Search Results (6,234)

We report a case of a 73-year-old man with minimally invasive lung adenocarcinoma, post-resection, evaluated with ¹⁸F-FDG PET/CT for suspected disease progression. Imaging showed increased FDG uptake in the right lower lung mass and systemic lymphadenopathy (mediastinal, supraclavicular, axillary, paraaortic, and iliac regions). The appearance of a stable lymph node and a clinical history of IgG4 lymphadenopathy suggested an inflammatory process, although malignancy in the lung mass and mediastinal nodes could not be excluded. Lobectomy confirmed the presence of lung adenocarcinoma, while radical lymph node dissection identified IgG4-related lymphadenopathy without metastasis. This case underscores the need for considering differential diagnosis of PET-positive lymphadenopathy, especially in patients with comorbid conditions that mimic or coexist with malignancy. Full article

Immune thrombocytopenia, formerly idiopathic thrombocytopenia purpura (ITP), is an autoimmune disease characterized by the depletion of platelets below 100,000/µL when other causes of thrombocytopenia have been ruled out. It is associated with several infectious pathologies, disease states, and as a known side effect and complication of several drugs and chemotherapies. Standard treatment calls for glucocorticoid-mediated immunosuppression, intravenous immunoglobin transfusion, platelet stimulation, platelet transfusion, and splenectomy in instances of chronic and severe disease. While standard treatments are often effective, some cases prove resistant, and more commonly, some patients are unable to tolerate standard treatment protocols or opt out of surgical intervention. In addition, second-line therapies can be unfeasibly expensive and are associated with side effects themselves. Therefore, for a subset of patients afflicted by immune thrombocytopenia, the exploration of alternative treatment methods is needed in order to ease their burden of disease. Emerging evidence suggests that plant-derived extracts, traditionally used in regions such as Asia and Africa to manage acute thrombocytopenia, hold promise as alternative or adjunctive therapies for the mentioned subset of patients. These natural compounds may provide a cost-effective and less invasive option, potentially bridging gaps in current treatment regimens. We propose these extracts may play a role in fulfilling this deficiency in current treatment protocols. With this review, we aim to characterize and compile evidence that various organic extracts and compounds may be utilized to improve outcomes in these patients. By highlighting their clinical relevance and potential for integration into ITP treatment protocols, this manuscript underscores the importance of expanding the alternative therapies for ITP to improve patient outcomes and reduce treatment burdens. Full article

Introduction: Adolescent smoking can lead to various health problems including atherosclerosis and cardiovascular disease, making it more difficult to quit smoking during adulthood. This study aims to evaluate the effect of the ordinance by assessing adolescents’ smoking cessation behaviors and environmental conditions, according to the “Ordinance for the Prevention of Child and Adolescent Smoking and Support for Smoking Cessation”, which was enacted in 2019 in Gwangju City, South Korea, for the first time in the country. Methods: The data for the analysis were obtained from the 2018 and 2021 Korea Youth Risk Behavior Survey. Propensity score matching (PSM) ensured homogeneity between ordinance-adopted and non-adopted areas, followed by a difference-in-differences (DID) analysis to assess changes in adolescent smoking behavior, secondhand smoke exposure, and related advertisements. Results: The difference-in-differences analysis of the homogeneous treatment and control groups in 2018 and 2021 showed statistically significant reductions in the variables “experience of secondhand smoke indoors at school” in the secondhand smoke category, and “exposure to smoking advertisements in convenience stores” in the smoking advertising category. However, there were no statistically significant changes in the other eight variables, such as smoking behavior and smoking cessation advertising. Conclusions: The results of this study suggest that the ordinance enacted in Gwangju Metropolitan City in 2019 created a positive environment for smoking prevention in convenience stores and schools for adolescents. Furthermore, if the ordinance is supplemented with the management of smoking behaviors and smoking cessation advertisements, it is expected to achieve the main purpose of the policy, which is to protect adolescents from smoking. Full article

Background: A Peripherally Inserted Central Catheter (PICC) is a safe and effective Central Vascular Access Device when properly used. Therefore, it has become an increasingly frequent procedure. Nurses are often the professionals responsible for its insertion, maintenance, and removal. Despite the advantages of this device, it presents risks and possible associated complications. This scoping review aims to identify and analyze nursing interventions to prevent complications in adults with PICC. Methods: The review was conducted according to Joanna Briggs Institute’s scoping review proposal. The electronic databases Pubmed, CINAHL Complete, MEDLINE Complete, Cochrane Central Register of Controlled Trials, Nursing & Allied Health Collection: Comprehensive, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Library, Information Science & Technology Abstracts, and MedicLatina were consulted in October 2023. Additionally, we searched the websites of the Registered Nurses Association of Ontario and the Canadian Vascular Access Association. We included articles published in English and Portuguese between 2018 and 2023. Results: A total of 170 articles were initially identified. After selecting and analyzing the articles, 13 studies were included. This review identified nursing interventions in adults to prevent PICC-related complications, categorized into five main groups: pre-procedure, during the procedure, post-procedure, maintenance, and team management interventions. Nurses are pivotal in averting PICC complications by employing evidence-based nursing interventions at each process stage. Conclusions: The importance of nursing interventions in enhancing patient safety, improving health outcomes, and informing clinical practice highlights the need for standardized protocols, specialized training, and consistent patient education for PICC care. Full article

Background: In the last decades, there has been a growing demand for outpatient services; understanding the factors influencing patient satisfaction is critical for improving healthcare quality. Objectives: This study evaluates patient satisfaction with nursing care and examines how satisfaction varies based on socio-demographic factors in ambulatory settings across five healthcare centers in the municipality of Vlora, Albania. Methods: In this cross-sectional study, a total of 246 patients were surveyed using the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), adapted for outpatient contexts, after assessing its validity and reliability. The mean age of the sample was 63.9 ± 13.1 years old with a range of 21 to 94 years, and 47.2% were aged between 50 and 69 years. Results: The results indicate that the overall satisfaction level was fair, with a mean PSNCQQ score of 2.55 on a five-point scale. Socio-demographic factors, such as age, gender, education, and socio-economic status, significantly impacted patient satisfaction. Younger patients (aged 20–49), females, and those with a higher education and socio-economic status reported higher satisfaction. Medical history also played a role, with patients attending general check-ups showing greater satisfaction compared to those with chronic conditions. Older patients tend to report a lower level of satisfaction with the care provided compared to younger patients. Conclusions: Communication and nurse–patient interactions emerged as key areas for improvement, particularly in outpatient settings where care is episodic. These findings suggest that personalized care, improved communication, and greater attention to socio-demographic and medical factors can enhance patient satisfaction in ambulatory care settings. Full article

Background: Diabetic foot sepsis (DFS) is the leading cause of lower extremity amputations and timely initiation of effective antimicrobial therapy is paramount during its management. This study investigated causative microorganisms and their antimicrobial susceptibility profile in patients with DFS. Materials and Methods: A retrospective review was conducted on patients who were 18-years and older admitted with DFS. Data collected included demographic information, comorbidities, clinical findings, types of specimens collected and results of microscopy, culture, and sensitivity (MC&S), treatment, and outcomes. Results: One hundred and sixty-eight records were found, of which 64.3% were of male patients. The median (IQR) age of males was 58 years (IQR 54–65) compared to 61 years (IQR 54–67) for females. Results of MC&S were available in 63.1% of the records, and E. faecalis was cultured in 16%, P. mirabilis in 10%, and S. aureus in 8% of cases. Amoxicillin/Clavulanic acid was prescribed in 69% of the cases. Resistance to at least one antimicrobial was shown in 88% of S. aureus and 80% of P. mirabilis species. Conclusions: The commonly cultured organisms in patients with DFS were E. faecalis 16%, P. mirabilis 10%, and S. aureus. Amoxicillin/Clavulanic was prescribed empirically in 69% of the cases despite high rates of resistance, and in 37% treatment was not preceded by collection of specimens for MC&S. We therefore recommend collection of specimens for MC&S before initiation of antimicrobial therapy in all patients with DFS. Full article

Objectives: This study investigated stroke survivors and the characteristics of care management after discharge from hospital to home. The study aimed to identify caregiving difficulties and to assess mastery of skills in implementing recovery activities at home. This was a cross-sectional study. Methods: As part of the study, we interviewed 205 informal caregivers caring for stroke survivors. For descriptive statistics, frequencies, mean, medians, and standard deviations were calculated. Results: Caregivers determined that the main aim was to restore motor activity in 58% (p ≤ 0.021), and the difficulties they most often encounter during caregiving are difficulties related to obtaining information from medical personnel, or not understanding the information received in people under 50 years of age, which were indicated in 47.9% of cases, while in people over 50 years of age, this indicator was 49.5%. The emotional state of the informal caregivers is closely interrelated with the state of stroke survivors. The informal caregivers with a higher education are more resistant to these changes related to the patient’s health. Conclusions: The informal caregivers in East Kazakhstan face challenges such as inadequate preparation, limited resources, and emotional strain, hindering effective care. High rates of stroke-related impairments highlight the need for better rehabilitation programs and informal caregiver support. Future research should assess intervention programs and support systems. Full article

Background/Objectives: Our research paper aims to analyse the relationship between the perceived impact on mental health due to the COVID-19 pandemic, social well-being, and psychological well-being among social work students. As we transition from the pandemic phase to an endemic phase of COVID-19, it is necessary to examine these aspects, recognizing the interdependence and complementarity of social and medical care within the healthcare system. Methods: The research was conducted nearly three years after the lockdown measures imposed by the spread of COVID-19, during a period when onsite academic activities had resumed, as they were prior to the pandemic. The sample consisted of 235 social work students from both bachelor’s and master’s programmes studying at a large university in Romania. Data was collected between December 2022 and January 2023, during a time when onsite educational activities were once again taking place. Results: Our results show that, despite the significant amount of time that had passed since the pandemic began, its negative effects were still strongly felt on a psychosocial level. Conclusions: This finding leads us to conclude that there is a long-term COVID-19 impact on mental health. Most study participants reported experiencing high (42.10%) or moderate (23%) levels of being mentally affected, which also affected their psychological and social well-being, key factors in preparing future social-medical care professionals to provide adequate integrated healthcare services. Full article

Background: Since 2023, ChatGPT-4 has been impactful across several sectors including healthcare, where it aids in medical information analysis and education. Electronic patient-reported outcomes (ePROs) play a crucial role in monitoring cancer patients’ post-treatment symptoms, enabling early interventions. However, managing the voluminous ePRO data presents significant challenges. This study assesses the feasibility of utilizing ChatGPT-4 for analyzing side effect data from ePROs. Methods: Thirty cancer patients were consecutively collected via a web-based ePRO platform, reporting side effects over 4 weeks. ChatGPT-4, simulating oncologists, dietitians, and nurses, analyzed this data and offered improvement suggestions, which were then reviewed by professionals in those fields. Results: Two oncologists, two dieticians, and two nurses evaluated the AI’s performance across roles with 540 reviews. ChatGPT-4 excelled in data accuracy and completeness and was noted for its empathy and support, enhancing communication and reducing caregiver stress. It was potentially effective as a dietician. Discussion: This study offers preliminary insights into the feasibility of integrating AI tools like ChatGPT-4 into ePRO cancer care, highlighting its potential to reduce healthcare provider workload. Key directions for future research include enhancing AI’s capabilities in cancer care knowledge validation, emotional support, improving doctor-patient communication, increasing patient health literacy, and minimizing errors in AI-driven clinical processes. As technology advances, AI holds promise for playing a more significant role in ePRO cancer care and supporting shared decision-making between clinicians and patients. Full article

The misuse of personalized listening devices (PLDs) resulting in noise-induced hearing loss (NIHL) has become a public health concern, especially among youths, including medical students. The occupational use of PLDs that produce high-intensity sounds amplifies the danger of cochlear deterioration and high-frequency NIHL especially when used in noisy environments. This study aims to evaluate the incidence and trends of NIHL among medical students using PLDs. Background/Objectives: The purpose of this study is to assess the prevalence of high-frequency NIHL among PLD-using medical students. Methods: A semi-structured questionnaire covering details on PLD usage, exposure to noisy environments, and hearing difficulties was used to gather the data required. Conventional pure-tone audiometry with extended high-frequency audiometry was preceded by routine clinical evaluation using tuning fork tests and otoscopic examination for hearing loss assessment and to rule out middle-ear pathology. Hearing impairment was determined and categorized according to the Goodman and Clark classification system (250 Hz to 8000 kHz). SPSS version 21 was used in the analysis of the frequency data collected. Results: Out of 100 participants, using conventional PTA, 33% were found to have hearing loss, with 42.9% of males and 23.5% of females affected. Bilateral hearing loss was seen in 36.4% of the cases. Left-sided hearing loss was found to be more common (28%). The duration of usage of PLD had a significant correlation with hearing loss with a p-value < 0.0001. Hearing thresholds were significantly elevated at 16 kHz and 18 kHz in both the right and left ear. Conclusions: The high prevalence of PLD misuse among medical students is a major risk factor for NIHL. To help combat chronic hearing loss, students need to be educated about safe listening levels that can prevent further damage to the cochlea and auditory system. Full article

Critical information is frequently lost when individuals with intellectual/developmental disabilities (I/DD) and co-occurring communication challenges transition from one educational/clinical setting to another. To encourage a seamless transition, speech–language pathologists (SLPs) developed This is Me (TiME), a customizable, digital transition tool designed to help students/patients share personal information and advocate for needed support in their new settings. Researchers conducted a content analysis of 92 TiME transcripts to determine how SLPs used the tool across school and inpatient contexts. Findings indicate the most common content domains included in TiME were personal information (e.g., strengths, hobbies, and preferences) and information about communication, learning styles, and behavior/emotion regulation. While school and inpatient units demonstrated similar patterns of domain use, TiME created in an inpatient context contained more information about behavior plans/supports and were almost twice as long on average. They also included more information about safety and diagnoses/medical needs and less information about self-advocacy strategies than TiME created in school contexts, reflecting the very different settings within which they were created. These findings suggest that TiME offers a solution that can readily be adapted to meet the needs of varied groups of individuals with disabilities as well as different audiences. Full article

High-risk Human Papillomavirus (HPV) is a sexually transmissible virus that causes cancer. Vaccination against HPV is available up to age 45. Gay and bisexual men (GBM) are at high risk for oropharyngeal and anal cancers caused by HPV. As part of a larger study of HPV prevention in GBM, we obtained anal swabs for HPV and offered HPV vaccination to GBM in Dar es Salaam, Tanzania. Participants were recruited by an outreach worker experienced with the GBM subculture using Respondent-Driven Sampling (RDS) from seeds. Eighty-three of a possible one hundred participants (mean age 26) were enrolled, tested, and given a first vaccination dose. Anal swabs were tested for twenty-eight HPV genotypes, both high and low risk for carcinogenicity, and a median of seven different HPV genotypes was found in participants. A total of 87% of participants carried at least one HPV genotype, and 76% carried at least one high-risk genotype. As a result of harassment and unanticipated risk to participants and staff at the unmarked community-based site, this study was terminated before the sample size was reached. Since a full course of vaccine was the standard of care, participants were contacted using the contact method they had provided to arrange follow-up vaccination doses at an alternative clinical site. Twenty-nine percent received the additional vaccination. A further 6% made appointments but did not attend, and another 10% would have received the second vaccination if they were incentivized to attend. The rate of HPV in anal samples was significantly higher than in our study using the same recruitment method in the same city in 2011–2012. The HIV rate was 45%. Anal HPV rates, including high-risk HPV rates, were significantly higher than in a similar population of gay and bisexual men 12 years ago. It is possible to provide HPV vaccination to gay and bisexual men in Tanzania and have approximately 45% potentially re-attend for a second dose if they are incentivized. Great care must be used to situate vaccination to avoid stigma leading to harassment, especially where homosexuality is criminalized. We infer that the high-risk harassment faced by participants and lack of incentive for the second visit depressed the return rate for revaccination. Full article

Starting from the metabolic profile of type 2 diabetes mellitus (T2DM), we hypothesized that the mechanisms of ¹³¹I-induced cardiotoxicity differ between patients diagnosed with differentiated thyroid cancer (DTC) with/without T2DM, with metformin potentially acting as a cardioprotective agent by mitigating inflammation in patients with T2DM. To address this hypothesis, we quantified, using ELISA, the serum concentration of several key biomarkers that reflect cardiac injury (NT-proBNP, NT-proANP, ST2/IL-33R, and cTn I) in 74 female patients with DTC/−T2DM and 25 with DTC/+T2DM treated with metformin. All patients received a cumulative oral dose of ¹³¹I exceeding 150 mCi (5.55 GBq) over approximately 53 months. Our results showed the following: (i) In DTC/−T2DM patients, high-cumulative ¹³¹I doses promote a pro-inflammatory state that accelerates the development of cardiotoxicity. Monitoring NT-proBNP, ST2/IL-33R, and cTn I in these patients may help identify those at risk of developing cardiac complications. (ii) In patients with DTC/+T2DM, high-cumulative ¹³¹I doses lead to the release of NT-proANP (r = 0.63), which signals that the atria are under significant stress. (iii) In patients with DTC/+T2DM, metformin suppresses inflammation, leading to a dose-dependent reduction in cTn I (r = −0.59). Monitoring cTn I and NT-proANP, and considering the use of metformin as part of the therapeutic strategy, could help manage cardiotoxicity in T2DM patients undergoing ¹³¹I therapy. Full article

Background: Understanding why Arab American women have lower adherence to cervical cancer screening compared to other racial/ethnic groups is important. The study aimed to understand attitudes and knowledge of cervical cancer prevention and HPV vaccination among Arab American women. Methods: A mixed-method approach was employed, including nine focus groups and an online questionnaire. Demographic characteristics, medical history, screening practices, and attitudes towards HPV vaccination and HPV self-sampling for cervical cancer screening were assessed. Results: Focus group participants (n = 22) demonstrated varying levels of knowledge about cervical cancer and HPV, including limited awareness of the Papanicolaou (Pap) test. Participants expressed mixed feelings about HPV self-sampling. Among questionnaire respondents (n = 25), who on average had a higher socioeconomic status than focus group participants, 73.9% had undergone a Pap test, with 94% up to date on screening. While 59% preferred self-sampling at home, almost two in five cited concerns about sample accuracy. Conclusions: Our study demonstrates the variability in attitudes and experiences towards cervical cancer screening among Arab American women, potentially driven by socioeconomic disparities. Our qualitative results suggest the need for targeted, culturally tailored health education in the Arab American community. Further research should explore effective strategies to engage this underserved group and enhance adherence to prevention programs. Full article

Background/Objectives: Schizophrenia is a chronic psychiatric disorder usually managed with antipsychotics, which can cause adverse drug reactions (ADRs) that may impact patients’ attitudes toward their treatment, as well as treatment adherence. This study aimed to assess the influence of ADRs and other factors on treatment attitudes among female patients with schizophrenia. Methods: A cross-sectional study was conducted at the Vrapče Psychiatry Clinic with 109 female schizophrenia patients. The DAI-10 (Drug Attitude Inventory) questionnaire was used to assess attitudes toward treatment. Data on their demographic details, pharmacotherapy, ADR occurrence and ADR reporting rates were collected. Multiple regression analyses were used to identify predictors of DAI-10 scores. Results: Patients using more medications and those experiencing ADRs had lower DAI-10 scores, indicating less favorable attitudes (F (2, 106) = 7.364, p = 0.001, R² = 0.105). ADRs, primarily extrapyramidal symptoms and weight gain, were reported by 43.1% of patients; however, only one patient formally reported them. First-generation antipsychotics were associated with a higher prevalence of ADRs (χ² = 4.969, df = 1, p = 0.022). Conclusion: Negative experiences with ADRs significantly impact patients’ attitudes and adherence. Low ADR reporting rates highlight the need for better pharmacovigilance education. Enhancing patient awareness may foster more positive attitudes and adherence, potentially improving patient outcomes. Full article