SAGE Open Medicine最新文献

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.

Introduction: The World Health Organization recommends the viral load test as the preferred method for monitoring responses to antiretroviral treatment; however, this test is not widely available in developing countries. Timely monitoring is crucial; early detection of virological failure can significantly improve health outcomes for these children and help prevent the development of drug resistance. Therefore, this study aims to contribute valuable insights into time to virological failure and its predictors among children with human immunodeficiency virus.

Methods: An institution-based retrospective follow-up study was conducted among 497 children who were enrolled for first-line antiretroviral treatment from January 1, 2017 to December 31, 2021 in Eastern Ethiopia public Hospitals. A standard pretested checklist was used to extract data. Data were entered using Epi-Data 4.6 and analyzed using STATA 16. Kaplan-Meier was used to estimate the cumulative probability of virological failure, and the log-rank test was used to compare failure curves. The Cox proportional hazard regression model was used to analyze the relationship between independent and outcome variables.

Results: The overall incidence rate of virological failure was 3.70/1000 person-month observations (95% confidence interval: 2.88-4.76). World Health Organization clinical stages 3 and 4 at the time of antiretroviral treatment beginning (adjusted hazard ratio: 2.38 (95% confidence interval: 1.34-4.26)), baseline cluster of differentiation 4 cells, type of T lymphocytes count below the threshold (adjusted hazard ratio: 3.65 (95% confidence interval: 2.12-6.30)), tuberculosis positive during the follow-up period (adjusted hazard ratio: 4.81 (95% confidence interval: 2.51-9.23)), and poor adherence to the antiretroviral treatment regimen (adjusted hazard ratio: 3.87 (95% confidence interval: 2.08-7.22)) were independent predictors of virological failure.

Conclusion: The incidence of virological failure in this area was significantly higher compared to nationally conducted studies in Ethiopia. Baseline World Health Organization clinical stages 3 and 4, baseline cluster of differentiation 4 cells, type of T lymphocytes level below the threshold, being tuberculosis infected during the follow-up, and poor adherence were identified as independent predictors of time to virological failure.

Drug-resistant frontal lobe epilepsy is a challenge in epilepsy surgery because it is the second most common epilepsy type after temporal lobe epilepsy. Additionally, the frontal lobe is the largest brain lobe, making the localization of epileptic foci difficult, thereby preventing necessary surgery and improving seizure control. This review discusses the epidemiology and aetiology of drug-resistant frontal lobe epilepsy, demonstrating that cortical developmental manifestations constitute the most common aetiology of epileptic focus. Additionally, we reviewed the anatomy and symptoms of frontal lobe seizures. The review discusses advances in the neurophysiological study, including magnetoencephalography and neuroimaging modalities, such as quantitative PET scans and 7T MRI, for lesion detection and outcome improvement in frontal lobe epilepsy surgery. Although 7T MRI is unavailable in many epilepsy centres, the imaging modality can increase the rate of lesion detection, particularly when its findings are confirmed using depth electrode implantation, along with the utilization of artificial intelligence and machine learning in interpreting the morphometric analysis of MRI and nuclear imaging.

Background: The midwifery-led continuum of care model is an approach where a single midwife or a team of midwives provides comprehensive care to a woman throughout pregnancy, childbirth, and the early postpartum period. This model of care has significantly improved maternal and newborn outcomes; however, it is primarily implemented in high-income countries.

Objectives: To evaluate the effect of the midwifery-led continuum of care model on maternal and neonatal health outcomes in general hospitals of the Sidama region in Ethiopia.

Methods: A prospective nonrandomized control trial was conducted from October 2023 to June 2024 in the Sidama region, Ethiopia. A systematic sampling technique was used to recruit 478 low-risk women in total for the intervention group and control group. Multivariable analysis for binary outcomes with the log link were conducted to estimate adjusted risk ratios Adjusted risk ratio (aRR) and 95% confidence intervals.

Results: Women in the intervention were significantly more likely to have spontaneous vaginal birth (aRR) of 1.21 (95% confidence interval 1.14-1.67), and less likely to have preterm birth aRR of 0.16 (95% confidence interval 0.11-0.57) in comparison with women and newborns who received shared care.

Conclusion: Women in the intervention group experience improved outcomes and seems to be a valuable strategy for improving pregnancy outcomes in low-resource settings. Further research should enhance the practical application of midwifery-led continuum of care for women facing social risk factors, and medical complications in low-resource settings.

Trial registration: PACTR202310532830947.

Website: https://pactr.samrc.ac.za/.