Positive Patient Outcomes Research Articles

Organisational quality and hospital pharmacists’ roles of outpatient parenteral antimicrobial therapy (OPAT) in Belgian hospitals: a national survey

ABSTRACT Objectives Implementation of outpatient parenteral antimicrobial therapy (OPAT), also known as intravenous (IV) antimicrobial treatment at home, has increased in recent years. Ensuring OPAT quality is crucial to achieve positive patient outcomes. However, data on the Belgian quality of OPAT organisation is lacking. We aimed to monitor the organisational quality of OPAT in Belgian hospitals and identify roles of hospital pharmacists involved in OPAT. Methods A cross-sectional study applying a web-based survey on OPAT quality was conducted from 2 to 29 April 2024. The survey assessed the presence of six core and five non-core structure indicators, and OPAT-related tasks of hospital pharmacists. Results Almost two-thirds (64%; 65/101) of Belgian hospitals answered the survey, with 77% of these hospitals providing OPAT, with an increase since 2023. All 11 structure indicators were present in 6% of hospitals, while 18% had all six core structure indicators. Three of the six core structure indicators were formally present in the majority of the hospitals: a policy on patient selection criteria (76%), a structured OPAT programme (70%), and a dedicated team (64%). In contrast, a system for fast communication between the patient and OPAT team members (50%), a mechanism for urgent clinical discussions (42%), and monitoring of quality indicators (28%) were not formally present in the majority of the hospitals. The primary tasks for hospital pharmacists included overseeing OPAT prescriptions and supplying antimicrobials and related materials. Conclusion While the adoption of OPAT is increasing among Belgian hospitals, significant opportunities remain for improving the quality of the OPAT organisation and expanding the OPAT-related tasks of Belgian hospital pharmacists.

Service Utilization and Value at an Athletic Training Student Run Clinic for University Employees and Students.

Student-run health clinics (SRHC) are commonly utilized to provide clinical experiences to students in healthcare education programs as well as healthcare services to a target community. Recent reports on athletic training SRHCs (AT-SRHCs) with a client population of university students, employees and/or community members have reported positive patient outcomes and high patient satisfaction, however there is limited data about the treated conditions, services and value provided by AT-SRHC. To track utilization of athletic training services at a free AT-SRHC. Retrospective chart review from September 2022-May 2024. University-based AT-SRHC. 97 patients (52 males, 44 females, 1 not documented; age 32.6±13.7 years, range: 18-65 years old; 50 employees, 47 students). Data were extracted from an electronic medical record and scheduling software. Variables extracted included patient demographics, appointment numbers, mechanism of injury, injured body part, days since injury, injury diagnosis, injury severity, and common procedural terminology (CPT) codes. Data were analyzed descriptively. Sixty-four percent (226/352) of available appointment sessions were reserved. The 3 most commonly injured body areas were the knee (n=26, 23.9%), shoulder (n=23, 21.1%), and thigh (n=13, 11.9%). The 3 most common diagnoses were sprains/strains (n=51, 46.8%), overuse conditions (e.g. epicondylitis, impingement, tendonitis; n=18, 16.5%), and nonspecific joint pain (n=22, 20.2%). The 3 most common CPT codes were for therapeutic exercise (n=136), athletic training evaluation (n=98), and manual therapy (n=78). Estimates for the total value of services range from $6,901 to $13,498 ($39.89-78.03 per session). Services at an AT-SRHC were utilized by a small portion of the campus population during its first 2 years of operation. Data provides preliminary insight into AT-SRHC service utilization and value. Additional organizations may benefit from developing an AT-SRHC to provide access to affordable care and student clinical experiences.

EMR 'one size does not fit all': Nurses' and midwives' opinions about using electronic medical records

Objective: To describe the impact that electronic medical record (EMR) documentation has on nurses’ and midwives’ practice. Background: Although both advantages and disadvantages of a digitised health system have been documented, nurses and midwives continue to express concerns about the effect EMRs and computers have on their practice and patient relationships. Study design and methods: A cross-sectional survey design was used. An anonymous questionnaire was distributed in electronic and paper formats to identify nurses’ and midwives’ opinions of the impact of EMRs and computers on their practice and patient relationships in a regional tertiary-level hospital. Quantitative data was analysed descriptively; free-text responses were analysed thematically. Results: Nurses (n=31) and midwives (n=49) responded. Both respondent groups disagreed that the EMR had improved teamwork with other health professionals. Overwhelmingly, midwives disagreed that EMRs had improved the quality of care (n=43, 87.8%). Nurses agreed EMRs had improved documentation standards (n=24, 77.4%) and patient safety (n=22, 71%). However, midwives responded that EMRs had not improved women’s safety (n=31, 63%). Three themes emerged from the data: computers affect my productivity; computers affect my relationship with the patient/woman; the EMR increases my frustration and stress levels. Nurses and midwives felt the heavy documentation load and lack of integration across the EMR platform reduced efficiency, discouraged teamwork, and further excluded patients/women from participating in their care. Discussion: Although nurses and midwives agreed that the accessibility of EMRs to all health care staff is advantageous, the documentation demands of each clinical area are vastly different. The hybrid system of paper and electronic documentation increases documentation workload. Generally, midwives were more critical of the impact of EMRs on their practice. Conclusion: Nurses and midwives identified current challenges of EMRs with respect to productivity, relationships with patients and colleagues, and user wellbeing aligning with results of other published studies. As primary users of EMRs, nurses and midwives can offer valuable feedback to health services to help deliver digitised healthcare that is user-friendly, and patient/woman centred. Implications for research, policy, and practice: Organisations need to enact policies and procedures that facilitate nurses and midwives identifying areas of potential improvement to increase the usability and operability of the EMR. Such processes should lessen the negative impacts of EMR (such as documentation burden) on nursing/midwifery practice, with the aim of enhancing clinical and safety outcomes. It is suggested that ethnographic research studies be undertaken to gain a deeper understanding of the EMRs on nurse/midwife productivity, wellbeing, job satisfaction and patient safety concerns. What is already known about the topic: Positive and negative EMR outcomes for patients and clinicians have been documented. Involving clinicians (especially nurses and midwives) in the development of digital systems prior to implementation has been shown to reduce negative attitudes towards them. Ongoing user analysis is recommended in human-centred design to improve usability and user wellbeing. What this paper adds: Description of the differing experiences and challenges faced by nurses and midwives using the EMR program and computers in the same hospital. Positive and negative effects of the current EMR program and computers have been identified. This paper verifies the results of other national studies about the effects of EMRs and computers on nurses’ and midwives’ productivity, relationships, and wellbeing.

Behavioral Weight Loss Treatment Promotes Weight Loss by Increasing Eating Disorder Symptoms: A Response to Grilo & Pittman (2024).

We provide commentary on the Grilo and Pittman (2024). Exploring Dietary Restraint as a Mediator of Behavioral and Cognitive-Behavioral Treatments on Outcomes for Patients With Binge-Eating Disorder With Obesity article published in the International Journal of Eating Disorders. Grilo and Pittman show that weight loss in the Behavioral Weight Loss Treatment condition is mediated by an increase in rigid restraint, whereas binge eating is not mediated by rigid restraint. They conclude that this result is a positive outcome for patients with binge-eating disorder and shows that BWL is not harmful in this population. We argue that increasing rigid restraint equates to increasing eating disorder symptoms and is harmful in any population, but specifically in those with an already diagnosed eating disorder. In addition, we point out the major limitations of no follow-up data in the mediation report, no measurement of additional eating disorder symptoms that could represent diagnostic migration, and lack of inclusion of weight stigma as additional problems with the stated conclusions. We recommend that the field moves away from measurement of weight loss as an outcome in those with eating disorders and carefully consider what it means to increase restraint/restriction in eating disorder populations.

Evaluation of a Pharmacist-Led Methicillin-Resistant Staphylococcus aureus Nasal PCR Testing Protocol.

Background/Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) can cause cases of community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia, and nasal colonization with this pathogen increases the risk of infection. Due to its high negative predictive value, multiple studies support using the MRSA nasal polymerase chain reaction (PCR) test to discontinue antimicrobials that target MRSA in the setting of a negative test result. The purpose of this project was to assess the utility of a protocol to allow pharmacists the ability to order MRSA nasal PCR screenings in hospitalized patients with pneumonia. Results: The pre-protocol group included a random sample of 100 patients, and the post-protocol group included 625 patients. Vancomycin DOTs when pharmacists ordered PCRs were significantly lower compared to the pre-protocol group (p < 0.5; 95% CI, 0.46-2.24). The average length of stay and readmission rates at 30 days were significantly lower in the post-protocol group compared to the pre-protocol group (p < 0.05 and p = 0.02, respectively), but there was no significant difference in mortality (p = 0.33). Methods: A protocol was implemented at our institution that allowed pharmacists to order an MRSA nasal PCR test in patients with pneumonia. This retrospective chart review compared a cohort of patients who received vancomycin from before implementation of the protocol to patients who received vancomycin after the protocol's implementation. The primary endpoint was vancomycin days of therapy (DOTs) between the pre-protocol group and the post-protocol group. Other endpoints assessed included the length of hospitalization, readmission rates, and mortality. Conclusions: Pharmacists ordering MRSA nasal PCR tests significantly reduced vancomycin DOTs, average length of stay, and 30-day readmission rates, contributing to positive outcomes in patients with pneumonia.

Segmental Lordosis Restoration During Lumbar Degenerative Spinal Fusion: Surgical Techniques and Outcomes.

The science of spinal alignment has progressed rapidly since Jean Doubousset described the cone of economy in the 1970s. It is now clearly established that global and regional spinal alignment are associated with improved patient-reported outcome and rates of success of lumbar spinal fusion. Evidence has now emerged that segmental level-by-level alignment is also associated with positive patient outcomes. As such, restoring sagittal alignment matched to spinopelvic morphology during degenerative lumbar surgery can optimize surgical outcomes by preventing adjacent segment pathology. This review focuses on the vital importance of spinal alignment in different spinal conditions, provides a guide for measurement of spinopelvic parameters, and outlines literature regarding lumbar restoration in degenerative spinal fusion.

Which Values Should Guide Health Care Organizations' Retrofit Expenditures on Patient-Centered and Evidence-Based Design?

When built environments in health care result from an evidence-based design (EBD) process, they are interventions that can improve patients' health outcomes. This commentary on a case discusses which ethical values should guide organizations' capital expenditure decisions about retrofits, which might be more costly than the original budget. This discussion urges reevaluation of the common assumption that capital improvements are "sunk costs," since such improvements can promote long-term positive health outcomes for an organization's patients, thereby advancing both financial value and ethical values. This commentary also suggests that EBD offers key interventions that are clinically and ethically relevant.

Efficacy and safety profile of 2nd line Anti TB drugs in DRTB patients in a tertiary care hospital of South Punjab.

The objective of the study was to assess the efficacy and safety profile of 2nd line Anti TB drugs in DR TB patients in a tertiary care hospital of South Punjab. This retrospective cohort study included patients who received therapy for multidrug-resistant tuberculosis (MDR-TB) between March 2018 and June 2021 at the Pulmonology Department of Sheikh Zayed Hospital, Rahim Yar Khan. Sociodemographic data, TB treatment history, treatment schemes, safety profiles, weight measures, and sputum smear results were obtained from medical records. Outcome variables of interest included body weight, sputum smear grading for treatment efficacy, and ADRs for safety assessment. The study showed a progressive decline in positive sputum smear results over the 24-month treatment for MDR-TB, with an increase in negative smear results from 33 (9.50%) at baseline to 97 (28.0%) by Month 24. Furthermore, the mean body weight significantly increased every three months throughout the trial. Beginning at 43.83 kg at baseline, the mean weight increased to 50.02 kg by the end of 24 months. ADRs were mostly mild to moderate, including depression (18.4%), arthralgia (17.1%), anxiety (16.5%), and Qtc prolongation (11.0%). The treatment adhered to international guidelines, using a tailored combination of second-line drugs and adjusting regimens based on drug resistance patterns from sputum culture and DST. The study findings suggest the efficacy of second-line anti-TB drug regimens in achieving sputum smear conversion and positive treatment outcomes in patients with MDR-TB. However, the occurrence of ADRs highlights the need for careful monitoring and management during treatment.

Atypically located lipomas in the head and neck region: two case reports and a review of the literature

Lipomas are the most frequently seen benign tumors and can develop in any region containing fatty tissue. Approximately 13% of lipomas appear in the head and neck, most commonly in the posterior cervical region. While subcutaneous lipomas are typically asymptomatic, those located in the upper aerodigestive tract can cause symptoms such as dysphagia, odynophagia, voice restriction, dyspnea, and a foreign body sensation. This report describes two cases of rare retropharyngeal and buccal space lipoma. Case 1: A 78-year-old man presented with difficulty swallowing and a foreign body sensation in the throat persisting for the previous two years. Examination revealed a soft, smooth mass extending from the soft palate to the upper margin of the epiglottis. Magnetic resonance imaging (MRI) revealed a retropharyngeal space lipoma approximately 49x18 mm in size. The lipoma was excluded intraorally without complications, and no recurrence was observed at follow-up. Case 2: A 51-year-old man presented with a history of a growing, painless mass in the left buccal region causing facial asymmetry for the previous three years. MRI revealed a 42x34 mm lipoma in the left buccal region.The lipoma was excluded intraorally without complications, and no recurrence was observed at follow-up. Lipomas in the head and neck region are relatively rare, and retropharyngeal and buccal space lipomas are less common. Surgical excision using an intraoral approach is effective and typically prevents recurrence. Pathological examination is needed to confirm the diagnosis and exclude malignancy, and provides positive outcomes for patients.

Interleukin-1α release during necrotic-like cell death generates myeloid-driven immunosuppression that restricts anti-tumor immunity

Necroptosis can promote antigen-specific immune responses, suggesting induced necroptosis as a therapeutic approach for cancer. Here we sought to determine the mechanism of immune activation but found the necroptosis mediators RIPK3 and MLKL dispensable for tumor growth in genetic and implantable models of breast or lung cancer. Surprisingly, inducing necroptosis within established breast tumors generates a myeloid suppressive microenvironment that inhibits Tcell function, promotes tumor growth, and reduces survival. This was dependent upon the release of the nuclear alarmin interleukin-1α (IL-1α) by dying cells. Critically, IL-1α release occurs during chemotherapy and targeting this molecule reduces the immunosuppressive capacity of tumor myeloid cells and promotes CD8+ Tcell recruitment and effector function. Neutralizing IL-1α enhances the efficacy of single agent paclitaxel or combination therapy with PD-1 blockade in preclinical models. Low IL1A levels correlates with positive patient outcome in several solid malignancies, particularly in patients treated with chemotherapy.

Systemic capillary leak syndrome.

The vascular endothelial barrier maintains intravascular volume and metabolic homeostasis. Although plasma fluids and proteins extravasate continuously from tissue microvasculature (capillaries, post-capillary venules), systemic vascular leakage increases in critical illness associated with sepsis, burns and trauma, among others, or in association with certain drugs or toxin exposures. Systemically dysregulated fluid homeostasis, which can lead to hypovolaemia, hypotensive shock and widespread tissue oedema, has been termed systemic capillary leak syndrome (SCLS) when overt secondary causes (for example, heart or liver failure) are excluded. In severe forms, SCLS is complicated by compartment syndrome in the extremities and multi-organ dysfunction syndrome due to shock and systemic hypoperfusion. The different forms of SCLS include idiopathic SCLS (ISCLS) and secondary SCLS(SSCLS), which can be triggered by several conditions, including certain infections and haematological malignancies. A subgroup of patients with ISCLS have monoclonal gammopathy-associated SCLS (also known as Clarkson disease), which is an ultra-rare and extreme form of ISCLS. ISCLS can be managed effectively with monthly prophylactic immunoglobulin therapy whereas SSCLS frequently does not recur once the underlying condition resolves or the offending agent is discontinued. Thus, differentiation between ISCLS, SSCLS and other causes of oedema is crucial for quick diagnosis and positive patient outcomes.

“They already trusted us a lot”: Allied health students’ experiences of an innovative hospital, service-focussed placement model

Background A service-focussed placement model involves an innovative partnership between service and education providers to a) address service delivery needs and b) facilitate students’ competency development. Services are collaboratively redesigned such that students are positioned as collaborators in service delivery with their learning supported through evidence-informed educational design. This model was implemented in the hospital setting and was found to promote positive patient outcomes. Our study explored whether this model supports student learning. Methods Students’ perception of learning was explored using a multiple-case study design with data collected from 22 semi-structured focus groups and interviews with 64 senior year allied health students (physiotherapy n = 55; occupational therapy n = 9) across six placement settings. Inductive thematic analysis identified aspects of this placement model that facilitated and challenged students’ learning. Results A service-focussed placement model provides a quality student learning experience. Students identified the need to be prepared for independent learning. This placement model promoted their professional development and sense of autonomy through engaging them in early, active learning within a safe learning environment. Conclusions Students perceived that a service-focussed placement model equipped them for the ever-changing complexities and challenges of hospital services.

A case study on COVID-19 infected patient&amp;rsquo;s experience - challenging journey at Colombo East Base Hospital- Mulleriyawa

This study investigates the patient experience within the COVID-19 treatment centre at Colombo East Base Hospital, Mulleriyawa, amidst the global pandemic. A cross-sectional descriptive study was conducted over one month, involving 30 participants recruited through convenience sampling. Participants completed self-administered questionnaires assessing various aspects of care, including staff interaction, cleanliness, health education, counselling, and attention to health-related matters. Results indicate high levels of satisfaction among participants across multiple care domains, with the majority expressing satisfaction with staff interaction, cleanliness, health education, counselling, and attention to health-related matters. These findings underscore the healthcare delivery system's effectiveness in meeting patients' diverse needs and expectations during the pandemic. The study highlights the importance of patient-centred care in promoting positive patient experiences and outcomes, particularly in the context of public health emergencies. Recommendations include sustaining and enhancing best practices in healthcare delivery, prioritizing infection prevention and control measures, and promoting effective communication and patient education. By prioritizing patient-centred care and continuous quality improvement initiatives, healthcare providers can ensure the safety, satisfaction, and well-being of patients amidst crises such as the COVID-19 pandemic.

Leiomyosarcoma of the inferior vena cava: case report

Introduction and Importance: Leiomyosarcomas of the inferior vena cava are exceedingly rare tumors, presenting diagnostic dilemmas due to their nonspecific clinical features. This case report aims to shed light on the challenges associated with diagnosing and managing such tumors, emphasizing the importance of a multidisciplinary approach. This article uses SCARE2023 criteria as a framework to sort out a case report in order[1]. Case Presentation: We present a case of leiomyosarcoma of the inferior vena cava in a patient presenting with abdominal pain. Initial clinical signs, supported by computed tomography (CT) and magnetic resonance imaging (MRI), led to the suspicion of the tumor. Histological analysis confirmed the diagnosis, prompting surgical intervention. Clinical Discussion: The diagnosis of tumors within the inferior vena cava is often challenging due to their nonspecific presentation. Imaging modalities such as CT and MRI play an important role in describing the extent of the tumor and guiding surgical planning. Histological analysis remains supreme for definitive diagnosis. Surgical resection, aimed at complete excision, is the keystone of treatment to minimize the risk of recurrence. Conclusion: Leiomyosarcomas of the inferior vena cava pose diagnostic and therapeutic challenges due to their rarity and nonspecific clinical presentation. A comprehensive approach integrating clinical assessment, imaging, and histological analysis is essential for accurate diagnosis and optimal management. Multidisciplinary collaboration is key for navigating the complexities associated with these rare vascular neoplasms, ensuring positive patient outcomes.

Safe Anesthesia Practices for Minimally Invasive, Image-guided Procedures: CT, MRI, and Ultrasound

Background: The demand for minimally invasive, image-guided procedures, such as CT, MRI, and ultrasound, is increasing. Understanding the role of anesthesia in enhancing patient safety, comfort, and procedural success is essential. Methods: This study was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, over two years, involving 150 patients. Anesthesia techniques were categorized as general anesthesia, sedation, and local anesthesia. Patient outcomes, complications, and satisfaction scores were recorded and analyzed. Results: In this study, general anesthesia was administered to 65 patients (43.3% of cases), sedation was used for 56 patients (37.3%), and local anesthesia was applied to 29 patients (19.3%). The overall procedural success rate was high, at 141 successful completions (94%), with minor complications occurring in 7 patients (4.7%) and major complications in 2 patients (1.3%). Patient satisfaction scores indicated that 96 participants (64%) reported being very satisfied with their anesthesia experience, while 45 patients (30%) indicated they were satisfied. These findings highlight the effectiveness and safety of the selected anesthesia practices in minimally invasive, image-guided procedures, demonstrating a strong correlation between appropriate anesthesia techniques and positive patient outcomes. The data underscore the importance of tailored anesthesia protocols to enhance procedural success and patient satisfaction in this clinical setting. Conclusion: The study demonstrates that tailored anesthesia practices can achieve high success rates and patient satisfaction in minimally invasive, image-guided procedures. Despite the low incidence of complications, ongoing research is needed to refine anesthesia protocols and explore advanced, image-guided techniques to further enhance patient safety and comfort.

INNV-18. FOCUS ON CURRENT AND EMERGING TREATMENT OPTIONS FOR GLIOMA: A COMPREHENSIVE REVIEW

Abstract This comprehensive review delves into the current updates and challenges associated with the management of low-grade gliomas (LGG), the predominant primary tumors in the central nervous system. With a general incidence rate of 5.81 per 100000, gliomas pose a significant global concern, necessitating advancements in treatment techniques to reduce mortality and morbidity. This review places a particular focus on immunotherapies, discussing promising agents such as Zotiraciclib and Lerapolturev. Zotiraciclib, a CDK9 inhibitor, has demonstrated efficacy in glioblastoma treatment in preclinical and clinical studies, showing its potential as a therapeutic breakthrough. Lerapolturev, a viral immunotherapy, induces inflammation in glioblastoma and displays positive outcomes in both adult and pediatric patients. Exploration of immunotherapy extends to Pembrolizumab, Nivolumab, and Entrectinib, revealing the challenges and variabilities in patient responses. Despite promising preclinical data, the monoclonal antibody Depatuxizumab has proven ineffective in glioblastoma treatment, emphasizing the critical need to understand resistance mechanisms. The review also covers the success of radiation therapy in pediatric LGG, with evolving techniques, such as proton therapy, showing potential improvements in patient quality of life. Surgical treatment is discussed in the context of achieving a balance between preserving the patient’s quality of life and attaining gross total resection, with the extent of surgical resection significantly influencing the survival outcomes. In addition to advancements in cancer vaccine development, this review highlights the evolving landscape of LGG treatment, emphasizing a shift toward personalized and targeted therapies. Ongoing research is essential for refining strategies and enhancing outcomes in the management of LGG.

Conceptualizing healthcare professionals’ relational competence in mental healthcare: An integrative review

IntroductionThe relationship between patients and mental health professionals is the cornerstone of all mental health treatment, and good patient-professional relationships are associated with several positive therapeutic outcomes for patients with mental health challenges. Mental health professionals’ relational competence is essential for high-quality services in mental healthcare. There is currently no unified understanding of the concept of relational competence. This study seeks to address this gap by exploring how relational competence is conceptualized within the context of mental healthcare. The research question was: How is relational competence described in the research literature within the context of mental healthcare? MethodsAn integrative review was conducted with systematic searches in the databases PsycInfo, Ovid Medline, Embase, CINAHL, ERIC, Academic Search Elite, IDUN, and Svemed+, spanning from January 2012 to October 2023, as well as hand searches in the reference lists of the included studies. A thematic synthesis was carried out based on the results in the included studies. ResultsOut of 2970 scientific studies screened, 30 were included, employing a variety of research methodologies to explore relational competence within mental healthcare. Four themes were found to describe relational competence in mental healthcare: having the ability to self-reflect and self-regulate, having a genuine interest in understanding the patient, engaging in reciprocal interaction with the patient, and meeting the patient so that they feel acknowledged. Each theme describes a central and important part of relational competence, but fully developed relational competence must be understood as a whole in which all the themes are present. ConclusionRelational competence in mental healthcare incorporates all the identified components. Each theme complements the others and contributes to the construction of a strong therapeutic relationship between patients and mental health professionals. To provide the best possible care for mentally ill patients, healthcare professionals must embrace and integrate these elements into their practice.

Insulin Injection Technique and Related Complications in Patients With Diabetes in a Northwest City of China.

Appropriate insulin injection technique can help to enhance positive clinical outcomes in insulin-treated patients. This cross-sectional survey was undertaken to assess the present state of injection technique practices of patients administering insulin and the incidence of local complications associated with insulin injection. This cross-sectional study was conducted at 11 tertiary hospitals in Xi'an City. A total of 1370 patients with diabetes were enroled in the survey. Each patient was asked questions on the Injection Technique questionnaire, demonstrated insulin injection on an injection training pad and had their injection sites inspected by a nurse. About 98% of participants were type 2 diabetic patients. The 5 mm length needles were used by 640 (46.71%) patients. Around 1286 participants reused pen needles. Only one-third of patients rotate the injection sites. Around 901 patients had ecchymosis at injection sites, 43 participants suffered rash and or pruritus and 661 patients had lipohypertrophy. About 2.99% of patients reported having infection at the injection sites. Most patients (72.55%) occasionally felt pain when injecting insulin. The results of the multivariable logistict analysis showed that gender (male), needle length, priming the pen before injections and correct site rotation were negatively associated with the incidence of injection site ecchymosis. Lower incidence of lipohypertrophy was associated with needle length 4 mm, needle length 6 mm, single use of pen needles, priming the pen before injections and correct site rotation. Higher incidence of injection site infection was related to not disinfecting injection sites before each injection. Despite some improvements detected in some aspects of patients' insulin injection practice in recent years, a large gap still exists between insulin injection guidelines and patients' actual injection behaviour. Injection-related complications at injection sites are still considerably common among our study population. Patients' education regarding insulin injection technique should be conducted repeatedly and regularly to make sure patients' compliance to injection guidelines.

Towards optimized biopsy use in vertebral compression fractures: integrating risk assessment for better clinical decision-making.

Tissue biopsy is the gold standard for differentiating osteoporotic vertebral compression fractures from malignant lesions. However, the necessity of routine biopsies during percutaneous vertebroplasty and kyphoplasty is debated due to the low malignancy detection rates. This study aims to identify key predictors of positive biopsy outcomes in patients undergoing these procedures, with the goal of refining biopsy selection criteria to enhance diagnostic yield and improve clinical decision-making. We conducted a retrospective cohort study involving 295 patients who underwent percutaneous vertebroplasty and kyphoplasty with biopsy between June and December 2023. Clinical data, including age, gender, fracture aetiology, imaging findings, and biopsy results, were collected. Binary logistic regression analysis was employed to identify significant predictors of positive biopsy outcomes. The biopsy results revealed an overall malignancy rate of 1.01% (3/295). Among the 17 cases with abnormal (positive) biopsy findings, 17.6% were malignant, while the remainder were benign. Significant predictors included age (OR = 0.936), gender (OR = 0.307 for males), fracture aetiology (OR = 5.300 for fractures with no apparent cause), and imaging abnormalities (OR = 8.388). This study underscores the low malignancy detection rate in routine biopsies for vertebral compression fractures, advocating for a more selective approach by reserving biopsies for patients with specific high-risk factors. A targeted biopsy strategy, informed by enhanced pre-operative screening, could improve diagnostic accuracy and treatment outcomes, optimizing clinical management.

Suppurative Flexor Tenosynovitis: A Case Report

Background: Suppurative flexor tenosynovitis is an infection of the flexor tendon sheath. This case report presents the clinical course and management of a patient diagnosed with suppurative flexor tenosynovitis. The diagnosis is based on history taking, physical examination, and supporting examination findings. Case Report: A 42-year-old man presented with chief complaints of pain, swelling, and immobility of the index finger of his right hand after being pierced by a fish spine 3 days prior. Physical examination revealed the second digit in a slightly flexed and swollen position, with pain elicited on palpation and passive extension, limiting the patient's range of motion. The patient was diagnosed with suppurative flexor tenosynovitis and treated with antibiotics, debridement, and drainage. Postoperative results were good, with no signs of complications such as spread of infection, tendon necrosis, osteomyelitis, or indications for amputation.Discussion: The treatment for suppurative flexor tenosynovitis involves a combination of antibiotics and surgery. Surgical interventions typically include open drainage and debridement or closed catheter irrigation. Additionally, postoperative rehabilitation is a crucial aspect that requires careful consideration, as it has been shown to accelerate the healing process.Conclusion: Suppurative flexor tenosynovitis is a rare but serious condition that demands early detection and a multidisciplinary approach. Timely surgical debridement and targeted antibiotics, guided by the identification of the causative organism, are essential for positive patient outcomes.