, and scores on the satisfaction questionnaire were analyzed. The patients were called for follow-up and consultation with a deadline of August 2023. The median follow-up time was 27 months (range, 14-37 months). In total, 212 patients were treated with three different staged procedures according to the individual assessment and patient willingness, including 168 patients who underwent one-stage debridement operation and two-stage suture operation (DO + SO), 25 patients who underwent one-stage debridement operation without suture (DO), and 19 patients who underwent one-stage debridement and simultaneous suture operation (DSO). The median recovery time was 29 days (range, 14-60 days). A minority of patients developed postoperative complications, including effusion (1.89%), flap ischemia (0.94%), areola-nipple ischemia (0.94%) and sinus tract formation (2.36%). The scores of the satisfaction questionnaire were 43.10±3.09, and 186 patients (87.74%) gave high scores for postoperative breast appearance. Only 5 of 212 patients (2.36%) developed recurrence. Staged operation performed in our institute is an effective and safe surgical therapy in patients with GLM, yielding a short recovery time, low recurrence and good cosmetic results.