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Universal skin and nasal decolonisation reduces multidrug-resistant pathogens and bloodstream infections in intensive care units. The effect of universal decolonisation on pathogens and infections in non-critical-care units is unknown. The aim of the ABATE Infection trial was to evaluate the use of chlorhexidine bathing in non-critical-care units, with an intervention similar to one that was found to reduce multidrug-resistant organisms and bacteraemia in intensive care units. The ABATE Infection (active bathing to eliminate infection) trial was a cluster-randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in non-critical-care units. The trial was done in hospitals affiliated with HCA Healthcare and consisted of a 12-month baseline period from March 1, 2013, to Feb 28, 2014, a 2-month phase-in period from April 1, 2014, to May 31, 2014, and a 21-month intervention period from June 1, 2014, to Feb 29, 2016. Hospitals were randomised and their participating non-critical-care units assigned to either routine care or daily chlorhexidine bathing for all patients plus mupirocin for known methicillin-resistant Staphylococcus aureus (MRSA) carriers. The primary outcome was MRSA or vancomycin-resistant enterococcus clinical cultures attributed to participating units, measured in the unadjusted, intention-to-treat population as the HR for the intervention period versus the baseline period in the decolonisation group versus the HR in the routine care group. Proportional hazards models assessed differences in outcome reductions across groups, accounting for clustering within hospitals. This trial is registered with ClinicalTrials.gov, number NCT02063867. There were 189 081 patients in the baseline period and 339 902 patients (156 889 patients in the routine care group and 183 013 patients in the decolonisation group) in the intervention period across 194 non-critical-care units in 53 hospitals. For the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures (figure 2), the HR for the intervention period versus the baseline period was 0·79 (0·73–0·87) in the decolonisation group versus 0·87 (95% CI 0·79–0·95) in the routine care group. No difference was seen in the relative HRs (p=0·17). There were 25 (<1%) adverse events, all involving chlorhexidine, among 183 013 patients in units assigned to chlorhexidine, and none were reported for mupirocin. Decolonisation with universal chlorhexidine bathing and targeted mupirocin for MRSA carriers did not significantly reduce multidrug-resistant organisms in non-critical-care patients. National Institutes of Health.

The aim of this study was to investigate the efficacy of a new therapeutic approach (cassava wax bath: CWB) compared with usual care (paraffin wax bath: PWB) in patients with plantar fasciitis (PF). Forty patients with PF were recruited into the study (CWB group, n = 20, PWB group, n = 20). Patients in the CWB group received cassava wax bath and patients in the PWB group received usual care (PWB). The primary outcome was pain intensity (PI). The secondary outcomes were the pressure pain threshold (PPT), pain frequency (PFr), foot and ankle ability measure (FAAM), and ankle dorsiflexion range of motion (ADROM). All outcomes were assessed before and after the five-week intervention, one month, and three months after the intervention period. After the intervention, statistically significant improvement was found in all outcomes after the intervention period and during the one month and three months follow-up study in both groups (P < 0.05). For all outcomes, no between-group differences were seen at any post-assessment time-point, except for PFr (P < 0.05). In conclusion, the findings of this study indicate that CWB was significantly superior to PWB in reducing PFr. For the other outcomes, CWB and PWB were both equally effective in reducing PI and increasing PPT, FAAM, and ADROM in patients with PF. Therefore, CWB might be considered as a novel useful therapeutic option for PF patients. Trial registration: Thai Clinical Trials Registry (TCTR) (Identification number: TCTR20220128002), First posted date: 28/01/2022.

PurposeAntiseptic bathing has garnered attention in an effort to reduce hospital-acquired infections. Previous studies have shown the efficacy of antiseptic bathing in high-risk environments, such as intensive care units (ICUs), using chlorhexidine. In this study we aimed to evaluate the effectiveness of octenidine as a potential alternative due to its established popularity and widespread use in Europe.MethodsWe compared the rates of ICU-acquired primary bacteremia and ICU-acquired multidrug-resistant organisms (MDROs) in a multicenter, cluster-randomized, double-blind, placebo-controlled, cross-over study using octenidine-impregnated and placebo washcloths. On 44 ICUs in 23 hospitals throughout Germany, we compared individual ICUs with themselves over two 12-month time periods. All data were obtained digitally via hospital information systems as individual ward-movement data and microbiological test results; both endpoints were algorithmically derived.Results104,039 ICU episodes from 93,438 patients with 712,784 microbiological test results were analyzed, thereby detecting 1508 cases of ICU-acquired primary bacteremia and 1871 cases of ICU-acquired MDRO. Bathing with octenidine-impregnated washcloths prevented ICU-acquired primary bacteremia; a risk reduction of 17% was seen homogeneously across all participating ICUs (adjusted hazard ratio (HR) 0.83, 95% confidence interval (CI) [0.75; 0.92], p = 0.0003). This reduction affected predominantly coagulase-negative staphylococci (53%) and enterococci (17%). However, no intervention effect was seen for ICU-acquired MDROs (adjusted HR 0.98, 95% CI [0.83; 1.15]). Heterogeneity among intra-ICU intervention effects on MDRO acquisition was substantial.ConclusionsAntiseptic bathing with octenidine may be effective in preventing ICU-acquired primary bacteremia, particularly due to Gram-positive bacteria and common skin commensals.

Aim Electronic bidets can be a substitute for sitz baths, but no study has examined the use of electronic bidets to manage anal problems. Methods A randomized, controlled, single-blind, multicenter, parallel group trial was performed. Patients who underwent hemorrhoidectomy were randomly assigned (1:1) to use the electronic bidet or warm sitz baths for 7 days after hemorrhoidectomy. The primary endpoint was the difference in the anal pain VAS score for 7 days posthemorrhoidectomy. Results Patients were assigned to the electronic bidet (51) or sitz bath (50) groups. Twenty-six patients dropped out after randomization, and the final analysis included 34 patients in the electronic bidet group and 41 in the sitz bath group. The VAS score for anal pain 7 days posthemorrhoidectomy did not differ between the electronic bidet and sitz bath groups (38.3 ± 21.9 vs. 42.0 ± 21.1, p  = 0.453). The upper limit of the 95% confidence interval of the VAS score in the electronic bidet group (81.22) was greater than the margin of noninferiority (46.20). Conclusion The VAS scores after hemorrhoidectomy did not differ between the electronic bidet and sitz bath groups, but the noninferiority of the electronic bidet to sitz baths for anal pain 7 days posthemorrhoidectomy was not verified. Trial Registration The trial was registered on ClinicalTrials.gov (Registration number: NCT02353156, date: 02/02/2015).

Hypertension is the predominant risk factor for premature cardiovascular disease, and contributes to heart failure, chronic kidney disease, and stroke. As of recently, scientists began to systematically investigate the vast physiological potential of hydrotherapy in individuals with cardiovascular disease. Hot baths in particular have been shown to transiently reduce arterial stiffness and to exert vasodilatory effects. Potentially beneficial in patients with uncontrolled hypertension, hot arm baths (HAB) have rarely been put to the test in randomized-controlled trials. Based on the hypothesis that HAB may exert short-term blood pressure-lowering effects, a monocentric, randomized-controlled pilot study was performed in participants with arterial hypertension. In a crossover design, participants received a HAB with a temperature of 45 °C and a thermoneutral arm bath (TAB) with a temperature of 28 °C for five minutes each, with a post-interventional observation period of 90 min. Effects on systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as on heart rate (HR) and hand and foot temperature (HT, FT) were measured in close intervals (after 1, 5, 10, 15, 30, 60 and 90 min). The washout period between both interventions was seven days. 54 participants with uncontrolled hypertension were included to the study, of which four participants had to be excluded from the analysis because they did not show up for the second intervention. The mean age of the remaining 50 participants in group A und in group B were 61 and 62 years, respectively. The participants in both groups were slightly overweight (group A: BMI 25.2 kg/m2, group B: BMI 27.1 kg/m2). The majority of participants in both groups took antihypertensive medication. Analysis revealed no carry-over effect. The analyses of treatment effects showed a significant decrease from baseline of DBP 5, 10 and 15 min after the HAB in comparison with the TAB. In addition, we found statistically significant differences of the two interventions in the changes from baseline of the HR after 1 and 5 min and HT after 1, 5, 10, 15 and 30. No major side effects were reported. HAB could be used as rapid-acting add-on tool in conjunction with pharmacotherapy to manage uncontrolled hypertension in various contexts at home.

Children with probable community-associated Staphylococcus aureus skin and soft tissue or invasive infections were randomized to routine daily hygienic measures with or without \"bleach baths\" twice a week for 3 months. Within 12 months, a medically attended recurrence occurred in 84 of 495 (17%) children using bleach baths compared to 103 of 492 (21%) of control participants (P = .15).

Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide, responsible for 3.5 million deaths in 2021. Effective preventive measures are needed. Forest bathing has been reported to have positive effects on the immune system. In addition, the clean air, mild climate, phytoncides, high oxygen concentration, and other elements of forests are expected to have benefits for respiratory diseases such as COPD. Based on the above background, this study used a randomized crossover design to examine the improving effects of forest bathing on inflammatory markers and subjective symptoms related to COPD.Methods: Thirty male subjects aged 63.1 ± 7.5 years were recruited after obtaining informed consent. These subjects participated in day trips to a Japanese cypress forest park and to a city area of Nagano Prefecture as a control in June 2024. Blood samples were taken in the afternoon of each day before and after the walks. Concentrations of α1-antitrypsin (α1-AT), C-reactive protein (CRP), fibrinogen, and interleukin 6 (IL-6) in blood were measured. Percutaneous oxygen saturation (SpO2), the profile of mood states (POMS), and questionnaires for subjective fatigue and respiratory symptoms and sleep quality were carried out before and after each trip.Results: Forest bathing significantly decreased the concentrations of blood CRP, α1-AT, IL-6, and fibrinogen, significantly increased SpO2, reduced subjective fatigue and respiratory symptoms, improved sleep and the scores of positive feelings, and reduced the scores for negative emotions in POMS.Conclusions: Forest bathing may improve inflammatory markers, SpO2, and subjective symptoms related to COPD.

This study investigated whether home‐based bathing intervention (HBBI) improve muscle strength gain and protect cardiovascular function by short‐term resistance training (RT). Thirty‐one healthy young men measured the maximum voluntary isometric contraction (MVC) of knee extensor, electrically evoked knee extension torque, and mean arterial pressure (MAP). Then, participants were divided into three groups with matching MVC: shower without bathing (control, n = 10), thermoneutral bathing (36°C‐bathing, n = 10), and hot bathing (40°C‐bathing, n = 11), and conducted 2 weeks of HBBI. Following familiarization for HBBI, participants completed 2 weeks of HBBI and acute RT (five sessions of three sets of 10 isometric knee extension at 60% MVC). Baseline neuromuscular and cardiovascular function was assessed again following completion of the 2 weeks of intervention. MVC was non‐significantly increased after the RT period in 40°C‐bathing with large effect size (partial η2 = 0.450). The electrically evoked knee extension torque (10/100‐Hz ratio) was significantly increased after the RT period in control (p = 0.020). MAP did not alter due to bathing intervention and RT (all p > 0.05). HBBI improved muscle strength without RT‐induced alteration of peripheral muscle condition. Shower without bathing reduced muscle strength gain but increased peripheral muscle condition. Short‐term RT does not adversely affect the cardiovascular function, regardless of HBBI.

Background Pain, fatigue, poor sleep quality and functional capacity are the most common symptoms in patients with rheumatoid arthritis. Complementary and integrative methods to be applied by nurses can be an essential strategy in successfully managing these symptoms. The purpose of this study was to examine the effects of warm salt water and warm water baths applied to the hands and feet on pain, fatigue, sleep quality and functional capacity in patients with rheumatoid arthritis. Methods This three-arm and prospective randomized controlled study fifty-four patients were randomly assigned to three groups (warm salt water: 18; warm water: 18; control: 18). Data were collected using the Visual Analog Scale, Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire, Disease Activity Score 28, Pittsburgh Sleep Quality Index, and Health Assessment Questionnaire. The intervention groups received warm saltwater or warm water hand-foot baths for six weeks. In all three groups, the measurements were taken at the beginning of the study and at the end of the last bathing sessions. Data were analyzed with chi-square test, one-way ANOVA, paired sample t-test, and two-way mixed ANOVA with Bonferroni’s test. Results Two-way mixed ANOVA revealed significant Group × Time interactions for pain (F = 9.736, p  < 0.001, η² = 0.249), fatigue (F = 4.323, p  = 0.013, η² = 0.158), and fatigue-related quality of life (F = 3.350, p  = 0.043, η² = 0.116). Bonferroni post-hoc analyses indicated that both interventions (warm salt water and warm water) led to significant improvements in pain, fatigue, and sleep quality scores compared to the control group ( p  < 0.05), Notably, the most significant improvement in pain was observed in the warm saltwater group, while the most pronounced reductions in fatigue and fatigue-related quality of life were observed in the warm water group ( p  < 0.05). Although significant within-group improvements were observed in both intervention groups for sleep quality and only in the warm saltwater group for functional capacity ( p  < 0.05), no significant Group × Time interactions were found for either outcome ( p  > 0.05). Conclusions The findings of this study confirmed that warm saltwater and warm water baths applied to the hands and feet improved pain, fatigue, and sleep quality in patients with rheumatoid arthritis. Additionally, warm saltwater baths significantly improved functional capacity. These interventions may serve as safe, accessible, and effective complementary methods for symptom management. Registration Retrospectively registered with the ClinicalTrials.gov (Ref. No: NCT05888220). (Registration Date: 24 May 2023).