1299 CO-CREATING A VIDEO FOR TRAINING HEALTHCARE PROFESSIONALS IN DEMENTIA

Introduction

There are 400 thousand people living with dementia (PLWD) in Egypt. Most of the care for PLWD is delivered by family members. Healthcare Professionals (HCP) supporting these families need adequate training. Involving HCP in designing and producing training material ensures sustainability of these educational resources as their content will be socially and culturally relevant.

Methods

The first part of the project involved the lead author (OM) meeting with two geriatricians to identify common challenging situations in dementia. A short video for training HCP in dementia using these situations was produced, based on OM lived experience, and then shared with two old-age psychiatrists for comments. Feedback on the video was subsequently obtained via semi-structured interviews with 16 HCP (2 doctors, 1 nurse, 1 dietitian, 1 communication therapist, 2 social workers, and 9 clinical psychologists) either in person (3), over the phone (1), or virtually (12) approached in two institutions for ageing in Cairo and Alexandria in 2021. The video was finally checked by an adult psychiatrist for consistency with non-violent communication approaches. All interviews were analysed using a thematic framework. Comments and feedback were used to co-produce a final version of the video.

Results

From the initial co-design phase, six frequently-encountered situations were identified: anger, low mood, wandering, repetitive behaviour, refusing support with activities of daily living, and sleep disturbance. Five key qualities for appropriate response in these situations were agreed on: kindness, sensitivity, compassion, avoiding confrontation, and shared-decision making in activities of daily living. The subsequent co-production phase with 19 HCP resulted in an 18-minute: 43-seconds simulation video of six challenging interactions between PLWD and their carers. The video is now freely available on YouTube, https://m.youtube.com/watch?v=ylINBXZwH8M&feature=youtu.be

Conclusions

Involving healthcare professionals in dementia in co-creating a video for training their peers led to a freely available online educational resource.

Value of CHA2DS2-VASc score and safe contrast volume for early detection of contrast induced nephropathy after percutaneous coronary intervention

Background

The CHA2DS2-VASc score is utilized to order the danger of embolization in atrial fibrillation (AF). Also it has been assessed to expect the worse clinical scenario in acute coronary syndrome patients, regardless of having AF. Therefore, the study aim was to use CHA2DS2-VASc score that has such a large area of use and the safe contrast volume – that represented by volume of the dye to creatinine clearance ratio (V/CrCl) – for contrast induced nephropathy (CIN) early detection after PCI.

Patients and methods

A total of 259 patients who underwent elective or primary PCI were enrolled in the study. For each patient, The CHA2DS2-VASc score and V/CrCl was evaluated. The patients in our study were divided, according to CIN development to two groups. CIN was identified as a rise in serum creatinine >0.5 mg/dl or >25% increase in baseline within48 to 72 hours after PCI. Statistical analysis: the receiver operating characteristic analysis was used to detect the best cut off values to predict CIN, and we concluded the independent predictors of CIN through multivariate logistic regression analysis.

Results

There was significant positive correlation between Mehran score and CHA2DS2-VASc score. Independent predictors of CIN were Mehran score, V/CrCl ratio>3.2 and CHA2DS2-VASc >3, CHF or EF <40%, hypotension, anemia, primary PCI and weight. If the patient had (CHA2DS2-VASc score>3 or V/CrCl >3.2), as a single predictor, we can predict CIN with (sensitivity 96.97%, 95% CI 0.71 to 0.82).

Conclusion

The Mehran score, V/CrCl ratio and CHA2DS2-VASc score are strong predictors of CIN, and we can use CHA2DS2-VASc score and safe contrast volume for early detection of CIN after PCI.

Funding Acknowledgement

Type of funding sources: None.

Assessment of serum adiponectin in Egyptian patients with HCV-related cirrhosis and hepatocellular carcinoma

BACKGROUND AND AIM

Hepatitis C-associated insulin resistance is involved in the development of various complications including hepatocarcinogenesis. Low plasma levels of adiponectin contribute to the pathogenesis of insulin resistance and type II diabetes mellitus. The aim of this study was to determine the value of serum adiponectin in Egyptian patients with hepatitis C-related cirrhosis and hepatocellular carcinoma.

PATIENTS AND METHODS

90 Egyptian patients with hepatitis C-related liver cirrhosis were enrolled in this study. Patients were divided into two groups as follows: group I: 61 patients with hepatitis C-related cirrhosis and hepatocellular carcinoma, group II: 29 patients with hepatitis C-related cirrhosis (hepatocellular carcinoma was excluded in these patients at the time of recruitment in the study). Serum adiponectin level was measured and correlated with all other studied parameters.

RESULTS

Serum adiponectin was significantly lower in patients with hepatocellular carcinoma and it had significant negative correlations with both the overall tumor size and the number of tumor foci. Highly significant negative correlations were found between adiponectin and all markers of insulin resistance in both groups. At a cut-off value ≤5.4 μg/ml, adiponectin had a sensitivity of 60.7%, a specificity of 93.1%, a positive predictive value of 94.9%, and a negative predictive value of 52.9% for detection of hepatocellular carcinoma (with an overall accuracy of 77.6%).

CONCLUSION

An independent association exists between serum adiponectin and hepatocellular carcinoma in Egyptian patients with hepatitis C-related cirrhosis. Therapy to increase circulating adiponectin concentration might represent a novel strategy to prevent hepatitis C-related hepatic complications.

Role of Helicobacter pylori in refractory iron deficiency anaemia

The role of Helicobacter pylori infection in the development of iron deficiency anaemia has been the focus of attention over the past decade. However, confirmation of a relationship has not confirmed the pathophysiological mechanisms involved in the phenomenon. The aim of the present work is to study the levels of fasting gastric acidity (free and total) as well as the level of tumour necrosis factor-alpha (TNF alpha) in male refractory iron deficiency anaemia patients seropositive for H. pylori infection versus those who are seronegative. Thirty adult patients with iron deficiency anaemia and gastroduodenitis were subdivided into two groups of matched age and haemoglobin value. Group 1 was H. pylori-seropositive for infection and these patients did not receive prior treatment for eradication of H. pylori infection. Group 2 comprised patients seronegative for H. pylori infection (control group). Patients with active bleeding or previous medical problems were excluded from the study. All patients and controls were subjected to the following at presentation: history taking and thorough clinical examination, complete blood picture, reticulocytes (%), assessment of serum iron, total iron binding capacity, serum ferritin, IgG anti-Helicobacter antibody and TNF alpha, stool for occult blood and measurement of gastric acidity (total and free). Upper endoscopy was performed and multiple biopsies were taken and tested for expression of cytotoxin-associated gene A (cagA) by the polymerase chain reaction (PCR). Results showed significantly higher values of free and total gastric acidity as well as TNF alpha levels in Group 1 compared to controls (Group 2). Among those in Group 1, higher TNF alpha levels were seen in seven H. pylori cagA-positive patients than in eight cagA-negative patients. Haemoglobin values were inversely correlated with TNF alpha levels. Thus, elevated serum TNF alpha in the H. pylori-seropositive group may be one of the underlying pathophysiological mechanism for iron deficiency anaemia observed in these patients.