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To estimate the healthcare costs associated with post-stroke dysphagia during acute hospitalisation and to identify factors influencing these costs in a tertiary hospital setting in Vietnam.
A cross-sectional study using clinical and billing data from hospital records.
The study was conducted at the Neurology Center of Bach Mai Hospital, a tertiary care facility in Hanoi, Vietnam, between June 2020 and January 2022.
A total of 951 patients aged ≥18 years with acute ischaemic stroke confirmed by CT or MRI were included. Dysphagia was assessed using the Gugging Swallowing Screen.
Direct healthcare costs during hospitalisation were collected from the hospital billing system and categorised as medications, diagnostic imaging, medical supplies, accommodation, food, procedures and laboratory tests. All costs were converted to USD. Associations between patient characteristics and total healthcare costs were analysed using generalised linear models (Gamma distribution with log link), applying robust standard errors.
The median treatment cost was 10.08 million VND (436.24 USD) in the dysphagia group vs 6.37 million VND (275.78 USD) in the non-dysphagia group. Costs increased with dysphagia severity, reaching 22.64 million VND (979.49 USD) among patients with severe dysphagia. In multivariate analysis, dysphagia was associated with a 21% increase in costs (exp(β) = 1.21; 95% CI 1.10 to 1.33; p14, pneumonia, prolonged hospitalisation and higher educational level.
Post-stroke dysphagia substantially increases acute hospitalisation costs in Vietnam. Early screening, standardised management and preventive care for complications may improve outcomes and reduce costs.
The study was registered on the Research Registry website (https://www.researchregistry.com/) under the unique identification number: researchregistry8203.
The study aims to investigate patients' perceptions of recurrence risk associated with atrial fibrillation, with the goal of establishing a theoretical foundation for developing future measurement scale and intervention strategies.
A qualitative interview study.
Seventeen patients diagnosed with atrial fibrillation at a Grade-A tertiary hospital participated in semi-structured, in-depth interviews conducted between October and December 2024. Participants were selected via purposive sampling. The data were analysed employing thematic analysis in accordance with Colaizzi's method. The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.
The perceptions of recurrence risk among patients with atrial fibrillation can be summarised into five themes: (1) perceived likelihood of recurrence, (2) perceived severity of recurrence, (3) perceived triggers of recurrence, (4) emotional reaction to recurrence, and (5) efficacy perception of managing recurrence risk.
Perceptions of recurrence risk among patients with atrial fibrillation are diverse and often underestimated due to limited knowledge and subjective symptom interpretation, affecting health behaviours. Understanding patients' subjective appraisals, emotions, and perceived efficacy is essential. Validated assessment tools and tailored risk communication may enhance self-management and support targeted interventions.
This study provides critical insights into how atrial fibrillation patients perceive their risk of recurrence. It also provides a theoretical foundation for creating validated assessment tools and tailoring individualised health education and intervention programmes.
Patients were involved in the study design, data collection, and interpretation of findings. Their contributions included providing feedback on the initial interview guide to ensure relevance and clarity, participating in in-depth interviews to share their lived experiences with atrial fibrillation recurrence, and offering reflections on key themes emerging from the data.
by Shanhe Liu, Shuailin Li, Shao-Lun Hsu, Fabian N. Fries, Zhen Li, Swarnali Kundu, Berthold Seitz, Maryam Amini, Shweta Suiwal, Julia Zimmermann, Simon Trusen, Tanja Stachon, Nóra Szentmáry
PurposeThe aim of this study was to investigate apoptosis in primary aniridia limbal stromal cells (LSCs) and to assess changes in the expression of genes and proteins associated with the apoptotic pathway in response to cobalt chloride (CoCl2)-induced hypoxic stress, in vitro.
MethodsPrimary human limbal stromal cells were isolated from the limbal region of both aniridia (AN-LSCs; n = 8) and healthy (LSCs; n = 8) donors. The cells were treated with 0 µM, 50 µM, and 75 µM CoCl2 for 48 hours. Apoptosis in each group was assessed by Flow cytometry (FC). The expression levels of apoptosis-related genes, including CASP 3/7/8/9/10, BCL2, BID, BAX, CDKN1A (p21), CDKN1B (p27), TNFα, XIAP, and BIRC5 (Survivin), were measured by qPCR. Protein level of these markers was analyzed by FC. TNFα protein expression in the supernatant was quantified using ELISA.
ResultsFlow cytometry analysis revealed a significantly higher apoptosis rate in AN-LSCs compared to LSCs (p BCL2 mRNA levels (p = 0.0291), Caspase-8 (p = 0.0341), Caspase-10 (p = 0.0085), Bcl-2 (p = 0.0014), XIAP (p = 0.0003) and Survivin (p = 0.0074) protein levels were significantly higher in LSCs than in AN-LSCs. Conversely, Caspase-3 (p = 0.0366), Caspase-9 (p = 0.0354), p21 (p = 0.0003), and p27 (p = 0.0164) protein levels were significantly higher in AN-LSCs than in LSCs. In LSCs, exposure to 75 µM CoCl₂ led to a reduction in BCL2 mRNA (p = 0.0102) and protein levels (p = 0.0484), accompanied by an increase in CDKN1B mRNA level (p = 0.0265). In AN-LSCs, 75 µM CoCl₂ treatment resulted in a decrease in CASP3 (p = 0.049), CASP7 (p = 0.041) and BCL2 (p = 0.0218) mRNA and Bcl-2 protein levels (p = 0.0405) and an increase of TNF-α protein levels in the cell culture supernatant (p = 0.0251).
ConclusionsThe apoptosis rate of LSCs from patients with congenital aniridia is higher than that of the control group, accompanied by alterations in multiple apoptosis-related markers. Additionally, CoCl₂-induced hypoxic stress further increases apoptosis in AN-LSCs and leads to changes in the expression of Caspase 3, Caspase 7, Bcl-2, and CDKN1B (p27). Further research is needed to elucidate the potential therapeutic targets in AAK, with the aim of preventing or slowing the progression of aniridia-associated keratopathy.
by Mai Dinh Thanh, Gemma Agustí, Anneluise Mader, Francesc Codony
Staphylococcus (S.) aureus is a prominent foodborne pathogen that can cause food poisoning due to its staphylococcal toxins. Controlling the viable levels of S. aureus is crucial for ensuring food safety. The detection of S. aureus during routine quality control is still primarily conducted using traditional culture-based methods, which are time-consuming and unable to detect viable but non-culturable cells. Viability PCR (vPCR) – a combination of traditional (or quantitative) PCR with photo-reactive DNA-intercalating dye(s) – has been introduced as an alternative to detect viable cells by excluding those with compromised membranes using molecular methods. Despite the success of the vPCR methodology, avoiding false-positive results remains a significant challenge. To enhance the accuracy of vPCR results for S. aureus, several approaches have been proposed by various researchers in the past decade; however, complete PCR signal suppression of dead cells has not been achieved. In this study, we developed a strategy to detect only viable S. aureus cells by combining double PMA treatment with a low PMA concentration and performing a tube change between the last dark incubation and light exposure to improve the vPCR protocol. For pure cultures, the optimized protocol was able to completely suppress DNA signals from 5.0 × 107 dead cells in a final reaction volume of 200 µl. For artificially contaminated food samples with such a high dead cell count, complete PCR signal reduction was observed in ground pepper, - oregano, and infant milk powder, while ground paprika, - allspice, and - pork exhibited PCR signals close to the detection limit. To simulate conditions in real samples, we artificially contaminated ground paprika, - pork, and milk powder with a low number of viable cells (~1.9 cfu/ml) and a high number of heat-inactivated S. aureus (~4.8 × 10⁶ cells/ml). The results showed that the optimized protocol is effective in detecting only the desired live cells, even in the presence of a high dead cell count. Our findings highlight that vPCR can be an accurate and reliable method with strong potential for high-throughput detection of live S. aureus cells in certain food matrices.This systematic review examined eHealth solutions used to assess and monitor symptoms among adults with CKD.
A systematic review was conducted and reported in accordance with the PRISMA checklist. The review protocol was registered in PROSPERO (CRD4202452973).
Seven databases were searched for English language studies that reported eHealth solutions for symptom assessment and monitoring in CKD between January 2000 and May 2024. The methodological quality of studies was evaluated using the Mixed Methods Appraisal Tool and a co-design evaluation tool.
Thirty-eight studies involving 4345 participants with CKD were included. Most of the included studies were non-randomised controlled trials (n = 16) and non-experimental studies (n = 13); only a few studies (n = 9) were randomised controlled trials. Current eHealth solutions varied in technologies and functions but were primarily focused on self-monitoring (n = 22), data recording (n = 14), education (n = 13), providing information (n = 10) and reminders/alerts (n = 10). There was limited evidence from few intervention studies involving eHealth solutions showing improvements in CKD symptoms and/or health-related quality of life. Among the 14 studies that assessed user satisfaction, satisfaction was high, but challenges and barriers to implementing these solutions were reported.
eHealth solutions have the potential to facilitate symptom assessment and monitoring for adults with CKD, but further high-quality experimental studies are required to provide better evidence in practice.
eHealth symptom assessment and monitoring are increasing in practice. While some adults are willing and able to use eHealth solutions, barriers remain due to limited digital health literacy. As few randomised controlled trials exist, further studies are needed to evaluate the benefits of reducing chronic kidney disease symptom burden.
No Patient or Public Contribution.
Virtual reality is an emerging non-drug treatment for pain caused by endoscopy procedure. We conducted a meta-analysis to evaluate the effectiveness and safety of virtual reality based interventions for pain during endoscopy.
PubMed, EMBASE, Cochrane Library, Web of Science and Clinical Trials database were searched until 26 May 2024. Randomised controlled trials on the application of virtual reality in endoscopic examinations were included. The standardised mean difference (SMD) was calculated using random-effects models, and included studies were appraised using Cochrane Risk of Bias tool version 1. Meta- analysis was conducted using Stata Statistical Software version 17.0.
Overall, 21 studies enrolling 1721 participants were included. Our results demonstrated that the patients receiving the virtual reality intervention had lower pain scores than those receiving the usual care (SMD = −0.42; 95% CI = −0.65, −0.20). Subgroup analysis showed that real-time assessment of pain scores during the medical process had less heterogeneity (I 2 = 20.2%, p = 0.257) and a smaller range of confidence intervals (95% CI = −0.43, −0.14) than retrospective assessment (95% CI = −0.75, −0.09). For different types of endoscopes, virtual reality was statistically significant for reducing pain during colonoscopy (SMD = −0.70; 95% CI = −1.12, −0.28), cystoscopy (SMD = −0.28; 95% CI = −0.53, −0.04) and laparoscopy (SMD = −0.54; 95% CI = −0.98, −0.10). Additionally, statistically significant improvements in relieving anxiety were reported when using virtual reality (SMD = −0.56; 95% CI = −0.78, −0.35).
The application of virtual reality can effectively relieve the pain and anxiety of endoscopy. The types of endoscopy and the way of retrospective evaluation of pain scores were the main sources of heterogeneity. More rigorous studies about the relationship between virtual reality and endoscopic pain relief will be needed.
The application effect of virtual reality technology on endoscopy was verified by summarising several randomised controlled trials. Patients and healthcare providers can be better informed about the use of such intervention to relieve pain.
Virtual reality is recommended as being potentially useful and practical for reducing the pain of endoscopy.
To explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community-dwelling older adults.
A cross-sectional study was conducted with 262 community-dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.
Validated self-reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis.
Anxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement.
Increased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community-dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community-dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning.
Understanding factors associated with advance care planning engagement among community-dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community-dwelling older adults in advance care planning.
The STROBE statement checklist was used as a guide to writing the manuscript.
The study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.
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