A large-scale survey on epidemiology and underreporting of needlestick and sharp injuries among healthcare workers in China.

Background: Needlestick and sharp injuries (NSI) carry the risk of transmitting numerous bloodborne pathogens, leading to both health and economic burdens. The underreporting of NSIs among healthcare workers (HCWs) is a global issue of concern, as timely treatment and prevention of complications rely on proper reporting. Underreporting further impedes accurate surveillance and appropriate resource allocation, with developed and developing nations facing disparities due to differences in healthcare policy. Purpose: The purpose of this research is to examine the epidemiology of NSIs and NSI underreporting, as well as to identify the determinants associated with the occurrence of NSIs and the underreporting of such injuries. Method: A retrospective online survey was conducted from January 15 to January 31, 2022 among healthcare workers (HCWs) across Gansu Province, China. Results: A total of 7,283 healthcare workers (HCWs) from various institutions participated in this study. After quality assurance checks, 6,464 (88.77%) responses were included in the final analysis. Results revealed a 32.86% self-reported needlestick and sharp injury (NSI) incidence among respondents, with 28.53% of NSIs going unreported. Contrary to common belief, more experienced HCWs exhibited higher rates of both NSIs and underreporting compared to their less experienced peers. The primary reasons cited for NSIs and underreporting were lapses in concentration and not perceiving patients as infectious. Multivariate regression analysis exposes the significant influence of training frequency, occupation, department and years of services on the occurrence of NSIs. Conversely, the reporting of NSIs is primarily influenced by training, reimbursement,occupation, department and hospital grade. Compared to HCWs with no training, those who received ≥3 training sessions per year showed a 12.16% lower NSI incidence (27.12% vs. 39.28%, p < 0.001) and a 55.68% lower underreporting rate (14.61% vs. 70.29%, p < 0.001). Conclusion: There is a pressing need for enhanced surveillance, tailored training programs, and more efficient reporting mechanisms to combat this significant occupational health challenge.

Clinical value of endoscopic ultrasonography in preoperative endoscopic retrograde cholangiopancreatography for undetermined common bile duct stones / 中华消化内镜杂志

Objective:To study the clinical value of endoscopic ultrasonography (EUS) before endoscopic retrograde cholangiopancreatography (ERCP) in patients with non-deterministic choledocholithiasis.Methods:Data of 132 patients with unconfirmed common bile duct calculi diagnosed in Tianjin Nankai Hospital from January 2017 to December 2019, whose clinical manifestations were not consistent with magnetic resonance cholangiopancreatography (MRCP) results, were retrospectively analyzed. Patients were divided into two groups: group A showed calculi under MRCP with no suspicious clinical manifestations, while group B showed no calculi under MRCP with suspected clinical manifestations. All patients underwent EUS. Necessity of ERCP was determined according to EUS results, and the diagnostic accuracy of EUS was analyzed compared with ERCP results and follow-up results as the gold standard.Results:Of the 132 patients, 87 were confirmed as choledocholithiasis, and 45 had no common bile duct calculi by the golden standard. Forty-four (33.3%) cases were negative in EUS and were confirmed free of calculi by follow-up. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EUS for choledocholithiasis were 95.40% (83/87), 97.78% (44/45), 96.21% (127/132), 98.81% (83/84) and 91.67% (44/48), respectively.The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRCP for choledocholithiasis were 66.67% (58/87), 82.22% (37/45), 71.97% (95/132), 87.88% (58/66) and 56.06% (37/66), respectively. There were significant differences in the sensitivity, accuracy, positive predictive value or negative predictive value between EUS and ERCP (all P<0.05). There was significant consistency between the EUS results and the final diagnosis ( Kappa=0.917, P<0.001), and good consistency between MRCP results and the final diagnosis ( Kappa=0.439, P<0.001). The detection rate of false positive MRCP in group A was higher than that of false negative MRCP in group B [8/8 VS 89.66% (26/29), P<0.001] under EUS. Conclusion:EUS is superior to MRCP in the diagnosis of uncertain choledocholithiasis, and EUS prior to ERCP can reduce unnecessary ERCP operations and avoid missing stones.

Role of anxiety in the comfort of nonsedated average-risk screening sigmoidoscopy.

OBJECTIVES: The aim of this prospective study was to assess the role of generalized anxiety disorder in the comfort of nonsedated, average-risk screening sigmoidoscopy. METHODS: Patients were asked to complete a screening questionnaire before undergoing average-risk colon cancer screening with nonsedated sigmoidoscopy. The questionnaire included demographic information and a series of Likert-based and visual analog scales designed to assess patient comfort, procedural symptom severity, and satisfaction. The Primary Care Evaluation of Mental Disorders questionnaire was used to assess for generalized anxiety disorder. Comfort levels and postprocedural symptom severity were recorded immediately after the procedure and 1 week postprocedure. χ and t tests were used to analyze the data. RESULTS: Eighty-one patients were enrolled in the study. Twenty-seven patients tested positive for anxiety (high anxiety), whereas 54 tested negative (low anxiety). There were no differences in anxiety according to sex (P = 0.53), or age (P = 0.32). There was no difference in reaching the splenic flexure between high- and low-anxiety patients (P = 0.15); however, pairwise comparisons revealed patients with high anxiety reported significantly higher levels of abdominal pain after the procedure (P < 0.01) and still recalled higher pain from the procedure 1 week later (P < 0.01) than those patients with low anxiety scores. Furthermore, those patients with high anxiety reported significantly more procedure-related cramping and bloating both immediately after the procedure and again 1 week later (P < 0.01). Finally, patients with high anxiety reported the procedure as being more uncomfortable 1 week later, when compared with low-anxiety patients (P = 0.01). CONCLUSIONS: The level of anxiety correlated directly to pain and discomfort postprocedure and related inversely to the level of satisfaction. Better management of anxiety may lead to better procedural comfort in nonsedated procedures.

Interferon α plus adefovir dipivoxil therapy for patients with HBeAg positive chronic hepatitis B nonresponding to interferon monotherapy / 中华临床感染病杂志

Objective To evaluate the efficacy and safety of interferon alpha (IFNα) combined with adefovir dipivoxil (ADV) for patients with chronic hepatitis B (CHB) non-responding to 24-week IFNα monotherapy.Methods Sixty CHB patients admitted to the First Affiliated Hospital of Xiamen University during 2009 and 2012 were enrolled in the study.All patients recieved IFNα monotherapy for 24 weeks and had no response.The patients were randomly divided into 3 groups by number table with 20 cases in each group.The experimental group was treated with IFNα combined with ADV,the control group 1 continued IFNα monotherapy,and the control group 2 shifted to ADV monotherapy.Virological,serological and biochemical responses were compared,and adverse reactions were observed.SPSS 19.0 software was used for data analysis.Results After 24 weeks of treatment,there was no statistical difference in HBV DNA loads,ALT levels and titers of HBeAg and HBsAg among three groups (F =0.985,0.717,0.985 and 0.717,P ＞ 0.05).And no HBeAg seroconversion was observed.After 48 weeks of treatment,the experimental group had higher HBV DNA negative conversion rate,ALT normalization rate and HBeAg conversion rate than control group 1 (x2 =10.00,3.956 and 4.800,P ＜ 0.05),but no statistically significant difference was found in HBeAg negative conversion rate (x2 =0.693,P ＞ 0.05).There was no significant difference in HBV DNA and HBeAg negative conversion rates between experimental group and the control group 2 (x2 =1.026,1.905 and 0.156,P ＞0.05),but the HBeAg conversion rate in experimental group was significantly higher than that in control group 2 (x2 =4.800,P ＜ 0.05).No HBsAg negative or serological conversion was observed,and there was no significant difference in titers of HBsAg among three groups (F =1.935,P ＞ 0.05).No adverse reaction was observed.Conclusion For patients nonresponding to IFNα monotherapy,combination of IFNα and ADV can achieve higher ALT normalization rate,HBeAg conversion rate and HBV DNA negative conversion rate,and improve the overall efficacy of CHB antiviral therapy.