Medical Science Monitor : International Medical Journal of Experimental and Clinical Research最新文献

BACKGROUND This study applied the SERVQUAL model, a widely recognized tool for assessing the quality of services, to understand the gap between patient expectations and perceptions of care quality among 413 dermatology patients at a single medical center in Poland. MATERIAL AND METHODS The study cohort included 413 patients: 195 inpatients and 218 outpatients. The SERVQUAL model's 5 dimensions - reliability, assurance, tangibility, empathy, and responsiveness, each including multiple specific items - served as our assessment criteria. Patient responses to these items measured the perceived and expected quality of service. The service quality index (SQ), calculated as the difference between perception and expectation ratings, was the study's primary outcome measure. A negative SQ score was interpreted as patient dissatisfaction. RESULTS The study results showed a negative SQ score, which signified a discrepancy between high patient expectations and the actual perceived quality of service. The largest gap was seen in the tangibility dimension. Differences emerged based on treatment setting, with inpatient and outpatient settings showing varying expectations and perceptions. Patient sex and residential location also influenced the tangibility dimension. Employed patients and patients with diminished quality of life had heightened expectations in certain dimensions, while patients below 36 years of age expressed higher expectations in responsiveness, assurance, and empathy. CONCLUSIONS The findings emphasize the critical role of care quality in shaping patients' satisfaction and perception, particularly in dermatology. Using the SERVQUAL model, this study identified the tangibility dimension as an area needing improvement. This insight serves as a stepping stone toward enhancing patient satisfaction by addressing these unmet expectations.

BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder that often requires long-term management of motor symptoms. Continuous infusion of levodopa-carbidopa intestinal gel (LCIG) has shown promising results in alleviating motor fluctuations and improving quality of life. This study aimed to evaluate the efficacy and safety of transgastric jejunostomy (PEG-J) as a delivery method for LCIG in a cohort of 43 PD patients. MATERIAL AND METHODS Forty-three PD patients who were candidates for LCIG therapy underwent transgastric jejunostomy to facilitate continuous infusion of LCIG. The primary outcomes assessed were motor symptom improvement, reduction in motor fluctuations, and medication-related adverse events. Secondary outcomes included changes in quality of life, dyskinesia severity, and healthcare resource utilization. RESULTS The results of this study demonstrated significant improvements in motor symptoms, reduction in motor fluctuations, and enhanced quality of life following PEG-J for LCIG infusion. The treatment was generally well-tolerated, with a low incidence of procedure-related complications. Notably, the use of PEG-J allowed for precise and continuous delivery of LCIG, minimizing variations in drug absorption and ensuring consistent therapeutic levels. CONCLUSIONS Transgastric jejunostomy (PEG-J) offers an effective approach for the continuous infusion of LCIG in Parkinson's disease treatment. This method provides a stable and reliable delivery system, leading to improved symptom control and enhanced quality of life for PD patients.

BACKGROUND This study aimed to identify the immediate effect of applying ankle mobilization to the elderly with chronic ankle instability on the range of joint motion, balance, and lower extremity muscle activity. MATERIAL AND METHODS This study, the Cumberland Ankle Instability Tool (CAIT) was used to evaluate chronic ankle instability, and as a result, 65-year-olds with a score of 24 or less were conducted. In this study, the grade III of Maitland mobilization was used to increase the range of joint motion in older people with chronic ankle instability. And four joint mobilizations were administered for a total of 40 minutes, 10 minutes per run. In the pre-examination, the range of motion of ankle joints, balance, and lower extremity muscle activity in the Limit of Stability (LOS) position prior to ankle mobilization. The reexamination was taken a right after the intervention to see the immediate effect of applying joint mobilization. This study was conducted after receiving the approval of the Institutional Review Board of the Korea National University of Transportation. RESULTS The study results show that, as a result of applying the ankle mobilization intervention, the range of dorsi flexor and plantar flexor motion increased, resulting in the improvement of balance and an immediate effect on the lower extremity muscle activity when measuring the Limit of Stability. CONCLUSIONS The conclusion of this study is ankle mobilization may be a useful intervention method in preventing falls and improving balance in older adults with chronic ankle instability.

BACKGROUND Placenta accreta spectrum (PAS) disorders involve abnormal adhesion or invasion of chorionic villi through the myometrium and uterine serosa. Maternal anemia during pregnancy is common and may contribute to complications during delivery, particularly with abnormal placentation. This study examines the association between preoperative maternal hemoglobin levels and the risk of intraoperative massive hemorrhage in pregnant women with PAS disorders. MATERIAL AND METHODS A retrospective study included 538 consecutive participants (mean age=31.12±4.68 years) who underwent cesarean sections and met the diagnostic criteria for PAS disorders. Logistic regression analysis was performed to investigate the relationship between maternal preoperative hemoglobin levels and the risk of massive intraoperative hemorrhage (blood loss ≥1500 mL). RESULTS The incidence of intraoperative massive hemorrhage among patients with PAS disorders was 38.66%. The mean preoperative maternal hemoglobin level was 10.99±1.39 g/dL, and overall anemia incidence (<11 g/dL) was 48.88% in our study. After adjusting for potential confounders, a non-linear relationship was observed between preoperative maternal hemoglobin levels and the risk of intraoperative massive hemorrhage. When the preoperative hemoglobin level of pregnant women was below 11.5 g/dL (OR=0.52, 95% CI 0.39-0.70), the lower hemoglobin level significantly increased the risk of intraoperative hemorrhage. CONCLUSIONS Maternal preoperative hemoglobin levels were inversely associated with the risk of massive intraoperative hemorrhage in PAS disorders. A non-linear relationship was identified, with a turning point at 11.5 g/dL. These findings emphasize the importance of monitoring and managing maternal hemoglobin levels to mitigate the risk of intraoperative hemorrhage in pregnant women with PAS disorders.

BACKGROUND The health sector in Poland is currently facing challenges such as limited financial resources, poor infrastructure, and insufficient human resources. To address these issues, increasing cost-effectiveness at the individual physician level has become essential. This study aimed to evaluate the efficiency and effectiveness of patient care at the level of individual primary health care physicians and to compare the performance of physicians working in urban and rural areas. MATERIAL AND METHODS Thirteen original effectiveness indicators were developed based on a literature review, expert consultations, and a pilot study at the Medical and Diagnostic Center in Siedlce. The indicators were used to evaluate the effectiveness of physicians and compare physicians' characteristics working in rural and urban areas. The study extracted data on physicians' characteristics and used the indicators to evaluate their effectiveness. RESULTS Physicians working in rural areas treated more patients due to staff shortages. However, physicians working in urban areas demonstrated greater effectiveness in performing routine and advanced health checks and mammograms. Despite this advantage, the average life expectancy of patients was higher among patients of physicians working in rural areas. CONCLUSIONS Five indicators developed in the study formed a scale, which is a step toward developing a uniform effectiveness indicator. Further research on consistently measuring effectiveness could significantly impact the development of sociometric research methodology. This study highlights the differences in efficiency and effectiveness of physicians working in rural vs urban areas and underscores the need for healthcare policymakers to consider these differences in addressing healthcare resource allocation.

BACKGROUND Chronic low back pain (CLBP) significantly affects the well-being of older adults, leading to diminished quality of life and heightened stress. Existing treatments have limited effectiveness and potential side effects. This study aimed to explore an integrative approach, employing a combination of spinal thermal massage bed (STMB) and intermittent pneumatic calf compression, as an alternative strategy for managing CLBP, improving body posture, reducing stress, and enhancing quality of life. MATERIAL AND METHODS Twenty-three participants aged 65-80 years completed a 4-week intervention involving eight sessions (2 per week) with the STMB device. Outcome measures included pain level assessed by the visual analog scale, trunk and pelvic tilting angles indicating spine curvature, stress level of the autonomic nervous system, Oswestry Disability Index, and EuroQol five-dimensions QoL questionnaire. RESULTS The study revealed significant reductions in pain intensity between baseline and mid-term scores (p=0.002) and between baseline and post-test scores (p=0.001). Moreover, notable improvements were observed in trunk and pelvic tilting angles (p<0.001) and stress scores between baseline and mid-term scores (p=0.037) and between baseline and post-test scores (p=0.019). However, no significant changes were observed in disability level or QoL. Participants expressed high satisfaction with the intervention, and no serious side effects were reported CONCLUSIONS This study provides compelling evidence supporting the safety and efficacy of combining STMB with intermittent pneumatic calf compression in reducing pain intensity and stress levels and improving trunk and pelvic tilting angles. Clinical trial number: KCT0008212.

BACKGROUND Acute pancreatitis, a sudden inflammation of the pancreas, can result in severe complications. The presence and volume of ascites, an abnormal accumulation of fluid in the abdomen, has been linked to disease severity. Our study investigates ascites volume, quantified via abdominal CT scans, as a potential predictive tool for disease severity. MATERIAL AND METHODS In this retrospective analysis, patients diagnosed with acute pancreatitis were evaluated. Patients were categorized into groups with and without ascites, with comparisons made regarding clinical characteristics. We further compared the mean ascitic volume against various outcome parameters in patients with ascites. Ascites volume and other predictive systems were assessed through receiver operating characteristic (ROC) curves, with the area under the ROC curve (AUC) for different predictive systems being analyzed. RESULTS The ascites group had higher severity scores and related serological indexes (P<0.05 for all). Among patients with ascites, a significant correlation was observed between ascites volume and outcome parameters (P<0.05 for all). The area under the ROC curve for predicting severe acute pancreatitis was 0.896, with 93% sensitivity and 79% specificity. Ascites volume yielded the highest diagnostic odds ratio (53.1; 95% confidence interval: 13.2,199.6). CONCLUSIONS Early-stage acute pancreatitis patients with ascites are indicative of severe illness and poor prognosis. An increase in ascites volume correlates with adverse clinical outcomes, thus highlighting the significance of ascites volume as a prognostic marker. This underscores the importance of abdominal CT in measuring ascites volume to predict disease severity.

BACKGROUND The microbiome is the collection of all micro-organisms and their genes, which naturally live in and on the body. The cervical and endometrial bacterial microbiome has previously been reported to affect fertility and influence the outcomes of assisted reproductive therapy (ART), including embryo transfer. This study aimed to evaluate the cervical and endometrial bacterial microbiome in 177 women treated for infertility before, during, and after embryo implantation, and the outcomes. MATERIAL AND METHODS Cervical and endometrial swabs were collected from 177 women diagnosed with infertility at 3 time points: (1) during the initial examination, (2) during implantation, (3) 10-14 days after implantation. Next-generation sequencing (NGS) was used to analyze the bacterial microbiome. Taxonomic identification was performed with the Usearch algorithm. RESULTS There was a significant change in the number of patients with Escherichia coli depending on the collection time. For the first swab collection, there were significant negative relationships between the percentage of Gardnerella vaginalis and Lactobacillus spp. For the second collection, there was a negative relationship between Lactobacillus helveticus and Lactobacillus jensenii. For the third collection, negative relationships were found between Escherichia coli and Lactobacillus spp. A similar distribution of the bacterial microbiome was observed in all 3 swab collections. CONCLUSIONS Lactobacillus spp. were the main bacteria identified in the cervix and endometrium, present before, during, and after successful embryo transfer. E. coli and G. vaginalis reduced the protective effect of Lactobacilli before, during, and after embryo transfer.

BACKGROUND The ankle-brachial index (ABI) is a critical diagnostic test for peripheral artery disease (PAD), albeit requiring technical expertise and dedicated resources. The advent of automatic ABI devices proposes a more accessible approach, necessitating fewer resources and less expertise. This study was conducted to gather data on PAD prevalence and to evaluate the correlation and efficacy of automatic ABI measurements vs traditional Doppler ABI measurements to understand their potential role in primary care settings. MATERIAL AND METHODS ABI measurements were obtained using both the Doppler method and an automatic plethysmographic device (Dopplex ABility, Huntleigh Healthcare). RESULTS Of the 290 participants (mean age 67.6±7.4 years), Doppler ABI method identified 16.8% with abnormal results (<0.9), while the automatic method identified only 5.9%. The mean Doppler ABI was 1.05±0.15, and the mean automatic ABI was 1.12±0.13. The sensitivity of the automatic ABI measurements was 22.2%, and the specificity was 96.8%, with a positive predictive value of 57.1%, and a negative predictive value of 86.9%. Adjustments in the automatic assessment and inclusion of pulse wave velocity enhanced the diagnostic capabilities of the automatic ABI device. CONCLUSIONS While the automatic plethysmographic ABI device may lack the necessary diagnostic capabilities to replace the traditional Doppler ABI device as a standalone test in PAD diagnosis, it could still offer significant value in primary care settings if integrated with adjusted cut-off points and pulse wave velocity analysis.

BACKGROUND Diabetes mellitus (DM), chronic kidney disease (CKD), and advanced age are associated with poor outcomes in patients with acute coronary syndrome (ACS). This real-world study utilized data from the Taiwan Chang Gung Research Database (CGRD) to compare outcomes in ACS patients with DM, CKD, and the elderly. MATERIAL AND METHODS The study enrolled 28,613 ACS patients diagnosed based on CGRD medical records between January 2005 and December 2019. Baseline characteristics and clinical outcomes were compared among groups based on patient characteristics. RESULTS Within the ACS cohort, 42.1% had DM, 48.2% had CKD, and 33.6% were elderly. Among them, 10.7% (3,070) were elderly patients with both DM and CKD. Elderly patients with DM and CKD had significantly higher risks of gastrointestinal bleeding (hazard ratio=11.32), cardiovascular events (HR=7.29), and all-cause mortality (HR=8.59). Patients with three or at least two of these risk factors had a 2.20-2.99-fold increased risk of recurrent ACS during the three-year follow-up period. CONCLUSIONS Patients with the combination of DM, CKD, and advanced age (elderly) experienced an 11.32-fold increased risk of gastrointestinal bleeding, 7.29-fold increased risk of cardiovascular events, and 8.59-fold increased risk of all-cause mortality compared to those without these risk factors. Furthermore, patients with two or more of these risk factors had a 2- to 3-fold increased risk of recurrent ACS. These findings emphasize the importance of managing multiple risk factors in ACS patients to improve outcomes.