Future Hospital Research Articles

Advance directive in a young patient: Palliative care in the context of grade 3 lupus nephritis

Systemic lupus erythematosus is an autoimmune systemic disease that compromises several organ systems, being able to reduce the quality of life of patients in many cases. Early diagnosis is associated with poor prognosis, since the period of activity of the disease is longer. Lupus nephritis is one of the consequences that can arise, and chronic kidney disease that follows becomes terminal in 10% of cases. The present study reports the case of a young patient, carrying lupus, with grade 3 lupus nephritis, who, in the face of the scarcity of resources that could alleviate her suffering and return her quality of life, chose not to receive advanced life support in future hospitalizations.

Burn Patients and Mental Health: A Matched Cohort Study.

To determine the association between burns and hospitalization for mental health disorders up to three decades later. Burns are associated with pain, disability, and scarring, but the long-term impact on mental health is unclear. We analyzed a cohort of 23,726 burn patients aged ≥10 years who were matched to 223,626 controls from Quebec, Canada, between 1989 and 2022. The main exposure was admission for a burn. We followed patients during 3,642,206 person-years of follow-up to identify future hospitalizations for psychiatric disorders, substance use disorders, and suicide attempts. We estimated adjusted hazard ratios (HR) with 95% confidence intervals (CI) for the association between burns and subsequent mental health hospitalization using Cox proportional hazards regression. Burn patients had 1.76 times greater risk of mental health hospitalization over time (95% CI 1.72-1.81), compared with controls. Associations were present regardless of burn site, but were greatest for burns covering ≥50% of the body (HR 3.29, 95% CI 2.61-4.15), third degree burns (HR 2.04, 95% CI 1.94-2.14), and burns requiring skin grafts (HR 2.00, 95% CI 1.90-2.10). Compared with controls, burn patients had more than two times the risk of hospitalization for eating disorders (HR 3.14, 95% CI 2.50-3.95), psychoactive substance use disorders (HR 2.27, 95% CI 2.17-2.39), and suicide attempts (HR 2.42, 95% CI 2.23-2.62). Risks were particularly elevated within 5 years of the burn, but persisted throughout follow-up. Burns are associated with an increased risk of hospitalization for mental health disorders up to 30 years later.

The 5 + 1 Practice Research Model in Health Social Work: The “Eye of the Storm”

Purpose: The 5 + 1 Collaboration is an initiative where five teaching hospitals and a leading Melbourne university collaborate to promote and strengthen research, clinical practice in health social work, teaching, and collaboration. This collaboration fosters greater connection between academics, practitioners, and social work students. The 5 + 1 Collaboration provides a unique platform for the advancement of effective practice, practice-driven research, and student field education placements. Method: In a prospective study (2020 through 2021), employing the 5 + 1 model, at the time of the COVID-19 pandemic, over 100 frontline hospital social workers from five Melbourne hospitals participated in this study to determine, in detail, how the pandemic had affected their work. Results: This provided at a granular level, significant insights relating to the impact of the pandemic on the provision of social work services in the acute hospital setting. Additionally, during the study period, academic social work student placements were made at the five participating hospitals, with the students actively participating as part of the research team and providing feedback about their own experiences. Discussion: The study documented the challenges to hospital social work practice because of the pandemic, how hospital social workers rose to the challenges, and, importantly, adapted their practice and acquired new skills. This information may inform future hospital social work practice. The study also demonstrated that effective on-line student placements were possible, even in the setting of a pandemic.

Research on contactless intelligent medication pickup mode selection based on a hospital in China under COVID-19.

During an outbreak such as COVID-19, hospital staff needs to be in close contact with all types of patients visiting the hospital and the risk of cross-infection is extremely high. Payment and medication pickup is a mandatory part of a patient's hospital visit, with direct contact between healthcare workers and patients, and long waiting times in the hospital area, which can easily lead to the spread of disease infection. This paper designed the prototype of a contactless smart medicine cabinet based on RFID technology and optimized the patient consultation and medication pickup process to address these problems. We conducted a 50-day field observation of patients for consultation and medication pickup at the First Hospital in H city, Jiangsu Province, China, and randomly timed 1600 sets of data from Surgery (ophthalmology) and Internal patients, then we designed the prototype of a contactless smart medicine cabinet based on RFID technology, optimized the patient consultation and medication pickup process, comparing the traditional and intelligent models using AnyLogic. The results show that this contactless medicine cabinet was able to reduce the time taken by patients in consultation and medicine pickup by 18.74 minutes, increasing the overall efficiency of the consultation by 32.20%. The simulation revealed that this contactless intelligent medication pickup model was able to reduce the time taken by patients in consultation and medicine pickup, increasing the overall efficiency of the consultation, effectively reducing the frequency of contact between healthcare workers and patients, and reducing the risk of disease infection. The proposed technical model provides a new idea to solve the problems of long queues, low efficiency and high risk of infection for patients to consult and get medicine during epidemics. Especially within hospitals it has important theoretical and practical implications for epidemic prevention and control as well as future hospital management.

Secundum atrial septal defect closure in adults in the UK.

To examine determinants of access to treatment, outcomes and hospital utilization in patients undergoing secundum atrial septal defect (ASD) closure in adulthood in England and Wales. Large retrospective cohort study of all adult patients undergoing secundum ASD closures in England and Wales between 2000/01 and 2016/17. Data were from population-based official data sets covering congenital heart disease procedures, hospital episodes and death registries.Out of 6541 index closures, 79.4% were transcatheter (median age 47 years, IQR 34-61) and 20.6% were surgical (40 years, 28-52). The study cohort was predominantly female (66%), with socio-ethnic profile similar to the general population.Mortality in hospital was 0.2% and at one year 1.0% (95%CI 0.8%-1.2%). Risk of death was lower for transcatheter repairs, adjusting for age, sex, year of procedure, comorbidities and cardiac risk factors (in-hospital adjusted-OR 0.09, 95%CI 0.02-0.46, one-year adjusted-HR 0.5, 0.3-0.9). There was excess mortality one year after ASD closure compared to matched population data.Median (IQR) peri-procedural length of stay was 1.8 (1.4-2.5) and 7.3 (6.2-9.2) days for transcatheter and surgical closures, respectively. Hospital resource use for cardiac reasons started the year before repair (median 2 inpatient and 2 outpatient-only days) and decreased post-repair (zero inpatient and one outpatient days during the first two years). This national study confirms that ASD closure in adults, by surgical or transcatheter methods, is provided independently of ethnic or socioeconomic differences, it is low (but not no) risk and appears to reduce future cardiac hospitalisation even in older ages.

The lived experiences of patients with severe obesity during hospital admissions in Norway: A phenomenological hermeneutic study.

To explore the lived experiences of patients with severe obesity during hospital admissions. Qualitative study design. Semi-structured individual interviews with 14 participants with severe obesity from Norway were conducted between May and October 2021. A qualitative phenomenological hermeneutical approach inspired by Paul Riceour was used to analyse the data. The following three themes were identified through the analysis of the lived experiences of patients with severe obesity during hospital admissions: blaming my weight, being prejudged and feeling different. The participants shared various emotional experiences of encounters with healthcare professionals at hospitals. They struggled to be recognized and welcomed like everyone else and found it difficult to be judged by someone who did not know them. The various experiences resulted in a vicious circle, ultimately leading to a fear of future hospitalization. Being a patient with obesity in a hospital setting can present various challenges, leading to feelings of shame and guilt. Experiences of stigma may not necessarily be related to the overall hospital context but rather to encounters with healthcare professionals who may be unfamiliar with the patient's history, which can lead to stigmatizing behaviours. Understanding how patients with severe obesity experience their hospital admissions and the importance of familiarizing themselves with the individual patients to avoid stigmatizing behaviours is important for healthcare professionals caring for obese patients. Consolidated Criteria for Reporting Qualitative Research. No patient or public contribution. Patients with obesity often encounter stigmatization and negative attitudes from healthcare professionals, particularly in primary care settings. Patients with severe obesity experienced various challenging encounters with healthcare professionals during hospital admissions, resulting in a vicious circle, ultimately leading to a fear of future hospitalization. It is crucial for healthcare professionals involved in the care of patients with obesity to acquaint themselves with individual patients to prevent stigmatizing behaviours.

Evidence-based design: a critical success factor for the implementation of Care Management Models

Introduction: health institutions are inserted in an organizational conglomerate and where each of the organizations that make up society are subject to management as a fundamental pillar for their permanence in the system. There is an element that in the evidence of the implementation of care management models has not been raised as a critical success factor and that is essential in the organizational structure. This is evidence-based design (EBD). Therefore, the objective of this article is to explain the relevance of DBE in the implementation of care management models. Development: the design of healthcare facilities is a complex process that not only creates and allocates physical spaces, but also shapes the dynamic flows of patients, staff, visitors, equipment and information. In this context, it is relevant that nurse managers are participants in the prior planning and programming process, so that they are involved in making structural decisions that allow patients' needs to be resolved. Conclusion: with the current unprecedented increase in hospital construction, it is imperative to integrate the institutional management model, the financing model and the care management model and consider the environmental characteristics that influence the well-being of patients, visitors and personnel are identified and incorporated into future hospital designs

Synchrotron Radiation Refraction-Contrast Computed Tomography Based on X-ray Dark-Field Imaging Optics of Pulmonary Malignancy: Comparison with Pathologic Examination.

Refraction-contrast computed tomography based on X-ray dark-field imaging (XDFI) using synchrotron radiation (SR) has shown superior resolution compared to conventional absorption-based methods and is often comparable to pathologic examination under light microscopy. This study aimed to investigate the potential of the XDFI technique for clinical application in lung cancer diagnosis. Two types of lung specimens, primary and secondary malignancies, were investigated using an XDFI optic system at beamline BL14B of the High-Energy Accelerator Research Organization Photon Factory, Tsukuba, Japan. Three-dimensional reconstruction and segmentation were performed on each specimen. Refraction-contrast computed tomographic images were compared with those obtained from pathological examinations. Pulmonary microstructures including arterioles, venules, bronchioles, alveolar sacs, and interalveolar septa were identified in SR images. Malignant lesions could be distinguished from the borders of normal structures. The lepidic pattern was defined as the invasive component of the same primary lung adenocarcinoma. The SR images of secondary lung adenocarcinomas of colorectal origin were distinct from those of primary lung adenocarcinomas. Refraction-contrast images based on XDFI optics of lung tissues correlated well with those of pathological examinations under light microscopy. This imaging method may have the potential for use in lung cancer diagnosis without tissue damage. Considerable equipment modifications are crucial before implementing them from the lab to the hospital in the near future.

Precision medicine for psychotic disorders: objective assessment, risk prediction, and pharmacogenomics.

Psychosis occurs inside the brain, but may have external manifestations (peripheral molecular biomarkers, behaviors) that can be objectively and quantitatively measured. Blood biomarkers that track core psychotic manifestations such as hallucinations and delusions could provide a window into the biology of psychosis, as well as help with diagnosis and treatment. We endeavored to identify objective blood gene expression biomarkers for hallucinations and delusions, using a stepwise discovery, prioritization, validation, and testing in independent cohorts design. We were successful in identifying biomarkers that were predictive of high hallucinations and of high delusions states, and of future psychiatric hospitalizations related to them, more so when personalized by gender and diagnosis. Top biomarkers for hallucinations that survived discovery, prioritization, validation and testing include PPP3CB, DLG1, ENPP2, ZEB2, and RTN4. Top biomarkers for delusions include AUTS2, MACROD2, NR4A2, PDE4D, PDP1, and RORA. The top biological pathways uncovered by our work are glutamatergic synapse for hallucinations, as well as Rap1 signaling for delusions. Some of the biomarkers are targets of existing drugs, of potential utility in pharmacogenomics approaches (matching patients to medications, monitoring response to treatment). The top biomarkers gene expression signatures through bioinformatic analyses suggested a prioritization of existing medications such as clozapine and risperidone, as well as of lithium, fluoxetine, valproate, and the nutraceuticals omega-3 fatty acids and magnesium. Finally, we provide an example of how a personalized laboratory report for doctors would look. Overall, our work provides advances for the improved diagnosis and treatment for schizophrenia and other psychotic disorders.

Oral and dental health promotion for children's nurses.

Tooth decay remains one of the most common preventable oral health concerns in children. After birth, advice to caregivers predominantly focuses on medical health with little attention paid to dental health. Before discharge from the maternity unit and during future hospital and community appointments, opportunistic dental advice should be provided by midwives, nurses and health visitors where possible, with the aim of preventing early onset dental disease. Registering with a dentist at birth is crucial due to long NHS dental waiting lists. Simple advice on toothbrushing should be offered, including brushing twice a day with a soft toothbrush using an age-appropriate amount of fluoride toothpaste. Mothers should be provided with information on the benefits of breastfeeding for oral health alongside tailored preventive care. Appropriate advice on bottle-feeding and weaning is required, including minimising the use of added sugar, drinking from free-flow cups after six months of age, and discouraging the use of milk bottles at bedtime and in general after one year of age. Written visual summaries can be shared with parents to consolidate verbal advice on oral and dental health.

Implementation of the CHIldren with acute COugh (CHICO) intervention to improve antibiotics management: a qualitative study in primary care.

Childhood respiratory tract infections (RTIs) are common and can lead to unnecessary antibiotic use and antimicrobial resistance. The CHIldren with COugh (CHICO) intervention incorporates a clinician-focused algorithm (STARWAVe) to predict future hospitalisation risk, elicitation of carer concerns, and a carer-focused personalised leaflet recording treatment decisions and safety-netting information. To examine the implementation of the CHICO intervention by primary care clinicians. A qualitative study with primary care clinicians in England taking part in the CHICO randomised controlled trial. Interviews explored the CHICO intervention's acceptability and use. Clinicians from a range of practices with high and low antibiotic dispensing rates were recruited. Normalisation process theory underpinned data collection and thematic analysis. Most clinicians liked the intervention because it was quick and easy to use, it helped elicit carer concerns, and reassured clinicians and carers of the appropriateness of treatment decisions. However, clinicians used it as a supportive aid for treatment decisions rather than as a tool for behaviour change. The accompanying advice leaflet helped explain treatment decisions and support self-care. The intervention did not always align with clinicians' usual processes, which could affect use. Increased familiarisation with the algorithm led to reduced intervention use, which was further reduced during the COVID-19 pandemic as a result of changes to practice and remote consultations. Clinicians found the CHICO intervention useful to support decision making around antibiotic prescribing and it helped discussions with carers about concerns and treatment decisions. The intervention may need to be adapted to align more with clinicians' consultation flow and remote consultations.

Private Islamic Hospital Service Management Strategy Model in Pekanbaru Based on Accreditation with an Analytic Network Process Approach

There are many factors that are the burden and responsibility of Islamic Hospital Practitioners, experts and regulators in resolving sharia service and accreditation problems and prioritizing effective solutions for Islamic Hospitals. From problems (1)Sharia services that focus on Customer Oriented, Transparency, Healthy Competition and Justice. (2)Patient problems, namely no sharia consultations, unsatisfactory services received, long queues, lack of services for disabled patients (3)Accreditation problems that focus on low classification and accreditation, poor maintenance, unsophisticated information systems and a poor hospital environment. not properly maintained (4)Ethical problems and Islamic hospital Business Management Concepts trigger problems. Planning for future hospital performance is not fulfilled, experts and employees are less professional, coordination of hospital staff is ineffective and does not have a Sharia Supervisory Board (DPS). This thought is the research problem, how to use the ANP method to find a solution that must be solved in this problem, assisted by Super Decision software. The results of this research are Solution Priorities (1) Sharia services, namely focusing on the main priority of Justice, Customer Oriented (2) Solutions for patients with the same priority, namely Sharia consultations, services received that satisfy patients. (3) Accreditation solutions in the order that the hospital environment is well maintained and goes green, maintenance is improved, quality management is improved (4) Islamic hospital Ethics Solutions and Business Concepts with future planning sequences fulfilled and professional employee experts selected, effective staff coordination and forming a DPS. The strategic priorities being developed are the implementation of superior and complete sharia services.

Recommendations for supporting healthcare workers' psychological well-being: Lessons learned during the COVID-19 pandemic.

Healthcare workers are at risk of adverse mental health outcomes due to occupational stress. Many organizations introduced initiatives to proactively support staff's psychological well-being in the face of the COVID-19 pandemic. One example is the STEADY wellness program, which was implemented in a large trauma centre in Toronto, Canada. Program implementors engaged teams in peer support sessions, psychoeducation workshops, critical incident stress debriefing, and community-building initiatives. As part of a project designed to illuminate the experiences of STEADY program implementors, this article describes recommendations for future hospital wellness programs. Participants described the importance of having the hospital and its leaders engage in supporting staff's psychological well-being. They recommended ways of doing so (e.g., incorporating conversations about wellness in staff onboarding and routine meetings), along with ways to increase program uptake and sustainability (e.g., using technology to increase accessibility). Results may be useful in future efforts to bolster hospital wellness programming.

P415 The influence of bowel urgency on the quality of life in individuals with ulcerative colitis

Abstract Background Ulcerative colitis (UC) is a persistent inflammatory condition marked by periods of relapse and remission, significantly impacting overall quality of life (QoL). Among the various symptoms influencing this quality, bowel urgency (BU) stands out as particularly distressing. BU manifests with profound negative implications on physical health, psychological well-being, and social aspects. Furthermore, bowel urgency (BU) is often omitted from the majority of disease activity scoring systems and is not consistently considered as a treatment outcome. Our objective was to explore the impact of BU on specific subgroups of QoL measures and its correlation with the partial Mayo score. Methods During this cross-sectional study, patients were categorized based on both BU and the concurrent partial Mayo score. The patients completed the Whoqol Bref questionnaire for assessing their QoL. Long-term outcomes, such as steroid use, hospitalization and colectomy, were evaluated at the 6-month follow-up. Results The study included 154 patients diagnosed with UC. When comparing BU with the partial Mayo score in terms of QoL, significant differences were found in the physical health domain (p<0.001), psychology domain (p<0.001), social relationship domain (p<0.014), and environmental domain (p<0.001). Among patients in remission according to the partial Mayo score (25/117, 21.3%), a notable proportion experienced bowel urgency (BU). BU was identified as a predictor for both steroid requirement (OR: 4.7; 95% CI [2.3-9.7], p<0.001) and hospitalization (OR: 4.7; 95% CI [2.3-9.7], p<0.001) during the six-month follow-up period. None of the patients required surgical intervention. Notably, even among patients in remission according to the partial Mayo score (25/117, 21.3%), bowel urgency (BU) persisted. Conclusion We noted that the existence of BU significantly impairs the quality of life for individuals with UC. Moreover, it is associated with an increased probability of future steroid use and hospitalization. Notably, some patients still experienced BU even while in remission. Further investigations are necessary to elucidate the mechanisms contributing to the persistence of these symptoms in these individuals.

P399 Impact of Body Mass Index on Clinical Outcomes in Intestinal Behçet’s disease

Abstract Background The impact of underweight and obesity on clinical outcomes for intestinal Behçet’s disease (BD) is unknown. We aimed to identify the association between body mass index (BMI) and clinical outcomes in patients with intestinal BD. Methods We categorized 760 patients with intestinal BD according to the BMI at diagnosis into four groups (underweight, normal, overweight, obese) at Severance Hospital, Seoul, Korea between 1997 and 2021.We performed a Cox proportional hazard analysis to investigate the predictive capability of BMI for clinical outcomes such as biologics use, surgery, hospitalization and emergency room visit. Results Of the 760 patients, 130 patients were classified into underweight group (BMI<18.5), 384 patients into normal group (BMI 18.5~22.9), 152 patients into overweight group (BMI 23~24.9), and 94 patients into obese group (BMI≥25). Patients with a higher BMI group showed significantly lower cumulative rates of biologics use (p trend = 0.001), surgery (p trend = 0.008), hospitalization (p trend = 0.002), and emergency room visits (p trend = 0.003) than those with a lower BMI group. In a multivariate analysis, normal BMI group (HR: 0.667, 95% CI 0.483-0.992, p =0.014), overweight group (HR: 0.589, 95% CI 0.394-0.879,p=0.010), and obese group (HR: 0.515, 95% CI 0.321-0.828, p=0.006) were negatively associated with future hospitalization compared to underweight group. Overweight group (HR: 0.490, 95% CI 0.241-0.996, p =0.049) and obese group (HR: 0.312, 95% CI 0.116-0.840,p =0.021) were negatively associated with future biologics use compared to the underweight group. Normal BMI group (HR: 0.706, 95% CI 0.484- 1.029, p=0.070) and obese group (HR : 0.556, 95% CI 0.303-1.020,p=0.058) were negatively associated with future surgery compared to the underweight group. Normal BMI group (HR: 0.711, 95% CI 0.513-0.985, p=0.041) and obese group (HR: 0.602, 95% CI 0.376-0.963, p=0.034) were negatively associated with future emergency room visit compared to the underweight group. Conclusion Underweight could affect poor outcomes in intestinal Behçet’s disease. Physicians should pay attention to the patients with underweight and make an effort to improve nutritional status.

The impact of approachable nurses: An exploratory study, the voice of hospitalized children with cancer

PurposeThe right of children to be heard was acclaimed at the 1989 Convention on the Rights of the Child, with subsequent research conducted in various settings, but with few in hospitals. This study explores the perceptions of children hospitalized with cancer and the impact of approachable nurses. Design & methodsThe impact of approachable nurses was explored using a qualitative, descriptive research design, including semi-structured interviews with seven school age children in a pediatric oncology service. Audio recorded interviews were content analyzed using immersion/crystallization and editing organizational styles. ResultsChildren felt a sense of genuine concern when the nurses took time to talk and listen to them and the positive impact of fun and laughter in the midst of difficult and challenging circumstances. They had a lasting feeling of gratitude for creative ways nurses cared for them. Individualized attire created an immediate openness and avenue to conversation. Children were less worried about a rehospitalization because approachable nurses made them feel at home while in the hospital. ImplicationsNursing administration and managers are urged to provide training and regularly evaluate communication competencies. Nurses need to be accountable for the impact of their presence and actions on children both inpatient and following hospitalization. The need to promote an environment of comfort and trust supports positive impact for present and future hospitalization experiences.

Healing architecture - A different approach of hospital design

Every day, in hospitals around the world, thousands of people spend hours, days, months for investigations, diagnosis or treatment, in search of healing. For patients and their families, the experience of the time spent in the hospital is often a crucial episode of their lives, whether their child was born there, whether it was the place where the life of a family member or loved one has been saved or a bout of illness was cured or treated there. The hospital often represents a milestone in people’s lives, a landmark underlying society’ life. The increase in the number of patients with chronic diseases, of the percentage of aging population and the number of patients requiring treatments influence the hospital’s contemporary approach, and issues such as the above will become even more significant in the future. Future hospitals will have to meet the citizens’ requirements, expectations, but especially their increasingly higher and more diverse needs. In this context, in order to gain the citizens’ confidence, hospitals need to become a safety landmark for the community, where quality care and effective care spaces should be designed and developed so that they provide a positive contribution to the healing process. There is growing awareness that the patients’ evolution and healing are influenced directly by the environment in which the healing process is carried out, so this concept has become the key to architectural layouts when hospitals and health care establishments are being designed or constructed. The aim of this paper is to define and present those innovative features of hospital design – both spatial and aesthetic - that would positively impact on the patients’ healing process. By creating an environment with positive psychological stimuli, reflected in an efficient structure and friendly interior finishings, the architecture of hospitals would support a contemporary approach to the treatment, recovery and healing of the patients.

Intelligent Reconstruction and Effectiveness Evaluation of Nursing Workflow for Future Hospitals

Abstract In this paper, the overall structure of the intelligent nursing system is designed in detail to realize the reconstruction of each process of nursing work by the intelligent nursing system. The data of nursing medical record documents of a tertiary hospital were collected as the basis of analysis, and statistical methods were used to compare and analyze the writing of medical records before and after the intelligent reconstruction of nursing workflow. Analysis of variance (ANOVA) and independent paired t-test were chosen to understand the clinical measurement differences between the intelligent nursing system and the traditional technology, and a self-designed questionnaire was used to explore the nurses’ intention to use the intelligent nursing system from their point of view. The results showed that the intelligent nursing system significantly reduced writing time (P≤0.001) and improved medical record writing ability compared with manual methods. The time efficiency of measuring physical sign data was improved by intelligent nursing systems by 74.16% and 69.8% respectively. Nurses’ knowledge of the intelligent nursing system was as high as 63.64%, and functionally, nurses’ intention to use the intelligent nursing system accounted for 85.29%, which was at a medium-high level.

Ophthalmic evaluation of a population simulated with AI: Epidemiology and future disease trends

The development of AI models for the diagnosis of diseases in Ophthalmology is accelerating rapidly. These models, however, mostly refer to a single or only a few diseases. In addition, only a few examination techniques are considered in a given model. For example, many current AI models only consider fundus images for their diagnosis. Thus, general clinical information that is also available about a patient is often neglected. This information includes, for example, age, sex and secondary diagnoses.In most cases, diseases have different frequencies depending on age and sex. This leads to a different a priori probability for a disease diagnosis depending on the patient's age. When considering several diseases in one model, this class imbalance must be considered in the model. Large longitudinal data sets of disease histories of individual persons are rare or under high data privacy requirements.With the aim of more holistic AI models that include multiple diagnoses, a novel AI model was developed that is able to simulate longitudinal disease histories of individual (synthetic) patients. This was made possible based on data from the German Federal Statistical Office and a newly developed AI algorithm. In this present study, the model is used to simulate different diagnoses of the German population that lead to inpatient hospital admissions. The data were generated as completely synthetic data and have no data privacy requirements. Information on epidemiology and disease incidence can be derived from this model. Furthermore, it is possible to generate forecasts about future hospital admissions and their underlying diagnoses by extrapolating the model into the future.

GIS-integrated multi-criteria suitability anal¬ysis for healthcare facilities site selection in Rajouri district, Jammu and Kashmir, India

The study aims to develop a Decision Support model for the selection of a suitable site to establish a new healthcare center with adequate facilities based on the analytical hierarchy process (AHP) in the Rajouri district of Jammu and Kashmir. This study utilized AHP and GIS to identify an appropriate location for a new healthcare center. The study employed eight criteria to evaluate potential locations and utilized pairwise comparison to assign weights to each criterion. GIS-based spatial analysis was used to create factor and suitability maps for each criterion. Suitability was evaluated on a scale of 0 to 10 and each factor map was combined using the ArcGIS weighted overlay selection tool. The final map of the study represents the suitable site for a healthcare center in the Rajouri district and it shows the sites from the highly suitable to the least suitable area. In Rajouri district, mostly the central part can be considered very suitable as the population density of this area is higher compared to other areas of the district. The southwestern parts of the district are moderately suitable or least suitable sites for a new healthcare center. The study displays the pattern of the existing location of healthcare centers, mostly, the existing locations are not proper and suitable. Therefore, in the future, the allocation of healthcare centers must be in more adequate areas. Policymakers and healthcare professionals can be benefitted from this study in selecting suitable locations for future hospitals, which could ultimately improve access to healthcare services in the region. Additionally, the study can be contemplated in developing new policies for better transportation system in the study area.