Different Categories Of Patients Research Articles

МАТЕМАТИЧЕСКИЕ МОДЕЛИ И ЧИСЛЕННЫЕ МЕТОДЫ В КАРДИОЛОГИИ: СОБСТВЕННЫЙ ОПЫТ

Вackground. In the era of digital transformation in medicine, which is radically changing the way patient information is stored, processed and used, medical professionals need new tools and approaches that can efficiently process and interpret data for fast and accurate decision making. These methods also enable the creation of personalized treatment approaches, taking into account individual patient characteristics and risks. In this article, the authors share their own experience in applying numerical methods in cardiology. Purpose of the study. To develop methods of effective risk assessment of cardiovascular outcomes in different categories of patients. Characteristics of patients and methods of the study. Three variants of outcome prediction were included in the study. The 1st - assessment of the total risk of one-year cardiovascular outcomes after myocardial infarction with ST-segment elevation, the 2nd - assessment of the risk of postinfarction chronic heart failure, the 3rd – assessment of the risk of progressive course of atherosclerosis. Statistical analysis methods included the free cross-platform visual programming system Orange, the SPSS 22.0 package, and the C programming language console. Results and Conclusion. The conducted study has shown that the application of different approaches: regression analysis, machine learning, Excel programming capabilities, C programming language and console interface allows to develop models of cardiovascular outcomes prediction with high accuracy.

Estimating cost of prostate cancer management: an experience from Tanzania

BackgroundProstate cancer (PC) is a significant public health problem affecting men worldwide and ranks third in incidence and mortality in East Africa. Cost of prostate cancer management is high in low-income countries because majority of patients presents with advanced (metastatic) PC. The cost related to management of PC including castrate resistant cancer in Tanzania has remained unknown; hence, policy makers do not have enough information for planning and resource allocation. This study therefore aimed to document costs related to the management of patients with prostate cancer including castrate resistant prostate cancer (CRPC) at Muhimbili National Hospital in Tanzania.MethodsThis was a retrospective descriptive hospital-based study which was conducted at Muhimbili National Hospital (MNH). Case notes of patients who were treated for prostate cancer were retrieved from medical records for review. A structured checklist was used to extract information regarding age, clinical presentation, investigations, stage of disease, type of treatment, payment modality and reimbursement. We considered data on the direct costs of prostate cancer management (diagnosis, treatment and follow-up) based on hospital price list of different categories. Costs reported were based on payment category in total and unit cost but also source of funding. Descriptive statistics were prepared and summarized as tables and figures.ResultsA total of 292 case notes of patients with prostate cancer were reviewed of which 189 patients received androgen deprivation therapy. Ninety-six (50.8%) met the criteria for the diagnoses of CRPC, and their mean age was 71.23 ± 4.2. Most of the patients had a poorly differentiated histology with prostate-specific antigen (PSA) over 100 ng/l. Bilateral orchiectomy was the most common treatment modality offered for advanced prostate cancer. Total cost for all PC patients was $148,136.4, equivalent to a unit cost per patient of $507.3. However, patients were in different categories of payment, 53% were public patients with an average cost of $471.3 per patient; 36.6% were cost sharing patients with an average cost of $441.8 per patient; 8.2% were National Health Insurance (NHIF) patients with an average cost of $893.8 per patient; and only 2.2% were private patients with an average cost of $1060.9 per patient.ConclusionCosts related to prostate cancer management need harmonization to accommodate different categories of patients in need.

Matching Market Design: Resource Matching Optimization in the Epidemic and Application of the Matching Theory

During the Covid-19 pandemic, the problem of inefficiency and one-sidedness of resources matching occurred, and economists proposed an innovative scheme-- reserve system. Different categories of patients, such as those with different symptoms, health care workers, and the elderly and young population, need to be matched with extremely limited medical resources (ventilator as study object in this research) in the epidemic. The upgrade from the current priority system to the reserve system which is capable of classified allocation is more in line with the fair and comprehensive ethical values, thus solving the complex matching problem better. Based on this original reserve system, this study further assists in explaining the concept connotation of its research on matching process, proposes possible improvements, and clarifies its effects and value. Moreover, based on this idea of matching, this study analyzes its role in the matching problem of "undergraduate-college".

Obstructive jaundice: routing, diagnostics, treatment tactics

Aim. To analyze three-level system of medical care for different categories of patients with obstructive jaundice on the example of Pavlov University.Materials and methods. The paper presents a retrospective analysis of treating patients with obstructive jaundice. The analysis covered the period from January 2015 to April 2023 and involved an etiology of obstructive jaundice, range of performed surgical interventions, postoperative complication rate, and mortality.Results. The study involved 2494 patients, including 1569 (62.9%) with cholelithiasis. The total mortality accounted for 7.2%, the incidence of postoperative complications – 13.9%. A choice of decompression procedure in patients with malignant tumors depended on the block level. Interventions included percutaneous transhepatic drainage, cholecystostomy, stenting of common bile duct. Hybrid surgery was performed in patients with calculous cholecystitis and choledocholithiasis. A number and size of concrements, a diameter of common bile duct influenced the choice of interventions and their volume. Two-stage tactics for stricture of biliodigestive anastomosis included percutaneous transhepatic drainage and reconstructive surgery. Endoscopic intervention was performed for choledocholithiasis. Procedures for stricture of biliary anastomoses after orthotopic liver transplantation involved endoscopic papillosphincterotomy, balloon dilatation of stricture and stenting of bile duct. Management of obstructive jaundice against the background of gestation included endoscopic papillosphincterotomy, lithoextraction, and, if necessary, treating the pregnancy termination threat.Conclusion. The routing of patients with obstructive jaundice to the 2nd and 3rd level of healthcare units is found necessary to be differentiated, depending on the etiology and severity of their condition. Obstructive jaundice in pregnant women requires the patient to be referred to the hospital of the 3rd level. Creation of a shared dispatch service responsible for a certain territory can reduce a number of routing stages.

Modeling Survival Time to Death among Stroke Patients at Jimma University Medical Center, Southwest Ethiopia: A Retrospective Cohort Study.

Stroke is a life-threatening condition that occurs due to impaired blood flow to brain tissues. Every year, about 15 million people worldwide suffer from a stroke, with five million of them suffering from some form of permanent physical disability. Globally, stroke is the second-leading cause of death following ischemic heart disease. It is a public health burden for both developed and developing nations, including Ethiopia. This study is aimed at estimating the time to death among stroke patients at Jimma University Medical Center, Southwest Ethiopia. A facility-based retrospective cohort study was conducted among 432 patients. The data were collected from stroke patients under follow-up at Jimma University Medical Center from January 1, 2016, to January 30, 2019. A log-rank test was used to compare the survival experiences of different categories of patients. The Cox proportional hazard model and the accelerated failure time model were used to analyze the survival analysis of stroke patients using R software. An Akaike's information criterion was used to compare the fitted models. Of the 432 stroke patients followed, 223 (51.6%) experienced the event of death. The median time to death among the patients was 15 days. According to the results of the Weibull accelerated failure time model, the age of patients, atrial fibrillation, alcohol consumption, types of stroke diagnosed, hypertension, and diabetes mellitus were found to be the significant prognostic factors that contribute to shorter survival times among stroke patients. The Weibull accelerated failure time model better described the time to death of the stroke patients' data set than other distributions used in this study. Patients' age, atrial fibrillation, alcohol consumption, being diagnosed with hemorrhagic types of stroke, having hypertension, and having diabetes mellitus were found to be factors shortening survival time to death for stroke patients. Hence, healthcare professionals need to thoroughly follow the patients who pass risk factors. Moreover, patients need to be educated about lifestyle modifications.

Personalized approach to pharmacotherapy of overactive bladder

The article provides an overview of modern approaches to pharmacotherapy of overactive bladder. It has been shown that the choice of drug therapy for overactive bladder should be made taking into account the pathophysiological mechanisms of the development of the disease, the characteristics of its clinical course, as well as the potential risks of developing side effects of treatment. A pathogenetic rationale for the choice of treatment tactics for different categories of patients is presented, including those with a hypersensitive bladder, bladder outlet obstruction, neurological and geriatric patients. The pharmacological properties of the β3-adrenergic receptor agonist mirabegron are described, which provide high efficacy and a favorable safety profile in the treatment of patients with overactive bladder. The practical issues of prescribing mirabegron in various clinical situations are considered.

Prediction of Atrial Fibrillation from Sinus-Rhythm Electrocardiograms Based on Deep Neural Networks: Analysis of Time Intervals and Longitudinal Study

ObjectiveArtificial Intelligence (AI) in electrocardiogram (ECG) analysis helps to identify persons at risk of developing atrial fibrillation (AF) and reduces the risk for severe complications. Our aim is to investigate the performance of AI-based methods predicting future AF from sinus rhythm (SR) ECGs, according to different characteristics of patients, time intervals for prediction, and longitudinal measures. MethodsWe designed a retrospective, prognostic study to predict AF occurrence in patients from 12-lead SR ECGs. We classified patients in two groups, according to their ECGs: 3,761 developed AF and 22,896 presented only SR ECGs. We assessed the impact of age on the overall performance of deep neural network (DNN)-based systems, which consist in a variation of Residual Networks for time series. Then, we analysed how much in advance our system can predict AF from SR ECGs and the performance for different categories of patients with AUC and other metrics. ResultsAfter balancing the age distribution between the two groups of patients, our model achieves AUC of 0.79 (0.72-0.86) without additional constraints, 0.83 (0.76-0.89) for ECGs recorded in the last six months before AF, and 0.87 (0.81-0.93) for patients with stable AF risk measures over time, with sensitivity of 90.62% (80.70-96.48) and diagnostic odd ratio of 20.49 (8.56-49.09). ConclusionThis study shows the ability of DNNs to predict new onsets of AF from SR ECGs, with the best performance achieved for patients with stable AF risk score over time. The introduction of this time-based score opens new possibilities for AF prediction, thanks to the analysis of long-span time intervals and score stability.

Deep reinforcement learning-based control of chemo-drug dose in cancer treatment

Background and objectiveAdvancement in the treatment of cancer, as a leading cause of death worldwide, has promoted several research activities in various related fields. The development of effective treatment regimens with optimal drug dose administration using a mathematical modeling framework has received extensive research attention during the last decades. However, most of the control techniques presented for cancer chemotherapy are mainly model-based approaches. The available model-free techniques based on Reinforcement Learning (RL), commonly discretize the problem states and variables, which other than demanding expert supervision, cannot model the real-world conditions accurately. The more recent Deep Reinforcement Learning (DRL) methods, which enable modeling the problem in its original continuous space, are rarely applied in cancer chemotherapy. MethodsIn this paper, we propose an effective and robust DRL-based, model-free method for the closed-loop control of cancer chemotherapy drug dosing. A nonlinear pharmacological cancer model is used for simulating the patient and capturing the cancer dynamics. In contrast to previous work, the state variables and control action are modeled in their original infinite spaces to avoid expert-guided discretization and provide a more realistic solution. The DRL network is trained to automatically adjust the drug dose based on the monitored states of the patient. The proposed method provides an adaptive control technique to respond to the special conditions and diagnosis measurements of different categories of patients. Results and conclusionsThe performance of the proposed DRL-based controller is evaluated by numerical analysis of different diverse simulated patients. Comparison to the state-of-the-art RL-based method, which uses discretized state and action spaces, shows the superiority of the approach in the process and duration of cancer chemotherapy treatment. In the majority of the studied cases, the proposed model decreases the medication period and the total amount of administrated drug, while increasing the rate of reduction in tumor cells.

Procalcitonin is elevated in severe malaria and is a promising biomarker of severe malaria and multi-organ dysfunction: A cross-sectional study and meta-analysis

BackgroundElevated procalcitonin (PCT) has been reported in bacterial infection and is positively associated with the severity of the disease. Patients with severe Plasmodium falciparum malaria also display higher procalcitonin levels compared to those with non-severe disease, indicating a possible role for bacterial infection in severe disease, however this observation remained variable in different study population. Furthermore, the significance of PCT in different clinical categories of severe malaria has not been evaluated so far. MethodsA total of 74 P. falciparum-infected subjects were enrolled in the study comprising of 55 cases complicated malaria [cerebral malaria- 14; non-cerebral severe malaria- 21; multi-organ dysfunction- 20] and 19 uncomplicated cases. Serum levels of PCT were quantified by fluorescence immunoassay. For meta-analysis, the literature search was performed in different databases, and all relevant articles were screened, and eligible reports were identified based on predefined inclusion and exclusion criteria. The meta-analysis was performed by comprehensive meta-analysis software V3 and MedCalc 20.218. ResultsPatients with severe P. falciparum malaria had significantly higher PCT levels compared to uncomplicated cases (p = 0.01). Analysis of PCT in different categories of patients with severe malaria revealed significantly elevated PCT in multi-organ dysfunctions compared to those with uncomplicated malaria (p = 0.004) and cerebral malaria (p = 0.05). Interestingly the receiver operating characteristics curve analysis showed procalcitonin as a promising biomarker for differentiating severe malaria (AUC: 0.697, p = 0.01) and multi-organ dysfunction (AUC: 0.704, p = 0.007) from uncomplicated malaria and other clinical categories of falciparum malaria, respectively. Furthermore, meta-analysis also revealed an elevated procalcitonin in severe malaria and it could be an important biomarker in the management of severe disease. ConclusionsPCT is elevated in P. falciparum-infected patients and could be a good biomarker for diagnosis of severe malaria and multi-organ dysfunction. It can help in the management of severe disease with additional treatment options.

Evaluation of knowledge and experience of fungal infections (mycoses) among clinical doctors in Senegal.

In order to assess the knowledge and experience of fungal infections (FIs) among clinicians in Senegal, a cross-sectional survey was carried out among medical practitioners in Senegal via a questionnaire designed with "Google Forms" between 24 January and 24 April 2022. A total of 100 clinicians responded to the questionnaire. Clinicians in the 31- 40-year-old age group formed the majority of respondents (51%). Male respondents were predominant (72%). Forty-one percent of respondents were general practitioners, 40% were specialist doctors, and the rest were residents. Dermatologists were the most common at 15% (6/40). In terms of clinicians' general knowledge of fungi, FIs and their therapeutic management, an average of 70% correct answers was recorded. The majority (70%) of respondents cared for between two to four different categories of patients at risk of invasive FIs (IFIs) at a time, with diabetes predominating. Eighty percent confirmed that they had been confronted with FIs, including 43% with superficial FIs, 3% with subcutaneous FIs and 5% with IFIs. Thirty-four percent of doctors stated that they had never suspected an IFI. Candidiasis was the most commonly mentioned mycosis by doctors. To support the diagnosis of these FIs, 22% of the clinicians said that they had recourse only to the clinical diagnosis. In total, 79% of clinicians responded that they had never used an antifungal chemoprophylaxis. In addition, 28% and 22% of practicing physicians chose a combination of antifungals for the chemoprophylaxis of invasive candidiasis and invasive aspergillosis, respectively. This survey shows that both clinicians' knowledge and experience of fungi, antifungals, FIs and their therapeutic management, as well as chemoprophylaxis, need to be improved. Indeed, half of the clinicians seem to be unaware of the incidence of FIs, in particular IFIs, which, nevertheless, represent some of the deadliest infectious diseases in the world.

Kinesiophobia and its associated factors in patients with coronary heart disease: a cross-sectional study based on latent feature analysis

ObjectivesThe aim of this study was to explore the current situation of kinesiophobia in patients with coronary heart disease, classify it based on potential profile analysis and explore the relevant...

Therapeutic learning as an organizational technology of tomorrow

BACKGROUND: According to the World Health Organization, global population aging is the main trend in the development of the society on the planet. Russia ranks 116th worldwide in terms of life expectancy. The development and implementation of measures aimed at preserving the able-bodied population of the country and slowing down the current trend of aging of the population with a focus on increasing life expectancy is manifested in national projects such as Health and Demography. Health-saving technologies for prolonging effective professional longevity of medical workers of older age groups will preserve a labor resource of the country and exclude economic losses of the state.
 AIM: The study aimed to determine the significance of individual risk factors affecting the professional effective longevity of physicians and form a set of measures to prolong the professional competence of physicians of older age groups.
 METHODS: In this study, the unit of observation is a physician providing medical care in the outpatient segment of Moscow and the Moscow region. The total number of subjects was 378. Sociological, analytical, and statistical methods and the method of organizational modeling were used. The main method was a face-to-face survey that included questionnaire data, questions on training, seniority, category, workload, and information assurance, and two blocks of questions to assess professional competencies and cognitive functions.
 RESULTS:
 
 An age-related decrease in the level of the physicians professional competence.
 An age-related decrease in the effectiveness of the prescribed treatment.
 A tendency toward an age-related increase in the proportion of cognitive disorders among physicians.
 Data analysis showing the need to implement a set of measures aimed at supporting the professional effective longevity of physicians of older age groups.
 
 CONCLUSIONS: The organizational technology represented by a complex of measures providing prolongation of professional effective longevity of physicians of older age groups was proposed. Essentially, the organizational technology is the prevention of chronic non-infectious diseases in conjunction with measures to optimize work activities and stimulate the professional competence of the physician. Therapeutic Learning Technology is a parallel annual dispensary examination of physicians of older age groups followed by a therapeutic and rehabilitation course based on the morbidity profile and combined with a cycle of continuing medical education. The therapeutic and rehabilitative course should include older physicians undergoing cognitive training and hemodynamic stabilization. Information support (a block of federally approved training materials, i.e. normative legal acts regulating medical activity, clinical guidelines, video manuals on schools for different categories of patients, and other materials) is placed at the geriatric contact center, providing each physician from the target group with prompt access both for the period of treatment and rehabilitation course and the entire period of the physicians medical activity.

Socio-psychological features in patients with pulmonary tuberculosis

BACKGROUND. The effectiveness of the therapy of patients with pulmonary tuberculosis (TB) of various categories is largely related to the psychotraumatic nature of the disease and treatment, however, their social and psychological features and the need for psychological help have not been sufficiently studied.
 OBJECTIVE. To study the socio-psychological features of patients with pulmonary TB depending on the category of the case and the terms of treatment.
 MATERIALS AND METHODS. 200 patients with pulmonary TB were interviewed anonymously, including 45 (22.5 %) – with new cases, 27 (13.5 %) – with repeated treatment, 128 (64.0 %) – with multiple drug resistance (MDR-TB), according to the special form of primary social and psychological assessment of a patient with TB – Patient Health Questionnaire (PHQ-9).
 RESULTS AND DISCUSSIONS. The difference in the presence of unfavorable social factors among TB patients of different categories was revealed: low income, unemployment, disability, bad habits, retirement age, negative social history (were in prisons, migrants or internally displaced, lack of permanent work) met 2-3 times more often among repeated cases of the disease and MDR-TB, than in patients with new cases of the disease. Depressive disorders at the initial stage of treatment were found in 95.0 % of all TB patients, and mostly the signs of depression were pronounced, as evidenced by: very low interest or satisfaction in ordinary things in 52.0 %; bad mood, depression or a feeling of helplessness in 91.5 %; difficulty falling asleep, interrupted or too long sleep in 90.0 %; a feeling of fatigue or exhaustion – loss of strength in 94.5 %; poor appetite or, on the contrary, overeating in 89.5 %; negative thoughts about oneself in 57.5 %; difficulty concentrating in 57.0 %. The duration of these symptoms for more than 7 days during the last 2 weeks in many interviewees indicates a significant expressiveness of depressive disorders in the vast majority of TB patients. The dependence of the psychological state of TB patients on the category of the case and the duration of treatment was established and statistically proven. In patients with repeated treatment and MDR-TB, symptoms of depressive disorders were not only more frequent, but also more severe than in patients with new cases. If 74.8 % of patients with repeated cases and 57.0 % of patients with MDR-TB had mild and moderate depression, then 77.8 % of patients with new cases had mild (subclinical) depression. In patients who were treated for more than 4 months, signs of depressive disorders were more pronounced compared to those who were treated for less.
 CONCLUSIONS. This study not only confirms the need for differentiated psychological support of the treatment process in phthisiology (depending on the category of the case and the duration of treatment), but also encourages the search for new approaches to the medical, social and psychological rehabilitation of TB patients, taking into account the negative impact of the war in Ukraine on the social and psychological condition of such patients and the characteristics of their management in wartime conditions. There is a need to introduce rates of psychologists and psychiatrists for constant counseling of TB patients.

The relationship between the dynamics of the spread of socially dangerous diseases and social inequalities and wartime conditions in Ukraine

The article analyzes the theoretical aspects of scientific researches the problems of spread the socially dangerous diseases and development of health sociology; highlights the results of expert survey of the specialists of public health centers, medical institutions, non-governmental organizations, scientists, conducted by employees of the Department of the Social expertise of the Institute of Sociology of NAS Ukraine in June-August 2022; the influence of existing social inequalities and military time on the spread of socially dangerous diseases is determined. The purpose of the article is to study the interrelation of the dynamics of spread the socially dangerous diseases with social inequalities and conditions of military time in Ukraine. The author made a detailed analysis of the current scientific approach in the field of health sociology, in particular: Ch. Winslow’s theory of "Factors", E. Wilson’s "Sociobiology", concepts of "Stressors" by H. Sale, "Disease of Civilization" by Ch. Rosenberg and "Social Maladaptation" by A. Honneth. The author paid special attention to studying the impact of social inequalities on the spread of socially dangerous diseases in Ukrainian society. In particular, the author highlighted unequal opportunities in access to medical care for different categories of patients with socially dangerous diseases, stigmatization (such forms as discrimination and self-stigmatization), territorial-spatial limitations and various quality of medical care. The analysis of the results of an expert survey of specialists of public health centers and medical institutions, non-governmental organizations and scientists, conducted by members of the Department of social expertise, Institute of Sociology, National Academy of Sciences of Ukraine in June and August 2022 made it possible to establish the influence of social inequalities on the spread of socially dangerous diseases in Ukrainian society. Special attention is paid to the role of Russian military aggression in the worsening situation with the spread of the socially dangerous diseases due to mass destruction of health care facilities, spontaneous movement of large populations, interruptions in the receipt of medicines for therapy, shortage of medical personnel and lack of access to free testing.

The Danish respiratory society guideline for long-term high flow nasal cannula treatment, with or without supplementary oxygen

ABSTRACT Introduction Long-term High Flow Nasal Cannula (LT-HFNC), defined as High Flow Nasal Cannula treatment provided to patients with chronic pulmonary conditions during stable phases, has emerged as a home treatment in different categories of patients with chronic lung diseases in recent years. Methods This paper summarizes the physiological effects of LT-HFNC and evaluates the clinical knowledge to date about treatment in patients with chronic obstructive lung disease, interstitial lung disease and bronchiectasis. The guideline is translated and summarized in this paper and presented unabridged as an appendix to the paper. Results The paper describes the working process behind the Danish Respiratory Society’s National guideline for treatment of stable disease, which has been written to support clinicians in both evidence-based decision making and practical issues concerning the treatment.

Dysbiotic microbiome variation in colorectal cancer patients is linked to lifestyles and metabolic diseases

BackgroundDifferences in the composition and diversity of the gut microbial communities among individuals are influenced by environmental factors. However, there is limited research on factors affecting microbiome variation in colorectal cancer patients, who display lower inter-individual variations than that of healthy individuals. In this study, we examined the association between modifiable factors and the microbiome variation in colorectal cancer patients.MethodsA total of 331 colorectal cancer patients who underwent resection surgery at the Department of Surgery, Seoul National University Hospital between October 2017 and August 2019 were included. Fecal samples from colorectal cancer patients were collected prior to the surgery. Variations in the gut microbiome among patients with different lifestyles and metabolic diseases were examined through the network analysis of inter-connected microbial abundance, the assessment of the Anna Karenina principle effect for microbial stochasticity, and the identification of the enriched bacteria using linear discrimination analysis effect size. Associations of dietary diversity with microbiome variation were investigated using the Procrustes analysis.ResultsWe found stronger network connectivity of microbial communities in non-smokers, non-drinkers, obese individuals, hypertensive subjects, and individuals without diabetes than in their counterparts. The Anna Karenina principle effect was found for history of smoking, alcohol consumption, and diabetes (with significantly greater intra-sample similarity index), whereas obesity and hypertension showed the anti-Anna Karenina principle effect (with significantly lower intra-sample similarity index). We found certain bacterial taxa to be significantly enriched in patients of different categories of lifestyles and metabolic diseases using linear discrimination analysis. Diversity of food and nutrient intake did not shape the microbial diversity between individuals (pProcrustes>0.05).ConclusionsOur findings suggested an immune dysregulation and a reduced ability of the host and its microbiome in regulating the community composition. History of smoking, alcohol consumption, and diabetes were shown to affect partial individuals in shifting new microbial communities, whereas obesity and history of hypertension appeared to affect majority of individuals and shifted to drastic reductions in microbial compositions. Understanding the contribution of modifiable factors to microbial stochasticity may provide insights into how the microbiome regulates effects of these factors on the health outcomes of colorectal cancer patients.

Decision making capacity assessment in general practice in Ireland.

It has been reported internationally that doctors have a limited understanding of the legal standard that applies to decision making capacity (DMC). No research on this has been conducted in Ireland to date. We sought to assess the understanding of legal principles relating to capacity and consent among Irish general practitioners (GPs), alongside how DMC assessments are conducted. This study utilised a cross-sectional cohort model circulating online questionnaires to Irish GPs associated with a university research network. Data were analysed using SPSS to conduct a variety of statistical tests. There were 64 participants, with 50% aged 35-44 years and 60.9% being female. Of these, 62.5% found DMC assessments time-consuming. Only 10.9% of participants felt extremely confident in their abilities; most participants (59.4%) felt 'somewhat confident' in their ability to assess DMC. Also, 90.6% of GPs routinely engaged with families when assessing capacity. GPs felt their medical training did not prepare them for DMC assessment (undergraduate 90.6%, non-consultant hospital doctor 78.1%, GP training 65.6%). 70.3% felt guidelines relating to DMC would be helpful and 65.6% felt they needed additional training. Most GPs recognise the importance of DMC assessment, and it is not considered a complex or burdensome task. There was limited knowledge of the legal instruments relevant to DMC. GPs felt there should be extra support available to assist them with DMC assessment; specific guidelines for different categories of patients was found to be the most popular resource requested.

A Multi-objective Mathematical Programing Model for the Problem of P-envy Emergency Medical Service Location.

To prevent the great dangers caused by emergency situations, providing rapid and high-quality emergency aid highly depends on the location of emergency medical centers. The purpose of this research is to present a multi-objective mathematical programing model based on the minimum P-envy algorithm to locate and construct emergency medical services (EMS). Maximizing the coverage in order to increase the probability of survival of different categories of patients, minimizing the costs of constructing EMS and optimizing the ratio of regions having the right to emergency medical services is one of the fundamental challenges in the health care system of countries. In this paper, a model for maximum utilization of EMS considering budget limitations is presented. In this study, since the problem is NP-Hard, the Genetic Algorithm (GA) and Simulated Annealing (SA) algorithm were used to solve this problem. The parameters of the metaheuristic algorithms were tuned using the Taguchi method. Several instance problems were solved to compare the performance of 2 algorithms. The results demonstrate that the validity of the proposed model. Also, the mean of the solutions obtained by GA for small, medium, and large-size problems are better than the SA algorithm. Also, the GA algorithm obtained more efficient solutions than the SA algorithm.

Risk Factors for the Development of Parastomal Hernia: A Narrative Review.

Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m2, altered collagen metabolism, and diabetes.

The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder.

The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD. An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews. Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD. An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.