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Background: Almost everywhere, neonatal mortality can be decreased with ease if competent obstetricians give the necessary treatment. Unfortunately, observational techniques were not used to examine basic essential newborn care practice among obstetric care providers in Ethiopia. Thus, the purpose of this study was to evaluate factors related to essential newborn care practice using observational techniques among obstetric care providers in public hospitals in the Gamo, Gofa, and Wolayta zones, southern Ethiopia. Methods: An institutional-based cross-sectional study carried out from May 15 to June 30, 2022. A simple random sampling method was used. Structured self-administered questionnaires with a clinical observational checklist were used to collect data. Data imported into Epidata version 4.6 and analyzed using the SPSS Version 25. Bivariable and multivariable analyses were used to identify factors associated with essential newborn care practices. An odds ratio with a 95% confidence interval was used to assess the direction and strength of the association. Results: The overall magnitude of good essential newborn care practice among obstetric care providers was 53.5% (95% CI = 49, 58). Factors positively associated with the practice of essential newborn care were having interest on working in delivery room (AOR = 3.16, 95% CI = 1.71,5.83), having no work load (AOR = 2.96, 95% CI = 1.78,4.49), received in-service training (AOR = 3.09, 95% CI = 1.75,5.45), having supportive supervision (AOR = 3.41, 95% CI = 1.25, 9.24), and having good knowledge on essential newborn care (AOR = 3.04, 95% CI = 1.89,4.90). Conclusion: The observed level of essential newborn care practices among obstetric care providers underscores the necessity for targeted interventions that stimulate interest in delivery room work, effectively manage workloads, and offer comprehensive training along with supportive supervision. By concentrating on these aspects and enhancing providers' knowledge, we can significantly improve essential newborn care practices. [ABSTRACT FROM AUTHOR]

Introduction: Grip strength serves as a significant marker for diagnosing and assessing sarcopenia, particularly in elderly populations. The study aims to explore the relationship between individual thigh muscle volumes and grip strength, leveraging advanced AI-based UNETR segmentation techniques for accurate muscle volume assessment. Methods: The study included 49 participants from a cohort of 478 patients diagnosed with hip fractures at Gyeongsang National University Hospital. We recorded Grip strength and height and utilized UNETR-based segmentation techniques on CT scans, to calculate individual thigh muscle volumes. Point-biserial correlation was employed to explore the relationship between sarcopenia and thigh muscle volumes. The research also included a quantile analysis of grip strength. Results: Our findings revealed a strong statistical significance in specific thigh muscles like Rectus femoris, Vastus lateralis, and Vastus intermedius, particularly in males, in relation to sarcopenia. The male cohort displayed a trend where higher thigh muscle volumes correlated with better grip strengths. Meanwhile no such relationship was found within the female group. Conclusion: The findings indicate that stronger grip strength correlates with larger thigh muscles in males but not in females, with specific muscles like the Rectus femoris and Vastus lateralis linked to sarcopenia in men only. The study's small sample size calls for further research with more diverse and gender-balanced groups to verify these results. [ABSTRACT FROM AUTHOR]

Objective: Few studies characterizing clinical outcomes of head and neck cancer (HNC) patients in sub-Saharan Africa report the proportion of patients who initiate and complete treatment, information integral to contextualizing survival outcomes. This retrospective cohort study describes HNC patients who presented to Muhimbili National Hospital and Ocean Road Cancer Institute in 2018, the highest-volume oncology tertiary referral centers in Tanzania. Logistic regression was applied to assess predictors of treatment initiation and completion. Results: Among the 176 head and neck squamous cell carcinoma (HNSCC) patients, 34% (59) had no treatment documented, 34%(59) had documentation of treatment initiation but not completion, and 33%(58) had documentation of treatment completion based on the modalities started. Univariate logistic regression showed that late-stage disease was associated with increased odds of initiating treatment (OR 8.24, 95% CI 2.05–33.11, p = 0.003) and trends toward completing treatment (OR 7.41, 95% CI 0.90–60.99, p = 0.063). At last visit, 36.9%(65) were alive with a median follow up of 5.6 months (IQR 1.64—12.5 months). A large proportion of HNC patients who presented to MNH and ORCI did not initiate or complete treatment. These metrics are critical to contextualize care outcomes of HNC patients in resource-constrained health systems and develop interventions. [ABSTRACT FROM AUTHOR]

Dilated cardiomyopathy (DCM) is a significant contributor to heart failure, characterized by ventricular dilation and reduced systolic function. This cross-sectional observational study was conducted from December 2022 to June 2023 at the Department of Medicine, Government Medical College, and Dr. Sushila Tiwari Government Hospital, Haldwani, Uttarakhand, to evaluate the clinico-epidemiological profile, risk factors, and diagnostic findings of DCM patients. A total of 102 patients with clinically diagnosed DCM were included. Comprehensive evaluations, including symptom profiling, physical examinations, baseline investigations, chest X-rays, electrocardiography, and echocardiography, were performed, and data were analyzed using SPSS version 18.0. The study population comprised 68 males (66.66%) and 34 females (33.33%) with a median age of 61 years, males presenting earlier (median 58 years) than females (median 65 years). Smoking (36.27%) and alcohol consumption (23.52%) emerged as significant risk factors, predominantly in males, while diabetes mellitus (20.58%), hypertension (17.64%), and hypothyroidism (10.78%) were notable comorbidities. Most patients were in NYHA class II (46.07%) and III (26.47%). Echocardiography revealed a median ejection fraction of 39.2%, with left ventricular end-diastolic and systolic diameters of 5.70 cm and 4.60 cm, respectively. DCM in the Kumaon region is more prevalent in males and is associated with modifiable risk factors such as smoking and alcohol consumption. Significant delays in presentation, particularly among females and residents of hilly areas, highlight the need for enhanced awareness, early detection, and timely intervention. Addressing comorbidities like diabetes and hypertension is crucial to improving outcomes in this high-risk population. [ABSTRACT FROM AUTHOR]

Introduction: Ectopic pregnancy is one of the commonest acute abdominal emergencies a gynecologist has to meet in his day-to-day practice. It is also a matter of great concern that a woman might have to face any time during her childbearing period. Aim & Objective: to determine the incidence, risk factors, clinical features, diagnostic methods, treatment of ectopic pregnancy. Materials and Methods: All diagnosed cases of ectopic pregnancy admitted to Government General hospital during a period of one year. It was a prospective study using Contingency Table analysis and Chi-square test. Results: A total of 51 patients were admitted with history suggestive of ectopic pregnancy. Frequency of ectopic pregnancy was 1:259 pregnancies. Risk factors were found in 49.1% of cases and the major contributors were dilatation and curettage (2%), PID(5.9%), infertility(13.7%), previous tubal surgery(13.7%) and previous abortions(9.8%). after the diagnosis of ruptured ectopic pregnancy was made. Blood transfusion was given in 72.5%. Postoperative period was uneventful in all of them. Conclusion: As the incidence of ectopic pregnancy has been on the rise, screening of high-risk cases, early diagnosis and early intervention are required to enhance maternal survival and conservation of reproductive capacity. [ABSTRACT FROM AUTHOR]

Background: Adequate, balanced, and individualized nutrition, planned according to the patients' life expectancy in palliative care units, is crucial for maintaining essential functions. Aim: To determine the knowledge levels of nurses working in palliative care units regarding enteral nutrition practices and their perceptions of nutritional care quality in their units. Methods: This descriptive, cross-sectional study was conducted in 25 palliative care units located in Izmir, Türkiye, between June and September 2022. The study sample consisted of 205 nurses working in palliative care units. Data were collected using a Personal Information Form, an Enteral Nutrition Practices Knowledge Form, and the Nurses' Perceived Nutrition Care Quality Assessment Scale. The STROBE checklist was also utilized. Results: The study found that the majority of participating nurses (94.6%) were female, with 78.5% holding bachelor's degrees. The median knowledge score for enteral nutrition: 15 (range: 2–27), perceived care quality score: 36 (range: 9–45). Those with enteral nutrition training had significantly higher knowledge scores (p <.001); palliative care certificate showed no difference (p =.846). Nurses lacking nutrition counseling knowledge had lower perceived care quality scores (p =.001). Monthly tube feeding applications correlated positively with knowledge scores (r =.173, p =.013), unlike professional experience duration (p =.126) and time spent in palliative care (p =.839). Conclusion: Nurses working in the palliative care unit find the quality of nutrition care provided to patients in their clinics to be sufficient, and the level of knowledge regarding enteral nutrition is at a moderate level. However, in questions related to nursing care such as fluid requirements during enteral nutrition with enteral solutions that affect both nutritional care and medical treatment, maintaining the opening of the jejunostomy tube, and enteral drug administration, correct response rates were low. Low correct response rates on specific issues highlight a need for targeted educational interventions. [ABSTRACT FROM AUTHOR]

Background: Dental anxiety has become a major concern for both dental practitioners and patients and prevents a significant proportion of people from attending dental clinics. The present study aimed to determine dental anxiety and associated factors among adult patients attending a public outpatient dental clinic in a base hospital, in the Eastern Province of Sri Lanka. Methods: A descriptive cross-sectional study was conducted among 400 adults aged 18 to 75 years awaiting dental treatment. A validated and pretested interviewer-administered questionnaire was utilised, and it included demographic information, past dental treatment, and the Modified Dental Anxiety Scale (MDAS) which was used to assess dental anxiety. Anxiety scores ranged from 5 to 25, with scores of 5–9 classified as less anxious, 10–18 as moderately anxious, and scores above 18 as extremely anxious. Statistical analysis was done using SPSS version 28. Descriptive analysis, correlation test, chi-square test and multiple logistic regression were applied for statistical analysis. The significance level was set at p < 0.05. Results: The majority of participants in this sample experienced dental anxiety, with 19% classified as extremely anxious, 70% as moderately anxious, and 11% as less anxious. The mean MDAS score was 14.5 (SD = 4.4). Bivariate analysis revealed that dental anxiety is significantly associated with age group, sex, marital status, employment status, monthly family income, past dental visits, sex of treatment provider and previous dental experiences. Multiple logistic regression analysis indicated that age, sex and postponing dental treatment appointments were significant predictor variables of dental anxiety. Conclusion: The findings reveal that the majority of participants in this study experience moderate to high levels of dental anxiety. Notably, younger individuals (under 35 years), females, and those who tend to postpone dental appointments were identified as significant predictors of heightened dental anxiety. [ABSTRACT FROM AUTHOR]

Background: Medical research is an essential aspect of the training of resident doctors and is required by postgraduate medical colleges in Nigeria as part of the fulfilment of fellowship awards. However, research participation among resident doctors in Nigeria is low, despite seemingly high interest in research among resident doctors. The objective of our study is to examine the knowledge, attitudes, practices, and barriers related to medical research among resident doctors in a public and private tertiary care in Nigeria. Methodology: The study is a descriptive cross-sectional study carried out between November 2023 and December 2023 in a public tertiary hospital and a private tertiary hospital in Nigeria. A total of 352 participants were recruited for the study—303 from the public tertiary hospital and 49 from the private tertiary hospital. The obtained data were analysed using SPSS Statistics version 26 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.). The significance level was set at P < 0.005. Results: The majority (63.92%) of the participants had spent between 2 and 5 years in residency training. A total of 57.67% had participated in research other than dissertations, while 35.23% had participated in research publications. The majority (48.58%) of participants assessed their research knowledge to be fair, whereas 2.56% assessed their knowledge to be excellent. Multivariate analysis revealed a significant positive correlation between self-reported knowledge of research and the number of research publications (adjusted ρ = 0.332; P < 0.001). The leading (60.8%) barrier to research participation among resident doctors in Nigeria was lack of time due to stress/pressure of the residency program. An overwhelming majority (95.17%) of resident doctors have shown interest in research participation, and up to 75.87% even want it to be mandatory for all resident doctors in Nigeria. Conclusion: This study showed that despite limited participation, resident doctors have a positive attitude towards research. However, there is a struggle to translate this enthusiasm into practical application; hence, there is a need to address the barriers to effective participation of resident doctors in medical research. [ABSTRACT FROM AUTHOR]

Background: Tele-physiotherapy, as pertinent to tele-rehabilitation, can facilitate health care continuity and needs to be accepted by both the health care providers and patients. Sufficient understanding of health information by the patient enhances his total participation in the management of his condition. In Nigeria, there is a dearth of published studies on the awareness and knowledge of patients on e-health and patient health education, particularly in tele-physiotherapy. Therefore, this study determined the knowledge, awareness, and perception of tele-physiotherapy among patients receiving physiotherapy in public hospitals in Ibadan, Nigeria. Methods: The mixed-method study involved quantitative (cross-sectional) and phenomenological qualitative (focus-group discussion [FGD]). The participants for the study were patients receiving physiotherapy care from selected public hospitals in Ibadan, Nigeria. Their knowledge, awareness, and perception (KAP) of tele-physiotherapy were assessed using a standard questionnaire, while the KAP was further explored through FGD. Results: Almost all the participants (150, 99.3%) lack KAP of tele-physiotherapy. They reported that they were not aware of the term "tele-physiotherapy". Five themes were generated, which were categorized into subthemes that guided the discussion. The FGD participants were unaware of tele-physiotherapy but have fair knowledge and perception. They were able to identify challenges and facilitators to the implementation of tele-physiotherapy in Nigeria. Conclusion: Patients receiving physiotherapy in public hospitals in Ibadan have inadequate knowledge and awareness of tele-physiotherapy but fair perception. [ABSTRACT FROM AUTHOR]

Introduction: Nurses require good knowledge about professional values to provide quality nursing care. Implementing professional values in clinical areas improves the quality of patients care. Even though applying professional values had significant impact on the continuity and quality of nursing care, there is scarcity of study on professional values in Ethiopia. Objective: The study was aimed to identify the level of nurses' professional values and related factors among nurses employed in South Wollo Zone public hospitals. Methods: A hospital-based, cross-sectional study was conducted among 422 nurses working in South Wollo Zone public hospitals from May to June 2023. Participants were selected by using simple random sampling technique. Nursing Professional Values Scale-Revised was used to measure the professional values. Data entry was performed using Epidata version 4.6.1 and then exported to Statistical Package for Social Sciences version 23.0 for analysis. To identify the strength of association between outcome and independent variables, binary logistic regression was applied. From the final model, those variables having p <.05 and adjusted odds ratio with 95% confidence interval were reported as statistically significant. Results: The mean (±standard deviation) age was 32.29 (±7.01), with 63% of nurses being males. Less than half, 47.9% (95% confidence interval [CI]: 43.2, 53.4), of nurses had good professional values. Monthly income (adjusted odds ratio [AOR] = 0.33; 95% CI: 0.16, 0.72), position (AOR = 0.22, 95% CI: 0.13, 0.38), training (AOR = 0.56, 95% CI: 0.34, 0.92), promotion (AOR = 3.06, 95% CI: 1.84, 5.1), and respect from one's profession (AOR = 0.48, 95% CI: 0.29, 0.78) were statistically associated with professional values. Conclusion: The majority of nurses demonstrated poor professional values. Professional values were substantially correlated with monthly income, position, training, promotion, and professional esteem. In order to ensure the quality and continuity of patient care, we advised nurses to be aware of nursing professional values and apply them in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Erectile dysfunction is a common problem among patients with diabetes, often going undiagnosed and having a significant negative impact on their health. This condition necessitates accurate evaluation and early intervention. However, there is an inconsistent explanation of factors and limited evidence on the prevalence of erectile dysfunction among patients with diabetes in eastern Ethiopia. Thus, this study aimed to determine the prevalence of erectile dysfunction and its associated factors among patients with diabetes in public hospitals in the Harari Region, eastern Ethiopia. Methods: A cross-sectional study was conducted involving 339 randomly selected participants. Data were collected using the Kobo Toolbox with standardized questionnaires administered by interviewers, along with a review of the patients' medical records. Data analysis was performed using Stata version 14. The Poisson regression model with robust variance estimate was fitted to examine the association of the independent variables and erectile dysfunction. An adjusted prevalence ratio (APR) with 95% confidence intervals was reported. Statistical significance was declared at the p-value < 0.05. Result: The prevalence of erectile dysfunction was 78.28% (95% CI 73–83). Age 35–45 years [APR = 1.38; 95% CI: 1.03–1.84], and > 45 years [APR = 1.58; 95% CI 1.17–2.13], depression [APR = 1.41; 95% CI 1.06–1.86], current khat use [APR = 1.14; 95% CI 1.00-1.28], low social support [APR = 1.70; 95% CI 1.09–2.65] and medium social support [APR = 1.79; 95% CI 1.16–2.78] were factors significantly associated with erectile dysfunction. Conclusions: More than three-fourths of the participants had erectile dysfunction. Significant factors associated with erectile dysfunction included age 35 years and above, depression, current hat use, and low and medium social support level. The management of erectile dysfunction should be integrated into routine medical care in diabetic follow-up clinics, with special attention for those participants aged 35 years and above, who have depression, currently use Khat, and have low-level social support. [ABSTRACT FROM AUTHOR]

Background: Active cytomegalovirus (CMV) infection is associated with poor prognosis in septic patients with critical illness. Patients of septic category are highly likely to benefit from prophylactic antiviral therapy. Nevertheless, the clinical characteristics for CMV reactivation are lacking among septic patients requiring mechanical ventilation. The aim of this study was to investigate the incidence, risk factors, and clinical outcomes regarding active CMV infection in mechanically ventilated patients with sepsis. Methods: A single-center, retrospective cohort study conducted from January 2021 to December 2023 that included septic patients on mechanical ventilation at the intensive care unit (ICU) of a national hospital. Study participants were divided into active and non-active CMV infection groups based on CMV DNAemia within a 28-day hospitalization period in ICU. Clinical features, laboratory findings, treatment measures, and clinical outcomes were compared between the two groups. Results: Among 118 septic patients, 21 (17.8%) exhibited active CMV infection within 28-day ICU admission. Hemoglobin served as an independent risk factor and predictor for active CMV infection (P < 0.05). Moreover, the duration of mechanical ventilation and ICU stay in active CMV infection patients were significantly higher than in the comparison group (P < 0.05). Conclusions: Active CMV infection is common and associated with adverse clinical outcomes in mechanically ventilated patients with sepsis. A low level of hemoglobin is an independent risk factor for active CMV infection. Further prospective studies are warranted to assess the efficacy of initiating prophylactic and preemptive antiviral therapies among patients with sepsis disorders. [ABSTRACT FROM AUTHOR]

Diabetic Retinopathy (DR) is a serious consequence of prolonged diabetic patients that causes vision threatening issues and irreversible blindness problem. In the beginning stage of DR, affected people do not realize any specific symptoms. Manual testing is a highly complicated task due to the variations and formation of tiny micro miniature lesions in the retina. Since the lesion features are difficult to detect, classifying the different stages of DR has been a significant challenge. It is essential to have an effective method of detecting the pathologies of the retina during the screening process. Deep learning methods have a significant impact on identifying and diagnosing the diseases at an early stage. In this paper, we propose an innovative OptiDex model that utilizes deep learning to achieve precise detection and classification of diabetic retinopathy severity levels. OptiDex uses an Explainable AI (XAI) framework that can provide transparent decision-making and insights into the decision-making process of model. Additionally, we use an enhanced cat swarm optimization (ECSO) algorithm to optimize the model performance. The performance of the OptiDex model is evaluated using both clinical and public datasets, showcasing its accuracy in detecting diabetic retinopathy and classifying the severity level with impressive results. Various morphological operations, hysteresis thresholding, top and black hat transformation are applied to perform the segmentation of lesions abnormalities. Then, the combined version of the Nas-Mob architecture is used to extract and retrieve the most relevant features from segmented retinal images that discover the tiny lesions and strongly recommended for a better classification task. DCNN parameters are optimized through a nature-inspired metaheuristic called ECSO algorithm that reduces the bias value, updates the weights in the network, and obtained better accuracy. Moreover, the heatmap images are generated through the suggested approach using gradient-weighted class activation maps. Finally, the experiments were conducted on clinical datasets and public datasets extensively. We compute the performance metrics of the developed OptiDex model on clinical datasets obtained from SRM Hospital and public benchmarking datasets, namely Aptos, IDRiD, Messidor for training, validation and testing purposes. According to the experimental outcomes, our proposed model namely, OptiDex based DCNN + ECSO obtained a greater accuracy, sensitivity and specificity of 97.65%, 96.46%, 93.45% respectively. [ABSTRACT FROM AUTHOR]

Background: Clinical competence is a critical element in providing high-quality nursing care. A higher level of clinical competence positively influences patient health outcomes as well as nurses' job performance and satisfaction. Nonetheless, there is limited data on nurses' clinical competence in Ethiopia. Objective: This study aimed to assess the level of clinical competency among nurses working in selected public hospitals. Method: Institution-based cross-sectional study design was conducted from March 1 to 30, 2022. Two hundred five randomly selected nurses from three selected hospitals in the West Shoa Zone namely H1, H2, and H3 participated in the study via a structured self-administered questionnaire. The collected data were checked for completeness and then entered Epi-data v.4.2.2 and analyzed by Stata software v.14.2. Independent t-test and analysis of variance were used to identify factors associated with nurses' clinical competence. The level of statistical significance was declared at a p -value <.05. Results: The overall clinical competence of participants was 2.501 (SD = 0.36), indicating a moderate level of clinical competence. Participants had higher competence scores on the professional development dimension and lower competence scores on the leadership dimension. The null hypothesis was rejected. Age, work experience, professional satisfaction, level of satisfaction, level of hospital, current position, shifting status, retrieval of newly published information, previous training, and frequency of training were the identified factors associated with nurses' clinical competence. Conclusion: Nearly five in 10 participants in the study setting had inadequate clinical competence. Professional satisfaction, level of satisfaction, previous training, and frequency of training were factors related to nurses' clinical competence. It is recommended that responsible stakeholders like the Minister of Health and the Ethiopian Nursing Association should work to improve nurses' clinical competence by focusing on the identified factors. Also, health policymakers should set strategies to assess nurses' clinical competence frequently to ensure quality nursing care. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections (HAIs) are a major global health threat, leading to higher morbidity and mortality, longer hospital stays, and increased healthcare expenses. Intensive care units (ICUs) present a particularly high risk of developing HAIs. This study aims to examine the risk factors of HAIs among healthcare workers (HCWs) in the ICUs of selected public hospitals. Methods: We employed a cross-sectional design using an online survey. Respondents were randomly selected from seven large public hospitals located in different areas of Riyadh, the capital city of Saudi Arabia. Data collection was conducted between November 1st to 15th, 2023. Logistic regression analysis was employed to examine previous exposure to HAIs as the response variable and selected predictors. Results: A total of 600 HCWs participated in the study (response rate 88.2%). Among the study HCWs, 75.1% were female, with nurses making up 50% of the sample. Of the respondents, 78% had at least a year's experience, 71% had applied infection prevention and control (IPC) training from the infection control department, and 93% reported they had good knowledge about infection control. The level of knowledge of IPC (OR = 0.9, p < 0.05) and applied IPC training (0.1, p < 0.001) were significantly associated with a lower risk of HAIs. Additionally, a higher risk of HAIs was associated with HCWs years of clinical experience (p < 0.001). Conclusion: Overall, the findings indicated that HCWs who have poor knowledge of IPC, who reported no previous IPC applied training, and who have more years of clinical work experience have a greater risk of HAIs. Thus, legislators and Health officials should prioritize the prevention of infections linked to healthcare, paying particular attention to tailored and applied IPC initiatives. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions Our study aimed to explore the experience of attaining higher education among women in medicine at the largest national hospital in Fiji, focusing on barriers and enablers to completing training, and to explore women's perception of gender‐based discrimination in the world of medicine. Findings subsequently informed evidence‐based recommendations on enablers and barriers at the hospital and medical university to improve experiences of women in medicine.We conducted a mixed‐method study, emphasising the phenomenological qualitative component. All women doctors working at the national hospital were invited to complete a survey, and those with past or present engagement in postgraduate specialty medical training participated in semi‐structured interviews. Survey data were analysed using descriptive statistics. Interviews were transcribed, coded then organised using thematic analysis. Reflexivity and triangulation were employed at all levels of the research to ensure rigour.Four distinct themes were found to illuminate women's enablers and barriers. Participants described work‐life stress, absence of advocacy, coercion‐control‐power and inflexible systems as barriers. For enablers, they described inner strength, social circles, work culture and mentors/role models/advocates. Participants had mixed perspectives on gender‐based discrimination in the workplace, with unanimity in calling for protected maternity leave entitlements.Challenges only become true barriers when enablers are eclipsed by them. Institutional support helps mitigate these barriers especially for those women who lack social support. Gender based discrimination continues in the Pacific, commonly covertly, especially in terms of policy gaps regarding maternity leave during training. [ABSTRACT FROM AUTHOR]

Background and purpose: This study aims to examine the challenges within the management structures of public hospitals, particularly how these challenges impede the achievement of executive goals. If the consequences of these challenges are not adequately addressed, they may result in significant issues in the management of medical and hospital services. These issues could have a detrimental impact on various stakeholders, including patients, hospital staff, and administrators. Therefore, this research identifies the key administrative challenges faced by public hospitals from the perspective of multiple stakeholders and proposes potential solutions to improve hospital management and service delivery. Materials and methods: This mixed-method study (quantitative and qualitative) involved two primary groups: healthcare providers and hospital managers/senior professionals, including 14 senior staff from a public hospital. In the qualitative phase, semi-structured interviews were conducted to identify the challenges in public hospitals. In the quantitative phase, a questionnaire was developed based on the qualitative findings and the opinions of 363 experts. Exploratory factor analysis was performed using SPSS and AMOS software (version 24). Results: According to stakeholders, the challenges in managing public hospitals were identified across four key categories: financial, procedural and decision-making, human resources, and infrastructure. The results of the data analysis revealed that procedural and decision-making challenges had a coefficient of 0.89 with a significance level of 7.881; financial challenges had a coefficient of 0.79 with a significance level of 6.994; human resource challenges had a coefficient of 0.75 with a significance level of 6.641; and infrastructure challenges had a coefficient of 0.43 with a significance level of 3.807. Conclusion: The study results indicate that procedural and decision-making challenges in public hospitals are key factors significantly affecting the achievement of hospital operational goals and have a broad influence on other critical aspects of public hospital services, including patient satisfaction and service efficiency. Additionally, financial constraints, human resource limitations, and infrastructure challenges diminish hospitals' capacity to effectively meet patients' needs and organizational goals in both quantitative and qualitative terms, posing serious barriers to healthcare quality and accessibility. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to examine the relationship between the relative opening of the ICA (RO-ICA) and the structure of the ciliary cleft (CC) using Ultrasound Biomicroscopy (UBM). Materials and methods: Clinical data from 31 eyes of 17 dogs at the Veterinary Teaching Hospital of Chungbuk National University, Korea, were analyzed. RO-ICA was categorized as "Slightly Narrow", "Narrow", "Open", and "Wide Open", with eyes further grouped into "Narrow" (including Slightly Narrow and Narrow) and "Open" (including Open and Wide Open) for analysis. Statistical methods, including linear regression and average comparisons between groups, were employed to explore correlations between RO-ICA and parameters such as ICA, CC width (CCW), CC length (CCL), and CC area (CCA). Results: The distribution showed "Narrow" (3 eyes, 9.7%), "Slightly Narrow" (13 eyes, 41.9%), and "Open" (14 eyes, 45.2%) as the predominant categories. In the Open group, CCL and CCA were significantly larger compared to the Narrow group. A positive correlation was observed between RO-ICA and CCL, and CCA across all groups. Notably, in the Narrow group, RO-ICA demonstrated a particularly significant positive correlation with all assessed parameters, including ICA, CCW, CCL, and CCA. However, no significant correlation was observed between RO-ICA and the assessed parameters in the Open group. In conclusion, while a smaller RO-ICA generally correlates with a smaller CC, a larger RO-ICA does not guarantee a larger CC. Conclusion: Additional UBM examinations are recommended for comprehensive evaluations, particularly in cases where gonioscopy indicates an open iridocorneal angle. [ABSTRACT FROM AUTHOR]

Background/Objectives: Moral hazard represents a significant challenge in healthcare systems globally, reflecting the tendency of insured individuals to over-utilize medical services when shielded from the full costs of care. Methods: This paper investigates the dynamics and implications of moral hazard within the Romanian public hospital sector, offering practical recommendations for healthcare policymakers to mitigate the financial risks associated with excessive healthcare utilization and ensure long-term sustainability. To achieve the objectives of this study, a quantitative research approach utilizing vignettes was employed. Vignettes allow for the simulation of real-world decision-making under conditions of insurance coverage, capturing nuanced behaviors that traditional surveys may overlook. Results: The study examined patient behaviors in the context of moral hazard in public hospitals in Romania, employing a quantitative approach based on vignettes. A total of 303 valid responses were collected. The findings indicate a significant tendency among insured patients, both publicly and privately insured, to opt for more expensive treatments compared to uninsured patients, who preferred more affordable options such as medication or physiotherapy. In the case of treatments for severe conditions, insured patients frequently chose combinations of higher-cost therapies, while uninsured individuals either delayed treatment or opted for less expensive alternatives. These results highlight the impact of moral hazard, driven by a reduced sensitivity to costs in the presence of insurance, and underscore the need for cost-sharing policies to mitigate the overutilization of medical resources. Conclusions: This paper uniquely contributes to the understanding of moral hazard by integrating insights from both Romanian public hospitals and international case studies, offering practical policy recommendations for mitigating the financial risks associated with excessive healthcare utilization. [ABSTRACT FROM AUTHOR]

The management of paracetamol poisoning in our local health network and consistency with national guidelines is unclear. We conducted a 4‐month retrospective study of all paracetamol poisonings identified in two South Australian hospitals. Most presentations were deliberate self‐poisoning (90.7%) with immediate‐release formulations (88.0%). Although most were managed in accordance with national guidelines, there were deficiencies in documentation of the poisoning details and patient weight as well as cases of underdosing of the antidote. Quality improvement initiatives are needed. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions The Northern Territory (NT) of Australia has the highest rates of alcohol consumption and injury in the country. We aimed to: (i) describe the epidemiology of alcohol‐related injury (ARI) hospitalisations in the NT; (ii) estimate the proportion of alcohol involvement in injury hospitalisations; and (iii) consider the influence of alcohol policies on ARI hospitalisation trends.We conducted a retrospective time‐series study using coded hospitalisation data from NT public hospitals between 2007 and 2022. ARI hospitalisation was defined combining indicators for injury and acute alcohol use. We undertook descriptive analyses and calculated alcohol involvement against all injury hospitalisations. Annual percent changes (APC) were computed using joinpoint regression to examine the influence of alcohol policies on ARI hospitalisation trends by NT geographical regions (Central Australia and Top End).Alcohol use was associated with 22.6% of all injury hospitalisations. The most common cause of ARI hospitalisations was assault (46%). In Central Australia, a significant trend decline (APC −12.2; p = 0.011) was observed after 2017 following alcohol policies implemented between 2017 and 2018 (Banned Drinkers Register v2; Minimum Unit Price; and Police Auxiliary Liquor Inspectors). Consecutive years with the greatest decrease in Central Australia were 2013–2014 (APC −25.8) and 2018–2019 (APC −35.1); likely influenced by alcohol policies in effect at the time. In the Top End, a non‐significant trend decline (APC −26.1; p = 0.186) was observed after 2020.Alcohol policies implemented between 2017 and 2018 were associated with reduced ARI hospitalisations in Central Australia. Alcohol policies that demonstrated reduced harm should be sustained. [ABSTRACT FROM AUTHOR]

Drawing on the metaphor of "care convoys," this study explores the experiences and strategies of family caregivers of older adults with dementia in rural areas of Northern Norway. The study is part of a broader project that investigates how these older adults and their caregivers use or do not use municipal health and care services. We conducted qualitative in‐depth interviews with 11 family caregivers in rural municipalities. The thematic analysis of the interview data yielded three main themes: Delaying the transition to long‐term care amid evolving needs, facilitating knowledge transition, and navigating divergent expectations about involvement. In addition, a fourth theme, caregiving in the rural Arctic, was identified as cross‐cutting, reflecting the unique rural Arctic context that was a backdrop across all themes. In navigating the caregiving journey, family caregivers assume various roles within care convoys. They may act as solitary vessels, as an integral part of a larger care convoy, or as the main ship guiding the convoy. At times, family caregivers serve as vessels called upon by the convoy when needed. Difficulties in assembling an adequate or robust care convoy were exacerbated by the context of the Artic North, which represents treacherous waters for the convoy to navigate, primarily due to two factors: first, many of the smaller ships (other family members) were not present or had to travel great distances to join the convoy and second, the lengthy journeys (long travel distances), and particularly in the winter time, made the convoys susceptible to loosing ships along the way. [ABSTRACT FROM AUTHOR]

Objectives Animals Studied Procedure Results Conclusion This study aimed to explore anatomical differences in the aqueous humor (AH) outflow pathway between male and female dogs using ultrasound biomicroscopy (UBM).Clinical data were collected from 30 eyes of 30 dogs (15 males: 10 right eyes, 5 left eyes; and 15 females: 7 right eyes, 8 left eyes) treated at the Veterinary Medical Teaching Hospital of Chungbuk National University, South Korea, between August 2018 and February 2024.The study conducted an in‐depth UBM examination, specifically observing peripheral anterior chamber depth (ACD), geometric iridocorneal angle (ICA), and angle‐opening distance (AOD) alongside measurements of ciliary cleft width (CCW), length (CCL), and area (CCA), and assessed the longitudinal fibers of ciliary muscle thickness (Lf‐CMT) and the longitudinal and radial fibers of ciliary muscle thickness (LRf‐CMT) for gender‐based differences.The study identified a significant sex difference in peripheral ACD, with females displaying shallower depths compared to males, potentially clarifying the higher incidence of glaucoma in female dogs. No significant gender differences were found in ICA, AOD, CC parameters, or ciliary muscle parameters measurements.This research uncovered that peripheral ACD is significantly shallower in females than in males, potentially indicating a risk factor that could contribute to the development of primary angle‐closure glaucoma. [ABSTRACT FROM AUTHOR]

Introduction: Air pollution poses significant risks to cardiovascular health, yet patients often lack comprehensive knowledge about its impact and mitigation strategies. This study aims to evaluate the effectiveness of an educational intervention within a cardiac rehabilitation (CR) context in enhancing patients' understanding of air pollution and its cardiovascular effects. Methods: A pre-post pilot study was conducted from February 2021 to June 2021 at the Gregorio Marañón University General Hospital, Madrid, Spain. A total of 43 patients with cardiovascular disease attending CR were enrolled. Participants received a 1-h educational intervention delivered either in-person or online, focusing on the effects of air pollution and strategies to reduce exposure. Pre- and post-intervention questionnaires assessed participants' knowledge and perceptions. Descriptive statistics were used to analyze changes in awareness and understanding. Results: Initially, participants demonstrated a high level of awareness about the health impacts of air pollution, with 100% acknowledging its effects on health. However, detailed knowledge about specific concepts such as the Air Quality Index (AQI) and particulate matter (PM2.5) was limited. Post-intervention, there was a significant increase in knowledge, with familiarity with AQI rising from 61% to 81% (p = 0.02) and understanding of PM2.5 improving from 28% to 58% (p = 0.01). This indicates that the educational intervention effectively bridged gaps in understanding and reinforced the importance of environmental factors in cardiovascular health management. Discussion: The pilot study highlights the critical role of targeted education in improving patient awareness and knowledge about air pollution. The significant improvement in understanding key concepts underscores the need for broader educational initiatives that extend beyond CR programs. Future research should explore the impact of such interventions on long-term health outcomes and consider expanding educational efforts to include healthcare providers and family members. [ABSTRACT FROM AUTHOR]

Background and purpose: Triggering receptor expressed on myeloid cells-1 (TREM-1) was reported to be critical for mediating the neurological function after stroke, while the impact of soluble TREM-1 (sTREM-1) on cognitive impairment after ischemic stroke is unclear. We aimed to explore the association between sTREM-1 and post-stroke cognitive impairment (PSCI). Methods: We prospectively recruited consecutive ischemic stroke patients who admitted hospital within 7 days of onset. Serum sTREM-1 concentrations were measured after admission. Cognitive function was assessed at 90 days follow-up using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). PSCI was defined as a MMSE score of <27 or a MoCA score < 26. Results: A total of 291 patients (mean age, 66.6 years; 46.0% female) were enrolled for this study. Among these participants, the median sTREM-1 concentrations were 289.4 pg/mL. According to the MoCA score, 153 (52.6%) patients experienced PSCI at 3 months. After adjustment for confounding risk factors by multivariate regression analysis, patients with sTREM-1 levels in the fourth quartile were more likely to have increased risk 3-month PSCI (as compared with the first quartile, odds ratio 12.22, 95% confidence intervals, 5.20–28.71, P = 0.001). Restricted cubic spline further confirmed a dose-dependent relationship between sTREM-1 levels and PSCI (P = 0.003 for linearity). Similar significant findings were observed when the cognitive impairment was diagnosed according to the MMSE criterion. Conclusion: Our study revealed that higher serum sTREM-1 levels at admission were associated with increased risk of 3-month PSCI. [ABSTRACT FROM AUTHOR]

Background: Graduate nurses commonly experience the transition phase and are required to adapt quickly to their new workplace, as it is a prerequisite for a successful transition. However, workplace adaptation is extremely challenging and may affect nurses' future career prospects if not managed properly. Therefore, we aimed to determine the factors that facilitate newly employed nurses' adaptation and integration at Ministry of Health (MOH)-run state hospitals in Malaysia. The study framework was derived and adapted from the Roy adaptation model and organisational socialisation theories. Methods: This quantitative study was conducted from May 2021 to December 2021. The sample population was newly employed nurses working at state hospitals with 1–2 years of service experience. This study involved 496 newly hired nurses from MOH state hospitals. Questionnaires were distributed through Google Forms. The data were analysed using covariance-based structural equation modelling. Results: The participants perceived that workplace organisation (OC), academic institution contribution (AIC), and new nurse's personality traits (PT) contributed approximately 36% to newly employed nurses' adaptation (NENA). PT partially mediated the relationship between OC and NENA and between AIC and NENA. Conclusions: The results could be useful to nursing authorities. We also recommend that a nurse's personality be developed, emphasised, and enhanced through continuous programmes or training to ensure that they can easily adapt to their new working environment. Furthermore, academic institution and work organisation collaboration should be encouraged to develop improvement cycles that facilitate newly employed nurses' prompt and efficient adaptation at MOH hospitals during transition. [ABSTRACT FROM AUTHOR]

Background: As core members of hospice care team, the hospice nurses' ability to care for patients not only directly affects the standard of patient care, but also significantly impacts patient quality of life. It can be seen that it is very meaningful for patients to improve the caring behavior of hospice nurses. Therefore, it is necessary to deeply explore the influencing factors of nurses' caring behavior and further clarify the mechanism between them. Methods: The STROBE guideline was performed to report this study. We conducted a cross-sectional survey from December 2023 to February 2024. In this study, 392 hospice nurses were recruited from tertiary public hospitals in East China by convenient sampling method. Participants were investigated using the Practice Environment Scale, Professional Identity Scale, and Caring Behaviors Inventory. Structural equation modelling was utilized to verify the research hypotheses. Results: The results revealed that there were significant and positive correlations between work environment, professional identity and caring behavior. Furthermore, professional identity partially mediated the relationship between work environment and caring behavior. Conclusion: Work environment is critical to improving hospice nurses' caring behavior. Professional identity plays an intermediary role impacting how work environment promotes caring behavior among Chinese hospice nurses. Nursing managers should have a correct understanding of the relationship between them. Targeted measures and coping strategies need to be actively taken to create a better working environment for hospice nurses. This would enhance professional identity, and thereby promote caring behavior. [ABSTRACT FROM AUTHOR]

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Objective: We aimed to develop an AI-based model that uses a portable electronic oral endoscope to capture intraoral images of patients for the detection of oral cancer. Subjects and methods: From September 2019 to October 2023, 205 high-quality annotated images of oral cancer were collected using a portable oral electronic endoscope at the Chinese PLA General Hospital for this study. The U-Net and ResNet-34 deep learning models were employed for oral cancer detection. The performance of these models was evaluated using several metrics: Dice coefficient, Intersection over Union (IoU), Loss, Precision, Recall, and F1 Score. Results: During the algorithm model training phase, the Dice values were approximately 0.8, the Loss values were close to 0, and the IoU values were around 0.7. In the validation phase, the highest Dice values ranged between 0.4 and 0.5, while the Loss values increased, and the training loss began to decrease gradually. In the test phase, the model achieved a maximum Precision of 0.96 with a confidence threshold of 0.990. Additionally, with a confidence threshold of 0.010, the highest F1 score reached was 0.58. Conclusion: This study provides an initial demonstration of the potential of deep learning models in identifying oral cancer. [ABSTRACT FROM AUTHOR]

Background: The majority of people living with Human Immunodeficiency Virus (HIV) are in low- and middle-income countries, particularly in sub-Saharan Africa. Increased risky sexual practice puts people living with the human immune virus at higher risk of acquiring sexually transmitted infections other than the human immune virus and unplanned pregnancies. Sexually transmitted infections, particularly viral hepatitis (B and C), significantly impair antiretroviral therapy and the clinical outcome of the co-infected individual, leading to increased morbidity and mortality. The purpose of this study was to investigate the prevalence of risky sexual practices among antiretroviral therapy (ART) attendees in public health facilities within the Wolaita Zone of South Ethiopia. Methods: From September to October 2023, a facility-based cross-sectional study was conducted among adult people living with HIV on ART in the Wolaita zone. Data was collected through a pretested and structured questionnaire. Six diploma nurses were trained to collect data. Systematic sampling techniques were used to select a total of 398 ART patients. Data were collected by Open Data Kit (ODK) and analyzed with SPSS Version 25. Binary and multiple logistic regression analyses were used. All the variables with a P -value of 0.25 associated with risky sexual practices are considered candidate variables. Multicollinearity was checked. The fitness of the model was tested by the Hosmer-Lemshow goodness of fit test. Finally, statistical significance was declared at a p -value of 0.05. Result: A total of 398 respondents took part in this study. The prevalence of risky sexual practices in the past six months was 174 (43.7%) at 95% of the CI (38.9–48.7). The result of multiple logistic regression analysis showed that not disclosing HIV status (AOR = 1.8, 95% CI: 1.1–3.31), alcohol drinking (AOR = 3.1, 95% CI: 1.66–0.023), and poor social support (AOR = 1.9, 95% CI: 1.75–3.9) were statistically significantly associated with risky sexual practices. Conclusion: This study revealed that the risky sexual practice among ART clients was high and disclosure status, social support, and alcohol use were factors associated with risky sexual practice. The governmental and non-governmental bodies have to strengthen social support for ART clients, disclosure status for ART clients, and counseling to avoid alcohol. [ABSTRACT FROM AUTHOR]

Background: Quality laboratory services are key in the healthcare system for successful diagnosis and patient care. Uninterrupted laboratory services are needed to meet the needs of all patients and clinical personnel, but studies in developing nations revealed that most clinicians were dissatisfied due to the lack of quality laboratory services and frequent interruptions. Objective: This study aimed to assess the level of health laboratory service quality, service interruptions, and its predictors in public Hospitals in Harar town, eastern Ethiopia. Method: A facility-based cross-sectional study was conducted at Hiwot Fana Specialized University Hospital and Jugel General Hospital between January and April 2024. Data collection utilized Standardized Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) checklists and questionnaires based on the Ethiopian Hospital Standard Transformation Guidelines. Data were entered and analyzed by Statistical Package for the Social Sciences, version 26. Descriptive statistics such as frequencies, proportions, and means, were calculated. Binary and multivariable logistic regression models were applied to identify predictors with adjusted odds ratio (AOR) and a cut-off p -values <0.05 with 95% confidence interval (CI). Results: Two public hospital laboratories and their 54 laboratory professionals were involved in our study. According to our study, the mean score of the two public hospitals was 168.5 (61%), while Hiwot Fana specialized university hospital scored 212 (77%) and Jugel General Hospital scored 127 (46.1%). The study also revealed that out of 72 tests, 31 (43.05%) were interrupted, with clinical chemistry tests being the most interrupted (16, 51.6%) followed by Serology (7, 22.6%) and Hematology (4, 12.9%) tests. Lack of timely management response (AOR = 7.78, 95% CI = 1.48–40.83) and shortage of supplies (AOR = 60.8, 95% CI = 1.07–32.83) were significantly associated predictors of laboratory service interruptions. Conclusion: Neither of the hospital's laboratories met the required score of the SLIPTA standard for quality clinical laboratory services. Moreover, laboratory service interruptions were very common in the two public hospitals in which clinical chemistry, serology and hematology tests were the most frequently interrupted. Shortage of reagents and supplies and inefficient laboratory management are the major causes of service interruptions. So, policymakers and other stakeholders should support continuous quality improvement for a better patient clinical outcome. [ABSTRACT FROM AUTHOR]

Introduction: The use and influence of coping mechanisms vary across cultures and evaluation methods. Limited research exists on coping mechanisms for non-specific chronic low back pain (CLBP) in African societies. This secondary qualitative study explored adaptive and maladaptive coping strategies used by adults with CLBP in Nigerian and Zambian communities. Methods: Primary qualitative data from studies in rural Nigeria and peri-urban Zambia were used. Primary data were collected through in-depth face-to-face interviews with adults living with back pain to explore their experiences and coping strategies. Thematic analyses of interview transcripts from both studies were conducted using the framework approach, combining inductive and deductive analysis techniques. Findings: Participants used a mix of adaptive and maladaptive coping strategies for CLBP. Some strategies had both positive and negative aspects, with varying effects on individuals. A few participants focused on adaptive coping, staying positive, and actively managing their pain through stretching, exercise, pacing activities, spirituality, and belief in their strategies. They avoided seeking treatment for their back pain. Discussion: The nuances in coping with CLBP should be taken into consideration when developing coping assessment strategies and rehabilitation interventions for individuals with CLBP. [ABSTRACT FROM AUTHOR]

Aim: This study has aimed to assess the effectiveness of the transitional care model (TCM) on functional status, perceived self‐efficacy and healthcare utilization in patients undergoing total knee arthroplasty (TKA). Method: This randomized controlled study was conducted between February and November 2021 in a public hospital. The study randomly assigned patients to either a 6‐week 'TCM' program or usual care. The sample size was n = 70, with each group comprising 35 individuals. Patient outcomes, including self‐efficacy, functional status and healthcare service readmission rates, were monitored for TKA patients. Results: Nursing care based on the 'TCM' was found to enhance functional status and increase the level of self‐efficacy among TKA patients, leading to a decrease in healthcare service readmissions. Conclusions: The study recommends preparing patients and their families for the preoperative and postoperative processes. It emphasizes the importance of providing necessary training and consultancy services under the leadership of orthopaedic nurses responsible for TKA patient care, guided by the principles of TCM. Summary statement: What is already known about this topic? Treatment for knee osteoarthritis aims to alleviate pain, maintain joint functions and improve the quality of life.The success of transitional care relies on effective hospital discharge planning, post‐discharge follow‐up and home support to reduce adverse events. What this paper adds? Patients receiving TCM demonstrated improved outcomes and reduced healthcare service readmission rates.Nursing care based on the transitional care model positively affected the functional status of TKA patients.TCM increased patients' self‐efficacy levels. The implications of this paper: Patient training and consultancy services should be led by nurses responsible for TKA patients, guided by the principles of TCM.TCM should serve as a valuable guide for nurses when planning care for TKA patients. [ABSTRACT FROM AUTHOR]

The article in the Clinical & Translational Medicine journal focuses on identifying metabolic dysregulation and biomarkers for clear cell renal cell carcinoma (ccRCC). The study used targeted metabolomics to analyze metabolites in ccRCC patients, identifying 163 significantly altered metabolites in tumour tissues. The research also constructed a metabolite-based risk model to predict prognosis at different stages of ccRCC, offering potential diagnostic and therapeutic opportunities. The study provides valuable insights into novel biomarkers for diagnosing ccRCC and predicting prognosis, independent of clinicopathologic factors. [Extracted from the article]

Objectives: The aim of this study was to describe the phenotypic and molecular characteristics of Acinetobacter baumannii isolates carrying resistance genes to beta-lactams and carbapenems in six Peruvian public hospital centers. Materials and methods: The susceptibility of bacterial isolates was determined using the automated MicroScan system, with interpretation according to the M100 S30 CLSI 2020. Resistance genes were identified by conventional polymerase chain reaction (PCR), and PCR products were visualized by 1% agarose gel electrophoresis. Results: Nine strains (TRU1, PM1, PM2, CUS1, CUS2, CUS3, CAL1, CAL2 and CAL3) out of a total of 21 strains in the study were reactivated, showing resistance of 77.8% to imipenem, ciprofloxacin and cefepime, followed by 66.7% resistance to meropenem and ceftazidime, indicating marked multidrug resistance. In addition, the detection of the group A beta-lactamase genes blaCTX-M and blaTEM was confirmed, showing co-resistance in strains CUS1, CUS2 and CUS3, despite their unusual presence in this pathogen, also determined by the presence of the group D carbapenemase blaOXA in strain CUS3, the only strain to show co-resistance of the three groups. Conclusion: The prevalence of Acinetobacter baumannii resistant to extended-spectrum beta-lactamases and carbapenemases in Peruvian public centers represents a critical challenge for the treatment of infections. Rigorous surveillance, infection control strategies, and the development of alternative therapies are urgently needed to address this growing bacterial resistance. [ABSTRACT FROM AUTHOR]

Purpose: To develop a selection pathway to facilitate the use of multifocal intraocular lenses (mfIOLs) in cataract surgery in a public hospital setting. Methods: A single-surgeon prospective cohort study in an Australian tertiary referral public hospital was conducted. A mfIOL selection pathway was designed and assessed. Outcomes measured included unaided distance (UDVA), intermediate (UIVA) and near visual acuity (UNVA), dysphotopsia, spectacle dependence and satisfaction. Patient-reported outcome measures (PROMs) were assessed using Catquest-9SF (CQ) and Near Visual Acuity Questionnaire (NAVQ). A cost-analysis was performed. Results: Fifty-four eyes from 27 patients underwent cataract surgery with mfIOL implantation. The monocular UDVA (mean ± standard deviation) was 0.05 ± 0.12 logMAR; UIVA 0.19 ± 0.05 logMAR; UNVA 0.28 ± 0.14 logMAR; 87% and 98% of eyes achieved within 0.5D and 1.0D of target refraction respectively. Spectacle independence was 85% at distance, 81% at intermediate, 59% at near vision. High satisfaction was reported with CQ (> 85%) and NAVQ (100%). The cost difference between bilateral monofocal and mfIOLs is comparable to a pair of spectacles. Projected annual cost to the health system for a 5%– 10% eligibility rate is 1.1– 2.3 million Australian dollars. Conclusion: The selection pathway presented overcomes the challenges in patient selection inherent to a public hospital setting and was implemented by a senior trainee with excellent vision and PROMs. The pathway ensures the cost-effectiveness of mfOL implantation. There are several funding models that can be applied to support equitable access and improved visual outcomes with mfIOLs within the government funded health system. Plain Language Summary: Cataract surgery is a safe and effective procedure that is performed in both the private and public sectors. Traditional intraocular lenses offer clear vision at one distance, meaning that spectacles are required post-surgery. Advances in lens technology now offer the possibility of multifocality, that is, clear vision at two or more distances and the possibility to remain spectacle free. These multifocal intraocular lenses (mfIOLs) are not readily available in the public sector, due to the complexity of patient selection and of trainee experience with the mfIOLs. In this study, conducted at Westmead Hospital in Sydney, Australia, researchers aimed to develop a pathway for patient selection for mfIOLs. The study evaluated outcomes including the resultant visual acuity, the experience of visual disturbances, dependence on glasses and patient satisfaction. They also performed a cost analysis. The results showed that the pathway was successful and that most patients achieved excellent visual outcomes with mfIOLs, with high satisfaction rates reported. Around 85% were able to see well without glasses at a distance, 81% at intermediate distances, and 59% at near distances. The additional cost of mfIOLs was found to be comparable to the cost of glasses over time, making them a cost-effective option. In conclusion, the study demonstrated that the selection pathway effectively addressed challenges in choosing patients for mfIOLs in public hospitals, which can facilitate access to mfIOLs for public patients. [ABSTRACT FROM AUTHOR]

Background: Same‐day cancellation of surgery affects up to 44% of cases at a public tertiary hospital in Lilongwe, Malawi. To characterize these cancellations, this study examines surgical volume, cancellation causes, and surgery completion rate after initial cancellation, which are not otherwise monitored for analysis in this setting. Methods: We conducted a serial cross‐sectional study at the Kamuzu Central Hospital (KCH) during a 6 month period. Variables included patient demographics, procedure information, and hospital capacity factors. Bivariate and multivariable regression models were constructed to assess factors associated with cancellation. Results: Of the 3121 total surgeries, 2626 (84.1%) were elective procedures, of which 747 (28.4%) were canceled. Orthopedic surgery observed the highest cancellation rate (36.5%). Process‐related factors, such as starting cases late, were the primary reason for cancellation (64.3%). Only 40% of patients with a canceled surgery underwent their procedure after index admission, with a median wait time of 3 days. Emergency cases (aOR: 0.50 and CI: 0.39 and 0.64) and first cases of the day (aOR: 0.02 and CI: 0.01 and 0.04) were associated with lower odds of cancellation. Facility factors associated with lower odds of cancellation included number of open operating rooms (OR: 0.86 and CI: 0.77 and 0.96) and anesthetists assigned on duty (OR: 0.94 and CI: 0.88 and 0.99). Conclusion: Cancellation of elective surgery was primarily driven by process‐related factors. We identify facility‐related factors associated with lower odds of cancellation and thus provide targets for future interventions at KCH. Studies examining patient outcomes following elective case cancellation are warranted as most patients never return for surgery following cancellation. [ABSTRACT FROM AUTHOR]

Background: In South Africa (SA), data on the incidence of thyroid cancer is limited. Papillary thyroid carcinoma is by far the most common malignancy in developed countries; however, a preponderance of follicular thyroid cancer in developing countries, despite iodized salt, has been observed. The aim of this study was to describe the national landscape of thyroid cancer in SA with reference to pathological subtypes, surgical outcomes, and treatments offered. Methods: A multi‐institutional retrospective review of thyroid cancer patients operated on between January 2015 and December 2019 was performed. Public hospitals with associated academic institutions were included. Data were collected from theater registers, pathology, and radiology records. Statistical analysis was done to determine intergroup significance. Results: A total of 464 thyroid cancer cases from 13 centers across five SA provinces were identified. Most patients presented with a mass (67%). Ultrasound was performed in 82% of patients, and 16.3% underwent surgery without pre‐operative cytology. Of the histologically confirmed thyroid cancers, 61.8% were papillary and 22.1% follicular thyroid cancer. There was a significant association between subtype and geographical area, and T‐stage and operation performed. Surgical complication rates included hematoma in 1.8%, post‐operative hypocalcemia in 28.7%, and recurrent laryngeal nerve injury in 3.5%. Conclusion: This first national review describes the landscape of thyroid cancer in SA, revealing considerable differences compared to international studies. It provides valuable insight into the unique South African experience with this disease. In addition, this study serves as an impetus towards a prospective national registry with real‐world data informing contextualized guidelines. [ABSTRACT FROM AUTHOR]

Antibiotics are frequently administered in the neonatal period and early infancy. Little is known about the long-term health consequences of early life antibiotic exposure. The objective is to investigate the association between neonatal and early life (0–6 months) antibiotic treatment and the development of atopic dermatitis, asthma and the use of inhaled corticosteroid medication later in childhood. We analyzed data obtained from hospital records and national registers in a cohort of 11,255 children. The association between early antibiotic exposure and the outcomes were analyzed using logistic regression. Confounding factors were included in the model. Neonatal antibiotic therapy for confirmed infection was associated with childhood atopic dermatitis (adjusted odds ratio 1.49; 95% confidence interval 1.15–1.94). Antibiotic therapy by six months of age was more common in children developing atopic dermatitis (adjusted odds ratio 1.38; 95% confidence interval 1.15–1.64), asthma (adjusted odds ratio 1.56; 95% confidence interval 1.32- 1.85) and inhaled corticosteroid medication use (adjusted odds ratio 1.88; 95% confidence interval 1.66–2.13). Conclusions: Neonatal antibiotic therapy for confirmed or clinically diagnosed infection is associated with increased risk of atopic dermatitis later in childhood. Antibiotic treatment before six months of age is associated with atopic dermatitis, asthma and inhaled corticosteroid use. What is known: • The use of antibiotics early in life has been associated with an increased risk of developing atopic dermatitis or asthma. • Confounding by indication or reverse causation may underlie the observed associations. What is new: • Our results demonstrate that neonatal antibiotic therapy for confirmed or clinically diagnosed infection was associated with increased risk of atopic dermatitis and antibiotic treatment before six months of age was associated with atopic dermatitis, asthma and inhaled corticosteroid use in analyses adjusted for confounding factors. [ABSTRACT FROM AUTHOR]

Introduction: Non Invasive Ventilation (NIV) is an effective ventilatory measure in the exacerbation of Chronic Obstructive Pulmonary Disease (COPD). However, the response among some patients is not favourable, leading to a requirement for invasive ventilation. This not only increases hospital stays but is also reported to elevate mortality rates. Therefore, there is a need for a scoring system that predicts NIV failures. The Heart rate, Acidosis, Consciousness, Oxygenation and Respiratory rate (HACOR) score is a promising tool that has demonstrated excellent predictive power in detecting early NIV failure. Aim: To predict NIV failure based on the HACOR score at two hours after the initiation of NIV in patients admitted for acute exacerbation of COPD with type 2 respiratory failure. Materials and Methods: The present hospital-based cross-sectional study was conducted in the Department of Pulmonary Medicine, Government Hospital for Chest and Communicable Diseases, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India, from November 2023 to April 2024. A total of 70 patients admitted with acute exacerbation of COPD and type 2 respiratory failure were included. All five variables of the HACOR score were measured two hours after the initiation of NIV to predict early NIV failure. These variables include heart rate, arterial blood pH, Glasgow Coma Scale (GCS) score (consciousness), oxygenation and respiratory rate. After the initiation of NIV, the HACOR score was evaluated at various intervals. The diagnostic accuracy of the HACOR score in predicting NIV failure was recorded, which was the main outcome of the study. Receiver Operating Characteristic (ROC) curve and Youden index were applied. The dependent variables were analysed using the Youden index to obtain the best cut-off value of the HACOR score. Results: Out of 70 patients, 66 (94.3%) were males and 4 (5.7%) were females, with a mean±Standard Deviation (SD) age of 68.5±6.1 years. The study reported a 27.1% (19 patients) NIV failure rate based on the HACOR score measured after two hours of NIV. The total study population was divided into two groups based on the measured HACOR score cut-off value of 5. A total of 33 patients had a score ≥5, while 37 patients had a score <5. Among the group with a score ≥5, 17 (51.5%) patients experienced NIV failure. In the group with a score <5, 2 (5.4%) patients had NIV failure. The area under the ROC curve (AUROC) for the entire population was 0.899 for a score ≥5, with a sensitivity of 89.47% and a specificity of 86.27% in determining the outcome of NIV. Conclusion: The HACOR score is a simple bedside test that can effectively predict early NIV failure with good predictive power. A score ≥5 at two hours after the initiation of NIV therapy can be considered a cut-off value for predicting NIV failure. [ABSTRACT FROM AUTHOR]

The California Department of State Hospitals and Department of Public Health collaborated to develop infection control programs in five inpatient psychiatric hospitals in response to COVID-19. In the retrospective observational study described here, conducted from March 2020 through February 2023, we calculated seven-day rolling averages of COVID-19 cases overlaid with key interventions, communication strategies, and policies implemented to break down silos for a consistent and coordinated response. Our findings may inform others regarding effective strategies and partnerships with public health experts during future outbreaks. (Am J Public Health. 2024;114(12):1317–1321. https://doi.org/10.2105/AJPH.2024.307846) [ABSTRACT FROM AUTHOR]

Background: Public health and social measures (PHSMs) are considered the most effective approaches for controlling epidemic diseases. This study aimed to explore variations in the time‐dependent characteristics of and public preferences for cosmetic treatments during and after the implementation of PHSMs during the COVID‐19 pandemic. Method: Medical records from six medical institutions were extracted retrospectively. Time–series analyses were conducted to reveal the variations in characteristics in volume and proportion of cosmetic treatments according to PHSMs. A cross‐sectional study was conducted with online questionnaire designed for the general population during and after the implementation of PHSMs. Result: A total of 141 033 records were included in this retrospective study. The implementation of PHSMs led to extremely low treatment volumes; compared with the increases in private hospitals, the treatment volumes in public hospitals exhibited earlier and more significant increases, even higher than pre‐PHSM levels (p < 0.05), which mainly contributed to the increase in plastic surgery volumes during and after the implementation of PHSMs. The differences in the anxiety state, self‐perceived appearance, and cosmetic treatment intentions of the participants were illustrated during and after PHSMs. We further demonstrated the participants' decisions on cosmetic treatments after the implementation of PHSMs during the COVID‐19 pandemic. Conclusion: The immediate effects and aftereffects of PHSMs on cosmetic treatments were different in public and private hospitals. Furthermore, as PHSMs guided the adjustment of cosmetic treatments in the post‐COVID‐19 era, the intention to undergo cosmetic treatment during PHSMs was associated with the anxiety states and preferences of the population. [ABSTRACT FROM AUTHOR]

Background: Intrahepatic bile duct stones, although common and benign, require varying therapeutic strategies due to their recurrent nature. Inadequate management can escalate to liver cirrhosis or cholangiocarcinoma. A surgical method merging indocyanine green fluorescence imaging (ICG-FI) with liver cone unit resection is optimal, ensuring complete lesion removal and healthy liver tissue conservation. Method: A retrospective descriptive study was conducted on 15 patients with intrahepatic bile duct stones who were admitted to Sichuan Provincial People's Hospital from January 2021 to December 2023. All patients underwent laparoscopic anatomical liver resection guided by ICG-FI. Results: Among the 15 patients included in the study, ten were male and five were female, with an average age of 52 years. All patients were free from underlying medical conditions. Intraoperatively, ICG-FI was good, with clear boundaries, and all patients successfully underwent surgery without any conversions to open surgery. The mean operative time was 236 ± 56 min, and the estimated blood loss was 320 ± 75 ml. Patients had a postoperative hospital stay of 5.5 ± 1.5 days. No severe complications occurred. Conclusions: Real-time ICG-FI with anatomical liver resection is a safe and effective approach for managing intrahepatic bile duct stones. [ABSTRACT FROM AUTHOR]

This study aimed to estimate participation in private breast screening in Queensland, Australia, where public-funded screening is implemented, and to identify factors associated with the screening setting, using an online survey (999 female respondents aged 40–74). Screening-specific and socio-demographic factors were collected. Multivariable logistic regression was used to identify factors associated with screening setting (public vs private) and screening recency (<2 vs ≥2 years). Participation estimates were 53.2% (95% confidence interval, CI: 50.0%–56.3%) and 10.9% (9.0%–13.0%) for national screening program and private screening, respectively. In the screening setting model, participation in private screening was significantly associated with longer time since last screening (>4 versus <2 years, odds ratio (OR) = 7.3, 95%CI: 4.1–12.9, p < 0.001), having symptoms (OR = 9.5, 5.8–15.5, p < 0.001), younger age (40–49 versus 50–74 years, OR = 1.8, 1.1–3.0, p = 0.018) and having children <18 years in household (OR = 2.4, 1.5–3.9, p < 0.001). In the screening recency model, only screening setting was statistically significant and private screening was associated with screening recency ≥2 years (OR = 4.0, 2.8–5.7, p < 0.001). Around one in nine women screen outside of the BreastScreen Queensland program. Clinical and socio-demographic factors associated with participation in private screening were identified, providing knowledge relevant to the program's endeavours to improve screening participation. [ABSTRACT FROM AUTHOR]

L'hôpital public est nécessaire aux patients présentant les souffrances psychiques les plus graves. Au sein d'une institution, les symptômes des uns impactent le fonctionnement collectif, entre contre-attitudes, projections scissionnelles, etc. Nous savons depuis Jean-Étienne Esquirol que l'hôpital peut être soignant en lui-même, s'il est investi par des soignants « habiles ». À l'heure d'une restructuration de l'hôpital public, les outils issus du champ de la psychothérapie institutionnelle peuvent-ils participer à « soigner l'hôpital pour qu'il devienne soignant », selon l'aphorisme d'Hermann Simon ? Nous proposons d'articuler des savoirs psychopathologiques aux concepts institutionnels, afin de questionner un possible soin des singularités via le travail collectif. Nous présentons une élaboration théorico-clinique à partir de vignettes cliniques qui tentent de rendre compte de la pratique quotidienne d'un service de psychiatrie publique orienté par la psychothérapie institutionnelle et du soin psychothérapique possible, en institution, de sujets psychotiques. Les concepts issus de la psychothérapie institutionnelle s'appuient sur des psychopathologies psychanalytiques et phénoménologiques qui font l'épreuve de la clinique : notamment les questions d'espace, d'ambiance et de transfert, au cœur de la psychopathologie des psychoses. Ces concepts peuvent être discutés et affinés au regard de l'actualité de la recherche et des pratiques et soutiennent des prises en soins créatives adossées à la logique de secteur. Les outils institutionnels semblent soutenir les équipes soignantes dans leurs accueils de la souffrance psychique. S'ils ne font pas l'objet de positionnements dogmatiques, ils favorisent une alliance thérapeutique au plus près de la subjectivité des acteurs, et permettent une théorisation performative de la pratique quotidienne. Une attention conjointe portée à la psychopathologie et à la clinique institutionnelle contribue à proposer des prises en soin individualisées et à soutenir la singularité et de la subjectivité des patients les plus fragiles et des équipes qui les accompagnent. Public hospitals are necessary for patients with the most severe psychological suffering. Within an institution, the symptoms of some have an impact on the way the group functions, with counter-attitudes, scissionary projections, and so on. Ever since Jean-Étienne Esquirol, we have known that hospitals can be healing in themselves, if they are staffed by "skilled" caregivers. At a time when public hospitals are being restructured, can tools from the field of institutional psychotherapy help to "heal the hospital so that it can heal", in Hermann Simon's aphorism? We articulate psychopathological knowledge with institutional concepts, in order to reflect on how to care for singularities through collective work. We present a theoretical-clinical elaboration based on clinical vignettes that attempt to capture the day-to-day practice of a public psychiatric department oriented towards institutional psychotherapy, and the psychotherapeutic care possible, in an institution, for psychotic subjects. Concepts derived from institutional psychotherapy are based on psychoanalytical and phenomenological psychopathologies that are tested in clinical practice: in particular, questions of space, atmosphere, and transference, at the heart of psychopathology. These concepts can be discussed and refined in the light of current research and practice, and support creative care approaches based on the logic of geographical sectors. Institutional tools seem to support caregiving teams in their response to psychological suffering. If they are not the subject of dogmatic positioning, they encourage a therapeutic alliance that is as close as possible to the subjectivity of the players involved, and enable a performative theorization of daily practice. Joint attention to psychopathology and institutional clinical practice helps to provide individualized care and support for the singularity and subjectivity of the most fragile patients and the teams who work with them. [ABSTRACT FROM AUTHOR]

With the aging of the population and the increase in chronic diseases, there is an inherent risk of polypharmacy and inappropriate medication use. This study aimed to determine the prevalence and incidence of potentially inappropriate medication use and its correlation with polypharmacy. This was a retrospective, population-based cohort study among patients ≥ 65 years hospitalized at The National University Hospital of Iceland from 2010-2020. Data on medication usage were retrieved from the National Prescription Medicine Registry. Based on the number of medications filled in the year prior to admission and post-discharge, participants were categorized as non-polypharmacy (<5), polypharmacy (5-9), and hyper-polypharmacy (≥10). The prevalence and incidence of potentially inappropriate medication use was assessed based on the 2019 Beers criteria. Regression models were used to correlate sociodemographic, clinical, and pharmacoepidemiologic variables and the odds of new potentially inappropriate medication use. The cohort comprised 55,859 patients (48.5% male) with a median [interquartile range] age of 80 [73-86] years. The prevalence of inappropriate medication use in the year preceding admission was 34.0%, 77.7%, and 96.4% for patients with non-polypharmacy, polypharmacy, and hyper-polypharmacy, respectively. The incidence of new potentially inappropriate medication use was 46.7% (95% confidence interval 45.6%-47.6%) among those with no potentially inappropriate medication use pre-admission. Factors associated with higher odds of new potentially inappropriate medication use after discharge were the use of multi-dose dispensing services, dementia, polypharmacy, and hyper-polypharmacy. An increased emphasis is needed to review and reevaluate the appropriateness of medication use among the older population in internal medicine. [ABSTRACT FROM AUTHOR]

There is growing evidence that gambling advertising disproportionately affects those experiencing more severe gambling harm. Such association has been studied by recruiting gamblers using online panels, by analysing registered users' data from gambling websites, and through surveys and focus group interviews. However, it is thought that these methods tend to overestimate gambling severity. The present study employed a sample of gamblers with a verified gambling disorder diagnosis (N = 210, 7.1% females, Mage = 39.4 years) recruited for a period of under two years at a large public hospital. It examined the relationship between self-reported impact of gambling advertising, gambling preference (strategic versus non-strategic) and gambling modality (online versus in-person). The results indicated that higher perceived impact of gambling advertising predicted higher gambling severity, which supports previous findings obtained from non-clinical settings. However, contrary to what was expected, strategic gambling and online gambling were not associated with higher perceived impact of gambling advertising, even though these groups are believed to be exposed to more gambling marketing and advertising from gambling operators. The study aligns well with available scientific evidence proposing further restrictions on gambling advertising regulation due to their disproportionate impact on those already experiencing gambling harm. [ABSTRACT FROM AUTHOR]

Background: Caring practice begins with awareness of the suffering of patients in a given context. Understanding the interrelationship between the perceived ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses is crucial for strengthening the caring competency of nurses. Research aim: This study aimed to examine the associations between the ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses and to investigate the mediating effect of ethical sensitivity on the association between ethical climate and caring efficacy. Research design: This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey that measured the ethical climate, ethical sensitivity and caring efficacy using the Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire-Revised and Caring Efficacy Scale, respectively. Participants and research context: The study recruited 293 nurses from two general hospitals that provided acute in-patient and extended care in Hong Kong. Ethical considerations: Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. Results: Ethical climate was associated with caring efficacy (β = 0.340, p <.001) and ethical sensitivity (β = 0.197, p <.001). After adjusting for ethical climate, ethical sensitivity was associated with caring efficacy (β = 0.860, p <.001). Ethical sensitivity showed a significant mediating effect on the association between ethical climate and caring efficacy (indirect effect = 0.169, 95% confidence interval: 0.097 to 0.261), which accounted for 50% of the total effect. Conclusions: The study reveals the complex and interwoven relationship between contextual and personal factors that affect nurses' caring efficacy from an ethical perspective. It provides insights into the significant roles of ethical climate and ethical sensitivity in strengthening caring efficacy. The results suggest theoretical and clinical implications for professionalisation. [ABSTRACT FROM AUTHOR]

The article in the Indian Journal of Medical Research discusses a study that evaluated prescriptions for adherence to standard treatment guidelines, revealing deviations, particularly with proton pump inhibitors. The study focused on rational use of medicine centers and government/municipal hospital OPDs, suggesting that similar research should be extended to the private sector and IPDs. Clinicians provided recommendations for improvement, including early training in prescription writing for medical graduates. The authors did not use AI technology for manuscript preparation. [Extracted from the article]

Depression is a significant concern for people living with HIV and AIDS as it is associated with negative health outcomes and suboptimal adherence to antiretroviral therapy (ART). To this extent, screening for depression is essential for early detection. The CESD-R-20 is a revised four-factor questionnaire developed to assess depressive symptoms in adults. This study explored the factor structure and psychometric properties of the CESD-R-20 among 685 individuals receiving ART. Data were collected at the Infectious Diseases Clinic of a large public hospital outside Cape Town from participants who had been receiving ART for at least six months. Exploratory factor analysis (EFA) of the CESD-R-20 was performed to identify its underlying factor structure. The EFA revealed a one-factor solution termed "depressive affect," comprising 19 items that encompassed the original factors. This finding suggests that depression is a cohesive construct rather than a collection of interconnected dimensions. The scale exhibited high internal consistency (Cronbach's alpha = 0.95) among the sample of persons living with HIV and AIDS. Our findings indicate that the CESD-R-20 can effectively measure depressive affect as a one-factor scale in South Africans receiving ART. The scale demonstrated strong internal consistency and is suitable for screening for depressive symptoms among persons living with HIV and AIDS. [ABSTRACT FROM AUTHOR]