International Journal of Clinical Practice最新文献

Aim. To determine the efficacy of interventional programs on nurses’ perceptions of parents’ support and attitudes toward parents’ participation in neonatal care in the neonatal intensive care unit (NICU). Methods. An experimental design was used to determine the efficacy of the interventional program on NICU nurses’ perceptions of parents’ support and attitudes toward parents’ participation in their neonatal care in three hospitals. Nearly 160 nurses from hospitals in North and Middle Jordan participated in the study and were divided into 80 intervention and 80 control groups. Results. The study displayed that nurses had a lower score in the perception of parents’ support and attitude towards their participation in neonatal care in pretest scores than in posttest scores. The mean perception score of parents supported in the control group was 59.17 (SD = 10.1) and in the intervention group was 64.16 (SD = 7.47) (P ≤ 0.01). The mean attitude score of parents’ participation in neonatal care in the control group was 37.08 (SD = 5.76) and that in the intervention group was 38.93 (SD = 5.92) (P = 0.04). Conclusion. The results of the study showed a positive impact of the intervention on nurses’ perceptions of parental support and attitudes toward their participation in neonatal care. Moreover, the study found that the only predictor of NPST and PPAS enhancement among nurses was the implementation of an education program.

Background. Evaluation of pelvic floor muscle (PFM) strength damage across different delivery modes, providing insights into potential preventive measures for pelvic floor dysfunctions (PFDs) in the early postpartum period. Aim. Compare the differences in PFM strength and endurance between full-term cesarean section (CS) and vaginal delivery (VD) in the early postpartum period of primiparous women. Methods. The assessment included stress urinary incontinence (SUI), pelvic organ prolapse (POP), and pelvic floor electromyography (PFE). Muscle fiber strength was categorized into four modes at a threshold level of 3: I < 3 II < 3, I < 3 II > 3; I > 3 II < 3, I > 3 II > 3. Multinomial logistic regression was employed for CS and VD, and a sensitivity analysis was conducted using level 2 as the threshold. Outcomes. When muscle fiber strength was categorized into four modes at a threshold level of 3, Type I, and Type II fiber muscle endurance (FME) are differences between the CS and VD groups. Results. The CS and VD groups differed significantly in SUI and anterior and posterior vaginal wall conditions. MDVP was below the normal range in both groups, and MDVP, PFM strength, and PFM endurance did not differ significantly (P > 0.05). Logistic regression results indicated that higher MDVP, Type I, and Type II FME were protective factors when I < 3 in the VD group. However, I < 3-II > 3, higher MDVP, and Type I FME were protective factors (OR: 0.339, 95% CI: 0.223, 0.516) in the CS group. Clinical Implications. The study introduces a nuanced understanding of the impact of different delivery modes on PFM, contributing valuable insights for clinical prevention and treatment strategies in the early postpartum period. Strengths and Limitations. Muscle fiber strength was categorized into four modes and further sensitivity analysis was conducted. This study only conducted a correlation analysis of outcome variables without considering intervenable variables. Conclusions. The VD group had a higher incidence of pelvic floor dysfunction in the early postpartum period than the CS group. Both groups experienced a decline in PFM function without significant differences. CS was primarily associated with Type I muscle fiber damage, while VD was related to both Type I and II muscle fiber damage. Improving PFM endurance is beneficial for muscle strength recovery.

Background. Propolis is a natural bee product that has garnered attention due to its harmlessness and numerous beneficial biological properties. This randomized, double-blinded, placebo-controlled clinical trial aimed to assess the effect of toothpastes containing different concentrations of propolis (10% and 15%) on the control of dentin hypersensitivity (DH). Methods. From adults aged 18–40 years with DH, 66 teeth were randomly divided into 3 treatment groups as follows (n = 22): control (toothpaste without active ingredient), 10% propolis toothpaste, and 15% propolis toothpaste. DH was assessed thrice (baseline and 15 and 30 days after treatment) by tactile and evaporative stimuli using the visual analog scale. Data were analyzed using Friedman and Kruskal–Wallis tests. A significance level of 5% was used in all analyses. Results. All the groups showed a reduction in DH during the study (p < 0.05). The experimental groups (10% and 15% propolis) showed significantly greater reduction in DH than the control group (p < 0.05) after 30 days of treatment; however, the experimental groups displayed similar results (p > 0.05). Conclusion. Toothpastes containing propolis at concentrations of 10% and 15% were equally effective in controlling DH, regardless of their concentration. Trial Registration. This trial is registered with NCT05083052. Date of registration: 19/10/2021.

Background. Polytrauma refers to multiple life-threatening injuries to more than 2 bodily regions with some significant physiologic derangement. It is a major cause of morbidity and mortality globally. This study aimed to evaluate the epidemiological profile of polytrauma and outline the distribution of extremity fractures among cases in Northern Ghana. Methods. A retrospective cross-sectional study was conducted at the Accident and Emergency Department of Tamale Teaching Hospital. Data were extracted using a data collection tool onto MS Excel, cleaned, and exported onto SPSS version 26 for analysis. Descriptive statistics was used to present data in tables and charts. Analysis of variance (ANOVA) was used to assess whether there was a significant difference in the mean ISS and mean length of stay of the direct causes of death. Results. About 186 out of 5413 attendants to the emergency department were polytrauma, period prevalence of 3.4%. The male-to-female ratio was 1.9 : 1. Young adults (21–40 years) contributed 64% of the participants. The mean age of participants was 32.9 ± 15.4 years, and the mean ISS was 40.6 ± 13.1. Road traffic accidents (68.8%) were the most common cause of polytrauma. The mortality was 33.0%. Traumatic brain injury (TBI) was the most common direct cause of mortality (54.1%). There was a significant mean difference (MD) in the length of stay between multiple organ failure (MOF) and TBI (MD = 3.169, 95% C.I. = 0.48–5.86) and between MOF and hemorrhage (MD = 6.212, 95% C.I. = 2.62–9.80). Most fractures were closed (75.3%) and affected the lower limbs (61.5%). Open reduction and internal fixation were the most common surgery for extremity fractures. Conclusion. We recommend a concerted multidisciplinary policy framework geared towards promoting road safety and reducing accidents in Ghana. We also recommend a tailored robust treatment algorithm for managing traumatic brain injury in our settings to reduce mortality thereof.

Background. Primary percutaneous coronary intervention (PPCI) is the treatment of choice for patients with ST-elevation myocardial infarction (STEMI). Delayed reperfusion leads to increased morbidity and mortality. Secular trends in the impact of interhospital transfers (IT) on long-term mortality in the United Kingdom (UK) have not been previously investigated. We analyzed the impact of IT on 5-year mortality in STEMI patients admitted to a tertiary care center in the UK (East Midlands North). Methods. Data of STEMI patients admitted to Nottingham University Hospitals NHS Trust from 2011 to 2016 were acquired from the National Institute for Cardiovascular Outcomes Research dataset (NICOR) and then combined with local patient-level data and mortality data from National Statistics. The baseline characteristics and mortality data of the interhospital transfer (IT) group were compared to those of a gender and age-matched direct admission (DA) group. Results. Of the total cohort (N = 2386), 29.9% of patients were admitted to the PPCI center via the interhospital transfer (IT) route. Cardiovascular risk profiles in both DA and IT groups were comparable. Five-year Kaplan–Meier (KM) survival analysis revealed better survival in the direct admission group (83% vs. 77.3%; p ≤ 0.001). In multivariate analysis, increased mortality was associated with severe left ventricular impairment (HR 4.7, 95% CI 2.9–7.6), the presence of cardiogenic shock (HR 3.6 (2.7–4.8)), chronic kidney disease (HR 2.56 (1.4–4.5)), smoking (HR 1.45 (1.1–1.8)), male gender (HR 1.7 (1.4–2.01)), and diabetes (HR 1.4 (1.07–1.8)). The radial access and call-to-balloon time less than 120 minutes were also associated with lower mortality (HR 0.52 (0.43–0.63): HR 0.75 (0.61–0.92)). Conclusion. Despite advancements in communication, technology, patient education, transportation systems, and guidelines within the UK’s NHS over the last decade, the delays incurred by IT for STEMI patients remain substantial and are associated with a poor prognosis.

Introduction. Further evidence is required to understand the impact of preexisting and newly diagnosed diabetes mellitus (DM) on atrial fibrillation (AF) recurrence and major adverse cardiac and cerebrovascular events (MACCEs) following catheter ablation. Materials and Methods. Data from 1,685 patients (1,406 without DM vs. 279 with DM) who underwent AF catheter ablation between 2015 and 2019 were analyzed. These participants were prospectively monitored for incidents of AF recurrence and MACCE over an average period of 58.1 months. Results. A higher incidence of AF recurrence (24.6% vs. 34.4%) and a greater frequency of MACCE (6.5% vs. 9.3%) were observed among DM patients. Kaplan–Meier curves indicated that DM significantly increased the rates of AF recurrence, with a hazard ratio (HR) of 1.506 and a 95% confidence interval (CI) of 1.165–1.948 (p = 0.0003). This association persisted in the propensity-matched cohort. DM was independently predictive of AF recurrence after adjusting for potential risks using Cox regression analysis. Notably, new-onset DM was also found to be an independent predictor of AF recurrence. Similarly, DM was an independent risk of MACCE (HR [95% CI], 2.273 [1.120–4.615], p = 0.023). Conclusions. Both existing DM and newly diagnosed DM were identified as independent risk factors for AF recurrence following ablation; they also significantly impacted MACCE outcomes. This study underscores the urgent need for careful management of DM among individuals undergoing AF ablation in order to reduce the likelihood of arrhythmic relapse. This analysis utilized data from a prospective observational study registered in the Chinese Clinical Trial Registry on July 20, 2014 (ChiCTR-OCH-14004674).

This study aimed to assess the favorable or unfavorable progress of dental implants in a patient sample from Oradea, Romania, considering different variables. A secondary objective was to describe the characteristics of the study sample, as well as different aspects regarding the implants used. This retrospective study analyzed medical records from 1 January 2018, to 1 January 2022, of patients at a dental clinic in Oradea, Romania, who received at least one dental implant. Variables examined included gender, age, systemic diseases, implant location, implant type, and timing of insertion. Clinical and radiological evaluations, using CBCT immediately postplacement and at six months, assessed implant stability and absence of complications. A standardized three-month loading time postinsertion was followed. Exclusion criteria included lack of follow-up, implants placed elsewhere, or incomplete medical records. Quantitative variables were assessed using the Shapiro–Wilk test and nonparametric tests (Mann–Whitney U and Kruskal–Wallis H tests). Fisher’s Exact test analyzed qualitative variables, with Z-tests and Dunn–Bonferroni tests providing detailed results. The study included 344 implants, with 153 (44.5%) placed in female patients and 191 (55.5%) in male patients. Most implants were bone level (61.6%, n = 212) and had a delayed placement (82.6%, n = 284). The majority were situated in the upper posterior dental arch (39.2%, n = 135). Notably, 96.5% (n = 332) of the implants exhibited a positive outcome, irrespective of age, gender, or associated systemic diseases. Immediate postextraction implants displayed a significantly higher association with a negative outcome (41.7% vs. 16.6%), whereas delayed placements were more frequently linked with a positive outcome (83.4% vs. 58.3%) (p = 0.040). Employing established techniques and protocols for dental implant insertion led to consistently positive outcomes, irrespective of the implant type, insertion timing, or location. Patient’s age, gender, and associated diseases did not significantly impact implant outcome, highlighting the robustness of these methods in achieving favorable results.

Introduction. The association between Helicobacter pylori (H. pylori) infection and depression and anxiety has been reported in the literature. The aim of this meta-analysis is to investigate the association of H. pylori infection with depression and anxiety. Methods. A systematic search was conducted in PubMed, Web of Science, Embase, and Chinese databases for observational studies that reported the incidence or prevalence of depression and anxiety in patients with H. pylori infection. We conducted meta-analysis with a random-effects model. Results. A total of twelve studies were included in this meta-analysis. Significant and positive association was found for H. pylori infection with anxiety (OR 2.49, 95% CI 1.83–3.39), but not depression (OR 1.40, 95% CI 0.75–2.58). Subgroup analysis from study design noted a significant positive association between H. pylori infection and anxiety (case-control and cross-sectional study, OR 2.36, 95% CI 1.65–3.38; cohort study, RR 1.72, 95% CI 1.28–2.32). The similar trend among studies used the Self-Rating Anxiety Scale (OR 2.43, 95% CI 1.78–3.32) and other questionnaires (OR 2.41, 95% CI 1.50–3.87) have been observed. However, subgroup analysis of the association between H. pylori infection and depression yields different results. Subgroup analysis from cohort studies noted a significant association between H. pylori infection and depression (RR 1.99, 95% CI 1.33–2.99), but not case-control and cross-sectional studies (OR 1.20, 95% CI 0.59–2.46). A significant positive association has been observed among studies used the Self-Rating Depression Scale (OR 2.03, 95% CI 1.11–3.70), as opposed to studies using other questionnaires (OR 1.03, 95% CI 0.31–3.44). Conclusion. This meta-analysis provide the support that a significant positive association between H. pylori infection and anxiety disorders. However, the association between H. pylori infection and depression appears to be insignificant.

Background. Invasive percutaneous liver parenchymal biopsy is the best test used to evaluate liver stiffness and fibrosis in the follow-up and treatment of chronic hepatitis B (CHB) patients. In this study, we aimed to indirectly evaluate the severity of liver parenchymal fibrosis with tests used in the laboratory. Methods. This retrospective study was conducted with 201 patients diagnosed with CHB who underwent liver biopsy between 2021 and 2022. Preprocedural examination information, laboratory tests, and histopathological data of the patients were taken from the hospital database and examined. “Aspartate aminotransferase (AST)-platelet ratio index” (APRI), “4 factor-based fibrosis index” (FIB-4) score, and “5 factor-based fibrosis index” (FIB-5) score were calculated and compared with liver histopathological features. Results. Of the 201 CHB patients, 76 were females and 125 were males. The average age of the patients was 38.05 ± 12.63 years. A weak, statistically significant correlation was observed between FIB-4 and APRI scores. The patients’ significant fibrosis scores were 31.3% and 33.8%, respectively (r = 0.313; r = 0.338; p = 0.001; p < 0.01). The very weak negative correlation of 17.4% between the patients’ FIB-5 score and fibrosis score was statistically significant (r = −0.174; p = 0.014; p < 0.05). Conclusions. According to the data we obtained in our study, while the APRI score and FIB-4 score can be used safely, more comprehensive studies are needed for the reliability of the FIB-5 score.

Objective. We aim to compare the outcomes between acute ischemic stroke (AIS) patients under vitamin K antagonist with those under direct oral anticoagulants (DOACs). Methods. This prospective, cross-sectional study was conducted for one year in a tertiary hospital operating as a stroke center. A total of 135 patients receiving oral anticoagulants (DOACs: 98 and VKA: 37) with AIS were included in the study. The patients’ vital parameters, examination and laboratory findings, acute stroke severity scores, stroke localizations, and 3-month clinical outcomes were recorded. Results. Of the 135 patients, 98 (mean age: 76.2, 52 women) were on DOACs while 37 (mean age: 69.7, 26 women) were on VKA. The average age was significantly higher in the group of patients receiving DOACs (p = 0.005). Although the mean age of the patient group using DOACs was higher, they did not score worse than patients using VKAs in terms of stroke severity and 3-month outcomes were equal in both groups. The rates of receiving iv-tPA (8.2% and 2.7%, respectively) and thrombectomy rates (23.5% and 29.7%, respectively) were low in the DOACs and VKA groups. Conclusion. The equality in stroke severity and 3-month outcome scores between the DOACs group, characterized by higher average age, and the VKA group is indicative of the comparable efficacy of DOACs in stroke management.