Objective:To compare the clinical efficacy of mifepristone-misoprostol medical management versus surgical curettage for first-trimester missed miscarriage,and to establish evidence-based sonographic cutoff values pred...Objective:To compare the clinical efficacy of mifepristone-misoprostol medical management versus surgical curettage for first-trimester missed miscarriage,and to establish evidence-based sonographic cutoff values predictive of incomplete abortion requiring surgical intervention.Methods:We retrospectively analyzed a cohort of 702 women diagnosed with first-trimester missed miscarriage between January 2020 and May 2023.Demographic characteristics and ultrasound parameters were systematically recorded.Receiver operating characteristic(ROC)curve analysis was performed to establish optimal sonographic cutoff values for predicting incomplete abortion requiring surgical intervention.Results:146 patients received medical treatment(mifepristone and misoprostol)and 556 underwent surgical curettage.At the 1-month follow-up,the medical group showed significantly greater endometrial thickness and longer postoperative bleeding duration than the surgical group(P<0.05).The menstrual volume reduction rate(23.56%)was significantly lower in the medical group than in the surgical group.The incomplete abortion rate was higher in the medical group(17.12%,25/146)than in the surgical group(2.88%,16/556).Among the medical group,14 patients(9.59%)required curettage due to incomplete abortion,while 11 cases resolved spontaneously after prolonged medication.ROC curve analysis identified two cut-off values indicating the need for surgical intervention:endometrial thickness>1.21 cm at 24 h post-medical abortion,and residual mass diameter>0.95 cm at 7 days post-medical abortion.Conclusions:Medical management of first-trimester missed miscarriage using mifepristone-misoprostol demonstrates comparable efficacy to surgical curettage.An endometrial thickness>1.21 cm at 24 h or residual tissue diameter>0.95 cm at 7 days post-medical abortion should prompt consideration of incomplete abortion.展开更多
Objectives:This study examined the levels of shared leadership and missed nursing care and their relationship among nurses in Egypt.Methods:A cross-sectional survey was conducted.From February to April 2024,340 nurses...Objectives:This study examined the levels of shared leadership and missed nursing care and their relationship among nurses in Egypt.Methods:A cross-sectional survey was conducted.From February to April 2024,340 nurses worked in all inpatient care units at Alexandria Main University Hospital.The Shared Leadership and Missed Nursing Care Survey was used for evaluation.Results:The overall score of shared leadership was(72.62±4.30),which imitates a high perception of shared leadership among nurses;the dimension of delegation achieved the highest average mean score(3.66±0.26),followed by collaboration(3.64±0.31),the vision dimension scored the lowest mean score(3.59±0.33).The elements of missed nursing care had a total score of(46.72±5.69),and the dimension of secondary care achieved the highest average mean score(3.74±0.31).The reasons for missed nursing care had a total mean score of(22.40±1.59),and the dimension of labor resources achieved the highest average mean score(3.20±0.22).Male nurses,less than 30 years old,married,held a bachelor’s degree in nursing sciences,less than five years of experience in the nursing profession,and less than five years of experience in the current working unit had higher total scores of the shared leadership and lower total scores of missed nursing care(P<0.001).A negative correlation existed between shared leadership and two dimentisons(the elements of nursing care[r=-0.383],the reasons for missing nursing care[r=-0.047])(P<0.001).Conclusions:The study’s findings can help as a theoretical underpinning for nursing leaders to stand in an environment that reduces the incidence of missed nursing care by encouraging teamwork,responsibility,workload management,and empowerment among nurses.展开更多
The quality of care and treatment can be impacted by a number of factors, including the rate of missed care. The present study was conducted with the aim to evaluate missed nursing care (MNC) and its association with ...The quality of care and treatment can be impacted by a number of factors, including the rate of missed care. The present study was conducted with the aim to evaluate missed nursing care (MNC) and its association with patient safety culture in the emergency department (ED). Until September 2024, the international databases MEDLINE (PubMed and Ovid), Embase and Cochrane, Scopus, Wiley Online Library, Web of Science, Cochrane Central Register of Controlled Trials, EBSCO, ISI, Elsevier, and Google Scholar were searched using the search terms including patient safety culture and MNC. A total of eight articles were reviewed. In the fixed-effect model with low heterogeneity (I^(2) = 0%, P = 1), the mean score of overall MNC was 2.07 (ES, 2.97;95% confidence interval: −2.21-6.35). According to meta-regression analyses, MNC significantly inversely correlated with patient safety culture, age, and work experience (P < 0.01). By improving the working conditions of ED nurses and providing training related to patient safety, the amount of lost nursing care will decrease.展开更多
AIM: To investigate the causes of missed diagnosis of early gastric cancer (EGC) or high-grade intraepithelial neoplasia (HGIN) in Chongqing, China. METHODS: The present study summarizes 103 cases of EGC/HGIN detected...AIM: To investigate the causes of missed diagnosis of early gastric cancer (EGC) or high-grade intraepithelial neoplasia (HGIN) in Chongqing, China. METHODS: The present study summarizes 103 cases of EGC/HGIN detected by esophagogastroduodenos-copy (EGD) and pathological analysis from January 2010 to December 2011. Dimethyl silicone oil was administrated orally 15 min before the EGD procedures. The stomach was cleaned by repeated washing with saline when the gastroscope entered the stomach cavity. Suspected EGC lesions were subject to conventional biopsy sampling and pathological examinations. The correlation between lesion locations, endoscopic morphology of cancerous sites, training level of the examiners, pathological biopsies, and missed diagnosis was analyzed. RESULTS: Twenty-three cases were missed among the 103 cases (22.23%) of EGC/HGIN. The rate of missed EGC in the gastroesophageal junction (8/19, 42.1%) was significantly higher than at other sites (15/84, 17.86%) (χ2 = 5.253, P = 0.022). In contrast, the rate of missed EGC in the lower stomach body (2/14, 14.29%) was lower than at other sites (21/89,23.6%), but there were no significant differences (χ2 = 0.289, P = 0.591). The rate of missed EGC in the gastric antrum (5/33, 15.15%) was lower than at other sites (18/70, 25.71%), but there were no significant differences (χ2 = 1.443, P = 0.230). Endoscopists from less prestigious hospitals were more prone to not diagnosing EGC than those from more prestigious hospitals (χ2 = 4.261, P = 0.039). When the number of biopsies was < 4, the rate of missed diagnosis was higher (20/23, 89.96%) than for when there were > 4 biopsies (3/23, 13.04%) (P < 0.001). In addition, there was no significant difference in the rate of missed diagnosis in patients with 1-3 biopsy specimens (χ2 = 0.141, P = 0.932). CONCLUSION: Endoscopists should have a clear understanding of the anatomical characteristics of the esophagus/stomach, and endoscopic identification of early lesions increases with the number of biopsies.展开更多
AIM To analyze the clinical characteristics of eosinophilic gastroenteritis(EGE)and to investigate the situations of missed diagnosis of EGE.METHODS First,the clinical characteristics of 20 EGE patients who were treat...AIM To analyze the clinical characteristics of eosinophilic gastroenteritis(EGE)and to investigate the situations of missed diagnosis of EGE.METHODS First,the clinical characteristics of 20 EGE patients who were treated at our hospital were retrospectively summarized.Second,159 patients who underwent gastroscopy and 211 patients who underwent colonoscopy were enrolled.The pathological diagnosis showed only chronic inflammation in their medical records.The biopsy slides of these patients were reevaluated to determine the number of infiltrating eosinophils in order to assess the probability of a missed diagnosis of EGE.Finally,122 patients who experienced refractory upper gastrointestinal symptoms for at least one month were recruited.At least 6biopsy specimens were obtained by gastroscopy,and the number of eosinophils that had infiltrated was evaluated.Those who met the pathological diagnostic criteria of EGE underwent further examination to confirm the diagnosis of EGE.The probability of a missed diagnosis of EGE was prospectively investigated.RESULTS Among the 20 patients with EGE,mucosal EGE was found in 15 patients,muscular EGE was found in 3patients and serosal EGE was found in 2 patients.Abdominal pain was the most common symptom.The number of peripheral blood eosinophils was elevated in all 20 patients,all of whom were sensitive to corticosteroids.Second,among the 159 patients who underwent gastroscopy,7(4.40%)patients met the criteria for pathological EGE(eosinophil count≥25/HPF).Among the 211 patients who underwent colonoscopy,9(4.27%)patients met the criteria for pathological EGE(eosinophil count≥30/HPF).No patients with eosinophil infiltration were diagnosed with EGE in clinical practice before or after endoscopy.Although these patients did not undergo further examination to exclude other diseases that can also lead to gastrointestinal eosinophil infiltration,these might be the cases where the diagnosis of EGE was missed.Finally,among the 122 patients with refractory upper gastrointestinal symptoms,eosinophil infiltration was seen in 7 patients(5.74%).The diagnosis of EGE was confirmed in all 7 patients after the exclusion of other diseases that can also lead to gastrointestinal eosinophil infiltration.A positive correlation was observed between the duration of the symptoms and the risk of EGE(r=0.18,P<0.01).The patients whose symptoms persisted longer than 6 mo more readily developed EGE.None of the patients were considered to have EGE by their physicians before endoscopy.CONCLUSION Although EGE is a rare inflammatory disorder,it is easily misdiagnosed.When a long history of abdominal symptoms fails to improve after conventional therapy,EGE should be considered.展开更多
Objective To determine the role of the circulating antisperm antibody （ASA） in the pathogenesis of missed abortion at the first-trimester pregnancy. Methods Sixty-two patients with a history of missed abortion at th...Objective To determine the role of the circulating antisperm antibody （ASA） in the pathogenesis of missed abortion at the first-trimester pregnancy. Methods Sixty-two patients with a history of missed abortion at the first-trimester pregnancy were enrolled into this study. Indirect immunobead test （IBT） was used to measure the circulating ASA levels. Fifty healthy women with the first-trimester pregnancy set as the control. Results No case had the positive level of ASA according to the World Health Organization criteria （50% or more of the motile sperm with immunobead binding）. Only 1 case in patient group and 1 case in the control had 10%-20% of the motile spermatozoa with ASA-IgG bead binding. In both patient and control groups, ASA-IgA was found to be completely negative binding. Conclusion The circulating ASA is not associated with the pathogenesis of missed abortions at the first-trimester pregnancy.展开更多
Severe fever with thrombocytopenia syndrome(SFTS),caused by SFTS virus(SFTSV)infection,was first reported in 2010 in China with an initial fatality of up to 30%.The laboratory confirmation of SFTSV infection in terms ...Severe fever with thrombocytopenia syndrome(SFTS),caused by SFTS virus(SFTSV)infection,was first reported in 2010 in China with an initial fatality of up to 30%.The laboratory confirmation of SFTSV infection in terms of detection of viral RNA or antibody levels is critical for SFTS diagnosis and therapy.In this study,a new luciferase immunoprecipitation system(LIPS)assay based on p REN2 plasmid expressing SFTSV NP gene and tagged with Renilla luciferase(Rluc),was established and used to investigate the levels of antibody responses to SFTSV.Totally 464 serum samples from febrile patients were collected in the hospital of Shaoxing City in Zhejiang Province in 2019.The results showed that 82 of the 464 patients(17.7%)had antibody response to SFTSV,which were further supported by immunofluorescence assays(IFAs).Further,q RT-PCR and microneutralization tests showed that among the 82 positive cases,15 patients had viremia,10 patients had neutralizing antibody,and one had both(totally 26 patient).However,none of these patients were diagnosed as SFTS in the hospital probably because of their mild symptoms or subclinical manifestations.All the results indicated that at least the 26 patients having viremia or neutralizing antibody were the missed diagnosis of SFTS cases.The findings suggested the occurrence of SFTS and the SFTS incidence were higher than the reported level in Shaoxing in 2019,and that LIPS may provide an alternative strategy to confirm SFTSV infection in the laboratory.展开更多
BACKGROUND Choledocholithiasis develops in up to 20%of patients with gall bladder stones.The challenge in diagnosis usually occurs with small stones that may be missed by magnetic resonance cholangiopancreatography(MR...BACKGROUND Choledocholithiasis develops in up to 20%of patients with gall bladder stones.The challenge in diagnosis usually occurs with small stones that may be missed by magnetic resonance cholangiopancreatography(MRCP).Endoscopic ultrasound(EUS)is accurate in detecting common bile duct(CBD)stones missed by MRCP,especially the small ones or those impacted at the distal CBD or the papillary region.AIM To evaluate the accuracy of EUS in detecting CBD stones missed by MRCP.METHODS Patients with an intermediate likelihood of choledocholithiasis according to ESGE guidelines and those with acute pancreatitis of undetermined cause were included.The presence of choledocholithiasis was evaluated by MRCP and EUS,and then results were confirmed by endoscopic retrograde cholangiopancreatography(ERCP).The sensitivity and specificity of EUS and MRCP were compared regarding the presence of stones,the size,and the number of detected stones.RESULTS Ninety out of 100 involved patients had choledocholithiasis,while ten patients were excluded as they had pancreatic or gall bladder masses during EUS examination.In choledocholithiasis patients,the mean age was 52.37±14.64 years,and 52.2%were males.Most patients had biliary obstruction(74.4%),while only 23(25.6%)patients had unexplained pancreatitis.The overall prevalence of choledocholithiasis was 83.3%by EUS,41.1%by MRCP,and 74.4%by ERCP.Also,the number and size of CBD stones could be detected accurately in 78.2%and 75.6%by EUS and 41.1%and 70.3%by MRCP,respectively.The sensitivity of EUS was higher than that of MRCP(98.51%vs 55.22%),and their predictive value was statistically different(P<0.001).Combination of both tools raised the sensitivity to 97.22%and specificity to 100%.CONCLUSION EUS could be a useful tool in assessing patients with suspected choledocholithiasis especially if combined with MRCP.However,its usefulness depends on its availability and the experience of the local centers.展开更多
AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients under...AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and191 patients were included for analysis of PVD,depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations.RESULTS： Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs（P =0.033） with the odds of missing a retinal break being1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy（PVR） and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae,pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD.Traumatic RRDs were rarely associated with PVD. CONCLUSION： Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.展开更多
Objective To explore the influence of galectin-3 on missed abortion. Methods Forty cases of normal intrauterine early pregnancy were randomly divided into 2 groups： surgical abortion group （group A, n=20） and medic...Objective To explore the influence of galectin-3 on missed abortion. Methods Forty cases of normal intrauterine early pregnancy were randomly divided into 2 groups： surgical abortion group （group A, n=20） and medical abortion group （group B, n =20）. The third group was missed abortion group （group C, n =20） with the gestational age less than 13 weeks. Serum was isolated from the blood samples, collected and used for ELISA quantification of galectin-3. Villus and decidua tissues were collected from the abortus for immunohistochemical examination and real-time fluorescence relative quantitative PCR. Results The level of galectin-3 in the serum was the lowest in missed abortion group （P〈0.05）. Immunohistochemistry showed that galectin-3 expression in villus of missed abortion group was significantly lower than that of surgical abortion group （P〈0. 01）. Real-time fluorescence relative quantitative PCR showed that galectin-3 mRNA relative expression in villus of missed abortion group （2^-△△Ct=0. 04± 0. 01） was significantly lower than that of surgical abortion group （2^-△△Ct=1.00 ± 0.00）. Galectin-3 mRNA relative expression in deciduas of medical abortion group （2-zact=o. 08 ± 0.02） was s!gnificantly lower than that of surgical abortion group （2^-△△Ct=1.00 ± 0.00） （P〈0. 01）. Conclusion Galectin-3 is related to the development of villus and decidua during early pregnancy. The decreased expression of galectin-3 may promote the occurrence of missed abortion.展开更多
Objective To access an ideal procedure terminating missed abortion within 12 weeks of gestational age. Methods Women with intrauterine fetal death were randomized into 3 groups. Group A （n=30）： vaginal misoprostol ...Objective To access an ideal procedure terminating missed abortion within 12 weeks of gestational age. Methods Women with intrauterine fetal death were randomized into 3 groups. Group A （n=30）： vaginal misoprostol （MP） 0.4 mg, 3 h before vacuum aspiration; group B（n=15）： vaginal MP 0.4 mg every 3 h, up to 5 doses; group C（n=30）： oral mifepristone （MF） 200 mg 36-48 h before vaginal MP 0.4 mg, MP was given every 3 h, up to 5 doses. Results Women in group A had the shortest interval of gestation tissue expulsion （3.2± 0.5 h） and the bleeding （3.2 ± 5.7 ml） during medical procedure, which were statistically significant in comparison with the other two groups （P〈0.001, P〈0.01, respectively）. Success rates of groups A, B and C were 100%, 33.3% and 90.0%, respectively. Percentages of women need surgical interventions were similar in group B and group C（80.0%,76.7%, respectively）. Bleeding during operation, pain after medical procedure and satisfaction presented no statistical significance among the 3 groups. Conclusion Vaginal MP followed by vacuum aspiration was valuable in safety, and efficacy, which led to less bleeding and a faster recovery.展开更多
Background: Nigeria has the largest paediatric HIV-infected population in the world. Missed opportunities for prevention of mother-to-child transmission of HIV (PMTCT) compromise efforts at eliminating new pediatric H...Background: Nigeria has the largest paediatric HIV-infected population in the world. Missed opportunities for prevention of mother-to-child transmission of HIV (PMTCT) compromise efforts at eliminating new pediatric HIV infections. Methods: Six hundred children, aged < 15 years, presenting to the pediatric units of the University College Hospital (UCH), Ibadan Southwest Nigeria between June to December 2007 were studied. The demographics, HIV status and socioeconomic status of mothers and their children were studied. A 4-step hierarchy was used to assess the missed opportunities for PMTCT. Step 1: utilization of a health facility for antenatal care and delivery;Step 2: maternal HIV status determination during pregnancy;Step 3: provision of antiretroviral medication to HIV-infected mother and baby;and Step 4: avoidance of mixed feeding in HIV-exposed children. The rates of missed opportunities for PMTCT services at different steps in the PMTCT cascade, perinatal transmission rates, and associated factors were reported. Results: There were 599 mothers and 600 children (one set of twins), 60 (10%) were HIV infected and 56 (93.3%) of these were adjudged perinatally infected. Of 78 HIV-infected women, 7 (9.0%) accessed all interventions in the PMTCT cascade and 71 (91.0%) had missed opportunities for PMTCT. Missed opportunities for PMTCT occurred 42.9% in cascade Step 1, 64.2% in Step 2, 52.6% in step 3 and 73.7% in Step 4. All mother-baby pairs who accessed complete PMTCT interventions received care at a teaching hospital. Among infants with perinatal HIV infection, 53 (94.6%) were born to mothers who had missed opportunities for PMTCT. Most women with missed opportunities attended antenatal care outside the teaching hospital setting and belonged to low socioeconomic status. Conclusion: It is imperative to expand PMTCT access to women who receive antenatal care outside the teaching hospitals and to those of low socioeconomic status.展开更多
Rationale: Pulmonary embolism is a severe cardiovascular disease. Acute pulmonary embolism is an extremely common and potentially the serious pattern of venous thromboembolic disease. Unfortunately, missed diagnosis o...Rationale: Pulmonary embolism is a severe cardiovascular disease. Acute pulmonary embolism is an extremely common and potentially the serious pattern of venous thromboembolic disease. Unfortunately, missed diagnosis of pulmonary embolism is lethal and common because of its non-specific symptoms and signs. Patient concerns: A 42-year-old male patient presented with acute chest pain that was treated as gastroesophageal reflux disease. Diagnosis: Suspected acute pulmonary embolism. Interventions: O2inhalation, urgent electrocardiography, and cardiopulmonary resuscitation. Outcomes: Deterioration and sudden cardiac death. Lessons: Physicians should pay much attention to the symptoms and signs of pulmonary embolism to reduce the rate of missed diagnosis.展开更多
BACKGROUND Missed or delayed diagnosis of cervical spine instability after acute trauma can have catastrophic consequences for the patient,resulting in severe neurological impairment.Currently,however,there is no cons...BACKGROUND Missed or delayed diagnosis of cervical spine instability after acute trauma can have catastrophic consequences for the patient,resulting in severe neurological impairment.Currently,however,there is no consensus on the optimal strategy for diagnosing occult cervical spine instability.Thus,we present a case of occult cervical spine instability and provide a clinical algorithm to aid physicians in diagnosing occult instability of the cervical spine.CASE SUMMARY A 57-year-old man presented with cervical spine pain and inability to stand following a serious fall from a height of 2 m.No obvious vertebral fracture or dislocation was found at the time on standard lateral X-ray,computed tomography,and magnetic resonance imaging(MRI).Subsequently,the initial surgical plan was unilateral open-door laminoplasty(C3-7)with alternative levels of centerpiece mini-plate fixation(C3,5,and 7).However,the intraoperative C-arm fluoroscopic X-rays revealed significantly increased intervertebral space at C5-6,indicating instability at this level that was previously unrecognized on preoperative imaging.We finally performed lateral mass fixation and fusion at the C5-6 level.Looking back at the preoperative images,we found that the preoperative T2 MRI showed non-obvious high signal intensity at the C5-6 intervertebral disc and posterior interspinous ligament.CONCLUSION MRI of cervical spine trauma patients should be carefully reviewed to detect disco-ligamentous injury,which will lead to further cervical spine instability.In patients with highly suspected cervical spine instability indicated on MRI,lateral X-ray under traction or after anesthesia and muscle relaxation needs to be performed to avoid missed diagnoses of occult cervical instability.展开更多
BACKGROUND Hepatitis C is a global epidemic and an estimated 230000 Australians were living with chronic hepatitis C in 2016.Through effective public health policy and state commitment,Australia has utilised the adven...BACKGROUND Hepatitis C is a global epidemic and an estimated 230000 Australians were living with chronic hepatitis C in 2016.Through effective public health policy and state commitment,Australia has utilised the advent of direct acting antiviral(DAA)therapy to transform the therapeutic landscape for hepatitis C virus(HCV).However,treatment rates are falling and novel public health approaches are required to maintain momentum for HCV elimination.Contemporary discourse in cascades of care have focused on expanding testing capabilities but less attention has been given to linking previously diagnosed patients back to care.Our simple and focused study rests on the premise that hospital admissions are an excellent opportunity to identify and refer previously diagnosed patients for HCV treatment.AIM To assess whether inpatients with HCV are appropriately referred on for treatment.METHODS We conducted a retrospective single centre cohort study that examined all patients with HCV presenting to The Queen Elizabeth Hospital(QEH)inpatient service between January 1 and December 31,2017.QEH is a tertiary care hospital in South Australia.The main inclusion criteria were patients with active HCV infection who were eligible for DAA therapy.Our study cohort was identified using a comprehensive list of diagnosis based on international classification of diseases-10 AM codes for chronic viral hepatitis.Patients were excluded from the analysis if they had previously received DAA therapy or spontaneously cleared HCV.Patients presenting with decompensated liver cirrhosis or other systemic medical conditions conferring poor short-term prognosis were also excluded from the analysis.The primary outcome of our study was referral of patients for HCV treatment.Secondary outcomes included assessment of factors predicting treatment referral.RESULTS There were 309 inpatients identified with hepatitis C as a principal or additional diagnosis between January 1 and December 31,2017.Of these patients,148 had active HCV infection without prior treatment or spontaneous clearance.Overall,131 patients were deemed eligible for DAA treatment and included in the main analysis.Mean patient age was 47.75±1.08 years,and 69%of the cohort were male and 13%identified as Aboriginal or Torres Strait Islander.Liver cirrhosis was a complication of hepatitis C in 7%of the study cohort.Only 10 patients were newly diagnosed with HCV infection during the study period with the remainder having been diagnosed prior to the study.CONCLUSION Under 25%of hepatitis C patients presenting to an Australian tertiary hospital were appropriately referred for treatment.Advanced age,cirrhosis and admission under medical specialties were predictors of treatment referral.展开更多
Background: Low vaccination coverage has been attributed to missed opportunities for vaccination (MOV). This study examines the prevalence of MOV, and its associated factors among children in Cameroon. Methods: Data f...Background: Low vaccination coverage has been attributed to missed opportunities for vaccination (MOV). This study examines the prevalence of MOV, and its associated factors among children in Cameroon. Methods: Data from the 2018 Demographic and Health Survey (DHS) was analyzed for children with at least one vaccination date in the home-based record (HBR). Immunization performances such as accessibility, drop-out, and timeliness, were assessed. Service quality was assessed using MOV. Multiple logistic regression examined the effect of DHS variables on MOV outcomes, and a decision tree approach was used to study their interaction. Results: Overall, 1824 children aged 12 to 23 months were surveyed;1285 (70.45%) had cards seen with vaccination dates leading to 85.03% of immunization activities. A proportion of 46.5% of children were not completely vaccinated. There was 27% of drop-out between BCG and MCV1, and less than 10% with the specific antigens. Vaccination timeliness proportions ranged from 42.18% for BGC to less than 70% for PENTA1-3. The national prevalence of MOV for simultaneous vaccines was 75.1% (95% confidence interval (CI) = 72;79). Among those who experienced MOV, 67.4% (95% CI = 60 - 73) were uncorrected MOV. MOV was an issue in all regions and comparable in rural areas that urban areas (p = 0.2). Dose-specific MOV ranged from 2.66% (for the third dose of the pneumococcal conjugate vaccine) to 91.12 (for the yellow fever vaccine). Second birth order children experienced more MOV than first born children (adjusted odds ratio (aOR) = 1.67, 95% CI: 1.11 - 2.47). Children born to non-educated/primary level mothers had increased odds of experiencing a MOV than those born to educated mothers (aOR = 1.48, 95% CI = 1.007 - 2.19/aOR = 1.55, 95% CI = 1.12 - 2.09). Children from poorest households were at high risk of experiencing MOV for any vaccine than richest households (aOR = 2.04, 95% CI = 1.11 - 3.76). Conclusion: There is a burden of MOV and under immunized children in the population. Direct interventions that target rural poor and focus on equity gaps that relate to maternal education, socio-economic status, and family planning, should be implemented. Such strategies should aim at reducing MOV for the achievement of the immunization agenda 2030 goals.展开更多
Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from preventio...Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from prevention of mother-to-child transmission of HIV program and antiretroviral drug resistance. The purpose of the study was to determine the prevalence of missed PMTCT visits and its associated predictors. A descriptive cross sectional survey was carried out at a District Hospital in Goromonzi, Zimbabwe. Fifty-three women completed closed-ended questionnaires pertaining to PMTCT visits and exposure to PMTCT activities. A total of 24.5% missed at least one scheduled PMTCT visit. Statistically significant predictors of not missing a PMTCT visit were satisfaction with family support (β = −0.73, p = 0.029) and level of satisfaction with PMTCT services (β = −0.00076;p = 0.04). The number of days by which scheduled visits were missed were inversely correlated with visit number (β = −2.99, p = 0.04). Enhanced family support and quality improvement to improve patient satisfaction may reduce missed visits. Availing women with a more active role in PMTCT may also reduce the prevalence of missed visits.展开更多
Background: With the inflation of economic constraints on health care and demand to increase care quality, there is an increasing need to develop a clear understanding of what actions by health professionals are perce...Background: With the inflation of economic constraints on health care and demand to increase care quality, there is an increasing need to develop a clear understanding of what actions by health professionals are perceived as threatening quality care. Objective: To explore graduate nursing and pastoral care student’s perceptions of missed care in Norway. Research design: A qualitative study was employed with the formation of six focus groups. Data was analyzed via a thematic content of the discussions. Participants and research context: Thirty-one students attending a University College in Oslo participated. Findings: Five major themes and thirty subthemes were identified. Major themes included labor constraints, organizational contraints, professional constraints, communication constaints and emotional strain. Discussion: Findings of this study resonate with other research as well as with studies on missed nursing care. Findings also lend support to the definition of missed nursing care actions as required care that is omitted, either in part or whole, or delayed. Conclusion: The findings from this study extend understanding of what barriers health professionals perceive as inhibiting them from offering quality care. The focus groups provided a valuable flora for discussion regarding what participants perceived as missed.展开更多
Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect e...Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care.The objective of this study was to examine the relationship between out-of-pocket(OOP)health expenditures and the likelihood of missing appointments.Method:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres(CTC)in Northern Tanzania were enrolled in the study.Clinic attendance and clinical characteristics were abstracted from medical records.Information on OOP health expenditures,demographics,and socio-economic factors were self-reported by the participants.We used a hurdle model.The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings(TZS)increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period.Results:Among these 618 participants,242(39%)had at least one missed clinic appointment in the past year.OOP expenditure was not significantly associated with the number of missed clinic appointments.The median amount of OOP paid was 5100 TZS per visit,about 7%of the median monthly income.Participants who were separated from their partners(adjusted odds ratio[AOR]=1.83,95%confidence interval[CZ]:1.11-8.03)and those aged above 50 years(AOR=2.85,95%CI:1.01-8.03)were significantly associated with missing an appointment.For those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC(P=0.49,95%CI:0.88-0.09)and aged between>25-35 years(P=0.90,95%CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between>25-35 years,above 50 years of age and those who are separated from their partners.展开更多
基金supported by National Natural Science Foundation of China(Project approval number 82201825).
文摘Objective:To compare the clinical efficacy of mifepristone-misoprostol medical management versus surgical curettage for first-trimester missed miscarriage,and to establish evidence-based sonographic cutoff values predictive of incomplete abortion requiring surgical intervention.Methods:We retrospectively analyzed a cohort of 702 women diagnosed with first-trimester missed miscarriage between January 2020 and May 2023.Demographic characteristics and ultrasound parameters were systematically recorded.Receiver operating characteristic(ROC)curve analysis was performed to establish optimal sonographic cutoff values for predicting incomplete abortion requiring surgical intervention.Results:146 patients received medical treatment(mifepristone and misoprostol)and 556 underwent surgical curettage.At the 1-month follow-up,the medical group showed significantly greater endometrial thickness and longer postoperative bleeding duration than the surgical group(P<0.05).The menstrual volume reduction rate(23.56%)was significantly lower in the medical group than in the surgical group.The incomplete abortion rate was higher in the medical group(17.12%,25/146)than in the surgical group(2.88%,16/556).Among the medical group,14 patients(9.59%)required curettage due to incomplete abortion,while 11 cases resolved spontaneously after prolonged medication.ROC curve analysis identified two cut-off values indicating the need for surgical intervention:endometrial thickness>1.21 cm at 24 h post-medical abortion,and residual mass diameter>0.95 cm at 7 days post-medical abortion.Conclusions:Medical management of first-trimester missed miscarriage using mifepristone-misoprostol demonstrates comparable efficacy to surgical curettage.An endometrial thickness>1.21 cm at 24 h or residual tissue diameter>0.95 cm at 7 days post-medical abortion should prompt consideration of incomplete abortion.
文摘Objectives:This study examined the levels of shared leadership and missed nursing care and their relationship among nurses in Egypt.Methods:A cross-sectional survey was conducted.From February to April 2024,340 nurses worked in all inpatient care units at Alexandria Main University Hospital.The Shared Leadership and Missed Nursing Care Survey was used for evaluation.Results:The overall score of shared leadership was(72.62±4.30),which imitates a high perception of shared leadership among nurses;the dimension of delegation achieved the highest average mean score(3.66±0.26),followed by collaboration(3.64±0.31),the vision dimension scored the lowest mean score(3.59±0.33).The elements of missed nursing care had a total score of(46.72±5.69),and the dimension of secondary care achieved the highest average mean score(3.74±0.31).The reasons for missed nursing care had a total mean score of(22.40±1.59),and the dimension of labor resources achieved the highest average mean score(3.20±0.22).Male nurses,less than 30 years old,married,held a bachelor’s degree in nursing sciences,less than five years of experience in the nursing profession,and less than five years of experience in the current working unit had higher total scores of the shared leadership and lower total scores of missed nursing care(P<0.001).A negative correlation existed between shared leadership and two dimentisons(the elements of nursing care[r=-0.383],the reasons for missing nursing care[r=-0.047])(P<0.001).Conclusions:The study’s findings can help as a theoretical underpinning for nursing leaders to stand in an environment that reduces the incidence of missed nursing care by encouraging teamwork,responsibility,workload management,and empowerment among nurses.
文摘The quality of care and treatment can be impacted by a number of factors, including the rate of missed care. The present study was conducted with the aim to evaluate missed nursing care (MNC) and its association with patient safety culture in the emergency department (ED). Until September 2024, the international databases MEDLINE (PubMed and Ovid), Embase and Cochrane, Scopus, Wiley Online Library, Web of Science, Cochrane Central Register of Controlled Trials, EBSCO, ISI, Elsevier, and Google Scholar were searched using the search terms including patient safety culture and MNC. A total of eight articles were reviewed. In the fixed-effect model with low heterogeneity (I^(2) = 0%, P = 1), the mean score of overall MNC was 2.07 (ES, 2.97;95% confidence interval: −2.21-6.35). According to meta-regression analyses, MNC significantly inversely correlated with patient safety culture, age, and work experience (P < 0.01). By improving the working conditions of ED nurses and providing training related to patient safety, the amount of lost nursing care will decrease.
文摘AIM: To investigate the causes of missed diagnosis of early gastric cancer (EGC) or high-grade intraepithelial neoplasia (HGIN) in Chongqing, China. METHODS: The present study summarizes 103 cases of EGC/HGIN detected by esophagogastroduodenos-copy (EGD) and pathological analysis from January 2010 to December 2011. Dimethyl silicone oil was administrated orally 15 min before the EGD procedures. The stomach was cleaned by repeated washing with saline when the gastroscope entered the stomach cavity. Suspected EGC lesions were subject to conventional biopsy sampling and pathological examinations. The correlation between lesion locations, endoscopic morphology of cancerous sites, training level of the examiners, pathological biopsies, and missed diagnosis was analyzed. RESULTS: Twenty-three cases were missed among the 103 cases (22.23%) of EGC/HGIN. The rate of missed EGC in the gastroesophageal junction (8/19, 42.1%) was significantly higher than at other sites (15/84, 17.86%) (χ2 = 5.253, P = 0.022). In contrast, the rate of missed EGC in the lower stomach body (2/14, 14.29%) was lower than at other sites (21/89,23.6%), but there were no significant differences (χ2 = 0.289, P = 0.591). The rate of missed EGC in the gastric antrum (5/33, 15.15%) was lower than at other sites (18/70, 25.71%), but there were no significant differences (χ2 = 1.443, P = 0.230). Endoscopists from less prestigious hospitals were more prone to not diagnosing EGC than those from more prestigious hospitals (χ2 = 4.261, P = 0.039). When the number of biopsies was < 4, the rate of missed diagnosis was higher (20/23, 89.96%) than for when there were > 4 biopsies (3/23, 13.04%) (P < 0.001). In addition, there was no significant difference in the rate of missed diagnosis in patients with 1-3 biopsy specimens (χ2 = 0.141, P = 0.932). CONCLUSION: Endoscopists should have a clear understanding of the anatomical characteristics of the esophagus/stomach, and endoscopic identification of early lesions increases with the number of biopsies.
基金Supported by Guangdong Science and Technology Program,No.2016A020216012
文摘AIM To analyze the clinical characteristics of eosinophilic gastroenteritis(EGE)and to investigate the situations of missed diagnosis of EGE.METHODS First,the clinical characteristics of 20 EGE patients who were treated at our hospital were retrospectively summarized.Second,159 patients who underwent gastroscopy and 211 patients who underwent colonoscopy were enrolled.The pathological diagnosis showed only chronic inflammation in their medical records.The biopsy slides of these patients were reevaluated to determine the number of infiltrating eosinophils in order to assess the probability of a missed diagnosis of EGE.Finally,122 patients who experienced refractory upper gastrointestinal symptoms for at least one month were recruited.At least 6biopsy specimens were obtained by gastroscopy,and the number of eosinophils that had infiltrated was evaluated.Those who met the pathological diagnostic criteria of EGE underwent further examination to confirm the diagnosis of EGE.The probability of a missed diagnosis of EGE was prospectively investigated.RESULTS Among the 20 patients with EGE,mucosal EGE was found in 15 patients,muscular EGE was found in 3patients and serosal EGE was found in 2 patients.Abdominal pain was the most common symptom.The number of peripheral blood eosinophils was elevated in all 20 patients,all of whom were sensitive to corticosteroids.Second,among the 159 patients who underwent gastroscopy,7(4.40%)patients met the criteria for pathological EGE(eosinophil count≥25/HPF).Among the 211 patients who underwent colonoscopy,9(4.27%)patients met the criteria for pathological EGE(eosinophil count≥30/HPF).No patients with eosinophil infiltration were diagnosed with EGE in clinical practice before or after endoscopy.Although these patients did not undergo further examination to exclude other diseases that can also lead to gastrointestinal eosinophil infiltration,these might be the cases where the diagnosis of EGE was missed.Finally,among the 122 patients with refractory upper gastrointestinal symptoms,eosinophil infiltration was seen in 7 patients(5.74%).The diagnosis of EGE was confirmed in all 7 patients after the exclusion of other diseases that can also lead to gastrointestinal eosinophil infiltration.A positive correlation was observed between the duration of the symptoms and the risk of EGE(r=0.18,P<0.01).The patients whose symptoms persisted longer than 6 mo more readily developed EGE.None of the patients were considered to have EGE by their physicians before endoscopy.CONCLUSION Although EGE is a rare inflammatory disorder,it is easily misdiagnosed.When a long history of abdominal symptoms fails to improve after conventional therapy,EGE should be considered.
文摘Objective To determine the role of the circulating antisperm antibody （ASA） in the pathogenesis of missed abortion at the first-trimester pregnancy. Methods Sixty-two patients with a history of missed abortion at the first-trimester pregnancy were enrolled into this study. Indirect immunobead test （IBT） was used to measure the circulating ASA levels. Fifty healthy women with the first-trimester pregnancy set as the control. Results No case had the positive level of ASA according to the World Health Organization criteria （50% or more of the motile sperm with immunobead binding）. Only 1 case in patient group and 1 case in the control had 10%-20% of the motile spermatozoa with ASA-IgG bead binding. In both patient and control groups, ASA-IgA was found to be completely negative binding. Conclusion The circulating ASA is not associated with the pathogenesis of missed abortions at the first-trimester pregnancy.
基金supported by the National Program on Key Research Project of China(2018YFE0200400,2019YFC1200700)the National Natural Science Foundation of China(U20A20135)+1 种基金the Strategic Biological Resources Capacity Building Project of Chinese Academy of Sciences(KFJ-BRP-017-06)the Key deployment projects of Chinese Academy of Sciences(KJZD-SW-L11)
文摘Severe fever with thrombocytopenia syndrome(SFTS),caused by SFTS virus(SFTSV)infection,was first reported in 2010 in China with an initial fatality of up to 30%.The laboratory confirmation of SFTSV infection in terms of detection of viral RNA or antibody levels is critical for SFTS diagnosis and therapy.In this study,a new luciferase immunoprecipitation system(LIPS)assay based on p REN2 plasmid expressing SFTSV NP gene and tagged with Renilla luciferase(Rluc),was established and used to investigate the levels of antibody responses to SFTSV.Totally 464 serum samples from febrile patients were collected in the hospital of Shaoxing City in Zhejiang Province in 2019.The results showed that 82 of the 464 patients(17.7%)had antibody response to SFTSV,which were further supported by immunofluorescence assays(IFAs).Further,q RT-PCR and microneutralization tests showed that among the 82 positive cases,15 patients had viremia,10 patients had neutralizing antibody,and one had both(totally 26 patient).However,none of these patients were diagnosed as SFTS in the hospital probably because of their mild symptoms or subclinical manifestations.All the results indicated that at least the 26 patients having viremia or neutralizing antibody were the missed diagnosis of SFTS cases.The findings suggested the occurrence of SFTS and the SFTS incidence were higher than the reported level in Shaoxing in 2019,and that LIPS may provide an alternative strategy to confirm SFTSV infection in the laboratory.
文摘BACKGROUND Choledocholithiasis develops in up to 20%of patients with gall bladder stones.The challenge in diagnosis usually occurs with small stones that may be missed by magnetic resonance cholangiopancreatography(MRCP).Endoscopic ultrasound(EUS)is accurate in detecting common bile duct(CBD)stones missed by MRCP,especially the small ones or those impacted at the distal CBD or the papillary region.AIM To evaluate the accuracy of EUS in detecting CBD stones missed by MRCP.METHODS Patients with an intermediate likelihood of choledocholithiasis according to ESGE guidelines and those with acute pancreatitis of undetermined cause were included.The presence of choledocholithiasis was evaluated by MRCP and EUS,and then results were confirmed by endoscopic retrograde cholangiopancreatography(ERCP).The sensitivity and specificity of EUS and MRCP were compared regarding the presence of stones,the size,and the number of detected stones.RESULTS Ninety out of 100 involved patients had choledocholithiasis,while ten patients were excluded as they had pancreatic or gall bladder masses during EUS examination.In choledocholithiasis patients,the mean age was 52.37±14.64 years,and 52.2%were males.Most patients had biliary obstruction(74.4%),while only 23(25.6%)patients had unexplained pancreatitis.The overall prevalence of choledocholithiasis was 83.3%by EUS,41.1%by MRCP,and 74.4%by ERCP.Also,the number and size of CBD stones could be detected accurately in 78.2%and 75.6%by EUS and 41.1%and 70.3%by MRCP,respectively.The sensitivity of EUS was higher than that of MRCP(98.51%vs 55.22%),and their predictive value was statistically different(P<0.001).Combination of both tools raised the sensitivity to 97.22%and specificity to 100%.CONCLUSION EUS could be a useful tool in assessing patients with suspected choledocholithiasis especially if combined with MRCP.However,its usefulness depends on its availability and the experience of the local centers.
文摘AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and191 patients were included for analysis of PVD,depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations.RESULTS： Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs（P =0.033） with the odds of missing a retinal break being1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy（PVR） and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae,pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD.Traumatic RRDs were rarely associated with PVD. CONCLUSION： Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.
文摘Objective To explore the influence of galectin-3 on missed abortion. Methods Forty cases of normal intrauterine early pregnancy were randomly divided into 2 groups： surgical abortion group （group A, n=20） and medical abortion group （group B, n =20）. The third group was missed abortion group （group C, n =20） with the gestational age less than 13 weeks. Serum was isolated from the blood samples, collected and used for ELISA quantification of galectin-3. Villus and decidua tissues were collected from the abortus for immunohistochemical examination and real-time fluorescence relative quantitative PCR. Results The level of galectin-3 in the serum was the lowest in missed abortion group （P〈0.05）. Immunohistochemistry showed that galectin-3 expression in villus of missed abortion group was significantly lower than that of surgical abortion group （P〈0. 01）. Real-time fluorescence relative quantitative PCR showed that galectin-3 mRNA relative expression in villus of missed abortion group （2^-△△Ct=0. 04± 0. 01） was significantly lower than that of surgical abortion group （2^-△△Ct=1.00 ± 0.00）. Galectin-3 mRNA relative expression in deciduas of medical abortion group （2-zact=o. 08 ± 0.02） was s!gnificantly lower than that of surgical abortion group （2^-△△Ct=1.00 ± 0.00） （P〈0. 01）. Conclusion Galectin-3 is related to the development of villus and decidua during early pregnancy. The decreased expression of galectin-3 may promote the occurrence of missed abortion.
文摘Objective To access an ideal procedure terminating missed abortion within 12 weeks of gestational age. Methods Women with intrauterine fetal death were randomized into 3 groups. Group A （n=30）： vaginal misoprostol （MP） 0.4 mg, 3 h before vacuum aspiration; group B（n=15）： vaginal MP 0.4 mg every 3 h, up to 5 doses; group C（n=30）： oral mifepristone （MF） 200 mg 36-48 h before vaginal MP 0.4 mg, MP was given every 3 h, up to 5 doses. Results Women in group A had the shortest interval of gestation tissue expulsion （3.2± 0.5 h） and the bleeding （3.2 ± 5.7 ml） during medical procedure, which were statistically significant in comparison with the other two groups （P〈0.001, P〈0.01, respectively）. Success rates of groups A, B and C were 100%, 33.3% and 90.0%, respectively. Percentages of women need surgical interventions were similar in group B and group C（80.0%,76.7%, respectively）. Bleeding during operation, pain after medical procedure and satisfaction presented no statistical significance among the 3 groups. Conclusion Vaginal MP followed by vacuum aspiration was valuable in safety, and efficacy, which led to less bleeding and a faster recovery.
文摘Background: Nigeria has the largest paediatric HIV-infected population in the world. Missed opportunities for prevention of mother-to-child transmission of HIV (PMTCT) compromise efforts at eliminating new pediatric HIV infections. Methods: Six hundred children, aged < 15 years, presenting to the pediatric units of the University College Hospital (UCH), Ibadan Southwest Nigeria between June to December 2007 were studied. The demographics, HIV status and socioeconomic status of mothers and their children were studied. A 4-step hierarchy was used to assess the missed opportunities for PMTCT. Step 1: utilization of a health facility for antenatal care and delivery;Step 2: maternal HIV status determination during pregnancy;Step 3: provision of antiretroviral medication to HIV-infected mother and baby;and Step 4: avoidance of mixed feeding in HIV-exposed children. The rates of missed opportunities for PMTCT services at different steps in the PMTCT cascade, perinatal transmission rates, and associated factors were reported. Results: There were 599 mothers and 600 children (one set of twins), 60 (10%) were HIV infected and 56 (93.3%) of these were adjudged perinatally infected. Of 78 HIV-infected women, 7 (9.0%) accessed all interventions in the PMTCT cascade and 71 (91.0%) had missed opportunities for PMTCT. Missed opportunities for PMTCT occurred 42.9% in cascade Step 1, 64.2% in Step 2, 52.6% in step 3 and 73.7% in Step 4. All mother-baby pairs who accessed complete PMTCT interventions received care at a teaching hospital. Among infants with perinatal HIV infection, 53 (94.6%) were born to mothers who had missed opportunities for PMTCT. Most women with missed opportunities attended antenatal care outside the teaching hospital setting and belonged to low socioeconomic status. Conclusion: It is imperative to expand PMTCT access to women who receive antenatal care outside the teaching hospitals and to those of low socioeconomic status.
文摘Rationale: Pulmonary embolism is a severe cardiovascular disease. Acute pulmonary embolism is an extremely common and potentially the serious pattern of venous thromboembolic disease. Unfortunately, missed diagnosis of pulmonary embolism is lethal and common because of its non-specific symptoms and signs. Patient concerns: A 42-year-old male patient presented with acute chest pain that was treated as gastroesophageal reflux disease. Diagnosis: Suspected acute pulmonary embolism. Interventions: O2inhalation, urgent electrocardiography, and cardiopulmonary resuscitation. Outcomes: Deterioration and sudden cardiac death. Lessons: Physicians should pay much attention to the symptoms and signs of pulmonary embolism to reduce the rate of missed diagnosis.
基金Supported by grants from China Postdoctoral Science Foundation General Program No.2019M653417Sichuan Science and Technology Program,No.2020YJ0025,No.2017SZ0046,and No.2017SZDZX0021+1 种基金Post-Doctor Research Project,Sichuan University,No.2019SCU12043and International Postdoctoral Exchange Fellowship Program,No.PC2019060.
文摘BACKGROUND Missed or delayed diagnosis of cervical spine instability after acute trauma can have catastrophic consequences for the patient,resulting in severe neurological impairment.Currently,however,there is no consensus on the optimal strategy for diagnosing occult cervical spine instability.Thus,we present a case of occult cervical spine instability and provide a clinical algorithm to aid physicians in diagnosing occult instability of the cervical spine.CASE SUMMARY A 57-year-old man presented with cervical spine pain and inability to stand following a serious fall from a height of 2 m.No obvious vertebral fracture or dislocation was found at the time on standard lateral X-ray,computed tomography,and magnetic resonance imaging(MRI).Subsequently,the initial surgical plan was unilateral open-door laminoplasty(C3-7)with alternative levels of centerpiece mini-plate fixation(C3,5,and 7).However,the intraoperative C-arm fluoroscopic X-rays revealed significantly increased intervertebral space at C5-6,indicating instability at this level that was previously unrecognized on preoperative imaging.We finally performed lateral mass fixation and fusion at the C5-6 level.Looking back at the preoperative images,we found that the preoperative T2 MRI showed non-obvious high signal intensity at the C5-6 intervertebral disc and posterior interspinous ligament.CONCLUSION MRI of cervical spine trauma patients should be carefully reviewed to detect disco-ligamentous injury,which will lead to further cervical spine instability.In patients with highly suspected cervical spine instability indicated on MRI,lateral X-ray under traction or after anesthesia and muscle relaxation needs to be performed to avoid missed diagnoses of occult cervical instability.
文摘BACKGROUND Hepatitis C is a global epidemic and an estimated 230000 Australians were living with chronic hepatitis C in 2016.Through effective public health policy and state commitment,Australia has utilised the advent of direct acting antiviral(DAA)therapy to transform the therapeutic landscape for hepatitis C virus(HCV).However,treatment rates are falling and novel public health approaches are required to maintain momentum for HCV elimination.Contemporary discourse in cascades of care have focused on expanding testing capabilities but less attention has been given to linking previously diagnosed patients back to care.Our simple and focused study rests on the premise that hospital admissions are an excellent opportunity to identify and refer previously diagnosed patients for HCV treatment.AIM To assess whether inpatients with HCV are appropriately referred on for treatment.METHODS We conducted a retrospective single centre cohort study that examined all patients with HCV presenting to The Queen Elizabeth Hospital(QEH)inpatient service between January 1 and December 31,2017.QEH is a tertiary care hospital in South Australia.The main inclusion criteria were patients with active HCV infection who were eligible for DAA therapy.Our study cohort was identified using a comprehensive list of diagnosis based on international classification of diseases-10 AM codes for chronic viral hepatitis.Patients were excluded from the analysis if they had previously received DAA therapy or spontaneously cleared HCV.Patients presenting with decompensated liver cirrhosis or other systemic medical conditions conferring poor short-term prognosis were also excluded from the analysis.The primary outcome of our study was referral of patients for HCV treatment.Secondary outcomes included assessment of factors predicting treatment referral.RESULTS There were 309 inpatients identified with hepatitis C as a principal or additional diagnosis between January 1 and December 31,2017.Of these patients,148 had active HCV infection without prior treatment or spontaneous clearance.Overall,131 patients were deemed eligible for DAA treatment and included in the main analysis.Mean patient age was 47.75±1.08 years,and 69%of the cohort were male and 13%identified as Aboriginal or Torres Strait Islander.Liver cirrhosis was a complication of hepatitis C in 7%of the study cohort.Only 10 patients were newly diagnosed with HCV infection during the study period with the remainder having been diagnosed prior to the study.CONCLUSION Under 25%of hepatitis C patients presenting to an Australian tertiary hospital were appropriately referred for treatment.Advanced age,cirrhosis and admission under medical specialties were predictors of treatment referral.
文摘Background: Low vaccination coverage has been attributed to missed opportunities for vaccination (MOV). This study examines the prevalence of MOV, and its associated factors among children in Cameroon. Methods: Data from the 2018 Demographic and Health Survey (DHS) was analyzed for children with at least one vaccination date in the home-based record (HBR). Immunization performances such as accessibility, drop-out, and timeliness, were assessed. Service quality was assessed using MOV. Multiple logistic regression examined the effect of DHS variables on MOV outcomes, and a decision tree approach was used to study their interaction. Results: Overall, 1824 children aged 12 to 23 months were surveyed;1285 (70.45%) had cards seen with vaccination dates leading to 85.03% of immunization activities. A proportion of 46.5% of children were not completely vaccinated. There was 27% of drop-out between BCG and MCV1, and less than 10% with the specific antigens. Vaccination timeliness proportions ranged from 42.18% for BGC to less than 70% for PENTA1-3. The national prevalence of MOV for simultaneous vaccines was 75.1% (95% confidence interval (CI) = 72;79). Among those who experienced MOV, 67.4% (95% CI = 60 - 73) were uncorrected MOV. MOV was an issue in all regions and comparable in rural areas that urban areas (p = 0.2). Dose-specific MOV ranged from 2.66% (for the third dose of the pneumococcal conjugate vaccine) to 91.12 (for the yellow fever vaccine). Second birth order children experienced more MOV than first born children (adjusted odds ratio (aOR) = 1.67, 95% CI: 1.11 - 2.47). Children born to non-educated/primary level mothers had increased odds of experiencing a MOV than those born to educated mothers (aOR = 1.48, 95% CI = 1.007 - 2.19/aOR = 1.55, 95% CI = 1.12 - 2.09). Children from poorest households were at high risk of experiencing MOV for any vaccine than richest households (aOR = 2.04, 95% CI = 1.11 - 3.76). Conclusion: There is a burden of MOV and under immunized children in the population. Direct interventions that target rural poor and focus on equity gaps that relate to maternal education, socio-economic status, and family planning, should be implemented. Such strategies should aim at reducing MOV for the achievement of the immunization agenda 2030 goals.
文摘Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from prevention of mother-to-child transmission of HIV program and antiretroviral drug resistance. The purpose of the study was to determine the prevalence of missed PMTCT visits and its associated predictors. A descriptive cross sectional survey was carried out at a District Hospital in Goromonzi, Zimbabwe. Fifty-three women completed closed-ended questionnaires pertaining to PMTCT visits and exposure to PMTCT activities. A total of 24.5% missed at least one scheduled PMTCT visit. Statistically significant predictors of not missing a PMTCT visit were satisfaction with family support (β = −0.73, p = 0.029) and level of satisfaction with PMTCT services (β = −0.00076;p = 0.04). The number of days by which scheduled visits were missed were inversely correlated with visit number (β = −2.99, p = 0.04). Enhanced family support and quality improvement to improve patient satisfaction may reduce missed visits. Availing women with a more active role in PMTCT may also reduce the prevalence of missed visits.
文摘Background: With the inflation of economic constraints on health care and demand to increase care quality, there is an increasing need to develop a clear understanding of what actions by health professionals are perceived as threatening quality care. Objective: To explore graduate nursing and pastoral care student’s perceptions of missed care in Norway. Research design: A qualitative study was employed with the formation of six focus groups. Data was analyzed via a thematic content of the discussions. Participants and research context: Thirty-one students attending a University College in Oslo participated. Findings: Five major themes and thirty subthemes were identified. Major themes included labor constraints, organizational contraints, professional constraints, communication constaints and emotional strain. Discussion: Findings of this study resonate with other research as well as with studies on missed nursing care. Findings also lend support to the definition of missed nursing care actions as required care that is omitted, either in part or whole, or delayed. Conclusion: The findings from this study extend understanding of what barriers health professionals perceive as inhibiting them from offering quality care. The focus groups provided a valuable flora for discussion regarding what participants perceived as missed.
基金support from the US National Institutes of Health D43 TW009595 and P30 AI064518 programsCharles Muiruri was supported by the National Heart,Lung,And Blood Institute of the National Institutes of Health trader Award U01HL142099.
文摘Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care.The objective of this study was to examine the relationship between out-of-pocket(OOP)health expenditures and the likelihood of missing appointments.Method:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres(CTC)in Northern Tanzania were enrolled in the study.Clinic attendance and clinical characteristics were abstracted from medical records.Information on OOP health expenditures,demographics,and socio-economic factors were self-reported by the participants.We used a hurdle model.The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings(TZS)increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period.Results:Among these 618 participants,242(39%)had at least one missed clinic appointment in the past year.OOP expenditure was not significantly associated with the number of missed clinic appointments.The median amount of OOP paid was 5100 TZS per visit,about 7%of the median monthly income.Participants who were separated from their partners(adjusted odds ratio[AOR]=1.83,95%confidence interval[CZ]:1.11-8.03)and those aged above 50 years(AOR=2.85,95%CI:1.01-8.03)were significantly associated with missing an appointment.For those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC(P=0.49,95%CI:0.88-0.09)and aged between>25-35 years(P=0.90,95%CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between>25-35 years,above 50 years of age and those who are separated from their partners.
