Department Of Hospital Research Articles

Exploring the perspective of adolescent childhood cancer survivors on follow-up care and their concerns regarding the transition process-A qualitative content analysis.

In Germany, children diagnosed with cancer survive their initial disease in more than 80%, and the majority will become long-term survivors. Around the age of 18, survivors are transferred to adult healthcare. The transition can be a critical period in the process of care at which many childhood cancer survivors discontinue to participate in regular follow-up care. Hence, the objective of the paper was to explore (a) survivors' attitudes towards pediatric follow-up care and (b) their concerns regarding the transition process to draw conclusions for optimizing pediatric care and transition processes. We conducted semi-structured interviews with 21 adolescent childhood cancer survivors between the ages of 14 and 20. The survivors were recruited via a pediatric oncology department of a university hospital in Germany. Based on the principles of qualitative content analysis, a deductive-inductive method according to Kuckartz was applied. Based on the interview guide and derived from the exploratory research questions, two key categories were generated: (a) Survivors' attitudes towards pediatric follow-up care, which encompasses all formal and emotional aspects of survivors regarding follow-up care, and (b) their concerns regarding transition from pediatric to adult healthcare, where hindering and facilitating factors for a successful transition occur. Our results show high satisfaction among survivors with follow-up care. Nevertheless, they wish to be more integrated into processes and the organization of their follow-up care. Most adolescent survivors do not feel ready for transition. The integration of survivors into the organization processes and routines, and the promotion of emotional detachment from pediatric health care professionals (HCPs) are important to reduce concerns and uncertainties of adolescent survivors regarding the transition process and to promote subjective readiness for transition. To gain confidence in the adult healthcare, it is crucial to provide tailored education depending on individual requirements and needs and to build trusting relationships between survivors and adult HCPs.

Responding to the need: An evaluation of the subspecialty units in a pediatric surgical department in a limited resource setting using selected optimal resources for children's surgery strategies.

The Global Initiative for Children's Surgery group published the Optimal Resources for Children's Surgery (OReCS) document outlining the essential criteria and strategies for children's surgical care in low-resource settings. Limited data exist on subspecialties in pediatric surgery and their contribution to global surgery efforts. The study aimed to evaluate the development of subspecialty units within Chris Hani Baragwanath Academic Hospital (CHBAH) Department of Pediatric Surgery (DPS) from January 1, 2018 to December 31, 2021 using selected OReCS strategies for the improvement of pediatric surgery. A retrospective descriptive research design was followed. The study population consisted of CHBAH PSD records. The following data were collected: number of patients managed in PSD subspecialty unit (the units) clinics and surgeries performed, number of trainees, available structures, processes and outcome data, and research output. Of the 17,249 patients seen in the units' outpatient clinics, 8275 (47.9%) burns, 6443 (37.3%) colorectal, and 2531 (14.6%) urology. The number of surgeries performed were 3205, of which 1306 (40.7%) were burns, 644 (20.1%) colorectal, 483 (15.1%) urology, 341 (10.6%) hepatobiliary, and 431 (12.8%) oncology. Of the 16 selected strategies evaluated across the 5 units, 94% were available, of which 16.4% was partly provided by Surgeons for Little Lives. Outcome data in the form of morbidity and mortality reviews for all the units is available, but there is no data for timeliness of care with waiting lists. There were 77 publications and 41 congress presentations. The subspecialty units respond to the global surgical need by meeting most selected OReCS resources in the clinical service provided.

Impact of Post-Dobbs Abortion Restrictions on Maternal Fetal Medicine Physicians in the Southeast: A Qualitative Study

BackgroundThe US Supreme Court overturned federal abortion protections in Dobbs v. Jackson Women's Health Organization. Many states in the Southeastern US responded with restrictive policies that limit and criminalize abortion care. ObjectiveTo characterize the impacts of abortion restrictions on maternal fetal medicine physicians (MFMs) in the Southeastern US post Dobbs. Study DesignWe conducted qualitative, semi-structured interviews with 35 MFMs in 10 Southeastern states between February and June 2023. Our recruitment strategy relied on convenience and snowball sampling. Audio-recorded interviews were analyzed using Dedoose software and a descriptive qualitative approach that incorporated deductive and inductive approaches. ResultsEmergent themes were identified, and a conceptual framework was developed based on overarching themes. We found that abortion laws and external constraints following Dobbs resulted in ethical, professional, and legal challenges for MFMs that led to changes in clinical practice and deviations from patient-centered care. These forced changes resulted in negative impacts on MFMs such as increased fear, hypervigilance, and increased workload for MFMs. The changes also prompted concerns about health risks and negative emotional impacts for patients. Supportive colleagues, hospital systems, and policies were associated with decreased stress, emotional distress, and disruption of healthcare delivery. ConclusionsAbortion restrictions in the Southeastern US limit the ability of MFMs to provide or facilitate abortions in the setting of fetal anomalies and maternal health risk. MFMs perceived these restrictions to have negative professional and emotional repercussions for themselves, as well as negative impacts on patients. Supportive colleagues and clear guidance from hospital systems and departments on how to interpret laws were protective. Our findings have implications for the MFM workforce and patient care in the region.

Association of nirmatrelvir–ritonavir with post-acute sequelae and mortality in patients admitted to hospital with COVID-19: a retrospective cohort study

Studies have established the short-term efficacy of nirmatrelvir-ritonavir in managing COVID-19, yet its effect on post-COVID-19 condition, especially in patients admitted to hospital, remains understudied. This study aimed to examine the effect of nirmatrelvir-ritonavir on post-COVID-19 condition among patients admitted to hospital in Hong Kong. This retrospective cohort study used real-world, territory-wide inpatient records, vaccination records, and confirmed COVID-19 case data from the Hong Kong Hospital Authority and Department of Health, The Government of the Hong Kong Special Administrative Region. Patients aged 18 years and older who tested positive for SARS-CoV-2 between March 11, 2022, and Oct 10, 2023, and who were admitted to hospital with COVID-19 were included. The treatment group included patients prescribed nirmatrelvir-ritonavir within 5 days of symptom onset, excluding those prescribed molnupiravir within 21 days, and the control group had no exposure to either nirmatrelvir-ritonavir or molnupiravir. The outcomes were post-acute inpatient death and 13 sequelae (congestive heart failure, atrial fibrillation, coronary artery disease, deep vein thrombosis, chronic pulmonary disease, acute respiratory distress syndrome, interstitial lung disease, seizure, anxiety, post-traumatic stress disorder, end-stage renal disease, acute kidney injury, and pancreatitis). These outcomes were evaluated starting at 21 days after the positive RT-PCR date in each respective cohort constructed for the outcome. Standardised mortality ratio weights were applied to balance covariates, and Cox proportional hazards regression was used to investigate the relationship between nirmatrelvir-ritonavir and outcomes. 136 973 patients were screened for inclusion, among whom 50 055 were eligible and included in the analysis (24 873 [49·7%] were female and 25 182 [50·3%] were male). 15 242 patients were prescribed nirmatrelvir-ritonavir during acute COVID-19 and 23 756 patients were included in the control group; 11 057 patients did not meet our definition for the exposed and unexposed groups. Patients were followed up for a median of 393 days (IQR 317-489). In the nirmatrelvir-ritonavir group compared with the control group, there was a significantly lower hazard of post-acute inpatient death (hazard ratio 0·62 [95% CI 0·57-0·68]; p<0·0001), congestive heart failure (0·70 [0·58-0·85]; p=0·0002), atrial fibrillation (0·63 [0·52-0·76]; p<0·0001), coronary artery disease (0·71 [0·59-0·85]; p=0·0002), chronic pulmonary disease (0·68 [0·54-0·86]; p=0·0011), acute respiratory distress syndrome (0·71 [0·58-0·86]; p=0·0007), interstitial lung disease (0·17 [0·04-0·75]; p=0·020), and end-stage renal disease (0·37 [0·18-0·74]; p=0·0049). There was no evidence indicating difference between the groups in deep vein thrombosis, seizure, anxiety, post-traumatic stress disorder, acute kidney injury, and pancreatitis. This study showed extended benefits of nirmatrelvir-ritonavir for reducing the risk of post-acute inpatient death as well as cardiovascular and respiratory complications among patients admitted to hospital with COVID-19. Further research is essential to uncover the underlying mechanisms responsible for these observed negative associations and to devise effective strategies for preventing the onset of post-acute sequelae. Health and Medical Research Fund, Research Grants Council theme-based research schemes, and Research Grants Council Collaborative Research Fund.

Evaluation of the pre-analytical phase in the hospital departments of University Hospital Center Mohammed VI Oujda

Evaluation of the pre-analytical phase in the hospital departments of University Hospital Center Mohammed VI Oujda

Médiations culturelles : modalités de mise en œuvre dans une institution de pédopsychiatrie

ContextArt-mediated activities and cultural care have become a component of most hospital institutions for children and adolescents. Yet their funding is not specified. Based on the experience of a university hospital department, we would like to consider measures that might encourage their continuation. MethodsWe conducted an observational study and interviews (n=15) to list all the activities carried out by an external contributor in 2023, their themes, the target audience, their objectives, the nature of the contributors, the existence of a formalized agreement, funding, as well as their frequency and duration. ResultsThirty-five different partners carried out 685 actions in 2023, 10% of which were carried out outside the hospital. The themes addressed are extremely varied (sports, performing arts, literature, visual arts, etc.). These activities represent an average of 210 interventions per unit, or 4 per week. However, they are less numerous in the intensive care unit and units for autistic patients with challenging behaviors, and virtually absent from outpatient units. Finally, specific funding or agreements are often absent. DiscussionDespite their frequency and the substantial investment made by the team and its partners, there are a number of weaknesses. We are developing the idea that the creation of a cultural policy co-constructed between a cultural and sponsorship department and the clinical components (in our case, child psychiatry) would make it possible to resolve some of these weaknesses and promote a better inclusion in patient care.

Correlation between the elevated level of interleukin-6 following actemra administration and the mortality rate of seven severe COVID-19 patients

The escalation and involvement of Interleukin 6 (IL-6) in the pathogenesis of COVID-19 have been documented in numerous studies and are recognized as a diagnostic criterion, disease biomarker, and therapeutic objective. Our study aims to explore the correlation between the elevated level of IL-6 following actemra administration and the mortality rate of seven severe COVID-19 patients who were admitted to the special care department of Ardabil city hospital. In this case-series study, 7 patients with severe COVID-19 were admitted to the special care department of Ardabil city hospital were included in the study. Venous blood samples (3 cc) were taken in admission and after actemra injection. The demographic characteristics of the patients, including age, sex, duration of hospitalization, need for intubation, BMI, and interleukin 6 levels, were recorded in a checklist. The patients were then monitored for their clinical course, disease outcome, and complications. The mean IL-6 before and after actemra was 413.57±138.38 and 805.50±128.18, respectively and the difference was significant. After treatment by actemra, 71.4% of patients were discharged from hospital without mortality. Although elevated IL-6 levels have been associated with cytokine storms and unfavorable consequences in COVID-19 patients. This report indicates that high interleukin levels do not guarantee mortality. Young individuals without underlying conditions were ultimately discharged from the ICU despite severe inflammation, thanks to timely treatment and albeit with severe disability.

The Safety of Ixekizumab in Chinese Adults with Moderate-to-Severe Plaque Psoriasis: Analyses from a Prospective, Single-Arm, Multicenter, 12-Week Observational Study.

Ixekizumab, a monoclonal antibody against interleukin-17A, is efficacious and well tolerated for the treatment of moderate-to-severe plaque psoriasis. However, there are limited data on the real-world safety of ixekizumab in Chinese patient populations. We performed an observational study of ixekizumab for the treatment of moderate-to-severe plaque psoriasis in routine clinical practice in China. Here we present a further safety analysis of this study. In this prospective, observational, single-arm, multicenter, post-marketing safety study, adults (≥18 years) with moderate-to-severe plaque psoriasis receiving ixekizumab were enroled at dermatology departments in hospitals across China and prospectively followed for 12 weeks or until their last dose of ixekizumab. In this analysis, we evaluated adverse events (AEs) of special interest (AESIs) identified using MedDRA® search strategies. We also analyzed AEs and AESIs occurring in greater than ten patients in subgroups by age (< 65/≥ 65 years), sex, body weight (< 60/60 kg to < 80/≥ 80 kg), renal impairment, hepatic impairment, history of tuberculosis, history of HBV infection, recent or active infection, history of allergic reaction/hypersensitivity, and number (0-1/2-4/5-7) of ixekizumab 80 mg injections after baseline until day 105. This analysis included 663/666 patients enrolled in the primary study. At least one AESI was reported in 224 (33.8%) patients and considered related to ixekizumab in 181 (27.3%); the most common were injection site reactions (n = 131, 19.8%), infections (n = 80,12.1%), and allergic reactions/hypersensitivity events (n = 59, 8.9%). The proportion of patients with ≥ 1 AE was higher for females versus males (99/186, 53.2% versus 184/477, 38.6%, p = 0.0006). The proportion of patients with ≥ 1 AE increased with the number of ixekizumab injections after baseline [61/188 (32.4%) for zero to one injection, 151/338 (44.7%) for two to four injections, and 61/106 (57.5%) for five to seven injections; p = 0.0001]. In this real-world study, ixekizumab was well tolerated in Chinese patients with moderate-to-severe plaque psoriasis, with no difference in safety across most patient subgroups.

The situation of pre-hospital emergency care through traumatic patients have been admitted to emergency department of Viet Duc University Hospital in 2023

Introductions: Pre-hospital Emergency Care (PEC), especially for severe trauma is playing an important role. The study was conducted to provide an overview of the situation of PEC in Vietnam through traumatic patients at Viet Duc University Hospital. Materials and methods: A cross-sectional study enrolled all traumatic patients admitted to the Emergency Department of Hospital and had complete medical records, during the period from July to September, 2023, regardless of gender, age. Data were collected and processed using SPSS 20.0 software. Results: Characteristics of target population: 343 cases of traumatic patients were enrolled, male was majority accounted for 71.4%; The age group from 15 to 59 years old accounted for highest proportion (63%), ≥ 60 years old (32.6%). The sites of accident were mostly occurred on road (64.3%), at home (23.9%) and working place (10.2%). The brain injury accounted for the highest proportion (55.4%), multiple injuries (54.8%), extremities injury (38.5%), maxillofacial injury (25.1%) and spine injury (21.0%). Situation of PEC: First aid was mostly provided by first witness/accompanying person (64.5%), by community first aid provider (24.1%), only 11.4% provided by professional health worker. 8.7% patients were transported by taxi/car, 16.7% by unsafe ambulance, lacking official regulated medicine or equipment, or the health personnel did not know about the patient’s medical history. Some first aid were not provided on scene including: airway management 22.2%, wound care and dressing 33.0%, collar to cervical spine 14.5%, extremities splint 34.9%. Additionally, many extremities splint and wound care, 24.5% and 37.5% respectively, were done improperly. Conclusions and recommendations: The study showed some challenges such as improper first aid provision or unsafe transportation, which potentially cause unwanted risk for the patients. The author highly recommend the improvement of PEC according to the new law on this issue.

Hospital Length of Stay and Associated Factors in Patients with Osteoarthritis from Germany: A Cross-Sectional Study.

Objective: There is a scarcity of data on hospital length of stay (LOS) in the osteoarthritis population. Therefore, this study aimed to investigate hospital LOS and associated factors in patients with osteoarthritis from Germany. Methods: The present cross-sectional study included patients hospitalized for osteoarthritis in one of fourteen hospitals in Germany between 2018 and 2023 (hospital database; IQVIA). The study outcome was the duration of hospital stay in days. Study covariables included age, sex, hospital department, osteoarthritis type, co-diagnosis, and hospitalization-related procedure. Associations between covariables and hospital LOS were analyzed using hierarchical linear regression models. Results: There were 8770 patients included in the study (mean [standard deviation] age 68.7 [10.8] years; 60.2% women). The mean (standard deviation) hospital LOS was 8.5 (5.0) days. Factors positively and significantly associated with hospital LOS were older age, female sex, orthopedic surgery and other medical specialty departments (compared with other surgery departments), knee and other and unspecified osteoarthritis (compared with hip osteoarthritis), multiple co-diagnoses (e.g., acute posthemorrhagic anemia, other disorders of fluid, electrolyte, and acid-base balance, and disorders of purine and pyrimidine metabolism), and several hospitalization-related procedures (i.e., geriatric rehabilitation, hip arthroplasty, and knee arthroplasty). Conclusions: The mean hospital LOS was higher than eight days in this osteoarthritis population from Germany, with a spectrum of demographic, clinical, and hospitalization-related factors associated with this hospital LOS. In this context, interventions are needed to reduce the LOS of hospitalizations for osteoarthritis in Germany.

Efficacy of human milk fortification in low-birth-weight infants; A randomized controlled trial

Introduction: Low Birth Weight (LBW), less than 2500grams, has significant effect on baby survival and growth. A good supportive care in addition to breastfeeding is very important. Breast milk fortification role is under research. Aims; To study the Efficacy of Human Milk Fortification in Low-Birth-Weight Infants Materials and Methods: This RCT was conducted at Department of pediatrics Lady Reading Hospital, Peshawar, Pakistan, from October 2021 to March 2022. A total of 60 low birth weight neonates were randomly allocated into two arms (group A fortified) and (group B unfortified) through non probability consecutive sampling technique. One group was given fortified expressed breast milk with 1g sachet of Human Milk Fortifier (HMF). The second group was fed with unfortified breast milk only. Babies were monitored every two-weekly with Biochemical markers. Data was analyzed through descriptive and inferential means using independent T Test. Results: The mean weight of neonates in the supplemented group was 2273.83g (Mean SD = 2273.83g 182.83g) and in the control group it was 2176.67g (Mean SD = 2176.67g 181.86g). Result shows that infants given human milk fortifier gain more weight as compared to breast milk. Statistical analysis also showed significant difference (P value 0.017) Conclusion: It is concluded that use of human fortified milk is helpful in gaining weight in low birth weight infants. It also improves serum calcium and protein levels.

A Study on The Internal Determinants of Financial Sustainability Performance in Private Hospitals

Financial sustainability has been a significant goal across all sectors recently. It is also imperative to set financial sustainability as an objective to sustain operations in private hospitals that are pivotal within Türkiye’s health system. Literature highlights that the hospitals deliver services amidst significant financial challenges. The purpose of this study is to explore the internal factors related to financial sustainability performance in private hospitals, analyze the relationships between them, and develop recommendations based on the analysis. A quantitative, cross-sectional approach was employed in the research, utilizing a questionnaire to collect data. Seventy participants working in the administrative and financial departments of private hospitals from different cities were included. The data were analyzed by structural equation modeling. The study identified cost management practices, logistic performance, and marketing efforts as variables potentially related to financial sustainability performance. Correlation analysis indicated a significant, positive relationship between the variables and financial sustainability performance. Path analysis revealed that marketing efforts had the most significant impact on financial sustainability performance followed by cost management. Logistic performance had no significant influence within the model. The number of studies on healthcare sector considering financial sustainability and its’ possible determinants is highly limited. This study provides practical implications by examining this phenomenon with its’ potential internal determinants.

Violence-Related Injuries: The Most Common Cases in Hyderabad, Pakistan

The law influences every aspect of human activity, including medical practice. The nature of casualty is affected by geographical regions, cultures, and social values. Determining characteristics of casualty can guide health policy and can assist in managing healthcare resources. Objective: To profile the cases at casualty department of a tertiary teaching hospital. Methods: The study was conducted at the casualty department of Liaquat University Hospital Hyderabad, Pakistan and Department of Forensic Medicine &amp; Toxicology LUMHS, Jamshoro, over a period of one year from January 2021 to December 2021. A total of 3,487 cases were recorded and categorized into violence-related, transportation-related, substance-related, and sexual assault-related injuries. Results: The majority of cases were violence-related incidents (84.65%), followed by transportation-related accidents (14.65%), substance-related injuries (3.61%), and sexual assault-related injuries (0.69%). Violence-related injuries were divided into assault cases, firearm incidents, and police torture. Transportation-related injuries were categorized as road traffic accidents and train accidents. Assault and road traffic accidents were the leading cause of violence-related and transportation-related injuries, respectively. The highest numbers of cases were observed in April, June, and May. Conclusions: A substantial portion of cases at casualty department of Liaquat University Hospital, Hyderabad is contributed by violence-related injuries

Seasonal Decomposition of Sexual Victimization-Related Cases in Hyderabad, Pakistan

The issue of sexual assault is a serious concern that contributes to abuses of human rights and risks to public health. Evaluating situations like these is absolutely necessary in order to make the judicial process easier for both the victim and the person who committed the crime. When the seasonality of sexual assault-related incidents is determined, it can provide the community and law enforcement authorities with information that can help them implement preventative measures. Objective: To assess the seasonality of sexual assault-related cases at casualty department of a teaching hospital in Hyderabad, Pakistan. Methods: In current descriptive/prospective study, ninety two sexual assault-related medico-legal cases (MLCs) were included. This study based on the seasonality of sexual assault-related MLCs using seasonal decomposition of three-year from January 2020 to December 2022 data from a leading tertiary care teaching hospital in the Hyderabad region. Results: Most of the cases (N=42) were reported in the year 2021. The percentage of sexual assault-related MLCs was found to be concentrated from June to August (10.86% to 14.13%). The highest number of sexual assault-related MLCs occurred in July. The seasonal decomposition also showed pronounced peaks in summer, with intense peaks in July for rape and total sexual assault cases. Conclusions: The number of sexual assault-related cases was aggregated in mid-year, showing a higher trend in summer season. Efficient preventive measures in certain seasons and education of vulnerable groups can minimize sexual violence in the community

Epidemiology and Risk Factors of Bacterial Dermohypodermatitis in Conakry (Guinea): A Series of 136 Cases

Bacterial Dermohypodermatitis (DHB) brings together three entities of pathologies with an acute and decidedly serious course in the event of a delay in diagnosis. The prognosis depends on the location and appearance of the local lesion. The objective of our study was to describe the epidemiological aspects and identify the risk factors for bacterial dermohypodermatitis in the dermatology-venereology department of the Donka national hospital (Guinea). Patients and methods: Retrospective descriptive study covering the files of hospitalized patients over a period of 2 years (2019-2021) with at least one associated risk factor. Results: We identified 535 cases of bacterial dermohypodermitis, 136 of which had at least one associated risk factor, i.e. 25.4% of cases. A female predominance was noted at 51.5%. The average age of the patients was 49.4±15.2 years. The main risk factors found were the existence of a portal of entry 87,5%, followed by artificial depigmentation 39%, diabetes 27.9%, lymphedema 19.9%, venous insufficiency 7.3%, history of erysipelas 6.6% and obesity with 5.9%. The diagnoses found were necrotizing fasciitis 41.9% followed by erysipelas 39% and necrotizing bacterial dermohypodermatitis 19.1% of cases. Conclusion: The study showed a female predominance of bacterial dermohypodermatitis. The main risk factors were a portal of entry and artificial depigmentation. It remains a potentially serious pathology favored by the underlying terrain and necrotizing forms.

Lymphology of Uzbekistan –55 years: the results and development prospects

In 2024, it will be 55 years since the birth of lymphology in Uzbekistan, as an actively developing scientific field. In 1969, a Lymphology research laboratory was created at the Department of Surgical Diseases of the Pediatric Faculty (currently the 1st Department of Hospital and Faculty Surgery) of the Andijan State Medical Institute. The initiator of the organization of the Lymphological Laboratory was the head of the Department, Doctor of Medical Sciences Satkul U. Dzhumabaev. In 1987, the laboratory was transformed into the Center for Clinical Lymphology of the Ministry of Health of Uzbek Soviet Socialist Republic. Today, Uzbekistan has its own School of Clinical Lymphology, recognized among specialists. 10 doctoral and 32 candidate dissertations have been defended, work continues on 6 doctoral and 10 candidate dissertations. More than 1 450 scientific papers, 12 monographs have been published, including the first manual in English “Regional lymphatic therapy” (Manchester, 1988), patents have been received for 14 inventions, and more than 35 lymphological techniques have been introduced into clinical practice. From 1992 to 2014 a specialized scientific and practical journal “Lymphology” was published. Cycles of training for doctors and nursing staff in lymphological treatment methods have been organized. A number of international scientific and practical conferences were held. In 2012, the scientific and practical activities and technologies developed in the field of clinical lymphology of the Republican Scientific Center for Clinical Lymphology were highly appreciated by the international foundation “International Arch of Europe for Quality and Technologies” and nominated for the award of the “golden sign” of this foundation.

Comparison of Hospital Expenditure and Revenue from 6% Hoteling-Eligible Items Over Two Years: A Case Study at Ayatollah Mosavi Zanjan Educational-Medical Center

Background: Drug and hoteling costs account for approximately 30% of hospital expenses. Therefore, a thorough focus on the efficiency and costs of this sector is of special importance for hospitals, as scrutinizing these costs can enhance service quality. It appears that insurance payments for hoteling services may not be economically viable for government hospitals. Hence, this study was conducted to examine this assumption. The aim of this study was to compare allocated hoteling costs with the actual amounts and assess the profit and loss in Ayatollah Mosavi Zanjan Educational-Medical Center in the years 2018 and 2019. Methods: The number and monetary value of hoteling items delivered from the pharmacy unit to the medical departments (each department separately) during 2018 and 2019 were determined by extracting data from the HIS system. Additionally, the occupied bed-days for each department were identified, and the amount received in rials from insurance organizations (6% income from hoteling services) was confirmed with the hospital's financial unit. Results: The research findings indicate significant differences in hoteling costs across various hospital departments. CCU, NICU, and Women's Active Ward were more profitable, while AICU, ICU-OH, and BICU incurred losses. Outpatient cases and certain departments were not covered by hoteling. Non-hoteling items also contributed to hospital losses. Furthermore, it was revealed that hoteling costs increased by 64% in 2019, while insurance tariffs saw only a 15% increase. Conclusion: The majority of hospital departments running at a loss can have detrimental effects on patient care quality. Therefore, this issue requires oversight from the Ministry of Health, Treatment Deputy, insurance organizations, and hospital management.

Analysis of risk factors of short-term prognosis in patients with severe Budd-Chiari syndrome

Objective: To explore the risk factors of short-term prognosis of severe BCS patients,established and verified the nomogram prediction model for these BCS patients and evaluated its clinical application value. Methods: This study is a retrospective cohort study. The clinical data of 171 patients with severe BCS diagnosed were retrospectively analyzed in the Department of Hepatopancreatobiliary Surgery First Affiliated Hospital of Zhengzhou University from January 2018 to December 2023. There were 105 males and 66 females, aged (52.1±12.8) years (range: 18 to 79 years). The patients were divided into two groups based on whether they died within 28 days: the death group (n=38) and the survival group (n=133). The risk factors for short-term death of patients were analyzed,and independent risk factors were screened by univariate and multivariate analysis. Furthermore,these factors were used to establish the nomogram prediction model. The area under the curve(AUC),the Bootstrap Resampling,the Hosmer-Lemeshow test and the Decision Curve Analysis(DCA) were used to verify the model's differentiation,internal verification,calibration degree and clinical effectiveness,respectively. Results: Univariate and multivariate Logistics regression analysis showed that the history of hepatic encephalopathy,white blood cell,glomerular filtration rate and prothrombin time are independent risk factors (P<0.05). The above factors were used to successfully establish the prediction model with 0.908 of AUC and 0.895 of the internal verification of AUC,indicating that the predictive model was valuable. The 0.663 P-values in the Hosmer-Lemeshow test indicated the high calibration degree of the model. The clinical effectiveness of the model was proved by the 18% clinical benefit population using the DCA curve with the 17% probability threshold. Conclusions: The independent risk factors are the history of hepatic encephalopathy,white blood cell,glomerular filtration rate and prothrombin time. An adequate basis was acquired by establishing a nomogram prediction model of the short-term prognosis of severe BCS,which was helpful for early clinical screening and identification of high-risk patients with severe BCS who could die in the short term and timely providing timely intervention measures for improving the prognosis.

Clinical insights into liver abscess: a comprehensive analysis of presentation, etiology and management in Northeastern India, Silchar, Assam

Hepatic abscess is a prevalent disease in Northeastern India with a myriad clinical feature. The present study is aimed to understand the clinical profile, microbiological aetiologies, and management outcomes in patients with hepatic abscesses in Northeastern India, Silchar. In the surgery department of Silchar medical college and hospital, 20 cases of hepatic abscess were studied from January 2022 to October 2023. Records were kept for history, examination, and laboratory investigations. Ultrasound-guided aspiration of the abscess was done, and samples were subject to relevant investigation. The mean age of patients was 33 years, 2/3rd of the patients were from lower socioeconomic status. Alcoholic history was elicited from 45% of the patients. The abscesses were predominantly in the right lobe (70%) and solitary (65%). Etiology of the cases, 55% amoebic, 40% pyogenic, and 5% were tubercular in origin. Pigtail catheterization was done in 70% of the patients; percutaneous needle aspiration was done in 25% of the cases. No cases of mortality were noted. Amoebic and tubercular abscess were solitary in nature whereas pyogenic abscesses were multiple. The amoebic and pyogenic abscess had right lobe predominantly affected whereas in tubercular abscesses left lobe involvement was more common. The most common presentation was young male of low socioeconomic status having solitary amoebic abscess usually in the right lobe of liver

Quality of Life and Perceived Stress in Chronic Spontaneous Urticaria: Counting the Burden

Abstract Background: Chronic spontaneous urticaria (CSU) is a dermatosis with a significant psychological component. Only a few studies have assessed the quality of life (QoL) and perceived stress in CSU patients. Objectives: To evaluate the QoL and perceived stress in patients with CSU. Materials and Methods: A cross-sectional study was done on 54 patients of CSU attending the Urticaria clinic of the Dermatology department in a tertiary care postgraduate teaching hospital in North Kerala. QoL in chronic urticaria was assessed using the Chronic Urticaria-Quality of Life (CU-QoL) questionnaire and perceived stress was assessed using the Perceived Stress Scale (PSS). Results: The mean scores of CU-QoL and PSS were 55.78 and 16.31, respectively. Out of 54 patients, 26 (48.1%) had mild impairment, 26 (48.1%) had moderate impairment, and 2 (3.7%) had severe impairment of QoL. Low stress was seen in 20 (37%) patients, moderate stress in 28 (51.9%), and six (11.1%) patients had high stress. Conclusion: This study shows that more than half of the patients with CSU had moderate to severe impairment of QoL and had moderate to severe stress.