ObjectiveTo investigate whether centrality bias is one of the contributing factors for patient mistriage in the emergency department.MethodsA randomized, controlled, single-blinded trial was conducted in an emergency department triage station between April 1 and November 3, 2021. Experienced triage nurses were divided into control and treatment groups. The control group triaged patients using the Canadian Triage and Acuity Scale 1–5 triage scale, and the treatment group used a four-level triage scale (created by removing level 3 from the original Canadian Triage and Acuity Scale). Neither group was exposed to the other’s ranking and the control group determined the patient’s actual triage ranking. The accuracy of each group’s ranking was determined by triage experts. Triage nurses’ levels of confidence was investigated, as was the correlation between triage ranking accuracy and confidence level.ResultsAfter excluding 58 patients with missing data, 146 assessments were analyzed. Statistical analysis was performed to compare three different aspects of triage rankings between the nurses’ groups and the control group. In the first and second analyses, accuracy levels of 49% and 68% (p = 0.003), 43% and 68% (p < 0.0001) were found for the control and experimental groups, respectively. The third aspect showed no significant differences. Within the control and experimental groups, the difference in accuracy rate at levels 2 and 5 was the most significant, with 13% and 75% (p = 0.40), 29% and 67% (p = 0.009), respectively.Conclusions:Central tendency has the potential to affect the accuracy of ranking among triage nurses in the emergency department. Further research is needed.

Introduction:Preconception care involves measures to enhance a woman’s physical, psychological, and nutritional health before pregnancy. Despite various observational studies assessing healthcare practitioners’ knowledge of preconception care in East Africa, the overall pooled knowledge level remains unclear, and the studies often report inconsistent associated factors. This systematic review and meta-analysis aimed to determine the aggregated knowledge of preconception care among healthcare providers in East Africa and identify influencing factors.Method:We searched studies using PubMed, Scopus, Embase, and Google Scholar that were published between January 01, 2018 and November 30, 2024. This study used the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The quality of studies was evaluated using the modified Newcastle-Ottawa quality assessment tool. The data were extracted by two authors independently using Microsoft Excel and analyzed by Stata version 17. A random effects model was applied to calculate the pooled level of knowledge and its associated factors. The International Prospective Register of Systematic Review registration number for the review was CRD42024608878.Results:A total of 12 studies comprising 4892 participants were involved in this meta-analysis. The pooled knowledge of preconception care among healthcare providers was 56% (95% CI: 45%–66%). This study showed that gender (odds ratio (OR) = 1.35), educational level (OR = 3.52), monthly salary (OR), work experience (OR = 1.77), Internet access (OR = 3.41), ever read the preconception care guideline (OR = 2.77), having Smartphone (OR = 1.70), working institution (OR = 2.05), Training on HIV testing and management (OR = 4.28), training on providing alcohol or tobacco cessation service (OR = 1.14), the presence of a library in a working health facility (OR = 1.98), taking training on preconception care education and counseling (OR = 3.44) were significant factors associated with knowledge of preconception care.Conclusion:The findings indicate that healthcare providers in East Africa have limited knowledge of preconception care. Gender, educational level, monthly salary, previous work experience, internet connection, awareness of preconception care policy, smartphone possession, type of work schedule, prior HIV testing, and management training, library access in healthcare facilities, and involvement in preconception care training meetings and counseling sessions are significant factors of the knowledge of preconception care among healthcare providers.

The objectives of the study are to assess the knowledge of advanced life support among general nurses in Spain, identify knowledge gaps and analyze the demographic, educational, and occupational determinants of their level of knowledge. A cross-sectional study was conducted from November 2020 to February 2021 among general nurses in Spain. A structured self-administered questionnaire was used to collect data on demographics, educational, and professional background, as well as theoretical knowledge questions. A binary logistic regression analysis was performed to identify the influencing factors associated with the outcome of the educational measure. A total of 888 general nurses participated in the study, with representation from all 52 Spanish provinces; 80% of whom were female nurses. The 72.3% of the nurses did not attain the 70% correct score on the theoretical questionnaire, a prerequisite for achieving an adequate pass rating. The study revealed inadequate knowledge among the participating nurses with regard to the characteristics of fluid therapy, the conditions for defibrillation and the action algorithm in the event of a defibrillate rhythm, and the recommendations for use of the LUCAS RCP® device. Nurse gender, possession of at least a Master's degree, practising in high-risk areas for cardiac arrest and having received recent advanced life support training were positively associated with better knowledge of advanced life support among nurses. The study shows that Spanish general nurses have insufficient knowledge of advanced life support and that there are evident knowledge gaps in key subject areas relating to best practices for cardiorespiratory arrests. This indicates that they require knowledge building to promote evidence-based patient care. Furthermore, the findings emphasize the significance of ongoing education needed to respond to high-risk events such as a cardiac arrest. The positive and negative factors identified in this study, which influence the attainment of a good level of advanced life support knowledge, should be taken into account.

Several studies have demonstrated that the team dynamic among healthcare professionals has an impact on the quality of care, as well as the satisfaction of healthcare team members at work. The Input-Process-Output and Intervention model is one way to structure complex interventions with the aim of improving the team dynamic and evaluating their impact on the healthcare professional team, patients, and the organization. The objective of the study was to describe the steps and results of a quality improvement project aimed at improving the team dynamic of healthcare professionals in the acute older people care unit of a university hospital and improving outcomes for the healthcare professional team, patients, and the organization. The project was based on the Deming cycle framework (Plan-Do-Check-Act) for improving the quality of care. It consisted of the following steps: (1) Implementation plan with an iterative process; (2) interventions according to the Input-Process-Output and Intervention model; and (3) evaluation of the impact of these interventions. The results demonstrated an improvement in most healthcare professional team outcomes, particularly in terms of satisfaction and absenteeism, as well as organizational outcomes. Patient outcomes were highly satisfactory and relatively stable throughout the process. The integration of a healthcare professional team dynamic improvement model into quality and safety of care processes should be considered to optimize clinical and organizational outcomes.

Endometriosis involves the presence of endometrial-like tissue outside the uterus, driven by inflammatory pathways including elevated interleukin-32 and vascular endothelial growth factor. One potential anti-inflammatory agent is active vitamin D (1,25(OH)2D3). This research investigates the correlation among 1,25(OH)2D3 levels, interleukin-32, and vascular endothelial growth factor in confirmed endometriosis cases. This observational analytic correlational study aimed to explore the relationship between these inflammatory factors and vitamin D levels in endometriosis. The study involved 46 participants, with histopathologically confirmed endometriosis cyst tissue collected from patients undergoing laparotomy or laparoscopy at three hospitals: Dr. Hasan Sadikin Hospital Bandung, Cibabat General Hospital Cimahi, and Limijati Maternity and Children's Hospital. The levels of interleukin-32, vascular endothelial growth factor, and 1,25(OH)2D3 were measured using the enzyme-linked immunosorbent assay method at the Clinical Pathology Laboratory of Dr. Hasan Sadikin Hospital Bandung. The study revealed significant negative correlations between 1,25(OH)2D3 and both interleukin-32 (r = -0.346; p = 0.019) and vascular endothelial growth factor levels (r = -0.316; p = 0.032). Conversely, there was a significant positive correlation between vascular endothelial growth factor and interleukin-32 (r = 0.490; p = 0.001). These findings underscore the role of active vitamin D in mitigating inflammation associated with endometriosis by reducing interleukin-32 and vascular endothelial growth factor, critical factors in inflammatory responses and blood vessel formation. Moreover, the positive association between vascular endothelial growth factor and interleukin-32 highlights their collaborative role in the inflammatory processes underlying endometriosis. This study contributes to understanding how vitamin D may modulate key inflammatory pathways implicated in the pathogenesis of this condition.

Gender-based violence is a major public health concern. Although, in many instances, violence against women and girls encompasses the entire spectrum of gender-based violence in the public eye, violence against men is a very real threat that is obscure and obliterated within cultural norms. Identification of the legal and cultural barriers men face is a very important step forward toward promoting gender equity. There is a severe paucity of research on gender-based violence against men in Sri Lanka. A qualitative study was conducted to explore the causes, effects, and help-seeking behaviors of men subjected to gender-based violence in the Colombo district, Sri Lanka. Two focus group discussions and two in-depth interviews were carried out among seventeen purposefully selected victims of gender-based violence and ten key informant interviews were carried out among service providers recruited purposefully in the Colombo district. Transcript analysis was done by using the thematic analysis method. The study participants of the focus group discussions described themes of preconceived notions about the male sex, gender bias, power play, and masculinity norms as causes leading to gender-based violence. Many participants described their own or a peer's life experience to explain the experiences and consequences of gender-based violence. The key informant interview revealed certain aspects of the support systems which need revision in order to make the services more accessible to men. This study provides evidence regarding the hitherto undiscussed topic of gender-based violence against men in Sri Lanka. The findings highlight the importance of taking into consideration and inclusion of men in the development of policies for gender-based violence in Sri Lanka.

Bursitis iliopectinea (BI) is a condition that is characterized by swelling of the iliopsoas bursa, leading to compression of inguinal neurovascular structures, causing swelling, pain, paresthesia, or thrombosis of the leg. Due to the rare occurrence of BI, the available literature consists of case reports. Our study aims to systematically review the literature for a comprehensive analysis of the etiology, treatment modalities, and clinical outcomes of patients with BI. We systematically analyzed 217 studies with 502 cases of BI and extracted information about the terminology, risk factors, diagnostic and treatment strategies, association with neurovascular compression syndromes, treatment outcomes, and recurrence rates. The overall quality of the analyzed studies was moderate to good. The terminology uses for BI was heterogeneous and included ganglion, tumor, mass, and bursitis. In addition to conventional X-ray, ultrasound, CT, or MRI were used to diagnose BI. The most prevalent etiology of BI was osteoarthritis of the hip or wear-related soft-tissue reactions after total hip replacement (THA). Nearly one-third of the patients suffered from compression syndromes, most frequently of the femoral vein (16%). Only rheumatoid arthritis showed an association with the occurrence of compression syndromes. The most common operative treatments were the resection of the bursa (30%), total hip arthroplasty (29%), and aspiration (24%). Use of analgesics (17%), injection of corticoids (11%), and physiotherapy (9%) were used for conservative treatments. The recurrence rate was highest after physiotherapy (OR: 4.1) or aspiration (4.5) and lowest after THA (OR: 0.2). Although BI is a condition commonly associated with hip arthritis or local tissue reactions following total hip prosthesis, its impact extends beyond typical hip-related symptoms. Notably, BI related to rheumatoid arthritis shows a high correlation with neurovascular compression symptoms, with femoral vein compression being the most frequently reported. This underscores the necessity of considering BI in patients presenting with nonspecific inguinal pain or neurovascular symptoms of the lower extremity. Additionally, standardizing the nomenclature of BI nomenclature could improve future research.

This study investigated the implementation of the ABCDEF bundle and the factors associated with its implementation according to national income levels. This study is cross-sectional research. We conducted a secondary analysis of an international 1-day point-prevalence study that investigated the implementation of the ABCDEF bundle in critically ill patients. All patients admitted to the ICU were eligible. This study was conducted across 135 ICUs in 54 countries, including data from 664 patients. Outcomes were categorized according to the income level of the country (high-income, middle-income, and low-income countries) in which each ICU was located. A multilevel generalized linear model was developed to identify the factors associated with ABCDEF bundle implementation for each income level. We identified 664 patients in 79 high-income countries, 278 in 26 middle-income countries, and 287 in 30 low-income countries ICUs. Implementation rates of the ABCDEF bundle were low for all income levels but varied. Few individuals completed the entire bundle on the survey date. Common factors associated with the implementation among all income levels were a multidisciplinary team approach for Element A (pain) and mechanical ventilation use for Element C (sedation), which were also associated with lower Element E (mobility). The existence of a protocol was frequently identified as a promoting factor associated with ABCDEF bundle implementation. The associated factors varied by income level; for example, dedicated intensivists were only identified in high-income countries, but not in middle-income countries or low-income countries. The overall low ABCDEF bundle implementation rates necessitate action. As factors associated with its implementation vary according to national income level, tailored strategies are essential for improving ICU care quality. NA.

Background:The association between smoking dependence and the risk of developing Barrett’s esophagus remains unclear. This study aimed to investigate whether a causal relationship exists between smoking dependence and Barrett’s esophagus, using Mendelian randomization analysis.Methods:Two-sample Mendelian randomization analysis was conducted to evaluate the impact of smoking and Barrett’s esophagus. Additionally, we applied summary data-based Mendelian randomization techniques to combine information from genome-wide association studies (GWAS) with expression quantitative trait locus and methylation quantitative trait locus.Results:Multivariable Mendelian randomization showed an association between smoking per day (odds ratio = 1.2, 95% confidence interval: 1.038–1.38, p = 0.014) or current smoking (odds ratio = 2.41, 95% confidence interval: 1.06–5.5, p = 0.037) and Barrett’s esophagus. Inverse variance-weighted methods of bidirectional Mendelian randomization also revealed that smoking per day was significantly associated with elevated risks of Barrett’s esophagus (odds ratio = 1.34, 95% confidence interval: 1.092–1.649, p = 0.005), while Barrett’s esophagus was also a susceptibility factor for smoking per day (odds ratio = 1.05, 95% confidence interval: 1.017–1.087, p = 0.003). By incorporating consistent summary data-based Mendelian randomization associations between DNA methylation and smoke/Barrett’s esophagus, gene expression and smoke/Barrett’s esophagus, and DNA methylation and gene expression, we identified that the genetic variant-cg00935895-RBM43 (ENSG00000184898)-smoke/Barrett’s esophagus axis exerted an effect on smoke/Barrett’s esophagus by altering the DNA methylation level, which regulated the expression level of RBM43.Conclusions:Our study provides evidence of a bidirectional causal association between smoking and Barrett’s esophagus from a genetic perspective, which sheds new light on the potential role of RBM43 as a mediator in facilitating the impact of smoking and Barrett’s esophagus.

Objectives:Pneumonia is a common perioperative complication in geriatric patients with hip fractures. This study aimed to analyze demographic characteristics, mortality rates, postoperative outcomes, and perioperative comorbidities, identify risk factors for mortality, and develop a nomogram for predicting the prognosis of these patients.Methods:Data on patients hospitalized for arthroplasty for hip fractures from 2020 to 2023 at three hospitals were retrospectively analyzed. Patients were divided into the P group (patients with hip fractures complicated with pneumonia) and the C group (patients with hip fractures without pneumonia) and demographic characteristics, mortality, postoperative outcomes, and perioperative comorbidities of the patients were analyzed. Multiple logistic regression was then used to identify independent risk factors for inpatient mortality in the P group and a nomogram was constructed to predict inpatient mortality. The predictive performance of the nomogram was assessed using receiver operating characteristic curves, decision curve analysis, and calibration curves.Results:A total of 311 patients participated in the study. Patients in the P group had longer hospitalization (p = 0.001), higher inpatient mortality (p < 0.001), higher mortality (30 days) (p < 0.001), and a poorer recovery of hip function (p < 0.001). Multiple logistic regression showed that age, BMI, total hip arthroplasty, diabetes, and chronic obstructive pulmonary disease were independent risk factors for inpatient mortality in the P group; these factors were incorporated in the nomogram. The C-index of the nomogram was 0.868 (95% CI: 0.802–0.933), and the C-index of internal bootstrapping validation was 0.851 (95% CI: 0.793–0.908), indicating the effectiveness of the nomogram in predicting patient prognosis.Conclusions:Coinfection with pneumonia adversely affected both recovery of hip function and survival in geriatric patients with hip fractures. Age, BMI, total hip arthroplasty, diabetes, and chronic obstructive pulmonary disease were found to be independent risk factors for mortality in this patient population.