Formal Medical Care Research Articles

Telemedicine in nephrology: future perspective and solutions.

Telemedicine is a medical practice that uses electronic information and communication technologies. It is not exclusive to face-to-face care but complements face-to-face care and other forms of medical care. It has advantages such as facilitating home therapy, reducing patient travel time and costs, and empowering patients. This makes equitable access to care feasible. Clinical studies have been conducted on telemedicine in nephrology outpatient care, inpatient consultations and hemodialysis, indicating that telemedicine can improve patient satisfaction, leading to enhanced treatment owing to increased adherence and frequency of visits. However, it has not been sufficiently used in the kidney field. The key to spreading "telenephrology" (telemedicine in nephrology) is how physical examinations and laboratory/imaging/physiological tests, currently challenging to perform without face-to-face contact, can be substituted with methods optimized for the telemedicine framework. This paper describes the current status of telemedicine and telenephrology, along with advanced methods for collecting data equivalent to laboratory, imaging and physiological tests outside of hospitals, including estimation of serum creatinine levels from saliva or tear fluid, estimation of blood hemoglobin levels by taking pictures of the eyelid conjunctiva or nails with a smartphone and ultrasound of the kidneys using motion capture technology. With an understanding of the strengths and weaknesses of current telemedicine, we should make full use of it for better treatment and patient care. However, further telenephrology research is required.

Aspects of application of digital solutions in primary health care

All over the world, with regard to digitalization in the provision of primary health care, issues of the principles of the cost-effective resource system for the provision of medical services covering all residents (any category of the population), ways to achieve other goals set for the health system at the territorial or regional level are being discussed. Depending on the main goals and principles set out in national legislation, including legislation in the field of health protection, approaches to achieving the Sustainable Development Goals and, accordingly, approaches to organizing the digitalization of medical care differ in different States. The issues of automating the processes of a medical organization and generating relevant information relate to the ways of using artificial intelligence to free up time for doctors, reduce the administrative burden on medical service providers. The level of digital medical literacy, combined with modern possibilities of remote interaction in the patient-medical worker format, can be decisive at the first stage of seeking medical help - with remote patient triage, which is an indispensable tool for determining both the need for assistance and the urgency of providing assistance. The experience of remote triage of patients by non-medical staff provided by the NHS Pathways clinical decision support system, used by the National Health Service of England, has freed up general practitioners (doctors and nurses) to provide other forms of medical care. In 2005, nurses and, to a lesser extent, general practitioners in England accounted for 100% of the staff handling telephone calls in the similar NHS Direct remote consultation system. The foreign experience of patient teletriage in our country will be limited by the legislation of the Russian Federation in the field of health protection, however, some existing restrictions, taking into account the assessment of risks to patients brought by innovative development, may be revised during the implementation of the «Program of experimental legal regime in the field of digital innovations in the field of medical activity, including the use of telemedicine technologies and technologies for collecting and processing information about the state of health and diagnoses of citizens», which will expire on 08/01/2026.

Первичное звено государственной системы здравоохранения в Российской Федерации: организационно-правовой статус

Primary care is the backbone of the healthcare system. The main function of primary care is the provision of primary health care to the population on a territorial-precinct basis through “first contact” doctors. There is a gap between the importance of primary health care and low public satisfaction with it. One of the main reasons for this current state of affairs is the inadequate organizational and legal status of primary care. The declared formation of a three-tier healthcare system must be based on a more understandable architectural network of healthcare units. It is necessary to harmonize between the types of objects and the types of care they provide, the conditions of provision and forms of medical care.

Sport participation as a tool for promoting wellness for youth of colour

AbstractYouth of colour, especially from low socioeconomic status (SES) backgrounds, are at higher risk for experiencing mental and physical health challenges due to poverty and racism; however, they are less likely to seek and engage in formal mental health services and medical care due to stigma, time constraints, financial burdens, and cultural mistrust for the medical field more broadly. This commentary will describe how participation in sport for youth of colour from low SES backgrounds has benefits that extend across the Eight Dimensions of Wellness Model, illustrating the power of sport as a tool for prevention and support. The authors conclude with a call to action to mobilize government officials, healthcare providers, educators and coaches to encourage sport participation as a tool to improve individual wellness for today's youth of colour and uplift communities. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Religious Anthropological Analysis of Unnatural Rituals: An Example from Northeastern Shamanic Culture

This paper discusses and introduces shamanic culture in Northeast China First, this article will show the steps and equipment used in common shamanic rituals, and introduce what shamanic worship is and its influence in Northeast China. It will also analyze the scientific principles of natural rituals as they manifest therein. This article will also explain why it is effective in some cases, why this ritual is not a substitute for formal medical care and the influence of shamanic culture on modern culture in Northeast China. Finally, this article will discuss how to preserve and pass on the positive cultural influences of shamanic rituals and discard the cultural influences that come with them.

Review of Legal Ethics in Applying Palliative Care to Improving the Quality of Life of Patients

Palliative care is a treatment for patients who have incurable diseases by optimizing the patient’s quality of life and reducing pain and other symptoms by paying attention to psychological and spiritual aspects. Previous studies have assessed the importance of implementing palliative care in Indonesia because of the high prevalence of incurable diseases such as cancer, heart failure, and other diseases such as HIV/AIDS. Palliative care is a form of medical care and patient comfort that controls the intensity of a disease or slows its progress, whether or not there is hope of recovery. Palliative care does not aim to provide a cure or reverse disease progression. It is an important part of caring for terminal patients, which can be done simply, although their main priority is quality of life and not recovery of the patient from the illness. Most patients come for treatment with a diagnosis of disease in an advanced stage. In such conditions, the patient tends to choose a short but happy life rather than a long life with many limitations. For patients, the only realistic treatment options are pain barriers and palliative care. So palliative care is an effective way to improve the quality of life of patients.
 Keywords: legal ethics, palliative care, patient

Cost‐effectiveness of amyloid‐targeting therapies: modelling based on 5724 biomarker positive AD patients in the Swedish Registry of Cognitive Disorders

AbstractBackgroundLecanemab is an amyloid‐targeting therapy recently approved by the U.S. FDA for treatment of early Alzheimer’s disease. A phase III trial (Clarity AD) demonstrated a reduction of disease progression, however uncertainty remains around the long‐term health outcomes and implications for cost‐effectiveness. Previous economic evaluations have been limited by lack of long‐term follow‐up data on health outcomes and resource utilization in AD patients with biomarker‐confirmed amyloid pathology.Method5724 patients with longitudinal follow‐up data were included from the Swedish Registry of Cognitive Disorders (SveDem), linked to other data sources. Amyloid positivity was determined from the CSF beta amyloid 1‐42/p‐Tau ratio, with optimal cut‐off levels determined from Abeta 40/42 ratios. Patients were followed up to 12.9 years from diagnosis (mean 4.9 years). A disease model model was constructed with states defined by cognitive status (MCI/dementia, MMSE score) and care setting (community/institution). The semi‐Markov design allows transition probabilities to vary with time spend in individual states. Hazard rates for disease progression, institutionalization and mortality were estimated using semiparametric survival models based on SveDem linked to the municipal care and death registries. Costs by disease state were estimated from resource utilization data from the national patient and prescription drug registries on formal medical and community care. Health utility values by disease state were derived from previous observational studies in Sweden.ResultA therapy reducing disease progression to more severe cognitive states by 31% over a treatment period of 18 months (as in Clarity AD) was associated with savings in formal care costs of 41,000 SEK and 0.140 quality‐adjusted life‐years (QALYs) gained. At 1 million SEK per QALY, treatment would be cost‐effective at an annual cost of 121,000 SEK, including costs for diagnosis and monitoring. Almost half of estimated QALY gains were due to reduced mortality; setting survival equal in treated and untreated patients resulted in fewer QALYs gained but higher cost savings.ConclusionThis is the first study to report on the cost‐effectiveness of amyloid‐targeting therapy based on integrated disease progression and cost data from a large, representative cohort of amyloid‐positive early AD patients. Such data is of critical importance to enable cost‐effective introduction of lecanemab.

Prevalence and related factors of non-adherence to antibiotics among the general public: a cross-sectional study in China

ABSTRACT Objectives This study aims to assess the prevalence and associated factors of non-adherence to antibiotics (NAA) during COVID-19. Methods A cross-sectional study was conducted from 28 October 2022 to 6 November 2022. A structured questionnaire was widely distributed on an online survey platform. Of the 8664 respondents, 7730 were included in the final analysis. Logistic regression analysis was used to examine the associated factors of NAA. Results Of the 7730 participants, 17.83% reported antibiotic use in the past month, of which 53.05% had NAA. Those who aged over 60 years old, perceived their economy as good, had moderate or good antibiotic knowledge, and with high convenience to medical services and medicines were less likely to NAA (p < 0.05); while those with chronic diseases, living in Western or Northeastern China, and those who used non-prescription antibiotics were more likely to NAA (p < 0.05). Conclusion The prevalence of NAA remains at high levels in the general public. Targeted health education needs to be conducted in communities, pharmacies and health facilities to overcome misconceptions about antibiotics and to encourage people to seek formal medical care when ill, in order to improve public adherence to antibiotics.

Healthcare utilization during the first two waves of the COVID-19 epidemic in South Africa: A cross-sectional household survey.

Healthcare utilization surveys contextualize facility-based surveillance data for burden estimates. We describe healthcare utilization in the catchment areas for sentinel site healthcare facilities during the first year of the COVID-19 pandemic. We conducted a cross-sectional healthcare utilization survey in households in three communities from three provinces (KwaZulu-Natal, Western Cape and North West). Field workers administered structured questionnaires electronically with the household members reporting influenza-like illness (ILI) in the past 30 days or severe respiratory illness (SRI) since March 2020. Multivariable logistic regression was used to identify factors associated with healthcare utilization among individuals that reported illness. From November 2020 through April 2021, we enrolled 5804 households and 23,003 individuals. Any respiratory illness was reported by 1.6% of individuals; 0.7% reported ILI only, 0.8% reported SRI only, and 0.1% reported both ILI and SRI. Any form of medical care was sought by 40.8% (95% CI 32.9% - 49.6%) and 71.3% (95% CI 63.2% - 78.6%) of individuals with ILI and SRI, respectively. On multivariable analysis, respiratory illness was more likely to be medically attended for individuals at the Pietermaritzburg site (aOR 3.2, 95% CI 1.1-9.5, compared to Klerksdorp), that were underweight (aOR 11.5, 95% CI 1.5-90.2, compared to normal weight), with underlying illness (aOR 3.2, 95%CI 1.2-8.5), that experienced severe illness (aOR 4.8, 95% CI 1.6-14.3) and those with symptom duration of ≥10 days (aOR 7.9, 95% CI 2.1-30.2, compared to <5 days). Less than half of ILI episodes and only 71% of SRI episodes were medically attended during the first two COVID-19 waves in South Africa. Facility-based data may underestimate disease burden during the COVID-19 pandemic.

The Health Needs of Sexual and Gender Minority Migrant Women in the United States: A Scoping Review.

Purpose: This scoping review characterizes the peer-reviewed evidence on the health of first-generation sexual and gender minority (SGM) migrant women to the United States and identifies research gaps and future priorities. Methods: On February 1, 2022, the following databases were searched: PubMed (MEDLINE), Embase, CINAHL Plus with Full Text, APA PsycINFO, and PAIS Index. Primary research studies based in the United States, in English, on first-generation SGM migrants (i.e., immigrants, refugees, asylum seekers) were included. Gray literature and review articles were excluded. Health outcome data were not extracted from nonbinary populations nor transgender men. Themes were generated using qualitative content analysis. Results: Thirty-three studies were reviewed, most were qualitative, and 11 focused on transgender women migrants (especially from Latin America), while only one was exclusively on sexual minority women (SMW) migrants. Premigration experiences of violence and discrimination were linked to high prevalence rates of post-traumatic stress disorder, depression, and anxiety. Postmigration stressors included lack of educational and employment opportunities, reduced access to social services, and experiences of stigma and discrimination, which were also associated with the development of depressive symptoms. Transgender women migrants reported not seeking formal medical care, given a lack of gender-affirming services and insurance resulting in reliance on unsafe informal care networks for hormone therapy and feminization procedures. Conclusion: Future interventions should focus on fostering social support networks of SGM migrant women to help improve their mental health outcomes. Research priorities should include studies on SMW migrants and more quantitative research that could identify additional health needs (i.e., sexual health) of SGM migrant women.

Care-seeking behaviours of mothers and associated factors for possible serious bacterial infection in young infants during COVID-19 pandemic in Ethiopia: mixed-methods formative research

ObjectivesImplementation research was employed to examine rates and contextual factors associated with mothers’ care-seeking for their sick neonates and identify challenges for community-based possible serious bacterial infection (PSBI) services access...

Types of Transaction Costs in Forms of Medical Care in Germany: Development of a Typology

Introduction: Transaction costs in forms of medical care is a new perspective in health science. Healthcare Management itself seems to get a new role of importance in these days. Objectives and research findings: In an increasingly competitive environment, cost optimisations need to be the focus of science and practice. Especially in the field of healthcare. Without the money of the insurances most people would not be able to get medical care in Germany. Core work concepts: The development of a convincing typology as a new approach in this field of expertise. Transaction costs play a big role in this context. Methodology: Developing a typology and defining types without losing sight of the specific features of forms of medical care is tried and within this the using of typology development. Outcome: The formation of three different informative types of transaction costs is achieved with this paper and it generates new areas for researchers additionally. Summary: Knowledge of the three types of transaction costs is helpful for theory and practice in the upcoming field of health care science

The importance of preventive dentistry on the oral health of individuals and the economy in the United States

Oral problems are related to the general health of individuals. When not preventively cared for or not treated properly, caries lesions, pain, discomfort, risks of spreading infections throughout the body, which can even lead to hospitalization. The absence of preventive care in oral health increases the chances of tooth loss, reducing the person’s ability to chew and compromising their nutrition. In addition, there is the aesthetic issue, because the person with teeth problems avoids smiling and even avoids interacting socially. The dental problems of a population unable to afford them, economically affect the general health system, since oral diseases refer to the impairment of people’s health, who will resort to formal medical care at some point in their existence. This literature review article featured specialized materials in Oral Health on the reality of low-income North Americans and their oral problems, using articles obtained from Google Scholar. As an objective, it is intended to demonstrate the importance of preventive care for dental health, through educational actions in needy communities, covering people of all ages, especially children. There is a need for specialized care for patients of different ages who are already affected by oral problems, and also about the importance of the efforts and investments of the US government in massive campaigns related to preventive dental care for people of all ages that make up the its poorest population.

How cranial surgery was performed in Italy during the centuries after the Roman Empire but before the rise of the medieval universities: Integrating paleopathology and medical history

How cranial surgery was performed in Italy during the centuries after the Roman Empire but before the rise of the medieval universities: Integrating paleopathology and medical history

Assessment of the Quality of Life Among Patients under Palliative Care

Abstract Background Palliative care is a form of medical care that focuses on providing comfort and pain relief to patients with severe, incurable diseases. The World Health Organization defines quality of life as “an individual’s perception of their position in life in the context of culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”. Quality of life and palliative medicine represent two aspects that should be inseparable in the comprehensive care and treatment of a patient at the end of life. Objectives The aim of this study was to assess quality of life among patients under palliative care using the WHOQOL-BREF and EQ-5D questionnaire. Material and methods The study included 100 consecutive patients admitted to palliative care between September 2018 and January 2019 being treated in a hospice and at home. A three-part survey process was used to collect data, including the following: Demographic Data Form; WHOQOL-BREF questionnaire; EQ-5D questionnaire. Results The WHOQOL-BREF questionnaire was analyzed for 4 domains. The study obtained the following results: Domain 1=40.2; Domain 2=39.94; Domain 3=36.1; Domain 4=37.7. According to the guidelines of the EQ-5D questionnaire, it was shown that 43% of patients are unable to walk or have serious problems with walking, 59% of patients are unable or have serious problems with self-care, 61% of patients are unable or have serious problems with ordinary activities, 52% of patients have severe or extreme pain/discomfort, 65% of patients are very anxious or depressed. Conclusions 1. The study showed that patients covered by palliative care present low indicators of quality of life. 2. According to the data obtained, palliative care programs should pay special attention to the improvement of quality of life by taking an interdisciplinary approach to its resources.

Труд медицинских работников в США: социальный аспект

The shortage of medical personnel is becoming a heavy burden on modern healthcare systems around the world. All countries, without exception, turned out to be vulnerable, regardless of the level of income and available forms of medical care. This study addresses the issue of staffing at the time of transition to a new technological level of the healthcare system in the United States. The paper shows that at the present stage in the country there is a need for fundamental changes in the personnel policy in the medical field. The challenges caused by the COVID&amp;#8209;19 pandemic not only exposed all the vulnerabilities of the national health system, but also opened up opportunities considering the lessons learned to rethink the long-term vision of solving the workforce problems directly related to the use of new technologies. Based on the analysis of statistical data and sociological research, the author identified the latest trends of overcoming barriers in the field of training and retraining of personnel in the context of the transition to digital medicine. Overexertion among medical personnel associated with increased workload has exacerbated the problem of their professional burnout. The mass protests of physicians necessitated the development of new approaches to the labor protection of employees in the medical field. Solution of such important social problems will require a long time and financial costs and is possible only through the joint efforts of the state and the entire community as a whole.

Dilemmas in patient-clinician communication about do-it-yourself hormone therapy: A qualitative study

Many transgender and gender diverse (trans) people use hormone therapy for gender-affirmation. Some trans people obtain hormone therapy without prescriptions from clinicians—a practice called “do-it-yourself hormone therapy” (DIY HT). When patients using DIY HT seek formal medical care, patient-clinician communication challenges arise. In an effort to explore these challenges and improve patient-clinician communication, we conducted qualitative interviews with 20 U.S.-based trans people who had practiced DIY HT. We performed a thematic analysis guided by Goldsmith's Normative Rhetorical Theory. We generated two themes regarding the dilemmas patients face when (not) communicating about DIY HT with clinicians. First, I want a clinician who is a partner, not a gatekeeper, describes patients' difficulties partnering with clinicians who often create barriers to accessing hormone therapy. Second, I (don't) want to be honest, describes a tension patients reported; patients desired honest communication with clinicians, but feared that disclosing DIY HT use would cause them to be stigmatized and labeled ‘non-compliant.’ We also developed two themes regarding trans patients' recommendations for clinicians. First, create respectful and inclusive clinic spaces, suggests that clinicians can demonstrate respect for trans identities by displaying pride flags, and asking for patients' pronouns and name they go by on intake forms. Second, share decision-making with patients, suggests that clinicians can build alliances with trans patients by communicating their desire to openly discuss, assess, and mutually agree upon hormone treatment plans. We offer strategies for how clinicians can practice patient-centered care and build partnerships with trans patients when communicating about hormone therapy.

Types, conditions and forms of medical care: legal and regulatory framework, structural and functional analysis

Relevance. According to the federal regulatory and legal acts, medical care is classified depending on its types, conditions and forms of provision, and is regulated by procedures, standards and clinical recommendations. This determines the relevance of the structural and functional representation of the main classifying principles of medical care within the framework of the regulatory and legal acts in conjunction with other fundamental terms of healthcare organization. However, in scientific and methodological publications, a number of authors unreasonably use the terms “first aid”, “qualified medical care” and other medical care that do not comply with the regulatory and legal acts.Intention – To analyze the leading terms and provisions of the federal legislation by types, services and forms of medical care and related definitions of the law, presenting them as structural-logical schemes.Methodology. The legal acts that define medical care by types, services and forms of its provision are analyzed, the analysis of scientific research is carried out.Results and Discussion. In Russia, the conceptual apparatus is legally defined in relation to the term “medical care”, the criteria for its types, conditions and forms. Based on the structural-functional approach, the authors analyzed the leading terms and provisions of the healthcare legislation by types, services and forms of medical care and related definitions of the law, presenting them as structural-logical schemes.Conclusion. A detailed analysis of the key term “medical care” and related definitions as structural and functional schemes gives visual and logical presentation for better understanding and use in practical work as well as for preparation of publications.

The current state and problematic issues of medical care in the waters of the Northern Sea Route

Introduction. The solution of state issues for the development of the Arctic zone of the Russian Federation involves the active use of the Northern Sea Route as the main strategic highway. In order to preserve the life and health of ship crews in conditions of climatic and geographical and industrial risks, a smoothly functioning national system of medical care, harmonized with international requirements, is of great importance. The study aims to assess the state of the medical care system for ship crews on the Northern Sea Route, identify regulatory and organizational problems, and substantiate proposals for their elimination. Materials and methods. The researchers conducted an expert and analytical study, as well as analyzed and compared data during search and rescue operations in the waters of the Northern Sea Route (2010-2020), statistical data on medical examinations of ship crews conducted in 2020 in the organizations of the FMBA of Russia. The authors also have studied the main stages and forms of medical care in the waters of the Northern Sea Route. Scientists have conducted the analysis of scientific publications for the period from 2000 to 2021, contained in scientific electronic libraries, current international and Russian regulatory legal acts, information from official websites of executive authorities and organizations. Results. The system of medical care involves the implementation of measures for several interrelated elements: the provision of medical care on a ship, consultation by a medical professional using communication means, search and rescue operations, medical evacuation, medical care in the conditions of a coastal medical organization. International and Russian regulatory legal acts regulate the implementation of measures to provide medical care on board the vessel, the work of a wide range of participants from among federal executive authorities, executive authorities of subjects, institutions and organizations, officials and employees. In the course of the study, we found that there are concretized schemes of medical care, name lists and coordinates of participants. Specialists update all this in the Basin Plans for each territory of the Northern Sea Route. Despite the established rules of interaction of participants and conditions of medical care, the gaps identified by the researchers in administrative and legal regulation significantly affect the quality of medical care to members of the crews of ships, violate the constitutional rights of citizens to health protection. Conclusions. Experts have substantiated the proposals for improving the system of medical care in the waters of the Northern Sea Route when applying an integrated approach to the development of the coastal infrastructure of medical organizations, staffing ships with medical workers and providing medicines. Ethics. Scientists conducted the study in compliance with Ethical standards. This study did not require the conclusion of the Ethics committee.

Mobile Applications for Self-Management of Hypertension: A Systematic Review

Aim: To recognize and describe applications from Apple and Google geared towards the self-management of hypertension and to evaluate their quality, functionality, content validity, and usefulness. Methods: This is a systematic review of the mobile applications for self-management of hypertension available in the Philippines. The inclusion criteria included applications that were created within the last five years, are smartphone-based, and operate on either the Android OS or iOS. The study excluded applications that target other medical conditions, and applications that are solely for reference and clinicians’ use. Selected applications were evaluated through the Mobile Application Rating Scale (MARS) and underwent clinical guidelines compliance analysis. Results: A total of 1607 applications were filtered, leaving 266 applications. Twelve applications complied with the criteria, but due to inaccessibility, only four (4) were included in the study. The FITZY+ obtained the highest MARS average (4.06). Functionality domain had the highest score of more than half (3/4, 75%) of the applications. All the applications (4/4, 100%) were adherent to the treatment for hypertension in reference to the clinical guidelines. Conclusion and Implications: Mobile health applications are promising tools, capable of minimizing the occurrence and degree of hypertension. However, the applications for self-management of hypertension are limited and of substandard quality due to inadequate information and research. Although applications satisfy some clinical guidelines, physical therapists should advise their patients not to rely solely on them as they are not the most optimal form of medical care.