Hospital Procedures Research Articles

Association of Racial Residential Segregation With Long-Term Outcomes and Readmissions After Out-of-Hospital Cardiac Arrest Among Medicare Beneficiaries.

Background The national impact of racial residential segregation on out-of-hospital cardiac arrest outcomes after initial resuscitation remains poorly understood. We sought to characterize the association between measures of racial and economic residential segregation at the ZIP code level and long-term survival and readmissions after out-of-hospital cardiac arrest among Medicare beneficiaries. Methods and Results In this retrospective cohort study, using Medicare claims data, our primary predictor was the index of concentration at the extremes, a measure of racial and economic segregation. The primary outcomes were death up to 3 years and readmissions. We estimated hazard ratios (HRs) across all 3 types of index of concentration at the extremes measures for each outcome while adjusting for beneficiary demographics, treating hospital characteristics, and index hospital procedures. In fully adjusted models for long-term survival, we found a decreased hazard of death and risk of readmission for beneficiaries residing in the more segregated White communities and higher-income ZIP codes compared with the more segregated Black communities and lower-income ZIP codes across all 3 indices of concentration at the extremes measures (race: HR, 0.87 [95% CI, 0.81-0.93]; income: HR, 0.75 [95% CI, 0.69-0.78]; and race+income: HR, 0.77 [95% CI, 0.72-0.82]). Conclusions We found a decreased hazard of death and risk for readmission for those residing in the more segregated White communities and higher-income ZIP codes compared with the more segregated Black communities and lower-income ZIP codes when using validated measures of racial and economic segregation. Although causal pathways and mechanisms remain unclear, disparities in outcomes after out-of-hospital cardiac arrest are associated with the structural components of race and wealth and persist up to 3 years after discharge.

Differentiated approach to glycemic management in type 2 diabetic patients during inpatient treatment of acute myocardial infarction: glycemic control and long-term prognosis

BACKGROUND: The risk of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (T2DM) is 2 times higher than without DM. Previously an association between the time in the target range of glycemia during hospitalization of AMI in patients with T2DM (hTIR — «hospital time in range») and long-term prognosis was found. It is supposed that a differentiated approach to glycemic management will help to achieve a higher level of hTIR and will lead to an improved prognosis.AIM: To evaluate the effectiveness of differentiated approach to glycemic management in patients with T2DM during inpatient treatment of AMI and impact on long-term prognosis.MATERIALS AND METHODS: The study included patients with T2DM who were hospitalized with AMI with ST-segment elevation and underwent percutaneous coronary intervention. A total amount of patients was 161; 102 were in the main group, 59 in the control group. There was a differentiated approach to glycemia management based on phenotype determination in the main group. Insulin therapy was prescribed to patients with the 1st phenotype during the entire inpatient treatment. Patients with the second phenotype received insulin therapy followed by switching oral antidiabetic drugs (OAD). Patients of the 3rd phenotype were prescribed only OAD. In the control group, therapy of T2DM was prescribed according to the standard hospital procedures based on current clinical recommendations.RESULTS: In the main group, 22 patients (22%) were in the 1st phenotype, 54 (53%) –in the 2nd, 26 (25%) –in the 3rd. The average glycemia during hospitalization in the main group was lower than in the control group: 9.4±1.7 mmol/l vs 10.3±2.3 mmol/l (p=0.006). The hTIR in the main group was 58 [53; 71]% vs 46 [33; 63]% in the control group (p<0.001). It was shown that when hTIR > 55% is reached, the risk of cardiovascular death within a year after hospitalization is reduced by 80%.CONCLUSION: The differentiated approach to glycemic management in patients with T2DM leads to an improvement in glycemic control during inpatient treatment of AMI and is accompanied by a tendency to a lower incidence of cardiovascular death within a year after hospitalization. Achieving hTIR > 55% is associated with a multifold reduction of the risk of cardiovascular death in a year. About 25% of patients with DM2 during inpatient treatment of AMI do not need the insulin therapy.

Comparison of 5-year follow-up outcomes between"one-stop"procedure and long-term oral anticoagulants after radiofrequency catheter ablation in patients with atrial fibrillation

Objective: To compare the 5-year follow-up outcomes of radiofrequency catheter ablation (RFCA) combined with left atrial appendage closure (LAAC) and long-term oral anticoagulant (OAC) after RFCA in patients with atrial fibrillation. Methods: This retrospective cross-sectional study included patients with atrial fibrillation who underwent"one-stop"procedure in the First Affiliated Hospital of Ningbo University from September 2015 to December 2017 (RFCA+LAAC group). Baseline data of patients were collected. Propensity score matching at the ratio of 1∶1 was used to select patients with atrial fibrillation who took long-term OAC after RFCA (RFCA+OAC group). The maintenance rate of sinus rhythm and the incidence of adverse events during follow-up were compared between the two groups. Results: A total of 110 patients were enrolled in the RFCA+LAAC group and RFCA+OAC group, respectively. Age of patients was (67.4±8.8) years in RFCA+LAAC group, and there were 42 (38.2%) female patients. Age of patients was (67.3±7.9) years in RFCA+OAC group, and there were 47 (42.7%) female patients. The patients were followed up for mean of (5.3±1.1) years. There was no significant difference in the maintenance rate of sinus rhythm (log-rank: χ2=0.277, P=0.602) and incidence of ischemic stroke events (2.7% (3/110) vs. 4.5% (5/110), P=0.719) during follow-up between the two groups. The incidence of bleeding events (6.4% (7/110) vs. 18.2% (20/110), P=0.008) and major bleeding events (1.8% (2/110) vs. 8.2% (9/110), P=0.030) was significantly higher in the RFCA+OAC group than in the RFCA+LAAC group. Conclusion: There is no significant difference between RFCA+LAAC group and RFCA+OAC group in maintenance rate of sinus rhythm and incidence of ischemic stroke events. Patients in the RFCA+LAAC group have a lower risk of bleeding events compared to the RFCA+OAC group.

Diagnostic Reference Levels in Interventional Pediatric Cardiology: Two-Year Experience in a Tertiary Referral Hospital in Latin America.

The goal of the present study was to propose the first local diagnostic reference levels (DRLs) for interventional pediatric cardiology procedures in a large hospital in Colombia. The data collection period was from April 2020 to July 2022. The local DRLs were calculated as the 3rd quartile of patient-dose distributions for the kerma-area product (Pka) values. The sample of collected clinical procedures (255) was divided into diagnostic and therapeutic procedures and grouped into five weight and five age bands. The Pka differences found between diagnostic and therapeutic procedures were statistically significant in all weight and age bands, except for the 1-5-year age group. The local DRLs for weight bands were 3.82 Gy·cm2 (<5 kg), 7.39 Gy·cm2 (5-<15 kg), 19.72 Gy·cm2 (15-<30 kg), 28.99 Gy·cm2 (30-<50 kg), and 81.71 Gy·cm2 (50-<80 kg), respectively. For age bands, the DRLs were 3.97 Gy·cm2 (<1 y), 9.94 Gy·cm2 (1-<5 y), 20.82 Gy·cm2 (5-<10 y), 58.00 Gy·cm2 (10-<16 y), and 31.56 Gy·cm2 (<16 y), respectively. In conclusion, when comparing our results with other existing DRL values, we found that they are similar to other centers and thus there is scope to continue optimizing the radiation dose values. This will contribute to establishing national DRLs for Colombia in the near future.

Enhancing Women's Health: Advancing Gynecological Laparoscopy in Resource-Limited Eastern Sudan

The history of surgery has witnessed a remarkable evolution with the widespread adoption of minimally invasive techniques, notably operative video laparoscopy. This study aims to shed light on the laparoscopy experience in a rural hospital in Eastern Sudan and contribute to understanding its outcomes and challenges in low-resource settings. This study systematically collected and analyzed data encompassing patient demographics, preoperative assessments, postoperative complications, and gender. The purpose was to derive insights and draw meaningful conclusions from this information. Among the 124 laparoscopic procedures scrutinized, laparoscopic ovarian cystectomy emerged as the most frequently performed intervention. Diagnostic laparoscopy for tubal examination and ovarian drilling were also prominent procedures. The patient cohort spanned a wide age range, from 25 to 55 years, with an average age of 30.5 years. Preoperative ultrasound scans unveiled crucial findings such as polycystic ovaries and cysts of varying sizes. The analysis highlighted significant correlations between cyst size, wall thickness, operative duration, symptom duration, and conversion rates. The range of operative time spanned from 9 to 150 minutes, with an average of 40.1 minutes. While a few cases necessitated conversion from laparoscopy to open intervention, no instances of mortality were reported. The introduction of laparoscopic gynecological procedures in the Eastern Sudan regional hospital has ushered in enhanced surgical outcomes for specific conditions. However, to further elevate this practice, emphasis must be placed on augmenting medical staff training and optimizing infrastructure. Expanding the scope of laparoscopic procedures, particularly in emergency gynecology and major surgeries, is pivotal. These concerted efforts will not only facilitate the diffusion of laparoscopy but also contribute to elevated patient care standards and the overall advancement of surgical gynecology in the region.

Investigating Resistance to Carbapenems in Enterobacterales: A Descriptive Epidemiological Study of 2021 Screening in an Italian Teaching Hospital.

Antimicrobial resistance (AMR) presents a growing threat to global healthcare. This descriptive epidemiological study investigates the prevalence and characteristics of Enterobacterales with AMR factors in a tertiary teaching hospital in Italy over the course of the year 2021. In 2021, the prevalence of colonisation by Enterobacterales with AMR factors in patients was 1.08%. During the observation period, a total of 8834 rectal swabs were performed, with 1453 testing positive. A total of 5639 rectal swabs were performed according to a hospital procedure for the active screening of MDRO colonisation at the time of admission. Of these, 679 were positive for microorganisms under surveillance, and 74 patients were colonised with Enterobacterales, predominantly Klebsiella pneumoniae and Escherichia coli. Antibiotic resistance factors were observed in 61 of these 74 patients (82.43%) of these patients, with NDM and KPC being the most frequent resistance factors. A statistically significant trend in positive swabs was observed across different ward categories (surgery, ICUs, and medical wards). Regarding specific trends, the rate of positive admission screening in medical and surgical wards was higher than in ICU wards. The results highlight the ease with which Enterobacterales develops resistance across different ward categories. The findings underscore the need for adjusted screening protocols and tailored infection prevention strategies in various care settings.

Glycemic control metrics in a cohort of hospitalized patients with type 1 diabetes using hybrid closed-loop and advanced hybrid closed-loop systems

AimsTo describe Hybrid closed-loop (HCL) and advanced hybrid closed-loop (AHCL) performance in the hospital setting based on the continuous glucose monitoring (CGM) metrics description. MethodsThis was an observational study from a cohort of patients with T1D using HCL/AHCL with history of hospitalization. CGM metrics were analyzed during the hospital stay. CGM metrics sub-analysis of the population with active Automated Mode (AM) and SmartGuard (SG) during hospitalization and/or surgical procedure was performed. ResultsTwenty-four patients were included (50 % women; mean age, 49 years [inter-quartile range (IQR), 39–62 years]). During hospitalization 70.8 % patients achieved %Time in Range (TIR) between 70 and 180 mg/dL ≥ 70 %. The overall %TIR was 75.5 % (IQR, 67.3–81.5 %), % time below range (TBR) < 70 mg/dL was 2.1 % (IQR, 0.7–5.4 %) and %TBR < 54 mg/dL was 0 % (IQR, 0–5.4 %). Users of the AHCL with active SG achieved a non-significant higher %TIR during hospitalization (79 % [73.8.88 %] vs. 76 % [72.81 %], p = 0.312) and had a shorter stay (3[IQR, 2.4] vs. 6 days[IQR, 5.7], p = 0.045) compared to the users of the HCL with AM active. No device-related serious adverse events occurred for users of either system. ConclusionsHCL/AHCL systems with active AM/SG in patients with T1D in the hospital environment leads to %TIR > 70 % in ranges of 70–180 mg/dL in patients without increasing hypoglycemia.

678 The Safe Use of Intraoperative Tourniquets in Orthopaedic Procedures

Abstract Aim The use of intra-operative tourniquets in orthopaedic procedures is required to provide bloodless fields, enabling surgical procedures to be performed with improved quality, accuracy, and safety. Documentation of tourniquet use is necessary for optimising patient safety, as this provides an essential medico-legal role, as well as ensures the continuity of care for patients. Method All patients who had orthopaedic procedures in the local hospital in November 2022 were reviewed. There were a total of 123 procedures. 40 procedures required intra-operative tourniquet use were included in our study. The primary outcome is the documentation of tourniquet use, which includes the site of the tourniquet applied, the pressure, and the duration of tourniquet use. The secondary outcome is compliance with tourniquet use according to the national guidelines set by BOA Standards for Trauma and Orthopaedics (BOAST). This states the maximum authorized pressure, depending on the age (below/above 16), and the type of procedures (upper/lower limb). Results All procedures (N = 40) recorded the site of the tourniquet attached. 68% (27/40) of procedures recorded the length of the tourniquet use and 63%(25/40) recorded the maximum pressure applied. From the recorded procedures, the length of tourniquet use (N = 27) and maximum pressure applied (N = 25) is compliant with the national BOAST guideline regardless of the age group and type of procedures. Conclusions Overall this study highlighted the importance of documentation of tourniquet use for medico-legal purposes while demonstrating high compliance with the BOAST guidelines. This could ultimately overcome the challenges associated with intra-operative complications, thus optimising patient safety.

Benefits of Early Utilization of Palliative Care Consultation in Trauma Patients.

To determine the effects of palliative care consultation if performed within 72 hours of admission on length of stay (LOS), mortality, and invasive procedures. Retrospective observational study. Single-center level 1 trauma center. Trauma patients, admitted to ICU with palliative care consultation. None. The ICU LOS was decreased in the early palliative care (EPC) group compared with the late palliative care (LPC) group, by 6 days versus 12 days, respectively. Similarly, the hospital LOS was also shorter in the EPC group by 8 days versus 17 days in the LPC group. In addition, the EPC group had lower rates of tracheostomy (4% vs 14%) and percutaneous gastrostomy tubes (4% vs 15%) compared with the LPC group. There was no difference in mortality or discharge disposition between patients in the EPC versus LPC groups. It is noteworthy that the patients who received EPC were slightly older, but there were no other significant differences in demographics. EPC is associated with fewer procedures and a shorter amount of time spent in the hospital, with no immediate effect on mortality. These outcomes are consistent with studies that show patients' preferences toward the end of life, which typically involve less time in the hospital and fewer invasive procedures.

The Effectiveness of Music Therapy in Patients with Stress-Related Anxiety, Surgical Procedures and Other Related Diseases

The purpose of this research is to know the mechanism and the relationship between listening to music and overcoming anxiety. This literature writing uses the literature review method by searching the literature using the keywords Anxiety, Music therapy and Music Intervention in several databases that published within the last 10 years. All types of research related to anxiety and music therapy with human samples were included and studies with abstracts only, studies with animal research subjects and studies that did not report results in English were excluded. Analisis data tidak dilakukan pada penelitian ini. After the appropriate literature is found, the writing of the literature manuscript begins. The results of this study explain that one of the psychological interventions that can be done is music therapy. Music therapy is stated to be effective in reducing the level of anxiety in patients with anxiety, beneficial in reducing anxietas due to work, hospital procedures such as surgery and cancer.

Drug utilization pattern of analgesics after a surgical procedure in a tertiary care hospital: a prospective observational single centre cohort study

Background: the study aimed to understand the prescription pattern of analgesics used in the post-operative period after a general surgical procedure in a tertiary care hospital in India and estimate the severity of post-operative pain up to 48 hours. Such a study was not done in this institute of recent hence it was carried out. Methods: 266 adults of either gender were recruited and prescription pattern analyzed over a period of 1 year beginning January 2021 to December 2021 from the post-operative general surgery wards of a tertiary care hospital in India. Patient interview and records were used to collect data. Follow ups at 4, 24 and 48 hours were undertaken to assess pain according to the visual analogue scale (VAS) that was analyzed using the Friedman’s test followed by the post hoc Dunn’s test. Results: an average of 1.52±0.58 analgesics were prescribed per patient. Paracetamol was most commonly used followed by tramadol and diclofenac. All analgesics prescribed were a part of the national list of essential medicines. Effective pain management is feasible as seen by the significant (p&lt;0.0001) reduction in average pain score from 4.75±1.35 to 3.05±1.18 at 24 hours and further to 2.16±1.04 at 48 hours. Conclusions: Use of analgesics prescribed from a standardized list is effective in majority of patients.

Direct costs of blood drawings with pre-analytical errors in tertiary paediatric hospital care.

Blood drawings is a common hospital procedure involving laboratory and clinical disciplines that is important for the diagnosis and management of illnesses in children. Blood drawings with pre-analytical error (PAE) can lead to increased costs for hospitals and healthcare organisations. The direct cost of blood drawings after a PAE is not fully understood in paediatric hospital care. The aim of this study was to estimate the average direct cost of PAE per year and per 10,000 blood drawings in tertiary paediatric care. A cost analysis using a bottom-up approach was conducted on the basis of combined information from the hospital's laboratory register for the period 2013-2014 and clinical in-ward observations at a tertiary children's referral hospital in Sweden, the Astrid Lindgren Children's Hospital. For the analysis, we hypothesised the re-collection of all blood drawings with PAE and included the average costs of the sampling materials, the time of the healthcare personnel, the laboratory analyses, and in-ward premises based on the time spent on the blood sampling procedure. The annual cost of PAE was estimated to be 74,267 euros per 54,040 blood drawings, which corresponds to 13,756 euros per 10,000 blood drawings or 1.5 euros per draw. The personnel cost represented 60.1% (45,261 euros per year) of the cost due to PAE, followed by costs for hospitalisation (25.2%), laboratory analyses (8.1%), and materials (5.7%). PAEs lead to substantial increases in the costs in tertiary paediatric hospital care. If these PAEs can be avoided, costs related to the re-collection of blood drawings with PAE may be re-allocated to other health-promoting activities for children visiting hospital institutions.

FTP6.8 Impact of frailty on patients undergoing emergency surgeries under general anaesthesia in a district general hospital

Abstract Aims To assess the impact of frailty on the outcome of elderly patients underwent emergency surgical procedures in a district general hospital. Methods All patients above 65 years who underwent moderate/ major risk emergency surgical procedures from 1st of January 2022 to 31st of Dec 2022 were included in retrospective study. Data was collected from on call hand over and hospital electronic patients record system. Their ASA (American society of anaesthesiologist physical status classification) and P-POSSUM (Portsmouth- Physiological and operative severity score for the enumeration of mortality and morbidity) was calculated. Results Eighty-five patients (males:47, females:38) underwent emergency procedures in one year period. Age range was 65 to 90 years with mean age was 80.6 years. We performed 57 laparotomies, seven had laparoscopic bowel surgery. Other procedures were incarcerated hernias repair, appendectomies, lap/ open cholecystectomy/ cholecystostomy, debridement of necrotising fasciitis. Twenty-eight patients were frail (CFS 5-7) with mean ASA 3.4 and mean P-POSSUM mortality was 14.89. Fifty-seven patients were non frail with mean ASA 2.59 and P-POSSUM mortality was 16.12. Length of hospital stay was from 1 to 106 days, average being 13.7 days. Average length of stay for frail patients was 15.8 days and for non-frail was 12.9 days. Twelve patients died within 30 days of surgery or during the same admission, among them 54% were frail. Seventy five percent of mortalities were after bowel surgeries, mainly after stoma formation (both open and laparoscopic approach). Conclusions Clinical frailty scale is one of the predictors of prognosis along with other parameters and must be calculated at the time of admission.

SuperKid makes it easier: Effect of an intervention prepared with cognitive behavioral technique on reducing fear and pain of children during intravenous insertion

PurposeThe aim of this randomized controlled trial was to evaluate the effectiveness of a cognitive-behavioral SuperKid intervention, in reducing fear and pain among children undergoing intravenous insertion in outpatient services. Design and methodsThis study was designed as a randomized controlled trial, with 96 children aged 5–7 years. SuperKid intervention employed cognitive-behavioral techniques, implemented through a set of prepared cards. Fear was assessed using the Child Fear Scale, while pain status was measured using the Wong Baker Face Pain Scale. Scoring was performed by the mother, child, and researcher. Time series tests were conducted using the Wilks Lambda test. ResultsMost children in both the experimental and control groups reported fear regarding hospital procedures, particularly those involving pain and separation from their mothers. However, children in the experimental group who underwent the SuperKid intervention during and after IV insertion procedure experienced significantly less fear and pain than those in the control group. ConclusionsSuperKid intervention was found to be effective in reducing the procedural fear and pain of children undergoing intravenous insertion in outpatient services. The utilization of cognitive-behavioral techniques through a set of prepared cards provides an accessible and engaging means of alleviating negative emotional experiences among children undergoing medical/nursing procedures. Practice implicationsSuperKid intervention can potentially improve children's attitudes toward medical care and make future procedures easier for them. Healthcare providers could consider incorporating cognitive-behavioral interventions, such as the SuperKid intervention, into their clinical practice to reduce the fear and pain experienced by children during medical/nursing procedures.

Pancreatic duct filling during cholecystectomy intraoperative cholangiogram and incidence of postoperative pancreatitis

AbstractBackground and AimLaparoscopic cholecystectomy (LC) with intraoperative cholangiography (IOC) is a commonly performed surgical procedure in most hospitals. Anecdotal evidence suggests that when the pancreatic duct (PD) inadvertently fills during IOC, there may be an increased risk of postoperative pancreatitis (POP). However, there is a paucity of information in the literature about both the incidence of pancreatitis post LC and the incidence of PD filling on IOC and any potential relationship between the two.MethodsA retrospective review was performed of all LC performed in our institution over a 10‐year period. IOC images were reviewed and clinical data collated.ResultsOf the 1243 procedures identified, 952 had IOC images available for review and were included in the study. The incidence of POP was 0.7%. The incidence of PD filling was 13.4%. Patient's age, sex, urgency of surgery, preoperative liver function tests (LFTs), history of pancreatitis, contrast leakage, and preoperative endoscopic retrograde cholangiopancreatography (ERCP) were not statistically related to the incidence of POP. Of those with PD filling, 2% had POP versus 0.5% who had no PD filling. This trended toward significance on univariate analysis (P = 0.05). However, on logistic regression, POP was the only significant independent risk factor (P = 0.02).ConclusionThe incidence of pancreatitis post LC and IOC is low. PD filling is associated with increased incidence of pancreatitis in this scenario and it is crucial for clinicians to be aware of this potential risk. This retrospective study was based on the review of saved images, and therefore PD filling might have been underestimated. Prospective studies would be useful to ascertain any definitive clinical association.

Preliminary results of a new surgical technique: bladder mucosal graft harvested with holmium:YAG (HO:YAG) laser. A new option in bulbar replacement urethroplasty?

To describe the technique of transurethral harvesting of bladder mucosal graft using the Holmium:YAG (Ho-YAG) laser and describe the preliminary results from 7 cases where this graft was used for urethroplasty. We performed a single-stage dorsal onlay urethroplasty using bladder mucosal graft in 7 patients with anterior urethral stricture. Transurethral harvesting was performed with the Ho-YAG laser. We performed a prospective and descriptive analysis with uroflowmetry performed at 30, 90 and 180 days after surgery and applied the PROM translated into Portuguese before and 6 months after urethroplasty. Seven patients were included, 2 (28.5%) with penile urethral stricture, and 5 (71.5%) with bulbar urethral stricture. Mean stricture length was 50mm (range 35-60mm). Stricture etiology was trauma in 3 (42.9%) patients, iatrogenic in 1 (14.3%) patient, and idiopathic in 3 (42.9%) patients. Two patients (28.6%) had previously undergone ventral buccal mucosa urethroplasty. Mean bladder mucosal graft length was 52.86mm (± 13.801), and mean harvest time was 46.43min (± 14.639). Dorsal onlay urethroplasty using bladder mucosa was successfully completed in 5 patients (71.4%). Two patients (28.6%) couldn't have the procedure completed using bladder mucosa, one due to thermal damage of the graft during harvesting, and one due to insufficient graft length. In both cases the procedure was completed using buccal mucosa. Two patients (28.6%) experienced minor hematuria between the twelfth and eighteenth postoperative day, but neither required hospitalization and/or additional procedures. All patients achieved normalization of peak flow, and this was maintained throughout the follow-up period. Mean peak flow was 17.8 ml/s (± 3.271) at 30 days, 20.6 ml/s (± 5.413) at 90 days, and 19.6 ml/s (± 8.019) 180 days. Mean IPSS score decreased from 19.3 to 5.4. Similar improvements were also seen in the ICIQ-MLUTS Score (a mean drop from 3.8 to 2.0) and Peeling's Voiding Picture Score (a mean drop from 4.0 to 2.2). Quality of Life improved post urethroplasty, with increases in EQ-5D (from 0.6371 to 0.7285) and EQ-VAS (from 58.0 to 84.0). Transurethral harvesting of bladder mucosa using the Holmium laser (Ho-YAG) is feasible and reproducible. Our preliminary experience suggests that bladder mucosa grafts achieve comparable results to other grafts when used for dorsal onlay urethroplasty. Further research is needed to confirm these results.

Combination of AROM with deep breathing exercise against fatigue and quality of life of hemodialysis patients; an experimental study

Introduction: In hemodialysis patients, the main problem that often occurs is experiencing fatigue. Untreated fatigue conditions have an impact on decreasing quality of life. Objectives: In this study, we aimed to analyse the effect of the combination of AROM with deep breathing on fatigue and quality of life in the Jemursari Islamic hospital of Surabaya. Patients and Methods: This study is a quasi-experimental investigation with a pre-post-test control group design. The population was 244 of all hemodialysis patients at our hospital. The research sample was 220 respondents, 110 respondents in the intervention group and the control group. The intervention group was given a combination of active range of motion (AROM) and deep breathing exercises for 30 minutes daily for one month. Meanwhile, the control group was assigned training according to hospital procedures. Results: The results showed that almost all of the intervention group (96.4%) had mild fatigue and almost half (40%) had good quality of life. In the control group, most participants (54.5%) experienced severe fatigue, and most (53.6%) experienced a poor quality of life. Data analysis showed that the combination of AROM with deep breathing affected hemodialysis patients’ fatigue and quality of life (P =0.000), which means that the combination of AROM with deep breathing affects the fatigue and quality of life of hemodialysis patients. Conclusion: A combination of air exercise regularly can reduce fatigue levels and improve quality of life. Nurses can provide a combination of AROM with deep breathing exercises in hemodialysis patients as an exercise program for hemodialysis patients.

Increasing Antimicrobial Resistance of Gram-Positive Cocci in the Nostrils of Health Care Workers in the Post–COVID-19 Era Compared to Pre–COVID-19 Era in North Khorasan, Iran

Background: In the COVID-19 era, co-infections can lead to an increase in morbidity and mortality. Normal flora bacteria can transfer to the pulmonary tract and create bacterial co-infections. The nasal cavity is one of the main areas housing normal flora in the human body. Objectives: In this study, we evaluated the prevalence and antibiotic resistance of gram-positive cocci in the pre– and post–COVID-19 eras among health care workers. Methods: We assessed 376 nasal swabs from the pre–COVID-19 era and 376 from the post–COVID-19 era. Conventional and molecular methods were used to identify bacterial types and evaluate antimicrobial resistance. Results: The most common gram-positive cocci in the pre–COVID-19 samples were Staphylococcus aureus, S. epidermidis, S. capitis, S. hominis, S. haemolyticus, Streptococcus pneumoniae, and Enterococcus faecalis. In the post–COVID-19 samples, the most common gram-positive cocci were S. aureus, S. epidermidis, S. warneri, S. hominis, and E. faecalis. We observed higher resistance rates in post–COVID-19 samples, as well as resistance to linezolid and vancomycin in S. aureus, S. epidermidis, and S. hominis. Additionally, our isolates showed a high resistance rate to antiseptics. Conclusions: It seems that after the beginning of the COVID-19 pandemic, due to the change in the protective procedures in hospitals, the prevalence and variety of bacteria have decreased, but instead, they have been replaced by more pathogenic bacteria with higher antibiotic resistance.

Direct-Acting Antivirals and the Risk of Arrhythmias and Conduction Disorders in Patients with Chronic Hepatitis C: A French Nationwide Cohort Study.

To quantify the risk of arrhythmias and conduction disorders (ACD) in patients receiving direct-acting antiviral (DAA) therapy for hepatitis C. All individuals aged 18 to 85 years old treated with DAAs between 01 January 2014 and 31 December 2021 were selected from the French national healthcare database (SNDS). Individuals with a history of ACD were excluded. The primary outcome was the incidence of hospitalization or medical procedure for ACD. Marginal structural models were used to adjust for age, sex, medical comorbidities, and concomitant medications. After analyzing 87,589 individuals (median age, 52 years; 60% male) from 01 January 2014 to 31 December 2021, 2131 hospitalizations or medical procedures for ACD were observed over 672,572 person-years (PY) of follow-up. The incidence of ACD was 245/100,000 PY [95% confidence interval (CI), 228-263/100,000 PY] before DAA and 375/100,000 PY (95% CI 355-395/100,000 PY) after DAA exposure (rate ratio 1.53; 95% CI 1.40-1.68; P < 0.001). The risk of ACD was increased after DAA exposure, compared with the pre-DAA period (adjusted hazard ratio,1.66; 95% CI 1.43-1.93; P < 0.001). The increase in ACD risk was similar among individuals treated with sofosbuvir-based and sofosbuvir-free regimens. Of the 1398 ACD detected after DAA exposure, 30% were hospitalizations for atrial fibrillation, 25% were medical procedures for ACD, and 15% were hospitalizations for atrioventricular blocks. A significant increase in the risk of ACD was observed in the population-level cohort of individuals treated with DAAs, regardless of the regimen. Further research is needed to identify patients at risk of ACD, determine cardiac monitoring strategies, and evaluate the need for Holter monitoring after DAA therapy.

Predictive Risk Factors for Childbirth-Associated Breast Infections in the United States: A 10-Year Perspective.

Infectious mastitis is a common condition that affects up to 33% of lactating women. Several risk factors have been suggested to be strongly associated with breast abscess, nipple infection, and non-purulent mastitis associated with childbirth. In this retrospective cohort study, we gathered data from the National Inpatient Sample (NIS) between 2005 and 2014 and utilized data stratification and backward linear regression to analyze the predictive factors associated with patients hospitalized with breast infection after childbirth, with special consideration of risk factors affecting hospital length of stay (LOS). In the ten-year period, 4614 women were hospitalized with a primary diagnosis of breast abscess, nipple infection, or non-purulent mastitis associated with childbirth. Mean (SD) age was 26.75 (6) years. The highest frequency distribution of cases was observed in patients aged 22-30 years (49.82%). Mean (SD) LOS was 2.83 (1.95) days. Mean (SD) LOS in patients with procedure was 3.53 (2.47) days, which was significantly longer than that in those with no procedure (2.39 (1.36) days, p < 0.001). Primary diagnosis of breast abscess and occurrence of a hospital procedure were most significantly associated with prolonged LOS. Factors such as age, socioeconomic position, severity of functional loss, as well as comorbidities were also contributing risk factors to the development of breast infection and increased hospital LOS. Further studies should examine these findings, as they relate to breastfeeding practices and concentrate on establishing best practices for risk reduction and prevention of childbirth-associated breast and nipple infections and hospitalizations.