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Purpose: Surgery wait times after diagnosis of appendicitis are an important factor influencing the success of a patient's treatment. The proposed study will be a quantitative multicenter retrospective cohort design with the primary aim of assessing the difference between appendicectomy wait times between rural and urban hospitals in Western Australia and the effect of this on operative outcomes. Selected outcome measures will be examined by time from initial presentation at an emergency department to the patient being diagnosed and then time of diagnosis to surgery being performed. The secondary aim is to compare rates of negative appendicectomies between hospitals. Methods: Appendicectomy patients will be identified from operating room register by medical student data collectors; then, each respective hospital's emergency room data collection will subsequently be accessed to complete case report forms based on demographics and clinical findings, pre-operative investigations, and management and follow-up. Case report forms with > 95% completeness will be accepted for pooled analysis. The expected duration of retrospective data collection will be 8 months. This study RGS6483 has received HREC approval by the Royal Perth Hospital HREC Ethics Committee, with a waiver of consent obtained and the HREC was notified of amendments to the protocol made on April 21, 2024. Dissemination of results. Data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. No patient-identifiable data will be entered into the system. Results will subsequently be shared via scientific journal publication and presentation at relevant meetings. [ABSTRACT FROM AUTHOR]

Background: To investigate the risk factors of pneumothorax of using computed tomography (CT) guidance to inject autologous blood to locate isolated lung nodules. Methods: In the First Hospital of Putian City, 92 cases of single small pulmonary nodules were retrospectively analyzed between November 2019 and March 2023. Before each surgery, autologous blood was injected, and the complications of each case, such as pneumothorax and pulmonary hemorrhage, were recorded. Patient sex, age, position at positioning, and nodule type, size, location, and distance from the visceral pleura were considered. Similarly, the thickness of the chest wall, the depth and duration of the needle-lung contact, the length of the positioning procedure, and complications connected to the patient's positioning were noted. Logistics single-factor and multi-factor variable analyses were used to identify the risk factors for pneumothorax. The multi-factor logistics analysis was incorporated into the final nomogram prediction model for modeling, and a nomogram was established. Results: Logistics analysis suggested that the nodule size and the contact depth between the needle and lung tissue were independent risk factors for pneumothorax. Conclusion: The factors associated with pneumothorax after localization are smaller nodules and deeper contact between the needle and lung tissue. [ABSTRACT FROM AUTHOR]

Objective: Although disparities have been described in epilepsy care, their contribution to status epilepticus (SE) and associated outcomes remains understudied. Methods: We used the 2010–2019 National Inpatient Sample to identify SE hospitalizations using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM)/ICD‐10‐CM codes. SE prevalence was stratified by demographics. Logistic regression was used to assess factors associated with electroencephalographic (EEG) monitoring, intubation, tracheostomy, gastrostomy, and mortality. Results: There were 486 861 SE hospitalizations (2010–2019), primarily at urban teaching hospitals (71.3%). SE prevalence per 10 000 admissions was 27.3 for non‐Hispanic (NH)‐Blacks, 16.1 for NH‐Others, 15.8 for Hispanics, and 13.7 for NH‐Whites (p <.01). SE prevalence was higher in the lowest (18.7) compared to highest income quartile (18.7 vs. 14, p <.01). Older age was associated with intubation, tracheostomy, gastrostomy, and in‐hospital mortality. Those ≥80 years old had the highest odds of intubation (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.43–1.58), tracheostomy (OR = 2, 95% CI = 1.75–2.27), gastrostomy (OR = 3.37, 95% CI = 2.97–3.83), and in‐hospital mortality (OR = 6.51, 95% CI = 5.95–7.13). Minority populations (NH‐Black, NH‐Other, and Hispanic) had higher odds of tracheostomy and gastrostomy compared to NH‐White populations. NH‐Black people had the highest odds of tracheostomy (OR = 1.7, 95% CI = 1.57–1.86) and gastrostomy (OR = 1.78, 95% CI = 1.65–1.92). The odds of receiving EEG monitoring rose progressively with higher income quartile (OR = 1.47, 95% CI = 1.34–1.62 for the highest income quartile) and was higher for those in urban teaching compared to rural hospitals (OR = 12.72, 95% CI = 8.92–18.14). Odds of mortality were lower (compared to NH‐Whites) in NH‐Blacks (OR =.71, 95% CI =.67–.75), Hispanics (OR =.82, 95% CI =.76–.89), and those in the highest income quartiles (OR =.9, 95% CI =.84–.97). Significance: Disparities exist in SE prevalence, tracheostomy, and gastrostomy utilization across age, race/ethnicity, and income. Older age and lower income are also associated with mortality. Access to EEG monitoring is modulated by income and urban teaching hospital status. Older adults, racial/ethnic minorities, and populations of lower income or rural location may represent vulnerable populations meriting increased attention to improve health outcomes and reduce disparities. [ABSTRACT FROM AUTHOR]

Background: Anemia in pregnancy is considered a significant public health problem. It has an essential role in disabled life and death of pregnant women and their future children, mainly in developing countries. Pregnant women in Yemen in internally displaced camps remain at most exposed to anemia. The aim of this study is to determine the prevalence and associated factors related to anemia among pregnant women in Marib, Yemen. Methods: A cross-sectional study was conducted among 402 pregnant women attending General hospitals from October 2023 to January 2024. The data were collected through structured pretested questionnaire, and via an interview. Laboratory investigations were done. Data Analysis: the data were statistically analyzed through SPSS program (version 21) using descriptive statistics, Chi square test for investigating the association between anemia and the independent factors. Results: The overall prevalence of anemia among study participants was 56.7%. The moderate anemia were the most prevalence among pregnant women (65.8%). Risk factors associated with anemia among pregnant women were displacement, level education, low family income, gestational age, space interval of birth, lack of iron supplementation during pregnancy, and one /zero consumption of monthly meat, liver and vegetables during pregnancy, habits such as taking tea immediately after meal and chewing of khat during pregnancy. Conclusion: prevalence of anemia in this study was public health problem. Several factors were found to be associated with anemia during pregnancy. Measures have to be taken to solve the problem by mass iron supplementation, family planning and health education towards risk factors that were associated with anemia to avoid them. [ABSTRACT FROM AUTHOR]

Background: The mortality rate of pediatric patients who require continuous renal replacement therapy is approximately 42%, and outcomes vary considerably depending on underlying disease, illness severity, and time of dialysis initiation. Delay in the initiation of such therapy may increase mortality risk, prolong intensive care unit stay, and worsen clinical outcomes. Local Problem: In the pediatric intensive care unit of an urban level I trauma children's hospital, continuous renal replacement therapy initiation times and factors associated with delays in therapy were unknown. Methods: This quality improvement process involved a retrospective review of data on patients who received continuous dialysis in the pediatric intensive care unit from January 1, 2017, to December 31, 2021. The objectives were to examine the characteristics of the children requiring continuous renal replacement therapy, therapy initiation times, and factors associated with initiation delays that might affect unit length of stay and mortality. Results: During the study period, 175 patients received continuous renal replacement therapy, with an average initiation time of 11.9 hours. Statistically significant associations were found between the degree of fluid overload and mortality (P <.001) and between the presence of acute kidney injury and prolonged length of stay (P =.04). No significant association was found between therapy initiation time and unit length of stay or mortality, although the average initiation time of survivors was 5.9 hours shorter than that of nonsurvivors. Conclusion: Future studies are needed to assess real time delays and to evaluate if the implementation of a standardized initiation process decreases initiation time. [ABSTRACT FROM AUTHOR]

To examine whether extended compared to standard level of physiotherapy is feasible and has beneficial effects on physical function in ICU survivors. This prospective pilot study with a before and after design included patients discharged from ICU to a surgical ward. The comparison group were recruited between January and April 2019 and received standard level of physiotherapy. The intervention group were recruited between May and December 2019 and received extended physiotherapy, corresponding to 50% additional physiotherapist, working 4 hours per weekday. The intervention participants received an individual rehabilitation plan developed in collaboration with a ward-based physiotherapist, and an extended number of sessions provided by the extra resource included practicing individualized exercises, for example walking and stair climbing. Physical function was measured with the Chelsea Critical Care Physical Assessment tool (CPAx) at ICU discharge, during hospital stay and discharge. Group differences were analyzed using the Mann–Whitney U-test and Chi2 test. Out of 46 eligible patients, 39 (85%) fulfilled the study (comparison n = 12, intervention n = 27) and were included in the final analyses. No adverse events occurred, and the attendance rate was high (98.5%). There were no statistically significant differences between the groups regarding physical function, hospital stay, and readmissions, but there were tendencies to better outcomes in all these parameters in favor of the intervention group. Additionally, patients in the intervention group had statistically significantly higher scores in the CPAx items "transferring from bed to chair" (median 5 vs 4, p =.039) and "stepping" (median 5 vs 4, p =.005) at hospital discharge. This pilot study indicates that extended physiotherapy after ICU discharge is feasible and does not entail patient safety risks. However, determining the potential beneficial effects for the patients remains to be evaluated in a larger trial. [ABSTRACT FROM AUTHOR]

The rise in life expectancy and the resulting increase in the number of older adults raise concerns about the unique challenges that will inevitably arise during this stage of life. Alzheimer's disease is a progressive condition that, if untreated, progresses to more advanced stages. This study aimed to create and evaluate the impact of a memory-enhancing mobile app on the cognitive function of older adults with cognitive dysfunction. The study utilized a quasi-experimental design with a pretest–posttest control group. A total of 42 older adults with Alzheimer's disease were selected using cluster sampling from comprehensive urban health service centers in Larestan county, located in southwest Iran. The intervention group participated in a two-month memory-boosting training program, which included seven components such as repetition and practice. The mobile app was designed to be user-friendly and convenient. The data analysis was conducted using SPSS 25. The research findings showed that the experimental group, who received cognitive stimulation treatment with memory-boosting applications, demonstrated significant improvements in overall cognitive functions and abilities compared to the control group. These improvements were observed in various dimensions, including time and location awareness, recall, attention and calculation, recent memory, language functions, and spatial thinking (P < 0.05). There are no significant differences between demographic variables and cognitive function in the experiment group. Memory-boosting apps can assist older adults in enhancing their cognitive functions, which is crucial for preventing disease progression and promoting adherence to self-care recommendations. Further research is necessary to validate and explore additional impacts of game apps on this demographic. [ABSTRACT FROM AUTHOR]

A recent National Academies report recommended that health systems invest in new infrastructure to integrate social and medical care. Although many health systems routinely screen patients for social concerns, few health systems achieve the recommended model of integration. In this critical case study in an urban safety net health system, we describe the human capital, operational redesign, and financial investment needed to implement the National Academy recommendations. Using data from this case study, we estimate that other health systems seeking to build and maintain this infrastructure would need to invest $1 million to $3 million per year. While health systems with robust existing resources may be able to bootstrap short-term funding to initiate this work, we conclude that long-term investments by insurers and other payers will be necessary for most health systems to achieve the recommended integration of medical and social care. Researchers seeking to test whether integrating social and medical care leads to better patient and population outcomes require access to health systems and communities who have already invested in this model infrastructure. (Am J Public Health. 2024;114(6):619–625. https://doi.org/10.2105/AJPH.2024.307602) [ABSTRACT FROM AUTHOR]

Background: WHO stated the environment is an important factor affecting the development of hospice care. The environment is the sum of factors affecting behavior besides the individual factors. Currently, a scale to comprehensively assess the hospice environment of nurse is still lacking. This study aimed to develop an instrument to investigate the environmental factors affecting hospice care of nurses. Methods: Literature review and a semi-structured interview were conducted to form the items pool of the Hospice Care Environment Scale. Two rounds of Delphi expert consultation were conducted by 16 experts to revise the scale dimensions and entries to form the Hospice Care Environment Scale. A psychometric evaluation was then performed among 530 oncology nurses in a large tertiary oncology hospital in Hubei Province. The 500 valid questionnaires were randomly divided into two groups in a 1:1 ratio, sample 1 (n1 = 250) for item screening and sample 2 (n2 = 250) for quality evaluation of the resulting scale. Item analysis, reliability analysis, validity analysis and acceptability analysis were performed. Result: The Hospice Care Environment Scale consists of two dimensions and 13 entries. The Cronbach's α coefficient of the Hospice Care Environment Scale was 0.970, and the Cronbach's α coefficient of the two dimensions were 0.952 and 0.969, respectively, with the Item-content validity index and average Scale- content validity index of the scale was both 1.000. The validation factor analysis showed the standardized path coefficients of each item were basically above 0.5, and the factor structure model was stable and suitable. The average completion time of the scale was about 3 min, which had good feasibility. Conclusion: The Hospice Care Environment Scale to assess the environment of hospice care services, has good content and construct validity and reliability. This scale can provide guidance to evaluate the hospice care environment. [ABSTRACT FROM AUTHOR]

Background: Globally, road traffic accidents are the eighth-leading cause of death for all age groups. The estimated number of road traffic deaths in low income countries was more than three times as high as in high-income countries. Africa had the highest rate of fatalities attributed to road traffic accidents. Ethiopia has the highest number of road traffic fatalities among Sub-Saharan African countries. The main objective of this study was to determine the incidence and predictors of mortality among road traffic victims admitted to hospitals in Hawassa City. Methods: A facility-based retrospective cohort study was conducted using secondary data from hospital records. A total of 398 road traffic accident victims admitted to selected hospitals in Hawassa city from January 2019 to December 2021 participated in the study. Data were analyzed using STATA version 14.1. The Cox regression model was used to determine the predictors of mortality. A hazard ratio with a 95% confidence interval and a cut-off value of P<0.05 was used to declare the risk and statistical significance, respectively. Result: The incidence rate of mortality for road traffic accident victims was 7.34 per 10,000 person-hours. The predictors of mortality were the value of GCS at admission <8 (aHR = 5.86; 95% CI: 2.00–17.19), GCS at admission 9–12 (aHR = 3.27; 95% CI: 1.28–8.40), the value of SBP at admission ≤89mmHg (aHR = 4.41; 95% CI: 2.22–8.77), admission to the ICU (aHR = 3.89; 95% CI: 1.83–8.28) and complications (aHR = 5.48; 95% CI: 2.74–10.01). Conclusion: The incidence of mortality among road traffic victims admitted to hospitals in Hawassa city was high. Thus, thorough follow-up and intensive management should be given to victims with critical health conditions. [ABSTRACT FROM AUTHOR]

Background: The high case-fatality rates among children with tuberculosis (TB) are reportedly driven by in-hospital mortality and severe forms of TB. Therefore, there is need to better understand the predictors of mortality among children hospitalised with TB. We examined the patient clinical profiles, length of hospital stay from date of admission to date of final admission outcome, and predictors of mortality among children hospitalised with TB at two tertiary hospitals in Uganda. Methods: We conducted a case-series study of children below 15 years of age hospitalised with TB, from January 1st, 2016, to December 31st, 2021. Convenience sampling was done to select TB cases from paper-based medical records at Mulago National Referral Hospital (MNRH) in urban Kampala, and Fort Portal Regional Referral Hospital (FRRH) in rural Fort Portal. We fitted linear and logistic regression models with length of stay and in-hospital mortality as key outcomes. Results: Out of the 201 children hospitalised with TB, 50 were at FRRH, and 151 at MNRH. The male to female ratio was 1.5 with median age of 2.6 years (Interquartile range-IQR 1–6). There was a high prevalence of HIV (67/171, 39%), severe malnutrition reported as weight-for-age Z-score <-3SD (51/168, 30%). Among children with pulmonary TB who initiated anti-tuberculosis therapy (ATT) either during hospitalisation or within seven days prior to hospitalisation; cough (134/143, 94%), fever (111/143, 78%), and dyspnoea (78/143, 55%) were common symptoms. Children with TB meningitis commonly presented with fever (17/24, 71%), convulsions (14/24 58%), and cough (13/24, 54%). The median length of hospital stay was 8 days (IQR 5–15). Of the 199 children with known in-hospital outcomes, 34 (17.1%) died during hospitalisation. TB meningitis was associated with in-hospital mortality (aOR = 3.50, 95% CI = 1.10–11.17, p = 0.035), while male sex was associated with reduced mortality (aOR = 0.33, 95% CI = 0.12–0.95, p = 0.035). Hospitalisation in the urban hospital predicted a 0.48-day increase in natural log-transformed length of hospital stay (ln-length of stay) (95% CI 0.15–0.82, p = 0.005), but not age, sex, HIV, malnutrition, or TB meningitis. Conclusions: In-hospital mortality was high, and significantly driven almost four times higher by TB meningitis, with longer hospital stay among children in urban hospitals. The high in-hospital mortality and long hospital stay may be reduced by timely TB diagnosis and treatment initiation among children. [ABSTRACT FROM AUTHOR]

Background: Lack of access to functional and hygienic toilets in healthcare facilities (HCFs) is a significant public health issue in low- and middle-income countries (LMICs), leading to the transmission of infectious diseases. Globally, there is a lack of studies characterising toilet conditions and estimating user-to-toilet ratios in large urban hospitals in LMICs. We conducted a cross-sectional study in 10-government and two-private hospitals to explore the availability, functionality, cleanliness, and user-to-toilet ratio in Dhaka, Bangladesh. Methods: From Aug-Dec 2022, we undertook infrastructure assessments of toilets in selected hospitals. We observed all toilets and recorded attributes of intended users, including sex, disability status, patient status (in-patient/out-patient/caregiver) and/or staff (doctor/nurse/cleaner/mixed-gender/shared). Toilet functionality was defined according to criteria used by the WHO/UNICEF Joint-Monitoring Programme in HCFs. Toilet cleanliness was assessed, considering visible feces on any surface, strong fecal odor, presence of flies, sputum, insects, and rodents, and solid waste. Results: Amongst 2875 toilets, 2459 (86%) were observed. Sixty-eight-percent of government hospital toilets and 92% of private hospital toilets were functional. Only 33% of toilets in government hospitals and 56% in private hospitals were clean. A high user-to-toilet ratio was observed in government hospitals' outpatients service (214:1) compared to inpatients service (17:1). User-to-toilet ratio was also high in private hospitals' outpatients service (94:1) compared to inpatients wards (19:1). Only 3% of toilets had bins for menstrual-pad disposal and <1% of toilets had facilities for disabled people. Conclusion: A high percentage of unclean toilets coupled with high user-to-toilet ratio hinders the achievement of SDG by 2030 and risks poor infection-control. Increasing the number of usable, clean toilets in proportion to users is crucial. The findings suggest an urgent call for attention to ensure basic sanitation facilities in Dhaka's HCFs. The policy makers should allocate resources for adequate toilets, maintenance staff, cleanliness, along with strong leadership of the hospital administrators. [ABSTRACT FROM AUTHOR]

Background/Objectives: Community-acquired pneumonia (CAP) is a common emergency presentation in Australia, with the choice of admitting specialty unit often influenced by pneumonia severity and comorbidities. However, it remains unclear whether there are between-specialty differences in patient characteristics and outcomes. We sought to address this issue by investigating the characteristics and outcomes of CAP patients admitted to General Medicine (GM) versus Respiratory units. Methods: This retrospective observational study utilised data from the two largest metropolitan hospitals in South Australia, encompassing all non-COVID-19-related CAP admissions throughout 2021 to 2023. The hospital length of stay (LOS), in-patient and 30-day mortality, and 30-day readmission rates were assessed by propensity score matching (PSM) using 17 variables. Results: Of the 3004 cases of non-COVID-19 CAP admitted across the two hospitals during the study period, 2673 (71.8%) were admitted under GM units and 331 (9.1%) under Respiratory units. GM patients were, on average, a decade older, presented with a significantly higher burden of comorbidities, exhibited a greater prevalence of frailty, and had higher pneumonia severity compared to those admitted under a Respiratory unit (p < 0.05). Unadjusted analysis revealed a shorter median LOS among GM-admitted patients (5.9 vs. 4.1 days, p < 0.001). After PSM adjustment, patients admitted under the Respiratory units had an 8-fold higher odds of a longer LOS compared to GM (adjusted odds ratio [aOR] 8.53, 95% CI 1.96–37.25, p = 0.004). Other clinical outcomes were comparable between the two groups. Conclusions: Our findings indicate that GM units compared to Respiratory units provide efficient and safe care for patients requiring hospitalisation for CAP. [ABSTRACT FROM AUTHOR]

Background: Distal radius fractures (DRFs) have become a public health problem for all countries, bringing a heavier economic burden of disease globally, with China's disease economic burden being even more acute due to the trend of an aging population. This study aimed to explore the influencing factors of hospitalization cost of patients with DRFs in traditional Chinese medicine (TCMa) hospitals to provide a scientific basis for controlling hospitalization cost. Methods: With 1306 cases of DRFs patients hospitalized in 15 public TCMa hospitals in two cities of Gansu Province in China from January 2017 to 2022 as the study object, the influencing factors of hospitalization cost were studied in depth gradually through univariate analysis, multiple linear regression, and path model. Results: Hospitalization cost of patients with DRFs is mainly affected by the length of stay, surgery and operation, hospital levels, payment methods of medical insurance, use of TCMa preparations, complications and comorbidities, and clinical pathways. The length of stay is the most critical factor influencing the hospitalization cost, and the longer the length of stay, the higher the hospitalization cost. Conclusions: TCMa hospitals should actively take advantage of TCMb diagnostic modalities and therapeutic methods to ensure the efficacy of treatment and effectively reduce the length of stay at the same time, to lower hospitalization cost. It is also necessary to further deepen the reform of the medical insurance payment methods and strengthen the construction of the hierarchical diagnosis and treatment system, to make the patients receive reasonable reimbursement for medical expenses, thus effectively alleviating the economic burden of the disease in the patients with DRFs. [ABSTRACT FROM AUTHOR]

Background: Pain is the most misunderstood, underdiagnosed, and undertreated/untreated medical problem, particularly in children. The main aim of this study was to assess practice and factors associated with pediatrics pain management among nurses working in Bahir Dar city public hospitals, Amhara region, North West Ethiopia, 2022. Method: An institutional-based cross-sectional concurrent mixed study design was conducted on randomly selected 421 nurses from November 1 to 30/2022. Purposively selected 8 nurses in different positions and qualifications were included in a qualitative study. A structured self-administered questionnaire and a semi-structured in-depth interview questionnaire were used for data collection. Epi info version 7.1 was used for data entry and SPSS version 25 was used for analysis. ATLAS ti version 7.0 and thematic analysis were used for qualitative study. Binary logistic regression was done to identify predictor variables associated with outcome variables at p <0.05 with a 95% confidence interval. Hosmer and Lemeshow's tests were checked for model goodness of fit, which was 0.71. Result: The good practice of pediatric pain management among nurses for hospitalized children was 216 (53.6%) (95% CI- 48.4% to 58.3%). Knowledge [AOR = 3.95; 95%CI: (2.30, 6.79)], attitude [AOR = 2.57; 95% CI: (1.53–4.30)], qualified in BSC pediatrics and child health nurses [AOR = 6.53; 95%CI: (1.56–27.25)], year of experience in pediatrics unit [(AOR = 1.92; 95% CI: (1.03–3.56)] and gating pain management training [AOR = 3.31; 95% CI: (1.73–6.33)] were significant factors. Four themes inadequate knowledge of pain assessment and management practice, inadequate professional commitment, organization-related factors, and impacts of family knowledge, culture, and economic status were explored. Conclusion: Only half of the participants had good practice. Knowledge, attitude, nurses qualified in BSC pediatrics and child health, years of experience in the pediatrics department, and pain management training were associated factors. From the qualitative findings, the unavailability of anti-pain drugs, lack of training, assessment tools, continuous monitoring and evaluation, updated protocols, shortage of resources, and others were the barriers to proper pain management. This study concludes that applying effective pain management practices to hospitalized children remains a challenge. Therefore, it is better to put further effort towards improving pediatric pain management practice. [ABSTRACT FROM AUTHOR]

Objective: This research aimed to identify the fundamental and geographic characteristics of the primary healthcare personnel mobility in Nanning from 2000 to 2021 and clarify the determinants that affect their transition to non-primary healthcare institutions. Methods: Through utilizing the Primary Healthcare Personnel Database (PHPD) for 2000–2021, the study conducts descriptive statistical analysis on demographic, economic, and professional aspects of healthcare personnel mobility across healthcare reform phases. Geographic Information Systems (QGIS) were used to map mobility patterns, and R software was employed to calculate spatial autocorrelation (Moran's I). Logistic regression identified factors that influenced the transition to non-primary institutions. Results: Primary healthcare personnel mobility is divided into four phases: initial (2000–2008), turning point (2009–2011), rapid development (2012–2020), and decline (2021). The rapid development stage saw increased mobility with no spatial clustering in inflow and outflow. From 2016 to 2020, primary healthcare worker mobility reached its peak, in which the most significant movement occurred between township health centers and other institutions. Aside from their transition to primary medical institutions, the primary movement of grassroots health personnel predominantly directs towards secondary general hospitals, tertiary general hospitals, and secondary specialized hospitals. Since 2012, the number and mobility distance of primary healthcare workers have become noticeably larger and remained at a higher level from 2016 to 2020. The main migration of primary healthcare personnel occurred in their districts (counties). Key transition factors include gender, education, ethnicity, professional category, general practice registration, and administrative division. Conclusions: This study provides evidence of the features of primary healthcare personnel mobility in the less developed western regions of China, in which Nanning was taken as a case study. It uncovers the factors that impact the flow of primary healthcare personnel to non-primary healthcare institutions. These findings are helpful to policy refinement and support the retention of primary healthcare workers. [ABSTRACT FROM AUTHOR]

Background: The risk of infection with avian influenza A viruses currently circulating in wild and domestic birds in the Americas is considered low for the general public; however, detections in humans have been reported and warning signs of increased zoonotic potential have been identified. In December 2022, two Canada geese residing on the grounds of an urban hospital in Maine tested positive for influenza A H5N1 clade 2.3.4.4b. Aims: Given the opportunity for exposure to staff and hospital visitors through potentially infected faeces on the property, public health authorities determined mitigation efforts were needed to prevent the spread of disease. The ensuing response relied on collaboration between the public health and animal health agencies to guide the hospital through efforts in preventing possible zoonotic transmission to humans. Materials and Methods: Mitigation efforts included staff communication and education, environmental cleaning and disinfection, enhanced illness surveillance among staff and patients, and exposure and source reduction. Results: No human H5N1 cases were identified, and no additional detections in birds on the property occurred. Hospital staff identified barriers to preparedness resulting from a lack of understanding of avian influenza A viruses and transmission prevention methods, including avian influenza risk in resident wild bird populations and proper wildlife management methods. Conclusion: As this virus continues to circulate at the animal‐human interface, this event and resulting response highlights the need for influenza A H5N1 risk awareness and guidance for facilities and groups not traditionally involved in avian influenza responses. [ABSTRACT FROM AUTHOR]

Introduction: Pre-discharge home assessments by occupational therapists facilitate safe and timely discharge from hospital and are associated with better health outcomes. Digital technology offers the potential to reduce duplication of documentation and improve communication and sharing of home assessment findings. Objective: This quality improvement project evaluated time-cost; clinician satisfaction and confidence; and acceptability of the use of a digital approach to home assessments. Methods: A prospective, cross-sectional design was used to compare usual practice with the digital approach across two sub-acute wards in a large metropolitan hospital in Queensland, Australia. Time to document and conduct home assessments as well as clinician satisfaction and confidence were compared using descriptive statistics. Clinician perspectives about the home assessment approaches were collected through a survey and analyzed using content analysis. Results: Home assessment and documentation time were significantly lower for the home assessments conducted using the digital approach compared with usual practice assessments. Clinician satisfaction with using digital technology was higher. Conclusions: The introduction of this simple technology reduced clinicians' time to conduct home assessments and document home assessment reports. The project was well received by occupational therapy clinicians. http://links.lww.com/IJEBH/A187 [ABSTRACT FROM AUTHOR]

Objective We determine whether racial concordance between postpartum patients and obstetric providers (dyads) impacts the perception of quality of care among people undergoing intrapartum obstetrical procedures. Study Design This is a prospective cohort study of postpartum people who underwent operative vaginal or cesarean deliveries in the second stage of labor. Participants were asked to identify the race of their primary provider and complete the Interpersonal Processes of Care (IPC) survey, which assesses communication, patient-centered decision-making, and interpersonal style. The association of participant-identified patient–provider racial concordance with IPC scores was determined. The primary outcome was the IPC subdomain related to discrimination, and secondary outcomes included other IPC subdomains and IPC results by participant racial identity (Black, LatinX vs. White). Sociodemographic and biomedical data were extracted from the medical record. Bivariable analyses were performed. Results Of 168 patients who were approached, 107 (63.6%) agreed to participate and 87 (81.3%) completed the survey. The majority (n =49) identified a racially discordant provider. Participants in racially concordant dyads were more likely to be older, White, use English as a primary language, complete a higher degree of education, and have a higher household income when compared with racially discordant dyads. Intrapartum outcomes were not significantly different between groups. Median IPC subtest scores were not significantly different between groups or between racial/ethnic identities. Conclusion There were no significant differences in perceptions of IPC between racially concordant versus discordant dyads. However, there is an ongoing need to further clarify measures of quality of care in high-acuity obstetrical situations to remediate ongoing racial and ethnic disparities in adverse health outcomes. Key Points Racial concordance between patient and clinician has been associated with improved quality of care. There are limited data on racial concordance and perceptions of operative obstetrical care (e.g., operative vaginal delivery). Racial concordance was not associated with differences in patient-perceived quality of care associated with operative obstetrics. [ABSTRACT FROM AUTHOR]

HIV infections disproportionately impact Latinx populations in the United States, yet oral pre-exposure prophylaxis (PrEP) uptake is low. This study was a secondary gendered analysis of interviews with Latina cisgender women (n = 20) recruited from an urban safety net hospital inNew York City between August 2019 and October 2022. All women were indicated for PrEP by the provider. In-depth interviews were conducted with participants in English and Spanish and asked about social determinants of health, sexual partnerships and behaviors, and PrEP-specific enablers and barriers. Secondary thematic content analysis was conducted to identify gender-related factors influencing PrEP uptake. The following themes emerged from the data:structural factors (e.g., employment), partner-related factors, low sexual health knowledge, and resilience and empowerment. Partner-related factors were the most salient; partner infidelity served as reasons for initiating PrEP. Despite being constrained by low power in relationships, women made empowered choices to initiate PrEP and protect themselves. Findings indicated that the impact of gender inequity was an important factor in Latina women's PrEP decision making, pointing to a need to address partner-driven HIV risk, imbalance of power in relationships, and gender norms. [ABSTRACT FROM AUTHOR]

Aggression is a costly public health problem with severe and multi‐faceted negative consequences and thus, identifying factors that contribute to aggression, particularly in understudied populations, is necessary to develop more effective interventions to reduce the public health cost of aggression. The goal this study was to test whether difficulties regulating emotions moderated the association between posttraumatic stress disorder (PTSD) symptoms and aggression in a community sample of predominantly Black females with high levels of trauma exposure. Furthermore, we explored unique relations between PTSD symptom clusters and distinct subscales of difficulties regulating emotions and aggression. The sample included 601 community participants recruited from an urban public hospital. Symptoms were assessed using self‐report measures including the Difficulties in Emotion Regulation Scale (DERS) and Behavioral Questionnaire‐Short. Regression analyses were conducted using PTSD symptoms and total DERS to test their interaction as predictors for aggression (using BQ‐Short). We found that higher levels of PTSD arousal symptoms and difficulty controlling impulses when upset were positively related to aggression. We also conducted an exploratory analysis to examine the association between PTSD symptom clusters using the Alternative Symptom Clusters hybrid model. The results suggest that some PTSD symptoms (externalizing behavior) and some emotion dysregulation processes (difficulties controlling impulses when upset), relate to aggression in independent, rather than multiplicative ways. These results offer insights for new directions of research that focuses on the independent association between specific emotion dysregulation processes and PTSD symptoms on aggression. [ABSTRACT FROM AUTHOR]

Background: Dyspepsia is a common gastrointestinal illness sometimes associated with Helicobacter pylori (H. pylori) infection. Screening and eradicating the bacterium reduces the risk of infection-related complications. The aim of this study was to determine the magnitude of H. pylori infection among dyspeptic patients and the effectiveness of triple eradication therapy at hospitals in Hawassa city, Ethiopia. Results: The prevalence of H. pylori infection was 48.5%. The H. pylori eradication rate using first-line triple therapy was 83.8%. Eradication therapy failure is associated with previous exposure compared to no exposure (AOR: 4.8, 95% CI: 1.37–10.97), a regimen for 10-days compared to 14-days (AOR: 4.05, 95% CI: 1.42–11.55), and self-reported side effects compared to no report (AOR: 2.5, 95% CI: 1.12–5.97). Based on Morisky-eight scale 230 (79.0%) patients were adherent to their triple therapy. Participants with no reports of adverse effects showed increased odds of adherence to triple therapy compared to those who had reports (AOR = 2.45, 95% CI: 1.29–4.62). Conclusions: This study demonstrated that about half of adult dyspeptic patients were infected with H. pylori, and moderate eradication was observed. Factors such as previous history of eradication therapy, duration of the eradication regimen, and perception of potential adverse effects are associated with eradication rate and should be considered during the initiation of eradication therapy. [ABSTRACT FROM AUTHOR]

Objective Delayed cord clamping (DCC) has been recently adopted in neonatal resuscitation. The immediate cardiac hemodynamic effects related to DCC more than 30 seconds was not studied. We aimed to study the effect of DCC at 120 seconds compared with 30 seconds on multiple hemodynamic variables in full-term infants using an electrical cardiometry (EC) device. Study Design Present study is a randomized clinical trial. The study was conducted with full-term infants who were delivered at the Obstetrics and Gynecology Department in Cairo University Hospital. Sixty-eight full term infants were successfully enrolled in this trial. Cardiac output (CO) and other hemodynamic parameters were evaluated in this study by EC device. Hemoglobin, glucose, and bilirubin concentrations were measured at 24 hours. Newborn infants were assigned randomly into group 1: DCC at 30 seconds, and group 2: DCC at 120 seconds, based on the time of cord clamping. Results Stroke volume (SV) (mL) and CO (L/min) were significantly higher in group 2 compared with group 1 at 5 minutes (6.71 vs. 5.35 and 1.09 vs. 0.75), 10 minutes (6.43 vs. 5.59 and 0.88 vs. 0.77), 15 minutes (6.45 vs. 5.60 and 0.89 vs. 0.76), and 24 hours (6.67 vs. 5.75 and 0.91vs. 0.81), respectively. Index of contractility (ICON; units) was significantly increased in group 2 at 5 minutes compared with group1 (114.2 vs. 83.8). Hematocrit (%) and total bilirubin concentrations (mg/dL) at 24 hours were significantly increased in group 2 compared with group 1 (51.5 vs. 40.5 and 3.8 vs. 2.9, respectively). Conclusion Stroke volume and cardiac output are significantly higher in neonates with DCC at 120 seconds compared with 30 seconds that continues for the first 24 hours. Key Points CO is significantly increased with DCC at 120 seconds. SV is significantly increased with DCC at 120 seconds. Such effects continued during the entire 24 hours of life in full-term infants. [ABSTRACT FROM AUTHOR]

Background: Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral. Methods and findings: A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 ± 19 years (mean ± standard deviation); 54% were male, and 75·3% of participants were white, 6·3% were Asian, 1·5% were black, 0·05% were mixed, and 4·6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2·19; 95% confidence interval (CI): [1·31, 3·66]; p = 0·002), 5th (2·02; [1·21, 3·38]; p = 0·05), 6th (2·32; [1·41, 3·83]; p = 0.05), and 8th (2·07; [1·25, 3·42]; p = 0·004)), lived in London (0·40; [0·29, 0·57]; p < 0·001), were male (females 1·52; [1·27, 1·81]; p < 0·001), or were older (0·97; [0·96, 0·97]; p < 0·001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1·99; [1·49, 2·66]; p < 0·001), 5th (1·75; [1·31, 2·33], p < 0·001), 6th (1·85; [1·39, 2·45]; p < 0·001), 7th (1·66; [1·25, 2·21]; p < 0·001), and 8th (1·74; [1·31, 2·31]; p < 0·001) deciles), the North of England or London (North 0·74; [0·62, 0·89]; p = 0·001; London 0·44; [0·35, 0·56]; p < 0·001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0·58; [0·43, 0·79]; p < 0·001; black 0·56; [0·34, 0·92]; p = 0·021), were male (females 1·46; [1·31, 1·62]; p < 0·001), or were older (0·98; [0·98, 0·98]; p < 0·001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups. Conclusions: The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process. In this multi-centre UK wide study including >6000 participants, Chloe Swords and co-workers explore referral patterns for cochlear implantation vary across the UK according to ethnicity and socioeconomics. Author summary: Why was this study done?: • This study was undertaken to investigate referral patterns for cochlear implantation among patients meeting pure tone audiometric threshold criteria in Great Britain and to identify if socioeconomic or ethnic disparities effect the likelihood of referral. What did the researchers do and find?: • Researchers conducted an observational study across 36 secondary care Otolaryngology and Audiology units in Great Britain, focusing on adults who met pure tone audiometric threshold criteria for cochlear implant assessment. • Of 6,171 included adults identified, 36% were informed of their potential eligibility for a cochlear implant, but only 9% were actually referred for assessment. • Referral likelihood was lower for those in more deprived areas, living in London, of male sex, or older age. • Ethnic minorities, particularly of Asian or black backgrounds, were also less likely to be informed about their eligibility. What do these findings mean?: • These data suggest that the majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are not being referred appropriately for cochlear implant assessments, indicating significant disparities in patient management based on socioeconomic status, ethnicity, and sex. • These disparities suggest a need for targeted efforts to improve referral rates among underrepresented groups and to ensure all patients are informed of their treatment options. • Further research is required to understand and address these disparities, with initiatives to ensure informed decision-making, educate healthcare providers, and explore reasons for declining cochlear implant assessments, especially among older ethnic minority groups. • Study limitations include its observational retrospective nature, potential inaccuracies in the reporting of sex and gender, and the impact of the COVID-19 pandemic on referral protocols. [ABSTRACT FROM AUTHOR]

This study aimed to describe the patient experience and incidence of adverse events in unfasted patients undergoing coronary angiography and angioplasty. In addition, to identify any association between duration of fasting and adverse events. Historically, patients were fasted before elective cardiac catheterisation. Routine fasting was not evidence-based, and many centres, including our unit, have discontinued the practice. Patients undergoing cardiac catheterisation at a large urban teaching hospital were invited to participate in a prospective observational cohort study documenting the duration of fasting and incidence of adverse events (n=508). Of these participants, 257 also completed a survey that captured perspectives and opinions regarding not fasting. The mean time since last fluid was 1.9±2.2 hours and for food was 3.9±3.7 hours. The most common adverse event was hypotension (10.0%). Rates of nausea (3.9%) and vomiting (0.6%) were low, and there were no episodes of aspiration. No associations were identified between the time since the last food or fluid and any adverse events. Thematic analysis of survey data yielded three themes: (1) in most, not fasting is preferable to fasting; (2) being able to eat and drink before the procedure positively affected well-being, and (3) one-fifth of the cohort expressed no preference between fasting and non-fasting. Not fasting before cardiac catheterisation is viewed favourably by patients. While this study provides additional evidence that not fasting is safe, event rates are low, and larger multicentre studies are needed for confirmation. [ABSTRACT FROM AUTHOR]

This Department of Social Work Services (the Department) is one of the largest hospital social work departments in the country, with almost 600 staff, in the largest of eight hospitals and one medical school of a major health system. The Department's senior directors (three current and one former) share its innovative and effective collective leadership model that was initially developed in response to a confluence of unprecedented complex events stemming from the Covid-19 pandemic. The experiences of these co-leaders, an evaluation of the model, future internal considerations as its applicability to other health care settings will be discussed. [ABSTRACT FROM AUTHOR]

Objective: First Nations Australians experience a higher burden and severity of Rheumatic Disease with poorer outcomes than the general population. Despite a widely acknowledged need to improve health outcomes, there has been minimal research assessing existing models of care from a First Nations perspective in Australia. The objective of this study was to describe First Nations experiences and barriers and enablers to accessing a hospital‐based adult Rheumatology service in Sydney. Methods: A qualitative study using semi‐structured interviews was undertaken. Patients who self‐identified as First Nations attending the Prince of Wales Hospital Rheumatology Clinic in 2021 were invited to participate. Interviews were conducted face‐to‐face or by telephone using culturally‐appropriate Yarning methods with an Aboriginal Health Worker (AHW) at the request of participants. Thematic analysis was done in consultation with an Aboriginal Reference Group (ARG). Results: Four categories, which encapsulated 11 themes were identified. Participants reported barriers to care such as logistics of the referral process, not feeling culturally safe because of uncomfortable clinic environments and health worker behaviours, inadequate cultural support and community perceptions of the specialty. Enabling factors included family member involvement, AHW support and telehealth consultation. Conclusion: The current model of care perpetuates access challenges for First Nations Australians within rheumatology. Barriers to care include the delayed referral process, limited cultural responsivity in the clinic environment and poor cross‐cultural communication. There is a need for models of care that are co‐designed with First Nations Peoples to address these barriers. Patient and Public Contribution: Participants were First Nations Australians with lived experience attending the rheumatology clinic. All interviewees were offered the opportunity to review their transcripts to ensure trustworthiness of the data. Preliminary thematic analysis was conducted in partnership with the AHW who has over 20 years experience. Following preliminary coding, a list of themes were presented to the ARG for iterative discussion and refinement. The ARG provided community representation and ensured that First Nations voices were privileged in the analysis. It's intended that the findings of this study will support the upcoming co‐design of a First Nations health service for Rheumatology patients. [ABSTRACT FROM AUTHOR]

Background & Objective: In the recent years, the use of clinical ultrasonography (USG) has become very popular among the anesthesiologists. USG guidance plays an important role in the practice of anesthesia to help patient evaluation, improving patient safety and the effectiveness of the procedure. USG guidance in anesthesia has been shown to reduce the complication rate and the frequency of unsuccessful procedures. Although there is a significant amount of data regarding the advantages of using USG in regional anesthesia (RA), there is limited data available on anesthesia assistants’ perspectives on USG. The purpose of this study was to assess the USG usage in RA in the perspective of anesthesia research assistants. Methodology: After approval by the institutional ethics committee, a questionnaire form was sent to one hundred and eighty-four anesthesia assistants via e-mail. The attitudes of anesthesia research assistants towards USG were evaluated using a 5-point Likert scale. Only anesthesiology and reanimation department assistants were included in the study. Results: The mean age of the participants was 28.9 ± 2.1 y (25-35 y). Most (54.9%) of the participants were female and 45.1% were male. Respective units of all participants had an USG device, but only 39% of the participants had access to an USG device specific to RA; 98.4% of the participants used USG in RA (97.8% for peripheral nerve blocks, 28.8% for neuraxial anesthesia). While most participants (99.5%) thought that the use of USG for peripheral nerve blocks was advantageous, fewer participants (54.9%) thought that it was advantageous for neuraxial anesthesia. Only 38.6% of the participants reported that their training was sufficient for USG usage. Approximately half (48.9%) of the resident physicians needed an USG course. There were differences among the hospitals in terms of USG device. USG device specific to RA was more common in city hospitals (50.9%) and university hospitals (40.3%) compared to training and research hospitals (25%). Conclusion: Anesthesia research assistants frequently prefer USG in regional anesthesia. With the removal of barriers to the use of USG, the rate of USG utilization and the success of procedures in regional anesthesia applications can be further increased. [ABSTRACT FROM AUTHOR]

Background. Violence at work against healthcare professionals is a frequent and pervasive problem. There are growing data that indicate nurses are especially susceptible to experiencing violent acts at work. Resilience helps strengthen nursing competency in the proper management of stressful circumstances, like being exposed to workplace violence. Aim. The aim of the study is to assess the impact of resilience on workplace violence among mental health nurses. Method. A cross-sectional research design was used to conduct this study with a convenience sample of 361 nurses recruited from a governmental psychiatric hospital in Saudi Arabia. Tools. Data were collected using two tools: the first tool was the workplace violence questionnaire, which collected nurses' demographic, job, and workplace violence data, and the second was the resilience at work scale to assess nurses' resilience. Results. This survey found that 70.4% of nurses experienced workplace violence in the last year, and fewer than half were resilient at work. Close to one-third (33.5%) of nurses were terrified and confused after workplace violence. The most violent repercussions were psychological (46.8%): dread, tension, and worry. Additionally, 48.8% of nurses exhibited high work resilience. Conclusion. A considerable percentage of mental health nurses encountered instances of violence during the provision of care inside mental health hospital settings. The variables of nationality (non-Saudi nurses), rotating work shift, educational levels, and exhibiting a lower level of resilience were found to have a statistically significant correlation with instances of workplace violence. Recommendation. Training programs and educational initiatives should be developed and implemented to equip nurses with the necessary knowledge and skills to effectively respond to and prevent workplace violence incidents. By providing comprehensive training, healthcare organizations can empower nurses to address and mitigate workplace violence, ultimately creating a safer and more supportive work environment. [ABSTRACT FROM AUTHOR]

Airborne array-interferometric synthetic aperture radar (array-InSAR), one of the implementation methods of tomographic SAR (TomoSAR), has the advantages of all-time, all-weather, high consistency, and exceptional timeliness. As urbanization continues to develop, the utilization of array-InSAR data for building detection holds significant application value. Existing methods, however, face challenges in terms of automation and detection accuracy, which can impact the subsequent accuracy and quality of building modeling. On the other hand, deep learning methods are still in their infancy in SAR point cloud processing. Existing deep learning methods do not adapt well to this problem. Therefore, we propose a Position-Feature Attention Network (PFA-Net), which seamlessly integrates positional encoding with point transformer for SAR point clouds building target segmentation tasks. Experimental results show that the proposed network is better suited to handle the inherent characteristics of SAR point clouds, including high noise levels and multiple scattering artifacts. And it achieves more accurate segmentation results while maintaining computational efficiency and avoiding errors associated with manual labeling. The experiments also investigate the role of multidimensional features in SAR point cloud data. This work also provides valuable insights and references for future research between SAR point clouds and deep learning. [ABSTRACT FROM AUTHOR]

Purpose: Venous thromboembolism (VTE) is a known complication of hip arthroplasty for femoral neck fractures (FNF) with various prophylactic anticoagulants utilized to decrease risk. The purpose of this study was to assess the efficacy and perioperative outcomes associated with aspirin for VTE prophylaxis following arthroplasty for FNF. Methods: Medical records of 1,220 patients who underwent hip hemiarthroplasty (HHA) or total hip arthroplasty (THA) at an urban academic center from 2011 to 2022 were retrospectively reviewed. Patient characteristics and perioperative outcomes, including length of stay (LOS), VTE, 90-day hospital encounters, and discharge disposition, were collected. Outcomes for patients prescribed aspirin (n = 214) were compared to those prescribed non-aspirin VTE prophylaxis (n = 1006) using propensity score matching. Results: Patients who received aspirin had higher rates of THA (36.0 vs 26.7%; p = 0.008). There were no significant risk-adjusted differences in the incidence of VTE (0.5 vs 0.5%, p = 1.000) and 90-day readmissions (10.4 vs 12.3%, p = 0.646) between patients prescribed aspirin and non-aspirin VTE prophylaxis, respectively. Patients prescribed non-aspirin agents had higher rates of non-home discharge (73.9 vs 58.5%; p < 0.001) and longer LOS (143.5 vs 124.9 h; p = 0.005). Sub-analysis of patients prescribed aspirin and non-aspirin prophylaxis based on comorbidity scores demonstrated no difference in VTE incidence for low (0.0 vs 1.6%, p = 1.000) and high scores (0.0 vs 0.0%, p = 1.000), respectively. Conclusion: Aspirin is not associated with increased incidence of VTE after HHA or THA for FNF. Aspirin prophylaxis should be considered in hip fracture patients to mitigate bleeding risk, particularly those with low to intermediate VTE risk. Level of evidence: Level III, Retrospective study. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to explore the experience and perceived value of travel nurses in a children's hospital. BACKGROUND: Children's hospitals face unique challenges related to highly specialized care requirements and workforce expansion limitations. Travel nurses can augment nurse staffing capacity during times of intense demand and may offer insights as organizations seek to strengthen work environments. METHODS: Pediatric travel nurses currently contracted at the hospital were invited to participate in a focus group or interview. Content analysis was used to summarize information and identify themes. RESULTS: From the 56 participants, 5 themes emerged. The themes were financial, flexibility, searching for healthy work environments, nursing care, and solutions. CONCLUSIONS: Hearing the voices of travel nurses may offer valuable feedback to strengthen future professional practice environments. [ABSTRACT FROM AUTHOR]

Background and Aims: Accurate case discovery is critical for disease surveillance, resource allocation and research. International Classification of Disease (ICD) diagnosis codes are commonly used for this purpose. We aimed to determine the sensitivity, specificity and positive predictive value (PPV) of ICD‐10 codes for opioid misuse case discovery in the emergency department (ED) setting. Design and Setting: Retrospective cohort study of ED encounters from January 2018 to December 2020 at an urban academic hospital in the United States. A sample of ED encounters enriched for opioid misuse was developed by oversampling ED encounters with positive urine opiate screens or pre‐existing opioid‐related diagnosis codes in addition to other opioid misuse risk factors. Cases: A total of 1200 randomly selected encounters were annotated by research staff for the presence of opioid misuse within health record documentation using a 5‐point scale for likelihood of opioid misuse and dichotomized into cohorts of opioid misuse and no opioid misuse. Measurements Using manual annotation as ground truth, the sensitivity and specificity of ICD‐10 codes entered during the encounter were determined with PPV adjusted for oversampled data. Metrics were also determined by disposition subgroup: discharged home or admitted. Findings There were 541 encounters annotated as opioid misuse and 617 with no opioid misuse. The majority were males (54.4%), average age was 47 years and 68.5% were discharged directly from the ED. The sensitivity of ICD‐10 codes was 0.56 (95% confidence interval [CI], 0.51–0.60), specificity 0.99 (95% CI, 0.97–0.99) and adjusted PPV 0.78 (95% CI, 0.65–0.92). The sensitivity was higher for patients discharged from the ED (0.65; 95% CI, 0.60–0.69) than those admitted (0.31; 95% CI, 0.24–0.39). Conclusions: International Classification of Disease‐10 codes appear to have low sensitivity but high specificity and positive predictive value in detecting opioid misuse among emergency department patients in the United States. [ABSTRACT FROM AUTHOR]

This study aimed to identify the level of satisfaction of patients who attend private Yemeni hospitals operating in the town of Rada'a, know the impact of electronic marketing for health services in gaining patient satisfaction, analyze the correlations between electronic marketing and patient satisfaction, and know the trends in the answers of the sample members especially in the role of electronic marketing for health services. The study relied on the descriptive analytical approach and distributed a questionnaire to a purposive sample of (51) patients receiving treatment at private Yemeni hospitals operating in the town of Rada'a The study reached a number of conclusions, the most important of which is the existence of a positive, statistically significant impact relationship between the dimensions of electronic marketing, electronic product, online promotion - website design for health services in gaining the satisfaction of patients who attend such hospitals, with the exception of the relationship of pricing health services through online in gaining patient satisfaction, which was an inverse relationship [ABSTRACT FROM AUTHOR]

Objectives: Screening for parental adverse childhood experiences (ACEs) in pediatric settings can be burdensome because of the questionnaire's length and sensitive nature. Rapid screening tools may help address these challenges. We evaluated a 2-item short ACE measure developed for adults in a cross-sectional sample of mothers of young children in an urban pediatric emergency department. Methods: From January 2011 to March 2020, we administered the ACE questionnaire in English or Spanish to 3999 biological mothers of children aged <4 years in a pediatric emergency department in Philadelphia, Pennsylvania. We assessed sensitivity and specificity of a shortened 2-item ACE measure defined as report of childhood emotional abuse and/or household substance use, using 4+ ACEs on the full questionnaire as the standard. We assessed convergent validity by comparing associations of the 2-item and standard measures with maternal, household, and child outcomes using adjusted log-binomial regression. Results: Mothers were racially and ethnically diverse (54% Latina, 35% Black non-Latina); 94% of children were publicly insured. Thirteen percent of mothers reported childhood emotional abuse and 16% childhood household substance use; 23% reported at least 1 of these and 6% both. Compared with 4+ ACEs on the full questionnaire, the 2-item measure had sensitivity 88% and specificity 90%. In adjusted models, high adversity was associated with poor maternal, household, and child outcomes. Conclusions: A 2-item ACE measure assessing childhood emotional abuse and household substance use may be useful in pediatric settings to identify mothers who may have experienced significant child adversity and inform development, testing, or provision of comprehensive family supports. [ABSTRACT FROM AUTHOR]

High levels of uncompensated care impact hospital profitability and may create challenges for rural hospitals at financial risk of closure. We explore 2019 hospital uncompensated care as a percentage of operating expenses and draw comparisons at a state level by Medicaid expansion status and rural classification. We further compare uncompensated care in 2019 to 2014 in rural hospitals by Medicaid expansion implementation timing. We found that, overall, rural hospitals had more uncompensated care than urban hospitals in 2019 (3.81% vs. 3.12%), but there was a larger difference by expansion status (expansion states: 2.55% vs. non-expansion states: 6.28%). In all but seven states, rural hospitals reported higher uncompensated care than urban, and the 14 states with the highest uncompensated care had not expanded Medicaid. We observed that rural hospital uncompensated care in non-expansion states increased between 2014 and 2019, while the most dramatic decrease occurred in late-expansion states. [ABSTRACT FROM AUTHOR]

Background: Most published reports analysing the differences in causation of stillbirth between different ethnic groups focus on stillbirth risk factors, with a paucity of data comparing actual causes of stillbirth. Aims: To determine whether causes of stillbirth differ between Caucasian and non‐Caucasian ethnic groups in an Australian context. Materials and Methods: Data from all stillbirths occurring at 20 or more completed weeks of gestation between 1 January 2010 and 31 December 2020 at a secondary level, outer metropolitan hospital, were analysed in this retrospective case series. Causes of stillbirth as determined by perinatal autopsy and placental histopathology were categorised using the Perinatal Society of Australia and New Zealand Perinatal Death Classification and compared between Caucasian and non‐Caucasian groups. Results: Ninety‐two stillbirths (0.7% of all births) were identified during the study period. A greater proportion of non‐Caucasian women had small for gestation age placentas compared to Caucasian women (n = 22/43 (51%) vs n = 12/49 (24%); P = 0.025). A greater proportion of stillbirths were caused by hypoxic peripartum death in non‐Caucasian than in Caucasian women (n = 4/43 (9%) vs n = 0/49 (0%); P = 0.044), and a greater prevalence of placental dysfunction was seen in the non‐Caucasian cohort compared to Caucasian women (n = 14/43 (33%) vs n = 8/49 (16%); P = 0.057). Conclusions: The differences observed in causes of stillbirth between Caucasian and non‐Caucasian women are hypothesis generating and warrant further larger‐scale, multi‐centred studies using standardised definitions and classification systems to determine whether these differences persist in a more representative sample. [ABSTRACT FROM AUTHOR]

Interpretation of the electrocardiogram (ECG) is fundamental in the practice and teaching of emergency medicine. Previous studies have shown that providers of all levels have expressed interest in additional education with ECGs. Asynchronous learning has been shown to be beneficial for improving residents' ability to recognize findings of acute myocardial ischemia. The goal of the study was to know whether a new format based on free, online content would improve residents' ability to interpret ECGs. In this 1-year educational pilot study at a single urban teaching hospital, resident physicians participated in a longitudinal curriculum based on free, online content, which was delivered to them electronically on a weekly basis. The study was conducted during the 2016–2017 academic year. Prior to and after the study period, their subjective attitudes toward ECG interpretation, and their objective ability to interpret them successfully, were assessed. Of 42 residents, 25 (59.5%) completed the pre- and post-ECG testing. During the study period, trainees demonstrated improvement in both their subjective attitude toward ECG interpretation and their objective ability to interpret various abnormalities. Despite some important limitations, we believe this study represents an essential step in the development of training methods for the modern emergency medicine trainee. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the utility of a novel ultrasound index "combined utero-cervical index (CUCI)" in the prediction of preterm delivery. Methods: The present prospective cohort study was conducted in Ankara Bilkent City Hospital Perinatology Clinic between January 1, 2023, and March 31, 2023. Pregnant women with uterine contractions between 24 and 36th gestational weeks but did not have dilatation or effacement were included. CUCI was calculated as: (utero-cervical angle)/(anterior cervical lip thickness + fundal thickness + lower uterine segment thickness + cervical length). In the presence of cervical funneling, one point was added to the final result. A ROC analysis was conducted to determine the potential of CUCI in predicting delivery <37 weeks of gestation, <34 weeks of gestation, and <4 weeks after the first admission to the hospital for uterine contractions, respectively. Results: Optimal cut-off values of CUCI were found to be 1.4 (67.1% sensitivity, 67.2% specificity) for predicting delivery at <37th weeks, 1.7 (72.7% sensitivity, 65.7% specificity) for predicting delivery at <34th weeks, and 1.4 (62.5% sensitivity, 61.7% specificity) for predicting delivery at <4 weeks. Conclusion: CUCI may be used in the prediction of preterm delivery for pregnant women admitted to hospital with preterm uterine contractions. [ABSTRACT FROM AUTHOR]

Background: The incidence of colorectal cancer (CRC) in sub-Saharan Africa (SSA) is rising, due to improving cancer registration efforts on one hand and an increasing westernisation of diets and lifestyle on the other as well as increasing rates of comorbidities. Methods: We present data for the clinical characteristics, pathology, treatments received, and survival outcomes of patients diagnosed with CRC at King Faisal Hospital (KFH) between January 2019 and May 2023. KFH is an urban tertiary hospital in Rwanda that provides chemotherapy and surgery to cancer patients. The data were extracted from electronic medical records, imaging and histopathology reports from the patient’s time of diagnosis. We plotted Kaplan–Meier estimation of survival, defined as the time from presentation to death, within the study period (2019–2023). Results: Seventy-four patients diagnosed with CRC with complete information were identified in the KFH oncology records. The mean age at diagnosis was 54.6 years, with ages ranging between 22 and 81 years. At diagnosis, 24 (32.4%) patients were less than 50 years old and 29 (39.2%) were females. The rectum (36.5%) was the most common tumour location, and 58.1 tumours were left-sided. Most patients presented with Stage III (41.9%) or IV (35.1%) disease. Adenocarcinoma was the most common histological type (98.6%) including adenocarcinoma not otherwise specified (NOS) (86.5%), mucinous adenocarcinoma (10.8%), signet ring cell carcinoma (1.4%) and followed by squamous cell carcinoma (1.4%). In terms of treatment, 19 (25.7%) patients received only chemotherapy, 43 (58.1%) patients received neo-adjuvant or adjuvant chemotherapy, 9 (12.2%) of patients received both neo-adjuvant and adjuvant chemotherapy, 49 patients (66.2%) underwent surgery and 17 (23%) patients also received radiation. At the end of the follow up period, 63 (85.1%) patients remained in surveillance, 10 (13.5%) patients died, and 1 (1.3%) patient was lost to follow up. Mean overall survival was 45.5 (SD ± 2.0) months. Conclusion: CRC patients presented at an advanced stage and required complex treatment regimens at KFH. Further epidemiologic and molecular research is needed to characterise CRC incidence and presentation at a national level in Rwanda as increasing westernisation continues to change the face of CRC in urban areas of SSA. [ABSTRACT FROM AUTHOR]

Background: Doctors are at high risk of developing hemorrhoidal disease (HD), but it is unclear whether doctors are aware of this risk. The OASIS (dOctors AS patIentS) study was performed to examine the prevalence, awareness, diagnosis, and treatment of HD among doctors in big cities in China. Methods: An online survey consisting of a structured questionnaire was carried out among doctors in grade-A tertiary hospitals in 29 provinces across China from August to October 2020. Results: A total of 1227 questionnaire responses were collected. HD prevalence was 56.8%, with a significant difference between internists and surgeons (P = 0.01). 15.6% of doctors with HD didn't have serious concerns about the recurrence and severity of HD. 91.5% of doctors adopted general treatments, and 83.0% considered oral medications only when topical medications were ineffective. Among the oral medications, Micronized Purified Flavonoid Fraction (MPFF) was most effective based on the scores from three important parameters, but only 17% of doctors received MPFF. Conclusions: Doctors are at higher risk of developing HD with a high prevalence among Chinese doctors, but they are not fully aware or not concerned about HD. There is a deficiency in treatment recommendations and clinical management of HD even for doctors, including late initiation and inadequate oral drug therapy. Therefore, awareness and standardized treatment of HD should be improved among Chinese doctors, as well as in the general population. [ABSTRACT FROM AUTHOR]

Patient satisfaction reflects the patient's attitude towards care consisting of emotions and perceptions of the health services provided to them, because patient satisfaction will influence patient loyalty. This research design was carried out with an analytical survey using a quantitative approach using cross sectional research, namely research carried out at the same time which aims to analyze and find out how service quality influences the level of patient satisfaction on patient loyalty. The sample in this study is the population of inpatients in 2022, namely 9,526 patients, the sampling was 276 patients, by calculating the sample size using the Lemeshow formula. The sampling technique used in this research uses the accidental sampling technique, namely a sampling technique based on chance, that is, anyone who meets the researcher by chance can be used as a sample. Based on the research results, there is a relationship between reliability and patient loyalty with statistical test results (p=0.000). Assurance has a significant relationship with patient loyalty and statistical test results (p=0.000), and empathy has a significant relationship with patient loyalty with statistical test results (p=0.000). There is no significant relationship between physical evidence (tangible) on patient loyalty and statistical test results (p=1.000), responsiveness has no relationship on patient loyalty and statistical test results (p=0.698). Researchers' recommendations relate to patient satisfaction and patient loyalty at RSUP Dr. Tadjuddin Chalid Makassar City, to further improve the services needed by the community in general. [ABSTRACT FROM AUTHOR]

Background & Objective: COVID-19 forced us to develop adaptive ways to the new normal of healthcare delivery. Neurology has one of the most diverse types of patients who require urgent, prolonged and multidisciplinary care. This study aimed to understand the impact of the unprecedented community lockdown among patients with chronic and new onset neurologic conditions on emergency room (ER) utilization in a single tertiary hospital in Makati City, Philippine. Methods: We retrospectively examined all consecutive neurology referrals made at the ER from March to August 2020 and compared them with a control group consisting of all ER neurology referrals during the same months in 2019. Results: There was a 45% decline in the volume of referral to neurology service at the ER during the first 6 months of the lockdown period. There were fewer females who sought emergency neurologic care (p=0.019). The average age of patients increased from 55.5 years (σ=19.9) in 2019 to 59.5 years (σ=18.4) in 2020 (p<0.001). The top three chief neurologic complaints in 2019 were dizziness (17.7%), motor weakness (14.1%), and headache (13.2%). In 2020, the top three neurologic complaints where motor weakness (19.0%), decreased level of consciousness or loss of consciousness (13.2%), and dizziness (11.2%), (p<0.001). The average time from symptom onset to ER admission in 2019 was 5.1 days (σ=23.9) which increased to 8.4 days in 2020(σ=28.1), (p<0.001). The proportion of patients with no co-morbidities at the ER decreased from 27.6% in 2019 to 17.0% in 2020 (p<0.001). Patients with pre-existing cardiovascular diseases, endocrine diseases, pulmonary diseases, renal diseases, cancers, and others have significantly increased (p<0.05). However, the increase in the proportion of patients with pre-existing neurological disorders (p=0.143) was not statistically significant (p>0.05). The only pre-existing neurologic conditions with significantly increased in proportion was stroke (p=0.010). Among new onset neurologic diagnoses, headache and facial pain (p<0.001) and peripheral and other neuropathies (p=0.005) significantly decreased in proportions while proportions of cases with new stroke or vascular pathology (p<0.001) and encephalopathy (p=0.003) have significantly increased. ER dispositions showed a significant (p<0.001) decrease in proportions of patients who were admitted, discharged, and transferred to hospital of choice; while patients who were discharged against medical advice and who died at the ER have significantly increased. Conclusion: The initial six months of community lockdown during COVID-19 pandemic caused a significant change in the characteristics of patients referred to neurology for emergency care. These changes provide us a new perspective on how to better deliver optimal neurologic care to these diverse patients especially during times of pandemic. [ABSTRACT FROM AUTHOR]

PURPOSE: To explore the impact of disruptions in information processing (DIPs) on social roles, well-being, and quality of life (QOL) in breast cancer survivors after chemotherapy. PARTICIPANTS & SETTING: Experiences of DIPs were explored in eight breast cancer survivors aged 53-70 years, 12-60 months post-treatment, referred from a National Cancer Institute-designated cancer center and a nonprofit breast cancer support organization from January 6 to August 31, 2020. METHODOLOGIC APPROACH: This study used a mixed-methods approach. Participants journaled and answered questionnaires sent via mail that asked them about changes in their cognition, QOL, and social roles. Qualitative data were thematically analyzed using constant comparative analysis, and questionnaire scores were compared with qualitative data. FINDINGS: Journals revealed problems with functioning in occupational roles and increased stress, anxiety, and frustration. Women with more DIPs tended to have lower role satisfaction and QOL. Greater role satisfaction was associated with higher QOL and social role participation. IMPLICATIONS FOR NURSING: Mitigating the effects of DIPs on social function may allow women to continue in important roles, which has the potential to affect QOL. [ABSTRACT FROM AUTHOR]

Biotinidase deficiency (BD) is an autosomal recessive inherited metabolic disorder which results from the inability of biotin-dependent carboxylase enzymes to function due to the release and absorption of biotin, leading to neurological and cutaneous findings. In the present study, evaluation of demographic characteristics, clinical findings, laboratory results, molecular genetic characteristics, and genotype–phenotype correlations of cases with BD. Two hundred forty-seven cases were included in the study who were admitted to the Department of Pediatric Metabolism of Ankara Bilkent City Hospital after being identified with potential BD through the Newborn Screening Program (NBS), during family screening or based on suspicious clinical findings, or following the detection of a pathogenic variant in a BTD genetic analysis during the period of October 2020 and February 2022. The medical files of the cases were reviewed retrospectively. An analysis of the admission routes of all cases to our clinic revealed 89.5% NBS, 5.7% family screening, and 4.9% suspicious clinical findings suggestive of BD. Complete enzyme deficiency was identified in 19.8%, partial enzyme deficiency in 55.1%, and heterogenous enzyme deficiency in 9.7%. The most common pathogenic variants were c.1270G > C (p.Asp424His), c.410G > A (p.Arg137His), and c.38_44delGCGCTGinsTCC (p.Cys13Phefs*36) in BTD gene. The c.1270G > C variant was most common in patients with cutaneous symptoms. The c.410G > A and c.38_44delGCGCTGinsTCC variants were more common in the patients with neurological symptoms. The mean activity level in patients with the c.1270G > C homozygous variant was statistically significantly higher than the mean activity level in the c.1270G > C compound heterozygous patients and the activity level of patients without the c.1270G > C variant. The mean activity level in c.410G > A homozygous patients was statistically significantly lower than the mean activity level of the c.410G > A compound heterozygous patients and the activity level of patients without the c.410G > A variant. In the course of our study, four new pathogenic variants were detected, namely: c.190G > A (p.Glu64Lys), c.249 + 5G > T, c.228delA (p.Val77*), and c.682A > G (p.Ile228Val). Conclusions: The present study has determined the clinical and genetic spectrum of a large group of patients with BD in a single center. The frequent mutations in our study were similar to those reported in literature, and four novel variants were also described. What is Known: • Biotinidase deficiency is an autosomal recessive, treatable inborn error of metabolism. Two hundred ninety-four pathogenic variants in the BTD gene have been identified and the c.1270G > C variant is the most frequent BTD gene mutation in both Turkey and around the world. What is New: • Four new pathogenic variants (c.190G > A, p.Glu64Lys; c.249 + 5G > T; c.228delA, p.Val77*; and c.682A > G, p.Ile228Val) have been identified. It is believed that the c.38_44delGCGGCTGinsTCC variant is more commonly seen in individuals with ocular issues; however, further genotype–phenotype correlations are needed. [ABSTRACT FROM AUTHOR]

Background: Transfusional iron overload causes significant morbidity and mortality in sickle cell disease (SCD). Nevertheless, red blood cell transfusions continue to be essential in its management. This study describes the transfusion patterns among SCD hospitalizations. Methods: Hospitalizations for SCD in the 2017–2018 Nationwide Readmissions Database were divided into two groups based on whether they received transfusions. Descriptive analysis was performed to compare their demographics and complications. Multivariable logistic regression was performed to determine the factors associated with transfusions. Results: Out of 109,783 hospitalizations, 28,300 were transfused, and 81,483 were not transfused. Females and older individuals were higher in the transfused category than the non-transfused category (59.49% vs. 53.52% and 28.86% vs. 21.27%, respectively; p < 0.001 for both). The wealthiest population was more likely to be in the transfused category (11.27% vs. 8.34%; p < 0.001). Admissions to teaching hospitals, large metropolitan hospitals, and highest-volume hospitals were higher in the non-transfused category vs. transfused category (79.89% vs. 72.17%; p < 0.001, 69.26% vs. 65.35%; p 0.003 and 74.71% vs. 63.51%; p < 0.001, respectively). Most admissions were transfused once, with three or more transfusions being given more in the non-teaching hospitals than the teaching hospitals (1.27% vs. 0.41%; p 0.01). Furthermore, a higher proportion of early transfusions occurred in the non-teaching hospitals (65.6% vs. 57.82% for admission days 1 and 2; p < 0.001). Admission to a teaching hospital was associated with lower blood transfusion odds than a non-teaching hospital. Conclusion: A quarter of admissions for SCD receive a blood transfusion. In addition to performing more frequent and early transfusions, the odds of being transfused are higher in non-teaching hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Lumbar degenerative spondylolisthesis with resultant stenosis is a common condition typically seen at L4-L5, in females more commonly than males, and in individuals older than 50 years of age. The slippage is generally due to degenerative changes in the zygapophyseal joints between the 2 vertebrae with accompanying degeneration of the disc at that level. Objectives: To evaluate the clinical outcome of surgically treated patients and also to evaluate the radiological outcome of surgically treated patients. Methodology: The study was conducted in Metropolitan Hospital, Thrissur, Kerala between August 2006 and January 2008 including 16 patients who were treated surgically for degenerative Spondylolisthesis. Results:The age distribution pattern in our study shows that 75% of the patients are less than 55 Years. The average age of patients is 51 years with standard deviation of 10.41. The male to female ratio of patients undergoing surgical treatment for degenerative spondylolisthesis in our study is 1:3. The radiological outcome of fused, partially fused and not fused categories were found in the ratio of 1:2:1. 8 patients have post-operative ODI between 11-20 of which 4 are in fused and 4 in partially fused category. Out of 3 patients with post-operative ODI ≤10, 2 are partially fused and 1 is not fused. Conclusion: Good clinical results can be obtained by augmenting the decompression and fusion procedure with instrumentation. [ABSTRACT FROM AUTHOR]