Cost of Medical Treatment for Primary Open-Angle Glaucoma in Relation to Patients’ Income and Its Impact on the Prognosis of the Disease, in Bouaké University Hospital

Introduction: Medical treatment for POAG is continuous and lifelong treatment. The aim of this study was to evaluate the relationship between the cost of this treatment and patients’ income and the impact of this relationship on treatment compliance. Materials and Methods: Prospective cross-sectional study with a descriptive aim covering sociodemographic data, average incomes, and direct and indirect costs of treatment of 57 patients followed for POAG during the period from January 1, 2012, to December 31, 2016 (5 years). Results: The patients were aged 25 to 77 years (mean = 54.4 years) with a male predominance (sex ratio = 1.5). Retirees were the most represented (26.32%), followed by workers in the informal sector (14.04%) and housewives (12.28%). Patients who had an annual income less than or equal to 900,000 CFA francs (€1370.83) per year represented 56.14% and those who did not have health coverage represented 57.89%. The treatment was monotherapy (64.91%), dual therapy (31.58%) or triple therapy (3.05%) and the average ratio of “annual cost of treatment to annual income” was 0.56 with for maximum 2.23 and 0.02 as minimum. Patients who considered the cost of treatment unbearable for their income represented 78.95%. Conclusion: Prevention of blindness due to glaucoma requires early detection but also the establishment of health coverage mechanisms to improve compliance with medical treatment. In addition, consideration should be given to the development of glaucoma surgery in our country, the indication of which could be the first intention in certain patients, considering for those patients, the geographical and financial accessibility of medical treatment. .

Exploration and Research on the Integrated Development of“Internet Plus Medical Treatment”

Objective To analyze the development of“internet plus medical treatment”and to explore advantages.Methods The literature of“internet plus medical treatment”was systematically combed and analyzed.Results and Conclusion After exploring the status quo of“internet plus hospitals”,smart pharmacy and web-assisted health management in China,we find that there are some problems in the medical service at present,such as the imperfect laws and regulations,the hidden dangers of information security and the obstacles of medical insurance payment.Therefore,we propose that the development of web-assisted medical service should be led by the government and relevant policies must be improved.Then,self-regulation should be strengthened,and industry standards should be enhanced.Three suggestions are made to improve medical insurance payment and benefit both hospitals and patients,which can provide reference for promoting the development of“internet plus medical treatment”in China.

Long-term medical treatment of patients with severe burns at exposed sites

BACKGROUND Body parts such as the face and hands are highly exposed during daily life and burns may accumulate in these areas.In addition,residual wounds,scar hyperplasia and contracture often exist in the late stage of a deep burn in these areas,which may affect patients’appearance,movements,and mental health.However,inadequate attention has been paid to this issue which can result in problems,such as difficulty in healing,possibility of carcinoma,chronic pain and a heavy mental burden.AIM To investigate the long-term medical treatment of patients with severe burns at exposed sites following a mass burn casualty event.METHODS A retrospective analysis of 13 patients with severe burns at exposed sites was performed to determine their respective long-term medical treatment.A combined wound dressing scheme consisting of traditional Chinese and Western medicine was introduced to repair residual wounds.Active and passive functional exercises with massage,Chinese herbal baths and compression fixation were proposed to ameliorate the condition of the hands.A combination of physical,chemical and photoelectrical measures was adopted for anti-scar treatment.A psychological intervention and recovery guide was provided which corresponded to the patients’psychological status.RESULTS Compared to patients who did not simultaneously receive the same treatment,patients who underwent systematic treatment recovered with a lower woundinfection rate(P<0.05),a shorter healing time(13.6±3.2 d)compared with(19.1±3.5 d)and more bearable pain during wound dressing at three days,one week and two weeks after a Chinese herbal bath(P<0.05).Satisfactory results were achieved with regard to restored function of patients’joints and blood supply to nerve endings,closure of the eyelids and the size of mouth opening tended to be normal,and only 7.1%of patients were diagnosed with severe scar hyperplasia and contracture deformity compared with 30.7%in the control group.In addition,the color,thickness,vascular distribution and softness score of the scars improved(P<0.01),and the effects of the psychological intervention was remarkable as shown by the Self-Rating Anxiety Scale and Self-Rating Depression Scale.CONCLUSION A better prognosis can be achieved in patients in the late stage of a burn with active residual wound repair,limb functional exercise,anti-scar and psychological rehabilitation.

Advances in medical treatment for pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms(PanNENs)are rare neoplasms with strong heterogeneity that have experienced an increasing incidence rate in recent years.For patients with locally advanced or distant metastatic PanNENs,systemic treatment options vary due to the different differentiations,grades and stages.The available options for systemic therapy include somatostatin analogs,molecularly targeted agents,cytotoxic chemotherapeutic agents,immune checkpoint inhibitors,and peptide receptor radionuclide therapy.In addition,the development of novel molecularly targeted agents is currently in progress.The sequence of selection between different chemotherapy regimens has been of great interest,and resistance to chemotherapeutic agents is the major limitation in their clinical application.Novel agents and high-level clinical evidence continue to emerge in the field of antiangiogenic agents.Peptide receptor radionuclide therapy is increasingly employed for the treatment of advanced neuroendocrine tumors,and greater therapeutic efficacy may be achieved by emerging radiolabeled peptides.Since immune checkpoint inhibitor monotherapies for PanNENs appear to have limited antitumor activity,dual immune checkpoint inhibitor therapies or combinations of antiangiogenic therapies and immune checkpoint inhibitors have been applied in the clinic to improve clinical efficacy.Combining the use of a variety of agents with different mechanisms of action provides new possibilities for clinical treatments.In the future,the study of systemic therapies will continue to focus on the screening of the optimal benefit population and the selection of the best treatment sequence strategy with the aim of truly achieving individualized precise treatment of PanNENs.

Medical treatment for a fish bone-induced ileal micro-perforation:A case report

Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification.Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations.We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation.The diagnosis was supported by computed tomography(CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient.Medical treatment was elected to manage the patient's condition instead of surgical intervention.The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication.Factors affecting clinical treatment decisions include the nature of microperforation,the patient's good overall health condition,and the early diagnosis before sepsis signs develop.Micro-perforation means the puncture of intestine wall without CT evidence of free air,purulent peritoneum or abscess.We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.

Impact of the adherence to medical treatment on the main urinary metabolic disorders in patients with kidney stones

Objective:To assess the effect of the adherence to medical treatment on urinary parameters in the 24-h metabolic study of patients with kidney stones.Methods:A retrospective,longitudinal,descriptive,and observational study was carried out by reviewing the hospital electronic medical record from 2014 to 2018.The adherence to drug treatment was measured 6 months after its initiation,and the numerical values of the metabolic studies were compared.Wilcoxon tests were performed to compare the difference before and after treatment.Results:Ninety patients were evaluated,with 73.3% of adherence.The 180-day overall adherence rate was 61.2% in patients treated with a single drug and 85.4% in patients treated with multiple drugs.There is a statistically significant increase in citrate levels in patients with good adherence in comparison with non-adherent patients(p=0.031 vs.p=0.528).Conclusions:Medical treatment and dietary measures in patients with kidney stones have an initial impact at 6 months on the values of the main urinary metabolic alterations that predispose to calculi formation;the most significant is seen in those patients with adherence to medical treatment for hypocitraturia.

Nursing Effects of Medical Treatment Combination on Patients at High Risk of Developing Pressure Ulcers at Rural Homes

Objective:To explore the nursing effects of medical treatment combination on patients at high risk of developing pressure ulcers at rural homes.Methods:From January 2018 to December 2018,86 patients at high risk of developing pressure ulcers at rural homes who were in Wenjiang Hospital were randomly divided into a control group and an observed group.The control group received the routine publicity and education and visiting,while the observed group adopted the cooperative nursing model of medical treatment combination.Then compare the healing status and nursing satisfaction of the two groups.Results:Of the 43 patients with pressure ulcers in the observed group,18 had been in the second stage of pressure ulcers and 16 had been healed;14 had been in the third stage of pressure ulcers and 8 had been healed;11 had been in the fourth stage of pressure ulcers and 5 had been healed.The nursing satisfaction of the patients in the observed group was 95.35%.Conclusion:Conducting medical treatment combination on patients at high risk of developing pressure ulcers at rural homes can effectively improve the patients’and their families’awareness of pressure ulcer nursing,standardize their nursing behaviour,help recover the patients themselves and promote the patients’satisfaction.

Compliance with Medical Treatment in Primary Open-Angle Glaucoma (POAG) at the Centre for the Application of the Diploma of Specialized Studies in Ophthalmology (CADES/O)

Introduction: Primary open-angle glaucoma, a chronic, potentially blinding disease, requires lifelong medical treatment that demands full patient compliance. The objective was to determine the rate of compliance and to study the determinants of compliance in glaucoma patients followed at CADES/O. Patients and Methods: This was an observational study, which included old and new glaucoma patients. Compliance was assessed on the availability of medication, regularity of dosing schedules, compliance with prescribed doses, and regularity at check-ups. Compliance was judged to be good when at least four (4) of these criteria were met, fair when only three (3) of these criteria were met and poor when only two (2) of these criteria were met. Results: Compliance was considered good in 38.4% of cases, fair in 48.2% of cases and poor in 13.4% of cases with an overall compliance rate of 86.6%. The correlation was not statistically significant for age, sex, origin, length of illness, route of administration, instiller, or therapeutic regime. On the other hand, profession, level of education, presence of systemic arterial hypertension, compliance with instillation schedules, prescribed dosage, regularity of treatment, compliance with control visits and the climate of trust between patient and treating physician were the determining factors with the greatest statistical influence on compliance with treatment. Conclusion: Compliance with glaucoma treatment is linked to the patient factor but especially to the doctor factor. Doctors should take their time to explain to patients their disease, its evolution with or without treatment and above all the necessity of a good therapeutic compliance.

Review of Medical Treatment of Stable Ischemic Heart Disease

Medical treatment is the initial treatment strategy and is the cornerstone of management in patients with stable ischemic heart disease (IHD). Many patients are not suitable for percutaneous or surgical revascularization because of unfavourable anatomy, or the presence of co-morbidities. In addition, many patients have recurrence of angina following revascularization due to restenosis or incomplete revascularization. Furthermore, randomized clinical trials comparing optimal medical treatment to revascularization have not clearly shown that myocardial revascularization is superior to optimal medical treatment. Traditional drugs for angina treatment include b-blockers, calcium channel blockers and nitrates. Newer drugs are available with different mechanisms of action and with equal efficacy that do not cause significant hemodynamic deterioration. The availability of these newer drugs expands the therapeutic potential of medical treatment to even a wider population with stable IHD. Revascularization in patients with stable ischemic heart disease has never been shown to reduce hard endpoints (death or myocardial infarction) in randomized clinical trials.

Antireflux surgery vs medical treatment for gastroesophageal reflux disease: A meta-analysis

AIM: To compare the effect of antireflux surgery with medicine in treating gastroesophageal reflux disease(GERD) patients using meta- analysis.METHODS: MEDLINE, Embase and the Cochrane Library were searched. We only included randomized controlled trials(RCTs) comparing the effect of surgical intervention with medical therapy for GERD. Statistical analyses were performed using Rev Man 5.2 and STATA 12.0 software. Rev Man 5.2 was used to assess the risk of bias and calculate the pooled effect size, while Stata 12.0 was used to evaluate publication bias and for sensitivity analysis. We evaluated the primary outcomes with GERD-/health-related quality of life in short(one to three years) and long(three to twelve years) periods of follow-up. Secondary outcomes evaluated were De Meester scores and the percentage of time that p H < 4 to evaluate the degree of acid exposure.RESULTS: This meta-analysis included 7 studies with 1972 patients. It showed a positive effect of antireflux surgery compared with medical treatment in terms of health-related quality of life [standardized mean difference(SMD) = 0.18; 95%CI: 0.01 to 0.34] and GERD-related quality of life(SMD = 0.35; 95%CI: 0.11 to 0.59). We also conducted the subgroup analyses based on follow-up periods and found that surgery remained more effective than medicine over the short to medium follow-up time, but the advantage of antireflux surgery probably not maintained for long time. GERD-related quality of life in the surgical group was significantly higher than medical group for the < 3 years follow-up(SMD = 0.45; 95%CI: 0.23 to 0.66); the difference was not statistically significant when the follow-up time was ≥ 3 years(SMD = 0.30; 95%CI:-0.10 to 0.69). Meta-analysis showed a statistically significant difference between thesurgical group and medical group in the percentage of time that p H < 4(SMD = 0.38; 95%CI: 0.14 to 0.61). Meta-analysis indicated a positive effect of antireflux surgery compared with medical treatment concerning De Meester scores(SMD = 0.32; 95%CI: 0.00 to 0.65).CONCLUSION: Although both were effective, in some respects surgical intervention was more effective than medical therapy to treat GERD when follow-up time was up to three years.

Access to Child Health Care, Medical Treatment of Sick Children and Childhood Mortality Relationships in Kenya

Child health care factors such as medical treatment of sick children have direct and indirect effect on childhood mortality. Through international cooperation, a number of countries including Kenya have gathered information on provision of child health services at facility level from periodic Service Provision Assessment (SPA) surveys. Kenya has also gathered information on medical treatment of sick children at household level from periodic Demographic and Health Surveys (DHS). However, establishing how health care information in the SPA surveys relates to childhood mortality and also how these factors relate to medical treatment of sick children in the DHS has been constrained by differences in sample designs of the surveys. This study deployed a fstrategy of constructing community level variables derived from the SPA survey data and incorporated them into DHS data which served as the main data source. The SPA and DHS sampling designs for Kenya allow computation of stable estimates of regional demographic and health service indicators at provincial level. This study analyzed information gathered from 690 health facilities in 2010 SPA and 6079 births born less than 60 months from 2008/09 DHS. The study found that access to child health services, waiting time before service in facility and time to the nearest referral facility were significant facilitating factors for medical treatment of sick children. The study also established that waiting time before service in facility was the only access to health care factor which had a significant effect on childhood mortality when HIV prevalence was excluded in the analysis. However, the significance of waiting time before service diminished with inclusion of HIV prevalence. Further research is required to refine definition and measurement for child health care variable on female autonomy.

Medical Treatment Process Modeling Based on Process Mining and Treatment Patterns

activities.Ex-periments on a synthetic log of the non-secondary hy-pertension MTP and empirical findings demonstrate the effectiveness of our approach.The results show that the process mining in our approach framework can automatically generate more accurate MTP mod-els,and the subprocess models based on treatment pat-terns make the models easy to understand.

The medical treatment of cardiogenic shock

Cardiogenic shock (CS) is a leading cause of mortality worldwide. CS presentation and management in the current era have been widely depicted in epidemiological studies. Its treatment is codified and relies on medical care and extracorporeal life support (ECLS) in the bridge to recovery, chronic mechanical device therapy, or transplantation. Recent improvements have changed the landscape of CS. The present analysis aims to review current medical treatments of CS in light of recent literature, including addressing excitation–contraction coupling and specific physiology on applied hemodynamics. Inotropism, vasopressor use, and immunomodulation are discussed as pre-clinical and clinical studies have focused on new therapeutic options to improve patient outcomes. Certain underlying conditions of CS, such as hypertrophic or Takotsubo cardiomyopathy, warrant specifically tailored management that will be overviewed in this review.

Medical treatments of endometriosis: a review

Endometriosis is a chronic gynecological disorder that affects approximately 10%of women of reproductive age.Most medical treatments used today for endometriosis pain are hormonal therapies,which are not an option for those trying to conceive and are not tolerated by a subset of patients due to side effects.In this article,we offer a comprehensive review of current and investigational medical therapeutic options used to treat endometriosis pain,as well as a symptom-based systematic approach for patients with painful endometriosis.We have also included recommendations for research to enhance the evolution of novel therapeutic options.A thorough literature search was carried out,and the data were synthesized using a synthesis matrix that classifies and categorizes various arguments.

The promoting effect of health education on medical treatment seeking behavior in the context of healthy China:based on the comparison of migrants and registered local residents

The migrants are the important participant and contributor in China’s economic and social construction,but they still have many restrictions on their access to health services.This paper analyzes the differences between the migrants and the regis-tered local residents in looking for medical treatment and explores the relationship between health education and medical treatment seeking behavior,so as to find an appropriate way to improve the health level of the migrants.By using the compara-tive survey data of the floating population and registered population in 2017 and establishing the binary Logit model,this paper finds that the health education has a promoting effect on medical treatment seeking behaviors.In terms of the influence mechanism of health education on medical treatment seeking behavior,the mediat-ing effect of social participation factors is stronger in the migrants’group because making new friends and learning about local public health resources through health education is of great significance to the migrants.It is proposed to expand the cov-erage of health education among migrant groups and improve the accessibility of health education.At the same time,public medical and health services should be used as a window to guide the migrants to seek medical treatment in an orderly manner while assisting their social integration.

Incidence and Management of Occupational Blood Exposure (OBE) among Medical Students at the University of Bangui

Introduction: Like healthcare workers, medical students are also exposed to a risk of accidental contamination during their hospital internships. However, they do not benefit from prevention services in the same way as workers in this sector, although they actively participate in the routine care provided to patients in the various hospital departments. The objective of our study is to determine the incidence of these accidents and their medical and administrative management among these victims (medical students) not classified in the category of workers. Materials and Method: This was a cross-sectional study carried out over three months from January 15 to March 14, 2023. The study population consisted of all medical students at the Faculty of Health Sciences at the University of Bangui. Regularly enrolled students from 2nd to 7th year, on placement in hospitals in the Central African Republic and who gave their informed consent were included. Data were collected through a self-administered questionnaire. Results: A cross-sectional study was carried out among medical students concerning the incidence and management of accidents involving exposure to blood in the Central African Republic. Of the 254 students included, three (9%) had already been correctly vaccinated against the viral hepatitis B virus, 198 (77.9%) reported still having access to personal protective equipment, 133 students (52.4%) reported being victims of OBE in the past 12 months. The main types of OBE were stings (62%), followed by liquid splashes (32%) and cuts (6%). Among the 133 victims, 92.9% carried out immediate hand disinfection or abundant eye washing, 41.9% obtained the serology of the source patient and 37% reported the accident to their supervisor. Conclusion: It is important that students benefit from better prevention and management of these accidents.

Confrontation and Integration: The Present and Future of Forensic Examinations on Medical Damage in China

In China,two administrative regulations and judicial interpretations related to forensic examinations of medical damage were issued from March 2017 to June 2018.In chronological order,they were interpretation of the supreme people’s court on several questions concerning the application of law in the trial of disputes over liability for medical damage and regulations on the prevention and handling of medical disputes.Those two laws,especially the regulation,have had a fundamental impact on the pattern of forensic examinations on medical damage.This paper systematically reviews the current status and existing problems with forensic examinations on medical damage following implementation of the law of tort liability;it discusses new concepts of procedures,institutional arrangements,and the selection of examiners for forensic examinations on medical damage.We believe that through the regulation,the dualistic confrontation status of forensic examinations on medical damage will gradually change toward integration.We consider that forensic examinations of medical damage will face three challenges in the future:(1)enhancing the establishment of standards;(2)undertaking theoretical research into forensic examinations onmedical damage;and(3)promoting the development ofinterdisciplinary identification specialistsmajoring in both medicine and law.Only in this way will it be possible to rectify the current dilemma with forensic examinations on medical damage in China.

Study to Explore Laughter As Adjunct to Medical Treatment

笑,真的是一帖良药吗?首次进行该类研究的是加利福尼亚大学洛杉矶分校的的乔森癌症中心,研究将确定笑是否能减轻疼痛,是否有助于对儿童或青少年癌症患者、获得性免疫缺陷病毒感染者或爱滋病患者的治疗。