Provincial Hospital Research Articles

Demographic and Clinical Factors Associated with Bacterial or Nonbacterial Etiologies of Acute Undifferentiated Febrile Illness: Findings from a 3-Year Observational Study in Thailand, 2017-2020.

Acute undifferentiated febrile illness (AUFI) is often undiagnosed in Thailand, resulting in delayed or ineffective treatment. We compared the demographic, exposure history, and clinical characteristics of AUFI patients with laboratory evidence of bacterial and nonbacterial pathogens. Patients aged 2-80 years presenting to 12 hospitals in Nakhon Phanom and Tak provinces were enrolled from April 2017 through May 2020. Interviews were conducted and blood, urine, and sputum were collected for culture as well as rapid diagnostic and molecular testing. A total of 1,263 patients tested positive for one or more bacterial, viral, or parasitic pathogens and were included in the analysis. Multivariable logistic regression was performed to compare factors associated with bacterial infections versus nonbacterial infections. Bacterial infections were more commonly identified in participants from Nakhon Phanom than Tak. Bacterial infections were independently associated with several factors including age ≥50 years (adjusted odds ratio [95% CI]): (4.18 [2.85-6.14]), contact with farm animals (1.82 [1.29-2.57]), antibiotic use within 72 hours of hospital presentation (2.37 [1.50-3.74]), jaundice (2.31 [1.15-4.63]), existing comorbidities (2.77 [1.93-3.96]), contact with febrile individuals (0.42 [0.31-0.57]), muscle pain (0.44 [0.31-0.64]), and rash (0.45 [0.29-0.70]). Bacterial infections were also associated with longer hospitalization (2.75 [2.08-3.64]) and lower odds of recovery at the time of discharge (0.14 [0.07-0.31]). Consideration of patient characteristics and signs/symptoms may help to inform targeted laboratory testing for suspected infectious etiologies. Understanding factors associated with bacterial and non-bacterial causes of AUFI may aid diagnosis and judicious use of antibiotics in resource-limited settings.

Prognostic value of cardiopulmonary exercise test in patients with acute myocardial infarction after percutaneous coronary intervention

To determine the independent risk factors of cardiopulmonary exercise test (CPET) parameters related to adverse prognostic events within 5 years in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), and establish a prediction model for the occurrence of adverse events within 5 years to provide a reference for cardiac rehabilitation training. From August 2015 to December 2021, patients who underwent PCI for AMI and completed CPET within 1–2 weeks after surgery before discharge from the Department of Cardiovascular Medicine of Zhengzhou Central Hospital Affiliated to Zhengzhou University, Henan Provincial Hospital of Traditional Chinese Medicine, and Anyang District Hospital were selected as participants. Univariate and multivariate analyses were used to screen for independent risk factors associated with 5-year adverse events. Feature importance was interpreted using SHapley Additive exPlanations (SHAP), and a logistic regression model was established for prediction. A receiver operating characteristic (ROC) curve was constructed to evaluate the performance of the prediction model. Calibration was assessed by the Hosmer–Lemeshow test and the calibration curve. In total, 375 patients met the inclusion criteria. Based on whether adverse events occurred during the 5-year follow-up period, the patients were divided into two groups: the event group (n = 53) and the non-event group (n = 322). Peak oxygen uptake (peakVO2), carbon dioxide ventilation equivalent slope (VE/VCO2slop), and peak end-tidal carbon dioxide partial pressure (PETCO2) were three independent risk factors for re-acute myocardial infarction (re-AMI), heart failure (HF), and even death after PCI for AMI (P < 0.05). The SHAP plots demonstrated that the significant contributors to model performance were related to peakVO2, VE/VCO2slop, and PETCO2. The risk of adverse events was significantly reduced when the peakVO2 was ≥ 20 mL/kg/min and the VE/VCO2slop was < 33. The ROC curves of the three models were drawn, including the no-event and event groups, re-AMI group, and HF group, which performed well, with AUC of 0.894, 0.760, and 0.883, respectively. The Hosmer–Lemeshow test showed that the three models were a good fit (P > 0.05). The calibration curve of the three models was close to the ideal diagonal lines. CPET parameters can predict the prognosis of adverse events within 5 years after PCI in patients with AMI and provide a theoretical basis for cardiac rehabilitation training.

Adipocytes impact on gastric cancer progression: Prognostic insights and molecular features.

Adipocytes, especially adipocytes within tumor tissue known as cancer-associated adipocytes, have been increasingly recognized for their pivotal role in the tumor microenvironment of gastric cancer (GC). Their influence on tumor progression and patient prognosis has sparked significant interest in recent research. The main objectives of this study were to investigate adipocyte infiltration, assess its correlation with clinical pathological features, develop a prognostic prediction model based on independent prognostic factors, evaluate the impact of adipocytes on immune cell infiltration and tumor invasiveness in GC, and identify and validate genes associated with high adipocyte expression, exploring their potential diagnostic and prognostic value. To explore the relationship between increased adipocytes within tumor tissue and prognosis in GC patients as well as the associated mechanisms and potential biomarkers, using public databases and clinical data. Using mRNA microarray datasets from the Gene Expression Omnibus database and clinical samples from Jiangsu Provincial Hospital, survival and regression analyses were conducted to determine the relevant prognostic factors in GC. Feature gene selection was performed using least absolute shrinkage and selection operator and support vector machine recursive feature elimination algorithms, followed by differential gene expression analysis, gene ontology, pathway analysis, and Gene Set Enrichment Analysis. Immune cell infiltration was analyzed using the CIBERSORT algorithm. Tumor adipocyte infiltration correlated with poor prognosis in GC, leading to the development of a highly accurate and discriminative prognostic prediction model. Key genes, ADH1B, SFRP1, PLAC9, and FABP4, were identified as associated with high adipocyte expression in GC. The diagnostic and prognostic potential of these identified genes was validated using independent datasets. Downregulation of immune cells was observed in GC with high adipocyte expression. GC with high intratumoral adipocyte expression demonstrated aggressive tumor biology and a poorer prognosis. The genes ADH1B, SFRP1, PLAC9, and FABP4 have been identified as holding diagnostic and prognostic significance in GC. These findings strongly support the use of adipocyte expression as a valuable indicator of tumor invasiveness and anticipated patient outcomes in GC.

Relationships among perceived social support, mindful self-care, and resilience among a sample of nurses in three provinces in China: a cross-sectional study.

In this study, we aimed to determine the relationships among perceived social support, mindful self-care, and resilience in a sample of nurses in three provinces of China. A cross-sectional study was conducted in seven hospitals in Guangdong, Guizhou, and Henan provinces between August and October, 2023; the provinces are located in south, southwest, and central China. A total of 389 nurses were surveyed using a self-designed sociodemographic characteristics questionnaire and the Chinese versions of Multidimensional Scale of the Perceived Social Support, Brief-Mindful Self-Care Scale and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). Of the 389 nurses, the majority were women (n = 365; 93.8%), aged 26-35 years (n = 244; 62.7%) and had bachelor's degrees (n = 337; 86.6%), had worked for 10-20 years (n = 136; 35%), with junior professional titles (n = 331; 85.1%), and had a monthly income in the range 3,001-6,000 yuan in CNY (n = 239; 61.4%). Nurses' resilience was measured using the CD-RISC-10, which ranges from 10 to 40 points. And average score of nurses' resilience was (23.94 ± 6.95). Multiple linear regression showed that scores for resilience were higher among nurses who had higher educational attainment (95% confidence interval: 0.568-3.024, p < 0.01), professional titles (95% confidence interval: 0.009-1.693, p < 0.05), scores of mindful self-care (95% confidence interval: 0.086-0.155, p < 0.01), and scores of perceived social support (95% confidence interval: 0.242-0.328, p < 0.01). Nurses with higher educational attainment and professional titles exhibited higher levels of resilience. Perceived social support and mindfulness self-care are significantly positively correlated with resilience of nurses. The findings of this study are beneficial to further our understanding of nurses' resilience. The identification of associated factors is conducive to providing more support for nurses who tend to have lower resilience earlier, and can provide useful information for research targeted intervention and support plans aimed at improving nurses' resilience in the future.

Biomechanically based Fu’s subcutaneous needling treatment for senile knee osteoarthritis: protocol for a randomized controlled trial

IntroductionFu’s subcutaneous needling (FSN) is a new type of acupuncture that uses subcutaneous tissue to oscillate from side to side to improve muscle pathology status and can be effective in treating Knee osteoarthritis. Nonetheless, whether the clinical effect is similar to that of most commonly used drugs is unclear. Thus, this study aims to determine the pain-relieving effect and improvement in the joint function of the FSN therapy by comparing it with that of a positive control drug (celecoxib). Furthermore, this clinical trial also aims to evaluate the effect of FSN on gait and lower limb muscle flexibility, which can further explore the scientific mechanisms of the FSN therapy.Methods and analysisThis study is a randomized, parallel-controlled, single-center prospective clinical study that includes 60 participants, with an FSN group (n = 30) and a drug group (n = 30). The Fu’s subcutaneous needling (FSN) group undergo the FSN therapy 3 times a week for 2 weeks, while the drug group receives 0.2 g/day oral celecoxib for 2 weeks, with a follow-up period of 4 weeks after the completion of treatment. The primary outcome is the difference in the visual analog scale score after 2 weeks of treatment compared with baseline. The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, joint active range of motion test, three-dimensional gait analysis, and shear wave elastic imaging technology analysis in lower limb muscles are also performed to demonstrate clinical efficacy.Ethics and disseminationThe trial is performed following the Declaration of Helsinki. The study protocol and consent form have been approved by the Ethics Committee of Guangdong Provincial Hospital of Chinese Medicine. All patients will give informed consent before participation and the trial is initiated after approval. The results of this trial will be disseminated through publication in peer-reviewed journals.Trial registration number: NCT06328153.

Direct Oral Anticoagulants and Concomitant Anti-seizure Medications: A Retrospective, Case–Control Study in a Real-World Setting

Although prescription of direct oral anticoagulants (DOACs) for epileptic patients on anti-seizure medications (ASMs) is on the increase, international guidelines pose strict restrictions because this may lead to pharmacologic interactions. However, current evidence on their clinical relevance remains scanty. This retrospective, case-control study assessed the frequency of ischemic/hemorrhagic events and epileptic seizures involving DOAC-ASM cotherapy in the real world, compared with DOAC and ASM monotherapy, in age- and gender-matched controls. Data on patients who had been prescribed a concomitant DOAC and ASM therapy for at least 6 months were extracted from the database of the Pharmaceutical Service of the Alessandria Province (Italy). After exclusions, the case group included 124 patients, 44 on valproic acid (VPA) and 80 on levetiracetam (LEV) concomitant with a DOAC, and it was compared with the DOAC-control and ASM-control groups. The clinical and laboratory data were extracted from the electronic archives of the hospitals in the same province. Two (1.6%) ischemic and 2 (1.6%) major hemorrhagic events were observed in the case group. Four (3.2%) ischemic and no hemorrhagic events occurred in the DOAC-control group. There were no statistically significant differences in the ischemic and hemorrhagic events between the case group (patients on concomitant LEV or VPA who were prescribed a DOAC) and the DOAC-control group, and there was no difference in the recurrence rate of epileptic seizures between the case group and the ASM-control group. Although this study has some limits, mainly the small sample size, our findings indicate that neither LEV nor VPA concomitant treatment significantly affects the effects of DOACs in a real-world setting.

Clinical efficacy of magnetic vibration magnetoelectric therapy in the treatment of chronic prostatitischronic pelvic pain syndrome.

The prominent symptoms of chronic pelvic pain syndrome (CPPS) are urogenital pain, lower urinary tract symptoms, psychological problems, and sexual dysfunction. Traditional pharmacological treatments have poor efficacy and more untoward reaction and complications. Magnetic vibration magnetoelectric therapy is a non-invasive form of physiotherapy. Nevertheless, its effectiveness in improving urinary discomfort and relieving pain in patients requires further exploration. To investigate the clinical efficacy of the magnetic vibration magnetoelectric therapy instrument in the treatment of chronic prostatitis (CP)/ CPPS. Seventy patients with CP/CPPS were collected from the outpatient clinic and ward of the Department of Male Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, and were treated with magnetic vibration magnetoelectric therapy once a day for a period of 14 d. National Institutes of health-chronic prostatitis symptom index (NIH-CPSI), international index of erectile function 5 (IIEF-5), premature ejaculation diagnostic tool (PEDT), generalized anxiety disorder (GAD), patient health questionnaire, the pain catastrophizing scale (PCS) and traditional Chinese medicine syndrome (TCMS) scores were performed before and after treatment. The total effective rate of treatment was 58.5%, and the total NIH-CPSI score, pain symptoms, voiding symptoms, quality of life, IIEF-5, PEDT, GAD, PCS and TCMS scores all decreased significantly (P < 0.05). Magnetic vibration magnetotherapy is effective in improving urinary discomfort, relieving pain, improving quality of life, improving sexual dysfunction and relieving negative emotions such as anxiety in patients with CP/CPPS.

THE IMPACT OF FAMILY PLANNING ON MATERNAL HEALTH IN QUETTA, BALOCHISTAN: A QUALITATIVE STUDY

Balochistan, a region with one of the highest maternal mortality rates in Pakistan, faces significant challenges in maternal health. This qualitative study focuses on the impact of family planning on maternal health in Quetta, Balochistan, emphasizing the importance of understanding and improving health outcomes for women and their families. Objectives: The primary aim of this study is to explore the experiences and perspectives of women regarding the use of family planning methods and their impact on maternal health and well-being. It aims to compare the health outcomes of women who have utilized family planning methods with those who have not. Method: The research design includes in-depth interviews and focus group discussions (FGDs) with a diverse sample of women aged 18-45 years and healthcare providers at Sandeman Provincial Hospital, commonly known as Civil Hospital, in Quetta. Purposive sampling was employed to account for age, socioeconomic status, and education level variations. Forty-seven in-depth interviews were conducted to gather rich, contextual data. Thematic analysis was used to identify recurring themes and patterns in the responses. Results: Preliminary findings indicate several key themes, including the motivations for choosing family planning methods, the impact of these methods on reducing pregnancy risks, improving spacing between pregnancies, and enhancing postpartum recovery. Additional insights were gained into the factors influencing the adoption of family planning services, such as cultural norms, religious beliefs, and access to healthcare and information. Conclusion: The study underscores the critical role of family planning in enhancing maternal health outcomes in Quetta, Balochistan. It highlights the need for targeted educational and healthcare interventions to improve the accessibility and acceptance of family planning services, thereby contributing to the well-being of women and their families in the region.

Analysis of Clinical Characteristics of Insomnia Patients and Effect of Acupuncture Therapy

Objective: To explore the clinical characteristics of insomnia patients and the function and mechanism of acupuncture therapy, to improve the recognition and diagnosis of insomnia. Methods: The clinical data of 60 patients with insomnia who met the criteria and were admitted to the Department of Acupuncture and moxibustion in Yunnan Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January 2023 to February 2024 were selected, the clinical characteristics of the patients were analyzed, and the patients were randomly divided into two groups for routine treatment and acupuncture treatment, respectively, to explore the therapeutic effect and possible mechanism. Results: The insomnia symptoms of the patients were mainly difficulty in falling asleep. Acupuncture treatment could significantly improve the insomnia symptoms and promote the expression levels of DA and NE. Conclusion: Patients with insomnia have various clinical features, mainly sleep difficulties. Acupuncture treatment can significantly relieve insomnia symptoms by up-regulating DA and NE levels, and then improve sleep quality.

Effect and safety of Burosumab in the treatment of 4 children with X-linked hypophosphatemia

Objective: To evaluate the effectiveness and safety of treatment with Burosumab in pediatric X-linked hypophosphatemia (XLH) patients. Methods: In this retrospective case study, 4 children with pediatric XLH, who were treated with Burosumab in Beijing Children's Hospital, Capital Medical University and Shandong Provincial Hospital affiliated to Shandong First Medical University from July 2022 to December 2023, were selected as the study objects. We collected and analyzed their clinical characteristics, biochemical indicators, imaging results, and treatment. The children were followed up every 3 months until December 2023, and the clinical outcomes and adverse drug reactions after treatment were evaluated. Results: Of the 4 patients, 3 were males and 1 was female; they were aged 6.7, 2.9, 2.1, and 2.3 years, respectively. Three patients had previously received treatment with phosphate supplements and active vitamins, but their wadding gait and lower limb deformities did not improve significantly, neither did their imaging changes of active richets. The initial dose of Burosumab in the 4 patients was 0.8 mg/kg, administered subcutaneously every 2 weeks, with a treatment course of 0.8-1.3 years. The fasting serum phosphorus and tubular maximum reabsorption of phosphate/glomerular filtration rate (TmP/GFR) of the 4 patients before treatment were 0.72, 0.95, 0.81, 0.66 mmol/L and 0.67, 0.85, 0.87, 0.61 mmol/L, respectively. At the last follow-up, the fasting serum phosphorus and TmP/GFR levels were significantly increased (0.96, 1.09, 1.09, 0.90 mmol/L, and 0.85, 0.79, 1.03, 0.98 mmol/L, respectively). Among them, only the TmP/GFR level (1.17 mmol/L) in case 2 achieved normal values at 3 months post-therapy, while the rest did not reach the normal range for children of the same age. After treatment, the alkaline phosphatase levels of all patients gradually decreased (the values were 461, 240, 423, and 237 U/L, respectively), and the ALP levels in cases 2 and 4 returned to normal at the last visit. Case 4 showed a slight increase in parathyroid hormone (PTH) levels after 9 months of treatment, while the PTH levels in the rest 3 cases remained normal. Case 1 underwent a 6-minute walking test, and the walking distance increased from 245 m to 570 m. Abnormal gait, lower limb deformity, and the severity of rickets in the 4 patients had all improved. No adverse drug reactions such as nephrocalcinosis, local skin injection reaction, hyperphosphatemia, or vitamin D deficiency were observed. Conclusion: Burosumab can improve clinical symptoms in children with XLH with a good safety profile.

The pattern of antibiotic utilisation among intensive care unit patients hospitalised in a Gauteng (South African) provincial tertiary hospital: Comparing findings before and during COVID-19.

Various mechanisms may contribute to and direct the progression of antibiotic resistance. A prominent driver associated with antibiotic resistance is inappropriate use or consumption. The sudden emergence of coronavirus disease 2019 (COVID-19 ) changed the conventional practices related to antibiotic utilisation through repurposing the use of antibiotics. Apart from the implementation of antibiotic stewardship programmes, the pressure COVID-19 placed on healthcare systems resulted in poor prescribing and medication review practices, potentially exacerbating antibiotic resistance. Furthermore, the public health system has issues that make it difficult to routinely monitor, quantify antibiotic consumption, and offer evaluation, feedback and intervention, particularly in low- and middle- income countries such as South Africa (SA). Therefore, this study aimed to determine antibiotic utilisation before and during the COVID-19 pandemic in a Gauteng provincial tertiary hospital (GPTH) in SA. To determine, examine, and compare antibiotic consumption among intensive care unit (ICU) patients admitted to a GPTH during the pre-COVID-19 period and during the COVID-19 pandemic, in addition to determining the prevalence of the World Health Organisation (WHO) 'watch' category antibiotics before and following the emergence of COVID-19 . A retrospective cross-sectional data analysis was undertaken of 335 medical files of ICU patients hospitalised in a GPTH between January 2017 and December 2021. Descriptive statistics were used to examine patient characteristics and antibiotic prescribing variables (antibiotic selection, dosage, route of administration, frequency, duration of course and indication for which antibiotic was prescribed). The study found that the most frequently prescribed antibiotics were amoxicillin in combination with clavulanate (pre-pandemic 31.99%; amid-COVID-19 38.43%), followed by ceftriaxone (pre-pandemic 15.44%; amid-COVID-19 14.55%), piperacillin in combination with tazobactam (pre-pandemic 11.40%; amid-COVID-19 8.58%) and azithromycin (pre-pandemic 7.725%; amid-COVID-19 19.78%). The macrolide and penicillin (in combination with a beta-lactamase inhibitor) classes demonstrated an increase in consumption from the pre-pandemic period moving into the COVID-19 pandemic. This highlights the need for improved antibiotic stewardship programmes and policies to combat inappropriate and unnecessary antibiotic usage.

Implementación piloto de la gestión integral de la farmacoterapia a pacientes hospitalizados con enfermedades cardiovasculares

Context: Comprehensive medication management service provides comprehensive pharmaceutical care to patients to meet their pharmacotherapeutic needs and improve their quality of life in terms of health. Aims: To describe the results of the pilot implementation of the comprehensive medication management service provided to inpatients with cardiovascular diseases. Methods: Longitudinal, prospective and intervention study was carried out, with qualitative research elements. The sample included patients with cardiovascular diseases and more than five days from the Cardiology Service of the “Saturnino Lora” Provincial Hospital in Santiago de Cuba. The care process was developed according to the OFIL's Guide for the implementation of Comprehensive Medication Management. The patients’ medication experiences were evaluated according to Ramalho de Oliveira et al. The evaluation of drug-related problems and the clinical outcomes was carried out according to the Pharmacotherapy Work-up Method. Results: Twenty patients were included, 65% male. The mean age was 66.2 ± 13.1 years. Eighty percent of the patients had hypertension. One hundred percent received antihypertensive and antithrombotic drugs. Forty percent reported body as a pharmacotherapeutic experience. One hundred and thirty-three drug-related problems were detected and 45.1% corresponded to safety problems. One hundred and fifty-five pharmaceutical interventions were performed and 89% were accepted. Ninety percent of the patients achieved positive clinical outcomes. Conclusions: The pilot implementation of the comprehensive medication management service contributed to the resolution of drug-related problems and showed positive clinical outcomes in patients with cardiovascular diseases.

Incidence and Mortality due to Colorectal Cancer in Mongolia, 2018-2022.

We aimed to update data on the morbidity and mortality rate of colorectal cancer (CRC) among the population of Mongolia by province between 2018 and 2022. This study was designed using a descriptive method. The data were collected from 21 general hospitals of provinces, 9 general hospitals of districts, and the National Cancer Center in 2018-2022. The incidence and mortality were calculated as mean annual numbers per 100,000 populations. The age-standardized rate (ASR) was utilized by the direct method, and it was rated by weighted average of age-specific incidence rates against the world population. In the country, a total of 1316 new cases were diagnosed and 782 deaths were caused by CRC in the last 5 years (2018-2022). The incidence of CRC in the last 5 years (2018-2022) was 7.9 per 100,000 populations, and the mortality rate was 4.7 per 100,000. The provinces of Orkhon (12), Khentii (11), and Central (10) reported the highest incidences of CRC, whereas the provinces of Sukhbaatar (6.9), Selenge (6.6), Dornod (6), and Darkhan-Uul (6) had the highest death rates (per 100,000 populations). The incidence of CRC didn't differ statistically significantly between men and women. Additionally, the estimated incidence has grown dramatically with patients' ages. Our study presents evidence of a steadily increasing CRC incidence in Mongolia over the past five years. Therefore, it is necessary to determine the distribution of risk factors, learn from.

Safety and efficacy of PCSK9 inhibitor (evolocumab) in patients with non-ST segment elevation acute coronary syndrome and non-culprit artery critical lesions: a randomised controlled trial protocol (SPECIAL study)

IntroductionPatients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) and concomitant multivessel coronary artery disease (CAD) are considered patients with extremely high-risk atherosclerotic cardiovascular disease (ASCVD), and current guidelines specify...

Bullous lesions in the course of the classic form of Kaposi’s sarcoma

Kaposi sarcoma (KS) is a cancer originating from the endothelial cells of blood and lymphatic vessels. It develops multifocally as a result of pathological vascular hyperplasia. There are four forms of the disease: classic, endemic, iatrogenic, and epidemic. The treatment of Kaposi’s sarcoma depends on the clinical form, stage of advancement, and the immunological condition of the patient. The article presents the case of an 82-year-old patient from the Dermatology Department of the Provincial Hospital in Elblag diagnosed with Kaposi’s sarcoma with bullous lesions. Key words: Kaposi’s sarcoma, Dermatology, Oncology

Evidence-based nursing practice for the prevention of nasal and facial pressure injuries in patients with non-invasive positive pressure ventilation

To investigate the evidence-based practice of prevention and care of nasal and facial pressure injuries in patients with non-invasive positive pressure ventilation (NPPV) using the knowledge to action framework (KTA), and to explore its effectiveness. Using an evidence-based nursing approach, an evidence-based practice group was established to formulate a clinical problem, the literature from domestic and international databases were researched for relevant evidence, the evidence was introduced into clinical scenarios, an evidence-based practice plan was developed, and a strategy for applying the best evidence was constructed by conducting a baseline review of healthcare professionals and patients with NPPV, analyzing barriers and promoting factors, and making changes in clinical practice at the organizational level, the practitioner level, and the patient level. Purposive sampling method was used to select the healthcare staff of the cardiac surgical intensive care unit (CSICU) of the Shandong Provincial Hospital Affiliated to Shandong First Medical University, as well as the patients with NPPV admitted from October 1 to November 15, 2023 (pre-evidence-based practice) and November 16 to December 31 (post-evidence-based practice), as the subjects of the study. Through questionnaire analysis, the incidence of nasal and facial pressure injury of NPPV patients, the implementation rate of review indicators of medical staff, the score of the knowledge, belief and conduct of medical staff, and the compliance and comfort of patients before and after evidence-based practice were compared. A total of 52 medical staff were included, aged (28.54±6.50) years old, with 3.00 (1.00, 12.75) years of working experience; 2 doctoral degree holders (3.85%), 4 master degree holders (7.69%), 46 bachelor degree holders (88.46%); 2 with senior title (3.85%), 17 with intermediate title (32.69%), and 33 junior titles (63.46%). Fifty patient questionnaires were collected before and after evidence-based nursing practice; the differences between before and after evidence-based practice in terms of gender, age, body weight, duration of ventilator usage, 24-hour bleeding and total bleeding were not statistically significant and were comparable. Compared with the pre-evidence-based practice, after carrying out the corresponding evidence-based nursing practice, the incidence of nasal and facial pressure injuries of NPPV patients decreased from 16.00% (8/50) to 4.00% (2/50, P < 0.05), the total implementation rate of review indicators of medical staff increased from 79.73% to 94.08% (P < 0.01), and the total scores of knowledge, belief and conduct were significantly improved (141.96±13.88 vs. 114.65±19.72, P < 0.05), and compliance and comfort of patients were significantly improved (compliance score: 4.60±0.99 vs. 5.82±1.42, comfort score: 4.10±1.63 vs. 6.92±2.33, both P < 0.05). The application of an evidence-based nursing approach to obtain evidence related to the prevention of nasal and facial pressure injuries in patients with NPPV can be used to guide clinical practice, significantly reducing the incidence of nasal and facial pressure injuries in such patients, improving the implementation rate of review indicators and the knowledge, belief, and conduct scores of medical staff, and enhancing compliance and comfort of NPPV patients.

Effects of Five-Element Music Stimulation in Perioperative Period on Sleep Status and Psychological Regulation in Patients Undergoing Orthopedic Surgery.

This study aimed to explore the effect of five-element music therapy on sleep status during perioperative period and psychological regulation in patients undergoing orthopedic surgery. The medical records of patients who underwent orthopedic surgery from March 2021 to December 2023 in the Gansu Provincial Hospital of Traditional Chinese Medicine were retrospectively analyzed. Patients were divided into two groups in accordance with the nursing time period. The control group (88 patients) received routine nursing, and the observation group (78 patients) received five-element music management in the perioperative period based on routine nursing. The management time was from admission to one week after surgery, with 30 min/times, TID. The sleep, physical signs, pain condition, and anxiety status of the two groups were compared on admission, before surgery, and one week after surgery. On admission, no significant difference in the scores of the Pittsburgh Sleep Quality Index (PSQI), the pain rating index (PRI), and the Self-Rating Anxiety Scale (SAS) was found between the two groups (P > 0.05). Before and one week after surgery, the PSQI, PRI, and SAS scores of the observation group were significantly lower than those of the control group (P < 0.001). No significant difference was found in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) between the two groups on admission and one week after surgery (P > 0.05). Before surgery, the observation group had significantly lower indices of SBP, DBP, and HR than the control group (P < 0.05). Five-element music stimulation in the perioperative period can improve the pain and anxiety of patients undergoing orthopedic surgery and enhance their sleep status.

Safety Attitudes among Vietnamese Medical Staff in a Vietnam Disadvantaged Area: Latent Class Analysis

Purpose: We conducted this study with the aim of characterizing safety attitudes (SA) among medical staff in a disadvantaged area of Vietnam and examining associated factors with SA.Methods: A cross-sectional survey was conducted on 442 health staff members at four hospitals in Son La Province from June until August 2021. We used the Vietnamese shortened edition of the Safety Attitudes Questionnaire to measure the SA of study participations. We chose latent class analysis (LCA) to identifying the number of latent classes of SA among the study subjects. Multinomial logistic regression was used to examine factors associated with the identified SA classes.Results: The results of our LCA showed that there were three latent classes, namely high SA group (n=150, 33.9%), moderate SA group (n=236, 53.4%), and low SA group (n=56, 12.7%). The multinomial logistic regression analysis found that medical staff who had university education and above, who were nurses, and who served in non-clinical areas were more likely to be in the moderate SA group and in the high SA group than in the low SA group.Conclusion: Based on these results, several recommendations could be made to improve the SA of healthcare workers in disadvantaged areas. Further research with larger sample sizes and more diverse populations is needed to confirm these findings and to develop effective interventions to improve the SA of healthcare workers in disadvantaged areas.

Two consecutive melioidosis septic arthritis successfully cured with conservative and operative treatment respectively: a case report

Melioidosis or Whitmore’s disease is an uncommon infectious condition caused by the gram-negative bacterium Burkholderia pseudomallei. The clinical manifestation of melioidosis varies, including septicemia, pneumonia, deep organ and soft tissue abscess. Septic arthritis is a rare manifestation of melioidosis, which is associated with high mortality rate, especially in immunocompromised patients. We present here a 60-year-old male who was admitted to our hospital with high fever and acute left hip pain, who was subsequently confirmed to have hematogenous melioidosis septic arthritis with positive blood and synovial fluid cultures. His condition fully responded to a 2-week administration of intravenous meropenem plus oral trimethoprim+sulfamethoxazole, before he was transferred to his provincial hospital to continue the antibiotic regimen. For some reason, he inadvertently stopped the regimen and came back to us with a right elbow septic arthritis caused by the same microbial agent a month later. This time, he received an urgent elbow arthroscopic debridement and completed intensive antibiotic therapy before being discharged to continue the eradication phase for 6 months. Until now, he has recovered completely without recurrence. Melioidosis septic arthritis is rare but should be considered in high-risk patients and can be successfully treated with prompt antibiotics alone or in combination with surgery. Regardless of the method, eradication treatment is extremely important.

Analisis Penggunaan Antibiotik Pada Pasien Infeksi Saluran Kemih (ISK) Secara Kuantitatif Di RSUD Provinsi NTB Tahun 2019

Introduction: Urinary Tract Infection (UTI) is a disease that often occurs in developing countries after upper respiratory tract infections. The incidence of UTI in 2018 in Indonesia is quite high, ranging from 39-60%. Antibiotics are the main therapy for UTIs, but excessive and inappropriate use of antibiotics can cause occurrence of antibiotic resistance. Objective: This study aims to quantitatively analyze patterns of antibiotic use in UTI patients at the NTB Provincial Hospital in 2019. Methods: This type of research is descriptive in nature using a cross-sectional design. There were 47 patients in case who were diagnosed with UTI ith the ICD-X code N39.0, which means the UTI suffered by the patient was a non-specidic type of UTI. Quantitative use of antibiotics was calculated using the ATC/DDD method according to WHO standards. Results: The total value of DDD/100 Patient-days was 51.26 with ceftriaxone as an antibiotic with the highest DDD/100 patient-days value of 19.78 and had the largest value in the 90% DU segment, which was 38.59%. Conclusion: Regular evaluation of antibiotic use is needed to minimize excessive use of antibiotics so that rational antibiotic use can be achieved.