Tertiary Hospital Research Articles

Effects of green tea based oral health strategies on disease activity in rheumatoid arthritis

AimIn this study, we aimed to evaluate oral health strategies in rheumatoid arthritis (RA) patients with periodontitis.MethodsWe enrolled 110 RA patients with periodontitis who were diagnosed in a Grade A tertiary hospital into an oral health strategies program. The control and test groups comprised 55 cases each. The management effect was evaluated by self-care ability, oral health-related quality of life, RA-related clinical indicators, and the DAS28 score. The control group received routine nursing, whereas the test group was in a self-health management program for 3 months.ResultsAfter the intervention, compared to the control group, the test group showed better self-care ability, oral health-related quality of life score, RA-related clinical indicators, and DAS28 score (P < 0.05).ConclusionOur oral health strategies program slowed down the progression of the disease and can be popularized in patients.

Does Real-time Feedback Guide Devices Improve the Quality of Chest Compressions in the Bystander (Naves) Provider?

Abstract Introduction: Cardiopulmonary resuscitation (CPR) is an important lifesaving technique that must taught to everyone. As most cardiac arrests occur outside of the hospital, training the general population in the recognition of cardiac arrest and performing high-quality CPR is vital. Thus, this study aimed to compare the chest compression quality data (rate, depth, and fraction) with and without the use of feedback devices during CPR. Methods: A crossover observational study was carried out at a tertiary hospital in September 2021. Five hundred and seventeen 1st-year university students were recruited, and the response rate was 90% (465). A feedback device was used to collect data. The data were numerically coded and statistical software (SPSS 21) was used to perform descriptive and inferential statistical analysis, including a paired t-test. Results: The mean compression rate with feedback was statistically significantly lower after performing one cycle of CPR (mean difference: −5.610; 95% confidence interval [CI]= −7.987–−3.233; P < 0.001), the difference between mean compression depth with and without feedback was not statistically significant (mean difference: = −0.006; 95% CI = −0.190–0.177; P = 0.944), and the mean compression target (%) with feedback was statistically significantly higher (mean difference: −15.951; 95% CI = −17.894–−14.009; P < 0.001). Conclusions: We found that the use of feedback devices during layperson-simulated CPR scenarios significantly improved the quality of chest compression in terms of depth and rate and resulted in more guidelines adherence. Moreover, national programs for CPR education should be implemented.

Family Resources and Parental Problem-Solving Skills Mediate Family Functioning and Family Adaptation in Families of Children With Cancer.

To explore the mediating roles of family resources (at the individual [parental self-efficacy], family [family resilience] and social level [social support]) and parental problem-solving skills in the association between family functioning and family adaptation in families of children with cancer. A cross-sectional study. This study recruited 318 parents of children with cancer from three tertiary hospitals in mainland China. Self-report questionnaires were used to collect data on key variables, including family functioning, parental self-efficacy, family resilience, social support, parental problem-solving skills and family adaptation. Data analyses were carried out using descriptive analysis, univariate analysis, Pearson correlation analysis, hierarchical linear regression and bootstrapping. Family functioning was significantly and positively correlated with family adaptation. Family resources (parental self-efficacy at the individual level, family resilience at the family level or social support at the social level) and parental problem-solving skills both independently mediated the relationship between family functioning and family adaptation. Additionally, family resources at all three levels mediated the relationship through their effects on cumulatively parental problem-solving skills, constructing a chain mediating model. The study underscores the significance of family functioning, family resources at the individual, family and social levels and parental problem-solving skills in promoting adaptation in families of children with cancer. It highlights the need for family-centred interventions targeted at these factors to improve family adaptation. This study extended related theories and previous studies to confirm the mediating role of family resources and parental problem-solving skills, both independently and sequentially. Moreover, parental problem-solving skills were confirmed as key elements that can be incorporated into future interventions, suggesting that problem-solving skills training may serve as a highly promising program for families of children with cancer. This study was reported according to the STROBE checklist. No Patient or Public Contribution.

Clinical Characteristics and Outcomes of Hospitalized COVID-19 Patients with Different Variants of SARS-CoV-2 in a Tertiary Care Hospital, Thailand

The different strains of SARS-CoV-2 were detected and labeled in 2021. Each strain differs in both clinical symptoms and severity. Previous studies found different clinical symptoms and treatment outcomes between outbreak waves; however, data in Southeast Asia were limited. This study collected data of hospitalized COVID-19 patients from a Tertiary hospital in Thailand between January 2020 and December 2023 and analyzed patients’ data in each outbreak wave using Pearson’s chi-square. A total of 1084 inpatients were included for analysis. The median age was 64 (IQR, 0.4–100) years. The patients were hospitalized in predominantly Alpha (22.78%), Delta (21.68%), and Omicron (5.07%) periods of the virus outbreak. The largest age group was elderly (over 65 years old) in all three variant of concern (VOC) periods; 82.65% of the patients had comorbidities, including 58.5% hypertension, 46.5% dyslipidemia, and 42.0% diabetes mellitus (DM). The study found pneumonia at 67.53%, septic shock at 4.61%, acute respiratory distress syndrome (ARDS) at 2.86%, and congestive heart failure at 0.83% in all age groups with no significant difference between outbreak periods. The overall mortality rate was 16.14%. A total of 75% of deaths occurred in patients over 65 years old. The mortality rates in each VOC period were 20.0% Delta, 19.83% Alpha, and 13.23% Omicron. In the elderly group, the mortality rates were Delta 15.32%, Alpha 11.75%, and Omicron 10.88%. The Omicron VOC was less severe than other variants, particularly in the elderly (65 years). There were no significant differences in the younger (<65 years) age group. The elderly still had more severe symptoms and the highest mortality rates in every wave of outbreak.

Development of prediction models for carbapenem-resistant Klebsiella pneumoniae acquisition and prognosis in adult patients

ObjectivesTo explore the risk factors and clinical outcomes of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and establish nomograms to predict the probability of CRKP infection and mortality in adult patients.MethodsPatients infected with KP from August 2019 to April 2021 in a tertiary hospital in Shanghai were enrolled. Risk factors associated with CRKP and 30-day mortality were identified using multivariate logistic regression analysis and Cox regression analysis.ResultsOverall, 467 patients with KP infection were enrolled, wherein 210 (45.0%) patients were infected with CRKP and 257 (55.0%) patients with carbapenem-susceptible K. pneumoniae (CSKP). Five factors, namely Charlson’s Comorbidity Index (CCI) ≥ 3, the use of central venous catheterization, prior hospitalization during the 3 months before infection, and previous exposure to carbapenems and broad-spectrum β-lactams, were found to be independently associated with CRKP infection. Based on these parameters, the nomogram showed a better performance as indicated by C-index of 0.94 (95% confidence interval [CI]: 0.92–0.96) and well-fitted calibration curves. CRKP was independently associated with 30-day mortality. Multivariate Cox regression analysis revealed that age ≥65 years, higher CCI scores, higher Sequential Organ Failure Assessment scores, the presence of respiratory failure, albumin levels ≤30 g/L, and non-appropriate treatments in 3 days, were associated with 30-day mortality.ConclusionThe predictive nomogram established in this study can facilitate the clinicians to make better clinical decisions when treating patients with KP infection.

Effect of weighted blankets on sleep quality among adults with insomnia: a pilot randomized controlled trial.

Weighted blanket is an emerging non-pharmacotherapy for sleep disorders, but its effect on sleep among relatively healthy adults with insomnia remains uncertain. This study aimed to evaluate whether weighted blankets could better improve sleep quality and sleep-related symptoms among adults with insomnia. In a prospective, pilot randomized controlled trial conducted in three tertiary hospitals in China, participants with clinical insomnia were randomized (1:1) to receive weighted blanket intervention or normal blanket intervention for 1 month by random-number tables. The primary outcomes were sleep quality assessed with Pittsburgh Sleep Quality Index (PSQI) and insomnia severity assessed with Insomnia Severity Index. Subjective outcomes were measured at baseline, 1 week, and 1-month post-intervention. Sleep was also objectively monitored by actigraphy. We did analysis by intention to treat. A total of 102 participants were randomly assigned to receive weighted blanket intervention (n = 52) or normal blanket intervention (n = 50). 95 (93.1%) participants completed the follow-up, and 7 (6.9%) participants dropped out of the study. The weighted blanket group had significant improvements in sleep quality compared to the normal blanket group after 1 month of intervention (changes in the mean [SD] of PSQI score: -4.1 [4.1] vs. -2.0 [3.2], P = 0.006). Similar results were observed for daytime sleepiness, stress, anxiety, fatigue, and bodily pain (all P < 0.05). Recordings from actigraphy showed a decrease in the mean (SD) of the number of awakenings in weighted blanket group (-1.4 [9.5]) and an increase in normal blanket group (+ 1.0 [7.9]) (P = 0.280). No severe adverse events occurred. Weighted blanket might be an effective, safe and promising non-pharmacotherapy tool for improving sleep-related symptoms among adults with insomnia, although validation with a larger sample size is needed. Chinese Clinical Trial Registry: ChiCTR2300078011, date of registration: 11/27/2023, retrospectively registered.

A Comparative Study of the Rate of Helicobacter pylori infection Using Three Diagnostic Techniques among Patients in Rivers State

Background: Approximately 89% of gastric cancers are attributable to H. pylori infection, however, only 1 in 5 patients survive longer than 5 years after diagnosis. Evidence has shown that screening and eradication of H. pylori in young adults would be cost-effective and could prevent 1 gastric cancer in every 4 to 6 cases. Diagnostic tests used to detect Helicobacter pylori are either invasive or noninvasive methods. These tests have varying sensitivity and specificity, having about 90% accuracy in the diagnosis of H. pylori infection in clinical practice. Aim: This study aims at detecting Helicobacter pylori using antibody-antigen, stool antigen and polymerase chain reaction (PCR) and to compare the infection rate among the different diagnostic techniques. Methodology: This was a cross-sectional study. The participants included attendants to tertiary and private hospitals in Port Harcourt metropolis for medical treatment. Blood and stool samples were collected from one hundred and eighty (180) subjects aged 1 to 60 years and above. Ethical approval for the study was obtained from the Rivers State University Teaching Hospital Ethics Committee. Convenience sampling technique was deployed. Samples were collected from subjects who consented to the study. All samples collected were analyzed in Medical Microbiology Laboratory, Rivers State Teaching Hospital and subsequently, molecular analysis was carried out. Results: The blood antibodies test (serology) method shows a greater number of positive cases (43.9%) than stool antigen method (8.3%). Also, out of the 75% stool antigen positive samples, subjected to more specific PCR, only 25% were positive. There was a significant difference (p-value of &lt;0.001) in sensitivity between antigen and serology, there was also a significant difference (p-value of &lt;0.025) between antigen and PCR result outcomes. Conclusion: The study has shown that there is a notable variation in the diagnosis of H pylori among the laboratory techniques used.

Comparison of Letrozole Versus Combination Letrozole and Clomiphene Citrate (CC) for Ovulation Induction in Sub Fertile Women with Polycystic Ovarian Syndrome (PCOS)-An Open Label Randomized Control Trial.

To evaluate the effectiveness of Letrozole and Clomiphene (CC) combination versus Letrozole alone for ovulation induction in infertile women with PCOS. This was an open label randomized controlled trial conducted between September 2020 and March 2023 at a tertiary level hospital. Women with a diagnosis of infertility and PCOS were included. Participants were randomized in a 1:1 ratio, to either the combination of 2.5mg letrozole and 50mg Clomiphene Citrate (CC) daily or 2.5mg letrozole alone from 2nd to 6thday of menstrual cycle for up to three treatment cycles. The primary outcome was ovulation rate per cycle. The secondary outcomes included ovulation rate per woman randomised, cumulative pregnancy and live birth rates. A total of the 120 participants, 59 women in Letrozole and CC arm (intervention) and 61 women in the Letrozole alone arm (control) were recruited. The woman per cycle ovulation rate following Letrozole and CC combination versus Letrozole alone (71/92 (77.2%) vs. 52/83 (62.6%), RR 1.43, 95%CI 0.99 to 2.06) but was not statistically significant. A per ITT analysis, the clinical pregnancy rate per woman randomized (16/61(26.2%) vs. 13/59(22%), RR 1.12, 95%CI 0.76 to 1.64) and live birth rate per woman randomized (10/61(16.4%) vs 11/59(18.6%), RR 0.92, 095%CI 0.57 to 1.50) did not differ significantly between Letrozole and CC versus Letrozole group. There was no significant improvement in ovulation, clinical pregnancy, or live birth rates with a combination of letrozole and CC versus letrozole alone in per woman randomized with PCOS. Trial RegistrationThe trial was prospectively registered in the clinical trial registry of India (CTRI registration number CTRI/2020/07/026263), Registration dated: February 26, 2020.

A Study on 128 Slice MDCT unit in a Tertiary Care Teaching Hospital with Special Emphasis on Work Flow and Break-Even Analysis

Purpose: To study the Cost Analysis of 128 Slice MDCT unit in a tertiary care teaching hospital Materials and methods: The study followed a biphasic design, comprising both retrospective and prospective components. The retrospective phase involved a record-based analysis conducted over a 3-month period, while the prospective phase included record review, observational methods, interviews, and material evaluation relevant to the study, carried out over the course of 1 month. Results: The cost of running the 128 Slice MDCT unit, including manpower, was calculated for a 3-month period, with an average of 28 cases per day. The unit handles a total workload of 54 TR (15 TR + 35 TR + 4 TR). Power is supplied by a 120KVA UPS located in the unit's UPS room. Depreciation for the building, with a lifespan of 100 years, is set at 1% of the capital cost. For an area of 51.2 sqm, the construction cost totals Rs 19,18,208/-, with a depreciation cost of Rs 47,955/- over 3 months. According to the CPWD manual, the annual maintenance cost is Rs 5104/- per sq.m., resulting in a maintenance expense of Rs 65,331/-. Additional costs for electricity, water, and linen over the 3-month period were also factored in. The breakeven point for the unit is estimated to be 744 days (approximately 2 years and 14 days). Conclusion: Getting each patient into and out of the procedure room in a timely manner can add minutes and maybe even hours to the daily schedules, allowing for the accommodation of a greater number of cases. Increasing the number of procedures performed per day or week can add to overall income.

Antibiotic Prescribing Practices in a Tertiary Care Teaching Hospital: A Retrospective Cross-Sectional Analysis.

Background Antibiotics are among the most frequently prescribed medications in hospitals, yet a significant portion of their use is inappropriate, contributing to the growing global threat of antimicrobial resistance (AMR). In Pakistan, AMR has reached alarming levels with the rise of multi- and extensively drug-resistant bacteria. This study evaluates antibiotic prescribing practices and the use of culture sensitivity (CS) testing to assess the appropriateness of antibiotic therapy. Methods This cross-sectional retrospective study was conducted in a 500-bed tertiary care teaching hospital in Islamabad, Pakistan, analyzing inpatient records from 2020 to 2022. From over 5000 patient files, 1012 met the inclusion criteria and were reviewed. The study assessed the rationality of antibiotic prescriptions based on the evidence of infection (EoI), clinical parameters, and the presence or absence of CS testing. Statistical analyses, including Chi-square tests, logistic regression, and Cox proportional hazards regression, were applied to determine the association between antibiotic use and patient outcomes. Results Among the 1,012 patients analyzed, 91.8% (n = 929) received one or more antibiotics. However, 30% (n = 274) of these prescriptions were issued without any documented EoI.Only 17.5% of patients underwent CS testing. Patients exposed to five or more antibiotics had a 2.5-fold increased risk of ICU mortality (HR = 2.50, p < 0.001). A positive correlation (r = 0.42, p < 0.001) was found between the number of antibiotics prescribed and the length of hospitalization. Conclusion The findings of this study reveal a high rate of inappropriate antibiotics prescribed without EoI and CS testing. The results emphasize the urgent need for comprehensive Antibiotic Stewardship Programs (ASPs) in hospital settings, particularly focusing on mandatory CStesting protocols. By reducing irrational antibiotic use, these initiatives can significantly mitigate the rise of AMRglobally, especially in resource-limited settings. Implementing ASPs not only optimizes antibiotic use but also aligns with the WHO recommendations, demonstrating the effectiveness of multifaceted interventions in minimizing resistance and improving patient outcomes.

The Thematic Analysis of Barriers to Immediate Post-Partum Long-Acting Reversible Contraception

Background: Globally, many women express the desire to avoid immediate pregnancy for 24 months postdelivery, and only forty percent use contraceptives during this period. There is an enormous demand for postpartum family planning, particularly in developing countries with low- or middle-income grades. Postpartum intrauterine devices such as long-acting reversible contraceptives (LARCs) are among the most effective methods of family planning in the immediate postpartum period, yet their effectiveness is hindered because of a lack of availability and training. Strategies to increase access to LARCs are essential. Hence, the purpose of the current study is to determine the barriers among healthcare providers in providing immediate postpartum family planning services. Methods: A cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at SIMS, a tertiary care teaching hospital, from January to March 2024. Approximately 293 healthcare providers who fulfilled the inclusion criteria were provided an online questionnaire in the form of a Google Forms link, which included a structured questionnaire focusing on various aspects, including demographics, knowledge, practices, and barriers in their practice. The data collected were analysed through SPSS version 26, which employs chi-square tests and Pearson’s correlation to determine any significant associations among them. Based on the key statistical outcomes and the significant correlations observed related to the data, a thematic analysis through SWOT (strengths, weaknesses, opportunities, threats) was conducted. The study adhered to the method outlined by Braun and Clarke (2006) and compiled with the COREQ (consolidated criteria for reporting qualitative research) checklist to uphold methodological integrity. Results: Among the participants, 92.4% provided family planning counselling after childbirth, predominantly during the antenatal period (75.1%), and the provision of immediate postnatal family planning was reported in 76.1% of the participants, with PPIUDs identified as the most utilized method by 52.6%. Various barriers were identified, including insufficient training on Implanon (33.4%) and the PPIUCD (12.6%), the unavailability of implants (59.0%), and a lack of interest among patients (46.1%). Statistically significant associations were observed between the practice setting and knowledge of postpartum family planning (p = 0.002), as well as deficiencies in training for the PPIUCD (p &lt; 0.001). The study highlights the place of practice and the practitioners’ experience as significant strengths in offering immediate postpartum contraception and referring patients for family planning. However, qualification was identified as a limiting factor for practicing immediate postpartum family planning. Conclusions: This study revealed significant difficulty in delivering prompt postpartum long-acting reversible contraceptives (LARCs), underscoring the necessity of improved education and training for professionals. Focusing on these challenges is important in enhancing postpartum family planning acceptance and decreasing unfulfilled requirements in resource-limited settings.

Pressure-Mediated Biofeedback With Pelvic Floor Muscle Training for Urinary Incontinence

Supervised pelvic floor muscle training (PFMT) has been recommended as the first-line treatment for women with stress urinary incontinence (SUI), but more evidence on whether adjunctive methods would provide additional benefits is needed. To compare the efficacy of PFMT with or without a home-based pressure-mediated biofeedback (BF) device. This multicenter assessor-blinded randomized clinical trial was conducted in the obstetric clinics of 5 participating tertiary hospitals in China. Participants included eligible women with new-onset postpartum SUI who were enrolled from March 28, 2022, to October 13, 2023. All participants received 3 months of supervised PFMT and were randomized to either the intervention (PFMT with a home-based pressure-mediated BF device) or the control group (home-based PFMT). The primary outcome was the severity of urinary incontinence evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form after 3 months of supervised PFMT. The secondary outcomes included the cure and improvement rates, PFM strength, quality of life, self-efficacy, and adherence. A total of 452 participants (median age, 34 [IQR, 31-36] years; median body mass index [calculated as the weight in kilograms divided by the height in square meters], 23.71 [IQR, 21.37-25.97]; median time since delivery, 50 [IQR, 43-61] days) were included in the analysis, with 223 in the intervention group and 229 in the control group. Compared with the control group, the intervention group achieved a significantly greater reduction in incontinence severity (median, 3.00 [IQR, 1.00-6.00] vs 2.00 [IQR, 0-4.00] points; z = -3.05; P = .002), significantly increased cure rate (45 of 223 [20.2%] vs 20 of 229 [8.7%]; z = 12.02; P = .001) and improvement (132 of 223 [59.2%] vs 102 of 229 [44.5%]; z = 9.71; P = .002), significantly greater pelvic floor muscle strength (median, 26.00 [IQR, 17.00-38.00] vs 21.00 [IQR, 13.50-33.50] cm H2O; z = -2.28; P = .02), and a significantly greater correlation between subjective and objective adherence (r = 0.825 vs r = 0.627). In this randomized clinical trial, the efficacy of pressure-mediated BF combined with PFMT was superior to that of PFMT alone. These findings support the use of pressure-mediated BF devices for improving treatment outcomes for patients with SUI. ClinicalTrials.gov Identifier: NCT05115864.

Parity-Driven Disparities in Placenta Previa: A Comprehensive Analysis of Obstetric and Perinatal Factors

OBJECTIVE: This retrospective cohort study aimed to investigate the incidence of known risk factors for placenta previa in primiparous patients and assess the maternal and fetal outcomes associated with this condition in a tertiary hospital setting. STUDY DESIGN: Data were collected from electronic medical records of pregnant women with confirmed placenta previa who were monitored at our clinic and delivered between January 2016 and June 2024. Demographic characteristics, obstetric history, and perinatal outcomes were analyzed. Statistical analysis was conducted using SPSS version 22, and comparisons between multiparous and nulliparous women were made using appropriate tests. RESULTS: A total of 674 pregnant women were included in the study, comprising 542 multiparous and 132 nulliparous women. Significant differences were observed between the two groups in terms of anesthesia type, transfusion rates, operation duration, and hemoglobin levels. Neonatal outcomes, including APGAR scores, showed variations between multiparous and nulliparous women. However, certain outcomes such as birth weight did not differ significantly between the groups. CONCLUSION: This study provides valuable information on maternal and neonatal outcomes associated with placenta previa in multiparous and nulliparous women. The findings highlight the complex interplay between maternal parity, anesthesia choice, and clinical outcomes and underscore the importance of tailored management approaches in this population.

Clinical profile, inhaler technique, and predictors of inhaler adherence among asthma and COPD patients who attended the outpatient emergency department for acute exacerbation.

Understanding the patients' clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. Convenience sampling was used in this study. The inhaler techniques and adherence of all subjects were evaluated. Regression analysis was used to identify predictors of inhaler adherence. We recruited 120 subjects with a mean age of 47.8 ± 16.0 and were predominantly asthma patients (n = 85, 70.8%). Most were on regular follow-up (n = 72, 60.0%) and adhered to their inhaler(s) (n = 86, 71.7%). Less than half of the subjects use their inhaler(s) correctly (n = 45, 37.5%). Three predictors of inhaler adherence were identified: regular follow-up (aOR 2.072, p = 0.041), correct inhaler technique (aOR 3.071, p = 0.039), and ability to explain inhalers' mode of action (aOR 10.906, p = 0.031). The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial.

Clinical Effectiveness of Multimodal Exercise Combined With Supportive Music and Imagery in the Management of Poststroke Mood Disorders.

BACKGROUND: The objective of this study is to investigate the clinical effectiveness of the combination of multimodal exercise (MME) with supportive music and imagery in the management of poststroke mood disorders (PSMD). METHODS: A total of 200 PSMD patients treated in the neurology department of a tertiary hospital in Jiangsu Province were enrolled. They were assigned to either a control group or the observation group using a random number table at a 1:1 ratio, with 100 patients in each group. The control group received conventional nursing care, and the observation group received both MME and music and imagery in addition to the conventional nursing interventions. The scores of the 10-item Kessler Psychological Distress Scale (K10), Hospital Anxiety and Depression Scale (HADS), and Well-being Index Scale (WBIS) were recorded before and 3, 6, and 9 months after the interventions and compared between the 2 groups. RESULTS: Changes in K10, HADS, and WBIS scores significantly differed between the 2 groups after interventions (all P < .05) and among different time points (all P < .05). There were interactions between the time points of the K10, HADS, and WBIS assessments and the intervention methods in both groups (P < .05). The improvements in anxiety or depression and psychological distress in the observation group were significantly superior to those in the control group. CONCLUSION: MME combined with music and imagery can effectively improve anxiety and depression, reduce symptoms of psychological distress, and improve well-being in PSMD patients.

Analysis of the Association between In Vitro Fertilization/Assisted Conception and the Development of Retinopathy of Prematurity in Very-Low-Birth Weight Newborns.

The objective is to study to what extent the development of retinopathy of prematurity (ROP) is associated with assisted conception (AC) and in vitro fertilization (IVF) in a tertiary referral hospital. This study is a retrospective observational cohort study. Very-low-birth weight (VLBW) infants with gestational age (GA) <32 weeks or birth weight <1500 g were admitted to the neonatal unit of a tertiary care hospital between January 1, 2011, and December 31, 2021. The study determined the degree of ROP developed according to the type of fertilization used for conception. Main outcome measures were ROP prevalence in pregnancies obtained after IVF/intracytoplasmic sperm injection (ICSI) in the period from January 1, 2011, to December 31, 2021, in a tertiary hospital. Of the 408 infants included in the study sample, 105 (25.7%) were born following AC and 12.4% of these developed ROP. In our sample, the practice of IVF was not associated with an increase in the incidence of VLBW infants (R2 = 0.12; P = .29). Conception achieved via AC or IVF is not significantly associated with ROP in any degree of severity.

Challenges and barriers toward conducting research at a tertiary hospital in Saudi Arabia

Background: In healthcare, research is essential for improving disease diagnosis and treatment, patient outcomes, and resource management, while fostering evidence-based practice. However, conducting research in this sector can be challenging, and healthcare workers may face various obstacles while engaging in research activities. Therefore, understanding healthcare workers’ attitudes toward research participation is essential for overcoming barriers and increasing research engagement. In this study, these aspects are examined through the analysis of survey data from a tertiary healthcare institution in Saudi Arabia. Method: Data obtained via a survey conducted between April and November 2022 among the healthcare workers and employees at a tertiary care hospital in Saudi Arabia were analyzed using descriptive and bivariate statistics. Results: The study sample comprised 713 respondents, 61.71% of whom were female, 58.06% were 26–41 years old, and 72.93% had not undertaken any research as employees or affiliates. A significant association was noted between age group and time constraints (p = 0.004) and lack of opportunity for research (p = 0.00), which were among the identified barriers to research participation. A significant association was also found between gender and barriers to pursuing research (p = 0.012). When the 193 (27.07%) participants who conducted research were asked about the challenges they encountered during this process, gender was significantly associated with difficulties in allocating time for conducting research (p = 0.042) and challenges in accessing journals and references (p = 0.016). Conclusion: The study findings highlight the importance of addressing the barriers and challenges in promoting positive attitudes toward research participation among healthcare workers considering their gender and age. In this manner, healthcare institutions can adopt an environment conducive for professional research engagement.

The Impact of Laparoscopic Treatment on Fertility Outcomes in Patients with Severe Endometriosis

Background: Endometriosis, a prevalent gynecological disorder affecting women of reproductive age, is a significant cause of infertility, especially in severe cases involving extensive adhesions, endometriomas, and deep infiltrating lesions. In Bangladesh, the delay in diagnosis and limited access to advanced treatments, including laparoscopic surgery, poses challenges to improving fertility outcomes for women with severe endometriosis. Objective: This study aimed to assess the impact of laparoscopic treatment on fertility outcomes in patients with severe endometriosis, particularly in a resource-limited healthcare setting in Bangladesh. Methods: This retrospective cohort study included 78 women with severe endometriosis from tertiary hospitals in Dhaka and Khulna, Bangladesh. All participants had previously experienced unsuccessful in vitro fertilization (IVF) attempts and subsequently underwent laparoscopic surgery between 2015 and 2024. Data collection involved reviewing primary and secondary data from these tertiary hospitals, including medical records and operative reports, and was supplemented by follow-up interviews for comprehensive analysis. Variables such as patient age, infertility duration, previous IVF cycles, operative findings, and postoperative fertility outcomes were analyzed using SPSS, with statistical significance set at P &lt; .05. Results: The mean age of patients was 34.3 years, and the average duration of infertility was 52.9 months. Post-laparoscopic surgery, 42.3% (33/78) of women successfully delivered, with 7% achieving spontaneous conception. Younger age, fewer prior IVF cycles, and a normal uterine appearance on transvaginal ultrasound were significantly associated with improved fertility outcomes. Salpingectomy was more common among those who delivered (70%), though the removal of ovarian endometriomas did not significantly impact fertility success. Conclusion: Laparoscopic treatment significantly improves fertility outcomes in Bangladeshi women with severe endometriosis, even in a resource-limited setting. Age, normal ovarian function, and uterine appearance were key factors influencing reproductive success. These findings underscore the importance of timely surgical intervention for endometriosis-related infertility, highlighting the need for improved access to laparoscopic surgery in low-resource healthcare systems.

Efficacy of a Video Education Program Regarding Basic Skin Care in Pediatric Atopic Dermatitis: A Randomized Controlled Trial.

Basic skin care education holds the potential to improve clinical outcomes in pediatric atopic dermatitis (AD). However, evidence is lacking on the efficacy of video education for patient guardians in Thailand to reduce AD disease severity. To compare the efficacy of a video education program for guardians of pediatric AD patients versus a control group by assessing the severity score of AD (SCORAD), transepidermal water loss (TEWL), and skin hydration (SH). A single-blinded, randomized controlled trial was conducted at a tertiary hospital from June 2023 to February 2024, involving AD patients aged < 18 years and their guardians. Both groups received standard treatment, and the educational group received an additional video education program. SCORAD, TEWL, SH, pruritus, sleeplessness, and parental/guardian confidence and knowledge accuracy were assessed at enrollment and a 4-week follow-up. Seventy patients (educational:control group, 34:36) with a median age of 3.1 years were enrolled. The groups exhibited no significant demographic or disease severity differences between them. At follow-up, the educational group showed significant SCORAD improvement compared to the control group (mean difference -10.93 [95% CI -16.92--4.95]; p < 0.001). SH (mean difference 3.82 [95% CI -2.7-10.33]; p = 0.25) and TEWL (mean difference -1.24 [95% CI -5.72-3.24]; p = 0.58) did not differ significantly. Video education demonstrated efficacy in significantly reducing SCORAD. While there were improvements in SH and TEWL in patients in the education group, these improvements were not statistically significant. Further investigation with a larger sample size is warranted. Thai Clinical Trials Registry (TCTR): TCTR20230524001.

Whole-Genome Sequencing Reveals the Population Structure and Genetic Diversity of Salmonella Typhimurium ST34 and ST19 Lineages.

Salmonella Typhimurium is an invasive gastrointestinal pathogen for both humans and animals. To investigate the genetic framework and diversity of S. Typhimurium, a total of 194 S. Typhimurium isolates were collected from patients in a tertiary hospital between 2020 and 2021. Antimicrobial susceptibility testing was used to confirm the resistance phenotype. Whole-genome sequencing and bioinformatics analysis were performed to determine the sequence type, phylogenetic relationships, resistance gene profiles, Salmonella pathogenicity island (SPI) and the diversity of the core and pan genome. The result showed that 57.22% of S. Typhimurium isolates were multidrug resistant and resistance of total isolates to the first-line drug ciprofloxacin was identified in 60.82%. The population structure of S. Typhimurium was categorized into three lineages: ST19 (20.10%, 39/194), ST34-1 (47.42%, 92/194) and ST34-2 (40.65%, 63/194), with the population size exhibiting increasing trends. All lineages harbored variety of fimbrial operons, prophages, SPIs and effectors that contributed to the virulence and long-term infections of S. Typhimurium. Importantly, ST34-1 lineage might potentially be more invasive due to the possession of SPI1-effector gene sopE which was essential for the proliferation, internalization and intracellular presence of S. Typhimurium in hosts. Multiple antimicrobial resistance genes were characteristically distributed across three lineages, especially carbapenem genes only detected in ST34-1&2 lineages. The distinct functional categories of pan genome among three lineages were observed in metabolism, signaling and gene information processing. This study provides a theoretical foundation for the evolved adaptation and genetic diversity of S. Typhimurium ST19 and ST34, among which ST34 lineages with multidrug resistance and potential hypervirulence need to pay more attention to epidemiological surveillance.