Telephone Follow-up Research Articles

The effect of nursing care during pregnancy termination on women's prenatal grief, depression, anxiety, stress and coping levels: A randomized controlled study.

The termination of pregnancy is considered an emotionally devastating experience. Early intervention and counseling are essential to prevent adverse complications following pregnancy loss. This study aimed to determine the effect of nursing care based on Swanson's Theory of Caring on women's prenatal grief, depression, anxiety, stress, and coping levels during pregnancy termination. The training and counseling program, based on Swanson's Theory of Caring, included hospital care, a mobile application, and telephone follow-ups. We conducted this prospective randomized controlled experimental study in the gynecology and obstetrics clinic of a tertiary university hospital in Türkiye between September 2021 and May 2022. The study sample consisted of 50 women (intervention group: 25, control group: 25) whose pregnancy was terminated in the second trimester. The women were assigned to groups according to a randomization list created by a statistician. Data collection tools included a Personal Information Form, the Perinatal Grief Scale, the Depression, Anxiety, and Stress Scale, the Coping and Adaptation Process Scale, and the Numerical Rating Scale. We collected the data during hospitalization, between the 6th and 8thweeks after discharge, and at the 12thweek. We performed a chi-square test, a paired samples t-test, and an independent samples t-test on the IBM Statistical Package for the Social Sciences Statistics 26. The intervention group had lower mean perinatal grief (54.76 ± 19.49), depression (2.56 ± 2.39), anxiety (2.08 ± 2.10), and stress (3.52 ± 1.78) scores and higher mean coping and adjustment scores (140.48 ± 11.47) than the control group(p < .05). The intervention group also had a lower perception of labor pain, shorter discharge time, and a higher level of readiness for a new pregnancy (p < .05). The program that we applied in the study was effective in managing the pregnancy termination and post-discharge period in the population we studied.

Adherence to national trauma triage criteria in Norway: a cross-sectional study

BackgroundNorwegian hospitals employed individual trauma triage criteria until 2015 when nationwide criteria were implemented. There is a lack of empirical evidence regarding adherence to Norwegian national criteria for activation of the trauma team (NTrC) and the decision-making processes regarding trauma team activation (TTA) within Norwegian trauma hospitals. The objectives of this study were to investigate institutional adherence to the NTrC and to investigate similarities and differences in the decision-making process leading to TTA in Norwegian trauma hospitals.MethodsA digital semi-structured questionnaire regarding adherence to criteria, TTA decision-making and criteria documentation was distributed to all Norwegian trauma hospitals (n = 38) in the spring of 2022. Contact details of trauma coordinators and registrars were provided by the Norwegian Trauma Registry secretariat. Follow-up telephone interviews were conducted at the investigator’s discretion in cases of non-respondents or need to clarify answers.ResultsThirty-eight trauma hospitals were invited to answer the survey, where 35 hospitals responded (92%), making 35 the denominator of the results. Thirty-four (97.1%) hospitals stated that they followed NTrC. Thirty-three (94.3%) of the responding hospitals provided documentation of their criteria in use, of which twenty-eight (80%) of responding hospitals adhered to the NTrC. Three (8.6%) hospitals employed a tiered TTA approach with different sized teams. In addition four hospitals (11.4%) used specialized teams to meet the needs of defined patient groups (e.g. geriatric patients, traumatic brain injury). Twenty-one (60%) of the responding hospitals had written guidelines on who could perform TTA and in 18 hospitals (51.4%) TTA could be performed by pre-hospital personnel. Twenty-three (65.7%) of the hospitals documented which criteria that were used for TTA.ConclusionThere is good adherence to the national criteria for activation of the trauma team among Norwegian trauma hospitals after implementation of national guidelines. Individual hospitals argue the use of certain local criteria and trauma team activation decision-making processes to increase their precision in specific patient populations and demographics. Further steps should be done to reduce the variation in TTA decision-making processes among hospitals and improve documentation quality.

The establishment of PD-1 inhibitor treatment prognosis model based on dynamic changes of peripheral blood indexes in patients with advanced lung squamous cell carcinoma

BackgroundUnlike patients with lung adenocarcinoma, patients with lung squamous cell carcinoma (LUSC) do not derive significant benefits from targeted therapy. In recent years, immunotherapy has revolutionized the treatment approach for LUSC. However, not all patients with this type of cancer respond to immunotherapy, necessitating the identification of effective biomarkers to predict survival prognosis and evaluate the efficacy of PD-1 inhibitors.Materials and methodsWe retrospectively collected case and hematologic data from 212 patients with advanced squamous lung cancer who received PD-1 combination therapy. Hematological indices mainly contained SCC, CEA, NSE, Hb, LDH, WBC and RBC at baseline, 6 and 12 weeks of treatment. All patients underwent imaging examinations and efficacy was evaluated according to RECIST1.1 criteria. Univariate tests were used to assess the relationship between changes in serum biomarkers, clinical characteristics and treatment outcome. The survival prognosis of patients was investigated by telephone follow-up. The optimal critical values of all hematological indicators were calculated by ROC curves, and then logistic regression and Cox regression were used to analyze multiple serum markers in relation to efficacy and survival prognosis, respectively. Finally, column line plots were constructed and validated to predict the probability of patient survival.ResultsPost-treatment RBC12w&amp;lt;3.81 × 10 12/L (p &amp;lt; 0.034) was associated with lower ORR, and WBC6w&amp;lt;9.34 × 109/L (p=0.041) was associated with higher DCR.SCC12w≥2.25 ng/mL (p = 0.015), NSE6w≥13.54 ng/mL(p = 0.044)and RBC0w≥4.2 × 10 9/L (p = 0.003) were independent predictors of PFS. SCC12w≥2.25 ng/mL (p &amp;lt; 0.001) and NSE6w≥13.54ng/mL(p = 0.042) were independent predictor of OS. Patients in the SCC12w≥2.25 ng/mL (HR = 1.943,95% CI:1.218-3.079 vs. HR = 2.161,95%CI:1.087-3.241) and NSE6w≥13.54 ng/mL (HR = 1.657,95% CI:1.118-2.535 vs. HR = 2.064,95% CI:1.569-4.169) groups had shorter PFS and OS. In subgroup analysis, patients with stage III advanced squamous lung cancer had a better pro-gnosis than those with stage IV. PD-L1-positive, and SCC12w ≥2.25 ng/mL had a worse prognosis. The results of constructing column-line plots for predicting the survival probability of 1-, 3-, and 5-year PFS and OS: The C-index and 95% CI for PFS and OS of column-line plots were 0.725 (95% CI: 0.478-1.928) and 0.755 (95% CI: 0.642-0.868), respectively, and the bootstrap correction showed a good consistency of the column-line plots.ConclusionChanges in RBC12w ≥3.81×1012/L, WBC6w ≥9.34×10 9/L, SCC12w ≥2.25 ng/mL, and NSE6w ≥13.54 ng/mL after treatment are prognostic indicators of immunotherapy in patients with advanced squamous lung cancer.

Post-discharge telephone follow-up calls to patients with chronic obstructive pulmonary disease by primary care nurses: a best practice implementation project.

Chronic obstructive pulmonary disease (COPD) is a complex health problem, with important repercussions for patients and their families. Interventions need to be improved to prevent exacerbations and reduce high readmission and mortality rates. Evidence suggests that including a telephone follow-up (TFU) call in discharge plans could improve outcomes in patients with a chronic disease. This project aimed to improve how primary care nurses in Gran Canaria, Spain, followed up COPD patients after hospital discharge. This project was guided by the JBI Evidence Implementation Framework, which includes the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) method. The JBI approach uses audit, feedback, and re-audit to promote evidence-based health care. A baseline audit was conducted to compare current practices against best practices. Five barriers to best practices were identified and improvement strategies were developed. The follow-up audit revealed 100% compliance for Criteria 1 and 2, which related to COPD patients having a discharge plan and that plan including TFU. There was a 4.88% improvement for both Criteria 3 and 4, which involved the TFU being prompt and using a validated clinical questionnaire. Following project implementation, the 30-day readmission rate increased from 2.78% to 4.88% but the 30-day emergency room presentation rate decreased from 25% to 9.76%. The practice changes were partly achieved, but further strategies are needed to achieve full compliance. Educational programs are necessary when conducting improvement projects. Chances of success increase when decisions about hospital discharge involve both the hospital and the primary care service. http://links.lww.com/IJEBH/A296.

Assessment of the Effect of Telephonic Follow-up on Readmissions and Mortality Rate of the Patients with Acute Coronary Syndrome and Acute Heart Failure in Rashid Hospital

Background: Acute coronary syndrome (ACS) and acute heart failure (AHF) are severe medical conditions that are closely associated with higher rates of readmissions and mortality in hospitals. These conditions pose an exponential challenge to the healthcare system and increase patient burden. Objectives: This study aims to identify the effect of telephonic follow-up on readmission and mortality rates in Rashid Hospital due to ACS and AHF. Methods: In 2022, we conducted a prospective study. We divided 805 patients admitted with ACS and AHF in Rashid Hospital into two groups and compared the readmission and mortality rates of patients who were followed up with those who were not. The data collection tool included a demographic questionnaire, which was then analyzed by statistical tests and SPSS software. Results: There were patients in the follow-up call group versus patients in the nonfollow- up call group. The patients with follow-up calls had a higher survival rate (98.3%) compared with the ones who had not been called (93.4%) (p = 0.003). Readmission rates for follow-up patients were (7.7%) versus (5.9%) for those without follow-up calls (p = 0.429). The study analyzed and investigated the individuals on various other factors; however, no statistically significant difference was observed between the two groups. Conclusion: The study provides insight into the various factors associated with patients’ outcomes. Even though the association of readmission rate to follow-up was unremarkable, the mortality rate of patients with follow-up was significantly lower.

Utilization and perceived usefulness of monitoring technology for family caregivers of people living with Alzheimer's disease and related dementias.

Caregivers of people living with dementia (PLWD) often experience burden based on their care recipients' symptoms of wandering, disorientation, and agitation. To examine the utilization and perceived value of technology-based solutions for caregiving among caregivers of PLWD. In collaboration with three Texas sites, PLWD and family caregiver dyads were recruited from clinical and community sites to assess the feasibility of a caregiving technology. PLWDs were asked to wear a GPS-based wearable device, which was paired with caregivers' smartphone application, that enabled location monitoring and was equipped with call functions. After three months, researchers called caregivers to ask about their utilization of the "system" (i.e., wearable paired with smartphone application) and the perceived value of this technology. Forty-one caregivers completed follow-up telephone interviews. About 70% of caregivers reported their care recipient wore the wearable device daily, and 39.1% used the smartphone application daily. Approximately 31% of caregivers reported daily use of the tracking feature, 30.8% reported daily use of the "safe zone" feature (i.e., geo-fencing), and 17.1% reported daily use of the two-way calling feature. About 39% of caregivers were extremely satisfied with the "system," 43.6% found it extremely easy to use, and 46.2% found it extremely useful for caregiving. On average, caregivers with higher baseline Zarit Burden Interview scores found the "system" to be more useful with their caregiving (f = 5.97, p = 0.006) and were more satisfied with the "system" (f = 3.75, p = 0.034). Findings suggest caregiver burden may drive the perceived usefulness of, and satisfaction with, technology-based solutions.

Effectiveness of Self-care Support Program on the Quality of Life and Resilience of Family Caregivers of Stroke Patient; A Randomized Controlled Trial

Background: Family caregivers of stroke patients often experience a decline in quality of life (QOL) and resilience due to the challenges posed by the patient's disability, inadequate support systems, and difficulty adapting to the new circumstances. Objectives: This study investigated the impact of a self-care support program (SSP) for stroke patients and their family caregivers on improving their QOL and resilience. Methods: This randomized controlled trial was conducted in Beesat Hospital, Hamadan, Iran, in 2022, involving stroke patients and their family caregivers. A total of 80 patients and 80 family caregivers were randomly assigned to either the intervention group or the control group. The intervention group received the SSP, which included four weeks of continuous face-to-face and telephone follow-up. The control group followed the routine care program provided by the neurology ward. The patients' quality of life was assessed using the stroke specific quality of life (SS-QOL) tool, while family caregivers' QOL and resilience were evaluated using the Short Form-12 and Sixbey 2005 tools, respectively, both before and after the intervention. Data were analyzed using descriptive and inferential statistics, including chi-square, paired t-tests, independent t-tests, and Fisher's exact test. The significance level was set at 0.05. Results: Among patients, the difference in the control group's total QOL score before and after the intervention was not statistically significant (P = 0.065), with scores of 83.77 ± 3.39 and 86.70 ± 8.25, respectively. Conversely, in the intervention group, the total QOL score significantly improved from 83.95 ± 1.43 to 119.72 ± 4.54 (P &lt; 0.0001). For family caregivers, the total QOL score in the control group showed no significant improvement, increasing from 17.30 ± 1.60 to 18.17 ± 2.45 (P = 0.096). However, the intervention group experienced a significant increase in QOL scores, from 17.70 ± 1.11 to 25.37 ± 2.31 (P &lt; 0.0001). Additionally, the resilience score in the control group slightly decreased from 129.15 ± 3.40 to 124.25 ± 5.31 (P = 0.12). In contrast, the resilience score in the intervention group increased significantly, from 130.25 ± 2.81 to 194.20 ± 2.15 (P &lt; 0.0001). Conclusions: The findings of this study demonstrate the effectiveness of the SSP in improving the QOL of stroke patients and their family caregivers while significantly enhancing the resilience of family caregivers. It is recommended that medical and treatment teams prioritize involving family caregivers in care plans for debilitating diseases such as stroke and consider integrating SSPs into standard care protocols.

Prognostic value of left atrial strain in patients with stage II light-chain cardiac amyloidosis receiving cardiac magnetic resonance imaging: a prospective cohort study.

The prognostic significance of left atrial (LA) dysfunction in cardiac amyloidosis is being increasingly acknowledged, but its importance in stage II light-chain cardiac amyloidosis (AL-CA) remains unclear. This study aimed to determine the prognostic value of LA strain in stage II AL-CA. Patients with stage II AL-CA who underwent cardiac magnetic resonance at Peking Union Medical College Hospital between January 1, 2015, and October 31, 2021, were consecutively enrolled in this cohort study. Telephone and clinical follow-ups were conducted monthly. The primary endpoints were all-cause mortality, and the secondary endpoints were the combination of all-cause mortality and cardiac progression. Cox regression and Kaplan-Meier survival analyses were performed to identify associations between variables and outcomes. We included 131 patients with stage II AL-CA [61% male; median age 59 years; interquartile range (IQR), 51-65 years]. Among these patients, 37 (28%) reached the primary endpoint (all-cause mortality), and 52 (40%) reached the secondary endpoint (median follow-up 28 months; IQR, 10-50 months). Serum biomarker N-terminal pro-B-type natriuretic peptide and LA strain were significantly associated with the outcomes (all P values <0.05). In the multivariable models, reduced LA booster strain remained associated with a higher risk of all-cause mortality [hazard ratio (HR) 0.64, 95% confidence interval (CI): 0.42-0.96; P=0.031] and the secondary endpoint (HR 0.68, 95% CI: 0.49-0.93; P=0.015). The metrics of cardiac function that showed superior accuracy in predicting the risk of mortality were LA reservoir strain [concordance index (C-index) 0.72; 95% CI: 0.64-0.80] and LA booster strain (C-index 0.71; 95% CI: 0.64-0.80). The addition of LA booster strain to established prognostic predictors improved the discrimination and goodness of fit (P<0.001). LA booster strain is an independent prognostic indicator in stage II AL-CA and is superior to metrics of LV function. LA strain has potential clinical value as an early prognostic marker and may aid in identifying underdiagnosed patients with poor prognosis.

Reconstructive endovascular treatment of patients with ruptured distal intracranial aneurysms in posterior circulation: a retrospective cohort study.

Cases of ruptured distal intracranial aneurysms (DIAs) in the posterior circulation are rare. Currently, the most commonly used approach in clinical practice to treat this condition is reconstructive endovascular treatment. However, research on endovascular treatment of intracranial posterior circulation ruptured DIAs is currently lacking. This study aimed to analyze the safety and efficacy of reconstructive endovascular treatment for DIAs in the posterior circulation. A retrospective cohort study was conducted on patients with ruptured distal posterior circulation aneurysms who underwent endovascular reconstructive treatment at The First Affiliated Hospital of Harbin Medical University from September 2014 to August 2023. We collected and analyzed the patients' characteristics, clinical outcomes, and angiographic follow-up results. Complications were determined and recorded based on the patients' hospital records and imaging examination results. Clinical information was collected through neurological assessments and follow-up telephone interviews. Follow-up angiographic evaluations using digital subtraction angiography (DSA) were planned for 6 months after the procedure until 1-year postprocedure. The procedure was successfully performed on all 49 patients. Among the patients, 16 (32.7%) were males. The mean age of all patients was 59.0±12.7 years. A total of 15 (30.6%) patients used stent-assisted coiling. During hospitalization, 16 (32.7%) patients experienced complications, including 6 with hemorrhagic complications, 7 with ischemic complications, and 4 with shunt-dependent hydrocephalus. One patient had both shunt-dependent hydrocephalus and ischemic complications. Three (6.1%) patients died during hospitalization, all related to aneurysm rebleeding. All patients underwent clinical follow-up, with a median follow-up time of 39 months [interquartile range (IQR), 21.0-70.5 months]. At the last follow-up, 42 (85.7%) patients had a modified Rankin scale score of 0-2. During the follow-up period, one patient died, resulting in an overall mortality rate of 8.2% (4/49). A total of 35 surviving patients underwent angiographic follow-up, with a follow-up rate of 76.1% (35/46) and a median follow-up time of 8.5 months (IQR, 6.0-12.0 months). Among the follow-up patients, 94.3% were classified as Raymond-Roy grade 1-2, and two patients experienced residual aneurysm. Survival analysis showed a 1-year complication-free survival rate of 69.4% and a 1-year overall survival rate of 89.3%. This study found that the incidence of complications during hospitalization was relatively high. However, the clinical follow-up results were satisfactory, and imaging follow-up demonstrated a high aneurysm occlusion rate. In summary, endovascular treatment of ruptured DIAs in the posterior circulation is feasible, safe, and effective, but attention should still be paid to the occurrence of related complications.

What they did next: Using follow-up phone calls to investigate health care access patterns of patients who take their own leave.

The purpose of the present study was to use telephone follow-up (TFU) to investigate the actions taken by patients after they took their own leave (TOL) from an ED, with a focus on priority groups who are at risk of experiencing health inequity. These included people experiencing homelessness (EH), people with a low socioeconomic status by index of relative socioeconomic disadvantage (IRSD) and First Nations people. The primary outcome was being seen by a general practitioner (GP) within 2 days of the TOL event. The utility of the TFU was also examined. This was an observational study of data collected during a quality improvement intervention at an inner-city, tertiary, teaching hospital in Melbourne from January to December 2022. Descriptive results were obtained from a TFU survey that was administered 24-48 h after the TOL event. During the study period, 4209 patients TOL from the ED. Eight hundred forty-one of these were contacted and consented to the TFU survey. 97.7% of patients expressed gratitude at being followed up. Patients EH, compared to patients not EH, were less likely to have seen their GP within 2 days of TOL event (0.295 [0.132-0.661], P < 0.001). Both First Nations patients and those from low IRSD areas were as likely to have seen their GP within 2 days as other groups. Patients EH were less likely to receive GP care within 2 days of TOL. Improving the access and acceptability of health care in these priority groups is important for achieving health equity.

Quality of Life Among Patients with Heart Failure with Reduced Ejection Fraction Receiving Telemedicine Care in Vietnam.

Background: Telemedicine is an effective method to monitor patients at home and improve outcomes of heart failure (HF), especially HF with reduced ejection fraction (HFrEF). However, little is known about the impact of telemedicine on the quality of life (QoL) among outpatients with HFrEF in lower-middle-income countries (LMICs). Methods: In this single-center, prospective, randomized, controlled, open, and parallel-group clinical trial in northern Vietnam, patients with HFrEF were allocated to either telemedicine or control groups. Participants in the experimental arm underwent a home-based telemedicine program with regular telephone follow-ups and consultations. Participants in the control group received usual care. Both groups were followed for 6 months. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline. The analysis was conducted on an intention-to-treat basis. Results: A total of 223 participants were randomized into two groups-the telemedicine group and the usual care group. Of the 223, 170 patients [mean age: 61.5 ± 15.0 years; female: 122 (71.8%)] completed follow-up and were included in the final analysis (87 in the telemedicine group and 83 in the usual care group). At baseline, the MLHFQ scores were equivalent between the two groups (median [interquartile range]: 81 [73-92] vs. 81 [74-92]; p = 0.992). After 6-month follow-up, the telemedicine group showed greater improvement in MLHFQ total scores than the usual care group (mean change in MLHFQ score: -15.5 ± 14.0 vs. -1.3 ± 6.2; difference in change: -14.2 [95% confidence interval, CI: -17.5, -11.0]; p < 0.0001). Similar results were found for the MLHFQ physical dimension score (difference in change: -5.8 [95% CI: -7.4, -4.1]; p < 0.0001) and the MLHFQ emotional dimension score (difference in change: -3.2 [95% CI: -4.2, -2.2]; p < 0.0001). Conclusions: In this study, a telemedicine intervention significantly improved QoL compared with usual care among patients with HFrEF in an LMIC.

The Relationship between Tumor Budding and Stromal Maturity with Tumor Characteristic and Survival in Patients Gastric Cancer

Background: Considering the prognostic role of stromal maturity and tumor budding in various cancer types, along with the importance of gastric cancer as the fifth most prevalent cancer globally and the second leading cause of cancer-related mortality, this study aimed to investigate the impact of stromal maturity and tumor budding on patients with gastric cancer. Methods: In this retrospective cohort study, 91 patients diagnosed with gastric cancer and who underwent total gastrectomy in educational hospitals of Babol between 2016 and 2021 were evaluated. Slides corresponding to the deepest invasive tumor edge were reviewed by two independent pathologists to assess tumor budding and stromal maturity. Immunohistochemical staining with AE1/AE3 marker was used to correlate the results of tumor budding evaluation. Other pathological information was collected from patients’ records, and patient survival data were obtained through telephone follow-up. Data analysis was performed with SPSS V.22, utilizing T-test, Anova, Chi-square, Fisher’s exact test, Kaplan-Meier and Cox regression method. P-value &lt;0.05 was considered as significant level. Results: The average survival of patients without tumor budding was 64.64 months, while the average survival of the low tumor budding group (less than 5 tumor buds in 10 microscopic fields at ×400 magnification) was 58.38 months, and the high tumor budding group (less than 5 tumor buds) had an average survival of 28.52 months (p=0.002). The average survival of patients with and without stromal maturity was 41.43 and 61.36 months, respectively (p=0.501). Conclusion: Tumor budding is an independent prognostic factor in gastric adenocarcinoma, but its predictive value is limited to the intestinal type of adenocarcinoma

The perioperative frailty index derived from the Chinese hospital information system: a validation study

BackgroundThere are various frailty assessment tools in the world, and the application choice of frailty assessment tools for the elderly perioperative population varies. It remains unclear which frailty assessment tool is more suitable for the perioperative population in China. To validate the Perioperative Frailty Index (FI-32) derived from the Chinese Hospital Information System by investigating the impact of preoperative frailty on postoperative outcomes, and ascertain the diagnostic value of FI-32 for predicting postoperative complications through comparing with the FRAIL scale and the modified Frailty Index (mFI-11).MethodsA prospective cohort study was conducted in a tertiary hospital. Elderly patients who were 60 years or older and underwent selective operation were included. The FI-32, FRAIL scale, and mFI-11 were assessed. Demographic, surgical variables and outcome variables were extracted from medical records. The data of readmission and mortality within 30 days and 90 days of surgery were ascertained by Telephone follow-up by professionally trained researchers. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves(ROC) were used to compare FI-32 with mFI-11 and FRAIL, to explore the predictive ability of frailty.Results335 patients qualified for the inclusion criteria and were enrolled in the study, and among them, 201 (60.0%) were females, and the Median(P25, P75)age at surgery was 69 (65,74) years. The prevalence of frailty in the study population was 16.4% (assessed by FI-32). After adjusting for concomitant variables including demographic characteristics (such as gender, BMI, smoking, drinking, average monthly income and educational level) and surgical factors (such as surgical approach, surgical site, anesthesia method, operation time, intraoperative bleeding, and intraoperative fluid intake), there was a statistically significant association between frailty and the development of postoperative complication after surgery (OR = 3.051, 95% CI:1.460–6.378, P = 0.003). There were also significant differences in mortality within 30 days of surgery, the length of hospital stay (LOS) and the hospitalization costs. FI-32, FRAIL and mFI-11 showed a moderate predictive ability for postoperative complications, the Area Under Curves (AUCs) were 0.582, 0.566 and 0.531, respectively. With adjusting concomitant variables associated with postoperative complications, the AUCs of FI-32, FRAIL and mFI-11 in the adjusted prediction models were 0.824, 0.827 and 0.820 respectively.ConclusionsThe FI-32 has a predictive effect on postoperative adverse outcomes in elderly Chinese patients. Compared to FRAIL and mFI-11, the FI-32 had the same ability to predict postoperative complications, and FI-32 can be extracted directly from HIS, which greatly saves the time for clinical medical staff to evaluate perioperative frailty.

Effectiveness of proactive health interventions in reducing symptoms and enhancing self-efficacy and self-management in prostate cancer survivors: a randomized controlled trial.

To evaluate the effectiveness of a proactive health intervention in reducing symptoms, enhancing self-efficacy, and improving self-management capabilities in prostate cancer survivors. A single-blind randomized controlled trial was conducted with 200 prostate cancer survivors at a tertiary hospital in Zhejiang Province. Participants were randomly assigned to either the intervention group (n = 95), which received a 3-month proactive health management program based on five health modules with online and telephone follow-up, or the control group (n = 97), which received routine telephone follow-up care. Outcomes were assessed at baseline, 1month, and 3months post-discharge, focusing on prostate cancer symptoms, self-care ability, self-efficacy, and psychological well-being. Compared to the control group, the intervention group showed significant improvements in prostate cancer symptoms (95% CI = [- 5.898, - 1.756], p < 0.001), self-care ability (95% CI = [14.427, 20.878], p < 0.001), and self-efficacy (95% CI = [0.078, 0.408], p = 0.004) after the intervention. Anxiety and depression (95% CI = [- 2.408, - 1.404], p < 0.001) were significantly reduced at the 3-month follow-up compared to baseline, although no significant difference was observed between the groups. The 3-month proactive health management intervention significantly reduced symptoms, anxiety, and depression in prostate cancer survivors, while improving self-care ability and self-efficacy. Further studies with larger samples and longer follow-up periods are needed to confirm these findings. Rehabilitation for prostate cancer survivors should integrate both physical and psychological recovery to address comprehensive health needs. Enhancing survivors' proactive health management skills supports sustained recovery. ClinicalTrial.gov Identifier: ChiCTR2300076594.

Predictors of In-hospital and Short-term Outcomes of Thoracic Endovascular Aortic Repair for Aortic Aneurysm and Aortic Syndrome: A Single-Center Experience

BACKGROUND: Endovascular technique has replaced open repair as primary treatment for different aortic disease indications and was associated with low perioperative mortality and acceptable short-, mid-, and long-term survival. Locally, thoracic endovascular aortic repair (TEVAR) was not widely practiced until year 2017. This study aims to determine the predictors of in-hospital and short-term outcomes of patients who underwent TEVAR for aortic aneurysm and aortic syndrome in a single center and how it compares with local and international data. METHODS: This study is a retrospective analysis of 52 adult patients who underwent TEVAR for the treatment of aortic aneurysm and aortic syndrome. Demographic and clinical data, diagnostic imaging, and procedural details were obtained via inpatient charts at the medical records section and hospital system database archiving. Outcomes at 30 days and 1 year postprocedure were obtained through telephone follow-up after attaining verbal consent. Gathered data were analyzed as to association of different variables with or without the presence of complications. Outcomes reported included in-hospital mortality rate, presence of major adverse events (MAEs), 30-day and 1-year survival rates, and rate of freedom from reintervention. RESULTS: The overall in-hospital mortality was 7.69% (n = 4/52), and complication rate was 32% (n = 20/52), with a survival rate of 92.31% and 87.76% at 30 days and 1 year, respectively. The rates of overall freedom from reintervention were 83.33% and 100% at 30 days and 1 year, respectively. The independent predictors for in-hospital mortality and development of MAEs were increasing weight (odds ratio [OR], 1.0588; 95% confidence interval [CI], 1.003–1.208), preexisting chronic kidney disease (OR, 10.33; 95% CI, 1.1069–96.462), and TEVAR with debranching done as a single procedure (OR, 3.6667; 95% CI, 1.1154–12.054), whereas an estimated glomerular filtration rate of 49.05 ± 19.25 (OR, 0.9402; 95% CI, 0.9019–0.9801) and TEVAR with debranching done as a staged procedure (OR, 0.1624; 95% CI, 0.0321–0.8225) statistically decrease the risk for development of in-hospital mortality and MAEs (P = 0.001 and P = 0.028, respectively). CONCLUSIONS: In this single-center study, indications for TEVAR were fusiform and saccular aneurysm, high-risk intramural hematoma and penetrating aortic ulcer, complicated acute type B dissection, chronic complicated type B dissection with high-risk feature, and aortic rupture. The outcome of this study shows comparable results with other international studies with an acceptable in-hospital mortality rate, complication rate, short-term survival rate, and rate freedom from reintervention at 30 days and 1 year. Increasing weight, preexisting chronic kidney disease, and TEVAR with debranching done as a single setting are independent predictors for developing in-hospital mortality and MAEs, whereas a normal estimated glomerular filtration rate and TEVAR with debranching done as a staged procedure decrease the risk; hence, careful planning and scheduling of procedure among elective and amenable cases could further reduce complication rates of future TEVAR procedures.

BRAF deletion in adult patients with Langerhans cell histiocytosis correlates with multisystem disease and poor outcome.

Langerhans cell histiocytosis (LCH) is a rare and highly heterogeneous histiocytosis. There are currently few studies examining the correlation between molecular profiling and clinical phenotype or outcome in adult patients with LCH. The objective of this study was to characterize the genomic landscape of adult LCH and correlate molecular findings with clinical features and patient outcomes. This study included 254 patients aged ≥18 years with biopsy-proven LCH from January 2000 to December 2023. All patients underwent next-generation sequencing (NGS) or fluorescence quantitative PCR (qPCR) for the BRAFV600E mutation. Patient demographics, disease characteristics and treatments were collected through electronic medical records. Patient outcomes were collected through clinical and telephone follow-up. Overall, 254 patients were enrolled. MAPK/PI3K pathway alterations were observed in 77.6%（n=197）of the patients. BRAFV600E mutation was the most common (30.7%, n=78), followed by BRAFindel (18.1%, n=46) andMAP2K1 mutations (12.6%, n=32). The proportion of BRAFindel was much higher in patients with MS involvement than single system disease (24.5% vs 6.6%, p＜0.001). In overall patients, BRAFindel was associated with inferior overall survival (3-year OS 89.6% vs 99.0%, p=0.014) and progression-free survival (3-year PFS 50.0% vs 78.6%, p＜0.001). In MS LCH patients, BRAFindel was associated to worse PFS (3-year PFS 47.8% vs 76.0%, p=0.001). This large study provides molecular and clinical pathologic characterization of adult LCH. BRAFindel was highly correlated with MS LCH, and was associated to worse outcome.

Midwifery-led brief counseling on the severity of posttraumatic stress symptoms of postpartum hemorrhage: quasi-experimental study

BackgroundPostpartum hemorrhage is a preventable cause of maternal mortality all over the world and a significant contributor to post-traumatic stress among women.MethodsThis quasi-experimental study was conducted in 2023 on 60 primiparous women with postpartum hemorrhage in Zahedan, Iran. The participants were identified and randomly assigned to two groups. The intervention group received face-to-face individual counseling based on Gamble’s counseling model, conducted by a midwife. The counseling lasted from 40 to 60 min and took place over two sessions; one within the first 48 to 72 h in the ward, and a follow-up telephone session two weeks postpartum. Assessments were made using the Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) and the Perinatal Post-Traumatic Stress Disorder Questionnaire-II (PPQ-II) before the intervention and four weeks after the last post-test session for the two groups, either in person or by phone.ResultsFollowing the intervention, the post-traumatic stress score (PCL-5) in the intervention group significantly decreased compared to the control group (P < 0.001). Moreover, the perinatal post-traumatic stress disorder score (PPQ-II) after midwife-led brief counseling in the intervention group was significantly lower than in the control group, as determined by an analysis of covariance (ANCOVA), controlling for pre-test effects (p =0.05).ConclusionsMidwife-led brief counseling may be effectively implemented by developing a localized clinical guideline based on midwifery recommendations following traumatic births caused by postpartum hemorrhage.

A Kansei engineering-based decision-making method for offline medical service quality evaluation with multidimensional attributes

The evaluation of doctors’ offline medical service quality plays a vital role in evaluating hospital performance. There are two challenges that need to be addressed: (1) Currently, telephone follow-up and questionnaire surveys are the main methods for evaluating the quality of offline (mainly outpatient and inpatient) medical services in hospitals. However, these methods suffer from drawbacks such as low efficiency and resource consumption. (2) There are certain limitations to determining attribute dimensions and weighting patient evaluation attributes based solely on word frequency. To this end, this study proposes a Kansei engineering-based decision-making method for offline medical service quality evaluation with multidimensional attributes. First, this study constructs a medical Kansei lexicon based on speed and cosine similarity. Second, a concept of Kansei utility values is been defined to represent attribute values in medical service quality evaluation. Additionally, this study builds upon the Kano model to obtain the Kano classification of each attribute. On that basis, a novel approach to obtaining the implicit importance of the attributes is proposed. Thus, the weight vector of the attributes can be calculated as the combination of explicit and implicit importance. Finally, the evaluation result is obtained by using the multiattribute decision-making method. The effectiveness of the proposed method is verified through an analysis of online reviews from Haodf.com. The case study reveals that offline patients consider medical ethics and communication skills as the ”must-be” dimension of attributes, medical competence as a one-dimensional attribute, and medical advice and prescriptions as the attractive dimension of attributes. A comparative analysis with the traditional method is conducted to demonstrate the importance of dimensional analysis for offline medical service quality evaluation. The main contributions of this study include the following: (1) A medical Kansei lexicon is constructed based on Kansei engineering, and (2) a novel decision-making framework for medical service evaluation based on both appearance and implicit importance is constructed.

Does Injury Type Influence Patient Preference, Response Rates, and Data Completeness for Online or Telephone Follow-up Following Injury?

Does Injury Type Influence Patient Preference, Response Rates, and Data Completeness for Online or Telephone Follow-up Following Injury?

Self-Management Intervention for Reducing Epilepsy Burden Among Adult Ugandans with Epilepsy (SMART-U): Randomised Clinical Trial Protocol.

People of all ages are affected by epilepsy, a prevalent chronic brain illness that is primarily found in underdeveloped nations. It is very necessary to implement epilepsy self-management techniques to support individuals with epilepsy in order to impact outcomes related to epilepsy. The purpose of this 2-site randomised controlled experiment is to investigate this further, based on encouraging preliminary evidence. A total of 188 adult people with epilepsy (PWE) attending the neurology clinics at Mulago and Mbarara hospitals and consent to participate in the study will be recruited. They will be randomised into intervention versus enhanced treatment control (eTAU) study groups. The intervention group will receive 12-week "intensive" educational sessions and a 12-week remotely accessed telephone follow-up stage. The controls will continue in their usual care supplemented by written materials on epilepsy in their preferred language and tailored to the reading level of most patients at the clinic. SMART-U consists of 2 main components: a 12-week "intensive" group format stage and a 12-week remotely accessed telephone follow-up stage. SMART-U will be assessed for acceptability, fidelity, and efficacy compared to eTAU. The primary study outcome is the mean change in cumulative past 24-week seizure frequency (24weeks prior to the study baseline compared to the 24-week follow-up). Seizure frequency will be via self-report with corroboration by family/support system informants whenever possible. Participants will self-report the seizure frequency (numeric count) that they experienced between baseline and 13weeks and again between 13 and 24weeks, and the mean change from baseline to 24weeks in QOL. The curriculum-guided Self-Management intervention for Reducing The epilepsy burden among Ugandans (SMART-U) program is anticipated to reduce the epilepsy burden seizure frequency and improve other health outcomes, including depression, functional status and health resource use. NCT06139198. November142023.