Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Evaluating The Impact of Giving Tooth Brushing Story Books on The Dental Plaque Levels of Children; A Parallel Arm Non-Randomized Clinical Trial

Objective: To assess the effect of giving toothbrushing storybooks along with verbal oral hygiene (OHI) instructions on plaque levels to schoolchildren. Methodology: This quasi-experimental study was conducted in a private school in Islamabad from October to November 2022. Children in Class V were selected as the Experimental Group I (Storybooks + OHI), while Class IV children were placed in the Control Group II (OHI alone). There were 20 students in each group. Plaque levels were compared at the baseline (before intervention) and after seven days. Toothbrushing practices were recorded at the baseline. Results: The mean age of the children was 9.6 + 1.08 years. A total of 16 (40%) boys and 24 (60%) girls were included in the study. Children in Group II had significantly better self-reported toothbrushing practices with 16 (80%) children brushing twice a day, as compared to 10 (50%) children from Group I (p = 0.041). There was no difference in the reduction in plaque scores between group I (0.14 + 0.21) and group II (0.08 + 0.21; p = 0.382). Conclusion: Giving story books to children is not an effective intervention to improve the oral hygiene status of children, as compared to oral hygiene instructions alone

EXPLORING PSYCHOSOCIAL AND MENTAL HEALTH ISSUES OF FEMALE WITH ACNE VULGARIS: A PHENOMENOLOGICAL STUDY.

Objective: The purpose/objective of this study was to explore psychosocial and mental health issues of females with acne vulgaris.  Methodology: In this qualitative study phenomenological approach was used. 8 Participants having severe acne vulgaris were selected by purposive sampling technique with the age range of 18 to 25. Semi-structured interviews were conducted to collect the information which was then analyzed by interpretive phenomenological Analysis. Results: Analysis revealed the combination of psychosocial and mental health problems experienced by females with acne vulgarois in the form of seven major themes which were frustration, inferiority complex, discrimination, bullying, physical discomfort,depression and social appearance anxiety. Conclusion: Culture has a significant part in the negative experiences that acne vulgaris have.Social stigmatiztion on the baisis of perceived terms which define beauty they are considered physically unattractive. As interviews were conducted in the hospital settings which don’t match the standards required for extraction of quality information.multitmodial method should be used to know exact causes of the problem.Clinicians must first take hold of the nature of the psychosocial and mental health experience of acne problems in order to provide information and help.The findings of this study give physicians with meaningful, empirically based information on how to develop awareness  in peoplehaving acne vulgaris to cope with psychosocial and mental health concern.The development of a comprehensive understanding of the experiences of females with acne problems, will lead to intervention strategies aimed to psycho-educate the females with acne to improve their ability to perform exceptionally well at their daily routine work

Exploring Drug-Related Problems in Diabetic Patients during Ramadan Fasting in Saudi Arabia: A Mixed-Methods Study

This study aimed to identify any drug-related problems (DRPs) in diabetic patients during Ramadan fasting in Saudi Arabia. The study used a mixed-methods approach consisting of two phases and was conducted in Makkah, Saudi Arabia from December 2017 to March 2018. The first phase of the study involved qualitative semi-structured individual interviews with diabetic patients. A 13-item questionnaire was used in the second phase to further identify DRPs in the wider population. The data was mainly presented as frequencies and percentages. Inferential statistics was performed using Statistical Package for Social Sciences (SPSS) version 21 to compare relevant variables/questions using the chi-square test. Twenty patients (10 male, 10 female) attended face-to-face interviews during the first phase of the study while 95 (40 male, 55 female) completed the questionnaire in the second phase of the study. Two possible risk factors for DRPs were identified from the qualitative data: patient-related factors, including changes in their medicine intake during fasting, and healthcare professionals-related factors, including lack of advice from healthcare professionals regarding fasting. The quantitative results indicated that 52 (54%) of the 95 participants who observed fasting reported to have changed the way they were taking their medicines. Furthermore, 41% of the participants experienced general healthcare problems such as hypoglycemia, hyperglycemia, fatigue, excessive sweating, and gastrointestinal disturbances. Healthcare professionals need to educate patients who are at risk of DRPs by providing structured education and counseling