Impact of the economic crisis and drug shortage on Lebanese cancer patients’care

BACKGROUND As a consequence of the economic crisis,the sociopolitical instability and the advent of the coronavirus disease-19 pandemic,nested challenges faced the Lebanese healthcare system.These have resulted in critical shortages of essential resources,including medications vital for oncologic patients.AIM To assess the ramifications of the ongoing economic crisis on oncology patient care focusing on our outpatient oncology department.METHODS A questionnaire was distributed during the month of February 2022 to oncology patients in Hôtel Dieu de France University Hospital in Beirut during their outpatient therapy.The primary objective was to assess the far-reaching impact of the economic crisis on patient care and the resulting psychological implications.RESULTS Among 182 interviewed patients,31.87%experienced treatment interruption mainly due to acute drug shortages.Despite 87.91%of the patients benefiting from third-party coverage,69.60%had to self-pay for their medications leading to 69.78%of patients perceiving that healthcare was more difficult to access after 2020.Psychologically,one-third of the patients exhibited symptoms of anxiety and/or depression,with 7 patients reporting suicidal ideations.Notably,37.93%of patients who interrupted cancer treatment reported a history of comorbidities,and 89.66%who altered their treatment cited financial difficulties.CONCLUSION Lebanese cancer patients face complex challenges spanning economic,healthcare,and psychological realms.Income inequalities exacerbated by the economic crisis hindered healthcare access.

Discharging patients home from the intensive care unit:A new trend

Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.

Improvement of the nutritional support management system for patients in intensive care units

BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.

Aggressive fluid management may be associated with disease progression in suspected sepsis patients admitted to the intensive care unit: a retrospective cohort study

Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Patients with a SOFA score<2 and at least one of the following were considered as“suspected sepsis”:(1)quick SOFA(qSOFA)score≥2;(2)SOFA score=1;or(3)National Early Warning Score(NEWS)4-6.[3]Compared with studies on fluid resuscitation in sepsis patients,there are few studies on fluid management in patients with suspected sepsis.Therefore,we conducted a retrospective cohort study to evaluate the relationship between fluid management and disease progression in suspected sepsis patients.

A Retrospective Analysis of Intoxicated Patients Admitted to the Intensive Care Unit: A Single-Institution Assessment in the Post-Pandemic Period

Background: The aim of this study was to evaluate the clinical and epidemiological characteristics of patients with acute intoxication admitted to the Intensive Care Unit (ICU). Material and Methods: An observational retrospective study was conducted on intoxicated patients who admitted to ICU between January 2022 and January 2024. Data were collected from the patients medical records. The demographic characteristics, causes of intoxications, clinical parameters, the mean stay in the ICU, treatment modalities and prognosis were recorded. Results: A total of 2875 critically ill patients were admitted during the study period, and 109 (3.79%) of them were acute intoxications. Their mean of ages was 38.09 ± 12.29. The female-to-male ratio was 1.37/1. Drugs were found to be the primary cause (62.39%) of intoxications, and analgesics, antidepressants, and antibiotics were the most frequent agents. Suicidal attempts were present in 66 patients, most of them were female (62.13%) and between 17 - 24 years (40.91%). The other common causes of intoxications were carbon monoxide (CO) (22.02%), methyl/ethyl alcohol (8.26%) and mushroom (5.50%). The mean stay in the ICU was 2.69 ± 0.89 days. Mechanical ventilation was applied to 10 of our patients. Renal replacement therapy was required in 6 patients. Despite all treatments, 6 of our patients died, and we found the mortality rate to be 5.50%. Conclusion: Intoxications were more frequent in young female patients and drugs were the most common cause with suicidal intent. Unfortunately, CO poisoning continues to be a very important problem in our city. These findings provided significant information about the characteristics of intoxications in Karabuk.

The Alzheimer’s Dementia Patients’ Observed Illness Course and Experience in Ghana and Care Lessons to Be Learnt: A Mental Health Professional’s Perspective

Alzheimer’s disease (AD) and associated dementia patient numbers continue to increase globally with associated economic costs to healthcare systems. Of note is the increase in numbers in lower and middle-income countries (LMICs) including Sub-Saharan African (SSA) countries, which already face challenges with their health budgets from communicable and non-communicable diseases. Ghana, an SSA country, faces the problem of healthcare budgetary difficulties and the additional impact of AD as a consequence of increasing population strata of old aged persons (OAPs) due to the demographic transition effect. This article uses examples of known patients’ illness courses to give a perspective on the lived experience of patients with dementia (PWD) in Ghana, living amongst a populace with a culture of stigmatization of PWD, and a relatively fragile public mental health system (PMHS) for those with mental illness, including AD. The lived experience of AD patients is characterised by stigmatisation, discrimination, non-inclusiveness, diminished dignity and human rights abuses in the face of their mental disability, and eventually death. This article is an advocacy article giving voice to the voiceless and all persons suffering from AD and other dementias in Ghana, whilst pleading for a call to action from healthcare professionals and responsible state agencies.

Depression and anxiety among cancer patients visiting a tertiary care cancer hospital

BACKGROUND Cancer patients frequently experience psychological problems related to reactions to cancer diagnosis,cancer type and stage,treatment effects,recurrence,fear of end-of-life,survivorship,and financial burden.Depression and anxiety are both psychological and physiological disturbances among cancer patients.AIM To assess the prevalence of depression and anxiety among cancer patients attending a tertiary care cancer hospital.METHODS A cross-sectional study was conducted at Bhaktapur Cancer Hospital in Kathmandu Valley among 220 cancer patients aged from 18 years to 70 years.Ethical approval was taken from the Institutional Review Committee of CiST College.Convenient sampling was used to interview patients with the standardized Patient-Health Questionnaire(PHQ-9)for Depression and Hospital Anxiety and Depression sub-scale(HADS-A)for anxiety.Epi-Data was used for data entry and transferred to SPSS Version 25 for analysis.RESULTS The study revealed that of 220 patients,most of the respondents belonged to the age group 51-60 years.More than half 131(59.6%)of the respondents were female,most of them had depression,and one-third had anxiety.Among the respondents,124(56.4%)had mild depression,70(31.8%)had moderate depression,and 3(1.3%)had severe depression;79(35.9%)had mild anxiety,64(29.1%)had moderate anxiety,and 4(1.8%)had severe anxiety.CONCLUSION Most respondents were depressed and one-third had anxiety.More than half and nearly one-third had mild and moderate depression,respectively,and nearly one-third had mild and moderate anxiety,which is higher than other studies.

Nursing Care of 10 Patients with Vasovagal Reflex Caused by Artificial Liver Support System Treatment

This study outlines the essential nursing strategies employed in the care of 10 patients experiencing vascular vagal reflex, managed with artificial liver support systems. It highlights a holistic nursing approach tailored to the distinct clinical manifestations of these patients. Key interventions included early detection of psychological issues prior to initiating treatment, the implementation of comprehensive health education, meticulous monitoring of vital signs throughout the therapy, prompt emergency interventions when needed, adherence to prescribed medication protocols, and careful post-treatment observations including venous catheter management. Following rigorous treatment and dedicated nursing care, 7 patients demonstrated significant improvement and were subsequently discharged.

Impact of continuous care on cardiac function in patients with lung cancer complicated by coronary heart disease

BACKGROUND Despite sharing similar pathogenic factors,cancer and coronary heart disease(CHD)occur in comparable populations at similar ages and possess similar susceptibility factors.Consequently,it is increasingly commonplace for patients to experience the simultaneous occurrence of cancer and CHD,a trend that is steadily rising.AIM To determine the impacts of continuing care on lung cancer patients with CHD following percutaneous coronary intervention(PCI).METHODS There were 94 lung cancer patients with CHD following PCI who were randomly assigned to the intervention group(n=38)and the control group(n=41).In the intervention group,continuing care was provided,while in the control group,routine care was provided.An evaluation of cardiac and pulmonary function,medication compliance,a 6-min walk test,and patient quality of life was performed.RESULTS Differences between the two groups were significant in left ventricular ejection fraction,6-min walk test,oxygen uptake,quality of life and medication compliance(P<0.05).In comparison with the control group,the enhancement in the intervention group was more significant.The intervention group had more patients with high medication compliance than the control group,with a statistically significant difference(P<0.05).CONCLUSION After undergoing PCI,lung patients with CHD could benefit from continued care in terms of cardiac and pulmonary function,medications compliance,and quality of life.

Development and validation of a nomogram for predicting in-hospital mortality of intensive care unit patients with liver cirrhosis

BACKGROUND Liver cirrhosis patients admitted to intensive care unit(ICU)have a high mortality rate.AIM To establish and validate a nomogram for predicting in-hospital mortality of ICU patients with liver cirrhosis.METHODS We extracted demographic,etiological,vital sign,laboratory test,comorbidity,complication,treatment,and severity score data of liver cirrhosis patients from the Medical Information Mart for Intensive Care IV(MIMIC-IV)and electronic ICU(eICU)collaborative research database(eICU-CRD).Predictor selection and model building were based on the MIMIC-IV dataset.The variables selected through least absolute shrinkage and selection operator analysis were further screened through multivariate regression analysis to obtain final predictors.The final predictors were included in the multivariate logistic regression model,which was used to construct a nomogram.Finally,we conducted external validation using the eICU-CRD.The area under the receiver operating characteristic curve(AUC),decision curve,and calibration curve were used to assess the efficacy of the models.RESULTS Risk factors,including the mean respiratory rate,mean systolic blood pressure,mean heart rate,white blood cells,international normalized ratio,total bilirubin,age,invasive ventilation,vasopressor use,maximum stage of acute kidney injury,and sequential organ failure assessment score,were included in the multivariate logistic regression.The model achieved AUCs of 0.864 and 0.808 in the MIMIC-IV and eICU-CRD databases,respectively.The calibration curve also confirmed the predictive ability of the model,while the decision curve confirmed its clinical value.CONCLUSION The nomogram has high accuracy in predicting in-hospital mortality.Improving the included predictors may help improve the prognosis of patients.

Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma

Primary biliary tract tumors are malignancies that originate in the liver,bile ducts,or gallbladder.These tumors often present with jaundice of unknown etiology,leading to delayed diagnosis and advanced disease.Currently,several palliative treatment options are available for primary biliary tract tumors.They include percutaneous transhepatic biliary drainage(PTBD),biliary stenting,and surgical interventions such as biliary diversion.Systemic therapy is also commonly used for the palliative treatment of primary biliary tract tumors.It involves the administration of chemotherapy drugs,such as gemcitabine and cisplatin,which have shown promising results in improving overall survival in patients with advanced biliary tract tumors.PTBD is another palliative treatment option for patients with unresectable or inoperable malignant biliary obstruction.Biliary stenting can also be used as a palliative treatment option to alleviate symptoms in patients with unresectable or inoperable malignant biliary obstruction.Surgical interventions,such as biliary diversion,have traditionally been used as palliative options for primary biliary tract tumors.However,biliary diversion only provides temporary relief and does not remove the tumor.Primary biliary tract tumors often present in advanced stages,making palliative treatment the primary option for improving the quality of life of patients.

Study of the intensive care unit activity scale in the early rehabilitation of patients after direct cardiac surgery

BACKGROUND Direct cardiac surgery often necessitates intensive post-operative care,and the intensive care unit(ICU)activity scale represents a crucial metric in assessing and guiding early rehabilitation efforts to enhance patient recovery.AIM To clarify the clinical application value of the ICU activity scale in the early recovery of patients after cardiac surgery.METHODS One hundred and twenty patients who underwent cardiac surgery between September 2020 and October 2021 were selected and divided into two groups using the random number table method.The observation group was rated using the ICU activity scale and the corresponding graded rehabilitation interventions were conducted based on the ICU activity scale.The control group was assessed in accordance with the routine rehabilitation activities,and the postoperative rehabilitation indexes of the patients in both groups were compared(time of tracheal intubation,time of ICU admission,occurrence of complications,and activity scores before ICU transfer).The two groups were compared according to postoperative rehabilitation indicators(time of tracheal intubation,length of ICU stay,and occurrence of complications)and activity scores before ICU transfer.RESULTS In the observation group,tracheal intubation time lasted for 18.30±3.28 h and ICU admission time was 4.04±0.83 d,which were significantly shorter than the control group(t-values:2.97 and 2.038,respectively,P<0.05).The observation group also had a significantly lower number of complications and adverse events compared to the control group(P<0.05).Before ICU transfer,the observation group(6.7%)had few complications and adverse events than the control group(30.0%),and this difference was statistically significant(P<0.05).Additionally,the activity score was significantly higher in the observation(26.89±0.97)compared to the control groups(22.63±1.12 points)(t-value;-17.83,P<0.05).CONCLUSION Implementation of early goal-directed activities in patients who underwent cardiac surgery using the ICU activity scale can promote the recovery of cardiac function.

Morbidity and Mortality of Acute Renal Failure in COVID-19 Patients in Intensive Care According to Waves/Variant: Case of the Grand Hôpital de l’Est Francilien Site de Meaux

Introduction: The incidence of acute renal failure (ARF) varies between 20% and 40% of cases for COVID-19 patients admitted to the intensive care unit, with very high mortality, but heterogeneous according to the different epidemic waves, probably due to the genetic variant phenomenon of the virus. The aim of this study is to determine the morbidity and mortality of COVID-19 patients admitted with ARF to the intensive care unit of the Grand H?pital Est Francilien (GHEF) according to the waves and variants. Methods: Cross-sectional observational study of COVID-19 patients with ARF admitted to the intensive care unit of the GHEF site in Meaux covering the period from March 1st 2020 to December, 31st 2021. Per-hospitalisation and outcome data were collected and analysed with SPSS version 25.0 software using the Chi-square or Fischer’s exact test or Student’s t-test and logistic regression for p Results: A total of 86 patients were included. The mean age was higher (70 ± 8.5) in patients in the fourth wave than in the other waves (p = 0.015), with male predominance in all waves without significant difference. Co-morbidities: hypertension, diabetes, heart disease, dyslipidaemia and arrhythmia complete with fibrillation were present in all waves. The majority of patients were classified as KDIGO 1 for the different waves (1st: 61.9%, 2nd: 86.5%, 3rd: 80%, and 4th: 75%), with the same trend according to variant (alpha: 80%, beta: 75%, delta: 81.3%, omicron: 75%). Mortality by the wave was: 1st: 28.5%, 2nd: 37.5%, 3rd: 23% and 4th: 11%) and by variant: alpha: 24.2%, beta: 44.8%, delta: 20.7%, omicron: 10.3%). Overall mortality was 33.7%. Case fatality was higher in the fourth wave. Hypertension, shock, failure to recover renal function, acute lung oedema, ventilator-associated lung disease and hyperkalaemia were factors associated with mortality (p Conclusion: Acute renal failure is common in COVID-19 patients admitted to the intensive care unit, and mortality is not negligible. The beta variants and the second wave presented more cases of renal impairment, although the mechanism is still unknown. Further studies are needed to understand this mechanism and perhaps to be able to identify the cause.

Progress in Investigating the Current Mental Health Status Among Caregivers for Surgical Oncology Patients

This article aims to discuss the current state and research progress concerning the mental health of caregivers for surgical oncology patients.The goal is to offer insights that can serve as a reference for further enhancements in caregivers’mental well-being.This article conducts a comprehensive review and analysis of recent studies on the mental health of caregivers for patients undergoing oncologic surgery.These studies reveal that caregivers commonly grapple with mental health issues,including anxiety,depression,and stress.These problems are closely linked to the stress of the patient’s condition and treatment,the caregiver’s own mental strain,and a lack of social support.In addition,the mental health status of caregivers significantly influences the patient’s treatment and recovery process.Implementing various interventions,such as mental health education,services,the establishment of mental health support teams,and engagement in mental health promotion activities,can contribute to the improvement of caregivers’mental well-being.This,in turn,has the potential to enhance treatment outcomes and the overall quality of life for patients.

Progress of Research on the Effect of Dietary Care on Patients with Gastritis and Gastric Ulcers

Gastritis gastric ulcer is a common disease of the digestive system,which has a serious impact on the quality of life and health of affected individuals.Dietary care is one of the important measures to treat and prevent gastritis gastric ulcers.This paper reviews the research progress on the impact of dietary care on patients with gastritis and gastric ulcers,including dietary behavioral intervention,dietary habit cultivation,dietary hygiene education,and nutritional support.Studies have shown that rational dietary care was able to improve the clinical symptoms of patients,regulate the intestinal microbial community,anti-inflammatory,antioxidant,and other pathways to improve the pathophysiological state of patients with gastritis and gastric ulcer and prevent recurrence.Therefore,dietary care is of great significance to patients with gastritis and gastric ulcers.

The Effect of Personalized Comprehensive Care on the Nursing Care of Severe Pneumonia Patients

Objective:To explore the value of receiving personalized comprehensive care for patients with severe pneumonia.Methods:73 patients with severe pneumonia who visited the clinic from February 2020 to February 2023 were included in this study.The patients were randomly grouped into Group A and Group B.Group A received personalized comprehensive care whereas Group B received conventional care.The value of care was compared.Results:The duration of mechanical ventilation time,the time taken for fever and dyspnea relief,and the hospitalization time of Group A were shorter than those in Group B(P<0.05).The blood gas indexes such as PaO_(2),PaCO_(2),and blood pH of Group A were better than those of Group B(P<0.05).The pulmonary function indexes such as peak expiratory flow(PEF),forced vital capacity(FVC),and forced expiratory volume in 1 second(FEV_(1))of Group A were better than those of Group B,P<0.05.Moreover,the patients in Group A were generally more satisfied with the care given compared to the patients in Group B(P<0.05).Conclusion:Personalized comprehensive care improves blood gas indexes,enhances lung function,accelerates the relief of symptoms,and also enhances patient satisfaction in severe pneumonia patients.

Application Effect of WeChat Platform Continuity of Care Model Based on KAP Theory on Self-Management of Stroke Patients with Hypertension

Objective: To explore the impact of the WeChat platform continuity of care model based on the KAP (knowledge, attitudes, and practices) theory on the self-management of stroke patients with hypertension after discharge from the hospital. Methods: 62 stroke patients with hypertension discharged from the rehabilitation department of a tertiary A hospital in Nanning City, Guangxi Zhuang Autonomous Region, from October 2022 to April 2023 were sampled by convenience sampling method. Patients discharged from Rehabilitation I were included in the control group, and conventional nursing care was used;while patients discharged from Rehabilitation II were included in the observation group, and WeChat platform continuity of nursing care model based on the KAP theory was implemented. The intervention effect of the two groups was compared. Results: After 4 and 12 weeks of intervention, the diastolic and systolic blood pressure of the patients in the observation group were lower than those in the control group (P < 0.05);after 12 weeks of intervention, the rate of medication adherence and the score of adherence to hypertension treatment in the observation group were significantly higher than those in the control group (P < 0.05). Conclusion: The application of the WeChat platform continuity of care model based on KAP theory to stroke patients with hypertension can improve blood pressure, medication adherence rate, hypertension treatment adherence, and overall enhance the self-management level of these patients.

Analysis of the Effect of Implementing Humanized Care Service in Severe ICU Patients

Objective:To analyze the effect of implementing humanized nursing service intervention for severe patients in the intensive care unit(ICU).Methods:A hundred severely ill ICU patients who were treated from January 2021 to December 2022 were selected and grouped into a control group and an observation group.The control group adopted routine nursing services and the observation group adopted humanized nursing services.The nursing outcome of the two groups was analyzed.Results:The nursing risk incidence of the observation group was lower than that of the control group(P<0.05).The scale of comfort and nursing satisfaction in the observation group was higher than those in the control group(P<0.05).Conclusion:The implementation of a humanized care service for ICU patients lowered nursing risk incidences and increased the physical comfort and nursing satisfaction of these patients.

Analysis of The Impact of Excellent Event Management on the Safety of Patients and Clinical Caregivers

Objective: To investigate the impact of excellent event management in improving patient safety and nursing staff care satisfaction. Methods: The study was analyzed by retrospective comparison, and routine management from January 2022 to December 2022 was set as the control group, and excellent event management from January 2023 to January 2024 was set as the study group. The differences in nursing outcomes between both groups were compared. Results: The rate of adverse events in the study group (0.61%) was lower than that in the control group (0.96%), and the rate of excellent events in the study group (2.57%) was higher than that in the control group (0.97%) (P < 0.05). Meanwhile, the satisfaction level of nursing safety in the study group reached 98.81%, which was much higher than in the control group (92.21%) (P < 0.05). Conclusion: Nursing excellent event management had a positive impact on improving patient care safety satisfaction, reducing the rate of adverse events, and increasing the rate of reporting excellent events.

Study on the Application of Refined Nursing Care in The Care for Elderly Patients with Reflux Esophagitis

Objective: To investigate the application effect of refined nursing care in the care for elderly patients with reflux esophagitis. Methods: Following the difference in nursing style, 84 cases of elderly patients with reflux esophagitis admitted to our hospital from May 2022 to May 2023 were randomly grouped into a control group and a research group, with 42 cases each. The control group was given conventional nursing care and the research group was given refined nursing care. The psychological state and treatment adherence of the two groups of patients after the nursing intervention were compared. Results: After the nursing intervention, the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores of the research group were lower than those of the control group (P < 0.05). The treatment compliance of the research group was better than the control group (P < 0.05). Conclusion: The implementation of refined nursing care for elderly patients with reflux esophagitis exhibited a significant effect on improving the patient’s psychological state, treatment compliance, and rehabilitation.