Prevalence and Factors Associated with Anemia among People Living with Human Immunodeficiency Virus Followed at the Outpatient Treatment Centre of Panzi General Referral Hospital in Eastern Democratic Republic of Congo

Introduction: Anemia in people living with human immunodeficiency virus (PLHIV) is a major health problem. Although anemia often responds to combination antiretroviral therapy, many patients remain anemic despite treatment, and such persistent anemia continues to adversely affect prognosis, regardless of drug response. Scientists have identified some of the factors involved. However, the mechanisms put in place have not been effective in overcoming them. Examples include the withdrawal of zidovudine from antiretroviral treatment lines, iron and folate supplementation, etc. Anemia is still a major concern in HIV-positive patients. The aim of this study is to assess the prevalence of anemia and its associated factors among PLHIV followed up at the outpatient treatment centre (CTA) of the Panzi General Reference Hospital (HGR) in South Kivu, Democratic Republic of Congo (DRC). Method: We conducted a cross-sectional, comparative study of 276 HIV-infected adults on antiretroviral therapy (ART) followed up at the CTA of Panzi HGR. Socio-demographic and nutritional parameters were collected using a survey questionnaire, and clinical assessment and nutritional status were performed at the centre. Hemoglobin, seric albumin and viral load determinations were performed at the HGRP laboratory. We constructed univariate and multivariate logistic regression models to assess factors associated with anemia in people living with HIV/AIDS. Results: We found a prevalence of anemia of 39.4%, including 4.1% severe anemia, 17.7% moderate anemia and 17.5% mild anemia. After multivariate adjustment, the factors associated with anemia in our PLHIV were: moderate undernutrition (aOR = 1.26;95% CI: 1.50 - 4.20;p = 0.001), severe undernutrition (aOR = 115.4;95% CI: 2.04 - 164.52;p = 0.021), hypoalbuminemia (aOR = 2.11;95% CI: 1.87 - 5.10;p = 0.004) and the lower degree of dietary diversity (aOR = 1.56;95% CI: 1.10 - 4.32;p = 0.034). Conclusion: The prevalence of anemia in PLHIV on ART is high. This greatly affects quality of life and increases the need for care. Early detection tools and management algorithms are essential in the follow-up of PLWHIV.

Comparison of Oral Manifestations in Hospitalized COVID-19 Positive Patients and COVID-19 Negative Dental Outpatients. A Case Series Study and Literature Review

Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.

Vitamin D deficiency among outpatients and hospitalized patients with diabetic foot ulcers:A systematic review and meta-analysis

BACKGROUND The definition of diabetic foot syndrome(DFS)varies depending on the location and resources.Few classifications are available according to the indication.DF ulcers and vitamin D deficiency are common diseases among patients with diabetes.Previous literature has shown an association between DF ulcer(DFU)and vitamin D deficiency.However,the available meta-0analysis was limited by substantial bias.AIM To investigate the association between DFUs and vitamin D levels.METHODS We searched PubMed,MEDLINE,and Cochrane Library,EBSCO,and Google Scholar for studies comparing vitamin D levels and DF.The keywords DFU,DFS,diabetic septic foot,vitamin D level,25-hydroxy vitamin D,vitamin D status,and vitamin D deficiency were used.The search engine was set for articles published during the period from inception to October 2022.A predetermined table was used to collect the study information.RESULTS Vitamin D level was lower among patients with DFU compared to their counterparts[odds ratio(OR):-5.77;95%confidence interval(CI):-7.87 to-3.66;χ2 was 84.62,mean difference,9;I2 for heterogeneity,89%;P<0.001 and P for overall effect<0.001].The results remained robust for hospitalized patients(OR:-6.3295%CI:-11.66 to-0.97;χ2 was 19.39;mean difference,2;I2 for heterogeneity,90%;P=0.02).CONCLUSION Vitamin D was lower among outpatients and hospitalized patients with DFUs.Further larger randomized controlled trials are needed.

An Online Outpatient Database System: A Case Study of General Hospital, Minna

Outpatients receive medical treatment without being admitted to a hospital. They are not hospitalized for 24 hours or more but visit hospital, clinic or associated facility for diagnosis or treatment [1]. But the problems of keeping their records for quick access by the management and provision of confidential, secure medical report that facilitates planning and decision making and hence improves medical service delivery are vital issues. This paper explores the challenges of manual outpatient records system for General Hospital, Minna and infers solutions to the current challenges by designing an online outpatient’s database system. The main method used for this research work is interview. Two (2) doctors, three (3) nurses on duty and two (2) staff at the record room were interviewed. Fifty (50) sampled outpatient records were collected. The combination of PHP, MYSQL and MACROMIDIA DREAMVEAVER was used to design the webpage and input data. The records were implemented on the designed outpatient management system and the outputs were produced. The finding shows these challenges facing the manual system of inventory management system. Distortion of patient’s folder and difficulty in searching a patient’s folder, difficulty in relating previous complaint with the new complains because of volume of the folder, slow access to patient diagnosis history during emergency, lack of back up when an information is lost, and preparation of accurate and prompt reports make it become a difficult task as information is difficult to collect from various register. Based on the findings, this paper highlights the possible solutions to the above problems. An online outpatient database system was designed to keep the outpatients records and improve medical service delivery.

Fever Outpatient Service of General Hospital Applies “1 + 3 + 3” Emergency Management Mode to Deal with COVID-19 Pandemic

Purpose: To discuss the effect of “1 + 3 + 3” emergency management mode to deal with COVID-19 pandemic in fever outpatient service of general hospitals. Method: This paper analyzes and summarizes the problems encountered by fever outpatient service in dealing with the COVID-19 pandemic from three aspects of “One Team”, “Three-Key” Control and “Three Mosts”. Results: The application of “1 + 3 + 3” emergency management mode can effectively boost the orderliness and efficiency of fever outpatient service in dealing with COVID-19 pandemic. Conclusion: The “1 + 3 + 3” emergency management mode provides a new management mode and idea for dealing with COVID-19 pandemic, so the fever outpatient service of general hospitals can better improve the national overall anti-pandemic situation.

Characterization of Salmonella Enterica Serotype Typhimurium from Outpatients of 28 Hospitals in Henan Province in 2006

Objective To characterize the diarrheal patients with Salmonella typhimurium （S. typhimurium） infections and to set up the first baseline for S. typhimuri_um pulsed-field gel electrophoresis （PFGE） patterns in Henan province, thus laying a foundation for comprehensive surveillance of Salmonella in human as well as foods. Methods S. typhimurium isolates recovered from outpatients with diarrhea in Henan province from May to October of 2006 were characterized. Antimicrobial susceptibility tests of 8 antimicrobial agents and PFGE were carried out to analyze the S. typhimurium isolates. Results Twenty-four （0.9%） S. typhimurium isolates were identified from 2661 stool specimens of diarrheal cases. Eighty-eight percent of isolates showed resistance to at least one antimicrobial agent. The resistance to chloramphenicol （79%） was most common. Fifty-eight percent of isolates were resistant to ciprofloxacin. All the 14 ciprofloxacin-resistant isolates were resistant to more than five antimicrobial agents. Thirty-three percent of S. typhimurium isolates were resistant to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline （R-type ACSSuT）. Eight antimicrobia-resistant phenotypes were found among the 24 isolates in 16 PFGE patterns. Conclusion The rate of multidrug-resistant S. typhimurium is relatively high in S. typhimurium PFGE patterns of Henan province. Multidrug-resistant S. typhimurium should be considered a public health threat.

Outpatient telephonic transitional care after hospital discharge improves survival in cirrhotic patients

BACKGROUND Intervention to improve outcomes in cirrhotic patients (CP) after hospital discharge often focus on 30 d readmission rate (RR). However, recent studies suggest dissociation between RR and survival. At our center, CP are now offered outpatient telephonic transitional care (OTTC) by a care coordinator for 30 d after hospital discharge. AIM To determine the effect of OTTC on survival in CP. METHODS In this cohort study from a tertiary center, CP who received OTTC formed the intervention group. They were compared with a control group discharged during the same period. Mortality and RR were compared between the groups. RESULTS After OTTC introduction, 194 CP were discharged. After applying exclusion criteria, 169 CP (51% male, mean age 58 years ± 12 years) were included. OTTC group comprised 76 patients and was compared with 93 controls. Baseline disease and index admission related characteristics were not significantly different between the groups. The intervention group showed significantly higher 6 mo survival compared to controls (84.2% vs 68.8%;P = 0.03), while RR at 1, 3, and 6 mo were comparable. On multivariable analysis, the intervention group showed lower odds for mortality compared to the controls (hazard ratio: 0.4;95% confidence interval: 0.2-0.82;P = 0.012), while higher model for endstage liver disease scores were associated with higher mortality (hazard ratio: 1.05;95% confidence interval: 1.01-1.1;P = 0.024).CONCLUSION CP provided OTTC had higher 6 mo survival compared to controls without a difference in RR. Use of RR to gauge quality of care provided during hospitalization or subsequent transitional care programs should be revisited.

Hypertension (HTN) Knowledge and with Its Associated Factors: About 456 Outpatients Seen in Cardiology Department in University Hospital (UH) Gabriel Touré—Bamako (Mali)

Background: High Blood Pressure (HBP) is high prevalent among adult population in Bamako, but little is known about factors associated with knowledge. Methods: It was a cross-sectional study involving patients aged 15 years and more with a first classification in normal blood pressure (HTN-) and high blood pressure (HTN+), and Second classification inpatients without knowledge (who answered No) (K-) and patients with knowledge (who answered Yes) (K+). A logistic regression was performed to look up predictors among different variables. Results: The sample involved 456 patients with a mean age of 51.39 years and 65.1% of female. The age group 45 - 59 years old made 32.5% and unschooled patients 60.3%. Patients with HBP accounted for 69.7% and those reporting to know about it 67.3%. HTN- and HTN+ differed significantly except for HR, height, sex and level of schooling. HBP prevalence increased with age up to 74 years. Regarding knowledge, sex, age group and number of FDRs did not differ significantly. High education level and duration of HBP was predictive of knowledge with an OR of 1.186 [CI 0.058 - 0.796] and 1.192 [CI 0.332 - 4.275] respectively. Conclusions: Our study provided data on HBP knowledge among outpatients with high educational level and HBP duration associated with better knowledge on HBP.

Assessment of Common Dental Indices and Need for Periodontal Treatment in the Cardiology Outpatients Unit at the University Hospital Gabriel Touré(UH-GT) in Bamako

Introduction: Little is known through the literature about dental status of patients seen in cardiology department, motivating this study which aims to assess most dental indices of outpatients and the need for periodontal treatment. Methodology: It was a cross-sectional study from November 2016 to April 2017 in the cardiology outpatient unit of the University Hospital Gabriel Touré (UH-GT) in Bamako. Included were all patients with minimum 24 teeth and willing to be involved in the study. History, cardiovascular parameters and dental examination by a resident in Odontostomatology were performed for each patient. Data were analyzed using SPSS 18, quantitative as means and standard deviation (SD) and categorical as proportions. Khi-2 Test, analysis of variance were applied with a significance level set at 0.05. All patients give their verbal consent after being informed about the procedures in the study. Results: Our sample involved 100 patients (66% female, mean age of 54.12 ± 16.150 and patients ≥ 60 years most represented with 50% for male and 37.9 for female patients. Tooth brush use was practiced by 100% and 98.5% respectively for male and female patients and twice daily brushing by 97.1% of male and 97% of female patients. Brushing duration was less than 3 minutes for 35.3% and 31.8% of respectively male and female patients. Plaque index and calculus index were in the male group with respectively 0.79 and 1.06 for male and 0.63 and 0.79 for female (p = 0.047 and 0.020). Mean Decayed Missed and Filled Teeth (DFMT) index showed a significantly increase from 0.22 in the age group under 30 to 0.68 for that other 60 years. Only 2.9% and 9.1% of respectively male and female patients had community paradontal index for treatment needs (CPITN) classe 0. The need for treatment was TN1 meaning instruction to an oral cavity hygiene, similar for both sex (55.9 and 57.6 respectively for male and female patients) and highest in the age-group 30 - 44 increased to 70%. The need for professional intervention in oral cavity was higher for men and higher for patients aged 45 - 59 and ≥60 years. Conclusion: Drawing attention of practitioners on the additional risk of bad periodontal conditions and education on a broad basis already in the school must be part of a preventive program in order to have a code 0 as goal.

Effects of Occupational Noise on the Hearing Ability of Outpatient Clinic Nurses in Different Classes of Hospitals in Guangzhou

Background: Occupational noise can induce hearing impairment. Work-related hearing impairment has become a growing threat to medical practitioners who feel anxious about occupational noise exposure and its health outcomes or even experience auditory dysesthesia (including drumming, distending pain in the ears, and otalgia) after long-term exposure to a noisy work environment. Objective: To investigate the effects of occupational noise on the hearing ability of outpatient clinic nurses in Grade III, Level A and Grade II, Level A hospitals in Guangzhou. Methods: During June 2019, noise monitoring was performed by quantifying the noise levels at four measuring points (reception, waiting area, hallway, blood-sampling room) in five Grade III, Level A and five Grade II, Level A hospitals, in Guangzhou, four times a day (8 AM, 10 AM, 2 PM, and 4 PM) for 19 working days, using a professional noise measuring application for smartphones. The measurements were verified and used to create a database in Excel. Data analysis was conducted using SPSS22.0, and questionnaires were distributed to nurses who had been working at outpatient clinics for five years and above to assess the impacts of occupational noise exposure on the hearing ability. Results: In the Grade III, Level A hospitals, the sound levels at the four measuring points during the specific time periods were 4.92 - 6.75 dB above the permissible limit of 55 dB and were all significantly higher than the sound levels at the outpatient clinics of the Grade II, Level A hospitals (P Conclusions: Exposure to excess noise can lead to auditory dysesthesia in outpatient clinic nurses. Compared to those from Grade II, Level A hospitals, outpatient clinic nurses from Grade III, Level A hospitals are at higher risk of auditory dysesthesia. The noise levels at outpatient clinics should be closely monitored, and effective measures should be taken to reduce occupational noise exposure. Outpatient clinic nurses should enhance protective measures and receive preventive health exams on a regular basis.

Outpatient Management of Sickle Cell Disease: Assessment of 13 Years Follow-Up of Pediatric Patients at the Sylvanus Olympio University Hospital

Objective: To evaluate thirteen years of ambulatory follow-up of patients with major forms of sickle cell disease. Methods: This was a study of 1055 records of sickle cell patients aged 6 months to 45 years followed between 2006 and 2018. Results: Six hundred and eighty-one (64.5%) homozygous SS, 283 (26.8%) SC, 86 (8.2%) SF, 4 (0.4%) S? thalassemia and 1 (0.1%) SD sickle cell patients were followed. The majority of the patients (97.9%) were living in the capital city of Lomé and its surrounding suburbs. Most children (67.3%) were less than 5-year-old when they were diagnosed with sickle cell disease, and only 21.3% of cases were discovered before the first year birthday of the patients. Osteo-articular vaso occlusive crisis (VOC) was the principal symptom at the onset of the diagnosis, approximately 28.9% of the cases, followed by severe anemia (19%), then hand-foot syndrome in 15.6%. The systematic screening was performed in 5.4%. Twenty-six percent were G6PD deficient, 4 were HIV immunocompromised, and 29.7% were transfused. Among the degenerative complications, 2.4% had retinopathy, 1.9% osteonecrosis of the femoral head, 1.4% leg ulcers, and 0.8% cardiomyopathy. Salmonella typhi was the main cause of infection, 51.4% of the cases. The mean baseline hemoglobin level (n = 27) was 7.67 ± 1.64 g/dl. Four (0.4%) patients had a splenectomy. The mortality rate was 2.4%. The primary cause of death was anemia (28%), followed by sepsis in 20% of the cases. One case of suicide was documented as the cause of death. Conclusion: Outpatient medical follow-up of sickle cell patients is essential in sub-Saharan African countries where neonatal screening does not exist, and diagnosis is often late. The improvement in quality of life observed should be studied.

Reducing Extended Hospital Lengths of Stay

In the United States, the costs of health care have become a major burden for the health care system. In order to address this problem, the hospitals of Syracuse, New York, developed programs to provide subacute and complex care. The Subacute programs provided patient transportation services for dialysis and other types of care outside hospitals. They also developed programs for services such as intravenous therapy in nursing homes. The Complex Care Programs, such as intravenous therapy and mental health services, have provided alternatives to extended care in hospitals. During the past five years, utilization of these programs has varied, declining between 2019 and 2022, and then increasing between 2022 and 2024. The programs have avoided the need for 1530 - 2974 patient days in hospitals. The programs saved the Syracuse hospitals approximately $600 per inpatient day. This amounted to savings of $918,000 - $1,784,400 per year. These programs demonstrated how relatively small mechanisms can save large amounts of health care resources.

Analysis of the Dilemma and Strategies of Elderly Patients Access to Outpatient Services-Based on the Examples from three Grade A Tertiary Hospitals in Jiangxi Province

Objective:To identify the dilemma of elderly patients’access to outpatient services,develop strategies to improve the environment and functions of the outpatient department,and encourage the elderly to access medical services independently.Methods:By observing and interviewing,this paper studies the environment,behavior,and experiences of elderly patients when accessing medical services,identifies and classifies the key issues,and provides corresponding suggestions.Results:Existing signs and voice prompt systems fail to guide elderly patients to access to medical services;Elderly patients have difficulty in finding places to transit and rest when accessing to outpatient services;Elderly patients have problems in using AI(artificial intelligence)technologies when they access to outpatient services;There are communication barriers between elderly patients and medical staffs.Conclusion:Optimizing the guiding signs and voice prompt systems according to the characteristics of elderly patients;Designing the areas of transition and rest reasonably;Enhancing the ability of elderly patients to use self-service equipment;Promoting the medical treatment process to the elderly in a humanized way.

Monitoring Changes in Hospital Utilization

This study focused on recent issues concerning health care utilization at the community level. The study focused on developments in hospital inpatient lengths of stay and discharges. The analysis in the study demonstrated that hospital lengths of stay in the metropolitan area of Syracuse, New York increased by 25.0 percent between 2019 and 2023. This has been a notable increase in the movement of patients with this indicator. The analysis also demonstrated that numbers of inpatient discharges for these hospital services declined substantially during the same periods. Review of the data suggested that this information has been related. The increase in hospital lengths of stay has been related to a rise in numbers of patients at high severity of illness. They have also been associated with a decline in numbers of patients at low severity.

Analysis of Hospital Budget Management Control Based on Smart Hospital

Hospitals are crucial healthcare facilities where patients seek treatment,and effective budget management within hospitals significantly impacts their operational efficiency and financial performance.In the age of information technology and advanced healthcare solutions,the emergence of smart hospitals represents a new trend in the medical industry’s evolution.Leveraging modern information technology can enhance the development of hospital IT systems and drive budget management toward greater intelligence.This paper begins by analyzing the influence of smart hospitals on hospital budget control.It then examines the current state of budget management control within smart hospitals.Finally,it proposes several strategies for budget management control in smart hospitals,aiming to provide guidance for relevant stakeholders.

Echocardiographic Aspects of Type 2 Diabetics Patients Hospitalized in the Medicine and Endocrinology Department of the Mali Hospital

Introduction: Cardiovascular disease is the leading cause of death in diabetics. The objective of our study was to investigate the echocardiographic aspects of type 2 diabetics. Patients and Method: Descriptive and cross-sectional study of 12 months from June 2020 to June 2021. We included hospitalized type 2 diabetics who underwent transthoracic cardiac ultrasound in the Department of Medicine and Endocrinology at the Mali Hospital. Results: We collected 128 type 2 diabetics. The predominance was male with a sex ratio of 1.2. The mean age of patients was 60.06 ± 11.54 years with extremes of 28 and 84 years. Echocardiographic abnormalities were dominated by abnormal relaxation of left ventricle in 62.5%, increased of left ventricle mass in 54.7% and left atrium dilation in 28.1%. Patients with type 2 diabetes mellitus and hypertension had more left atrium dilation with a p of 0.02. Disorders of global kinetics and systolic dysfunction were more prevalent in smoking patients with statistically significant associations, respectively, p = 0.02;p = 0.03. Dyslipidemia had a statistically significant association with segmental kinetic disorders with a p of 0.008. Duration of diabetes greater than 5 years was associated with left atrium dilation and p-value was 0.04. Conclusion: Diabetes is responsible for cardiovascular manifestations that can be identified with transthoracic echocardiography. Its performance in diabetic patients makes it possible to refine the patient’s management.

Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Heart Failure in the Medical Department at Gao Regional Hospital

Introduction: Heart failure is a major public health pandemic, particularly in Africa, where its prevalence continues to increase. In northern Mali, few data exist, hence the interest of this study with the objective of studying the epidemiological, clinical and therapeutic and evolutionary aspects of Heart failure at the regional hospital of Gao. Patients and Methods: This was a cross-sectional, descriptive study that took place from July 2022 to June 2023 in the medical department at Gao Hospital. Results: The hospital prevalence of heart failure was 44.1%. The mean age was 47.30 ± 20 years (range: 16-88). Hypertension was the most common with 46.1%, followed by a sedentary lifestyle, and diabetes with 18.2% and 8.3% respectively;NYHA stage III-IV dyspnea was found in 83.9%. Reduced EF heart failure was present in 110 patients (76.9%), seventeen cases with moderately reduced EF (11.9%) and sixteen patients had preserved EF (11.2%). Global heart failure was the dominant (91.6%). The main etiologies of heart failure were dominated by hypertensive heart disease in 46 patients (32.2%), followed by postpartum cardiomyopathy with 43 cases (30.1%), primary dilated cardiomyopathy in 18 patients (12.6%), ischemic heart disease in 16 patients with 11.2%. Seven cases of valvular heart disease, or 4.9%. The evolution was favorable under treatment in 104 patients or 72.7%. In-hospital mortality was 14.7%. Conclusion: Heart failure is a common condition in sub-Saharan Africa, particularly in our country.

Outpatient management of obscure gastrointestinal bleeding:A new perspective in high-risk patients

Mid-gastrointestinal bleeding accounts for approximately 5%-10%of all gastrointestinal bleeding cases,and vascular lesions represent the most frequent cause.The rebleeding rate for these lesions is quite high(about 42%).We hereby recommend that scheduled outpatient management of these patients could reduce the risk of rebleeding episodes.

Therapeutic Compliance of Hypertensive Patients Followed in Ambulatory in the Cardiology Department of Kati University Hospital

Introduction: High blood pressure is a major public health problem worldwide due to its frequency and cardiovascular complications. Adherence to treatment for chronic diseases is a global problem. The aim was to study therapeutic adherence in hypertensive patients followed in ambulatory. Materials and Methods: This was a cross-sectional, descriptive study with prospective recruitment that took place from July 1 to December 31, 2022 (6 months) in the cardiology department of the university hospital of Kati. The variables studied were sociodemographic data, cardiovascular risk factors, comorbidities, the possession of insurance and compliance (the Girerd questionnaire was used to assess adherence). Results: A total of 1182 patients were consulted, including 887 for hypertension, a frequency of 75%. Fifty-six patients were included in the study. The average age was 58.18 ± 13.25 years with extremes of 30 and 80 years. There was a female predominance (75%) with a sex ratio of 0.3. The majority of patients lived in urban areas (89.3%). Out-of-school patients accounted for 44.6%, more than half of patients or 55.4% had no income, patients with medical coverage accounted for 67.9% of cases. The main risk factors were physical inactivity (25%) followed by smoking 14.3%. More than 71% of patients had a compliance problem and the main reasons were forgetting to take the drug with 73.2%, followed by delayed treatment of 50% and drug discontinuation of 28.6%. Conclusion: Compliance is a real challenge and a major public health issue. This study allowed us to find a real problem of compliance in our hypertensive patients. There was a statistically significant relationship between drug adherence and forgetting to take the drug and drug discontinuation.

The Impact of Health Information Technology on Hospital Performance: A Systematic Integrative Literature Review

Objective: To review, categorise, and synthesise findings from literature on health information technology (HIT) functionalities, HIT use, and the impact of HIT on hospital performance. Materials and Methods: We conducted a systematic integrative literature review based on a compre-hensive database search. To organise, categorise and synthesise the ex-isting literature, we adopted the affordance actualization theory. To align the literature with our research framework, we used four categories: 1) the functionalities of HIT and how these functionalities are measured;2) use and immediate outcomes of HIT functionalities;3) different perfor-mance indicators and how HIT functionalities affect them;and 4) what hospital characteristics influence the outcome of hospital performance. Results: Fifty-two studies were included. We identified four types of HIT. Only ten studies (19.2%) define the use of HIT by explicitly meas-uring the use rate of HIT. We identified five dimensions of hospital per-formance indicators. Every dimension showed mixed results;however, in general, HIT has a positive impact on mortality and patient readmis-sions. We found several hospital characteristics that may affect the rela-tionship between HIT and hospital-level outcomes. Discussion: Further efforts should focus on embedded research on HIT functionalities, use and effects of HIT implementations with more performance indicators and adjusted for hospital characteristics. Conclusion: The proposed framework could help hospitals and researchers make decisions regard-ing the functionalities, use and effects of HIT implementation in hospi-tals. Given our research outcomes, we suggest future research opportuni-ties to improve understanding of how HIT affects hospital performance. .