Disease Management System Research Articles

Impact Analysis of De-Identification in Clinical Notes Classification.

Clinical notes provide valuable data in telemonitoring systems for disease management. Such data must be converted into structured information to be effective in automated analysis. One way to achieve this is by classification (e.g. into categories). However, to conform with privacy regulations and concerns, text is usually de-identified. This study investigated the effects of de-identification on classification. Two pseudonymisation and two classification algorithms were applied to clinical messages from a telehealth system. Divergence in classification compared to clear text classification was measured. Overall, de-identification notably altered classification. The delicate classification algorithm was severely impacted, especially losses of sensitivity were noticeable. However, the simpler classification method was more robust and in combination with a more yielding pseudonymisation technique, had only a negligible impact on classification. The results indicate that de-identification can impact text classification and suggest, that considering de-identification during development of the classification methods could be beneficial.

The role and tasks of patient groups as an innovator of health and medical system : Focused on the activities of Korean Society Type 1 Diabetes

The health and medical service paradigm is changing from provider-centered treatment to consumer-centered prevention and management. As medical expenses increase due to an increase in the number of chronically ill patients, national policy support is in progress to increase their healthy lifespan. The perception of the patient is also changing from a passive object to a subject. Accordingly, discussions on how to re-establish the role of the patient and organize and grow as an innovation agent are also in full swing. In this study, the case of ‘Korean Society Type 1 Diabetes’, which is leading user-driven innovation activities in the living lab method. The Korean Society Type 1 Diabetes has been building a new patient-led disease management system by not only developing patient-led devices, but also taking the lead in medical policies and improving social awareness. In particular, since it was an ‘undone science’ field that specialized institutions and related organizations were not interested in, patients and their families as the parties and the final user are making related technologies, laws, and institutions. By operating a field-based, patient-led living lab, it is becoming a major player of building a patient-centered research platform while developing capabilities and creating alternatives to problem-solving. Through technological experiments, network expansion, and related institutional innovation activities related to type 1 diabetes, patient group is conducting a leading experiment in achieving a transition from a hospital and treatment-oriented health care system to a patient-centered, prevention and care-centered health care system.

The Impact of Diabetes on Vascular Disease: Progress from the Perspective of Epidemics and Treatments

At present, the global incidence of diabetes has increased in countries with large populations, and the changes in developing regions are particularly worthy of attention. In the past 40 years or so, the income situation in China, India, and other countries has exploded, leading to changes in the way of life and work as well as an increase in the prevalence of diabetes. Metabolic disorders caused by diabetes can lead to secondary vascular complications, which have long-term malignant effects on the heart, kidneys, brain, and other vital organs of patients. Adequate primary prevention measures are needed to reduce the incidence of diabetic vascular complications, and more attention should be given to treatment after the disease. To this end, it is necessary to determine a standardized drug and physical therapy system and to build a more efficient and low-cost chronic disease management system.

Elements of chronic disease management service system: an empirical study from large hospitals in China

At present, more patients suffer from multiple chronic diseases. However, the hospital's existing chronic disease management is carried out according to the department. This means that a patient needs to go to more than one department for a chronic disease treatment. Therefore, this study proposes 6 dimensions (organizational management, medical service support, medical service, community alliance, self-management support, management information system) and 36 questions, to help evaluate the current chronic disease management system in China's large third-class hospitals. In this study, 143 survey samples from doctors and nurses were collected. A principal component analysis was used to extract three key elements of chronic disease management service delivery system (service management organization, management information system, medical core service). Then, multiple regression was used to establish the relationship model between the overall performance of the system and the main elements. Three key service nodes of the system (medical specialist support, patient tracking management and personalized intervention) were determined according to the weight of the regression model. The regression coefficients of the above three main elements show a similar impact on the overall performance of the system, but the key service nodes under each major element have relative differences, including medical specialist support, patient tracking management and personalized intervention. Finally, to establish a chronic disease management system with multiple departmental continuous care for chronic diseases, it is necessary to improve the chronic disease management system from three aspects of medical specialty support, patient tracking management and personalized intervention. This paper proposes corresponding improvement strategies.

Comparison of Disability-Adjusted Life Years (DALYs) and Economic Burden on People With Drug-Susceptible Tuberculosis and Multidrug-Resistant Tuberculosis in Korea.

In the future, tuberculosis (TB) will place a heavy burden on the aging population in Korea. To prepare for this crisis, it is important to analyze the disease burden trend of drug-susceptible tuberculosis (DS-TB) and multidrug-resistant tuberculosis (MDR-TB). Measuring disability-adjusted life years (DALYs) and economic burden on MDR-TB patients can help reduce the incidence of TB. Accordingly, in this study, we measured the DALYs and economic burden on DS-TB and MDR-TB patients in 2014–2017 using a combination of National Health Insurance claims data, Annual Report on the Notified TB data, and Statistics Korea's mortality data. The incidence-based DALY approach implemented involved the summation of years of life lost and years lived with disability. For measuring economic burden, direct and indirect costs incurred by patients were totaled. From 2014 to 2017, DALYs per 100,000 people with DS-TB were 56, 49, 46, and 40, respectively, and DALYs per 100,000 people with MDR-TB were 3, 2, 2, and 2, respectively. The economic burden for the DS-TB population from 2014 to 2017 was $143.89 million, $136.36 million, $122.85 million, and $116.62 million, respectively, while that for MDR-TB was $413.44 million, $380.25 million, $376.46 million and $408.14 million, respectively. The results showed a decreasing trend in DALYs and economic burden for DS-TB, whereas MDR-TB was still found to be burdensome without a specific trend. With respect to age, the economic burden for both DS-TB and MDR-TB was higher among men than among women till ≤ 79 years. Conversely, the economic burden for women aged ≥80 years was higher as compared to their male counterparts. In conclusion, the incidence and spread of TB in all areas of society must be suppressed through intensive management of MDR-TB in the older population. We hope that the national TB management project will proceed efficiently when the infectious disease management system is biased to one side due to the COVID-19 pandemic.

A Flexible Dual-Analyte Electrochemical Biosensor for Salivary Glucose and Lactate Detection.

Electrochemical biosensors have been widely applied in the development of metabolite detection systems for disease management. However, conventional intravenous and fingertip blood tests are invasive and cannot track dynamic trends of multiple metabolites. Among various body fluids, saliva can be easily accessed and is regarded as a promising candidate for non-invasive metabolite detection. Recent works on the development of electrochemical biosensors for monitoring salivary metabolites have demonstrated high sensitivity and wide linear range. However, most of this research has been focused on salivary detection of a single metabolite. Here, we present a dual-channel electrochemical biosensor for simultaneous detection of lactate and glucose in saliva based on a flexible screen-printed electrode with two working electrodes. The sensitivities of glucose and lactate channels were 18.7 μA/(mM·cm2) and 21.8 μA/(mM·cm2), respectively. The dual-channel biosensor exhibited wide linear ranges of 0–1500 μM for the glucose channel and 0–2000 μM for the lactate channel and the cross-talk between the two detection channels was negligible, which made it adequately suitable for sensing low-level salivary metabolites. Such attractive characteristics demonstrate the potential of this dual-analyte biosensor in the development of wearable devices for monitoring disease progression and fitness.

Application of nanotechnology in ophthalmology: Where are we?

Nanotechnology is a subject that studies, processes, and applies various functional materials, equipment, and systems, and controls substances on a nanoscale. Nanomedicine refers to its application in diagnosing, treating, preventing, and monitoring various diseases. Drugs administered through eye drops must travel a long distance to avoid various eye barriers reaching the posterior segment of the eye, to achieve the lowest drug level. This review focuses on nanotechnology-based eye disease treatment systems and highlights the obstacles affecting the drug management of eyes and nano-systems for the treatment of eye diseases. This paper summarizes the development prospect of nanotechnology and the challenges it faces in the treatment and diagnosis of ophthalmic diseases, to provide information and new ideas for the implementation of treatment and the development of a refractory eye disease management system.

Cost-effectiveness and cost-utility of traditional and telemedicine combined population-based age-related macular degeneration and diabetic retinopathy screening in rural and urban China

SummaryBackgroundTo assess the cost-effectiveness and cost-utility of a population-level traditional and telemedicine combined age-related macular degeneration (AMD) and diabetic retinopathy (DR) screening program in rural and urban China.MethodsDecision-analytic Markov models were conducted to evaluate the costs and benefits of traditional and telemedicine combined AMD and DR screening from a societal perspective. A cohort of all participants aged 50 years old and above was followed through a total of 30 1-year Markov cycles. Separate analyses were performed for rural and urban settings. Relevant parameters such as the prevalence of AMD and DR, transition probability, compliance with screening and treatment, screening sensitivity, specificity, utility, and mortality were collected from published studies specific to China, other Asian counties' studies, or unpublished data sources such as the National Committee for the Prevention of Blindness. Costs of screening, full examination, and treatment come from the real medical environments and unified pricing of Beijing Municipal Medical Insurance Bureau. Primary outcomes were incremental cost-utility ratios (ICURs) using quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) using years of blindness avoided. One-way deterministic and simulated probabilistic sensitivity analyses were conducted to reflect uncertainty.FindingsUnder the status quo, the total expected medical costs for a 50-year-old patient with AMD or DR were $869·59 and $1,514·18 in rural and urban settings, respectively. Both traditional and telemedicine screening were highly cost-effective. In rural settings, ICURs were $191 (95% confidence interval [CI]: $66 to $239) and $199 (95% CI: $-12 to $217), and ICERs were $2,436 (95% CI: $1,089 to $3,254) and $2,441 (95% CI: $1,452 to $3,900) for traditional and telemedicine screening separately. Even more surprising, both screening strategies dominated no screening in urban settings. Our results were insensitive and robust to extensive sensitivity analyses. Among all acceptable screening intervals (from 1 to 5 years), annual screening could not only produce biggest benefits but also keep ICERs less than three times and one time the per capita gross domestic product (GDP) in rural and urban settings separately. When compared with traditional screening, ICERs of telescreening were less than three times the per capita GDP in rural settings ($2,559 to $8,809) and less than one time the per capita GDP in urban settings (less than $5,564), annual telescreening produced the biggest benefits, it could avert 119 and 270 years of blindness in rural and urban areas separately when 100,000 people were screened.InterpretationWe performed decision-analytic Markov models for combined AMD and DR screening in rural and urban China, and the results showed that population-level combined screening for AMD and DR is likely to be highly cost-effective in both rural and urban China for people over 50 years old. Optimal screening may have an interval of every year based on teleophthalmology platforms. In the future, China should pay more attention to chronic eye diseases and the government should establish a sound chronic disease management system and make every patient enjoy equal medical services.FundingNational Natural Science Foundation of China, NSFC (82171051); the Major Innovation Platform of Public Health & Disease Control and Prevention, Renmin University of China and Beijing Nova program (Z191100001119072).

The epidemiological characteristics of pneumoconiosis in Qingyuan City from 1949 to 2018

Objective: In order to find out the prevalence and death of pneumoconiosis in Qingyuan City, to explore the regularity of pneumoconiosis and lay a foundation for the prevention and management of pneumoconiosis. Methods: In August to December 2019, the basic data of pneumoconiosis from 1949 to 2018 were obtained through the monitoring of death causes of residents, occupational disease management system, Guangdong population information system and other means. The reported cases of pneumoconiosis were followed up, and retrospective investigation was conducted to analyze the basic conditions, the length of service exposed to dust, the time of diagnosis, the type of disease, the stage and the combined status of tuberculosis of pneumoconiosis cases. Results: From 1949 to 2018, a total of 466 cases of new pneumoconiosis were reported in Qingyuan City, including 325 cases of death (69.74%) , 114 cases of survival (24.46%) and 27 cases of loss of follow-up (5.80%) . The cases were mainly concentrated in the age group of 40-89 years (80.04%, 373/466) . There were 411 male cases (88.20%) and 7 female cases (1.50%) . The median length of service exposed to dust was 10.7 (6.0, 16.0) years. The diagnosis time of pneumoconiosis cases was mainly from 1949 to 1986 (68.67%, 320/466) , and the death cases were mainly from 1949 to 1986 (82.77%, 269/325) . Silicosis was the main type of pneumoconiosis (398 cases, 85.41%) . 200 cases (42.92%) were diagnosed as stage I pneumoconiosis, 185 cases (39.69%) were stage II pneumoconiosis, 81 cases (17.38%) were stage III pneumoconiosis at the first diagnosis. 102 cases (21.89%) were pneumoconiosis with tuberculosis. The proportion of death and lost follow-up cases diagnosed as stage I pneumoconiosis for the first time was significantly lower than that of survival cases, and the proportion diagnosed as stage II pneumoconiosis and the complication rate of tuberculosis were significantly higher than those of survival cases (χ(2)=15.48, 11.29, 32.73, P<0.001) . Conclusion: Pneumoconiosis in Qingyuan City is mainly silicosis. The number of new cases has been increasing in the past decade, and the prevention and control situation is still severe. The comprehensive prevention and treatment of silica dust should be included in the focus of supervision of government functional departments.

COVID-19 in North Korea and Its Effect on the Cooperation of North and South Korea in the Field of Health Care

COVID-19 is an infectious respiratory disease that first appeared in December 2019 in Wuhan, China and first spread throughout the country and then worldwide. WHO Director-General Tedros Adhanom Ghebreyesus, concerned about the rapid spread of COVID-19, officially declared a global pandemic on March 11, 2020. North Korea (Democratic People’s Republic of Korea) barred foreign tourists from China on January 21, 2020, and then completely closed its border with China. In this article, I will explore the impact of COVID-19 on North Korean society and research the cooperation plan between South and North Korea. I will also briefly introduce in the post-COVID-19 period. To better understand the health care system and health conditions in North Korea, I will first analyse the infectious disease management system and, in the context of this, then try to investigate in detail how COVID-19 has affected North Korea. From an economic point of view, I will examine the changes in economic cooperation between North Korea and China, and then try to explain the social changes caused by restrictions on movement and lack of goods, and the political situation in North Korea during the COVID-19 crisis. Finally, I will try to research the situation facing North Korea and suggest a way for cooperation between South and North Korea in the future. The basic aim of this research is to find a useful alternative for joint cooperation in the field of health care and safety and to improve cooperation between South and North Korea in the post-COVID-19 era.

Comparison of Deep Learning Models for Corn Disease Region Location, Identification of Disease Type, and Severity Estimation Using Images Acquired From UAS-Mounted and Handheld Sensors

Highlights An approach using deep learning was proposed for identifying diseased regions in UAS imagery of corn fields with 97.23% testing accuracy using the VGG16 model. Disease types were identified within the diseased regions with a testing accuracy of 98.85% using the VGG16 model. On the diseased leaves, severity was estimated with a testing accuracy of 94.20% using the VGG16 model. Deep Learning models have the potential to bring efficiency and accuracy to field scouting. Abstract. Accurately locating diseased regions, identifying disease types, and estimating disease severity in corn fields are all connected steps for developing an effective disease management system. Traditional disease management that relied on a manual scouting approach was inefficient. Therefore, the research community is working on developing advanced disease management systems using deep learning. However, most of the past studies used public datasets consisting of images with uniform backgrounds acquired under lab conditions to train deep learning models, thus, limiting their use under field conditions. In addition, limited studies have been conducted for in-field corn disease analysis using Unmanned Aerial System (UAS) imagery. Therefore, UAS and handheld imagery sensors were used in this study to acquire corn disease images from fields located at Purdue University’s Agronomy Center for Research and Education (ACRE) in the summer of 2020. A total of 55 UAS flights were conducted over three different corn fields from June 20 through September 29, resulting in a collection of approximately 59,000 images. A novel three-stage approach was proposed by independently training a total of nine image classification models using three neural network architectures, namely: VGG16, ResNet50, and InceptionV3, for locating diseased regions, identifying disease types, and estimating disease severity under field conditions. Diseased regions were first identified accurately in UAS-acquired corn field imagery by a sliding window and deep learning-based image classification, with testing accuracies of up to 97.23%. Diseased region identification was followed by accurately identifying three common corn diseases, namely Northern Leaf Blight (NLB), Gray Leaf Spot (GLS), and Northern Leaf Spot (NLS), within the diseased regions with testing accuracies of up to 98.85%. Finally, the severity of the NLS disease on leaves was estimated with a testing accuracy of up to 94.20%. The VGG16 model achieved the highest testing accuracies for identifying diseased regions in corn fields, identifying corn disease types, and estimating NLS's severity. This study presents promising results for three main elements of a disease management system and could advance traditional scouting by integrating deep learning with UAS imagery. Keywords: Corn Diseases, Datasets, Deep Learning, Disease Identification, Disease Region Location, Image Classification, Severity Estimation, UAS Imagery.

Hypoglycaemia Prediction Models With Auto Explanation

World-wide statistics show a considerable growth of the occurrence of different types of Diabetes Mellitus, posing diverse challenges at many levels for public health policies. Some of these challenges may be addressed by means of computerised systems which may pave the way to provide practitioners with insight on their patient’s conditions anywhere and at anytime, but also to empower Diabetes patients as managers of their health. These systems for disease management come in many shapes and sizes, being the most promising trends the ones that involve expert systems that comprise specialised knowledge, use predictive models, feature engineering and reasoning. This study presents the state-of-the-art on reasoning and prediction models related with either blood glucose level or hypoglycaemia events. The main findings revealed are that there is room for improvement on predictive models, namely to enhance its accuracy and ability to forecast future events into a wider time frame. On the other hand, reasoning models are understudied and its usage in Diabetes management is reduced. We discuss an architecture that combines a predictive model and a reasoning system, with the objective of alerting of impending occurrences and interpret the current situation to accurately advise the diabetic user.

Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research.

Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality despite current treatment strategies which focus on smoking cessation, pulmonary rehabilitation, and symptomatic relief. A focus of COPD care is to encourage self-management, particularly during COVID-19, where much face-to-face care has been reduced or ceased. Digital health solutions may offer affordable and scalable solutions to support COPD patient education and self-management, such solutions could improve clinical outcomes and expand service reach for limited additional cost. However, optimal ways to deliver digital medicine are still in development, and there are a number of important considerations for clinicians, commissioners, and patients to ensure successful implementation of digitally augmented care. In this narrative review, we discuss advantages, pitfalls, and future prospects of digital healthcare, which offer a variety of tools including self-management plans, education videos, inhaler training videos, feedback to patients and healthcare professionals (HCPs), exacerbation monitoring, and pulmonary rehabilitation. We discuss the key issues with sustaining patient and HCP engagement and limiting attrition of use, interoperability with devices, integration into healthcare systems, and ensuring inclusivity and accessibility. We explore the essential areas of research beyond determining safety and efficacy to understand the acceptability of digital healthcare solutions to patients, clinicians, and healthcare systems, and hence ways to improve this and sustain engagement. Finally, we explore the regulatory challenges to ensure quality and engagement and effective integration into current healthcare systems and care pathways, while maintaining patients’ autonomy and privacy. Understanding and addressing these issues and successful incorporation of an acceptable, simple, scalable, affordable, and future-proof digital solution into healthcare systems could help remodel global chronic disease management and fractured healthcare systems to provide best patient care and optimisation of healthcare resources to meet the global burden and unmet clinical need of COPD.

Discussion on the Users’ Personal Characteristics and the Operation of the Residential Treatment Center under the COVID-19 Pandemic Situation - Focusing on the Case of the Gyeonggi International 2 Residential Treatment Center

Korea faced an unprecedented crisis in infectious disease management system as the number of confirmed cases of COVID-19 in Korea soared in March 2020. It was difficult not only for the confirmed patients but also for the seriously ill patients to be assigned beds, so the Residential Treatment Centers were introduced under the concept of isolating and treating asymptomatic or mild patients without treating them in hospitals or self-isolation. In this study, we examined user analysis, legal basis, and operational problems, focusing on the operation of the Gyeonggi International 2 Residential Treatment Center (hereinafter referred to as Ansan Residential Center), which quarantined and treated people diagnosed with COVID-19 from overseas. From March 26 to May 13, 2020, for 49 days, 115 confirmed patients with “COVID-19” who were hospitalized at Ansan Residential Treatment Center were analyzed for their general characteristics and medical records including length of stay and treatment results. Major results showed that 56 people were diagnosed with complete recovery in the Residential Treatment Center, 26 were moved to other Residential Treatment Centers on demand and 28 were taken to other hospitals due to worsening health conditions. The operational problems of Ansan Residential Treatment Center were the lack of operating principles, a lack of skilled medical personnel, a long-term delay in payment of allowances for working applicants and a lack of medical video-related facilities. Through this study, we found that Residential Treatment Center can be a positive factor that prevents the spread of COVID-19 in Korea, but we raise the need to comprehensively analyze the performance of the treatment in Residential Treatment Centers at the national level.

Smallholder cocoa agroforestry systems; is increased yield worth the labour and capital inputs?

CONTEXTSmallholder cocoa agroforestry systems provide most of the cocoa produced world-wide and can improve the livelihoods of rural families in the tropics. However, many smallholder cocoa producers experience low cocoa yields due to generally poor management practices, pests, disease, and low soil fertility. In Papua New Guinea, pest and disease management systems have been developed to provide improved yields and revenues, but there has been limited uptake. OBJECTIVEWe hypothesized that the low uptake of these systems may be due to the improved yields not being sufficient to justify the required increase in labour and capital inputs. Our objective was to assess if the integrated pest and disease management systems were financially viable. METHODSOur methods involved developing discounted cash flow models that incorporated Monte Carlo risk analysis software. We populated the models with labour inputs, costs, and revenue data collected in country, and from scientific literature. In addition to net present value, we evaluated the production systems with additional criteria we deemed appropriate for assessing the required labour inputs and capital outlays; return on labour; mean labour hours/day; mean annual capital outlays, mean hourly income, and mean annual income. RESULTS AND CONCLUSIONSOur results show that under the current cocoa prices being received, all the production systems had a negative net present value, and a mean hourly income that was below the Papua New Guinea minimum wage and less than 1 USD/h. Furthermore, the progressive addition of labour inputs and capital outlays of the pest and disease management systems resulted in mean hourly incomes that are less than currently being received. These decreased hourly earnings may explain the low adoption of these technologies. SIGNIFICANCEFinancial analyses of new smallholder agroforestry technologies should be used to evaluate the viability and likelihood of smallholder technology adoption. Previous research on cocoa pest and disease management systems failed to account for costs related to labour and capital inputs. Even if farm family labour does not incur a direct cash outflow, it does represent an opportunity cost to farmers. Including additional criteria that measure financial returns to farmers relative to labour and capital requirements should be a part these assessments. These additional criteria can aid in evaluating all the economic thresholds that may impact if and how smallholders will incorporate new agroforestry technologies, which can help improve the success for agriculture-based development projects throughout the global tropics.

Epidemiological Characteristics and Trend in the Incidence of Human Brucellosis in Iran from 2009 to 2017.

Background: The development of preventive measures and promotion of healthcare delivery systems for disease management is dependent on detecting the incidence rates of the diseases and important risk factors. The current study aimed to determine some epidemiological indices and trends of the human brucellosis incidence in Iran between 2009 and 2017. Study design: A descriptive cross-sectional study. Methods: In the current study, online data were gathered from all cases of brucellosis who were potentially or definitely diagnosed and registered in medical centers, hospitals, laboratories, and private clinics in all districts of Iran. Epidemiologic questionnaires were used to collect data on demographic and background characteristics, risk factors, high-risk behaviors, and lab test results, respectively, based on the national brucellosis control plan. Results: A total of 138,448 cases of brucellosis have been studied in Iran from 2009 to 2017. The highest (25.89) and the lowest (12.07) incidence rates were observed in 2014 and 2009, respectively. In this nine-year study, the highest incidences were reported in the Hamadan, Lorestan, Kurdistan, and Kermanshah provinces. The cumulative percentages of the disease were estimated for different variables at the following rates: by gender: 57.9% for males; by age groups: 36.2% and 16.7% for the 25-44 and16-24 years age groups, respectively; by occupation: 33.2% for housewives; and by residential area: 75.7% for rural residents. Conclusions: Based on the obtained results, although the incidence of human brucellosis in Iran has declined since 2015, the number of cases has remained high.

From assurance to coproduction: a century of improving the quality of health-care service.

Over the last century, the invitation to improve health-care service quality has taken many different forms: questions, observations, methods, tools and actions have emerged and evolved to create relevant 'improvement work.' In this paper we present three phases of this work. The basic frameworks used in these phases have not supplanted each other, but they have been layered one upon the next over time. Each brought important new thinking, new change opportunities and a new set of limits. The important messages of each need to be carried together into the future, as must the sense of curiosity and possibility about the commonalities that has driven this evolution. Literature, personal experience and other artifacts were reviewed to develop this description of how the focus on quality work has evolved (and continues to evolve) over the last century. We describe three phases. Quality 1.0 seeks to answer the question 'How might we establish thresholds for good healthcare services?' It described certain 'basic' standards that should be used to certify acceptable performance and capability. This led to the formation of formal processes for review, documentation and external audits and a system for public notice and recognition. Over time, the limits and risks of this approach also became more visible: a 'micro-accounting compliance' sometimes triumphed over what might be of even greater strategic importance in the development and operations of effective systems of disease prevention and management to improve outcomes for patients and families. Quality 2.0 asked 'How might we use enterprise-wide systems for disease management?' It added a focus on the processes and systems of production, reduction of unwanted variation, the intrinsic motivation to take pride in work, outcome measurement and collaborative work practices as ways to improve quality, modeled on experiences in other industries. Quality 3.0 asks 'How might we improve the value of the contribution that healthcare service makes to health?' It requires careful consideration of the meaning of 'service' and 'value', service-creating logic, and prompts us to consider both relationships and activities in the context of the coproduction of health-care services. Efforts to improve the quality and value of health-care services have evolved over the last century. With each success have come new challenges and questions, requiring the addition of new frames and approaches.

Using Graphene-Based Biosensors to Detect Dopamine for Efficient Parkinson's Disease Diagnostics.

Parkinson’s disease (PD) is a neurodegenerative disease in which the neurotransmitter dopamine (DA) depletes due to the progressive loss of nigrostriatal neurons. Therefore, DA measurement might be a useful diagnostic tool for targeting the early stages of PD, as well as helping to optimize DA replacement therapy. Moreover, DA sensing appears to be a useful analytical tool in complex biological systems in PD studies. To support the feasibility of this concept, this mini-review explores the currently developed graphene-based biosensors dedicated to DA detection. We discuss various graphene modifications designed for high-performance DA sensing electrodes alongside their analytical performances and interference studies, which we listed based on their limit of detection in biological samples. Moreover, graphene-based biosensors for optical DA detection are also presented herein. Regarding clinical relevance, we explored the development trends of graphene-based electrochemical sensing of DA as they relate to point-of-care testing suitable for the site-of-location diagnostics needed for personalized PD management. In this field, the biosensors are developed into smartphone-connected systems for intelligent disease management. However, we highlighted that the focus should be on the clinical utility rather than analytical and technical performance.

The current status of sexually transmitted infections in South Korean children in the last 10 years.

ObjectivesThis study aimed to review the status of sexually transmitted infections (STIs) in children in South Korea between 2010 and 2019, as well as to establish guidelines for the prevention and management to reduce the incidence of STIs in children.MethodsData reports from 590 STI surveillance institutions in local health center, hospital-level medical institutions with urology or obstetrics/gynecology departments and public hospitals between 2010 and 2019 in the integrative disease management system of the Korea Disease Control and Prevention Agency as of December 2020 were analyzed.ResultsA total of 172,645 cases of STIs were reported over the 10-year period (2010–2019), of which 2,179 cases (1.26%) represented STIs in children below the age of 18 years. A higher incidence of infections was observed in girls (1,499 cases, 68.79%) than in boys (680 cases, 31.21%). The STIs that had the highest incidence were, in descending order, chlamydial infections (997 cases, 45.75%), gonorrhea (592 cases, 27.17%), condyloma acuminata (338 cases, 15.51%), genital herpes (250 cases, 11.47%), and chancroid (2 cases, 0.09%). In adolescents aged 14 to 17 years, chlamydial infections, genital herpes, and gonorrhea were most frequently reported. Condyloma acuminata, in particular, have been consistently reported in children below the age of 14 years.ConclusionChildren must be protected legally and institutionally from sexual abuse. Specific management protocols for STIs in children must be established by local governments and associated organizations. National human papillomavirus vaccination programs should be expanded to include boys, and anti-STI educational efforts using modern media should be more activated.

An Intelligent Information Management System for Retinal Image Storage and Recognition in Chronic Disease using Digital Signal and Image Processing

Retinal imaging plays a very significant role in the study of retinal vasculature changes indicative of chronic disease information related to vision. This study investigates the invulnerability of retinal image information in the disease information system and assesses the quantitative method of the morphological changes in the retinal vascular network. In this work, the medical digital image transmission protocol Digital Imaging &amp; Communications in Medicine (DICOM) version 3.0 and the retinal image Picture Archiving &amp; Communication System (PACS) were constructed in the laboratory using browser/server mode. Also, the DICOM-SR document was designed in this article using a list or hierarchy, and the retinal images to report the information of patients by using the Hypertext Transfer Protocol (HTTP) – based Web Access to DICOM Persistent Objects (WADO) approach. The results showed that the retinal image PACS system constructed in Browser/Server mode can effectively store and transmit DICOM images. When the imaging device is combined with the application program, special adapters are used to negotiate the transmission syntax. The message flow is decoded in the communication process, which can be connected with the realization to improve the efficiency of information collection. The proposed PACS system integrates the quantitative features of retina providing more meaningful research data for data mining in comparison to the traditional state of the art methods based on chronic disease management system. The diagnostic ability of the retinal imaging procedure using the DICOM images is justified by obtaining 98.51%, 98.04%, 99% and 99.01% of accuracy, sensitivity, specificity and precision values respectively.