Score Mean Research Articles

Quality of information on fertility clinic websites accredited by the Latin American Network of Assisted Reproduction.

To access to reproductive health information on the Internet helps patients understand their infertility journey and make decisions about their treatment. This study aimed to evaluate the quality of fertility clinic websites accredited by the Latin American Network for Assisted Reproduction (REDLARA) using the QUality Evaluation Scoring Tool (QUEST). This observational, cross-sectional, and online study evaluated the clinic websites registered as accredited centers on the REDLARA website. The QUEST was used for the quality assessment of the websites. Data were collected from the available websites of all accredited fertility clinics between September 2023 and January 2024. A total of 173 websites from fertility clinics accredited by REDLARA were evaluated, and 152 (87.8%) clinics had functioning websites. The majority of analyzed websites were from Brazilian fertility clinics (n=58; 38.1%), followed by Mexican (n=23; 15.1%) and Argentine (n=21; 13.8%). No indication of authorship or username was observed on most websites. Some form of support for the patient-physician relationship was reported by 86.8% of websites. The mean (standard deviation±SD) of the total score obtained by all fertility clinics was 12.73±4.7 (range: 1-26). Brazil had the highest total score (mean±SD=16.03±4.6), whereas Peru had the lowest (6.42±1.7). Statistical analysis revealed a difference in the quality of websites among Latin American countries. The health information disseminated by fertility clinic websites in Latin America is of poor quality. Therefore, REDLARA should implement rules for building good-quality websites.

Helicopter Parenting among Late Adolescents

Background: In the contemporary context, helicopter parenting which is a common practice and in Southeast Asia region, it is a growing parenting approach. It has several components that affect adolescents and emerging adults physical, psychological and social well-being. The aim of the study is to measures the parenting style for the adolescent for which the Helicopter Parenting Scale (HPS) was used. Material and methods: A cross-sectional study was conducted to assess the state of helicopter parenting style of parents on late adolescents of Police Lines School and College, Rangpur, Bangladesh. Results: The mean age of the adolescent was 17.7±0.6 years. The mean of HP scores was 3.6±0.5. About three out of five participants had a perceived average level of HP (58.9%) and a few of them had a high level of HP (2.3%). A statistically significant association found within the level of HP and adolescent’s family type (p<0.05) and the perceived level of HP was average among the adolescents who came from the nuclear family (61.8%). The HP scores were high in the nuclear family (3.62±0.413) and parents’ living together (3.59±0.422). There were significant differences found in the HP scores with the adolescent’s family type and their parent’s relationship state (p<0.05). Conclusion: The study found that nuclear families were more likely to adopt helicopter parenting than other types of families, with their perceived level of this parenting style being assessed as averagely good. IAHS Medical Journal Vol 7(1), June 2024; 26-31

Comparison of different surgical strategies for cervical dystonia: Evidence from Bayesian network analysis.

Several surgical techniques have been used to treat cervical dystonia (CD), however, to date, the optimal surgical technique for CD remains controversial. We therefore conducted the first network meta-analysis to compare different surgical strategies for CD to inform clinical practice. Electronic databases were searched for surgical strategies for treating CD. The primary outcome was improvement in total Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) score. Subgroup analysis was performed to compare short-term (< 1 year) and long-term (≥ 1 year) outcomes. Safety outcomes included surgery-related adverse events (AEs). A total of 55 trials with 2032 patients employing five surgical strategies were identified, including globus pallidus internus (GPi)/subthalamic nucleus (STN)-deep brain stimulation (DBS), selective peripheral denervation (SPD), microvascular decompression (MVD) and pallidotomy. All strategies led to significant improvement in total TWSTRS score (mean improvement range 18.65-28.22). GPi-DBS showed significantly greater enhancement than SPD for the whole dataset (mean difference [MD] 7.03, 95% credible interval [Crl] 1.53-12.56), while both GPi-DBS (MD 8.05, 95% Crl 2.35-13.80) and STN-DBS (MD 10.71, 95% Crl 2.22-19.20) exhibited more long-term improvement than SPD. Regarding safety outcomes, GPi/STN-DBS and MVD were associated with fewer surgery-related AEs than SPD (ln odds ratio range -1.68 to -1.41). We conclude that DBS should be the preferred surgical option for CD, and the STN is a promising alternative target choice due to its comparable efficacy with the GPi. However, more direct evidence is still required.

The Effect of Sun Knowledge and Self-Efficacy on Sun Protection Behavior in Skin Cancer Among Young People.

Purpose: The aim of this study is to reveal the impact of skin cancer and sun knowledge on sun protection behavior in young people. In addition, identifying predictors influencing sun protection behaviors in young people is also aimed. Methods: A cross-sectional study was conducted with 424 young people in Turkey. Data were collected using Skin Cancer and Sun Knowledge Scale, Self-Efficacy Scale for Sun Protection, and Sun Protection Behavior Scale. The independent samples t-test was used to determine differences between the mean scores of sociodemographic characteristics, Bonferroni-corrected one-way ANOVA was used to determine differences among three or more groups, and the relationship between scale score means was analyzed using Pearson correlation analysis. Factors influencing sun protection behavior were identified using multiple linear regression. Results: Of the young people, 43.4% use sunscreen continuously throughout the year, 10.10% go to solarium, and 25.7% perform self-examinations of their skin. In youth, high sun protection self-efficacy (β = 0.486), being female (β = 0.077), regular use of sunscreen throughout the year (β = 0.464), and avoiding tanning beds (β = 0.075) positively influence sun protection behavior scores. Spending more than 6 hours in the sun during the summer months (β= -0.118) negatively affects sun protection behavior. Conclusion: The level of skin cancer sun knowledge, sun protection self-efficacy, and sun protection behaviors of young people are moderate and there is a positive correlation among them. The study's findings indicate the necessity to increase awareness of skin cancer risk factors among young people and initiate effective interventions to promote sun protection behaviors.

Knowledge, Attitude, and Practice of General Dentists Towards Tele-dentistry

Background: Considering the growing importance of tele-dentistry and its potential to enhance the delivery of dental services, this study aimed to assess the knowledge, attitude, and practice (KAP) of private dental offices towards this technology. Methods: This analytical cross-sectional study included 50 general dentists practicing in Semnan city, selected based on entry criteria through the enumeration method. Participants completed a demographic questionnaire (including gender and years since graduation) and a 15-item researcher-made questionnaire designed to assess their KAP towards tele-dentistry. Results: Among the participants, 54% (27 participants) were female, and 46% (23 participants) were male, with an average age of 30.2 ± 6.48 years. The mean number of years since graduation was 7.74 ± 5.13 years. The mean and standard deviation of KAP scores were 5.96 ± 1.07 (knowledge), 34.32 ± 3.41 (attitude), and 1.44 ± 0.50 (practice), respectively. Men scored significantly higher in knowledge compared to women (7.26 ± 0.91 vs. 6.70 ± 1.14; P = 0.037). There was a significant inverse correlation between knowledge scores and years since graduation (r = -0.292; P = 0.032). Additionally, 52% (26 participants) reported having used tele-dentistry, while 96% (48 participants) expressed an intention to use it in the future. Conclusions: The findings suggest that knowledge regarding tele-dentistry was notably higher among men and those with fewer years since graduation. Health policies should prioritize training programs to enhance general dentists' knowledge and practice of tele-dentistry, supporting its effective implementation in dental care.

Translation, Cultural Adaptation, and Validation of the Arabic Version of the Student Evidence-Based Practice Questionnaire (S-EBPQ)”

BackgroundEvidence-based practice (EBP) lowers costs, guarantees staying current with new technology and abilities, and enables the provision of high-quality care. Evidence-based practice (EBP) considered the foundation for safe patient care.Aimis to validate and carry out the linguistic-cultural adaptation of the S-EBPQ for the Arabic language.DesignA methodological study design was used.MethodThere were two primary stages: translation and validation. Three experts reviewed the contents during the translation and validation in order to ensure their relevancy. 15 nursing students conducted face validation to confirm the produced items' clarity and understandability. Reliability assessment was achieved by conducting a pilot study on 72 nursing students. Ethical approval was taken. For statistical analysis, SPSS software was used. The internal reliability of the questionnaire was evaluated using Cronbach's Alpha. The Pearson Correlation was used to test the relationship between the student's score on the questionnaire and their age and gender.ResultsThe Scale-Content Validity Index was 0.90; Cronbach's Alpha value was 0.963. Students in face validation phase confirmed that wording, clarity, and understandable language of the items were achieved. The Mean of students total score was 80.2 (SD = 21.5). Pearson test revealed that there was a weak positive correlation between students’ scores and age R = 0.320 (p = 0.001). Also, it demonstrated that there was no correlation between the students’ scores and the gender R =—0,028 (p = 0.817).ConclusionThe Arabic version of the S-EBPQ generally had a solid structure and it demonstrated high validity and reliability. The questionnaire could be used in future studies.

The psychological empowerment and quality of work life among Jordanian primary care nurses and midwives

IntroductionThe healthcare industry, particularly in the context of primary care, presents various challenges to nurses and midwives, influencing their psychological empowerment (PE) and quality of work life (QWL).ObjectiveThis study’s objective is to assess the levels of PE and QWL among Jordanian primary care nurses and midwives and explore the relationship between PE and QWL.MethodsUtilizing a descriptive correlational design, the study included 273 Jordanian primary care nurses and midwives through convenience sampling. The Psychological Empowerment Instrument and Brook’s Quality of Nursing Work Life Survey were used to measure PE and QWL. Data was analyzed using descriptive statistics to describe the study participant’s characteristics and inferential analysis such as Pearson correlation, and multiple regression to examine relationships and identify predictors of study variables.ResultsThe study found that the QWL scale had high reliability (Cronbach’s alpha = 0.954), and similarly, the PE scale demonstrated strong reliability (Cronbach’s alpha = 0.948). Moving on to the core findings, significant positive correlations were identified between PE and QWL, with a correlation coefficient of r = 0.568 (p &amp;lt; 0.01), indicating that higher levels of psychological empowerment were associated with better quality of work life. Furthermore, the regression analysis revealed that PE accounted for approximately 32.3% of the variability in QWL scores. Interestingly, participants holding diplomas reported the highest QWL scores (mean = 136.14), while those contemplating leaving the nursing profession displayed significantly lower QWL scores (mean = 114.14). No significant correlations were found between PE and sociodemographic variables such as age, income, and years of experience.ConclusionThis study reveals a crucial need to enhance PE and QWL. Key findings show moderate PE and QWL levels, with variations based on educational background and workplace. The positive correlation between PE and QWL identifies the benefits of fostering empowerment through professional development, job autonomy, and decision-making. These insights are vital for improving nursing practice and policy and enhancing nurse satisfaction and patient care.

Development and validation of a method for deriving MMPI-3 scores from MMPI-2/MMPI-2-RF item responses.

The Minnesota Multiphasic Personality Inventory-3 (MMPI-3; Ben-Porath & Tellegen, 2020a) was developed to expand the content coverage of the MMPI-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) and to update the test's norms to better represent the U.S. population. Because most MMPI-3 items were carried over from the MMPI-2-RF, most MMPI-3 scales can be either fully scored or prorated from the MMPI-2/MMPI-2-RF item pool. We describe development of a procedure for deriving MMPI-3 scores from MMPI-2/MMPI-2-RF protocols and examine the psychometric properties of prorated MMPI-3 scores across various samples. Following Tarescavage et al. (2016), who developed a method for prorating most MMPI-2-RF scores from the original MMPI, prorated MMPI-3 scales had to meet three criteria: (a) sufficient representation in the MMPI-2-RF item pool, (b) association with the full-length corresponding MMPI-3 scale at r ≥ .90 in multiple samples, and (c) comparable T score means and standard deviations in multiple samples. These criteria resulted in the exclusion of the three MMPI-3 non-content-based Validity Scales, as well as nine Specific Problems Scales, yielding 16 MMPI-3 scales that can be fully scored and 24 for which psychometrically comparable prorated score estimates can be derived from responses to the MMPI-2 or MMPI-2-RF item pools. Evidence of the psychometric functioning of the resulting scale scores and their comparability with the full versions of these scales across samples is presented and discussed. This procedure provides a means to study 40 of the 52 MMPI-3 scales using archival data obtained with older versions of the inventory. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Functional outcomes of tension band wiring versus hook plating in displaced, closed, and isolated distal clavicle fractures in adults: a comparative retrospective study.

Clavicle fractures are common among young people, generally as a consequence of car accidents, bike falls, and contact sports injuries. 15-20% of all clavicle fractures involve the lateral end of the bone. Thus, the distal clavicle fractures, in particular, have a high non-union rate ranging from 21 to 33% when treated non-operatively, underscoring the usual advice for operative treatment. While significant research has been conducted on clavicle fractures and their treatment options, no definitive guidelines or optimal approaches have been established. Hence, the aim of this study was to assess the clinical and radiological results of the two highly used surgical techniques, Tension Band Wiring (TBW) and Hook plate ones, in addition to investigating the associated functional recovery and outcomes. Between August 2019 and 2022, An analytical retrospective comparative study, was done on 38 patients (20 TBW and 18 Hook plate) diagnosed with unstable fracture of the lateral third of clavicle (Neer 2), aged between 18 and 65 years old, and followed up for more than 12 months. TBW technique was used in 20 patients (14 males and 6 females) with mean age 39.25 years and Hook plate was used in 18 patients (14 males,4 females) with mean age of 43.11 years. The union rate was 100% in Hook plate group and 95% in TBW group. The mean time of bony union to occur was (9.55) weeks in TBW group and (8.94) weeks in Hook plate group. The mean of constant-Murley score in the last follow-up was 85.32 in the TBW group and 87.38 in the Hook plate group. superficial infection occurred in 3 cases in TBW group (15%). Four patients complained of impingement, three patients complained of acromial erosion and one patient complained of acromial osteolysis in the Hook plate group. Both TBW and Hook plate are a good choice for the fixation of displaced distal clavicle fractures with good functional and radiological outcomes, where Hook plate have some advantages such as rigid fixation and early motion of the affected shoulder.

Critical thinking of masculine students with impulsive cognitive style in solving geometry problems

The problem and the aim of the study. Critical thinking has a vital role in education because it is one of the essential skills that students must possess to face future challenges. By thinking critically, students can learn how to identify problems, analyze information from various sources, evaluate alternatives, and make logical decisions. In solving mathematical problems, it is common to find masculine students who are highly capable and impulsive (fast in solving problems). Therefore, this study aims to explore the critical thinking of masculine students with an impulsive cognitive style in solving geometry problems. Research methods. The study involved 70 junior high school students sitting in grade 9. The selection of research subjects was carried out in three public schools in Pringsewu Regency, Lampung province in Indonesia, namely Public Junior High Schools in Pringsewu Regency-Lampung, namely: SMP Negeri 2 Pringsewu, SMP N 4 Pringsewu and SMP N 1 Ambarawa. The research subjects were masculine students with moderate mathematics ability and above who had an impulsive cognitive style. In recruiting the research subjects, the gender questionnaire, cognitive style questionnaire, and math ability test were used. Moreover, the research is a descriptive qualitative study. The primary data was collected through geometry problem-solving test results and in-depth interviews. Several procedures were also set for analyzing critical thinking data to achieve these goals. Lastly, data analysis was done through data reduction, presentation, interpretation, and conclusion drawing. Results. After 70 students were given a gender questionnaire, cognitive style and math ability test with a minimum score of 75 found as many as 7 students with masculine gender with impulsive cognitive style with high math ability. With scores (mean score masculine: 4.2 ≥ 4: median score masculine) and (mean score feminine: 4.6 ≤ 5 median score feminine). However, one student (S1) was recommended by the math teacher at the school where the research was conducted to be used as a research subject. After in-depth analysis and interviewing S1, it was found that there were 5 aspects of critical thinking in solving geometry problems on the circle theme, namely aspects of clarity, relevance, depth, logicality, and significance. In conclusion, from the qualitative data analysis it was found that during the problem solving process this study has shown aspects of critical thinking namely aspects of clarity, relevance, depth, logicality, and significance.

The multifaceted effects of migraine on Syrian society: insights from a multicenter cross-sectional study

BackgroundMigraine is the most common primary headache. It’s alone responsible for 1.3% of disability in the world. Migraine both worsen quality of life of individuals and place a significant burden on the society. Despite this, there exists a knowledge gap regarding its repercussions on the Syrian population.MethodsThis cross-sectional study enrolled 679 migraine-diagnosed patients from all over Syria through electronic questionnaires disseminated on official social media platforms. Depending on demographic characteristics, physical and mental debility assessed using the Chalder scale, the Migraine Specific Quality of Life Questionnaire (MSQ) and the Generalized Anxiety Disorder 2-item (GAD_2) scale.ResultsOur study included 679 participants (mean age: 29.49 years; BMI: 24.55). The sample was predominantly female (74.7%) and mostly single (52%). Females reported higher fatigue (mean = 21.48) than males (mean = 19.22; p < .001). However, Males had better Migraine-Specific Quality of Life (MSQ) scores (mean = 49.90) compared to females (mean = 42.27; p < .001). Females scored higher on anxiety (GAD-2: mean = 2.99 vs. mean = 2.35; p < .001). Moreover, urban residents had higher scores on the Role Preventive (RF-P) subscale of the MSQ than rural residents (mean = 49.93 vs. mean = 44.82; p = .014). Higher fatigue and anxiety levels were associated with lower quality of life scores.ConclusionsThis study aimed to elucidate the multifaceted impact of migraines on daily life, considering diverse demographic variables to enhance diagnostic accuracy, treatment efficacy, and disease management strategies.

An Implementation of XGBoost and Random Forest Algorithm to Estimate Effective Porosity and Permeability on Well log data at Fajar Field, South Sumatera Basin, Indonesia

&lt;p class="Keywords"&gt;New approaches and methodologies have been developed to petrophysical analysis from well logs data using machine learning. Through this method, a machine learning algorithm is applied to predict the accuracy of the model on effective porosity (∅e) and permeability (K) which implemented using Random Forest and Xtreme Gradient Boosting (XGBoost) algorithm. The dataset used is obtained from well logs data that have been calculated petrophysical analysis. This study proposes the algorithm which is known to be effective in providing accurate predictions in a short time in estimating effective porosity and permeability. The results of the prediction model is optimized by GridSearchCV (GS), validated by the k-fold cross-validation, and evaluated using R2 score and Root Mean Square Error (RMSE). Model is applied to 5 research wells in Fajar Field of south Sumatra Basin, Indonesia with 4 variations of well training and well testing data split. The best evaluation results obtained with evaluation metrics were up to 0.90 (R2 score) and 0.01 (RMSE) for effective porosity and permeability by Random Forest, while evaluation metrics are 0.90 (R2 score) and under 0.68 (RMSE) for effective porosity and permeability by XGBoost. There is no decrease in accuracy until the last variation so that it can be concluded that these algorithm models can effectively estimate reservoir porosity and permeability in the field and contributed an alternative for the problem of many incomplete and dissimilar well logs data.&lt;/p&gt;

Improving Interprofessional Provider Perceptions About Opioid Use Disorder in the Acute Care Setting Through a Blended Educational Simulation Intervention

Background The influx of patients in the acute care setting with opioid use disorder (OUD) has outpaced many hospitals’ ability to educate interprofessional staff. This creates distressing experiences for interprofessional staff and patients, leading to moral distress and burnout in staff and poor patient outcomes. Objective The purpose of this study was to improve interprofessional staff knowledge, attitudes, and perceptions toward working with patients who have OUD using a blended classroom-simulation–based curriculum. Methods A preintervention and postintervention design was selected. Interprofessional staff (n = 46) participated in a blended classroom-simulation educational intervention focused on the neurobiology of OUD, stigma reduction, pain management, and harm reduction principles, followed by 3 high-fidelity simulation scenarios. Participants completed the Drug and Drug Problems Perceptions Questionnaire to measure staff self-perceived knowledge, skills, and attitudes when working with patients who use drugs before, immediately after, and again 3 and 6 months postintervention. Results Most respondents were nurses with an average of 7.6 (SD, 9.6) years of experience. The majority did not have prior training in substance use disorder before (75.6%). There was a statistically significant decrease in mean Drug and Drug Problems Perceptions Questionnaire scores across the total score mean: 55.2 (95% confidence interval, 52.2-58.3) versus 45.5 (95% confidence interval, 43.9-47.1), P &lt; .001. Decreased score indicates improved attitude and perception. Discussion A curriculum consisting of a blended classroom-simulation intervention was successful at improving several domains regarding perceptions of caring for patients with OUD. This educational intervention can serve as a model for health care systems with goal of improving patient outcomes and staff well-being.

Long-Term Impact of an Online Physician Group-Coaching Program to Improve Burnout and Self-Compassion in Trainees

SUMMARY Goal To evaluate long-term outcomes of Better Together Physician Coaching, a digital life-coaching program to improve resident well-being. Methods We performed a secondary analysis of survey data from the pilot program implementation between January 2021 and June 2022. An intention-to-treat analysis was completed for baseline versus post-6 months and baseline versus post-12 months for all outcome measures. Principal Findings Of 101 participants, 95 completed a baseline survey (94%), 66 completed a 6-month survey (65%) and 36 completed a 12-month survey (35%). There were no significant differences in burnout scale scores between baseline to 6 or 12 months. Self-compassion scores (i.e., means) improved after 6 months, from 33.2 to 38.2 (p &lt; .001) and remained improved after 12 months at 36.7 (p = .020). Impostor syndrome score means decreased after 6 months, from 5.41 to 4.38 (p = .005) but were not sustained after 12 months (4.66, p = .081). Moral injury score means decreased from baseline to 6 months from 41.2 to 37.0 (p = .018), but reductions were not sustained at 12 months (38.1, p = .166). Practical Applications This study showed significant, sustained improvement in self-compassion for coaching program participants.

Perceived protective behavioral changes in Chinese residents post-dynamic zero-COVID policy lifting: a cross-sectional study.

To investigate how Chinese residents perceived changes in their protective behaviors in the early stage after the lifting of the dynamic zero-COVID policy, and to explore the associations between the overall perceived change and factors such as demographic and health-related information, COVID-19 related perceptions, negative emotions, and coping styles. This cross-sectional study involved 798 Chinese residents who completed an online questionnaire between 16 and 25 December 2022. The questionnaire covered demographic and health-related information, COVID-19 related perceptions, negative emotions, coping styles, and perceived changes in protective behaviors. Multiple linear stepwise regression analysis was used to determine the factors associated with the overall perceived change in protective behaviors. The mean score for perceived protective behavioral change among participants was 61.38 (SD = 10.20), which was significantly higher than the hypothesized no-change value of 49 (p < 0.001). The mean scores for each of the 15 behaviors (excluding the two vaccination-related items) were significantly greater than the hypothesized no-change value of 3 (p < 0.001). The mean scores for the two vaccination-related items were significantly greater than the hypothesized no-change value of 2 (p < 0.001). Among all behaviors, avoiding dining out or gathering with friends had the highest mean score (Mean = 4.16), while engaging in regular physical activity had the lowest (Mean = 3.32). Avoiding dining out or gathering with friends had the highest percentage of individuals reporting an increase (71.3%), whereas maintaining a social distance of more than 1 m had the highest percentage of individuals reporting a decrease (17.5%). Regression analysis indicated that age, worry, positive coping, female sex, negative coping, and perceived severity were associated with the overall perceived change in protective behaviors, with worry being the most predictive variable. This study suggested that Chinese residents perceived an increase in their protective behaviors in the early stage after the policy change, with varying magnitudes across behaviors. We identified some potentially modifiable factors associated with perceived protective behavioral change, with worry emerging as the strongest predictor, followed by positive coping, negative coping, and perceived severity. These insights offer valuable information for developing effective communication strategies, psychological support, and comprehensive models in health behavior research.

Extracranial systemic embolic events in patients with atrial fibrillation: an individual patient-level meta-analysis of 71 683 patients randomized to NOAC vs warfarin from the COMBINE-AF study

Abstract Background Atrial Fibrillation (AF) poses a significant risk for both ischemic stroke and systemic embolic events (SEE). While the effectiveness of NOAC in preventing ischemic stroke is well-established, there is a lack of detailed analyses specifically characterizing SEE, which constitutes 5- 10% of all embolic events. Purpose To study the clinical characteristics, procedural management, and outcomes by randomized treatment (NOAC vs warfarin) of patients with SEE. Methods Using the COMBINE AF dataset, we conducted an individual patient level meta-analysis of 4 global RCTs (RE-LY, ROCKET AF, ARISTOTLE, ENGAGE AF-TIMI 48) of warfarin vs. NOAC in AF to assess risks of SEE. Outcomes were analyzed as time-to-first-event using a Cox proportional hazards model. Two authors independently reviewed deaths within 30 days after SEE to identify fatal SEE. Moreover, we independently assessed post SEE procedures to determined relatedness to SEE. Results There were 188 total SEEs, 9 patients (5%) had SEE then developed ischemic stroke; 16 patients (9%) had ischemic stroke then developed SEE; 1 patient had SEE and ischemic stroke simultaneously. Among the 171 patients with SEEs as first event, the median (IQR) age was 75 (68-80) years, 49.7% were female, median (IQR) of BMI was 27.5 (23.5-30.7) kg/m2, mean (SD) of CHADS2-VASC score was 4.7 (1.5). As compared with ischemic stroke (n=1789), SEE patients were more likely to have, PAD (16.5% vs. 5.4%, p &amp;lt;0.001), prior MI (24% vs. 17%, p = 0.02), be Vitamin K Antagonist experienced (57% vs 46%; p=0.007), have worse renal function (median CrCl mL/min; 58 vs 62, p = 0.02) and less likely to have paroxysmal AF (14% vs. 20%, p = 0.05). Of the total of 188 SEEs, 33 (18%) were fatal, 62 (31%) patients underwent surgical or percutaneous intervention (Fig). Standard dose (SD) NOAC significantly reduced the risk of SEE by 29% (95% CI 1-49%, p=0.04) compared with warfarin, However, no significant difference in the risk of SEE was observed between low dose (LD) NOAC and warfarin (Fig). Conclusion Standard dose NOAC was superior to warfarin in preventing SEE in AF patients. This benefit trends to be more pronounced for fatal cases. While SEE were about 1/10th as frequent as ischemic stroke in patients with AF, they were associated with significant morbidity and mortality and often required surgical or percutaneous intervention to restore blood flow.

Organizational health literacy responsiveness in community pharmacies in Serbia

Abstract Background The Faculty of Pharmacy at the University of Belgrade conducted a pilot study at community pharmacies in Serbia in 2023 in the framework of the M-POHL organizational health literacy (OHL) project. Community pharmacies in Serbia are considered relevant settings where people’s health can be promoted within the organization. Methods The validated and culturally adopted Serbian version of the International Self-Assessment Tool for Organizational Health Literacy in Primary Health Care Services (OHL-PHC) was used. We recruited employees from 3 pharmacy chains with pharmacists from different units. A preparatory workshop was organized to explain the procedure and the concept of OHL. First, the self-assessment was performed in a small group of 5 persons individually, and then the results were discussed in a joint assessment. The self-assessment was based on the degree of fulfillment of 4 categories offered for each indicator: not fulfilled (0-25%), predominantly not fulfilled (26-50%), predominantly fulfilled (51-75%), and completely fulfilled (76-100%). The same scale was applied for the indicators, sub-standards and standards and the final score was the mean of the individual scores (min. 0, max. 4). Results The overall score of the OHL on the sample level was 1.93±0.86, with the highest score for providing of easy access to primary care service and facilitating navigation (2.3±0.5). The least fulfilled standards were related to promotion of digital health literacy and promoting health literacy with the same score values of 1.7±1.0. Out of 69 indicators 1 had been self-assessed as not fulfilled and 15 reached low consensus (SD ≤ 1), and needed to be discussed further. Conclusions Improvements in OHL in the piloted institutions are necessary for successful healthcare and health promotion and could be tailed in further usage of the OHL-PHC on a broader scope. More pilot studies are needed in other healthcare settings at primary level in Serbia.

Comparison between Split Dose and Single Dose Bowel Laxatives for Preparation of Colonoscopy in Patients with Bangladeshi Diets: A Randomized Clinical Trial

Introduction: Colonoscopy is an important diagnostic tool for colonic disease and its efficacy and safety have been correlated with adequate bowel preparation. This study compared the efficacy and tolerability of single-dose and split-dose sodium picosulfate lavage as a colon cleansing agent for colonoscopy preparation. Methods: This randomized clinical trial was conducted at the Department of Gastroenterology in Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from June 2021 to May 2022.A total of 110 patients were selected by randomized sampling technique who underwent elective colonoscopy and were divided into split-dose (n=57) and single-dose (n=53) laxative groups. Bowel preparation was assessed by the Ottawa Bowel Preparation Scale (OBPS) and data were analyzed by SPSS 24.0. Result: The mean age of the patients was 47.4±17.7(SD) years in split-dose and 47.6±15.9 (SD) years in single-dose group. Both groups were statistically similar in terms of socio-demographic profile, medical history, clinical manifestation, and indication of colonoscopy (p&gt;0.05). The mean of total OBPS score (4.39±2.0 vs 5.56±2.2, p=0.004) and caecal intubation time (6.60±3 vs 7.74±2.5, p=0.035) was lower significantly in split-dose than the single-dose group. However, colonoscopy findings, adverse events, and patient compliance were similar between groups (p&gt;0.05). Conclusion: Split-dose is superior to single-dose bowel laxatives for colonoscopy preparation in terms of better mucosal cleanliness and lower caecal intubation time. However, further randomized controlled trial is recommended. J Bangladesh Coll Phys Surg 2024; 42: 329-335

Unveiling the intrinsic role of malnutrition in patients with Crohn's disease undergoing major surgery using entropy balancing weighting analysis.

The negative role of malnutrition in patients with Crohn's disease is known; however, many coexisting disease-related factors could cause misinterpretation of the real culprit. This study aimed to describe the role of malnutrition using a novel methodology, entropy balancing. This was a retrospective analysis of consecutive patients undergoing elective major surgery for Crohn's disease, preoperatively screened following the European Society for Clinical Nutrition guidelines. Two-step entropy balancing was applied to the group of malnourished patients to obtain an equal cohort having a null or low risk of malnutrition. The first reweighting homogenised the cohorts for non-modifiable confounding factors. The second reweighting matched the two groups for modifiable nutritional factors, assuming successful treatment of malnutrition. The entropy balancing was evaluated using the d-value. Postoperative results are reported as mean difference or OR, with a 95 % CI. Of the 183 patients, 69 (37·7 %) were at moderate/high risk for malnutrition. The malnourished patients had lower BMI (d = 1·000), Hb (d = 0·715), serum albumin (d = 0·981), a higher lymphocyte count (d = 0·124), Charlson Comorbidity Index (d = 0·257), American Society of Anaesthesiologists (d = 0·327) and Harvey-Bradshaw scores (d = 0·696). Protective loop ileostomy was more frequently performed (d = 0·648) in the malnourished group. After the first reweighting, malnourished patients experienced a prolonged length of stay (mean difference = 1·9; 0·11, 3·71, days), higher overall complication rate (OR 4·42; 1·39, 13·97) and higher comprehensive complication index score (mean difference = 8·9; 2·2 15·7). After thesecond reweighting, the postoperative course of the two groups was comparable. Entropy balancing showed the independent role of preoperative malnutrition and the possible advantages obtainable from a pre-habilitation programme in Crohn's disease patients awaiting surgery.

Quality of life in atrial fibrillation patients and its relationship to family member anxiety and depression

Abstract Background Atrial fibrillation (AF) has been found to decrease quality of life (QOL), and a few studies suggest that family members of AF patients can also experience negative emotions. This study aims to assess the anxiety and depression of the immediate family members of AF patients and to investigate the influence of the QOL of the AF patients on this anxiety and depression. Method This cross-sectional study recruited 121 pairs of AF patients and their immediate relatives along with 121 controls who and whose immediate relatives did not have AF. The patients filled out the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire, and the relatives and the controls were required to complete the State-Trait Anxiety Inventory (ST-AI) and Self-Rating Depression Scale (SDS). Results The score (mean (SD)) of the State Anxiety Inventory (S-AI, a subscale of ST-AI) in the relatives’ group was 44.9 (10.6), which was significantly higher than that of the control group (38.5 (9.5), p &amp;lt; 0.001). Among the different kinship subgroups, the children of the AF patients had the highest state anxiety score (mean value = 47.0, p=0.075). A negative linear relationship between the patients' overall AFEQT score and the relatives' S-AI score was found (standardized regression coefficient = -0.244, p &amp;lt; 0.001). For those patients who had particularly low AFEQT scores of less than 40, their relatives’ S-AI scores were significantly higher than other members of the relatives’ group (52.1 vs. 42.9, p = 0.001). AF patients in the peri-ablation period (81, 66.9%) had no difference in their AFEQT scores compared to other patients (60.8 vs. 64.4, p= 0.316) and there was also no difference in their family members’ ST-AI or SDS scores. Conclusion Study members showed considerable state anxiety if their family members had AF and increases in this anxiety were positively correlated with decreases in the HRQOL of the AF patients.