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Objective: : To develop an international Core Outcome Set (COS), a minimal collection of outcomes that should be measured and reported in all future clinical trials evaluating treatments of acute simple appendicitis in children.Summary Background Data: A previous systematic review identified 115 outcomes in 60 trials and systematic reviews evaluating treatments for children with appendicitis, suggesting the need for a COS.Methods: The development process consisted of four phases: (1) an updated systematic review identifying all previously reported outcomes, (2) a two-stage international Delphi study in which parents with their children and surgeons rated these outcomes for inclusion in the COS, (3) focus groups with young people to identify missing outcomes, and (4) international expert meetings to ratify the final COS.Results: The systematic review identified 129 outcomes which were mapped to 43 unique outcome terms for the Delphi survey. The first-round included 137 parents (eight countries) and 245 surgeons (10 countries), the second-round response rates were 61% and 85% respectively, with ten outcomes emerging with consensus. After two young peoples’ focus groups, two additional outcomes were added to the final COS (12): mortality, bowel obstruction, intra-abdominal abscess, recurrent appendicitis, complicated appendicitis, return to baseline health, readmission, reoperation, unplanned appendectomy, adverse events related to treatment, major and minor complications.Conclusion: An evidence-informed COS based on international consensus, including patients and parents has been developed. This COS is recommended for all future studies evaluating treatment of simple appendicitis in children, to reduce heterogeneity between studies and facilitate data synthesis and evidence-based decision-making.

Objectives. To develop an imputation method to produce estimates for suppressed values within a shared government administrative data set to facilitate accurate data sharing and statistical and spatial analyses. Methods. We developed an imputation approach that incorporated known features of suppressed Massachusetts surveillance data from 2011 to 2017 to predict missing values more precisely. Our methods for 35 de-identified opioid prescription data sets combined modified previous or next substitution followed by mean imputation and a count adjustment to estimate suppressed values before sharing. We modeled 4 methods and compared the results to baseline mean imputation. Results. We assessed performance by comparing root mean squared error (RMSE), mean absolute error (MAE), and proportional variance between imputed and suppressed values. Our method outperformed mean imputation; we retained 46% of the suppressed value’s proportional variance with better precision (22% lower RMSE and 26% lower MAE) than simple mean imputation. Conclusions. Our easy-to-implement imputation technique largely overcomes the adverse effects of low count value suppression with superior results to simple mean imputation. This novel method is generalizable to researchers sharing protected public health surveillance data. (Am J Public Health. 2021; 111(10):1830–1838. https://doi.org/10.2105/AJPH.2021.306432 )

Summary Introduction College students use their voices at excessively loud intensities and long durations during college fests. The accumulative effect of vocally abusive behaviors in the presence of high ambient noise, poor vocal hygiene, and other environmental factors contribute significantly towards reducing vocal effectiveness in college students. Objective The present study aimed to study the effect of a vocally demanding situation (college Fest) on perceptual and objective voice features of college students. Methodology In this study, a total number of 27 undergraduate female students participated in the age range of 18–27 years. Pre-test—post-test research design was applied. Data analysis consisted of video stroboscopic examination, acoustic analysis using the Multi-dimensional voice program (MDVP), and perceptual evaluation with the GRBAS scale. The data obtained were processed using descriptive statistics and non-parametric tests to determine the difference in each measured parameter pre- and postfest. Results and Discussion Incomplete glottis closure, asymmetric vibration of vocal folds, and aperiodicity of vocal folds increased significantly postcollege Fest. GRBAS parameters also showed a change from pre Fest scores on grade (hoarseness) increased by 38%, breathiness in 34%, roughness in 26%, Asthenia in 15%, and strain increased in 38% participants. A P-value estimation revealed significantly higher scores in Jitter percent, Shimmer percent, and relative average perturbation than pre-fest scores. Conclusion The results of the present study indicate a high risk of vocal disorders among college students post Fest. This study suggests a potential unmet need for college students to receive education before cultural events on optimal vocal usage, vocal hygiene, and an appropriate period of vocal rest.

Malnutrition is a health disorder due to a lack or imbalance of nutrients needed for growth, thinking activities and all things related to life. One of the efforts made to help meet the nutritional needs of malnourished children under five is the Recovery Supplementary Feeding (PMT) program. The purpose of this study was to analyze whether the effect of supplementary feeding with local ingredients on changes in body weight of undernourished children under five. The type of research used is pre-experimental research design with one group pre and post-test design. This research was conducted in the working area of the Nanga Public Health Center. The population in this study were all underweight children under five in the working area of the Nanga Health Center as many as 30 people, the sampling technique in this study was total sampling. Data processing is done by editing, coding, entry, tabulating and cleaning. Data analysis in this study was bivariate with Paired Test. The results showed that there was an effect of providing local-based supplementary food to changes in body weight of undernourished children under five as indicated by a p value of 0.000 < 0.05, with a pre-test Mean value (9.744) < Post-test Mean (10.022). and the value of t-count (7.409) > t-table (2005). Based on these results, it can be concluded that the provision of local-based supplementary food is effective in increasing the weight of undernourished children under five.

OBJECTIVE The Affordable Care Act mandates that primary preventive services have no out-of-pocket costs but does not exempt secondary prevention from out-of-pocket costs. Most commercially insured patients with diabetes have high-deductible health plans (HDHPs) that subject key microvascular disease–related services to high out-of-pocket costs. Brief treatment delays can significantly worsen microvascular disease outcomes. RESEARCH DESIGN AND METHODS This cohort study used a large national commercial (and Medicare Advantage) health insurance claims data set to examine matched groups before and after an insurance design change. The study group included 50,790 patients with diabetes who were continuously enrolled in low-deductible (≤$500) health plans during a baseline year, followed by up to 4 years in high-deductible (≥$1,000) plans after an employer-mandated switch. HDHPs had low out-of-pocket costs for nephropathy screening but not retinopathy screening. A matched control group included 335,178 patients with diabetes who were contemporaneously enrolled in low-deductible plans. Measures included time to first detected microvascular disease screening, severe microvascular disease diagnosis, vision loss diagnosis/treatment, and renal function loss diagnosis/treatment. RESULTS HDHP enrollment was associated with relative delays in retinopathy screening (0.7 months [95% CI 0.4, 1.0]), severe retinopathy diagnosis (2.9 months [0.5, 5.3]), and vision loss diagnosis/treatment (3.8 months [1.2, 6.3]). Nephropathy-associated measures did not change to a statistically significant degree among HDHP members relative to control subjects at follow-up. CONCLUSIONS People with diabetes in HDHPs experienced delayed retinopathy diagnosis and vision loss diagnosis/treatment of up to 3.8 months compared with low-deductible plan enrollees. Findings raise concerns about visual health among HDHP members and call attention to discrepancies in Affordable Care Act cost sharing exemptions.

Background A combination of yoga practices has been documented to reduce stress and stress-induced cortisol levels. The objective of the current study is to examine the effects of six months of a single pranayama practice (Bhramari [Bhr. P]) on reducing salivary cortisol response to the cold pressor test (CPT) among adolescents. Methods Twenty-six healthy adolescents between the ages of 11 and 19 were randomly assigned to either yoga group (n-13) or control group (n-13). Yoga group participants were trained to do Bhr. P for 45 min, thrice a week for six months. All participants underwent CPT at baseline and at end of six months. Saliva samples were collected at baseline (t0), at 20 min (t1), 40 min (t2), and 60 min after the CPT (t3). Results Contradictory to our hypothesis, participants in the yoga group exhibited a higher salivary cortisol response to the CPT at t1 (p = 0.04) when compared to the control group. However, the t3 salivary cortisol levels showed a statistically significant reduction (p = 0.03) in yoga group when compared to the control group. A significant interaction with time (F (1, 88) = 316.5, p = .001, ηp2:0.91) and between the group × time (F (3, 88) = 2.83, p = 0.04, ηp2:0.8) was found after the intervention. Conclusions An increase in the cortisol responsiveness observed in the study is an indication of the adaptive capability achieved through regular yoga training, evidenced by an initial rise in cortisol followed by a rapid fall below baseline after 60 min. Further research is required to conclusively determine the changes in cortisol levels over time in response to stress in long-term yoga practitioners.

Background: The use of levetiracetam (LEV) has been increasing given its favorable pharmacokinetic profile. Numerous population pharmacokinetic studies for LEV have been conducted. However, there are some discrepancies regarding factors affecting its pharmacokinetic variability. Therefore, this systematic review aimed to summarize significant predictors for LEV pharmacokinetics as well as the need for dosage adjustments. Methods: We performed a systematic search for population pharmacokinetic studies of LEV conducted using a nonlinear-mixed effect approach from PubMed, Scopus, CINAHL Complete, and Science Direct databases from their inception to March 2020. Information on study design, model methodologies, significant covariate-parameter relationships, and model evaluation was extracted. The quality of the reported studies was also assessed. Results: A total of 16 studies were included in this review. Only two studies were conducted with a two-compartment model, while the rest were performed with a one-compartment structure. Bodyweight and creatinine clearance were the two most frequently identified covariates on LEV clearance (CLLEV). Additionally, postmenstrual age (PMA) or postnatal age (PNA) were significant predictors for CLLEV in neonates. Only three studies externally validated the models. Two studies conducted pharmacodynamic models for LEV with relatively small sample size. Conclusion: Significant predictors for LEV pharmacokinetics are highlighted in this review. For future research, a population pharmacokinetic-pharmacodynamic model using a larger sample size should be conducted. From a clinical perspective, the published models should be externally evaluated before clinical implementation.

The development of high-quality research is desired in all healthcare fields. Experimental and nonexperimental designs are used to investigate the effect or association of an intervention and clinical or surrogate outcome. The aims of these methods are to improve knowledge and to develop new strategies to manage a disease or condition. Randomized clinical trials are considered one of the standard methods to test the efficacy of a new drug or intervention; however, they are costly, have reduced generalizability, and cannot be feasible in all scenarios. Well-designed observational studies can provide valuable information regarding exposure factor and the event under investigation. In physical and rehabilitation medicine, where complex procedures and multiple risk factors can be involved in the same disease, the use of observational study must be planned in detail and a priori to avoid overestimations. In this article, we will give an overview of the methods used for observational design studies in physical and rehabilitation medicine using clinical examples to illustrate each method. We will describe when it is appropriate and how to use the observational studies in different scenarios explaining how to deal with potential bias and confounders using the adequate design and statistical plan for the situation.

OBJECTIVE Prior trauma history is a reliable and robust risk predictor for PTSD development. Obtaining an accurate measurement of prior trauma history is critical in research of trauma-related outcomes. The Life Events Checklist (LEC) is a widely used self-report measure of trauma history that categorizes events by the proximity to trauma exposure; however, the field has published multiple scoring methods when assessing the LEC. Herein, we propose a novel scoring procedure in which total scores from the LEC are weighted according to the proximity of trauma exposure with "experienced" events weighted most and "learned about" events weighted least. METHOD The utility of this weighted score was assessed in two traumatically-injured civilian samples and compared against previously published scoring methods, including a nonweighted score including all events experienced, witnessed, and learned about, as well as a score consisting of only experienced events. RESULTS Results indicated the standard total score was most reliable, followed by the weighted score. The experienced events score was least reliable, but the best predictor of future PTSD symptoms. CONCLUSIONS One method to balance the predictive strength of experienced events and the excellent reliability of a total LEC score, is to adopt the newly proposed weighted score. Future use of this weighted scoring method can provide a comprehensive estimate of lifetime trauma exposure while still emphasizing the direct proximity of experienced events compared with other degrees of exposure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perception is an essential skill leading to expertise in diagnostic radiology. We determined if practicing "Where's Waldo?" images improves accuracy and speed with which first and second year radiology residents detect abnormalities on chest radiographs (CXRs).Residents at three institutions were pretested using 50 CXRs, identifying locations of potential abnormalities. They were then split into trained (examining 7 "Where's Waldo?" images over three weeks) and control groups (no "Where's Waldo?"). They were then re-tested on the 50 CXRs. At one site, visual search parameters were acquired. Data were analyzed with repeated measures ANOVAs.There was no significant difference in performance for trained vs control (F = 0.622, p = 0.436), with both improving significantly on post-test (F = 4.72, p = 0.037). Session time decreased significantly for both groups from pre to post-test (F = 81.47, p0.0001) and the decrease was significantly more (F = 31.59, p0.0001) for the trained group than the control group as well as for PGY with PGY3 having a larger average decrease in session time than PGY2. Eye-tracking data also showed significant increases in per image search efficiency with training.Practicing "Where's Waldo?" or similar nonradiology search tasks may facilitate the acquisition of radiology image search but not detection skills, impacting reading efficiency more than detection accuracy.

Emotion dysregulation frequently co-occurs with chronic pain, which in turn leads to heightened emotional and physical suffering. This cycle of association has prompted a recommendation for psychological treatment of chronic pain to target mechanisms for emotion regulation. The current trial addressed this need by investigating a new internet-delivered treatment incorporating emotional skills training from dialectical behavioural therapy (DBT). Using a single-case experimental design that is suited to heterogeneous populations and can demonstrate efficacy with a small sample, three participants with chronic pain were recruited. Participants received four weeks of online DBT skills training (iDBT-Pain intervention) which incorporated one-on-one sessions over Zoom and a web app. Results revealed compelling evidence for the intervention on the primary outcome of emotion dysregulation and were promising for the secondary outcome of pain intensity. Improvement was also identified on pre-and post-measures of depression, coping behaviours, sleep problems, wellbeing, and harm avoidance, indicating that the intervention may positively influence other factors related to chronic pain. Overall, the trial provides preliminary efficacy for the intervention to improve chronic pain. However, we recommend further investigation of the iDBT-Pain intervention, either in single case trials, which when conducted with scientific rigour may be aggregated to derive nomothetic conclusions, or in a group-comparison trial to compare with usual modes of treatment. Perspective: This trial advances understanding of emotion-focused treatment for chronic pain and provides evidence for a viable new technological treatment. Importantly, as an internet-delivered approach, the iDBT-Pain intervention is accessible to those with restricted mobility and remote communities where there are often limited psychological services for people with chronic pain. Trial registration: The trial was registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12620000604909)

Summary Researchers and practitioners are faced with an exponential increase in the number of systematic reviews (SRs) (with or without meta-analysis), a so-called `secondary' research method that synthesizes data from primary research. This growing number, sometimes with discordant results on the same subject or with non-conclusions, has led to the introduction of the concept of reviews to synthesize SR in order to combine scientific knowledge useful to practitioners. These so-called ``umbrella reviews'' (UR) constitute a new tertiary research tool. Surgical research is no exception to this development but umbrella surgical reviews remain relatively rare. Any UR must be transparent and meet rigorous methodological criteria. The UR could thus provide answers to practical questions in the field of surgery, but only on condition that the bias of the included SRs is limited. Let us not forget that the base requirement of clinical surgical research remains the good methodological quality of clinical studies (primary research). Only thus can SRs or URs (secondary or tertiary research) be more useful and decisive.

Characterized by small, highly heterogeneous patient populations, rare disease trials magnify the challenges often encountered in traditional clinical trials. In recent years, there have been increased efforts by stakeholders to improve drug development in rare diseases through novel approaches to clinical trial designs and statistical analyses. We highlight and discuss some of the current and emerging approaches aimed at overcoming challenges in rare disease clinical trials, with a focus on the ultimate stakeholder, the patient.

Objective The aim of this study was to explore expert opinion to identify the components of sprinting technique they believed to be risk factors for hamstring strain injuries (HSI). Design Mixed-method research design. Methods The Concept Systems groupwisdom™ web platform was used to analyse and collect data. Participants brainstormed, sorted and rated the components of sprinting technique to consider in a HSI prevention strategy. Results Twenty-three experts (academic/researcher, physiotherapist, strength and conditioning coaches and sprint coaches) brainstormed 66 statements that were synthesised and edited to 60 statements. Nineteen participants sorted the statements into clusters and rated them for relative importance and confidence they could be addressed in a hamstring injury prevention program. Multidimensional scaling and cluster analysis identified a 8-cluster solution modified to a 5-cluster solution by the research team: Training prescription (10 statements, mean importance: 3.79 out of 5 and mean confidence: 3.79); Neuromuscular and tendon properties (9, 3.09, 3.08); Kinematics parameters/Technical skills (27, 2.99, 2.98); Kinetics parameters (10, 2.85, 2.92); and Hip mechanics (4, 2.70, 2.63). The statement: “low exposure to maximal sprint running” located in the cluster “Training prescription” received the highest mean importance (4.55) and confidence ratings (4.42) of all statements. Conclusion The five clusters of components of sprinting technique believed to be risk factors for HSIs in order of most to least important were: training prescription, neuromuscular and tendon properties, kinematics parameters/technical drills, kinetics parameters and hip mechanics.

Objective To demonstrate the clinical value of OneTouch (OT) Verio Flex glucose meter used in combination with a Spanish-language version of the OT Reveal mobile application (app) to support diabetes care and improve glycemic control in an underserved Hispanic population with type 2 diabetes. Research Design and Methods Test subjects (n = 81) used the meter and app for 12 weeks, while a randomized control group (n = 39) used their own glucose meters without connection to an app. Thereafter, test subjects continued the same regimen for an additional 12 weeks to determine the durability of effect, and control subjects crossed over to use the new meter and app. Results Test subjects experienced a mean reduction in A1C of 1.0% after 12 weeks (P Conclusion Use of the OT meter and a Spanish-language version of its diabetes management app in an underserved population helped participants achieve a sustained improvement in glycemic control. The tools were well received by the subjects and may have important utility in other low-numeracy, low-literacy populations.

Given the persistence of racial health disparities, scholars have called for investigations into structural origins of health inequity and deeper engagement with theory. We systematically assessed uses of theory-including theory-informed conceptualizations of race and ethnicity, social structure, and racial hierarchy-in epidemiology and other quantitative population health literature on racial health disparities. We conducted a scoping review of systematically identified original research articles (n=650) that sought to explain racial health disparities; articles were published in 17 high-impact epidemiology, public health, and social science journals. Trained coders abstracted data from each article. We applied Public Health Critical Race Praxis and an iterative data-charting method to identify key themes. Only 63 (9.7%) of 650 racial health disparities articles explicitly used theory. Among studies that engaged theory, one third (n=21/63) clearly conceptualized race and/or ethnicity, and a minority theorized social structure (n=19/63; 30%) and/or racial hierarchy as a structural relation (n=4/63; 6%). There is a pressing need for racial health disparities researchers to unambiguously use theory to conceptualize race and ethnicity in social and historical contexts and explain relational aspects of racial hierarchy. These approaches can better elucidate and inform action on structural determinants of both racial inequity and racial health inequity.

The purpose of this study was to determine if written rehearsal of informed consent improved 6-month recall and comprehension compared with the current best practices.A consultation was provided and subjects read the modified informed consent document. They were randomized to group A (received the core and up to 4 custom elements of treatment, wrote what each image displayed) or group B (presentation of the 18 elements with core elements chunked at the end followed by up to 4 custom elements). Interviews recording knowledge recall/comprehension occurred immediately and after months later.Overall, no significant differences in baseline or 6-month follow-up scores were found between groups. Initially, group A outperformed group B in some core domains. There were no significant differences between groups in the change of scores from initial to follow-up. Follow-up scores were significantly lower than baseline scores (P 0.05). Higher initial scores were associated with larger drops at follow-up. A decrease in knowledge 20% was common.Overall the methods are comparable at baseline and 6-months. Initial content retention was roughly 60+%, with 6%-9% deterioration. For areas of treatment methods, risk, discomfort, and resorption at 6-months, the current processes failed the patient and left the practitioner vulnerable to risk management issues. Results support the rehearsal method with immediate feedback for misunderstandings as the preferred method for informed consent.

Background Reporting complications and/or adverse events after spinal surgical procedures enables the estimation of their prevalence and of their impact on patient outcomes. However, the documentation of complications is relatively infrequent and highly heterogeneous. The purpose of this study was to evaluate the quality of complication and adverse event reporting in spinal surgery literature. Methods A systematic review of the literature from 5 international, peer-reviewed, indexed spinal journals was performed. Included studies were published between January and December 2020 and reported the surgical results of spinal procedures. Data on the level of evidence and study design were collected and analyzed as well as whether the studies were single-center or multicenter studies. The quality of complication reports was evaluated through a 5-item checklist, with 5 questions divided into 3 parts: definition, evaluation, and report. Results Complications associated with spinal surgical procedures were reported in 292 studies. According to the level of evidence, significantly higher reporting quality was seen in level I and II studies compared with level III and IV studies (P = 0.003). Regarding the 5-item checklist, 49% (143/292) of studies fulfilled the definition section, 16.4% (48/292) fulfilled the evaluation section, and 92% (270/292) fulfilled the report section. Conclusions Overall quality assessment when reporting complications in surgical spinal studies showed that only 13% (38/292) of publications that reported complications as part of the outcomes exhibited all items of the 5-item checklist. Additionally, significantly better reports were observed in level I studies compared with level II–IV studies.

Background Local outbreak control plans (LOCPs) are statutory documents produced by local authorities (LAs) across England. LOCPs outline LAs’ response to Coronavirus Disease 19 (COVID19) outbreaks and the coordination of local resources, data and communication to support outbreak response. LOCPs are therefore crucial in the nation’s response to COVID-19. However, there has been no previous systematic assessment of these documents. We performed this study to systematically assess the quality of LOCPs and to offer recommendations of good practice. Methods All published LOCPs were assessed for basic characteristics. A framework based on Department of Health and Social Care guidelines was used to assess a random sample of LOCPs. Qualitative analysis was undertaken for LOCPs with highest completeness. Results Hundred and thirty-seven of 150 LAs publicly published a full LOCP; 9 were drafts. Statistical analysis demonstrated the significant difference between reporting of mainstream schools, care homes and the homeless population and other educational settings, high-risk settings and other vulnerable groups. LOCPs varied in approach when structuring outbreak response information and focused on different areas of outbreak management. Conclusions The majority of LAs are publicly accessible. There is significant variation between the reporting of high-risk settings and groups. Suggested recommendations may help to improve future LOCP updates.

Chronic obstructive pulmonary disease (COPD) is the end result of a series of dynamic and cumulative gene–environment interactions over a lifetime. The evolving understanding of COPD biology provides novel opportunities for prevention, early diagnosis, and intervention. To advance these concepts, we propose therapeutic trials in two major groups of subjects: “young” individuals with COPD and those with pre-COPD. Given that lungs grow to about 20 years of age and begin to age at approximately 50 years, we consider “young” patients with COPD those patients in the age range of 20–50 years. Pre-COPD relates to individuals of any age who have respiratory symptoms with or without structural and/or functional abnormalities, in the absence of airflow limitation, and who may develop persistent airflow limitation over time. We exclude from the current discussion infants and adolescents because of their unique physiological context and COPD in older adults given their representation in prior randomized controlled trials (RCTs). We highlight the need of RCTs focused on COPD in young patients or pre-COPD to reduce disease progression, providing innovative approaches to identifying and engaging potential study subjects. We detail approaches to RCT design, including potential outcomes such as lung function, patient-reported outcomes, exacerbations, lung imaging, mortality, and composite endpoints. We critically review study design components such as statistical powering and analysis, duration of study treatment, and formats to trial structure, including platform, basket, and umbrella trials. We provide a call to action for treatment RCTs in 1) young adults with COPD and 2) those with pre-COPD at any age.

The Covid-19 pandemic situation has affected community activities, work, income which decreased, psychological disorders such as stress, and limited accessibility to dental practice service, which is now for emergency cases only. This condition can affect oral health in the community. This study aimed to assess the oral health condition in the community during the Covid-19 pandemic. This study was implementing a cross-sectional research design. Data were obtained from online questionnaires with the respondent's consent. The sample selection with inclusion criteria comprised 1960 years old who lived in Bandung West Java. The self-report questionnaire for oral health assessment was followed, the previous research, by Levin et al.,2013. It has been trans-adapted to Bahasa Indonesia and validated. Respondents of the study were 380 participants. Poor oral hygiene maintenance was the wrong frequency of brushing teeth (12.1%), only visiting the dentist when having a toothache (72.9%), and smoking (7.9%). Oral health problems include gingival bleeding on brushing (15.3%), tooth mobility (13.2%), tooth cavities (62.9%), toothache (27.1%), and bad breath (22.6%). Most of the oral health problems were tooth cavities followed by toothache. The contributing factors include poor oral hygiene maintenance, improper brushing, smoking habits, and infrequent dental care. Furthermore, the accessibility and availability of services in dental practice in the pandemic situation are limited. Therefore, it is reasonable to say that oral self-examination probably could minimize the distancingrelated problem in this Covid-19 pandemic situation and be helpful in the early detection of oral health problems. KEYWORDS: assessment, Covid-19 pandemic, oral health

Background Functional neurological disorder is defined by symptoms not explained by the current model of disease and its pathophysiology. It is found in 8.4% of patients presenting as acute stroke. Treatment is difficult and recurrence rates are high. We introduced hypnotherapy as a therapeutic option in addition to standard stroke unit care. Methods This is an observational study of successive patients with functional neurological disorder presenting as acute stroke treated with hypnotherapy between 1 April 2014 and 1 February 2018. The diagnosis of functional neurological disorder was confirmed by clinical examination and computed tomography/magnetic resonance imaging. Hypnosis was delivered by a hypnotherapy trained stroke physician using imagery for induction. A positive response was defined as a National Institutes of Health Stroke score reduction to 0 or by ≥4 points posthypnotherapy. Costs were calculated as therapist time and benefits as reduction in disability/bed days. Results Sixty-eight patients (mean age 36.4 years, 52 (76%) females, mean baseline National Institutes of Health Stroke 5.0 (range 1–9)) were included. Two patients (3%) could not be hypnotized. Fifty-eight 58 (85%) responded, 47 (81%) required one treatment session, while 19% needed up to three sessions for symptomatic improvement. No adverse events were observed. Disability (modified Rankin Scale) reduced from a mean of 2.3 to 0.5 resulting in an average cost saving of £1,658 per patient. Most (n = 50, 86%) remained well without recurrence at six-month follow-up. Conclusions In this case series, hypnotherapy was associated with rapid and sustained recovery of symptoms. A prospective randomized controlled study is required to confirm the findings and establish generalizability of the results.

Since the outbreak of COVID-19 in Wuhan, China in December 2019, it has spread quickly and become a global pandemic. While the epidemic has been contained well in China due to unprecedented public health interventions, it is still raging or not yet been restrained in some neighboring countries. Chinese government adopted a strict policy of immigration diversion in major entry ports, and it makes Suifenhe port in Heilongjiang Province undertook more importing population. It is essential to understand how imported cases and other key factors of screening affect the epidemic rebound and its mitigation in Heilongjiang Province. Thus we proposed a time switching dynamical system to explore and mimic the disease transmission in three time stages considering importation and control. Cross validation of parameter estimations was carried out to improve the credibility of estimations by fitting the model with eight time series of cumulative numbers simultaneous. Simulation of the dynamics shows that illegal imported cases and imperfect protection in hospitals are the main reasons for the second epidemic wave, the actual border control intensities in the province are relatively effective in early stage. However, a long-term border closure may cause a paradox phenomenon such that it is much harder to restrain the epidemic. Hence it is essential to design an effective border reopening strategy for long-term border control by balancing the limited resources on hotel rooms for quarantine and hospital beds. Our results can be helpful for public health to design border control strategies to suppress COVID-19 transmission.

BACKGROUND Critically ill patients who are mechanically ventilated are at a high risk for malnutrition, which is associated with poor clinical outcomes. AIM The aim of this study was to determine whether the modified version of Nutrition Risk in the Critically Ill (mNUTRIC) score predicts patients' clinical and functional outcomes in intensive care units (ICUs) in Jordan. METHODS A prospective, observational, quantitative research design was used. A convenience sample of 129 mechanically ventilated patients was recruited from ICUs in 7 hospitals across the different Jordanian health care sectors. Each patient was assessed and scored by the mNUTRIC tool. RESULTS Of the total 129 mechanically ventilated patients, the mean (SD) age of critically ill participants was 66.38 (17.46) years, 69.8% of the participants were male (n = 90), and 30.2% were female (n = 39). Approximately 88.4% of mechanical ventilator patients were at a high risk of malnutrition at the time of ICU admission. Overall, high mNUTRIC score (≥5) was significantly associated with MV duration (P = .004), ICU length of stay (P = .002), mortality (odds ratio, 5.43; P = .005), and functional outcomes (odds ratio, 0.184; P = .009). RELEVANCE TO CLINICAL PRACTICE Using nutrition risk screening tools such as the mNUTRIC score will add great benefits to nursing practice through identifying patients who are at a high risk of malnutrition within the first 48 hours of their admission in the ICU.

The opioid abuse epidemic represents a major public health threat to global populations. The role social media may play in facilitating illicit drug trade is largely unknown due to limited research. However, it is known that social media use among adults in the US is widespread, there is vast capability for online promotion of illegal drugs with delayed or limited deterrence of such messaging, and further, general commercial sale applications provide safeguards for transactions; however, they do not discriminate between legal and illegal sale transactions. These characteristics of the social media environment present challenges to surveillance which is needed for advancing knowledge of online drug markets and the role they play in the drug abuse and overdose deaths. In this paper, we present a computational framework developed to automatically detect illicit drug ads and communities of vendors. The SVM- and CNN- based methods for detecting illicit drug ads, and a matrix factorization based method for discovering overlapping communities have been extensively validated on the large dataset collected from Google+, Flickr and Tumblr. Pilot test results demonstrate that our computational methods can effectively identify illicit drug ads and detect vendor-community with accuracy. These methods hold promise to advance scientific knowledge surrounding the role social media may play in perpetuating the drug abuse epidemic.

In the United States, nutrition-related morbidities are rising steadily at rates corresponding to increasing overweight and obesity in the population. Such morbidities take huge tolls on personal health and impose high costs on health care systems. In 2019, the Academy of Nutrition and Dietetics (Academy) and the Academy of Nutrition and Dietetics Foundation (Academy Foundation) embarked on a new project titled "The State of Food and Nutrition Series" to demonstrate the value of nutrition interventions led by registered dietitian nutritionists for individuals with the following 3 high-priority non-communicable diseases that affect many in the United States and globally: type 2 diabetes mellitus, chronic kidney disease, and hypertension. Poor nutritional status contributes to disease onset and progression in these non-communicable diseases, and appropriate medical nutrition therapy can prevent or delay worsening and ameliorate poor health outcomes. However, many people who have these conditions do not have access to an registered dietitian nutritionist, and consequently do not receive the nutrition care they need. On February 19-20, 2020 in Arlington, VA, as the first stage in The State of Food and Nutrition Series, the Academy and the Academy Foundation gathered health care policymakers, clinicians, and researchers from across the country for the State of Food and Nutrition Series Forum, where Academy leaders sought input to build a comprehensive research strategy that will quantify the impact of patient access to registered dietitian nutritionist-led nutrition interventions for type 2 diabetes mellitus, chronic kidney disease, and hypertension. This article summarizes the findings of that forum.

Summary Despite several recent meta-analyses on the topic, the comparative risk of hepatocellular carcinoma in patients with chronic hepatitis B (CHB) receiving entecavir (ETV) or tenofovir disoproxil fumarate (TDF) remains controversial. The controversy partly results from the arbitrary nature of significance levels leading to contradictory conclusions from very similar datasets. However, the use of observational data, which is prone to both within- and between-study heterogeneity of patient characteristics, also lends additional uncertainty. The asynchronous introduction of ETV and TDF in East Asia, where the majority of these studies have been conducted, further complicates analyses, as does the ensuing difference in follow-up time between ETV and TDF cohorts. Researchers conducting meta-analyses in this area must make many methodological decisions to mitigate bias but are ultimately limited to the methodologies of the included studies. It is therefore important for researchers, as well as the audience of published meta-analyses, to be aware of the quality of observational studies and meta-analyses in terms of patient characteristics, study design and statistical methodologies. In this review, we aim to help clinicians navigate the published meta-analyses on this topic and to provide researchers with recommendations for future work.

Contains fulltext : 237219.pdf (Publisher’s version ) (Open Access) Objective: To describe characteristics of randomised controlled trials (RCTs) conducted using electronic health records (EHRs), including completeness and transparency of reporting assessed against the 2021 CONSORT Extension for RCTs Conducted Using Cohorts and Routinely Collected Data (CONSORT-ROUTINE) criteria. Study design: MEDLINE and Cochrane Methodology Register were searched for a sample of RCTs published from 2011–2018. Completeness of reporting was assessed in a random sample using a pre-defined coding form. Results 183 RCT publications were identified; 122 (67%) used EHRs to identify eligible participants, 139 (76%) used the EHR as part of the intervention and 137 (75%) to ascertain outcomes. When 60 publications were evaluated against the CONSORT 2010 item and the corresponding extension for the 8 modified items, four items were 'adequately reported' for the majority of trials. Five new reporting items were identified for the CONSORT-ROUTINE extension; when evaluated, one was 'adequately reported', three were reported 'inadequately or not at all', the other 'partially'. There were, however, some encouraging signs with adequate and partial reporting of many important items, including descriptions of trial design, the consent process, outcome ascertainment and interpretation. Conclusion: Aspects of RCTs using EHRs are sub-optimally reported. Uptake of the CONSORT-ROUTINE Extension may improve reporting. 12 p.

OBJECTIVE To investigate the nature of the relationship between HbA1c and sepsis among individuals with type 2 diabetes, and to assess the association between sepsis and all-cause mortality in such patients. RESEARCH DESIGN AND METHODS We included 502,871 individuals with type 2 diabetes recorded in the Swedish National Diabetes Register and used multivariable Cox regression and restricted cubic spline analyses to assess the association between time-updated HbA1c values and sepsis occurrence between 1 January 2005 and 31 December 2015. The association between sepsis and death was examined using multivariable Cox regression analysis. RESULTS Overall, 14,534 (2.9%) patients developed sepsis during the study period. On multivariable Cox regression analysis, compared with an HbA1c of 48–52 mmol/mol (6.5–6.9%), the adjusted hazard ratio for sepsis was 1.15 (95% CI 1.07–1.24) for HbA1c 82 mmol/mol (9.7%). In the cubic spline model, a reduction of the adjusted risk was observed within the lower HbA1c range until 53 mmol/mol (7.0%), with a hazard ratio of 0.78 (0.73–0.82) per SD; it increased thereafter (P for nonlinearity CONCLUSIONS In a nationwide cohort of individuals with type 2 diabetes, we found a U-shaped association between HbA1c and sepsis and a fourfold increased risk of death among those developing sepsis.

To evaluate the effectiveness of 2 interventions, including the DrugFactsBox format for presenting written medication information and the SMART (Strategic Memory Advanced Reasoning Training) program designed to enhance gist (i.e., "bottom-line" meaning) reasoning ability.We used a 2 × 2 factorial research design. A total of 286 patients with rheumatoid arthritis were randomly assigned to 1 of 4 groups, including DrugFactsBox with the SMART program, DrugFactsBox without the SMART program, other consumer medication information (CMI) with the SMART program, and other CMI without the SMART program. Data were collected via telephone interviews and online questionnaires at 4 time points, including baseline and 6-week, 3-month, and 6-month time points following baseline. The primary outcome variable was informed decision-making, which was defined as making a value-consistent decision concerning use of disease-modifying antirheumatic drugs based on adequate knowledge.We found no main effects for the 2 interventions, either alone or in combination. However, there was a significant interaction between assignment to the SMART/no SMART groups and informed decision-making at baseline. Among participants in the SMART groups who did not meet the criteria for informed decision-making at baseline, 42.5% met the criteria at the 6-month follow-up, compared to 23.6% of participants in the no SMART groups (mean difference 18.9 [95% confidence interval 5.6, 32.2]; P = 0.007). This difference was driven by increased knowledge in the SMART groups. Among participants who met the criteria for informed decision-making at baseline, the difference between the SMART and no SMART groups was not statistically significant.Participation in a theory-driven program to enhance gist reasoning may have a beneficial effect on informed decision-making among patients with inadequate knowledge concerning therapeutic options.

BACKGROUND International Statistical Classification of Disease and Related Health Problems, 10th Revision codes (ICD-10) are used to characterize cohort comorbidities. Recent literature does not demonstrate standardized extraction methods. OBJECTIVE Compare COVID-19 cohort manual-chart-review and ICD-10-based comorbidity data; characterize the accuracy of different methods of extracting ICD-10-code-based comorbidity, including the temporal accuracy with respect to critical time points such as day of admission. METHODS Design: Retrospective cross-sectional study. MEASUREMENTS ICD-10-based-data performance characteristics relative to manual-chart-review. RESULTS Discharge billing diagnoses had a sensitivity of 0.82 (95% Confidence Interval [CI]: 0.79-0.85; comorbidity range 0.35-0.96). The past medical history table had a sensitivity of 0.72 (95% CI: 0.69-0.76; range 0.44-0.87). The active problem list had a sensitivity of 0.67 (95% CI: 0.63-0.71; range 0.47-0.71). On day of admission, the active problem list had a sensitivity of 0.58 (95% CI: 0.54-0.63; range 0.30-0.68) and past medical history table had a sensitivity of 0.48 (95% CI: 0.43-0.53; range 0.30-0.56). CONCLUSIONS AND RELEVANCE ICD-10-based comorbidity data performance varies depending on comorbidity, data source, and time of retrieval; there are notable opportunities for improvement. Future researchers should clearly outline comorbidity data source and validate against manual-chart-review. This article is protected by copyright. All rights reserved.

Background : Durability of immune response by the COVID-19 natural infection and the necessity of vaccines in recovered patients are important inquiries for the healthcare provider. Research design and methods : Here, we investigated the characteristics and the rate of cases with reinfection that have been admitted to our tertiary hospital. Results : A total of 119985 patients were applied between March 2020 and May 2021. Of these patients, 32607 (27%, 32607/119985) tested positive. A total of 27 (0.08%, 27/32607) patients were found to be reinfected beyond 90 days. Only one of these reinfected patients (0.003, 1/32607) had novel COVID-19 pneumonia and was hospitalized for the second time. Other 26 reinfected patients were followed up as outpatients. Conclusions : COVID-19 reinfection is extremely rare. However, the reinfection may be severe in patients with immune deficiency. Healthcare providers may prioritize uninfected and immune-compromised patients for vaccination.

OBJECTIVE To assess whether introduction of Continuous Glucose Monitoring (CGM) at diagnosis of type 1 diabetes (T1D), leads to greater uptake and continuation at 12 and 24 months, in a population based paediatric diabetes clinic. RESEARCH DESIGN AND METHODS All T1D children and adolescents diagnosed in the 12 months following full government subsidisation of CGM were offered CGM from diagnosis at Women's and Children's Hospital, SA (Cohort 1). Uptake and continuation of CGM was compared to those diagnosed in the preceding year, who were started on CGM after diagnosis, but otherwise had identical diabetes management (Cohort 2). Demographic and clinical data was collected prospectively. The primary outcome variable was CGM wear >75% of the time at 12 and 24 months. RESULTS In Cohort 1, 84% were started on CGM at diagnosis. 88% had commenced CGM by 12 months and 90% by 24 months. In Cohort 2, CGM was started on average 10 months after diagnosis (range 1-25 months), with 81% started on CGM within 24 months of subsidisation. At 24 months, 78% of Cohort 1 and 66% of Cohort 2 were wearing CGM >75% of the time (p=0.26), higher than the WCH Clinic as a whole (58%). There was no difference in HbA1c between cohorts. CONCLUSION Starting CGM at diagnosis of T1D is feasible and well received by families, with high uptake across all ages. Although CGM continuation (wearing CGM >75% of the time) was slightly higher in Cohort 1 than Cohort 2, this did not reach statistical significance. This article is protected by copyright. All rights reserved.

BACKGROUND Medication errors remain one of the most common types of incidents reported in Australian hospitals. Studies have reported that for every 10 medication administrations, a medication administration error is likely to occur and reach the patient, potentially contributing to a preventable patient harm. OBJECTIVE To assess the impact of a mixed intervention model on medication administration errors in an Australian hospital. METHODS Two types of intervention model (human and system orientated) were implemented through collaboration with key stakeholders (nurses, educators, and policy makers) to reduce medication administration errors across this 650-bed multisite Australian hospital from August 2018 to June 2019. To assess the impact of the mixed intervention model, the total number of reported medication errors and the number of medication administration errors were retrieved from the hospital electronic medication management system for 12 months before (from June 2017 to July 2018) and after (from July 2019 to June 2020) implementation of all interventions. RESULTS Implementation of a mixed intervention model through collaboration with stakeholders resulted in significant reduction in the number of medication administration errors, and those with harm (from 68 to 55%, P

Background: Improving the mothers' knowledge and practice regarding preserved food is very important and can reduce the effects of preserved food on their children's health. Aim: To evaluate the effect of video-assisted teaching on mothers' knowledge and practices regarding preserved food and their children health. Subjects and Methods: Design: A quasi-experimental research design was utilized in this study. Setting: This study was applied in Pediatric Outpatient Clinics at Sohag University Hospital. Sample: A convenient sample of (300) mothers was included in the study. Tools of data collection: One tool was used: (I) structured interviewing questionnaire, it consisted of three parts: (I) demographic data of the studied mothers, (II) knowledge assessment tool, and (III) reported practice assessment tool. Results: According to the findings of this study, after participating in a video-assisted structured education program mothers' total knowledge and practice about preserved foods improved with statistically significant differences. Conclusion: The current study concluded that video-assisted structured teaching was effective in improving mothers' knowledge and practices level regarding the effects of preserved food on their children's health. Recommendations: It is very important to provide mothers with a teaching program regarding the effects of preserved food on their children's health to promote and improve their knowledge and practices.

Background: Vaccines are vital in containing the COVID-19 epidemic and may be an essential tool in re-establishing "normalcy". The aim of the research was to investigate COVID‑19 vaccination and predictors of vaccine hesitancy in Zagazig City. Research design: A descriptive, cross-sectional design was used. Setting: The research was carried out in Zagazig City and Shaybah Village, Egypt. Subjects: A multistage systematic random sample involving 997 participants. Tools: Three questionnaires were used for data collection. I. The interview questionnaire consists of three tools: socio-demographic data, individual factors, and knowledge about the COVID-19 vaccine. II. Attitude assessment toward vaccine, and III. Application of the Health Belief Model regarding COVID‑19 vaccination. Results: Only 10% of studied subjects had taken the vaccine, and 24.2% of them had the intention to take the vaccine. In addition, 75.8% of them have vaccine hesitancy. Moreover, 54.0% of the studied subjects had adequate knowledge about the COVID-19 vaccine. The highest percentage of the studied subjects did not know the difference between types of vaccine (40.9%). In addition, 60% of subjects have positive attitudes about the COVID-19 vaccine. Furthermore, 40.3% of subjects have a neutral health belief model regarding the COVID-19 vaccine. Conclusion: The study presented that more than three-quarters of study participants had vaccine hesitancy. In general, more than half of the subjects examined have enough knowledge. Moreover, three-fifths of them have a positive attitude toward the COVID-19 vaccine. Furthermore, two-fifths of the studied subjects had a neutral health belief model about the COVID-19 vaccine. Recommendation: Health awareness about the importance of vaccines to protect from severe infection and deadly complications of COVID- 19 virus

Background: Everyone has been affected by the coronavirus disease (COVID-19) epidemic, including students. Understanding public knowledge and adherence level to preventive measures is vital for prevention of COVID-19 pandemic. Aim: to assess adherence to COVID-19 related public health measures among Minia university students based on health belief model. Research design: a descriptive cross-sectional design was used. Setting: Minia University, which comprises (20) faculties. Sample: A systematic random sample consisted of 460 students Data collection Tools: 1st tool: Structured interview questionnaire: included questions related to socio-demographic characteristics, medical data and life style data. 2nd tool: COVID-19 Knowledge Assessment Questionnaire. 3rd tool: COVID-19 Health Belief Scale. 4th tool: Covid-19 Self-Efficacy Scale and the 5th tool: Adherence to COVID-19 related Public Health Measures Scale. Results: less than half of participants their age ranged from 21 – 23yrs. with mean age (21 ± 2.05 yrs.). More than two-thirds of them were knowledgeable about COVID-19 related public health preventive measures with mean score (21.45 ± 3.55). 60.6% of participants students were adherent to these measures. 70.2% of participants have high perceived susceptibility to get COVID-19 while 68.4% of them have high perceived severity. 70.7% of them have high self-efficacy to comply with those preventive measures. Conclusion: There was highly statistically significant relation between participants level of adherence and their perceived susceptibility, perceived severity, perceived barriers, their cues to adhere with those measures and their self-efficacy. Recommendations: Additional research studies in Egypt should be conducted with a broader geographic scope to assess over all community-level of adherence to preventive measures and to identify barriers of noncompliance with these measures.

Background: Pain and fear may be experienced by children who are subjected to uncomfortable procedures. Pain management is an important topic to explore, as is how distraction techniques can be utilized to divert children's attention away from uncomfortable stimuli during painful procedures. This study was aimed to evaluate the effect of storytelling versus cartoon on pain and fear relief among children undergoing venipuncture. Design: The current study used a quasi-experimental research design. Setting: the current study was conducted in Surgical Pediatric Department at Beni Suef University Hospital. Subjects: 120 preschool-age children selected through the purposive sampling method were equally and randomly assigned into three groups, (40 children in the storytelling group, 40 children in cartoon group, and 40 children in the control group who received routine hospital care). Tools: Four tools were used as the following: I-A structured interviewing questionnaire, II-NumericRating Scale (NRS), III-Wong-Baker FACES Pain Rating Scale, and IV Children's Fear Scale were used for collecting data. Results: In the cartoon group, children having the lowest mean pain (2.3+1.2). About one-third of children had moderate pain, more than half of the children remained relaxed, with statistical significance differences of (0.001*). More than half of children in the cartoon group reporting no pain on WBFS. The children in the cartoon group (1.2+0.5) had lower mean ratings for fear. Conclusion: Cartoon was an effective method for reducing and relieving pain and fear among children during venipuncture more than the storytelling method. Control group who received the routine work of the hospital only, their pain and fair still high. Recommendations: Application of the storytelling and cartoon distraction techniques besides routine hospital programs during intravenous injection is recommended in the care of children to reduce pain and fear related to intravenous injection

Background As the use of Chinese herbal medicine (CHM) in the international market increases, the number of clinical studies including randomized controlled trials (RCTs) of CHM which published in international journals has also increased. Using bibliometrics, we systematically and comprehensively analyzed the research status of CHM RCTs published in English during the period of 2010 to 2019. Methods Electronic searches in MEDLINE, EMBASE, and Cochrane Library databases were undertaken. CHM RCTs published in English between January 2010 and December 2019 were included. We randomly selected 20% from the eligible articles. Descriptive statistical analysis was carried out by extracting information on general information, characteristics of the study participants, interventions, outcomes, and risk of bias assessment of included RCTs. Results Two hundred and twenty-seven CHM RCTs published in English were included in our study. Chinese Journal of Integrative Medicine was the journal which published most of the relevant papers (22.0%). A total of 45,774 participants were included, sample size ranged from 12 to 3,143 (median: 115). The most common disease was the circulatory diseases (n=36, 15.9%). Decoction was the most common dosage form (28.2%), and "CHM vs. placebo" was the most common type of control (36.1%). The median of the total number of outcomes was 4 (range: 1-14), 92 (40.5%) did not clearly specify any primary outcome, 56 (24.7%) did not report any adverse event, 41 (18.1%) and 68 (30.0%) reported traditional Chinese medicine (TCM)- specific outcomes and quality of life, respectively. Eighty-five (37.4%) did not report sufficient information about the random sequence generation process, 100 (44.1%) used the adequate allocation concealment, 92 (40.5%) blinded participants and key study personnel, and 24 (10.6%) blinded outcome assessors. Conclusions Our results provided insight into the research status regarding CHM RCTs published in English during the past decade, this study may be helpful in understanding research trends in this field.

PURPOSE The CDC's National Program of Cancer Registries has expanded the use of electronic reporting to collect more timely information on newly diagnosed cancers. The adoption, implementation, and use of electronic reporting vary significantly among central cancer registries. We identify factors affecting the adoption of electronic reporting among these registries. METHODS Directors and data managers of nine National Program of Cancer Registries took part in separate 1-hour telephone interviews in early 2019. Directors were asked about their registry's key data quality goals; staffing, resources, and tools used to aid processes; their definition and self-perception of electronic reporting adoption; key helpers and challenges; and cost and sustainability implications for adoption of electronic reporting. Data managers were asked about specific data collection processes, software applications, electronic reporting adoption and self-perception, information technology infrastructure, and helpers and challenges to data collection and processing, data quality, and sustainability of approach. RESULTS Larger registries identified organizational capacity and technical expertise as key aides. Other help for implementing electronic reporting processes came from partnerships, funding availability, management support, legislation, and access to an interstate data exchange. Common challenges among lower adopters included lack of capacity at both registry and data source levels, insufficient staffing, and a lack of information technology or technical support. Other challenges consisted of automation and interoperability of software, volume of cases received, state political environment, and quality of data received. CONCLUSION Feedback from the formative evaluation yielded several useful solutions that can guide implementation of electronic reporting and help refine the technical assistance provided to registries. Our findings may help guide future process and economic evaluations of electronic reporting and identify best practices to strengthen registry operations.

Background: abdominal surgery is a trans-abdominal incision. Persistent postoperative pain is a well-known consequence of this surgery. Foot massage appears to be effective in reducing incisional pain and improve sleep patterns among post abdominal surgery patients. Aim: To assess the effect of foot massage on incisional pain and sleep pattern among post abdominal surgery patients. Subjects and Methods: Design: A quasi-experimental pretest-posttest control group research design was used. Setting: The study was conducted in the surgical adult department at El Demerdash Hospital affiliated to Ain Shams University. Subject: Non-probability purposive sampling technique was used to select a sample of 200 post abdominal surgery patients and were randomly assigned into two groups, 100 for each the experimental and control groups. Three tools were used: (I) a structured interview questionnaire, (II) a numerical pain rating scale, and (III) a sleep quality index scale. Findings: The current study findings showed that during the posttest all post abdominal surgery patients had a mild level of pain in experimental compared to the majority in the control group had a mild level of pain. During the pretest majority of abdominal surgery patients had poor sleep patterns in both the experimental and control group. during the posttest, more than four fifth of the abdominal surgery patients had a good quality of sleep pattern in the experimental group and poor quality of sleep pattern in the control group was among all abdominal surgery patients. The study revealed that there was a difference between mean pretest and posttest scores were found statistically significant at p < 0.05 level in the experimental group regarding pain level and sleep pattern. Conclusion: Foot massage was found to be useful in reducing incisional pain and improving the quality of sleep patterns in post- abdominal surgery patients. Recommendations: Post abdominal surgery patients should be provided with a simple and applicable strategy to control pain and improve sleep patterns.

Background: Heart failure (HF) is a common cause of hospitalisation and mortality in elderly. The frequent rehospitalisations put a serious burden on patients, health-care budgets, and health-care capacity. Frequent hospital admissions are also associated with a substantial additional hazard for serious complications and reduced quality of life. The NWE-Chance project will explore the feasibility and scalability of providing home hospitalisation supported by a newly developed digital health-supported platform and daily visits of specialised nurses. Methods/Design: Hundred patients with chronic HF will be recruited over a 1-year period. The digital health-supported home hospitalisation strategy will be tested in 3 hospitals with different experience in delivering home hospitalisation: Isala Zwolle, Maastricht UMC+, both in The Netherlands, and Jessa Hospital, Hasselt in Belgium. The home hospitalisation intervention will have a maximal duration of 14 days. Feasibility will be measured with acceptability, satisfaction, and usability questionnaires for patients, nurses, and physicians. Furthermore, safety and costs will be assessed for 30 days after the start of the home hospitalisation intervention. Discussion: The NWE-Chance project will be one of the first studies to examine the feasibility of a digital health-supported home hospitalisation platform for HF patients. It has the potential to augment current standard HF care and quality of life of HF patients and to innovate the standard HF care to potentially lower the hospitalisation-related complications, the burden of HF on health-care systems, and to potentially implement more patient-centred care strategies.

Background: Spinal cord injury is a damage in the spinal cord that communication between brain and the rest of the body is disrupted, resulting in a loss of movement and sensation from below the level of injury. Damage to the spinal cord can be caused by a trauma like an accident, or as a result of infection or disease. Aim This study was to assess the nurses' knowledge and practice regarding caring for patients with spinal cord injury in critical care unit. Research design: A descriptive exploratory design, utilized for the conduction of the study, setting conducted at general intensive care unit and neurological intensive care unit in Ain Shams University hospital. Study sample: A purposive sample of 50 nurses. Tools: Two tools were used for data collection were 1) nurses self-administered questionnaire sheet. It included two parts. part one concerned with the assessment of the demographic characteristics of the studied nurses and part two concerned with nurses knowledge questionnaire regarding caring for patients with spinal cord injury.2) Nurses' observational check list about nursing practice for patients with spinal cord injury to assess nurses practice. Results; the result of the study showed that 54% of the studied nurses had satisfactory total knowledge regarding caring for patients with spinal cord injury in critical care unit and 58%of the studied nurses had an un satisfactory level of total practice regarding caring for patients with spinal cord injury in critical care unit, the study finding revealed that there was statically significant relation between nurses knowledge and their level of practice regarding caring for patients with spinal cord injury. Conclusion: the current study concluded that the studied nurses' knowledge and practice had statistically significant relation between total knowledge and practice. Recommendation: recommended health care setting should provide in-service educational programs and upgrading courses based on evidence based guidelines to improve the nurses knowledge and practice among patients with spinal cord injury in critical care unit.

Summary: Previous studies have explored the role of laparoscopic surgery (LS) in the surgical management of gallbladder carcinoma (GBC) and obtained satisfactory outcomes versus conventional open surgery. However, most of them either included a small number of patients or mainly focused on the early-staged lesions. Therefore, their results were less statistical powerful and a more comprehensive evaluation on the role of LS in GBC is warranted. A thorough database searching was performed in PubMed, EMBASE and Cochrane Library for comparative studies between the laparoscopic and open approach in the surgical management of GBC and 18 comparative studies were finally identified. RevMan 5.3 and Stata 13.0 software were used for statistical analyses. Pooled results revealed that patients in the laparoscopic group recovered faster with less intraoperative hemorrhage and less postoperative morbidity. Comparable operative time, overall recurrence rate, R0 resection rate, lymph node yield, intraoperative gallbladder violation rate and postoperative survival outcomes were also acquired. Regarding the debating issue of port-site recurrence, a significantly higher incidence of port-site recurrence was observed in laparoscopic group. However, having excluded studies on incidental gallbladder carcinoma, the subsequent pooled result showed no significant difference. Considering the inherent inconsistency of the surgical indication between laparoscopic and open surgeries and the deficiency of advanced lesions, we drew a conclusion that laparoscopic surgery seems to be only safe and feasible for early- or middle-staged lesions. Upcoming random controlled trials or comparative studies with equivalent surgical indication focused on advanced lesions are warranted for further evaluation.

Background and Objectives Sleep problems are a public health burden and have adverse health consequences in older adults. Despite sleep being a shared biological process between couples, to date, there have not been any studies that have assessed the association between retirement and sleep in older couples. The objective of this study was to examine the impact of retirement on diagnosed sleep problems in older Dutch couples. Research Design and Methods This study used data from 2 waves of the Netherlands Interdisciplinary Demographic Institute Pension Panel Study for older Dutch adults living with a partner (n = 3,726). Logistic regression models examined the strength of association between retirement and sleep problems, while accounting for the moderating role of relationship characteristics. Results Retirement was associated with decreased odds of sleep problems at Wave 2 (odds ratio [OR] = 0.60, 95% confidence interval [95% CI] = 0.46–0.78). Lower relationship quality was associated with increased odds of sleep problems in the fully adjusted model (OR = 1.81, 95% CI = 1.32–2.49). Having a partner with sleep problems was associated with an increased risk of sleep problems as well (OR = 1.51, 95% CI = 1.07–2.13). There was evidence of effect modification by relationship quality (OR = 1.87, 95% CI = 1.05–3.31). Discussion and Implications Retirement and sleep do not occur in a social vacuum and have implications beyond the individual level. More research is therefore needed to understand the impact of sleep and its health consequences on older coupled workers. Such research may provide valuable insights for the management and treatment of sleep problems and may have implications for the public health of aging communities.

Adherence may be an important factor to consider when interpreting the results of an exercise intervention. This article will discuss the importance of measuring and reporting adherence to exercise interventions that are designed to improve targeted health outcomes. Additionally, we will propose and describe a universal method to measure and report adherence to exercise interventions.

Background: There is no doubt that the mothers' adaptation helps improve the quality of life, not only for any child with special needs but for the whole family, which greatly helps in improving the child's condition and improving the care provided to him by a conscious parent who can meet the child's needs properly. The present study aimed to evaluate the effect of parent training regarding coping strategies on reducing stress among mothers of children with autism spectrum disorder (ASD). Research design: A quasi-experimental design was used in carrying out this study. Setting at This study was conducted at the Child Psychiatry out-patient clinic at Sohag University Hospital. Sample: A purposive sample of a total of forty mothers and their children with ASD aged 4-12 years participated in this study. Tools: Four tools were utilized for data collection. I- A structured interviewing questionnaire sheet, which included two parts, part 1: Demographic characteristic of the mothers, Part 2: Demographic characteristic of their children, II-Parenting Stress Index: Short Form Abidin (1992), III- Coping Strategies Inventory (CSI), IV- Child Behavior Checklist. The data were collected before, immediately after and 3 months after the implementation of the parent training program. Results: The current study revealed a statistically significant improvement was found between the Parenting Stress Index and the Coping Strategies Inventory of the studied mothers as pre/ immediate post and after three months after the training program implementation (p < 0.05). Conclusion: implementation of parent training regarding coping strategies reduced stress among mothers of children with ASD, so the study mainly recommended that parent training regarding coping strategies for mothers of children with ASD should be conducted to reduce stress among mothers of children with ASD.

One of the most common procedures among pregnant women is a cesarean section. The worry that pregnant women experience throughout the preparatory stages of operation day, as well as their lack of control over being in a new setting and feeling in danger, causes anxiety and, as a result, instability. The aim was to determine the effect of video-assisted teaching guidelines on knowledge regarding anxiety levels among primigravida mothers undergoing caesarian sections. Subjects and method: Design: A quasi-experimental research design was utilized to achieve the aim of this study. Setting: the research was conducted at the Antenatal Outpatient Clinic at South Valley University Hospital. Subjects: A purposive included 139 primigravida mothers who were included in the study within six months. Three tools were used: Tool (I) A structured interview questionnaire, Tool (II) Primigravida mothers' knowledge regarding caesarian section (pre/post), and Tool (III) Anxiety Rating Scale (pre/post). Results: The majority of primigravida mothers reported that the main source of information regarding their knowledge was nurses. There was a positive significant correlation (P=0.005) between primigravida mothers ' knowledge scores pre and post-video-assisted teaching guidelines. There were highly significant improvements in primigravida mothers' knowledge regarding the caesarian section post-video-assisted teaching guidelines (P=0.005). Statistical highly significant differences and reductions were detected between anxiety levels of primigravida mothers pre and post-video-assisted teaching guidelines. Conclusion: The present study concluded that video-assisted structured teaching guidelines had a highly significant positive effect on improving knowledge and reducing anxiety levels among primigravida mothers undergoing caesarian section. Recommendations: Educational guidelines about the caesarian section should be taught and discussed in the antenatal care follow-up visits for primigravida mothers.

Background : Sexual dysfunction is highly prevalent worldwide. A specific form is persistent sexual dysfunction after SSRI withdrawal. We conducted a systematic literature review in order to characterize factors related to post SSRI sexual dysfunction (PSSD) and analyzed spontaneous reports of persistent sexual dysfunction reported to the Netherlands Pharmacovigilance Centre Lareb. Research design and methods A systematic literature review was conducted following the PRISMA-ScR guidelines. In addition, reports of PSSD submitted to the Netherlands Pharmacovigilance Centre Lareb between 1992 and 2021 were analyzed. Results : A total of 237 articles were retrieved through the search and 33 articles were selected for inclusion in this review, in accordance with the inclusion criteria. Information regarding the characteristics of the condition, it's clinical management, patient characteristics and impact of PSSD is presented. A total of 86 reports of persistent sexual dysfunction, were analyzed. The longest case being a patient with PSSD for 23 years. The main symptoms were: loss or decreased libido (n= 53), erectile dysfunction (n= 23) and anorgasmia (n= 5). Conclusions PSSD impact includes sexual, psychological and social consequences. Little is known about the mechanisms underlying PSSD and no effective treatment exists. It is necessary to increase recognition of PSSD among prescribers and improve its management at the clinical level.