Conditions In Patients Research Articles

COVID-19: Disease, management, treatment, and social impact

COVID-19 was originated from Wuhan city of Hubei Province in China in December 2019. Since then it has spread in more than 210 countries and territories. It is a viral disease due to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. The patients show flu-like symptoms with a dry cough, sore throat, high fever, and breathing problems. The disease due to SARS-CoV-2 was named as COVID-19. About 2.2 million people have been infected with more than 0.15 million deaths globally. The United States of America is the most affected country with the highest patients of about 0.7 million. Despite great efforts, there is no treatment of this disease. However, prevention and management are the best options. This article describes SARS-CoV-2, disease, prevention and management, treatment and social impact on society. It was analyzed that a combination of antiviral drugs with hydroxyl-chloroquine and azithromycin (with the consultation of a medical practitioner) may be the best option to treat the patients, depending on the patient's conditions and symptoms. However, Unani therapy may be useful along with allopathic treatment. It is urgently advised and requested that all the persons should follow the preventive measures, managements and quarantine strictly without any religious discrepancy otherwise the situation may be the worst. Also, there is an urgent requirement to educate our new generation for science and technology to fight against any such disaster in future; if any. There is no need to be panic and proper prevention and management are essential to combat this disease. This article may be useful to create awareness among the public, to prevent, manage and treat COVID-19.

Diseño, modelado 3D y optimización del comportamiento mecanoacústico de un nuevo tubo de ventilación transtimpánico

Introducción y Objetivos: En este trabajo mostramos un nuevo tubo de ventilación transtimpánico cuyo diseño pretende solventar los efectos indeseables aparecidos durante la inserción de tubos de ventilación actualmente comercializados; analizamos su comportamiento mecánico en un modelo 3D del oído a fin de optimizar su comportamiento acústico. Métodos: Para el diseño del tubo se empleó un software autoCAD; El comportamiento mecánico se analizó en un modelo computadorizado dinámico 3D del oído humano basado en el método de los elementos finitos (FEM). Resultados: El nuevo tubo de ventilación posee un tamaño y una masa significativamente menores a los actualmente disponibles en el mercado lo que provoca un menor interferencia en la vibración del sistema tímpano-osicular; su diseño facilita que permanezca insertado mientras las condiciones del paciente así lo aconsejen evitando su caída hacia la caja o su precoz extrusión. Conclusiones: Las ventajas teóricas biológicas y acústicas del nuevo tubo desarrollado (con menor masa y cuyo diseño evita las complicaciones de los actuales) puede abrir una nueva posibilidad de tratamiento de la otitis media seromucosa crónica.

Neurocritical Management of Traumatic Acute Subdural Hematomas.

Acute subdural hematoma (ASDH) has been a major part of traumatic brain injury. Intracranial hypertension may be followed by ASDH and brain edema. Regardless of the complicated pathophysiology of ASDH, the extent of primary brain injury underlying the ASDH is the most important factor affecting outcome. Ongoing intracranial pressure (ICP) increasing lead to cerebral perfusion pressure (CPP) decrease and cerebral blood flow (CBF) decreasing occurred by CPP decrease. In additionally, disruption of cerebral autoregulation, vasospasm, decreasing of metabolic demand may lead to CBF decreasing. Various protocols for ICP lowering were introduced in neuro-trauma field. Usage of anti-epileptic drugs (AEDs) for ASDH patients have controversy. AEDs may reduce the risk of early seizure (<7 days), but, does not for late-onset epilepsy. Usage of anticoagulants/antiplatelets is increasing due to life-long medical disease conditions in aging populations. It makes a difficulty to decide the proper management. Tranexamic acid may use to reducing bleeding and reduce ASDH related death rate. Decompressive craniectomy for ASDH can reduce patient's death rate. However, it may be accompanied with surgical risks due to big operation and additional cranioplasty afterwards. If the craniotomy is a sufficient management for the ASDH, endoscopic surgery will be good alternative to a conventional larger craniotomy to evacuate the hematoma. The management plan for the ASDH should be individualized based on age, neurologic status, radiologic findings, and the patient's conditions.

Bariatric procedure selection in patients with type 2 diabetes: choice between Roux-en-Y gastric bypass or sleeve gastrectomy.

Guiding patients with type 2 diabetes (T2D) toward the most appropriate bariatric and metabolic procedure is crucial for improving outcomes. In recent years, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have been the most commonly performed bariatric procedures worldwide. Both are safe, effective, and durable metabolic procedures. The aim of this review was to critically examine the best available evidence derived from the randomized clinical trials (RCTs) to identify which bariatric procedure is superior in an individual with T2D to provide sustainable long-term remission. There are 4 RCTs in patients with T2D that directly compare RYGB with SG, report outcomes up to 5 years after randomization, and provide level I evidence for procedure selection. While the remission rate of T2D after RYGB versus SG is comparable in all 4 RCTs, all studies are underpowered to reveal differences in T2D-related endpoints between these 2 procedures. Combined analysis of RCTs (RYGB, n = 176 versus SG, n = 175) would indicate that either there is no significant long-term difference between RYGB and SG in improving T2D, or in case of a true difference (and we still do not have enough statistical power to reveal the difference), that difference would be <15% favoring RYGB. Prediction tools, such as the individualized metabolic surgery score, can identify patients who can benefit the most from the antidiabetic effects of RYGB. Nonetheless, the procedure selection should not be solely based on T2D-related outcomes. Diabetes is one outcome; one of many outcomes that needs to be considered in decision-making. Patient's conditions and clinical outcomes that are critical in choosing the most optimal bariatric and metabolic procedure will also be explained in this review.

PENGARUH TINDAKAN MOBILISASI DINI TERHADAP DENYUT JANTUNG DAN FREKUENSI PERNAPASAN PADA PASIEN KRITIS DI ICU RSUD SLEMAN YOGYAKARTA

Background: Patients with critical conditions in the ICU depend on a variety of tools to support their lifes. Patients’ conditions and and their unstable hemodynamic are challenges for nurses to perform mobilization. Less mobilization in critical patients can cause a variety of physical problems, one of them is cardiorespiratory function disorder.&#x0D; Objective: to investigate differences in heart rate (HR) and respiratory rate (RR) before, during, and immediately after early mobilization.&#x0D; Methods: This study employed quasi experiment with one group pre and post test design. Twenty four respondents were selected based on the criteria HR &lt;110 / min at rest, Mean Arterial Blood Pressure between 60 to 110 mmHg, and the fraction of inspired oxygen &lt;0.6. Early mobilization was performed to the respondents, and followed by assessments on the changes of respiratory rate and heart rate before, during, and immediately after the mobilization. Analysis of differences in this study used ANNOVA.&#x0D; Results: Before the early mobilization, mean RR was 22.54 and mean HR was 78.58. Immediately after the mobilization, mean RR was 23.21 and mean HR was 80.75. There was no differences in the value of RR and HR, before and immediately after the early mobilization with the p-value of 0.540 and 0.314, respectively.&#x0D; Conclusions: Early mobilization of critical patients is relatively safe. Nurses are expected to perform early mobilization for critical patients. However, it should be with regard to security standards and rigorous assessment of the patient's conditions.&#x0D; Keywords: Early mobilization, critical patients, ICU

Patient Monitor for SpO2 and Temperature Parameters

Patient monitor is an apparatus used to monitor the patient's condition in real-time, hence the patient's physiological conditions can be identified at that time. The purpose of this study is to design a patient monitor for SpO2 and temperature parameters based on computer with Delphi progaming. In this work, the author developed patient monitor with two parameters (SpO2 and Temperature). The workings of this tool are very simple by installing the finger sensor on the finger and the temperature sensor in the armpit area will then be detected by the two sensors that will be displayed on the PC and LCD Characters, analog data from the ADC Atmega is received by the personal computer (PC) via Bluetooth HC -05 and values ​​per parameter are also displayed on the Character LCD. After measuring, get an error in the tool, the biggest SpO2 error of this tool is 1.02% and get the smallest error of 0.8%. And for the biggest error of Temperature of 1.02% and the smallest error of 0.8%.

What approaches to social prescribing work, for whom, and in what circumstances? A realist review.

The use of non‐medical referral, community referral or social prescribing interventions has been proposed as a cost‐effective alternative to help those with long‐term conditions manage their illness and improve health and well‐being. However, the evidence base for social prescribing currently lags considerably behind practice. In this paper, we explore what is known about whether different methods of social prescribing referral and supported uptake do (or do not) work. Supported by an Expert Advisory Group, we conducted a realist review in two phases. The first identified evidence specifically relating to social prescribing in order to develop programme theories in the form of ‘if‐then’ statements, articulating how social prescribing models are expected to work. In the second phase, we aimed to clarify these processes and include broader evidence to better explain the proposed mechanisms. The first phase resulted in 109 studies contributing to the synthesis, and the second phase 34. We generated 40 statements relating to organising principles of how the referral takes place (Enrolment), is accepted (Engagement), and completing an activity (Adherence). Six of these statements were prioritised using web‐based nominal group technique by our Expert Group. Studies indicate that patients are more likely to enrol if they believe the social prescription will be of benefit, the referral is presented in an acceptable way that matches their needs and expectations, and concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if the activity is both accessible and transit to the first session supported. Adherence to activity programmes can be impacted through having an activity leader who is skilled and knowledgeable or through changes in the patient's conditions or symptoms. However, the evidence base is not sufficiently developed methodologically for us to make any general inferences about effectiveness of particular models or approaches.

Electrophoretically assembly of silk fibroin coatings from different pre‐assembled nanostructures on dental abutment to tune the release of antibiotics

Background Constructing coatings on dental abutment surfaces via electrophoretic deposition (EPD) technique is highly appealing strategy to act as a reservoir to release therapeutic antibiotics for patients with serious periodontal disease or diabetes. Previous studies attempt to incorporate various drug delivery vehicles into EPD matrix to control drug release. However, these methods lead to formation of new substances or use of additional chemicals, which could often cause concerns on biosafety and cost. Aim/Hypothesis We hypothesize that deposition of controlled pre-assembled nanostructures of EPD matrix, instead of SF (silk fibroin) molecule solution, would provide more control over drug release. Material and Methods 2% wt SF solution was obtained by dissolving cocoons in saturated LiBr solution. 2wt% SF nanospheres were synthesized via precipitation reaction. Different EPD matrix solutions of 2 wt% were made by mixing SF molecule with SF nanospheres at different weight ratios of 0%, 25%, 50%, 75%, 100%. We coated these EPD matrixes on titanium disks by EPD technique, and they were denoted as SF0, SF25, SF50, SF75 and SF100, respectively. We characterized the surface properties of these coatings, including conformations, topography, roughness, adhesion strength, wettability, and degradation. Doxycycline was applied as a model antibiotic drug. The release kinetics of doxycycline from different coatings was monitored by means of high-performance liquid chromatography (HPLC). P. gingivalis and minimum inhibition concentration (MIC) tests were used to show antibacterial bioactivity of released doxycycline at different time points. Fibroblasts were cultured on coatings to evaluate their biocompatibility. Results Through optimization, different SF coatings with different composition of pre-assembled nanostructures were deposited on titanium disks. With increasing the weight ratio of nanospheres, the roughness of the coatings ascended, and the adhesion strength decreased. The b-sheet content of SF conformations, wettability, degradation rates and biocompatibility of the coatings were comparable among all groups. When there were more pre-assembled nanospheres inside the coatings, the release time of doxycycline could gradually change from 3 day to 3 weeks measured by HPLC, whose antibacterial bioactivity was consistent with the results of MIC. Conclusion and Clinical Implications We proposed a novel strategy to electrophoretically assembly SF coatings from different pre-assembled nanostructures. This strategy largely enhanced the control release capability of drug without formation of new substances or use of additional chemicals. This study not only constitutes a straightforward approach to control antibiotics’ release from abutment to deal with different patient's conditions, but also opens up a new insight for the development of EPD coating based drug release system.

Added value of [18F]fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of post-operative instrumented spine infection.

Post-operative instrumented spine infection (PISI) is an infrequent complication. Diagnosis of spinal implant infection can be difficult, especially in case of chronic infection. This retrospective study attempts to evaluate the diagnostic performance of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in PISI. Imagings were performed between April 2010 and June 2018 among patients referred for suspected chronic spinal implant infection. PET/CT were performed more than 12 weeks after surgery. PET/CT images were re-interpreted independently by two nuclear medicine physicians without knowledge of the patient's conditions. PET/CT data were analyzed both visually and semi-quantitatively (SUVmax). MRI results were collected from medical records. The final diagnosis of infection was based on bacteriological cultures or a twelve-month follow-up. Forty-nine PET/CT were performed in 44 patients (22 women, median age 65.0 years). Twenty-two patients had a diagnosis of infection during follow-up. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for PET/CT were 86.4%, 81.5%, 79.2%, and 88.0%. Sensitivity, specificity, PPV and NPV were 66.7%, 75.0%, 66.0%, 75.0% respectively for MRI and 50.0%, 92.6%, 84.6% and 69.4% for serum C-reactive protein (CRP). Although these values were higher for PET/CT than for MRI or CRP, the differences were not statistically significant. In this setting, false positives with PET/CT can be observed in case of previous spine infection or adjacent segments disc disease. False negatives can result of extensive instrumented arthrodesis or infection with low virulence bacteria. PET/CT is useful for the diagnosis of PISI. These results should be evaluated in further prospective study.

Caracterização dos incidentes de quedas de pacientes adultos internados em um hospital universitário

To evaluate the occurrences and to characterize the falling incidents of adult patients hospitalized in clinical and surgical units of a university hospital in the southern region of the country, in the period from 2011 to 2014. Descriptive, cross-sectional and retrospective study, carried out from December 2016 to December 2017. The sample consisted of 1112 reports, covering all hospitalized patients who were notified with falls occurring in the studied period. Data were analyzed using descriptive and analytical statistics. Female and elderly patients were predominant in the sample, in which 69.4% of the incidents did not present any damage. The occurrence of falls was significantly higher at night. Limitation to walking and being unaccompanied were the most prevalent factors in the patient's conditions before the fall. The fall is a multifactorial event that requires periodic evaluation of the risk factors by the team to plan their prevention.

Amyand hernia: A case report and literature review

Amyand hernia is a rare form of inguinal hernia wherein the appendix is in the hernial sac. Moreover, the incidence of Amyand hernia is reportedly three times higher in children than in adults. Here, we report a case of Amyand hernia in the right groin of a 55-year-old patient admitted to our hospital. We describe our approach to the diagnosis and treatment of Amyand hernia in this case. Altogether, we conclude that reasonable individualized diagnosis and treatment for Amyand hernia according to the patient's conditions is warranted in such cases.

A Multi-Criteria 2-Tuple Linguistic Group Decision-Making Method Based on TODIM for Cholecystitis Treatments Selection

Cholecystitis is a common disease with a high incidence, and attracts much attention. It not only harms human health, but also affects quality of work and life. Therefore, the choice of a suitable treatment is badly important for patients. In this paper, a novel selection model of treatments for cholecystitis based on hybrid multiple-criteria group decision-making (MCGDM), which is helpful to choose the most suitable treatment in the case of asymmetric information between doctors and patients. Subsequently, subjective and objective criteria are comprehensively taken into account in the index system of the selection model for cholecystitis, and combines 2-tuple linguistic with quantitative data analysis. Besides, the evaluation information obtained from the patient's conditions, the treatment and the hospital's medical status, etc., including real numbers, interval numbers, and linguistic labels with multi-granularity, is more complete and real. And the 2-tuple linguistic model is used to unify the non-homogeneous information, so the treatment selection is accurate and reliable. Simultaneously, for the unknown index and criteria weight, the improved entropy weight method and the BWM (best-worst-method) are utilized to figure out the index weight and criteria weight, respectively. Further, TODIM (an acronym in Portuguese for interactive and multi-criteria decision-making model) method based on the prospect theory is applied to solve the prioritization of cholecystitis treatments, and give full consideration to the decision maker of risk aversion. Eventually, an empirical study of treatment selection for cholecystitis is conducted. Sensitivity analysis and comparative analysis indicate that the proposed selection model of treatments for cholecystitis patients is reliable and effective.

Iranian nurses' perceptions of the conditions of the families with terminally ill patients: Family in limbo

Background: Understanding the conditions of terminally-ill patients' family members is the first step in reducing their emotional distress. Objectives: The aim of this study was to explore nurses' perceptions of the conditions of terminally ill patients' families. Methods: This qualitative content analysis study was conducted in 2016–2017. Participants were 24 nurses purposively recruited from 14 hospitals in Tehran, Iran. Data were collected through semi-structured interviews and analyzed through conventional content analysis. Results: Participants' perceptions were categorized into two main categories, namely, behavioral and emotional turmoil and perceived worries. The two subcategories of the first category were family turmoil after receiving bad news and family members' violent behaviors after receiving bad news. The second category included four subcategories, namely, feeling guilty, worries about patient's fate, worries about the aggravation of patient's conditions, and financial worries. The main theme of the study was family in limbo. Conclusion: Terminally ill patients' family members are in limbo due to behavioral and emotional turmoil and different worries. Nurses can use the findings of this study to help terminally ill patients' family members undergo a healthy grief.

Acute Esophageal Necrosis: The Black Hole of Endoscopy

Acute esophageal necrosis (AEN) is a rare condition that appears as circumferential necrotic mucosa of the distal esophagus. With a prevalence of 0.2% in autopsy series and 0.001-0.2% in endoscopy series, little is known about the etiology of AEN. What we do know is that AEN has a 4:1 predilection to males and the mean age of diagnosis is 68 years. Many of the patients previously described had multiple comorbid conditions that include but were not limited to ischemia, malnutrition, vascular diseases, diabetes mellitus, and septic shock. With a mortality rate of 13-35%, further knowledge of AEN and recommended management is essential. We present a case of a 94 year old male with a past medical history of hypertension, hyperlipidemia, acute on chronic renal disease, COPD, anemia, and previous CABG s/p stenting and heart valve repair that was admitted to the hospital for urosepsis, failure to thrive, and hyperkalemia. Hemoglobin upon admission was 11.8 and WBC was elevated at 13.3. Lactic acid remained within normal limits. On day 3, the gastroenterology service was consulted for dysphagia and failed MBS to evaluate for PEG placement, which was denied by the patient's proxy. On day 4, the patient's condition significantly deteriorated and he aspirated. Nasogastric tube was subsequently placed and 200 cc of bloody gastric contents were suctioned. The patient's hemoglobin dropped from 12.0 to 10.4 overnight. A KUB was performed and showed no acute findings. The patient was started on PPI and Octreotide drips. Urgent endoscopy revealed grossly black appearing mucosa in the upper, mid, and lower esophagus consistent with necrosis. Stomach and duodenum revealed antral gastritis and multiple large, clean-based ulcers in the duodenal bulb with no active bleeding respectively. The patient was continued on protonix and octreotide drips and kept NPO. The patient passed away the following day. This patient presented with many of the risk factors described in AEN. Unfortunately, with his rapid decline, management in this case was highly limited. In general, AEN management focuses on intravenous fluid resuscitation, PPI therapy, and treatment of the patient's comorbid conditions. Early endoscopic detection is essential in order to begin prompt treatment of the patient's comorbidities that could potentiate a case of AEN.1744_A Figure 1. Diffuse and circumferential necrosis of the esophagus1744_B Figure 2. Diffuse and circumferential necrosis of the esophagus1744_C Figure 3. Diffuse and circumferential necrosis of the esophagus

Medical and Economical Effects by Introducing Helicopter Emergency Medical Service (HEMS) in Toyama Prefecture, Japan

Introduction As well as other countries, helicopter emergency medical service (HEMS) with physicians is one of the most important medical resources for emergency medical services in Japan. In previous studies, however, the effectiveness of HEMS has remained controversial. The aims of this study are to analyze the medical and economical effectiveness of HEMS as an example using database of HEMS of Toyama Prefecture in Japan. And factors affected to patient's outcome, survival after transported to hospital, were also analyzed. Methods We used database of HEMS of Toyama that registered all HEMS transported patient's records. The period in the analysis is from September 1, 2015 to March 31, 2017. Among them, we use patients with serious conditions and following data were excluded in advance; 1) patients diagnosed with cardiopulmonary arrest when the helicopter arrived, 2) patients requested from Tateyama Fire Department, because requests dispatch HEMS from Tateyama mountain range area are considered special cases, and thus not applicable for analysis with other requests, 3) patients transported from hospital to other hospital. To clarify the medical effectiveness, we compared transport time and survival rate of HEMS with grand medical emergency services (GEMS). Transport time was defined as time from receiving a call for emergency to start of physician treatment. Transport time of HEMS was measured from receiving a call for emergency to physician's contact on scene. Transport time of GEMS was estimated time of from receiving a call for emergency to arrival at hospital by emergency medical technicians, referring a web map server, if patients had been transferred by ambulance. Survival was defined according with patient's condition during three month from the onset. We compared survival by HEMS and expected survival by GEMS assuming the same period. The cost effectiveness was calculated by exogenous and endogenous diseases respectively by using following formulation; number of life years by 67 year-old from the onset was counted each patient, then total life years of each disease category were summed up. Next, total quality adjustment life years (QALYs) were calculated using the utility value, which mean patients' quality of life in extended life, e.g., recover is 1, disability is 0.5, and dead is 0. Total cost of each disease category was calculated by multiplying both overall QALYs and cost per year. The cost effectiveness of each disease category was finally summed up to obtain the overall cost -effectiveness. Lastly, factors affected on patient's outcome were analyzed. Death was defined as main outcome. Simple binary logistic regression was used to run a multivariate analysis on confounding variables of the differences of transport time between helicopter and ambulance, disease category, gender and age. Results Ultimately, 263 subjects were conducted in the study, including those with exogenous disease (e.g., trauma, n=75 and other, n=9) and endogenous disease (e.g., stroke, n=62 and other, n=117). HEMS had shortened transport time approximately 17 mins. HEMS improved outcome 25 % of whole patients. The overall cost-effectiveness of HEMS is estimated 15 million dollars, which is 10 million dollars per a year. According to the logistic regression analysis, reducing transport time by transferring with helicopter showed low mortality (odds 0.89, 95% interval confidence 0.77-0.98). Conclusion Based on this study, HEMS of Toyama showed effective medical and economical effects. HEMS staff recognize that early treatments and rapid transports improve patient's outcome. In case of Toyama, HEMS staff effort to contact patients rapidly, and start critical treatments as soon as possible after arrival on scene, and to minimum the staying time. Moreover, all hospitals in Toyama receive patients for treating optimal care immediately along with patient's conditions. Those efforts could lead to the result.

Orbital decompression for thyroid associated ophthalmopathy: transnasal endoscopic approach or external orbital approach?

External orbital decompression, including medial wall, inferior wall, lateral wall and orbital fat decompression alone or in combination, has long been considered to be the standard treatment for thyroid related eye diseases. Deep lateral wall orbital decompression has better effect in the balance of eye position, correction of serious exophthalmos and severe oppression optic neuropathy. Recently, however, endoscopic orbital decompression is becoming increasingly popular with the development of endoscopic surgery technique in naso-orbit related diseases. Endoscopic orbital decompression has the advantages of avoiding an external incision scar. Nevertheless, the new method also has some disadvantages, for example, application limited to medial and inferior orbital wall orbital decompression, high incidence of esotropia, need for external lateral wall decompression and expensive cost for equipment. Both surgical approaches have advantages and disadvantages respectively for medial wall and inferior wall decompression. The operative result depends on the individualized surgical design and the experience of the surgeon rather than the choice of the surgical approach. As a result, the choice of the surgical approaches should be specifically based on the patient's conditions, patient's acceptance of the operation, experience of the surgeon and available resources. (Chin J Ophthalmol, 2018, 54: 484-487).

Should we calculate or measure energy expenditure? practical aspects in the ICU.

Indirect calorimetry is currently a gold standard of resting energy expenditure (REE) assessment in critically ill patients. Many predictive equations of energy expenditure have been proved to imprecisely predict REE and lead to under- or overfeeding. The benefits of indirect calorimetry-guided nutrition therapy rather than calculation-based strategy have been demonstrated in randomized controlled trials. To minimize energy debt in the intensive care unit, we support early enteral feeding. REE should be measured as soon as the patient's conditions allow and the target of delivered calorie should be around 0.7 to 1 of measured REE to avoid overfeeding. The supplemental parenteral nutrition should be prescribed to close the caloric gap if the goal is not reached by enteral nutrition alone.

Perception of family caregivers about barriers of leisure in care of individuals with chronic psychiatric disorders: a qualitative study.

BackgroundFamily caregivers of individuals with chronic psychiatric disorders play an important role in the management of the patient’s conditions, which interferes with other activities of daily living, work, social and leisure activities.ObjectiveThis study was conducted in an Iranian context to explore the perception of family caregivers about barriers of leisure in care of individuals with chronic psychiatric disorders.MethodsThe current qualitative study was conducted on the basis of conventional content analysis. Participants were 15 family caregivers of individuals with chronic psychiatric disorders who were selected by Purposeful sampling method between July 2016 and March 2017 in Tehran, Iran. The data was collected via in-depth semi-structured interviews. The interviews were tape recorded, written and transcribed. Then, data were analyzed by inductive content analysis method.ResultsData analysis led to extraction of 3 main categories and 10 sub categories. Obstacles to leisure-time of family caregivers have been placed in three main categories which are patient-related factors (Resentment from psychological problems, Resentment from behavioral problems, Need for continuous monitoring and access), caregiver-related factors (Physical harm, Psychosocial harm, Temporal stress, Accumulation of responsibilities, Concerns), and community-related factors (Feeling of sympathy and rejection, Social stigma).ConclusionUnderstanding the barriers of leisure in this group of family caregivers has contributed to understanding the family caregivers’ perception in this area and regarding their leisure, it can provide a broader perspective to mental health therapists, rehabilitation managers and policy makers for understanding the needs, addressing the challenges and barriers of this group of family caregivers.

Conversion between 2 military combat-related injury coding systems.

Deployable medical systems(DEPMEDS) patient conditions (PCs) and Military Combat Injury Scale (MCIS) are 2 important military medical coding systems. However, both of them have defects when applied in military medical planning. Although each PC code contains information about treatment, intensity of care, treatment time, length of stay, and probability of disposition that is relevant to simulation, its description is too comprehensive and ambiguous to code historical military medical records. Therefore, conversion between PC and other medical coding systems applied in standard medical data is required when validity is required following simulation. The information linked to each PC code is based on subject matter expert opinion instead of standard medical data from the theater that need to be continuously updated depending on the results of medical data analysis. MCIS, a combat-related injury coding system, shows significant promise in coding real medical data, but it does not seek detailed information important for prediction and simulation unlike PCs. Therefore, MCIS cannot be used in planning tools directly. Thus, the effort to map MCIS to PCs is significant for medical logistic planning. We aim to identify whether conversion between PCs and MCIS is possible and to evaluate inter-coder reliability.Three senior coders assigned all possible MCIS codes to 187 combat-related PC codes. The data records were structured based on an earlier study. Inter-rater reliability was measured by using Cohen's k statistic and percent agreement.Low inter-rater reliability indicated the difficulty in conversion between PCs and MCIS.The injury descriptors of PCs should be expanded by referring to new standard medical data. The existing MCIS codes need to be modified to include more information on treatment brief, treatment time, length of stay, and other key information, and historical data statistics need to be developed.

Bayesian averaging over Decision Tree models for trauma severity scoring.

Health care practitioners analyse possible risks of misleading decisions and need to estimate and quantify uncertainty in predictions. We have examined the "gold" standard of screening a patient's conditions for predicting survival probability, based on logistic regression modelling, which is used in trauma care for clinical purposes and quality audit. This methodology is based on theoretical assumptions about data and uncertainties. Models induced within such an approach have exposed a number of problems, providing unexplained fluctuation of predicted survival and low accuracy of estimating uncertainty intervals within which predictions are made. Bayesian method, which in theory is capable of providing accurate predictions and uncertainty estimates, has been adopted in our study using Decision Tree models. Our approach has been tested on a large set of patients registered in the US National Trauma Data Bank and has outperformed the standard method in terms of prediction accuracy, thereby providing practitioners with accurate estimates of the predictive posterior densities of interest that are required for making risk-aware decisions.