Hospital Experience Research Articles

A Hospital-Based Survey Assessing Facility-Level Factors Contributing to Late-Stage Cervical Cancer Diagnosis: A Mixed-Methods Approach.

Background In Kenya, cervical cancer is the 2nd commonly diagnosed type of cancer and the top cause of cancer-related deaths among women. Over 50% of cervical cancer cases worldwide are diagnosed at a late stage, with this percentage rising to 80% in developing countries. Poor Health systems are major causes of late-stage diagnosis, leading to low survival rates and increased mortalities among cervical cancer patients. This study focused on determining the facility-level factors that contribute to late-stage diagnosis among cervical cancer patients. Methods An analytical cross-sectional mixed method study was conducted to collect data on hospital and referral systems experiences from 139 cervical cancer patients systematically sampled at Kenyatta National Hospital (KNH), using a semi structured questionnaire. In-depth interviews were conducted on 8 Key Informants. Associations between stage at diagnosis (dependent variable) and independent variables were tested using logistic regression at 95% Confidence Interval. Qualitative data was analyzed using content analysis method. Results Participants mean age was 51 years. 86 (61.9%) were diagnosed at advanced stages III and IV. A higher number of hospital referral instances, facing challenges during the referral process, and prolonged waiting times for diagnostic results were identified as key contributors to late-stage cervical cancer diagnosis. Conclusion Delays in diagnosis for most patients is due to poor health and referral systems. The study recommends improving referral systems and encouraging partnerships to decentralize cancer diagnostic.

Impact of COVID-19 on Hospital Admissions for Children With Developmental Disadvantages: A Western Sydney Metropolitan Hospital Experience on Health Inequity.

To investigate the impact of Sydney's COVID-19 lockdown on children with developmental disadvantages and reflect on current clinical practice. Retrospective data was collected from a western Sydney metropolitan hospital's electronic database and patients. We reviewed all children with Autism Spectrum Disorder (ASD), Cerebral Palsy (CP) or Intellectual Disability (ID) admitted 36 months prior to and after lockdown policy being implemented. The prevalence of hospital presentation was reduced during the lockdown period. The average length of stay (LoS) increased by approximately 1.5 folds. Comparatively, the average LoS of the general paediatric population increased minimally. Seizures, asthma, and upper respiratory tract infections were the three commonest issues for hospital admissions in both periods. COVID-19 infection accounted for 4% of admissions in the lockdown period. Around 20.8% of patients with disadvantages were admitted with more than two major issues. None of these patients had concurrent COVID-19 infection. Children with developmental disabilities experience greater disadvantages during lockdown. The likely reasons include inequity caused by increased barriers to healthcare service. The indirect benefit of reducing infection transmission during lockdown was not reflected in our patient group, contributing to the disease burden. Chronic diseases remain the most common causes of admissions in all periods, suggesting the essentiality of improving chronic disease management in future clinical practice.

ChatGPT’s role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study

Background: Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored. Methods: In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires. Results: Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P<.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels. Conclusions: ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.

Factors Predicting Major Complications and Mortality in Percutaneous Endoscopic Gastrostomy: 8 Years of Experience of a Tertiary Surgery Center.

Percutaneous endoscopic gastrostomy (PEG) is a safe method of choice for patients who need long-term nutritional support. However, complications and high mortality rates have been reported. Based on 8 years of experience in tertiary care hospitals, we aimed to identify risk factors associated with major complications and 30-day mortality after PEG. Patients who underwent PEG in the General Surgery clinic of Tokat Gaziosmanpaşa University, Faculty of Medicine between January 2014 and March 2022 were included in the study. Data regarding patient demographics, comorbidities, laboratory data, drugs used together, and indications for PEG tube placement were collected. There were 429 patients. The mean age of the patients was 66.9±16.75 years, and 180 (44%) patients were female. The mean follow-up period was 8.84±6.75 months. Twenty patients (4.9%) had major complications. Female sex [Odds Ratio (OR) 0.33, 95% CI, CI=1.23-8.87, P=0.02] and diabetes mellitus (DM) (OR=0.23, 95% CI=1.93-6, P=0.002) were the independent variables associated with major complications. The all-cause 30-day mortality rate was 5.9% (n=24). Malignancy, DM, corticosteroid use, low albumin, and platelet values were associated with increased mortality in multivariate analysis as indications for PEG. Female sex and patients with DM may potentially face major complications. The patients with cancer, diabetes, and corticosteroid use were associated with higher mortality. In addition, low serum albumin and platelet levels were an effective factor for survival in patients undergoing PEG, and this should be taken into account in decision-making.

Perceptual service robot attributes affecting customer value co-creation intention in luxury hotels industry

Service robots have become a trend in hotel services, presenting new opportunities and challenges for the development of the hospitality industry. This study aims to explore how the perceptual attributes of service robots affect customer value co-creation intention in the luxury hotel industry. In China, Shanghai is the city with the most hotels from luxury brands and the city with the highest number of service robots deployed in luxury hotels. Currently, only 11 luxury hotels in Shanghai use service robots. Therefore, this study conducted an online survey of customers who have used service robots in these 11 luxury hotels in Shanghai. A total of 644 responses were collected from customers in luxury hotels in China who have used service robots through convenience sampling. Subsequently, the data underwent a validity analysis, and structural equation modeling was used to process the data. The results indicate that when service robots are perceived as possessing anthropomorphism, animacy, perceived intelligence, and perceived safety, they significantly enhance the customer hospitality experience. These attributes boost the enjoyment and trust customers feel when interacting with the robots, leading to greater engagement during the experience. Notably, likeability lacks significant impact on customer hospitality experience, suggesting that in luxury hotel settings, customers place more emphasis on whether robots possess practical attributes like intelligence and safety. Moreover, the customer hospitality experience serves as a significant mediator, implying the anthropomorphism, as the most critical attribute.

Outpatient flexible cystoscopy in urogynaecology: a tertiary hospital's experience.

This study is a retrospective evaluation of a new outpatient flexible cystoscopy service in a tertiary care hospital in Dublin, Ireland. This is a retrospective observational study. This study has been held at the Department of Gynaecology, Rotunda Hospital, Dublin. This included all women who underwent outpatient flexible cystoscopy in Rotunda Hospital between May 2023 to October 2024. Retrospective data collection included patient demographics, indications for referrals, cystoscopic findings, post-procedural complications, and cost-benefit analysis. A total of 77 women underwent flexible cystoscopy. The mean age was 52.5years ranging from 20 to 85years. Flexible cystoscopy was successfully completed in all patients, and there were no post procedure complications. The most common indications were as follows: recurrent urinary tract infections (36%) and bladder pain syndrome (36%), followed by overactive bladder symptoms (14%). Fifty-five percent of patients had no abnormal findings. The most common abnormality found was trabeculations (39%), followed by glomerulations (9%). A cost-benefit analysis showed an approximate saving of € 1211 per patient leading to a saving of over € 93,000 over a period of 18months. Outpatient cystoscopy is a low-risk, feasible, well tolerated, and safe diagnostic procedure, with no post-procedure complications observed in this study. It avoids the risks of general anaesthesia and is associated with lower procedural costs.

2023 epidemic dengue fever outbreak: the experience of a pediatric hospital in the City of Buenos Aires.

Introduction. Dengue is a viral infection that may be asymptomatic or include severe manifestations. This study aims to describe the characteristics of a pediatric population during the epidemic outbreak in 2023. Population and methods. This cross-sectional study included patients with probable or confirmed dengue fever who were seen from March 13, 2023, to May 19, 2023, in a pediatric hospital in the Autonomous City of Buenos Aires. Results. A total of 112 patients were included. The median age was 12 years; 58% were male. Seventy-six percent of them came from the City of Buenos Aires. Twenty-five percent had cohabitants with symptoms compatible with a suspected case. The most frequent clinical manifestations were fever, headache, retro-ocular pain, myalgia, and arthralgia. The most frequent laboratory alterations were leukopenia (65%) and elevated transaminases (60%). Twenty-one percent (24/112) presented alarm signs and required hospitalization. Leukopenia, plateletopenia, and elevated transaminases were associated with the presence of alarm signs. RT-PCR was detected in fifty-three patients; serotype 2 was the most frequent. Twenty-one patients had positive NS1 tests, 18 patients had positive IgM, and 20 patients with clinical and epidemiological links were assumed to be probable dengue cases. There were no cases of severe dengue. Conclusion. Early clinical suspicion and recognition of laboratory parameters associated with alarm signs are essential for an adequate approach to the disease and early supportive treatment during dengue infection.

Changing trends from inguinal radical orchiectomy to testis-sparing surgery in pediatric testicular tumors

Changing trends from inguinal radical orchiectomy to testis-sparing surgery in pediatric testicular tumors

The Forgotten Voices: Enabling Children and Young People With Intellectual Disability to Express Their Views on Their Inpatient Hospital Experience.

The importance of enabling patients to provide feedback on their experience of healthcare is widely accepted but there are few appropriate measures to enable children and young people to directly provide feedback, particularly those with intellectual disability or younger children. Our primary aim was to develop and test patient-reported experience measures for children and young people with intellectual disability who use inpatient hospital services. A secondary aim was to test these measures with younger children aged 4-7 years without intellectual disability. A hospital inpatient patient-reported experience measure previously developed for children aged 8-11 years was revised iteratively in conjunction with a parent advisory group (comprising five parents of children and young people with and without intellectual disability) and children and young people with intellectual disability. The final patient-reported experience measure was tested in children's inpatient wards at seven hospitals in England over a 3-month period. Parents suggested a need for a single patient-reported experience measure for all children with intellectual disability which contained simpler language, fewer questions and response options, and images to illustrate each question. The final patient-reported experience measure had 22 questions, each with a corresponding image, and a free text box in which children could add anything further. Questions addressed environment, people, care and treatment and safety. During testing at seven children's hospitals, 52 children and young people with intellectual disability (4-18 years) and 76 children without intellectual disability (4-7 years), all of whom received inpatient care, completed the patient-reported experience measure. Two percent of data were missing; in 16 instances respondents either ticked two responses or placed a tick between two response categories. Half the respondents added comments and/or drew a picture. The development of a patient-reported experience measure for children and young people with intellectual disability provides a previously unavailable opportunity for them to report on their experiences of inpatient care and have their voices heard. Future work to extend testing to a wider group is underway and will enable us to clarify whether one patient-reported experience measure is valid and reliable for all children and young people with intellectual disability. A parent advisory group, comprising parents/carers of young people with or without a learning disability, advised on all aspects of the wider study design and specifically on revisions to the measure reported in this manuscript. The parent advisory group met twice a year during the study with email contact between meetings for specific requests and study updates. Representatives of the advisory group also attended the study steering group.

Hypothermia theraphy in patients post cardiac arrest

Cardiovascular disease is the leading cause of death in several developing countries, and many of these deaths occur before reaching the hospital due to cardiac arrest. Most patients who return to spontaneous circulation (ROSC) and are brought to the hospital experience severe neurological damage during cardiac arrest, and this damage is the cause of in-hospital mortality. Improvements in survival and neurologic improvement of patients with CA have focused on two main therapy areas. The first area is improved education and skills of medical and paramedical personnel to improve perfusion post CA. The second area is a greater emphasis on post-resuscitation care which includes optimizing oxygenation and ventilation, avoiding hypotension, treating causes of CA such as acute coronary ischemia, and initiating hypothermia therapy if necessary, as in the 2020 guidelines and recommendations from the American Heart Association (AHA), International Liaison Committee of Resuscitation, and European Resuscitation Council covering the entire spectrum of post-resuscitation care. The AHA guidelines 2020 recommend optimizing hypothermia therapy for 24 hours with a target temperature between 320C - 360C in ROSC patients to improve clinical outcomes of neurological status after cardiac arrest. This is contrast to the study of Martinell et al in their research which concluded that there was no significant difference in survival rates within 30 days after cardiac arrest in patients who received either hypothermia therapy or those who did not. Hypothermia therapy, which is currently part of the post-resuscitation care recommendations, has varied variables and remains controversial in its implementation. Based on this, this referent will discuss the effects of hypothermia therapy on post-cardiac arrest patients, the stages, and the practical aspects of implementing hypothermia therapy. Keywords: Return of spontaneous circulation, cardiac arrest, hypothermia.

Clinical Spectrum and Associated Features of Autism Spectrum Disorders: Experience in A Tertiary Level Hospital

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with a heterogeneous and complex presentation of clinical symptoms related to social communicative and interactive behavior. Thus, the aim was to evaluate the clinical features and associated condition of autism spectrum disorder in Bangladeshi children. Method: A cross-sectional study was done in Out-patient department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2023 to June 2023 Children age 3 to 10 years who satisfied the inclusion and exclusion criteria and met the diagnostic criteria (DSM-V) of ASD were enrolled in this study. In all confirmed cases, clinical features and co-occurring condition were evaluated. Data was collected by a structured questionnaire supplied by department of Pediatric Neurology. Informed written consent was taken from all legal guardians. Results: A total of 75 children of 3-10 years were included. Mean age was 4.27±1.99 with male predominance. Among the associated features; pointing, social interaction, response to call and eye contact were absent in 94.67 %, 97.33%, 92% and 86.67% cases respectively. In this study more than three fourth of studied children were presented with speech delay (80%) and more than half of the children presented with speech regression. ADHD (46.67%), bruxism (25.33%) constipation (22.67%), epilepsy (5.33%), febrile seizure (9.33%) and gratification syndrome (12%) were mostly observed in ASD children. Conclusion: In our study, more than one-third of studied children had ADHD and sleep disturbance followed by bruxism, epilepsy, febrile seizure, gratification syndrome and constipation as other associated features. J Bangladesh Coll Phys Surg 2025; 43: 53-58

Menopausal Symptoms and Coping Strategies among Women of 40-60 Years Age-Group: A Tertiary Care Hospital Experience from Bangladesh

Menopausal Symptoms and Coping Strategies among Women of 40-60 Years Age-Group: A Tertiary Care Hospital Experience from Bangladesh

P-294. The pathway to a decade of carbapenem-resistant Enterobacterales (CRE) : A 9-years experience in a teaching hospital in the Dominican Republic

Abstract Background WHO warns about carbapenem-resistant Enterobacterales (CRE) and carbapenemase production, posing challenges in hospitals owing to treatment failure and rapid dissemination. In order to design adequate infection control and prevention strategies and local treatment guidelines, it is important to characterize the prevalence of these isolates. We aimed to assess the frequency of CRE and carbapenemase production in hospitalized patients between October 2015- March 2024. Methods A retrospective, descriptive and longitudinal study was conducted including all patients with positive CRE cultures, from January 2015 to March 2024, in a 289-bed tertiary hospital in the Dominican Republic. A database of susceptible and resistant Enterobacterales isolates was obtained, reviewing electronic records for culture origin, microorganisms, and carbapenemase production. Annual CRE rates were calculated including all hospitalized patients with Enterobacterales isolates. Results The CRE rate over a 9-years period was 1.7% (83/4843). A slight decrease was observed from years 2015 to 2017, followed by the lowest CRE rate in 2018 (0.2%). 2020 reported an increase of 160% in the CRE rate when compared to 2019, peaking at 3.5% in 2022. The most common microorganisms isolated were Klebsiella spp. (42.6%; 43/101) and Enterobacter cloacae complex (33,7%; 34/101) while the most common carbapenemase produced was KPC (39.4%; 39/99) followed by MBL (21.2%; 21/99). Urine cultures were the most common samples to isolate CRE, but a shift in the trend was observed in 2020, with blood cultures becoming the most common source of CRE. Sequencing of a small sample as part of a previous study reported the presence of KPC2 and KPC3. Conclusion Despite being in a low resource country, infection prevention and control strategies have managed to limit the spread reported in other hospital settings in Latin America. The increase seen post pandemic emphasizes this importance. Although KPC is the most common carbapenemase type, NDM has been increasing, posing a major growing concern on treatment failure. Laboratory methods stand as a fundamental tool to understand the magnitude of dissemination, to elaborate clinical guidelines and improve diagnosis and patients outcomes. Disclosures Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria

Exploring stress echocardiography in coronary artery disease: insights from a tertiary echocardiography center

Abstract Background/ Introduction Stress echocardiography (SE) is an established functional test with high sensitivity and specificity for diagnosing obstructive coronary artery disease (CAD). Purpose The present study aimed to document the experience of a tertiary hospital’s echocardiography center in using dynamic echocardiography to assess myocardial ischemia. Methods The study was performed retrospectively, including all patients who underwent SE at our center from January 2021 to December 2021. The goal for each test was to reach 85% of the age-predicted maximal heart rate (HR) (220 minus the subject’s age). The adopted Dobutamine stress protocol involved a continuous intravenous infusion of Dobutamine in 3-minute increments, starting at 10μg/kg/min and gradually increasing to 50μg/kg/min. Handgrip exercises were typically used, along with a small dose of intravenous atropine (0.25mg, up to a maximum of 1 mg) if the endpoint was not reached. Parasternal and apical echocardiographic views were obtained at all stages, and a contrast agent was used when appropriate. All tests were conducted under continuous 12-lead electrocardiographic (ECG) monitoring. Results Out of the 323 subjects [mean age 63.5 ± 10.5 years, 221 males (68.4%)], 123 (38.0%) underwent testing due to suspected CAD symptoms, while the remaining subjects (200 / 62.0%) were tested to reassess known CAD (with or without previous intervention). Twenty-one (7.0%) subjects had a left ventricular ejection fraction (LVEF) ≤40% at rest. The maximum dose of dobutamine most commonly administered was 30 μg/kg/min [137 subjects, (43.0%)], and atropine was given in 51 subjects (16.0%). The target HR was achieved in 291 (90.0%) tests. Eighty-seven (27.0%) SEs utilized a contrast agent in all stages, while in 177 (55.0%) a contrast agent was administered only at rest and peak HR. Major complications, such as acute myocardial infarction or persistent ventricular tachycardia, occurred in 6 patients (1.8%). Specifically, 5 (1.5%) experienced transient ST-segment elevation during the test, and one patient had a lateral myocardial infarction with ST-segment elevation after the test. No allergic reactions were reported. In 226 (70.0%) tests, results were classified as "negative for ischemia up to the achieved HR". In the remaining tests, classified as "positive for ischemia" (97/30.0%), the mean wall motion score index (WMSI) at peak HR was 1.3 ± 0.2 with a mean peak-to-rest ΔWMSI of 0.1 ± 0.1 (Table 1). Conclusion Of all the SEs performed at our center with an indication for assessing myocardial ischemia, 30.0% were positive, while major complications occurred in 1.8% of the subjects.

Use of a mini 3D transesophageal echocardiogram (TEE) probe in adult patients for outpatient TEE: initial experience in a national tertiary hospital

Abstract Background The mini 3D TEE probe, initially developed for pediatric patients, is now being utilized for adult patients due to its smaller size and clear 2D & 3-dimensional imaging and Doppler studies, potentially limiting anesthesia use and procedural complications. Purpose This study aimed to analyze the clinical profiles and outcomes of adult patients who underwent an outpatient TEE using a mini 3D TEE probe, including image quality and ease of use. Proper evaluation is vital for patient safety, and this initial study aims to determine the mini 3D TEE probe's applicability and safety in adults, potentially guiding future clinical practice. Methods This was a retrospective cross-sectional, and observational study. Medical records were reviewed, including demographic and clinical profiles, echocardiographic data, and procedural and safety outcomes. For each patient, two operators rated ease of use and all imaging modalities on a 5-point scale, from 1 (very difficult/poor) to 5 (very easy/good). Results Eight adult patients were included in the study to undergo a comprehensive TEE using a mini 3D TEE probe. Most patients were female (63%) with a median age of 28.5 years (IQR 5.13), with valvular heart diseases (38%), congenital heart diseases (38%), and heart failure (50%). Most patients had an ASA Physical Classification of Class II (38%) or III (38%). Indications for TEE were primarily suspected congenital heart disease with inadequate transthoracic echo (63%) and pre-intervention evaluation of valvular structures (63%). The probe insertion was rated very easy (100%), and handling was mostly very easy (87.5%). 2D, 3D, 2D color, continuous, and pulsed wave Dopplers were rated very good (100%), with 87.5% rating 3D color flow Doppler as very good. All patients received local pharyngeal anesthesia, with only half of the patients given low-dose intravenous midazolam. The median procedure time for a full study was 40 minutes (IQR 17). After the procedure, all patients were fully awake and recovered (median recovery time 4.5 minutes, IQR 1.88), with only minor post-TEE complications like pharyngeal irritation (13%) and hoarseness (13%). No major morbidities, GI bleeding, esophageal perforation, arrhythmia, respiratory compromise, or mortality occurred. All patients were discharged after recovery with a median outpatient length of stay of 47 minutes (IQR 15.25). Conclusion The mini 3D TEE probe demonstrates ease of use and excellent imaging quality for adult patients across all imaging modalities. It is safe to use and can be performed with local pharyngeal anesthesia alone or with mild intravenous sedation, with no significant post-procedural complications. This study supports the mini 3D TEE probe's applicability and safety in adult patients, suggesting its potential for broader clinical application in cardiovascular diagnostics. A larger scale prospective study is recommended to further confirm these preliminary findings.

Outcomes of Pregnancy-Associated Breast Cancer: A Tertiary Care Cancer Hospital Experience

Outcomes of Pregnancy-Associated Breast Cancer: A Tertiary Care Cancer Hospital Experience

Retrospective analysis of prognostic determinants of neonatal hearing loss: an Indian experience in a tertiary care hospital

Background: Childhood hearing impairment is a result of combination of intrauterine environment, perinatal and postnatal factors. The Joint Committee on Infant Hearing (JCIH) has been providing guidelines for early detection of infants with or at risk of hearing loss. In India, UNHSP (Universal neonatal hearing screening program) as a part of NPPCD (National Program for Prevention and Control of Deafness) is a strategy that enables to identify congenital deafness and hearing loss. Methods: Retrospective cross-sectional study was carried out of a database of newborn hearing screening at a tertiary care hospital of New Delhi, India. The screening results, the risk indicators for hearing loss, diagnosis and the prognosis were descriptively analysed. Results: 3640 neonates were included in the study between January 2021 and November 2023. It was observed that, of the 25 babies diagnosed with hearing loss the common risk factors were low birth weight with preterm delivery, hyperbilirubinemia, low birth weight, preterm delivery, NICU stay>05 days and syndromes. Conclusions: UNHSP (Universal Neonatal Hearing Screening Program) aids in early diagnosis of hearing loss using DPOAE (distortion product otoacoustic emission) and BERA (brainstem evoked response audiometry) and significantly reduces the referral rate. Babies with hyperbilirubinemia, preterm delivery and low birth weight have a poor prognosis and are at a higher risk for neonatal hearing loss as per our study. Hearing augmentation in early years of life reduces morbidity and aids better quality of life.

Caught in the Crossfire: A Single Institution's 10-Year Experience with Pediatric Firearm Injury.

Pediatric firearm-related injuries are now the leading cause of death among children in the United States. We sought to characterize the experience of a large free-standing children's hospital treating children with firearm injuries. We reviewed all 2012-2022 gunshot wound encounters using the institutional trauma database of an urban Level 1 pediatric trauma center in Texas. Patient demographics, incident characteristics, and clinical outcomes were analyzed. Statistical analysis was performed using ANOVA and chi-square tests to evaluate the influence of socioeconomic factors. Injuries from recreational firearms like BB and pellet guns were excluded from this analysis. Two hundred eleven pediatric patients were treated for gunshot wounds during the study period. There was an upward trend in the number of injuries per year, ranging from 6 in 2012 to 39 in 2021. The average patient age was 10.2 years. Violent injuries accounted for 51.7%, while accidental injuries led to 44.1%, and self-inflicted injuries made up 4.3%. Based on the Child Opportunity Index. 63.0% of patients lived in neighborhoods in the lowest opportunity quartile, while only 2.8% of patients lived in neighborhoods in the highest opportunity quartile. 22.7% of patients sustained injuries characterized as "major trauma," as indicated by an Injury Severity Score of >15, and 8.5% of patients died. Firearms pose a substantial risk to children in the United States. There has been an increasing trend in pediatric firearm injuries over the last decade. The majority of children treated for firearm injury at our institution sustained injuries in the setting of gun violence. Injury prevention efforts should be aimed at decreasing intentional pediatric firearm injuries.

Emergency primary anastomosis with or without intraoperative colonic lavage following sigmoidectomy in sigmoid volvulus: 175-patient experience in a tertiary referral hospital

Objectives: Emergency primary anastomosis following sigmoidectomy is one of the main treatment options in sigmoid volvulus (SV). However, during this procedure, the role of intraoperative colonic lavage (ICL) is controversial. Our aim was to evaluate the role of ICL in 175-patient SV series. Methods: In Ataturk University Faculty of Medicine Department of General Surgery, ICL was applied in 76 cases (43.4%), while it was not used in the remained 99 patients (56.6%) in 58.5-year period. In a partial retrospective (first 20 years, from June 1966 to June 1986) and prospective (later 38.5 years, from June 1986 to December 2024) evaluation, some preoperative, operative, and postoperative findings were utilized. Results: As preoperative data, mean age (56.4 years vs. 57.1 years, P>0.05), male/female ratio (4.8 vs. 4.2, P>0.05), and rate of shock (5.3% vs. 6.1%, P>0.05) were statistically similar in both groups, while mean ASA score (3.1 vs. 2.9, P<0.05) was significantly lower in ICL group. Among operative findings, rates of bowel gangrene (67.1% vs. 63.6%, P>0.05) and perforation (1.3% vs. 1.0%, P>0.05) were statistically similar in both groups, while mean operation time (205.4 minutes vs. 176.8 minutes, P<0.005) was significantly longer in ICL group. As surgical outcomes, rates of mortality (13.2% vs 12.1%, P>0.05) and morbidity (39.5% vs. 28.3%, P>0.05) were statistically similar in both groups, while mean hospitalization time (14.7 days vs. 9.4 days, P<0.001) was significantly longer and mean cost (3,455.4 USD vs. 2,752.1 USD, P<0.001) was significantly higher in ICL group. Conclusion: When compared with that of primary anastomosis with ICL, primary anastomosis without ICL provided shorter operation and hospitalization times, and less cost in addition to similar mortality and morbidity rates in the emergency treatment of SV. doi: https://doi.org/10.12669/pjms.41.2.11399 How to cite this: Altundas N, Peksoz R, Disci E, Atamanalp SS. Emergency primary anastomosis with or without intraoperative colonic lavage following sigmoidectomy in sigmoid volvulus: 175-patient experience in a tertiary referral hospital. Pak J Med Sci. 2025;41(2):603-607. doi: https://doi.org/10.12669/pjms.41.2.11399 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Bridging Experience and Practice: A Grounded Theory Study of Nurses' Hospitalisation Experiences as Patients or Family Members.

This study aimed to develop a grounded theory that explains how nurses' experiences as patients or family members influence their provision of patient-centred care. A grounded theory approach. Twenty clinical nurses in South Korea participated; nine had experiences as patients and 11 as family members during hospitalisation. Data were collected through semi-structured, in-depth interviews from January to October 2021. Participants were purposively sampled for diverse experiences, and all interviews were audio-recorded and transcribed verbatim. Data analysis followed grounded theory using the constant comparative method, with theoretical saturation reached after 20 interviews. The theory developed was built around the core category of 'transforming nursing practice through empathy and reflection in hospitalization experiences'. Participants experienced healthcare services in a wide range of areas, including nursing interactions, patient rights, the healthcare delivery system and hospital facilities. Based on these experiences, participants developed a deep understanding and empathy for the emotions and needs of patients and families, gaining new insights and reflections on their nursing practice. It led to a transformation in participants' attitudes and behaviours towards patient-centred care. This study demonstrates that reflective practice and empathy developed through personal hospitalisation are important factors in leading to the shift towards patient-centred care. These findings provide a theoretical framework for emphasising experiential learning opportunities in nursing education and training to apply patient-centred approaches in practice. Experiential learning approaches, such as simulation, role playing or caregiver training, can bridge the gap between clinical practice and patient expectations. Supportive work environments that encourage reflection on patient experiences help nurses maintain patient-centred practices despite challenges, leading to professional growth and improved patient outcomes. This study adhered to the COREQ checklist for reporting. No patient or public involvement.