Health Services Research Articles

The Situation of Senior Citizens in the UK and Poland

The aim of this article is to compare and analyse the life situation of older people in the United Kingdom and the Republic of Poland. The similarities and differences presented within this paper are based on the results of conducted research in both countries, statistical data analysis and scholar papers. The article addresses such areas influencing the quality of life of older people as: demography, medical care, the pension system, social care homes, social and cultural activities of seniors, medical support and long-term care systems. This article is also a reference to the quantitative and qualitative research project "The World Tailored to Seniors - the Situation of Older People in Poland" conducted by the Ministry of Science and Higher Education in Poland and Cardinal Stefan Wyszynski University in Warsaw, Poland in 2024.

In-hospital new-onset seizures in patients admitted to the medical intensive care unit: An observational study and algorithmic approach

BACKGROUND Seizures are one of the most common neurological complications encountered in the intensive care unit (ICU). They can occur in the background of exacerbation of a known neurological disease or secondary to non-neurological conditions such as sepsis and metabolic disturbances. However, there is a paucity of literature on the incidence and pattern of new-onset seizures in ICUs. AIM To study the incidence and patterns of new-onset seizures in patients admitted to the medical ICU. METHODS This was a prospective, multicenter, observational study performed in two tertiary care centers in Hyderabad, India over a period of 1 year. Patients upon ICU admission, who developed new-onset generalized tonic clonic seizures (GTCS), were enrolled. Those with a pre-existing seizure disorder, acute cerebrovascular accident, head injury, known structural brain lesions, or chronic liver disease were excluded as they have a higher likelihood of developing seizures. All enrolled patients were subjected to biochemical routines, radiological imaging of either computed tomography or magnetic resonance imaging, and other relevant laboratory tests as per clinical suspicion according to the protocol, and their data were recorded. Statistical analyses were conducted using descriptive statistics, χ 2 tests, and linear regression. RESULTS A total of 61 of 2522 patients developed GTCS. Among all etiologies of seizures, metabolic causes were most frequent (35%) followed by infective causes (27%) and others (new-onset structural, drug withdrawal, drug-induced, toxicology-related, and miscellaneous factors). Logistic regression analysis showed that increased sodium and calcium levels were associated with a lower likelihood of developing seizures. CONCLUSION This study identified the etiology of new-onset seizures developing in critically ill patients admitted to the ICU. These findings highlight the need for targeted monitoring of those at risk of developing seizures.

Clinical prediction scores predicting weaning failure from invasive mechanical ventilation: Role and limitations

Invasive mechanical ventilation (IMV) has become integral to modern-day critical care. Even though critically ill patients frequently require IMV support, weaning from IMV remains an arduous task, with the reported weaning failure (WF) rates being as high as 50%. Optimizing the timing for weaning may aid in reducing time spent on the ventilator, associated adverse effects, patient discomfort, and medical care costs. Since weaning is a complex process and WF is often multi-factorial, several weaning scores have been developed to predict WF and aid decision-making. These scores are based on the patient's physiological and ventilatory parameters, but each has limitations. This review highlights the current role and limitations of the various clinical prediction scores available to predict WF.

Delta shock index predicts injury severity, interventions, and outcomes in trauma patients: A 10-year retrospective observational study

BACKGROUND Most trauma occurs among young male subjects in Qatar. We examined the predictive values of the delta shock index (DSI), defined as the change in the shock index (SI) value from the scene to the initial reading in the emergency unit (i.e. , subtracting the calculated SI at admission from SI at the scene), at a Level 1 trauma center. AIM To explore whether high DSI is associated with severe injuries, more interventions, and worse outcomes [i.e. , blood transfusion, exploratory laparotomy, ventilator-associated pneumonia, hospital length of stay (HLOS), and in-hospital mortality]. METHODS A retrospective analysis was conducted after data were extracted from the National Trauma Registry between 2011 and 2021. Patients were grouped based on DSI as low (≤ 0.1) or high (> 0.1). Data were analyzed and compared using χ 2 and Student’s t -tests. Correlations between DSI and injury severity score (ISS), revised trauma score (RTS), abbreviated injury scale (AIS), Glasgow coma scale (GCS), trauma score-ISS (TRISS), HLOS, and number of transfused blood units (NTBU), were assessed using correlation coefficient analysis. The diagnostic testing accuracy for predicting mortality was determined using the validity measures of the DSI. Logistic regression analysis was performed to identify predictors of mortality. RESULTS This analysis included 13212 patients with a mean age of 33 ± 14 years, and 24% had a high DSI. Males accounted for 91% of the study population. The trauma activation level was higher in patients with a high DSI (38% vs 15%, P = 0.001). DSI correlated with RTS (r = -0.30), TRISS (r = -0.30), NTBU (r = 0.20), GCS (r = -0.24), ISS (r = 0.22), and HLOS (r = 0.14) (P = 0.001 for all). High DSI was associated with significantly higher rates of intubation, laparotomy, ventilator-associated pneumonia, massive transfusion activation, and mortality than low DSI. For mortality prediction, a high DSI had better specificity, negative predictive value, and negative likelihood ratio (77%, 99%, and 0.49%, respectively). After adjusting for age, emergency medical services time, GCS score, and ISS, multivariable regression analysis showed that DSI was an independent predictor of mortality (odds ratio = 1.9; 95% confidence interval: 1.35-2.76). CONCLUSION In addition to sex-biased observations, almost one-quarter of the study cohort had a higher DSI and were mostly young. High DSI correlated significantly with the other injury severity scores, which require more time and imaging to be ready to use. Therefore, DSI is a practical, simple bedside tool for triaging and prognosis in young patients with trauma.

Integrating eugenol with intensive care in leukemia patients: exploration of pro-apoptotic potential against HL-60, human leukemia cell line

Objective: The objective of this in-vitro study was to explore the pro-apoptotic potential of eugenol (4-allyl-2-methoxyphenol) on Human Leukemia-60 (HL-60) cell line as a potent phytochemical in intensive care setting to leukemia patients. Methodology: After formal approval by all of the respective ethical committees, this study was simultaneously conducted at all respective institutional departments. The study included culturing HL-60 cell line and its treatment with serial concentrations of eugenol for calculation of subsequent IC50 values (half-maximal inhibitory concentration) via MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] assay, expression analysis of gene, comparative analysis of relative gene fold (Intrinsic Biomarkers Caspase-3, Caspase-9) as apoptosis mediator markers followed by RT-qPCR. Cellular apoptotic morphology was confirmed via Hoechst 333258 staining. Results: For HL-60 cell line, the IC50 of eugenol (14.1 uM) showed high gene expression of pro-apoptotic biomarkers (Caspase-3 and Caspase-9). Hoechst 333258 staining showed prominent apoptotic bodies leading to nuclear fragmentations. Conclusion: Eugenol proved to possess robust pro-apoptotic potential leading to diagnostic efficacy against leukemia HL-60 cell line. Further studies would help in identifying key mechanisms by which eugenol exhibits anti-cancer potential against HL-60 cell lines. Abbreviations: HL-60 - Human Leukemia-60; IC50 - Half-Maximal Inhibitory Concentration Keywords: Eugenol, Pro-apoptotic Effects, Intensive Care, Anti-Cancer Mechanisms, HL-60, Natural Chemotherapeutics Citation: Khaliq HMH, Bughio R, Nangdev P, Aziz O, Javed W. Integrating eugenol with intensive care in leukemia patients: exploration of pro-apoptotic potential against HL-60, human leukemia cell line. Anaesth. pain intensive care 2024;28(5):871−875; DOI: 10.35975/apic.v28i5.2491 Received: June 18, 2024; Reviewed: August 03, 2024; Accepted: August 11, 2024

Community needs assessment for social service delivery in Chengdu, China

ABSTRACT This study explores the community needs assessment of social service delivery in Chengdu, China. Using a qualitative approach to explore needs assessments, the authors conducted in-depth interviews and focus-group discussions with community members and social workers. The authors identified various needs for residences, and these include issues related to welfare for senior citizens, service delivery, the social service speciality, health and medical services, children, environmental degradation, and concerns relating to the problems faced by ethnic minorities. The findings provide insights to the Chinese government to strengthen community social work practice development and enhance community service delivery in Chengdu, China.

Multimodal emotion recognition in the metaverse era: New needs and transformation in mental health work

This editorial comments on an article recently published by López del Hoyo et al . The metaverse, hailed as "the successor to the mobile Internet", is undoubtedly one of the most fashionable terms in recent years. Although metaverse development is a complex and multifaceted evolutionary process influenced by many factors, it is almost certain that it will significantly impact our lives, including mental health services. Like any other technological advancements, the metaverse era presents a double-edged sword for mental health work, which must clearly understand the needs and transformations of its target audience. In this editorial, our primary focus is to contemplate potential new needs and transformation in mental health work during the metaverse era from the perspective of multimodal emotion recognition.

Enhancing preoperative patient education through virtual reality: A leap forward in nursing practice

Integration of virtual reality (VR) technology into preoperative patient education has shown potential to improve nursing practice. The study by Kim et al examines the impact of VR on nurse satisfaction, usability, and burnout. A prospective study involving 20 nurses and 80 patients was conducted, comparing traditional paper-based education with VR-based education in the plastic surgery ward at Chungnam National University Hospital. Findings demonstrated that VR significantly enhanced satisfaction and usability among nurses, while also reducing emotional exhaustion, a critical factor in nurse burnout. Consistency in education quality was also improved, ensuring uniform patient care. These results underscore the importance of VR in reducing the stress of repetitive tasks, improving job satisfaction, and potentially enhancing nurse retention. Future research should explore the broader applications of VR in healthcare and address the logistical challenges of integrating this technology into routine clinical practice. The study by Kim et al highlights VR’s transformative potential in preoperative education for both patients and healthcare providers.

Treatment of high risk myelodysplastic syndrome.

The myelodysplastic syndrome (MDS) is considered to be a heterogeneous myeloid malignancy with a common origin in the hematopoietic stem cell compartment, generally divided into lower and higher risk. While treatment goal for lower risk MDS (LR-MDS) is to decrease transfusion burden and transformation into acute leukemia major aim for high risk MDS is to prolong survival and ultimately cure. While novel agents such as luspatercept or imetelstat have recently been approved as new treatment options for LR-MDS, hypomethylating agents (HMA) remain currently the only approved non-transplant option for HR-MDS and is the standard of care for non-transplant-eligible patients. Combinations with other drugs as first-line treatment has to date not proven more efficacious than monotherapy in HR-MDS, and outcome after HMA failure is poor. The only potential cure and standard of care for eligible patients is allogeneic stem cell transplantation (HSCT) and even if the number of transplanted - especially older - MDS patients increased over time due to a better management and donor availability the majority of MDS patients will not be eligible for this curative approach. Current challenges encompass to decrease the relapse risk, the main cause of HSCT failure. This review will summarize current knowledge of options of transplant- and non-transplant treatment approaches for these patients and demonstrate the unmet clinical need for more effective therapies.

Experiences of imagery in obsessive-compulsive disorder: An interpretative phenomenological analysis.

Mental imagery is a defining criterion within current OCD diagnoses, and yet little has been written about how this is experienced. This study aimed to investigate how people with a diagnosis of OCD experience imagery, to better understand how this might contribute to the condition. This research employed Interpretative Phenomenological Analysis (IPA) and used semi-structured interviews. An expert-by-experience was involved in the study design. Eight adults with an OCD diagnosis were purposively sampled from NHS mental health services and interviewed about their experience of imagery. Interviews were transcribed and analysed in accordance with IPA guidelines. A reflexive log and audit trail were maintained during the research process to enhance quality control and to support the analytical process. Six superordinate themes were found: Submersion in intense and multifaceted imagery; Overwhelming, uncontrollable imagery; Imagery is explosive and expansive; Imagery involves past memories and future fears; People respond to imagery as if it is real; Therapy shifts imagery. This study highlights the intensity of OCD-related imagery experienced by people with OCD and the significance of this imagery in their everyday lives. All participants experienced imagery related to their OCD, demonstrating its importance in the phenomenology of the condition. Images relating to past experiences and images of future fears were identified. Clinicians should routinely seek to include imagery in assessment, formulation, and individual treatment plans for those with OCD.

Cleft Team Clinicians' Perspectives on the Process of Patient Transition from Childhood to Adulthood in New Zealand.

This study sought to understand cleft team clinician experiences of transitioning patients from pediatric to adult cleft care services in New Zealand. The qualitative study conducted 4 interviews and 4 focus groups with Cleft Team clinicians either in person or over Zoom. Data were analyzed using inductive thematic analysis to identify themes. Twelve Cleft Team clinicians from 4 Health New Zealand cleft services. Patients are treated by the same clinicians both before and after transition, however, changes at age 16 include gaining treatment decision-making autonomy, inpatient stays within general plastic surgery wards, and evolving life experiences outside of the hospital. Clinicians reported unmet psychosocial needs of patients and their families, and difficulties experienced by patients returning to cleft services as adults. The development of peer support networks between adolescents and young adults who have experiences of cleft care is also recommended. Ongoing cleft care provision and expansion of services are recommended. Furthermore, future studies to understand patients' perspectives of transition are paramount, and incorporating patient voice into any proposed interventions is essential. Potential supports for families of patients with a cleft should also be further investigated, and the application of international standards would promote increased consistency and collaboration between the practice of Cleft Team clinicians around the world.

The experiences of cardiovascular surgeons and nurses with mutual support through interprofessional collaboration in the intensive care unit.

The World Health Organization (WHO) emphasizes the need for radical approaches in its Global Patient Safety Action Plan, particularly in terms of interprofessional and multidisciplinary approaches. The plan highlights the importance of providing training on patient safety for all professionals, focusing on team and task-based strategies that include bedside and simulation education. TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) is an educational programme developed to teach health care professionals on specific tools and strategies to enhance basic teamwork skills. Mutual support, one of the teamwork skills described in TeamSTEPPS®, involves team members assisting one another, providing and receiving feedback on performance, and advocating assertively when patient safety is threatened. The aim of this study was to explore the experiences of cardiovascular surgeons and nurses with mutual support through interprofessional collaboration in the intensive care unit (ICU) at Hacettepe University. The study employed a basic qualitative research design. The data were gathered through in-depth interviews and analysed with inductive content analysis in accordance with Elo and Kyngäs. We used the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to describe and report the components of study design. We interviewed 13 participants: 6 surgeons and 7 nurses. Six themes were identified: mutual support, positiveness of working in a supportive environment, feedback, effective communication, patient safety and conflict resolution. The results of our study revealed that intra/inter-professional collaboration and mutual trust based on the variety of individual and workplace-related factors improved patient safety through individual motivation while monitoring and supporting each other in a positive environment, providing feedback and encouraging effective communication, patient advocacy and conflict resolution. Exploring the experiences, challenges and successes of health care workers in interprofessional collaboration is crucial. Understanding team dynamics, communication barriers and collaboration strategies can help promote more effective teamwork and contribute to the development of plans to improve the quality of patient care.

Integrating Stakeholder Priorities for the Optimization of Care of the Preterm Infant in a Safety-Net NICU.

This study aimed to engage clinical and community stakeholders to create a prioritization matrix of interventions to reduce neonatal brain injury and improve neurodevelopmental outcomes. We collaborated with our community partner to establish a Lived Experience Advisory Group (LEAG). Faculty performed a literature review to identify neonatal neuroprotective interventions; additional priorities from the LEAG were also included. Project leaders scored and presented intervention bundles for impact. Stakeholder priorities for value/feasibility were obtained via questionnaire. Mean values were incorporated into a prioritization matrix. Themes from discussions with LEAG members included the role of the neonatal intensive care unit (NICU) parent, the experience of trauma, shared decision-making, communication and trust with the health care team, and bias in medical care. Five interventions were placed in the highest priority quadrant of the prioritization matrix: thermoregulation, maternal antepartum steroids, delayed cord clamping, optimized oxygen delivery, and optimized glucose regulation. It is feasible to incorporate community and parent values into clinically oriented neuroprotective intervention bundles for preterm infants. This clinical-community collaboration is vital to ensure that our project objectives meet the needs and priorities of the population it is intended to serve. · Including input from parent advisory groups supports interventions that meet the needs of families.. · Collaboration between clinical and community stakeholders can improve neuroprotective and neurodevelopmental strategies.. · Incorporation of clinical interventions into a prioritization matrix improves resource utilization.. · Five perinatal interventions were ranked highly for impact and feasibility in the prioritization matrix..

Equity-Focused Interventions Improve Interpreter Use in the Pediatric Intensive Care Unit.

Federal guidelines and equitable care mandate that patients who use a language other than English receive interpretation in their preferred language. Substantial variability exists in interpreter use in intensive care settings. We aimed to increase the rate of interpretations in our pediatric intensive care unit (PICU) through a series of targeted interventions. A multidisciplinary team developed a key driver diagram to identify areas for focused intervention. Each plan-do-study-act cycle informed the next cycle of interventions, targeting increasing interpreter (video, phone, and in-person) use. Interventions included standardizing technology, standardizing placement of interpretation devices in patient rooms, provider education, and creating accountability systems of interpreter use by care providers. We reviewed data from PICU encounters between January 2018 and January 2022 and used summary statistics and statistical process control methods to measure the impact of our interventions. We analyzed 882 patient encounters over the 4-year study period. Demographic characteristics were similar in the preintervention and postintervention periods. The total interpretation rate increased to 2.7 interpretations per patient per day from a baseline rate of 1.4. Each individual interpretation modality demonstrated increases in use. Average time spent interpreting via phone increased from 8 to 10.5 minutes per patient per day, and average time spent interpreting via video went from 9.5 to 22 minutes per patient per day. Iterative quality improvement methodology effectively identified barriers to equitable care, guided development of focused interventions, and improved interpreter use among pediatric patients who were critically ill.

Transforming Healthcare in Low-Resource Settings With Artificial Intelligence: Recent Developments and Outcomes.

Artificial intelligence now encompasses technologies like machine learning, natural language processing, and robotics, allowing machines to undertake complex tasks traditionally done by humans. AI's application in healthcare has led to advancements in diagnostic tools, predictive analytics, and surgical precision. This comprehensive review aims to explore the transformative impact of AI across diverse healthcare domains, highlighting its applications, advancements, challenges, and contributions to enhancing patient care. A comprehensive literature search was conducted across multiple databases, covering publications from 2014 to 2024. Keywords related to AI applications in healthcare were used to gather data, focusing on studies exploring AI's role in medical specialties. AI has demonstrated substantial benefits across various fields of medicine. In cardiology, it aids in automated image interpretation, risk prediction, and the management of cardiovascular diseases. In oncology, AI enhances cancer detection, treatment planning, and personalized drug selection. Radiology benefits from improved image analysis and diagnostic accuracy, while critical care sees advancements in patient triage and resource optimization. AI's integration into pediatrics, surgery, public health, neurology, pathology, and mental health has similarly shown significant improvements in diagnostic precision, personalized treatment, and overall patient care. The implementation of AI in low-resource settings has been particularly impactful, enhancing access to advanced diagnostic tools and treatments. AI is rapidly changing the healthcare industry by greatly increasing the accuracy of diagnoses, streamlining treatment plans, and improving patient outcomes across a variety of medical specializations. This review underscores AI's transformative potential, from early disease detection to personalized treatment plans, and its ability to augment healthcare delivery, particularly in resource-limited settings.

Exploring Saudi paramedics’ experiences in managing adult trauma cases: a qualitative study

BackgroundSaudi paramedics face numerous challenges while providing care for adult trauma patients affecting their care but little is known about these specific challenges.MethodsA qualitative study was conducted using a purposive sample of Saudi paramedics from the Saudi Red Crescent Authority (SRCA) across various cities. Data were collected through online semi-structured interviews and analyzed using the framework method.ResultsA total of 20 paramedics were recruited and interviewed. They identified challenges in trauma response, including coordinating care, ensuring the accuracy and accessibility of patient information, and maintaining confidence and readiness. Participants emphasized the need for independent knowledge acquisition through courses, simulations, and peer discussions. They also highlighted the need for more paramedics, strategies to reduce burnout, and the importance of accurately assessing patient conditions. Additionally, they also stressed the importance of raising public awareness to enhance trauma care.ConclusionThis study explored Saudi paramedics' experiences in managing adult trauma patients. standardized handovers, more staff, and greater public awareness are the main key needs to improve daily practice.

Telehealth and Telemedicine in the Management of Adult Patients after Liver Transplantation: A Scoping Review.

Introduction: Telemedicine can support home-based self-care for liver transplant recipients after discharge from the hospital. This study aimed to (1) provide an overview of the forms of home care for liver transplant patients; (2) identify the content elements of telemedicine in the home care of liver transplant patients; and (3) summarize the effect and outcome indexes of using telemedicine in liver transplantation patients. Methods: A search was performed in the electronic databases of PubMed, CINAHL, Web of Science, Cochrane Library, Embase, Google Scholar, CNKI, Wan Fang data and Wei Pu database through March 1, 2024. Subject heading and keywords were used to reflect the concepts of telemedicine, hepatic transplantation. Studies of tele-home care after transplantation in liver transplant recipients over 18 years of age and the form, content elements, and outcome assessments of telemedicine were included. Results: A total of 16 articles met the inclusion criteria, and from this, the application form of telemedicine in liver transplantation patients, intervention elements and evaluation outcome indexes were identified. The forms of application include internet platform, applications, network communication software, and portable devices; and the elements of intervention include telemonitoring, remote health guidance, telerecordings, teleconsultation, and telerehabilitation; and the outcome indicators include physiological indicators, psychological status, Quality of life, self-management ability, compliance, satisfactory degree, complication rate, readmission rate, and feasibility. Conclusion: Telemedicine is active and feasible in the home-based self-care of patients after liver transplantation, but its application is immature and there are still some problems.

Unveiling the National Platform for Health and Insurance Exchange Services: Data Exchange Era within in the Healthcare System in Saudi Arabia

Unveiling the National Platform for Health and Insurance Exchange Services: Data Exchange Era within in the Healthcare System in Saudi Arabia

Impact of the COVID-19 pandemic on growth determinants in premature neonates: observational study in a secondary health service in Carapicuíba, São Paulo (2020–2023)

Impact of the COVID-19 pandemic on growth determinants in premature neonates: observational study in a secondary health service in Carapicuíba, São Paulo (2020–2023)

Self-harm-related mental health presentations to emergency departments by children and young people from culturally and linguistically diverse groups in South Western Sydney.

Rates of self-harm among children and young people (CYP) have been on the rise, presenting major public health concerns in Australia and worldwide. However, there is a scarcity of evidence relating to self-harm among CYP from culturally and linguistically diverse (CALD) backgrounds. To analyse the relationship between self-harm-related mental health presentations of CYP to emergency departments and CALD status in South Western Sydney (SWS), Australia. We analysed electronic medical records of mental health-related emergency department presentations by CYP aged between 10 and up to 18 years in six public hospitals in the SWS region from January 2016 to March 2022. A multilevel logistic regression model was used on these data to assess the association between self-harm-related presentations and CALD status while adjusting for covariates and individual-level clustering. Self-harm accounted for 2457 (31.5%) of the 7789 mental health-related emergency department presentations by CYP; CYP from a CALD background accounted for only 8% (n = 198) of the self-harm-related presentations. CYP from the lowest two most socioeconomic disadvantaged areas made 63% (n = 1544) of the total self-harm-related presentations. Findings of the regression models showed that CYP from a CALD background (compared with those from non-CALD backgrounds) had 19% lower odds of self-harm (adjusted odds ratio 0.81, 95% CI 0.66-0.99). Findings of this study provide insights into the self-harm-related mental health presentations and other critical clinical features related to CYP from CALD backgrounds that could better inform health service planning and policy to manage self-harm presentations and mental health problems among CYP.