Effect of Home-based Pulmonary Rehabilitation on Fatigue, Dyspnea, and Activities of Daily Living of COVID-19 Patients

Background: The acute nature and complications of COVID-19, including fatigue and dyspnea, reduce the ability of the affected individuals to play individual and social roles and perform activities of daily living, and have adverse effects on the life quality and economic status of patients. Conducting pre-discharge rehabilitation programs following a home-based approach can be effective in reducing fatigue and dyspnea and improving the activities of daily living of COVID-19 patients. Objectives: This study aimed to investigate the effect of home-based pulmonary rehabilitation on fatigue, dyspnea, and activities of daily living of COVID-19 patients in the teaching hospitals of Zahedan University of Medical Sciences in 2020. Methods: The quasi-experimental study enrolled 60 patients with COVID-19 respiratory symptoms admitted to the COVID-19 intensive care units of teaching hospitals affiliated with Zahedan University of Medical Sciences in 2020. The patients who met the inclusion criteria were selected using convenience sampling and randomly divided into intervention and control groups with color cards. The instruments used to collect the data were the Fatigue Severity Scale (FSS), the Borg Dyspnea Scale, and the Barthel Index completed by the participants before, two weeks, and two months after the intervention. The rehabilitation training was provided to the patient and the primary caregiver in the intervention group in three 45-min sessions individually and using training videos during the hospital stay. After discharge, the patients were followed up in person or by phone for eight weeks to ensure the effectiveness of the rehabilitation program. The collected data were analyzed using SPSS-22 software through repeated measures analysis of variance (ANOVA), independent samples t-test, and chi-square test at a significance level of 0.05 (P < 0.05). Results: The repeated measures ANOVA showed that changes in the fatigue and dyspnea scores were significant over time (P < 0.001). Furthermore, the intervention effect was significant (P = 0.04), and more remarkable changes were observed in the intervention group than in the control group. Given the significance of the group-time interactive effect on the two given variables, the comparisons were made point by point and with Bonferroni correction again by time and group. There were significant differences in the mean fatigue scores in the second (P = 0.03) and third (P < 0.001) stages and the mean dyspnea scores (P < 0.001) between the two groups. The mean scores of activities of daily living two weeks and two months after the intervention were significantly different between the two groups, with higher scores in the intervention group than in the control group (P = 0.01). The repeated measures ANOVA confirmed a statistically significant difference between the two groups in terms of the effect of time (P < 0.001) and group (P = 0.03) on the patients’ activities of daily living. Conclusions: The study showed that home-based pulmonary rehabilitation measures were effective on fatigue, dyspnea, and activities of daily living of COVID-19 patients. Thus, this intervention approach by nurses for family participation can be practical for treating acute and chronic respiratory diseases.

Short-Term Clinical Efficacy of Femoral Neck System Versus Multiple Cannulated Compression Screws in the Treatment of Garden III and IV Femoral Neck Fractures

Femoral neck system (FNS) , as a novel minimally invasive internal fixation device, has been gradually applied in the treatment of femoral neck fracture.However, there are few related clinical studies on FNS at present, especially there is no clinical report on FNS in treating GardenIII and IV femoral neck fractures. The aim of the present study was to compare the short-term clinical efficacy of FNS and multiple cannulated compression screws (MCCS) in the treatment of Garden III and IV femoral neck fractures. The data of 78 patients with femoral neck fracture who were admitted to three teaching hospitals affiliated to Anhui Medical University and received internal fixation with FNS and MCCS from June 2019 to December 2020 were collected for a retrospective study. There were 39 patients in both the FNS and MCCS groups. The basic data, perioperative data were recorded and compared between the two groups of patients. The results of the study are encouraging. The operation time was shorter in FNS group than that in MCCS group (p<0.001). The post-operative partial and complete weight-bearing time was earlier in FNS group than that in MCCS group (p<0.001). The Harris hip score in FNS group was higher than that in MCCS group (p<0.001). The incidence rate of lateral thigh irritation in FNS group and MCCS group was 0 (0/39) and 33.3% (13/39), respectively (χ2=15.600, p<0.001). The length of femoral neck shortening was significantly shorter in FNS group than that in MCCS group (t=-5.093, p<0.001). In conclusion, The application of FNS for Garden III and IV femoral neck fractures can shorten the operation time, reduce the frequency of intraoperative fluoroscopy, and facilitate the recovery of hip joint function, so it provides a novel choice for the treatment of Garden III and IV femoral neck fractures in young people.

Oral Hygiene Practices and Knowledge among Adolescents Aged between 15 and 17 Years Old during Fixed Orthodontic Treatment: Multicentre Study Conducted in France

The aims of this study were to assess oral health knowledge, attitudes, and practices among orthodontic patients between the ages of 15 and 17 years old compared to adolescents without orthodontic treatment. This cross-sectional study included 392 adolescents drawn from various French teaching hospitals. A closed-ended questionnaire was used to collect data. Adolescents undergoing orthodontic treatment had a higher knowledge of oral health than adolescents without orthodontic treatment. The majority of adolescents for both groups (69%) claimed to brush their teeth twice a day. Regarding complimentary dental material, 81.9% of adolescents without orthodontic treatment never used an interdental brush and 78.8% never used dental floss. For those undergoing orthodontic treatment, 48.5% never used interdental brush. Only 4% of adolescents without and 3% of adolescents with orthodontic treatment never consumed fizzy drinks, 4.9% and 3% never consumed sweets, 4% and 8.4% never ate fast-food. Adolescents without treatment consumed more sodas (p=0.04) and more fast food (p=0.03). Adolescents had insufficient knowledge of oral health. Health education programmes should be implemented to improve adolescents' knowledge and individual oral prophylaxis with interdental brushes.

Modelling Outpatients Cost of Wound Dressing in Nigeria: A Prospective Study

Background: Estimating the direct cost of wound dressing poses a challenge to patients, nurse managers, hospital administrators, health maintenance organisations and other policy makers. This study therefore model the weekly cost of wound dressing in South West NigeriaMethods: A descriptive cross sectional research design was utilized to assess the cost of wound dressing among outpatients’ clinics attendees. An inventory of direct cost of wound dressing per week consisting of cost of materials, lotion and consumables were recorded. The data collection was for period of three months in three selected Teaching Hospitals South West Nigeria. Then modelling weekly cost of wound types was done by regression analysis. The effect of various independent variables such as age, occupation, family size, monthly income, aetiology, diagnosis, wound type, comorbidities, frequency of wound dressing and health insurance coverage on cost of wound dressing per week was considered. Ethical approval was obtained from each of the hospital and Covid-19 precautions were observed.1 USD equalled ₦570Results: The estimated cost of wound dressing per week with no contribution from other variables was found to be ₦36,922- Open wound, ₦6011-Leg ulcer, ₦3768- Cancer wound, ₦2785- Diabetic Foot Ulcer, ₦610-Surgical wound. Only frequency of wound dressing was found to contribute to weekly cost of leg ulcers (P value= 0.003)Conclusions: The estimated cost of various type of wound provides yardstick for determining the weekly cost of wound dressing in Nigeria. Also, frequency of wound dressing is a major determinant of the outpatient cost of dressing. Therefore, it is imperative for nurses to render high quality wound care to match up with the huge financial commitment from patients and families

Validation of the efficacy of the NUTRISCORE for the nutritional screening of cancer patients in China

Background Malnutrition is common in cancer patients. The NUTRISCORE is a newly developed cancer-specific nutritional screening tool and was validated by comparison with the Patient-Generated Subjective Global Assessment (PG-SGA) and Malnutrition Screening Tool (MST) in Spain. We aimed to evaluate the performance of the NUTRISCORE, MST, and PG-SGA in estimating the risk of malnutrition in Chinese cancer patients. Methods Data from an open parallel and multicenter cross-sectional study in 29 clinical teaching hospitals in 14 Chinese cities were used. Cancer patients were assessed for malnutrition using the PG-SGA, NUTRISCORE, and MST. The sensitivity, specificity, and areas under the receiver operating characteristic curve were estimated for the NUTRISCORE and MST using the PG-SGA as a reference. Results A total of 1000 cancer patients were included. The mean age was 55.9 (19 to 92 years), and 47.5% were male. Of these patients, 450 (45.0%) had PG-SGA B and C, 29 (2.9%) had a NUTRISCORE ≥5, and 367 (36.7%) had an MST ≥ 2. Using the PG-SGA as a reference, the sensitivity, specificity, and area under the curve values of the NUTRISCORE were found to be 6.2, 99.8%, and 0.53, respectively. The sensitivity, specificity, and area under the curve values of the MST were 50.9, 74.9%, and 0.63, respectively. The kappa index between the NUTRISCORE and PG-SGA was 0.066, and that between the MST and PG-SGA was 0.262 (P < 0.05). Conclusions The NUTRISCORE had an extremely low sensitivity in cancer patients in China compared with the MST when the PG-SGA was used as a reference.

Two-Step Estimation of the Impact of Contextual Variables on Technical Efficiency of Hospitals: The Case Study of Public Hospitals in Iran

Background: Measuring the efficiency and productivity of hospitals is a key tool to cost contamination and management that is very important for any healthcare system for having an efficient system.Objective: The purpose of this study is to examine the effects of contextual factors on hospital efficiency in Iranian public hospitals.Methods: This was a quantitative and descriptive-analytical study conducted in two steps. First, we measured the efficiency score of teaching and non-teaching hospitals by using the Data Envelopment Analysis (DEA) method. Second, the relationship between efficiency score and contextual factors was analyzed. We used median statistics (first and third quarters) to describe the concentration and distribution of each variable in teaching and non-teaching hospitals, then the Wilcoxon test was used to compare them. The Spearman test was used to evaluate the correlation between the efficiency of hospitals and contextual variables (province area, province population, population density, and the number of beds per hospital).Results: On average, the efficiency score in non-teaching hospitals in 31 provinces was 0.67 and for teaching hospitals was 0.54. Results showed that there is no significant relationship between the efficiency score and the number of hospitals in the provinces (p = 0.1 and 0.15, respectively). The relationship between the number of hospitals and the population of the province was significant and positive. Also, there was a positive relationship between the number of beds and the area of the province in both types of teaching and non-teaching hospitals.Conclusion: Multilateral factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its context should be developed. It is necessary to pay attention to contextual factors and organizational architecture to improve efficiency.

Hardiness in Family Caregivers During Caring From Persons With Alzheimer's Disease: A Deductive Content Analysis Study

Objective: This study was designed to describe the experiences of family Caregivers' hardiness in caring for Alzheimer's Patients.Methods: The deductive content analysis method was performed between April 2020 and February 2021 in one of the teaching hospitals in Iran. Fourteen family caregivers of Alzheimer's patients were selected using purposive and snowballing sampling and the data were collected by semi-structured interviews. After that, data were analyzed using Elo and Kingas steps.Results: The results of this study showed that based on the experiences of family caregivers, the family caregivers' hardiness in caring for Alzheimer's patients is a feature of cognitive ability to deal with stressful care situations and consists of five dimensions of commitment, control, challenge, communication and culture with 22 generic categories that they were nested into this five dimension.Conclusion: Family caregivers' hardiness is a trait related to the individual and environmental factors, and the prevailing social and cultural conditions affect the individual's perception and experience of hardship and threats, as well as his/her understanding of protective factors and how to use them. Therefore, hardiness should not be interpreted as a simple approach regardless of culture.

Economic Burden of Inpatient Wound Dressing in Nigeria: Implication for Catastrophic Household Expenditure

Background: The literature is replete with family impoverishment resulting from out of pocket healthcare financing on the Africa continent. In Nigeria the healthcare insurance scheme is evolving and requires wider coverage. The aim of this study is to examine catastrophic household expenditure emanating from daily or alternate day wound dressing.Methods. The study was based on a descriptive cross-sectional research design to investigate the economic burden of daily or alternate day wound dressing among hospitalized patients in selected teaching hospitals in south west Nigeria. The inclusion criteria focused on inpatients about to be discharged or already spent minimum of four weeks in hospital. The data collection instrument was pre-tested with a coefficient of stability of 0.774. Respondents were selected via convenience sampling while an interview administered questionnaire was used to elicit information on wound care from patients in medical surgical wards. Covid-19 protocols were strictly adhered to and ethical approval was sought from each hospital.Results: The result revealed that the mean age of the respondents was 44.95 ± 16.12. Two-thirds were men who are artisans and traders with only secondary school education. Over 70% of the respondents have between 5 and 10 family members, more than 50% earn less than ₦50000 per month. The majority have no comorbidities (79.5%), about 50% were on daily dressing which required 1–5 moderate or major dressing packs per week. The length of hospital stay for the majority of the respondents (85.3%) was less than 11 weeks.Conclusions: The daily or alternate day wound dressing requires a financial input beyond the coping capacity of the indigenous Nigerian families. The Nigerian government should scale up coverage of health insurance scheme to cover artisans, small traders and other low income earners to reduce the incidence of catastrophic household expenditure.

“More than just a medical student”: a mixed methods exploration of a structured volunteering programme for undergraduate medical students

Background As a result of the COVID-19 pandemic Imperial College School of Medicine developed a structured volunteering programme involving 398 medical students, across eight teaching hospitals. This case study aims to explore the relationship between the processes, context, participant experiences and impacts of the programme so that lessons can be learned for future emergencies and service-learning programmes. Methods Using an illuminative approach to evaluation we invited all volunteers and supervisors to complete a mixed-methods survey. This explored differences in experience across demographics and contextual factors, correlations between aspects of induction, supervision and overall experience, and reviewed the impacts of the programme. Quantitative responses were statistically analysed and qualitative reflections were thematically coded to triangulate and explain quantitative findings. Follow up interviews were carried out to check back findings and co-create conclusions. Results We received responses from 61 students and 17 supervisors. Student participants described predominantly altruistic motivations and transformational changes to their professional identity driven by feeling included, having responsibility, and engaging in authentic workplace-based learning afforded by freedom from the assessed curriculum. They reported new perspectives on their future professional role within the multidisciplinary team and the value of workplace-based learning. They reported increases in wellbeing and self-esteem related to feeling included and valued, and positively contributing to service provision at a time of need. Significantly higher overall satisfaction was associated with a personalised induction, active supervision, earlier stage of training, and male gender. Gender-related differences were not explained through our data but have been reported elsewhere and warrant further study. The duration, intensity and type of role that volunteers performed was similar across demographics and did not appear to modulate their overall experience. Conclusions Whilst acknowledging the uniqueness of emergency volunteering and the survey response rate of 15% of volunteers, we suggest the features of a successful service-learning programme include: a learner-centred induction, regular contact with engaged and appreciative supervisors, and roles where students feel valued. Programmes in similar settings may find that service learning is most impactful earlier in medical students’ training and that students with altruistic motivations and meaningful work may flourish without formal outcomes and assessments.

Effectiveness of Acupuncture as Adjunctive Therapy in Type 2 Diabetic: Study Protocol for a Randomized Controlled Trial

Background: The incidence of type 2 diabetes mellitus is increasing worldwide. The literature suggests that acupuncture is a possible complementary therapy for type 2 diabetes mellitus. This study aims to determine the effect of acupuncture as an adjunctive therapy on homeostasis model assessment-insulin resistance (HOMA-IR), adiposity and health-related quality of life (HRQOL) in patients with type 2 diabetes mellitus. Method and design: This randomised, double-blind, placebo controlled and parallel design trial will be carried out in three public university teaching hospitals in Malaysia. Eligible type 2 diabetes mellitus subjects will be randomly assigned to receive either acupuncture (n=30) or a placebo (n=30). The intervention is carried out using acupuncture ‘press’ needle on abdomen area (10 sessions of treatment), twice a week over 6 weeks. Both groups will continue with their routine diabetes care. Primary outcome of HOMA-IR and secondary outcomes of body mass index and waist circumference will be measured at the time of recruitment (baseline) and after completion of 10 sessions (week 7) of the treatment. Additionally, secondary outcome of HRQOL will be measured at the time of recruitment (baseline), after completion of 5 sessions (week 3/4) and 10 sessions (week 7) of the treatment. Any adverse event will be recorded at every visit.Discussion: The findings of this study will provide important clinical evidence for the effect of acupuncture as adjunctive therapy on HOMA-IR, adiposity and HRQOL of type 2 diabetes mellitus. Name of the registry: US National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov). Trial registration Number: NCT04829045 Date of registration: 2 April 2021URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT04829045?cond=Type+2+diabetes%2C+acupuncture&draw=2&rank=1