Specialist Hospital Research Articles

Factors Affecting The Efficiency And Effectiveness Of Pharmaceutical Inventory Control Of IVF Services Using The Minimum-Maximum Stock Level (MMSL) Method

Good control of the supply of drugs and consumables (BMHP) by Hospital Pharmaceutical Installations (IFRS) can avoid shortages or overstocks in pharmaceutical warehouses. The Type C "X" Special Hospital in Semarang City experienced a stockout of IVF drugs and embryo laboratory BMHP which resulted in delays in medical procedures and a decrease in the quality of service. The purpose of this study is to determine the factors that affect the efficiency and effectiveness of pharmaceutical preparations using the MMSL method. This study is a quasi-experimental non-equivalent without control group, samples were taken purposively using retrospective data from October – December 2023 with a stable supply and the research was applied prospectively from January – March 2024. Twelve types of IVF drugs and 56 types of BMHP embryo laboratories were used as research samples. The statistical test used cross-tabulation between efficiency variables (inventory value, inventory turnover ratio [ITOR], stockout value) and effectiveness (number of stockout events). The test results showed that the lower the price of IVF drugs and BMHP in embryo laboratories led to lower inventory values. The more expensive the BMHP price of embryo laboratories results in higher ITOR. The faster the lead time supplier BMHP embryo laboratory, the smaller the stockout will occur. The larger the Smin, Smax, and BMHP safety stock of the embryo laboratory, the lower the incidence of stockout. This study provides an insight into the factors that support the application of MMSL to inventory control in IFRS "X".

Assessing differences among persistent, episodic, and non- high-need high-cost hospitalized children in China after categorization by an unsupervised learning algorithm

BackgroundHigh-need, high-cost (HNHC) patients are a major focus of international healthcare reform. However, research on HNHC children in China remains limited. This study aims to classify HNHC pediatric patients, analyze the differences among groups, and explore the factors influencing HNHC status.MethodsData were obtained from a retrospective observational cohort of hospitalized children in Shanghai, China from 2017 to 2023. K-means clustering, one of the unsupervised learning algorithms, was employed to classify patients according to their HNHC status. Descriptive statistical analysis and the Kruskal-Wallis H test were used to describe and test the differences among different groups, with the logit regression models to analyze the predictors.Results688,131 hospitalized children were classified into three groups: 1,871 persistent HNHC, 32,539 episodic HNHC, and 653,721 non-HNHC. Significant differences were observed among these groups. Persistent HNHC patients have significantly higher costs and longer HNHC durations compared to episodic and non-HNHC patients, who were more likely to be aged 30 days to 1 year or 13–18 years, female with only one type of health insurance, and leukemia was the most prevalent and costly disease. They exhibited distinct healthcare utilization patterns, including emergency admissions, higher surgery rates, longer hospital stays, more frequent hospitalizations, and a preference for tertiary and specialized hospitals in city centers. Multiple influencing factors of persistent HNHC versus episodic HNHC and non-HNHC were identified.ConclusionThis study provides valuable insights into the classification, characteristics, and influencing factors of persistent, episodic, and non-HNHC hospitalized children in China. Persistent HNHC patients warrant targeted interventions to improve health outcomes and reduce healthcare costs. Enhanced medical coverage for key diseases, high-quality healthcare services tailored to their needs, and early interventions are crucial.

Nurse and doctor turnover and patient outcomes in NHS acute trusts in England: retrospective longitudinal study

ObjectiveTo investigate the association between monthly turnover rates of hospital nurses and senior doctors and patient health outcomes (mortality and unplanned hospital readmissions).DesignRetrospective longitudinal study.SettingAll 148 NHS acute trusts in...

Effect of Phytochemical-Rich Food Intake on Respiratory and Muscle Function in Middle-Aged Patients with COPD: A Cross-Sectional Study.

Background: It is known that the consumption of single phytochemicals improves respiratory function in chronic obstructive pulmonary disease (COPD) patients. Since phytochemicals have a synergistic effect on health, a more comprehensive analysis is needed. The aim of this study was to estimate the intake of phytochemicals using the dietary phytochemical index (DPI) and assess their association with respiratory function, inspiratory muscle strength and function, and peripheral muscle strength. Methods: This study was conducted at the Special Hospital for Pulmonary Diseases in Zagreb (September 2023 to May 2024). The DPI was assessed using three 24 h recalls from 71 COPD patients (66.5 ± 8.4 years; 53.5% men). Anthropometric measurements, respiratory function, inspiratory muscle function and strength, and peripheral muscle strength were assessed during pulmonary rehabilitation following standard protocols. Results: Patients were divided into DPI tertiles with mean values of 7.3 ± 3.0, 16.0 ± 3.0, and 32.2 ± 8.8, respectively. After controlling for confounding factors, a significant association was found between DPI tertiles and FEV1 (p-trend < 0.001), FVC (p-trend = 0.002), FEV1/FVC (p-trend < 0.001), MIP (p-trend = 0.012), and MSUE (p-trend = 0.002). In addition, an inverse association was found between DPI tertiles and diaphragm thickness during inhalation (p-trend = 0.012) and exhalation (p-trend = 0.013). Conclusions: This study suggests that a higher intake of phytochemicals could be beneficial in dietary interventions for COPD therapy. Future prospective studies are needed to confirm these findings.

Poor treatment outcomes of acute exacerbations of chronic obstructive pulmonary disease and their associated factors among admitted patients in East Gojjam, 2023.

Acute exacerbation of chronic obstructive pulmonary disease (COPD) poses a significant public health challenge globally, resulting in considerable health and economic burden. To date, there has been insufficient research in Ethiopia regarding poor treatment outcomes associated with these acute exacerbations. This study aims to assess the poor treatment outcomes of acute exacerbations of chronic obstructive pulmonary disease and identify the associated factors among admitted patients in East Gojjam in 2023. An institutional-based cross-sectional study design was employed. The institutional-based cross-sectional study was conducted from 7 April 2023 to 7 May 2023, involving 384 participants selected through simple random sampling. Data were extracted from patient charts and registers. Data entry was performed using EpiData, and the analysis was conducted using IBM SPSS Statistics version 26 software. Binary logistic regression analysis was used to identify the association between dependent and independent variables. Variables with a p-value of <0.25 in the bivariable logistic regression analysis were considered candidates for multivariable logistic regression. Variables with a p-value of <0.05 were considered statistically significant. Out of a total of 346 patients, 99 (28.6%) (95% CI, 23.9-33.3) developed poor treatment outcomes following exacerbations of chronic obstructive pulmonary diseases. Poor treatment outcomes were significantly associated with the following variables: age 65 or older (AOR = 3.9; 95% CI: 1.57-9.71), presence of comorbidities (AOR = 2.6; 95% CI: 1.287-5.20), a hospital stay longer than 7 days (AOR = 3.9; 95% CI: 1.97-7.70), and low oxygen saturation (<88%) (AOR = 9.0; 95% CI: 4.43-18.34). Approximately one-third of the patients treated for acute exacerbations of chronic obstructive pulmonary disease at the Debre Markos Comprehensive Specialized Hospital experienced poor treatment outcomes. There is a significant association between poor treatment outcomes of acute exacerbation of chronic obstructive pulmonary disease and age ≥ 65 years, having comorbidities, prolonged hospital stay, and low oxygen saturation.

Anxiety and care experiences in adolescents with chronic health conditions: an international, longitudinal study across the transfer of care

ObjectivesTo evaluate changes in anxiety, care experiences and condition impact among adolescents with chronic health conditions in two countries as they transfer to adult healthcare and to assess factors influencing...

Failure mode and effects analysis-based strategies for controlling multidrug-resistant organism infections in cancer patients.

In the context of advancing medical procedures, postoperative infections in cancer patients, particularly those involving multidrug-resistant organisms, have become a significant clinical concern. This study aims to comprehensively and systematically evaluate the effectiveness of infection prevention and control for multidrug-resistant organisms (MDROs) in postoperative cancer patients using Failure Mode and Effects Analysis (FMEA). This study was conducted in a tertiary A-level cancer specialty hospital in China, employing Failure Mode and Effects Analysis (FMEA) to assess the risks of hospital infections. Intervention measures were implemented for high-risk and medium-high-risk factors. Through the hospital's infection information system, data on patients who underwent surgical treatment from 2017 to 2022 were extracted. Data from 2017 to 2019 served as the control group, and data from 2020 to 2022 as the intervention group, to compare the changes in hospital infection incidence and MDRO infection incidence before and after the intervention. Categorical data were described in terms of frequency and percentage. The chi-square test was utilized for statistical inference to assess the differences in infection rates before and after the intervention. Prior to the intervention (2017-2019), the incidence rate of hospital infections was 1.66%, which decreased to 1.22% after the intervention (2020-2022), showing a statistically significant difference (χ2 = 48.83, P < 0.001). The incidence rate of MDRO infections also decreased from 1.808‰ before the intervention to 1.136‰ after the intervention, with a statistically significant difference (χ2 = 11.417, P = 0.001). This study confirms the effectiveness of the FMEA method in preventing and controlling MDRO infections in postoperative cancer patients. It highlights the practicality and value of widespread adoption of this method, particularly in the context of the COVID-19 pandemic.

A Comparative Review of Spine Surgeries in Two New Neurosurgery Centres in an Urban and Rural Environment in Southeast Nigeria

Background: The Imo State University Teaching Hospital (IMSUTH) located in a rural setting commenced neurosurgical services in January 2016 with a spine procedure as the first case whereas the Imo State Specialist Hospital (IMSSH) located in an urban setting commenced neurosurgical services in April 2021 and spine procedures in August 2021. The presentation of surgically managed spine pathologies in both hospitals were compared. Aims: The study aimed to descriptively compare the number of spine procedures performed in both hospitals including the age and gender distribution of the surgically managed spine patients, the spine pathologies and their distribution. Methods: The surgical records of all spine patients who had surgical procedures at IMSUTH, Orlu, from January 2016 to May 2020 (42 months), and at IMSSH, Owerri, from August 2021 to July 2024 (36 months) were retrospectively reviewed. Results: During the study periods, in IMSUTH, Orlu, there were 27 spine surgeries, giving an average of 1 spine procedure in 2 months whereas in IMSSH, Owerri, there were 157 spine surgeries giving an average of 4 spine surgeries per month. Interestingly the distribution of spine procedures revealed that the highest frequency of spine surgeries was performed in the lumbar spine (n=7, 26% in IMSUTH; n=43, 27.3% in IMSSH) followed by lumbosacral spine (n=6, 22.2% in IMSUTH; n=42, 26.8% in IMSSH) in both hospitals. And quite interesting also is that trauma (n=15, 55.6%) accounted for the highest number of spine surgeries in the rural environment of IMSUTH, Orlu, while degenerative spine diseases (n=113, 71.9%) accounted for the highest number of spine surgeries in the urban environment of IMSSH, Owerri. Conclusion: The study revealed that spine pathologies are not uncommon in resource poor settings especially in the urban environment. There is a male preponderance for spine surgeries. Lumbar/lumbosacral spine pathologies are common in our resource poor settings but trauma related spine pathologies are more common factors for spine surgeries in rural settings. There is need to improve access to spine care in the rural environments.

Prevalence of chronic kidney disease and associated factors among adult diabetic patients: a hospital-based cross-sectional study.

Chronic kidney disease (CKD) has a significant impact on public health with a high morbidity and death rate. Most diabetic patients, in the course of their lives, develop diabetic kidney disease. In the least developed nations, its size is outstripping itself. This study aimed to determine the prevalence of chronic kidney disease and associated factors among adult diabetic patients. A hospital-based cross-sectional study was conducted on 328 adult diabetic patients from 1 December 2023 to 4 April 2024 at the Ayder Comprehensive Specialized Hospital, northern Ethiopia. A systematic random sampling method was utilized to select the study participants. Pretested structured questionnaires were used to collect sociodemographic, economic, and behavioral/lifestyle factors. Medical records were also reviewed to collect clinical data. Creatinine analysis was performed by kinetic alkaline picrate method and Chronic Kidney Disease Epidemiology Collaboration 2021 equation was used to calculate the glomerular filtration rate from the serum creatinine, age, and sex. Proteinuria was determined by using the dipstick semiquantitative method. Data were entered and analyzed using SPSS version 29. A variable with a p-value of <0.25 in bivariate logistic regression analyses was analyzed in multivariate logistic regression to identify the associated factors. In multivariable logistic regression, a variable was deemed statistically significant if it had a p-value <0.05. Associations were presented as odds ratio (OR) along with 95% confidence intervals (CIs). The prevalence of chronic kidney diseases in adult diabetic patients was 26.5% (95% CI, 21.8%-31.7%). About 5.2%, 12.5%, 7.3%, 0.9%, and 0.6% had stage 1-5 chronic kidney diseases, respectively. Hypertension [adjusted OR (AOR) = 2.390; 95% CI, 1.394-4.099, p = 0.002], >10-year duration of diabetes (AOR = 2.585; 95% CI, 2.321-5.807; p = 0.001), and family history of kidney diseases (AOR = 2.884; 95% CI, 1.338-6.218; p = 0.007) were associated factors of chronic kidney diseases. The study revealed that one in four diabetic patients had chronic kidney disease. Special attention should be given to patients with family history of CKD, long duration on diabetes, and concomitant hypertension.

Challenges and outcomes of airway surgery in a post-war low-resource setting: A case series from Mekelle, Ethiopia.

This study aims to document and analyze the challenges and outcomes of performing complex airway surgery in a low-resource, post-war setting in Mekelle, Ethiopia. This prospective case series examines clinical data from five patients who underwent airway reconstruction surgeries and one patient who underwent total laryngectomy at Ayder Comprehensive Specialized Hospital in Mekelle. Data included patient demographics, airway stenosis etiology and severity, operative details, postoperative outcomes, complications, and hospital length of stay. Ethical approval was obtained from institutional review boards at Mayo Clinic and Mekelle University. The study included six patients aged 9-62 years, with surgeries comprising three cricotracheal resections, two tracheal resections, and one laryngectomy. Three reconstructions were for war-related injuries. Challenges included power outages during surgeries, limitations in medical supplies and equipment, and inadequate perioperative care. Despite these, three patients requiring tracheostomies were successfully decannulated within a year. However, complications such as restenosis, infections, and the need for reintubation were common. Airway surgeries in a low-resource, post-war setting face significant hurdles, including perioperative care quality, resource limitations, and infrastructure issues. Successful outcomes require multidisciplinary training tailored to local contexts, investments in hospital infrastructure and reliable electricity, and proper perioperative nutrition. This study highlights the need for comprehensive interventions to improve surgical care in such settings. Level of evidence: IV.

Adverse drug reactions and its associated factors among geriatric hospitalized patients at selected comprehensive specialized hospitals of the Amhara Region, Ethiopia: a multicenter prospective cohort study

BackgroundAdverse drug reactions are more prevalent in geriatric patients and are frequently associated with a range of polypharmacy-related issues as well as some physiological aging-related alterations. These affect the pharmacokinetic and pharmacodynamic properties of drugs. This study aimed to assess the magnitude of ADRs and their contributing factors among geriatric patients admitted at Comprehensive Specialized Hospitals of the Amhara Region.MethodsA multicenter prospective cohort study was carried out from May 2023 to August 2023 on geriatric patients admitted to four randomly selected comprehensive hospitals in the Amhara region. We used logistic regression to find the factors influencing the occurrence of ADRs. A P value of less than 0.05 was deemed statistically significant.ResultsDuring the study’s follow-up period, 373 patients in total were included. An incidence rate of 31.10% (95% CI: 26.38–35.82) was obtained from the identification of 121 ADRs in total. The organ most frequently affected by ADRs was the gastrointestinal tract (28.92%), followed by the cardiovascular system (19.01%), and the drug class most often implicated in ADRs was antibiotics (21.49%), then anticoagulants (12.40%). ADRs were substantially linked to being overweight (P < 0.001), having been hospitalized in the previous six months (P = 0.000), and hyperpolypharmacy (p = 0.047). 93.39% of all ADRs received the interventions. 85.12% of the adverse drug reactions were successfully resolved.ConclusionsThis study found that over one-third of older people and individuals admitted to the hospital experienced ADRs. Overweight, hyperpolypharmacy, and patients who had previously been admitted during the preceding six months were significantly linked with the occurrence of ADRs. Improving the drug safety of elderly patients, particularly those who are admitted, should be a greater priority for healthcare professionals.

Epidemiology of Orofacial Clefts: A Spatio-Temporal Descriptive Analysis in Tripoli, Libya, 2017-2021

Orofacial clefts are the most common congenital anomalies affecting the orofacial region. An abnormal facial development causes this congenital deformity during gestation; its aetiology is multifactorial. It is crucial to understand the prevalence of craniofacial anomalies in each community to determine the size of the problem, enhance the life standards for the patients, and assess the efficacy of interventions. In this study, we aimed to provide a picture of the prevalence of orofacial clefts in Tripoli, Libya. Also, it provides a useful reference for cleft-type distribution with their etiological risk factors. The data was collected from the archives of cleft babies referred to major specialized hospitals in Tripoli, Libya, from 2017 to 2021. Variables were collected and analyzed, including data related to cleft cases and their parents. During the study period, the incidence of orofacial clefts was 1.06 per 1,000 live births. The prevalence of cleft lip was 38.3%, cleft palate was 42.2%, and cleft lip with palate was 19.6%. The results showed that 2017 had the highest incidence rate, reaching 32.2%, while it was 8.3% in 2021. The prevalence was generally higher among males than females, at a difference rate of 3.47%. A history of folic acid deficiency and unsupervised drug intake during pregnancy was noted (58.3% and 61.7%, respectively). In addition, the higher prevalence was more common among mothers older than 34. Moreover, it has observed that 46.8% of patients` fathers were smokers. The study concluded that the incidence of cleft defects in Tripoli, Libya, was relatively low, and the role of the predisposing factors in increasing the incidence of cleft deformity remains uncertain. Further studies are recommended to find out the root cause.

The effectiveness of liver transplantation in reducing lipid levels in Saudi children with homozygous familial hypercholesterolemia

IntroductionThe lipid profiles of patients aged &amp;lt;15 years who have been diagnosed with homozygous familial hypercholesterolemia (HoFH) at King Faisal Specialist Hospital &amp;amp; Research Center (Riyadh) were examined.MethodsThe total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels of 17 patients were measured on initial presentation and compared with the levels measured after pharmacological treatment and then again after liver transplantation.ResultsAt the end of the pharmacological treatment, the total cholesterol levels decreased by an average of 3.79 mmol/L (reduced by 15.40%) (P &amp;lt; 0.001), and LDL-C levels decreased on average by 2.73 mmol/L (reduced by 13.46%) (P = 0.014). However, in two patients, LDL-C levels increased by 5.42% and 9.03% after pharmacological treatment. Conversely, the lipid values measured after liver transplantation decreased significantly nearly to within normal and borderline limits. The post-transplant total cholesterol and LDL-C levels declined by a mean of 19.96 mmol/L (reduced by 81.04%) and 17.47 mmol/L (reduced by 84.27%), respectively (P &amp;lt; 0.001 for both).DiscussionThese findings suggest that liver transplantation provides a more effective means to reduce elevated total cholesterol and LDL-C levels in patients with HoFH. Although liver transplantation is considered a better treatment for FHoH, risks, complications, and donor organ shortage may present problems.

Retrospective analysis of neonatal hyperbilirubinemia at Hiwot Fana Comprehensive Specialized Hospital, Ethiopia: prevalence, associated factors, and treatment outcome

BackgroundNeonatal hyperbilirubinemia, a condition marked by yellow discoloration of the skin and eyes due to elevated bilirubin levels, poses significant risks including kernicterus, a severe form of bilirubin encephalopathy. Understanding its prevalence, associated factors, and outcomes is crucial for effective management.ObjectivesThis study aimed to assess the prevalence, associated factors, and treatment outcomes of neonatal hyperbilirubinemia at Hiwot Fana Comprehensive Specialized Hospital, Eastern Ethiopia.MethodologyA hospital-based, cross-sectional study was conducted. We reviewed the medical charts of 328 neonates admitted to the Neonatal Intensive Care Unit of Hiwot Fana Comprehensive Specialized Hospital between January 1, 2019, and December 30, 2020. Data were collected using a checklist and analyzed with SPSS version 22, employing descriptive statistics and logistic regression.ResultThe prevalence of neonatal hyperbilirubinemia was 44.2% (95% CI 38.9, 49.6). Sepsis (66.9%) and Rh incompatibility (4.8%) were prevalent among neonates with neonatal hyperbilirubinemia. Prematurity and age at admission were significantly associated with neonatal hyperbilirubinemia. Most neonates with neonatal hyperbilirubinemia (94%) were treated with phototherapy alone, while a smaller proportion (6%) required a combination of phototherapy and exchange transfusion. The overall improvement rate was 93.8%, with a mortality rate of 1.4% due to bilirubin encephalopathy.ConclusionNeonatal hyperbilirubinemia was prevalent among neonates admitted to Hiwot Fana Comprehensive Specialized Hospital, with significant associations to age at admission, prematurity, and sepsis. Effective management, including timely phototherapy and addressing resource shortages, is crucial to improving neonatal outcomes.

Early Diagnostic Prediction of Infective Endocarditis: Development and Validation of EndoPredict-Dx.

Infective endocarditis is a life-threatening disease with diverse clinical presentations, making diagnosis challenging and requiring a range of complementary tests. The level of suspicion, based on clinical judgment, guides decisions regarding the initiation of empirical treatment and the selection of appropriate diagnostic tools. This study aimed to develop and validate the EndoPredict-Dx score for early prediction of infective endocarditis diagnosis. Patients admitted to a specialized cardiovascular hospital emergency department with suspected infective endocarditis between January 2011 and January 2020 were included. The primary outcome was left-sided infective endocarditis according to the Duke criteria. Logistic regression was used to derive the scoring system, with internal validation performed through bootstrapping. Candidate variables were obtained from the admission medical history, physical examination, and laboratory parameters. Of the 805 individuals with suspected infective endocarditis (median age 56 years (40-73); 58.6% men), 530 confirmed the diagnosis based on the Duke criteria. The EndoPredict-Dx assigned points for male sex, previous endocarditis, petechiae, heart murmur, suspected embolism, symptoms lasting 14 or more days at the time of admission, hemoglobin level ≤ 12 g/dL, leukocyte level ≥ 10 × 109/L, C-reactive protein level ≥ 20 mg/L, and urine red blood cells ≥ 20,000 cells/mL. Patients were divided into three risk groups. The AUROC was 0.78 (95% CI 0.75-0.81) for the derivation cohort and 0.77 for the internal validation. The EndoPredict-Dx score accurately predicted the likelihood of infective endocarditis using clinical and laboratory data collected at admission.

Testicular enlargement, abdominal pain and vomiting in 3‐month‐old, male, entire Airedale terrier

AbstractNon‐neoplastic scrotal testicular torsions in juvenile dogs have been rarely reported. This case report describes a scenario in which a patient presented with abdominal pain, vomiting and unilateral testicular enlargement. The primary veterinarian performed abdominal radiographs that were suspicious for a hernia. The patient was referred to a specialty hospital for further diagnostics and treatment. Upon referral, an abdominal ultrasound revealed a suspected non‐neoplastic scrotal testicular torsion. The patient underwent hemicastration to remove the affected testis and recovered uneventfully.

Patient awareness, knowledge, and acceptability of antenatal perineal massage: A single-center cross-sectional study from Saudi Arabia.

This study assessed the knowledge, awareness, and acceptability of antenatal perineal massage (APM) among pregnant women in Saudi Arabia. This cross-sectional study included 240 pregnant women who met the predefined inclusion criteria and attended the Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, from 1 October to 31 December 2023. Participants answered seven knowledge questions, classified as having good knowledge if they answered ≥4 correctly and poor knowledge if <4 were correct. Most women (46.25%) reported it was their first encounter with APM. Common sources of information included the internet (39.58%), physicians/midwives (7.92%), and friends/family (3.75%). Nearly half (47.5%) had heard of APM, but only 8.75% had practiced it, and 3.75% attended related classes. Only 17.5% knew that APM could be performed by the woman or her partner, while 25.83% knew it should start at 34 weeks, and 17.92% recognized the recommended duration of 5 to 10 minutes daily. Additionally, 22.5%, 15.83%, and 35.42% acknowledged APM's benefits for labor duration, anal sphincter dysfunction, and perineal injuries, respectively. The average knowledge score was 1.39±1.84, with 84.17% classified as having poor knowledge. No significant differences were found between knowledge levels (p>0.05). Low acceptability was noted, with only 58% of patients and 37% of their partners willing to engage in APM. No significant differences in acceptability were found between poor and good knowledge groups (p>0.05). The study revealed low awareness, poor knowledge, and weak acceptability of APM among pregnant patients. Targeted education for patients and healthcare providers could enhance knowledge and improve maternal-fetal health outcomes.

Assessing the effect of implementing a central line care bundle on central line-associated bloodstream infections in a tertiary hospital in Saudi Arabia

Central line-associated bloodstream infections (CLABSIs) are severe bloodstream infections caused by catheter use and are often associated with a longer hospital stay, increased healthcare costs, and a higher mortality rate. However, catheter-related bloodstream infections can be successfully treated. It is essential that healthcare workers are aware of central line (CL) insertion and maintenance bundles to reduce and prevent the incidence of CLABSI. The objective of this study was to assess the impact of implementing CL care bundles on hospital-wide CLABSI incidence rates. This is a prospective study conducted at the King Faisal Specialist Hospital and Research Center in Saudi Arabia from January 2017 to December 2021. The research period was divided into two phases: the pre-intervention phase (January 1, 2017 to December 31, 2018) and the post-intervention phase (January, 2019 to December 31, 2020). During both phases, outcome variables, including CLABSI rate, were assessed. In the present study, the total number of CLABSIs is 439, of which 266 were in the pre-intervention phase and 173 were in the post-intervention phase. The overall CLABSI rate significantly decreased from 1.6±0.05 in the pre-intervention phase to 0.9±0.05 in the post-intervention phase. This decline in CLABSI was significant (p&lt;0.0001) across all hospital settings, including critical care and non-critical care units. The implementation of care bundles is essential and has been shown to significantly reduce CLABSI rates in nearly all participating units.

Hematological changes in women with cervical cancer before and after cancer treatment: retrospective cohort study

Hematological changes is one of the most common complications occurred in cancer patients. Therefore, the current study aimed to assess the hematological toxicity of cervical cancer patients before and after the initiation of treatment. The retrospective cohort study was conducted from 2015 to 2022 at the University of Gondar Comprehensive Specialized Hospital. The hematological profile and sociodemographic and clinical data of the cervical cancer patients were collected using data extraction sheets. The Epidata version 3.1 and SPSS version 25 were used for data entry and analysis, respectively. Descriptive statistics were employed to summarize the data. To compare the median differences in hematological parameters before and after treatment, the Wilcoxon rank test was used. In addition, to assess the presence of an independent association between hematological abnormalities and the independent variables, logistic regression models were used. A p value less than 0.05 was considered to indicate statistical significance for all tests. In current study, the median (Interquartile range) of hemoglobin levels, white blood cell counts, and platelet counts, before treatment were 13.2 (12.1, 15) g/dl, 7.5 (5.8, 11.8) *109/L, and 330 (252, 383) *109/L, respectively. However, after treatment the median (Interquartile range) value of hemoglobin levels, white blood cell counts, and platelet counts were significantly lowered. On the other hand, red cell distribution width was significantly greater after treatment. At baseline, the magnitude of leucocytosis, anemia, and thrombocytosis were 27.9%, 24.6%, and 18.7%, respectively. After the treatment, anemia increased to 44.3%, but leucocytosis and thrombocytosis were replaced by leucopenia 18.3% and thrombocytopenia 17.8%, respectively. Hematological abnormalities such as anemia, leucopenia and thrombocytopenia were high after chemo-radiotherapy, and surgery. As the stage of cancer advances, the risk of developing anemia, leucocytosis, and thrombocytosis increased in 7.6, 6.9 and 9 times, respectively. Furthermore, being HIV patients and rural resident increased the risk of developing anemia about twofold. In conclusion hematological abnormalities were observed before and after cervical cancer treatment, with significance increment after chemo-radiotherapy and surgery. As the stage of cancer advances, the risk of developing hematological abnormalities increases. Therefore, routine monitoring of hematological changes before and after treatment and screening for major risk factors are important for improved patients’ management.

The effect of comorbidity on 28-day perioperative mortality rate among non-cardiac surgical patients in Northwest Ethiopia: a prospective cohort study using propensity score matching

BackgroundNon-communicable diseases account for nearly three-fourths of global deaths impacting public health and development. Coexisting diseases can complicate the management of surgical diseases, increasing the risk of perioperative mortality. Despite this, few studies have examined the burden of comorbidities among surgical patients and their effect on perioperative outcomes in low-income countries. In this study, we assessed the impact of comorbidity burden on 28-day perioperative mortality using a prospective data set.MethodsThis was a facility-based prospective cohort study. Adult patients aged ≥ 18 who underwent non-cardiac surgery were included. Patients were followed for 28 days following surgery. Perioperative data were collected using an electronic data collection system from June 01, 2019, to June 30, 2021, at Tibebe Ghion Specialized Hospital, Northwest, Ethiopia. A propensity score-matched analysis was employed to assess the effect of comorbidity on the 28-day perioperative mortality rate.ResultsOf the 3030 patients included in this study, 715 (23.59%) had at least one comorbidity. Based on the prevalence rate, the top four comorbid conditions observed were hypertension (0.050), cancer (0.036), diabetes mellitus (0.021), and human immunodeficiency virus (0.021). The 28-day perioperative mortality rate was shown to be significantly higher among patients with comorbidity, where 45 (6.29%) of the 715 patients with comorbidity died compared to 49 (2.12%) of the 2315 patients with no comorbidity (p-value < 0.0001). After propensity score matching potential confounders, patients who have comorbidity had a 2.52% (average treatment effect on treated (ATT) = 0.0252) higher risk of perioperative death at 28 days after surgery compared with patients who did not have comorbidity.ConclusionThis study found a moderate prevalence of comorbid illnesses among non-cardiac surgical patients, with comorbidity increasing the risk of 28-day perioperative mortality. Preoperative screening and optimization are highly recommended for patients with comorbid illness to decrease perioperative mortality rate.