Different Kinds Of Patients Research Articles

Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nosocomial Respiratory Viral Infections on the Leeside of the Pandemic.

The COVID-19 pandemic has had an unprecedented impact on population health and hospital operations. Over 7 million patients have been hospitalized for COVID-19 thus far in the United States alone. Mortality rates for hospitalized patients during the first wave of the pandemic were > 30%, but as we enter the fifth year of the pandemic hospitalizations have fallen and mortality rates for hospitalized patients with COVID-19 have plummeted to 5% or less. These gains reflect lessons learned about how to optimize respiratory support for different kinds of patients, targeted use of therapeutics for patients with different manifestations of COVID-19 including immunosuppressants and antivirals as appropriate, and high levels of population immunity acquired through vaccines and natural infections. At the same time, the pandemic has helped highlight some longstanding sources of harm for hospitalized patients including hospital-acquired pneumonia, ventilator-associated events (VAEs), and hospital-acquired respiratory viral infections. We are, thankfully, on the leeside of the pandemic at present; but the large increases in ventilator-associated pneumonia (VAP), VAEs, bacterial superinfections, and nosocomial respiratory viral infections associated with the pandemic beg the question of how best to prevent these complications moving forward. This paper reviews the burden of hospitalization for COVID-19, the intersection between COVID-19 and both VAP and VAEs, the frequency and impact of hospital-acquired respiratory viral infections, new recommendations on how best to prevent VAP and VAEs, and current insights into effective strategies to prevent nosocomial spread of respiratory viruses.

Feature Selection Using a Hybrid Approach Depends on Filter and Wrapper Methods for Accurate Breast Cancer Diagnosis

Breast cancer is the biggest cause of mortality in women, outscoring all other malignancies. Diagnosing breast cancer is hard because the disease is complicated, treatment methods change, and there are many different kinds of patients. Information technology and artificial intelligence contribute to improve diagnostic procedures, which are critical for care and treatment as well as reducing and controlling cancer recurrence. The primary part of this research is to develop a new feature selection strategy based on a hybrid approach that combines two methods for selecting features: the filter and the wrapper. In two stages, this method reduces the number of features from 30 to 15 to increase and improve classification accuracy. The suggested method was tested using the Wisconsin Breast Cancer Dataset dataset (WDBC). To enhance the classification of breast cancer tumors, a soft voting classifier was used in this study. The proposed methodology outperforms previous research, achieving 1 for the F1 score, 1 for AUC, 1 for recall, 1 for precision, and 100% for accuracy. Furthermore, 10-fold cross-validation has a 98.2% accuracy rate.

AI Enhanced Person-Centred Care Services for Monitoring Stroke Outpatient Rehabilitation.

Development of person-centred care (PCC) services require adjustment to specific domain of application and integration with existing processes implemented in healthcare institution. This poster present PCC services for monitoring stroke outpatient rehabilitation, enhanced by modern ICT technologies (thus enabling adjustments to different kind of patients, which is especially relevant due to potential consequences of the stroke and caused degree of disability).

Effect of community rehabilitation skill on patients with depression

To explore the effect of community depression rehabilitation skill on depressive symptoms and social function of patients with different diagnoses. A total of 74 patients(20 males, 54 females)with depression in Beijing primary care center were divided into rehabilitation group(49 cases, average 51.80 years) and control group(25 cases, average 54.42 years) from August to November 2019.A total of 70 patients in two groups completed the final follow-up study. Patients in the rehabilitation group received depression community rehabilitation skill training for 8 weeks, while patients in the control group received daily community services. The two groups were assessed by the scale at baseline and 8 weeks later. The scales are as follow: basic information form and Hamilton depression scale(HAMD-17) and social disability screening schedule(SDSS), nurses global assessment of suicide risk(NGASR), morisky medication aderence scale(MMAS-8). For counting data χ~2inspection; The t-test for measurement data. Before the intervention, There was no significant difference in HAMD-17, NGASR, MMAS-8 and SDSS total score and each factor score of SDSS between the two groups(P>0.05). Paired t-test showed that after intervention, HAMD-17 total score, NGASR total score, and SDSS factors of social withdrawal, social activities outside the family, activities within the family, family functions, self-care of personal life, relationship and interest to the outside world, sense of responsibility and planning(P<0.05) in rehabilitation group were all significantly lower than before intervention. The rehabilitation skills of depression can improve the depressive symptoms and social function of different kinds of patients, and is suitable for promotion in the community.

Thea: empowering the therapeutic alliance of children with ASD by multimedia interaction

The Therapeutic Alliance (TA) between patient and health provider (therapist or clinician) is one of the most relevant factors for the success of a therapy. In the case of people suffering from Autism Spectrum Disorder (ASD), the alliance is extended to all the people involved in their care (i.e., teachers, therapists, clinicians, relatives). In this paper, we propose a multimedia application named Thea for empowering the TA of children with ASD by improving the communication among the TA members, sharing guidelines, multimedia contents, and strategies to comply with challenging behaviors and progress with particular attention towards end-users who are occasional smart-users. A detailed process for empowering the TA members by enhancing the informed interaction among all of them is proposed and implemented. A vocal assistant also supports patients/caregivers and therapists in documenting their activity with the person with ASD by recording videos in a free-hand modality. After a contextual analysis based on Thematic Analysis Template, Thea has been implemented using a user-centered development approach. We performed three iterations involving the end-users. A user study is performed at the third iteration. Results of the user study revealed a positive attitude towards the application. In particular, the perception of empowerment of participants increased after the tool had been used. We also highlighted the guidelines and tools that may be adopted for empowering different kinds of patients. The first results seem to suggest that the use of Thea may increase the belief of the caregivers of a person with ASD to be able to better take care of her, in a more controlled and informed way.

Spinal Anesthesia: Much More Than Single Shot of Hyperbaric Bupivacaine

There is significant and renewed attentiveness in the use of regional anesthesia techniques for many common surgeries. The vast majority of anesthesiologists world wide use the routinely the hyperbaric solution of bupivacaine for almost all types of surgery. However, they ignore that spinal anesthesia has more to offer. A different kind of technique for a different kind of patients. The understanding of spinal anesthesia in relation to sensory and motor blocks with hyperbaric and isobaric solutions is shown in this article. The possibilities of performing unilateral spinal anesthesia are described.

A journey through roses and thorns: becoming a physician by learning from patients with life-threatening illnesses. A qualitative study with international medical students.

The medical students' well-being may be threatened by various stressors associated with providing care to different kinds of patients. This study aims to explore students' clinical experiences with patients who suffer from life-threatening illnesses, focusing on potential risk and protective factors. Audio-recorded and face-to-face interviews were conducted and transcribed verbatim. The "Interpretive Description" approach was used to analyse data. Overall, ten medical students with a mean age of 28 years old were interviewed. Well-being promoting factors were the following: therapeutic relationships, work-life balance, social support and communication, perception of improvement in knowledge and availability of advanced directives. Whilst factors that may reduce well-being included death exposure, managing emotions, communication difficulties, internal conflicts and disagreements, lack of knowledge and subjective concerns. These findings shed light on facets that are inherent parts of clinical experience with patients suffering from a life-threatening illness and that may turn in risk or protective factors for the medical students. Understanding the students' subjective experiences may aid in the improvement of the current educational programs, as well as in the development of tailored supportive and preventative interventions to promote well-being and professional competencies among this kind of students.

Either you Break or Brighten up: Exploring Dental Professionals’ Experiences of Dealing with Emotional Distress during Dental Practice. A Qualitative Description

Purpose: The study purpose was to provide qualitative description of distress, its manifestations and role of resilience as perceived by practicing dentists in the Kingdom of Saudi Arabia (KSA). The goal was to provide fresh insights into the topic of distress and required coping skills in order to inform the development of future stress management programs.Methodology: This study was designed qualitatively to determine the causes and impacts of stress among practicing dentists in KSA. Purposive sampling of dentists having not less than 5 years of practice and an average of 54 working hours per week (SD= 6) was done based on convenience approach. Twelve semi structured individual interviews with the help of an interview guide, were conducted and audiotaped to collect the data. After analysis of descriptive data, a coding scheme with four categories was generated by continuous adjustments. The categories originated as; stressful situations, impacts of distress, coping strategies and need of future interventions, were then applied to every single interview. This had identified many codes/themes and sub codes/subthemes related to the topic. The codes emerged were also double checked with the supervisor to have an inter-coder agreement. The participants were contacted again to validate the given information in the transcribed interview to increase the credibility of the study.Findings: Work load, different kind of patients and financial pressure were reported as major cause of distress for dentists during practice. The cognitive reactions to distress came out to be some physical and many emotional disturbances affecting both the professional and family lives of dentists.Regarding the experiences to cope, they implemented personal strategies to be resilient instead of compromising the quality of care they deliver. Also, they emphasized on the need of following interventions; Continued dental education with training courses to improve resilience amongst dentists and modified dental curriculum for dental students to face positively, the distressful situations in future practical part of their profession.Unique contribution to theory, practice and policy: This study provided deep understandings of already developed concepts regarding stress and coping. The study findings proposed that individuals should focus on delivering high quality care by utilizing positive stress coping strategies. They should learn to adopt strategies that are easily accessible and sustainable within the context of a busy dental practice. Interventions to improve skills like motivation, self-determination and decision making should be implemented. Thus the study calls for imperative steps to be taken by stakeholders in dental institutes and at dental practices.

Nothing Else Than Decay: Theodoor van der Schuer’s Allegory of Human Deprivation for Leiden’s Plague Hospital

In 1682, the highly regarded artist Theodoor Cornelisz van der Schuer (1634–1707) painted a canvas for the boardroom of the plague hospital in Leiden. He transformed well-known depictions of the plague to create an image of an unspecified hospital in a timeless setting. More than simply an image of a hospital, the painting is also an allegory of human dependence on God. Focusing on the plague-stricken figure of Charity, the allegory visualizes moral ideas that were disseminated in a 1526 tract on poor relief written by Juan Luis Vives. In the painting, the plague becomes a symbol of human deprivation, and by depicting Charity as a plague victim, van der Schuer projects the idea that humility is an essential part of charity. Since Vives was widely known throughout the seventeenth century, we may assume that his ideas were familiar to the hospital’s regents. And although van der Schuer disguises Charity as a plague victim, visitors to the boardroom probably recognized the personification nevertheless. Images of Charity were ubiquitous, especially in the context of hospitals, where they reflected the actions of the regents donating their time and dedicating their skills to the destitute. In reality, the hospital probably did not ever house plague victims; although the disease remained a constant threat, the institution served different kinds of patients. Combining a scene of the plague with a broad-reaching allegory, the painting proved relevant for decades to come.

Multiple Vulnerabilities in Medical Settings: Invisible Suffering of Doctors

While there is a substantive amount of literature on vulnerability of different kinds of patients in different settings, medical professionals are usually considered as the ones who possess power and gain a privileged position. In this paper, we aim to demonstrate that in a certain context physicians—a social group which is usually referred to as “powerful”—consider themselves vulnerable, and this positioning may influence patients in turn. This perspective highlights the complexity of interactions within medical organizations and contributes to the studies of sensitive topics and vulnerable groups. We conceptualize vulnerability of doctors and discuss what can be problematic in powerful doctors’ position. We describe some features of the post-Soviet context of Russian healthcare system and maternity care, both of which can be conceptualized as a hybrid of legacy of Soviet paternalism and new neoliberal reforms, managerialism and marketization. Empirical research is based on the ethnographic evidence from the study of a Russian perinatal center. In this article, we explore specific “existential” and “moral” vulnerabilities of medical professionals who routinely have to cope with multiple challenges, such as complicated clinical tasks, rigid control of different state bodies and emotional responses of suffering patients. We argue that there is a bond between the vulnerability of doctors and that of patients, whose position becomes more problematic as professionals become more vulnerable. At the end, we discuss methodological and theoretical implications of our research.

Metamodel-based simulation optimisation for bed allocation

Hospital beds are one of the most critical resources in healthcare institutions. In practice, beds are usually allocated to different departments in advance to accommodate different kinds of patients. Inappropriate decisions in the allocation may lead to the idleness of beds or the high rejection ratio of patients. Hospital managers are under pressure to allocate beds to different departments. High variability in patient arrivals and service times make the allocation problem complex and challenging to solve. To address this problem, a mixed-integer non-linear programming model is formulated, with the objective of minimising the weighted cost of rejecting patients and holding them waiting. To solve this model, a data-driven metamodel simulation optimisation method is proposed, in which metamodels, based on an analytical queuing model and a general function, are proposed and embedded into a general-purpose algorithm Adaptive Hyperbox Algorithm. The metamodels designated for local and global approximation are separately fitted using different sets of simulation observations, which can combine structural information and simulation information, and can provide insightful guidance in solution improvements. A case study is conducted based on the real data collected from a public hospital in Shanghai. Numerical results demonstrate the efficiency of the proposed method.

The possibilities of using local thermometry to objectify the effect of osteopathic correction in patients with dorsopathy at the cervicothoracic level

Introduction. Neurological manifestations of osteochondrosis of the spine are among the most common processes contributing to the onset of chronic pain syndrome. For a number of reasons, there are still diffi culties in treatment of this group of diseases. That is why in recent years the interest of the medical community to non-medicamentous methods of treatment, such as osteopathy, has reasonably increased. At the same time, the problem of objectifying somatic dysfunctions, as well as the results of osteopathic treatment, is quite acute.Goal of research — to assess the dynamics of the local temperature in the zones of regional somatic dysfunctions against the background of osteopathic treatment in patients with dorsopathy at the cervicothoracic level.Materials and methods. Longitudinal study was carried out in the specialized osteopathic clinic «Mokhov Institute of Osteopathy» from 01.2018 to 06.2018. The study involved 18 patients aged 25 to 45 years with dorsopathy at the cervicothoracic level. All patients underwent a clinical osteopathic examination. A visual analogue pain scale was used to assess the severity of the pain syndrome. Local thermometry was performed in the areas of identifi ed regional somatic dysfunctions. Each patient underwent individual osteopathic treatment based on the results of osteopathic diagnosis. At the time of the study patients did not receive any other treatment.Results. Against the background of osteopathic treatment, the mean number of revealed somatic dysfunctions decreased from 9±0,5 to 4±0,2 (p<0,05) per patient. Prior to treatment, there was a decrease in the local temperature and the presence of signifi cant thermic asymmetry in the cervical, thoracic, lumbar and pelvic regions. In the region of the head, on the contrary, there was an increase in the local temperature. In other regions the level of thermal asymmetry was insignifi cant. After osteopathic correction, a statistically signifi cant (p<0,05) dynamics (a decrease in the expression of thermic asymmetry) was obtained in the following regions: the cervical region (the structural component), the thoracic region (the structural component), the lumbar region (the structural component), the region of the head. Also, the treatment contributed to the signifi cant reduction in the severity of pain syndrome in patients.Conclusion. At the present stage, non-pharmacological methods of treatment can signifi cantly expand the possibilities of therapy and rehabilitation of different kinds of patients including neurological ones. The local thermometry method can potentially be used to objectify the effect of osteopathic treatment.

Discussion of “Life on Her Own Terms: A Story of Reclamation”

My response to Beritzhoff’s paper focuses on the central relationship between play and the development of the self. I argue that her presentation of a set of ideas and clinical techniques for actively fostering a potential play space is courageous in the context of a history of psychoanalytic controversy about the activity of the analyst. I also point out that her effective work with her melancholic patient could apply to many different kinds of patients, as well. I then try to highlight Beritzhoff’s ideas by showing their usefulness in a case of my own—a patient very different from Janet who was able to develop his sense of self through play.

Pilot research: construction of emergency rescue database

To construct a database containing multiple kinds of diseases that can provide "real world" data for first-aid clinical research. Structured or non-structured information from hospital information system, laboratory information system, emergency medical system, emergency nursing system and bedside monitoring instruments of patients who visited department of emergency in PLA General Hospital from January 2014 to January 2018 were extracted. Database was created by forms, code writing, and data process. Emergency Rescue Database is a single center database established by PLA General Hospital. The information was collected from the patients who had visited the emergency department in PLA General Hospital since January 2014 to January 2018. The database included 530 585 patients' information of triage and 22 941 patients' information of treatment in critical rescue room, including information related to human demography, triage, medical records, vital signs, lab tests, image and biological examinations and so on. There were 12 tables (PATIENTS, TRIAGE_PATIENTS, EMG_PATIENTS_VISIT, VITAL_SIGNS, CHARTEVENTS, MEDICAL_ORDER, MEDICAL_RECORD, NURSING_RECORD, LAB_TEST_MASTER, LAB_RESULT, MEDICAL_EXAMINATION, EMG_INOUT_RECORD) that containing different kinds of patients' information. The setup of high quality emergency databases lay solid ground for scientific researches based on data. The model of constructing Emergency Rescue Database could be the reference for other medical institutions to build multiple-diseases databases.

Whole-body physiology-based pharmacokinetics of caspofungin for general patients, intensive care unit patients and hepatic insufficiency patients.

Caspofungin is an echinocandin antifungal agent licensed as a first-line therapy for invasive candidiasis in patients with moderate to severe illness or recent exposure to azoles. In this study we developed a whole-body physiology-based pharmacokinetics (WB-PBPK) model to predict the pharmacokinetics (PK) of caspofungin, and combined with Monte Carlo simulation (MCS) to optimize clinical dosage regimens of caspofungin in different kinds of patients. A WB-PBPK model of caspofungin was built and validated with raw data from 4 previous trials of general patients, intensive care unit (ICU) patients with Child-Pugh B, ICU patients on continuous renal replacement therapy, mild and moderate hepatic insuffciency (HI) patients. MCS was used to optimize clinical dosage regimens of caspofungin in these patients. A cumulative fraction of response (CFR) value of ≥90% was considered to be the minimum for achieving optimal empirical therapy. The simulated results of the WB-PBPK model were in good agreement with observed values of all trials. For general and ICU patients with caspofungin 70/50 mg, AUC and Cmax were decreased with the increase of body weight (BW) and showed great variation. MCS showed all general patients achieved CFR≥90% regardless of BW. But not all ICU patients with higher BW (≥70 kg) could achieve CFR≥90%. Compared with standard dosage regimens in general patients, caspofungin 70/35 mg in ICU patients with Child-Pugh B achieved significantly decreased AUC and Cmax, but obtained similar AUC and Cmax in moderate HI patients with Child-Pugh B. The WB-PBPK model of caspofungin is able to predict PK of all populations correctly. The combined WB-PBPK model with MCS can successfully optimize clinical dosage regimens of caspofungin in all patient populations.

The Hypothalamic–Pituitary Axis and Autoantibody Related Disorders

This review summarized different studies reporting the presence of autoantibodies reacting against cells of the pituitary (APAs) and/or hypothalamus (AHAs). Both APAs and AHAs have been revealed through immunofluorescence using different kinds of substrates. Autoantibodies against gonadotropic cells were mainly found in patients affected by cryptorchidism and hypogonadotropic hypogonadism while those against prolactin cells were found in different kinds of patients, the majority without pituitary abnormalities. APAs to growth hormone (GH) cells have been associated with GH deficiency while those against the adrenocorticotropic cells have distinguished central Cushing’s disease patients at risk of incomplete cure after surgical adenoma removal. AHAs to vasopressin cells have identified patients at risk of developing diabetes insipidus. APAs have been also found together with AHAs in patients affected by idiopathic hypopituitarism, but both were also present in different kinds of patients without abnormalities of the hypothalamic–pituitary axis. Despite some data being promising, the clinical use of pituitary and hypothalamus autoantibodies is still limited by the low diagnostic sensitivity, irreproducibility of the results, and the absence of autoantigen/s able to discriminate the autoimmune reaction involving the pituitary or the hypothalamus from the other autoimmune states.

El Modelo de Asimilación como un Modelo Integrador sobre el Cambio Terapéutico


 
 
 Este trabajo se centra en el modelo de asimilación de experiencias problemáticas. Dicho modelo es un modelo de corte integrador que nos permite estudiar el proceso de cambio en cualquier enfoque terapéutico y con diversos tipos de pacientes y sujetos. Por ello, expondremos, en primer lugar, los principales conceptos y características del modelo, como por ejemplo, qué significa asimilar, el concepto de voz y de voz no dominante y voz dominante, junto con la descripción de la Escala de Asimilación de Experiencias Problemáticas. A continuación, se describirán los resultados más destacados alcanzados en tres áreas principales: el estudio del proceso de cambio en pacientes; el proceso irregular y dentado de asimilación y el papel que tiene el terapeuta en dicho proceso. Esta última cuestión se relaciona con el concepto de responsividad y con el concepto de integración asimilativa.
 
 

Bridging patients with hepatocellular cancer waiting for liver transplant: all the patients are the same?

Liver transplant (LT) is considered the best curative treatment for patients with cirrhosis and hepatocellular carcinoma (HCC) within Milan criteria. The possibility to perform LT in HCC patients is limited by the liver grafts supply; indeed, the shortage of donors often leads to a long time on waiting list and then to dropout because of tumor progression. Bridging therapies are neo-adjuvant treatments given to patients on LT waitlist, with the aim to prevent tumor progression and to reduce dropout rate. Many bridging modalities have been proposed. The choice of each treatment is based on the characteristics of the patient, liver function, comorbidities and on the number, dimensions and localization of HCC. This review article describes several types of bridging therapies, focusing on the indications for different kind of patients.

Evaluation of cytochrome P450 2C9 activity in normal, healthy, adult Western Indian population by both phenotyping and genotyping.

Objectives:Cytochrome P450 2C9 (CYP2C9) is a member of cytochrome P450 (CYP) family that accounts for nearly 18% of the total CYP protein content in the human liver microsomes and catalyzes almost 15–20% of the drugs. Considering the paucity of data on the polymorphisms of CYP2C9 in Western Indian population, the present study was conducted to evaluate the prevalence of CYP2C9 polymorphisms (*1, *2 and *3) and correlate it with the activity using flurbiprofen (FLB) as a probe drug.Materials and Methods:A 100 mg FLB capsule was administered to 298 healthy adult participants. Venous blood samples were analyzed at 2 h postdose for the estimation of FLB and 4-hydroxy FLB. Metabolic ratio (MR) was calculated to determine the extent of poor metabolizer (PM) and rapid metabolizer status using probit plot. Genotyping of CYP2C9 polymorphism was performed using polymerase chain reaction-restriction fragment length polymorphism technique.Results:Of the total 298 participants, phenotype was assessable in 288 and genotype was performed in 289 participants. The median (range) MR of the study population was 6.6 (1.65–66.05). Five participants were found to be PMs by phenotype. Of the total 289 participants, 209 (72.3%) (66.7, 77.2) had CYP2C9*1/*1, 25 (8.7%) (5.8, 12.7) with CYP2C9*1/*2, 55 (19%) (14.8, 24.1) had CYP2C9*1/*3, 3 (1%) (0.3, 3.3) had CYP2C9*2/*3 genotype. A significant association between phenotype and genotype was observed.Conclusion:To conclude, the present study found significant association of CYP2C9 activity by both phenotype and genotype and these findings have to be corroborated in different kinds of patients.

AB1156-HPR Do Rheumatic Patients under Biological Therapy Receive More Attention from Their Doctors Compared with Those Who do not Receive Such Therapy?

BackgroundChronic rheumatic patients come in contact with health system more often than regular people that give them the opportunity to better identify both the strengths and weakness of this system....