Different Areas Of Health Care Research Articles

Impacts of Clinical Decision Support Systems on the Relationship, Communication, and Shared Decision-Making Between Health Care Professionals and Patients: Multistakeholder Interview Study.

Clinical decision support systems (CDSSs) are increasingly being introduced into various domains of health care. Little is known so far about the impact of such systems on the health care professional-patient relationship, and there is a lack of agreement about whether and how patients should be informed about the use of CDSSs. This study aims to explore, in an empirically informed manner, the potential implications for the health care professional-patient relationship and to underline the importance of this relationship when using CDSSs for both patients and future professionals. Using a methodological triangulation, 15 medical students and 12 trainee nurses were interviewed in semistructured interviews and 18 patients were involved in focus groups between April 2021 and April 2022. All participants came from Germany. Three examples of CDSSs covering different areas of health care (ie, surgery, nephrology, and intensive home care) were used as stimuli in the study to identify similarities and differences regarding the use of CDSSs in different fields of application. The interview and focus group transcripts were analyzed using a structured qualitative content analysis. From the interviews and focus groups analyzed, three topics were identified that interdependently address the interactions between patients and health care professionals: (1) CDSSs and their impact on the roles of and requirements for health care professionals, (2) CDSSs and their impact on the relationship between health care professionals and patients (including communication requirements for shared decision-making), and (3) stakeholders' expectations for patient education and information about CDSSs and their use. The results indicate that using CDSSs could restructure established power and decision-making relationships between (future) health care professionals and patients. In addition, respondents expected that the use of CDSSs would involve more communication, so they anticipated an increased time commitment. The results shed new light on the existing discourse by demonstrating that the anticipated impact of CDSSs on the health care professional-patient relationship appears to stem less from the function of a CDSS and more from its integration in the relationship. Therefore, the anticipated effects on the relationship between health care professionals and patients could be specifically addressed in patient information about the use of CDSSs.

Strategies to improve implementation of collaborative care for functional disorders and persistent somatic symptoms: A qualitative study using a Research World Café design

IntroductionPersistent somatic symptoms and functional disorders (PSS/FD) are often complex conditions requiring care from multiple disciplines. One way of bringing the different disciplines together is through collaborative care. Little is known about the implementation barriers faced and relevant strategies to tackle the barriers in this field. Therefore, using expert knowledge, we aim to develop realistic strategies for dealing with implementation barriers of collaborative care in PSS/FD. MethodsThe Research World Café method is a single-session, expert-based method with multiple focus-groups forming and reforming to answer a set of inter-related questions, under the guidance of moderators. Using this method, participants involved in PSS/FD care across different areas of healthcare in the Netherlands developed several realistic strategies for dealing with ten implementation barriers for collaborative care in PSS/FD that were previously identified in a Delphi study. Strategies were grouped into strategy clusters using a card-sorting task. ResultsThirty-three participants took part, representing ten different disciplines, most commonly physiotherapists, psychologists, and physicians. In total, 54 strategies, identified in response to the ten barriers, were grouped into eight strategy clusters. The strategy clusters were professional education, communication, care coordination, care pathways, joint consults, funding, patient involvement, and prevention. ConclusionWe identified a number of useful strategies for dealing with implementation barriers for collaborative care in PSS/FD. Many strategies provided ways to deal with multiple barriers at once. The effects of applying these strategies in collaborative care in PSS/FD will need testing through implementation studies, as well as in other areas needing multidisciplinary care.

Multidisciplinary reflections on the NHS long-term workforce plan

Three professionals working in different areas of healthcare reflect on the implications of NHS England's first long-term workforce plan for England across acute care, mental health services and the UK's health and care education system.

Effectiveness of visceral fascial therapy targeting visceral dysfunctions outcome: systematic review of randomized controlled trials

BackgroundFascial Therapy is an ancient and widespread practice throughout the world. These approaches are very common in osteopathic practice and taught in workshops for professionals from different areas of health care, including Physiotherapy. This type of treatment is quite specialized and centered on the therapist. However, there is a lack of high-quality and low-risk bias studies that justify the use of this practice. Despite this, there is little scientific evidence about the effectiveness of Fascial Therapy to treat some visceral disorders. The purpose of this study was to critically appraise the scientific literature concerning the clinical efficacy of techniques used in Fascial Therapy targeting the visceral system.MethodsThis systematic review included randomized controlled trials in any language or date of publication. All primary outcomes reported were included. The methodological quality and statistical reporting of each eligible trial were evaluated using the version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). This systematic review provided a synthesis of current evidence on the effects of Fascial Therapy in patients with visceral disorders and/or pain. A total of 11 studies were included, with five of them covering gastrointestinal dysfunction, two covering cardiorespiratory dysfunction, two covering musculoskeletal dysfunction, and two covering urogenital dysfunction.ResultsFascial Therapy targeting the visceral system has been shown to be effective in reducing pain over the long term in people with low back pain when combined with standard physical therapy and effective in reducing gastroesophageal reflux symptoms over the short term. Considering the overall bias, six studies were at high risk of bias, two studies had some concerns and only three studies were at low risk of bias. Of the three studies with a low risk of bias, only two showed positive results and were effective in improving the studied outcome.ConclusionThis systematic review shows that currently, there is poor evidence for the efficacy of the techniques used in Fascial Therapy targeting the visceral system, and this information can help healthcare professionals in decision-making related to the use of Fascial Therapy targeting the visceral system in patients with visceral disorders and/or pain.

Impact of COVID-19 on electroconvulsive therapy practice across Canadian provinces during the first wave of the pandemic

BackgroundElectroconvulsive therapy (ECT) is a procedural treatment that is potentially life-saving for some patients with severe psychiatric illness. At the start of the global coronavirus disease 2019 (COVID-19) pandemic, ECT practice was remarkably disrupted, putting vulnerable individuals at increased risk of symptom exacerbation and death by suicide. This study aimed to capture the self-reported experiences of psychiatrists based at healthcare facilities across Canadian provinces who were delivering ECT treatments during the first phase of the COVID-19 pandemic (i.e., from mid-March 2020 to mid-May 2020).MethodsA multidisciplinary team of experts developed a survey focusing on five domains: ECT unit operations, decision-making, hospital resources, ECT procedure, and mitigating patient impact. Responses were collected from psychiatrists providing ECT at 67 ECT centres in Canada, grouped by four geographical regions (Ontario, Quebec, Atlantic Canada, and Western Canada).ResultsClinical operations of ECT programs were disrupted across all four regions – however, centres in Atlantic Canada were able to best preserve outpatient and maintenance care, while centres in Western Canada were able to best preserve inpatient and acute care. Similarly, Atlantic and Western Canada demonstrated the best decision-making practices of involving the ECT team and clinical ethicists in the development of pandemic-related guidelines. Across all four regions, ECT practice was affected by the redeployment of professionals, the shortage of personal protective equipment, and the need to enforce social distancing. Attempts to introduce modifications to the ECT delivery room and minimize bag-valve-mask ventilation were consistently reported. All four regions developed a new patient prioritization framework, and Western Canada, notably, aimed to provide ECT to only the most severe cases.ConclusionsThe results suggest that ECT provision was disproportionately affected across different parts of Canada. Possible factors that could explain these interregional differences include population, distribution of urban vs. rural areas, pre-pandemic barriers in access to ECT, number of cases, ability to control the spread of infection, and the general reduction in physicians’ activities across different areas of health care. Studying these factors in the future will inform how medical centres should respond to public health emergencies and pandemic-related circumstances in the context of procedural treatments.

Confluence of Blockchain and Artificial Intelligence Technologies for Secure and Scalable Healthcare Solutions: A Review

Blockchain (BC) and Artificial Intelligence (AI) technologies have independent applications in multiple industries, including banking, finance, health care, construction, transportation, hospitality, manufacturing, and insurance, to name a few. Moreover, these two technologies can be integrated seamlessly, thanks to their complementary and mutually-supportive features. AI algorithms can make the medical blockchain storage efficient by their processing algorithms, also playing the role of knowledgeable gatekeepers. Blockchain can support AI models by providing secure, sizeable, traceable, diverse, and immutable healthcare data for the training purpose. The integration of BC and AI has multiple use cases in the healthcare industry ranging from disease prediction to pandemic management. Previously, researchers have reviewed the applications of each of these technologies in health care independently. Although the integration of BC and AI has been fruitful, to the best of our knowledge, there has been no work in the past reviewing the confluence of these two technologies in the health care sector. We have classified the works based on two different classification schemes: application-based and AI-training paradigm-based classification. We have also provided a compilation of tools used in the integrated systems of BC and AI for healthcare. We identified that the integration of BC and AI technologies had been applied in quite different areas of healthcare ranging from biomedical research to pandemic management. It is also noted that the supervised learning algorithms and federated learning paradigm for secure decentralized AI model training are often used in the integration. Our findings reveal that majority of the reviewed works use blockchain as a secure database for AI models. Further, we also have pointed out the potential applications of these two technologies in health care.

Oregis-The German ophthalmological registry

Medical registries have shown their potential for medical research in different areas of healthcare in the past. The United States of America uses the well-known national ophthalmology registry Intelligent Research in Sight (IRIS®), on the basis of which insights into the ophthalmological care situation in the USA can be gained. Comparable projects do not currently exist in Germany. The oregis is the first disease-independent registry to collect comprehensive data in the field of ophthalmology in Germany for the purpose of healthcare research. The oregis collects anonymized clinical patient information from all subfields of ophthalmology and makes it available for research purposes. Participating centers read their data into the registry free of charge and preferably in an automated fashion. Currently, the oregis parameter list contains about 600 parameters, of which about 100 are used in the current pilot phase. Since its initiation, the German ophthalmological registry oregis has compiled data on more than 1.75million physician visits for more than 400,000 patients from German ophthalmologic centers. As of late 2022, more than 2.8million visual acuity measurements and an equal number of intraocular pressure measurements have been recorded. The aim of the oregis project is to establish anationwide ophthalmology databank that forms the basis for alearning healthcare system in the field of ophthalmology. With the help of continuous updating, oregis can also illustrate short-term innovations in ophthalmological care.

Machine learning models for predicting the number of COVID-19 patients in Ukraine and India

Models for predicting the number of patients with COVID-19 using machine learning methods have been built. The data for models are obtained from various official sources, including the World Health Organization, from the beginning of the epidemic to the present time. The data in Ukraine and India were selected to teach models for predicting the number of patients with COVID-19. Algorithms of linear regression for Ukraine and gradient boosting for India proved to be the methods that provided high accuracy of the forecast for the existing data. Data analysis was performed using the Python programming language with Sklearn library which is based on SciPy (Scientific Python). In addition, the XGboost gradient boost algorithm library was used. To develop the model, multifactor prediction of time series with the delays as predictors was chosen. It is established that the such characteristics as the date of the event, day of the week, week number, month affect to the model. Model errors are smallest and forecast accuracy were estimated with the best values of 0.83 for Ukraine and 0.75 for India. The built models allow to predict the epidemiological situation in the future, to coordinate actions in different areas of health care and to carry out reasonable preventive measures at the state level.

Analysis of Research Status on Disease of Women and Children in North Korea: Literature Analysis Through Academic Journals

Purpose: Since the division of the Korean Peninsula into South and North Korea in 1948, the gaps in the medical system and the socioeconomic status between these 2 countries has expanded. The purpose of this study was to analyze the distribution of different areas of research, as well as the types of research that was conducted in the North Korean medical journal, ‘Pediatrics, Obstetrics and Gynecology.’ This study aimed to specifically investigate the medical research status of healthcare in women and children.Methods: This study analyzed a total of 949 papers that were published in the North Korean medical journal, ‘Pediatrics, Obstetrics and Gynecology.’ Papers from January 2015 to December 2019 were included. For the analysis, the 8th Korean Standard Classification of Diseases, disease name, subspecialty classification, and research classifications were extracted from the papers.Result: Of the 949 papers included in the analysis, 495, 366, and 88 studies were conducted in the major fields of obstetrics and gynecology, pediatrics, and on breast surgery, respectively. Within the field of obstetrics and gynecology, the most studied subspecialties were maternal and fetal medicine, general gynecology, and gynecologic oncology. To a lesser extent, the following subspecialties were reported: gynecologic endocrinology (6.7%), infertility (6.3%), and urogynecology (approximately 1%).Conclusion: Although North Korean papers differ from those published worldwide (due to government intervention), they are still a useful source of information as they are easier to access than alternative data sources. The results from this study have implications for understanding the distribution of research on different areas of healthcare, as well as the burden of healthcare in North Korea.

The Application of Multicriteria Decision Analysis Methods in Health Care: A Literature Review.

The main objectives of this article are 2-fold. First, we explore the application of multicriteria decision analysis (MCDA) methods in different areas of health care, particularly the adoption of various MCDA methods across health care decision making problems. Second, we report on the publication trends on the application of MCDA methods in health care. PubMed was searched for literature from 1960 to 2019 in the English language. A wide range of keywords was used to retrieve relevant studies. The literature search was performed in September 2019. Articles were included only if they have reported an MCDA case in health care. The search yielded 8,318 abstracts, of which 158 fulfilled the inclusion criteria and were considered for further analysis. Hybrid methods are the most widely used methods in health care decision making problems. When it comes to single methods, analytic hierarchy process (AHP) is the most widely used method followed by TOPSIS (technique for order preference by similarity to ideal solution), multiattribute utility theory, goal programming, EVIDEM (evidence and value: impact on decision making), evidential reasoning, discrete choice experiment, and so on. Interestingly, the usage of hybrid methods has been high in recent years. AHP is most widely applied in screening and diagnosing and followed by treatment, medical devices, resource allocation, and so on. Furthermore, treatment, screening and diagnosing, medical devices, and drug development and assessment got more attention in the MCDA context. It is indicated that the application of MCDA methods to health care decision making problem is determined by the nature and complexity of the health care problem. However, guidelines and tools exist that assist in the selection of an MCDA method.

Impact of Late Shift Rapid Response Team (RRT) Input on Length of Stay and Discharge Destination in Emergency Care

Prolonged length of stay (LOS) is a significant financial burden to the hospitals. Although Physiotherapists (PT) are expanding their role in different areas of health care, including Emergency Care (EC), the impact of late shift PT input on LOS is not yet known. The objective was to determine the impact of the late shift Rapid Response Team (RRT) input on LOS and discharge destination. Patients who are referred to the RRT Physiotherapy/Occupational Therapy (PT/OT) include those with musculoskeletal conditions, cardio-respiratory and neurological problems. The therapists establish patient’s premorbid mobility level, social status and complete mobility and balance assessments. The outcome measures considered for this study was LOS and discharge destination. A total of 131 patients were assessed during 2016/2017. Out of 131, 72 patients were discharged on the day of treatment. Out of 138 patients referred during 2017/2018, 79 patients were discharged on the day of assessment. Most patients had significant comorbidities when admitted as the number of comorbidities is approximately four conditions for both durations. The discharge destination included from patients own home, rehabilitation hospital, long stay wardand interim placementfrom ward and this has saved 151 bed days in the hospital. Late shift RRT service in the ED resulted in reduced LOS and improved discharge destination.

Redeployment of dental trainees: challenges and opportunities during the COVID-19 pandemic

Dental trainees require a degree of adaptability to navigate a training pathway. We outline the transferrable skills that can be adapted and utilised during the process of redeployment in response to COVID-19. Despite the challenging circumstances, opportunities can arise for trainees redeployed to different areas of healthcare, and contribute towards the formation of a holistic and rounded professional. Transferable skills acquired from different areas of healthcare contribute towards the formation of a holistic dental professional.

Patients' perception of user involvement in psychiatric outpatient treatment: Associations with patient characteristics and satisfaction.

BackgroundThe patient's right to be involved in treatment decisions is anchored in guidelines and legislation in many countries. Previous research suggests challenges in the implementation of user involvement across different areas of health care, including mental health. However, little is known about psychiatric outpatients’ experiences of being involved in their treatment.ObjectiveTo investigate how psychiatric outpatients after treatment rate the degree to which they were included in the treatment and explore the associations between perceived user involvement, demographic characteristics of the sample and patient satisfaction.DesignCross‐sectional.Setting and participantsThe sample consisted of 188 psychiatric outpatients (67% female, mean age 42.2 years) who were discharged in the two years prior to data collection.Main variables studiedPerceived user involvement in psychiatric outpatient treatment and patient satisfaction as measured by the Psychiatric Out‐Patient Experiences Questionnaire.ResultsAbout half of the participants rated the overall degree of involvement in their treatment as high or very high. The lowest percentage of participants reporting high or very high involvement was found for sufficient information to contribute to treatment decisions (36%). Female gender, higher education and, to a small degree, younger age were associated with more involvement. Perceived user involvement was strongly associated with treatment satisfaction.Discussion and conclusionThe findings suggest that user involvement in psychiatric outpatient treatment can be improved. Patient information that facilitates user involvement should be given more attention.Patient or Public ContributionThe hospital's user panel was involved in the development of items assessing user involvement.

Interpretability of machine learning‐based prediction models in healthcare

AbstractThere is a need of ensuring that learning (ML) models are interpretable. Higher interpretability of the model means easier comprehension and explanation of future predictions for end‐users. Further, interpretable ML models allow healthcare experts to make reasonable and data‐driven decisions to provide personalized decisions that can ultimately lead to higher quality of service in healthcare. Generally, we can classify interpretability approaches in two groups where the first focuses on personalized interpretation (local interpretability) while the second summarizes prediction models on a population level (global interpretability). Alternatively, we can group interpretability methods into model‐specific techniques, which are designed to interpret predictions generated by a specific model, such as a neural network, and model‐agnostic approaches, which provide easy‐to‐understand explanations of predictions made by any ML model. Here, we give an overview of interpretability approaches using structured data and provide examples of practical interpretability of ML in different areas of healthcare, including prediction of health‐related outcomes, optimizing treatments, or improving the efficiency of screening for specific conditions. Further, we outline future directions for interpretable ML and highlight the importance of developing algorithmic solutions that can enable ML driven decision making in high‐stakes healthcare problems.This article is categorized under: Application Areas > Health Care

A new application of community detection for identifying the real specialty of physicians

BackgroundThere is an increasing trend in using network science methods and algorithms, including community detection methods, in different areas of healthcare. These areas include protein networks, drug prescriptions, healthcare fraud detection, and drug abuse. Counterfeit drugs, off-label marketing issues, and finding the healthcare community structures in a network of hospitals, are examples of using community detection in healthcare. ObjectiveThis paper attempts to find physicians’ real medical specialties based on their prescription history. As a novel application of community detection in the healthcare field, this knowledge can be used as an alternative for missing values of the healthcare databases. Therefore, it could help scientists and researchers to obtain more accurate and more reliable results. MethodsThis research is done through the community detection method and applying big data tools as well as interviews with the field experts. The big data, which is used in this paper, includes 32 million written medical prescriptions in the year 2014, provided by the Health Insurance Organization. The results are validated both qualitatively and quantitatively. ResultsThe findings reveal nine major communities of physicians, and labeling these communities by experts presents almost every specialty in the drug prescriptions field. Some of these communities are labeled as a single well-known specialty, and some others are consist of two or more specialties that have overlap with each other. ConclusionAfter receiving the prescription data and getting the experts’ opinions, it was revealed that some physicians might persistently prescribe drugs that are not in their fields of expertise. Regarding the accuracy of community detection and the use of existing data values, we proved this hypothesis.

Challenges to the Implementation of Interprofessional Education in Health Profession Education in Iran.

BackgroundChanges in the structure and nature of health care highlight the need for better collaboration between professions focusing on patient or health-care users. Interprofessional education (IPE) has attracted a lot of attention at the international level, and its positive consequences in different areas of health care have been investigated and approved. This study explored the opinions and viewpoints of professors and experts regarding the challenges to the implementation of interprofessional education in health profession education in Iran in 2018.MethodsThis qualitative study was conducted with 15 IPE professors and experts using semi-structured interviews. We used an inductive approach to content analysis as developed by Elo et al. The interviews were analyzed using Graneheim and Lundman method by MAXQDA software version 12.ResultsThe main challenges to the implementation of IPE were categorized into educational system, structural and cultural challenges. The educational challenges were the professors’ lack of ability, a non-flexible and single-disciplined curriculum, and weaknesses in the current education. The professors and experts felt that the most important structural challenges included centralism, hierarchy of power, poor educational groundwork, and lack of support of organizations. Cultural challenges mainly related to the attitudes of managers, professors, and even students regarding IPE and the need for change.ConclusionDesigning and implementing IPE in Iran face major challenges. Cultural and attitude issues were the greatest challenges to be addressed in the context of implementing IPE in health-care education.

A review on the use of operational research techniques in the medical records department

Introduction: Various operational research (OR) techniques have been used in different areas of healthcare. One of the areas in which OR techniques can be effective is the medical records department (MRD). The aim of this study is to review the applications of OR in the management of MRD and its related processes. Methods: This is a review article. In order to collect data, English-language studies published between 2000 and 2018, related to the use of OR techniques in MRD, in the Medline, Science Direct, ProQuest and Web of science databases were investigated. From 1165 retrieved studies, 19 articles met the inclusion criteria and were included in the final review. Results: The results showed that different OR techniques such as linear programming, integer programming, simulation, hierarchical analysis process, etc. have been used in various aspects of the MRD and its ongoing processes such as improving efficiency, workload management, resource allocation, optimal scheduling of staff work hours, patient scheduling, patient admission and discharge. Conclusion: It can be concluded that if the managers and experts of MRD and health information management become familiar with the principles and techniques of OR and become aware of the importance of these techniques in improving efficiency of MRD, there is a hope that in the future these techniques will find their true place in MRD and ultimately enhance the quality of services provided to patients.

Shanghai expert consensus on totally implantable access ports 2019

Totally implantable access ports (TIAPs) are used for patients with poor peripheral vascular support requiring central venous access. In recent years, TIAPs have been gradually accepted and promoted by patients, doctors, and nurses owing to their advantages of convenient carrying, a long maintenance period, low complications, and a high quality of life for patients. Currently, medical personnel that handle TIAP implantation and management in China are from different areas of healthcare, including surgery, internal medicine, radiology, nurse anesthesia, vascular access, etc., and many only handle TIAP as a part of their duties. Therefore, the operating procedures and steps for the diagnosis and treatment of complications of TIAP vary from person to person, resulting in different incidence and treatment methods for complications in the implantation and use of TIAP in different medical units. Based on this, we have updated the Shanghai expert consensus on TIAPs from 2015 and explored the diagnosis and treatment procedures of related complications while continuing to emphasize standardized implantation and maintenance.

Nano-emulgel: Emerging as a Smarter Topical Lipidic Emulsion-based Nanocarrier for Skin Healthcare Applications.

In recent decades, enormous efforts for different drug discovery processes have led to a number of drug molecules available today to overcome different challenges of the health care system. Unfortunately, more than half of these drugs are listed in either BCS (biopharmaceutical classification system) class II/ IV or both are eliminated from the development pipeline due to their limited clinical use. A nanotechnological approach bears much hope and lipoidal fabrication is found to be suitable for the delivery of such drugs. Nanoemulsion based gel i.e. nanoemulgel out of different nanolipoidal formulations has been found to be a suitable approach to successful drug delivery through topical routes. In past few years many herbal and synthetic active pharmaceutical ingredients (APIs) has been patented as nano sized emulsified gel for various therapeutic activities. Nanoemulgel is basically an emulsion-based topical gel formulation, where nanosized emulsion globules can be prepared with the help of high energy or low energy methods and further converted into nanoemulgel by adding a suitable gelling agent. Nanoemulgel fabrication enlists various kinds of polymeric materials, surfactants and fatty substances of natural, synthetic and semi-synthetic nature with a globule size range from 5 to 500 nm. Nanoemulgel can be applicable to various acute and chronic diseases through topical routes. Nanoemulgel preparations of many recently approved drugs are being used successfully in different areas of health care and have re-defined the significance of topical route of delivery as compared to other routes. However, along with various improvements in the current state of the delivery system, the safety factor needs to be taken into account by toxicological studies of the materials used in such formulations.

Patient satisfaction on Trigger finger management

Trigger finger relatively a common hand problem with varied treatment options from conservative to surgical release done as outpatient and daycare procedure with its own applications and limitations. Our aim is to assess patient satisfaction among the different types of trigger finger release at different areas of health care. 60 patients (Female 60%: Male 40%) with single-digit trigger finger involvement (Ring finger28.33%, Thumb26.66%, Middle finger25%, Index finger18.33%) with a mean age of 49years were divided into four groups based on card selection. The mean Short Assessment of Patient Satisfaction SAPS score was highest amongst the group in which the procedure was done at the outpatient area under percutaneous needle release technique, while the mean lowest score was obtained from group IV in which the procedure was done at the operation theatre by open release technique as daycare. Patient satisfaction and compliance were found to be higher in the group who underwent a procedure at an outpatient area.