SAGE Open Medicine最新文献

Background: Pediatric patients with critical illnesses often exhibit serum electrolyte disturbances, which significantly influence their clinical outcomes.

Methods: This prospective observational study included 534 pediatric patients (age range 1 month to 18 years) admitted to the pediatric intensive care unit of R.D. Gardi Medical College, Ujjain, from January 1, 2023 to April 30, 2024. The objective of the study was to study associations of disturbances in the levels of serum sodium, potassium, calcium, magnesium, and phosphorus with organ system involvement and child mortality, using multiple logistic regression models.

Results: Among the 534 patients, 325 (61%) were boys and 209 (39%) were girls, with a mean ± SD age of 5.17 ± 4.79 years. Most patients presented with fever (71%), fatigue (34%), and malaise (21%). A total of 1057 electrolyte abnormalities were recorded, with hypocalcemia (263 episodes, 25%) being the most common, followed by hypokalemia (192 episodes, 18%) and hyponatremia (172 episodes, 16%). A total of 173 episodes of severe hypocalcemia (S. calcium <6.5 mg/d), 21 episodes of severe hypernatremia (S. sodium >150 mEq/L) and 12 episodes of hypokalemia (S. potassium <2.5 mEq/L). All children with hypocalcemia had neurological symptoms. Hypokalemia was significantly associated with neurological (adjusted odds ratio 2.07), endocrine (adjusted odds ratio 2.26) and cardiovascular system (adjusted odds ratio 10.20) symptoms. Hyponatremia was significantly associated with symptoms of respiratory system (adjusted odds ratio 2.82) and gastrointestinal system (adjusted odds ratio 1.95). Hyperkalemia was significantly associated with symptoms of neurological (adjusted odds ratio 3.84), endocrine (adjusted odds ratio 2.24) and cardiovascular system (adjusted odds ratio 3.53). A total of 34 (6%) deaths were recorded and found to be associated mainly with hypokalemia (56%), hypocalcemia (44%), and hyponatremia (32%). Among these, hypokalemia (odds ratio: 2.43) and hypernatremia (odds ratio: 2.26) were significantly associated with mortality.

Conclusion: Electrolyte abnormalities were highly prevalent among children in the pediatric intensive care unit, with imbalances in the calcium, potassium, and sodium levels being the most common. Hypokalemia and hypernatremia were significantly and positively associated with mortality.

Background: Labor companions often lack clarity about their support roles during childbirth. Therefore, this study aims to analyze factors influencing companions' adherence to support roles during labor and childbirth.

Methods: A convergent parallel mixed-methods design was used to examine factors influencing companions' adherence to support roles from May to June 2024. Systematic random sampling selected 320 participants from the maternity ward. Data were collected via face-to-face exit interviews. Purposive sampling chose 24 labor companions for in-depth interviews. Adherence to support roles was measured using a four-point Likert scale, ranging from "not at all" to "all of the time." Ethical approval was obtained from the IRB at Jimma University, and support letters were secured for each study facility. Written consent was obtained from all participants.

Results: Companions' adherence to support roles during childbirth had an overall mean score of 1.39 (95% CI: 1.29-1.49) on the four-point Likert scale. Specifically, 27.5% of companions reported not at all, and 35.63% reported only a little support, while 17.19% reported providing support all of the time. Awareness among companions was associated with increased adherence to support roles (B = 0.238, p = 0.029). Nevertheless, companions with less prior experience (first time: B = -0.377, p = 0.001; second time: B = -0.280, p = 0.031) showed significantly lower adherence to support roles. The qualitative data also explored that, unclear role definition, unwelcoming approach of healthcare providers, and social-cultural factors were associated with minimal adherence to support roles.

Conclusion: A structured orientation session for companions is a vital recommendation to address hindering factors to their support roles. Such a session might equip them with techniques how to provide.

[This corrects the article DOI: 10.1177/20503121251358313.].

Objectives: This study aimed to develop and validate a nomogram prediction model for identifying the risk of early perforation (within 24 h) in patients with acute appendicitis, using objective clinical and imaging indicators.

Methods: A retrospective study was performed on 880 patients with acute appendicitis who underwent laparoscopic appendectomy within 24 h of symptom onset at the General Surgery Department of the Central Theater Command General Hospital between January 2011 and December 2022. Patients admitted from 2011 to 2020 were assigned to the modeling group (n = 616), and those from 2021 to 2022 to the validation group (n = 264). Based on postoperative pathology, patients were classified as having early or non-early perforated appendicitis. Independent risk factors for early perforation were identified using LASSO and multivariate logistic regression and were used to develop a predictive nomogram. Model performance was assessed by the area under the receiver operating characteristic (ROC) curve (AUC) for discrimination and the Hosmer-Lemeshow test for calibration.

Results: Appendiceal diameter, body temperature, white blood cell count, fibrinogen level, appendiceal fecalith, age, and diabetes mellitus were identified as independent predictors of early perforation in acute appendicitis within 24 h (p < 0.05). ROC analysis indicated that diameter (AUC = 0.673), temperature (AUC = 0.705), white blood cell (AUC = 0.713), fibrinogen (AUC = 0.742), and age (AUC = 0.759) had moderate predictive power. Incorporating fecalith and diabetes significantly enhanced model performance, yielding an AUC of 0.891.

Conclusion: The nomogram prediction model incorporating appendiceal diameter, body temperature, white blood cell count, fibrinogen level, appendiceal fecalith, age, and diabetes mellitus demonstrates clinical utility in estimating the probability of perforation within 24 h in patients with acute appendicitis.

Background: Sleep disorders and disturbances are a significant issue that affects occupational health and safety, yet their association with occupational injuries remains understudied. Therefore, this systematic review and meta-analysis aimed to investigates the association between sleep disturbance, sleep disorder, and occupational injuries among industry workers in Ethiopia.

Methods: Observational studies reporting occupational injury, sleep disturbance, and sleep disorder were considered in this study. A comprehensive search of electronic databases, including PubMed, Google Scholar, Semantic Scholar, HINARI, and ScienceDirect, and a Google manual search was conducted up to December 18, 2024. The recommended Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting items. Data were extracted using a standard data extraction template and exported to STATA V 17 for analysis. The Joanna Briggs Institute quality assessment tool was used to determine the quality of the reviewed research articles. To estimate the pooled association, a random effects model was used. The Egger's regression test and the funnel plot were used to evaluate publication bias.

Results: This review included a total of 27 studies that met the inclusion criteria. The finding revealed that industrial workers who have sleep disorder and sleep disturbance had a 2.6 and 2.5-fold increased risk of experiencing occupational injuries than those without sleep disorder and disturbance, respectively. Subgroup analyses demonstrated that high heterogeneity exists among manufacturing and agricultural workers for sleep disorders and moderate heterogeneity among building and construction sectors for sleep disturbances. The leave-one-out sensitivity analysis showed the robustness of the results.

Conclusion: Sleep disorders and sleep disturbances increase the risk of occupational injuries. Therefore, integrated interventions tailored to the manufacturing, service-providing, building and construction, and agricultural workers context are required. Applying workplace policies, prioritizing mental health supportd to lessen the effects of sleep disturbances and disorders in service-providing industry sectors, and implementing thorough health and safety training, promoting better sleep hygiene practices to lower their risk of injury in agricultural workers, are advised.

Objective: Sexual and reproductive health services for disabled students are an important aspect of ensuring their overall well-being and empowerment. Therefore, the aim of this study was to assess the magnitude of risky sexual behavior and its associated factors among students with disabilities in higher academic institutions of Debre Markos city.

Methods: An institution-based cross-sectional study was conducted among 168 study subjects with disabilities in higher academic institutions in Debre Markos city. The data were collected from November 5, 2024 to January 25, 2025, by using interviewer-administered structured questionnaires. Training for data collectors was conducted to maintain the quality of the data. The data were analyzed using SPSS version 20 software. Descriptive statistics with both bivariable and multivariable logistic regression were performed to estimate the crude and adjusted odds ratio with a 95% confidence interval.

Results: The overall magnitude of risky sexual behavior among disabled students at higher academic institutions in Debre Markos city was 48 (28.6%). The mean (standard deviation) age of the participants was 24.7 (4.9), and 120 (71.4%) were male respondents. Sex (AOR = 0.125; 95% CI: 0.04-0.41), age group under 20 (AOR = 0.101; 95% CI: 0.02-0.59) and 21-24 years (AOR = 0.095; 95% CI: 0.03-0.31), religion (AOR = 0.132; 95% CI: 0.02-0.75), and place of residence (AOR = 4.129; 95% CI: 1.78-9.57) were significantly associated with risky sexual behavior.

Conclusion and recommendation: Considerable proportions of students were engaged in risky sexual behavior and have an association with sex, age, religion, and place of residence. Interventions are needed for those female disabled students, aged greater than 25 years, Muslim religion followers, and urban residents to reduce the risky sexual behavior.

Background: Kidney transplantation is the ideal treatment for patients with end-stage renal disease. However, this population has a higher risk of cancer. This highlights the importance of early screening to improve outcomes in the detection of neoplasms, associated risk factors, and prompt treatment in this population.

Objectives: The objective of this study is to determine the incidence and risk factors associated with post-transplant cancer.

Methods: This was a historical analytical cohort observational study that evaluated the incidence of cancer and associated risk factors in kidney transplant recipients in the Clínica Universitaria Colombia program between 2007 and 2022.

Result: A total of 555 patients were included, with a predominance of males (61.1%). An incidence of posttransplant cancer was documented in n = 79 (14%) patients at a follow-up of 84.7 months, with skin neoplasms in n = 33 (41.7%) of cases, followed by solid organ neoplasms n = 31 (39.2%). Associated risk factors identified were age at the time of transplantation being statistically significant (Hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.02-1.06), a history of cancer prior to kidney transplantation (HR: 3.62; 95% CI: 1.46-8.99), and diabetes mellitus (HR: 2.08; 95% CI: 1.24-3.49). A statistically significant relationship was documented as a protective factor for mammalian Target of Rapamicyn (mTOR) inhibitors and solid organ neoplasms with relative risk (RR) 0.414 (95% CI: 0.19-0.88). No increase of posttransplant lymphoproliferative disorder (PTLD) was found with co-stimulation signal inhibitor-based therapy.

Conclusions: In a Latin American kidney transplant cohort the incidence of post-transplant malignancy was found to be 14% in a median follow-up of 7 years. This study found that risk factors include age, history of cancer prior to transplantation, and diabetes mellitus. Use of mTOR pathway inhibitors was associated with a reduced risk of solid organ neoplasms. No increase in the frequency of PTLD was found in patients receiving costimulation signal inhibitors.

Objectives: Early exercise is beneficial for mechanically ventilated intensive care unit patients. However, there remains a paucity of research data on the pattern of early assisted exercise delivery and the role of active and passive exercise modalities.

Methods: Herein, we collected 349 mechanically ventilated patients admitted to the intensive care unit of Tianjin First Central Hospital from April 2020 to 2022 and divided them into a control group (176 patients) and an exercise intervention group (173 patients) according to whether or not early rehabilitative exercise was performed.

Results: The results showed that the maximum negative inspiratory pressure, rapid shallow breathing index, limb muscle strength, swelling index, some clinical physicochemical indexes, the number of days of endotracheal intubation, the use of sedative and analgesic drugs, the duration of delirium, and the final prognosis of patients in the intervention group were all improved to different degrees. Subgroup analyses showed that compound and active movement patterns were more conducive to the recovery of limb muscle strength than single assisted movement patterns, but faced higher consumption of sedative and analgesic drugs.

Conclusion: Our results suggest that early bedside-assisted exercise is beneficial, but still needs to be matched appropriately to the patient's condition in order to maximize the patient's prognosis. Our study provides valuable data to support subsequent clinical practice of early bedside-assisted training and the establishment of relevant guidelines.

Objectives: Burnout is an impactful and highly prevalent concern within healthcare systems. Identifying a valid, accessible measure of this occupational phenomenon is crucial to its identification, intervention, and evaluation. The objective of this study was to compare a newly developed, positively phrased, burnout question to the Mini-Z single-item emotional exhaustion and a single-item depersonalization item.

Methods: Using cross-sectional survey data from four rural hospitals in the United States Mountain West (n = 457), we utilized Cohen's kappa statistics, intraclass correlation coefficients, and Bland-Altman plots to assess agreement for dichotomous and continuous versions of the new, single-item burnout measure with the gold standard emotional exhaustion and depersonalization single items.

Results: Based on the new Utah single-item measure, the prevalence of burnout was 30.4%; however, it was 39.4% and 19.3% as measured by emotional exhaustion and depersonalization, respectively. Our analysis demonstrated a substantial level of agreement with the Mini-Z single-item emotional exhaustion (Cohen's kappa: 0.61; intraclass correlation coefficient: 0.64) and a fair level of agreement with the single-item depersonalization (Cohen's kappa: 0.36; intraclass correlation coefficient: 0.49).

Conclusions: Burnout can be easily, quickly, and routinely screened among healthcare professionals. Further, when medical professionals are regularly assessed for increased burnout, proactive team and system-level steps can be implemented to prevent burnout from occurring or worsening. Our findings suggest initial validation of a new, positively phrased single-item burnout measure, showing substantial agreement with the widely used Mini-Z emotional exhaustion item.

Introduction: Patient safety during surgical procedures is especially critical in resource-limited and conflict-affected regions such as the Gaza Strip. Nurses play a central role in implementing and monitoring safety protocols in operating rooms. However, their perspectives on safety practices have been understudied in this context. This study aimed to assess nurses' views on preoperative and intraoperative patient safety measures in Gaza's government hospitals.

Methods: A cross-sectional descriptive study was conducted in 2023 across three major public hospitals in Gaza: Al Shifa Medical Complex, Nasser Medical Complex, and Gaza European Hospital. Using a census sampling method, 150 nurses working in the main operating rooms were recruited, resulting in a 92.6% response rate. Data were gathered using a structured, validated questionnaire based on the World Health Organization Patient Safety Assessment Tool. Demographic and professional characteristics were also recorded. Data analysis was conducted using SPSS version 26.

Results: The sample was predominantly male (78.0%) with a mean age of 32.9 ± 7.3 years and an average of 7.23 years of surgical experience. Most nurses held a bachelor's degree (71.4%), and 43.3% had specialized training in operating room care. High levels of reported adherence were observed in preoperative preparation (85.3%), preoperative assessment (74.7%), and operating room readiness (76.0%). Lower adherence rates were noted in documentation practices (68.7%) and identification of surgical risks (64.0%). No statistically significant differences were found between hospitals.

Conclusion: Despite resource constraints, safety protocols are largely followed in preoperative procedures and operating room readiness. However, shortcomings remain in risk identification, monitoring, and documentation. The study highlights nurses' key role and calls for better training, policies, infrastructure, and teamwork to improve surgical safety in conflict-affected areas.