Hospital Experience Research Articles

Clinical Presentation, Diagnosis, Treatment, and Outcomes of Myocarditis in Children: A Tertiary Care Hospital Experience.

Background Clinical presentation, diagnosis, and treatment of myocarditis in children can be highly challenging, and results can vary greatly. Research on the precise processes of myocardial injury, including the effects of viral infections and newly identified variables like COVID-19, is still underway. Though treatment approaches, such as immunosuppressive therapy, are still debatable, diagnostic methodssuch as cardiac MRI and biomarkersshow promise in improving diagnostic accuracy. The purpose of this study is to describe the spectrum of pediatric acute myocarditis, assess existing therapy approaches, and develop regional guidelines based on the experience of a tertiary care institution. Methods Children diagnosed with acute myocarditis over a six-month period were included in this retrospective and descriptive hospital-based study. Data on demographics, clinical presentations, diagnostic tests, treatments, and results were gathered and examined. Descriptive statistics, non-parametric tests for categorical variables, and Spearman's correlation tests for continuous data were used in the statistical analysis, with a significance level of p < 0.05. Results Of the 99 patients included, the mean age was 2.37 years, with males making up the majority (n = 54, 54.55%). Clinical symptoms typically included shortness of breath (n = 998, 99.0%), vomiting (n = 63, 63.6%), and chest pain (n = 6, 6.1%). High levels of troponin I (n = 70, 70.7%), cardiomegaly on a chest X-ray (n = 97, 97.0%), and different degrees of ventricular dysfunction were found in the laboratory and in imaging studies. Methylprednisolone (n = 84, 84.8%) and IV immunoglobulin (n = 54, 54.5%) were the most often used treatment modalities, and there were no appreciable differences in the two treatment groups' outcomes. A weak negative association (Spearman's rho = -0.211, p = 0.036) was found in the correlation study between the administration of methylprednisolone and length of stay (LOS), indicating possible benefits in terms of shortening hospital stays. Conclusion This research offers a significant understanding of the clinical manifestation, treatment, and complications of acute myocarditis in children. Methylprednisolone administration seems to be linked to a shorter length of stay (LOS), despite disagreements over treatment approaches. To confirm these results and provide guidance for evidence-based management guidelines for pediatric myocarditis in our setup, more studies are necessary.

The motivations and experiences of specialists who provide outreach services in rural operating rooms: A survey study from British Columbia.

Outreach care has long been used in Canada to address the lack of access to specialist care in rural settings, but research on the experiences of specialists providing these services is lacking. This descriptive survey study aimed to understand 1) specialists' motivation for engaging in outreach work, (2) their perceptions of the quality of care at their rural outreach hospital, and (3) the supports they receive for their outreach work, in order to create a supportive framework to encourage specialist outreach contributions. In July 2022, specialist physicians who provide outreach operating room services at rural hospitals participating in the Rural Surgical and Obstetrical Networks initiative in the province of British Columbia were invited to complete an anonymous survey. 21 of 45 invited outreach specialists completed the survey (47% response rate). Three-quarters of respondents had a surgical specialty. The opportunity to deliver care to underserved patients was the most common motivator for outreach work. Rural hospitals received high ratings from respondents on overall safety and various aspects of communication and teamwork. Postoperative care was a concern for a minority (one-fifth) of respondents, and about half had experienced unnecessary delays between procedures some or most of the time. Generally, respondents felt integrated into rural teams and reported receiving adequate nursing and anesthetic support. The two most common desired additional supports were better/more equipment and space and additional staffing. All 19 respondents not planning to retire soon intended to provide outreach services for at least three more years. Specialists providing outreach OR services in small volume rural hospitals in BC usually have altruistic motives for outreach work. For the most part, these specialists have positive experiences in rural hospitals, but they can be better supported through investment in infrastructure and health human resources. Specialists intend to provide outreach services long-term, indicating a stable outreach workforce. More research on the facilitators and barriers of specialist outreach work is needed.

Management of pancreatic and duodenal trauma in childhood: a university hospital experience over a 10-year period

PurposeDuodenal/pancreatic injuries occur in less than 10% of intra-abdominal injuries in pediatric blunt trauma. Isolated duodenal/pancreatic injuries occur in two-thirds of cases, while combined injuries occur in the remaining. This study aimed to investigate pediatric patients with pancreatic and duodenal trauma.MethodsData from 31 patients admitted to Atatürk University, Medical Faculty, Department of Pediatric Surgery for pancreatic/duodenal trauma between 2010 and 2019 were retrospectively analyzed. Age/gender, province of origin, duration before hospital admission, trauma type, injured organs, injury severity, diagnostic and therapeutic modalities, complications, hospitalization duration, blood transfusion requirement, and mortality rate were recorded.ResultsTwenty-four patients were male, and 7 were female. The mean age was 9 years. The leading cause was bicycle accidents, with 12 cases, followed by traffic accidents/bumps, with 7 cases each. Comorbid organ injuries accompanied 18 cases. Duodenal trauma was most commonly accompanied by liver injuries (4/8), whereas pancreatic injury by pulmonary injuries (7/23). Serum amylase at initial hospital presentation was elevated in 83.9% of the patients. Thirty patients underwent abdominal CT, and FAST was performed in 20. While 54.8% of the patients were conservatively managed, 45.2% underwent surgery.ConclusionBecause of the anatomical proximity of the pancreas and the duodenum, both organs should be considered being co-affected by a localized trauma. Radiologic confirmation of perforation in duodenal trauma and an intra-abdominal pancreatic pseudocyst in pancreatic trauma are the most critical surgical indications of pancreaticoduodenal trauma. Conservative management’s success is increased in the absence of duodenal perforation and cases of non-symptomatic pancreatic pseudocyst.

Debate: The experience of involuntary psychiatric hospitalisation for children and young people.

Involuntary treatment has been reported to be traumatic, stigmatising and frightening, as well as sometimes lifesaving. However, there has been little research into the experiences of people who have been hospitalised involuntarily prior to the age of 18. A greater understanding of this may help us to make changes which could improve the experience of involuntary psychiatric treatment for children and young people. Lizzie Mitchell is an expert by experience who was admitted to a psychiatric hospital in England under the Mental Health Act (MHA) when she was 16 years old. Here, in discussion with Susan Walker, a child and adolescent psychiatrist, Lizzie reflects on her own experiences alongside wider reflections around the involuntary hospitalisation of young people, including the potential short and long-term impact on mental health, education, friendships, family and identity.

Job crafting, positive psychological capital, and social support as predictors of job embeddedness on among clinical nurses- a structural model design

BackgroundThis study establishes the relationships among role conflict, positive psychological capital, social support, job crafting, and job embeddedness among clinical nurses. The results are expected to provide a basis for efficient human resource management in hospitals.MethodsConsidering a 15% dropout rate, we distributed 300 copies of our questionnaire, of which 290 were returned. We used 260 responses in the final analysis after excluding 40 responses that were incomplete or showed an identical pattern in the item responses. Participants were clinical nurses with less than one year of experience in general and tertiary general hospitals in G province and D metropolitan city in South Korea. A structured questionnaire was administered from January 10 to February 28, 2022. The collected data were analyzed using SPSS 26.0 and AMOS 26.0. We assessed the statistical significance using the bootstrapping method.ResultsThe direct and total effects (both β = 0.806, p =.007) of positive psychological capital on job crafting were significant. The direct and total effects (both β = 0.451, p =.004) of social support on job crafting were significant. The direct (γ = 0.292, p =.055), indirect (γ = -. 671, p =.003), and total (γ = − 0.379, p =.008) effects of role conflict on job crafting were significant. The direct (γ = − 0.382, p =.007), indirect (γ = − 0.208 p =.003), and total (γ = − 0.589, p =.006) effects of role conflict on job embeddedness were significant. The direct and total (both β = 0.548, p =.005) effects of job crafting on job embeddedness were significant.ConclusionsNurses’ job embeddedness is directly influenced by their job crafting, which is shaped by high levels of positive psychological capital and social support. When job crafting takes place, role conflict increases, and if job crafting becomes difficult because of severe role conflict, job embeddedness decreases. Therefore, to increase job embeddedness among clinical nurses, hospitals must implement support systems and programs to increase job autonomy, and positive psychological capital to promote job crafting.

The Association of Job Stress, Quality of Sleep, and the Experience of Near-Miss Errors among Nurses in General Hospitals.

This study investigated the association of job stress, quality of sleep, and near-miss error experiences among nurses working in general hospitals. A convenience sample of 195 nurses with over 3 months of work experience in a general hospital participated in the study. Statistical analyses were performed using SPSS 27.0. Factors influencing experiences of near-miss errors were examined through univariable and multivariate logistic regression. In total, 58.5% of nurses in a general hospital had experienced near-miss errors. Nurses in the upper job stress tertile (≥118) were 2.24 times more likely to encounter near-miss errors (95% CI: 1.07-4.69) and particularly 2.58 times (95% CI: 1.26-5.26) in falls and medical equipment-related near-miss errors. Nurses working more than 3 h of overtime per week had a 2.72 times higher (95% CI: 1.35-5.48) likelihood of experiencing near-miss errors related to falls and medical equipment and 4.03 times higher (95% CI: 1.92-8.45) likelihood of experiencing near-miss errors associated with examination procedures. To prevent near-miss errors among nurses in general hospitals, effective management of organizational job stress is crucial. Particularly for departments with a high level of overtime work (more than 3 h/week), it is essential to provide and manage educational programs on patient safety.

Innovation in hospital pharmacy: Modeling the installation of automated dispensing systems based on an oncology hospital experience transfer.

This study explores automated dispensing systems (ADS) implementation in hospitals, focusing on experience transfer between the National Institute of Oncology of Rabat (NIO) and the specialties hospital of Rabat (SHR) to develop a transferable ADS installation and management model. A retrospective implementation and experience data analysis of 3 years ADS implementation at NIO and a prospective planification for SHR new implementation on 6 months were employed. Data collection included pharmacist team reports, personnel interviews, direct observations, and information system data exports. The study focused on identifying challenges a plan-do-check-act (PDCA) cycle. The analysis revealed overestimation in ADS needs at NIO about 42%, leading to: Resource exhaustion; Challenges in timeline installation staff training and management, Disruptions in data integration and Incident Reports. These issues underscored the importance of a phased, well-planned implementation process. The study highlighted the crucial role of many comprehensive strategies. In accordance with the results of several studies, this work demonstrates the benefits of ADS in reducing medication errors and enhancing resource management, while also pointing out the necessity for accurate system sizing, effective integration with hospital information systems, and comprehensive staff training. The experience transfer between NIO and SHR provides a valuable model for ADS implementation in hospital pharmacies, proposing optimizations on: Implementation process; Timelines and mapping; Risk management and incident reports; Staff training, sensibilization and change control.

Total femoral spanning for distal femur "fragility" fractures utilising nail-plate fixation "short-term experience of a district general hospital".

Our primary objective was to investigate the time to radiological union following linked nail-plate fixation of distal femur "fragility" fractures. Secondary objectives were to evaluate all-cause reoperations, 90-day mortality, rate of blood transfusion and the impact on quality of life. In this retrospective study of all adults (≥ 65years) with native or periprosthetic distal femur fragility fractures, underwent a linked nail-plate fixation, data were retrieved on fracture classifications, clinical frailty score, blood transfusion, length of hospital stay, 90-day mortality, time to radiological union, overall complication rates and EuroQoL-5D. In total, 18 out of 23 patients completed sequential follow-up. Radiological union was observed in 14 patients (median 143days; range 42-414). Three patients underwent reoperations. There were no implant failures or a subsequent periprosthetic fractures. Ninety-day mortality was 17.4%. Eighteen patients required blood transfusion. The QoL was significantly lower after index surgery (0.875 vs. 0.684; p < 0.01). Based on our observation, with short-term follow-up, the linked nail-plate yields optimal stability to allow immediate weight bearing, in a cohort with moderate frailty. It is reproducible,with variable radiological union rates. The concept of "total femoral spanning" reduces the risk of subsequent periprosthetic fractures. The additional intervention has increased the rates of allogenic blood transfusion. There is significant impact on overall QoL, with almost 50% being more dependent in self-care.

Evaluation of Antibody Response After COVID-19 Vaccination in Healthcare Workers: A Turkish Tertiary Hospital Experience

Objective: It was aimed to explore the correlation between demographic characteristics and the presence of comorbidity in the antibody response after the second dose of vaccination in healthcare workers in this study. In addition, the third and fourth dose approaches of the participants and the protection of the antibody levels formed by the two doses of vaccine against COVID-19 were examined observationally.&#x0D; Materials and Methods: Health workers, whose NCP and S protein antibody levels were detected on the 30th day after the second dose of the CoronaVac vaccine, were followed up in terms of being vaccinated for the third and fourth doses and having COVID-19.&#x0D; Results: Higher levels of S antibodies were detected in women after two doses of vaccination (p=0.001). It was pointed out that smoking has a negative effect on the antibody response after vaccination (p=0.008). People who had pre-vaccine COVID-19 had higher NCP antibody levels after two doses of vaccination (p=0.013). Of the participants, 152 (97.4%) were vaccinated with the third dose and 110 (70.5%) with the fourth dose.&#x0D; Conclusion: The antibody response after two doses of inactivated CoronaVac® vaccination probe is significantly higher in women, younger people, non-smokers, and people who have not been previously infected with the SARS-CoV-2.

Guillain–Barre syndrome: small-volume plasmapheresis versus intravenous immunoglobulin—3rd level hospital experience

BackgroundSpecific treatment for Guillain–Barre syndrome is based on plasma exchange and intravenous immunoglobulin (IvIg). In developing countries such as Morocco, we are often confronted with constraints in terms of price and availability of substitutes. Comparative studies of these two therapeutic modalities have been conducted particularly in severely extensive forms.ResultsOur study compared small-volume plasmapheresis (SVP) with intravenous Immunoglobulin over a nine-year period in the neurology department of the University Hospital Center of Marrakech in terms of efficacy and safety in Moroccan patients with GBS of varying degrees of severity.We included 76 patients who were hospitalized for GBS. Forty-six patients were treated with SVP and 30 were treated with IvIg. The therapeutic choice depended on contraindications, socioeconomic considerations, patient choice, and availability of treatment. The clinical and paraclinical evaluations of the two groups were statistically comparable, including factors that may influence the prognosis (p > 0.05). The efficacy of IvIg and SVP did not show a statistically significant difference except for a longer neurology department stay with plasmapheresis (p < 0.001). This efficacy is evaluated by the evolution of the Hughes and MRC sum scores one month after treatment, length of hospital stay, use of mechanical ventilation and its duration, and mortality rate.ConclusionThe results selected further encourage the use of SVP because of its efficacy and safety, which are comparable to those of IvIg. And the review of the literature confirms our recommendations.

FNAC as preoperative diagnostic tool for neoplastic and non-neoplastic breast lesions with special reference to IAC standardised reporting in Coastal population - A teaching hospital experience

Breast cancer is steadily increasing worldwide. This study is based on application of recently proposed International Academy of cytology (IAC) Yokohama categorisation system of Breast cytology from C1 to C5. (C1-Insufficient material, C2-Benign, C3- Atypical, C4-Suspicious &amp; C5-Malignant). We aim to categorize the breast lesions based on the above-mentioned categorization scheme (IAC, Yokohama 2016) along with histopathological correlation (wherever possible). This was a retrospective observational study conducted from January 2018 to December 2021 in the Department of Pathology of a tertiary care hospital involving coastal population. Ethical clearance was taken from institutional reviw committee. All patients with palpable breast lumps who had undergone FNAC were included in the study. Patient details and data were collected from the case records maintained in Department of Pathology. All quantitative parameters were described through descriptive statistics. Total scores were computed for all the risk factors. Sensitivity, specificity, Positive Predictive Value, Negative Predictive Value calculated. Risk of malignancy(ROM) was calculated for each category. A total 200 patients, with age group ranging from 17 - 67 years with breast lesions were included in the study. C1 lesions were found in 5 cases, C2 in 152 cases, C3 in 11 cases, C4 in 4 cases, and C5 in 28 cases. Cytohistological correlation obtained in 94 cases with concordance noted in 89 cases and discordance in 5 cases. Breast FNAC cytology categorization according to IAC Yokohama system increases accuracy of diagnosis and helps clinician in appropriate patient management.

Prevalence of Transfusion-transmissible Infections in Blood Donors: A Private Hospital Experience

Introduction: Blood transfusion, a vital component of established medical protocols, has the potential to save lives and enhance well-being. Nonetheless, it carries inherent risks, with transfusion-transmissible infections (TTIs) remaining a global public health concern. Vigilant monitoring of TTI prevalence among blood donors and understanding of evolving patterns are crucial safety endeavours. The objective of this study was to assess the prevalence of TTIs and their patterns among blood donors within a private hospital’s transfusion service. Methods: This retrospective study involved TTI testing results of blood donations at Normah Medical Specialist Centre (NMSC) in Kuching, Sarawak, spanning a decade from 2010 to 2019. Results: A total of 7329 blood donors contributed 16,085 blood units (2010 – 2019). Among them, 353 donors exhibited reactivity to TTIs, resulting in a prevalence of 4.81%. The majority of reactive donors were male (87.3%), of Malay ethnicity (62.6%), and first-time donors (73.9%). The prevalence rates were highest for HCV (2.69%), followed by HBV (1.41%), HIV (0.42%), and syphilis (0.39%). Both HBV and HCV demonstrated declining prevalence trends, while the prevalence of HIV and syphilis remained consistently low. The response to notification of positivity among reactive donors stood at a mere 4.0%, and the seroconversion rate among repeat donors reached 36.9%. No significant disparities in prevalence or response rates were observed between first-time and repeat donors. Conclusions: The prevalence of TTIs within NMSC’s blood donor populace remains relatively low, though not negligible. The responsiveness of reactive donors to notifications displayed considerable deficiencies.

Recovery at an Adult Psychiatric Day Hospital—A Qualitative Interview Study Describing Patients’ Experiences

Psychiatric Day Hospitals offer time-limited active treatment programmes that are therapeutically intensive, coordinated, and with structured clinical services within a stable environment. No previous studies have described patients’ experiences of recovery-oriented care at a Psychiatric Day Hospital in a Swedish or Nordic healthcare context. The aim of the study was to explore patients’ experiences of a Psychiatric Day Hospital with focus on patient recovery. A qualitative method was used; 12 in-depth interviews were performed with patients all analysed with content analysis. The theme that emerged was “A safe haven.” To do something routinely and meaningful during the days, feelings of security, and to gain increased knowledge about mental ill health were concepts which felt important and contributed to recovery. Feelings of belonging and prevention of loneliness were also highlighted.

Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital.

To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.

Impact of COVID-19 on paediatric chronic intestinal failure: A tertiary care children's hospital experience.

Paediatric patients with intestinal failure (IF) are at risk for both gastrointestinal (GI) and systemic complications, thus depending on a functioning network of multidisciplinary care. Data on the clinical impact of coronavirus disease 2019 (COVID-19) or the pandemic-related restrictions are limited. We aimed to analyse the clinical course of COVID-19 in children with IF, and to evaluate the perceived impact of the COVID-19 pandemic on IF patients and their caregivers by analysing quality of life (QoL), health-related QoL (HRQoL) and health care. Children with IF presenting at our intestinal rehabilitation centre were enrolled and interviewed about test-proven COVID-19 infection. A standardised questionnaire was offered to all caregivers of IF patients and to two control groups (children with inflammatory bowel disease and gastrointestinal healthy children). Between December 2020 and November 2022, 25 out of 127 patients with IF contracted COVID-19. Forty-eight per cent had GI symptoms, 32% required additional intravenous fluids and 20% were hospitalized. Only 25% of vaccinated children showed signs of GI dysfunction, compared to 52% of unvaccinated children. Analysis of 93 questionnaires showed a negative impact on QoL and HRQoL (>66.7% and >27.8%, respectively). IF patients frequently experienced restrictions in health care, including appointments, services and supply of parenteral nutrition or medications. Caregiver burden increased significantly more often in caregivers of children with IF (p = 0.007). Paediatric patients with IF contracting COVID-19 have an increased risk for GI dysfunction which may be alleviated by vaccination. Children and their caregivers were highly burdened by pandemic-related restrictions and reductions in health care provision.

The economic and resource burden of e-scooter-related orthopaedic injuries: A district general hospital's experience

PurposeElectric scooters (e-scooters) are an increasingly popular method of transportation worldwide. However, there are concerns regarding their safety, specifically with regards to orthopaedic injuries. We aimed to investigate the overall burden and financial impact on orthopaedic services as a result of e-scooter-related orthopaedic injuries. MethodsWe retrospectively identified all e-scooter-related injuries requiring orthopaedic admission or surgical intervention in a large District General Hospital in England over a 16-month period between September 2020 and December 2021. Injuries sustained, surgical management, inpatient stay and resources used were calculated. ResultsSeventy-nine patients presented with orthopaedic injuries as a result of e-scooter transportation with a mean age of 30.1 years (SD 11.6), of which 62 were males and 17 were females. A total of 86 individual orthopaedic injuries were sustained, with fractures being the most common type of injury. Of these, 23 patients required 28 individual surgical procedures. The combined theatre and recovery time of these procedures was 5500 min, while isolated operating time was 2088 min. The total cost of theatre running time for these patients was estimated at £77,000. A total of 17 patients required hospital admission under Trauma and Orthopaedics, which accounted for total combined stay of 99 days with a mean length of stay of 5.8 days. ConclusionWhile there are potential environmental benefits to e-scooters, we demonstrate the risks of injury associated with their use and the associated increased burden to the healthcare system through additional emergency attendances, frequent outpatient clinic appointments, surgical procedures, and hospital inpatient admissions.

In Hospital Experiences of Mothers of Children with Major External Birth Defects During Hospitalisation at a Tertiary Hospital in South Western Uganda

Mothers are regarded as primary care givers and in many African countries, women are culturally held responsible for the child’s health. The birth of a child with birth defect (s) may have significant impact on mothers psychological, physical and socioeconomic well-being. The in hospital experience of mothers of children with birth defects has not been adequately explored and therefore not fully attended to especially in low resource settings. At Mbarara Regional Referral Hospital (MRRH), the medical care team often is more directed towards medical treatment and surgery of the child born with a birth defect with little or no focused psychosocial support to their mothers.  Objectives The aim of this study was to explore and describe the experiences of mothers of children with major externally visible birth defects during their hospitalization at MRRH.  Method A phenomenological study with purposive sampling of 12 participants. The adjusted ecological model was used. Data was collected by self-report using unstructured face to face interviews until saturation was reached. Five themes emerged from the study which include: Negative emotional experience, acceptance of child’s condition, supportive part of the medical team despite some medical system challenges (like stock outs of medications and sundries, fewer staffs in the night) financial challenges and spiritual, family plus health team support were cope strategies.  Conclusion Mothers of children with major external birth defects were negatively affected especially, emotionally and financially. These mothers, therefore require psychosocial, financial and also spiritual support during their hospital stay at MRRH.

Impact of Cardiorenal Anaemia Syndrome on Clinical Features in Elderly Outpatients with Chronic Heart Failure: A Japanese Community Hospital Experience

Background: Cardiorenal anaemia syndrome (CRAS) has been reported to be associated with all-cause mortality and cardiovascular events in outpatients with heart failure (HF). Objective: To evaluate the clinical situation of CRAS including NYHA class and care status in elderly outpatients with HF. Methods: A total of 41 elderly (&gt;65 years) outpatients with HF attending our hospital were analysed retrospectively and cross-sectionally. Clinical variables included lifestyle diseases, atrial fibrillation, valvular heart disease, HFpEF, chronic kidney disease (CKD), cardiac function (LVEF, E/e’, LADI, BNP), anaemia (Hb, Fe/TIBC (%), ferritin), medications (diuretics, MRA, ACEI/ARB, β-blockers, SGLT2i, ARNI, tolvaptan), NYHA class (I/II/III/IV). The nursing variables analysed were Japanese nursing certification class, which assesses active daily living (ADL), instrumental ADL, cognitive function, mental function, physical function, communication, and need for support/care (from least to most intensive, independence 0/support(S)1/S2/care(C)1/C2/C3/C4/C5) and frailty. Subjects were divided into two groups (CRAS+group and CRAS−group) according to the presence of CRAS, defined as HF associated with CKD (eGFR &lt; 60 mL/min/1.73 m2) and anaemia (Hb &lt; 13 g/dL, men and Hb &lt; 12 g/dL, women). All variables were compared between the two groups. Results: Mean age was 83.7 ± 7.1 years (67∼100). Female gender was 63.4% (26/41). The incidence of HFpEF was 33/41 (80.5%). The incidence of CRAS was 53.7% (22/41). The incidence of lifestyle diseases was not different between the two groups. Cardiac function was not significantly different between the two groups (CRAS+ vs. CRAS−): LVEF (59.1 ± 8.3 vs. 61.3 ± 7.2); E/e (15.1 ± 5.8 vs. 15.0 ± 7.0); LAVI (50.6 ± 16.6 vs. 54.3 ± 30.9); BNP (347.0 ± 234.4 vs. 291.3 ± 197.0). Hb was significantly lower in the CRAS+ group than in the CRAS group (10.4 ± 1.4 vs. 13.4 ± 1.7, P &lt; 0.0001). Fe/TIBC and ferritin were not significantly different between the two groups. Regarding medications, tolvaptan tended to be used more frequently in the CRAS+ group than in the CRSA− group (4/22 vs. 0/18, P = 0.111). The other drugs were used with similar frequency. Meanwhile, the NYHA class tended to be higher in the CRAS+ group than in the CRAS− group: NYHA (8/9/5/0 vs. 8/11/0/0, P = 0.082). Nursing class showed more intensive care in the CRAS+ group than in the CRAS−group (4/3/3/2/4/1/3/2 vs. 11/0/6/1/0/1/0/0, P = 0.021). Conclusions: The association of CRAS with HF was associated with more intensive support/care status but not with cardiac function/BNP and other factors. Prevention and active treatment of CRAS may improve the independence of elderly outpatients with HF.

(264) Outcome of Intra-Cytoplasmic Sperm Injection ICSI with Testicular Sperm Aspiration (TESA) In Patients with High Sperm DNA fragmentation, Hospital Experience

Abstract Introduction Sperm DNA fragmentation (SDF) is considered as an important biomarker in the assessment of male fertility potential with contradictory results regarding its effect on ICSI. In our study we focus on the outcomes of Intra-Cytoplasmic Sperm Injection (ICSI) in male patients with high SDF using testicular spermatozoa (TESA). Objective To evaluate intra- cytoplasmic sperm injection (ICSI) outcomes in male patients with high SDF using testicular spermatozoa and analysis of the cofactors (Age, Smoking, Chemical Exposure and usage of Anti-oxidants agents) Methods Retrospective study, institutional experience. Results In our study, we evaluated 41 men with high-SDF levels who had a previous ICSI cycle from their ejaculates. A subsequent ICSI cycle was performed using spermatozoa retrieved through testicular sperm aspiration. The mean (SD) SDF level is 33.7%. live birth rate was 29.2% (12 out of 41) In addition of that, we analyzed the cofactors of men such as Age, Smoking, Chemical Exposure and usage of Anti-oxidants agents. The mean age is 33 %. Men received anti oxidants agent prior to TESA were 9 out of 12 (75%) Conclusions Intra-cytoplasmic sperm injection (ICSI) outcomes in male patients with high SDF using testicular spermatozoa has higher clinical pregnancy and higher chance of live-birth. The rate is higher with those who received anti-oxidant supplements for at least 6 moths. Disclosure No.

Inpatients’ Experiences with Pharmacist-Led Pain Management Programs: Exploring Patients’ Perspectives on the Effectiveness and Impact of Pharmacist-Managed Pain Management Plans During Their Hospital Stay

This qualitative study explores inpatients’ experiences with pharmacist-led pain management programs in a hospital setting. Through semi-structured interviews, 15 participants’ perspectives on the effectiveness and impact of pharmacist-managed pain interventions were investigated. Findings highlight the role of pharmacists in optimizing pain relief, enhancing patient communication, and improving overall hospital experiences. Participants valued pharmacist involvement in pain management, emphasizing personalized care and education. Recommendations for program enhancement include increased pharmacist presence and streamlined communication channels. This study contributes to understanding patient-centered approaches to pain management in hospital settings.