Enhanced recovery after surgery versus conventional postoperative care in patients undergoing hysterectomy: a systematic review and meta-analysis.

PURPOSE: Hysterectomy is a common gynecological surgery associated with significant postoperative discomfort and extended hospital stays. Enhanced recovery after surgery (ERAS), a multidisciplinary approach, has emerged as a strategy aimed at improving perioperative outcomes and promoting faster patient recovery and satisfaction. This meta-analysis aimed to evaluate the impact of ERAS protocols on clinical outcomes, such as hospital stay length, readmission rates, and postoperative complications, in patients undergoing gynecological hysterectomy. METHODS: Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic review and meta-analysis were conducted. Databases including PubMed, Embase, and Cochrane library were searched for relevant studies published up to January 31, 2023. A total of seventeen studies were selected based on predefined eligibility and exclusion criteria. Meta-analysis was carried out using a random-effects model with the STATA SE 14.0 software, focusing on outcomes like length of hospital stay, postoperative complications, and readmission rates. RESULTS: ERAS protocols significantly reduced the length of hospital stays and incidence of postoperative complications such as ileus, without increasing readmission rates or the level of patient-reported pain. Notable heterogeneity was observed among included studies, attributed to the variation in patient populations and the specificity of the documented study protocols. CONCLUSION: The findings underscore the effectiveness of ERAS protocols in enhancing recovery trajectories in gynecological hysterectomy patients. This reinforces the imperative for broader, standardized adoption of ERAS pathways as an evidence-based approach, fostering a safer and more efficient perioperative care paradigm.

Post-abortion needs-based education via the WeChat platform to lessen fear and encourage effective contraception: a post-abortion care service intervention-controlled trial.

OBJECTIVE: Our study aims to investigate post-abortion needs-based education via the WeChat platform for women who had intended abortion in the first trimester, whether they are using effective contraception or becoming pregnant again. DESIGN: This single hospital intervention-controlled trial used a nearly 1:1 allocation ratio. Women who had intended abortions were randomly assigned to a Wechat group (needs-based education) and a control group (Traditional education). The women's ability to use effective contraception was the main result. Whether they unknowingly became pregnant again was the second result. Another result was patient anxiousness. Before and after education, women filled out questionnaires to assess their contraception methods and anxiety. METHODS: Based on the theoretical framework of contraceptions of IBL (inquiry-based learning), post-abortion women were included in WeChat groups. We use WeChat Group Announcement, regularly sending health education information, one-on-one answers to questions, and consultation methods to explore the possibilities and advantages of WeChat health education for women after abortion. A knowledge paradigm for post-abortion health education was established: From November 2021 until December 2021, 180 women who had an unintended pregnancy and undergone an induced or medical abortion were recruited, their progress was tracked for four months, and the PAC service team monitored the women's speech, discussed and classified the speech entries and summarized the common post-abortion needs in 8 aspects. At least 2 research group members routinely extracted records and categorized the outcomes. RESULTS: Before education, there were no appreciable variations between the two groups regarding sociodemographic characteristics, obstetrical conditions, abortion rates, or methods of contraception (P > 0.05). Following education, the WeChat group had a greater rate of effective contraception (63.0%) than the control group (28.6%), and their SAS score dropped statistically more than that of the control group (P < 0.05). Following the education, there were no unwanted pregnancies in the WeChat group, whereas there were 2 in the traditional PAC group. Only 5 participants in the WeChat group and 32 in the conventional PAC group reported mild anxiety after the education.

A nomogram model for predicting lower extremity deep vein thrombosis after gynecologic laparoscopic surgery: a retrospective cohort study.

Objective: To investigate the risk factors associated with lower extremity deep vein thrombosis (LEDVT) and to establish a predictive model for patients who undergo gynecologic laparoscopic surgery. Methods: A review of clinical data was conducted on patients who underwent gynecologic laparoscopic surgery between November 1, 2020, and January 31, 2022. Patients who developed LEDVT after surgery were included as the observation group, while the control group comprised patients who did not experience complications. Multivariate forward stepwise logistic regression models were used to identify independent risk factors associated with LEDVT. A nomogram model was then developed based on these risk factors. Results: A total of 659 patients underwent gynecologic laparoscopic surgery during the study period, and 52 (7.89%) of these patients developed postoperative LEDVT. Multivariate logistic regression analysis showed that older age (adjusted OR, 1.085; 95% CI [1.034-1.138]; P < 0.05), longer operation duration (adjusted OR, 1.014; 95% CI [1.009-1.020]; P < 0.05), shorter activated partial thromboplastin time (APTT) (adjusted OR, 0.749; 95% CI [0.635-0.884]; P < 0.05), higher D-dimer (adjusted OR, 4.929; 95% CI [2.369-10.255]; P < 0.05), higher Human Epididymis Protein 4 (HE4) (adjusted OR, 1.007; 95% CI [1.001-1.012]; P < 0.05), and history of hypertension (adjusted OR, 3.732; 95% CI [1.405-9.915]; P < 0.05) were all independent risk factors for LEDVT in patients who underwent gynecologic laparoscopic surgery. A nomogram model was then created, which had an area under the curve of 0.927 (95% CI [0.893-0.961]; P < 0.05), a sensitivity of 96.1%, and a specificity of 79.5%. Conclusions: A nomogram model that incorporates information on age, operation duration, APTT, D-dimer, history of hypertension, and HE4 could effectively predict the risk of LEDVT in patients undergoing gynecologic laparoscopic surgery, potentially helping to prevent the development of this complication.

Organizational display rules in nursing: Impacts on caring behaviors and emotional exhaustion through emotional labor.

AIM: To examine the impact of display rules on nurses' caring behaviors and emotional exhaustion and the mediating role of emotional labor (surface/deep acting). BACKGROUND: Hospitals often implement emotional display rules for nurses with the expectation of performance benefits. However, these rules may have an impact on nurses' caring behaviors and emotional exhaustion. METHODS: This cross-sectional correlational study included a sample of 746 nurses from five hospitals and used the STROBE checklist. Relationships between display rules, emotional labor, caring behaviors, and emotional exhaustion were analyzed using structural equation modeling. RESULTS: Display rules did not directly affect caring behaviors or emotional exhaustion. Emotional labor mediated the relationships. Display rules were associated more with surface acting. Deep acting increased caring behaviors and reduced emotional exhaustion; surface acting had the opposite effect. CONCLUSIONS: Findings challenge the assumption that display rules effectively promote caring behaviors. Display rules lead to emotional labor and emotional exhaustion. Reducing display rules, emotional labor, and surface acting while supporting deep acting may alleviate emotional exhaustion. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse managers should review the nature and implementation of emotional display rules and explore ways to reduce emotional labor, encourage deep acting, mitigate the negative impact of surface acting, and ultimately improve nursing caring behaviors.

Effect of Health Belief Model Education on Increasing Cognition and Self-Care Behaviour among Elderly Women with Malignant Gynaecological Tumours in Fujian, China.

Objective: This study evaluated the effect of a health belief model (HBM) educational intervention on the self-perception of and complications related to disease in elderly gynaecological malignancy patients. Methods: This randomized controlled trial was conducted at the Fujian Maternal and Child Health Hospital, China. A total of 301 women aged 60 years and older who were diagnosed with gynaecological malignancies from January 2019 to August 2020 were recruited. Participants were randomly divided into the HBM education and basic nursing groups. The participants in the HBM education group received perioperative rehabilitation education based on the HBM, and the participants in the basic nursing group received routine basic nursing. Rehabilitation training compliance, psychological resilience, psychological flexibility, self-efficacy, self-care ability, and lower extremity deep venous thrombosis (LEDVT) incidence were assessed before and after the intervention. Results: Thirty-three women were excluded based on the exclusion criteria, and 268 participants were eventually included and randomly divided into two groups: 134 participants in the HBM education group and 134 participants in the basic nursing group. Before HBM education, there were no significant differences in the mean scores of psychological resilience (50.43 ± 3.29 vs. 50.55 ± 2.29, P = 0.738), psychological flexibility (48.98 ± 3.45 vs. 49.29 ± 3.59, P = 0.465), self-efficacy (26.49 ± 5.26 vs. 26.29 ± 6.41, P = 0.781), or rehabilitation training compliance (28.4% vs. 27.8%, P = 0.922) between the two groups. After HBM education, the scores of training compliance (80.6% vs. 30.1%, P < 0.001), psychological resilience (55.47 ± 5.01 vs. 50.46 ± 2.62, P < 0.001), psychological flexibility (56.53 ± 4.51 vs. 49.13 ± 3.62, P < 0.001), self-efficacy (30.79 ± 4.56 vs. 26.41 ± 6.37, P < 0.001), self-care knowledge (43.36 ± 7.60 vs. 34.05 ± 6.99, P < 0.001), self-concept (29.57 ± 5.67 vs. 20.11 ± 3.86, P < 0.001), self-care responsibility (27.54 ± 5.09 vs. 20.86 ± 4.53, P < 0.001), and self-care skills (34.51 ± 5.62 vs. 21.62 ± 5.64, P < 0.001) were higher in the HBM education group than those in the basic nursing group. Additionally, the incidence of LEDVT was lower in the HBM group than that in the basic nursing group (2.2% vs. 8.3%, P = 0.027). Conclusion: This study indicated that perioperative HBM education can improve the cognition and self-care ability of elderly gynaecological malignancy patients and reduce postoperative complications.

The interaction mechanism between fludarabine and human serum albumin researched by comprehensive spectroscopic methods and molecular docking technique.

Fludarabine (Flu) is widely used to treat B-cell chronic lymphocytic leukemia. HSA is of the essence to human, especially in blood circulation system. The interaction mechanism between Flu and HSA was studied by comprehensive spectroscopic methods and molecular docking technique. UV-vis and FL spectrum results indicated that Flu bond with HSA, and there was a new complex produced at the binding site I in subdomain IIA. Association constants at 298 K were 1.637 × 104 M-1 and 1.552 × 104 M-1 at 310 K, respectively. The negative enthalpy (ΔH) and positive entropy (ΔS) values for the interaction revealed that the binding behavior was driven by hydrophobic forces and hydrogen bonds. The results obtained from UV, RLS spectra, 3D fluorescence and CD spectrum illustrated that Flu could change the secondary structure of HSA. According to molecule docking result, the binding energy of interaction is -11.15 kcal/mol.

Facile one-step synthesis of quaternary AgInZnS quantum dots and their applications for causing bioeffects and detecting Cu2.

Water-soluble AgInZnS quantum dots (AIZS QDs) were synthesized with glutathione (GSH) as a stabilizer by a facile one-step method based on a hydrothermal reaction between the nitrate salts of the corresponding metals and sodium sulfide as a sulfide precursor at 110 °C. The optimal reaction conditions (temperature, time, pH, and the molar ratios of the precursors) were studied. According to the data from TEM, XPS, and XRD, AIZS QDs were characterized with excellent optical properties. The results showed that the aqueous-dispersible AIZS QDs were quasi-spherical and their average diameter was 3.51 nm. Furthermore, the cytotoxicity of AIZS QDs was investigated by microcalorimetry and microscopy techniques (confocal microscopy and TEM). The data revealed that AIZS QDs exhibited low toxicity, biocompatibility, and good water stability, due to which they could be used as a fluorescent probe for bioimaging and labeling. In addition, AIZS QDs could be used as a sensor to detect Cu2+ because the fluorescence of AIZS QDs was quenched by Cu2+.