BACKGROUND

Healthcare-acquired infections (HAIs) are adverse events brought about by non-compliance of the healthcare staff to set of infection prevention and control (IPC) standards. Consequently, additional medical costs, increased mortality and morbidity rates, and decreased quality of life among patients can happen. As valuable players in preventing and controlling HAIs, nurses must have good knowledge and strict compliance with infection control; however, recent evidence suggests that nurses may need more knowledge or better integration into practice. Nurses' degree of knowledge and practice in preventing and controlling HAIs and factors influencing them should be determined to provide solutions appropriately.

The study specifically sought answers to the following questions: (1) What is the level of knowledge of nurses in the prevention and control of HAIs? (2) What is the degree of practice of nurses in the prevention and control of HAIs? (3) Is there a significant relationship between nurses' knowledge level and degree of practice in the prevention and control of HAIs? (4) What are the facilitating and hindering factors that affect nurses' practice in the prevention and control of HAIs?

The study utilized a quantitative descriptive correlational design. The study was conducted from May to June 2023 at a private tertiary hospital in Baguio City. The study included 128 nurses who fit the inclusion criteria. The respondents were asked to answer three questionnaires, and the data were statistically treated using mean, Spearman Rank correlation, frequency, percentage, and rank distribution.

The study found that nurses possess good knowledge and a suboptimal degree of practice in preventing and controlling HAIs. The results showed that no significant relationship existed between nurses' knowledge level and degree of practice in preventing and controlling HAIs. Perceived personal benefits and organizational encouragement were seen to primarily facilitate the prevention and control practices of nurses. The primary hindrance identified was workload due to staff shortage, poor dissemination of guidelines, and personal discomfort associated with the use of PPE.

A good level of knowledge is a derivative of learnings obtained through various educational modalities and these strategies are considered effective means of knowledge formulation. However, created knowledge without actual application into practice results in overuse of unhelpful interventions. To avoid the unnecessary effects of ineffective knowledge translation, a multifactorial consideration is necessary to identify other factors that may influence the practices of nurses on HAI prevention and control because knowledge does not solely improve or worsen actual practices. Identified facilitating factors should be supported, and hindering factors should be addressed. Further recommendations based on the study results include strengthening existing programs and policies, and developing accessible materials to improve the present practices of nurses.

INTRODUCTION

Effective mosquito control is pivotal in the epidemiology of vector-borne diseases, but no successful preventive measures have been recorded for dengue vector control. Hence, possible alternatives to chemical larvicides have been explored, including plant alcoholic extracts. This study determined the larvicidal efficacy of Annona squamosa ethanolic leaf extracts against third instar larvae of Aedes aegypti.

Three replicates of varying concentrations of Annona squamosa ethanolic extract (i.e., 10%, 40%, and 70%) versus positive (Novaluron) and negative controls (tap water) were used to determine larval mortality.

Greatest larval mortality was noted using the 70% concentration (i.e., 24% versus the observed values of 20% and 8%, respectively for the 40% and 10% ethanolic concentrations). Relative to the controls, the mean differences in the mortality rates of the Aedes aegypti larvae across the leaf ethanolic concentrations were statistically significant (i.e., p-value < 0.05). There was increasing trend in larval mortality over time, but 50% lethal dose was not achieved. In conclusion, the different Annona squamosa ethanolic leaf extracts could be used as alternative botanical larvicides against Aedes species.

BACKGROUND

There is an increasing population of elderly patients with diabetes. Malnutrition has been associated to higher morbidity and mortality among these patients. Currently, there are limited data on malnutrition and its risk factors among elderly patients with diabetes in the Philippines.

This study determined the prevalence, clinical profile and risk factors associated with malnutrition and identify the association of malnutrition with glycemic status and insulin resistance among elderly patients with diabetes.

This is a cross-sectional study involving 117 elderly patients with diabetes seen at a tertiary hospital in Manila, Philippines. Demographic, anthropometric, and clinical data were collected. Mini-Nutritional Assessment-Short form (MNA-SF), Simple FRAIL questionnaire and Mini-cog assessment were administered. Patients were categorized into normal, at risk for malnutrition, and malnourished using the MNA-SF. Comparative and logistic regression analyses were performed to identify the clinical profile and possible risk factors.

The prevalence of malnutrition was 1.71% with 29.06% at risk for malnutrition. There was no significant difference in demographic, anthropometric and biochemical parameters between the different nutrition statuses. High BMI, central obesity, and increased insulin resistance were observed across all nutrition status. Frail patients had almost five times increased likelihood (OR=4.94, p=0.043) of developing malnutrition. Good glycemic control had two-fold decreased likelihood (OR=0.44, p=0.050) of malnutrition. Insulin resistance was not associated with malnutrition.

Malnutrition is prevalent among elderly patients with diabetes. Frailty and poor glycemic control increased the risk of malnutrition. Therefore, malnutrition screening should be routinely performed among these patients. Diabetes management among elderly patients should include maintaining good glycemic control and preventing frailty and its complications.

Child ; Humans ; Mpox (monkeypox)/prevention & control* ; Disease Outbreaks

Objective: To determine the efficacy of metformin and insulin in the management of gestational diabetes mellitus (GDM). Methodology: Randomized controlled trials (RCT) were retrieved from the databases. All references cited in the articles were also searched by hand to identify additional publications. Studies included were limited to trials on metformin and insulin in the management of GDM in singleton pregnancies. Four RCTs were analyzed in the study. The risk of bias was assessed using Preferred Reporting Items for Systematic reviews and Meta-Analyses Cochrane Collaboration’s tool (Rob 2). Random effects meta-analysis was carried out to pool the data. All analyses were conducted in Review Manager 5.3.5 (2014). Results: Meta-analysis of four RCT involving 807 participants (405 were treated with metformin and 402 were treated with insulin) shows that there was no significant difference between metformin and insulin in achieving glycemic control as to fasting blood sugar (FBS), postprandial blood glucose (PPBG), and glycosylated hemoglobin, mean difference (MD) −0.43 (95% confidence interval [CI] −2.77–1.91; P = 0.72), MD −2.13 (95% CI −5.16–0.90, P = 0.17), MD −0.09 (95% CI −0.20–0.02, P = 0.10), respectively. For maternal outcomes, there was a statistically significant 69% decreased risk of hypoglycemia in the metformin group (risk ratio [RR] 0.31, 95% CI 0.20–0.49; P < 0.001). There was no difference in terms of risk of preterm birth (RR 1.11, 95% CI 0.75–1.64, P = 0.60); hypertensive disorders (RR 1.06, 95% CI 0.71–1.60, P = 0.77); polyhydramnios (RR 1.04, 95% CI 0.51–2.14, P = 0.91); and risk of cesarean delivery (RR 0.90, 95% CI 0.75–1.08, P = 0.27). For neonatal outcomes, there was statistically significant 34% reduction on the risk of neonatal hypoglycemia (RR 0.66, 95% CI 0.46–0.94; P = 0.02) in the metformin group. There was no statistical difference in terms of mean birthweight (MD − 81.34, 95% CI −181.69–19.02, P = 0.11). Metformin has decreased the risk of newborns weighing more than 4000 g, babies with birthweight >90th percentile by 27% (RR 0.73, 95% CI 0.28–1.90, P = 0.52), and 20% (RR 0.80, 95% CI 0.54–1.18,P = 0.26), respectively, but these were not statistically significant. There was no significant difference in terms of risk of birthweight <10th percentile (RR 1.17, 95% CI 0.60–2.31, P = 0.65); APGAR <7 (RR 1.17, 95% CI 0.65–2.08, P = 0.60), birth trauma (RR 0.77, 95% CI 0.23–2.58, P = 0.67), and jaundice requiring phototherapy RR 1.04, 95% CI 0.66–1.65, P = 0.85). Neonatal intensive care unit admission (RR 0.89, 95% CI 0.64–1.23, P = 0.48), respiratory distress syndrome (RR 0.73, 95% CI 0.36–1.50, P = 0.39), transient tachypnea (RR 0.78, 95% CI 0.27–2.19, P = 0.63), and any congenital anomaly (RR 0.58, 95% CI 0.20–1.67, P = 0.31) were decreased in the metformin group but was not statistically significant. Conclusion There was no significant difference between metformin and insulin in achieving glycemic control as to FBS and PPBG among patients with GDM. There was a statistically significant reduction in the risk of maternal and neonatal hypoglycemia in the use of metformin.
Diabetes, Gestational ; Glycemic Control ; Insulin ; Metformin

Background: Healthcare-acquired infections (HAIs) are adverse events brought about by non-compliance of the healthcare staff to set of infection prevention and control (IPC) standards. Consequently, additional medical costs, increased mortality and morbidity rates, and decreased quality of life among patients can happen. As valuable players in preventing and controlling HAIs, nurses must have good knowledge and strict compliance with infection control; however, recent evidence suggests that nurses may need more knowledge or better integration into practice. Nurses' degree of knowledge and practice in preventing and controlling HAIs and factors influencing them should be determined to provide solutions appropriately. Objectives: The study specifically sought answers to the following questions: (1) What is the level of knowledge of nurses in the prevention and control of HAIs? (2) What is the degree of practice of nurses in the prevention and control of HAIs? (3) Is there a significant relationship between nurses' knowledge level and degree of practice in the prevention and control of HAIs? (4) What are the facilitating and hindering factors that affect nurses' practice in the prevention and control of HAIs? Methods: The study utilized a quantitative descriptive correlational design. The study was conducted from May to June 2023 at a private tertiary hospital in Baguio City. The study included 128 nurses who fit the inclusion criteria. The respondents were asked to answer three questionnaires, and the data were statistically treated using mean, Spearman Rank correlation, frequency, percentage, and rank distribution. Results: The study found that nurses possess good knowledge and a suboptimal degree of practice in preventing and controlling HAIs. The results showed that no significant relationship existed between nurses' knowledge level and degree of practice in preventing and controlling HAIs. Perceived personal benefits and organizational encouragement were seen to primarily facilitate the prevention and control practices of nurses. The primary hindrance identified was workload due to staff shortage, poor dissemination of guidelines, and personal discomfort associated with the use of PPE. Conclusions A good level of knowledge is a derivative of learnings obtained through various educational modalities and these strategies are considered effective means of knowledge formulation. However, created knowledge without actual application into practice results in overuse of unhelpful interventions. To avoid the unnecessary effects of ineffective knowledge translation, a multifactorial consideration is necessary to identify other factors that may influence the practices of nurses on HAI prevention and control because knowledge does not solely improve or worsen actual practices. Identified facilitating factors should be supported, and hindering factors should be addressed. Further recommendations based on the study results include strengthening existing programs and policies, and developing accessible materials to improve the present practices of nurses.
Infection Control

Background: According to the guidelines of the Department of Health (DOH)’s Health Facilities and Services Regulatory Bureau (HFSRB), accreditation of drug testing laboratories (DTLs) requires annual participation in a proficiency testing (PT) program. Since 2009, the National Reference Laboratory for Environmental and Occupational Health, Toxicology and Micronutrient Assay of the East Avenue Medical Center (NRL-EAMC) has conducted the PT program for DTLs. Objectives: This article aims to provide a general overview of the PT program conducted for screening drug testing laboratories (SDTLs) and to examine data on laboratories’ participation and performance in the PT program. Methodology: Laboratories registered for the PT program were given ten 3-mL synthetic urine specimens which may or may not contain drugs of abuse such as methamphetamine and tetrahydrocannabinol at or above the cut-off level. Laboratories analyzed the PT specimens using immunoassay test kits. The results of the analysis were reported back to NRL-EAMC. The performance of the laboratories in the PT depends on the number of incorrect responses. Results: For ten years (2009-2019), 1102 ± 188 laboratories annually participated in the program. The mean passing rate was 96.6 ± 4.8%. The number of laboratories which initially failed the PT program significantly decreased from 2009 (15.1%) to 2012 (1.5%). From 2013 to 2019, only below 2.5% of the participating laboratories initially failed the PT. On average, 48.4 ± 18.4% of the laboratories achieved an excellent performance, 34.0 ± 13.6% had a highly satisfactory performance, and 14.3 ± 5.4% got an acceptable performance. Conclusion The continued decreasing number of laboratories which failed the PT signifies the improvement of laboratories in urine drug testing. In general, some laboratories participating in the PT for the first time are the ones which initially fail the PT which could be due to a lack of experience in handling PT test items. The PT program highlights the effectiveness of quality control procedures being implemented in a drug testing laboratory.
Laboratories ; Quality Control ; Accreditation ; Methamphetamine

BACKGROUND: Owing to shortage of surgical and N95 filtering facepiece respirators (FFRs) during the COVID-2019 pandemic, various masks were developed to prevent infection. This study aimed to examine the inward leakage rate (ILR) of sealed face masks and modified surgical masks using a quantitative fit test and compared it with the ILR of unmodified N95 FFRs. METHODS: We conducted paired comparisons of ILRs of bent nose-fit wire masks, double masks, and N95 FFRs from October to December 2021. To measure the protective effectiveness of masks, participants wore masks, and the number of particles outside and inside the mask were measured. The ILR was based on the percentage of particles entering the mask using a fit tester. RESULTS: We enrolled 54 participants (20 men and 34 women) in this study. The median ILR for surgical masks without and with a W-shaped bend in the nose-fit wire were 96.44% and 50.82%, respectively. The nose-fit wire adjustment reduced the ILR of surgical masks by a mean of 28.57%, which was significantly lower than the ILR without adjustment (P < 0.001). For double masks, with surgical or polyurethane masks on top of the W-shaped mask, the ILR did not differ significantly from that of N95. Although the filtration performance of double surgical masks matched that of N95 masks, their ILR was notably higher, indicating that double masks do not provide equivalent protection. CONCLUSIONS Wearing N95 masks alone is effective in many cases. However, surgical mask modifications do not guarantee consistent effectiveness. Properly selected, sealed masks with a good fit overcome leakage, emphasizing their crucial role. Without evidence, mask-wearing may lead to unexpected infections. Education based on quantitative data is crucial for preventing adverse outcomes.
Male ; Humans ; Female ; N95 Respirators ; COVID-19/epidemiology* ; Masks ; Pandemics/prevention & control* ; Respiratory Protective Devices ; Materials Testing ; Equipment Design ; Occupational Exposure/prevention & control*

INTRODUCTION: The use of periarticular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) TXA have not been well explored in the literature. This retrospective cohort study aimed to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate postoperative pain relief and functional outcomes in patients after unilateral primary total knee arthroplasty (TKA). METHODS: A total of 63 patients underwent TKA, and they were divided into the IA TXA delivery group ( n = 42) and PA TXA delivery group ( n = 21). All patients were administered 1 g of TXA. They also received pericapsular infiltration consisting of 0.5 mL of adrenaline, 0.4 mL of morphine, 1 g of vancomycin, 1 mL of ketorolac and 15 mL of ropivacaine. Outcomes for blood loss and surrogate markers for immediate functional recovery were measured. RESULTS: Of the 63 patients, 54% were female and 46% male. The mean drop in postoperative haemoglobin levels in the PA and IA groups was 2.0 g/dL and 1.6 g/dL, respectively, and this was not statistically significant ( P = 0.10). The mean haematocrit drop in the PA and IA groups was 6.1% and 5.3%, respectively, and this was also not statistically significant ( P = 0.58). The postoperative day (POD) 1 and discharge day flexion angles, POD 1 and POD 2 visual analogue scale (VAS) scores, gait distance on discharge and length of hospitalisation stay were largely similar in the two groups. CONCLUSION Our study showed that both IA and PA TXA with analgesic components were equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.
Humans ; Male ; Female ; Tranexamic Acid/adverse effects* ; Arthroplasty, Replacement, Knee/adverse effects* ; Antifibrinolytic Agents/adverse effects* ; Retrospective Studies ; Postoperative Hemorrhage ; Blood Loss, Surgical/prevention & control* ; Administration, Intravenous ; Analgesia ; Analgesics/therapeutic use* ; Pain, Postoperative/drug therapy* ; Injections, Intra-Articular

Cardiovascular risk assessment is a basic tenet of the prevention of cardiovascular disease. Conventional risk assessment models require measurements of blood pressure, blood lipids, and other health-related information prior to assessment of risk via regression models. Compared with traditional approaches, fundus photograph-based cardiovascular risk assessment using artificial intelligence (AI) technology is novel, and has the advantages of immediacy, non-invasiveness, easy performance, and low cost. The Health Risk Assessment and Control Committee of the Chinese Preventive Medicine Association, in collaboration with the Chinese Society of Cardiology and the Society of Health Examination, invited multi-disciplinary experts to form a panel to develop the present consensus, which includes relevant theories, progress in research, and requirements for AI model development, as well as applicable scenarios, applicable subjects, assessment processes, and other issues associated with applying AI technology to assess cardiovascular risk based on fundus photographs. A consensus was reached after multiple careful discussions on the relevant research, and the needs of the health management industry in China and abroad, in order to guide the development and promotion of this new technology.
Humans ; Cardiovascular Diseases/prevention & control* ; Artificial Intelligence ; Consensus ; Risk Factors ; Heart Disease Risk Factors