Medical Care Services Research Articles

Association between multimorbidity and utilization of medical and long-term care among older adults in a rural mountainous area in Japan.

With the accelerated population aging, multimorbidity has become an important healthcare issue. However, few studies have examined multimorbidity and its impact on the use of medical and long-term care services in Japan. Therefore, this study aimed to examine the association between multimorbidity and the use of medical and long-term care services among older adults living in the depopulated mountainous areas of Japan. A cross-sectional study was conducted using insurance claims data from late-stage medical insurance and long-term care insurance (April 2017 to March 2018) for older adults ≥75 years residing in a mountainous area in the Tottori prefecture. In addition to the descriptive analysis, multiple generalized linear regressions with family gamma and log-link functions were used to examine the association between the number of morbidities and total annual medical and long-term care expenditures. A total of 970 participants ≥75 years were included in the analysis. Participants who had two or more morbidities constituted 86.5% of the total sample. Furthermore, participants with mental disorders were found to have more comorbidities. The number of comorbidities is associated with higher medical and long-term care expenditures. Multimorbidity was dominant among late-stage older adults living in depopulated mountainous areas of Japan, and the number of morbidities was associated with higher economic costs of medical and long-term care services. Mitigating the impact of multimorbidity among older adults in depopulated regions of Japan is an urgent challenge. Future research should investigate the degree and effectiveness of social protections for vulnerable older adults living in remote areas.

Deep Learning-Empowered Clinical Big Data Analytics in Healthcare Digital Twins.

With the rapid development of information technology, great changes have taken place in the way of managing, analyzing, and using data in all walks of life. Using deep learning algorithm for data analysis in the field of medicine can improve the accuracy of disease recognition. The purpose is to realize the intelligent medical service mode of sharing medical resources among many people under the dilemma of limited medical resources. Firstly, the Digital Twins module in the Deep Learning algorithm is used to establish the medical care and disease auxiliary diagnosis model. With the help of the digital visualization model of Internet of Things technology, data is collected at the client and server. Based on the improved Random Forest algorithm, the demand analysis and target function design of the medical and health care system are carried out. Based on data analysis, the medical and health care system is designed using the improved algorithm. The results show that the intelligent medical service platform can collect and analyze the clinical trial data of patients. The accuracy of improved ReliefF & Wrapper Random Forest (RW-RF) for sepsis disease recognition can reach about 98%, and the accuracy of algorithm for disease recognition is also more than 80%, which can provide better technical support for disease recognition and medical care services. It provides a solution and experimental reference for the practical problem of scarce medical resources.

A Brief Review of Anatomy Education in Korea, Encompassing Its Past, Present, and Future Direction.

Anatomy is a foundational subject in medicine and serves as its language. Hippocrates highlighted its importance, while Herophilus pioneered human dissection, earning him the title of the founder of anatomy. Vesalius later established modern anatomy, which has since evolved historically. In Korea, formal anatomy education for medical training began with the introduction of Western medicine during the late Joseon Dynasty. Before and after the Japanese occupation, anatomy education was conducted in the German style, and after liberation, it was maintained and developed by a small number of domestic anatomists. Medicine in Korea has grown alongside the country's rapid economic and social development. Today, 40 medical colleges produce world-class doctors to provide the best medical care service in the country. However, the societal demand for more doctors is growing in order to proactively address to challenges such as public healthcare issues, essential healthcare provision, regional medical service disparities, and an aging population. This study examines the history, current state, and challenges of anatomy education in Korea, emphasizing the availability of medical educators, support staff, and cadavers for gross anatomy instruction. While variations exist between Seoul and provincial medical colleges, each manages to deliver adequate education under challenging conditions. However, the rapid increase in medical student enrollment threatens to strain existing anatomy education resources, potentially compromising educational quality. To address these concerns, we propose strategies for training qualified gross anatomy educators, ensuring a sustainable cadaver supply, and enhancing infrastructure.

"In My Mind, It Was Just Temporary": A Qualitative Study of the Impacts of Cancer on Men and Their Strategies to Cope.

Individuals who are diagnosed and treated for cancer use a variety of strategies to manage its impacts. However, there is currently a lack of research on men's experience with managing cancer impacts, which is necessary to better support them throughout the cancer care continuum. This study explored the experience of men diagnosed with cancer, focusing on the impacts of the illness and its treatment and men's strategies to cope. A qualitative descriptive design was used. Thirty-one men (Mage = 52.7 [26-82] years) diagnosed with various cancer types were recruited to take part in individual telephone interviews (n = 14) or online focus groups (n = 17) addressing the impacts of cancer and strategies they used to cope with these impacts. Directed content analysis was performed, using Fitch's (2008) supportive care framework to guide the analysis. Cancer impacts and strategies used to cope were classified into six categories: physical, psychological, interpersonal, informational, practical, and spiritual. Results indicate that the cancer experience is diverse and multifaceted rather than homogeneous. Medical and supportive care services could be more effectively personalized to meet the diversity of men's needs by adopting a comprehensive and holistic approach to supportive care. Working in partnership with patients, it appears promising to recognize and identify men's needs and match them to appropriate resources to provide truly supportive care.

The impact of the COVID-19 pandemic on stress and coping in parents of children with Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by impairments in communication, social interaction, and repetitive behavior. The declaration of the COVID-19 pandemic in March 2020 resulted in significant changes in daily life due to restrictive measures. This period posed particular challenges for families with children living with autism, given the limitations in medical care and social services. This study aimed to understand how families with autistic children perceive stress during the pandemic and the coping strategies employed in unexpected situations. A total of 44 families with children with ASD and 300 control families, including 44 control families in a matched subsample, were included in the study. To assess stress and parental coping with COVID-19-related stress, the Responses to Stress Questionnaire (Adult Self-Report RSQ-COVID-19) was utilized. Caregivers of autistic children experienced significantly higher stress levels (p = .027, d = 0.479) during the pandemic, with notable stressors such as limited access to medical care and challenges associated with remote work. Despite expectations, coping strategy differences were not statistically significant. Families and supporters of children with autism naturally encounter various experiences and challenges stemming from their additional needs. Our study's results highlight an accentuation of stress during challenging situations. As these situations may recur in the future, there is a need to design and implement support plans for these families, appropriate intervention programs, and preparations for the utilization of telemedicine tools.

Psycho-Social Condition of Elder Persons in Bangladesh: A Case Study on Elder People in Bangladesh

Ageing is basically a biological process that needs continuous health and medical care and other related support services. Unfortunately, older persons (OP) in Bangladesh are suffering very badly in this area due to lack of our national, cultural and even individual farsightedness, prudence, appropriate preparations, balanced initiatives and arrangements. In Bangladesh due to improved quality of life the number of people over 60 years is increasing rapidly. This should be seen as an emerging challenge as the elderly will have special needs and require different care-giving services. Since Bangladesh does not have a social welfare system there will be competition for inadequate resources specially health and medical services. Older persons suffer the cumulative effects of a lifetime deprivation, entering old age in a poor state of health and without savings or material assets. Older persons are always neglected in our society. It is envisaged that due to more elderly population the demographic structure will undergo a slow change from the present pyramid structure. The growing trend towards nuclear family or where children live abroad will put the elderly parents in a dilemma-the financial and social support that is essential for them has not yet emerged. The nutrition and health status of elderly people depend on adequate food safe water, proper sanitation facilities and maintaining hygienic standards. Our new generations have to be responsive, informed and attentive about their duties and responsibilities towards the elderly people. Taking proper care of the elderly is our ethical duty and responsibility.

Secure Electronics Medical Infrastructure for Healthcare 4.0: A Voice Identity Management-Based Approach

Securing Electronic Medical Records for Healthcare 4.0 is one of the prime requirements in the medical care service domains. Healthcare 4.0 refers to the evolution process of healthcare systems that leverage digital technologies, connectivity, and data-driven insights to provide more personalized and efficient care. With the increasing adoption of electronic healthcare records and the growing importance of data in the healthcare sector, ensuring the privacy of patient data becomes paramount. To ensuring the security for healthcare 4.0 in the current work a voice authentication-based system is devised. This enables the protection of electronic healthcare records (EHRs) in the association of healthcare 4.0. More precisely here the voice authentication is used as an additional layer of security for accessing and managing EHRs. The Voice authentication can also be categorized as the voice biometric. This is a technology that uses unique voice characteristics and patterns to verify the identity of individuals. The result establishes the innovative smart security arrangement for the Healthcare 4.0 using the voice authentication-based identity management infrastructure; and a modified version of asymmetric cryptosystem has been used inside the blockchain. The simulation outcome indicates better performance in the form of block generation time, block number, ensure the transaction, and minimize the latency of the transaction.

A Novel Experience-Driven and Federated Intelligent Threat-Defense Framework in IoMT.

The Artificial Intelligence-enabled Internet of Medical Things (AI-IoMT) envisions the connectivity of medical devices encompassing advanced computing technologies to empower large-scale intelligent healthcare networks. The AI-IoMT continuously monitors patients' health and vital computations via IoMT sensors with enhanced resource utilization for providing progressive medical care services. However, the security concerns of these autonomous systems against potential threats are still underdeveloped. Since these IoMT sensor networks carry a bulk of sensitive data, they are susceptible to unobservable False Data Injection Attacks (FDIA), thus jeopardizing patients' health. This paper presents a novel threat-defense analysis framework that establishes an experience-driven approach based on a deep deterministic policy gradient to inject false measurements into IoMT sensors, computing vitals, causing patients' health instability. Subsequently, a privacy-preserved and optimized federated intelligent FDIA detector is deployed to detect malicious activity. The proposed method is parallelizable and computationally efficient to work collaboratively in a dynamic domain. Compared to existing techniques, the proposed threat-defense framework is able to thoroughly analyze severe systems' security holes and combats the risk with lower computing cost and high detection accuracy along with preserving the patients' data privacy.

Kinetics of IL-6, C-reactive Protein and Fibrinogen Levels in COVID-19 Outpatients Who Evolved to Hypoxemia.

Despite the efficacy of the COVID-19, the search for improvements in the management of severe/critical cases continues to be important. The aim is to demonstrate the kinetics of 4 serological markers in patients with COVID-19 who evolved in hypoxemia. From June to December 2020, the Health Secretariat of Rondônia State, Brazil, established a home medical care service team (HMCS) that provided clinical follow-up for health professionals and military personnel with COVID-19. The clinical and laboratory monitoring was individualized at home by a nursing and medical team. In addition to laboratory parameters, C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, and D-dimer levels were periodically taken to monitor the evolution of treatment. Of 218 patients telemonitored, 48 patients needed special care by the HMCS team due to shortness of breath. Chest tomography showed multiple ground-glass shadows and lung parenchymal condensations that was compatible with secondary bacterial infection associated with leukocytosis, for which antibiotics were prescribed. The symptoms were accompanied by increases of CRP and IL-6 levels followed by fibrinogen after a few days, for which an anticoagulant therapy was included. Thirty-three patients evolved to improvements in clinical signs and laboratory results. Between the sixth and eighth day of illness, 15 patients presented signs of hypoxemia with low O2 saturation accompanied with an increase in the respiratory rate, with some of them requiring oxygen therapy. As they did not present signs of clinical severity, but their laboratory markers showed an abrupt IL-6 peak that was higher than the increase in CRP and a new alteration in fibrinogen levels, they received a supplemental dose of anticoagulant and a high dose of corticosteroids, which resulted in clinical improvement. Our study demonstrates that monitoring of IL-6 and CRP may identify precocious hypoxemia in COVID-19 patients and prevented the progressive deterioration of the lung injury.

Long-term care insurance facilitating integrated care: the "whole-person, full-responsibility" system in Qingdao City of China

Introduction: The ageing of China has brought the burden of long-term care, and some local areas started the piloting of long-term care insurance (LTCI). In response to its rapid ageing situation, Qingdao was the first city in China to establish LTCI, and it became a national pilot city in 2016. Qingdao has explored an integrated LTCI system, featuring "whole-person, full-responsibility", which promotes the integration of health and long-term care service delivery.
 Short description of practice change implemented: LTCI in Qingdao is financed through a variety of channels, including the reallocation of medical insurance funds, government financial subsidies and premiums. The scope of LTCI coverage is centred on people’s needs and facilitate the provision of integrated services, including medical care, nursing care, living care, functional maintenance and spiritual comfort services. It meets the complex care needs of people with long-term disabilities, reduces the use of hospital beds, and promotes the development of the care service market.
 Targeted population and stakeholders: The targeted population is the LTCI participants in Qingdao, especially the severely disabled and dementia population. Stakeholders include medical insurance agencies, medical institutions, long-term and elderly care facilities, families, etc.
 Timeline: Qingdao has been exploring the construction of LTCI since 2012, and in 2018 it introduced the concept of ""whole-person, full-responsibility"" as a new insurance model.
 Highlights: Qingdao has innovatively established a ""whole-person, full-responsibility"" integrated insurance model facilitating the combination of medical, ageing, nursing, rehabilitation and prevention services. The core is a person-centred, integrated approach to care needs, with the same designated care provider taking full responsibility for providing the integrated services.
 The care includes ""special care"", "" institutional care"", ""home care"" and ""ambulatory care"", covering longer-term hospitalization, institutional care and home care.
 People with dementia were also reimbursed for dementia care. In addition, the Dementia Prevention Fund has been established to promote the prevention of dementia.
 Sustainability and transfer-ability: The establishment of LTCI in Qingdao has effectively reduced the use of hospital beds, reduced the burden of medical insurance funds and promoted the development of the service market. It has been scaled up to the whole province of Shandong and became a national model for LCTI with potential of large scale duplication. But the scheme still faces funding pressure as its expansion of benefits.
 Conclusion: LTCI in Qingdao is based on the concept of ""whole-person, full-responsibility"", taking into account the care needs of people in a holistic manner, which addresses the care integration for long-term disabled and dementia population. It also promoted the development and capacity building of providers and reduced the burden of medical system, resulting in a win-win situation for all parties. It provided a model for China to explore the LTCI system and integrated care for the elderly.
 Discussion: To promote the sustainable development of Qingdao's LTCI system as well as the national LTCI system, issues should be considered in the next step including the sustainable fund raising through diversified channels, the supervision of service quality, training of professionals and workforce, and priority given to disability prevention.

Integrating health and social care in the community to support a new model of Long-term Life Care at home.

Background: Long-term care (LTC) reform was an international priority well before the COVID-19 pandemic. While strategies to promote de-institutionalization, rehabilitation, caregiver support and enhanced home and community care have varied by country in terms of implementation and success, the pandemic universally reinforced existing system-specific barriers and weaknesses. In Canada, heightened access issues and silo-ed delivery of community-based medical, functional and social care and support services contributed to increased caregiver burnout and growing residential care waitlists.
 Aims: This study aimed to develop an alternative model to residential LTC that would enable older adults to live, age and receive care at home long-term. The specific objectives were to: 1) describe variation in medical, functional and psychosocial ‘life care’ needs of community-dwelling older adults; 2) develop a model of needs-based care with packages to support variation in needs; and 3) to assess preliminary feasibility of the model using the Ontario, Canada (population 15 million) health care market. 
 Approach: An exploratory, sequential, mixed methods design was applied (5). Phase 1 involved historical analysis of 2017-18 Ontario interRAI home care assessments (n=283,601) and 2018-19 Ontario service utilization data (n=115,000) to develop unique patient vignettes. Phase 2 was a 6-week modified eDelphi process with interdisciplinary home care clinicians (n=42) to develop care packages for the model, including types and dose of care and services. Six focus groups (n=67) were then conducted with older adults, caregivers and health and social care providers across Ontario to validate and refine the model. Phase 3 explored feasibility of the emerging model through comparison of the home care patient vignettes with the needs of the residential LTC population using 2017-18 Ontario interRAI data (n=115,000). Preliminary costing of the model was based on existing system per diems and direct care costs in comparable transitional care models.
 Results: A model of ‘Long-term Life Care’ at home (LTLifeC model) includes care packages to meet the dominant life care needs of 6 unique patient groups representing known predictors of LTC home admission: social frailty, caregiver distress, chronic disease, cognition/ behaviours, medical complexity, and geriatric syndromes. Overlap in care needs of home care and LTC populations confirms potential to shift care to the community; yet current home care clients receive six times less daily care hours on average, compared to residential LTC standards. New LTLifeC packages of home-based interdisciplinary care ranged from 3.1-8.9 hours daily, including comprehensive assessment, integrated care planning, direct care provision and community referral(s). Initial cost comparisons suggest plausible short and long-term system benefits of model adoption.
 Learnings: Evidence-informed decision making for sustainable home and community care as part of an integrated system of LTC requires attention to both routinely collected health information, or ‘big data’, and expertise by lived-experience. Adoption of the LTLifeC model will require decision-making to prioritize societal values for living and aging at home and in community. 
 Next Steps: An evaluation framework will be developed to guide pilot implementation and testing of the LTLifeC model through the lens of the quadruple aim.

Impact of a transitional care program for heart failure patients at Baylor Scott & White Health: a pilot study

Heart failure is a chronic health condition characterized by complex symptom management and costly hospitalizations. Hospitalization for the treatment of heart failure symptoms is common; however, many hospitalizations are thought to be preventable with effective self-management. This study describes the small, pilot implementation of a new, interventional, self-management heart failure program, “Engagement in Heart Failure Care” (EHFC), developed to assist heart failure patients with the management of disease symptoms following discharge from an inpatient hospital stay. EHFC was designed to engage patients in managing their symptoms and coaching them in skills that enable them to access medical and supportive care services across community, clinic, and hospital settings to help address both their current and future needs. The results of this pilot study suggest that EHFC’s coaching model may have positive benefits on key health and well-being indicators of the patients enrolled.

DEVELOPMENT AND IMPROVEMENT OF QUALITY CHARACTERISTICS OF MEDICAL CARE

The aim: to investigate changes in the interpretation of the content of the characteristics of the quality of medical care and medical service; to propose practical approaches to the formation of modern quality criteria and indicators in health care institutions.
 Materials and methods: sources of scientific literature from the databases PubMed, NICE, according to the selected research topic, were selected as research materials; methods: bibliosemantic; analysis and generalization of the obtained data.
 Results. Classic characteristics of quality – safety, quality of resources, quality of the medical care process, treatment outcome, patient satisfaction, timeliness, fairness, efficiency – are reviewed over time and acquire additional or radically changed content. The selection of relevant quality characteristics is important for health care managers to define quality criteria and indicators according to the requirements of the local context. In addition to the traditional components of infectious safety and the safety of medical interventions, the safety criterion is today complemented by the components of radiation, environmental, epidemic, physical, informational, and terrorist safety. Safety also refers to the ability of professionals to avoid, prevent and reduce harmful interventions or risks to themselves and the environment. Patient-centeredness must include respect for the relationship not only between physician and patient, but also between the patient and all providers of health care for that patient. Effective, safe health care is reflected in a culture of excellence that includes collaboration, communication, compassion, competence, advocacy, respect, accountability and reliability. The most relevant criteria and indicators of the quality of medical care must be developed in accordance with the structure of innovative organizational models of academic health care centers, where scientific, clinical and educational activities are integrated. This requires the formation of end-to-end quality criteria and indicators that cover all activities of academic centers.
 Conclusions: criteria and indicators of the quality of medical care and medical service are constantly supplemented with new components, in accordance with the achievements of medical science and practice. The transformation of the organizational structures of medical care into academic centers, where scientific and educational activities are added to traditional medical practice, requires the development and introduction of end-to-end criteria for the quality of medical care.

UTILIZATION OF COMMUNITY CARE SERVICE AND SUBJECTIVE WELL-BEING OF OLDER PEOPLE: EVIDENCE FROM WEIFANG, CHINA

Abstract Many developed countries have established community-based care systems to address care needs of older people. However, community-based care in China is still in an early stage, some of its shortcomings are highlighted under the COVID-19 pandemic. Studying the wellbeing effect of community care in China could provide policy reference for developing countries. Based on the Elderly Health Survey in Weifang, China, using the two-stage least squares method, the effect and mechanism of the utilization of community care services on the subjective wellbeing of elder people were evaluated. Results show that: first, the utilization of community care services could promote the subjective wellbeing of older people and has a stronger effect on people with a higher level of subjective wellbeing. Second, the utilization of different types of community elderly care services has different effects on the subjective wellbeing of older people. When receiving a single type of community elderly care services, medical care services have the strongest promotion effect, while taking spiritual and cultural services and other types of services together will be a stronger synergistic effect on subjective wellbeing. Third, with the support of various community service subjects, the utilization of community care services could improve the subjective wellbeing by improving their health status, sleep quality and declining feeling of pain. In this regard, this study proposes policy suggestion in optimizing the types of community care service projects, building elderly care service consortiums, and improving community health management service capabilities to coping with deep aging and fewer birth.

PROJECTION OF MEDICAID SPENDING ON PEOPLE WITH ALZHEIMER’S DISEASE AND OTHER RELATED DEMENTIAS

Abstract As the US population is aging, the number of people with Alzheimer’s Disease and Other Related Dementias (ADRD) is increasing. People with ADRD have high expenditures on medical care and long-term services and supports (LTSS). Medicaid is the largest single payor for LTSS, however, the literature on the demographic trends and epidemiology of people with ADRD does not offer projections of Medicaid spending. The goal of this study was to develop an estimate for future Medicaid spending for people with ADRD for the state of Pennsylvania. The approach taken was to develop a demographic projection of the size of the older population, then estimate the fraction of people with ADRD who are eligible for Medicaid. Next, we used estimates of current spending trends to project future spending through 2025. Nearly all Medicaid participants with ADRD are dually eligible for both Medicaid and Medicare, however, Medicare managed care encounter data were not available for analysis. Thus, the prevalence of ADRD was constructed using Medicaid and Medicare fee-for-service (FFS) claims data. Two alternate estimates of the prevalence of ADRD among Medicare managed care enrollees were used (same as Medicare FFS, or slightly lower). Estimates were generated under several growth rates in per person spending on home and community-based services (HCBS). The results shows that growth in HCBS spending is the largest factor in predicting spending, leading to estimates ranging from $2.8 billion to $3.5 billion. Future research will extend the model to additional years.

MEASURING QUALITY IN LONG-TERM SERVICES AND SUPPORTS THROUGH PERSON-REPORTED OUTCOMES: VALUE OF NCI DATA

Abstract Long-Term Services and Supports (LTSS) include medical, social, and personal care services that people may need to perform activities of daily living due to physical or cognitive impairments. Measuring the quality of LTSS is essential for improving the care and outcomes of people with disabilities and older adults and ensuring that services meet consumer needs. Several frameworks have been developed to measure LTSS quality, including the National Quality Forum’s LTSS Framework. Yet, few data sources are available to measure person-reported quality in HCBS. This symposium will provide an overview of National Core Indicators (NCI) as a unique data source to address this gap. It also includes presentations from researchers from organizations in two states who utilize NCI data – Minnesota and Massachusetts – who will share their perspectives about the value of the data, results from empirical analyses, and how they use and plan to use the data to inform policy. Researchers from the Lurie Institute for Disability Policy will present findings on the association between person-centered planning and key person-reported outcomes in Medicaid HCBS. Researchers from the University of Minnesota School of Public Health and Brown University will share findings from national NCI data on unmet needs among older adults by dementia status and race/ethnicity. They will also share results of analyses in MN, linking person-reported HCBS plan quality and healthcare utilization, using claims data. Collectively, this symposium will address the gap in measurement of HCBS quality nationally and identify key directions for policy and future research.

Policy Suggestions Based on the New Model of Combining Medical and Elderly Care Services in Rural Areas

In recent years, population ageing has been deepening, and promoting the combination of medical care and old-age care services is an important measure to optimize the supply of health and old-age care services for the elderly. Although the policy of combining medical and elderly care services in rural areas has been continuously improved and made positive progress, there are still some problems in policy support, service capacity and talent construction. Therefore, the government should carefully plan the rural medical and pension system, formulate medium- and long-term plans, and actively take reform measures to establish a new rural medical and pension model. At the same time, strengthen the law, government supervision and publicity to promote the stable operation of the new model of combining rural medical care and old-age care.

P17: What happens if your colleague was the first person who notice that you have early-onset dementia?

Objective:A national prevalence study of early-onset dementia in Japan has provided data on their challenges and support needs, as documented by the individual and their family members. This study examined differences between 1) cases that the onset of early-onset dementia was detected by work colleagues, and 2) other cases.Methods:After identifying medical or long-term care service offices used by people with early-onset dementia in 12 regions in Japan, a questionnaire was distributed to the individuals and their family members. The items surveyed were age at the time of the survey, gender, employment at the onset, age when the initial symptoms were detected, the person who detected the initial symptoms, and consideration received at the workplace. In this report, only those who were working at the onset were included in the analysis. Next, they were divided into two groups according to whether the person who detected the initial symptoms was a colleague or not, and a chi-square test was used to compare the two groups. This study was conducted with the approval of the Ethics Committee of the Tokyo Metropolitan Institute of Gerontology and Geriatric Medicine.Results:Of the 1035 questionnaires collected, 559 were were working at the time of onset of initial symptoms, and 149 (26.7%) of these cases were initially detected by a colleague. Comparison between groups revealed that the cases detected by colleagues 1) were recommended to see an occupational physician (P<0.001), 2) were referred to a specialist (P<0.001), 3) received consideration such as reassignment in the workplace (P<0.001), 4) received consideration regarding transportation (P=0.023), 5) had someone to talk to in the workplace (P<0.001), and 6) were significantly unlikely to receive no consideration at all (P=0.010).Conclusion:Early-onset dementia was noticed by a colleague due to an increase mistake in the workplace but may have received reasonable accommodations that could have been considered by each workplace. The results of this study may help to promote dementia-friendly workplace strategies.

Development of indicators for avoidable emergency medical service calls by mapping paramedic clinical impression codes to ambulatory care sensitive conditions and mental health conditions in the UK and Canada

ObjectiveParamedic assessment data have not been used for research on avoidable calls. Paramedic impression codes are designated by paramedics on responding to a 911/999 medical emergency after an assessment of...

The Million Patient Labset: A large, de-identified dataset of longitudinal clinical laboratory results from one million patients

Abstract Laboratory testing is integral to the diagnosis and treatment of disease. Advances in electronic medical records and computation have initiated an era of ‘big data’ for laboratory medicine. However, most health data continues to exist in isolated and inaccessible information silos, limiting public utility. To address this gap, we have developed a large, de-identified, longitudinal dataset of laboratory results from over one million patients, called the Million Patient Labset (MPL), which is free and open to the public. The MPL was produced from the combination of two large healthcare systems with IRB and information security approvals. It includes 1,112,550 patients from across 1,920 healthcare sites in two states from 2017 through 2021, with 4,404 different clinical assays represented. Sites included primary care clinics, secondary care facilities for dialysis, infusions, rehabilitation, and other subspecialties, and tertiary centers for major surgery, trauma care, cancer care, and other complex medical services. Assays having fewer than 100 results were excluded. Limited patient demographic and encounter metadata are also included. Protected health information was de-identified in accordance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) safe harbor standards. Service dates and times were altered to obscure absolute timestamps, while approximately preserving interval lengths between test results of the same patient, and general age and time of testing averages across patients. Time of day, day of week, and seasonality were approximately preserved. Data were validated through randomly selected comparisons against the original patient records, prior to destroying re-identification keys. In conclusion, we have produced a large de-identified open-access dataset of clinical laboratory results from over one million real patients. We hope this resource will be valuable for researchers exploring human clinical variation, medical artificial intelligence, reference interval optimization, and other data-driven studies.