Units In General Hospitals Research Articles

Determinants of neonatal jaundice among neonates admitted to neonatal intensive care unit in public hospitals of Sidama Region, Sidama, Ethiopia, 2022: an unmatched case-control study.

neonatal jaundice appears in most neonates as "physiological jaundice" in the first few weeks of life; however, pathological jaundice is associated with an increased risk of long-term complications and mortality only a few studies have been conducted on the determinants of neonatal jaundice in Ethiopia. The aim of this study was to identify the determinants of neonatal jaundice (pathological) among neonates admitted to neonatal intensive care units in Sidama Region general and referral public hospitals. a hospital-based unmatched case-control study was conducted among 270 neonates in public hospitals of Sidama Region from June 23 to August 8, 2022. We used a pre-tested interviewer-administered questionnaire and collected by open data kit (ODK) then the data was downloaded and exported to Microsoft Excel worksheets (XLS) and imported to SPSS version 26 for further analysis. Bi-variable logistic regression analysis was performed. Variables with a P-Value of less than 0.25 were included in multivariable logistic regression. Multi-variable logistic regression was performed and Adjusted Odds ratio (AOR) with a 95% confidence interval was computed and statistical significance was declared at a p-value <0.05. a total of 270 neonates with mothers (90 cases and 180 controls) with a response rate of 100% were included in this study. Factors significantly increased the odds of developing neonatal jaundice were multiparty (AOR=2.869(95%CI 1.426-5.769)), prolonged duration of labor (AOR=4.618(95%CI 1.689 - 12.625)). ABO incompatibility (AOR=3.362(95%CI, 1.185 - 9.537)). Preterm (AOR=2.936(95%CI, 1.2456.923)), birthasphyxia (AOR=2.278(95%CI,1.1454.531)) and polycythemia (AOR=3.397(95%CI, 1.147-10.061)). in this study multiparty, prolonged duration labor, ABO incompatibility, preterm gestational age, birth asphyxia, and polycythemia were factors that significantly increased the odds of developing neonatal jaundice.

Neonatal Jaundice: Its Determinants Among Neonates Admitted to Neonatal Intensive Care Units of Tigray Region General Hospitals, Northern Ethiopia.

Background. Despite the significant public health impact of neonatal jaundice on neonatal survival, local epidemiologic data are scarce. Methods. A multi-centered, unmatched case-control study was conducted among 180 consecutively admitted neonates (60 cases and 120 controls). The independent determinants of newborn jaundice were determined using a multivariable binary logistic regression model, and a P-value of <0.05 was used to indicate statistical significance. Results. Maternal medical complications during the index pregnancy (AOR = 2.45; 95% CI 1.01-5.97), rural residence (AOR = 3.1; 95% CI 1.02-9.42), being a low birthweight neonate (AOR = 3.42; 95% CI 1.12-10.41), neonatal B blood group (AOR = 10.19; 95% CI 2.89-35.9), neonatal O blood group (AOR = 2.99; 95% CI 1.04-8.59), and a longer duration of hospital stay (AOR = 9.83; 95% CI 3.11-31.02) were the independent determinants of neonatal jaundice. Conclusions. Early assessment of high-risk neonates might reduce the long-term neurodevelopmental consequences.

A Cross-Sectional Study on Behavioral Manifestation in Alzheimer’s Disease Patients and their Association with Cognitive Impairment

Background and Aim: Dementia psychological and behavioral symptoms are significantly associated to Alzheimer’s disease (AD). Clinical profile and characterization of Alzheimer’s disease patients might assist in evolution, diagnosis, and better treatment of the disease. The present study aimed to evaluate the behavioral manifestation of Alzheimer’s disease patients. Methodology: This multi-centered cross-sectional study was carried out on 96 Alzheimer’s disease patients in the department of Psychiatry Lahore General Hospital and Psychiatry unit, Khyber Teaching Hospital Peshawar, Pakistan for duration of six months from 1st July 2021 to 30th December 2021. Alzheimer’s disease patients with lower and higher Behavioural and psychological symptoms of dementia (BPSD) scores (≤25 and 26-50 respectively) were enrolled. The patient’s demographic details and clinical information were gathered. Mini-Mental State Examination (MMSE) was used for the evaluation of dementia severity whereas severity varies from mild 27-21 to severe ≤10. Demographic details, AD pharmacological treatments, psychotic breaks presence, AD diagnosis, treatment of concomitant diseases, and extrapyramidal symptoms such as hypokinesia, fluctuating cognition, tremors, etc. were secondary outcomes. Results: Of the total 96 AD patients, 44 (45.8%) had higher and 52 (54.2%) had lower BPSD scores. About 62 (64.6%) were women and 34 (35.4%) were male patients. The overall mean age was 79.6±8.4 years. The majority of the patients had a BPSD score at inclusion and the incidence of psychotic out breaks was reported in 19 (19.8%) patients. The prevalence of symptoms such as depression, delusions, lack of concentration, lack of cooperation, and tremors was 41 (42.5%), 33 (34%), 52 (54.6%), 34 (35.9%), and 52 (54.6%) respectively. Psychotic symptoms such as hallucinations, delusions, and delirium were significantly prevalent in patients with high BPSD scores whereas Apathy and tearfulness-like emotional symptoms were predominated in lower BPSD patients. ADAS-non cognitive score and MMSE were adversely related (p=0.0314), signifying BPSD and cognitive impairment correlation. Appetite changes and lack of concentration were prominently associated with MMSE (p=0.035 and 0.052). Conclusion: Our study found a higher prevalence of non-cognitive symptoms in Alzheimer’s disease patients. Also, BPSD and cognitive impairment are significantly associated with AD. ADAS-non cognitive is a useful assessment tool. Keywords: Behavioral Manifestation, Alzheimer’s disease, Cognitive Impairment

Prevalence, clinical features and prescription patterns of psychotropic medications for patients with psychotic depression in China

ObjectiveTo investigate the prevalence of psychotic depression and the differences in sociodemographic and clinical characteristics and prescription patterns of psychotropic medications between patients with psychotic depression (PD) and patients with nonpsychotic depression (NPD) in China. MethodsWe conducted a cross-sectional study in 13 major psychiatric hospitals or the psychiatric units of general hospitals in China from September 1, 2010, to February 28, 2011. PD was defined according to the psychotic disorder section of the Mini International Neuropsychiatric Interview (MINI). The sociodemographic and clinical characteristics and the prescription patterns of psychotropic medications were compared between the PD and NPD groups. Multivariate logistic regression analysis was used to investigate factors associated with an increased likelihood of PD. ResultsAmong 1172 MDD patients, the prevalence of psychotic features was 9.2% in the present study. The logistic regression analysis indicated that unmarried (OR = 2.08, p < 0.001), frequent depressive episodes (OR = 2.10, p = 0.020), depressive episodes with suicidal ideation and attempts (OR = 1.91, p = 0.004), and patients who were prescribed any antipsychotics (OR = 2.94, p < 0.001) were associated with psychotic features in patients with MDD. LimitationsCross-sectional design, retrospective recall of some data ConclusionThe prevalence of PD is high in China, and there were some differences in demographic and clinical characteristics between patients with PD and patients with NPD. Clinicians should regularly assess psychotic symptoms and consider intensive treatment and close monitoring when treating subjects with PD.

A national study of antibiotic use in Greek pediatric hematology oncology and bone marrow transplant units.

We surveyed antimicrobials used in Greek pediatric hematology-oncology (PHO) and bone marrow transplant (BMT) units before and after an intervention involving education regarding the 2017 clinical practice guidelines (CPG) for the management of febrile neutropenia in children with cancer and hematopoietic stem-cell transplant recipients. Antibiotic prescribing practices were prospectively recorded between June 2016 and November 2017. In December 2017, baseline data feedback was provided, and CPG education was provided. Prescribing practices were followed for one more year. For antibiotic stewardship, days of therapy, and length of therapy were calculated. Five of the 6 PHO units in Greece and the single pediatric BMT unit participated. Admitted children in each unit who received the first 15 new antibiotic courses each month. Administration of ≥4 antibiotics simultaneously and administration of antibiotics with overlapping activity for ≥2 days were significantly more common in PHO units in general hospitals compared to children's hospitals. Use of at least 1 antifungal was recorded in ∼47% of the patients before and after the intervention. De-escalation and/or discontinuation of antibiotics on day 6 of initial treatment increased significantly from 43% to 53.5% (P = .032). Although the number of patients requiring intensive care support for sepsis did not change, a significant drop was noted in all-cause mortality (P = .008). We recorded the antibiotic prescribing practices in Greek PHO and BMT units, we achieved improved prescribing with a simple intervention, and we identified areas in need of improvement.

Measuring Seclusion in Psychiatric Intensive Care: Development and Measurement Properties of the Clinical Seclusion Checklist.

Background: Acute psychiatric units in general hospitals must ensure that acutely disturbed patients do not harm themselves or others, and simultaneously provide care and treatment and help patients regain control of their behavior. This led to the development of strategies for the seclusion of a patient in this state within a particular area separated from other patients in the ward. While versions of this practice have been used in different countries and settings, a systematic framework for describing the various parameters and types of seclusion interventions has not been available. The aims of the project were to develop and test a valid and reliable checklist for characterizing seclusion in inpatient psychiatric care.Methods: Development and testing of the checklist were accomplished in five stages. Staff in psychiatric units completed detailed descriptions of seclusion episodes. Elements of seclusion were identified by thematic analysis of this material, and consensus regarding these elements was achieved through a Delphi process comprising two rounds. Good content validity was ensured through the sample of seclusion episodes and the representative participants in the Delphi process. The first draft of the checklist was revised based on testing by clinicians assessing seclusion episodes. The revised checklist with six reasons for and 10 elements of seclusion was tested with different response scales, and acceptable interrater reliability was achieved.Results: The Clinical Seclusion Checklist is a brief and feasible tool measuring six reasons for seclusion, 10 elements of seclusion, and four contextual factors. It was developed through a transparent process and exhibited good content validity and acceptable interrater reliability.Conclusion: The checklist is a step toward achieving valid and clinically relevant measurements of seclusion. Its use in psychiatric units may contribute to quality assurance, more reliable statistics and comparisons across sites and periods, improved research on patients' experiences of seclusion and its effects, reduction of negative consequences of seclusion, and improvement of psychiatric intensive care.

Impact of charge nurses' span of control on the work attitudes of nurses

To determine the number of nurses who are supervised by a charge nurse in the Nursing Units of Aragonese general public hospitals and to analyze how this affects the organizational behaviors of nurses and the quality of the relationships established with the charge nurses. Cross-sectional study carried out in nine public hospitals. Validated questionnaires were used to assess the working behavior of nurses and the quality of their relationships with charge nurses, and the charge nurse's relationship with their immediate superior and nursing staff. We analyzed whether there was an association between these variables and the number of nurses per unit. The study included 2,541 nurses and 192 supervisors. The mean span of control was 29 (SD=22.4). Statistically significant differences were observed with respect to empowerment (p<0.001), satisfaction (p=0.027), perceived organizational support (p<0.001) and the quality of the nurse's relationships with the supervisor (p<0.001) and the supervisor with her immediate superior (p<0.001), obtaining lower scores as the span of control increased. No significant associations were observed with respect to turnover intention, organizational citizenship behavior and organizational commitment. The span of control is related to the perception of nurses' organizational behaviors and with the quality of interpersonal relationships with the charge nurse, indicating a need to adjust the span of of control per unit in order to improve the quality of the management of the units.

Moderating Effect of Nurse's Character on the Relationship between Attitudes toward Nursing Care of the Dying and Performance of Terminal Care in South Korea.

This study aimed to investigate the moderating effect of nurses’ characteristics on the relationship between attitudes toward nursing care and terminal care performance of hospice nurses. The participants included nurses working in hospice care units in general hospitals in South Korea. Data collected from August 1 to 31, 2020 were analyzed using t-test, ANOVA, Pearson′s correlation coefficients, and hierarchical multiple regression. The performance of terminal care was positively correlated with attitudes toward nursing care of the dying (r = 0.45, p < 0.001) and nurses’ characteristics (r = 0.60, p < 0.001). There was also a positive correlation (r = 0.58, p < 0.001) between attitudes toward nursing care for dying patients and nurses′ characteristics. Nurses’ characteristics had a significant moderating effect on the relationship between attitudes toward nursing care of the dying and performance of terminal care. This means that the nurses’ character had a buffering effect on the relationship between attitudes toward nursing care of the dying and performance of terminal care in hospice care units. These findings suggest that continuous and repetitive educational programs on terminal care need to be enhanced, and strategies to strengthen attitudes toward nursing care of the dying and nurses’ character need to be included in these programs.

"Patient Comfort Can Be Sacrificed for Patient Safety"-Perception and Practice Reported by Critical Care Nurses Toward Physical Restraints: A Qualitative Descriptive Study.

Aim: The aim of the study was to explore the perception and practice of physical restraints used by critical care nurses.Design: A qualitative descriptive design was used.Method: From December 2019 to May 2020, a one-to-one, semi-structured in-depth interview with 10 critical care nurses from two intensive care units in a tertiary general hospital with 3,200 beds in China was conducted using the method of purposeful sampling. The data were analyzed using inductive thematic analysis.Findings: The perception of physical restraints among critical care nurses was that patient comfort can be sacrificed for patient safety. Physical restraints protected patient safety by preventing patients from unplanned extubation but influenced patient comfort. Physical restraints were common practice of critical care nurses. Relative physical restraints provided patients with more freedom of movement and rationalization of physical restraints which were the practical strategies.Conclusion: The study identified problems in critical care nurses' perception and practice on physical restraints. Critical care nurses are confident that physical restraints can protect patient safety, and the influence of physical restraints on patient comfort is just like the side effect. Although physical restraints were common practice, critical care nurses still faced dilemmas in the implementation of physical restraints. Relative physical restraints and rationalization of physical restraints help critical care nurses cope with the “bad feelings,” which may also be the cause of unplanned extubation. It is necessary for the adaptation of clinical practice guidelines about physical restraints for critically ill patients in the Chinese context, to change the perception and practice of critical care nurses and deliver safe and high-quality patient care.

Commonly diagnosed mental disorders in a general hospital system

BackgroundConsidering many patients receive care from general hospitals, these healthcare institutions are uniquely situated to address mental and physical health needs. Little is documented, however, on the common current mental disorders diagnosed in patients receiving care in general hospital settings, especially in Puerto Rico. The objective of this study was to characterize the five most common current DSM-5 mental disorder diagnoses made in patients receiving non-psychiatric medical and surgical care from a general hospital system in southern Puerto Rico between January 2015 and December 2019.MethodsOur clinical health psychology team provides integrated psychology consultation-liaison services to select clinical units in general hospitals across the southwestern region of Puerto Rico. The clinical team conducted routine standardized psychological evaluations at patients' bedside, arrived at a current DSM-5 diagnosis if warranted, and documented the diagnosis and other select variables. A retrospective study of cross-sectional data generated from the clinical team’s standardized evaluations of 5494 medical patients was implemented. Multinomial logistic regression analyses were used to assess the odds of being diagnosed with a current DSM-5 mental disorder during hospitalization.ResultsOverall, 53% of the entire sample was diagnosed with a mental disorder during hospitalization. Major depressive, neurocognitive, anxiety, substance-related and schizophrenia-spectrum disorders were the most frequently diagnosed. Interestingly, females were 23% less likely to have been diagnosed with major depressive disorder than males (aOR: 0.769, CI [0.650, 0.909], p = 0.002). This is to say males evidenced 1.30 higher odds of being diagnosed with depression compared to their female counterpart. Age, biological sex, civil status, employment status, monthly household income, previous mental disorder and history substance use/abuse history was differentially associated with receiving a current DSM-5 disorder.ConclusionThe integration of clinical health psychology services within a general hospital facilitated our team’s work of identifying and treating co-occurring mental disorders among hospitalized patients receiving medical and surgical care. Future studies examining the opportunities and barriers of integrating clinical health psychology services within a general hospital’s administrative and clinical infrastructure for rapid identification and treatment of co-occurring mental disorders among medical patients is encouraged.

Integrated Pharmaceutical Logistics System Implementation in Chagni Primary Hospital and Injibara General Hospital, Awi Zone, Ethiopia.

BackgroundIntegrated Pharmaceutical Logistics System is the primary mechanism through which all public health facilities in Ethiopia get essential pharmaceutical products from their main supplier. Pharmaceuticals should be managed appropriately because they are part of the link between the patient and health services and account for up to half of the healthcare budget. This study aimed to assess the status of Integrated Pharmaceutical Logistics System implementation at both Chagni Primary Hospital and Injibara General Hospital.MethodsFacility-based descriptive study design supported with a qualitative study design was used. Face-to-face interviews, observation of practices, and document review were conducted to gather quantitative data. Besides, the qualitative data were collected through in-depth face-to-face interviews. Frequency and percentage were computed, and the results were briefly described in text and displayed in tables and graphs. The qualitative data were transcribed manually, and thematic analysis was done.ResultsAll IPLS materials were available in both hospitals, but the stock recording card was not available at Injibara General Hospital. About 90% and 100% of the dispensing units in Chagni Primary Hospital and Injibara general hospital were utilizing bin-cards, respectively. Besides, 50% and 80% of the bin-cards in Chagrin Primary Hospital and Injibara General Hospital were regularly updated, respectively. About 80% and 75% of the IFRRs in Chagni Primary Hospital and Injibara General Hospital reported valid data, respectively. Besides, 66.67% and 50% of the RRFs reviewed at Chagni Primary Hospital and Injibara General Hospital reported valid data, respectively. Medicine stockouts, poor staff commitment, and workload were the major bottlenecks for IPLS execution.ConclusionThe status of most of the IPLS implementation indicators in both hospitals was good. Especially, the availabilities of IPLS materials and the calculation accuracy of both RRFs and IFRRs were encouraging in both hospitals. However, the validity of the data reported in IFRRs and RRFs, and the status of the storage conditions in both hospitals need some improvement during the implementations of IPLS.

Effect of Community Health Workers on 30-Day Hospital Readmissions in an Accountable Care Organization Population

Value-based care within accountable care organizations (ACOs) has magnified the importance of reducing preventable hospital readmissions. Community health worker (CHW) interventions may address patients' unmet psychosocial and clinical care needs but have been underused in inpatient and postdischarge care. To determine if pairing hospitalized patients with ACO insurance with CHWs would reduce 30-day readmission rates. This randomized clinical trial was conducted in 6 general medicine hospital units within 1 academic medical center in Boston, Massachusetts. Participants included adults hospitalized from April 1, 2017, through March 31, 2019, who had ACO insurance and were at risk for 30-day readmission based on a hospital readmission algorithm. The main inclusion criterion was frequency of prior nonelective hospitalizations (≥2 in the past 3 months or ≥3 in the 12 months prior to enrollment). Data were analyzed from February 1, 2018, through March 3, 2021. CHWs met with intervention participants prior to discharge and maintained contact for 30 days postdischarge to assist participants with clinical access and social resources via telephone calls, text messages, and field visits. CHWs additionally provided psychosocial support and health coaching, using motivational interviewing, goal-setting, and other behavioral strategies. The control group received usual care, which included routine care from primary care clinics and any outpatient referrals made by hospital case management or social work at the time of discharge. The primary outcome was 30-day hospital readmissions. Secondary outcomes included 30-day missed primary care physician or specialty appointments. A total of 573 participants were enrolled, and 550 participants (mean [SD] age, 70.1 [15.7] years; 266 [48.4%] women) were included in analysis, with 277 participants randomized to the intervention group and 273 participants randomized to the control group. At baseline, participants had a mean (SD) of 3 (0.8) hospitalizations in the prior 12 months. There were 432 participants (78.5%) discharged home and 127 participants (23.1%) discharged to a short rehabilitation stay prior to returning home. Compared with participants in the control group, participants in the intervention group were less likely to be readmitted within 30 days (odds ratio [OR], 0.44; 95% CI, 0.28-0.90) and to miss clinic appointments within 30 days (OR, 0.56; 95% CI, 0.38-0.81). A post hoc subgroup analysis showed that compared with control participants, intervention participants discharged to rehabilitation had a reduction in readmissions (OR, 0.09; 95% CI, 0.03-0.31), but there was no significant reduction for those discharged home (OR, 0.68; 95% CI, 0.41-1.12). This randomized clinical trial found that pairing ACO-insured inpatient adults with CHWs reduced readmissions and missed outpatient visits 30 days postdischarge. The effect was significant for those discharged to short-term rehabilitation but not for those discharged home. ClinicalTrials.gov Identifier: NCT03085264.

Is unipolar mania a distinct entity: findings from the bipolar disorder course and outcome study from India (BiD-CoIN study)

Aim This study aimed to evaluate the prevalence of unipolar mania (UM) in a group of patients of bipolar disorder (BD). Additionally, effort was made to evaluate the demographic, clinical and treatment related factors, which distinguish subjects of UM from BD. Methodology Seven hundred and seventy-three patients with BD, of at least 10 years duration, recruited from 14 General Hospital Units of tertiary care centers from India were evaluated for UM. Results The prevalence of UM, varied from 5.4% to 20.3%, depending on the definition used. With the most stringent definition of ≥4 episodes of mania and at least 5 years of follow-up, the prevalence of UM was 5.4%. Compared to patients of BD, who have episodes other than mania too, those with UM had lower proportion of patients with lifetime history of suicide attempts, spent less time in the episodes in their lifetime and had lower severity of residual depressive and manic symptoms. Further, compared to those with episodes other than mania too, those with UM had higher number of manic episodes per year of illness, had higher proportion of patients who had more than five episodes in the lifetime and had higher proportion of those with at least one episode with psychotic symptoms in the lifetime. Conclusion The present study suggests that a small proportion of patients with BD have UM course and this runs a different clinical course compared to that seen in patients with traditionally recognized as BD.

Psychiatric Co-Morbidities of Suicide Attempters: A Cross Sectional Observation in a Tertiary Care Hospital of North India

Background: Psychiatric disorders are at increased risk for suicide. Attempted suicide is a common clinical problem in a general hospital. It has a serious clinical and socio-economical impact too. Aims: This study was carried out to assess the prevalence of psychiatric co-morbidities of suicide attempters attending the emergency. Material and methods: This study was a cross sectional, observational study which was conducted at the Community General Hospital Unit, Institute of Mental Health and Neurosciences-Kashmir an associated hospital of Government Medical College Srinagar among the suicide patients attending the outpatient service and inpatient services of the hospital fulfilling inclusion and exclusion criteria over a period of one and a half year, from November 2017 to May 2019. Written informed consent was obtained in a simple and easily understandable unambiguous language. For the diagnosis of psychiatric comorbidity, we used MINI International Neuropsychiatric Interview Schedule Plus (MINI PLUS). A p-value of &lt;0.05 was taken as statistically significant. Results: A total of 221 cases who had been admitted following unsuccessful suicide attempts to the emergency and psychiatry department were taken up for the study. They were evaluated in detail with regards to past attempt of suicide, family history of psychiatric illness or suicide and the presence of psychiatric co-morbidity and the results have been presented below in tabulated and graphical forms. 77.4% of the attempters had no history of psychiatric illness in their family while 22.6% of patients did have family history of a psychiatric illness. 98.2% of attempters had no family history of suicide while 1.8% of the patients gave a family history of suicide. 21.26% males and 54.75% females had associated psychiatric co-morbidities and 23.9% had no associated psychiatric co-morbidities. Conclusion: The most common psychiatric morbidity associated with suicide was found to be major depressive disorder. Most importantly, the suicide attempters should be looked with sympathy rather than with a grimace on face. Such people should not be stigmatized and we should not let their shoulders drop. Keywords: Depression, Bipolar Disorder, Morbidity, Suicide.

Effect of Body Position on Oxygenation and Hemodynamic Status among Patients with Traumatic Brain Injury

Context: Positioning is one of the most frequently performed nursing activities in the critical care unit. It is often providing a central pivotal focus for planning other nursing activities. Therapeutic positioning of the patient's head, different degrees of the head of the bed elevation has been suggested as a low-cost and simple approach to preventing secondary brain injury.&#x0D; Aim: determine the effect of body position on oxygenation and hemodynamic status among patients with traumatic brain injury.&#x0D; Methods: Quasi-experiments (single group pre/posttest design). The study was conducted in the Critical Care Units in El-Mansoura general hospital at El-Mansoura city. A purposive sample of (67) adult patients diagnosed with traumatic brain injuries was recruited in this study. A structured socio-demographic interview questionnaire, patients’ medical records to elicit clinical variables and record cardiorespiratory assessment findings, Glasgow Coma Scale, and Richmond Agitation Sedation Scale were used to either include or exclude the patient according to the study criteria.&#x0D; Results: There was a significant increase in oxygen saturation in post right lateral position from (94.93 ± 1.25 to 95.37 ± 1.17) and the semi fowler position from (95.37 ± 1.17 to 97.31 ± 11.13) compared to pre-positioning. The hemodynamic parameters (heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure) were significantly decreased in the post-semi-fowler position and then right lateral position compared to pre. Besides, the CVP is significantly increased in the semi-fowler position.&#x0D; Conclusion: Oxygen saturation and all hemodynamic parameters were significantly improved compared to their normal range in post-semi-fowler position, then right lateral position. Develop nursing practice protocol for critical care nurses to position patients at the semi-fowler position after traumatic brain injury can improve oxygenation and hemodynamic parameters. Moreover, further studies should be carried out to assess the effect of other body positions in other medical conditions.

The first national action plan on depression in China: Progress and challenges

The first national action plan on depression in China: Progress and challenges

Evaluation of using agar combined with phototherapy in management of neonatal unconjugated hyperbilirubinemia

Background:Neonatal hyperbilirubinemia is a common problem in neonates.Phototherapy is an efficient way to decrease the accumulation of bilirubin, although it involves hospitalization, and can force the baby to stop eating due to the breast separation. In certain cases of infant jaundice, the hepatic circulation of bilirubin plays a major role Objectives: The purpose of the study was todetermine the value of oral agar ingestion combined with phototherapy in management of neonatal unconjugated hyperbilirubinemia and to compare it with the use of phototherapy alone in the management. Patients and methods: This was a randomized controlled study conducted at Neonatal intensive care units in Qena university hospital and Qena general hospital. They were divided into: Case group (neonates received oral agar with phototherapy).Control group (neonates received phototherapy alone). The duration of this study was 6 months. Results: The study included 517 neonates,314 neonates (60.74%) treated withphototherapy alone and 203 neonates (39.26%) treated withphototherapy combined with agar .There was a significant decrease in total serum bilirubin (TSB) in both subgroups, but the decrease was more significant in term male babies andin group that received agar with phototherapy than the group received phototherapy alone. Conclusion: Our results show that the administration of oral agar in full-term neonates was safe to decrease total serum bilirubin (TSB) concentrations and to shorten the length of phototherapy in hyperbilirubinemic neonates. As a supplementary treatment for neonates with hyperbilirubinemia, our results indicated that agar may benefit in minimizing the length of hospitalization.

A journey through psychiatry - A personal perspective.

A journey through psychiatry - A personal perspective.

Inpatient Treatment for Anorexia Nervosa in Psychiatry Units of General Hospitals

Inpatient Treatment for Anorexia Nervosa in Psychiatry Units of General Hospitals

Hubungan Karakteristik Individu dan Riwayat Stroke dengan Kekuatan Otot Pada Pasien Stroke

Stroke merupakan penyebab ketiga tertinggi kematian di dunia. Kecacatan dan kelumpuhan jangka panjang menjadi beban bagi penderita stroke yang hidup. Kecacatan diakibatkan oleh kelemahan otot dan syaraf ekstremitas atas dan bawah. Penelitian ini bertujuan untuk mengidentifikasi hubungan karakteristik individu dan riwayat stroke pertama dengan kekuatan otot pasien stroke di unit rawat jalan dan inap, rumah sakit pemerintah di Kalimantan Barat. Penelitian ini menggunakan pendekatan analisis deksriptif cross-sectional dengan kuesioner dan Manual Muscle Testing (MMT). Total sampel pada penelitian ini sebanyak 99 responden. Penelitian ini dilakukan pada bulan April hingga Juni tahun 2018. Hasil uji statistik menunjukkan terdapat hubungan yang signifikan antara umur ( p =0,026), jenis kelamin ( p =0,029), dan riwayat stroke ( p =0,036) dengan kekuatan otot. Kekuatan otot dapat ditingkatkan dengan latihan penguatan yang dilakukan secara konsisten dan berulang. Latihan ini juga harus disesuaikan dengan usia, jenis kelamin, dan keadaan atropi otot yang dialami pasien sebelumnya untuk mencegah kecacatan jangka panjang.