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To study the efficacy of swept source optical coherence tomography angiography (SSOCTA) to longitudinally follow-up patients with extrafoveal polyps post-laser photocoagulation and anti-vascular endothelial growth factor injection.Observational case series. Four patients diagnosed as polypoidal choroidal vasculopathy with extrafoveal polyps on multimodal imaging were followed up serially on SSOCT, en face and cross-sectional SSOCTA at a month and then 3 monthly for a year. Indocyanine green angiography was repeated at 4 months and 1 year.Anatomical regression of extrafoveal polyps was documented on a combination of en face and cross-sectional SSOCTA, 3 months post-laser photocoagulation and anti-vascular endothelial growth factor. Regression of polyps was maintained at the 12-month follow-up visit in all cases. Changes in branching vascular network morphology post-treatment were well-delineated on en face SSOCTA. Swept source optical coherence tomography angiography findings correlated well with the gold standard indocyanine green angiography.Swept source optical coherence tomography angiography is an effective noninvasive imaging modality to diagnose and longitudinally follow-up extrafoveal polyps postintervention. Laser photocoagulation with anti-vascular endothelial growth factor achieved regression of polyps in all cases and this was maintained over 12 months.

OBJECTIVE: To evaluate a shared decision-making (SDM) intervention in orthopaedic hip and knee osteoarthritis care.METHODS: Using a pre- post intervention design study, we tested an intervention, that included a decision aid for patients (ptDA) and a SDM training course for residents in training and orthopaedic surgeons. The theory of planned behaviour was used for intervention development. Primary outcomes included patient reported decisional conflict, SDM, and satisfaction. Secondary outcomes were physicians' attitude and knowledge, and uptake of the ptDA.RESULTS: 317 patients were included. The intervention improved physicians' knowledge about SDM but had no effect on the primary outcomes. 19 eligible patients used the ptDA (17%). SDM was higher for middle educated patients compared to lower educated (mean difference 9.91, p=0.004), patients who saw surgeons instead of residents (mean difference 5.46, p=0.044) and when surgery was chosen and desired by patients compared to situations where surgery was desired but not chosen (mean difference 15.39, p=0.036).CONCLUSION: Our multifaceted intervention did not improve SDM and ptDA uptake was low.PRACTICE IMPLICATIONS: In orthopaedic hip and knee osteoarthritic care other ways should be explored to successful implement SDM. Since residents received lower SDM scores, special focus should go to this group.

A quality assurance study was completed following the implementation of a standardized opioid prescribing and education protocol post cesarean delivery. The primary goal was to determine the need for a policy on postpartum opioid prescribing practices and whether the protocol worked. There was a decrease in the number of tablets provided post intervention and no statistically significant maternal or neonatal readmissions for suspected opioid toxicity or pain control. Combination prescribing of Tylenol 3 and/or tramadol and another opioid occurred in both groups. Our results show a need for concise guidelines regarding opioid prescribing following cesarean delivery.

PURPOSE: This study examined the usage, acceptability, usability, perceived usefulness, and satisfaction of a web-based video-tailored physical activity (PA) intervention (TaylorActive) in adults. METHODS: In 2013-2014, 501 Australian adults aged 18+ years were randomized into a video-tailored intervention, text-tailored intervention, or control group. Over 3 months, the intervention groups received access to 8 sessions of personally tailored PA advice delivered via the TaylorActive website. Only the delivery method differed between the intervention groups: video-tailored vs. text-tailored. Google Analytics and telephone surveys conducted at post intervention (3 months) were used to assess intervention usage, acceptability, usability, perceived usefulness, and satisfaction. Quantitative and qualitative process data were analyzed using descriptive statistics and thematic content analysis. RESULTS: Of 501 recruited adults, 259 completed the 3-month post-intervention survey (52% retention). Overall, usage of the TaylorActive website with respect to number of website visits, intervention sessions, and action plans completed was modest in both the video-tailored (7.6 ± 7.2 visits, mean ± SD) and text-tailored (7.3 ± 5.4 visits) groups with no significant between-group differences. The majority of participants in all groups used the TaylorActive website less than once in 2 weeks (66.7% video-tailored, 62.7% text-tailored, 87.5% control; p < 0.001). Acceptability was rated mostly high in all groups and, in some instances, significantly higher in the intervention groups compared to the control group (p < 0.01). Usability was also rated high; mean Systems Usability Scores were 77.3 (video-tailored), 75.7 (text-tailored), and 74.1 (control) with no significant between-group differences. Perceived usefulness of the TaylorActive intervention was low, though mostly rated higher in the intervention groups compared to the control group (p < 0.01). Satisfaction with the TaylorActive website was mixed. Participants in both intervention groups liked its ease of use, personalized feedback, and tracking of progress, but also found completing action plans and survey questions for each session repetitive and tedious. CONCLUSION: Providing personally tailored PA advice on its own (through either video or text) is likely insufficient to ensure good retention, usage, perceived usefulness, and satisfaction with a web-based PA intervention. Strategies to address this may include the incorporation of additional intervention components such as activity trackers, social interactions, gamification, as well as the use of advanced artificial intelligence and machine learning technologies to allow more personalized dialogue with participants.

Aim Our aim was to evaluate the clinical and radiological outcome of Gamma knife radiosurgery (GKS) in the treatment of intracranial dural arteriovenous fistula (DAVF) with cortical venous drainage (CVD) and compare it with the outcome of endovascular therapy. Methodology This series includes patients who underwent GKS or endovascular therapy for intracranial DAVF with CVD over 10 years (Jan 2007 to Dec 2016) at the All India Institute of Medical Sciences, New Delhi. Their demographic profile, clinical presentation, imaging details, and follow up clinical status were reviewed retrospectively. Clinical follow up was done once every 6 months. Radiological follow up using digital subtraction angiography (DSA) was performed at a mean duration of 24 months post intervention. Patients who had a clinical follow up of less than 1 year were excluded from the study. Results 35 patients (26 in the embolization group and 9 in GKS group) who had intracranial DAVF with CVD were included in the study. Clinical improvement was seen in 77.78% of the patients who received GKS and 57.7% in the patients who underwent embolization (p = 0.431). Complete obliteration of DAVF was seen in 55.56% of the patients in the GKS group and 57.7% of the patients in the embolization group (p = 1). Our study shows that GKS is at least as effective as embolization in terms of clinical and radiological outcome in the treatment of intracranial DAVF with CVD. Conclusion Contrary to popular perception, GKS should be considered as an effective first line treatment alternative of intracranial DAVF with CVD.

Despite benefits of safety event reporting, few are trainee initiated. A comprehensive intervention was created to increase trainee reporting, partnering a trainee safety council with high-level faculty. Data were collected for 12 months pre intervention and 30 months post intervention, including short-term (1-12 mo) and long-term (13-30 mo) follow-up. A total of 2337 trainee events were submitted over the study period, primarily communication-related (40%) and on the medicine service (39%). Monthly submissions increased from 29.3 pre intervention to 66.2, 77.7, and 58.6 events/mo at post intervention, short-term follow-up, and long-term follow-up, respectively (P < 0.001). Proportion of hospital events submitted by trainees increased from 2.3% pre intervention to 4.1%, 4.9%, and 3.6% at post intervention, short-term, and long-term follow-up, respectively (P < 0.001). Trainee monthly submissions (P = 0.015) and proportion of hospital events (P < 0.001) declined from short- to long-term follow-up. Low- and intermediate-level harm events significantly increased post intervention (P < 0.001) while high-level events did not (P = 0.15-1.0). Our comprehensive intervention increased trainee event submissions at long-term follow-up.

[Objective] Evidence supporting the efficiency of clinically administered therapies against interstitial lung disease (ILD)-related cough is limited. Thus, we conducted a study to evaluate the efficacy of short-term use of chest bands on cough in patients with ILD. [Methods] This pre-post intervention study was performed at two university hospitals between April 2017 and August 2020. Scores of the visual analog scale (VAS) for cough severity (in terms of frequency and intensity), Leicester Cough Questionnaire (LCQ)-acute, and frequency scale for symptoms of gastroesophageal reflux disease (FSSG) were assessed before and after the use of the chest band (24/48 hours). [Patients] The study included patients with idiopathic interstitial pneumonias (IIPs) or connective tissue disease-associated interstitial lung disease (CTD-ILD). [Results] Four patients with IIPs and seven with CTD-ILD were included in the analysis. The cough intensity and LCQ-acute total score improved significantly after the use of the chest band (p=0.007 and p=0.005, respectively), although the cough frequency showed no significant reduction (p=0.074). Furthermore, the FSSG total and acid-reflux symptom scores improved (p=0.018 and p=0.027, respectively), and a negative correlation between the change in LCQ-acute total score and that in FSSG score for acid-reflux symptoms was observed (Spearman rho =-0.841, p=0.001). [Conclusion] The results of the current study suggest that chest bands might be useful for treating chronic refractory cough in patients with ILD and gastroesophageal reflux disease. However, these results should be interpreted with caution due to methodological limitations associated with this study.

INTRODUCTION One of the most essential steps in improving the quality of service delivery in the health service is the improvement of patients' medical record completeness. The aim of this study is to assess patient medical record completeness in the Saint Paul hospital department of surgery and assess the pattern of improvement in record completeness after intervention. METHODS surgical Patient charts were randomly reviewed with a standard patient chart completeness evaluation checklist prepared by the Federal Ministry of Health. Baseline data was collected in June 2019 and post intervention data was collected in November 2019. The schedule for intervention was carried out between July and October 2019. Interventions include modification of formats, continuous monitoring, and inclusion of chart completeness in the monthly morbidity and mortality conference, and establishment of a recognition system for best performing wards. RESULT A total of 253 and 273 medical charts were evaluated during baseline and post intervention. The Post intervention assessment showed 206 (75.5%) of records had admission notes completed, 205 (75%), the order sheet was completed in 218 (79.7%) and the discharge summary was completed in 217 (79.5%) of medical records. From nursing parameters, the medication sheet was completed in 177 (64.8%) and the nursing care plan was completed in 155 (56.8%) of medical records. When all six indicators were seen in aggregate, total medical record completeness showed a statistically significant improvement from 41% during base line to 72% post intervention (p

A study was undertaken to determine whether benefits gained by providing small-quantity lipid-based nutrient supplements (SQ-LNS) from age 6–12 months were maintained at age 18 months compared with...

Objectives In 2015, the National Academy of Medicine IOM estimated that 12 million patients were misdiagnosed annually. This suggests that despite prolonged training in medical school and residency there remains a need to improve diagnostic reasoning education. This study evaluates a new approach. Methods A total of 285 medical students were enrolled in this 8 center, IRB approved trial. Students were randomized to receive training in either abdominal pain (AP) or loss of consciousness (LOC). Baseline diagnostic accuracy of the two different symptoms was assessed by completing a multiple-choice question (MCQ) examination and virtual patient encounters. Following a structured educational intervention, including a lecture on the diagnostic approach to that symptom and three virtual patient practice cases, each student was re-assessed. Results The change in diagnostic accuracy on virtual patient encounters was compared between (1) baseline and post intervention and (2) post intervention students trained in the prescribed symptom vs. the alternate symptom (controls). The completeness of the student’s differential diagnosis was also compared. Comparison of proportions were conducted using χ 2-tests. Mixed-effects regressions were used to examine differences accounting for case and repeated measures. Compared with baseline, both the AP and LOC groups had marked post-intervention improvements in obtaining a correct final diagnosis; a 27% absolute improvement in the AP group (p Conclusions The study showed that a virtual patient platform combined with a diagnostic reasoning framework could be used for education and diagnostic assessment and improved correct diagnosis compared with baseline performance in a simulated platform.

Introduction: Miscarriage is a common gynaecological problem in day to day practice. Post miscarriage care is a challenging area coming under reproductive health. Prevention of pelvic sepsis is a main component. Effective antibiotic prophylaxis at the time of treatment for incomplete and missed miscarriage may be the answer for it. But in current practice, there is conflicting evidence and no clear guidance for the necessity of antibiotic prophylaxis. Objective: To determine the effectiveness of prophylactic doxycycline use, prior to surgical and medical evacuation of incomplete and missed miscarriage, in view of reducing the post -procedure pelvic infections. Method: Three hundred and ninety four patients were randomized into two groups. One group (n=200) received 200mg doxycycline single dose and the other group (n=194) received placebo single dose, one hour prior to the medical and surgical management. Post procedure pelvic infection was assessed by five clinical parameters within three days and two weeks later. SPSS used for the data analysis. Result: There were no statistically significant differences in the age, parity, number of children and gestational age in between the doxycycline and placebo groups. Post intervention pelvic infection was diagnosed 4% in the doxycycline group and 6.18% in the placebo group within three days, which was not statistically significant (P=0.367). It was 4.5% and 8.7% for doxycycline and placebo treated groups respectively at two weeks. It was also not clinically significant (P=0.104). There was no statistically significant difference in the type of miscarriage or the type of interventions in between the two groups. Conclusion: The study revealed that single dose doxycycline prophylaxis prior to medical and surgical management of miscarriage was not able to achieve a statistically significant reduction in post intervention pelvic infection.

Objective: To assess the effect of a nutritional/educational intervention over malnutrition due to excess in university students. Materials & Methods: A quantitative study with a descriptive approach and an experimental design was employed. Intervention was conducted through the implementation of educational strategies promoting healthy lifestyles, nutritional status of participants was monitored throughout the entire scholar cycle (16 weeks). Non-probabilistic sampling was used including 52 university students who willingly accepted to participate. Data was processed using descriptive statistics (frequency, category variable percentages, measures of central tendency, dispersion for numerical variables). Nutritional profiles of the participants were evaluated based on the normality of the data through the use Kolmogorv Smirnov test, averages, T tests for related samples and the Wilcoxon test to evaluate the intervention effects. Results: Weight average on the pre-intervention stage was 74.7 kg and 68.2 kg post intervention. Before intervention 42.31% (32.69/9.62) presented overweight or obesity, after intervention a thus 17.3% (15.38/1.92) presented overweight or obesity which signifies a decrease of 25. 01 % was recorded (p value < 0.001) Conclusions: Educational intervention had an impact on the nutritional status of university students in relation with the percentage of obesity and overweight the ratio of normal weight students was increased. Key Words: Educational intervention, Obesity, Nutritional Profile.

Introduction: Lumbar stabilization and McKenzie exercises are becoming a popular trend for managing chronic low back pain though it is currently not known whether lumbar stabilization exercises produce better results in improving functional status compared to McKenzie approach. The purpose of this study was to determine the effectiveness of the McKenzie approach versus lumbar stabilization in the treatment of chronic low back pain. Material & Methods: This was a randomized controlled trial. Lottery method was used to randomly divide individuals who fulfilled inclusion criteria into 2 groups. Assessments of the patients were done in OPD. Baseline assessment was done on day 1 and post intervention assessment was done after 2 weeks. A total of 8 treatment sessions spread across 2 weeks were given (4 days per week). Data were assessed at baseline level and post intervention. Data was entered and analysed by SPSS version 21. Results: A total of 28 females and 02 males (mean age of 50.88 ±12.29) participated in the study. After 02 weeks of intervention, both treatment groups showed improvement in decreasing pain and improving functional status. The lumber stabilization group showed significant gains on Numeric Pain Rating Scale and (p=0.001) and Modified Oswestry Disability Index (p=0.001) compared to the Mckenzie group. Conclusion: Patients in both lumber stabilisation and McKenzie groups showed significant improvement, however, the patients in lumbar stabilization group were superior than the patients in McKenzie group on the selected outcomes.

Background: Femoral pseudoaneurysm considered the common complication of repeated femoral puncture during drug addiction by self-trials injections. Pseudo aneurysms form at the different sites arterial entrance (femoral, brachial, radial…) if not sealed, leaking of blood and result in a well formed pulsatile hematoma. This is a very crucial problem by the exponential growth of drug addiction. Methods: A prospective clinical trial study over a period of 20 months, 22 patients were attended complaining of a local pulsatile swelling at different site of recurrent drug injection and involved in this study. Antegrade or retrograde approach used depending on the site of the pseudoaneurysm and feeding neck. Excluded from study any patient presented with signs of infection or bleeding or treated by other method. Results: 22 patients, 20 were males and 2 were females. Age was 31.2 + 9.2 in years. The incidence of traumatic pseudo aneurysm between 15 - 25 years old (45.5% of our cases ). the most common site forming pseudoaneurysm the groin (femoral artery), the antecubital region (brachial artery) and carotid artery (11) 44%, (8) 32% and 3 (12%) respectively. Management by endovascular covered stent may with different complications post intervention like 4.5% (one patient) thrombosis on brachial artery, endo-leak of the femoral artery ( one patient) and all managed with no residual complication and all patients passed well. Conclusion: endovascular intervention using covered stent to close the feeding neck, with less controllable complications and less hospitalization time. Key words: endovascular, pseudoaneurysm, covered stent and endo-leak.

OBJECTIVES For hospitalized children and their families, laboratory study collection at night and in the early morning interrupts sleep and increases the stress of a hospitalization. To change this practice, our quality improvement (QI) study developed a rounding checklist aimed at increasing the percentage of routine laboratory studies ordered for and collected after 7 am. METHODS Our QI study was conducted on the pediatric hospital medicine service at a single-site urban children’s hospital over 28 months. Medical records from 420 randomly selected pediatric inpatients were abstracted, and 5 plan-do-study-act cycles were implemented during the intervention. Outcome measures included the percentage of routine laboratory studies ordered for and collected after 7 am. The process measure was use of the rounding checklist. Run charts were used for analysis. RESULTS The percentage of laboratory studies ordered for after 7 am increased from a baseline median of 25.8% to a postintervention median of 75.0%, exceeding our goal of 50% and revealing special cause variation. In addition, the percentage of laboratory studies collected after 7 am increased from a baseline median of 37.1% to 76.4% post intervention, with special cause variation observed. CONCLUSIONS By implementing a rounding checklist, our QI study successfully increased the percentage of laboratory studies ordered for and collected after 7 am and could serve as a model for other health care systems to impact provider ordering practices and behavior. In future initiatives, investigators should evaluate the effects of similar interventions on caregiver and provider perceptions of patient- and family-centeredness, satisfaction, and the quality of patient care.

Background: Premature ejaculation (PE) is a significant and common medical problem affecting many men worldwide. While PE is not a life- threatening disorder, its effect on quality-of-life (QoL) issues is significant. Objective: To evaluate the feasibility, safety and efficacy of pulse radiofrequency (PRF) of dorsal nerve of the penis in lifelong premature ejaculation refractory to conventional treatment. Patients and Methods: In this prospective study, all adult males complaining from lifelong PE resistant to conventional treatment, and seeking treatment of PE, at Al-Azhar University Hospitals [Al-Hussein and Sayed Galal]; Cairo; Egypt during the period from December 2019 to July 2020 were studied. Detailed history, physical examination, serum testosterone, serum prolactin were obtained. Patients underwent ultrasound guided pulsed radiofrequency of dorsal nerve of the penis. Any operative complications were recorded. To assess the efficacy of the procedure, patients were evaluated by intra vaginal ejaculatory latency time (IELT) and sex satisfaction scale (SSS). Results: As regard SSS, 3 weeks before intervention, all the subjects (20 subjects) were unsatisfied. Three weeks post intervention, 9 (45%) of subjects were satisfied, while 11 (55%) were unsatisfied. Four months post intervention, 8 (40%) subjects were satisfied, and 12 (60%) were unsatisfied SSS 3 weeks post intervention was significantly different from SSS 3 weeks before intervention and 4 months post intervention (p < 0.001). The mean of IELT was 33.4±19, 188.4±154.9, and 141.5±129.7 seconds at 3 weeks before PRF, 3 weeks after PRF, and 4 months after PRF, respectively. A significant difference was found between IELT pre intervention, 3 weeks and 4 months post intervention (p < 0.001). A strong positive correlation was found between IELT and SSS at 3 weeks and 4 months post intervention (p < 0.001& r = 0.78) and (p < 0.001& r = 0.91) respectively. In our study, 4 (20%) patients had pain that relieved by analgesic and 2 (10%) patients had minimal bleeding at site of needle insertion & resolved by compression. No subjects complained of erectile dysfunction nor loss of sensation, while 2 (10%) patients reported superficial infection in first week post intervention which may contribute to uncontrolled DM, 4 (20%) patients had tingling within the first 3 weeks, and 2 (10%) had numbness within the first 3 weeks. All these complications resolved with conservative treatment. Conclusion: PRF is a hopeful treatments in life long PE. Objective data on change in sensation (biothesiometry) and the short term of objective follow-up data are the significant limitations of this study.

Introduction Heel pain is a common foot and ankle complaint in the Orthopaedic OPD. Posterior heel pain occurs due to a handful of etiologies, more prominent of which is retrocalcaneal bursitis. Management of posterior heel pain in majority of the cases is non-operative. However, surgical intervention may be indicated if conservative therapies fail. This study aims at finding the functional outcome after arthroscopic management of retrocalcaneal bursitis. Methodology A total of 29 patients were recruited for the study after applying the selection criteria. Standard knee arthroscopy equipment and instruments were used with gravity assisted fluid system. After making medial and lateral portals, the inflamed bursa was debrided using a motorised shaver and an arthroscopic burr was used to resect the calcaneal prominence. A post-operative rehabilitation protocol was followed and the cases were followed up at regular intervals for a minimum of 12 months. Results After excluding losses to follow-up and post intervention exclusions, data of 23 patients were considered for statistical analysis. There was a consistent improvement in the variables of the AOFAS score at the follow up intervals. The total AOFAS score showed consistent improvement from a pre-operative mean score of 66.96 to a mean score of 88.44 at 03 months to maximal mean score of 96.00 at 6 months (p Conclusion Arthroscopic decompression is a feasible and efficient procedure for the treatment of retrocalcaneal disorders. The time to return to normal activity level is short. Sufficient exposure of the Achilles tendon and adequate removal of the calcaneal prominence and bursal tissue can be done effectively using an arthroscopic technique. It yields cosmetically better results with low incidence of complications.

BACKGROUND Measurement of post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) demonstrates residual ischemia in a large percentage of cases deemed angiographically successful which, in turn, has been associated with worse long-term outcomes. It has recently been shown that a resting pressure index, Pd/Pa, has prognostic value post stenting, however, its diagnostic value relative to FFR post-PCI has not been evaluated. METHODS The diagnostic accuracy of Pd/Pa in identifying ischemia (FFR≤0.80) pre- and post-PCI was evaluated. Three patient subsets were analyzed. A reference pre-PCI cohort of 1,255 patients (1,560 vessels) was used to measure the accuracy of pre-PCI Pd/Pa vs. FFR. A derivation post-PCI group of 574 patient (664 vessels) was then used to calculate the diagnostic accuracy of post-PCI Pd/Pa vs. FFR. A final prospective validation cohort of 230 patients (255 vessels) was used to test and validate the diagnostic performance of post-PCI Pd/Pa. RESULTS Median Pd/Pa and FFR were 0.90 (IQR 0.90-0.98) and 0.80 (IQR 0.71-0.88) in the reference pre-PCI model, 0.96 (IQR 0.93-1.00) and 0.87 (IQR 0.77-0.90) in the post-PCI derivation model, and 0.94 (IQR 0.89-0.97) and 0.84 (IQR 0.77-0.90) in the post-PCI validation model respectively. There was a strong linear correlation between Pd/Pa and FFR in all three models (p

Cataract is the second cause of visual impairment and the first cause of blindness globally so inadequate nursing intervention lead to serious complications for the patient with cataract surgery. Purpose of the study: to evaluate the effect of educational nursing intervention on the nurses’ performance, patients’ daily living activities, needs and selected visual problems of cataract surgery. Setting: The current study was carried out at ophthalmology department and out patients’ ophthalamology clinic in Menoufia university hospital and El Ramad hospital in Shebin El-Kom district, Menoufia governorate, Egypt. Subjects: A purposive sample of adult 25 nurses and 100 patients was divided into two equal groups (study and control). Tools of the study: Three tools for data collection; two tools for nurses (a self-administered questionnaire (tool I) and an observation checklist for nurses’ performance (tool II) and one tool for patients (an interview questionnaire, tool III). Results: There was a highly statistically significant improvement in total mean score of nurses’ knowledge from 27.56±3.11 pre intervention to 41.08±4.09 post intervention and after one week to 38.0±3.69 as a follow up. Also, there was a highly statistically significant improvement in the total nurse's performance mean score from 102.84±21.54 pre intervention to 245.44±22.84 post intervention and after one week to 239.84±23.05 as a follow up p < 0.001. Also, there were highly statistically significant improvements in meeting all patients’ daily living activities and needs with minimized visual complications after intervention (p < 0.001). Conclusions: Total good level of knowledge, satisfactory performance of the studied nurses significantly improved after implementing educational nursing intervention with better achievement of patients’ daily living activities and needs with major limitation in visual problems.

Very few early childhood interventions have observed sustained effects regarding television viewing and none have examined the mechanisms behind sustained intervention effects at long-term follow-ups. Thus, the aim of this study was to investigate potential mechanisms relating to the maintained intervention effect on television viewing at two long-term follow-ups in the Melbourne Infant Feeding Activity and Nutrition Trial (INFANT). INFANT was a cluster-randomised controlled trial. At the 2- and 3.5-year follow-ups, a total of 262 infant/mother pairs had complete information. Television viewing was assessed via a questionnaire at both follow-ups and six potential mediators were measured post-intervention (i.e. 15 months after baseline). Causal mediation analysis was conducted. At the 2- and 3.5-year follow-ups, the positive impacts of INFANT on maternal television viewing knowledge were maintained (B = 0.34 units; 95% confidence interval (CI95): 0.21, 0.48). An indirect effect of the intervention on reducing children’s television viewing time was observed at the 2- and 3.5-year follow-ups (B = −11.73 min/day; CI95: −22.26, −3.28 and B = −4.78 min/day; CI95: −9.48, −0.99, respectively) via improved maternal television viewing knowledge.Conclusion: The positive impacts of INFANT on maternal television viewing knowledge were maintained at both follow-ups, with better maternal knowledge associated with less television viewing time in their children. These results have implications for paediatricians and healthcare professionals as educating new parents early on regarding screen time may lead to the development of healthier screen time habits that are sustained through to the pre-school years. What is Known: • Lifestyle behaviours inclusive of screen time have been found to be established before the pre-school years and track. • Few trials have evaluated the long-term mechanisms related to maintained intervention effectiveness. What is New: • This study shows the positive impacts of a low-dose intervention on maternal television viewing knowledge at two long-term follow-ups. • Better maternal television viewing knowledge was associated with less television viewing time in their children.

The aim of our study was to evaluate the impact of an internist physician specialized in diabetes, appointed as an in-house physician in the orthopedic wards, on improving clinical outcomes and in particular 30-day mortality. We analyzed a cohort of patients hospitalized more than 24 h in the orthopedic service. The analyses included a comparative analysis between the pre- and post-intervention time periods and an interrupted time series (ITS) analysis, which were conducted in stratification to three populations: whole population, patients with at least one chronic disease and/or older than 75 years of age and patients diagnosed with diabetes. The primary outcome was 30-day mortality following the hospitalization. A total of 11,546 patients were included in the study, of which 19% (2212) were hospitalized in the post intervention period. Although in the comparative analysis there was no significant change in 30-day mortality, in the ITS there was a decrease in the mortality trend during the post intervention period in the entire and chronic disease/elderly populations, compared to no change during the pre-intervention period: a post-intervention slope of − 0.14(p value

Objectives: To evaluate the Ministry of Health (MoH) hospitals preparedness for potential disasters and crisis events using the World Health Organization (WHO) hospital emergency response checklist. Methods: A cross-sectional study was conducted at MoH hospitals in Al-Madina, Saudi Arabia using the WHO hospital emergency response checklist. The overall level of hospital preparedness was categorized as unacceptable if the rating is between 0-64, insufficient if it is between 65-129 and effective preparedness if the score is between 130-184. The study conducted in 3 phases. First phase, the preintervention assessment was conducted from August 23 to 27, 2017. Second phase, intervention strategies were implemented between 2018 and 2019 to enhance the hospitals preparedness for any potential disaster situation. Third phase, the postintervention assessment was conducted from September 5 to 7, 2019, using with the same checklist. Results: The preparedness score of key components at the participating hospitals showed an “insufficient” level of preparedness. The mean preparedness score of the participating hospitals was 81.5±11.39 (range: 65-91), which is lower than the recommended WHO cut-off level of effective preparedness. The preparedness score of the post-recovery component was very low 01±1.15 compared to the WHO range (0-18). Conclusion: A total of 4 hospitals participated in the study. The participated hospitals showed insufficient levels of preparedness for potential disasters and crisis events.

AIM: Children with Down syndrome (DS) have delayed development and atypical movements including kicking. We hypothesized that a kicking intervention would significantly increase leg movement rate. METHODS: Nine infants, 3–5 months old, with DS used a commercially available toy that encouraged kicking. The intervention was administered in their home for 20 minutes, 5 days a week, for 8 weeks. Leg movement rate was measured using Opal wearable sensors before and after the intervention. At post-test, a secondary analysis compared infants with DS to infants with typical development (TD). RESULTS: Average leg movement rate increased significantly from pre to post intervention, from 2253 to 2645 movements per hour of awake time (p=0.049). Compared to data from nine infants with TD, infants with DS had a significantly lower movement rate post intervention (p=0.002). CONCLUSION: The study revealed that infants with DS demonstrated a higher leg movement rate following an in-home kicking intervention.

To compare the effectiveness of high dose fixed alternate day intratympanic gentamicin with methylprednisolone in the treatment of patients with unilateral, intractable Meniere’s disease with poor hearing. Randomized single blind prospective parallel group trial in a tertiary referral centre. Twenty-two patients with definite unilateral Meniere’s disease with average pure tone thresholds worse than 50 dB in the affected ear were enrolled. Eleven patients were treated with intratympanic buffered gentamicin and the other eleven were administered intratympanic methylprednisolone (both 4 injections, 40 mg/ml, on alternate days). Patients were assessed pre-intervention, 3 months post intervention and subsequently followed up for 2–4 years. Both groups of patients had significant control of vertigo, DHI scores and THI scores after treatment while the functional scores in the methylprednisolone group was not better than the pre- treatment scores in the long-term follow-up. 9 of 11(82%) patients in gentamicin group and 3 of 11(27%) patients in the methylprednisolone group achieved Class A vertigo control. The gentamicin group had better post intervention DHI scores (p = 0.016, 3 months and p = 0.046, long term) and Functional score (p = 0.014, 3 months and p = 0.05, long term). The hearing in both groups and THI scores, post intervention was similar between both groups. In patients with unilateral intractable MD with non-serviceable hearing, high fixed doses of both intratympanic gentamicin and methylprednisolone are effective in alleviating disease symptoms in long term follow-up. However, intratympanic gentamicin resulted in better control of vertigo, total DHI score and functional level scores than intratympanic methylprednisolone with no significant difference in hearing levels. Clinical Trials Registry of India (CTRI- REF/2016/10/012363)

Background The overhead throwing motion repetitively stresses the dominant arm in baseball players, frequently altering normal range of motion (ROM) in multiple directions. Baseball players regularly perform a combination of static stretches (SS) and dynamic tubing (DT) resistance exercises in pre-throwing warm-up routines intended to improve shoulder ROM and reduce injuries. Purpose The purpose of this study was to compare acute changes in dominant shoulder ROM improvements between SS and DT warm-up exercise protocols. The DT exercises were hypothesized to elicit greater improvements in shoulder ROM. Study Design Two-way crossover study. Methods Twenty-five healthy collegiate baseball players (mean age = 19.8 ±1.0 years) presenting with glenohumeral internal rotation deficit (GIRD) >20° and total rotational range of motion (TRROM) losses >5° completed the SS and DT interventions on different days. Dominant arm internal rotation (IR), external rotation (ER) and TRROM were measured before, immediately after, 30-minutes after, and 60-minutes after each treatment session. A two-way repeated measures analysis of variance (ANOVA) compared the effect of SS and DT over time on IR, ER and TRROM. Results IR improved on average 10.68 ± 0.82° (p < .001) post intervention, 11.18 ± 0.79° (p < .001) 30-min post intervention, and 9.03 ± 0.95° (p < .001) 60-min post intervention. ER improved on average 8.60 ± 0.67° (p < .001) post intervention, 8.25 ± 0.85° (p < .001) 30-min post intervention, and 6.65 ± 0.91° (p < .001) 60-min post intervention. TRROM improved on average 19.28 ± 1.09° (p < .001) post intervention, 19.43 ± 1.36° (p < .001) 30-min post intervention, and 15.68 ± 1.55° (p < .001) 60-min post intervention. There were no significant differences between the main effects of treatment and time for IR, ER, and TRROM. For IR, SS improved by an average of 1.73 ± 0.55° (p = .005) more than DT. For ER and TRROM, there were no differences between SS and DT. Conclusion Both SS and DT exercises improve glenohumeral IR, ER and TRROM up to one-hour post intervention, with no significant differences noted between interventions for treatment or time. Baseball players can benefit equally from performing SS or DT exercises to acutely improve shoulder ROM. Level of Evidence Level 3, The purpose of this study was to compare acute changes in dominant shoulder ROM improvements between statice and dynamic warm-up exercise protocols in college baseball players.

Background: Reflexology is a type of massage that involves applying different amounts of pressure to the feet, hands, and ears. It is based on a theory that, these body parts are connected to certain organs and body systems. Aim: The study was aimed to evaluate the effect of reflexology on post-operative pain severity after laparoscopic appendectomy for patients at surgical units. Methods: A quasi experimental research design was utilized to conduct this study in the general surgery department at Benha University Hospital. A purposive sample of (60) adult patients post laparoscopic appedectomy were included in this study. Three tools were used; (Tool I) patients’ knowledge assessment questionnaire, (Tool II) patients’ practice observational checklist and (Tool III) visual pain analogue scale to assess pain severity. Results: This study showed that most patients (study group) had an unsatisfactory level of total knowledge and inadequate total practice regarding reflexology technique after laparoscopic appendectomy pre intervention (22% and 2%). This result improved significantly regarding all knowledge and practice elements post intervention, where the majority of patients (study group) had satisfactory level of total knowledge and adequate total practice (82% and 95%). Also, there was marked improvement in pain severity among the study group pre and post intervention.While, there was no improvement noticed in the control group regarding their total knowledge, practice, and pain severity pre and post intervention.Conclusion: The current study concluded that, performance of the study group post intervention concerning pain severity has been greatly improved after application of reflexology technique that supports the first and second research hypotheses. Also, there was a significant negative correlation between patients’ performance and pain severity immediate post intervention for the study group that supports the third research hypothesis. The study recommended continuous in-service training programs and repeating the study on a high probability sample to achieve generalization of the findings.

OBJECTIVE To evaluate impact of directing patients with back pain for first visit to a physiotherapist on sick leaves, healthcare utilization, and patient satisfaction. METHODS Pre-post intervention study of 70,138 patients treated in Poland for back pain: 27,034 before the care pathway redesign and 43,104 after. RESULTS After the redesign, all per-patient measures (mean ± SD) significantly decreased over the 12-month follow-up: sick leaves number from 0.32 ± 0.87 to 0.29 ± 0.86, sick leaves days from 2.78 ± 11.56 to 2.56 ± 11.25, doctors' visits from 2.02 ± 1.70 to 1.51 ± 1.63, diagnostic imaging services from 0.63 ± 0.79 to 0.43 ± 0.71 and rehabilitation services from 7.55 ± 14.90 to 4.70 ± 12.61.The Net Promoter Score was higher for physiotherapist (83), than for orthopedists (59), primary care (74), or neurologists (67). CONCLUSIONS Involving physiotherapists early in the back pain care may result in benefits for patients and healthcare organizations.

Background: Republic of Indonesia's Health Survey in 2009, finding that the therapy through surgery was the 11th, because of surgery conduct in Indonesia in 2012 reached 1.2 million. The problem that often arises after surgery is a sleep disorder, pain and uncomfortable. Purpose: To identify effectiveness of foot massage on sleep quality among post-surgical patients in Dr. H Abdul Moeloek Hospital, Lampung-Indonesia Methods: The design of this research is quasy experiment with pretest design with posttest with control group design. This type of quantitative research using consecutive sampling techniques. The population in the study were 64 participants. The analysis used is the dependent and independent t test. Results: Indicating the average score of sleep quality in the control group post intervention 9.12. Whereas sleep quality in the intervention group was obtained at 4.78 post intervention. A p-valeu 0.000 was obtained which showed differences in sleep quality scores both groups and interventions. Conclusion: There is effectiveness of foot massage on sleep quality among post-surgical patients in Dr. H Abdul Moeloek Hospital, Lampung-Indonesia. It is recommended that hospitals can include foot massage therapy as an alternative therapy in overcoming sleep disorders in postoperative clients.

Spektrum der Augenheilkunde 35(2), 75-82 (2021). doi:10.1007/s00717-020-00480-4, Published by Springer, Wien [u.a.]

Background/Purpose The purpose of this study was to reduce unplanned Emergency Department (ED) visits for minor complaints in children after appendectomy through proactive institution-driven communication and utilization of telehealth resources. Methods We developed a text messaging system to initiate communication with parents of postappendectomy patients and connect them with a telehealth visit or a phone call with a surgical provider as needed. Using descriptive statistics, chi square, and statistical process control analytics, we compared rates of postoperative ED visits for the 8 months pre- and post-implementation of the messaging system and summarized the feedback we received from patients. Results A total of 791 laparoscopic appendectomies were performed in two institutions (preintervention = 382, post-intervention = 409). The postoperative ED visit rate decreased from 5.8% preimplementation to 2.4% post-implementation (p = 0.02). Over one-fifth of families messaged (21.6%) had questions in the postoperative period. The majority expressed interest in a video visit (52.5%), while some preferred to speak with the surgeon's office (25%). Over 90% of respondents found the system helpful, and 4.9% opted out. Conclusion Implementation of a hospital-initiated text messaging system has the potential to reduce ED visits in the immediate postoperative period after appendectomy. This system can be scaled to include different surgeries across multiple disciplines. Level of Evidence III. Type of Study Clinical Retrospective Pre/Post Intervention Study.

Background The tobacco epidemic is one of the biggest public health threats the world has ever faced. World Health Organization has estimated that tobacco use (smoking and smokeless) is currently responsible for the death of about 7 million people across the world each year. The objective of the study was not only to find the effect of group intervention on tobacco cessation but also to describe certain epidemiological factors associated with tobacco cessation and make suitable recommendations to tackle this epidemic. Methods A randomized controlled trial was carried out among male employees who were tobacco users in health-care setting in Western Maharashtra. In the study, 60 subjects each in intervention and control arm were taken. Pretested validated questionnaires were used for the study. The intervention comprised of two sessions delivered 5 weeks apart. Control arm received self-help material (Booklet) immediately after baseline data collection. The outcomes were measured using structured interview schedule. The data were analyzed using SPSS, version 20. Results Overall, 13.3% of the study subjects had quit tobacco use post intervention. In the intervention group 21.7% of the participants had quit tobacco since past one month and 5% in the control group (relative risk (RR) = 4.33). Low to moderate nicotine dependence (p = 0.023, RR = 6.46) and stage of contemplation (p = 0.018) were found to be important predictors of abstinence. Conclusion Community-based group intervention for tobacco cessation is the way forward to tackle the tobacco epidemic.

Background: For many people, varicose veins and spider veins are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems. Objective: To evaluate the effect of staging down of the lower limb varicose veins by injection sclerotherapy before surgical treatment in comparison with the standard procedure. Patients and Methods: Included 40 patients, aged 25–42 years (Range), who were recruited from the outpatient clinic of the Department of Vascular Surgery, Al-Hussein University Hospital. All patients were followed up monthly for 6 months. The duration of the study had been from 6 to 12 months from July 2018 to July 2019. Patients were divided into 2 groups: group I: In this group patients with varicose veins were treated stage down before surgery and control group: This was an age and sex matched group of patients with the first group. The clinical and hemodynamic assessments were carried on. Duplex ultrasound was done at the end of follow up period to detect the degree of improvement. Results: Mean duration of varicose veins was 3.0 ±0.2 with a range of (1.5-5) years. Varicose veins were distributed in leg in 50% of group I and 70% of group II. Median baseline anatomical extent of varicose veins was 5 and 6 in group I and II respectively with range of 4-9. As regard symptoms, aching was present in 5% of cases,, heaviness was in 5%, itching in 10% of cases, cosmetic concerns was in 5%, swelling in 0% of cases. Regarding post intervention complications, pain was present in 15% of cases, swelling in 5%, bruising in 10% of cases, and discoloration in 0%, and pigmentation in 10% of cases. As regard comparison of the two groups regarding the patient satisfaction score, 40% of cases were highly satisfied in group one, compared with 25% of cases of group II. There was a high significant improvement of anatomical extent of varicose veins over 6 months follow up period. Conclusion: Sclerotherapy before surgical treatment provided symptomatic relief and significant improvements and patient satisfaction in patients diagnosed with uncomplicated varicose veins.

Chronic metabolic disorder diabetes mellitus is a fast-growing global problem withhuge social, health, and economic consequences. It is estimated that in 2010 there wereglobally 285 million people (approximately 6.4% of the adult population) suffering fromthis disease. Therefore, the aim of the study was to evaluate the effect of instructionallearning package on knowledge and self-care of diabetic patients at mansoura universityhospital. Setting The study was conducted at endocrine department at specialized medicalhospital, Mansoura University, Egypt. Tools, three tools were used (1) Demographiccharacteristics and medical history interview sheet, (2) Patients’ knowledge Questionnairefor DM, (3) Self-care of diabetic patient’s questionnaire.Methods Quasi-experimental research design was used in this study. Knowledgeand Self-care of diabetic patients’ questionnaire was designed after the literature review. Apurposive sample of sixty adult male and female patients were included in this studyadmitted through a period of 6 months from January, 2019 to June, 2019 diagnosed withdiabetes mellitus confirmed by diagnosis in patient file. Results The results revealed thatthe total mean score for patient knowledge about disease and patient self-care were higherin the post intervention more than the pre intervention. The total mean score for patientfoot care was higher in the post intervention than the pre intervention. The total mean scorefor insulin self-administration was higher in the post intervention than the pre intervention.

Objective We sought to evaluate and improve knowledge of lactation compatibility of medications commonly used to treat rheumatic diseases among rheumatology, obstetric, and newborn providers practicing at an academic safety net hospital. Methods Baseline knowledge of rheumatic disease medication compatibility with lactation among 49 providers was obtained via a multiple‐choice questionnaire. Following initial evaluation, providers were given a rheumatic diseases and lactation information card. The questionnaire was readministered at the time of card distribution and 5 months later. Results At baseline, more rheumatology providers correctly identified a higher number of lactation‐compatible and noncompatible medications than nonrheumatology providers (78% and 65% vs 31% and 46%, respectively; P < 0.0001). After the intervention, rheumatology providers correctly identified lactation‐compatible and noncompatible medications 98% and 100% of the time, compared with 78% and 65% of the time before the intervention (P < 0.0001 and P < 0.0001). This improvement was durable because rheumatology providers correctly identified lactation‐compatible and noncompatible medications 96% and 98% of the time 5 months following the initial intervention (P = 0.0021 and P < 0.0001). Nonrheumatology providers correctly identified lactation‐compatible and noncompatible medications 31% and 46% of the time before the intervention and 95% and 100% of the time after the intervention (P < 0.0001 and P < 0.0001). Conclusion Rheumatology providers had better baseline knowledge than obstetric and newborn providers of the breastfeeding compatibility of medications used to treat rheumatic diseases. However, all providers had knowledge gaps. After a simple educational intervention, the knowledge gap was significantly narrowed in all provider groups. This improvement was durable because repeat testing of the rheumatology provider subset 5 months post intervention continued to show significant improvement.