Current Issue : January-March Volume : 2022 Issue Number : 1 Articles : 5 Articles
Background: People-centered tuberculosis (TB) care promotes treatment adherence and outcomes. TB patients’ and families’ health education and protection of their rights are among the core components of people-centered care. We aimed to assess the level of people-centeredness of TB care as a proxy to quality in the largest inpatient unit of the National Pulmonology Center (NPC) in Armenia. Methods: We conducted a qualitative study by interviewing clinical and administrative staff, TB patients, and family members to learn their experiences about patient and family education and rights (PFE&R) protection practices focusing on two Joint Commission International (JCI) Standards for Hospital Accreditation. Mixed-conventional inductive and directed deductive content approach guided the analysis of data. Results: The study revealed various gaps in the provided services. According to the TB physicians and nurses, they routinely educated patients and families and took actions to protect their rights. However, practices reported by TB providers varied across clinical departments and professionals and did not meet the recommendations of the JCI standards. The document review revealed that no written policies or procedures existed in the NPC inpatient unit to guide the implementation of PFE&R. Lastly, patients’ inconsistent experiences were also indicative of the lack of standardization and issues with PFE&R implementation. Conclusion: Bridging the gap between existing and recommended practices by establishing and enforcing new people-centered policies and procedures is a pledge for improving operations and patients’ experiences with a potential nationwide impact in Armenia....
Background: Comparative studies regarding the long-term clinical outcomes of statin intensity between acute myocardial infarction (AMI) patients with prediabetes and those with type 2 diabetes mellitus (T2DM), after successful implantation of newer-generation drug-eluting stents (DES) with statin treatment, are limited. We compared the 2-year clinical outcomes between these patients. Methods: A total of 11,612 AMI patients were classified as statin users (n = 9893) and non-users (n = 1719). Thereafter, statin users were further divided into high-intensity (n = 2984) or low-moderate-intensity statin (n = 6909) treatment groups. Those in these two groups were further classified into patients with normoglycemia, prediabetes, and T2DM. The major outcomes were the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (Re-MI), or any repeat coronary revascularization. Results: After adjusting for both high-intensity and low-moderate-intensity statin users, the cumulative incidences of MACE (p = 0.737, p = 0.062, respectively), all-cause death, Re-MI, and any repeat revascularization were similar between the prediabetes and T2DM groups. In the total study population, both high-intensity and low-moderateintensity statin treatments showed comparable results. However, in the patients who enrolled after October 2012, the cumulative incidences of MACE (aHR 1.533; 95% CI 1.144–2.053; p = 0.004) and any repeat revascularization (aHR, 1.587; 95% CI 1.026–2.456; p = 0.038) were significantly lower in high-intensity statin users than in low-moderate intensity statin users. The beneficial effects of high-intensity compared to low-moderate-intensity statin therapy were more apparent in the normoglycemia group than hyperglycemia group, as it reduced the cumulative incidences of MACE (aHR 1.903; 95% CI 1.203–3.010; p = 0.006) and any repeat revascularization (aHR 3.248; 95% CI 1.539–6.854; p = 0.002). Conclusions: In this retrospective registry study, prediabetes and T2DM groups showed comparable clinical outcomes, after administering both high-intensity and low-moderate-intensity statin treatments. However, these results are likely to be clearly proved by further studies, especially in patients with AMI who are being treated in contemporary practice. Trial registration: Retrospectively registered....
Objectives: To assess the safety and effectiveness of Yinhuangsan (YHS) in patients with diabetic foot ulcers (DFU). Search Methods: Studies were selected from PubMed (1966 to January 2021), the Excerpta Medica Database (EMBASE) (1974 to January 2021), the Cochrane Library (1988 to January 2021), SinoMed (CBM) (1978 to January 2021), China Science and Technology Journal Data-base (VIP) (1994 to January 2021), Wanfang Data Knowl-edge Service Platform (1998 to January 2021) and the China National Knowledge Infrastructure (CNKI) (1984 to January 2021). No language restrictions were applied. Studies were identified and selected, and the data were extracted independently by two reviewers. The Cochrane Risk of Bias tool was used to assess the quality of studies. Revman 5.3 software was used for data synthesis and analysis. Results: Two studies were included based on the selection criteria. Two trials were of unsatisfied methodological quality and adopting different criteria to judge outcomes. As such, we were unable to perform a summary meta-analysis but concentrated on a narrative summary of results. Both the included studies had a low risk of incomplete data bias and selective reporting bias, while neither of them mentioned allocation concealment and blinding. Both two trials showed positive results favoring YHS compared with positive controls independently in total effective rate. One reported amputation rate, mortality and ulcer area change, and the other described ulcer healing rate. Neither of the trials stated adverse reactions and quality of life. Conclusions: There is currently inadequate evidence on evaluating YHS for DFU effectively, due to the paucity of randomized controlled trials and the low methodological quality in included studies. The safety of YHS remains unknown for lack of ample data on adverse events. Hence, YHS should be applied with caution. More high quality randomized controlled trials (RCTs) expected to strengthen the evidence for the effectiveness and safety of YHS treating DFU are in demand. Standardized monitoring or a valid reporting system should be adopted to critically estimate adverse events and the safety in the future....
Background: Duodenal neuroendocrine tumours (D‐NETs) are rare but increasingly diagnosed. This study aimed to assess the overall survival and recurrence rate among patients treated for D‐NETs. Methods: Patients with D‐NETs were retrospectively reviewed with a median followup time of 4.8 years (range 0.0–17.2 years). Results: A total of 32 patients with median age 68.0 years were identified. Fifteen patients underwent surgery while ten patients underwent endoscopic treatment. Mean estimated overall survival for the entire population was 12.1 years (95% CI 9.5–14.7 years), while 5‐year overall survival was 81.3%. Tumour grade G1 was associated with longer mean estimated survival compared to G2 tumours (13.2 years versus 4.4 years, p = 0.010). None of the 23 patients who underwent presumed radical endoscopic or surgical resection had disease recurrence during follow‐up. Tumours <10 mm could be treated endoscopically whereas a high proportion of patients with tumours 10–20 mm should be considered for surgery. Conclusion: Patients with DNETs had long overall survival, and mortality was more influenced by other diseases. Both endoscopic and surgical resections were effective as no recurrences were diagnosed during follow‐up....
Objectives: In many articles, gastroesophageal reflux has been identified as a strong underlying factor in laryngeal and extra-laryngeal disorders. But the exact mechanism of these complications is still controversial. The present study was designed to investigate the association of gastroesophageal acid reflux to ear, nose and throat diseases in children. Materials and Methods: The present study is a descriptive cross-sectional study and its statistical population includes children with gastroesophageal reflux disease over a period of 18 months visited Salmaniya Medical Complex, Kingdom of Bahrain. The diagnosis of GERD (Gastroesophageal reflux disease) was recorded based on symptoms, radiological and endoscopic findings and ESPGHAN guidelines. The ear, nose and throat were examined and problems recorded followed by initiation of medical treatment. After one and six months of follow up post treatment all clinical findings were recorded. Results: 26.4% of the children were under one year old. In 78% of children, a family history of GERD was reported to be negative. Cough was the most common clinical complaint. After one month of treatment, 15% of gastrointestinal symptoms and 40% of ENT symptoms completely improved. After six months of treatment 72% percentage of gastrointestinal symptoms and ENT symptoms completely improved. Conclusion: This study showed that gastroesophageal reflux disease should be considered, diagnosed and treated in all children with refractory ear, nose and throat symptoms....
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