Tertiary Hospital Research Articles

Investigation of Nosocomial Urinary Tract Infections Post Transplantation, Main Pathogens, and Sensitivity Tests

Background: Regarding end-stage organ disease, transplantation is recommended as the best therapeutic management. After organ transplantation, the incidence of nosocomial urinary tract infections (NUTIs) due to multidrug-resistant Gram-negative bacilli increases. Aim: The study aimed to investigate NUTIs post-transplantation, the main pathogens involved, and sensitivity tests conducted in a tertiary hospital in Isfahan, Iran. Methods: A retrospective survey on patients admitted to a tertiary hospital in Isfahan (Alzahra), Iran, was performed between 27 March, 2017, and 9 February, 2022. The information recorded included the date of infection, date of hospitalization, gender, age, type of pathogens, and resistance or sensitivity to antibiotics. Results: 73 kidney transplant recipients (61% females) with a mean age of 43. 2 ± 15.1 years were included. Within this population involving both genders, the main pathogens involved in NUTIs were as follows: Escherichia coli (30%), Klebsiella pneumonia (19%), Candida albicans and non-albicans (14%), Enterococcus faecalis (12%), Enterobacteriaceae (8%), Pseudomonas aeruginosa (6%), Staphylococcus spp. (6%), Acinetobacter baumannii (4%), and Streptococcus spp. (4%). Antibiotic susceptibility testing showed the most sensitivity of isolates against amikacin (n=29; 66%), meropenem (n= 28; 64%), piperacillin/tazobactam (n=26; 54%), cefepime (n= 25; 40%), ceftazidime (n= 27; 30%), ciprofloxacin (n= 40; 18%), and co-trimoxazole (n= 29; 10%). Conclusion: Escherichia coli, Klebsiella pneumonia, and Candida spp. were the major causes of NUTIs within the studied organ-transplanted recipients. Amikacin, meropenem, and piperacillin/ tazobactam have shown more than 50% sensitivity against isolates. Further evidence-based pharmacotherapy investigations associated with the different spectrum antibiotics and overall antimicrobial success rate is recommended to be advantageous.

Evaluation of Ascitic Fluid Cytology in a Tertiary Hospital in South-Western Nigeria: A 7-year Retrospective Study

Background: Ascites is the pathological accumulation of fluid within the peritoneal cavity of varied etiology. Various abnormalities can be detected through cytological analysis of ascitic fluid. Ascitic fluid cytology (AFC) is a rapid and cost-effective means of evaluating ascites to establish its nature and cause. Aim: To evaluate ascitic fluid cytological findings over a seven-year period and to correlate the cytological features with the clinical profile of the patients. Materials and Methods: This was an observational retrospective study conducted in a healthcare facility in south-western Nigeria. The reports of AFC tests performed from January 1, 2016 to December 31, 2022 were retrieved to obtain the following information for analysis: Age, Gender, Tribe, Year of the test, Provisional diagnosis, and Cytological diagnosis. Results: The data of a total number of 121 patients were analyzed; 61 males (50.4%) and 60 females (49.6%) with a mean (±SD) age of 51.51 ± 15.22. Decompensated cirrhosis was the commonest clinical diagnosis 65 (53.7%) followed by hepatocellular carcinoma 11 (9.1%). Ascitic fluid cytological findings showed 45 (37.2%) were positive for malignant cells; 46 (38.0%) were negative for malignant cells; 13 (10.7%) were suspicious for malignancy; 9 (7.4%) were acellular smears; and 8 (6.6%) were inflammatory smears. The ascitic fluid of only 4 out of 11 patients with hepatocellular carcinoma tested positive for malignant cells, giving a sensitivity of 36.4%. Conclusion: AFC remains very useful in the diagnostic work-up of patients with ascites but should not be completely relied upon in confirming a malignancy, other additional diagnostic investigations should be deployed.

Systemic immune-inflammation index and 2-year all-cause mortality in elderly patients with hip fracture

PurposeTo assess the association between systemic immune-inflammation index (SII) and 2-year all-cause mortality in elderly patients with hip fractures. MethodsWe performed a cohort study of hip fracture patients aged 65 years or older who received hip fracture surgery at a tertiary hospital from January 2005 to March 2022. The SII was calculated as: SII = (neutrophil count * platelet count) / lymphocyte count, based on the latest blood test before discharge. Patients were categorized into 3 groups according to SII tertiles: low SII group (≤770.92 × 109/L), medium SII group (770.92 × 109/L -1293.03 × 109/L), and high SII group (>1293.03 × 109/L). The primary outcome was 2-year all-cause mortality. We evaluated the association between SII and 2-year all-cause mortality using the multivariate Cox regression model. ResultsAmong 2,766 patients, 296 patients died during the 2-year follow-up period. The incidence of 2-year all-cause mortality per 1,000 persons was 90.0 (95% CI, 73.2-110.2) in the low SII group, 86.8 (95% CI, 70.3-106.7) in the medium SII group, and 144.3 (95% CI, 123.1-168.5) in the high SII group. Compared with patients in the low SII group, the hazard ratio for 2-year all-cause mortality was 0.97 (95% Cl 0.69-1.37) in the medium SII group and 1.47 (95% Cl 1.07-2.01) in the high SII group (P for trend, 0.001). ConclusionSII is significantly associated with 2-year all-cause mortality in elderly patients with hip fracture. SII may be used to identify patients at high risk of mortality after hip fracture surgery.

Nurse-Authored Patents and Their Influencing Factors Analysis Among Oncology Nurses Based on the Structural Equation Model.

This study analysed the status of nurse-authored patents and their influencing factors. In particular, this study examined the effects of nurses' innovative behaviour and creative self-efficacy on nurse-authored patent output via structural equation modelling (SEM). A descriptive cross-sectional study. Nurses were recruited from one tertiary cancer hospital in Beijing, China. Among them, 352 oncology nurses completed the online versions of the Nurse Innovative Behavior Scale and Creative Self-Efficacy Scale in 2023. We collected a total of 332 valid questionnaires. Fifty-seven (17.2%) nurses had 1-3 patents, and only 6 (1.8%) had more than three patents. The final model revealed a chain reaction between creative self-efficacy, innovation behaviour and nurse-authored patent output (χ2 = 11.962, df = 7, p = 0.102). Significant differences were observed in the number of nurse-authored patents and based on age, educational profile, professional title, length of service, position, participation in science and technology innovation training, and experience in project presentation (all p < 0.05). Nurses still play a minor role in the field of medical technology innovation. It is necessary to promote innovative behaviour among nurses and improve their creative self-efficacy in terms of innovation. Developing intervention strategies to encourage nurses to pursue clinical innovations is crucial for nursing managers and technological innovation promoters.

CT-guided Coaxial Lung Biopsy: Number of Cores and Association with Complications.

Background Percutaneous CT-guided lung core-needle biopsy is a frequently performed and generally safe procedure. However, with advances in the management of lung cancer, there is a need for a greater amount of tissue for tumor genomic profiling and characterization. Purpose To determine whether the number of core samples obtained with percutaneous CT-guided lung biopsy is associated with postprocedural complications. Materials and Methods This retrospective study included consecutive patients who underwent percutaneous CT-guided coaxial lung core-needle biopsy for suspected primary lung cancer between November 2012 and August 2023 at an academic tertiary referral hospital. Patient data from medical records were collected, including demographics, lesion size and distance from pleura, and number of obtained biopsy samples. Postprocedural complications of pneumothorax, chest tube placement, perilesional hemorrhage, and hemoptysis were recorded. Multivariable logistic regression models were used to assess whether the number of cores was a predictive factor for lung biopsy complications. Results A total of 827 patients (mean age, 70.9 years ± 9.6 [SD]; 474 [57.3%] female patients) were included. The median lesion size was 22 mm (IQR, 15-34 mm), with 517 of 827 (62.5%) patients diagnosed with lung adenocarcinoma. Pneumothorax was noted in 171 of 827 (20.7%) patients, with a chest tube placed in 32 of 827 (3.9%), perilesional hemorrhage in 353 of 827 (42.7%), and hemoptysis in 20 of 827 (2.4%) patients. The median number of samples obtained was four (range, one to 12). Multivariable analysis showed no evidence of an association between the number of core samples obtained and any complications: pneumothorax (coefficient, -0.02; P = .81), chest tube (coefficient, 0.18; P = .26), perilesional hemorrhage (coefficient, -0.03; P = .63), or hemoptysis (coefficient, -0.10; P = .60). Conclusion In patients suspected of having lung cancer who underwent percutaneous CT-guided coaxial lung core biopsy, there was no evidence of an association between the number of core biopsy samples obtained and any postprocedural complications. © RSNA, 2024 See also the editorial by Zuckerman in this issue.

Molecular characterization of colistin-resistant Klebsiella pneumoniae isolates and their conjugative mcr-carrying plasmids

BackgroundThis study aimed to characterize colistin-resistant K. pneumoniae (CoRKp) strains isolated from patients with urinary tract infections and bacteremia between 1999 and 2022 at a tertiary teaching hospital in Taiwan. MethodsA total of 1,966K. pneumoniae isolates were collected, among which 21 strains were identified as CoRKp. The antimicrobial susceptibility of these CoRKp strains to 19 antibiotics was assessed. The genome characteristics of 21 CoRKp strains were determined by Nanopore-Illumina hybrid whole genome sequencing. Additionally, conjugation assays were conducted to determine the transferability of plasmids carrying mcr genes to K. pneumoniae ATCC BAA-1706 and E. coli C600. The larvae infection model was used to analyze the differences in virulence between transconjugants and recipient strains. ResultsAmong the 21 CoRKp, 12 were multidrug-resistant, and four were extensively drug-resistant. The distribution of sequence types (STs) and K types among the CoRKp strains was quite diverse, and ST307 (5 strains) and K64 (3 strains) dominated in CoRKp. The insertion elements IS903B and ISVsa5, were found to inactivate mgrB of 1 and 2 CoRKp isolates, respectively. Moreover, 1, 4, 6, and 1 missense mutations of PhoQ, PmrA, PmrB, and MgrB, were identified in 21 CoRKp. Only two isolates SC-KP169 and SC-KP585 carried mcr-1 and mcr-8, respectively. The plasmid pSC-KP169-1 could be transferred inter- and intra-genus and contributed to the virulence of K. pneumoniae to larvae. In contrast, the plasmid pSC-KP585-1 could be transferred to E. coli but could not affect its virulence to larvae. ConclusionsWe identified 21 CoRKp from 1,966 isolates and found a conjugative plasmid carrying mcr-1 gene that contributed to the virulence of K. pneumoniae to larvae.

The Extra Length of Stay, Costs, and Mortality Associated With Healthcare-Associated Infections: A Case-Control Study.

This study aims to compare the mortality rate, length of stay (LOS), and hospitalization cost in patients with and without healthcare-associated infections (HCAIs). This prospective cohort study is conducted on 396 matched patients admitted to a tertiary teaching hospital with 800 beds in the southwest of Iran from July 2021 to January 2022. The cases were patients admitted during the study period who had, at minimum, one type of HCAI. For a comparison group, we considered all patients without HCAIs who hospitalized in the same ward and at the same time with the same age and gender in a ratio of one case to three controls. Descriptive analyses were done based on direct medical costs, LOS, and mortality rate in patients. The magnitude of the relationship between potential risk factors and HCAI was quantified using logistic regression. The most common HCAI and microorganisms were urinary tract infection (UTI) and Escherichia coli, respectively. The mean LOS for infected patients was 20.3 (±16) days, compared to 8.7 (±8.6) days for noninfected patients (p value ≤ 0.05). Lengths of stay (odds ratio [OR] = 1.09; 95% CI = 1.06-1.19; p value = 0.000), ICU lengths of stay (OR = 1.08; 95% CI = 1.02-1.15; p value = 0.003), presence of central Catheter (OR = 0.127; 95% CI = 0.51-0.319; p value = 0.000), and urinary catheter (OR = 0.225; 95% CI = 0.122-0.415; p value = 0.000), mechanical ventilation (OR = 0.136; 95% CI = 0.57-0.325; p value = 0.000), receipt of immunosuppressors (OR = 1.99; 95% CI = 11.12-3.56; p value = 0.01), were Significantly associated with HCAI. Patients with infections had a more costly hospital stay than noninfected patients (mean diff: $2037.46 ([SD]: 482.25$) (p value = 0.000). The highest cost component was the cost of medication expenditure (mean: $1612.66 ([SD]: $2542.27). UTI was the most common HCAI in our study. An infection acquired during a hospital stay may be associated with higher hospitalization costs, prolonged hospitalization, and an increase in the rate of mortality. Longer lengths of stay, presence of central and urinary Catheters, receipt of immunosuppressors, use of mechanical ventilator were common risk factors for HCAI. This study reveals that the median reimbursement cost per hospitalization of patients with HCAIs was higher than patients without HCAIs. This highlights the necessity for implementation of HCAI prevention and control measures.

Pediatric nasolacrimal duct intubation using deep sedation outside the operating room- comparison of three types of stents

BackgroundCongenital nasolacrimal duct obstructions that persist after 9 months of age often require surgical intervention through probing and stenting of the tear duct. These procedures typically occur under general anesthesia in an operating room setting. We propose a novel approach using intravenous sedation outside the operating room. MethodsWe reviewed the medical records of patients at a tertiary pediatric hospital treated for nasolacrimal duct obstruction from 2018 to 2023 using monocanalicular Monoka, Masterka, and LacriJet nasolacrimal stents. All procedures were performed outside of the operating room under intravenous sedation provided by a specialized sedation team. Symptom resolution, sedation duration and complications were reviewed for each type of stent. ResultsA total of 64 patients (81 stents) were included in our analysis. Of the 81 stents used, 32 were Monoka, 15 Masterka, and 34 LacriJet. Symptoms resolved in 86% of the eyes. Sedation side effects were minor and infrequent. Occasionally brief apnea, hypoxia, hypotension or laryngospasm occurred, but in no cases were patients harmed or was hospitalization required. A single factor analysis of variance showed no statistically significant difference between the stents for recurrence or sedation time. The Fisher exact test suggested a higher risk of side effects in the Monoka group. ConclusionsIn our pediatric patient cohort, nasolacrimal duct stenting procedures have a high success rate and safety profile when performed under deep sedation outside of the operating room.

Candida parapsilosis keratitis: A case series

Purposeto describe the diagnosis and management of Candida parapsilosis keratitis Designa retrospective, observational case series. Methodsthis study was carried out in a single-centre tertiary referral eye hospital and includes 20 eyes of 19 patients. Electronic case notes and in vivo confocal microscopy (IVCM) records were searched for the keyword ‘parapsilosis’, with inclusion if there was keratitis with either a corresponding positive polymerase chain reaction (PCR) or microbial culture result for Candida parapsilosis. Individual case notes were reviewed to obtain information regarding diagnosis, treatment, and final visual outcomes. Cases were excluded if a patient was lost to follow-up before the end of antifungal treatment. Resultsthe risk factors for C. parapsilosis keratitis were: ocular surface disease, concurrent topical steroid use, previous corneal surgery and long-term contact lens wear. The mean presenting corrected distance visual acuity (CDVA) was LogMAR 1.49 (range 0.2 – 2.3), with a final CDVA of LogMAR 1.11 (-0.2 – 2.3). Where used, microbiological culture was positive in 19 out of 20 cases, PCR in 6 out of 11 cases, and IVCM in 8 out of 13 cases. Two-thirds of cases were managed with either topical voriconazole or amphotericin B, with four cases surgically managed by therapeutic keratoplasty and two cases requiring evisceration. ConclusionsPatients presenting with microbial keratitis with risk factors for C. parapsilosis keratitis should be managed with a high degree of clinical suspicion. Post-infection visual outcomes are poor but reflect pre-existing ocular comorbidities. Delays in diagnosis can be reduced by through the use of ICVM and PCR.

Can the APACHE II score be used to assess the risk of mortality in the elderly with hip fractures?

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim &amp;lt;/strong&amp;gt;Various predictive models have been developed to help identify patients with hip fractures with greater or lower probability of survival. The aim of this study was to establish the capacity of the APACHE II score to predict the survival of patients with hip fracture, in people aged over 65 years, and compare it with the existing score used to predict the survival of these patients.&amp;amp;nbsp;&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Methods &amp;lt;/strong&amp;gt;This was a prospective, cohort study conducted in a tertiary care teaching hospital including 410 consecutive patients with hip fracture aged &amp;amp;ge;65 years. As part of the preoperative preparation, general health of the patients was classified according to the ASA score. The Charlson Comorbidity Index (CCI), the Nottingham Hip Fracture Score (NHFS), the POSSUM-P and the APACHE II scores were analysed.&amp;amp;nbsp;&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Results &amp;lt;/strong&amp;gt;The sensitivity and specificity of the P-POSSUM score were 78.3 and 73.0, respectively, which was better than the APACHE II whose sensitivity and specificity were 56.6 and 89.7. The area beneath the ROC curve for P-POSSUM was 0.809, and for APACHE II, 0.803. However, there was no statistically significant difference between the APACHE II and P-POSSUM scores. The P-POSSUM and APACHE II scores were statistically significantly better than ASA, the Nottingham score and CCI.&amp;amp;nbsp;&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Conclusion &amp;lt;/strong&amp;gt;This study showed that POSSUM-P and APACHE II can be used to predict mortality in elderly people with hip fractures.&amp;amp;nbsp;&amp;lt;/p&amp;gt;

An Analysis of Psychological Capital and Influencing Factors Among Disaster Care Reservists

IntroductionIn recent years, with the frequent occurrence of public health emergencies, various infectious diseases and natural disasters (earthquakes, tsunamis, and fires have placed a burden on global public health and health care systems, especially on health care workers. This study aimed to investigate the current state of psychological capital among disaster care reservists and the factors influencing it. MethodsBetween January and February 2024, a total of 330 members of the disaster nursing reserve team from 4 tertiary general hospitals in Mianyang, China, were surveyed using an online platform named Wenjuanxing to obtain information on general demographics, psychological capital, and job burnout. ResultsThe total score of psychological capital was 91.10 ± 16.15. Psychological capital was negatively correlated with emotional depletion dimension and depersonalization dimension scores (P < .01) and positively correlated with personal achievement dimension scores (P < .01). The results of multiple regression analysis revealed that the psychological capital of members in disaster nursing reserve teams was influenced by various factors such as their marital status, having children, work experience in the department, level of public recognition and respect, number of disaster relief trainings, participation in disaster relief activities, types of disaster relief activities, and level of job burnout (P < .05). This accounted for 48.9% of the total variation. DiscussionThe psychological capital of disaster nursing reserve team members is affected by several aspects, which warrant great attention. Relevant management departments should adopt appropriate strategies to effectively mobilize their self-efficacy, improve their professional identity and sense of achievement, and enhance their psychological capital level.

Integrated measure for training transfer in nursing practice: Development and validation study

BackgroundThe persistent knowledge-practice gap in nursing, where competencies gained through continuing professional development fail to integrate into practice, remains a significant challenge. Effective transfer of acquired knowledge and skills to the workplace is essential for bridging this gap. However, there is a lack of comprehensive, validated instruments to assess factors influencing training transfer in nursing practice. ObjectiveThis study aims to develop a questionnaire capable of assessing training transfer as an integrated construct, encompassing all factors influencing this process in nursing practice. DesignThe study followed a developmental, iterative approach guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Setting(s)Eight tertiary teaching hospitals in the Netherlands. ParticipantsEducational experts (n = 8) and nurses (n = 1588). MethodsThe questionnaire development consisted of three phases: Phase 1) content development, in which instruments were identified based on a literature study and translation of included instruments into Dutch, Phase 2) pilot phase: content validation and usability testing using Delphi studies with experts and nurses, Phase 3) psychometric validation: construct validation using exploratory and confirmatory factor analysis, composite reliability and discriminant validity. The phases were completed from January 2023 till June 2024. ResultsThe literature review led to the inclusion of two key instruments: the Learning Transfer System Inventory (LTSI) and the Learning Climate Questionnaire (LCQ). Following item reduction based on Delphi rounds, nurses completed the adapted instruments. Psychometric validation demonstrated a good fit for these instruments in nursing practice. The adapted LTSI showed loadings ranging from 0.37 to 0.99, with a Normed Χ2 of 1.996, TLI of 0.908, CFI of 0.920, and RMSEA of 0.050 [CI = 0.047–0.054]. The adapted LCQ exhibited loadings from 0.64 to 0.94, with a Normed Χ2 of 3.385, TLI of 0.963, CFI of 0.974, and RMSEA of 0.069 [CI = 0.061–0.078]. The combined model demonstrated a Normed Χ2 of 2.014, TLI of 0.900, CFI of 0.907, and RMSEA of 0.051 [CI = 0.048–0.054]. ConclusionsThe adapted LTSI and LCQ, both separately and combined, are reliable and valid instruments for use in the Dutch nursing hospital context. Together, they provide a comprehensive assessment of factors influencing training transfer. They can also be used independently to examine specific components such as trainers (LCQ), context (LTSI), personal aspects (LTSI), or training (LTSI/LCQ). Furthermore, these instruments can facilitate discussions between nurses, managers, and educational experts to address barriers to training transfer in nursing practice.

Pulmonary Aspergillosis: An Observation from a Tertiary Care Hospital of Western Uttar Pradesh

Background: Aspergillus is the most frequently occurring fungal infection in immunocompromised patients with a high mortality rate. Invasive pulmonary aspergillosis is the most serious entity on the spectrum of pulmonary aspergillosis. Limited studies on the occurrence of pulmonary aspergillosis from this geographical area prompted us to carry out this study. Materials and Methods: This hospital-based cross-sectional observational study was carried out in the Postgraduate Department of Microbiology of a tertiary care medical teaching hospital in western Uttar Pradesh for one year. A total of 1032 respiratory samples were subjected for isolation and identification of fungal pathogens by direct microscopic examination (KOH mount) and culture on Sabouraud dextrose agar. Results: The isolation rate of pulmonary aspergilli was 6.97%. The majority of the respiratory samples received were sputum 900 (87.2%) followed by bronchoalveolar lavage fluid 132 (12.7%). The pulmonary pathology was predominantly seen in the age group of 41–50 years (25%). Male patients (69%) were predominant. The majority of the samples (50%) were from the respiratory medicine ward followed by the respiratory medicine ICU (25%). Aspergillus fumigatus (58%) was the predominant species isolated followed by Aspergillus flavus (25%). Conclusion: Isolation of Aspergillus species from patients of pulmonary pathology needs to be correlated clinically to rule out colonization as they may need proper antifungal treatment. Indiscriminate use of antifungals may lead to the emergence of antifungal drug resistance.

Minimally Invasive Tube Surgery (MITS)-A Novel Method in Glaucoma Drainage Device Implantation.

Background/Objectives: We introduce a new surgical technique for inserting the eyePlate-300-a glaucoma drainage device (GDD). The flexibility of the eyePlate-300 allows for folding and insertion through a smaller conjunctival incision. The procedure is termed minimally invasive tube surgery (MITS). Methods: We performed a retrospective analysis of thirteen eyes to assess the efficacy of the MITS technique in a large London tertiary teaching eye hospital with 12 months follow-up. The primary outcome was complete success: defined as 'IOP > 5 mmHg, <21 mmHg and off drops'. Secondary outcomes: best corrected visual acuity at 12 months, complications, a reduction in the number of drops and need for further pressure-lowering surgery. Results: Twelve eyes (92%) achieved a lower IOP. The mean pre-operative IOP was 35.69 mmHg (20-53 mmHg); post-operatively, it was reduced to 11.08 mmHg (5-20 mmHg) (p < 0.001). The mean pre-operative drops were 3.462 (3-4), reducing to 0.85 (0-3) at 12 months (p < 0.001). There was no change in the mean BCVA. No intraoperative complications were recorded, and no further IOP lowering surgeries were required. Conclusions: The MITS technique facilitates the implantation of a glaucoma drainage device through a smaller, less traumatic incision. Preliminary one-year data suggest that the procedure may be safe and effective.

Associations of maternal serum ferritin levels across gestation with gestational diabetes mellitus: A longitudinal cohort study.

The longitudinal changes in maternal serum ferritin (SF) levels across gestation, which indirectly reflect iron supplementation, have not been extensively investigated in relation to gestational diabetes mellitus (GDM). We conducted a retrospective cohort study at a tertiary maternal hospital in Shanghai. Women with SF concentration measurements at 8.0-13.6 weeks' gestation (GW), 29.0-31.6 GW, and an oral glucose tolerance test (OGTT) at 24-28 GW were included. We utilized logistic regression analysis to assess GDM association with maternal SF levels and longitudinal changes. The study included 17 560 women, with 2160 (12.3%) participants diagnosed with GDM. Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for GDM across increasing quartiles of SF concentrations at 8.0-13.6 GW were 1.00 (reference), 1.139 (95% CI: 1.012-1.283), 1.093 (95% CI: 0.969-1.233), and 1.248 (95% CI: 1.111-1.403). Similarly, at 29.0-31.6 GW, increasing quartiles of SF concentrations were associated with higher adjusted ORs for GDM: 1.00 (reference), 1.165 (95% CI: 1.029-1.320), 1.335 (95% CI: 1.184-1.505), and 1.428 (95% CI: 1.268-1.607). Pregnant women with higher SF levels (upper 25th percentile) at 8.0-13.6 GW had a reduced GDM risk if their SF levels decreased to the lower 25th percentile at 29.0-31.6 GW. Conversely, the subgroup with higher SF levels (upper 25th percentile) at both time points had the highest incidence rate of GDM (15.3%, 1.235 [95% CI: 1.087-1.404]). Maternal SF levels independently and positively associated with GDM risk during early and late gestational stages. Considering the increased GDM risk, routine iron supplementation for iron-replete women is questionable.

Time is Brain: Detection of Nonconvulsive Seizures and Status Epilepticus During Acute Stroke Evaluation Using Point-of-Care Electroencephalography.

Seizures are both a common mimic and a potential complication of acute stroke. Although EEG can be helpful to evaluate this differential diagnosis, conventional EEG infrastructure is resource-intensive and unable to provide timely monitoring to match the emergent context of a stroke code. We aimed to evaluate the real-world use and utility of a point-of-care EEG device as an adjunct to acute stroke evaluation. We performed a retrospective observational cohort study at a tertiary care community teaching hospital by identifying patients who underwent point-of-care EEG monitoring using Rapid Response EEG system (Ceribell Inc., Sunnyvale, CA) during stroke code evaluation of acute neurological deficits during the study period from January 1, 2020 to December 31, 2020. We assessed the frequency of seizures and highly epileptiform patterns among patients with either confirmed strokes or stroke mimics. Point-of-care EEG monitoring was used in the wake of a stroke code in 70 patients. Of these, neuroimaging and clinical information resulted in a diagnosis of stroke in 38 patients (28 ischemic, 6 hemorrhagic, 4 transient ischemic attack; median NIHSS score of 6.5 [IQR 2.0-12.0]) and absence of any stroke in 32 patients. Point-of-care EEG detected seizures and highly epileptiform patterns in 6 (15.8%) stroke patients and 11 (34.4%) stroke-mimic patients, including 2 patients with persistent expressive aphasia due to repeated focal seizures. Point-of-care EEG has utility for detecting nonconvulsive seizures in patients undergoing acute stroke evaluations.

Does Combining Warm Perineal Compresses with Perineal Massage During the Second Stage of Labor Reduce Perineal Trauma? A Randomized Controlled Trial: Warm compresses for reducing perineal trauma.

Various interventions have been applied to reduce perineal trauma and obstetric anal sphincter injuries (OASIS). The efficacy of warm compresses during the second stage of labor for reducing the occurrence of perineal tears is controversial. We aimed to compare rates of spontaneous perineal tears requiring suturing, between women who received warm compresses plus perineal massage vs. perineal massage alone. Women admitted to a single tertiary university-affiliated hospital between June 2023 and January 2024 were randomized to receive warm compresses and perineal massage (n=206) or perineal message only (n=206) during the second stage of labor. Excluded were women with a history of third-degree perineal tear, nut allergy, fetal death, Crohn's disease with perineal involvement, or delivery number >5. Participant allocation was concealed until the second stage of labor. The allocated perineal management was implemented at the time of active fetal descent and when the participant felt the need to push. During active maternal pushing, gentle perineal massage with almond oil was performed in both study groups. In one group, warm compresses were applied between contractions, for a minimum of 10 minutes and a maximum of 30. The temperature of the warm compresses was kept in the range of 45-59°C. The perineum was protected during delivery with a hands-on technique. After delivery, the perineum was assessed by an intervention-blinded senior midwife and rectal examination was performed for ruling out OASIS. The primary outcome was the rate of perineal tears requiring suturing. Secondary outcomes included the rates of OASIS and episiotomies. A sub-analysis according to parity and an intention-to-treat analysis were performed. Similar proportions of women treated and not treated with warm compresses had spontaneous perineal tears requiring suturing: 43.7% vs 45.1%, p-value=0.766. The groups did not differ in the proportions with first-degree tears, 22.8% vs 21.4%, p-value=0.722; second-degree tears, 21.4% vs 23.8%, p-value=0.566; and OASIS rates, 0.5% in each. In a sub-analysis according to parity, the proportion with perineal tears did not differ between the two groups. For women treated during the second stage of labor with warm compresses and perineal massage, compared to perineal massage alone, the rate of spontaneous perineal tears requiring suturing was similar. VIDEO ABSTRACT.

The “Genetic Test Request”: A genomic stewardship intervention for inpatient exome and genome orders at a tertiary pediatric hospital

The “Genetic Test Request”: A genomic stewardship intervention for inpatient exome and genome orders at a tertiary pediatric hospital

The Frequency of Health Anxiety, Coronavirus Anxiety and Anxiety Disorder in Patients With Tinnitus During the COVID-19 Pandemic and the Impact of Pandemic on Tinnitus.

This study aimed to examine the frequency of anxiety disorder, coronavirus anxiety and health anxiety in tinnitus patients during the pandemic and also, determined the psychophysiological impact of COVID-19 on tinnitus. This cross-sectional study was conducted in a tertiary central pandemic hospital from 15 July 2021 to 15 December 2022. In total, 124 patients with tinnitus and 77 healthy controls participated in the study. The sociodemographic data, a set of valid and reliable assessment instruments were used to measure outcomes of anxiety disorder, coronavirus anxiety, health anxiety and severity of tinnitus. Patients with tinnitus were found to experience higher levels of coronavirus anxiety, health anxiety and anxiety disorder than controls (p < 0.05). In tinnitus patients, the frequency of coronavirus anxiety was 22.6% and anxiety disorder was 18.5%. Notably, the levels of tinnitus severity were moderate to severe in more than half of the patients (51.6%) and also most of them (81.3%) reported that the severity of tinnitus during the pandemic was higher compared with the pre-pandemic. Tinnitus patients had high levels of anxiety disorder, coronavirus anxiety and health anxiety. In line with these findings, it was evaluated that there was a relationship between the COVID-19 pandemic with psychological problems and tinnitus. Therefore, the predominance of tinnitus symptoms at presentation should not lead the clinician to neglect the underlying psychopathological problems in these patients.

Interdisciplinary cooperation with solution-focused brief therapy to reduce job stress, burnout, and coping in Chinese nurses: A randomised controlled trial

BackgroundIncreased job stress and burnout are common among clinical nurses in China, reducing their work efficiency and nursing quality. Multiple studies have been conducted on brief interventions to reduce job stress and burnout among nurses. However, research has been hampered by a lack of psychological knowledge among nursing staff. AimTo assess a short-term intervention designed to improve nurses' coping strategies and to mitigate job stress and burnout through interdisciplinary cooperation DesignThis randomised controlled trial Settingsand participants: We randomly allocated 60 nurses working at a tertiary general hospital in a city in China to an experimental (n = 30) or a control group (n = 30). MethodsA collaborative research team comprising psychology and nursing specialists was established to conduct this study. The control group received routine psychological intervention, whereas the intervention group received a short-term interdisciplinary treatment approach that focused on cooperation. Chinese nurses’ job stressors, job burnout, and simplified coping style scales were used to evaluate both groups before and after the intervention. ResultsA comparison of the scores for job burnout, total job stress, and positive coping before and after the interventions revealed significant improvements in the test group, whereas the scores for emotional exhaustion, depersonalisation, and total work stress in the control group demonstrated statistically significant differences. No significant differences were observed in the scores for negative coping, personal achievement, and simple coping style between the test and control groups before and after the intervention. ConclusionsSolution-focused brief therapy implemented through interdisciplinary collaboration effectively enhances clinical nurses' active coping style, alleviates job stress and burnout, and offers valuable guidance for nursing management practices.