Standard Care Protocol Research Articles

ASSISTÊNCIA DE ENFERMAGEM A MULHERES VÍTIMAS DE VIOLÊNCIA SEXUAL

Sexual violence is a public health problem affecting millions of women worldwide, with severe consequences for their physical and mental health. In this context, nursing plays a fundamental role in attending to women who suffer domestico/sexual violence, highlighting the need for a victim-centered approach. Objective: To analyze the role of nursin in attending to victims of sexual violence, identifying challenges and perspectives for improving assistance. Methodology: Integrative literature review using databases: PubMed, Google Scholar, SciELO, and Virtual Health Library-BVS, including articles and publications from the last five years (2019-2023). Results: Significant challenges were identified in care, including lack of training, inadequate resources, and social stigma. Nursing plays a crucial role in welcoming and caring for victims, requiring a humanized and empathetic approach. Discussion: Nursing assistance to victims of sexual violence is essential for their recovery. It is necessary to invest in continuous training, adequate resources, and combating social stigma.Conclusion: Implementing standardized care protocols and providing psychosocial support to nursing professionals is also essential. Improving nursing assistance can enhance care effectiveness and promote the integral recove of affected women.

Improving central venous catheter care with chlorhexidine gluconate dressings: evidence from a systematic review and Meta-analysis

BackgroundThe prevention of catheter-related bloodstream infections (CRBSI) is a critical priority in the clinical management of central venous catheters (CVCs). This meta-analysis aims to evaluate the efficacy of chlorhexidine gluconate antibacterial dressings in the context of CVC care.MethodsA systematic literature search was performed in PubMed, Web of Science, Embase et al. databases up to May 28, 2024. The search targeted randomized controlled trials (RCTs) that investigated the impact of chlorhexidine gluconate antibacterial dressings on CVC-related outcomes. The meta-analysis was conducted using RevMan 5.3 software.ResultsThe final analysis included 14 RCTs involving a total of 8920 patients with CVCs, with participants divided into a chlorhexidine antibacterial dressing group (n = 4731) and a control group (n = 4189). The chlorhexidine dressing group demonstrated a statistically significant reduction in the incidence of CRBSI compared to the control group, with a relative risk (RR) of 0.48, 95% confidence interval (CI) 0.36–0.64, P < 0.001. The chlorhexidine dressing group also showed a significant decrease in bacterial colonization, with an RR of 0.46, 95% CI 0.38–0.55, P < 0.001. Assessment of publication bias through funnel plot asymmetry and Egger’s test revealed no significant bias in the included studies (all P > 0.05).ConclusionsThere is a notable reduction in the incidence of CRBSI and bacterial colonization in patients with CVCs through the application of chlorhexidine gluconate dressings. Given the compelling evidence, the integration of these dressings into standard nursing care protocols for the management of CVCs is advocated.

Comparative analysis of treatment outcomes in osteoarthritis knee: integrating physiotherapy and medication versus mono-therapies

Background: Osteoarthritis (OA) of the knee is a prevalent degenerative joint disorder that significantly impacts patients' mobility and quality of life. Effective management of knee OA is crucial to alleviate symptoms and improve daily functioning. This study aims to conduct a comparative analysis of treatment outcomes for knee OA by evaluating three distinct therapeutic approaches: a combination of physiotherapy and medication, physiotherapy alone and medication alone, all supplemented with routine daily activities. Methods: The research involves a cohort of patients diagnosed with knee OA, divided into three groups, each receiving one of the specified treatments. Outcome measures include pain reduction, assessed through the Visual Analog Scale (VAS); functional mobility, evaluated using the Timed Up and Go (TUG) test; and overall quality of life, measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS). Results: Preliminary findings suggest that patients receiving the integrated treatment of physiotherapy and medication show significantly greater improvements in pain relief and functional mobility compared to those undergoing mono-therapies. The combination approach appears to leverage the synergistic effects of both modalities, offering a more comprehensive management strategy. Physiotherapy alone also demonstrates notable benefits in enhancing mobility and reducing pain, while medication primarily provides symptomatic relief. Conclusions: This study underscores the importance of a multidisciplinary approach in treating knee OA, highlighting that integrated treatment plans may offer superior outcomes. These findings aim to inform clinical practice, suggesting that combining physiotherapy with medication can optimize therapeutic efficacy, improve patient quality of life and potentially alter the standard care protocols for knee OA. Further research is warranted to substantiate these results and explore long-term benefits.

Postoperative wound care protocol prevents surgical site infection after craniotomy.

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

Rapid Acute Coronary Syndrome Evaluation Over One Hour With High-Sensitivity Cardiac Troponin I: A United States-Based Stepped-Wedge, Randomized Trial

The real-world effectiveness and safety of a 0/1-hour accelerated protocol using high-sensitivity cardiac troponin (hs-cTn) to exclude myocardial infarction (MI) compared to routine care in the United States is uncertain. The objective was to compare a 0/1-hour accelerated protocol for evaluation of MI to a 0/3-hour standard care protocol. The RACE-IT trial was a stepped-wedge, randomized trial across 9 emergency departments (EDs) that enrolled 32,609 patientsevaluated for possible MI from July 2020 through April 2021. Patients undergoing high-sensitivity cardiac troponin I testing with concentrations less than or equal to 99th percentile were included. Patients who had MI excluded by the 0/1-hour protocol could be discharged from the ED. Patients in the standard care protocol had 0- and 3-hour troponin testing and application of a modified HEART score to be eligible for discharge. The primary endpoint was the proportion of patients discharged from the ED without 30-day death or MI. There were 13,505 and 19,104 patients evaluated in the standard care and accelerated protocol groups, respectively, of whom 19,152 (58.7%) were discharged directly from the ED. There was no significant difference in safe discharges between standard care and the accelerated protocol (59.5% vs 57.8%; adjusted odds ratio (aOR)=1.05, 95% confidence interval [CI] 0.95 to 1.16). At 30 days, there were 90 deaths or MIs with 38 (0.4%) in the standard care group and 52 (0.4%) in the accelerated protocol group (aOR=0.84, 95% CI 0.43 to 1.68). A 0/1-hour accelerated protocol using high-sensitivity cardiac troponin I did not lead to more safe ED discharges compared with standard care.

The Power of Thought: The Role of Psychological Attentiveness and Emotional Support in Patient Trajectories.

In modern healthcare, the influence of a patient's mindset on health outcomes is an often neglected yet vital component of holistic care. This review explores the significant impact of positive and negative mindsets on disease progression and recovery, emphasizing the need to integrate mental wellness practices into conventional medical care. Drawing from a wide array of studies, it demonstrates how fostering a positive mindset can enhance patient trajectories across various medical specialties. The article advocates for training healthcare providers to adopt a more empathetic and patient-centered approach, bridging the gap between mind and body. By presenting compelling evidence on the correlation between patient mindset and health outcomes, this review highlights the potential benefits of incorporating psychological support and holistic strategies into standard care protocols. Practical strategies for implementing mindset-focused interventions are also proposed, including training programs for healthcare professionals and the development of interdisciplinary treatment plans. Ultimately, this article underscores the need for a paradigm shift in medical practice, advocating for a comprehensive approach that recognizes the power of thought in promoting patient wellness.

Impact of daily music on comfort scores in preterm infants: a randomized controlled trial.

Premature birth heightens neurodevelopmental risks, theorized to partly stem from altered sensory inputs and disrupted sleep patterns. Modifying the acoustic milieu through music intervention (MI) offers promise to improve neonatal comfort, reduce sleep disturbances, and stabilize physiological parameters. This study explores the impact of non-pharmacological MI on these health indicators within the Neonatal Intensive Care Unit (NICU). A single-blinded RCT was conducted. Premature infants (34 > GA > 29 wks) were randomly assigned to either receive 8 min of daily MI or placebo for up to 15 days. Validated behavioral comfort scores were visually obtained by a blinded observer before and after intervention. Additionally, physiological signs (HR, RR, SatO2) were recorded. Differences between the groups were analyzed using χ² tests and t-tests. In total 56 preterm infants were included. After intervention, comfort levels increased significantly in the MI compared to placebo group (p = 0.000). Neonates receiving MI transitioned from wakefulness to a state of sleep significantly more compared to placebo (p = 0.002). Physiological parameters remained stable. This study adds to existing literature demonstrating that a music intervention in a NICU setting can enhance comfort and sleep of premature infants without adversely affecting physiological parameters. The study demonstrates that music interventions (MI) in a Neonatal Intensive Care Unit (NICU) setting can significantly increase comfort levels and positively impact the sleep of premature infants without negatively impacting their physiological parameters. This research increases evidence for non-pharmacological interventions, specifically music, as beneficial for the well-being of premature infants in NICU settings. It replicates and expands upon previous methodological designs, providing more robust evidence of MI's positive effects on this vulnerable population. The positive outcomes of music intervention could influence hospital policies by integrating non-pharmacological practices into standard neonatal care protocols to enhance developmental support for premature infants.

Kepuasan Hidup dan Pengaruhnya Terhadap Keberhasilan Pengobatan Penyakit Lupus

This study examines the relationship between life satisfaction and the effectiveness of systemic lupus erythematosus (SLE) treatment through a systematic review and meta-analysis of 32 studies (N=8,746) published between 2018 and 2023. The analysis reveals a moderate negative correlation between life satisfaction and lupus disease activity (r=-0.38, 95% CI: -0.44 to -0.32, p&lt;0.001). More specifically, the data demonstrate a strong positive correlation between life satisfaction and quality of life in the context of health (r=0.52, 95% CI: 0.47-0.57, p&lt;0.001) and a moderate positive correlation with medication adherence (r=0.34, 95% CI: 0.28-0.40, p&lt;0.001). Longitudinal analysis (n=6 studies) shows that early improvements in life satisfaction are significantly predictive of reductions in lupus disease activity (?=-0.24, p&lt;0.001) and enhancements in quality of life (?=0.29, p&lt;0.001) over six months to 2 years. Meta-regression analysis further identifies age (?=0.008, p=0.03) and disease duration (?=0.015, p=0.01) as significant moderators of the effect of life satisfaction on SLE treatment outcomes. These findings extend previous research by Diener and Chan (2011) on well-being and health and by Mok et al. (2019) on depression in SLE by emphasizing the specific role of life satisfaction in SLE management. The novelty of this study lies in its focus on life satisfaction rather than solely negative risk factors, highlighting the potential for life satisfaction-based interventions in the management of SLE. This research supports the integration of life satisfaction assessments and psychosocial interventions into standard SLE care protocols, offering new insights into the psychoimmunological approach to SLE treatment.

Breast Cancer Patient Flap Management after Mastectomy: A Best Practice Implementation Project

BackgroundBreast cancer is a prevalent malignancy in women, with mastectomy as the main surgery. Common post-mastectomy complications are seroma (15%-81%), infections (2.9%-3.8%), and flap necrosis (10%-18%), severely impacting quality of life and costs. Howerever, there's a lack of standardized flap care protocols and limited staff knowledge. ObjectivesThis study aims to apply best evidence for flap management post-mastectomy to standardize practices, reduce complications, and enhance patient's quality of life. MethodsThis project followed JBI PACES and GRiP principles, implementing evidence-based practices in a Chinese tertiary hospital between January and May 2023. It entailed evidence identification, integration into clinical context, protocol development, baseline audits, barrier/enabler analysis. The study compared pre- and post-evidence implementation rates of flap complications, healthcare staff's knowledge/skill scores on mastectomy flap management, and audit indicator adherence by both staff and patients. ResultsAfter evidence application, flap ischemia/necrosis rates dropped from 8.57% to 5.56% (P<0.001), wound infection rates after surgery reduced from 5.71% to 2.78% (P<0.001), and seroma rates decreased from 17.14% to 2.78% (P<0.001). Healthcare staff's knowledge and skill scores for flap management following mastectomy increased from 50.67±18.32 pre-implementation to 98.33±4.01 (t=-13.90, p<0.001). Audit criterion compliance rates increased from 8.57% to 94.29% to between 91.67% and 100%, with statistically significant differences in all 15 criteria (P<0.001). ConclusionsEvidence-based management of flaps after mastectomy improves healthcare staff's knowledge and skills, enhances nursing quality, effectively reduces flap complications in patients, and boosts their quality of life. micro abstractThis study implemented evidence-based practices for post-mastectomy flap management at a Chinese tertiary hospital, reducing complications: flap ischemia/necrosis from 8.57% to 5.56%, infections from 5.71% to 2.78%, and seroma from 17.14% to 2.78%. Healthcare staff's knowledge and skills improved significantly, boosting compliance with audit criteria. Results indicate enhancements in nursing quality and patient quality of life.

A Review of Current Approaches to Pain Management in Knee Osteoarthritis with a Focus on Italian Clinical Landscape.

The global cases of knee osteoarthritis (KOA) are projected to increase by 74.9% by 2050. Currently, over half of patients remain dissatisfied with their pain relief. This review addresses unmet needs for moderate-to-severe KOA pain; it offers evidence and insights for improved management. Italian experts from the fields of rheumatology, physical medicine and rehabilitation, orthopedics, primary care, and pain therapy have identified several key issues. They emphasized the need for standardized care protocols to address inconsistencies in patient management across different specialties. Early diagnosis is crucial, as cartilage responds better to early protective and structural therapies. Faster access to physiatrist evaluation and reimbursement for physical, rehabilitative, and pharmacological treatments, including intra-articular (IA) therapy, could reduce access disparities. Concerns surround the adverse effects of oral pharmacological treatments, highlighting the need for safer alternatives. Patient satisfaction with corticosteroids and hyaluronic acid-based IA therapies reduces over time and there is no consensus on the optimal IA therapy protocol. Surgery should be reserved for severe symptoms and radiographic KOA evidence, as chronic pain post-surgery poses significant societal and economic burdens. The experts advocate for a multidisciplinary approach, promoting interaction and collaboration between specialists and general practitioners, to enhance KOA care and treatment consistency in Italy.

Effectiveness of yoga intervention on depression, stress, and sleep quality in IT professionals with chronic low back pain: A randomized controlled trial

Chronic low back pain (CLBP) is prevalent among IT professionals and often accompanied by psychological symptoms such as depression, stress, and sleep disturbances. While conventional treatments primarily target pain management, holistic approaches like yoga show promising results in addressing both physical and psychosomatic factors. This randomized controlled trial (RCT) aims to assess the impact of a yoga intervention on depression, stress, and sleep quality in IT professionals with CLBP. A total of 83 IT professionals with CLBP were randomly allocated to either a yoga (n = 40) intervention group or a control group (n = 40) receiving standard care. The intervention group underwent a structured yoga program tailored for CLBP, while the control group followed a standard care protocol. Outcome measures, including pain intensity, depression levels, perceived stress, and sleep quality, were assessed using validated standard questionnaires. Preliminary analysis reveals significant enhancements in the yoga intervention group compared to the control group. Specifically, participants in the yoga group reported a statistically significant reduction in pain intensity (p &lt; 0.05), along with notable decreases in depression scores (p &lt; 0.05), anxiety score (p &lt; 0.05), and stress levels (p &lt; 0.05). Additionally, the yoga intervention group demonstrated enhanced sleep quality (p &lt; 0.05) compared to the control group. This RCT provides compelling evidence for the efficacy of yoga as an adjunctive therapy for CLBP management in IT professionals. The findings emphasize the potential of yoga in alleviating both physical and psychological symptoms associated with CLBP. Healthcare providers may consider incorporating yoga into treatment programs for CLBP in IT professionals to optimize outcomes and enhance overall well-being. Moreover, these results emphasize the importance of holistic interventions in addressing the complex nature of CLBP in the workplace.

The Impact of Enhanced Recovery Protocols Regarding Postoperative Nausea and Vomiting Following Sleeve Gastrectomy under Triple Prophylaxis: A Controlled Randomized Study

Background Following a sleeve gastrectomy, post-operative nausea and vomiting (PONV) is a typical issue. Furthermore, several prophylactic techniques have been developed, such as preventive antiemetic and accelerated recovery after surgery (ERAS). However, PONV has not entirely disappeared, and clinicians are still working to lower PONV incidence. Aim Our goal was to evaluate how adopting Enhanced Recovery Protocols (ERAS) affects postoperative nausea and vomiting (PONV) in comparison to standard care protocol after laparoscopic sleeve gastrectomy (LSG) while receiving triple antiemetic prophylaxis. Objective The objective of this study was to verify that the ERAS procedure is crucial for lowering PONV despite the use of an efficient and effective antiemetic. Methods This is a computer-generated randomized clinical trial. Haloperidol, dexamethasone, and ondansetron were administered to all patients undergoing elective LSG, 29 patients within an ERAS protocol, and 29 within a standard care protocol. The primary finding was the incidence of PONV within 36 hours following LSG. The time to initially administer rescue antiemetic medication, number of rescue antiemetic medication administrations, postoperative opioid consumption, oral fluid tolerance, complications, and QoR-15 questionnaire for quality of recovery were the secondary outcomes. Results Within the first 36 hours following LSG, the incidence of PONV in the ERAS group was 17.20%, while in the non-ERAS group, it was 51.7%, with P&lt;0.012 and higher PONV severity (P&lt;0.021) in the non-ERAS group. The ERAS group took a longer time (6 hours) for the first rescue antiemetic medicine than the Non-ERAS group (2 hours), with P&lt;0.001 and significantly less number of patients (20.7%) needing rescue antiemetic, compared to the Non-ERAS group (65.5%), with P&lt;0.001. The dosage of nalbuphine needed by the ERAS group was lower (2.7±2.8) than the non-ERAS group (19.9±6.0). Regarding the QoR-15 scores, there was a significant difference in the two groups' overall performance (P &lt;0.001). Between the two groups, there were no significant complications following surgery. Conclusion This study reveals that even though triple antiemetic prophylaxis was used, the ERAS protocol had a beneficial effect on PONV when compared to the standard care approach.

Redefining Management in Hypertrophic Cardiomyopathy: The Role and Challenges of Exercise Rehabilitation.

Hypertrophic cardiomyopathy (HCM), a common genetic heart condition, is characterized by thickening of the left ventricle, which can result in a range of health issues, such as arrhythmias, heart failure, and sudden death. Despite traditional cautions against exercise in HCM patients due to potential exacerbation of symptoms and risk of sudden death, recent evidence suggests a paradigm shift toward the benefits of structured exercise rehabilitation. The pathogenesis of HCM, the physical and psychological effects of the illness on patients, and changing views on exercise as a therapeutic intervention are all covered in this review. Recent research shows that modest physical activity can considerably enhance functional ability, psychological health, and overall quality of life in individuals with heart failure without increasing the risk of unfavorable cardiac events, challenging earlier recommendations. Moreover, exercise rehabilitation has been shown to induce favorable myocardial remodeling and enhance cardiovascular fitness, suggesting a revaluation of exercise prescriptions tailored to individual patient profiles. Despite the promising role of exercise in managing HCM, this review also acknowledges the complexities of implementing rehabilitation programs, including the need for comprehensive patient assessment, personalized exercise regimens, and monitoring for potential complications. Future research should focus on optimizing exercise recommendations, understanding long-term outcomes, and integrating exercise rehabilitation into standard care protocols for HCM to foster a more holistic approach to patient management. Underscoring the necessity of a multidisciplinary strategy that balances the benefits of physical activity with the unique risks associated with HCM with the aim of improving patient outcomes through evidence-based, patient-centered care.

The Effect of Oral Care Protocols on Mucositis in Pediatric Cancer Patients: A Randomized Controlled Trial

Background/Aims: Standard oral care protocols can reduce the incidence of mucositis. This study aimed to evaluate the effect of the "Oral Care Protocol" containing sodium bicarbonate or saline on mucositis development, degree, and duration in pediatric cancer patients. Methods: This study is a blind, parallel trial design, randomized controlled study. Patients (n = 43) who received inpatient chemotherapy treatment for more than three days at the Pediatric Hematology and Oncology Unit were included. The oral care protocol with saline was given to the patients in the control group (n = 22), and the oral care protocol with sodium bicarbonate was given to the patients in the study group (n = 21). The primary outcome was the development of mucositis. The secondary outcomes were mucositis degree, patient data at the time of mucositis development, and the duration of mucositis. The characteristics of the patients in the study and control groups and the data of patients with and without mucositis were compared with Fisher's exact test, t-test, and chi-square analysis. Results: No statistically significant difference was found between the study and control groups in terms of mean age, gender, diagnosis, relapse status, treatment stage, risk group, and treatment protocols. Mucositis developed in 18.2% of the patients in the control group and 9.5% of the patients in the study group. No statistically significant difference was found in terms of mucositis development, degree, and duration. Conclusions: The oral care protocol with sodium bicarbonate can be used to prevent mucositis in pediatric cancer patients. ClinicalTrials.gov Identifier: NCTXXX.

Effectiveness of Acceptance and Commitment Therapy on Psychotic Severity Among Inpatients With Primary Psychoses: A Randomized Controlled Trial.

This study investigated the effectiveness of acceptance and commitment therapy (ACT) compared to treatment as usual in managing psychotic symptoms, emotional dysregulation, recovery and psychological flexibility in inpatients with primary psychoses. The Primary outcome assessed the positive and negative syndrome scale, while the secondary outcomes were to assess difficulties in the emotion regulation scale, recovery assessment scale and acceptance and action questionnaire. An open-label, two-arm parallel randomized controlled trial was conducted. Participants diagnosed with primary psychoses were randomly assigned to either the ACT (n = 33) or treatment-as-usual (n = 32) group. The intervention included six structured sessions of ACT. ACT significantly reduced psychotic symptoms from 128 to 104 (Z = 5.01) compared to treatment as usual from 130 to 117 (Z = 4.88). Emotional regulation improved significantly in the ACT group from 73 to 55 (Z = 4.835) compared to treatment as usual from 73 to 70 (Z = 2.406). Recovery increased in the ACT group from 50 to 88 (Z = 5.01) compared to treatment as usual from 51 to 61 (Z = 4.93). Psychological flexibility improved in the ACT group from 33 to 25 (Z = 4.98) compared to treatment as usual from 33 to 31 (Z = 4.75). Between-group differences after intervention were significant for psychotic symptoms, emotional regulation, recovery and psychological flexibility (Z = 2.356, 4.652, 3.881 and 4.453, respectively). Accordingly, the current study demonstrates the effectiveness of ACT in reducing psychotic symptoms and improving emotional regulation, recovery and psychological flexibility in patients with primary psychoses. Integrating ACT into standard care protocols can enhance treatment outcomes, offering a comprehensive approach to managing complex mental health conditions. Trial Registration: ClinicalTrials.gov identifier: NCT06160869.

Patient Perception on Physiotherapy and the Breath of Hope in Breast Cancer Patients Undergoing Chemotherapy: Impact of Breathing Exercises in Enhancing Lung Function and Quality of Life: A Quasi-Experimental Study

Background: Breast cancer is the leading type of cancer among women globally, significantly impacting mortality and morbidity rates. Respiratory complications and diminished quality of life are common among patients undergoing chemotherapy, highlighting the need for effective supportive treatments. Objective: This study aimed to evaluate the efficacy of respiratory physiotherapy interventions, specifically breathing exercises, in improving lung function and quality of life in breast cancer patients undergoing chemotherapy. Methods: This quasi-experimental study enrolled thirty female breast cancer patients from the oncology wards of Allied Hospital and PINUM, Faisalabad. Participants were selected using a purposive sampling technique and were provided with respiratory physiotherapy, including spirometry and breathing exercises, three times a week for six months. Data were collected through initial and final assessments of lung function and quality of life, using self-administered questionnaires and spirometry. Ethical considerations followed the Declaration of Helsinki guidelines, with all participants providing informed consent. Statistical analysis was conducted using SPSS Version 25, employing the Wilcoxon signed-rank test. Results: The interventions showed statistically significant improvements in lung capacity; Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1) witnessed positive ranks in 22 and 21 patients respectively, with mean ranks of 11.50 and 11.00, and sum of ranks at 253.00 and 231.00 (p&lt;.001 for both). Quality of life assessments indicated improvements across physical, emotional, and cognitive functions with significant p-values (&lt;.001 to .025). About 70% of participants reported a good perception, and 10% reported an excellent perception of the physiotherapy's effectiveness in improving their condition. Conclusion: The study confirms that structured respiratory physiotherapy significantly enhances lung function and quality of life in breast cancer patients undergoing chemotherapy. These findings advocate for the integration of tailored respiratory physiotherapy into standard care protocols to improve clinical outcomes for this patient group. Keywords: Breast Cancer, Chemotherapy, Respiratory Physiotherapy, Breathing Exercises, Lung Function, Quality of Life, Patient Perception, SPSS Analysis, Oncology Rehabilitation.

Hyperbaric Oxygen Therapy for Complications in Nipple-Sparing Mastectomy with Breast Reconstruction: A Systematic Review.

Background: Research advancing effective treatments for breast cancer is crucial for eradicating the disease, reducing recurrence, and improving survival rates. Nipple-sparing mastectomy (NSM), a common method for treating breast cancer, often leads to complications requiring re-operation. Despite advancements, the use of hyperbaric oxygen therapy (HBOT) for treating these complications remains underexplored. Therefore, we analyze the efficacy of HBOT in the post-operative care of patients undergoing NSM. Methods: A systematic search was conducted using PubMed, Scopus, and the Cochrane Library. Studies were assessed for eligibility using the PICO (Population, Intervention, Comparison, Outcome) framework and classified based on American Society of Plastic Surgeons (ASPS) levels of evidence. Seven studies, totaling a pool of 63 female patients, met the inclusion criteria. Among these studies, four were categorized as Level III (57.1%), one as Level IV (14.3%), and two as Level V (28.6%). These studies focused on HBOT's role in wound healing, the successful salvage of breast reconstruction, and the optimal timing for HBOT. Results: This review revealed that HBOT indeed has potential for improving tissue oxygenation, vascularization, and, consequently, wound healing. It is noted that HBOT is efficacious for mitigating post-NMS complications, including infections, re-operation, flap loss, seroma, and hematoma. Conclusions: Overall, HBOT could be beneficial in standard post-surgical care protocols for patients undergoing NSM due to its role in mitigating common adverse effects that occur after mastectomy. Despite promising outcomes, the recent literature lacks rigorous clinical trials and well-defined control groups, underscoring the need for further research to establish standardized HBOT protocols.

Postoperative hypoalbuminemia and outcomes of pediatric liver transplantation

BackgroundHypoalbuminemia after liver transplantation (LT) is associated with acute kidney injury (AKI) and poor outcomes in adult LT recipients. This study was performed to examine the association between the postoperative serum albumin level and early postoperative outcomes of LT in children.MethodsThis single-center retrospective review involved pediatric LT recipients (0–18 years old) treated from January 2013 to June 2020. All patients were admitted to PICU and received standard post-LT care protocol. We divided patients into low (< 30 g/L) and normal (> 30 g/L) groups based on postoperative albumin day 1 to 3.ResultsAmong 108 LT recipients, most had biliary atresia. The median age at the time of LT was 1.8 years [interquartile range (IQR), 1.5–5.7]. There were 18 patients in low albumin group [median albumin level, 27.9 g/L (IQR, 25.8–29.6) and 90 patients in normal albumin group [median albumin level, 34.5 g/L (IQR, 32.4–36.9). The low albumin group had significantly higher incidence of AKI, occurring in 20% of patients with a median onset of 2.5 days following LT (IQR, 1–5). Postoperative hypoalbuminemia (OR, 4.94; 95% CI, 1.32–18.47; p = 0.01) and a longer operative time (OR, 1.37; 95% CI, 1.01–1.47; p = 0.02) were independent risk factors for AKI by multivariable analysis. No significant differences between the two groups were found in other early postoperative outcomes.ConclusionPostoperative hypoalbuminemia was associated with early postoperative AKI following LT in children but not with other worsening outcomes.

Association between body mass index and short-term outcomes of laparoscopic right hemicolectomy for colon cancer

BackgroundLaparoscopic right hemicolectomy can be technically challenging in patients with increased body mass index, reportedly associated with higher surgical site infection (SSI) and incisional hernia rates. We aimed to assess the association between increased body mass index and short-term outcomes of laparoscopic right hemicolectomy. MethodsThis retrospective cohort study included patients with colon cancer who underwent laparoscopic right hemicolectomy between 2011 and 2021. Patients were managed with a standardized care protocol that comprised preoperative, intraoperative, and postoperative measures and were divided according to body mass index—normal body mass index (18–24.9 kg/m2), overweight (25–29.9 kg/m2), and obesity (≥30 kg/m2). Body mass index groups were compared for baseline characteristics and outcomes. The main outcome measures were operative time, hospital stay, 30-day complications, reoperation, number of harvested lymph nodes, and resection status. ResultsA total of 270 patients (50% male sex; mean age: 68.7 ± 13.5 years) were included—28.5% had normal body mass index, 47% were overweight, and 24.5% had obesity. Mean operative times in obese and overweight patients were significantly longer than patients with normal body mass index (172.1 and 168.8 versus 143.3 minutes, P = .01). Compared to normal body mass index, obesity was associated with significantly higher odds of incisional SSI (odds ratio: 9.29, P = .039). Body mass index had a significant positive correlation with operation time (r = 0.205, P = .004) and incisional SSI (r = 0.126, P = .04). Body mass index groups had similar hospital stays, 30-day complications and mortality, anastomotic leak, ileus, and reoperation. ConclusionPatients with increased body mass index had longer operative times and higher SSI rates, yet similar hospital stays and comparable 30-day complication rates, mortality, and reoperation to patients with normal body mass index.

Enhancing Survival in Septic Shock: A Systematic Review and Meta-Analysis of the Efficacy of Plasma Exchange Therapy.

Sepsis is a life-threatening condition that occurs when the body's immune response to infection becomes unregulated, causing organ dysfunction and a heightened risk of mortality. Despite increased awareness campaigns, its prevalence escalates, annually afflicting over 1.7 million adults in the United States. This research explores the potential of therapeutic plasma exchange (TPE) in septic shock management, aiming to highlight its capacity to improve patient outcomes and reduce mortality. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, our comprehensive search across 51,534 studies, using keywords such as plasmapheresis, plasma exchange therapy, therapeutic plasma exchange, septic shock, and reduction in mortality integrated with medical subject headings terms, led to the meticulous selection of six pivotal studies. Through rigorous evaluation with tools such as the revised Cochrane Risk-of-Bias tool, Newcastle-Ottawa Scale, and Assessment of Methodological Quality of Systematic Reviews, we extracted strong evidence supporting TPE's significant impact on decreasing mortality in septic shock patients compared to standard care, as demonstrated in three randomized controlled trials and one cohort study, with an odds ratio (OR) of 0.43 (95% confidence interval (CI) = 0.26-0.72). Additionally, two meta-analyses further validate TPE's effectiveness, showing a mortality reduction with an OR of 0.30 (95% CI = 0.20-0.46). This advantage also extends to critically ill COVID-19 patients, underscoring TPE's crucial role in modulating the coagulation cascade, decreasing sepsis-related complications, and reducing the risk of bleeding and organ failure. Nevertheless, the benefits of TPE must be carefully balanced against potential risks such as hypocalcemia, hypotension, and citrate toxicity, especially in patients with underlying renal or liver issues, emphasizing the importance of shared decision-making. While TPE emerges as a promising therapy, its formal integration into standard care protocols awaits further confirmation, highlighting the critical need for more in-depth research to conclusively determine its efficacy and safety in septic shock management.