The impact of medication belief on adherence to infliximab in patients with Crohn's disease.

Objective: Crohn's disease (CD) is an incurable chronic disease that requires long-term treatment. As an anti-tumor necrosis factor (TNF) agent, Infliximab (IFX) is widely used in the treatment of Crohn's disease, while the adherence is not high. The purpose of this study was to investigate the adherence to IFX among CD patients in China and evaluate the association between medication belief and IFX adherence. Methods: Demographic data, clinical information and patients' medication beliefs were collected using an online questionnaire and reviewing electronic medical records (EMRs). The Beliefs about Medicines Questionnaire (BMQ)-specific was used to assess medication beliefs which contains the BMQ-specific concern score and the BMQ-specific necessity score. An evaluation of adherence factors was conducted using univariate and multidimensional logistic regression analyses. Results: In all, 166 CD patients responded the online questionnaire among which 77 (46.39%) patients had high adherence. The BMQ-specific concern score in patients in low adherence was 30.00 and in high adherence patients was 27.50, and patients with lower BMQ-specific concern score had higher adherence (p = 0.013). The multiple regression analysis showed that the BMQ-specific concern score (OR = 0.940, 95% CI: 0.888-0.996) significantly affected the IFX adherence in CD patients. Otherwise, gender, marital status, time spent on the way (including the waiting time in infusion center) and accommodation to the center were also the influencing factors of adherence. Conclusion: The IFX adherence to CD in China was not high. Medicine concerns may be predictive factor of adherence. Education, the duration of IFX therapy and experience of adverse effects were not significantly associated with IFX adherence. By enhancing knowledge and relieving medicine concerns, we may increase patients' adherence to IFX.

A new model to assist decision-making of optimal antibiotics duration for treating asymptomatic bacteriuria or pyuria prior to retrograde intrarenal surgery.

BACKGROUND: The aim of this study was to establish a model that predicts postoperative fever and enables decision-making regarding optimal antibiotic therapy duration for asymptomatic bacteriuria or pyuria prior to retrograde intrarenal surgery (RIRS). METHODS: We retrospectively investigated 667 consecutive patients with asymptomatic bacteriuria or pyuria who underwent RIRS between September 2016 and December 2019. We constructed a predictive nomogram for risk quantification of postoperative infection. A preoperative score model was used for risk stratification. The effect of antibiotic therapy duration (short-course [2-3 days] vs. long-course [≥4 days]) was evaluated. RESULTS: Infections occurred in 113 (16.9%) patients. The incidence of fever was marginally lower in long-course group than in short-course group (15% vs. 19%, P=0.173). Hydronephrosis, stone size, multi-drug resistant bacteriuria, and degree of pyuria were used to construct a preoperative score model (the H-SMP score). Using the H-SMP score, the patients were stratified into low- and high-risk groups based on varying incidence rates of postoperative fever (11.0% vs. 29.9%, P<0.001). Significant reduction in fever occurred only among high-risk patients in the long-course group (23.5% vs. 38.0%, P=0.022), and no such reduction in postoperative fever rates occurred in low-risk patients (10.4% vs. 11.5%, P=0.712). Even after propensity score matching, the low-risk group showed no improvement in postoperative fever incidence with long-course antibiotic therapy (7.5% vs. 10.0%, P=0.419). CONCLUSIONS: Based on the newly developed H-SMP score, we concluded that long-course antibiotics (≥4 days) recommended in high-risk patients may not bring in more benefit in low-risk patients for treating asymptomatic bacteriuria or pyuria prior to RIRS.

Intermittent ice-cooling to prevent skin heat injury caused by high-intensity focused ultrasound therapy targeting desmoid-type fibromatosis: A case report.

INTRODUCTION: Desmoid-type fibromatosis (DF) is a fibrous tumor characterized by low-grade malignant and easy invasive growth and high recurrence. High-intensity focused ultrasound (HIFU) therapy has been identified as a novel non-invasive approach for DF treatment; however, the ultrasonic energy generated by HIFU can cause skin heat injury. CASE: A 31-year-old female patient with signs and symptoms of DF received treatment in our institution. The patient had undergone HIFU treatment six times from April 27, 2018, to August 21, 2019. After HIFU therapy for the third time, she had a third-degree skin burn showing as orange peel-like change and spent three months to promote the recovery of the skin lesions. An intermittent ice-cooling strategy was used to avoid skin damage during the fourth HIFU treatment. This patient did not have any apparent skin injury during the last three HIFU therapy and acquired satisfactory anti-tumor therapeutic effect. CONCLUSIONS: There are differences in the thermal selectivity of tumor tissues, which leads to different critical thermal injury temperature values that the tissue can tolerate. Ice-cooling can lower skin tissue temperature and reduce the thermal damage caused by HIFU treatment.

The Effectiveness of Using a Nurse-Led Pain Relief Model for Pain Management among Abdominal Surgical Patients: A Single-Center, Controlled before-after Study in China.

BACKGROUND: Effective pain management is closely related to the prognosis of patients after surgery. Setting up acute pain service is among the effective strategies to control pain. The operation of acute pain service is mostly dominated by anesthesiologists; however, control of postsurgical pain is still unsatisfactory. Nurses are the main force for providing postoperative care of patients, and their role in acute pain service is crucial. Therefore, in the current study, we have developed a nurse-led pain relief model that emphasizes the central role of nurses during the entire surgical procedure. However, the effect of using this model for pain management among abdominal surgical patients remains unknown. AIMS: The current study was conducted to investigate the effect of using a nurse-led pain relief model for pain management among abdominal surgical patients. DESIGN: A single-center, propensity score-matched, controlled before-after study. METHODS: The patients, hospitalized for abdominal surgery in a university-affiliated hospital from January 2015 to December 2017, were enrolled and divided into group A (hospitalized before nurse-led pain relief model implementation, from January, 2015 to October, 2016) and group B (hospitalized after nurse-led pain relief model implementation, from October, 2016, to December, 2017) using propensity score match assay. The researchers compared the quality of acute pain management, the main side effects of pain management, and nurses' pain knowledge and attitude between group A and group B. RESULTS: A total of 2851 patients undergoing nonemergency abdominal surgery were enrolled in the current study and were propensity matched 1:1 into two groups with 1,127 subjects in each group. The quality of acute pain management postsurgery was better after implementation of the nurse-led pain relief model. More patients received higher numerical rating scales cores (≥4 points) at indicated time points after surgery in group A compared with group B (14.20% vs. 12.24% 6 hours postsurgery, p = .001; 12.33% vs. 8.52% 12 hours postsurgery, p = .004; 12.95% vs. 3.99% 24 hours postsurgery, p = .036; 16.06% vs. 7.19% 48 hours postsurgery, p = .001). Furthermore, the occurrence of nausea and vomiting during pain management were significantly decreased in patients from group B (nausea: X2 = 38.926, p < .05; vomit: X2 = 39.302, p < .05). Additionally, after using the nurse-led pain relief model, nurses were more open to improving their knowledge and attitudes to pain management (p < .05). CONCLUSION: Our study demonstrated that a nurse-led pain relief model can enhance the quality of acute pain management among post-abdominal surgical patients, suggesting that such a model can be an effective intervention for providing a better pain control among postsurgical patients.

Evaluation of day-care versus inpatient mini-percutaneous nephrolithotomy: a propensity score-matching study.

Day-care percutaneous nephrolithotomy (day-PCNL) is being performed more routinely, however, safety remains a concern. The purpose of this study was to compare the complication rate, readmission rate and medical cost saving between day-PCNL and inpatient-PCNL. A protocol for day-PCNL was applied. A retrospective review of 86 patients planned day-PCNL by one surgeon were conducted. Using propensity matching, 86 inpatients (minimum 2-day post-operative stay) treated with the same procedure were matched. For each cohort, 14-day occurrence of complications and unplanned readmissions were recorded and compared. More than 80% of patients had multiple or staghorn stones in both groups. There were no significant differences between stone-free rate, operative time, multiple-tracts use, hemoglobin drop (each p > 0.05). Day- PCNL has a higher tubeless rate (60.8% vs. 24.4%, p < 0.001) and were less costly (mean 2732 vs. 3828 dollars) compared with inpatient PCNL. Within 14 days post-operatively, 10 day-care patients (11.6%) and 13 inpatients (15.1%) experienced complications, with no difference in rate or severity. Four patients (4.6%) required full admission (longer than 24 h) and two patents needed readmission in day-PCNL group. Day-care PCNL was more cost-effective than in-patients PCNL, with no significant difference in complications along with very low unplanned readmission during the postoperative period of 14 days. Therefore, day-care PCNL is a cost-effective choice in selected patients.

Day-surgery percutaneous nephrolithotomy: a high-volume center retrospective experience.

PURPOSE: Percutaneous nephrolithotomy (PCNL) is traditionally performed on an inpatient basis. We determine the safety and outcome of day-surgery PCNL by experienced surgeon hands. PATIENTS AND METHODS: A protocol for day-surgery PCNL was undertaken. A retrospective analysis of all 86 cases of planned day-surgery PCNL accomplished by an experienced surgeon who followed this protocol between May 2017 and March 2019 was performed. Patient demographics, operative data, complications, and readmission rates were recorded. Day-surgery PCNL was defined as discharge of patients either the same day or within 24 h after surgery. RESULTS: The average stone burden was 361.1 mm2 and 70 (81.4%) of patients had multiple stones or staghorn stones. 82 (95.4%) patients achieved same-day discharge or received overnight observation prior to discharge, and 4 patients (4.6%) required full admission (longer than 24 h). The readmission rate was 2.3% (2 patients). The postoperative complications occurred in 10 (11.6%) patients, including 7, 2, 2 of grade I, II, III complications. The average operation time was 64 min and the hemoglobin drop was 15.7 ± 16.9 g/L. The established tracts size ranged from 16 to 22Fr. The stone clearance rate was 90.7%. The tubeless without nephrostomy tube was performed in 60.5%. Eight cases were performed by multiple-tracts PCNL with 2-4 tracts, with only two case required full admission. CONCLUSION: Experienced surgeons who performed day-surgery PCNL experience excellent patient outcomes in appropriately selected patients. Most complications can be treated conservatively and only a few required intervention or readmission.

An easy risk stratification to recommend the optimal patients with 2-3 cm kidney stones to receive retrograde intrarenal surgery or mini-percutaneous nephrolithotomy.

To create an easy risk stratification to recommend the optimal subset of patients with 2-3 cm kidney stones to receive retrograde intrarenal surgery (RIRS) or mini-percutaneous nephrolithotomy (MPCNL). A retrospective patient cohort was reviewed and compared (RIRS, n = 147 and MPCNL, n = 129). Overall, RIRS group obtained a lower SFR (66% vs. 93.3%, p < 0.001) compared to MPCNL group. The RIRS group had more overall complication (12.2% vs. 8.5%) and more urosepsis (2.7% vs. 1.6%) than the MPCNL group, although there was no statistical significance. However, two patients in MPCNL group underwent embolization to treat perioperative bleeding. On multivariate analysis for RIRS group, lower calyx involved [OR 2.67], multiple calyces [OR 4.49], severe hydronephrosis [OR 2.38] were three significant predictors of SFR, which decreased from 88.8%, 70.3%, 52.1% to 25% corresponding to patients with 0, 1, 2, 3 risk predictors, respectively (p = 0.008), with a good predictive accuracy (AUC = 0.657; p = 0.002). When patients with no risk factor and patients undergoing RIRS had a similar high SFR and no possibility of bleeding, compared to matched patients undergoing MPCNL. Although generally RIRS showed a lower SFR for 2-3 cm stones compared to MPCNL, our easy risk stratification can recommend the optimal subset of patients with 2-3 cm kidney stones to receive RIRS or MPCNL. When these patients with no above-mentioned risk factors, RIRS can be first considered as an alternative to PCNL because it might be potentially less invasive and achieve a similar very high stone-free rate.

Recommended antibiotic prophylaxis regimen in retrograde intrarenal surgery: evidence from a randomised controlled trial.

OBJECTIVE: To study the incidence of postoperative systemic inflammatory response syndrome (SIRS) following different antibiotic prophylaxis (ABP) regimens in retrograde intrarenal surgery (RIRS). PATIENTS AND METHODS: Single-centre, randomised, controlled trial (August 2014-September 2017) including 426 patients with renal stones with preoperative sterile urine managed by RIRS (ClinicalTrials.gov NCT02304822). Different ciprofloxacin-based ABP regimens were used and included a zero dose, single dose (30 min before surgery) or two doses (first dose at 30 min before RIRS and additional dose within 6 h after RIRS). The incidence of SIRS was compared using intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS: Each group enrolled 142 patients. In the ITT analysis, a zero dose of ABP was statistically similar to the two ABP regimes for the incidence of SIRS (9.9% vs single dose 4.9%, P = 0.112; vs two doses 4.2%, P = 0.062). There were also no relevant differences across groups in the PP analysis; no urosepsis was recorded. In subgroup analysis with stratification by stone area, the three regimens all had a low and similar incidence of SIRS for stones of ≤200 mm2 in the ITT analysis with a sufficient power value (5.4% vs 6.2% vs 3.6%, P = 0.945 vs single dose and P = 0.553 vs two doses). However, there was a greater chance of SIRS in patients who received no ABP with stones of >200 mm2 (18% vs single dose 4.3%, P = 0.036; vs two doses 5.5%, P = 0.044). Similar trends were seen in the PP analysis. CONCLUSIONS: For patients with preoperative sterile urine, ABP is not strongly recommended in patients with stones of ≤200 mm2 , but for stones >200 mm2 single-dose ABP is still required.