Hospital Institute Research Articles

Comparison of Recovery Rate and Early Complications Between Primary Resection and Two-stage Operation in the Treatment of Acute Non- Complicated Sigmoid Volvulus

Background: This study compares recovery rates and early complications associated with primary resection and a two-stage operation in treating acute sigmoid volvulus, a gastrointestinal emergency requiring prompt intervention. Proper diagnosis and appropriate operative approaches are crucial for lifesaving treatment. Objectives: This study was aim to compair of recovery rate and early complecations between two operative procedures. Methods: The cross-sectional analytical study was conducted from May to October 2015in National Institute Cancer Research and Hospital, Mohakhali, Dhaka, Bangladesh, involved 50 patients with acute non-complicated sigmoid volvulus, randomly divided into two groups, with the outcome variable being the only difference between two groups. Results: Two stage operation patients experienced 24% stomal complications, while one stage operation patients did not experience any late complication. The mean time for one stage operation was longer, and one stage operation resulted in 200 ml blood loss compared to 156 ml in two stage operations. Conclusion: In consideration of anastomotic leakage, operative time, operative blood loss post-operative hospital stay, two stage operation was better than primary resection. J Rang Med Col. March 2024; Vol. 9, No. 1: 59-64

Optometrist-delivered selective laser trabeculoplasty in the HES - a training protocol and early service evaluation.

Over the last decade, the delivery of glaucoma care in the UK has changed dramatically, with more non-medical ophthalmic practitioners involved in the care of glaucoma patients. Optometrists and other non-medical professionals are now involved in the delivery of laser treatments in the Hospital Eye Service (HES), but there is currently no standardised national training framework for non-medical clinicians. Moorfields Eye Hospital and UCL's Institute of Ophthalmology have developed and delivered an education and training programme for the delivery of lasers, including Selective Laser Trabeculoplasty (SLT) by non-medical ophthalmic practitioners. The training programme is based on medical education principles, is informed by previous qualitative research into the role of ophthalmic practitioners in the delivery of laser treatments and is expected to have multidisciplinary benefits for ophthalmic healthcare. Clinical audit data indicate that optometrists can deliver safe SLT treatments, adhering to local protocols.

Mental health sequelae in survivors of cardiogenic shock complicating myocardial infarction. A population-based cohort study.

Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short- and long-term morbidity and mortality. However, there are limited data on mental health sequelae that survivors experience following discharge. We conducted a retrospective, population-based cohort study in Ontario, Canada of critically ill adult (≥ 18years) survivors of AMI-CS, admitted to hospital between April 1, 2009 and March 31, 2019. We compared these patients to AMI survivors without shock. We captured outcome data using linked health administrative databases. The primary outcome was a new mental health diagnosis (a composite of mood, anxiety, or related disorders; schizophrenia/psychotic disorders; and other mental health disorders) following hospital discharge. We secondarily evaluated incidence of deliberate self-harm and death by suicide. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models. We included 7812 consecutive survivors of AMI-CS, from 135 centers. Mean age was 68.4 (standard deviation (SD) 12.2) years, and 70.3% were male. Median follow-up time was 767days (interquartile range (IQR) 225-1682). Incidence of new mental health diagnosis among AMI-CS survivors was 109.6 per 1,000 person-years (95% confidence interval (CI) 105.4-113.9), compared with 103.8 per 1000 person-years (95% CI 102.5-105.2) among AMI survivors without shock. After propensity score adjustment, there was no difference in the risk of new mental health diagnoses following discharge [hazard ratio (HR) 0.99 (95% CI 0.94-1.03)]. Factors associated with new mental health diagnoses following AMI-CS included female sex, pre-existing mental health diagnoses, and discharge to a long-term hospital or rehabilitation institute. Survivors of AMI-CS experience substantial mental health morbidity following discharge. Risk of new mental health diagnoses was comparable between survivors of AMI with and without shock. Future research on interventions to mitigate psychiatric sequelae after AMI-CS is warranted.

Abstract PO3-12-08: Hypersensitivity reactions to paclitaxel and carboplatin in breast cancer: safety and effectiveness of desensitization

Abstract Introduction. Taxanes and platinums are first line treatment of breast cancer for early stages and metastatic disease and constitute the most commonly implicated chemotherapeutics in hypersensitivity reactions.1 Clinical manifestations range from mild skin reactions to anaphylaxis.2 Hypersensitivity reactions (HSR) to paclitaxel and carboplatin occur in a significant percentage of patients, with estimates of 30% and 40% respectively,3,4,5 leading to discontinuation of treatment.6 Using alternative drugs can be poorly tolerated or much less effective, entailing to high morbidity and mortality.7 Desensitization is the procedure performed to achieve a tolerance to the drug to which a HSR previously occurred, in order to maintain first-line treatment.8 The evaluation of the oncological response remains in the importance of assessing the shrinkage of the tumor and the time of progression of the disease.9 Objective: To describe the hypersensitivity reactions to paclitaxel and carboplatin, and the safety and effectiveness of desensitization protocols after anaphylaxis in patients with breast cancer. Materials and Methods: Original, retrospective, descriptive, and analytical study, approved by the Bioethics and Research Committee ON23-00016 code, included patients >18 years with breast cancer who developed a hypersensitivity reaction to first-line chemotherapy and performed a 3-bag-12-step desensitization according to the Brigham and Women's Hospital, Dana Farber Institute, Boston protocol. Results: Forty-five desensitization to paclitaxel or carboplatin were performed in 8 women with breast cancer, mean age 38.6 years. 6 patients developed HSR to paclitaxel, 83% of which were in the first application, and 2 patients developed HSR to carboplatin after several cycles. The most predominant symptom of HSR was cutaneous in 87% of the cases, and all patients presented cardiovascular HSR to paclitaxel. No patients developed HSR during desensitization. Currently, only 1 patient developed disease progression, while the rest presented a complete response to treatment. Discussion. HSR to paclitaxel appear in the 1-2 cycle,10 while to platinums after various exposures ( >6 cycles) similar to our study.3,4 The symptoms associated with paclitaxel are cardiovascular10,11 while urticaria is the most frequent in carboplatin.3,11 The desensitization protocol implemented did not develop HSR in any of the patients. Neoadjuvant chemotherapy in breast cancer has been shown to yield better disease-free interval results alongside improved pathological response.12 Conclusions. The program implemented in our hospital's chemotherapy desensitization clinic, replicating the model of the Dana-Farber Cancer Institute, Brigham, and Women's Hospital in Boston, has enabled cancer patients to continue with first-line treatment, thus improving their prognosis and quality of life, opening new areas of opportunity in the multidisciplinary management of these patients to improve overall survival. Characteristics of patients with hypersensitivity reactions HSR: hypersensitivity reactions ND: No data m: months yrs.: years Desensitization protocol to Paclitaxel IV (300 mg) IV: intravenous mg: milligram mL: milliliter h: hour Citation Format: Rosalaura V. Villarreal-González, Oscar Vidal-Gutiérrez, Javier A. Martínez-Moyano, Marianela Madrazo-Morales, Kathia S. Sáenz-Cantú, Patricia Rodríguez-Niño. Hypersensitivity reactions to paclitaxel and carboplatin in breast cancer: safety and effectiveness of desensitization [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-12-08.

Les soins palliatifs au Liban, un essor freiné mais une résilience à toute épreuve

The history of palliative care in Lebanon is marked by resilience and perseverance. Supported by personal initiatives, legislative battles and private donations, Palliative Care has managed to gradually anchor itself in the medical landscape, despite the meager means offered by the State. The delivery of Palliative Care in Lebanon has the particularity of being supported mainly by non-profit NGOs, whose operation is halfway between French HAD (Home hospitalization) and EMSP (Mobile palliative care units) and which offer free care to patients. More than 30% of patients followed by the NGO BALSAM suffer from chronic non-cancerous diseases. Pediatric palliative care is almost non-existent, with BALSAM being the only NGO providing support for children in their homes. Faced with the major financial difficulties facing the country, these NGOs are now turning to international partnerships, both to ensure the means to pursue their missions, and to reserve a place on the world stage. The Lebanese model developed by BALSAM is presented in developing countries as a possible example of operation in a crisis context. A delegation from the Medical-Chirurgical Center for Rehabilitation of Massues (CMCR) in Lyon also intervened at the Rafik Hariri Hospital Center in Beirut to discuss three themes: management, rehabilitation and palliative care. The same difficulties that we encounter in France regarding the temporality of intervention in care could be noted: It is uncommon for Lebanese medical colleagues to seek palliative care support early. The place of palliative care within the hospital institution is still new, and the resources allocated are too low, both in terms of nursing time and suitable premises. The road remains long, but everything is being done to ensure that palliative care continues to be talked about and extends ever deeper within the Lebanese health system.

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

Context: Art-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.Methods: We 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.Results: Thirty 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.Discussion: Despite 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.

The lived experience of South African men having a premature baby

Background: Much has been written about fathers, fatherhood and premature babies. However, in the South African context, studies about the experiences of fathers having a premature baby are lacking.Aim: This study aimed to explore how South African fathers (n = 10) experience having a premature baby using a descriptive phenomenological approach.Setting: This research study was conducted online using various social media platforms such as WhatsApp, Google Meet and through telephonic conversations.Methods: A descriptive phenomenological approach that allowed for the distillation and elucidation of common core experiences among fathers who had a premature baby.Results: The findings demonstrated that the participants experienced intense fears regarding the survival and well-being of their children. They reported experiencing financial difficulties related to hospital bills and experienced being alienated by hospital institutions. Despite these reported barriers, these fathers were adamant in their resolve to support their children and partners during this challenging time.Conclusion: The experiences of fathers were riddled with fear, uncertainty, ambiguity and alienation, which placed them in very precarious situations when trying to navigate their role in a more sensitive and enlightened way. Having a premature infant calls into question the systems that men are positioned within as these systems to a large extent shape these events and how they are experienced.Contribution: This study is original as no other published studies seem to exist in South Africa that speaks to fathers’ lived experiences of having a premature baby.

Women in engineering, science and technology in sub-Saharan Africa: cultural attitudes, challenges, and gaps affecting clinical engineering and medical devices maintenance practices

Abstract Purpose From previous studies, we had observed that the number of biomedical engineers and technicians (BMETs) skilled in the maintenance of medical devices (MDs) were limited in sub-Saharan Africa (SSA) and that a likely parallelism existed between BME maintenance-related tasks and house chores mainly carried out by women in daily life. Our objective in carrying out this study was to understand underlying local cultural and social factors and domestic traditions interfering with the inclusion of women in the field of clinical and biomedical engineering (BME), and to identify existing gaps in opportunities for women in Engineering, Science and Technology (EST) in this region. Methods We carried out an online survey involving 51 respondents (70.6% women, 29.4% men), to investigate gender-biased and cultural perceptions of maintenance-related tasks among engineers/technologists/technicians in BME and other allied professions in SSA​. The survey was refined through focus groups and pilot tests to assess its validity, and then shared among specific associations of women in engineering and other bodies in EST, as well as some hospital communities and institutions. Results The survey brought to light evidence of prejudices against women in the society and workplace and showed that the adoption of our parallelism hypothesis has potential for increasing medical device maintenance practices in SSA hospitals. Conclusions There is an apparent need to further study the possible effects of this sociological model through leveraging local culture and domestic traditions in ways that could ultimately increase the leadership and numbers of women BMETs in SSA.

The Impact of Breast Implant Cohesivity on Rippling and Revision Procedures in Two-Stage Prepectoral Breast Reconstruction

Abstract Background Rippling remains one of the most common complications following prepectoral implant-based reconstruction (IBR). Objectives The purpose of this study was to assess how implant cohesivity, a measure of elasticity and form stability, effects the incidence of rippling in prepectoral IBR. Methods We performed a retrospective cohort study of two-stage prepectoral IBR performed between January 2020 and June 2022 at the Brigham and Women’s Hospital and Dana Farber Cancer Institute, comparing outcomes in patients who received Allergan Natrelle® least cohesive, moderately cohesive, and most cohesive silicone gel implants. Outcomes of interest were rippling and re-operation for fat grafting. Results 129 patients were identified, of whom 52 had the least cohesive implants, 24 had the moderately cohesive implants, and 53 patients had the most cohesive implants. Mean follow-up time was 463 (± 220) days. Decreased incidence of rippling was seen with moderately cohesive (OR 0.30, p < 0.05) and most cohesive (OR 0.39, p < 0.05) implants. Third stage re-operation for fat grafting was less frequent in patients with the most cohesive implant (OR 0.07, p < 0.05). In subgroup analyses, the patients with the most cohesive implant, who did not receive fat grafting at the time of initial implant placement, did not require re-operation for fat grafting (0%). Conclusions The use of highly cohesive implants in prepectoral IBR is associated with decreased rippling and fewer re-operations for fat grafting.

Antimicrobial activity of cefepime-tazobactam combination against extended spectrum beta-lactamase and/or AmpC beta-lactamase- producing gram-negative bacilli

BackgroundThe problem of resistance to beta-lactam antibiotics, which is caused by ESBL and AmpC β-lactamases, is getting worse globally. Infections caused by bacterial isolates harboring these enzymes are difficult to treat with carbapenems being the sole effective treatment option for such infections. The objective of this study was to determine the frequency of ESBLs and AmpC-producing Gram-negative bacilli isolated from clinical specimens and to evaluate the sensitivity of cefepime-tazobactam combination against them.MethodsThis is an observational cross-sectional study carried out on 100 Gram-negative bacilli at Theodor Bilharz Research Institute Hospital during the period from February 2015 to January 2016. ESBL production was screened by using the disc diffusion test followed by confirmation by the combined disc confirmatory test, the screening for AmpC production was conducted using the cefoxitin disc test, which was subsequently confirmed by the AmpC disc test. Isolates confirmed positive for ESBL and/ or AmpC production were investigated for their susceptibility to antibiotics.ResultsAmong 100 Gram-negative bacilli, 44 isolates were confirmed as ESBL producers by the combined disc confirmatory test out of 56 isolates that tested positive for ESBL production through the disc diffusion test. The presence of AmpC production was assessed using the cefoxitin disc test, 32 isolates were screened to be AmpC producers, and the AmpC disc test confirmed AmpC production in 9 isolates of them. Using the Mast® D68C set, 32 isolates were ESBL producers, 3 were AmpC producers, and 4 isolates were ESBL/AmpC co-producers. The highest sensitivity was to cefepime-tazobactam (91.48%) followed by the carbapenems.ConclusionCefepime-tazobactam showed remarkable activity against ESBL and/or AmpC-producing Gram-negative bacilli and may be considered as a therapeutic alternative to carbapenems.

Evaluating the moderating role of management inspection between safety hazards in hospital working conditions: A study of hospitals in Islamabad

The study identifies the relationship between safety hazards and hospitals working conditions. The management inspection role supported by the management in hospitals is identified to bring safety measures precautions and effectiveness for the healthcare staff and make the hospital working conditions better. The hospital management inspection role helps to accomplish occupational safety and better working conditions. The objective of this study is to identify the relationship of management inspection role in tackling with the safety hazards to find out working conditions in Al-Shifa International hospital and Pakistan Institute of Medical Sciences hospital. The study used various statistical tests like Pearson’s correlation and KMOs Bartlet’s test to evaluate the predictors of safety barriers, working conditions and management inspection role. Data was gathered using research questionnaire and the response rate was 73%. Among the 500 respondents, 75% were males while 25%were females. The age range was 40 or above years with a mean of 2.5. The reliability analysis for the constructs is in the acceptable range. The management lacking in providing the safety information rated as 0.61 correlation matrix. The medical doctors’ responded noise as the most detrimental factor resulted with 0.70 communality and lack of health facility comes as 0.61. The structure matrix shows biological hazards rated as 0.66 and physical explosion hazards rated as 0.70 which is analyzed through KMO Bartlet’s test. The safety hazards existence in the hospitals calls upon the attention on conducting research on inspection, detection and reporting of the hazards.

The mediating role of cardiac patients’ perception of nursing care on the relationship between kinesiophobia, anxiety and depression in rural hospitals: a cross-sectional study

BackgroundKinesiophobia could act as a significant barrier against physical activity following cardiac procedures worsening cardiovascular health problems and potentially leading to conditions like hospital-acquired anxiety and depression among patients with cardiovascular disease (CVD). Nurses are the vanguard health care team who can aid patients in taking proactive steps to overcome fear of movement following cardiac procedures.AimThe overarching aim is to investigate the relationship between kinesiophobia, anxiety and depression, and patients’ perception of nursing care.MethodA descriptive correlational research design in two rural hospitals, conducted at cardiac intensive care units of Kafr Eldawar Hospital and Damanhur Medical National Institute. Data were collected from 265 nurses, using the following patient-reported outcome measures, the Tampa Scale for Kinesiophobia (TSK), the Hospital Anxiety and Depression Scale (HADS), the Person-Centered Critical Care Nursing Questionnaire (PCCNP) and the patients’ demographic and clinical profile.ResultA significant negative correlation was found between HADS and PCCNP (r: -0.510, p < 0.001) however, Kinesiophobia was significantly and positively correlated (r: 0.271, p < 0.001). A direct effect of PCCNP in the presence of the mediator was found to be not statistically significant (-0.015, CR = 0.302, p = 0.763). Nonetheless, PCCNP indirectly affects kinesiophobia through HADS (p=-0.099).Implication for nursing practiceCustomizing individualized cardiac rehabilitation (CR) programs based on the emotional experience of cardiac patients will be conducive to rehabilitation and prognosis for patients, thereby lessening the physical burden and improving their quality of life.

Factors that influence the patient safety climate: perception of the multidisciplinary team

To identify factors that influence the patient safety climate of a hospital institution. Cross-sectional study carried out with a multidisciplinary team of a private hospital in the Central-West of Brazil in 2019. An instrument covering sociodemographic and work aspects and the Safety Attitudes Questionnaire – Short Form 2006 were used for data collection. The data were analyzed through the Kruskal Wallis, Mann-Whitney, Spearman’s, Nemenyi and Fisher’s tests. 293 healthcare providers participated in the study, with a mean age of 36 years, 72.01% female, and 35.49% with complete high school education. Data revealed an unfavorable patient safety climate (mean=73.53). Among the domains, job satisfaction presented the highest score (mean=83.28), while perception of the management of the unit and the hospital showed greater fragility (mean=67.40). The domain Patient safety training in the last 12 months led to an mean increase of 5.64 in the patient safety climate. A negative perception of the patient safety climate was found, with a significant influence from patient safety training and the intention to leave the job. The evidence confirms the importance of continuous investments in patient safety training and research, as trained professionals have a more critical and wider view of safety processes, a positive factor for constructive and sustainable changes.

Obstetric violence and racism: analysis of scientific production from an intersectional perspective

This study aimed to investigate obstetric violence as a phenomenon arising from racism and its intersectionality, as factors suffered during the pregnancy and puerperal period in hospital institutions in several countries. To this end, systematic literature review research was used as a method, as well as the PRISMA protocol perspective was adopted for data collection. References were recruited from the databases, using the descriptors “obstetric violence” and “racism” or “intersectionality”. The search resulted in 1126 articles which, when applying the eligibility criteria, reached the volume of 3 (three) works. Based on the findings, two categories were constructed, “Intersectionality (race, gender and social class)” and “Obstetric violence”. As a result, there was a shortage in national and international journals dedicated to Health Sciences. Such absences or insufficiencies may indicate the non-consolidation of black women's health as thematic and research fields, related to the low degree of penetration in research institutions debates about racism, its impacts on health and ways of coping.

Perceptions on Medical Professionalism Among Future Healthcare Professionals: A Mixed Method Study.

Background Accreditation councils across the world constantly examine policies and practices in professionalism in their medical curriculum. The National Medical Commission (NMC) in India has recognized the pressing need to reform and include professionalism in its undergraduate curriculum. Objectives The objective of this study was to explore the perspectives of medical and nursing students on professional behavior, suitable teaching-learning methods, and assessment strategies for curriculum integration. Methodology The study utilized a concurrent triangulation mixed method design, collecting both qualitative and quantitative data simultaneously to gain a comprehensive understanding of medical and nursing students' perceptions of professionalism. It included 83 final-year undergraduate medical students and 42 final-year undergraduate nursing students. The approval of the Institutional Review Board of Meenakshi Medical College Hospital & Research Institute was obtained. A semi-structured questionnaire consisting of demographic characteristicsand opinions regarding academic professional behavior, teaching-learning, and evaluation of professionalism was used. Perceptions regarding the meaning of professionalism, behavior of professionalism to be emphasized in teaching, and pressing challenges of professionalism were explored. Students were also asked to rank the best behavior associated with professionalism. Frequency and percentages were used for descriptive statistics. Means and standard deviations were calculated for continuous variables. An unpaired t-test was used to determine a statistically significant difference between the means in the two groups. The quantitative data was analyzed with R programming and content analysis was performed for the qualitative data using ATLAS.ti qualitative data analysis software. Results Unexplained/unauthorized absence from academic activities (2.39 ± 1.553), not following the timeline (2.41 ± 1.560), making fun of patients and peers (2.16 ± 1.619), cheating in the exams (2.37 ± 1.651), and inebriation (2.39 ± 1.666) were unacceptable behaviors by undergraduate medical students compared with nursing students. Clinical experience (1.54 ± 0.857) and role models (1.74 ± 0.935) were the highly acceptable methods of teaching professionalism and interprofessional interactions (1.58 ± 0.650) and awards (1.98 ± 1.100) were the most common suggestions to improve the course curriculum by both groups. Community/field activity (1.78 ± 0.860) and clinical examination (1.89 ±1.123) were the most preferred methods of evaluation of professionalism. According to the students, dedication, honesty, respect, and self-improvement were identified as the best behaviors associated with professionalism. Conclusions The study revealed that students had a wide range of perspectives about professionalism. Different unprofessional acts were acceptable to students. The causes of these perspectives need to be explored and resolved to promote professionalism. Students identified the need for strong positive role models and frequent clinical experiences, along with improved interprofessional interactions and awards to improve teaching and learning professionalism. Community/field activity was the preferred assessment method proposed by the students. Medical institutions must promote these components in curriculum, faculty development, and clinical settings to foster the development of professionalism among students.

Obésité de type complexe : à la jonction entre obésité développementale et réactionnelle

ContextWhether medical or surgical, the management of obesity faces significant resistance to weight loss. In this context, Bruch's work (1973) on the concepts of developmental and reactive obesity is foundational for clinical practice. However, in the most severe cases of obesity, these concepts can be reductionist and can limit the complexity observed when caring for these patients. These questions are particularly present in hospital services that handle third-level care, especially in Specialized Obesity Centers. ObjectivesUsing a clinical vignette, we will illustrate the utility of the concept of complex obesity and emphasize the therapeutic challenges in the management of patients requiring third-level care, as defined by the Health Authority. MethodIn the context of research on obesity and trauma, we present a clinical vignette of a patient treated in a specialized obesity service. We rely on data collected during clinical research interviews. ResultsThis singular case highlights the challenge regularly faced by clinicians in differentiating developmental and reactive types of obesity. Indeed, listening to the life stories of patients with severe obesity often reveals a construction of this chronic disease through successive layers. Thus, including patients in a single typology would overlook fundamental aspects involved in the onset of their obesity. Faced with this difficulty, we suggest introducing the notion of complex obesity, which would precisely account for situations at the intersection between developmental and reactive obesity. The relevance of developing this third typology becomes clinically meaningful, allowing questioning of the proposed accompaniments, particularly for level 3 interventions. ConclusionThe use of this third typology is now necessary to consider issues of resistance to weight loss and to highlight the complexity of the psychogenic origin of this disease in interdisciplinary exchanges. These reflections also question the relevance of treatments that prioritize urgent weight loss. Thus, we emphasize the importance of focusing on individuals’ intrapsychic functioning of and on promoting long-term historical work. Finally, we propose several perspectives to address the challenges encountered in the transformations of hospital and healthcare institutions in France, and suggest research perspectives to demonstrate the long-term effectiveness of a comprehensive approach to individuals with obesity.

IJCM_287A: A Study on Quality of Life of Leprosy Patients in Bankura in West Bengal

Background: By effectively implementing the National Leprosy Elimination Programme (NLEP), India was able to lower the prevalence rate from 57.8/10,000 in 1983 to 0.45/10,000 in 2021–22. Despite its progress, India still accounts for 60% of all new cases recorded globally each year. The stigma associated with leprosy and abnormalities causes worse social functioning, lower self-esteem, and social isolation in even cured patients, which has a severe impact on patient’s quality of life. This study aims to find out the quality of life among leprosy patients. Objective: To find out the quality of life among leprosy patients admitted to the Regional Leprosy Training and Research Institute and Gouripur Leprosy Hospital, Gouripur. Methodology: An institutional-based cross-sectional study in a rural area of Bankura by simple random sampling, was conducted from August 2023 to November 2023 among the leprosy patients and was approved by the Institutional Ethics Committee of AIIHPH and a face-to-face interview was done by pretested questionnaire, Dermatological quality of life assessed by DLQI tool and data was analysed by Spss. Results: The mean age of 128 study participants was 57.09 ±15.14 years with 60.2% male participants. 25.8% were currently working,40.6% were currently married. Of the participants whose duration of illness was more than 10yrs were71.9%and 66.4% had grade 2 disability. The mean DLQI score was 5.73±3.7, and about half of the patients reported that it had a moderate to large effect on their quality of life, whereas 15 patients (11.7%) reported that it had no effect at all. None of the patients had a very severe impact. Conclusion: Present study reveals that the mean DLQI score was found to be 5.73±3.7 and around half of them have moderate to large effect on their quality of life.

Evaluation of Circular RNA SMARCA5 as a Novel Biomarker for Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the fourth most prevalent type of cancer in Egypt and the sixth globally. Most patients with HCC are typically diagnosed during the advanced stages of the disease due to the absence of biomarkers for early detection. Consequently, these patients miss the optimal timeframe for receiving therapy. we aimed to assess the circular RNA SMARCA5 level and SMARCA5 mRNA gene expression as a potential biomarker for early detection of HCC. The present study utilized a case-control design comprising 159 participants. Participants were selected from both inpatient and outpatient hepatology and gastroenterology clinics at the National Liver Institute Hospital, Menoufia University. They were evenly distributed among three groups: Group I: 53 control subjects, Group II: 53 HCV cirrhotic patients, and Group III: 53 HCC patients. Tumor staging was done using BCLC staging system. Each patient underwent a thorough clinical examination, radiological examination, complete history taking, and serum Alpha-fetoprotein (AFP) assessment and detection of circular RNASMARCA5 and SMARCA5mRNA gene sutilizing quantitative real-time polymerase chain reaction. Statistically substantial differences were observed in the examined groups in terms of AFP, SMARCA5, and CircSMARCA5 (P-value = 0.001, 0.001 & 0.001). CircSMARCA5 and SMARCA5mRNA were markedly down regulated in the HCC group compared to HCV cirrhotic patients and controls. ROC analysis for early HCC diagnosis demonstrated that the CircSMARCA5 area under the curve (AUC) at cut-off point 4.55 yielded a specificity of 83.8% and sensitivity of 91.7%. The AUC for AFP at a cut-off point of 515ng/ml yielded a specificity of 89.2% and a sensitivity of 91.3%. CircSMARCA5 has the potential to be a more sensitive predictor of HCC disease compared to AFP.

193 Price Transparency and Cash Discounts for Implantable Pulse Generator Implantation in the United States

INTRODUCTION: Since the Healthcare PRICE Transparency Act (January 2021), hospitals are required to publicly disclose standard prices for care and procedures. METHODS: This is a cross-sectional study conducted with data obtained from Turquoise Health from January to April 2021. Current procedural terminology (CPT) code 61885 was used to query cases of DBS IPG connected to a single electrode. Inclusion criteria required reporting of both commercial and cash prices. Hospitals were filtered for cash to commercial price ratios &lt;2. The Healthy Marketplace Index (HMI) was used to assess city-level hospital competition and the 2022 Lown Institute Hospital Index (LIHI) was used to assess hospital bed size. Differences in continuous variables were analyzed with a Kruskal-Wallis test. RESULTS: Eight-hundred forty-six centers met inclusion criteria, of which 98 (11.6%) provided commercial and cash prices and a cash to commercial ratio of &lt;2. Of those 98, the median commercial price was $18,562 (IQR $1,572-28,476) and the median cash price was $4,340 ($1,596-27,223), with a median intrahospital cash to commercial price ratio of 0.78. Sixty-eight of those 98 (69.4%) hospitals provided a discount for cash payments (cash:commercial ratio&lt;1) of 41% relative to commercial and 39% discount relative to Medicare prices (p&lt;0.001). Medicaid prices significantly differed between hospital sizes. Univariate analysis demonstrated that hospital size and market share were not significant predictors of providing a fair cash estimate. Twenty-eight (56%) states provided a cash discount. CONCLUSIONS: Prices for IPG implantation varied greatly, with self-pay cash pricing providing significant discounts relative to commercial pricing. Cost data should be systematically analyzed and leveraged to increase cost awareness of the procedure, inform hospital reimbursements, and broaden patient accessibility to this valuable therapy.

Measuring the efficiency of health services financing in Algeria using the data envelopment analysis method (DEA) an applied study of a sample of hospital institutions in the Algerian East (2019-2020)

Measuring the efficiency of health services financing in Algeria using the data envelopment analysis method (DEA) an applied study of a sample of hospital institutions in the Algerian East (2019-2020)