Hospitalists Research Articles

Is there a relationship between nurses' hand hygiene beliefs, practices and ethical sensitivity?

BackgroundHand hygiene is the most important way to prevent health care-associated infections. It is important for all nurses that come in physical contact with patients the most to follow hand hygiene rules. AimThis study aimed to determine the relationship between nurses' hand hygiene beliefs and practices and their ethical sensitivity. MethodThis descriptive and cross-sectional study was conducted with nurses working in internal medicine, surgery and intensive care clinics of a university hospital between June and August 2022. A total of 350 nurses participated in the study. A Personal Information Form, the Ethical Sensitivity Questionnaire (ESQ), the Hand Hygiene Practice Inventory (HHPI), and the Hand Hygiene Beliefs Scale (HHBS) were used for data collection. ResultsFindings support that nurses have moderate ethical sensitivity (88.36 ± 26.33), good hand hygiene beliefs (85.60 ± 9.21) and practice (66.14 ± 5.90). Despite there being no statistical significance in evaluating the relationship between hand hygiene practice and ethical sensitivity (p = 0.253, r = −0.061), there was a statically significant inverse relationship between hand hygiene beliefs and ethical sensitivity (p = 0.001, r = −0.172). The hand hygiene compliance score of the nurses who received only ethics training after nursing school (p = 0.000); the hand hygiene belief (p = 0.011) and hand hygiene practice (p = 0.007) scores of those who received both ethics and hand hygiene training were higher. ConclusionsIt can be said that the ethical sensitivity of nurses does not affect their hand hygiene practices, and the hand hygiene and ethics education they receive after school education increases their hand hygiene beliefs and practices.

Through the Looking Glass: Comparing Hospitalists' and Internal Medicine Residents' Perceptions of Feedback.

Feedback is critical for resident growth and is most effective when the relationship between residents and attendings is collaborative, with shared expectations for the purpose, timing, and manner of communication for feedback. Within internal medicine, there is limited work exploring the resident and hospitalist perspectives on whether key elements are included in feedback sessions. We surveyed internal medicine residents and supervising hospitalists at a large urban training program about their perspectives on four components of effective feedback: specificity,timeliness, respectful communication, and actionability. We received surveys from 130/184 internal medicine residents and 74/129 hospitalists (71% and 57% response rate, respectively). Residents and hospitalists differed in their perspectives about specificity and timeliness: 54% (70/129) of residents reported they did not receive specific feedback while 90% (65/72) of hospitalists reported they delivered specific feedback (p<0.01), and 33% (43/129) of residents compared with 82% (59/72) of hospitalists perceived feedback as timely (p<0.01). Internal medicine residents and hospitalists reported concordant rates of feedback sessions consisting of a two-way conversation (84%, 109/129; 89%, 64/72, respectively, p=0.82) and that communication was delivered in a respectful manner (95%, 122/129; 97%, 70/72, respectively, p=0.57). We observed discordance between internal medicine residents and supervising hospitalist perspectives on the inclusion of two critical components of feedback: specificity and timing. The hospitalist cohort reported delivering more components of effective feedback than the resident cohort reported receiving. The etiology of this discordance is likely multifactorial and requires further investigation.

Screening and assessment of nutritional status and some related factors in patients who have laparoscopic surgery for colon cancer

Background: Preoperative malnutrition is a significant problem for cancer and colon cancer patients, so screening, monitoring, and supporting this condition becomes increasingly essential in the surgical field. In colorectal cancer, malnutrition is significantly associated with several consequences, including mortality and increasing the length of hospital stay after surgery. The NRS 2002 and SGA scores are practical malnutrition assessment tools widely used in clinical practice today. Materials and methods: A cross-sectional descriptive study was performed on 53 patients undergoing laparoscopic surgery due to colon cancer at Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital. The NRS-2002 tool was used for risk screening, and the SGA was used to assess the patient’s nutritional status. Information about the disease and related factors are referenced from medical records combined with asking the patient. Results: The average age was 61.5±14.5, of which 50.9% were male. ASA 1 accounted for the majority at 66.0%. Complications of surgical site infection accounted for 11.3%. Two patients with subcutaneous emphysema accounted for 3.8%, and one with urinary retention accounted for 1.9% were treated with conservative treatment. One patient had early postoperative small bowel obstruction due to abdominal drainage and was successfully treated medically, accounting for 1.9%. There were no major complications requiring reoperation and short-term mortality. The average hospital stay was 7.4 ± 2.1 days. According to the 2002 NRS score, there were 19 (35.8%) cases of nutritional at-risk; the SGA rating had 1.9% SGA-C and 15.1% SGA-B cases. There was a relationship between NRS-2002 and the patient’s blood albumin concentration. Conclusion: The prevalence of patients at nutritional risk and malnutrition is quite common. It is necessary to carry out routine screening and nutritional risk assessment to support colon cancer treatment. Key words: malnutrition, colorectal cancer, NRS 2002, SGA score.

Studying on correlation between Ki-67 index and histopathological and immunohistochemical characteristics in invasive breast carcinoma

Background: Breast cancer is the most common cancer and the leading cause of cancer death in women. Molecular subtyping of breast cancer is based on the expression of biomarkers such as ER, PR, HER2/neu and Ki-67. Among them, Ki-67 is a biomarker expressing the proliferation level of breast cancer cells, directly related to disease progression, treatment response and prognosis. Our study aims to evaluate the Ki-67 index and its relationship with histopathological and immunohistochemical characteristics in invasive breast carcinoma. Methods: A cross-sectional descriptive study in 101 paraffin-embedded specimens of patients with invasive breast carcinoma who underwent surgery at Hue University of Medicine and Pharmacy Hospital from October 2019 to June 2021. Results: Tumors with Ki-67 index ≥ 14% account for 65.3%. Breast cancer tumors with tumor size ≤ 2 cm occupy for 50.5%. Histological grade II accounts for 53.1%. The most common disease stage is stage II (40.6%). The rate of axillary lymph node metastasis is 48.5%; The ER(+) and PR(+) rates are 64.4% and 47.5%, respectively. Tumors with HER2(+) account for 32.7%. The Luminal B accounts for the highest proportion (39.4%). The Ki-67 index has a statistically significant relationship with disease stage, histological grade, axillary lymph node metastasis, ER, PR, HER2 and molecular subtypes. There is no relationship between Ki 67 and age, tumor size and histopathological type. Conclusion: Tumors with Ki-67 ≥ 14% account for a high proportion (65.3%). The Ki-67 index has a statistically significant relationship with histopathological and immunohistochemical features: stage of disease, histological grade, axillary lymph node metastasis, ER/PR hormone receptors, and other factors. HER2-positive endodermal growth and molecular subtypes. There is no significant relationship between Ki-67 and age, tumor size and histopathological type. Key words: breast carcinoma; Ki-67; histopathology; immunohistochemistry.

Innovative behaviour profile and its associated factors among nurses in China: a cross-sectional study based on latent profile analysis

ObjectivesThis study aimed to investigate the current status of innovative behaviours among nurses in traditional Chinese medicine (TCM) hospitals using latent profile analysis, identify potential subgroups and their population characteristics...

Comparison of the effectiveness of the endodontic treatment using Reciproc Blue instrument with or without glide path preparation

Background: To overcome file fracture due to torsional stress and cyclic fatigue during root canal preparation, the Reciproc Blue endodontic file system with reciprocating motion helps to shape the canal with only one instrument. Objective: To compare the time of root canal shaping and the results of endodontic treatment of first molars with Reciproc Blue files with and without glide path preparation. Materials and Methods: A controlled clinical trial on 78 first molars with irreversible pulpitis in patients visiting Hue University of Medicine and Pharmacy Hospital from July 2020 to October 2022. Group 1 and Group 2 (n = 36 each) were respectively prepared with a Reciproc Blue file with and without a glide path preparation. Comparison of preparation time and treatment outcome based on clinical and radiographic characteristics at 1 week, 3 months, and 6 months. Results: Endodontic treatment using Reciproc Blue file without glide path preparation recorded a shorter time consumption (p &lt; 0.05) and no complications. However, the treatment results after 1 week, 3 months, and 6 months were not different between the two groups regards to glide path preparation (p &gt; 0.05). Conclusion: Shaping root canals with Reciproc Blue without creating a glide path reduces shaping time, simplifies the procedure, and does not adversely affect treatment outcomes compared to the group with glide path creation. Key words: First molar, glide path, Reciproc Blue, root canal preparation.

The study of serum cortisol in patients prescribed glucocorticoid in Hue University of Medicine and Pharmacy Hospital

Background: The adrenal disorders such as adrenal insufficiency and Cushing syndrome may be life-threatening unless patients are diagnosed and treated timely. Taking exogenous glucocorticoid (GC) interfered with the interpretation of the level of serum cortisol in either diagnosis of adrenal insufficiency or evaluation the function of hypothalamic-pituitary-adrenal axis. Objectives: 1) Evaluating the difference between the level of basal serum cortisol before and after taking GC. 2) Evaluating the level of basal serum cortisol in patients who were prescribed physiological dose of GC when withdrawn. Materials and method: This is a cross-sectional study that enrolled patients prescribed GC. It obtained the levels of basal serum cortisol before and after taking GC. In 2nd objective, the level of basal serum cortisol was measured in patients who were diagnosed with GC-induced adrenal insufficiency and prescribed physiological dose of GC when withdrawn temporarily. Results: The values of basal serum cortisol when taking hydrocortisone and prednisolone were higher than before prescribed (p &lt; 0.05). In contrast, the values of basal serum cortisol when taking fluticasone were lower than before prescribed (p &lt; 0.05). Even inhaled fluticasone could affect the level of basal serum cortisol. In GC-induced adrenal insufficiency patients prescribed physiological dose of GC, the group of patients with the values of cortisol when withdrawn &lt; 100 nmol/L accounted for 61.9% while ones with the values 100 - 375 nmol/L accounted for 38.1%. The analysis of ROC curve shows that the duration of physiological-dose-GC prescription could predict the levels of basal serum cortisol when withdrawn and hypothalamic-pituitary-adrenal axis recovery with optimal cut-off of duration is 13 months (Sensitivity: 100%, specificity: 92.3%). Conclusion: Exogenous glucocorticoid could affect the results of basal serum cortisol. The duration of physiologic-dose-GC prescription could predict that hypothalamic-pituitary-adrenal axis recovery in patients with glucocorticoid-induced-adrenal insufficiency could be happened and who could achieve adequate response of Synacthen stimulation test. Key words: cortisol, glucocorticoid, hydrocortisone, methylprednisolone, fluticasone, dexamethasone, cross-reactivity.

Outcomes and factors influencing the second stage of labour in singleton deliveries

Objective: To define the characteristics of the second stage of labour and the outcomes of labour. Study design: The study includes 725 cases of pregnant monitored during the second stage of labour at the Obstetrics Centers of Hue Central Hospital and the Hue University of Medicine and Pharmacy Hospital from January 2022 to August 2023. Inclusion criteria: Singleton pregnancy, cephalic presentation, gestational age between 37 and 41 weeks 6 days, height ≥ 145 cm. Exclusion criteria: Category 2 and 3 cardiotocography (CTG) during the first stage of labour, refusal to participate in the study. Methodology is a cross-sectional descriptive study with a convenient sample size. Results: The average duration of the second stage was 51.73 ± 22.55 minutes. The mean duration for vaginal deliveries was 46.45 ± 16.27 minutes, instrumental deliveries were 48.89 ± 22.65 minutes, and cesarean sections were 59.86 ± 28.75 minutes (p &lt; 0.05). Vaginal deliveries constituted 87.5%, cesarean sections 10.4%, and instrumental deliveries 2.2%. Non-engagement of the fetal head in the second stage was associated with a 19.5 higher risk of instrumental or cesarean delivery compared to engaged presentations (p &lt; 0.05). Occurrence of transverse or posterior positions had a 6.4 higher intervention rate for instrumental or cesarean deliveries than anterior positions (p &lt; 0.05). Less than 3 contractions during the second stage increased the risk of cesarean or instrumental delivery by 5.5 times compared to those with ≥ 3 contractions (p &lt; 0.05). Key words: Second stage of labour, cesarean delivery, instrumental delivery, fetal presentation.

Efficacy of using 810-nm diode laser after impacted lower third molar extraction surgery at Hue University of Medicine and Pharmacy Hospital

Efficacy of using 810-nm diode laser after impacted lower third molar extraction surgery at Hue University of Medicine and Pharmacy Hospital

Survey the frequency of some clinical symptoms and syndromes in according to traditional medicine in patients with urticaria

Background: Urticaria is a common disease, caused by many different causes, and can occur at all ages. Traditional medicine refers to it as “Hives” or “Welts” characterized by intense itching and blurry redness in the skin upon onset. Therefore, in oder to contribute to help doctors orient their examination and treatment of this disease more effectively, we conducted study. Objectives: To survey the frequency of occurrence of some clinical symptoms and syndromes according to traditional medicine in patients with urticaria and learn about some factors related to the clinical types of the disease. Matetials and Method: Including 46 patients who were diagnosed with urticaria and examined at the Dermatology Clinic of Hue University of Medicine and Pharmacy Hospital. Research method: Cross-sectional description. Results: The average age was 32.89 ± 15.82, the age group from 20 to 29 years old accounted for the highest proportion. Most lesions had an average size of &lt; 1.27 cm (52.2%), lasted less than 4 hours (76.1%) and 17.4% of patients has an accompanying angioedema. The wheal can appear anywhere on the body, with 41.3% white, 37.0% red and 21.7% pink. About the tongue: pink tongue substance 52.2%, white tongue moss 65.2%, thin moss 78.3% accounting for the highest proportion. 65.2% of patients had difficulty sleeping or poor sleep due to discomfort caused by urticaria. Regarding the pulse: 82.6% edematous pulses, 43.5% rapid pulses and pretty rapid pulses, 84.8% forceful pulses accounts for the majority. The clinical types according to traditional medicine are: wind-cold type (47.8%), wind-heat type (26.1%), dampness - heat in stomach and intestine type (13.0%), deficiency of qi and blood type (13.0%). Conclusions: The assessment revealed that most of lesions are mild reactions to pathogens. The symptoms show that most patients have righteous qi that has not deteriorated and diseases in the shallow. Urticaria affects sleep quality. The two most common types are wind-cold and wind-heat. There were significant relationships between clinical types and age, tongue color, tongue fur color and pulse frequency (p &lt; 0.05). Key words: urticaria, hives, traditional medicine.

Comparing the characteristics and outcomes of hospitalizations between cancer and non-cancer survivors.

12138 Background: Cancer prevalence is rising, with a corresponding increase in hospitalizations across the cancer continuum. However, little is known about how in-hospital patterns of care and outcomes of cancer survivors compare with non-cancer survivors as administrative data may not capture in-hospital details (e.g., investigations and medications) required for characterization. Understanding differences in how cancer and non-cancer inpatients are managed and their outcomes can help optimize their acute care delivery. Methods: In a multicenter registry of all patients (pts) admitted to medical wards across 26 hospitals (Ontario, Canada) from 2015-2022, we deterministically linked population-level administrative data, including ambulatory oncology data for cancer survivors, with each hospital’s electronic information (pharmacy, orders, notes, laboratory, imaging) at the patient level. Multivariable regression models compared resource use and outcomes between cancer and non-cancer pts for the top 5 discharge diagnoses among non-cancer pts. Results: Of 1,221,067 hospitalizations belonging to 666,569 pts, 30% of medical ward hospitalizations were for pts with a cancer history, with median admission date 4 years post-diagnosis; most common cancer sites were genitourinary (21%), gastrointestinal (20%), breast (12%), lung (10%). Most common discharge diagnoses among cancer pts were heart failure (HF) (5%), palliative care (5%), urinary tract infection (UTI) (2%), pneumonia (2%) renal failure (2%); while for non-cancer pts were HF (5%), myocardial infarction (3%), coronary artery disease (3%), COPD (2%) and UTI (2%). Compared to non-cancer pts, cancer pts were older (72 vs 66), had greater length of stay (LOS; 10 vs 8.7 days), in-hospital mortality (11% vs 6%) and 30 day re-admission rates (16% vs 11%) and were more likely to receive CTs (21% vs 15%), MRIs (9% vs 8%) and interventional procedures (6% vs 4%) (p &lt; 0.001, all comparisons). When evaluating the top 5 discharge diagnoses among non-cancer patients, cancer survivors had higher LOS (aOR=1.06 95% [1.05-1.07] p&lt;0.001), in-hospital mortality (aOR=1.20 [1.14-1.26] p&lt;0.001), and 30 day re-admission rates (aOR=1.24 [1.14-1.35] p&lt;0.001) and were more likely to receive CTs (aOR=1.25 [1.21-1.30] p&lt;0.001), MRIs (aOR=1.36 [1.25-1.48] p&lt;0.001) and interventional procedures (aOR=1.36 [1.25-1.47] p&lt;0.001). Subgroup analyses focusing on cancer survivors admitted 3 and 5 years out from their diagnosis showed resource use and outcomes were closer to non-cancer patients. Conclusions: Cancer survivors represent a unique population on medical wards and have higher resource use, mortality and LOS compared to non-cancer patients, even for the same non-cancer diagnoses. Specialized models of care for hospitalized cancer survivors may be warranted, in particular for those admitted closer to their diagnosis date.

Clinical Outcomes of Orthopedic Surgery Co-Management by Internal Medicine Advanced Practice Clinicians: A Cohort Study

BackgroundComanagement of orthopedic surgery patients by internal medicine hospitalists is associated with improvements in clinical outcomes including complications, length of stay, and cost. Clinical outcomes of orthopedic comanagement performed solely by internal medicine advanced practice clinicians have not been reported. Our objecyive was to compare clinical outcomes between advanced practice clinician-based comanagement and usual orthopedic care. MethodsThis is a retrospective cohort study in patients 18 years or older, hospitalized for orthopedic joint or spine surgery between May 1, 2014 and January 1, 2022. Outcomes assessed were length of stay, intensive care unit (ICU) transfer, return to operating room, in-hospital and 30-day mortality, 30-day readmission, and total direct cost, excluding surgical implants. Generalized boosted regression and propensity score weighting was used to compare clinical outcomes and health care cost between usual care and advanced practice clinician comanagement. ResultsAdvanced practice clinician comanagement was associated with a 5% reduction in mean length of stay (rate ratio = 0.95, P = .009), decreased odds of returning to the operating room (odds ratio [OR] 0.51, P = .002), and a significant reduction in 30-day mortality (OR 0.32, P = .037) compared with usual orthopedic care in a weighted analysis. Need for ICU transfer was higher with advanced practice clinician comanagement (OR 1.54, P = .009), without significant differences in 30-day readmission or in-hospital mortality. ConclusionsWe observed reductions in length of stay, health care costs, return to the operating room, and 30-day mortality with advanced practice clinician comanagement compared with usual orthopedic care. Our findings suggest that advanced practice clinician-based comanagement may represent a safe and cost-effective model for orthopedic comanagement.

Safely Doing Less in Pediatrics and Pediatric Hospital Medicine

Safely Doing Less in Pediatrics and Pediatric Hospital Medicine

Impact of staffing an inpatient oncology consult service with dedicated hospital-based oncologists.

e13538 Background: No standard care model for hospitalized patients with cancer currently exists. The majority of oncology care is provided in the outpatient setting. Consequently, for many oncologists, inpatient care is a secondary responsibility. To address this issue, several U.S. institutions have changed their inpatient oncology models to include dedicated inpatient oncology-trained attendings (hospital-based oncologists). In this study, we investigate outcomes following such a change on an inpatient solid oncology consult service. Methods: This is a single-institution retrospective study of the University of California, San Francisco (UCSF)’s inpatient solid oncology consult service, which switched from a rotating outpatient oncologist attending model to a dedicated inpatient oncologist model in 2018. Since data prior to the switch were not available, we compared all inpatients who received an oncology consult (n=3974) with a comparison group (CG) of all inpatients with a solid tumor diagnosis who did not receive an oncology consult (n=3200) between fiscal years 2018 and 2023. We analyzed trends in case mix index (case complexity), in-hospital mortality index (observed/expected), 30-day unplanned readmission rate, length of stay index, and direct cost index using the Pearson correlation coefficient. In 2022, we conducted an anonymous retrospective pre/post-switch survey of hospitalists who had worked on the hospital medicine service both before and after the switch and compared mean satisfaction with oncology consultation (5-point scale) using Student’s t test. Results: Following the switch, the number of weeks per year covered by dedicated inpatient oncologists increased from seven (2018) to 39 (2023) out of 52. From 2018 to 2023, we found a significant increase in annual consults (495 to 919, r=0.95, p&lt;0.01) and case mix index (2.30 to 3.30, r=0.90, p=0.01; CG 1.60 to 1.70, r=0.60, p=0.20), and a significant decrease in mortality index (1.59 to 0.70, r=-0.98, p&lt;0.01; CG 0.90 to 0.48, r=-0.66, p=0.15). There were non-significant decreases in 30-day unplanned readmission rate (35.8% to 30.5%, r=-0.77, p=0.07), length of stay index (1.45 to 1.32, r=-0.75, p=0.08), and direct cost index (2.2 to 1.8, r=-0.61, p=0.20), similar to the CG. Mean (standard deviation) satisfaction increased from 3.27 (1.22) pre-switch to 4.53 (0.92) post-switch ( p=0.02, response rate 15/51, 29%). Conclusions: Switching to a dedicated inpatient oncologist model on a consult service was associated with decreased in-hospital mortality and increased satisfaction with oncology consultation despite growing case volume and complexity, while readmission rate, length of stay, and cost remained unchanged. This study adds to growing literature supporting dedicated inpatient oncologist attending models of care and is in line with recent literature from other specialties supporting similar inpatient care models.

Study on reliability of the abridged Vietnamese version of the cold and heat pattern identification questionnaire (CHPIQ) on the knee osteoarthritis patient

Background: Cold and Heat are two important principles in the Eight Principles, reflecting the nature of the disease. Objective: Evaluate the reliability of the abridged Vietnamese version of the Cold and heat pattern identification questionnaire (CHPIQ) and survey some characteristics of cold and heat in patients with knee osteoarthritis. Method: A descriptive cross-sectional study on 165 patients diagnosed with knee osteoarthritis who came for treatment at Thua Thien Hue Traditional Medicine Hospital. Result: The Vietnamese version of the Cold and heat pattern identification questionnaire has a Cronbach’s Alpha coefficient of 0.875 (cold pattern) and 0.930 (heat pattern). In patients with knee osteoarthritis, cold pattern was 55.2%, heat pattern was 26.1%, no cold- heat parttern was 26.1% and combined cold and heat pattern was 3.0%. Conclusion: The Vietnamese version of the Cold and heat pattern identification has high reliability assessed through the Cronbach’s Alpha coefficient. The majority of patients with knee osteoarthritis have cold pattern, followed by heat pattern and no cold-heat with equal proportions, with low combined cold and heat pattern. Key words: Reliability, cold and heat, CHPIQ, Vietnamese version, knee osteoarthritis

A prospective cohort study on the improvement of disease-free progression survival in patients with hepatocellular carcinoma by combining Sophora japonica granules with targeted and immune checkpoint inhibitors.

e16187 Background: To evaluate the clinical efficacy of combining Sophora japonica granules with targeted therapy and immune checkpoint inhibitors (ICIs) in patients with unresectable hepatocellular carcinoma (HCC) who had not undergone systemic treatment. Methods: A prospective cohort study design was adopted (ChiCTR2400079626), collecting HCC patients visited the Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from July 1, 2019, to July 1, 2023. All patients received targeted therapy and ICIs treatment. "Whether Sophora japonica granules were combined during treatment" was considered as the exposure factor. Patients who met this exposure factor were included in the exposure group (n = 48), and those who did not meet this factor were included in the non-exposure group (n = 44). The disease-free survival (PFS), six-month PFS rate, and subgroup analysis between two groups. Results: The PFS of the exposure group was 8.9 months (m), and that of the non-exposure group was 5m(P = 0.001 HR = 0.50, 95%CI (0.32~0.78)). The six-month PFS rates were 66.7% compared to 34.1%(P = 0.001). Subgroup analysis showed that in subgroups with hepatitis, cirrhosis, vascular invasion, extrahepatic metastasis, tumor maximum diameter ≥5cm, combined TKI, the exposure group had significantly longer PFS than the non-exposure group (respectively: 9m VS 5m, 10m VS 4m, 13m VS 3m, 8.3m VS 4m, 9m VS 4m, 9m VS 5m),(P &lt; 0.05). In the subgroup with a history of alcohol consumption, the exposure group's PFS was extended by 9 m (14m VS 5m; P = 0.010); in the subgroup with baseline AFP ≥400ng/ml, PFS was extended by 6m (9m VS 3m; P = 0.017), and in the subgroup with baseline AFP &lt; 400ng/ml, PFS was also extended by 2.9m (8.9m VS 6m; P = 0.024), with all differences being statistically significant. Multivariate analysis showed that extrahepatic metastasis was an independent prognostic factor, with a disease progression risk 1.77 times higher than that of patients without extrahepatic metastasis [HR = 1.77, 95%CI (1.11~2.81), P = 0.016]. Combining Sophora japonica granules was a protective factor [HR = 0.53, 95%CI (0.33~0.84), P = 0.006], reducing the risk of disease progression in HCC patients treated with targeted therapy and ICIs by 47%. Conclusions: Combining Sophora japonica granules can extend the progression-free survival of HCC patients treated with targeted therapy and ICIs, increase the six-month PFS rate, and significantly reduce the risk of disease progression. The survival benefit was more pronounced in subgroups with vascular invasion and a history of alcohol consumption, with PFS exceeding one year. After combining Sophora japonica granules, the survival benefit improved more in the ICIs + TKI subgroup compared to the ICIs + bevacizumab subgroup. Clinical trial information: ChiCTR2400079626.

Prospective Clinical Follow-Up Results of Infective Endocarditis.

Infective endocarditis incidence has been rising in recent years, with high mortality. Risk factors such as underlying heart diseases, chronic diseases, healthcare-associated infections, advanced age, and intravenous (IV) drug use have gained importance in the incidence, the treatment approach, and the disease course. The aim of this study is to contribute to Türkiye's data on infective endocarditis epidemiology and risk factors. This study examined risk factors, diagnostic and treatment approaches, and prognosis of infective endocarditis cases at Pamukkale University Faculty of Medicine Hospital. It was carried out prospectively for 28 months. During this period, 67 endocarditis cases were detected in 65 patients. Among cardiac diseases, the rate of congenital heart diseases (41%), degenerative heart diseases (37%), and acute rheumatic fever (ARF) related valvular heart disease (31%) were found to be high. Hospitalization in the last six months (53.7%), history of cardiac surgery (41.8%), use of IV catheters (22.4%), hemodialysis (14.9%) and IV drug use (7.5%) were also determined. Staphylococci, streptococci, and enterococci were the primary agents. The most used empirical treatments were ampicillin, ampicillin-sulbactam, and gentamicin. Natural valve endocarditis was most determined. Surgical treatment was applied in 56.7% of endocarditis cases. Septic embolism and cardiac failure were the most common complications. This study's findings regarding the epidemiology and prognosis of infective endocarditis pointed out that it is still a disease with a high mortality rate.

The effect of treatment of low back pain due to spondylosis by Jin’s 3-needle technique and “Doc hoat tang ky sinh” remedy combine with cupping therapy

Background: Low back pain due to spondylosis is a common musculoskeletal disease that is frequently encountered in clinical practice and tends to increase in modern society. Treatment of low back pain due to spondylosis of Jin’s 3 - needle technique and “Doc hoat tang ky sinh” remedy combine with cupping therapy has many positive clinical results. Objectives: To evaluate of treatment of low back pain due to spondylosis by Jin’s 3 - needle technique and “Doc hoat tang ky sinh” remedy combine with cupping therapy. Methods: A total of 40 patients with low back pain due to spondylosis treated by Jin’s 3 - needle technique and remedy combine with cupping therapy at Thua Thien Hue Traditional Medicine Hospital. The study was designed by the method of uncontrolled clinical trial study. The outcomes were assessed at baseline and after treatment. Results: After 18 days of treatment, VAS score decreased from 4.83 ± 1.647 to 1.98 ± 0.947 (p &lt; 0.05), lumbar spine dilation increased from 2.23 ± 0.653 to 3.425 ± 0.516 (p &lt; 0.05), lumbar spine range of motion increased from 1.98 ± 0.698 to 3.83 ± 0.385 (p &lt; 0.05). Conclusions: Jin’s 3 - needle technique and “Doc hoat tang ky sinh” remedy combine with cupping therapy had a good effect in treatment of low back pain due to spondylosis. Key words: low back pain, spondylosis, Jin’s 3 - needle technique, Doc hoat tang ky sinh, cupping.

A Survey on Korean medicine doctors' attitudes toward blood tests, status of usage, and experience and demand for related education

Objectives: This study aimed to investigate the attitudes towards blood tests (BT), the utilization of BT in clinical contexts, and the educational needs and experiences among Korean medicine doctors (KMDs).Methods: An anonymous online survey was conducted among KMDs over a two-week period in 2023. The survey data were subjected to basic statistical analysis and logistic regression.Results: A total of 773 respondents participated in the survey, yielding a response rate of approximately 3%. Most respondents recognized the necessity of BT in Korean medicine, with 74.77% reporting prior utilization. However, only 43.73% currently utilize BTs. Key barriers to BT utilization included insufficient legal and institutional safeguards and cost burdens. Although 77.62% reported receiving BT education, only 54.85% deemed it useful, yet 95.21% expressed intent for future education. Younger KMDs exhibited lower BT utilization and lower agreement rates on the usefulness of education but higher demand for education. The longer the training period in Korean medicine hospitals, the higher the rate of experience with BTs, related education and the agreement on the usefulness of the education. And they had relatively less need for further education.Conclusions: Efforts are needed to meet the demand for BT education among KMDs. In particular, it seems necessary to identify the higher demand among young KMDs and prepare for education at a level equivalent to a training course in Korean medicine hospitals rather than in a form that just follows past education practices.

Comparing Video Head Impulse Testing in Patients With Acute Vestibular Dysfunction

Objective: The video head impulse test (v-HIT) can evaluate the function of all semicircular canals (SCCs) in a short period. In this work, we sought to compare v-HIT results among 2 commercially available devices, the ICS impulse (Otometrics, Denmark) (ICS) and Eye See Cam (Interacoustics, Denmark) (ESC), among individuals with unilateral vestibular disorders. Design: Retrospective study (n = 15). Setting: St. Marianna University School of Medicine Hospital. Patients: Fifteen patients with acute unilateral vestibular disorders. Intervention: Two v-HIT devices were conducted across patients to compare the results of the 2 models. Main Outcome Measures: Gain values and pathological saccades for each SCC were compared across the 2 models. Monothermal caloric testing was performed to compare alongside v-HIT gain values. Results: There was no difference between the 2 models for the evaluation of the horizontal SCCs. There was a significant negative correlation (ESC: r = −0.52, ICS: r = −0.53) between caloric testing and the gain values of the 2 models. In the vertical SCCs, the gain values of ESC were significantly higher than the gain values of ICS. Detection of catch-up saccades in vertical SCCs was similar across the 2 models. Conclusion: For the horizontal SCCs, there was no difference in test results between the 2 models. However, in the vertical SCCs, gain values were variable across the 2 devices. Larger scale studies are needed to develop normative ranges for the vertical canals.