Current Issue : July-September Volume : 2025 Issue Number : 3 Articles : 5 Articles
Introduction: Despite reduced fees, many patients struggle to access care at the National Center for Research and Care for Sickle Cell Patients (CNRSD). This prompted an evaluation of the costs associated with managing a painful vaso-occlusive crisis (VOC), the most common reason for hospitalization among individuals with sickle cell disease. Methods: This was a cross-sectional study which was conducted among patients admitted to the CNRSD for painful VOC. Costs were calculated in CFA francs (XOF), encompassing consultation fees, medication expenses, laboratory test costs, and hospitalization charges. The total cost per patient was derived by summing these components. Results: The study included 300 patients with a median age of 16.5 years. Most were children and adolescents (61.33% were under 20 years of age) with an SS genotype (64%). The average length of hospital stay was 3.1 days, with variations based on genotype. The median cost of managing a VOC episode was 64,130 XOF (€97.77), with 66.5% of this expenditure attributable to medications and consumables. Costs were influenced by age and genotype but were not associated with the presence of comorbidities. Notably, 67.33% of patients reported no fixed monthly income, significantly hindering their ability to afford care. Conclusion: The cost of managing a painful VOC episode is relatively high, exceeding the minimum wage in Togo. The lack of universal health insurance coverage exacerbates the difficulty for individuals with chronic conditions, such as sickle cell disease, to access quality care....
Acute pharyngotonsillitis is a common reason to visit primary care providers. Group A Streptococcal (GAS) pharyngitis is the most common bacterial infection which needs antibiotic treatment. GAS accounts for only 10–15% of adult acute pharyngitis cases. The overuse of antibiotics for viral pharyngotonsillitis is common and may lead to inappropriate antimicrobial stewardship and the emergence of bacterial resistance. However, the etiology of acute pharyngotonsillitis for hospitalized adult patients is rarely studied. So, we reported the 10-year surveillance data of hospitalized adult patients with acute pharyngotonsillitis in a regional hospital in Taiwan. Every consecutive adult patient admitted with acute pharyngotonsillitis in 2011–2021 was recruited for a complete etiology study. The etiology of acute pharyngotonsillitis was identified in 117 patients. Overall, 42 herpes simplex virus cases, 26 adenovirus cases, 16 acute human immunodeficiency virus cases, 12 influenza cases, three parainfluenza cases, six Epstein–Barr virus cases, one cytomegalovirus case, four enterovirus cases, one varicella-zoster virus case, four Mycoplasma pneumoniae cases, one Chlamydophila pneumoniae case, and only one GAS case were identified. The average of the points for the Modified Centor Criteria was 1.38 (55% of patients with 0–1 points and 45% with 2–3 points). However, 88.9%of patients received antibiotics at the emergency department, and 76.9%also received antibiotics while hospitalized. Only a few patients required antibiotic treatment, while the majority of patients with viral illness needed only symptomatic treatment. However, distinguishing viral etiology from GAS pharyngitis is challenging even in the presence of tonsil exudates, high C-reactive protein, and leukocytosis. A diagnostic algorithm and the application of the Modified Centor Criteria should be considered for hospitalized adults with acute pharyngotonsillitis to improve antimicrobial stewardship....
Background: In response to the limitations of logical empiricism, interpretivism emerged as a philosophical approach for developing nursing knowledge. This paper discusses interpretivist constructivism and its value to qualitative nursing research. Methods: The paper synthesizes relevant literature on the importance of interpretivist constructivism in nursing research. It reviews the key elements of interpretivism, the principles of constructivism, the connection between the two approaches, the benefits and limitations of constructivism in nursing research, and the steps for conducting constructivist stroke nursing research. Results: Interpretivist constructivism emphasizes the importance of human experiences, interactions, and social contexts in knowledge development. It allows nurse researchers to adopt flexible, participant-driven approaches to explore and understand complex subjective human phenomena. This approach respects the unique perspectives and contexts of stakeholders, including patients, caregivers, healthcare professionals, and knowledge users. By following specific steps, constructivist researchers can improve the rigor, transparency, and validity of qualitative nursing research while reducing biases in interpreting the inherently subjective experiences of patients. Conclusion: A deeper understanding of the complexities of interpretivism and constructivism in qualitative research is essential. This paper provides a clear, comprehensive guide for effectively applying these approaches in qualitative nursing research....
Background: Pulmonary embolism (PE), particularly in its severe form, presents a critical clinical challenge requiring immediate intervention. Thrombolytic therapy is widely recognized as a cornerstone of treatment, but its application in settings with limited resources, such as in Sub-Saharan Africa, is not well documented. This study investigates the role of thrombolysis in managing severe pulmonary embolism in an intensive care unit (ICU) at a leading referral hospital in Sub-Saharan Africa. Methods: We performed a retrospective analysis of patients admitted to the ICU with severe pulmonary embolism over a 10-year period (2013-2022) at a major tertiary hospital in Sub-Saharan Africa. Clinical data, including demographic characteristics, treatment modalities, and outcomes, were reviewed. The primary outcome was in-hospital mortality, with secondary outcomes focusing on complications and factors influencing survival. Results: Among 150 patients diagnosed with severe pulmonary embolism, 13 (8.7%) received thrombolytic therapy. The average age of the cohort was 48 years (SD = 12), and comorbidities such as hypertension (35%) and diabetes (20%) were prevalent. The mortality rate for patients who received thrombolysis was significantly lower at 15%, compared to 45% in those who did not receive thrombolysis (p < 0.05). Complications in the thrombolysis group included major hemorrhages (15%), with 3% of patients experiencing cerebral bleeding. Delays in thrombolytic administration, partic-ularly beyond 3 hours, were linked to worse outcomes (p < 0.01). Conclusions: In this Sub-Saharan African ICU cohort, thrombolysis substantially decreased in-hospital mortality in patients with severe pulmonary embolism. While the therapy was administered to only a small proportion of patients due to resource limitations and delays, its use highlighted its efficacy. This study emphasizes the need for timely thrombolysis and the improvement of healthcare infrastructure in resource-constrained environments to enhance outcomes for patients with life-threatening pulmonary embolism....
Effective communication between the members of the healthcare team and the patient and families is essential components for patient-centered care, and it improves patient outcomes. Likewise, poor communication between healthcare team members and the patient and families is associated with poor patient outcomes. Due to several communication challenges, the use of visual tools such as bedside WB to enhance communication has been widely implemented; however, the exact benefit of its use from patient perspective is still understudied. Thus, this study aims to determine the impact of bedside WB use in facilitating patient’s involvement in achieving the day’s goal, adherence to pain medication schedule and use, tests and procedures schedule, patients and family engagement with the healthcare team, and discharge planning. This study is a descriptive cross-sectional study conducted among 335 patients and/or family members admitted in six hospitals in Makkah city: Al Noor hospital, Hera hospital, King Abdul-Aziz hospital, King Abdullah Medical City, King Faisal specialist hospital, and Maternity and Children hospital. The survey questionnaire used was adapted from previous studies and revalidated to ensure its suitability to the study subjects. Data collection was performed from August 1 to 31, 2020 and data analysis was done with SPSS software. Of the 335 participants, the majority were satisfied to bedside white board for its use (4.36), and they recommend it to be used in hospitals because they perceived that through this medium of communication, their connection with the healthcare team will be easier (4.35). In regression analysis, the day’s goal and patient and/or family member engagement are found to be the significant predictors of patient’s satisfaction level. Therefore, WB is a useful tool to help patients achieve their daily goals and to improve their engagement with the healthcare team which also impacts on patient satisfaction....
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