SAGE Open Medicine最新文献

Introduction: Orthopaedic procedures are associated with the highest rates of opioid use among surgical specialties. Factors such as time constraints, communication barriers, and variable patient preferences are recognised challenges. There is limited research explicitly addressing the drivers for opioid prescribing in surgical patients or seeking to understand how health professionals engage patients in decision-making. This study aimed to explore patient and healthcare professional perceptions of the role of opioids in pain management in the orthopaedic context.

Methods: This research adopted a qualitative study design underpinned by critical realism. Interviews were conducted with patients and healthcare professionals involved in the care of patients with pain in an orthopaedic setting at a metropolitan tertiary hospital in South Australia. Analysis of the interviews was informed by a reflexive thematic analysis approach.

Findings: Forty participants (20 patients and 20 healthcare professionals) participated in this study between June and October 2020. A total of three themes, with sub-themes were identified (1) The patient as an individual; (2) the acute care setting; and (3) patient engagement and education. It was clear from both patient and healthcare professional participants that individual patient factors influence patients' understandings of opioids and pain management as well as the acute care setting. Additionally, all participants described the importance of patient engagement and education for improvement in pain management and opioid use.

Conclusions: This study demonstrates the complex factors that influence pain management and opioid perceptions within the orthopaedic context. We recommend that patient engagement and education is the critical factor to navigating individual patients and the acute care setting when it comes to pain and pain management.

Objectives: To evaluate the efficacy of intensive care unit ventilators versus dedicated noninvasive ventilators when used for noninvasive ventilation.

Methods: This was a secondary analysis of data from a multicenter prospective observational study. Eligible patients were recruited from 17 hospitals in China between September 2017 and September 2021. Inclusion criteria were restricted to those receiving noninvasive ventilation for acute hypoxemic respiratory failure. The type of ventilator used was determined at the discretion of the treating clinicians. The primary objective was to compare clinical outcomes between intensive care unit ventilators and dedicated noninvasive ventilation ventilators for noninvasive ventilation delivery. Key outcomes included noninvasive ventilation failure rate, 28-day mortality, intensive care unit length of stay, and hospital length of stay.

Results: A total of 2054 patients were enrolled, with 5% (n = 103) receiving noninvasive ventilation via intensive care unit ventilators and 95% (n = 1951) via dedicated noninvasive ventilation ventilators. No significant difference was observed in the overall noninvasive ventilation failure rate between the two groups (46% versus 38%, p = 0.15). However, the median time from noninvasive ventilation initiation to endotracheal intubation was shorter in the intensive care unit ventilator group (9 h, interquartile range: 3-25) compared with the dedicated noninvasive ventilation ventilator group (21 h, interquartile range: 6-65). The 28-day cumulative incidence of noninvasive ventilation failure was significantly higher in the intensive care unit ventilator group (log-rank test p = 0.01; crude hazard ratio = 1.43, 95% confidence interval: 1.06-1.91; adjusted hazard ratio = 1.41, 95% confidence interval: 1.04-1.93). No significant difference was found in 28-day mortality between the groups (16% versus 17%, p = 0.79). The 28-day cumulative incidence of mortality also did not differ (log-rank test p = 0.65; crude hazard ratio = 0.84, 95% confidence interval: 0.52-1.34; adjusted hazard ratio = 0.95, 95% confidence interval: 0.58-1.55).

Conclusions: The use of intensive care unit ventilators for noninvasive ventilation is uncommon in China. Based on low-level evidence, intensive care unit ventilators are not associated with a difference in mortality compared with dedicated noninvasive ventilation ventilators, but are linked to earlier endotracheal intubation.

Background: The practice of self-medication with antibiotics is expanding globally, particularly in developing countries. This practice is associated with increasing rates of health-related problems, including antibiotic resistance.

Objective: A survey was conducted to investigate knowledge, attitudes, and practices regarding self-medication with antibiotics among senior undergraduate pharmacy students in Jordan.

Methods: A cross-sectional study was performed by using a validated questionnaire for data collection. This questionnaire was randomly distributed online to senior undergraduate pharmacy students from a range of universities. Respondents' knowledge of, attitudes towards, and practice of self-medication with antibiotics were thus assessed. Data analysis was performed using IBM SPSS version 24.0 (IBM Corp., Armonk, NY, USA).

Results: Among the 250 respondents, who represented a response rate of 66.3%, 80.8% had self-medicated with antibiotics. The majority (85.6%) of antibiotics used for such self-medication were purchased from pharmacy drug stores. The most frequently used antibiotic for self-medication during the prior 6 months was amoxicillin (53.2%), ciprofloxacin (42.4%), and metronidazole (34.4%). Respiratory health issues were the most common reason for self-medication, with tonsilitis (90%) being major reason, then skin infections (34%). About 34% of students had changed their dose during treatment, while 30% kept some antibiotics for future use. Additionally, the majority of students (69.6%) recommended antibiotics to others without prescription, with 24% of students using antibiotics despite receiving advice that these were not required. The mean score for students' attitudes was 4.06, which indicated a positive attitude towards antibiotics use. The undergraduate senior pharmacy students had good knowledge and positive attitudes yet demonstrated poor practice with regard to antibiotic use, as the prevalence of self-medication was alarmingly high.

Conclusion: This malpractice highlights the importance of identifying effective and urgent interventions to be performed at different levels, including by educational and regulatory authorities, to mitigate the misuse of antibiotics.

Objective: To investigate changes in serum neuroinflammatory biomarker concentrations and associated psychopathological manifestations in individuals with post-traumatic stress disorder, taking into account the presence or absence of traumatic brain injury.

Methods: The study involved 159 male combat veterans who had been involved in combat within the year prior to their inclusion in the study, divided into four groups: veterans without post-traumatic stress disorder or traumatic brain injury (n = 43), veterans without post-traumatic stress disorder but with traumatic brain injury (n = 41), veterans with post-traumatic stress disorder but without traumatic brain injury (n = 38), and veterans with both post-traumatic stress disorder and traumatic brain injury (n = 37). Psychometric parameters (subjective stress severity, depression, avoidance, hyperarousal, intrusive thoughts, and alterations in personality traits) were evaluated. Serum concentrations of antibodies to glial fibrillary acidic protein and neuron-specific enolase were assessed using enzyme-linked immunosorbent assay, while YKL-40, migration inhibitory factor, receptor for advanced glycation end-products, interleukin-34, B-lymphocyte chemoattractant, and triggering receptor expressed on myeloid cells 2 were measured using multiplex assays.

Results: Traumatic brain injury presence was associated with reduced severity of depression and avoidance symptoms compared to individuals with post-traumatic stress disorder alone. Elevated serum levels of glial fibrillary acidic protein and neuron-specific enolase antibodies were observed in post-traumatic stress disorder patients, with neuron-specific enolase antibodies particularly increased in the post-traumatic stress disorder + traumatic brain injury group. Notably, YKL-40 levels were decreased in the post-traumatic stress disorder + traumatic brain injury group. Migration inhibitory factor concentration was reduced in post-traumatic stress disorder, while isolated post-traumatic stress disorder was linked to higher receptor for advanced glycation end-products levels. Significant correlations were found between biomarker concentrations and psychometric indices.

Conclusion: The findings reveal distinct clinical and biochemical profiles for isolated post-traumatic stress disorder and post-traumatic stress disorder comorbid with traumatic brain injury, reflecting differences in underlying pathophysiological processes. The data suggest involvement of neuroinflammation, blood-brain barrier disruption, and autoimmune mechanisms in post-traumatic stress disorder pathogenesis-particularly when traumatic brain injury is also present. Identified biomarkers may enhance diagnostic and prognostic tools in combat psychiatry.

Objectives: The primary objective of this study was to assess the outcomes and complication rates associated with different arteriovenous shunt cannulation methods among patients with end-stage chronic kidney disease.

Methods: The study was carried out at two major hemodialysis centers in a resource-limited healthcare system. A total of 309 patients were included. Vascular access was achieved using the area puncture technique in 171 patients (55.3%) and the rope-ladder technique in 138 patients (44.7%).

Results: Of the patients, 62 (20.1%) suffered vascular access complications (0.63 events/1000 access days). Hematoma was the most common complication, occurring in 43 patients. Hematoma was significantly associated with female sex (p = 0.024), shorter hemodialysis vintage (p = 0.026), and longer duration of hemodialysis sessions (p = 0.048). High venous access pressure was significantly associated with the rope-ladder technique (p = 0.022), jugular implanted shunts (p < 0.001), and with longer duration of hemodialysis sessions (p = 0.002). Bleeding was associated with a shorter hemodialysis vintage (p = 0.047). Infection was significantly associated with the area puncture technique (p = 0.043) and with cannulation during the noon dialysis shift (p = 0.007). Moreover, thrombosis was significantly associated with female sex (p = 0.014), residing in rural areas (p = 0.018), and absence of comorbidities (p = 0.008).

Conclusion: Our findings underscore the critical need to implement evidence-based protocols, enhance staff training, and address systemic obstacles in vascular access management.

Background: Delayed trophic feeding initiation is a significant risk for physical and neurological complications in neonates; however, data on feeding initiation in the current study setting are limited.

Objective: This study aimed to determine the time to initiation of trophic feeding and to identify reasons for delayed initiation among preterm neonates.

Methods: A prospective cohort study was conducted among 153 neonates admitted to Neonatal Intensive Care Units from February to April 20, 2023. Data were collected via Kobo and analyzed with STATA. Kaplan-Meier survival curves and Cox proportional hazards models were used for analysis.

Primary and secondary outcomes: Median time and rate of trophic feeding initiation were estimated using Kaplan-Meier and simple frequency statistics, respectively, and adjusted hazard ratio with 95% confidence interval was used to identify factors for delayed initiation.

Results: Among 153 neonates followed for 6853 person-hours, 85% initiated trophic feeding. The incidence rate of trophic feeding initiating was 1.9/100 person-hours with a median time of 41 h (95% confidence interval: 31-45). Delayed initiation was significantly associated with gestational age <34 weeks (adjusted hazard ratio: 0.54, 95% confidence interval: 0.37-0.79), first min APGAR score <7 (adjusted hazard ratio: 0.4, 95% confidence interval: 0.25-0.65), fifth min APGAR score <7 (adjusted hazard ratio: 0.51, 95% confidence interval: 0.34-0.79), small for gestational age (adjusted hazard ratio: 0.54, 95% confidence interval: 0.33-0.88), cesarean delivery (adjusted hazard ratio: 0.47, 95% confidence interval: 0.31-0.71), being out-born (adjusted hazard ratio: 0.50, 95% confidence interval: 0.30-0.83), respiratory distress syndrome (adjusted hazard ratio: 0.63, 95% confidence interval: 0.43-0.94), and hemodynamic instability (adjusted hazard ratio: 0.46, 95% confidence interval: 0.31-0.68).

Conclusion: The study found a significant delay in trophic feeding initiation, despite guidelines recommending within 24 h. Gestational age <34 weeks, low APGAR scores, small for gestational age, cesarean delivery, being out-born, respiratory distress syndrome, and hemodynamic instability were associated factors. The authors emphasize the need for healthcare workers to begin trophic feeding within 24 h, regardless of these factors. They also recommend conducting larger studies nationwide to strengthen the evidence on this issue.

Objective: Overweight and obesity are highly prevalent in Saudi Arabia, likely due to a combination of poor dietary choices and sedentary lifestyles. Young Saudi females face increasing societal pressure related to family life and higher education. Previous studies suggest that the transition to higher education at the university level, particularly in health-related disciplines, is a critical period for the development of unhealthy lifestyle. In this study, we aimed to evaluate changes in weight, appetite, and physical activities among medical students over time and compare them with those of nonmedical students.

Methods: In this 5-month prospective cohort study, we evaluated changes in weight, appetite, and physical activity among normal-weight females enrolled in medical (n = 25) and business (n = 26) programs at the University of Jeddah, Saudi Arabia, during a single academic semester.

Results: Business students experienced a small but significant weight loss (approximately 1.7%, p = 0.03), while medical students showed no change in weight (p = 0.83). However, in both groups, waist circumference increased significantly (3%-4%; p = 0.012), suggesting a shift toward central fat accumulation. Total physical activity, particularly low-intensity activity, decreased significantly in both groups (p < 0.03). Sedentary time increased in business students but decreased among medical students (time-by-group interaction, p = 0.003). Diastolic blood pressure followed an opposite pattern; it decreased significantly in business students (-6.3%) and increased significantly in medical students (+3.0%; time-by-group interaction, p = 0.003).

Conclusions: Different academic disciplines were not associated with weight gain among initially normal-weight Saudi females. Both groups experienced an unfavorable shift in body fat redistribution (increased waist circumference), likely driven by reduced physical activity. These changes may exacerbate long-term health risks even in the absence of overt obesity, underscoring the need for lifestyle interventions.

Objectives: Legionellosis, primarily caused by Legionella pneumophila serogroup 1, remains a public health concern in Thailand, particularly in tourism-driven regions. Conventional culture-based surveillance is hindered by limited sensitivity and prolonged turnaround times. This study aimed to develop and validate an optimized multiplex TaqMan real-time PCR assay for simultaneous detection of Legionella spp., Legionella pneumophila, and Legionella pneumophila serogroup 1 in environmental water, while also investigating antimicrobial resistance genes.

Methods: A modified primer-probe set targeting the 23S-5S rRNA, mip, and wzm genes was combined with optimized DNA extraction and PCR conditions. Analytical sensitivity was assessed using colony suspensions and spiked water, and specificity was tested against 24 bacterial strains. The assay was validated on 202 environmental water samples collected from four provinces in southern Thailand. Samples positive by real-time PCR were further screened for antimicrobial resistance genes (lpeAB and tet56) using conventional PCR.

Results: The optimized assay achieved a detection limit of 1 CFU/mL in suspensions and 1 CFU/L in filtered water, with 100% specificity. Among 202 field samples, PCR detected Legionella in 48.51%, significantly higher than culture (24.26%; p < 0.001). Detection was particularly enhanced in cold-water systems from premise plumbing (41.61% versus 9.49%; p < 0.001). Both methods identified Legionella pneumophila serogroup 1 in 14.29% of samples. Spatial mapping identified Patong subdistrict, Phuket, as a contamination hotspot. Antimicrobial resistance surveillance showed lpeAB in 6.1% of samples and tet56 in one Legionella pneumophila isolate, representing the first report of antimicrobial resistance in environmental Legionella from Thailand.

Conclusions: This optimized multiplex real-time PCR assay offers a rapid, sensitive, specific, and cost-effective alternative to culture for Legionella surveillance. The detection of antimicrobial resistance genes highlights potential emerging resistance risks, underscoring the need for integrated molecular and resistance monitoring. Implementation of this approach can strengthen outbreak preparedness and improve water safety management in high-risk settings.

Objective: To identify the association between sex hormones and Sjogren's disease.

Methods: A case-control study investigating the relationship between sex hormones and Sjogren's disease was conducted at Nanjing Drum Tower Hospital from January 2018 to January 2024. Two-sample Mendelian randomization was then performed to identify the causal association by using the public genome-wide association study data from the UK Biobank and the FinnGen consortium.

Results: In the case-control study, a total of 93 cases diagnosed with Sjogren's disease were compared to 90 Sjogren's disease-like non-Sjogren's disease controls from a population of naturally postmenopausal women. An association was observed between E2 (aOR = 0.984; 95% CI: 0.971-0.997; p = 0.018), hypo-estradiol (aOR = 2.195; 95% CI: 1.156-4.165; p = 0.016), and Sjogren's disease. Mendelian randomization analysis indicated that higher odds of Sjogren's disease were associated with decreased E2 in females, as estimated by the inverse-variance weighted (OR = 0.954; 95% CI: 0.917-0.992; p = 0.019).

Conclusion: Our study demonstrates that Sjogren's disease leads to reduced E2. This indicates that low E2 is a consequence of the disease rather than a causative factor.

Purpose: To evaluate the efficacy of pars plana vitrectomy combined with subretinal tissue plasminogen activator injection, pneumatic displacement, and intraoperative intravitreal antivascular endothelial growth factor therapy for treating submacular hemorrhage secondary to polypoidal choroidal vasculopathy or neovascular age-related macular degeneration.

Methods: This retrospective study enrolled 28 patients who were diagnosed with submacular hemorrhage secondary to polypoidal choroidal vasculopathy or neovascular age-related macular degeneration, all of whom received a minimum follow-up period of 6 months. Key preoperative parameters, such as submacular hemorrhage height and diameter, tissue plasminogen activator dosage, and hemorrhage duration, were documented. Postoperative outcomes evaluated included the degree of submacular hemorrhage displacement, visual acuity changes, incidence of complications, and the requirement for additional intravitreal antivascular endothelial growth factor injections during the follow-up period.

Results: The mean patient age was 66.71 ± 10.62 years. The mean visual acuity progressively improved from a preoperative logMAR of 1.57 ± 0.64 to 1.26 ± 0.67, 1.15 ± 0.59, 1.14 ± 0.55, and 1.12 ± 0.56 at postoperative months 1, 3, and 6, respectively. Complete hemorrhage displacement was achieved in 85.71% (24/28) of cases. Preoperative hemorrhage duration was significantly negatively correlated with postoperative best-corrected visual acuity at 1 month (r = 0.46; p = 0.013), 3 months (r = 0.42; p = 0.028), 6 months (r = 0.41; p = 0.032), and final follow-up (r = 0.38; p = 0.047).

Conclusions: Pars plana vitrectomy with tissue plasminogen activator subretinal injection, pneumatic displacement, and intraoperative vitreous antivascular endothelial growth factor injection represents a safe and effective approach for managing submacular hemorrhage secondary to polypoidal choroidal vasculopathy and neovascular age-related macular degeneration. The duration of submacular hemorrhage emerges as the most critical prognostic factor for final visual outcomes. Patients with hemorrhage duration exceeding 14 days demonstrate a significantly reduced likelihood of achieving favorable visual outcomes.