Current Health Care System Research Articles

2.56 Understanding Pediatric Mental Health in Primary Care: Needs in a Rural State

2.56 Understanding Pediatric Mental Health in Primary Care: Needs in a Rural State

Current state of antimicrobial stewardship and organ transplantation in Saudi Arabia.

Antimicrobial resistance constitutes a major public health issue that leads to poor outcomes and increased costs associated with healthcare. Solid organ transplant recipients are more prone due to prolonged exposure to antimicrobials. We reviewed existing programs in the Kingdom of Saudi Arabia and pattern of drug resistance, and the extent of transplant medicine in the kingdom through published articles in databases and official documents from health authorities. A national committee for antimicrobial resistance (AMR) was established to set the guidelines required for an antimicrobial stewardship program (ASP), especially when there is a high prevalence of AMR. A survey noted that ASPs are implemented in only 26% of Saudi Ministry of Health hospitals. Factors affecting the implementation of ASPs in Saudi hospitals included a lack of necessary staff resources and specific ASP staff/teams to advocate adopting ASP in the organizations. Specific attention should be given to transplant patients as transplantations are expected to increase in the next few years. No antimicrobial stewardship programs are currently specifically tailored to transplant centers. The current healthcare system transformation in Saudi Arabia should take into consideration the urgent need for effective ASP that might help face the increasing trends in the multidrug-resistant organisms (MDRO) prevalence rate.

Healthcare Management of Human African Trypanosomiasis Cases in the Eastern, Muchinga and Lusaka Provinces of Zambia.

Human African trypanosomiasis (HAT) is a neglected tropical disease that has not received much attention in Zambia and most of the countries in which it occurs. In this study, we assessed the adequacy of the healthcare delivery system in diagnosis and management of rHAT cases, the environmental factors associated with transmission, the population at risk and the geographical location of rHAT cases. Structured questionnaires, focus group discussions and key informant interviews were conducted among the affected communities and health workers. The study identified 64 cases of rHAT, of which 26 were identified through active surveillance and 38 through passive surveillance. We identified a significant association between knowledge of the vector for rHAT and knowledge of rHAT transmission (p < 0.028). In all four districts, late or poor diagnosis occurred due to a lack of qualified laboratory technicians and diagnostic equipment. This study reveals that the current Zambian healthcare system is not able to adequately handle rHAT cases. Targeted policies to improve staff training in rHAT disease detection and management are needed to ensure that sustainable elimination of this public health problem is achieved in line with global targets.

Key stakeholders' experiences and expectations of the care system for individuals affected by borderline personality disorder: An interpretative phenomenological analysis towards co-production of care.

BackgroundThe diagnosis of borderline personality disorder (BPD) consists of extreme emotional dysregulation and long-term disability when left untreated. It is associated with ineffective use of health care systems and mismanaged care in emergency departments, which can result in a revolving door phenomenon of urgent system usage, poor treatment outcomes, or patients falling out of care entirely–all of which primarily affect patients with BPD as well as their caregivers and clinicians. This crisis must be addressed with a comprehensive understanding of key stakeholder perspectives on the challenges of the system and potential solutions.ObjectiveThis study explored the perspectives of three key stakeholder groups (i.e., patients, clinicians, and caregivers) in relation to their experiences with and future expectations of the care system for those affected by BPD.MethodsFour patients with BPD, three generalist clinicians with experience treating BPD, and three caregivers of individuals with BPD participated in individual semi-structured interviews. Participants were asked about their experiences with the current healthcare system and their suggestions for improvement. Responses were analyzed using interpretative phenomenological analysis.FindingsIn-depth analysis of the qualitative data revealed twelve shared themes and three themes that were unique to each key stakeholder group. These themes are discussed and used to inform recommendations for promising practices, policies, and training in this area.ConclusionFindings support the importance of a comprehensive mental health system approach for improving the accessibility, effectiveness, and acceptability of the management and treatment of BPD.

HealthGuard: An Intelligent Healthcare System Security Framework Based on Machine Learning

Utilization of the Internet of Things and ubiquitous computing in medical apparatuses have “smartified” the current healthcare system. These days, healthcare is used for more than simply curing patients. A Smart Healthcare System (SHS) is a network of implanted medical devices and wearables that monitors patients in real-time to detect and avert potentially fatal illnesses. With its expanding capabilities comes a slew of security threats, and there are many ways in which a SHS might be exploited by malicious actors. These include, but are not limited to, interfering with regular SHS functioning, inserting bogus data to modify vital signs, and meddling with medical devices. This study presents HealthGuard, an innovative security architecture for SHSs that uses machine learning to identify potentially harmful actions taken by users. HealthGuard monitors the vitals of many SHS-connected devices and compares the vitals to distinguish normal from abnormal activity. For the purpose of locating potentially dangerous actions inside a SHS, HealthGuard employs four distinct machine learning-based detection approaches (Artificial Neural Network, Decision Tree, Random Forest, and k-Nearest Neighbor). Eight different smart medical devices were used to train HealthGuard for a total of twelve harmless occurrences, seven of which are common user activities and five of which are disease-related occurrences. HealthGuard was also tested for its ability to defend against three distinct forms of harmful attack. Our comprehensive analysis demonstrates that HealthGuard is a reliable security architecture for SHSs, with a 91% success rate and in F1-score of 90% success.

Patient-Centric Multichain Healthcare Record

In this paper, the authors have amplified the concept that EHRs need to be patient-centric and patient-driven, that is the patient should be the real owner as well as the manager of his medical records. The authors propose patient-centric multichain healthcare record (PCMHR) that implements health records using smart contracts on ethereum blockchain and also utilizes the multichain framework - Polygon. PCMHR can concurrently implement blockchain functionality while addressing the concerns of interoperability among authorized hospitals and patient health information confidentiality that damages our healthcare system. The authors propose a solution to fully decentralize the current medical healthcare system by storing PCMHR on IPFS (InterPlanetary File System) to resolve the limitation of blockchain-based applications in scalability and high cost. The authors have depicted the cost and time analysis of transactions on the polygon framework to give a clear view of this multichain framework and its advantages over the ethereum blockchain.

32655 Assessment of literacy inclusivity of dermatologic patient education material at UMass dermatology and beyond

Inequalities in society are emphasized, consciously or not, by the current health care system. They can be based off race, income, and education level. The needs of marginalized communities should be examined, and systems corrected accordingly, to provide more equality in care. Patient education materials are an opportunity to bridge the gap in patient care. However, these materials are often not inclusive to the public. With 82.7% of people reporting to use the internet as a medical resource and the NIH recommending a literacy level between 3rd and 7th grade, it is critical to examine these websites.

Biological Activities, Pharmacokinetics and Toxicity of Nootkatone: A Review.

Plant-based drugs have a significant impact on modern therapeutics due to their vast array of pharmacological activities. The integration of herbal plants in the current healthcare system has emerged as a new field of research. It can be used for the identification of novel lead compound candidates for future drug development. Nootkatone is a sesquiterpene derivative and an isolate of grapefruit. Shreds of evidence illustrate that nootkatone targets few molecular mechanisms to exhibit its pharmacological activity and yet needs more exploration. The current review is related to nootkatone, drafted through a literature search using research articles and books from different sources, including Science Direct, Google Scholar, Elsevier, PubMed, and Scopus. It has been reported to possess a wide range of pharmacological activities such as anti-inflammatory, anticancer, antibacterial, hepatoprotective, neuroprotective, and cardioprotective. Although preclinical studies in experimental animal models suggest that nootkatone has therapeutic potential, it is further warranted to evaluate its toxicity and pharmacokinetic parameters before being applied to humans. Hence, in the present review, we have summarized the scientific knowledge on nootkatone with a particular emphasis on its pharmacological properties to encourage researchers for further exploration in preclinical and clinical settings.

A novel fraud detection and prevention method for healthcare claim processing using machine learning and blockchain technology

Healthcare fraud is a global problem affecting both developing and developed countries. It is the deliberate attempt of the perpetrators to take undue advantage of the inefficiencies in current healthcare systems. Fraud tends to deny legitimate beneficiaries of universal health coverage, especially those under health insurance protection. In this work, we propose using machine learning techniques and blockchain technology to detect and prevent fraud in healthcare, especially in claims processing. A decision tree classification algorithm is adopted to classify the original claims dataset. The extracted knowledge is programmed in the Ethereum blockchain smart contract to detect and prevent healthcare fraud. The comparative experimental results show that the best performing tool achieves a classification accuracy of 97.96% and a sensitivity of 98.09%. This means that the proposed system enhances the blockchain smart contract’s ability to detect fraud with an accuracy of 97.96%.

O74 - Support for midwives to practice with professional autonomy within their full scope of practice: Evidence from a scoping review

Midwives in Australia are educated and professionally accountable to practice in partnership with childbearing women and their families, yet most do not practice to their scope. There is an urgent need to review models of maternity care in Australia to facilitate growth in midwifery continuity of carer, relationship building, and partnership to optimise perinatal health and wellbeing, and to reduce midwifery burnout. This systematic scoping review of the literature maps the role and scope of contemporary midwifery practice in Australia to identify key issues that impact upon midwives practising to their full scope of practice. A scoping review guided by Arksey and O’Malley’s five-stage methodological framework, together with a ‘best fit’ framework synthesis using the Nursing and Midwifery Board of Australia’s Midwifery Standards for Practice. Following initial screening, 517 publications were retrieved, and with full text review evidence from 96 papers was included in this review. Key themes that emerged from the review included the central tenet of Partnership with women, facilitated by the Professional roles of the midwife, and mediated by Contextual influences . Tensions were identified between the midwifery scope of practice associated with optimal outcomes for women and babies supported by current evidence and the actual role and scope of most midwives employed in models of care in the current Australian public healthcare system. There is a mismatch between the operational parameters for midwifery practice in Australia and the evidence-based models of continuity of midwifery carer that are associated with optimal outcomes for childbearing women and babies and the midwives themselves. There is an urgent need to review the representation of the midwifery profession at leadership, executive and policy levels to support the role of the midwife to practice with professional autonomy within their full scope of practice.

Strengthening Care for Children (SC4C): protocol for a stepped wedge cluster randomised controlled trial of an integrated general practitioner-paediatrician model of primary care

IntroductionAustralia’s current healthcare system for children is neither sustainable nor equitable. As children (0–4 years) comprise the largest proportion of all primary care-type emergency department presentations, general practitioners (GPs) report...

Psychosocial Intervention in Response to COVID-19 Pandemic in Sarawak

In the wake of the COVID-19 pandemic, the world has been anticipating a greater need for mental health and psychosocial support with the rise in mental health issues when facing many struggles and uncertainties, testing the limits of our current health care system. In this paper, we aim to present a general view of the psychosocial support implemented in Sarawak during the COVID-19 pandemic from the lens of different socio-ecological systems in Sarawak which include the healthcare system, community organizations, and the policy makers. Firstly, this paper provides an overview of the COVID-19 situation in Sarawak in general for the past year. Worth to mention, Sarawak was the first state in Malaysia recorded fatality case resulted from COVID-19 and this inevitably triggered strong negative emotional response during the initial stage of the pandemic. Secondly, the combined efforts initiated by the local state government, the state health departments, several general hospitals and major health clinics were addressed. The delivery of health care service had to be modified according to the strict preventive and social distancing measures recommended by the public health system, including the shift of conventional service to the provision of tele-counselling and psychological first aid. Also, the COVID-19 pandemic and its impact on mental health has brought the politicians’ attention. Lastly, the challenges faced in dealing with the mental health services during the COVID-19 pandemic and the potential paths of the mental health movement were discussed.

Designing of Registration System based on Estimated Patient Consultation Time for Crowded Prevention

Along with the increase in population and the development of information technology, it is necessary to have a system that is able to support the process of improving health care. One of the weaknesses of the current health care system is the patient waiting time which is still below the established standard, which is less than 60 minutes. This study designed a patient registration system that can estimate the patient's arrival time based on the input symptoms. The use of QR Code technology and meeting applications helps to support patient registration and consultation. The research methodology uses the waterfall method by involving doctors and patients as data sources. Test results using black boxes indicate that the system is able to categorize patient care as expected. The system has also been able to function well functionally. It takes a process of updating symptoms periodically by doctors so that the system is able to recognize new symptoms that have not been recorded previously. With the estimated arrival time, the queue or crowd of patients in the waiting room can be minimized properly.

Three delays model applied to pediatric injury care seeking in Northern Tanzania: A mixed methods study.

Pediatric injuries are a leading cause of morbidity and mortality in low-and middle-income countries. Timely presentation to care is key for favorable outcomes. The goal of this study was to identify and examine delays that children experience between injury and receiving definitive care at a zonal referral hospital in Northern Tanzania. Between November 2020 and October 2021, we enrolled 348 pediatric trauma patients, collecting quantitative data on referral and timing information. In-depth interviews (IDIs) to explain and explore delays to care were completed with a sub-set of 30 family members. Data were analyzed according to the Three Delays Model. 81.0% (n = 290) of pediatric injury patients sought care at an intermediary facility before reaching the referral hospital. Time from injury to presentation at the referral hospital was 10.2 hours [IQR 4.8, 26.5] if patients presented first to clinics, 8.0 hours [IQR 3.9, 40.0] if patients presented first to district/regional hospitals, and 1.4 hours [IQR 0.7, 3.5] if patients presented directly to the referral hospital. In-hospital mortality was 8.2% (n = 30); 86.7% (n = 26) of these children sought care at an intermediary facility prior to reaching the referral hospital. IDIs revealed themes related to each delay. For decision to seek care (Delay 1), delays included emergency recognition, applying first aid, and anticipated challenges. For reaching definitive care (Delay 2), delays included caregiver rationale for using intermediary facilities, the complex referral system, logistical challenges, and intermediary facility delays. For receiving definitive care (Delay 3), wait time and delays due to treatment cost existed at the referral hospital. Factors throughout the healthcare system contribute to delays in receipt of definitive care for pediatric injuries. To minimize delays and improve patient outcomes, interventions are needed to improve caregiver and healthcare worker education, streamline the current trauma healthcare system, and improve quality of care in the hospital setting.

Reframing Our Health Care System for Patients With Hearing Loss.

Nearly 20% of U.S. Americans report a hearing loss, yet our current health care system is poorly designed and equipped to effectively care for these individuals. Individuals with hearing loss report communication breakdowns, inaccessible health information, reduced awareness and training by health care providers, and decreased satisfaction while struggling with inadequate health literacy. These all contribute to health inequities and increased health care expenditures and inefficiencies. It is time to reframe the health care system for these individuals using existing models of best practices and accessibility to mitigate inequities and improve quality of care. A review of system-, clinic-, provider-, and patient-level barriers, along with existing and suggested efforts to improve care for individuals with hearing loss, are presented. These strategies include improving screening and identification of hearing loss, adopting universal design and inclusion principles, implementing effective communication approaches, leveraging assistive technologies and training, and diversifying a team to better care for patients with hearing loss. Patients should also be encouraged to seek social support and resources from hearing loss organizations while leveraging technologies to help facilitate communication. The strategies described introduce actionable steps that can be made at the system, clinic, provider, and patient levels. With implementation of these steps, significant progress can be made to more proactively meet the needs of patients with hearing loss. Presentation Video: https://doi.org/10.23641/asha.21215843.

Public sector implementation strategies to approach the judicialization of health care: a systematic review protocol

BackgroundThe judicialization of health care can be understood as a societal response to pressing healthcare needs, which probably are not being adequately addressed by the current healthcare system. This phenomenon increases the strain on service resources, both in the health sector and in the judiciary system as well, demanding an institutional reorganization to manage judicial actions. It is believed that each institution has developed strategies for coping with the problem in isolation and with little public disclosure. The purpose of this review will be to identify institutional strategies implemented and to investigate their effects in approaching the judicialization of health care.MethodsElectronic searches will be conducted up to December 2021 on 11 databases, supplemented with gray literature and references lists of secondary studies. The descriptor “judicialization of health” will be the basis for conducting the main research. Studies describing any strategy implemented by public institutions to approach the judicialization of health care will be included. Results related to the quality of services provided by the implemented strategy reported in the studies and those that report accessibility, usability, and potential adverse effects or harms caused by the implemented strategy will be investigated. In addition, it will be explored if there have been changes related to the value or characteristics of health litigation. Two reviewers will independently screen all citations, abstract data, and full-text papers. The risk of bias in each study will be appraised using a tool suggested by Cochrane Effective Practice and Care Organization Group (EPOC). Subsequently, the reviewers will also extract the data of interest and classify the findings of these studies according to their performance at the institutional level. The results obtained will be described as a narrative synthesis.DiscussionThis review may provide evidence on the effects of the strategies implemented to approach the judicialization of health care. It will potentially benefit health care and legal professionals, decision-makers, and researchers by identifying the types and characteristics of strategies that have the potential to improve service delivery in the future.Systematic review registrationPROSPERO CRD42020160608

Trainee Perspectives on Race, Antiracism, and the Path toward Justice in Kidney Care.

Trainee Perspectives on Race, Antiracism, and the Path toward Justice in Kidney Care.

Identifying Barriers to the Adoption of Information Communication Technology in Ethiopian Healthcare Systems. A Systematic Review.

BackgroundEthiopia’s government has planned to digitize the healthcare industry. However, most implementations fail due to various technological and personnel barriers. As a result, this systematic review aimed to comprehensively examine evidence regarding the barriers to adopting information communication technology in the Ethiopian healthcare system.MethodsThis systematic review was conducted by searching the major databases, such as Medline, PubMed, Scopus, Science Direct, Google, Google Scholar, and other online databases. The authors looked for, analyzed, and summarized information about barriers to ICT adoption in the healthcare system. This study included nine articles that described barriers to ICT adoption in the Ethiopian healthcare system.ResultsThis systematic review identified 15 barriers to adopting ICT in the healthcare system. The reviewed articles looked into technological barriers to ICT adoption, such as ICT skill, ICT knowledge, a lack of training opportunities, a lack of computer literacy, a lack of computer access, inadequate internet connectivity, and a lack of experience with ICT were cited as barriers to ICT implementation in Ethiopia’s healthcare system. Furthermore, organizational components such as Lack of job satisfaction, Lack of Refreshment training, poor staff initiation, management problem, poor infrastructure, and lack of resources remained barriers to ICT adoption in Ethiopia’s healthcare system.ConclusionThis review confirmed that lack of training in ICT, poor ICT knowledge, Poor ICT skill, and a lack of computer access were the most common barriers to adopting ICT in the Ethiopian healthcare system. Therefore, it is recommended that the emphasized barriers to ICT adoption be addressed in order to modernize the current Ethiopian healthcare system.

What is the scope of teaching and training of undergraduate students and trainees in point of care testing in United Kingdom universities and hospital laboratories?

Point of care testing (POCT) is an analytical test performed by a healthcare professional outside of a conventional laboratory. The global POCT market was valued at US$ 23.16 billion in 2016 and is forecasted to grow to US$ 36.96 billion in 2021. This upward trend for POCT has increased workload for pathology departments who manage POCT. This research aims to characterize and analyse the teaching and training of POCT at United Kingdom (UK) universities on Institute of Biomedical Science (IBMS) accredited biomedical science degrees, and at UK hospital laboratories. A freedom of information (FOI) request was sent in 2018 to all 52 UK universities with an accredited IBMS Biomedical science degree to request information on teaching of POCT, with a 100% response rate. Further FOI requests were sent to all National Health Service (NHS) hospital pathology departments in the UK, regarding POCT training provided to trainee Biomedical scientists, with a 97% response rate. Twelve of the degrees contained no POCT teaching, with a further 9 having no specific POCT teaching. Sixty-six laboratories confirmed that there was no POCT training. The university teaching hours varied between 0 and 35 hours. The median time spent teaching POCT at university was 2 hours. The laboratory teaching hours varied between 0 and 450 hours The median time spent teaching POCT in hospital laboratories was 3 hours. A content analysis of the learning outcomes provided by 29 universities showed that only 61% (84/137) were measurable and 26% (36/137) of the learning outcomes used action verbs that have previously been listed to be avoided in learning outcome writing. Only 9% (13/137) of outcomes specifically described POCT, with 8 of these being measurable. The findings demonstrate that although this is a commonly required skill for biomedical scientists, there is a clear lack of POCT teaching and training in the UK. To meet the new Quality Assurance Agency for Higher Education (QAA) guidelines, but most importantly to ensure the workforce is fit for the needs of the current healthcare system, the quality and quantity of POCT teaching and training needs to improve.

Positive Medicine - Disrupting the Future of Medical Practice

Dr David Beaumont is a consultant occupational physician who started his career as a general practitioner in rural practice in the UK. He subsequently trained in occupational medicine and was active in the Society of Occupational Medicine in the 1990s and 2000s. He then relocated to New Zealand, where he served in leadership roles in the Royal Australasian College of Physicians, and as President of the Australasian Faculty of Occupational and Environmental Medicine. As such, this book is written from the perspective of both a general practitioner and an occupational physician. In this book, Beaumont begins by examining the state of health care and its current focus and preoccupation with the medical model, in spite of the many shortcomings of this model. He notes that a wider perspective on health and well-being is largely absent. For example, in the UK, only 5% of the health budget is spent on prevention. Disease management often takes precedence over disease prevention, with patients frequently being referred for secondary care because primary care cannot cope. The current healthcare system is described as a deficit model, which attempts to address and correct the absence of health. It is therefore essentially a disease-care system. In contrast, positive medicine is an abundance model that aims not only to help people manage illness and disease, but also to enhance their health. In this regard, the global health and wellness industry offers a more holistic and whole-person approach that many people seek.