bluuebunny/crossref_metadata_2025 huggingface dataset:
EFETIVIDADE DO CATETER CENTRAL DE INSERÇÃO PERIFÉRICA NA TERAPIA INTRAVENOSA EM PEDIATRIA
Authors: Santos de Carvalho Tatiana , Da Silva Carlos Roberto Lyra , Dos Santos Marcia Rodrigues , Bridi Adriana Carla , Louro Thiago Quinellato , Fraga de Carvalho Márglory
Published: June 2024

Objetivo: comparar a efetividade entre o cateter central de inserção periférica (CCIP) e o cateter venoso central de curta permanência (CVC) na população pediátrica em unidades hospitalares. Método: revisão sistemática, com inclusão de artigos originais, disponíveis em completo, em português, inglês e espanhol, publicados entre os anos de 2010 e 2021. Foram utilizadas as bases de dados Pubmed/Medline, Embase, BVS, CINAHL, Web of Science e Clinical Trials, com os seguintes descritores: “pediatrics”; “adolescent”; “central venous catheters”; " catheterization, peripheral". Resultados: dos 412 estudos encontrados, seis foram selecionados. A qualidade dos estudos foi avaliada pelo protocolo Newcastle-Ottawa Scale. Conclusão: o CCIP é efetivo como acesso venoso central na população pediátrica hospitalizada, visto que não houve diferenças significativas nas taxas de infecção de corrente sanguínea associada ao cateter central e tromboembolismo venoso comparado ao cateter venoso central.
Factors enabling innovation readiness of long-term care organizations: stakeholder opinions (pre-print)
Authors: van den Hoed Monique W , backhaus ramona , Beaulen Audrey , Hamers Jan P. H. , Daniels Ramon
Published: June 2024

BackgroundIncreasing innovation readiness of long-term care organizations for older adults is vital to ensure future provision and affordability of care delivery. Research into innovation readiness of health care organizations is a rather new field. This study addresses following research question: What factors contribute to innovation readiness of long-term care organizations for older adults?MethodsSemi-structured interviews were conducted with 16 stakeholders connected to long-term care for older adults in the Netherlands: academics, (top) management, innovation managers and consultants. A thematic content analysis was used to analyze the data.ResultsFour main factors were identified that contribute to innovation readiness of long-term care organizations for older adults: 1) a clear strategic course for innovation, 2) a tailored innovation journey, 3) inspirational leading for innovation, and 4) hands-on-learning for innovation. Stakeholders highlighted that innovation readiness should not be developed as an ad-hoc initiative but should be embedded into corporate strategies and decision-making processes. All stakeholders mentioned the importance of ‘preparing’ the organization for innovation readiness via a strategic course and its deployment in an innovation journey. They also stressed the importance of professional ‘learning for innovation’ in becoming innovation ready. ConclusionsThis study provides a step toward evidence-based factors that contribute to innovation readiness of long-term care organizations for older adults. This study’s 4 main factors contributing to innovation readiness are substantiated by existing literature. Therefore, the findings of this study can support long-term care managers to structurally embed innovation. A better understanding of the contribution and interplay of factors enabling innovation readiness at all stages of the innovation process is needed. Future research could verify the findings of this study and develop a scan, based on this study’s innovation readiness factors, indicating the maturity of long-term organizations for older adults.
Personality and well-being are genetically associated: Extending previous twin and molecular genetic studies
Authors: Deppe Marco , Pahnke Charlotte Katharina Louise , Maj Carlo , Aldisi Rana , Nöthen Markus , Diewald Martin , Spinath Frank M. , Forstner Andreas , Kandler Christian
Published: June 2024

Neuroticism, extraversion, and conscientiousness are the most notable personality predictors of subjective well-being (SWB) in phenotypic and behavior genetic studies. We aim to quasi-replicate and extend previous findings. Using data from the German twin family panel TwinLife, we analyzed Big Five personality traits and life satisfaction of 3,080 twin pairs from three birth cohorts (born 2003/04, 1997/98, and 1990–93). Prior research has repeatedly provided evidence that genetic variance in personality traits largely explained genetic variance in SWB. Our results replicated this pattern with no significant unique genetic variance in life satisfaction. However, we found significant age cohort differences (e.g., only in ages 11–17 did genetic variance in openness partly explain genetic variance in life satisfaction). Furthermore, we tested personality—SWB associations using polygenic scores (PGSs) for Big Five personality traits and SWB. PGSs were calculated for 𝑁 = 5,355 genotyped twin family members from the TwinSNPs study (age range 8–77). PGSs showed genetic association patterns similar to the twin study results, with neuroticism as the most robust predictor (𝛽 = −.118) and openness showing near-null associations. Despite low overall explanatory power, phenotype prediction mirrored this as well (e.g., neuroticism PGSs predicted life satisfaction with 𝛽 = −.057).
Variation Exists in the Expression of Romantic Love: A Cluster Analytic Study of Young Adults Experiencing Romantic Love
Authors: Bode Adam , Kavanagh Phillip Sean
Published: June 2024

Variation exists in the expression of romantic love, but to date, no studies have specifically investigated this phenomenon. This study employed a TwoStep cluster analysis to group 809 partnered young adults experiencing romantic love according to intensity of romantic love, obsessive thinking, commitment, and frequency of sex per week. The results revealed four clusters: (i) mild romantic lovers (20.02%) characterized by the lowest intensity, lowest obsessive thinking, lowest commitment, and lowest frequency of sex; (ii) moderate romantic lovers (40.91%), characterized by relatively low intensity, relatively low obsessive thinking, relatively high commitment, and relatively moderate frequency of sex; (iii) libidinous romantic lovers (9.64%), characterized by relatively high intensity, relatively high obsessive thinking, relatively high commitment, and exceptionally high frequency of sex; and (iv) intense romantic lovers (29.42%), characterized by the highest intensity, highest obsessive thinking, highest commitment, and relatively high frequency of sex. Each cluster may represent distinct phenotypes of romantic lovers and differ on a range of personal and relationship characteristics. The findings can generate theory and hypotheses about romantic love and provide impetus for future research.
A Pilot Study of Twice-Weekly Group-Based Written Exposure Therapy for Veterans in Residential Substance Use Treatment: Effects on PTSD and Depressive Symptoms
Authors: Van Doren Natalia , Chang Fang Hsi , Nguyen Amanda , McKenna Kevin R. , Satre Derek D. , Stirman Shannon Wiltsey
Published: June 2024

AbstractBackground: Posttraumatic stress disorder (PTSD) is highly comorbid with substance use disorders (SUDs), resulting in high prevalence of PTSD among individuals in residential SUD care. However, there is limited research on integrating trauma treatment into residential SUD care settings. The aim of the present project was to conduct an initial evaluation of the effects of group-based Written Exposure Therapy (WET) on PTSD and depressive symptoms that was integrated into programming for individuals in residential SUD treatment.Methods: Participants were 48 Veterans with comorbid PTSD-SUD from a 28-day residential SUD program at a Veterans Affairs Medical Center. Eligible participants were enrolled in 5 sessions of WET, delivered in twice-weekly in a group format. PTSD symptoms and depressive symptoms were assessed at each session with the Posttraumatic Stress Disorder Checklist, DSM-5 version (PCL-5) and the Patient Health Questionnaire (PHQ-9). Results: Of the enrolled sample of 48 participants, 92% (n = 44) completed 3 sessions, while 56% (n = 28) completed 5 sessions. Dependent samples t-tests showed significant reductions from baseline in PTSD symptoms within-persons at both the 3-session (t(43) = 4.77, p < .001, d = .72) and 5-session mark (t(27) = 4.36, p < .001, d = .82). In addition, there were significant reductions in depressive symptoms after 3 sessions (t(38) = 3.01, p < .01, d = .48) and after 5 sessions (t(23) = 2.97, p < .01, d = .61). Conclusion: Findings demonstrate that brief, group-delivered WET shows promise for addressing PTSD and depressive symptoms in residential SUD treatment. Results of the present evaluation could inform further efficacy testing and implementation of PTSD treatment into residential SUD settings.
Clinical outcomes of patients with SIBO and adherence to the carnivore diet: An analysis from a functional medicine perspective
Authors: Barton Karolina
Published: June 2024

Small Intestinal Bacterial Overgrowth (SIBO) manifests through excessive bacterial growth in the small intestine, causing significant gastrointestinal disturbances and impairments in nutrient absorption. The quest for innovative remedies is crucial, with conventional treatments like antibiotics facing limitations due to antibiotic resistance. Elemental and low-FODMAP diets, although partially effective, have their limitations. The carnivore diet, consisting solely of animal products, aims to curb SIBO by eliminating carbohydrates—bacteria's primary nutrient source—and providing nutrient-dense foods to remedy deficiencies. This thesis examines the carnivore diet's effectiveness in treating SIBO and its broader health implications. A survey assessed the carnivore diet's impact on health, especially SIBO, among 40 participants from Funmed clinics, gathering feedback on motivation, diet, symptom changes, health improvements, impressions, and challenges. Also, a search of electronic medical records mapped the feedback from the 46 non-survey completers who had adopted the diet. Statistical analysis utilised the Shapiro-Wilk test for data normality, the Wilcoxon rank-sum test for non-normal numerical data between groups with (n=27) and without SIBO (n=13), and the Pearson chi-squared and Fisher's exact tests for categorical variables. Results indicate improvements in gastrointestinal function, fatigue reduction, effective weight management, enhanced cognition, subjectively lower blood sugar levels, and the vast majority of participants would recommend the diet to others, underscoring the diet's therapeutic potential beyond SIBO treatment. These findings suggest that the carnivore diet could offer a promising SIBO and general health improvement alternative, warranting further investigation into its long-term safety and efficacy.
Clinicoetiological profile and outcome of patients of acute febrile encephalopathy in a tertiary care hospital in New Delhi - A prospective observational study
Authors: Dar Maqsood Ahmad , Eijaz Ahmed Bhat  , Ajay Kotwal  , Mir Sadaqat Hassan Zaffer  , Owvass Hamid Dar
Published: June 2024

Background: Acute febrile encephalopathy (AFE) in spite of being a common clinical condition is less known to the general population thereby resulting in delay in seeking medical attention with detrimental consequences. The causes can range from infectious central nervous system (CNS) and systemic diseases to non-infectious conditions such as neuroleptic malignant syndrome, poisoning, and drug overdose. Early diagnosis and prompt medical management can result in good clinical outcome in terms of morbidity and mortality.
Aims and Objectives: The aims and objectives are to study the clinical profile, etiology, seasonal variation, and outcome in patients admitted as case of AFE in a tertiary care hospital.
Materials and Methods: All patients of AFE fulfilling the inclusion and exclusion criteria admitted in the departments of neurology and general medicine in Batra Hospital and Medical Research Centre (BHMRC) New Delhi, a tertiary care hospital were subjected to study analysis. The patients underwent detailed history, examination, baseline, and special investigations such as cerebrospinal fluid and magnetic resonance imaging brain whenever needed. Patients of AFE were studied according to the prevalence, etiological diagnosis, and seasonal variations. The final outcome at discharge was based on modified Rankin scale (mRs).
Results: About 122 serially admitted patients diagnosed with AFE were found eligible and included in the study. About 47 (45%) patients had acute pyogenic CNS infection while as 36 (35%) had non-pyogenic CNS infection followed by malarial, tubercular, and cryptococcal CNS infection. We found maximum number of cases (n=61, 50%) of AFE during monsoon followed by 36 patients (30%) in post-monsoon, 15 patients (12%) were in summer, and only 10 cases (8%) during winter. We found higher and statistically significant disability in CNS infection group, patients with delayed hospitalization (P=0.001), and lower Glasgow coma scale (0.00001).
Conclusion: AFE being a condition with serious consequences, we conclude that clinical suspicion, sensitization, and swift response from the treating physicians are required to avoid worse outcomes associated with the delayed diagnosis and late hospitalization of these patients.
Relationship between pupil to limbus diameter ratio with blood pressure and pulse rate in young adults: An observational study
Authors: Himanshu Sharma  , Ishrat Khan  , Varsha Porwal  , Haneef Khan
Published: June 2024

Background: Autonomic function tests play a crucial role in the diagnosis and prognosis of clinical conditions. Although there are multiple autonomic function tests available, there is still a need for rapid and less expensive tests for the benefit of the general population. The pupil-to-limbus diameter (PLD) ratio is one such test that is simple and cost-effective. It uses the principle of pupil dilation and constriction due to the influence of the autonomic neurons’ activity.
Aims and Objectives: The present study aimed to observe a correlation between PLD ratio with blood pressure and pulse rate in young adults.
Materials and Methods: The present study was conducted at the Department of Physiology, Jhalawar Medical College, Jhalawar. The present study was an observational study conducted among 1st-year medical students in the age group of 18–24 years. PLD ratio was measured by the two-box method as described in the literature. After providing 3–5 min of rest, blood pressure and pulse were recorded in the right arm in the sitting position by a digital blood pressure monitor.
Results: Positive correlation was observed between the PLD ratio of right eye and pulse rate (r=0.9696). There is a weak negative correlation exists between the PLD ratio of right eye and systolic blood pressure (r value=−0.3802).
Conclusion: The study concludes that the PLD ratio correlates with autonomic activity. However, there is a need for a study with large population to confirm the correlation. Furthermore, there is a study to assess the autonomic responses in female participants in different phases of menstrual cycle.
Jejunogastric intussusception: A case report of unusual cause of upper gastrointestinal bleeding after gastrojejunostomy
Authors: Rajan Swaminathan , Sivasankar Amarapathy  , Somasekar Durairajan
Published: June 2024

Upper gastrointestinal bleeding is following gastrojejunostomy due to stromal ulceration, marginal ulcer bleeding from anastomotic site, remnant cancer. Gastrojejunostomy done for benign gastric outlet obstruction has many complications. Jejunogastric intussusceptions (JGI) is a rare complication of gastrojejunostomy surgery (<0.1% of cases), yet requires an urgent diagnosis. Mortality rates range from 10% to 50% based on delay in diagnosis and surgical intervention. Vomiting, abdominal pain, and hematemesis are the most common symptoms. We report a 53-year-old man admitted to the emergency department, complaining of epigastric pain and recurrent hematemesis for 3 days. Abdominopelvic computed tomography scan also showed a target sign in favor of jejunal intussusception. Midline emergency laparotomy was done and the gangrenous jejunum was resected with reconstruction Roux en Y loop was done. The patient was discharged without any further complications. In patients presented with hematemesis and abdominal pain and a history of gastrojejunostomy, JGI must consider a possible cause because early diagnosis and treatment are necessary to prevent further complications.
Clinicopathological features and risk stratification by the sokal score of patients with chronic myeloid leukemia at a tertiary care hospital in North-East India: A prospective study
Authors: Anjanjyoti Rajkonwar  , Upam Kumar Sharma  , Sima Sonowal  , Arpita Nath  , Hiranya Saikia  , Gautam Hazarika
Published: June 2024

Background: Chronic myeloid leukemia (CML) is a hematologic malignancy characterized by excessive growth of myeloid cells and their progenitors. The incidence of CML is approximately 1–2/100,000 population per year.
Aims and Objectives: The aims and objectives of the study are to determine the clinicopathological features of patients with CML and their risk stratification by the Sokal score at a tertiary care hospital in North-East India.
Materials and Methods: This was a single-center prospective study conducted for 5 years (2018–2022). A total of 109 cases diagnosed with CML by qualitative analysis of BCR-ABL1 transcript reverse transcription-polymerase chain reaction were included in the study. The Sokal score was calculated using previously published formulae to classify the patients into different risk groups. The outcome (dead or alive) of CML patients was compared with their individual risk groups using Fisher’s exact test.
Results: Out of 109 CML patients, 73 were males and 36 were females. At the end of the study, 85 patients were alive whereas 24 died. The mean age at presentation was 42.08±15.06 years. The pediatric age group comprises 1.84% of total cases. The percentages of death were higher (79.17%) in patients aged 18–59 years, followed by 20.83% in ≥60 years age group, whereas no death was recorded in the pediatric age group (<18 years). The abdominal hard lump was the most common clinical presentation, followed by abdominal fullness, weakness, and pain abdomen. The Sokal score assigns the majority (66.06%) of patients to the intermediate risk (IR) category, followed by 25.69% and 8.26% in the high-risk (HR) and low-risk (LR) categories, respectively. It was observed that the majority (28.57%) of patients died in the HR group, followed by 20.83% in the IR group and 11.11% in the LR group.
Conclusion: The mean age of CML patients is lower than that observed in many Western countries. The Sokal score assigns the majority of patients to IR category and the maximum death were seen in the HR group.
Bacterial pathogens and treatment outcomes in neonatal sepsis: A comparative observational study across various hospital settings
Authors: Radhika B  , Vijayasri BSS  , Vidyasagar V  , Jyothi Prakash Raju S
Published: June 2024

Background: Neonatal sepsis is a leading cause of neonatal morbidity and mortality globally, with variations in causative bacteria and treatment efficacy across health-care facilities.
Aims and Objectives: The aims and objectives of the study are to analyze the bacterial pathogens causing neonatal sepsis and the effectiveness of their treatment in diverse hospital environments. By highlighting the differences in treatment success rates, antibiotic resistance profiles, and the pathogens involved, this study demonstrate the impact of health-care practices and infrastructure on the management of neonatal sepsis.
Materials and Methods: The study encompassed 100 neonates with sepsis, evenly distributed across the three hospital types. It involved identifying bacterial pathogens through blood cultures, assessing antibiotic sensitivity, and examining treatment outcomes such as success rate, mortality, hospital stay duration, and complication rates. Statistical methods were employed to evaluate differences in outcomes among the settings.
Results: Seventy percent of neonates tested positive for bacterial pathogens, with a 60% predominance of Gram-positive over Gram-negative bacteria (40%). Staphylococcus aureus (22%) and Streptococcus agalactiae (18%) were the leading pathogens. Notably, resistance was high against ampicillin (65%) and gentamicin (40%) but lower for cephalosporins and vancomycin. The overall success rate of treatments was 80%, with the tertiary care hospital achieving an 88% success rate, significantly outperforming the private hospitals (72%). The mortality rate was 10%, and 30% of the cases developed complications, predominantly respiratory distress syndrome.
Conclusion: Hospital setting significantly influences the management and outcomes of neonatal sepsis, with tertiary care centers showing better results. These findings highlight the need for focused antimicrobial stewardship and the adoption of sophisticated care protocols in less advanced settings to improve neonatal sepsis outcomes.
Classic polyarteritis nodosa presenting initially as a case of cutaneous polyarteritis nodosa: A case report
Authors: Adhikari Sabina
Published: June 2024

Classic polyarteritis nodosa (PAN) is an uncommon form of aggressive systemic vasculitis involving small-to-medium sized arteries usually of renal vasculature and other visceral organs but characteristically sparing the lung vasculature. Cutaneous PAN (c-PAN) is still a rare type of small-to-medium vessel vasculitis with involvement of skin without any systemic or visceral involvement. However, extracutaneous features such as arthritis, arthralgia, myopathy, and myositis can co-exist with the cutaneous features. c-PAN can be confirmed histopathologically by the presence of polymorphonuclear leukocytes around the medium-sized vessels with evidence of fibrinoid necrosis and luminal thrombi at the bifurcations. While c-PAN has a benign but chronic course and can be managed with low doses of short-course oral steroids or anti-inflammatory drugs, systemic involvement has an aggressive course and needs adequate and prompt immunosuppression with high dose oral steroids, cyclophosphamide, rituximab, or other immunosuppressive. We present a case of a 33-year-old male who landed in our OPD with features of c-PAN and on further investigative workup was found to have a renal infarct.
Bilateral superficial cervical plexus block as sole anesthesia for parathyroid surgeries in chronic kidney disease patients
Authors: Kanika Agarwal  , Sharma Nidhi , Sharma Aseem , Banjare Manish
Published: June 2024

Chronic kidney disease (CKD), especially in stages III, IV, V patients presenting for surgical removal of parathyroid glands, has special concerns regarding anesthesia. Their renal disease restricts the choice of drugs that can be used for general anesthesia induction and management. Bilateral superficial cervical plexus block (SCPB) under ultrasound guidance can be an alternative mode of anesthesia in parathyroid surgeries in these patients. The aim of the present case series was to evaluate the effectiveness of bilateral SCPB in CKD (stages III, IV, V) patients undergoing parathyroid surgeries in terms of hemodynamic stability, intraoperative and post-operative analgesia, and surgeon’s satisfaction. In the present case series, USG-guided bilateral SCPB was performed under aseptic precautions and 10 mL of local anesthetic was injected on each side. Effect was confirmed with wet swab and blunt pin prick. Then, patient was handed over to the surgeon. Continuous hemodynamic monitoring was done and time of first rescue analgesia was noted. Bilateral SCPB proved to be a good alternative mode of anesthesia for CKD (stages III, IV, V) patients undergoing parathyroid surgeries.
Torsion of paraovarian cyst: An enigma
Authors: Latika  , Dahiya Pushpa
Published: June 2024

Paraovarian cysts are extremely rare and represent approximately 10% of adnexal masses. They are found commonly in women of reproductive age group and arise from the mesothelium. Paraovarian cyst is an entity which is rarely diagnosed preoperatively and often remains undiagnosed and missed out even by radiologists. Most often they remain asymptomatic but when large in size may present with complications such as torsion, hemorrhage, and infection. Isolated torsion of paraovarian cyst is extremely rare. Its diagnosis is often missed out leading to complications.
Sensory processing patterns in children with attention-deficit hyperactivity disorder: A case–control study
Authors: Bandyopadhyay Aritra , Nath Saswati , Mandal Uday Sankar , Ghoshal Sreeprova , Dandapath Abhishek , Mallick Suchismita
Published: June 2024

Background: Sensory processing (SP) indicates the ability of the nervous system to receive, analyze, process, and respond to external sensory input and coordinates motor movements accordingly. Children with various neurodevelopmental disorders, like autism spectrum disorder, have SP issues. However, studies regarding SP issues in attention-deficit/hyperactivity disorder (ADHD) compared to typically developing children are relatively less.
Aims and Objectives: To study the SP pattern of children with ADHD, to compare with the control group, and to study the correlation of symptom severity with SP deficit in children with ADHD.
Materials and Methods: All children attending the child guidance clinic at R. G. Kar Medical College and Hospital were screened, and children with ADHD without any other comorbid disorder as diagnosed by Diagnostic and Statistical Manual 5 were selected. Their ADHD symptom severity was assessed using the ADHD test, and SP was assessed using the Short Sensory Profile (SSP).
Results: The SSP mean score of the children with ADHD was significantly different than the mean score of the control group, and the percentage of children having a definite difference in SP was significantly different in the ADHD children group compared to the control group. The severity of the SP deficit also correlates with the severity of ADHD symptoms, as found by the correlation study.
Conclusion: Children with ADHD have shown a definite difference in SP compared to controls, and the severity of the sensory problem is proportionate to the severity of the symptoms of ADHD.
Determining the factors which impact management of acute poisonings due to therapeutic medicines
Authors: Sudan Aishwarya , Princy Louis Palatty  , Jayachandran Mamatha , Sabarish Balachandran
Published: June 2024

Background: In a developing country such as India, intentional poisoning is associated with a high degree of morbidity and mortality. Historically, the use of agricultural poisons for attempted deliberate self-harm (DSH) has taken precedence. However, urbanization and stringent laws governing sale of agricultural chemicals, in recent years, may have shifted the focus of seekers toward commercially available therapeutic medications. Further, urbanization, high health-care seeking behavior, and poor regulation on sale of medicines, in Kerala, provide a conducive environment for such attempts.
Aims and Objectives: The objective of this study was to determine the contribution of therapeutic medication toward acute poisoning as a means of DSH and the factors contributing to the same.
Materials and Methods: Patients who obtained treatment for acute poisoning after DSH, between 2017 and 2023, were screened, those who employed therapeutic medication for the same were further determined. Sociodemographic details, clinical profile, and history of previous such attempts and treatment history including toxicological screening report were gathered and analyzed.
Results: In our study of 154 patients arriving at the emergency department with history of DSH, 41% used therapeutic medicines for the same. Majority were women (75%) and most had a high school education (64%) or above. The most common agents were determined as paracetamol (23%) and benzodiazepine (10.6%). Tox screen was performed for 45% of patients. Organ failure developed in 36% patients with drug levels above and 42% of those with levels below the therapeutic range. However, 48% of those who did not undergo toxicological screening developed organ failure. Organ failure developed in 42% of patients, with acute liver injury being the most common culprit (25%). Management was symptomatic unless an antidote was available.
Conclusion: Prescription drugs utilization for DSH was common in women and patients with higher educational status. Over-the-counter drugs and psychiatric medication were frequently used. Lack of prompt access to healthcare may contribute to organ failure. Tox-screen is recommended for drug detection.
Effects of administration of melatonin on agitation and duration of stay in patients of traumatic brain injury admitted to neurosurgical intensive care unit – A retrospective study
Authors: Zulfiqar Ali  , Iqra Nazir  , Shahid Ahmad Mir  , Zoya Sehar  , Aymen Masood  , Eman Aftab  , Muqtashid Rashid
Published: June 2024

Background: Agitation is frequently encountered in patients recovering from traumatic brain injury (TBI) in the intensive care unit (ICU). The etiopathology for agitation is multifactorial. Melatonin has been widely used to study the effects of delirium in ICU, however, its effect on agitation is not well studied.
Aims and Objectives: The aim of this study was to assess the effect of melatonin administration on the prevalence of agitation and length of stay in patients with severe TBI, managed conservatively, or undergoing decompressive craniectomy.
Materials and Methods: A retrospective observational study with 70 patients undergoing various decompressive craniotomy or managed conservatively, and admitted to neurosurgical ICU was included in the study. Thirty-six patients were recruited from the control group and 34 patients received melatonin during their stay in the ICU. In this study, records of 70 patients who had suffered isolated TBI with no associated injuries were analyzed. The patients had a Glasgow coma score of 3–14 on admission to ICU. The patients were managed as per the standard protocols, as per the existing guidelines, and based on TBI guidelines.
Results: A non-significant decreasing trend of agitation and reduced duration of ICU stay was noted in patients who received melatonin compared with the control group. The prevalence of agitation observed on modified Ramsay scale (Mean±SD) in patients who received melatonin on Day 3, Day 4, Day 5, Day 6, Day 7, Day 8, and Day 9 were −1.67±3.01; −1.61±2.82; −1.2±2.55; −1.23±2.51; −1.23±2.11; −1.05±2.09; and 0.76±2.03, respectively. These scores were slightly lower than observed in the control group on Day 3, Day 4, Day 5, Day 6, Day 7, Day 8, and Day 9 as −1.58±3.16; −1.33±2.72; −1.08±2.46; −1.13±2.25; −0.94±1.87; −0.52±1.7; and 0.52±1.36, respectively. The mean±SD duration of stay in ICU of patients receiving melatonin (13.14±3.37) and not receiving melatonin (14.52±3.73) was comparable (P=0.1).
Conclusion: Although there was a decreased prevalence of agitation and a decrease in the mean duration of the ICU stay in patients who received oral melatonin, these beneficial effects did not show any statistical significance once compared with the control group.
Navigating the transition: Implementing competency-based medical education in medical curriculum in India
Authors: Aditi Aikat
Published: June 2024

The road to implementation of competency-based medical education (CBME) in the medical curriculum in India has both challenges and windows of opportunities in its folds. The hindrances identified were reluctance to change, capacity building of faculties, lack of infrastructural support, and methods of assessment. Notwithstanding, CBME has the potential to ensure that the Indian medical graduates are equipped with better clinical skills, and learner-centric education, that aligns well with individual competence, and community healthcare needs. Effective navigation through this transition calls for collaborative efforts among academicians, regulatory bodies, and related stakeholders while drawing from relevant successful models of our country itself. It is imperative to address the challenges concerning capacity building of faculties, resource allocation, and assessment methodology for successful implementation. Given appropriate adoption, the CBME-based curriculum can go a long way to deliver quality healthcare.
A prospective study of various pre-operative factors and the development of a scoring system in predicting difficult laparoscopic cholecystectomy
Authors: Usha Ramakrishna N  , Radhika Potnuri  , Raj Kumar Sahu  , Hitesh Chavda
Published: June 2024

Background: Laparoscopic cholecystectomy (LC) is a common surgical procedure, the difficulty of which can vary significantly based on pre-operative factors. Identifying these factors can improve surgical planning, patient counseling, and outcomes.
Aims and Objectives: To develop a predictive scoring system for assessing the difficulty of LC preoperatively based on individual patient parameters. To employ operative time and intra-operative events to validate the accuracy of the scoring system in reflecting the technical difficulty of LCs.
Materials and Methods: This prospective study enrolled 104 patients scheduled for LC, assessing them with a pre-operative scoring system to predict operative difficulty. Patients were categorized into groups indicating expected levels of difficulty: Easy, difficult, and very difficult. Demographic information, clinical characteristics, and operative outcomes were analyzed to validate the scoring system’s predictive accuracy.
Results: Of the patients assessed, 68.3% were predicted to have an easy LC (scores 0–5), whereas 31.7% were anticipated to face a difficult LC (scores 6–10). Key predictors of operative difficulty included age, sex, history of previous hospitalization for acute cholecystitis, body mass index (BMI), the presence of an abdominal scar, palpable gallbladder (GB), thickened GB wall, pericholecystic collection, and impacted stone. The study found that operative outcomes closely aligned with pre-operative predictions, confirming the scoring system’s moderate predictive accuracy (area under the curve of 0.798).
Conclusion: The pre-operative scoring system demonstrated moderate effectiveness in predicting LC difficulty, with significant predictors including a history of hospitalization, BMI, palpable GB, and thickened GB wall. These findings can aid in pre-operative planning and optimizing patient outcomes.
Prevalence of chronic kidney disease and its risk factors among Type 2 diabetes patients in a tertiary care hospital
Authors: Noor Mohamed Rasik B  , Sakthi Suganya ST  , Vikram Manamala Sudhakar  , Vignesh C
Published: June 2024

Background: An increased chance of developing chronic kidney disease (CKD), which has higher morbidity and mortality, exists among patients with Type 2 diabetes (T2D).
Aims and Objectives: Our goal was to determine and classify the anthropometric, physiological, and demographic risk factors for CKD in individuals with T2D.
Materials and Methods: A cross-sectional research study was conducted at a tertiary care hospital involving 218 participants. Data were collected on various parameters including age, gender, education level, employment status, height, weight, blood pressure, hemoglobin levels, and estimated glomerular filtration rates (eGFRs). Participants were selected based on specific inclusion and exclusion criteria, and rigorous statistical analyses were applied to the collected data. Using the SPSS program, we analyzed the data, and when the P<0.05, we declared the results statistically significant.
Results: There were 218 people in the research, 58.3% of whom were male and 41.7% of whom were female. The mean age group was between 51 and 60 at 36.2%. The age group distribution among the patients showed significant value (P<0.0001). About 87.6% of the patients had normal weight. 49.5% were recorded in Stage 1 CKD. Fasting blood sugar has a negative correlation (−182) with glomerular filtration rate (GFR) and shows a significant result. The post-prandial blood sugar value is also statistically significant and negatively relates to GFR. In addition, random blood sugar and glycated hemoglobin also reported statistically significant values.
Conclusion: In individuals with T2D, it was determined that significant risk factors for the onset of CKD include eGFR, age, and the duration of diabetes. Males had a considerably greater incidence of CAD, peripheral neuropathy, and diabetic foot.
Assessing the link between rivaroxaban concentration and the onset of renal impairment in elderly patients: A retrospective observational study
Authors: Motakatla Usha Rani  , Chitra Karuppiah  , Penupothu Sree Nagamani
Published: June 2024

Background: Rivaroxaban is a widely used anticoagulant, but its impact on renal function, particularly at varying plasma concentrations, remains a critical area of investigation. This study examines the relationship between rivaroxaban concentration and renal impairment in elderly patients.
Aims and Objectives: The aim of the study was to investigate the relationship between rivaroxaban plasma concentrations and the incidence of renal impairment in elderly patients.
Materials and Methods: A retrospective observational study was conducted on 100 elderly patients prescribed rivaroxaban for atrial fibrillation or venous thromboembolism prevention. Patients were categorized based on their rivaroxaban plasma concentrations into three groups: Low (<50 ng/mL), medium (between 50 and 200 ng/mL), and high (>200 ng/mL). Renal impairment was characterized as having an estimated glomerular filtration rate <60 mL/min/1.73 m². The analysis of the data consisted of Chi-square testing and multivariable logistic regression, with adjustments made for age, gender, baseline renal function, and treatment indication.
Results: The incidence of renal impairment escalated with increasing rivaroxaban concentrations, 20%, 40%, and 60% in low, medium, and high concentration groups, respectively. Statistical analysis revealed a significant association between rivaroxaban concentration and renal impairment (χ2=10.57, P=0.005). Patients with high concentrations had 2.8-fold higher odds of developing renal impairment compared to the low concentration group. Cox proportional hazards analysis showed a 2.2 times higher hazard of renal impairment in high versus low concentration groups over 18 months.
Conclusion: Higher trough plasma concentrations of rivaroxaban are associated with an increased risk of renal impairment in elderly patients. This finding highlights the importance of monitoring rivaroxaban levels to mitigate renal risks.
Multi-parametric MR Evaluation of Post Neo-adjuvant Chemo-radiation Cases of Rectal Cancer
Authors: Gara Harsha , Raj Gaurav
Published: June 2024

Introduction: In India as per ICMR|NCDIR newly diagnosed rectal cancer cases in 20211 were 15,782. Among these new cases, more cases were registered in males (9506) than females (6276). MRI is the imaging modality of choice for staging and restaging after chemo radiotherapy. Multi-parametric MRI implies addition of multiple parameters including diffusion weighted imaging, dynamic contrast enhancement, conventional MRI and specific sequences tailored to rectal cancer. As such Dynamic contrast enhanced MRI and Diffusion weighted imaging remains an active area of ongoing research. Characterization of lymph nodes based on morphologic criteria helps in diagnosing metastatic lymph nodes. Objectives: Primary objective is to establish the role of novel MRI pulse sequences and protocols in patients with rectal cancer post-treatment (neo-adjuvant chemo-radiation). Secondary objective is to evaluate post-treatment morphological components of tumour on MRI and its correlation with treatment response. Methods: Present prospective study was conducted in the Department of Radio-diagnosis of a tertiary level care. Results: Total 40 patients were enrolled in this study. Dynamic contrast enhanced and diffusion weighted sequences gave most significant results, where the exact localization of tumour was done, however in DCE MRI and DWI MRI there were 1 (97.5%) and 2 (95%) patients respectively, showed inconclusive results in T staging after post NACRT. As per the study, conventional sequences in post NACRT patients are less sensitive in T staging due to the post NACRT fibrosis and necrosis. Conclusion: Among conventional sequences oblique axial T2 weighted imaging with minimal spacing and slice thickness along with post contrast T1 images allow the most accurate assessment of residual tumor. In novel sequences DWI and dynamic contrast imaging also shows accurate results and should be added to routine sequences if possible.
Nursing Leaders to Address Workplace Bullying
Authors: Zolkefli Yusrita
Published: June 2024

The letter centers around a recent study published in the Malaysian Journal of Nursing, titled "Workplace bullying among nurses in Singapore: Aquantitative survey,” which sheds light on nurses' experiences regarding workplace bullying. The study deserves praise for its insightful look at nurse workplace bullying. This study calls for serious reflection because it undermines our caring professionals. This study also shows that nursing leaders can improve the workplace. What can nurse leaders do to help? This commentary will focus on two salient strategies that could assist nurse leaders in mitigating bullying: having the knowledge, skills, and confidence to identify bullying and prioritizing targeted support.
Nurses' Challenges Regarding Adolescent Behavior in Preventing Early Pregnancy
Authors: Suwarsi Suwarsi , Damayanti Santi
Published: June 2024

Early adolescent pregnancy remains a persistent and unresolved phenomenon worldwide. The World Health Organization reports that 16 million girls aged 15-19 give birth annually. Indonesia continues to grapple with high rates of young pregnancy. The consequences of early pregnancy are extensive, ranging from abortion, school dropout, early marriage, and divorce to psychological distress such as stress and depression. Aim:This research contributes to understanding adolescent behaviors aimed at preventing early pregnancy. Methods:Employing a quantitative research design with a descriptive approach, the study sampled 225 female students through simple random sampling. Avalidated questionnaire was utilized for data collection, and analysis was conducted using SPSS 21 software. Results:The findings reveal that most respondents demonstrated commendable behaviors in preventing early pregnancy, with 193 individuals (85.8%) exhibiting good prevention practices. Nevertheless, some respondents displayed moderately positive behaviors, while others exhibited unsatisfactory practices. Conclusion:To address the behavior of adolescent females and its impact, community health nurses should intervene promptly. This intervention should focus on educating and coaching adolescents to raise awareness and promote effective prevention strategies, with the goal of reducing the prevalence of early pregnancy.
Voices of Women Public Healthcare Workers amidst the Armed Conflict in Southern Philippines
Authors: Rame Rambe Jr. , Maranda Jiddo Andrei , Veloso Karen , Mangarun Abdullah Junior , Santillana Lynuel , Orias Jessica
Published: June 2024

Healthcare workers face hazards and risks that are inherent in their job. However, the most tragic and perilous encounter for these professionals in the Southern Philippines occurred when Maute-ISIS insurgents took over the Islamic City of Marawi in the Province of Lanao del Sur. Methods:This study delves into the experiences of women public healthcare workers at the time of human-induced conflict using a qualitative phenomenological research design. Results:Data revealed that they experienced fear, anxiety, flashbacks, and trauma, though they were accustomed to hearing gunshots, as claimed. Furthermore, they have exhausted all means to survive, helped one another, and served their constituents despite being in a terrible situation.Conclusion:Disturbances can be seen on the physical, emotional, and mental levels as typical reactions to an unwelcome and terrifying situation. Camaraderie among Muslims and Christians became evident in times of trouble, suchasthearmedconflict.Inaddition,therespondentsdemonstratedtheirzealtoserve, notwithstanding the perilous situation. Setting up institutional policies on disaster preparedness for human-induced crises is beneficial for sound crisis management.
Enhancing Teamwork Through Effective Handover Practices among Nurses in Elder Care Setting
Authors: Angelen Shirley Sili Gaing @ , Abdullah Bibi Florina , Dioso Regidor III
Published: June 2024

This study aims to investigate how effective handover practices among nurses contribute to enhancing teamwork within elder care settings. It will explore the impact of clear communication, structured handover processes, and collaboration among nursing teams during handovers on various aspects of teamwork, including coordination, information sharing, and mutual support. Methods:Aqualitative, descriptive study employed semi-structured interviews with nurses and other healthcare professionals involved in handover processes. Participants included nurses and various healthcare professionals. Thematic analysis, guided framework, was utilized to examine handover practices and their impact on patient care. Responses were meticulously coded manually to identify recurring themes and subthemes.Results:The study identified three key themes in healthcare handover practices: the importance of objective and clear documentation, including essential information for continuity of care, and the role of effective documentation in promoting understandingandaccountabilityamonghealthcareprofessionals.Thesepracticesenhance communication, teamwork, and accountability, leading to improved patient outcomes. Effective communication involves aspects such as frequency, timeliness, accuracy, problem-solving, shared knowledge, goals, and mutual respect among team members, fostering a culture of teamwork and accountability that benefits both staff and patients. Conclusion:Achieving optimal teamwork in professional hierarchies requires insights and experiences on handover implementation from an interprofessional perspective. This collaborative approach involves professionals working together toprovidecomprehensivepatientcare.Interprofessionalcollaborationencourageseffective communication, mutual respect, and shared decision-making among team members, ultimately enhancing patient outcomes.
The Needs of Critical Care Unit Patient's Family Members in East Cost Malaysia: A Cross-Sectional Study
Authors: Ali Nor Ayliwati , Hashim Noraini
Published: June 2024

Involving family members is integral to the healing process and the patient's well-being in the Critical Care Unit (CCU). However, having a patient hospitalised in the CCU is quite challenging for the patient's family members and has become a traumatic experience for them. Therefore, the study objectives are to identify the important needs of CCU patients' family members and determine the relationship between their needs and sociodemographic characteristics. Methods: Across-sectional study was conducted among family members of patients who were admitted to the CCU in one government hospital in East Malaysia. About 96 participants were identified using convenience sampling and answered 42 questions in the Malay Critical Care Family Needs Inventory (CCFNI-M). The data were analysed using IBM-SPSS Statistics Version 25. Results:Most of the family members who cared for the patient in the ICU were female, 76% (n= 73). The findings demonstrated that family members ranked assurance (3.69 ± 0.26) and information (3.59±0.34) as the most important needs compared to proximity (3.18±0.46), support (3.04±0.50), and comfort (2.53±0.46). There was no association between family members' age, gender, and experience with assurance,support,comfort,proximity,andinformationneedswhenthep-value>0.05. Conclusions:In conclusion, recognising and addressing the needs of the ICU patient's family members is crucial for the strategy of CCU patient-family-centered care. The result of the study informs the importance of the involvement of family members in supporting CCU patients. By prioritising their needs and offering tailored support, healthcare providers can contribute to better patient outcomes and improved family well-being.