Introduction: The rising global prevalence of cancer reveals significant regional disparities in palliative care adoption. While some countries have incorporated palliative care into their systems, over half of the world lacks such services, and oncology-specific palliative care integration is sparse. This study evaluates the global prevalence of palliative care use among cancer patients.
Methods: A comprehensive search across multiple databases was conducted to identify relevant studies. Data extraction and organisation were managed using Microsoft Excel, and analysis was performed with STATA/MP 17.0. A weighted inverse variance random-effects model was applied, and heterogeneity was assessed with Cochrane I² statistics. Subgroup analyses, sensitivity analyses and Egger's test were used to explore heterogeneity, publication bias and influential studies.
Results: The global prevalence of palliative care among cancer patients was 34.43% (95% CI: 26.60 to 42.25). Africa had the highest utilisation rate at 55.72% (95% CI: 35.45 to 75.99), while the USA had the lowest at 30.34% (95% CI: 19.83 to 40.86). Studies with sample sizes under 1000 showed a higher utilisation rate of 47.51% (95% CI: 36.69 to 58.32). Approximately 55% (95% CI: 35.26 to 74.80) of patients had a positive attitude towards palliative care, and 57.54% (95% CI: 46.09 to 69.00) were satisfied with the services. Positive attitudes were significantly associated with higher palliative care utilisation.
Conclusion: Only about one-third of cancer patients globally receive palliative care, with the highest utilisation in Africa. Nearly half of patients have a favourable attitude towards palliative care, and a similar proportion are satisfied with the services.

Keywords: Cancer; End of life care; Nursing Home care; Palliative Care.

IntroductionCancer is a leading cause of global morbidity and mortality, significantly impairing patients’quality of life (QoL). Integrated Palliative Care (IPC) has been proposed as a holisticapproach to enhance quality of life by addressing patients’ physical, emotional, and psy-chosocial needs. While some studies suggest Integrated Palliative Care improves qualityof life more than standard care, the evidence remains inconclusive. This systematic reviewand meta-analysis aim to evaluate the comparative impact of Integrated Palliative Careversus standard care on the quality of life in cancer patients.MethodsA comprehensive search of databases including PubMed, Cochrane Library, and Embase wasconducted. We selected randomized controlled trials (RCTs) comparing Integrated Palliative Careand standard care for cancer patients, focusing on the quality of life as measured by validatedtools such as the EORTC QLQ-C30 and FACT-G. Data were pooled using a random-effectsmodel to account for study heterogeneity. Subgroup and sensitivity analyses were also performed.ResultsNine randomized controlled trials involving 1,794 patients met the inclusion criteria.Meta-analysis showed that Integrated Palliative Care significantly improved quality oflife compared to standard care (SMD = 3.25; 95% CI: 1.20–5.30; p < 0.001). Studiesconducted in Asia showed the highest standardized mean difference (SMD = 6.15; 95%CI: 3.07–9.23; p < 0.001), followed closely by studies from Africa (SMD = 6.0; 95% CI:5.13–6.87; p < 0.001), compared to those from other regions. Similarly, research focusingon lung cancer patients showed the greatest standardized mean difference of (SMD =6.15; 95% CI: 3.07–9.23; p < 0.001) relative to other cancer types. Furthermore, studies
involving newly diagnosed cancer patients recorded the highest standardized mean differ-ence of (SMD = 5.69; 95% CI: 4.57–6.80; p < 0.001).ConclusionIntegrated Palliative Care significantly enhances the quality of life in cancer patients comparedto standard care. These findings support integrating Integrated Palliative Care into oncologypractices to provide comprehensive, patient-centered care that addresses both physical andemotional needs. Further research should explore long-term benefits across diverse populations.

Introduction: Barber-related infections, including hepatitis B virus (HBV), continue to be a major cause of illness and death. Numerous beauticians use razors and scissors on multiple customers without adequately sanitizing these tools. There is a lack of published research on the prevention practices and associated factors of hepatitis B virus infection among barbers in Ethiopia. Therefore, this study aimed to assess the practice and associated factors of hepatitis B virus infection among barbers.
Method: A cross-sectional study was carried out involving 411 barbers selected through simple random sampling. Data collection was performed using an interviewer-administered questionnaire and an observational checklist. The collected data were first cleaned and entered into EpiData version 4.6 and then exported to SPSS version 25 for analysis. Model fitness was assessed using the Hosmer-Lemeshow test, and multicollinearity was evaluated with the variance inflation factor. A binary logistic regression model was employed for the analysis. To address confounding factors, explanatory variables with a p-value of less than 0.25 in the bivariable logistic regression were included in the multivariable logistic regression analysis. Factors with a p-value of less than 0.05 in the multivariable analysis were considered statistically significant.
Results: Among the 411 participants, 328 (79.8, 95% CI: 75.6-83.6%) exhibited unsafe hepatitis B virus infection prevention practices. Unsafe practices were significantly associated with barbers who could not read or write (AOR 3.75, 95% CI: 1.39-10.12); primary and secondary education (AOR 3.44, 95% CI: 1.89-6.27) compared to those with college education and above; not using ultraviolet sterilizers (AOR 2.85, 95% CI: 1.30-6.27); insufficient knowledge (AOR 4.23, 95% CI: 2.13-8.40); unfavorable attitudes toward infection control (AOR 2.40, 95% CI: 1.34-4.31); and working hours of less than 8 h (AOR 0.27, 95% CI: 0.15-0.50).
Conclusion: Nearly four-fifths of barbers exhibited unsafe practices in preventing hepatitis B virus infection. Low education levels, not utilizing UV sterilizers, lack of knowledge, working fewer hours, and negative attitudes toward infection prevention were all strongly associated with unsafe practices in the prevention of hepatitis B virus among barbers. Consequently, these findings underscore the need for targeted educational programs, improved access to sterilization tools, and policy changes to promote safer practices.

Keywords: Ethiopia; barber; factors; hepatitis B virus; prevention practices.

Introduction: Stillbirth is still a major public health problem in middle- and low-income countries. However, there has been limited research conducted to identify determinants of stillbirth in Ethiopia. Therefore, this study aimed to identify the determinants of stillbirth among women who gave birth in public hospitals in the West Gojjam Zone, Northwest Ethiopia.
Methods: An unmatched case-control study was conducted among 418 mothers who gave birth from March 1-30, 2022. Consecutive and systematic sampling techniques were used to select the cases and controls, respectively. The collected data were entered into Epidata and exported into SPSS version 16 for analysis. Numerical descriptive statistics were expressed by using the mean with standard deviation (SD) and/or median with interquartile range (IQR), whereas categorical variables were expressed by proportions. Bivariable and multivariable binary logistic regression analyses were used to identify determinants of stillbirth. The model goodness of fit test was checked using the Hosmer-Lemeshow test. Variables having a P-value ≤ 0.25 in the bivariable analysis were entered into the multivariable analysis model. Adjusted odds ratio with 95% confidence intervals (CIs) was used to report the strength of association, and variables with a P-value < 0.05 were considered statistically significant.
Results: A total of 105 cases and 313 controls were included in this study. The odds of having stillbirth were higher among women who were illiterate (AOR: 1.6, 95% CI: 1.34, 7.55), had first ANC visit in the second trimester (AOR: 11.4, 95% CI: 2.99, 43.71), had an induced mode of delivery (AOR: 8.7, 95% CI: 2.10, 36.03), history of stillbirth (AOR: 1.5, 95% CI: 1.45, 4.90), bad obstetric history (AOR: 4.8, 95% CI: 1.44, 15.89), history of preterm (AOR: 7.6, 95% CI: 1.57, 37.21), not vaccinated for TT (AOR: 8.8, 95% CI: 2.23, 35.17), labor not followed by using partograph (AOR: 3.1, 95% CI: 1.10, 8.42), and history of abortion (AOR: 11, 95% CI: 2.91, 41.31).
Conclusion: The determinants of stillbirth included women who were illiterate, started ANC visits in the second trimester, had an induced mode of delivery, history of stillbirth, bad obstetric history, history of preterm, history of abortion, not vaccinated for TT, and not followed by partograph. It is better to improve partograph utilization during intrapartum care and screen mothers who had a higher risk of adverse birth outcomes during their pregnancy to avert the problem.

Keywords: Cases; Controls; Determinants; Ethiopia; Stillbirth.

Background Ethical dilemmas in emergency and critical care nursing often involve complex decision-makingthat impacts patient outcomes, emotional well-being of healthcare providers, and team dynamics. Understandingthese dilemmas and the decision-making processes involved is crucial for improving nursing practices and patientoutcomes in this context.Objective This study aims to explore the ethical dilemmas and decision-making processes of emergency and criticalcare nurses, using the Four Box. Method ethical decision-making framework.Methods A multi-method qualitative approach was employed, incorporating in-depth individual interviews(IDI), focus group discussions (FGD), and case studies to capture diverse perspectives. Data were collected from28 nurses working in emergency and critical care settings at Tibebe Ghion Specialized Hospital and Felege HiwotComprehensive Specialized Hospital through purposive sampling. The interviews and focus groups were audiorecorded, transcribed verbatim in Amharic, translated into English, and entered into OpenCode software for analysis.Inductive thematic analysis method was applied to analyze the data.Results The study revealed several key ethical dilemmas faced by nurses, including balancing patient autonomywith beneficence, and the allocation of limited resources during crises, opioid administration for pain managementvs. respiratory depression, and conflicts regarding informed consent. Nurses reported emotional and professionalimpacts from these dilemmas, contributing to moral distress, burnout, and ethical fatigue. Nurses emphasizedthe importance of interdisciplinary collaboration and structured decision-making frameworks to navigate thesechallenges. However, the lack of consistent access to ethics consultations and peer support during critical momentswas noted as a significant barrier.Conclusion and recommendation Nurses encounter complex ethical dilemmas that impact their emotional well-being and job satisfaction. Effective decision-making requires applying ethical principles, adhering to guidelines,and consulting peers. The study reveals the need for improved support systems, including more frequent and
comprehensive ethics training, better access to ethics consultations, and structured frameworks to guide decision-making in high-pressure situations.Clinical trial registration The study is not a clinical trial, a clinical trial number is not applicable.Keywords Ethical dilemma, Decision making, Emergency and critical care, Nursing

Introduction: The increasing prevalence of diabetes mellites (DM), especially type 2 diabetes mellitus, presents significant challenges for healthcare systems. Effective blood glucose management is essential for preventing serious complications, and telehealth offers a promising approach to improve patient engagement and adherence. The effectiveness of telehealth on blood glucose management should be investigated. The evaluated metric for diabetes management plans in this study was the change in blood glucose levels, specifically HbA1c, as an indicator of glycemic control. The impact of telehealth interventions on these outcomes was analyzed across various patient groups. This review conducts a comprehensive analysis of the current literature to offer insights that can guide clinical practices and inform policymakers about the advantages of telehealth in managing diabetes.
Methods: In this study, several evidence-based databases and relevant clinical trial registries were searched to evaluate the effects of telehealth on blood glucose management among patients with diabetes. The included studies were randomized controlled trials that compared telehealth with traditional in-person management. Microsoft Excel was used to extract and sort the data before it was exported to STATA/MP 17.0 for analysis. A weighted inverse variance random-effects model with a 95% confidence interval was employed to pool the data. Egger's test and Cochrane I2 statistics were used to assess publication bias and heterogeneity, respectively.
Result: This review identified six randomized controlled trials (RCTs) involving a total of 3,995 patients, with 2,022 in the telehealth intervention group and 1,973 in the control group, conducted across the USA, Asia, and Europe. The analysis showed a significant improvement in blood glucose control for patients using telehealth, evidenced by a Standard Mean Difference (SMD) of 0.20 (95% CI: 0.10-0.29; p < 0.001), with USA studies reflecting the highest SMD of 0.24 and diabetic veterans showing an even greater SMD of 0.41.
Conclusion and recommendations: This study demonstrates that telehealth interventions significantly enhance blood glucose management among patients with diabetes. The findings highlight the need for healthcare systems to prioritize telehealth integration into diabetes management protocols while developing tailored interventions to meet the diverse needs of various patient populations.

Keywords: Blood glucose; Diabetes mellitus; HbA1c; Meta-analysis; Systematic review; Telehealth.

Background: Armed conflicts significantly disrupt healthcare systems, leading to infrastructure destruction, shortages of medical supplies, and reduced access to essential health services. The Amhara region has experienced prolonged conflict, raising concerns about its impact on healthcare delivery. Understanding the extent of these disruptions is crucial for informing policy responses and humanitarian interventions.
Objectives: This systematic review and meta-analysis aimed to assess the impact of armed conflict on healthcare delivery in the Amhara region.
Study design: Systematic review and meta-analysis.
Methods: Conducted between June 1 and July 10, 2024, this meta-analysis followed PRISMA guidelines. A comprehensive search was performed across PubMed/MEDLINE, EMBASE, CINAHL, Google Scholar, ScienceDirect, and the Cochrane Library. Eligible studies included English-language observational studies and grey literature addressing healthcare disruptions, infrastructure damage, and health crises. Data were analyzed using STATA Version 14, and study quality was assessed using a modified Newcastle-Ottawa Scale.
Results: Twelve studies, encompassing 12,037,279 participants, were included. The pooled prevalence of health impacts was 76.71 % (95 % CI: 76.63-76.78). The conflict rendered 60 % of healthcare facilities nonfunctional, disrupted medical supplies for 70 % of the population, and reduced service availability by 80 %. Chronic disease management, mental health services, maternal care, and immunization programs experienced significant declines. Subgroup analyses indicated a higher prevalence of health impacts in studies published after 2022 (70.72 %) compared to those published before 2022 (28.35 %).
Conclusion: Armed conflict in the Amhara region has severely disrupted healthcare services, leading to facility closures, medical supply shortages, and significant declines in essential health services. Urgent interventions are required to restore healthcare infrastructure and services.

Keywords: Amhara; Armed conflict; Meta-analysis; Prevalence; Systematic review.

Introduction Depression and anxiety are prevalent psychological disorders that significantly affect physical,emotional, and social well-being, reducing quality of life and increasing medical costs. These issues are especiallychallenging for cancer survivors, complicating treatment management, affecting adherence, and potentiallyimpacting survival rates. Thus, this umbrella review aimed to evaluate the global prevalence of pain, depression, andanxiety, as well as their determinants among cancer patients.Method An exhaustive umbrella review was conducted to systematically assess the prevalence and determinants ofpain, depression, and anxiety among cancer survivors worldwide by analyzing systematic reviews and meta-analyses.The review involved a thorough search of multiple databases and included studies published in English up to July2024 that reported on these symptoms. The process involved screening and selecting studies based on specificcriteria, assessing the risk of bias using the AMSTAR tool, and analyzing data with statistical methods to determineoverall prevalence and identify predictors. This comprehensive approach aimed to provide a detailed understandingof these psychological issues in cancer survivors and guide future research and interventions.Result The global summary prevalence of depression among cancer survivors was 33.16% (95% CI 27.59–38.74),while anxiety had a prevalence of 30.55% (95% CI 24.04–37.06). Pain prevalence after treatment was 39.77% (95%CI 31.84–47.70). Before treatment, 65.22% (95% CI 62.86–67.57) of cancer patients reported pain, which persistedin 51.34% (95% CI 40.01–62.67) during treatment. The analysis also found that during the COVID-19 pandemic,depression and anxiety rates among cancer patients were at their highest, with prevalences of 43.25% (95% CI41.25–45.26) and 52.93% (95% CI 50.91–54.96), respectively.Conclusion The umbrella review found that depression and anxiety prevalence among cancer survivors was33.16% and 30.55%, respectively, with significantly higher rates during COVID-19 at 43.25% and 52.93%. Key factorscontributing to depression included poor social support, advanced cancer stage, and inadequate sleep, while anxietywas significantly linked to advanced cancer stage and poor sleep quality.
Clinical trial number Not applicable.Keywords Cancer, Oncology, Pain, Depression, Anxiety, Cancer survivors, Systematic review, Meta-analysis, Umbrellareview

Background: Heart failure is a leading cause of hospital readmissions in the Amhara region, Northwest Ethiopia.Aim: This study aimed to determine the number of readmissions and identify the determinants among patients with heartfailure at referral hospitals in the Amhara region, Northwest Ethiopia, in 2023.Methods: A cross‐sectional study was conducted with 663 heart failure patients in Amhara region referral hospitals fromSeptember 2022 to February 2023. Simple random sampling was used for patient selection, and data were collected throughchart reviews and interviewer‐administered questionnaires. Zero‐inflated negative binomial models were applied for dataanalysis. Data collection tools were pre‐tested for reliability and validity.Results: Among 663 patients, 237 (35.7%) were readmitted at least once. An increased respiratory rate (IRR = 1.015; 95%CI: 1.0004, 1.031; p < 0.044) and longer medication duration (IRR = 1.011; 95% CI: 1.016, 1.051; p < 0.0001) were asso-ciated with more readmissions. Patients with poor social support had 59.4% fewer readmissions compared to those withgood social support (IRR = −1.595; 95% CI: −0.02, −0.005; p < 0.041). A higher body mass index (IRR = 0.115; 95% CI:0.035, 0.196; p < 0.004) was linked with a higher likelihood of remaining in the “always‐zero” group, while an increasedpulse rate reduced the odds (IRR = −0.013; 95% CI: −0.025, −0.008; p < 0.036). The mortality rate among readmittedpatients was 11.39%.Conclusion: This study found significant readmission rates among HF patients. Factors such as respiratory rate andmedication duration were linked to increased readmissions, while poor social support was associated with fewerreadmissions, this likely reflects limited healthcare access in low‐ and middle‐income countries among individuals withlower social support. The high mortality rate underscores the need for targeted interventions to improve patientoutcomes.

Background
Anemia is a critical complication among hemodialysis patients, often leading to poor outcomes. This study aimed to assess anemia prevalence and identify predictors among hemodialysis patients at Felege Hiote Referral Hospital, Northwest Ethiopia, in 2022.


Research design and methods
A retrospective cohort study analyzed 410 hemodialysis patients from January 2018 to February 2022. Data was collected from medical records, entered using Epi-data Version 4.1, and analyzed with STATA Version 14. Kaplan-Meier survival curves assessed survival time, while Cox regression identified anemia predictors.


Results
Of 410 patients, 66 (16.1%) developed anemia, with an incidence rate of 7.9 per 100 person-years (95% CI: 3.1–13.5). Significant predictors included female sex (IRR: 1.5, p = 0.04), rural residence (IRR: 2.5, p = 0.01), low body mass index (IRR: 1.6, p = 0.02), and congestive heart failure (IRR: 6.9, p = 0.02).


Conclusions
Anemia prevalence among hemodialysis patients is high, with key predictors including gender, residence, body mass index, and comorbidities. Interventions targeting these factors, especially in rural areas, could reduce anemia incidence. Study limitations include single-center data, incomplete variables, and lack of causality.





KEYWORDS: Anemia, incidence, predictors of anemia, end stage kidney disease, hemodialysis