Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation and Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Treatment: A Pilot Study among Zambian Women

Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.

Successful outcome of massive carbon dioxide embolism during laparoscopic hepatectomy

Carbon dioxide embolism is a rare but severe complication of laparoscopic hepatectomy.We reported a case of massive carbon dioxide embolism that developed into a rare paradoxical gas embolism during laparoscopic hepatectomy and resulted in reduced muscular power of the left upper extremity,severe pleural effusion and hypoalbuminemia after surgery.Fortunately,the patient fully recovered with positive prevention and postoperative treatment.This case report highlights that the surgeon and anaesthesiologist must be aware of the risks and the importance for prompt treatment when massive carbon dioxide embolism occurs.

Orienting a new generation of nurses: Expectations of the millennial new graduate

Generational diversity provides a unique quandary for nursing leaders and educators to enlist, orient, and retain nurses. Millennials are the largest cohort since the Baby Boomers and the age group from which the nursing profession will build its future workforce. This study examined the experiences of the new graduate nurse of the millennial generation as they navigate orientation in an acute care setting. Using a Web-based survey to conduct the study allowed nurses from across the country to participate while providing easy access to the study questions. Analysis of the data through qualitative content analysis demonstrated a dominate theme of seeking structure while expecting an individualized orientation. The survey also revealed the importance of the preceptor and manager in the perceived success of this generation’s transition and a need to assimilate into the professional role of RN. Recognizing that there is a need to promote a more individualized orientation with improved mentoring for novice nurses and their preceptors is evident and challenges nursing leaders and educators to rethink current practices to retain new nurses. Established roles within the hospital and individual nursing units are changing and traditional strategies for recruitment and retention no longer apply. A structured orientation can facilitate the transition from new graduate to professional nurse and assist in the retention of qualified nurses and ultimately safe patient care.

Clinical nursing competency assessment:a scoping review

Objective:To ensure that only competent graduates are licensed to practice nursing,councils conduct licensing examinations,which may include among others clinical competency assessment.This review explored current practices in clinical competency assess­ment of nursing students as part of a larger study aimed at developing an evidence-based,context-specific framework for clinical competency assessment in a sub-Saharan African(SSA)country.Methods:A scoping guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR)was conducted.Results:Findings from 28 out of 1151 studies identified from Scopus,PubMed,CINAHL,Wiley Online Library,and ProQuest were included and synthesized.Results show that a good assessment system must be valid,reliable,transparent,feasible,fair,objective,and must provide feedback and continually improve to have an educational impact.Clinical competency assessment systems must be developed on sound empirical evidence,pilot tested,and involve thorough training and evaluation of the examiners.Continuous evaluation of the assessment system is also essential to ensure the quality and relevance of the assessment system.Only one of the included studies was conducted in Africa.Conclusions:The paucity of clinical competency assessment research in sub-Saharan Africa may lead to benchmarking assessment systems on research conducted outside the context.Sub-Saharan Africa has a set of circumstances that demand a context-specific clinical competency assessment framework to guide clinical competency assessment.

Determining the effect of Plantago major L. and Rosa damascene herbal ointment for bedsore healing

Background:Bedsores are damage or loss of skin integrity due to prolonged pressure which there are several ways to treat and prevent them.The aim of the study was to determine the effect of Plantago major L.and Rosa damascene herbal ointment for bedsore healing in hospitalized patients.Methods:This clinical trial study was accomplished with 100 patients divided into control(50 patients)and intervention(50 patients)groups.The control group had received routine treatment(dressing with Comfeel),but the intervention group only had received herbal ointment and then both groups were compared with each other through the pressure ulcer scale for healing(PUSH)tool.Results:The mean and standard deviation of recovery time in the Comfeel group was 27.40±12.467 and in the herbal ointment group was 21.57±12.695.In the pre-intervention evaluation,the mean and standard deviation of the PUSH score in the herbal ointment group was 10.44±0.323 while in the last evaluation in the same group it was 0.68±0.288 but in the Comfeel group,in the pre-intervention evaluation,the mean and standard deviation of the PUSH score was 10.68±0.317,while in the last evaluation it was 1.98±0.472.The highest frequency of bedsores in the study units was in the sacral region(49%)and the lowest frequency was in the sole of the foot with 1%.Conclusion:The results showed that Plantago major L.and Rosa damascene herbal ointment was effective in accelerating recovery time and wound healing.

肯尼亚西阿亚医院护士对患者家属在场时实施复苏的自信心与实践的关联性研究

目的本研究旨在确定护士对家属在场时实施复苏的自信心与实践之间的关系,并描述护士对相关情形的偏好。方法采用横断面调查方法,研究对象来自肯尼亚西阿亚县转诊医院内外科不同单元。采用匿名自填问卷进行调查,主要测量工具为Twibel等设计的家属在场自信量表(Family Presence Self-confi-dence Scale)。采用χ^(2)检验和二元回归分析进行统计学分析。结果护士对家属在场时实施复苏操作的自信心与实践存在关联(χ^(2)=8.060,P=0.01)。非常自信的护士在临床实践中实施家属在场情况下复苏操作的可能性是有点自信的护士的4.9倍(OR=4.94,95%CI 1.07~22.71)。结论护士对实施家属在场复苏操作的自信心差异较大。为成功实施家属在场复苏实践,护士还需通过更多专门培训和实践获得更高水平的自信心。

Factors influencing comfort level in head and neck neoplasm patients receiving radiotherapy

Objective:To determine factors that influence comfort in head and neck neoplasm patients receiving radiotherapy.Methods:In total,200 head and neck neoplasm patients receiving radiotherapy were recruited from three tertiary first class hospitals.They were assessed by Radiotherapy Comfort Questionnaire for patients with head and neck neoplasm,Social Support Scale,and Medical Coping Modes Questionnaire.Results:The total score of comfort was 60.54±8.32.Multiple linear regression analysis indicated that number of radiation treatments,family accompaniment,educational level,resignation coping mode,complications due to diabetes,accompanying chemotherapy,and the utilization of social support significantly influenced comfort level(p<0.05).Among these,number of radiation treatments,complications due to diabetes,accompanying chemotherapy,and resignation coping were negative factors.Conclusion:Encouraging utilization of social support systems and a positive coping mode is important for increasing comfort level in head and neck neoplasm patients during radiotherapy.Nurses should pay particular attention to those patients during later stages of radiotherapy or chemotherapy,with diabetes,without family accompaniment,and with lower education level.

Chinese Herbal Medicine Combined Conventional Chemotherapy Regimens in Advanced Recurrent Breast Mammary Carcinoma

Purpose: Aiming at starting the ball rolling and contributing humble effort to promoting traditional Chinese medicine, we report one successful case of “GP” regimen of combining chemotherapy with traditional Chinese medicine decoction (“lung description”) for breast cancer with lung and bone metastases. Patients and Methods: A second-line chemotherapy regimen of GP (cisplatin + gemcitabine) was applied. In the meantime, we administered Chinese herbal medicine (Fei Decoction, mixed with a variety of effective herbal components) to help her recover from the poor condition. Results: The tumor markers (CEA, CA15-3) had dramatically decreased to the normal range. Both lung and bone metastatic sites reduced according to CT and ECT imaging, and this patient felt free from the complaint of pulmonary and cardiac discomfort. The quality of life has been greatly improved, and the PFS (Progression-Free-Survival) and TTP (Time-to-Progression) have been prolonged from the onset to date. Conclusions: In the course of this combined treatment, it has been shown that Chinese herbal medicine played an important role in the therapy of breast mammary carcinoma. Therefore, Chinese herb may turn out to be an additional choice with its better benefits and tolerability in the treatment of recurrent breast mammary carcinoma.

湿疹和银屑病患者接受皮肤科治疗后生活质量的改变

The objective of this study was to assess the impact of chronic dermatological diseases on quality of life (QoL) of Norwegian patients following in-patient management. QoL was measured by the Norwegian version of the Dermatology Life Quality Index, a validated, self-administered questionnaire. Adult inpatients with psoriasis and eczema were selected for one year from the dermatological departments in Norway. A total of 212 patients were included, and 126 patients (50% men, 85 with psoriasis and 41 with eczema, mean age 46 years) completed the questionnaires at time of hospital admission and one week after discharge. The patients reported adverse impacton QoL, but no differences between the psoriasis and eczema groups could be demonstrated. Patients with psoriasis improved from 18.3 (7.6) (mean (SD)) to 12.1 (8.2) (p < 0.01), and those with eczema improved from 20.0 (6.0) to 14.4 (7.8) (p < 0.01). Seventy percent of the patients showed improvement, 20% remained unchanged and 10% worsened. The parameters for which the most improvement was seen were those that were of most concern to the patients, i.e. their symptoms and embarrassment. In conclusion, the results are consistent with previous international studies.

Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation, and Loop Electrosurgical Excision Procedure for Cervical Treatments among Reproductive Age Women in Zambia

Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Most recipients are women of reproductive age who, as reported in the literature, may be at risk of adverse pregnancy outcomes. This study investigated the risk of abortions, prematurity, stillbirths, and prolonged labor among reproductive-age women following Cryotherapy, Thermal ablation, and Loop Electrosurgical Excision Procedure treatments in Zambia. Methods: This cross-sectional study analyzed records of 8000 women aged 15 - 49 years at the Adult Infectious Disease Control Centre using records between January 2010 and December 2020. Women constituting the treatment group were all respondents treated by cryotherapy, thermal ablation, and LEEP, while the control group were VIA negative women. Women from both groups were invited to answer a phone survey. Data were analyzed using Stata version 16;descriptive analysis estimated the prevalence and obtained the frequency distribution of abortion, prematurity, prolonged labor and fresh stillbiths. Chi-square and Fisher’s exact test established the associations of CIN and APOs at 95% Confidence intervals. Univariate and multivariable binary logistic regression estimated the odds of adverse pregnancy outcomes across the three treatments. Results: Adverse pregnancy outcomes were more prevalent in the treatment group (39.2%) compared to the untreated group (16.9%). Across the two groups, normal outcomes were lower in the treated (42.3% vs 57.7%). The treated group accounted for the majority of abortions (74.5% vs 25.5%) and prolonged labor (72.5% vs 27.5%), while the untreated group accounted for higher proportions of stillbirths (66.7% vs 33.3%) and prematurity (53% vs 47%). Adverse pregnancy outcomes were five and two times more likely in women treated with thermal ablation (aOR = 5.05, 95% CI = 4.01 - 6.36, p Conclusion: Cervical treatment among Zambian women increases the risk of abortion and prolongs labor. Therefore, caution should be taken when administered to those of reproductive age. Vigilant monitoring should be maintained during pregnancy, delivery, and postpartum to improve maternal and neonatal health.