Non-randomized Quasi-experimental Study Research Articles

Using Electronic Health Record Mortality Data to Promote Goals-of-Care Discussions in Seriously Ill Transferred Patients: A Pilot Study

Abstract Background Mortality prediction data may aid in identifying seriously ill transferred patients at high risk of dying and facilitate early goals-of-care discussions (GOCD); however, this is rarely evaluated. We recently developed a model for predicting 30-day inpatient mortality, which may be useful for promoting early GOCD. Objectives Our objectives were to examine the effects of sharing model-generated mortality risk with hospitalists by assessing (1) if hospitalists agreed with the mortality risk prediction, (2) if they planned to conduct GOCD or consult palliative care within 72 hours of transfer, and (3) if the communication alert affected GOCD timing and other clinical outcomes. We also aimed to measure the association between both the model-generated and hospitalists' stratified risk assessments with patient mortality. Methods This was a nonrandomized quasi-experimental pilot study with a historical control group. On the second day of hospitalization, the model-generated risk was communicated to the hospitalists. Hospitalists were asked to answer questions via a HIPAA (Health Insurance Portability and Accountability Act)-compliant mobile communication system, and clinical outcomes were extracted via chart review. Results Eighty-four patients (42 in the control and 42 in the intervention group) were included in this study. Hospitalists agreed that all patients in the intervention group were at risk for inpatient mortality. Hospitalists were more likely to indicate a plan to conduct GOCD in the intervention group (n = 9) compared with the control group (n = 4, p < 0.001). In this subset of patients, GOCD was completed within 72 hours in 78% of intervention patients (n = 7) as compared with 50% in the control group (n = 2). The greater absolute value of the model-generated mortality risk was significantly associated with deaths (p = 0.01), similar to the hospitalists' prediction of the mortality risk (p = 0.02). Conclusion Communicating model-generated mortality risk to hospitalists is a promising approach to promote timely GOCD.

A quasi-experimental study to estimate effectiveness of seasonal malaria chemoprevention in Aweil South County in Northern Bahr El Ghazal, South Sudan

BackgroundSeasonal malaria chemoprevention (SMC) is an effective intervention to prevent malaria in children in locations where the burden of malaria is high and transmission is seasonal. There is growing evidence suggesting that SMC with sulfadoxine–pyrimethamine and amodiaquine can retain its high level of effectiveness in East and Southern Africa despite resistance concerns. This study aims to generate evidence on the effectiveness of SMC when delivered under programmatic conditions in an area with an unknown anti-malarial drug resistance profile in the Northern Bahr el-Ghazal region of South Sudan.MethodsA non-randomized quasi experimental study was conducted to compare an intervention county with a control county. Five monthly SMC cycles were delivered between July and November 2022, targeting about 19,000 children 3–59 months old. Data were obtained from repeated cross-sectional household surveys of caregivers of children aged 3–59 months using cluster sampling. Wave 1 survey took place in both counties before SMC implementation; Waves 2 and 3 took place after the second and fourth monthly SMC cycles. Difference-in-differences analyses were performed by fitting logistic regression models with interactions between county and wave.ResultsA total of 2760 children were sampled in the study across the three survey waves in both study counties. Children in the intervention arm had 70% lower odds of caregiver-reported fever relative to those in the control arm during the one-month period prior to Wave 2 (OR: 0.30, 95% CI 0.12–0.70, p = 0.003), and 37% lower odds in Wave 3 (OR: 0.63, 95% CI 0.22–1.59, p = 0.306) after controlling for baseline difference between counties in Wave 1. Odds of caregiver-reported RDT-confirmed malaria were 82% lower in the previous 1-month period prior to Wave 2 (OR: 0.18, 95% CI 0.07–0.49, p = 0.001) and Wave 3 (OR: 0.18, 95% CI 0.06–0.54, p = 0.003).ConclusionThese results show high effectiveness of SMC using SPAQ in terms of reducing malaria disease during the high transmission season in children 3–59 month. Despite the promising results, additional evidence and insights from chemoprevention efficacy cohort studies, and analyses of relevant resistance markers, are required to assess the suitability of SMC for this specific context.

Effect of a telephone-based perioperative nurse-led counselling programme on unmet needs, quality of life and sexual function in colorectal cancer patients: A non-randomised quasi-experimental study

PurposeTo investigate the effect of perioperative nurse-led counselling intervention on unmet needs, sexual function and quality of life in colorectal cancer patients. MethodThis quasi-experimental study included 82 patients who underwent colorectal cancer surgery (control n = 45, intervention n = 37). The telephone-based perioperative nurse-led counselling intervention, which contained implementation, follow-up, and assessment, was applied to start from pre-surgery to post-surgery 3rd month. Data were collected with the Unmet Needs of Cancer Survivors Scale, European Organisation for Treatment and Research of Cancer Quality of Life Scale-30, Colorectal-29, Female Sexual Function Index, and International Index of Erectile Function pre- and post-surgery 3rd-6th months. The control data was collected before the pandemic, and the intervention group throughout the pandemic. The Mann-Whitney-U, Wilcoxon rank test was used. ResultsCompared to the control group, intervention group patients reported lower unmet and total needs scores (p = 0.000); higher quality of life (p = 0.000), physical, emotional (p = 0.000), role (p = 0.001), and social functioning scores (p = 0.002); lower fatigue (p = 0.000), constipation (p = 0.034), pain (p = 0.018), nausea-vomiting (p = 0.004), and insomnia scores (p = 0.003); and higher body image, anxiety (p = 0.000) and weight scores (p = 0.003), lower urinary frequency buttock pain (p = 0.000), dysuria (p = 0.001), abdominal pain (p = 0.001), fluctuance (p = 0.000), stool frequency (p = 0.002), and faecal incontinence (p = 0.006) scores at the sixth month (p < 0.05). There were no statistically significant differences between male and female sexual function scores (p > 0.05). ConclusionsPerioperative nurse-led counselling reduced unmet needs and increased the overall quality of life by decreasing symptom levels but did not affect sexual health outcomes in patients with colorectal cancer surgery.

Improvement in Erectile Dysfunction Among Male Obese Patient, Following Bariatric Surgery in Hospital Canselor Tuanku Muhriz (HUKM).

Obesity is associated with multiple health-related complications and affects various aspects of life, including erectile dysfunction (ED). The aim of this study is to postulate that erectile dysfunction in male obese patients can be reversed following bariatric surgery. We conducted a non-randomized quasi-experimental study (prospective) between 2 groups, those who underwent surgery with the control group. In this study, the resolution of erectile dysfunction following bariatric surgery comparing with the control group was evaluated in terms of International Index of Erectile Function (IIEF) score. IIEF score is taken by delivering validated questionnaire to participants that enrolled in this study, both the control and intervention group. A total of 25 patients were included in this study, 13 from the intervention group and 12 from the control group. From our study, we evaluated the resolution of IIEF score in both groups. We found that the resolution of erectile function is statistically significant in the intervention group compared to control group. Spearman rank correlation (rs) test was performed to identify the correlation between age and IIEF score. Statistically significant improvements in erectile function were found following bariatric surgery. This is evidenced by the improvements in the IIEF score post-surgery compared to control group.

Effects of virtual reality natural experiences on factory workers' psychological and physiological stress.

Manufacturing facilities and factories are stressful work environments. Interventions to improve factory workers' stress is necessary to promote occupational health. This study aimed to examine the effects of virtual reality natural experiences on furniture factory employees' psychological and physiological stress. A single-blinded, non-randomised quasi-experimental study was conducted between July and December 2021. Factory workers were recruited from two factories, and all participants at a given factory were assigned to either an experimental group or a comparison group. The intervention was conducted in a clean conference room once a week for 12 weeks during the worker's break time. The experimental group received virtual reality natural experiences consisting of 30-minute nature-based 360° videos which were played in a headset. The generalised estimating equations were performed for the statistical analyses. In total, 35 participants completed the intervention. As to psychological stress, the experimental group showed improvements in distress, depression, and anxiety, and a positive affect after the intervention compared to the comparison group. As to physiological stress, the experimental group showed improvements in indicators of heart rate variability compared to the comparison group, including standard deviations of all normal-to-normal intervals, low-frequency power, and high-frequency power. Virtual reality is an innovative platform to bring the natural environment into an indoor environment to create similar health effects.

Management of bone metastasis with zoledronic acid: A systematic review and Bayesian network meta-analysis

BackgroundWhile considered the mainstay of treatment for specific bone metastases, ZA is used predominantly to treat osteolytic lesions. The purpose of this network meta-analysis is to compare ZA to other treatment options in its ability to improve specific clinical outcomes in patients with bone metastases secondary to any primary tumor. MethodsPubMed, Embase and Web of Science were systematically searched from inception to May 5th, 2022. Keywords used were solid tumor, lung neoplasm, kidney neoplasm, breast neoplasm, prostate neoplasm, ZA and bone metastasis. Every randomized controlled trial and non-randomized quasi-experimental study of systemic ZA administration for patients with bone metastases and any comparator were included. A Bayesian network meta-analysis was done on the primary outcomes including number of SREs, time to developing a first on-study SRE, overall survival, and disease progression-free survival. Secondary outcome was pain at 3, 6 and 12 months after treatment. ResultsOur search yielded 3861 titles with 27 meeting inclusion criteria. For the number of SRE, ZA in combination with chemotherapy or hormone therapy was statistically superior to placebo (OR 0.079; 95 % CrI: 0.022–0.27). For the time to the first on study SRE, the relative effectiveness of ZA 4 mg was statistically superior to placebo (HR 0.58; 95 % CrI:0.48–0.77). At 3 and 6 months, ZA 4 mg was significantly superior to placebo for reducing pain with a SMD of −0.85 (95 % CrI:-1.6, −0.0025) and −2.6 (95 % CrI:-4.7, −0.52) respectively. ConclusionsThis systematic review shows the benefits of ZA in decreasing the incidence of SREs, increasing the time to the first on-study SRE, and reducing the pain level at 3 and 6 months.

A novel community-based therapeutic education program for reducing alcohol-related harms and stigma in people with alcohol use disorders: A quasi-experimental study (ETHER study).

Alcohol use disorder (AUD) is associated with a significant disease burden in France, where alcohol use is deeply rooted in culture. However, the treatment gap is large because of several barriers, including stigmatisation and drinkers' apprehension about total abstinence. However, standardised and evidence-based interventions based on controlled-drinking for people with AUD are lacking. We aimed to assess the effectiveness of a novel community-based French therapeutic patient education (TPE) program for people with AUD named Choizitaconso. A before-after non-randomised quasi-experimental study, named ETHER, was designed and implemented with people living with AUD, over a period of 6 months. The primary outcome was percentage change in the number of alcohol-related harms experienced. Secondary outcomes were percentage changes in psycho-social patient-reported and community-validated outcomes. Participants in the intervention group (n=34) benefited from the 10-week TPE program Choizitaconso, while the comparison group (n=58) received standard care. The Kruskall-Wallis and chi-squared or Fisher's exact tests were used to compare before-after changes in variables in both groups. Linear regression models were used to test for the effect of study group on each outcome and to test for the effect of alcohol consumption as a confounder. At 6 months, all outcomes but one either remained stable or numerically improved in both groups. Internalised stigma significantly improved in the intervention group (p=0.026) but not in the comparison group (p=0.207), with a significant group effect (p=0.014). This study demonstrates the effectiveness of the Choizitaconso TPE program on community-validated outcomes, especially internalised stigma.

Basic Life Support Training: The Effectiveness and Retention of The Distance-Learning Method

Introduction: Basic Life Support (BLS) training during the COVID-19 pandemic needed to be effective as well as prevent disease transmission between trainers and participants. The distance-learning method is one of the recommended modified training methods. However, there is still limited research that evaluates the effectiveness of the distance-learning method for BLS training for laypersons during the COVID-19 pandemic. Objective: To evaluate the effectiveness and retention of the distance-learning method for BLS training in improving the participant’s knowledge and skills. Materials and Methods: This is a non-randomized quasi-experimental study (one group pre-test and post-test design). A total of 64 TAGANA (Taruna Siaga Bencana/disaster volunteer) members of Sleman Regency who had undergone the distance learning method for BLS training were the participants of this study. A knowledge questionnaire and observation checklist were prepared and tested for context validity by an expert group. Data on the participant’s knowledge were collected before and after the training session, and data on the participant’s skills were recorded after the training session. After the training, a social media group was created to provide a periodical refresher of the BLS materials and facilitate discussions between the speakers and the study’s samples. Data on knowledge retention and skills were recorded six months post-training. Results: The distance-learning method for BLS training effectively increased the participants' knowledge of BLS, indicated by a significantly higher final knowledge score than before the training (Z=-6.904, p &lt;0.001). The method also provided sufficient BLS skills, indicated by most of the samples (93.7%) passing the skill observation test even though no participant had attended a similar training before. Moreover, the participant’s knowledge and skills scores were significantly lower six months after the training session than immediately after training (Z=-5.157, p &lt;0.001; Z=-4.219, p &lt;0.001). Conclusion: The distance-learning method for BLS training effectively increased the participant’s BLS knowledge and skills. However, their knowledge and skills decreased at six months post-training. Overall, the distance-learning method has been proven as a promising alternative to BLS training during and after the COVID-19 pandemic.

Short hydration education video and hiker fluid selection and consumption at trails, a non-randomized quasi-experimental field study.

Background: Education may improve hiker safety on trails. Aim: To investigate the impact of an educational video on hiker fluid selection and fluid consumption in a hot environment. Methods: Quasi-experimental field study at hiking trails in which the intervention group (INT) viewed a three-minute hydration education video, whereas the control group (CON) did not. Before the hike, all hikers were asked if they wanted to select extra fluid, which was provided by the research team. Results: A total of n = 97 hikers participated in the study, with n = 56 in INT (32 male) and n = 41 in CON (25 male). Despite absolute differences in environmental conditions, the differences fell within the same WBGT category. The total amount of fluid brought to the trails by participants was different between INT: 904 (503-1758) mL and CON: 1509 (880-2176) mL (P = 0.006), but participants in the INT group selected extra fluid (41%; n = 23) significantly more often when compared with participants in the CON group (7%; n = 3; P < 0.001). As a result, there was no difference in the amount of fluid brought on the trail between INT: 1047 (611-1936) mL and CON: 1509 (932-2176) mL (P = 0.069), nor for fluid consumption between INT: 433 (289-615) mL/h and CON: 489 (374-719) mL/h (P = 0.18). Conclusions and Implications: A 3-min educational video may encourage hikers to select additional fluid before the start of their hike but does not appear to increase fluid intake.

Protocol-directed weaning versus conventional weaning from mechanical ventilation for neurocritical patients in an intensive care unit: a nonrandomized quasi-experimental study.

To investigate whether protocol-directed weaning in neurocritical patients would reduce the rate of extubation failure (as a primary outcome) and the associated complications (as a secondary outcome) compared with conventional weaning. A quasi-experimental study was conducted in a medical-surgical intensive care unit from January 2016 to December 2018. Patients aged 18 years or older with an acute neurological disease who were on mechanical ventilation > 24 hours were included. All patients included in the study were ready to wean, with no or minimal sedation, Glasgow coma score ≥ 9, spontaneous ventilatory stimulus, noradrenaline ≤ 0.2μgr/kg/ minute, fraction of inspired oxygen ≤ 0.5, positive end-expiratory pressure ≤ 5cmH2O, maximal inspiratory pressure < -20cmH2O, and occlusion pressure < 6cmH2O. Ninety-four of 314 patients admitted to the intensive care unit were included (50 in the Intervention Group and 44 in the Control Group). There was no significant difference in spontaneous breathing trial failure (18% in the Intervention Group versus 34% in the Control Group, p = 0.12). More patients in the Intervention Group were extubated than in the Control Group (100% versus 79%, p = 0.01). The rate of extubation failure was not signifiantly diffrent between the groups (18% in the Intervention Group versus 17% in the Control Group; relative risk 1.02; 95%CI 0.64 - 1.61; p = 1.00). The reintubation rate was lower in the Control Group (16% in the Intervention Group versus 11% in the Control Group; relative risk 1.15; 95%CI 0.74 - 1.82; p = 0.75). The need for tracheotomy was lower in the Intervention Group [4 (8%) versus 11 (25%) in the Control Group; relative risk 0.32; 95%CI 0.11 - 0.93; p = 0.04]. At Day 28, the patients in the Intervention Group had more ventilator-free days than those in the Control Group [28 (26 - 28) days versus 26 (19 - 28) days; p = 0.01]. The total duration of mechanical ventilation was shorter in the Intervention Group than in the Control Group [5 (2 - 13) days versus 9 (3 - 22) days; p = 0.01]. There were no diffrences in the length of intensive care unit stay, 28-day free from mechanical ventilation, hospital stay or 90-day mortality. Considering the limitations of our study, the application of a weaning protocol for neurocritical patients led to a high percentage of extubation, a reduced need for tracheotomy and a shortened duration of mechanical ventilation. However, there was no reduction in extubation failure or the 28-day free of from mechanical ventilation compared with the Control Group.ClinicalTrials.gov Registry: NCT03128086.

Remdesivir Therapy versus Standard Care in Hospitalized Pregnant Women with Moderate and Severe COVID-19 in a Tertiary Care Center of Dubai: A Quasi-experimental Study

Background: Pregnant women with COVID-19 are more likely to be hospitalized and require respiratory support than non-pregnant women. There is little published data on Remdesivir use in pregnant women with COVID-19. We aimed to investigate the clinical course and obstetric outcomes for pregnant women with COVID-19 administered Remdesivir versus standard therapy.&#x0D; Methods: We conducted a non-randomized quasi experimental study among 100 pregnant women with moderate or severe COVID-19 who were admitted to a tertiary care hospital in Dubai between 18 January and 31 March 2021. We compared women receiving Remdesivir (treatment arm) and women receiving standard therapy (control arm).&#x0D; Results: More women in the Remdesivir group had normal vaginal delivery (n=17, 39.5%) than controls (n=9, 20.5%). Newborn Apgar scores at 1 and 5 minutes were similar in both groups. The mean standard deviation time to recovery and discharge was lower for patients receiving Remdesivir than controls (8.4\(\pm\)3.3 versus 13.6\(\pm\)9.2 days). Fewer treated patients required intensive care; at 60- day follow-up, all women on Remdesivir were doing well whereas six (12.0%) women on standard therapy had died.&#x0D; Conclusions: Pregnant women with moderate or severe COVID-19 treated early with Remdesivir showed an overall better clinical course and outcomes than those on standard therapy.

Effects of Music and Preoperative Education on Coronary Artery Bypass Graft Surgery Patients' Anxiety

The aim of this study was to evaluate the effectiveness of music and preoperative education on anxiety, physiological responses, length of hospital stay, and quality of life in Coronary Artery Bypass Graft Surgery (CABG) patients. This was a non-randomized quasi-experimental study. For this study, 214 patients were separated into an experimental and control group. A dual intervention using preoperative education and a CD with classical Turkish music was applied to the experimental group. The control group was provided with an uninterrupted rest period at the same time. The primary outcome was the difference in anxiety of the patients. Other outcomes included differences in the physiological responses, length of hospital stay, and quality of life. Anxiety decreased in the preoperative and postoperative periods in both groups (P = .000), and patients' anxiety level in the experimental group was lower than the control group (P = .000). The experimental group patients had a decrease in systolic blood pressure, diastolic blood pressure, and heart rate in the preoperative period (P = .000), and all physiological responses in the postoperative period were lower than the control group (P = .000). Furthermore, the experimental group's length of hospital stay was shorter (5.8 ± 1 days), and their quality of life was better (P = .000). The dual integrative nursing intervention (music and preoperative education) was effective in reducing anxiety in CABG patients. The results of the study will contribute to nonpharmacological approaches in the management of anxiety in CABG patients.

Evaluating the Change Process of a Brief Cognitive Behavior Therapy Workshop for Psychological Distress Among Primary Care Self-Referrals in Selangor, Malaysia.

Despite the high prevalence of psychological distress in primary care, only a limited number of individuals can benefit from early and evidenced-based psychological approach. Barriers to help-seeking attributable to stigma, lack of proper care pathway to evidence-based psychological interventions, and a high volume of primary care attendees are among the factors that contribute to the inadequate psychological treatments. This study examined the implementation of a change process using a brief cognitive behavioral therapy (b-CBT) workshop as a potential approach in managing psychological distress among 73 primary care self-referrals using purposive sampling. One-way repeated-measures multivariate analysis of variance (ANOVA) was used to analyze changes in psychological distress within a non-randomized quasi-experimental study. Results revealed significant differences in psychological distress using Depression, Anxiety, and Stress Scale-21 items at three time points (pre-intervention, post-intervention, and 1-month follow-up). Implementation of the b-CBT workshop showed positive changes for psychological distress, suggesting the possibility of integrating brief, non-stigmatized, and evidence-based psychological approach at the primary care level. However, the self-referral characteristics of the attendees remain unknown. Factors such as potential feasibility, participant's usability and satisfaction, and implementation of b-CBT workshop to improve psychological distress are discussed in this study.

Influence of pretesting and a near peer sharing real life experiences on CPR training outcomes in first year medical students: a non-randomized quasi-experimental study

BackgroundExisting literature on cardiopulmonary resuscitation (CPR) training focuses on the knowledge and skill components while the attitudinal component is rarely addressed. There is a need to explore how peer interaction, learning atmosphere, and communication influence learning effectiveness during CPR training. Therefore, this study’s objective was to evaluate how a senior student (near peer) sharing their real-life experience of performing CPR would influence medical students’ learning and readiness to perform CPR.MethodsThe present study involved 250 newly enrolled undergraduate medical students. The Solomon’s four-group study design was used to evaluate the influence of both pretesting and peer interaction. Students belonging to two groups initially completed a pre-training knowledge test (pretest) and a questionnaire on readiness to perform CPR. Students from all four groups then participated in instructor-led hands-on skills training, after which the two intervention groups interacted with their senior, who shared their life experiences of performing CPR. Finally, all four groups underwent skills evaluation, immediate and delayed post-tests, and completed a questionnaire to assess readiness to perform CPR. The students also provided their feedback on the experience of interacting with a peer during the training.ResultsPost-test scores were significantly higher than pretest scores (Kruskal–Wallis test, p < 0.05). Scores were significantly higher in pretested intervention groups than in the non-pretested non-intervention group (p < 0.05). Delayed post-test scores were slightly but not significantly lower than the immediate post-test scores with no significant difference observed in the scores among the groups. The pretested groups showed more readiness to perform CPR and the pretested intervention group were least concerned about acquiring infection during CPR. Students in all groups were confident of performing chest compressions correctly, and found it inspiring and motivating listening to and discussing real-life experiences with a near peer.ConclusionsHearing from peers about real-life CPR experience during CPR training sessions significantly impacted learning, enhanced student motivation to learn and may be an effective strategy to consider in routine CPR training. However, the positive effects of pretesting and peer interaction on knowledge were not sustained, highlighting a need for repeat training.

Intravenous iron sucrose vs. blood transfusion in the management of moderate postpartum iron deficiency anemia: A non-randomized quasi-experimental study

IntroductionPostpartum anemia is often over-treated with blood transfusion without clear indication despite having a potential alternative of parenteral iron therapy. The present study aimed to compare the efficacy of intravenous (IV) iron sucrose with blood transfusion in increasing the hematological parameters in postpartum women with moderate anemia. MethodsThis prospective non-randomized quasi-experimental study was conducted among 44 hemodynamically stable postpartum women with moderate anemia (Hb 7–8 g/dl) in the Obstetrics department of Dhaka Medical College Hospital (DMCH) from January to June 2021. Among them, 22 patients received 600 mg of IV iron sucrose after 48 h of delivery for three subsequent days and the other 22 patients received two units of blood transfusion after 48 h of delivery in two subsequent days. The primary endpoint was increase in Hemoglobin (Hb) and serum ferritin level after 6 weeks of the intervention. Two-way repeated measures ANOVA (mixed factor ANOVA) was applied to compare between before and after effect in the two intervention groups. ResultsBaseline Hb and ferritin were 7.4 g/dl and 73.5 μg/l in IV iron group and 7.3 g/dl and 73.2 μg/l in blood transfusion group. Mean Hb level was increased 4.2 g/dl in IV iron sucrose group and 4.5 g/dl in blood transfusion group at sixth week. Besides, serum ferritin level was increased 40.5 μg/l and 44.8 μg/l after six weeks in IV iron sucrose group and blood transfusion group respectively. Other hematological parameters like reticulocyte count, MCV, MCH, and MCHC also increased significantly after intervention in both groups. However, no significant difference was noticed in the change of hematological parameters in between the groups. ConclusionsThe IV iron sucrose is as effective as blood transfusion in replenishing the hemoglobin and iron storage status in hemodynamically stable women with moderate post-partum anemia. This could be an effective alternative of blood transfusion in treating these patients, especially in resource-poor settings.

Management of Infected Non-union Tibia with Ilizarov External Fixator: Study on Tertiary Hospital in Bangladesh

Introduction: Infection is the most prominent cause of delayed or non-union in tibial fractures because of the bone's sensitive subcutaneous location. Ilizarov external fixator application is regarded as the best approach for treating them because of several benefits. Analysis of the role of Ilizarov fixation in infected tibial non-union was the goal of this investigation and evaluating clinical &amp; functional outcomes of infected tibial non-union. Materials and Methods: A Multicenter based non-randomized quasi-experimental prospective study was performed in Rajshahi Medical College Hospital, Rajshahi, Bangladesh. From 1st January 2015 to 31st December 2020. The study comprised a total of 61 (n=61) Tibial non-union patients treated with the Ilizarov fixator who also had an infection. ASAMI score criteria were used to evaluate the outcome. Results: The most common organism for infection was identified to be at Staphylococcus Aureus. The final follow-up showed that all but one patient had achieved union; one patient had to amputate due to infection and non-union. ASAMI score rating methodology for bone and function results rated the majority of patients as outstanding. Pin tract infections were the most prevalent problem discovered in this research. Conclusion: The Ilizarov external fixator is safe and successful for treating infected non-union of the tibia since it can offer a stable mechanical environment, bone transfer, rectify deformities, eradicate the infection, and allow patients to bear weight. Therefore, we still suggest it despite its disadvantages.

Effects of vegetables consumption before carbohydrates on blood glucose and GLP-1 levels among diabetic patients in Indonesia

Type 2 Diabetes Mellitus (T2DM) is the prominent public health issue. Pharmacotherapy and diet modification should be integrated into T2DM management. To investigate the effects of vegetables consumption before carbohydrates on blood glucose and GLP-1 levels in T2DM patients. A non-randomized quasi experimental study was conducted to recruit T2DM patients who attended at the Gatot Soebroto Central Army Hospital, Jakarta, Indonesia from April to May 2016. The Lemeshow's formula was used to determine sample size. A total of 12 non-diabetic and 24 diabetic patients were participated in our study. Glucose levels were measured using a routine hexokinase method while serum GLP-1 levels were determined using the ELISA. The student t-test was used to compare two groups with parametric data. The significant difference was at P < 0.05. Our data showed that T2DM patients who consumed vegetables before carbohydrates, had relatively stable glucose levels at 0, 60 and 120 mins (164.25 ± 86.89 vs 183.5 ± 55.96 vs 167.83 ± 65.53, P = 0.163) and stay lowered within the normal range compared to T2DM patients who consumed vegetables after carbohydrates (165.08 ± 67.89 vs 241.92 ± 68.03 vs 204.92 ± 81.76, P = 0.022). Additionally, GLP-1 levels remained stable after 60 and 120 min at day 1 (P = 0.816) and day 3 (P = 0.955). Vegetables consumption before carbohydrate is a promising and simple method of diabetes diet for maintaining blood glucose and GLP-1 levels and preventing from vascular complication.

Outcome and Evaluation of Celiac Plexus Block (CPB) Enhancement Level of Well-Being in Patient’s Pancreatic Cancer Pain: Study on Tertiary Hospital in Bangladesh

Background: Malignant pancreatic cancer has a high death rate, and it is difficult to treat because of the excruciating agony it causes. Opioids and adjuvants are commonly used to alleviate severe stomach pain. Objectives: CPB is a type of neural therapy treatment. Limited and inconsistent research has been done on the impact of QoL on patients. We hoped to find a solution to this problem with this investigation. Materials and Methods: Multicenter non-randomized quasi-experimental prospective study has been conducted in Rajshahi Medical College Hospital and tertiary care Hospital Rajshahi, Bangladesh. From January 2019 until July 2021.We studied a total of 16 patients with severe abdominal pain who had failed to react to combination systemic analgesic treatment or who had adverse effects that made it impossible to continue with the current dosage. A 35-day follow-up study looked at the effectiveness of CPB as a palliative analgesic. The VAS questionnaire was used to see if pain intensity could be altered as a primary result. The SF-36 questionnaire enhanced QoL secondary outcomes. We closely monitored the pain medications for any undesirable side effects. Results: Patients' VAS pain scores dropped significantly (P=0.002) after CPB, and their need for opiates dropped as well. When the extent of the impact is taken into consideration, their QoL scores also increased (P&lt;0.001). During the research period, no side effects associated with CPB were found. There were also no negative medication responses. Conclusion: Our findings provide early evidence that CPB may be beneficial in individuals with advanced pancreatic cancer who are also receiving conventional pain medication. CPB appears to enhance QoL in these individuals at least 5 weeks after the Intervention, according to this research.

A systematic review of group therapy programs for smoking cessation in Asian countries.

INTRODUCTIONTobacco causes more than 8 million deaths each year. Behavioral interventions such as group therapy, which provides counselling for smoking cessation, can be delivered in group form and smokers who receive cessation counselling are more likely to quit smoking compared to no assistance. We review the evidence of group-based counselling for smoking cessation for smokers in Asian countries.METHODSThe review aims to determine the availability of group-based therapy for smoking cessation in Asian countries. The outcome measured was abstinence from smoking following group therapy. Electronic database searches in PubMed, OVID Medline, SCOPUS, Google Scholar, and PsycINFO, using keywords such as: ‘smoking’, ‘cigarette’, ‘tobacco’, ‘nicotine’, ‘group therapy’ and ‘cessation’ (smok*, *cigarette*, tobacco, nicotine, group therap*, cessation) were used. The results were reported following PRISMA and PROSPERO guidelines. Review Manager was used for data analysis.RESULTSA total of 21251 records were retrieved for screening the abstracts. In all, 300 articles for review were identified and assessed for eligibility. Nine articles, including Cochrane reviews, randomized control trials, cohort, observational and cross-sectional studies, were included in the final review. There were three observational qualitative studies, two prospective cohort studies, two crosssectional studies, one non-randomized quasi-experimental study and a single cluster-randomized, controlled trial. Group therapy was found to significantly increase the abstinence rate. Group therapy provided at the workplace, smoking cessation services, availability of pharmacotherapy, and socioeconomic status, appear to be key factors determining success.CONCLUSIONSEvidence of the use of group therapy for smoking cessation in Asian countries is still lacking despite publications in the Western population showed that group therapy was effective. Further research on group-based interventions for smoking cessation in Asian countries is required and direct one-to-one comparisons between group therapy and individual therapy for smokers who want to quit smoking, are needed.

The effect of psychodrama group practices on nursing students' self-liking, self-competence, and self-acceptance: A quasi-experimental study.

This study aims to investigate the effects of psychodrama group practices on nursing students' levels of self-liking, self-competence, and self-acceptance. This study was a non-randomized quasi-experimental study with a control group including pre-test, post-test, and follow-up test procedures. The study was carried out with 29 participants, including 15 experimental and 14 control group participants. The study data were collected using the sociodemographic characteristics questionnaire, the Self-Liking/Self-Competence Scale, and the Unconditional Self-Acceptance Scale. It was found that the self-liking sub-dimension, self-liking/self-competence, and unconditional self-acceptance total scores in the experimental group were significantly higher than the control group in the post-test measurements. Psychodrama group practices have significant positive effects on students' self-liking, self-competence, and self-acceptance among nursing students.