Hospital Level Research Articles

Current status of postoperative care for elderly osteoporotic fracture patients in Jiangsu Province, China: A multicenter cross-sectional study

BackgroundThe postoperative care behavior of elderly osteoporotic fracture patients has a significant impact on their prognosis and rehabilitation; thus, it is critical to completely comprehend their current state of care before optimizing postoperative care strategies. AimsTo determine the current status of postoperative care for elderly osteoporotic fracture patients in Jiangsu Province. MethodsFrom October to December 2023, 669 elderly postoperative patients with osteoporotic fractures were recruited for a cross-sectional study via convenience sampling and a self-designed questionnaire from 21 hospitals in seven urban areas in Jiangsu Province. ResultsA total of 800 questionnaires were distributed, and 709 questionnaires were recovered, for a return rate of 88.6%. The postoperative support and care received by the patients were mostly by their children and spouses, and the postoperative health education knowledge received by the patients was mostly about fracture-related knowledge and precautions for the use of medications. Health education methods were mainly conducted by medical staff explanations and health brochures; only 45.3% of the patients were treated with anti-osteoporosis therapy. ConclusionsThe current status of postoperative care for osteoporotic fracture patients in Jiangsu Province varies somewhat according to geographic location, hospital level and other factors, with tertiary hospitals and more economically developed areas having relatively better care outcomes. For in-hospital care, it is necessary to improve the content and methods of in-hospital education. For out-of-hospital care, it is necessary to raise the level of awareness of anti-osteoporosis treatment and the prevention and treatment of re-fractures, and to improve hospital-community referral services.

Care partner engagement in patient safety at the direct care level in hospital: a qualitative systematic review protocol.

The objective of this systematic review is to understand the experiences of care partner engagement in patient safety at the direct care level from the perspective of care partners, patients, and health care professionals. Care partner engagement is a strategy for promoting patient safety in hospitals at the direct care level (ie, at the point where patient care is delivered). When present, care partners can increase safety by watching, listening, and taking action to protect admitted patients. To improve care partner presence policies and safety engagement strategies within hospitals, a comprehensive understanding of the current qualitative evidence about the breadth of experiences of care partner engagement in patient safety is required. This review will include qualitative studies that consider the experiences of care partners, adult patients, and health care professionals. The engagement of care partners in patient safety within pediatric hospital settings will not be considered. This review will follow the JBI methodology for systematic reviews of qualitative evidence. A preliminary literature search was conducted in MEDLINE and a full search strategy was developed for MEDLINE, Embase, CINAHL, and PsycINFO (all via Ovid), as well as the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis. The JBI approach to study selection, critical appraisal, data extraction, data synthesis, and assessment of confidence will be followed. Two reviewers will test the screening criteria and data extraction protocol. PROSPERO CRD42023476286.

Temporal trends and practice variation in early repair of the ruptured aneurysm among patients with aneurysmal subarachnoid hemorrhage in the United States, 2012-2019.

Early repair of the ruptured cerebral aneurysm (RRCA), preferably within 24 h of onset, is endorsed by clinical guideline as the preferred management strategy for patients with aneurysmal subarachnoid hemorrhage (aSAH). However, a comprehensive picture of this guideline-recommended usage in contemporary clinical practice is not available. This study aimed to characterize trends over time and practice variation in the implementation of an early RRCA strategy among patients with aSAH in a large, national representative data. Using data from the 2012-2019 National Inpatient Sample, we measured trends in the proportion of early RRCA, defined as within day 1 of admission, overall, and by demographic and geographical subgroups. In addition, we created multilevel regression models to quantify hospital-level variation in the early RRCA rates. We identified 82,615 aSAH hospitalizations (mean age = 56.1 years; 68.9% women) undergoing RRCA and, among these, 84.0% (95% confidence interval (CI) = 83.4-84.7%) receiving early RRCA. The proportion of early RRCA increased steadily from 82.5% in 2012 to 85.8% in 2019 (p for trend <0.001). The proportion of patients receiving early RRCA across geographic regions ranged from 78.7% to 87.9%, with a median (interquartile range (IQR)) of 84.2% (83.0-86.1%). In contrast, the delivery of early RRCA varied widely among hospitals, with a median (IQR) rate of 86.1% (75.0-100.0%) and a range from 0% to 100.0%. The median odds ratio for the early use of RRCA treatment was 1.24 (95% CI = 1.21-1.27) in 2019, indicating 24% increased odds of implementing early RRCA if moving from a lower-use to a higher-use hospital. Most patients in the United States with aSAH received early RRCA treatment and exhibited an upward trend over the recent 8-year period. However, substantial variation in access to early RRCA was observed across population subgroups, particularly at the hospital level. Future efforts are necessary to identify further sources of this variation and to develop initiatives that could represent an opportunity to optimize guideline-based quality of care in aSAH management. The data are available from the corresponding author upon reasonable request following completion of onboarding and verification procedures as specified by the HCUP.

Establishing national hospital costing systems: insights from the qualitative assessment of cost surveillance pilot in Indian hospitals

ObjectiveThe Indian Government launched Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), the world’s largest health insurance scheme, in 2018. To reform pricing and gather evidence on healthcare costs, a...

Linkage of Hospital and Community level records for Epidemiological Research: Experiences from Kagando Health and Demographic Surveillance System in Western Uganda

BackgroundLinkage of census data and hospital records is crucial in conducting epidemiological research to inform public health decisions. In this study, we share our experiences in linking community-level data collected through census with hospital records and highlight the challenges and opportunities from our engagements with stakeholders. MethodologyWe undertook engagements with Uganda Christian University Ethics Research Committee, Hospital Management, and Community Health Volunteers to set up a platform to integrate hospital and census records using key identifiers. Trained data clerks prospectively linked data during patients’ visits following the data protection guidelines. ResultsFrom a population of approximately 30,000 people, we managed to link 1000 records within three months. Lessons learnt and opportunities: It is possible to link data with a set of identifiers, not only relying on common identifiers, especially for communities where ownership of a national identity card or birth certificate is not universal. Building stakeholder partnerships is essential, and frequent meetings with the hospital staff, epidemiologists and data programmers helped to identify problems and solutions. ChallengesLack of local capacity at the health facilities to develop linkage platforms. However, after development they can efficiently run the program. Frequent changes in the versions of the electronic system were later resolved. RecommendationsThere is a need to conduct regular capacity building for stakeholders to help them understand the importance of data linkage. ConclusionPublic engagement is an ethical imperative that enhances the quality, credibility, and long-term impact of research by incorporating the perspectives of the communities being studied.

Knowledge and Practice of Biomedical Waste Management among Nurses at a Tertiary Level Hospital in Bangladesh

Knowledge and Practice of Biomedical Waste Management among Nurses at a Tertiary Level Hospital in Bangladesh

EP592 - A surgical case report of an epiploic hernia - A mobile right colon herniating through the foramen of Winslow

Abstract Introduction An Epiploic Hernia is an extremely rare type of abdominal hernia with &amp;lt;0.1 % incidence where the bowel or other intra-abdominal contents herniate through the Foramen of Winslow. A case of an Epiploic hernia in a middle-aged female is presented here. Presentation of case A woman in her 60s was admitted to a tertiary level hospital with severe right sided intermittent upper abdominal pain associated with nausea, bloating and constipation. The symptoms were thought to be due to biliary colic and managed conservatively. Since the symptoms persisted and a computed tomography scan of abdomen was organized. CT scan showed that the caecum was in the upper left quadrant. A laparoscopy was performed and demonstrated that her right colon was mobile herniating through the Foramen of Winslow into the lesser sac. The hernia was reduced, and the bowel was viable. The patient was discharged with no complications. Discussion There have been case reports of small bowel as the content of the hernia with lesser occurrences of caecum, ascending colon, transverse colon, gall bladder, omentum, or Meckel's diverticulum. A caecal herniation through the Foramen of Winslow is reported only with an incidence of 0.02 %. &amp;lt;10 % of these Epiploic hernias are diagnosed preoperatively making it a potentially life-threatening condition if not treated promptly due to high risk of bowel strangulation and mortality of up to 50 %. Conclusion A high index of suspicion is needed for the diagnosis of this internal hernia and radiological investigation is fundamental in making this diagnosis for allowing prompt surgical treatment.

FP6.9 - Improving Compliance &amp; Implementation of the STAR Score at a tertiary level hospital in India: A continuous process

Abstract Aim To perform an audit to check the Quality and compliance of Surgical documentation using STAR Score at a tertiary hospital in India. Method A total of 90 case files were studied and assessed in detail from all surgical departments. The “STAR: Surgical tool for auditing records” tool was used to collect data accordingly. The results were compared with standard guidelines and further analyzed. A series of departmental training and implementation meetings were carried out. Three cycles were carried out and a re-audit was performed at the end of every cycle. Result The overall compliance score of the hospital was found to be 74%. While the departments of General surgery and orthopaedics showed a higher rate of compliance, each constituting 82%, Neurosurgery showed the least compliance at 62%. It was also seen that the maximum percentage of missing information constituted anaesthetic records and subsequent entries. At the end of 3 cycles, a considerable improvement was observed, with the compliance rate improving to 98% in all departments. Conclusion We believe that compliance and implementation of the STAR Score is mandatory, as it can significantly improve the quality of documentation and can be implemented universally.

FP6.10 - Improving Compliance &amp; Implementation of WHO Surgical Safety Checklist At a Tertiary Level Hospital in India: A continuous process

Abstract Aim To complete an audit on the level of compliance with the WHO surgical safety checklist in surgical operating theatres at a Tertiary level hospital in India. Method A total of 40 general surgeries were observed at the operating theatres at a tertiary-level hospital in India to confirm the practice of the WHO surgical safety checklist. The study was conducted for 1 month in September 2021. The results were compared with standard guidelines and further analyzed. Interventions were carried out through a series of rigorous departmental meetings and discussions with the medical and nursing staff. A re-audit was conducted. Results Of all the operations audited, 45% Sign-In and only 1% Sign-Out were performed in the first cycle. After the re-audit, a significant change was reported as the Sign-In improved to 80%, and a 55% Sign-Out was conducted. The Time-Out was observed to increase from 15% to 65%. Compliance in the final third cycle showed improvement in Sign-In at 95%, Sign-Out at 85%, and Time-Out at 90%. Conclusion Though in the first cycle of our audit, the compliance to the SSCL was found to be suboptimal, significant improvement was demonstrated in the second cycle and eventually in the final third cycle bringing it closer to 100% compliance, after rigorous awareness programs and training sessions. Compliance with all items in the checklist and active participation by all medical and nursing staff is mandatory for the successful implementation of the Surgical safety checklist.

The efficiency evaluation of traditional Chinese medicine hospitals by data envelopment analysis in Zhengzhou, China.

This study aimed to evaluate the operational efficiency of traditional Chinese medicine (TCM) hospitals in China. Pearson's analysis was used to test the correlation between the input and output variables. Data envelopment analysis (DEA) was utilized to analyze the input and output variables of 16 TCM hospitals, and each hospital efficiency score was computed by Deap 2.1, assuming variable return to scale (VRS), which is an input-oriented model. t tests were conducted to confirm the significant difference of efficiency scores at the hospital level and by hospital type, and ANOVA was used to test for significant differences in efficiency scores according to hospitals' size. The correlation coefficient of the input and output indicators was between 0.613 and 0.956 (p < 0.05). The difference in number of doctors (ND) and numbers of pharmacists (NP) were statistically significant (p < 0.05) at the hospital level. The mean efficiency scores for technical efficiency (TE), pure technical efficiency (PTE), and scale efficiency (SE) in secondary TCM hospitals were 0.766, 0.919, and 0.838, respectively. Additionally, the lowest TE, PTE, and SE were 0.380, 0.426, and 0.380, respectively. Eight TCM hospitals in this study were DEA efficient, with an efficiency score of 1. There were no statistically significant differences in TE, PTE, and SE among hospital levels, hospital types or hospital sizes groups (p > 0.05). This study revealed that tertiary TCM hospitals had a greater level of efficiency than secondary TCM hospitals. In our study, 50% of TCM hospitals had inefficient management. Therefore, to activate the new development power of TCM hospitals, it is necessary to reform and improve the management system and mechanism of TCM hospitals, optimize the development environment of TCM hospitals and formulate development plans and measures based on local conditions.

Workplace violence against junior doctors in Iraq: implications for job satisfaction and retention

IntroductionHealth workers worldwide report being exposed to workplace violence, but those in conflict settings (or post-conflict settings) are especially targeted, as political conflict shifts societal norms. Iraq has suffered war and conflict for decades. A 2013 study of 567 Iraqi-trained physicians found nearly 2/3 had emigrated to mostly English-speaking countries; further, half of those remaining wished to leave Iraq. While prior studies have examined the phenomenon of violence against health workers in Iraq, no qualitative study has characterized Iraqi front line junior doctors’ experiences of workplace violence within a workplace violence causal framework, to inform an educational and policy response.MethodsWe consented and interviewed 73 junior physicians at six teaching hospitals across Central Iraq between December 2021, and January 2022. We analyzed 22 of the 73 conversations, after rejecting 29 because they were terminated prematurely when doctors were called away for patient care, and 22 others where doctors indicated they had no experience with workplace violence. (Our goal was to understand these interactions, not to quantify them).ResultsThe physicians we interviewed had been practicing an average 3 years since graduating from medical school (ranging from 6 months to 7 years). Interviewees represented eight hospital departments, with most coming from internal medicine and surgery. Within a socio-ecological framework, we identified two primary individual-level factors prompting patient-associated violence: patients and their families don’t understand triage (and resent being pushed to the side when doctors focus on more serious cases), and junior doctors (by definition) are young and inexperienced. At the family level, doctors reported patient relatives often demonstrate their devotion to the patient by acting out. At the hospital level, institutions are operating in an environment of scarcity, which generates high emotions as patients compete for attention, supplies and space. At a societal level, doctors reported family attacks persist because perpetrators face no real legal consequences. In addition to causes of violence, there are consequences. Doctors who are targets of violence reported experiencing mental health problems, including depression and loss of self-esteem, and reported thoughts of leaving their positions and even their country. Doctors also expressed regret for choosing a career in medicine.ConclusionYoung, inexperienced junior doctors in Iraq are bearing the brunt of patient frustrations with the scarcity of resources in the health system. Hospitals would likely improve the job satisfaction of junior physicians, and their longevity in the health system, by attending to this problem.

Pediatric Organ Donation: 16-Year Experience of PICU/ICU of a Third Level Hospital in Portugal, 2006-2021.

Although pediatric organ donation represents a small proportion of overall organ donation, children and adolescents make a significant contribution to the pool of donated organs. In this study 252 solid organs were collected from children and adolescent. Two hundred and two recipients benefited from 62 pediatric organ donors, with a recipient/donor ratio of 3.3.

Potential for tumor aggressiveness and its association with vasculogenic mimicry marker in colorectal carcinomas in Indian population- A tertiary care hospital level study.

Vasculogenic mimicry (VM) is the ability of cancer stem cells of aggressive phenotype to mimic embryonic vascular network by forming channels lined by tumor cells, thereby, promoting tumor growth. These channels are periodic acid-schiff positive and CD34 negative and have been associated with tumor invasion, metastasis, and poor prognosis. It is a promising target for developing novel anticancer therapeutics and contributes to personalized medicine. Our study aims to look for an association of vasculogenic mimicry marker (VMM) with the aggressiveness of colorectal carcinomas (CRCs). All retrospective and prospective cases of colorectal adenocarcinomas received over period of five years, from 2017 to 2021 were included in this study and a case-control study was planned. The study population was divided into two comparison groups based on TNM staging (a) those with non-aggressive tumors (controls; TNM stage I and II) and (b) those with aggressive tumors (cases; TNM stage III and IV). A total of 36 controls and 27 cases were studied. Hematoxylin and eosin stain, PAS, and CD34 immunohistochemistry were conducted. PAS positivity with negative CD34 in the same case was designated as VMM positive. VMM status was correlated with tumor stage, grade, and other pathological markers of prognosis. The Chi-square test was used to find an association between the aggressiveness of CRCs and VM positivity. The P value < 0.05 was considered to be significant. It was found that VMM was significantly associated with the aggressiveness of CRCs. VMM is a promising marker for its clinical utility in day-to-day routine IHC studies and its positivity correlates with tumor aggressiveness.

Over- and underreporting of prices: most hospitals are not compliant with the Hospital Price Transparency Rule.

Concern has been raised about the effectiveness of the Hospital Price Transparency Rule to facilitate a clear understanding of health care prices due to poor reporting by hospitals. However, the relationship between what services the hospital provides and what prices they report is not clear. We assessed reported prices in the Turquoise Health database and compared them at the hospital level with the CMS Provider of Services File to identify if a shoppable service was provided at a hospital. We found significant mismatch between the hospital prices being reported and the services being provided. For example, 56% of hospitals providing at least 1 shoppable service that requires public price reporting did not report any prices. Of hospitals reporting prices, most hospitals (66%) reported prices for only a portion of the services they provide. In addition, 12% of hospitals reported prices for services they do not provide. Only 6% of hospitals had complete concordance with price reporting and services they actually provide. Current compliance enforcement and penalties do not appear to be adequate to achieve the goals of the Hospital Price Transparency Rule.

Causal associations between COVID-19 and erectile dysfunction: a Mendelian randomization study.

In this study, we aimed to explore the potential association between COVID-19 infection, hospitalization, severe COVID-19, and erection dysfunction (ED) using the two-sample Mendelian randomization (MR) method. Data pertaining to COVID-19 were extracted from the latest version of the COVID-19 Host Genetics Initiative genome-wide association study (GWAS) meta-analyses (Round 7, April 2022), and outcome data were obtained from the Open GWAS database. We applied various MR analysis methods, including the inverse variance weighted method, weighted median method, and MR-Egger regression. Our investigation revealed a negative causal association between COVID-19 hospitalization and ED (total testosterone levels: beta = -0.026; 95% confidence interval: -0.049 to -0.001). However, no evidence supported causal relationships between COVID-19 infection, hospitalization for COVID-19, or severe COVID-19 and other ED risk factors. The results of this comprehensive MR analysis suggest a negative causal link between COVID-19 hospitalization and total testosterone levels. Nonetheless, COVID-19 (comprising infection, hospitalization, and severe illness) may not directly correlate with an increased risk of ED. These findings imply that COVID-19 may exert a distinct impact on ED through indirect pathways.

A Novel Preoperative Risk Score to Identify Patients at High Risk for Nonhome Discharge after Elective Open Abdominal Aortic Aneurysm Repair

Non-home discharge (NHD) to a rehabilitation or skilled nursing facility after vascular surgery is poorly described despite its impact on patients. For home-dwelling patients undergoing elective surgery, the need for postoperative NHD can have meaningful implications on quality of life, long-term outcomes, and healthcare spending. Understanding post-surgical NHD risk is essential to preoperative counseling and shared decision making. This is particularly true for the treatment of abdominal aortic aneurysms as the postoperative course can vary between open and endovascular surgery. We aimed to identify independent predictors of NHD following elective open abdominal aortic aneurysm repair (OAR), and to create a clinically useful preoperative risk score. Elective OAR cases were queried from the SVS Vascular Quality Initiative from years 2013-2022. A risk score was created by splitting the data set into two-thirds for development and one-third for validation. A parsimonious stepwise hierarchical multivariable logistic regression controlling for hospital level variation was performed in the development dataset, and the beta-coefficients were used to assign points for a risk score. The score was then validated, and model performance assessed. Overall, 8,274 patients were included and 1,502 (18.2%) required NHD. At baseline, patients who required NHD were more likely to be ≥ 80 years old (23.6% vs. 6.5%), female (35.9% vs. 23.1%), not independently ambulatory (14.6% vs. 4.3%), anemic (24.4% vs. 13.9%), have COPD (41.6% vs. 30.7%), ASA class ≥ 4 (41.0% vs. 32.5%), and a supraceliac proximal clamp (9.8% vs. 5.7%; all P<0.05). Multivariable analysis in the development group identified the following independent predictors of NHD: age ≥ 80 years, not independently ambulatory, proximal clamp location, hypogastric artery occlusion, anemia (Hb <12 g/dL), chronic obstructive pulmonary disease, female sex, hypertension, and American Society of Anesthesiologists class ≥ 4. These were then used to create a 14-point risk score. Patients were stratified into three groups based upon their risk score: low risk (0-4 points; n=4,966) with an NHD rate of 9.9%, moderate risk (5-6 points; n=2,442) with an NHD rate of 25.5%, and high risk (≥ 7 points; n=886) with an NHD rate of 44.6%. The risk score had good predictive ability with c-statistic=0.73 for model development and c-statistic=0.72 in the validation dataset. This novel risk score can predict NHD following elective OAR using characteristics that can be identified preoperatively. Utilization of this score may allow for improved risk assessment, preoperative counseling, and shared decision making.

272. HOSPITAL VARIATION IN PALLIATIVE TREATMENT FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER: A NATIONWIDE POPULATION-BASED STUDY IN THE NETHERLANDS

Abstract Background Palliative care for patients with esophageal (EC) includes a large variety of treatments and data on variation of palliative care across centers are unknown. This study aims to evaluate treatment variation at the hospital level for EC and GC patients in the Netherlands. Methods A nationwide retrospective cohort study was conducted using population-based data from the Netherlands Cancer Registry. Patients diagnosed with inoperable advanced (cT4B) or synchronous metastatic (cM1) EC between 2015-2022 were included. Probability of receiving potentially life-prolonging treatment (palliative resection, chemoradiotherapy or systemic treatment) according to hospital of diagnosis was analyzed using multilevel logistic regression analysis. Hospitals were categorized in tertiles according to this probability (high, medium, low) and overall survival (OS) was assessed using cox regression analysis. Results 8,580 EC patients were included. Potentially life-prolonging treatment ranged from 23.5%-74.0% across hospitals of diagnosis (p&amp;lt;0.0001). After adjustment for patient and tumor characteristics, the probability of receiving these treatments was associated with hospital of diagnosis (p&amp;lt;0.0001). 13 of 79 hospitals demonstrated a significantly lower probability of giving potentially life-prolonging treatment. Patients diagnosed in hospitals with low probability of potentially life-prolonging treatment with had significantly worse OS than medium- (HR 0.85 (0.80-0.90) p&amp;lt;0.0001) or high-probability hospitals (HR 0.77 (0.73-0.82) p&amp;lt;0.0001). Conclusion This study shows substantial variation in palliative treatment for EC and GC care across Dutch hospitals, emphasizing the challenge of defining optimal treatment plans. Hospital of diagnosis was significantly associated with the probability of receiving potentially life-prolonging treatment and also with overall survival. These results suggest that appropriate selection of patients for treatment with potentially life-prolonging treatment leads to improved OS.

482. REFLUXSTOP PROCEDURE IN THE LAPAROSCOPIC REPAIR OF HIATAL HERNIA

Abstract The video demonstrates laparoscopic anti-reflux surgery with the RefluxStop procedure, first introduced in 2016 and now offered in multiple centers across Europe. As this tertiary level hospital was among the first to offer this treatment to patients in clinical practice, this video provides unique insight to the lessons learned from the early experience of this surgery, with regard to optimizing effectiveness and safety. In light of the promising clinical outcomes that are emerging as follow-up data become available, the number of surgeons performing this this technique is likely to continue to increase. The RefluxStop procedure addresses all 3 components of the anti-reflux barrier as follows: 1) laparoscopic hiatal hernia repair, 2) high mediastinal dissection to achieve 4-6 cm intraabdominal length of esophagus, allowing the LES to be brought into an optimal intraabdominal position, and 3) recreation of the flap valve at the angle of His though creation of a 90-degree esophago-gastric plication. The 22mm round silicone RefluxStop device is then positioned high-up and close to the esophagus in a fundic pocket, to maintain the correct position of the repair. https://drive.google.com/file/d/1hlXXRUUMkDPmheW_mgPM_g1wWCu2R_Y3/view

Abstract P105: Comparative Effectiveness between Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors on Mortality: a Nationwide, Population-based, Prospective Cohort Study in China

Background: Contemporary evidence comparing the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) versus angiotensin II receptor blockers (ARBs) on long-term outcomes in patients with hypertension is sparse and inconsistent. The aim is to compare the effectiveness of ACEI monotherapy versus ARB monotherapy on all-cause death and cardiovascular death. Methods: Based on a nationwide, population-based prospective cohort project, which covered 318 study sites from 2014 to 2021 in China. Detailed information was collected by questionnaire, physical measurement, and blood test. Participants aged 35-75 years with hypertension and taking ACEI or ARB monotherapy once daily, and with good medication adherence at baseline were included. Information on mortality was followed up until 31 December 2021. Stabilized inverse probability treatment weighting (IPTW) was applied to compare the effectiveness. Results: 68 771 (49326 ARB, 19445 ACEI) participants were finally included, with a mean age of 59.9±8.3 years and 40.2% being female. During a median follow-up time of 44 months, 785 cardiovascular deaths and 1657 deaths were recorded. Compared with ACEI monotherapy, ARB monotherapy was associated with a quarter relative risk reduction of cardiovascular death (IPTW rates: 0.95 % Vs 1.43%, HR =0.73 [ 95%CI , 0.62-0.87]) and one-fifth relative risk reduction of all-cause death (IPTW rates: 2.13% Vs 2.84%, HR =0.80 [ 95%CI , 0.71-0.89]). These differences remained consistent after further adjusting for blood pressure and with differences more pronounced in patients with controlled and newly onset hypertension. Sensitive analysis and subgroup analysis yielded consistent results. Conclusions: Attention should be paid that ARB can be preferred to ACEI in patients with hypertension in terms of long-term health outcomes. Funding: This work was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Science (2021-I2M-1-011), and the National High Level Hospital Clinical Research Funding (2022-GSP-GG-4, NCRCSZ-2023-016). Keywords: Hypertension, Angiotensin receptor blocker, Angiotensin-converting enzyme inhibitor, Mortality, Comparative effectiveness

Demographic and Clinical Characters of the Patient of Condylar Fracture Treated under the Department of Oral and Maxillofacial Surgery in a Tertiary Level Hospital

Introduction: Mandible is the only mobile bone of the facial skeleton which plays an important role in mastication, speech and deglutition. Being a prominent bone of the facial skeleton, it is one of the most common facial bone to be fractured. Fracture in the mandible causes severe loss of function and disfigurement. Objective: The aim of this paper was to investigate the demographic and clinical characteristics of the patients of condyle fracture treated under the oral and maxillofacial department of a tertiary level hospital of Bangladesh. Methods: This retrospective cross-sectional descriptive type of study was conducted at the Department of Oral and Maxillofacial Surgery in Dhaka Dental College and Hospital, Dhaka, Bangladesh during June, 20 23 to December, 2023. A consecutive sampling technique was used and a series of 120 cases of condyle fracture aged 17-65 years of both sex were retrospectively enrolled in this study. The data were analyzed using Statistical Package for Social Sciences (SPSS), version-23.0. Results: A series of 120 cases of condyle fracture patients were enrolled in this study. Among the patients, the most frequent age group was 30-39 years which includes 62(51.25%) patients. The mean age of the patients was 41.10±10.21 years. A significant gender disparity was observed, with 87(72.5%) of the patients being male. Most of the patients were service holder 63(52.5%). The major cause of injury of the patients was road traffic accident 75(62.5%).Among the study patients, 111(92.5%) had third molar teeth present. Of them, the most frequent 75(67.56%) patients had erupted third molar condition and 36(32.43%) patients had impacted third molar condition. According to distribution of type of impacted teeth, 21(50%) cases, had oriented vertically and followed by mesioangular 11(25%), disto-angular 4(10.7%), and horizontal 6(14.3%). According to distribution of condylar fracture, the most frequent 73 (6.25%) patients had non-displaced injuries. followed by displaced 36(30%) and dislocated 11(8.75%). Conclusion: This study investigated that road accident is the principal factor of condylar fracture and third molar teeth and its position has a significant impact on condylar fracture and at the same time the male are the more prone to condylar fracture than the female in Bangladesh