Frontiers in Medicine

As the worldwide vaccination, it is imperative to minimize vaccine wastage by effectively using all doses available. Vaccine wastage can occur at multiple points during the vaccination process, but it is mainly because the device dead space and the filling process technique. However, there are no studies discussing the waste volume effect of COVID-19 vaccines in clinical practice. There is an increasing COVID-19 vaccine demand that we estimate up to several billion dual doses. The objective of this study was to assess the number of 0.3mL doses obtained from a multiple-dose vial using 1ml and 3ml syringes with different type of needles replicating the first COVID-19 vaccination protocol. Our results suggest that it is possible to obtain six or seven doses from each vial instead five. We provide evidence to optimize between 20% and 40% additional vaccine doses per vial if the current 5-dose vials are used, making scarce supplies go further. It is our duty, as researchers, to ensure the efficacy and efficiency of the worldwide COVID-19 vaccination process. However, if standard syringes-needles and technique are used, there may not be sufficient volume to draw extra doses from a single vial.

IntroductionHealthcare-associated infections (HAIs) and antimicrobial resistance (AMR) are critical global challenges. Antimicrobial Stewardship Programs (ASPs) aim to optimize antibiotic use and reduce resistance. This study evaluates carbapenem stewardship compliance in open-heart surgery patients at Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran, emphasizing improved infection control and antibiotic management. MethodologyThis descriptive, cross-sectional study assessed carbapenem antibiotic use compliance with national guidelines in open-heart surgery patients at Shaheed Rajaie Cardiovascular Medical Center, Tehran. Seventy patients were selected, and data on demographics, clinical factors, microbiology, and antibiotic use were analyzed using SPSS 26 to evaluate compliance rates and prescribing factors. ResultsThis study analyzed data from 70 patients undergoing open-heart surgery at a cardiovascular hospital in Tehran. The cohort had an equal gender distribution and a mean age of 59.15 years (SD: 12.0). Of the procedures, 51.43% were elective, while 48.57% were emergencies. The most common surgeries included CABG (45.71%) and valvular procedures (30%). Meropenem was the most prescribed antibiotic (92.9%), with prophylactic use noted in 78.57% intraoperatively. Positive cultures identified Candida albicans (32.7%), Klebsiella pneumoniae (29.8%), and Staphylococcus aureus (22.6%) as predominant pathogens. Serum creatinine levels exceeded the normal range in 55.7% of patients, necessitating dosage adjustments. Antibiotic side effects led to treatment discontinuation in 15.7% of cases. ConclusionThis study highlights a high level of rational carbapenem use in a specialized cardiac surgery ICU, with prescribing guided by infectious disease consultations and adherence to guidelines. Implementing antibiotic stewardship programs can further optimize carbapenem use, reduce antibiotic resistance, and improve treatment outcomes, emphasizing the importance of individualized infection management and monitoring in cardiac surgery patients.

Applying monoclonal antibodies against Covid-19 is a promising treatment option for avoiding severe outcomes. However, real life data, especially in regional hospitals are still scarce. We here report on our first results with this therapy in a retrospective, observational study. Indeed, compared to a risk-factor matched reference group, hospitalisation time was reduced but survival rate and kinetics of SARS-CoV-2 RT-PCR results remained apparently unaffected.

PurposeHospital-acquired pressure injuries (HAPIs) increase the medical burden of patients in the cardiovascular intensive care unit (CCU). Thus, identification of CCU patients with a risk for HAPIs is important. To establish a nomogram model for predicting the occurrence of HAPIs in patients in the CCU. MethodsThis was a retrospective cohort study in patients in the CCU at our hospital who developed HAPIs between January 2023 and June 2023. Patient data were extracted from the hospitals information management system. Risk factors for HAPIs were identified using univariate and multivariate logistic regression analyses and the screened indicators were integrated into a nomogram. The effectiveness of the nomogram was evaluated and verified using receiver operating characteristic curve and decision curve analysis (DCA). ResultsIn this study, a total of 161 patients were enrolled. Univariate logistic regression analysis showed that vasopressor use (OR=2.51, 95%CI=1.24-5.09, p=.010) and NT-proBNP (OR=2.92, 95%CI=1.45-5.92, p=.003), lactic acid (OR=9.43, 95%CI=4.15-21.41, p <.000), procalcitonin (OR=1.37, 95%CI=1.07-1.75, p=.012), D-dimer (OR=1.16, 95%CI=1.05-1.28, p= .004), and albumin (OR=0.88, 95%CI=0.81-0.95, p=.002) levels were independent risk factors for HAPIs. Multivariate logistic regression analysis showed that vasopressor use (OR=3.05, 95%CI=1.20-7.73, p=.019) and lactic acid (OR=12.05, 95%Cl=4.13-35.21, p <.000), procalcitonin (OR=1.30, 95%Cl=1.01-1.69, p=.043) and albumin (OR=0.82, 95%Cl=0.73-0.93, p=.002) levels were independent risk factors for HAPIs. The nomogram was well-calibrated and showed good discriminative ability (AUC=.87). The DCA showed a better net benefit, and the results were confirmed within the validation cohort. ConclusionThe nomogram model developed in this study showed good predictability and can identify patients at risk of developing HAPIs and aid the formulation of targeted interventions.

BackgroundPreventing Stage 1 pressure injuries (PIs) from worsening in the ICU is a key clinical challenge. Early prediction of high-risk patients enables targeted prevention. We aimed to develop a model for this progression using admission data. MethodsIn this retrospective cohort study, eligible ICU patients with Stage 1 pressure injuries were randomly allocated into training (70%) and validation (30%) sets. Predictors were selected using LASSO regression. A multivariable logistic regression model was constructed and visualized as a nomogram. Model performance was evaluated by discrimination (AUC), calibration, and clinical utility (decision curve analysis). ResultsA total of 278 patients were randomly divided into training (n=195) and validation (n=83) sets. LASSO regression identified four independent predictors: diabetes (OR: 3.266; 95% CI: 1.451-7.352), maximum norepinephrine dose (OR: 13.032; 95% CI: 1.212-140.137), use of pneumatic compression pumps (OR: 3.308; 95% CI: 1.444-7.579), and albumin level at ICU admission (OR: 0.836 per unit increase; 95% CI: 0.777-0.900). The nomogram demonstrated excellent discrimination, with an AUC of 0.810 (95% CI: 0.748-0.872) in the training set and 0.805 (95% CI: 0.696-0.914) in the validation set. Good calibration and clinical utility were confirmed. ConclusionsA nomogram incorporating four readily available factors at ICU admission effectively predicts the risk of Stage 1 PI progression. This tool may aid early risk stratification and guide precise preventive measures.

PurposeAlthough prostate cancer is the most common cancer in men in Western countries, there is significant variability in geographical incidence. This might result from genetic factors, discrepancies in screening policies or differences in lifestyle. Gut microbiota has been recently associated with cancer progression, but its role in prostate cancer is unclear. MethodsIn a prospective multicenter clinical trial (NCT02241122), the gut microbiota profiles of 181 men with a clinical suspicion of prostate cancer were assessed utilizing 16S rRNA gene sequencing. Sequences were assigned to operational taxonomic units, and differential abundance analysis, - and {beta}-diversities, and predictive functional (PICRUSt) analyses were performed. Additionally, plasma steroid hormone levels were correlated with the predicted microbiota functions. ResultsSeveral differences in the gut microbiota between the subjects with and without prostate cancer were noted. Prevotella 9, members of the Erysipelotrichaceae family and Escherichia-Shigella were higher, and Jonquetella, Moryella, Anaeroglobus, Corynebacterium and CAG-352 were lower in the cancer group. Predictive functional analyses revealed higher 5--reductase, copper absorption, and retinal metabolism in the prostate cancer associated microbiome. Plasma testosterone associated negatively with the microbial 5--reductase activity (p=0.030). In a subgroup of men taking 5--reductase inhibitors (n=17), plasma estrone (p=0.027) and estradiol (p=0.059) levels were lower in men with predicted elevation of the microbial 5--reductase function. ConclusionsGut microbiota of the prostate cancer patients differed significantly compared to benign subjects. Microbial 5--reductase, copper absorption and retinol metabolism are potential mechanisms of action. These findings could explain the observed association of lifestyle, geography, and prostate cancer incidence.

BackgroundAs increasing cases of COVID-19 around world, urgent need for effective COVID-19-specific therapeutic drugs is necessary; therefore, we conducted a pilot randomized-controlled study to evaluate the efficacy of 99mTc-MDP for COVID-19 therapeutic treatment. MethodsA total of 21 mild patients with COVID-19 were enrolled in this pilot RCT from February 2020 through March 2020, and then were assigned, in a 1:1 ratio, into control (11 patients) and 99mTc-MDP group (10 patients). Patients in the control group received routine treatment and patients assigned to the 99mTc-MDP group received a combination of routine treatment and an administration of 99mTc-MDP injection of 5ml/day. Both of the patients in the control and 99mTc-MDP groups were treated for 7 days with the primary end point of CT-based radiological pulmonary changes during 7-day follow-up. FindingsFrom baseline to the day 7, 8 (80%) of 10 mild patients in the 99mTc-MDP group had a significant radiological improvement in lung and a decline in inflammatory infiltration, whereas only 1 (9.1%) of 11 patients in the control group had a radiological improvement in lung. None of the patients in the 99mTc-MDP group had disease progression from mild to severe, as well as an inflammatory cytokine storm, and 2 mild patients (18.2%) in the control group developed severe. During days 7 through 14, the number of patients with radiological improvement in the 99mTc-MDP group remained consistent, and only 1 additional case (22%) in the control group were reported. ConclusionIn this randomized pilot study, 99mTc-MDP had an effective inhibitory effect on the inflammatory disease progression for the therapy of COVID-19, and it can accelerate the absorption of pulmonary inflammation in a short period of time during the process of treatment.

BackgroundUnderstanding humoral responses and seroprevalence in SARS-CoV-2 infection is essential for guiding vaccination strategies in both infected and uninfected individuals. MethodsWe determine the kinetics of IgM against the nucleocapsid (N) and IgG against the spike (S) and N proteins of SARS-CoV-2 in a cohort of 860 health professionals (healthy and infected) in northern Barcelona. We model the kinetics of IgG and IgM at nine time points over 13.5 months from infection, using non-linear mixed models by sex and clinical disease severity. ResultsOf the 781 participants who were followed up, 478 (61.2%) became infected with SARS-CoV-2. Significant differences were found for the three antibodies by disease severity and sex. At day 270 after diagnosis, median IgM(N) levels were already below the positivity threshold in patients with asymptomatic and mild-moderate disease, while IgG(N, S) levels remained positive to days 360 and 270, respectively. Kinetic modelling showed a general rise in both IgM(N) and IgG(N) levels up to day 30, followed by a decay whose rate depended on disease severity. IgG(S) levels increased at day 15 and remained relatively constant over time. ConclusionsWe describe kinetic models of IgM(N) and IgG(N, S) SARS-CoV-2 antibodies at 13.5 months from infection and disease spectrum. Our analyses delineate differences in the kinetics of IgM and IgG over a year and differences in the levels of IgM and IgG as early as 15 days from symptoms onset in severe cases. These results can inform public health policies around vaccination criteria. Funded by the regional Ministry of Health of the Generalitat de Catalunya (Call COVID19-PoC SLT16_04; NCT04885478)

PurposeThe aim of the present study was to assess whether SARS-CoV-2 can be detected in the expressed prostatic secretion (EPS) of patients with corona virus disease 2019 (COVID-19). Methods18 cases of COVID-19, and 5 suspected cases, were selected from three medical centers to detect the RNA expression of SARS-CoV-2 in their EPS with RT-PCR. ResultsResults were negative in all EPS samples for SARS-CoV-2 of suspected and confirmed patients. ConclusionsNo SARS-CoV-2 was expressed in EPS of patients with COVID-19.

IntroductionRheumatoid arthritis (RA) is an auto-immune disease which causes irreversible damage to tissue and cartilage within synovial joints. Rapid diagnosis and treatment with disease-modifying therapies is essential to reduce inflammation and prevent joint destruction. RA is a heterogeneous disease, and many patients do not respond to front-line therapies, requiring escalation of treatment onto biologics, of which TNF inhibitors (TNF-i) are the most common. Objectives/MethodsIn this study we determined whether serum metabolomics, using nuclear magnetic resonance (NMR) and Fourier transform infrared (FTIR) spectroscopy, could discriminate RA blood sera from healthy human controls and whether serum metabolomics could be used to predict response or non-response to TNF inhibitor (TNF-i) therapy. ResultsNMR spectroscopy identified 35 metabolites in RA sera, with acetic acid being significantly lower in RA sera compared to healthy controls (HC, FDR<0.05). PLS-DA modelling identified 2-hydroxyisovalericacetic acid, acetoacetic acid, mobile lipids, alanine and leucine as important metabolites for discrimination of RA and HC sera by 1H NMR spectroscopy (averaged 83.1% balanced accuracy, VIP score >1). FTIR spectroscopy identified a significant difference between RA and HC sera in the 1000-1200 cm-1 spectral area, representing the mixed region of carbohydrates and nucleic acids (FDR<0.05). Sera from RA patients who responded to TNF-i were significantly different from TNF-i non-responder sera in the 1600-1700 cm-1 region (FDR<0.05). ConclusionWe propose that NMR and FTIR serum metabolomics could be used as a diagnostic tool alongside current clinical parameters to diagnose RA and to predict whether someone with severe RA will respond to TNF-i.

IntroductionDespite an increasing number of studies, there is as yet no efficient antiviral treatment developed for the disease. In this clinical trial, we examined the efficacy of a novel herbal antiviral preparation comprising Zataria multiflora Boiss, Glycyrrhiza glabra, Cinnamomum Vermont, Allium sativuml, and Syzygium aromaticum in critically ill patients with COVID-19 patients. MethodsA total number of 120 ICU-admitted patients requiring pulmonary support with a diagnosis of COVID-19 pneumonia were recruited to the trial. Participants were equally randomized to receive either the novel antiviral preparation sublingually, for up to two consecutive weeks or till discharge, or normal saline as the matching placebo. Clinical and laboratory parameters as well as survival rates were compared between the two groups at the study end. ResultsThe cumulative incidence of death throughout the study period was 8.33% in the medication group and 60% in the placebo group (risk ratio: 0.14; 95% confidence interval [CI], 0.05 to 0.32; P<0.001). Survival rates were significantly higher in the treatment group. Additionally, on day 7, several laboratory factors including white blood cells (WBCs) count, C-reactive protein (CRP), and SpO2 were improved in patients treated with the novel antiviral preparation compared with the placebo group. ConclusionThe novel antiviral preparation tested in this trial significantly improved the survival rate and reduced mortality in critically ill patients with COVID-19. Thus, this preparation might be suggested as a potentially promising COVID-19 treatment. Funded by Shimi Teb Salamat Co., Shiraz, Iran, and registered on the Iranian registry of clinical trials (registration No. IRCT20200509047373N2).

BackgroundResearch interest in the topic of complementary interventions to treat menstrual pain is increasing. In future research, researchers need information about trends and new things on complementary interventions to treat menstrual pain. PurposeThe research aims to determine trends in the number of publications, journals with the highest number of publications, which fields receive the most publication permits, network visualization, overlay visualization, and density visualization on complementary topics related to intervention dealing with menstrual pain. MethodsA search for publications on trends in complementary interventions to treat primary menstrual pain in adolescents resulted in 23,935 articles, four grants, 2,427 patents, and 42 clinical trials. After filtering through specified criteria, the number of articles obtained was 3,214, 249 patents, and 19 clinical trials. ResultsA search for publications on trends in complementary interventions to treat primary menstrual pain in adolescents resulted in 23,935 articles, four grants, 2,427 patents, and 42 clinical trials. After filtering through criteria such as publication year, research categories, publication type, published between 2018-2023, focus in the field of Health sciences, nursing, public health, clinical sciences, and article publication type were included as inclusion criteria of this study. The study obtained 3,214 articles, 249 patents, and 19 clinical trials. The peak of publications regarding trends in complementary interventions to treat primary menstrual pain in adolescents occurred in 2018. Meanwhile, the lowest number was in 2023. Research on complementary intervention trends to overcome primary menstrual pain in adolescents is in medicine, public health, nursing, and other fields such as trade management, tourism and services, human society, law, and legal studies. In addition, there is currently a trend for complementary therapy interventions to treat menstrual pain. Complementary therapies that are still rarely researched are progressive muscle relaxation therapy or herbal ginger to ease menstrual pain. Apart from that, progressive muscle relaxation therapy can also be used to treat anxiety in teenagers who experience menstrual pain, or the ginger herb has rarely been researched to treat menstrual pain. ConclusionTrends regarding complementary therapy interventions to treat menstrual pain need a review to find relevant alternative interventions for adolescent development and current digital developments. It is suggested that the next researcher choose a low visualization category theme to look for novelties in further research, one of which is ginger herbal therapy to overcome menstrual pain or interventions to overcome adolescent anxiety when experiencing menstrual pain.

BackgroundUrinary tract infections are among the adverse outcomes of urinary catheter placement. After the installation of a catheter, urinary tract infections happen more often than twice a day. Examining prevention strategies for UTIs in critical care units is the aim of this writing audit. MethodUse ProQuest, Scopus, and ScienceDirect to look up review literature. Urinary tract infections, prevention and management, and intensive care unit were the search terms used to find publications. Search parameters for full-text, open-access, English-language papers published between 2019 and 2023. ResultsThe studys findings indicate that adherence to patient information recording, installation and maintenance procedures, guidelines for the detection and prevention of CAUTI, staff education and good nursing practices, and the application of CAUTI prevention can all help lower the incidence of urinary tract infections. ConclusionHealthcare facilities need to have a program in place to avoid urinary tract infections brought on by catheter installation, as well as the best care possible for patients who use them. In order to solve the problem, all interdisciplinary teams must collaborate and analyze the issue using the PDSA methodology.

Recently, stroke is a new trend among the young age group in the range of 15-45 years. One of the main complications of this disease is s physical disability, but it also causes communication disorders, emotional disturbances, pain, sleep disturbances, depression, and dysphagia. All of these signs have a major impact on the productivity of the young age group. This article aims to review literatures related to the factors that influence the incidence of stroke at a young age. This study uses a literature study design from 6 databases, namely: Science Direct, ProQuest, Wiley, Sage Pub and Pubmed research. The search used various keyword combinations with the help of Boolean operators, including: "Young Stroke" OR "Young Adults" AND "Risk Factor" OR "Factor", combined as MESH terms and keywords, and assessment of article quality using the JBI Cohort Studies Cross-Sectional Studies Cohort studies and Case-Control Studies. There were 19 selected articles were analyzed by adjusting the inclusion criteria, namely articles published in the last year, full text accessible, young stroke patient respondents, and discuss the factors that influence the incidence of stroke at a young age. Based on the results of the review, there are several factors that influence the occurance of stroke at a young age including physical factors with a percentage of 85%, lifestyle factors with a percentage of 55%, psychological factors with a percentage of 15%, sex factors with a percentage of 10% and age factors. as much as 5%. Implications in clinical practice include providing psychoeducation as a preventive measure to reduce the incidence of stroke at a young age.

BackgroundProstate cancer is one of the most common malignant tumors and poses a substantial threat to human health. PSA or enhanced MRI is widely used in prostate cancer screening or diagnosis. However, false-positive results of PSA or enhanced MRI will lead to unnecessary puncture biopsy, and patients will have to bear the adverse consequences of mental pain, expensive examination costs, and examination injuries; whereas false-negative results of PSA or enhanced MRI will lead to delayed treatment, and patients will have to bear the adverse consequences of poor prognosis, expensive treatment costs, poor quality of life, and short survival period. There is an urgent need to find convenient, economical and non-invasive diagnostic methods to reduce the PSA or enhanced MRI false-negative and false-positive rates. The aim of this study was to evaluate the diagnostic value of YiDiXie-SS and YiDiXie-HS in prostate cancer. Patients and methodsThe study finally included 464 subjects with positive PSA test (prostate cancer group, n=292; BPH group, n=172). Remaining serum samples from the subjects were collected and tested with YiDiXie all-cancer detection kit. The sensitivity and specificity of YiDiXie-SS and YiDiXie-HS were evaluated respectively. ResultsThe sensitivity of YiDiXie-SS was 100% (95% CI: 98.7% - 100%; 292/292) and its specificity was 60.5% (95% CI: 53.0% - 67.5%; 104/172). As shown in Table 3, the sensitivity of YiDiXie-HS was 93.8% (95% CI: 90.5% - 96.1%; 274/292) and its specificity was 86.0% (95% CI: 80.1% - 90.4%; 148/172). The sensitivity of YiDiXie-SS in PSA-positive patients was 100% (95% CI: 98.6% - 100%; 279/279), and the specificity was 58.0% (95% CI: 49.8% - 65.2%; 90/ 156). This means that the application of YiDiXie-SS reduces the PSA false-positive rate by 58.0% (95% CI: 49.8% - 65.2%; 90/156) with essentially no increase in malignancy leakage. The sensitivity of YiDiXie-HS in PSA-negative patients was 92.3% (95% CI: 66.7% - 99.6%; 12/13), and the specificity was 81.3% (95% CI: 57.0% - 93.4%; 13/ 16). This means that the application of YiDiXie-HS reduced the PSA false negative rate by 92.3% (95% CI: 66.7% - 99.6%; 12/13). YiDiXie-SS had a sensitivity of 100% (95% CI: 97.6% - 100%; 159/159) and a specificity of 59.6% (95% CI: 49.5% - 68.9%; 56/94) in enhanced MRI-positive patients. This means that the application of YiDiXie-SS reduces the false-positive rate of enhanced MRI by 59.6% (95% CI: 49.5% - 68.9%; 56/94) with essentially no increase in malignancy leakage. the sensitivity of YiDiXie-HS in enhanced MRI-negative patients was 90.2% (95% CI: 79.0% - 95.7%; 46/51), and the specificity was 83.3% (95% CI: 55.2% - 97.0%; 10/12). This means that the application of YiDiXie-HS reduced the false negative rate of enhanced MRI by 90.2% (95% CI: 79.0% - 95.7%; 46/51). O_TBL View this table: org.highwire.dtl.DTLVardef@11a3a26org.highwire.dtl.DTLVardef@dfb213org.highwire.dtl.DTLVardef@24332forg.highwire.dtl.DTLVardef@9c6e6eorg.highwire.dtl.DTLVardef@15f918_HPS_FORMAT_FIGEXP M_TBL O_FLOATNOTable 3.C_FLOATNO O_TABLECAPTIONThe performance of YiDiXie-HS C_TABLECAPTION C_TBL ConclusionYiDiXie-SS significantly reduces the false-positive rate of PSA or enhanced MRI-positive patients without increasing the number of under-diagnosed malignant tumors. YiDiXie-HS significantly reduces the false-negative rate of PSA or enhanced MRI-negative patients. YiDiXie-SS and YiDiXie-HS can play an important role in prostate cancer, and are expected to solve the problem of "high false-positive rate of PSA or enhanced MRI" and "high false-negative rate of PSA or enhanced MRI". Clinical trial numberChiCTR2200066840.

BackgroundThe efficacy of spiritual support for cancer patients is crucial in the course of treatment. As a result, it is crucial to consider the mentoring techniques employed. The purpose of this review of the literature is to methodically look at worldwide research from the previous ten years that has been published in English-language journals from different nations that relates to the usefulness of spiritual support for cancer patients to improve quality of life MethodThe method used in this literature review is by database search strategy: data search using a systematic and comprehensive electronic database from several indexing and hand searching. The following indexes were searched for research data: Scopus, CINAHL, PubMed, and Proquest. By utilizing the search terms "OR" spirituality accompanying "AND" quality of life, spirituality support. The eligibility requirements established by the PICO model (Population, Intervention, Comparison/controls, Outcome) were taken into consideration when conducting the article search. Population: cancer patients, Intervention: Spiritual support, Comparison: Intervention provided, Outcome: Improved quality of life. The process of selecting and extracting data involves stating the problem to be studied, pertinent groups, intervention to be provided, and results to be measured. The author then goes on to clarify the selection and analysis process by outlining the specific inclusion and exclusion criteria as follows: The inclusion criteria for the articles reviewed were: the article had to be a full paper, the research subjects were cancer patients, the intervention carried out was spiritual assistance with a comparison of cancer patients without usual care spiritual assistance. An improvement in cancer patients quality of life is the searchs result. The exclusion criteria for articles reviewed are: articles other than English, research articles before 2017 and articles that are not free access Result11 articles were examined. Focuses on providing spiritual support to cancer sufferers, including how to do it and the results. Spiritual support provided through a variety of techniques, including mindfulness, meditation, music therapy, and telephone counseling, encourages patients to be more passionate about their treatments and enhances their quality of life. The patient is religious preferences should be taken into consideration when providing care. ConclusionSpiritual support has a positive impact on a cancer patient is quality of life by giving them a sense of calm and desire to keep going through the treatment and their daily lives. Through improving coping mechanisms, bringing patients closer to something transcendent (God), and providing a sense of comfort for cancer patients going through chemotherapy, spiritual assistance techniques like mindfulness, listening to music, and counseling can help patients improve their quality of life.

IntroductionQuality of life is the ultimate outcome for a patient who has undergone myocardial revascularization. Among several influencing factors, adherence to drug regimen enhances its level by preventing restenosis of stent or graft and restricting the progress of native CAD. Nurses role is to assist patient with myocardial revascularization for maintaining high quality of life by exploring the associated issues in a greater extent. ObjectivesThe objectives of the study were to assess the level of adherence to drug regimen, to explore potential factors of adherence to drug regimen and to assess quality of life among patients who have undergone myocardial revascularization. MethodologyA quantitative research approach and prospective longitudinal cohort study design was adopted to collect data from three hundred and fifty (355) patients who have undergone either PTCA or CABG, selected by nonprobability convenience sampling technique. ARMS, SF-36 short form and an interview schedule were used to collect data from the subject at three months interval till nine (9) months after revascularisation. ResultThe study result shows that majority (82%) of the patients with myocardial revascularisation were adherent to drug regimen at initial month after revascularisation but reduced to 52% after nine months(p<0.01). The percentage of adherence with medication was significantly reduced to 74% after 3 months, 75% after 6 months, and 59 % after 9 months among patients with CABG whereas percentage of adherence among patient with PTCA was also reduced to 66% after 3 months, 63% after 6 months and 44 % after 9 months (p<0.01) Age and educational status were independent predictive factors for adherence to drug regimen among patient with PTCA. The potential associated factors related to adherence to drug regimen was no of drugs unavailable at Govt. medicine counter. The two main domains, of quality of life as Physical component summary and Mental component summary of patient with myocardial revascularisation were improved from one month to 9 months after intervention (p<0.001) Physical component summary of Quality of life had a negative relationship with adherence to drug regimen at 3 months, 6 months and 9 months time period whereas mental component summary of Quality of life had a significant negative relationship with adherence to drug regimen at 6 months time period. ConclusionAdherence to drug regimen was decreased over time but Quality of life was improved among patients with myocardial revascularisation. There was a positive relationship with adherence to drug regimen with PCS domain of quality of life among patients with myocardial revascularisation. Age and educational status were independent predictive or potential factors for adherence to drug regimen among patient with PTCA.

BackgroundControlling blood pressure in hypertensive patients is one of the most important interventions in preventing complications, reducing morbidity, and premature mortality. Patients must practice hypertension self-care to prevent the diseases frequent recurrence from deteriorating their health and to maintain effective behavior. ObjectiveAnalyze the factors that influence the implementation of self-care in hypertensive patients. MethodCross-sectional using the purposive sampling technique involving 120 respondents. The study was conducted in the working area of the Gianyar 1 Health Center, Bali, Indonesia. Data collection utilized the Indonesian version of the High Blood Pressure self-care profile questionnaire. Analysis included univariate, bivariate using chi-square, and multivariate using multinomial logistic regression. ResultsA long history of suffering from hypertension has an effect on behavior; education has an effect on motivation; and education and work have an effect on self-efficacy. ConclusionThe article emphasizes the importance of holistic treatments in managing high blood pressure, with a focus on patient engagement to improve taking care of themselves with focused education and support systems. The outcomes align with the axiological dimension of philosophy by highlighting practical values that enhance patients autonomy and quality of life through education and supportive systems. Further, the research makes an empirical contribution by providing a comprehensive knowledge of self-care characteristics, which can be used to develop culturally appropriate and patient-focused intervention techniques.

BackgroundIntralesional corticosteroid injections (ILCS) are a common treatment for keloid lesions; however, many patients exhibit resistance, and some experience worsening of their keloids following treatment. ObjectiveTo develop a machine learning (ML) tool capable of identifying factors that predict response to ILCS. MethodsA keloid-specific survey database was accessed in May 2024. Various clinical and demographic factors were analyzed for correlation with self-reported responses to ILCS among 940 patients. Multiple ML models, including Neural Networks (NN) and Random Forest (RF), were trained on a subset of the survey data (training set) and tested on a separate subset (test set) to assess predictive accuracy. ResultsMM and RF models identified gender, keloid shape and age of the patients as the strongest determinants of ILCS response in keloid patients, achieving [~]95% predictive accuracy on our test dataset. LimitationsThe ML models were trained on self-reported survey data rather than data collected by clinicians, which may impact accuracy and reliability. ConclusionsNN and RF based ML models using basic keloid patient data can be used to predict response to intralesional steroids in keloid patients accurately using a web-based user interface. Similar ML models maybe useful in clinical decision making regarding the use of steroid therapy for additional conditions. Capsule SummaryO_LIMethods to predict response to intralesional corticosteroid treatment for keloids are unavailable but urgently needed given the significant number of patients who are refractory to steroid treatment. C_LIO_LIMachine learning algorithms based of self-reported keloid parameters and demographic information can be used to predict response to steroids prior to initiating therapy. C_LI

Background and ObjectivesThe integration of intelligent technologies in operating room nursing represents a rapidly evolving field requiring systematic analysis to understand global research trends and development patterns. This study aimed to comprehensively analyze worldwide research trends, identify key contributors, and reveal emerging developments in intelligent operating room nursing through bibliometric analysis. MethodsA comprehensive literature search was conducted across six international databases (Web of Science, Scopus, PubMed, Embase, Cochrane Library, and CINAHL) from January 2015 to April 2025. Following rigorous screening criteria, 291 eligible articles were analyzed using R software with bibliometrix package, VOSviewer, and CiteSpace for bibliometric analysis, network visualization, and thematic evolution assessment. ResultsPublication output increased from 16 articles in 2015 to 49 in 2024, with 45.4% of total publications concentrated in 2022-2024. The United States dominated with 132 publications, followed by Germany and the United Kingdom (33 each). Technical University of Munich led institutional contributions with 7 publications. Six major research themes emerged: operating room management, robotic technology, nursing practice, patient safety, quality improvement, and intelligent algorithms. Keyword analysis revealed evolution from early focus on operating room scheduling and multi-objective optimization (2017) to deep learning applications (2020-2023), natural language processing (2023), and robotic scrub nurse development (2023-2025). ConclusionsThe field demonstrates rapid growth with clear thematic evolution toward human-machine collaboration systems. Future research should prioritize comparative effectiveness studies, implementation science methodologies, and global health equity considerations to ensure widespread clinical translation.