Morbidity Costs Research Articles

37 Evaluation of Prophylactic Negative Pressure Wound Therapy Versus Standard Surgical Dressings on Wound Outcomes in Posterior Spinal Surgery Patients: A Systematic Review and Meta-Analysis

Abstract Aim Negative pressure wound therapy has frequently been used in a variety of surgical specialities, yet its effectiveness as a prophylactic therapy in spinal surgery remains unclear. A comprehensive systematic review and meta-analysis was performed, incorporating the most recent evidence, addressing this paucity in the literature. Method A systematic search of the literature from inception to June 2023 was conducted using the following databases: Ovid Medline, EMBASE, Cochrane Register of Controlled Trials (CENTRAL) and Web of Science. All included studies assessed primary wound closure for posterior spinal surgical incisions. Evidence was quality assessed and outcomes of interest were meta-analysed using odds ratios, comparing negative pressure wound therapy and standard dressing groups. Results Seven studies (n = 1319, mean age = 59.9 years, 55.8% male) were included. Patients with negative pressure dressings had a reduced risk of surgical site infection (odds ratio = 0.45, 95% CI 0.29 to 0.72, p < 0.001). Wound dehiscence approached significance favouring negative pressure dressings (odds ratio = 0.53, 95% CI 0.26 to 1.06, p = 0.07). Patients requiring a return to theatre for wound related complications showed no significant difference between groups (odds ratio = 0.66, 95% CI 0.37 to 1.18, p = 0.16). Conclusions Negative pressure wound therapy reduces the risk of surgical site infection in posterior spinal surgery patients. Given that surgical site infection in spine surgery is associated with significant morbidity and financial costs, implementation of prophylactic negative pressure wound therapy for this patient demographic may be beneficial.

Effects of Heart Failure Therapies on Atrial Fibrillation: Biological and Clinical Perspectives.

Heart failure (HF) and atrial fibrillation (AF) are prevalent cardiovascular diseases that contribute significantly to morbidity, mortality, hospitalisation, and healthcare costs. It is not uncommon for these conditions to coexist and have mutually reinforcing effects. A critical factor in the aetiology of these conditions is oxidative stress, driven by reactive oxygen species (ROS), which contributes to atrial remodelling and fibrosis. The recent introduction of new drugs for the treatment of heart failure has also had an impact on the management of atrial fibrillation due to their influence on oxidative stress. The objective of this review is to analyse the effects of these therapies, including their role in mitigating ROS, on the prevention and treatment of AF in HF patients.

Falls prevention in older people and the role of nursing.

Falls among older individuals pose a significant public health challenge globally, impacting both individual wellbeing and healthcare systems. This article examines the importance of falls prevention in older people and the pivotal role of nursing in this domain. It presents statistics indicating the high prevalence of falls among older adults, highlighting their substantial impact on morbidity, mortality and healthcare costs. Furthermore, it discusses the multifactorial nature of fall risk factors, including age-related changes, chronic health conditions, medication use, impaired mobility, sensory deficits and environmental hazards. Nursing interventions encompass comprehensive assessments, personalised care plans, patient education and advocacy efforts aimed at reducing fall risks and enhancing safety. By addressing intrinsic and extrinsic factors contributing to falls, nurses contribute significantly to improving the quality of life for older adults and reducing the economic burden associated with fall-related injuries.

Association between heat and upper urinary tract stones morbidity and medical costs: A study in the subtropical humid climate zone

Urolithiasis is a heat-specific disease. Exploring heat-related urolithiasis susceptibility subtypes, economic burden, and modifying factors could assist governments in targeting interventions to reduce the heat-related health risks of urolithiasis morbidity. We collected data on 23,492 patients with upper urinary tract stones (main subtypes of urolithiasis) from 2013 to 2017 in Nanjing, China. We adopted generalized additive quasi-Poisson models to examine the associations between daily mean temperatures and morbidity of upper urinary tract stones, while generalized additive Gaussian models were used to explore the relationships between temperatures and log-transformed medical costs. We examined the modification effects of disease subtypes (kidney and ureteral calculus), sex, and age through stratified analyses and the modification effects of other meteorological factors by introducing interaction terms in the models. We found that short-term summer heat exposure has a statistically significant effect on ureteral calculus morbidity but not on kidney calculus morbidity. For ureter calculus, a 1 °C temperature increase was associated with a 4.36% (95% confidence interval [CI]: 1.94%, 6.83%) increase in daily hospitalization and a 5.44% (95% CI: 2.71%, 8.25%) increase in daily medical costs. The attributable fraction associated with heat (greater than the median value of daily mean temperature, 26.8 °C) was 7.85% (95% empirical confidence interval [eCI]: 3.64%, 11.44%) for hospitalization and 9.36% (95% eCI: 4.91%, 13.14%) for medical costs. The effects of heat on ureter calculus morbidity were significantly higher among the males and those with high sunshine duration than females and those with low sunshine duration. Short-term summer heat exposure was associated with increased morbidity and medical costs of ureteral calculus. Relevant government organizations should take effective intervention measures, including community health education, to reduce the health hazards and economic losses caused by heat.

Beyond clinical trials – The cost saving associated with dapagliflozin use in Portugal hospital clinical practice

Introduction and objectivesHeart failure (HF) is a clinical syndrome associated with substantial morbidity, mortality, and healthcare costs. Dapagliflozin has proven efficacy in reducing the risk of death and hospitalization in HF patients, regardless of left ventricular ejection fraction (LVEF). This paper aimed to project the potential impact of dapagliflozin on healthcare costs related to HF subsequent hospitalizations (HFHs) in Portuguese hospitals. MethodsThe total number of HF-related hospitalizations (hHF), HFHs, and the average length of stay for patients with a primary diagnosis of HF from six Portuguese hospitals, between January 2019 and December 2021, were collected and aggregated by hospital classification. Costs associated with HFHs were calculated according to Portuguese legislation and considering conservative, average, and complex approaches. Cost-saving projections were based on extrapolations from hHF risk reductions reported in dapagliflozin clinical trials. ResultsConsidering a 26% risk reduction in hHF reported on pooled-analysis of DAPA-HF and DELIVER as the expected reduction in HFHs, the use of dapagliflozin would be associated with cost savings ranging from EUR 1612851.54 up to EUR 6587360.09, when considering all hospitals and the different approaches, between 2019 and 2021. A similar projection is observed based on 24% RRR derived by weighting DAPA-HF and DELIVER sub-analyses and PORTHOS epidemiological data. ConclusionsIn this projection, dapagliflozin use in all eligible hHF patients is associated with a significant reduction in direct costs. Our data support that, in addition to the improvements in HF-related outcomes, dapagliflozin may have a significant economic impact on healthcare costs in Portuguese hospitals.

Risk Factors for 90-Day Readmission Among Patients with Metastatic Spine Tumors in South Korea: A Nationwide Population-Based Study

Population-based studies on the cause of readmission within 90 days after surgery or radiotherapy for metastatic spine tumors are scarce. We aimed to investigate the risk factors for readmission within 90 days after initial surgical or radiation treatment for metastatic spine tumors. Patients who were diagnosed with metastatic spine tumors between 2012 and 2019 and underwent spinal magnetic resonance imaging within 1 year were classified according to treatment (surgical or radiotherapy groups), and the causes of the 90-day readmission and patient characteristics were compared. Overall, data from 15,815 patients (surgical group, 13,974 patients; radiotherapy group, 1,841 patients) were evaluated. Radiotherapy was preferred in younger and male patients with a high Charlson Comorbidity Index (CCI), whereas surgery was mainly performed in patients with lumbar metastasis. Radiotherapy, age of 30-69 years, male sex, and CCI > 1 increased the risk of 90-day readmission in patients with metastatic spine tumors. The main causes of 90-day readmission among patients with metastatic spine tumors who received radiotherapy included tumor recurrence, chemotherapy, radiotherapy, and treatment of other organ metastases with radiotherapy. These study findings offer a better understanding of the causes of readmission following radiotherapy or surgical treatment in patients with metastatic spine tumors, and these results can help reduce postoperative morbidity and medical costs among these patients.

Perioperative Albumin Among Adults Undergoing Thoracic Surgery in the United States: Utilization, Associations With Clinical Outcomes, and Contribution to Hospital Costs

Objectives: To estimate the use of albumin among adults undergoing thoracic surgery in the United States, compare baseline characteristics, clinical and cost outcomes of recipients versus non-recipients, and determine albumin's contribution to total hospital costs. Design: Retrospective cohort study. Setting: Nationwide sample of US hospitals. Participants: Adults undergoing open and minimally invasive thoracic surgery between 2011 and 2017. Interventions: Albumin on the day of surgery (identified using itemized hospital billing logs). Measurements and Main Results: Albumin was used in 170 of 342 US hospitals, among 13% and 7% of 14672 and 22532 patients who respectively underwent open and minimally invasive thoracic surgery (median volume 500cc). Baseline comorbidities and organ supportive treatments were several-fold more prevalent among recipients (particularly vasopressors, mechanical ventilation, red cell transfusions). In standardized mortality ratio propensity score weighted analysis, albumin use was not associated with in-hospital mortality (adjusted RR 1.17 [0.72, 1.92] and 1.51 [0.97, 2.34], with open and minimally procedures), but was associated with morbidity and higher costs, more so with minimally invasive than open surgery. Total costs among recipients were higher by $4,744 [$3,591, $5,897] and $5,088 [$4,075, $6,100] for open and minimally invasive procedures respectively. Albumin accounted for 2.6% of this difference (median $124 [$83-$189] per patient). Conclusions: Albumin use varies widely across hospitals, and 9% of patients receive it (median 500cc). Use was not associated with in-hospital mortality and was associated with more morbidity and cost. The cost of albumin accounted for a trivial portion of hospital costs. Clinical trials must examine effects of albumin on complications and costs after thoracic surgery.

Evaluation of General Surgery Physicians' Approaches to Surgical Antimicrobial Prophylaxis by Questionnaire Method

Introduction: Surgical site infections (SSIs) are infections of the incision site, organ or cavity that occur after surgery, causing a significant burden in terms of morbidity, mortality and healthcare costs. SSIs are the most common healthcare-associated infections in low- and middle-income countries and may affect one-third of surgical patients. This study aimed to conduct a face-to-face survey to evaluate general surgeons' approaches and knowledge levels before and after the training seminar on the use of surgical antimicrobial prophylaxis (SAP). Material and Method: An information-oriented questionnaire consisting of 10 questions was administered to a total of 18 surgeons working a General Surgery Department before and after the education meeting to evaluate their knowledge and attitudes towards the use of SAP. Data were presented as number, percentage, mean (standard deviation) and Fisher exact test was used to compare categorical data. Results: All participants answered the question regarding the time of prophylactic antibiotic administration correctly in both surveys. According to the current American Society of Health-System Pharmacists (ASHP) guideline for cefazolin, 42.2% of the patients had the correct time of antibiotic administration. The proportion of patients whose cefazolin selection, dose and time of administration were appropriate was 14.6%. The number of physicians who thought that postoperative antibiotic prophylaxis was not significantly increased from 16 (88.8%) before the meeting to 18 (100%) after the meeting (p>0.05). In our study, the number of patients who continued to be given antibiotics unnecessarily postoperatively was 66 (16.4%). Conclusion: In order to increase the rate of optimal application of the theoretical knowledge to patients in practice, it is important to organize routine trainings based on current literature and service data for surgeons with a high workload and to follow the reflection of these trainings to the clinic in order to improve SAP compliance rates.

Medical weight loss in older persons with obesity.

The prevalence of individuals with obesity or overweight has steadily increased over the past decades both worldwide, and in the United States. This trend is also evident in the older adult population, which has experienced a continuous rise in the number of individuals with overweight or obesity. This is relevant due to the impact of obesity in older adults' quality of life, physical function, morbidity, and healthcare costs. This review aims to provide practical guidance and currently available approaches for healthcare professionals in managing this population. Both non-pharmacological methods such as intensive behavioural therapy, nutritional interventions, and physical activity, as well as anti-obesity medications, are discussed, with a focus on their potential positive and negative effects in older adults. Additionally, bariatric therapy is evaluated, including current procedures available and the associated results and risks in the older population.

Macrophage-derived CD36 + exosome subpopulations as novel biomarkers of Candida albicans infection

Invasive candidiasis (IC) is a notable healthcare-associated fungal infection, characterized by high morbidity, mortality, and substantial treatment costs. Candida albicans emerges as a principal pathogen in this context. Recent academic advancements have shed light on the critical role of exosomes in key biological processes, such as immune responses and antigen presentation. This burgeoning body of research underscores the potential of exosomes in the realm of medical diagnostics and therapeutics, particularly in relation to fungal infections like IC. The exploration of exosomal functions in the pathophysiology of IC not only enhances our understanding of the disease but also opens new avenues for innovative therapeutic interventions. In this investigation, we focus on exosomes (Exos) secreted by macrophages, both uninfected and those infected with C. albicans. Our objective is to extract and analyze these exosomes, delving into the nuances of their protein compositions and subgroups. To achieve this, we employ an innovative technique known as Proximity Barcoding Assay (PBA). This methodology is pivotal in our quest to identify novel biological targets, which could significantly enhance the diagnostic and therapeutic approaches for C. albicans infection. The comparative analysis of exosomal contents from these two distinct cellular states promises to yield insightful data, potentially leading to breakthroughs in understanding and treating this invasive fungal infection. In our study, we analyzed differentially expressed proteins in exosomes from macrophages and C. albicans -infected macrophages, focusing on proteins such as ACE2, CD36, CAV1, LAMP2, CD27, and MPO. We also examined exosome subpopulations, finding a dominant expression of MPO in the most prevalent subgroup, and a distinct expression of CD36 in cluster14. These findings are crucial for understanding the host response to C. albicans and may inform targeted diagnostic and therapeutic approaches. Our study leads us to infer that MPO and CD36 proteins may play roles in the immune escape mechanisms of C. albicans. Additionally, the CD36 exosome subpopulations, identified through our analysis, could serve as potential biomarkers and therapeutic targets for C. albicans infection. This insight opens new avenues for understanding the infection's pathology and developing targeted treatments.

Accurate Modeling of Ejection Fraction and Stroke Volume With Mobile Phone Auscultation: Prospective Case-Control Study.

Heart failure (HF) contributes greatly to morbidity, mortality, and health care costs worldwide. Hospital readmission rates are tracked closely and determine federal reimbursement dollars. No current modality or technology allows for accurate measurement of relevant HF parameters in ambulatory, rural, or underserved settings. This limits the use of telehealth to diagnose or monitor HF in ambulatory patients. This study describes a novel HF diagnostic technology using audio recordings from a standard mobile phone. This prospective study of acoustic microphone recordings enrolled convenience samples of patients from 2 different clinical sites in 2 separate areas of the United States. Recordings were obtained at the aortic (second intercostal) site with the patient sitting upright. The team used recordings to create predictive algorithms using physics-based (not neural networks) models. The analysis matched mobile phone acoustic data to ejection fraction (EF) and stroke volume (SV) as evaluated by echocardiograms. Using the physics-based approach to determine features eliminates the need for neural networks and overfitting strategies entirely, potentially offering advantages in data efficiency, model stability, regulatory visibility, and physical insightfulness. Recordings were obtained from 113 participants. No recordings were excluded due to background noise or for any other reason. Participants had diverse racial backgrounds and body surface areas. Reliable echocardiogram data were available for EF from 113 patients and for SV from 65 patients. The mean age of the EF cohort was 66.3 (SD 13.3) years, with female patients comprising 38.3% (43/113) of the group. Using an EF cutoff of ≤40% versus >40%, the model (using 4 features) had an area under the receiver operating curve (AUROC) of 0.955, sensitivity of 0.952, specificity of 0.958, and accuracy of 0.956. The mean age of the SV cohort was 65.5 (SD 12.7) years, with female patients comprising 34% (38/65) of the group. Using a clinically relevant SV cutoff of <50 mL versus >50 mL, the model (using 3 features) had an AUROC of 0.922, sensitivity of 1.000, specificity of 0.844, and accuracy of 0.923. Acoustics frequencies associated with SV were observed to be higher than those associated with EF and, therefore, were less likely to pass through the tissue without distortion. This work describes the use of mobile phone auscultation recordings obtained with unaltered cellular microphones. The analysis reproduced the estimates of EF and SV with impressive accuracy. This technology will be further developed into a mobile app that could bring screening and monitoring of HF to several clinical settings, such as home or telehealth, rural, remote, and underserved areas across the globe. This would bring high-quality diagnostic methods to patients with HF using equipment they already own and in situations where no other diagnostic and monitoring options exist.

Leveraging machine learning to develop a postoperative predictive model for postoperative urinary retention following lumbar spine surgery.

Postoperative urinary retention (POUR) is the inability to urinate after a surgical procedure despite having a full bladder. It is a common complication following lumbar spine surgery which has been extensively linked to increased patient morbidity and hospital costs. This study hopes to development and validate a predictive model for POUR following lumbar spine surgery using patient demographics, surgical and anesthesia variables. This is a retrospective observational cohort study of 903 patients who underwent lumbar spine surgery over the period of June 2017 to June 2019 in a tertiary academic medical center. Four hundred and nineteen variables were collected including patient demographics, ICD-10 codes, and intraoperative factors. Least absolute shrinkage and selection operation (LASSO) regression and logistic regression models were compared. A decision tree model was fitted to the optimal model to classify each patient's risk of developing POUR as high, intermediate, or low risk. Predictive performance of POUR was assessed by area under the receiver operating characteristic curve (AUC-ROC). 903 patients were included with average age 60 ± 15 years, body mass index of 30.5 ± 6.4 kg/m2, 476 (53%) male, 785 (87%) white, 446 (49%) involving fusions, with average 2.1 ± 2.0 levels. The incidence of POUR was 235 (26%) with 63 (7%) requiring indwelling catheter placement. A decision tree was constructed with an accuracy of 87.8%. We present a highly accurate and easy to implement decision tree model which predicts POUR following lumbar spine surgery using preoperative and intraoperative variables.

A novel web-based risk calculator for predicting surgical site infection in HIV-positive facture patients: a multicenter cohort study in China.

Surgical site infection (SSI) is a common complication in HIV-positive fracture patients undergoing surgery, leading to increased morbidity, mortality, and healthcare costs. Accurate prediction of SSI risk can help guide clinical decision-making and improve patient outcomes. However, there is a lack of user-friendly, Web-based calculator for predicting SSI risk in this patient population. This study aimed to develop and validate a novel web-based risk calculator for predicting SSI in HIV-positive fracture patients undergoing surgery in China. A multicenter retrospective cohort study was conducted using data from HIV-positive fracture patients who underwent surgery in three tertiary hospitals in China between May 2011 and September 2023. We used patients from Beijing Ditan Hospital as the training cohort and patients from Chengdu Public Health and Changsha First Hospital as the external validation cohort. Univariate, multivariate logistic regression analyses and SVM-RFE were performed to identify independent risk factors for SSIs. A web-based calculator was developed using the identified risk factors and validated using an external validation cohort. The performance of the nomogram was evaluated using the area under the receiver operating characteristic (AUC) curves, calibration plots, and decision curve analysis (DCA). A total of 338 HIV-positive patients were included in the study, with 216 patients in the training cohort and 122 patients in the validation cohort. The overall SSI incidence was 10.7%. The web-based risk calculator (https://sydtliubo.shinyapps.io/DynNom_for_SSI/) incorporated six risk factors: HBV/HCV co-infection, HIV RNA load, CD4+ T-cell count, Neu and Lym level. The nomogram demonstrated good discrimination, with an AUC of 0.890 in the training cohort and 0.853 in the validation cohort. The calibration plot showed good agreement between predicted and observed SSI probabilities. The DCA indicated that the nomogram had clinical utility across a wide range of threshold probabilities. Our study developed and validated a novel web-based risk calculator for predicting SSI risk in HIV-positive fracture patients undergoing surgery in China. The nomogram demonstrated good discrimination, calibration, and clinical utility, and can serve as a valuable tool for risk stratification and clinical decision-making in this patient population. Future studies should focus on integrating this nomogram into hospital information systems for real-time risk assessment and management.

The economic impact of tobacco smoking and secondhand smoke exposure in Jordan: estimating the direct and indirect costs

Aim To quantify the economic burden associated with tobacco smoking among smokers aged 30-69 years, and second-hand smokers (SHS) aged 15-69 years in Jordan. Materials and methods A prevalence-based analysis was conducted in alignment with the Economics of Tobacco Toolkit developed by the WHO. The time-horizon of the analysis was one year (2019). Direct and indirect costs were estimated using data from the 2019 Global Burden of Diseases study. The analysis targeted the Jordanian population of smokers aged 30–69 years, and SHS aged 15-69 years. Adjustments were applied for age, gender, and smoking-related diseases. Direct costs were estimated using the smoking-attributable fraction (SAF) and national health expenditures. Indirect costs were divided into morbidity and mortality components. A discount rate of 3.0% and an annual productivity growth rate of 1.0% were assumed in modelling future economic losses. A sensitivity analysis was conducted on the lower and upper estimates of data used in this study. Results The cost of tobacco smoking and SHS exposure was estimated at US$2,108 million (95% confidence interval [CI] = US$2,003 million-US$2,245 million). This represents 4.7% (95%CI = 4.5%–5.0%) of national gross domestic product (GDP). Direct costs accounted for 3.1% of national GDP. Tobacco smoking accounted for 85.0% of total cost and SHS exposure accounted for 15.0% of total cost. Direct costs accounted for 67.0% of total cost, while indirect morbidity and mortality costs accounted for 9.0% and 24.0% of total cost, respectively. Non-communicable diseases accounted for 96.0% of total direct costs compared to communicable diseases (4.0% of total direct costs). Conclusions Smoking cessation interventions such as raising taxes on cigarettes, protecting people from tobacco smoke, warning labels, plain packaging, and bans on advertising, are crucial for controlling national expenditures for treating smoking-related diseases and for averting future economic losses.

Assessment of knowledge, and practices of urban women towards folic acid fortified maize meal in Zimbabwe

Neural tube defects (NTDs) are the second most common birth defects in humans and are associated with high rates of neonatal mortality, morbidity, disability, psychological and economic costs. Roughly 200,000 neonates are born with NTDs in low- and middle-income countries. To reduce the risks associated with NTDs, pregnant women are recommended to supplement their diets with folate tablets or to consume foods fortified with folic acid. Despite the introduction of a mandatory fortification program of maize meal with folic acid, in Zimbabwe, there is a paucity of literature about the perceptions of individuals towards fortified foods, as well as the storage and processing practices of fortified maize meal. This study aimed to assess the knowledge, as well as, storage and processing practices of folic acid-fortified maize meal in urban poor women. Data on knowledge and practices on fortified maize was gathered using a structured questionnaire from 630 women of childbearing age from low-income suburbs in Kwekwe town, Zimbabwe. The results showed that a paltry 26.3% of the respondents knew about folic acid, 22.5% knew about the effects of folic acid deficiency, 13.8% knew foodstuffs containing folic acid, 4% knew about food fortification and 35.6% had bought and used folic acid fortified maize meal before. Availability and accessibility were the main drivers to purchasing fortified maize meal (90%). There was no significant relationship (p &lt; 0.05) between age and folic acid knowledge as well as between level of education and folic acid knowledge. Furthermore, the result indicates that the households were engaged in poor storage practices of the folic acid fortified maize meal. There was a significant relationship between the level of education and knowledge about food fortification. In conclusion, urban women's knowledge regarding folic acid and fortified maize meal is very low in Zimbabwe and households also store the folic acid fortified maize meal under conditions that speed deterioration of the folic acid. Folic acid awareness campaigns are recommended for people to benefit from the government of Zimbabwe's fortification programme. Key words: Neural tube defects, maize, folate, deficiency, fortification, women

Synthesis of high-performance antibacterial agent based on incorporated vancomycin into MOF-modified lignin nanocomposites

The alarming rise in antibiotic resistance necessitates urgent action, particularly against the backdrop of resistant bacteria evolving to render conventional antibiotics less effective, leading to an increase in morbidity, mortality, and healthcare costs. Vancomycin-loaded Metal-Organic Framework (MOF) nanocomposites have emerged as a promising strategy in enhancing the eradication of pathogenic bacteria. This study introduces lignin as a novel synergistic agent in Vancomycin-loaded MOF (Lig-Van-MOF), which substantially enhances the antibacterial activity against drug-resistant bacteria. Lig-Van-MOF exhibits six-fold lower minimum inhibitory concentration (MICs) than free vancomycin and Van-MOF with a much higher antibacterial potential against sensitive and resistant strains of Staphylococcus aureus and Escherichia coli. Remarkably, it reduces biofilms of these strains by over 85 % in minimal biofilm inhibitory concentration (MBIC). Utilization of lignin to modify surface properties of MOFs improves their adhesion to bacterial membranes and boosts the local concentration of Reactive Oxygen Species (ROS) via unique synergistic mechanism. Additionally, lignin induces substantial cell deformation in treated bacterial cells. It confirms the superior bactericidal properties of Lig-Van-MOF against Staphylococcus species, underlining its significant potential as a bionanomaterial designed to combat antibiotic resistance effectively. This research paves the way for novel antibacterial platforms that optimize cost-efficiency and broaden microbial resistance management applications.

ROLE OF INTERVENTION STRATEGIES AND PSYCHOLOGICAL EFFECT ON THE CONTROL OF INFECTIOUS DISEASES IN THE RANDOM ENVIRONMENT

Infectious disease outbreaks have caused significant losses to populations worldwide in terms of morbidity, social and economic costs. This has prompted governments to seek suitable intervention policies to suppress the outbreaks. This paper aims to explore the intrinsic impact of intervention strategies and the psychological behavior of people on the spread of infectious diseases. Employing the finite state Markov chain, we formulate a new stochastic SIS epidemic model under regime switching by using the Beddington–DeAngelis transmission function, in the presence of some governmental control measures. The study of the model is centered on three different scenarios in terms of varying two control parameters. We analyze the deterministic system for the global dynamics in terms of basic reproductive number. Some new threshold parameters are defined to discuss the extinction and the persistence of the disease in the stochastic setting. Numerical assessments were undertaken to validate theoretical findings for the deterministic and stochastic systems. Our findings strongly suggest that heightened awareness among susceptible individuals contributes significantly to the eradication of infection and fosters a stable epidemiological situation. As levels of public awareness increase, particularly within the susceptible population, a discernible trend toward the eradication of the infection emerges, ultimately ensuring sustained stability within the epidemiological landscape.

Non-infective post-mastectomy complications: A comparison of outcomes of sharp and electrocautery dissection for modified radical mastectomy

Objectives Post-mastectomy seroma and haematoma increase morbidity and overall healthcare costs among patients undergoing mastectomy. Electrocautery and scissors are tools frequently used to raise the flap during mastectomy, each having advantages and disadvantages as to forming seroma and haematoma. The present study compared the incidence and volume of post-mastectomy seroma and haematoma following sharp and electrocautery dissection in mobilising flaps. Material and Methods A two-centre prospective, randomised comparative study involving patients with histologically diagnosed breast cancer who underwent mastectomy. Participants were randomly divided into two groups. Group A had electrocautery dissection and haemostasis, while group B had scissors dissection and haemostasis achieved by ligation and pressure packing. Seroma and haematoma formation, including Volume, surgery duration of drainage, and estimated blood loss, were recorded and analysed using SPSS for Windows version 25 (IBM Corp. Armonk, NY). Results The incidence of seroma was 60.9% for group A and 34.8% for Group B, while the mean duration of seroma drainage in Group A was 8.1 ± 0.7 and 6.6 ± 0.7 for Group B (p &lt; 0.001). The mean total volume of seroma drained in group A was 587.9 ± 84.6, while that for Group B was 470.0 ± 75.2 (p = 0.004). The incidence of haematoma formation was 8.7% for group A and 4.3% for Group B (p = 0.550). Conclusion Sharp dissection significantly reduces the volume and duration of seroma drainage.

Knowledge &amp; Practice of Nurses Regarding Central Line-Associated Bloodstream Infection &amp; Prevention

Background: Central venous catheters (CVCs) are crucial in medical care but pose a significant risk for bloodstream infections, leading to increased morbidity, mortality, and healthcare costs. Effective knowledge and practices among nurses are essential for preventing central line-associated bloodstream infections (CLABSI). Objective: To assess the knowledge and practices of nurses regarding the prevention of CLABSI at Sughra Shafi Medical Complex Narowal and identify factors influencing these practices. Methods: This descriptive cross-sectional study involved 200 staff nurses selected from a population of 400 using a non-probability convenient sampling technique. Data were collected via a self-administered questionnaire covering demographics, professional experience, and specific knowledge and practices related to CLABSI prevention. The study was conducted over six months, and data analysis was performed using SPSS version 25, with chi-square and Fisher exact tests applied to determine associations between variables. Ethical approval was obtained, and all participants provided informed consent. Results: The study included 200 nurses, predominantly female (90%), with ages ranging from 18 to 37 years (mean age 25 ± 3.9 years). Professional experience varied, with 36.5% having 1-5 years, 41% having 6-10 years, and 22.5% having 11-15 years of experience (mean experience 7.31 ± 3.0 years). Knowledge assessment revealed that 68.5% knew CVCs should be routinely replaced, and 88.5% were aware of disinfecting catheter insertion sites with 10% povidone-iodine. However, only 43% regularly performed hand hygiene before inserting a central line, and 48.5% used chlorhexidine for skin preparation. Conclusion: While nurses demonstrated satisfactory knowledge regarding CLABSI prevention, their practices were inadequate, indicating a need for enhanced training and adherence to infection prevention protocols.

Prophylactic somatostatin analogs for postoperative pancreatic fistulas: a cross-sectional survey of AHPBA surgeons

BackgroundPostoperative pancreatic fistulas lead to substantially increased morbidity, mortality, and healthcare costs after pancreatectomy. Studies have reported conflicting data on the role of prophylactic somatostatin analogs in the reduction of postoperative pancreatic fistula. Current practice patterns, surgeon beliefs, and barriers to using these drugs in the Americas is not known. MethodsAn online 26-question cross-sectional survey was distributed via email to the members of the Americas Hepato-Pancreato-Biliary Association in April 2023. ResultsOne hundred and two surgeons responded in spring 2023. 48.0% of respondents reported using prophylactic SSAs during their surgical training, however, only 29.4% do so in their current practice, most commonly when performing Whipple procedures. Octreotide was the most frequently used SSA (34.3%), followed by octreotide LAR (12.7%) and pasireotide (11.8%). Reasons for not prescribing included a lack of high-quality data (62.7%), perception of limited efficacy (34.3%) and high cost (30.4%). ConclusionThese results highlight key areas for future study including understanding surgeon rationale for patient and drug selection. Variable practice patterns amongst surgeons also underscore the importance of generalizability in the design of future clinical trials in order to maximize impact.