Clinical Support Research Articles

Nurses’ and midwives’ experiences of clinical supervision in practice: a scoping review protocol

ObjectiveTo outline and examine what evidence exists related to nurses’ and midwives’ experiences of participating in clinical supervision.IntroductionThe practice of clinical supervision is increasingly prevalent in nursing and midwifery, yet...

Assessment of Voice Content for Voice Hearers: Psychometric Evaluation of the Perth Voice Content Questionnaire.

The experience of hearing voices is common to an estimated 7% of the general population, with the presence of negative content being the best predictor of whether individuals will require clinical support. Whilst largely neglected in the literature to date, there are calls to consider the significance of voice content for reducing voice-related distress. However, no quantitative and comprehensive measure of voice content with suitability for research and clinical use exists. This pilot study aimed to demonstrate preliminary psychometric properties of a newly developed measure, the Perth Voice Content Questionnaire (PVCQ), designed to measure the intensity and themes of positively and negatively valenced voice content, primarily of the dominant voice. The PVCQ and measures of voice severity and related beliefs were completed by 47 voice-hearing participants. The measure was found to be internally consistent, loaded onto two distinct factors of positive and negative content, and these factors were associated with voice-related distress and negative beliefs about voices and positive beliefs about voices, respectively, indicating good validity. The PVCQ offers the first self-report measure of voice content, with preliminary psychometric properties indicating its suitability for clinical and research use.

Marital Satisfaction, Social Support and Coping Strategies Among Couple Having Miscarriage

Miscarriage is a challenging and emotionally distressing experience for couples, often affecting various aspects of their lives, including marital satisfaction, social support, and coping strategies. This study aims to explore the interplay between these factors to better understand the dynamics within couples facing the aftermath of miscarriage. A cross-sectional study was conducted involving 200 couples who had recently experienced a miscarriage. Participants were recruited through hospitals, support groups, and online platforms. Each couple completed a set of structured questionnaires, including the Comprehensive Marital Satisfaction Scale (CMSS) to assess marital satisfaction, the Multidimensional Scale of Perceived Social Support (MSPSS) to measure perceived social support, and the Brief COPE inventory to identify coping strategies. Findings revealed a significant negative correlation between miscarriage and marital satisfaction (r = -0.45, p < 0.001). Couples reported lower scores on the marital satisfaction scale, indicating decreased satisfaction within their relationships. Perceived social support played a crucial role, with higher support levels associated with better marital satisfaction (r = 0.32, p < 0.001). Coping strategies varied among couples, with active coping, acceptance, and positive re framing positively correlated with marital satisfaction, while avoidant coping strategies showed a negative association. Results indicated that the relationship between coping strategies and marital satisfaction was mediated by perceived social support, and this mediation effect was moderated by the intensity of the miscarriage experience. The findings underscore the importance of addressing these factors in clinical interventions and support services for couples dealing with pregnancy loss. , ,

Co-designing an intervention using the COM-B model to change an eating behaviour in people living with achalasia.

Achalasia is a rare motility disorder affecting the oesophagus, leading to difficulties with eating and drinking. Participants in previous studies reported that they needed more social, clinical and behavioural support in the long-term management of achalasia. This study, therefore aimed to 1) identify the most challenging eating behaviour for people living with achalasia and 2) co-design a behaviour change intervention to help address the challenges they experience. This study used a qualitative approach involving online focus groups. The COM-B model was the theoretical framework, with behaviour change techniques (BCTs) as the active ingredients that target a mixture of capability, opportunity and/or motivation. Three focus groups were undertaken to obtain a range of input from different people living with achalasia. Participants in this study identified the target behaviour, prioritised the different BCTs which most resonated with them to design an intervention and decided on the mode of delivery. The research team analysed the techniques that helped participants with their eating behaviour using the COM-B model as a framework to create the intervention. The 24 participants in this study identified "eating in a social setting" as the target behaviour for the intervention. A workbook that can be personalised by the individual was the most suitable intervention. The workbook structure aligns with the constructs of the COM-B model. It includes reflection, activities and goal-setting sections based on what was indicated to be useful for the majority of the participants. Key techniques to overcome the challenges with eating in a social setting included social support, regulation to reduce negative emotions, goals and planning. Using a focus group approach with the COM-B model as the theoretical framework, the participants in this study developed an intervention to support people living with achalasia. In order to achieve long-term behaviour change, engagement with a personalised workbook could facilitate eating in a social setting. Future work will need to pilot the workbook to ensure it can support people to improve their quality of life and complement the ongoing care they receive from health services.

Consumer and audiologist perspectives on hearables: a qualitative study

Objective We aimed to explore (i) what adults with hearing difficulties want and need from hearables, which we defined as any non-medical personal sound amplification product, and (ii) what hearing care professionals think about hearables. Design This was an exploratory, qualitative study conducted using separate focus groups with adults with hearing difficulties and audiologists. Data were analysed inductively using reflexive thematic analysis. Study sample Participants were 12 adults with hearing difficulties and 6 audiologists. Results Adults with hearing difficulties expressed desire for trustworthy information and support, described evaluating hearables and other devices according to diverse personal criteria, and expressed willingness to vary their budget according to product quality. Audiologists expressed views that hearables are an inferior product but useful tool, that it is not necessarily their role to assist with hearables, that hearables are a source of uncertainty, and that the provision of hearables by audiologists is not currently practical. Conclusion Adults with hearing difficulties may have complex reasons for considering hearables and may desire a high level of clinical support in this area. Ongoing research into the efficacy and effectiveness of hearables is needed together with research into effective strategies to incorporate hearables into clinical practice.

Pharmacogenomic Clinical Support Tools for the Treatment of Depression.

In this review, the authors update the 2018 position statement of the American Psychiatric Association Council of Research Workgroup on Biomarkers and Novel Treatments on pharmacogenomic (PGx) tools for treatment selection in depression. The literature was reviewed for new clinical trials and meta-analyses, published from 2017 to 2022, of studies using PGx tools for treatment selection in depression. The blinding and control conditions, as well as primary and secondary outcomes and post hoc analyses, were summarized. Eleven new clinical trials and five meta-analyses were identified; all studies had primary outcome measures related to speed or efficacy of treatment response. Three trials (27%) demonstrated efficacy on the primary outcome measure with statistical significance; the three studies used different PGx tools; one study was open-label and the other two were small single-blind trials. Five trials (45%) did not detect efficacy with statistical significance on either primary or secondary outcome measures. Only one trial (9%) used adverse events as a primary outcome measure. All studies had significant limitations; for example, none adopted a fully blinded study design, only two studies attempted to blind the treating clinician, and none incorporated measures to estimate the effectiveness of the blinds or the influence of lack of blinding on the study results. The addition of these new data do not alter the recommendations of the 2018 report, or the advice of the U.S. Food and Drug Administration, that the evidence does not support the use of currently available combinatorial PGx tools for treatment selection in major depressive disorder. Priority efforts for future studies and the development and testing of effective tools include fully blinded study designs, inclusion of promising genetic variants not currently included in any commercially available tests, and investigation of other uses of pharmacogenomics, such as estimating the likelihood of rare adverse drug effects, rather than increasing the speed or magnitude of drug response.

Strengthening caesarean birth: Sub-Saharan Africa health system evaluation: Scoping review.

Promoting safe caesarean birth (CB) is a challenge in sub-Saharan Africa (SSA) where maternal and neonatal mortality rates are high due to inadequate maternal health services. Although the CB rate in SSA is lower than the World Health Organization (WHO) recommendation, it is often associated with high maternal and neonatal mortality. The aim of this scoping review was to report on the extent to which SSA health systems deliver safe CB. A systematic search across various databases identified 53 relevant studies, comprising 30 quantitative, 10 qualitative and 16 mixed methods studies. These studies focused on clinical protocols, training, availability, accreditation, staff credentialing, hospital supervision, support infrastructure, risk factors, surgical interventions and complications related to maternal mortality and stillbirth. CB rates in SSA varied significantly, ranging from less than 1% to a high rate of 29.7%. Both very low as well as high rates contributed to significant maternal and neonatal morbidity. Factors influencing maternal and perinatal mortality include poor referral systems, inadequate healthcare facilities, poor quality of CBs, inequalities in access to maternity care and affordable CB intervention. The inadequate distribution of healthcare facilities, and limited access to emergency obstetric care impacted the quality of CBs. Early access to quality maternity services with skilled providers is recommended to improve CB safety.Contributions:This scoping review contributes to the body of knowledge motivating for the prioritization of maternal service across SSA.

The nexus between maternity care and bordering practices: A qualitative study of provider perspectives on maternal healthcare provision for Afghan women migrating through Serbia to Western Europe

Serbia is a well-established transit country for Afghans travelling overland to seek protection in Western Europe, and Afghan women continue to experience pregnancy and birth during migration. This qualitative study aimed to explore the perspectives and experiences and of clinical and non-clinical perinatal care and support providers to Afghan women during migration through Serbia, using a critical border studies lens. Semi-structured interviews with 21 Serbia-based providers (conducted August 2021–October 2022 and analysed thematically) provided five inductive themes: (1) contours of life in Serbia for Afghan women; (2) providing maternity care and support to a highly mobile group; (3) enablers and barriers to accessing and using maternity care; (4) risks of onward migration; and (5) supporting women in a landscape of constant change. We identified ways in which regional geopolitics translated to bordering practices that interfered with maternity support provision to Afghan women in Serbia. We argue that non-exclusionary systems of care are needed to ensure women on the move receive adequate maternity support.

OA32 A national survey of rheumatology telephone adviceline support in the United Kingdom: frontline perspectives

Abstract Background/Aims Telephone advicelines (TALs) are a core feature of rheumatology services and highly valued by patients for providing clinical advice and support. The demand for TALs has increased since the pandemic, placing pressure on current capacity. This study aimed to assess how TALs are currently provided and the impact on rheumatology nurses who routinely deliver this service. Methods An online questionnaire was developed and piloted with input from patients and stakeholders and advertised through the Royal College of Nursing Rheumatology Forum and the British Society for Rheumatology. The survey included health professional demographics, how TALs operate, reasons for contacting TALs, documentation recorded and the impact on provider wellbeing using closed and free text questions. The survey was available from March to September 2023 and had university ethics approval. Results 123 people completed the survey. The majority were rheumatology nurses (n = 118), over 45yrs (n = 96,81%), band 7 or above (n = 88;74%) with over 10 years experience (n = 77,65%), with a first degree or higher (n = 106, 90%). 45 (38%) nurses had a prescribing qualification. The majority of TALs provided a voicemail response (n = 90, 76%),with a triaging system (n = 75, 64%) conducted by clinical support workers (n = 44, 37%) and nurses (n = 29,25%). The number of calls received over a month ranged from 100 to over 800 with 68 (58%) respondents reporting between 500-700 calls. TALs were provided over 5 days (n = 93,79%) for 8 hours (n = 61, 52%), by rheumatology nurses (n = 118), with calls returned within 1-2 days (n = 96,81%) by 1-2 nurses (n = 72,61%), although some calls took over 7 days to respond to (n = 19). The three main reasons for contacting TALs included increased disease activity, managing pain, and concerns relating to DMARDs. There was often no standard operating procedure (n = 72, 61%) or provision for people whose first language is not English (n = 99,84%). Data were collected on the nature of the call (n = 74, 63%) and the response given (n = 47, 40%). Providing TALs negatively impacted on provider wellbeing; 89 (75%) felt anxious ‘sometimes to mostly’ and 79 (67%) found it ‘mostly-always’ stressful. 85 (72%) had not received any training to conduct TALs and 79 (67%) reported that cover was often not available for leave or sickness. The qualitative findings also confirmed that expert providers found delivering TALs stressful and felt underprepared. One respondent commented that “The adviceline is the most stressful aspect of the role but has the least support.” Many felt the adviceline had developed without adequate planning, contributing to the service being under resourced and under recognised. Conclusion TALs support patients with concerns about their symptoms and treatments on a daily basis, yet the increased demand for delivering TALs is impacting on nurse wellbeing. Consequently, national guidelines are required on optimal service requirements including resource allocation, training and health professional support. Disclosure S. Ryan: None. S. Hider: None. A. Hassell: None.

Nutrition nurses’ status, practices, and routines: an online cross-sectional survey

Objectives: Nutrition is an integral component of care in the intensive care unit. However, no international comparison has been published about the status and practices of nutrition nurses, their legal titles, gained certificates, and routine duties. To describe the working conditions, educational background, nutrition-related practices, challenges, and future development needs of nutrition nurses in Türkiye, the European countries, and the USA. Methods: A cross-sectional design was used. A thirty-three-item online cross-sectional survey was sent to nutrition support nurses in collaboration with national nutrition societies. The data were collected between November 2020 and August 2021. One-way ANOVA and chi-squared test were used to compare the three countries. Results: Eighty-one nurses completed the survey: 44 (54.4%) from Türkiye, 27 (33.3%) from the European countries, and 10 (12.3%) from the USA. All nurses in Türkiye reported having a clinical nutrition support team, while 88.8% in the European countries and 80% of nurses in the USA had this team (p=0.040). Significant differences were found in terms of nurses’ age, length of service, estimated number of ambulant nutritional consultations per week, and time spent on nutritional practices during work (p<0.001). The type of first-line test for nasogastric tube placement was X-ray confirmation (70%) in the US, whereas it is auscultation (77.2%) in Türkiye and pH-testing of gastric aspirate (81.4%) in the European countries (p<0.001). The most frequently reported professional challenge among nurses in Türkiye (66%) and the European countries (22.5%) was having no legal job title. Conclusion: These findings reflect the broader picture of nutrition nurses’ status and point out the need to develop standardized strategies for education and evidence-based nutrition practices. This study has revealed important differences in the roles and responsibilities of nutrition nurses. The study guides the future development needs of nutrition nurses, highlighting the standardized guidelines and protocols for nutrition practices and calling for comprehensive training programs.

Developmental Milestone Attainment in US Children Before and During the COVID-19 Pandemic

Restrictions related to the COVID-19 pandemic disrupted the lives of young children, but the association between the pandemic and any changes in early childhood developmental milestone achievement in the US remains unclear. To determine the association between the COVID-19 pandemic and changes in developmental screening scores among US children aged 0 to 5 years and to investigate whether caregivers self-reported more worries about their children or concerns about children's behavior during the pandemic, regardless of milestone achievement. This was a cohort study using an interrupted time series analysis comparing prepandemic (March 1, 2018, to February 29, 2020), interruption (March 1 to May 31, 2020), and intrapandemic (June 1, 2020, to May 30, 2022) periods among 50 205 children (randomly sampled from a population of 502 052 children) aged 0 to 5 years whose parents or caregivers completed developmental screening at pediatric visits at US pediatric primary care practices participating in a web-based clinical process support system. COVID-19 pandemic period. Age-standardized Ages and Stages Questionnaire, Third Edition (ASQ) domain scores (communication, personal-social, problem-solving, gross motor, fine motor), and rate of caregivers' concerns about the child's behavior or worries about the child as measured on the ASQ. A total of 50 205 children (25 852 [51.5%] male; mean [SD] age, 18.6 [16.0] months) and 134 342 ASQ observations were included. In adjusted models, significant age-specific mean score decreases from prepandemic to intrapandemic were observed in communication (-0.029; 95% CI, -0.041 to -0.017), problem-solving (-0.018; 95% CI, -0.030 to -0.006), and personal-social (-0.016; 95% CI, -0.028 to -0.004) domains. There were no changes in fine or gross motor domains prepandemic to intrapandemic. For infants aged 0 to 12 months, similar effect sizes were observed but only for communication (-0.027; 95% CI, -0.044 to -0.011) and problem-solving (-0.018; 95% CI, -0.035 to -0.001). After accounting for age-standardized ASQ scores, caregiver worries about the child increased slightly in the intrapandemic period compared with the prepandemic period (rate ratio, 1.088; 95% CI, 1.036-1.143), but there were no changes in caregiver concerns about the child's behavior. While changes in developmental screening scores were modest (2%-3%), nationwide, this could translate to more than 1500 additional recommended developmental referrals over baseline each month. Modest changes in developmental screening scores are reassuring in the short term but may tax an already overburdened developmental behavioral pediatrics infrastructure. Continued attention to developmental surveillance is critical since the long-term population- and individual-level implications of these changes are unclear.

Cystatin C Use for CKD Detection in the Veterans Health Administration System: A Qualitative Study of Barriers and Facilitators

Rationale & ObjectiveThe measurement of cystatin C has been recommended to enhance chronic kidney disease (CKD) detection and risk stratification in clinical practice. This study gathered insights into the perceptions and experiences of clinical staff regarding the use of cystatin C in CKD detection within the Veterans Health Administration (VHA) System. Study DesignA qualitative approach was employed to explore barriers and facilitators of clinical staff regarding the use of cystatin C in CKD detection within the VHA system. The Organizational Theory of Implementation Effectiveness informed the development of a semi-structured interview guide. Setting & ParticipantsHealthcare providers, nurses, and clinical pharmacists from the VHA systems in San Francisco, San Diego, and Houston were interviewed between October 2021 and May 2022. Analytical ApproachParticipant responses from individual interviews were analyzed by a multidisciplinary team using rapid qualitative analysis methods. ResultsFourteen in-depth interviews were conducted across the three VHA systems. Ten of eleven providers worked in primary care. Five key barriers to using cystatin C for CKD detection were identified. These included: lack of patient awareness of CKD testing, lack of provider awareness about cystatin C, knowledge barriers about cystatin C testing, unclear roles and ownership of CKD detection, and lack of clinic support to enhance CKD detection. Suggested interventions to overcome these barriers included educational and training programs, improved clinic workflows, and electronic health record aids to support CKD detection and use of cystatin C. LimitationsThe results may not be generalizable to other healthcare systems outside the VHA. ConclusionsFindings indicate a need for targeted interventions such as educational and training programs, improved clinical workflows, and electronic health record aids to address barriers limiting the use of cystatin C in clinical practice for enhanced CKD detection.

Proactive Polypharmacy Management Using Large Language Models: Opportunities to Enhance Geriatric Care.

Polypharmacy remains an important challenge for patients with extensive medical complexity. Given the primary care shortage and the increasing aging population, effective polypharmacy management is crucial to manage the increasing burden of care. The capacity of large language model (LLM)-based artificial intelligence to aid in polypharmacy management has yet to be evaluated. Here, we evaluate ChatGPT's performance in polypharmacy management via its deprescribing decisions in standardized clinical vignettes.We inputted several clinical vignettes originally from a study of general practicioners' deprescribing decisions into ChatGPT 3.5, a publicly available LLM, and evaluated its capacity for yes/no binary deprescribing decisions as well as list-based prompts in which the model was prompted to choose which of several medications to deprescribe. We recorded ChatGPT responses to yes/no binary deprescribing prompts and the number and types of medications deprescribed.In yes/no binary deprescribing decisions, ChatGPT universally recommended deprescribing medications regardless of ADL status in patients with no overlying CVD history; in patients with CVD history, ChatGPT's answers varied by technical replicate. Total number of medications deprescribed ranged from 2.67 to 3.67 (out of 7) and did not vary with CVD status, but increased linearly with severity of ADL impairment. Among medication types, ChatGPT preferentially deprescribed pain medications.ChatGPT's deprescribing decisions vary along the axes of ADL status, CVD history, and medication type, indicating some concordance of internal logic between general practitioners and the model. These results indicate that specifically trained LLMs may provide useful clinical support in polypharmacy management for primary care physicians.

Earlier laryngeal cancer detection using hybrid M-RCNN technique

One of the most common types of cancer is Laryngeal cancer, which has a high mortality rate. The primary malignant tumor responsible for this disease is squamous cell carcinoma (SCC). Early diagnosis is very important to avoid experiencing morbidity and mortality. Various tools and techniques are used to detect and monitor laryngeal cancers. Unfortunately, these tools and techniques have various limitations, for example, Existing tools and approaches Mask R-CNN for identifying laryngeal cancer have various performance limitations. These include the inability to accurately identify the disease in its early stages, the complexity of the computational environment, and the time-consuming process of conducting patient screenings by utilizing diverse image datasets, but it lagging to detect large dataset. In this paper, we present a hybrid deep-learning model which can be used to analyze and monitor the different symptoms of laryngeal cancers. Proposed model takes Laryngeal cancer dataset as input; preprocessing is done using median filter, then data augmentation is applied to increase data diversity, then feature extraction is performed using LBP-KNN, finally cancer identification/classification is done using Mask-RCNN. Proposed model attains Accuracy:99.3%; Precision:97.99%; Recall:98.09% and F-measure: 97.01%. This method could be useful in providing clinical support to radiologists and doctors. The proposed model can be used to detect minor malignancies in patients in a fast and accurate manner. It can also help improve the efficiency of the clinical process by allowing clinicians to screen more patients.

Clinical-academic positions that promote research activity and adoption of findings are dependent on clinical leadership support.

Clinical-academic positions that promote research activity and adoption of findings are dependent on clinical leadership support.

Availability and use of institutional support programs for emergency department healthcare personnel during the COVID-19 pandemic.

The COVID-19 pandemic placed health care personnel (HCP) at risk for stress, anxiety, burnout, and post-traumatic stress disorder (PTSD). To address this, hospitals developed programs to mitigate risk. The objectives of the current study were to measure the availability and use of these programs in a cohort of academic emergency departments (EDs) in the United States early in the pandemic and identify factors associated with program use. Cross-sectional survey of ED HCP in 21 academic EDs in 15 states between June and September 2020. Site investigators provided data on the availability of 28 programs grouped into 9 categories. Individual support programs included: financial, workload mitigation, individual COVID-19 testing, emotional (e.g., mental health hotline), and instrumental (e.g., childcare) Clinical work support programs included: COVID-19 team communication (e.g., debriefing critical incident), patient-family communication facilitation, patient services (e.g., social work, ethics consultation), and system-level exposure reduction. Participants provided corresponding data on whether they used the programs. We used generalized linear mixed models clustered on site to measure the association between demographic and facility characteristics and program use. We received 1,541 survey responses (96% response rate) from emergency physicians or advanced practice providers, nurses, and nonclinical staff. Program availability in each of the 9 categories was high (>95% of hospitals). Program use was variable, with clinical work support programs used more frequently (28-50% of eligible HCP across categories) than individual employee support programs (6-13% of eligible HCP across categories). Fifty-seven percent of respondents reported that the COVID-19 pandemic had affected their stress and anxiety, and 12% were at elevated risk for PTSD. Program use did not significantly differ for HCP who reported symptoms of anxiety and/or stress compared to those who did not. Early in the pandemic, support programs were widely available to ED HCP, but program use was low. Future work will focus on identifying barriers and facilitators to use and specific programs most likely to be effective during periods of highest occupational stress.

Sensemaking Process of Parents of Children with Autism Spectrum Disorder: Identification of Specific Clusters of “Sense of Grip”

AbstractAutism spectrum disorder (ASD) represents a pervasive neurodevelopmental disorder characterized by persistent atypicalities in social communication and social interactions across different domains of life, often with restricted, repetitive, stereotyped patterns of behaviors, interests, and activities. A large corpus of previous research shows that parental involvement in caregiving is perceived as stressful and challenging, in many cases resulting in poorer parental quality of life. The authors present a quali-quantitative mixed method research on sensemaking process of 34 parents (16 mothers and 18 fathers) of children with ASD. The interviews were collected and analyzed according to the “Sense of Grip” (SoG) methodology. SoG indeed refers to the sensemaking processes that a person realizes to manage the relationship with diseases or disorders by organizing several degrees of flexibility, differentiation, and adaptation to the variability of experiences and contexts of life. This construct of health psychology—semiotically and clinically oriented—is based on specific narrative functions (i.e., temporal, integrative, emotional, sharing, and agentive functions). The cluster analysis procedure allowed to identify three different SoG profiles: (a) enterprising (parents who are able to construct flexible and dynamic familiar routines), (b) opposing (parents who experience the ASD disorder as a deep unacceptable crisis, hindering the rest of familiar and professional activities), and (c) condescending (parents who organize family life completely on adherence to medical prescriptions and care protocols). These profiles show interesting implications for clinical practice and support as showing specific aspects of treating, managing, and sharing children conditions within family and relational contexts of life.

The socioeconomic epidemiology of inherited retinal diseases in Portugal

BackgroundInherited retinal diseases (IRDs) are a group of rare degenerative disorders of the retina that can lead to blindness from birth to late middle age. Knowing the target population and its resources is essential to better plan support measures. The aim of this study was to evaluate the socioeconomic characteristics of regions in Portugal where IRD patients reside to inform the planning of vision aid and rehabilitation intervention measures.ResultsThis study included 1082 patients from 973 families, aged 3 to 92 years, with a mean age of 44.8 ± 18.1 years. Patients living with an IRD were identified in 190 of the 308 municipalities. According to this study, the estimated IRD prevalence in Portugal was 10.4 per 100,000 inhabitants, and by municipalities, it ranged from 0 to 131.2 per 100,000 inhabitants. Overall, regions with a higher prevalence of IRD have a lower population density (r=-0.371, p < 0.001), a higher illiteracy rate (r = 0.404, p < 0.001) and an overall older population (r = 0.475, p < 0.001). Additionally, there is a lower proportion of doctor per capita (r = 0.350, p < 0.001), higher social security pensions beneficiaries (r = 0.439, p < 0.001), worse water quality for human consumption (r=-0.194, p = 0.008), fewer audiences at the cinema (r=-0.315, p < 0.001) and lower proportion of foreign guests in tourist accommodations (r=-0.287, p < 0.001).ConclusionThe number of identified patients with IRD varied between regions. Using data from national statistics (PORDATA), we observed differences in socioeconomic characteristics between regions. Multiple targeted aid strategies can be developed to ensure that all IRD patients are granted full clinical and socioeconomic support.

Intelligent Differentiation Framework for Lewy Body Dementia and Alzheimer’s disease using Adaptive Multi-Cascaded ResNet–Autoencoder–LSTM Network

In recent years, most of the patients with dementia have acquired healthcare systems within the primary care system and they also have some challenging psychiatric and medical issues. Here, dementia-based symptoms are not identified in the primary care center, because they are affected by various factors like psychological symptoms, clinically relevant behavior, numerous psychotropic medications, and multiple chronic medical conditions. To enhance the healthcare-related applications, the primary healthcare system with additional resources like coordination with interdisciplinary dementia specialists, feasible diagnosis, and screening process need to be improved. Therefore, the differentiation between Alzheimer’s Disease (AD) and Lewy Body Dementia (LBD) has been acquired to provide the best clinical support to the patients. In this research work, the deep structure depending on AD and LBD systems has been implemented with the help of an adaptive algorithm to provide promising outcomes over dementia detection. Initially, the input images are collected from online sources. Thus, the collected images are forwarded to the newly designed Multi-Cascaded Deep Learning (MSDL), where the ResNet, Autoencoder, and weighted Long-Short Term Memory (LSTM) networks are serially cascaded to provide effective classification results. Then, the fully connected layer of ResNet is given to the Autoencoder structure. Here, the output from the encoder phase is optimized by using the Adaptive Water Wave Cuttlefish Optimization (AWWCO), which is derived from the Water Wave Optimization (WWO) and Cuttlefish Algorithm (CA), and the resultant selected output is fed to the weight-optimized LSTM network. Further, the parameters in the MSDL network are optimized by using the same AWWCO algorithm. Finally, the performance comparison over different heuristic algorithms and conventional dementia detection approaches is done for the validation of the overall effectiveness of the suggested model in terms of various estimation measures.

Fast Healthcare Interoperability Resources-Based Support System for Predicting Delivery Type: Model Development and Evaluation Study.

The escalating prevalence of cesarean delivery globally poses significant health impacts on mothers and newborns. Despite this trend, the underlying reasons for increased cesarean delivery rates, which have risen to 36.3% in Portugal as of 2020, remain unclear. This study delves into these issues within the Portuguese health care context, where national efforts are underway to reduce cesarean delivery occurrences. This paper aims to introduce a machine learning, algorithm-based support system designed to assist clinical teams in identifying potentially unnecessary cesarean deliveries. Key objectives include developing clinical decision support systems for cesarean deliveries using interoperability standards, identifying predictive factors influencing delivery type, assessing the economic impact of implementing this tool, and comparing system outputs with clinicians' decisions. This study used retrospective data collected from 9 public Portuguese hospitals, encompassing maternal and fetal data and delivery methods from 2019 to 2020. We used various machine learning algorithms for model development, with light gradient-boosting machine (LightGBM) selected for deployment due to its efficiency. The model's performance was compared with clinician assessments through questionnaires. Additionally, an economic simulation was conducted to evaluate the financial impact on Portuguese public hospitals. The deployed model, based on LightGBM, achieved an area under the receiver operating characteristic curve of 88%. In the trial deployment phase at a single hospital, 3.8% (123/3231) of cases triggered alarms for potentially unnecessary cesarean deliveries. Financial simulation results indicated potential benefits for 30% (15/48) of Portuguese public hospitals with the implementation of our tool. However, this study acknowledges biases in the model, such as combining different vaginal delivery types and focusing on potentially unwarranted cesarean deliveries. This study presents a promising system capable of identifying potentially incorrect cesarean delivery decisions, with potentially positive implications for medical practice and health care economics. However, it also highlights the challenges and considerations necessary for real-world application, including further evaluation of clinical decision-making impacts and understanding the diverse reasons behind delivery type choices. This study underscores the need for careful implementation and further robust analysis to realize the full potential and real-world applicability of such clinical support systems.