Prospective Quasi-experimental Study Research Articles

Surgical Outcomes of Patients with Benign Spinal Tumors: Insights from A Prospective Quasi Experimental Study

Background: Spinal tumor is one of the causes of back pain, sensory motor deficit and bowel bladder dysfunction. Evaluation of postoperative mortality, morbidity and outcomes after resection of spinal cord tumors is critical to the practice of evidencebased medicine. Hence, it is important to carefully examine surgical outcomes at an institutional level. Objectives: The aim of the study was to describe the results of benign spinal tumor after surgical treatment according to location. Materials & Method: This quasi-experimental study was conducted in the Department of Neurosurgery, Chittagong Medical College and Hospital for a period of 12 months. Twenty eight cases of benign spinal tumor underwent surgical treatment were enrolled in the study. Average hospital stay from surgery to discharge was 12-15 days. Postoperative neurological outcome in Frankel’s grade and bowel bladder involvement were assessed from 1st POD to 3rd month after surgery and data were recorded at 7th POD, 1st month and 3rd month after surgery. Collected data were analyzed by using SPSS-23. Results: Among the 28 cases, 15 were men and 13 were women. The mean age was 36.19 (±14.29) years and age range was 15 to 62 years. Twenty three (82.14%) patients improved by at least one Frankel grade and remaining five (17.86%) patients maintained their preoperative Frankel grade. Out of eight (28.6%) cases with absent bowel bladder dysfunction before surgery six (75%) recovered within three months. Postoperative deterioration was not observed in any of the included case. Ten (35.7%) patients had excellent outcome (having Frankel grade E with normal bowel bladder control) and 18 patients (64.3%) had good/fair outcome (partial recovery or clinically insignificant recovery) after 3 months. Age, gender and location (axial and sagittal) of benign spinal tumor were not found to have significant variation of neurological outcome. Conclusion: Majority of patients irrespective of the location (axial/sagittal) of the tumor had a favorable clinical outcome three months after the operation. Bang. J Neurosurgery 2024; 13(2): 130-139

Effectiveness of Citicoline versus Citicoline with Piracetam in Moderate to Severe Acute Ischemic Stroke Patients: A Quasi Experimental Prospective Study

Stroke is a sudden cerebral root neurologic collapse, a major cause for global morbidity and death, necessitates the use of neuroprotectants to prevent further damage to ischemic decline. Citicoline and piracetam are widely used as neuro-protectives, however their benefits in Acute Ischemic Stroke have not yet been established. This prospective, quasi-experimental study compared the effectiveness of citicoline (Group A) and citicoline with piracetam combination (Group B) in moderate-to-severe patients. 75 patients were divided into two groups (25 in Group A and 50 in Group B) and followed for a period of 90 days. Their cognitive and functioning events were examined using National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI). There is no discernible difference (p > 0.05) amongst the two groups by NIHSS whereas, there was a significant difference (p<0.05) in mRS and BI. After 90 days, Group A patients significantly progressed in terms of overall functional and cognitive improvement. The administration of citicoline within the first 24 hours of a stroke helps to prevent further sequelae and minimizes the severity of AIS. This study concludes that citicoline alone responds better than piracetam combination, but its neuroprotective properties have not been proven. Keywords: Acute Ischemic Stroke. Citicoline. Piracetam. NIHSS. BI. mRS.

Postoperative wound care protocol prevents surgical site infection after craniotomy.

Postoperative wound care after craniotomy is not standardized. Evaluate the impact of a standardized post-craniotomy wound care protocol on surgical site infection (SSI). Prospective quasi-experimental single-center intervention cohort study involving adult patients undergoing craniotomy at a 461-bed academic medical center in Orange County, California from January 2019-March 2023 (intervention) compared to January 2017-December 2018 (baseline). A postoperative neurosurgical wound care protocol was developed involving chlorhexidine cloths to remove incisional clots and to clean the surgical incision and adjacent hair after craniotomy surgery. Protocol adherence was monitored by routine inpatient surveillance of wounds and photo-documentation for real-time feedback to surgeons and nursing staff. Impact of the intervention was assessed using multivariable regression models. There were 3560 craniotomy surgeries and 62 (1.7%) SSIs; 1251 surgeries and 30 (2.4%) SSIs during baseline, and 2309 surgeries and 32 (1.4%) SSIs during intervention. Process evaluation after implementation found significant decreases in incisional clots, erythema, drainage, and unclean hair. In multivariable analysis, the intervention was associated with fewer SSI (odds ratio (OR): 0.5 (0.3, 0.9), P = 0.02). A standardized post-craniotomy wound care protocol involving cleaning of the incision and adjacent hair, including removal of incisional clots with chlorhexidine cloths was effective in reducing the risk of SSI.

Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) program in Nairobi, Kenya: a quasi-experimental prospective study

Background Persons seeking emergency injury care are often from higher-risk and underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons. Methods This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed as a multi-component intervention employing setting appropriate strategies for HIV care sensitization and integration, task shifting, resource reorganization, linkage advocacy, skills development and education to promote ED-HTS with a focus on higher-risk persons. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18–24 years), victims of interpersonal violence, persons with hazardous alcohol use and persons never HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March − 16 April 2023) and post-implementation (period 1, 1 May − 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June − 20 August 2023). HTS data were evaluated as facility-based HIV testing (completed in the ED) and distribution of HIV self-tests independently, and aggregated as ED-HTS. Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains. Results All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS among all presenting patients increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR = 1.31, 95% CI: 1.21–1.43; p < 0.001). Among 605 enrolled patient participants, facilities-based HTS increased from 5.7% pre-implementation to 62.3% post-implementation period 1 (RR = 11.2, 95%CI: 6.9–18.1; p < 0.001). There were 440 (72.7%) patient participants identified as KPs (5.6%) and/or PPs (65.3%). For enrolled KPs/PPs, facilities-based HTS increased from 4.6% pre-implementation to 72.3% post-implementation period 1 (RR = 13.8, 95%CI: 5.5–28.7, p < 0.001). Systems and participant level data demonstrated successful adoption and implementation of the HEATED program. Through 16 wk post-implementation a significant increase in ED-HTS delivery was maintained as compared to pre-implementation. Conclusions The HEATED program increased overall ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons already in contact with health systems.

Effectiveness of preoperative micronized purified flavonoid fraction treatment and sucralfate-based rectal ointment on hemorrhoidal disease: A case-matched analysis

BackgroundHemorrhoidal disease (HD) significantly impacts patients’ quality of life. This study aimed to evaluate the effectiveness of preoperative treatment with the micronized purified flavonoid fraction (MPFF) and a sucralfate-based rectal ointment in managing HD symptoms and reducing interventions.MethodsA prospective quasi-experimental study including consecutive cases and controls matched on the basis of sex was performed in a tertiary referral center. Cases received systemic and local therapy for HD, consisting of a rectal ointment containing 3% sucralfate and herbal extracts plus MPFF, in addition to conservative therapy, while controls received conservative therapy alone. The hemorrhoidal disease symptom score (HDSS), the Short Health Scale for HD (SHS-HD) score, and the Vaizey Incontinence Score were used to evaluate symptoms severity and their impact on quality of life and continence. Intervention requirements were assessed at baseline (T0) and after 60 days of treatment (T1).ResultsBetween January and December 2023, a total of 98 patients were assessed for eligibility. After exclusions, 56 patients were enrolled, with 28 in each group. Significant improvements were observed in HD symptom scores from T0 to T1: the intervention group showed a mean change in HDSS of −9 [95% confidence interval (CI) −10 to −8], and the control group showed no significant change (mean change of 0; 95% CI −1.5 to 0). At T1, a higher proportion of patients in the intervention group underwent less invasive interventions compared with controls (18% versus 11%). Age, treatment group, and baseline symptom severity significantly predicted post-treatment symptom scores.ConclusionsIn our study the preoperative treatment with MPFF and a sucralfate-based rectal ointment demonstrated clinical benefits in managing HD symptoms and reducing interventions. Further prospective trials are warranted to confirm and explore additional therapeutic strategies.

Assessing the Efficacy of Thoracic Erector Spinae Plane Block for Postoperative Analgesia in Lumbosacral Spine Surgery: A Prospective Quasi-experimental Study.

Background and aims Optimal postoperative care and analgesia are the key factors in the management of cases of lumbosacral spine surgery. The erector spinae plane (ESP) block is a recently evolving entity and has a dynamic role in postoperative pain management. However, its role in the management of pain in lumber spinal surgeries is still not clear, and the literature remains anecdotal. Therefore, we planned to study the efficacy of ultrasound-guided preoperative ESP block at the T12 level using levobupivacaine for perioperative analgesia in lumbosacral spine surgeries. Methods A total of 60 patients scheduled for elective or emergency lumbosacral spine surgery were divided into two groups - the GA group received standard general anesthesia (GA)and the GA+ESP group received standard general anesthesia along with ultra-sound guided ESP block at the T12 level with a bilateral injection of20 ml 0.25% levobupivacaine. Perioperative analgesia was assessed by total intra-operative fentanyl dose and frequency, intra-operative hemodynamic parameters, post-operative numeric rating scale (NRS) scores, time of first systemic rescue analgesia, tramadol usage, mobilization day, and hospital stay duration. Results Intraoperative fentanyl sparing was observed in 83% of the GA+ESP group compared to 33% in the GA group. Postoperative tramadol sparing was observed in 80% of the GA+ESP group compared to 26.7% of the GA group. Twenty-four-hour postoperative NRS scores >3/10 were observed in 20% of the GA+ ESP group compared to 73.3% of the GA group. Conclusion In this study, superior perioperative analgesia, opioid-sparing effect, and decreased requirement of postoperative rescue analgesia were observed with ESP block.

Impact of a therapeutic educational intervention using a gamification method aimed at adolescents with type 1 diabetes mellitus.

ntroduction : Autoimmune type 1 diabetes mellitus (T1D) is one of the most prevalent chronic diseases in the paediatric age group. Gamification in diabetes education may have the potential to change health behaviours by creating an innovative, engaging and interactive learning environment. Material and methods : A 6-month prospective quasiexperimental pilot study aimed at evaluating the impact of a gamified educational intervention (own kahoot ®, face-to-face, in 2 sessions, with immediate feedback) on diabetes knowledge, metabolic control and quality of life of adolescents with T1D. Variables recorded : knowledge using the Diabetes Knowledge Questionnaire Test (DKQ2) and own Diabethoc questionnaire, metabolic control parameters through glycosylated haemoglobin, main parameters established according to the recommendations of the Advanced Technologies &amp; Treatments for Diabetes (for sensor use &gt;70%) and quality of life in diabetes with the PedsQL test. Results : Twenty-one patients (61.9% boys) with a mean age of 13.8±0.81SD years on multi-dose insulin therapy 71.4% (n=15) and the insulin pump 28.6% (n=6) were included. Assessment by DKQ2 showed a 38.7% increase in knowledge post-intervention. The Diabet-hoc test showed an increase of 65.3% throughout the study. Changes in metabolic control and the quality-of-life test were not statistically significant. Conclusions : Our tool demonstrated an improvement in diabetes knowledge maintained at 6 months after the study

The effect of intestinal stoma care training on knowledge and skill levels of pediatric surgery nurses

Objectives: The study aimed to examine the effect of intestinal stoma care training on the knowledge and skill levels of pediatric surgery nurses in stoma care and to determine the factors affecting the knowledge and skill levels of pediatric surgery nurses in stoma care. Materials and methods: This quasi-experimental prospective study included 30 nurses (28 females, 2 males; mean age: 33.0±7.5 years; range, 23 to 46 years) working in pediatric surgery clinics who met the inclusion criteria between September 2023 and January 2024. A pediatric intestinal stoma care training was given to the nurses using a 20-min video prepared by the researchers. Data were collected by using a sociodemographic survey and a pediatric stoma care knowledge and skills survey developed by the researchers. The knowledge and skill levels of the nurses before and after the training and after three months were compared. Results: It was found that the pediatric intestinal stoma care training increased the knowledge and skill levels of the nurses. There was a difference between the mean number of practiced skills of nurses working only during the day and nurses working only at night before the training, and this difference was found to be statistically significant. Conclusion: Increasing the knowledge and skill levels of nurses about stoma care could decrease the risk of complications and the duration of hospitalization, ensure cost-effective care, and support the national economy in this direction.

Evaluation of factors predicting tinnitus outcomes following cochlear implantation: Protocol for a prospective quasi-experimental study.

Cochlear implantation is an effective intervention to restore useful aspects of hearing function in adults with severe-to-profound hearing loss. Tinnitus, the perception of sound in the absence of an external source, is common in people with severe-to-profound hearing loss. Existing evidence suggests cochlear implantation may be effective in reducing the negative impact of tinnitus in this population. However, this is contradicted by data suggesting that up to half of cochlear implant recipients experience tinnitus, and that some of these patients who did not have tinnitus before cochlear implantation experience it after surgery or cochlear implant activation. Most evidence on the effects of cochlear implantation on tinnitus comes from secondary data in cochlear implant studies primarily concerned with hearing-related outcomes. Hence, the quality of the evidence for effects on tinnitus is low and not suitable to inform clinical recommendations or decision-making. This study will systematically collect data on tinnitus and tinnitus-related outcomes from patients at multiple points during the cochlear implant pathway to characterise changes in tinnitus. This will improve our understanding of the effects of cochlear implantation for tinnitus in adults with severe to profound hearing loss and inform the design of clinical trials of cochlear implantation for tinnitus.

Comparison of Postprocedure Cardiac Catheterization Recovery Instructions on Participant’s Perceived Comprehension and Satisfaction

PurposeThe purpose of this study was to evaluate the effect of education timing on patient satisfaction and perceived knowledge comprehension of recovery instructions in cardiac catheterization patients. DesignThis prospective quasi-experimental single-blinded study was blinded to the participant. MethodsThis study was conducted between January and August 2022 in the cardiac catheterization laboratory of a New York metropolitan community hospital. Seventy-seven cardiac catheterization participants were randomized into two groups. The intervention group (n = 40) received instructions preprocedurally, while the control group (n = 37) received instructions per standard of care postprocedurally. The study team designed a nine-question satisfaction and perceived comprehension survey, which was used as the primary data collection tool. Data were collected through telephone interviews conducted 24 to 48 hours postprocedure. Chi-square (χ2) analysis was used to determine associations between the two groups. FindingsResults revealed the participants in the intervention group (97.5%, n = 39) were more satisfied than those in the control group (83.8%, n = 31). Satisfaction with instructions about managing arterial bleeding was higher in the intervention group (100%, n = 40) than in the control group (83.8%, n = 31). There was a statistically significant difference in perceived comprehension of management of arterial bleeding (χ2 = 5.22, P < .05) and management difficulty urinating (χ2 = 5.69, P < .05), where the intervention group scored significantly higher than the control group. Major feedback from participants included recommendations to enhance written instructions for clarity. ConclusionsDelivering instructions preprocedurally compared to the standard of care revealed higher patient satisfaction and perceived comprehension of recovery instructions in cardiac catheterization patients. This study demonstrates how clinical nurses can translate nursing research into patient-centered outcomes, bridging research and practice gaps.

Comparison between two-hole-assisted phaco-chop and stop-and-chop techniques for nuclear disassembly in residents’ cataract surgery

Abstract PURPOSE: The purpose of this study was to evaluate the safety of the novel two-hole-assisted phaco-chop technique as a transition between stop-and-chop and direct-chop techniques and to compare its phacoemulsification parameters with the stop-and-chop technique. METHODS: A prospective quasi-experimental study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. One hundred and three patients (103 eyes), aged 18 years and above, with nuclear sclerosis (NS)+2, NS +3, +4, cortical, and posterior subcapsular cataracts (WHO Cataract Grading Group) were included, whereas patients with uveitis, glaucoma, traumatic cataracts, small pupils, zonular weakness, lens subluxation, small palpebral fissures, soft cataracts (NS + 1), and posterior polar cataracts were excluded from the study. The stop-and-chop technique was performed in 58 (56.3%) patients, whereas the two-hole-assisted chop technique in the rest. Ultrasound time (UST), total surgical time, and volume of balanced salt solution (BSS) delivered were recorded. RESULTS: The mean age of the participants was 65.12 ± 8.85 years. The comparison of the two techniques revealed no statistically significant difference in the UST (P = 0.723), volume of BSS used (P = 0.102), and total surgery time (P = 0.517). However, a significant positive correlation between cataract grade and UST (Spearman’s r = 0.888, P &lt; 0.001), BSS volume delivered (Spearman’s r = 0.831, P &lt; 0.001), and surgery time (Spearman’s r = 0.846, P &lt; 0.001) was observed. Moreover, the UST comparison between cataract grades revealed a significant difference between the three groups (F = 185.09 P &lt; 0.001). P &lt; 0.05 was considered statistically significant. CONCLUSION: The two-hole-assisted phaco chop is a safe and efficient transitional technique between stop-and-chop and direct-chop techniques for nuclear disassembly in cataract surgery performed by resident surgeons. In addition, the phacoemulsification parameters of the two-hole-assisted chop technique are comparable with the stop-and-chop technique.

Short-term cost-utility analysis of biventricular cardiac resynchronization therapy in comparison with left bundle branch area pacing cardiac resynchronization therapy

Abstract Background Cardiac resynchronisation therapy (CRT) is a well-established form of treatment for patients with heart failure and cardiac dyssynchrony. Recently, left bundle branch area pacing (LBBAP) has emerged as a more physiological alternative for biventricular pacing (BiVP) cardiac resynchronization therapy (1,2). Purpose The purpose of this study was to conduct a cost-utility analysis for LBBAP CRT, compared to BiVP CRT in a cohort of patients with heart failure from the Spanish health system perspective. Methods A multicenter prospective quasi-experimental study in which 44 consecutive patients underwent CRT was conducted. According to the study protocol, the four centers would perform their usual clinical practice: two out of them would perform conventional BiVP-CRT while the other half LBBAP-CRT. Intention-to-treat analysis was carried-out. Health outcomes were quality-adjusted life years (QALYs), measured by the EuroQol-5D-5L questionnaire, which the patients were asked to complete at baseline and 12 weeks after the CRT device implantation. The total direct costs include device, leads, guidewires, introducer kits, sheats and operating theater time. The results were expressed as the incremental cost-utility ratio (ICUR). In order to analyze the uncertainty of ICUR results, we performed a non-parametric bootstrapping with 1000 replications. Results The LBBAP procedure was attempted for a total of 26 consecutive patients (1 patient underwent rescue BiVP), while BiVP was attempted for 18 patients (2 patients switched to LBBAP). Mean QALYs over 3 months were 0.1914 ± 0.009 in the LBBAP CRT group and 0.1904 ± 0.0112 in the BiVP CRT. Improvements from baseline were greater in the LBBA CRT group but not statistically significant. The total costs at the end of the intervention were 7546.6 €± 602.15€ in the LBBAP CRT group and 16064.56€ ± 723.7€ in the BiVP CRT group. When excluding from the analysis the cases in which ICD was implanted, the mean difference in QALYs is 0.002; 95% confidence interval [95%CI]: -0.03 to 0.036) and the mean saving is -3.510.38 €. The LBBAP CRT leads to cost savings for the health system and similar QALYs outcomes; 95%CI: -6.660 to -360.71. Based on 1000 bootstrapping replication, the cost savings of using LBBAP vs BiVP occur in 99% of the simulations. Conclusion LBBAP CRT is an efficient alternative to BiVP CRT for cardiac resynchronization in patients with heart failure with similar results in terms of QALYs but with significant average savings per patient.Cost-utility plane for 1000 bootstrappedBaseline characteristics of patients

Health-related quality of life among patients after cardiac resynchronization therapy: a comparison between biventricular and left bundle branch area pacing

Abstract Background Cardiac resynchronization therapy (CRT) with biventricular pacing (BiVP) has the potential to improve cardiac function in patients with heart failure (HF). However, a portion of patients do not respond to therapy. Recently, left bundle branch area pacing (LBBAP) has emerged as a more physiological alternative for CRT in selected cases (1,2). Quality of life (QoL) tools measures subjective experience and its results are relevant as they may help to assessed the impact that medical interventions have in patient's health. Purpose The authors sought to measure and compare the quality of life in a cohort of patients after the implantation of either a BiVP or a LBBaP CRT device. Methods A multicenter prospective quasi-experimental study in which consecutive patients underwent CRT was conducted. According to the study protocol, the four centers would perform their usual clinical practice: two out of them would perform conventional BiVP-CRT while the other half LBBAP-CRT. The health related QoL was measured by the Spanish version of the EuroQol Group’s five-level EuroQol five-dimensional questionnaire (EQ-5D-5L), which the patients were asked to complete at baseline and 12 weeks after the CRT device implantation. The descriptive system section of the EQ-5D-5L questionnaire produces a 5-digit health state profile that can be converted into a single index value. The EQ-5D-5L Spanish index values range from -0.225 to 1.0 (full health). The EQ-5D visual analogue scale (EQ-VAS) is a vertical scale numbered from 0 to 100 (the worst and the best health you can imagine). Both groups (BiVP and LBBaP) were compared with data from the general population of Spain for the EQ-5D-5L and EQ-VAS (n=20.587) according to the national survey (3). Results The study included 44 consecutive patients (31 males, mean age 66 ± 11 years, LVEF 28.9% ± 6.9%). The LBBAP procedure was finally performed in 27 patients, while BiVP was the therapy performed in the other 17 patients. Crossover rate was less than 12% (1 patient underwent rescue BiVP and 2 patients switched to LBBAP). The basal characteristics of included patients are presented in Table 1. Among the individuals with BiVP the mean EQ-5D-5L index score and the EQ-VAS score were 0.74±0.24 and 65.71±17.90 respectively at baseline while they were 0.83±0.19 [+0.08±0.16, p 0.054, CI 95%] and 76.59±15.76 three months later [+10.80±15.38, p 0.01, CI 95%]. In the LBBAP group, the mean EQ-5D-5L index score and the EQ-VAS score were 0.71±0.25 and 50.04±25.49 respectively at baseline while they were 0.80±0.19 [+0.09±0.22, p 0.044, CI 95%] and 69.30±23.53 [+19.26±22.83, p 0.0001, CI 95%] three months later. Conclusion It was found that the EQ-5D-5L index value and EQ-VAS improved in the LBBAP group. In the BiVP group only EQ-VAS improved although there was also a non-statistically significant trend in EQ-5D-5L index score. The main limitation of the study was the small sample size.Table 1Figure 1

Nutritional Issues in Children with Dysphagia.

(1) Background: Pediatric dysphagia presents significant nutritional challenges, often impacting growth and development due to reduced oral intake, increased nutritional needs, and gastrointestinal complications; (2) Methods: This prospective quasi-experimental study assessed 117 children under 14 years old (20 patients were under 1 year old, 80 were aged 1-7 years, and 17 were older than 7 years), diagnosed with swallowing disorders, to analyze their caloric, macro-, and micronutrient intake and identify potential deficiencies. The severity of dysphagia was established using functional oral intake scales, and dietary records were reviewed over a 3-day period; (3) Results: The study revealed that 39.8% of participants did not meet their total energy expenditure (TEE), highlighting a high prevalence of malnutrition among these children. Furthermore, patients using feeding devices exhibited a significantly lower caloric intake, and over half required significantly modified food textures. After individualized speech therapy and nutritional rehabilitation, participants showed significant improvements in caloric intake, with their energy coverage increasing from 958% to 1198% of the daily requirement. Rehabilitation also improved tolerance to a broader range of food textures; (4) Conclusions: This research underscores the importance of multidisciplinary, individualized nutritional strategies to address the specific challenges of pediatric dysphagia, emphasizing the role of enteral nutrition and therapeutic interventions in improving the quality of life and nutritional outcomes of these children. Further studies are recommended to assess the long-term impact of such strategies.

Is the Serum Prostate-Specific Antigen Level Affected by Urethral Catheterization in Patients with Acute Urinary Retention?

Background: The reason for elevated serum prostate-specific antigen (PSA) levels in patients undergoing urethral catheterization due to acute urinary retention (AUR) remains a significant and controversial issue. Objectives: To assess the serum PSA level in men with AUR and its changes after catheterization. Methods: This prospective quasi-experimental study (reviewer 1 - comment 7) was conducted on 43 patients who underwent transurethral catheterization following AUR caused by benign prostatic hyperplasia (BPH). Total PSA levels and free/total PSA ratios were measured before catheterization and one and three days after catheter insertion. Additionally, prostate volume and urine output after catheterization (UOAC) were recorded. Results: The mean age, prostate volume, and UOAC of the patients were 69.05 ± 9.45 years, 60.51 ± 26.35 g, and 844.04 ± 341.66 mL, respectively. The mean and median baseline total PSA levels were 12.59 ± 17.71 ng/mL and 6.30 ng/mL, respectively. These values changed to 13.73 ± 19.83 ng/mL (median = 4.80 ng/mL) and 11.57 ± 17.70 ng/mL (median = 4.40 ng/mL) after 1 and 3 days of catheterization, respectively. The changes in total PSA and free/total PSA levels during the study period were not statistically significant (P &gt; 0.05). Moreover, the PSA levels showed no statistically significant difference before, 1 day, and 3 days after catheterization in groups with total PSA ≤ 4 and total PSA &gt; 4 (P = 0.37; 0.22, respectively). Conclusions: Our results suggest an initial elevation in PSA levels in patients with AUR before urethral catheterization. Both PSA and free/total PSA ratios showed no statistically significant differences before and after urethral catheter insertion, and initial PSA levels did not affect their changes post-catheterization (reviewer 1 - comment 1).

Effectiveness of a Teach-Back Education Program on Perioperative Pain in Patients With Lung Cancer: An Intervention Study Using Behavior Change Wheel

To assess the effect of a teach-back educational intervention using Behavior Change Wheel (BCW) framework on perioperative pain among patients with lung cancer. A prospective quasi-experimental study was conducted in 88 patients with lung cancer from a tertiary hospital in China. According to the order of admission, they were allocated to either control group or intervention group, with 44 patients in each group. Patients in the control group received routine nursing care, while patients in the intervention group were given a teach-back education program based on BCW framework. The visual analog scale (VAS) was adopted to evaluate patients' pain on the day of surgery (T0), 1 (T1), 2 (T2), and 3 (T3) days after surgery. We also recorded the use of patient-controlled analgesia (PCA), the length of hospital stay, and the degree of patients' satisfaction. Rest pain, pain when coughing, and pain during activity that patients in the intervention group experienced were significantly less severe than those in the control group on T0 and T1. The pain when coughing in the intervention group was also significantly milder on T2 and T3. In addition, the number of self-control time, use duration, and total dose of PCA were significantly lower in the intervention group. Moreover, patients' satisfaction of nursing service was significantly higher in the intervention group. A teach-back education program based on BCW framework was effective in pain management among the perioperative patients with lung cancer. This study demonstrates the application of teach-back method and the BCW in the development of patient education intervention to mitigate perioperative pain.

Early ambulation protocol after diagnostic transfemoral cerebral angiography: an evidence-based practice project

BackgroundNo uniform consensus has been achieved regarding the ambulation protocol after transfemoral cerebral angiography (TFA). Until now, in most hospitals patients are prescribed 8-12 h strict immobilization along with bed rest in the supine position after TFA in China, which causes great discomfort to patients.ObjectiveTo evaluate the effect of an evidence-based early ambulation protocol on the prevention of vascular complications and general discomfort in patients following transfemoral cerebral angiography (TFA).MethodsA prospective quasi-experimental study was conducted on 214 patients undergoing TFA with manual compression. Patients in the experimental group were placed supine position for 2 h with a sandbag placed on the wound dressing, followed by a semi-seated position for another 2 h. After this period, patients took 2 h bed rest (move freely) with the sandbag removed, and were allowed to get out of bed 6 h after TFA. Patients in the control group were restricted to an 8 h bed rest in a supine position with the affected leg straight and immobilized. The vascular complications (bleeding, hematoma, ecchymosis) and levels of comfort (low back pain, leg pain, and blood pressure) were evaluated after the procedure. Numeric Rating Scale (NRS) pain scores, systolic blood pressure (SBP); diastolic blood pressure (DBP) were measured hourly for 8 h after TFA.ResultsThere was no significant difference in the two groups with regard to vascular complications including bleeding events (P = 0.621), bleeding volume (P = 0.321), and area of hematoma (P = 0.156).The area of ecchymosis in the experimental group was significantly smaller than the control group (P = 0.031). Compared with the control group, the NRS score for low back pain in the 4th, 5th, 6th, 7th, and 8th hour after TFA were significantly lower (P < 0.05), and the NRS score for leg pain in the 5th, 6th, 7th, 8th hour after TFA were significantly lower (P < 0.05). The SBP and DBP in the 6th, 7th, and 8th hour after TFA were significantly lower than the control group (all P < 0.05).ConclusionsThe evidence-based early ambulation protocol can effectively and safely increase comfort and decrease the pain level for patients undergoing TFA, without change in the incidence of vascular complications.

Comparing pre- and postoperative etoricoxib administration versus only postoperative on third molar extraction sequelae and oral health quality of life: a prospective quasi-experimental study

ObjectivesThis study aimed to compare the impact of pre- and postoperative etoricoxib administration versus only postoperative on third molar extraction sequelae and oral health quality of life.Materials and methodsThis prospective quasi experimental study involved 56 patients, divided into a study group receiving preemptive etoricoxib 120 mg before surgery and postoperative etoricoxib 120 mg (n = 28), and a control group receiving preemptive placebo before surgery and postoperative etoricoxib 120 mg (n = 28).Follow-up assessments were conducted at 3- and 7-days post-surgery, recording swelling, trismus, and adverse events. Patients rated perceived pain using the visual analog scale (VAS) and completed an oral health-related quality of life (OHRQoL) questionnaire at specified intervals. Statistical analysis employed non-parametric tests (i.e., the Mann–Whitney test, Friedman test, and Wilcoxon sign test) with P < 0.05.ResultsSignificantly lower VAS scores were reported in the study group throughout the follow-up period (P < 0.05). Pharmacological protocol did not have a significant impact on postoperative edema and trismus (P > 0.05). However, double etoricoxib intake significantly improved postoperative quality of life on day 3 after surgery (P < 0.05).ConclusionsPre- and postoperative etoricoxib 120 mg intake in third molar surgery reduced postoperative pain and enhanced postoperative quality of life on day 3 after surgery. Importantly, it was equally effective in managing swelling and trismus compared to exclusive postoperative intake.Clinical RelevancePreemptive etoricoxib use may decrease patient discomfort following impacted mandibular third molar extraction.

Effectiveness of a Theory-Based Intervention to Improve Postpartum Type-2 Diabetes Mellitus Screening Uptake Among Women with Gestational Diabetes Mellitus in Malaysia: A Prospective Quasi-Experimental Study

Introduction: Despite the importance of postpartum type-2 diabetes mellitus (T2DM) screening to ensure early detection and effective management of T2DM among women previously diagnosed with gestational diabetes mellitus, low uptake has been reported. In view of the proven effectiveness of theory-based interventions, this study aimed to evaluate the effectiveness of Information Motivation Behavioural Skills (IMB)-based intervention to improve postpartum T2DM screening uptake among pregnant women with GDM in Negeri Sembilan, Malaysia. Methods: A prospective quasi-experimental study was carried out among comparable respondents in the intervention and control groups, involving 61 and 55 respondents respectively. Validated and reliable self-administered questionnaire was used to measure pre- and post-intervention of knowledge, attitude and self-efficacy, based on the constructs of the IMB model, with postpartum T2DM screening uptake measured at 6-week postpartum. Results: The IMB-based intervention was effectively improved knowledge on gestational diabetes mellitus (GDM), and attitude as well as self-efficacy related to the screening, with significant difference in the 6-week postpartum T2DM screening uptake between the intervention and control groups. Between groups comparison revealed significantly higher mean scores for knowledge (ηp 2 =0.11), attitude (ηp 2 =0.031) and self-efficacy (ηp 2 =0.52) in the intervention group compared to the control group, with self-efficacy is showing the largest size effect. Conclusion: The IMB-based health intervention had effectively improved the 6-week postpartum T2DM screening among women with GDM in the intervention group, through the significant improvement of knowledge on GDM and attitude as well as self-efficacy related to the screening.

The Effect of Postural Restoration Institute Training on Selected Kinematic Variables of Lower Limbs and Pelvis During Walking in Middle-Aged Men With Nonspecific Chronic Low Back Pain: A Prospective Observational Study

Background and Aims Concerning the effectiveness of training on people with chronic low back pain, the present study aimed to evaluate the effect of postural restoration institute (PRI) training on lower limb kinematics during walking in middle-aged subjects with discogenic low back pain. Methods In this prospective observational quasi-experimental study, 42 people participated in three groups: people without low back pain (healthy group, n=14) and people with low back pain in two groups (intervention group, n=14; and control group, n=14). Kinematic data were recorded by 7 Qualisys cameras with a frequency of 100 Hz in the pretest and post-test. Analysis of variance with repeated measures was used in SPSS software version 23 at a significance level 0.05. Results The results showed that people with low back pain in the intervention and control groups walk with a slower velocity, lower cadence, and shorter step length than healthy individuals for both right and left limbs. However, after the PRI training, the intervention group showed a significant increase in those three variables. Furthermore, there were significant differences between the healthy group and the two groups of intervention and control in the range of motion (ROM) for the pelvis in the sagittal and frontal planes, the right hip joint in the horizontal plane, the right ankle in the frontal plane, the left hip joint in the sagittal and horizontal planes as well as the left ankle in the sagittal plane. After applying PRI, the differences between the healthy and the intervention groups regarding the pelvis ROM on the sagittal plane, the right ankle ROM on the sagittal plane, the left hip joint ROM on the frontal plane, and the left knee ROM on the sagittal plane were minimized and became insignificant. Conclusion The present study’s findings confirmed the effectiveness of using PRI training in improving biomechanical indicators, such as the range of joint movements and increasing the velocity and step length of walking, to treat and manage the performance of people with discogenic chronic low back pain.