Global Healthcare Systems Research Articles

Decarbonisation of Kidney Care in the United Arab Emirates: A Roadmap to an Environmentally Sustainable Care.

Chronic kidney disease (CKD) remains a major public health burden and a leading cause of mortality worldwide and in the United Arab Emirates (UAE). Alongside its clinical and humanistic burden, CKD care is associated with a significant carbon footprint. In this narrative review, we present an overview of the carbon footprint of current CKD treatments and the results of an analysis estimating the carbon footprint of CKD treatments in the UAE. Using the life cycle assessment (LCA) method and local data from the published national reports and inventory sources, we estimated that haemodialysis leads to greenhouse gas (GHG) emissions of ~12.8 tons of CO2 equivalents (CO2eq) per person in the UAE annually. Thus, the decarbonisation of CKD care is crucial in establishing an environmentally sustainable healthcare system. We propose a framework to decarbonise CKD care in the UAE that tackles the carbon footprint of CKD care in the UAE by focusing on three main pillars: Delaying early CKD and slowing its progression; reducing anthropogenic emissions from CKD and dialysis care by promoting best practices and eco-friendly technologies; and enhancing access to kidney transplantation. Such approaches are relevant not only for the UAE but also for global healthcare systems aiming towards net-zero emissions.

The Impact of the COVID-19 Pandemic on One-Year Mortality in Geriatric Hip Fracture: A Retrospective Cohort Study.

The COVID-19 pandemic has profoundly impacted global healthcare systems, necessitating substantial shifts in patient care strategies. The pandemic's onset led to drastic operational changes in hospitals, including reduced bed capacity and staffing levels, which could have further influenced the mortality outcomes for geriatric patients. The study aimed to assess the impact of the COVID-19 pandemic on 1-year mortality rates of surgically treated geriatric hip fractures. This retrospective, single-center cohort study included 346 participants aged 65 and above who underwent surgical treatment for hip fractures. We compared mortality rates between the pre-COVID and COVID eras. Data included demographics, treatment, complications, and COVID-19 status. The independent samples t test and Chi-square tests (or Fisher's exact test) were used for comparisons for era cohorts. Survival probabilities were assessed using Kaplan-Meier, while multivariate analysis identified mortality predictors. 175 patients were included in the pre-COVID era, and 171 patients were included in the COVID era. During the COVID era, the 30-day mortality rate was 11.7% (compared to 13.7% in the pre-COVID era, p = 0.573), and the 1-year mortality rate was 43.9% (compared to 49.1% in the pre-COVID era, p = 0.325). The overall 1-year mortality rate was 46.5%. Patients who underwent surgery within 48hours had a higher 1-year survival rate (60.5%) compared to those with delayed surgery (51.2%), p = 0.031. Additionally, patients not admitted to the ICU had a higher 1-year survival rate (74.7%) than those who were admitted (44.9%), p < 0.001. 70.1% of the total deaths occurred within the first 90days. Elderly patients with hip fractures experienced high mortality rates before and during the pandemic. This study demonstrates that the 1-year mortality rates of geriatric hip fractures were not significantly affected by the pandemic. The findings emphasize the importance of pandemic preparedness and prompt surgeries and attentive ICU care in reducing mortality rates.

Assessment of Non-Adherence to Anti-TB Drugs and Associated Factors Among Patients Attending TB Treatment Centers During COVID-19 Pandemic in Mogadishu, Somalia: A Cross-Sectional Study.

The COVID-19 pandemic's first wave and subsequent lockdowns disrupted global healthcare systems, significantly impacting essential services including tuberculosis (TB) care. Non-adherence to anti-TB drugs is a critical concern, leading to treatment failure, drug resistance, and increased morbidity and mortality. This study assessed the rate and determinants of non-adherence to TB treatment among patients at TB centers during the first wave of the pandemic. A cross-sectional study was conducted from June 15 to July 30, 2020, involving 255 TB patients at three centers in Mogadishu. Data were gathered using the Morisky Medication Adherence Scale-8 (MMAS-8) through structured interviews and analyzed using descriptive statistics and binary logistic regression. The study found a 34.5% non-adherence rate during the pandemic. Key reasons for non-adherence included forgetting to take medication (33%), feeling well (29%), experiencing side effects (18%), and fear of contracting COVID-19 (16%). Significant factors associated with non-adherence were age groups 25-34 years (OR = 2.96, p = 0.024) and 35-44 years (OR = 4.55, p = 0.005), unemployment (OR = 2.57, p = 0.037), smoking (OR = 3.49, p = 0.029), tobacco use (OR = 4.15, p = 0.034), proximity to a health facility (OR = 0.44, p = 0.033), perception of healthcare providers as very friendly (OR = 0.24, p = 0.031) or friendly (OR = 0.45, p = 0.023), being in the continuous treatment phase (OR = 3.2, p < 0.001), and experiencing adverse treatment effects (OR = 2.42, p = 0.003). Non-adherence to anti-tuberculosis treatment was notably high in Mogadishu during the first wave of the pandemic, necessitating targeted interventions to improve adherence.

Heart-on-a-chip systems: disease modeling and drug screening applications.

Cardiovascular disease (CVD) is the leading cause of death worldwide, casting a substantial economic footprint and burdening the global healthcare system. Historically, pre-clinical CVD modeling and therapeutic screening have been performed using animal models. Unfortunately, animal models oftentimes fail to adequately mimic human physiology, leading to a poor translation of therapeutics from pre-clinical trials to consumers. Even those that make it to market can be removed due to unforeseen side effects. As such, there exists a clinical, technological, and economical need for systems that faithfully capture human (patho)physiology for modeling CVD, assessing cardiotoxicity, and evaluating drug efficacy. Heart-on-a-chip (HoC) systems are a part of the broader organ-on-a-chip paradigm that leverages microfluidics, tissue engineering, microfabrication, electronics, and gene editing to create human-relevant models for studying disease, drug-induced side effects, and therapeutic efficacy. These compact systems can be capable of real-time measurements and on-demand characterization of tissue behavior and could revolutionize the drug development process. In this review, we highlight the key components that comprise a HoC system followed by a review of contemporary reports of their use in disease modeling, drug toxicity and efficacy assessment, and as part of multi-organ-on-a-chip platforms. We also discuss future perspectives and challenges facing the field, including a discussion on the role that standardization is expected to play in accelerating the widespread adoption of these platforms.

Does the South African government have a duty to fund influenza vaccination of adults 65 years and older?

In this paper, we draw on the thinking about solidarity, reciprocity and distributive justice grounded in Afro-communitarian ethics from the Global South to argue for institutions, particularly the South African (SA) government, have a prima facie duty to foster influenza vaccine uptake for adults 65 years and older. Although we focus specifically on the South African government to defend our position, we believe that our argument extends to all governments. Notably, these duties are that the SA government ought to make influenza vaccines freely available for the older adult in both the public and private health facilities, provided financial allocation and their extant relationships allow for this. Further, the SA government has a duty to improve influenza vaccine procurement and availability in the country, preferably through increasing manufacturing capabilities. This paper is intrinsically valuable to promote epistemic justice, thereby contributing toward the decolonization of the global healthcare system. Moreover, this project has social significance in contributing to mitigation efforts against future public health challenges associated with population aging in resource-limited developing African nations, wherein the impact of population transition will be felt most.

Impact of COVID-19 on pediatric surgical practice in Taiwan: a comprehensive analysis.

The COVID-19 pandemic has profoundly impacted global healthcare systems, causing significant disruptions in various medical practices. This study focuses on the specific effects of the pandemic on pediatric surgical practice in Taiwan, a region known for its effective public health measures and proximity to the initial outbreak. The study analyzes data from January 2020 to August 2022, comparing it with historical records from January 2017 to August 2019. It examines changes in surgical case volumes, patient demographics, surgical indications, and trends in preoperative evaluations, surgical procedures, and postoperative care. The study reveals a decrease in total surgical cases from 2,255 to 1,931 during the pandemic. Notable findings include a slight increase in the average age of patients (4.81 to 5.10 years, p = 0.064), a significant shift in gender distribution towards male patients (68.9% to 73.5%, p = 0.0009), and changes in the types of surgical procedures performed, with head and neck and gastrointestinal surgeries seeing an increase. The average hospital stay lengthened, and certain specific surgical diseases, like hypospadias and liver tumors, showed an increase. However, the age distribution of pediatric surgical patients remained stable, and emergency surgical care was resiliently maintained. The findings demonstrate the adaptability of Taiwan's healthcare system in maintaining pediatric surgical care during the pandemic. The study highlights a significant gender disparity in surgical interventions and a shift towards more urgent and emergent care, reflecting the reorganization of healthcare services during this period. The study's limitations include its retrospective nature and focus on a single institution. This research contributes valuable insights into the impact of the COVID-19 pandemic on pediatric surgical practice in Taiwan. It underscores the importance of adaptable healthcare strategies in ensuring continuity and quality of care during public health emergencies. Future research should focus on multi-institutional data and prospective studies to further understand these dynamics.

Clinical Application of Machine Learning Methods in Psychiatric Disorders

Abstract: Psychiatric disorders, especially bipolar affective disorder, present a significant burden on national and global healthcare systems, warranting advanced clinical management methods. Machine learning (ML) has emerged as a reliable tool to advance diagnosis, treatment, and monitoring. This paper compiles insights from literature to confirm the applicability of ML models in the clinical setting. The findings indicate that ML can predict psychiatric disorder symptoms from speech and imaging data with up to 89% accuracy. Furthermore, individual responses to treatment and remission cases can be forecasted with accuracies exceeding 80%. ML can also predict prevailing symptoms after treatment with up to 91.26% accuracy.

Comparative Analysis of International Health Policies: A Comparison of COVID-19 and post-COVID-19 Health Policies

This research paper discusses the dynamics of COVID-19 health policies, focusing on the strategies of China and Germany in managing the pandemic, and exploring the opportunities and challenges in enhancing healthcare policies in the post-COVID era. The COVID-19 pandemic has exposed the strengths and vulnerabilities of healthcare systems globally, underscoring the need for adaptable health policies. China and Germany employed distinct strategies in responding to the pandemic. The paper compares these strategies and their outcomes. The comparative assessment highlights the importance of early and sustained interventions, as China's aggressive suppression approach yielded better results than Germany's mitigation strategy. The lessons learned from China and Germany's pandemic responses provide valuable insights into the importance of preparedness and adaptability in healthcare policies. These lessons should guide future policies and actions to build a better global healthcare system.

Advancements, Challenges, and Future Directions of Stem Cell Therapies in Skin Cancer

Skin cancer, one of the most prevalent malignancies worldwide, remains a significant challenge for global healthcare systems. Despite the availability of numerous treatments, many patients face suboptimal outcomes and a range of adverse effects. In the quest for more effective therapeutic strategies, attention has turned to stem cells, renowned for their unique ability to differentiate and regenerate. These attributes position them as potential game-changers in skin cancer therapeutics. This comprehensive review delves into the multifaceted world of skin stem cells, exploring their diverse types and the roles they play in tissue repair and regeneration. The current landscape of stem cell utilization in skin cancer therapy is examined, highlighting inherent limitations and proposing innovative solutions. By looking into future advancements, the review offers a panoramic view of stem cell applications across various global contexts. The aim is to amalgamate the existing body of knowledge, pinpoint areas awaiting further exploration, and pave the way for more effective strategies in skin cancer management.

Can we increase the value of data from bladder diaries? International Consultation on Incontinence-Research Society 2023.

Bladder diaries represent a fundamental component in the assessment of patients presenting with lower urinary tract symptoms. Nevertheless, their importance often remains underappreciated and undervalued within clinical practice. This paper aims to conduct a comprehensive review of the existing literature concerning the utility of bladder diaries, underscore the criticality of their precision, elucidate the factors contributing to noncompliance with bladder diary completion, and investigate potential strategies for enhancing patient compliance. A review of the English-language scientific literature available in the domains of Medline, Embase, Emcare, Midirs, and Cinahl was conducted. This was supplemented by discussion at the International Consultation on Incontinence Research Society Proposal session to define knowledge and identify gaps in knowledge surrounding the utility of bladder diaries. The existing evidence and outcome of the relevant discussion held in the meeting are presented. Bladder diaries (BD) serve to characterize the nature and severity of storage lower urinary tract symptoms (LUTS) and provide an objective record of an individual's urination patterns. They aid in the refinement and customization of treatment strategies based on the clinical responses documented in the diary, optimizing treatment outcomes. Notably, both BD and urodynamic studies (UDS) play complementary yet distinct roles in LUTS evaluation. BD offers a more comprehensive and accessible approach to assessing specific storage LUTS, particularly due to their affordability and widespread availability, especially in resource-limited settings. Nevertheless, the absence of a standardized BD format across global healthcare systems presents a significant challenge. Despite being recognized as reliable, noninvasive, validated, and cost-effective tools for evaluating patients with LUTS, the implementation and completion of BD have proven to be complex. The introduction of automated bladder diaries heralds an era of precise, real-time data collection, potentially enhancing the patient-clinician relationship. Completion of bladder diaries depends on an array of individual, social, and healthcare-specific factors. Compliance with bladder diary completion could be enhanced with clear instructions, patient education, regular follow-ups and positive re-enforcement. This study has identified four critical areas for future research: Addressing healthcare disparities between affluent and developing nations, enhancing the current functionality and effectiveness of bladder diaries, exploring the feasibility of incorporating bladder diaries into the treatment and education process and improving the quality and functionality of existing bladder diaries. Bladder diaries play a pivotal role in the evaluation and management of patients with LUTS, providing a holistic perspective. When their complete potential is harnessed, they have the capacity to revolutionize the paradigm of LUTS management, ushering in a patient-centered era of care.

Assessing changes in the pattern of healthcare-associated infectious agents in intensive care units during a novel coronavirus infection pandemic (COVID-19)

Introduction. The novel coronavirus infection (COVID-19) pandemic has been a major challenge to the global healthcare system, affecting more than 32 million patients worldwide. Unprecedented anti-epidemic measures carried out in hospitals allowed clinicians to hope for a decrease of hospital infection, however, the pandemic exacerbated the problem of the spread and circulation of multidrug-resistant bacteria in hospitals. The goal of study to conduct a comparative assessment of changes in the microbial landscape and the level of antibiotic resistance of the main pathogens of lower respiratory tract infections in ICU patients who were in different epidemiological conditions during the COVID-19 pandemic in comparison with the “pre-Covid” period. Materials and methods. A multicenter retrospective observational cohort study was conducted, which included the ICU of 4 hospitals in Yekaterinburg, which were in different epidemiological situations during the COVID-19 pandemic, as well as a comparative analysis of the length of stay of patients in the ICU, the frequency and duration of mechanical ventilation, the resuscitation mortality rate, and also the results of microbiological examination of sputum with an assessment of the structure of pathogens and the level of their antibiotic resistance. Results. The structure of pathogens in sputum in ICU patients of the “green zone” has not fundamentally changed. In the “red zone” there was an increase in the number of documented infections of the lower respiratory tract and blood flow, while hospitals showed differences in changes in the microbial landscape. The microbiological situation in the ICU of the “red zone” was characterized by a decrease in the number of isolated strains of Enterobacterales and non-fermenting Gram-negative bacteria by the end of the pandemic, as well as a significant increase fungi in sputum. In hospitals, where there was an alternation of periods of work in the “red” and “green” zones, there was a decrease of Enterobacterales, an increase in non-fermenting Gram-negative bacteria and a fungi. Among the microflora isolated by bacteriological methods in patients with COVID-19, gram-negative bacteria and fungi predominated, mainly Klebsiella pneumonia, Acinetobacter baumanii and fungi of the Candida spp. A significant increase in the proportion of fungi in sputum was noted in ICU patients in infectious diseases hospitals during the pandemic period. An increase in the level of antibiotic resistance of the main pathogens of lower respiratory tract infections was revealed with the appearance of multi-resistant and extremely resistant strains of Klebsiella pneumoniae and Acinetobacter baumanii. Discussion. Changes in the microbial landscape may indirectly reflect the features of immune damage in patients with a new coronavirus infection COVID-19, which, combined with the severity of the disease and the characteristics of its therapy, led to an increase in complications in the form of a secondary bacterial infection. The reasons for the increase in HAI cases include: an increase in the number of patients with severe comorbidities in an artificial closed ecosystem - the “red zone”; features of the methods of treatment (glucocorticosteroids, genetically engineered biological products - IL-6 inhibitors, etc.); high frequency of unreasonable use of antibacterial drugs; increase in the duration ofuse of various invasive devices and mechanical ventilation; changing the structure and practice of staffing hospitals, increasing the number of inexperienced medical workers and volunteers; inadequate hand hygiene, use of unsuitable individual protection means with a lack of developed methods for their processing in the new conditions. Conclusion. The results obtained indicate the importance of the work of a multidisciplinary with a microbiologist, epidemiologist, clinical pharmacologist in order to improve the quality of care for patients, especially in a difficult epidemiological situation. Surveillance over the spread of HAI pathogens should be attributed to the most progressive form of anti-epidemic activity. Microbiological monitoring and its results can serve as the basis for making managerial decisions to combat and prevent hospital infections. It is the main method for assessing the etiology, phenotype, mechanisms of resistance to antimicrobial drugs, allows you to identify epidemiological relationships between diseases, reasonably prescribe antibiotic therapy, and conduct targeted purchases of drugs (antibiotics) for the needs of this hospital.

Management of COVID-19 in a Sickle Cell Anaemia Patient: A Case Report

BACKGROUND: COVID-19 has had a significant impact on global healthcare systems, causing severe cases with acute respiratory distress syndrome, multi-organ failure, and death. Survivors of the virus may also experience long-term health problems. Sickle cell disease (SCD), an inherited red blood cell disorder, is characterized by chronic hemolytic anemia, vascular occlusion, and organ deterioration. SCD primarily affects African Americans, and common symptoms include acute and chronic pain, as well as severe conditions like acute chest syndrome and stroke. METHODS: We present the case of a 19-year-old female with sickle cell anemia who presented with symptoms of illness, jaundice, and no fever after receiving intravenous paracetamol. They were stable overall, with a Glasgow Coma Scale (GCS) score of 15/15 and no abnormal chest sounds. The patient had red, soft stools for two days and reduced bowel movements. Bowel sounds were normal, and they had sufficient urine output but experienced lower limb edema without joint swelling. Blood pressure was 107/62 mm Hg, mean arterial pressure was 72 mm Hg, pulse rate was 104 beats per minute, respiratory rate was 21 breaths per minute, and random blood glucose level was 102.5 mg/dL. The patient tested positive for COVID-19 via Polymerase Chain Reaction (PCR) testing. Laboratory results revealed low hemoglobin (6.8 g/dL), red blood cell count (2.16 x 10^6/micL), and high white blood cell count (22.4 x 10^3/micL) with 75.4% neutrophils. Hematocrit was 18.5%, mean corpuscular volume (MCV) was 85.7 pictogram/cell, mean corpuscular hemoglobin (MCH) was 31.4, mean corpuscular hemoglobin concentration (MCHC) was 36.7 g/dL, and platelet count was 215/micL. Other laboratory findings included urea (8 mg/dL), total protein (6.8 g/L), total bilirubin (2.15 mg/dL), direct bilirubin (0.98 mg/dL), aspartate aminotransferase (AST) (107 IU/L), alanine aminotransferase (ALT) (30 IU/L), alkaline phosphatase (ALP) (178 IU/L), and C-reactive protein (CRP) (48 mg/L). The patient's management plan involved intravenous dextrose and sodium chloride infusion, ceftriaxone (Samixon®), warfarin as needed, paracetamol as needed, folic acid once daily, vitamin C and zinc supplementation, levofloxacin once daily, Enema (Enemax) as needed, Pantoprazole (pantodac) (40 mg), nebulized hypertonic saline solution three times daily, diclofenac sodium (vortex) (75 mg) twice daily, and rivaroxaban (15 mg) twice daily. The patient received two blood transfusions during their hospital stay, with the first occurring on the first day of admission. CONCLUSION: Sickle cell anemia patients are at a higher risk of severe COVID-19 infection and associated complications. Early detection and treatment of complications are crucial. Blood transfusion, particularly red blood cell exchange transfusion, may be beneficial in managing these patients, reducing respiratory distress and the need for intensive care. However, more research is needed to establish optimal management strategies. This case report provides valuable insights into the presentation and management of sickle cell anemia patients with COVID-19. Clinicians should consider the examination findings and laboratory investigations for diagnosis and management. Limitations of this report include the lack of baseline information and long-term follow-up data, emphasizing the need for further research to generalize the findings.

Effects of a collaborative health management model on peoplewith congestive heart failure: A systematic review and meta-analysis.

To determine the effects of collaborative health management of congestive heart failure through the rigorous evaluation and extraction of evidence. Over the past two decades, cardiovascular disease has been the leading cause of death worldwide. Multidisciplinary team intervention for congestive heart failure has increased with population ageing and congestive heart failure incidence rate as well as cost of care. However, the effectiveness and feasibility of collaborative health management need to be explored. Systematic review and meta-analysis. We conducted systematic literature searches in the Cochrane Library, PubMed, CINAHL and Medline for articles published between 2002 and 2022. After screening based on the inclusion and exclusion criteria, 13 articles were included in a rigorous review and evidence extraction process, evaluated methodological quality using the Jadad Quality Scale. Statistical heterogeneity was evaluated using Review Manager (RevMan Version 5.4) for the meta-analysis. In this study, a systematic review and meta-analysis were performed on 13 studies regarding the collaborative health management of people with congestive heart failure. The common result is that the collaborative health management model enables the enhancement of self-care and monitoring abilities, the strengthening of cardiac function, the alleviation of physiological and psychological symptoms and the improvement of readmission rates, mortality rate and quality of life. The congestive heart failure collaborative health management model could decrease the hospitalization rate related to congestive heart failure, all-cause mortality rate, and all-cause hospitalization rate, and improve the quality of life. The collaborative health management model could effectively coordinate interdisciplinary team cooperation and provide information, which decreases hospitalization and mortality risks and improves their quality of life. Our paper is a systematic review and meta-analysis, and such details do not apply to our work. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The Collaborative Health Management Model provides in-depth insights, aiding in the design tailored to the specific circumstances of each country. Highlighting its critical role in the context of a global shortage of nursing staff, the model emphasizes the integration of multidisciplinary professional roles and the strengthening of collaboration as essential elements in addressing challenges posed by workforce shortages. Implementation of the Collaborative Health Management Model not only enhances patient care outcomes but also relieves pressure on healthcare systems, lowers medical costs, and addresses challenges arising from the shortage of nursing staff. Consequently, this model not only contributes to individual patient care improvement but also holds broader implications for enhancing the efficiency and sustainability of global healthcare systems. The detailed study protocol can be found on the PROSPERO website.

Features of anxiety and depressive disorders associated with COVID-19, on at different stages of the pandemic (literature review)

Annotation. The COVID-19 pandemic has worsened the state of mental health of the population, in particular caused an increase in the level of anxiety and depressive disorders. Scientific views on the causes, prevalence, clinical manifestations, and consequences of anxiety and depressive disorders associated with COVID-19 have changed and expanded over time. The purpose of our work is to study data on anxiety and depressive disorders associated with COVID-19 in the initial stages, in the period of intensive manifestations and in the stage of the consequences of the pandemic. We conducted a literature review and analysis based on the PubMed database. When searching for information on the study of anxiety and depressive disorders associated with COVID-19, combinations of keywords were used - anxiety, depressive disorders, COVID-19. As a result of a thorough search, the results of 34 studies on this issue, performed at various stages of the pandemic, were selected. The need for dynamic information on anxiety and depressive disorders associated with COVID-19 is essential for further improvement and development of the global health care system.

Impact of the COVID-19 pandemic on the attitude of parents to the use of vitamin K in newborns for prevention of bleeding due to vitamin K deficiency

Introduction and objective: The COVID-19 pandemic has significantly impacted the global healthcare system and all aspects of medical education. In this study, the knowledge of parents about the prophylactic use of vitamin K in newborns and infants, and the method of prophylaxis of vitamin K deficiency bleeding was assessed. Materials and methods: Data for the study were collected by conducting an online survey of 232 parents. They were assigned to two groups: group 1, responding before the COVID-19 pandemic, and group 2, responding during the COVID-19 pandemic. Results: Vitamin K was administered intramuscularly in 99% of cases in group 1 and 57% in group 2 (significant relationship – p &lt; 0.001). Half of group 2 mistakenly thought that vitamin K was given orally after childbirth. This answer was given by 20% of people from group 1 (p &lt; 0.001). Conversely, the correct answer (intramuscular injection) was given by 52% of respondents in group 1 and 46% in group 2. More parents in the pre-pandemic group knew the symptoms of vitamin K deficiency in the body (54% vs. 25%; p = 0.006), when compared to the parents surveyed during the pandemic. Almost half of group 2 (46%) and 23% of group 1 also reported that oral vitamin K supplementation is recommended after childbirth (p = 0.001). Conclusions: Based on the study, it can be concluded that parents’ knowledge of the prevention of vitamin K deficiency is low. The COVID-19 pandemic has had an adverse effect on the public awareness and education regarding vitamin K deficiency bleeding prophylaxis commonly used in Poland. There is a link between the emergence of the COVID-19 pandemic and parents’ perspectives on the intramuscular administration of vitamin K for the purpose of preventing deficiency.

Distribution incidence, mortality of tuberculosis and human development index in Iran: estimates from the global burden of disease study 2019

BackgroundTuberculosis is one of the most serious challenges facing the global healthcare system. This study aims to investigate the incidence and mortality of tuberculosis in Iran from 2010 to 2019 as well as its relationship with the human development index (HDI).MethodsThe present study is an ecological study aiming at investigating the incidence and mortality of tuberculosis in Iran during the years 2010 to 2019. The related data were extracted from the Global Burden of Disease (GBD) website. The spatial pattern attributed to tuberculosis in the provinces of Iran was analyzed using ArcGIS software. In this study, the two-variable correlation method was used to analyze the data extracted to study the correlation between Tuberculosis and HDI.ResultBased on the results recorded in GBD, the incidence of tuberculosis in 2010, that is, 14.61 (12.72, 16.74), declined compared to 2019, namely 12.29 (10.71, 14.09). The age-standardized mortality rate which was 1.63 (1.52, 1.73) in 2010, has decreased compared to 2019: 1.17 (1.07, 1.32). The incidence and mortality rates of tuberculosis in Iran in all age groups have decreased in 2019 compared to 2010. The highest incidence and mortality among tuberculosis patients were recorded in Sistan and Baluchistan and Golestan provinces. The results indicated that there was a negative and significant correlation between the mortality rate of tuberculosis and the human development index in 2010 (r = -0.509, P-value = 0.003) and 2019 (r = -0.36, P-value = 0.001); however, this correlation between incidence and human development index was not significant (p > 0.05).ConclusionSince mortality is mostly observed in areas with low HDI, health system policymakers must pay more attention to these areas in order to improve care and perform screenings to diagnose and treat patients thus reducing the mortality rate of tuberculosis and preventing an increase in its incidence in Iran.

Developing an AI-based decision engine for disease-modifying therapy in heart failure – A pilot study

Abstract Aim Heart failure is an escalating burden on global health care systems. Modernizing heart failure care is inevitable, with eHealth products poised to play an important role. However, eHealth devices that can initiate and adjust heart failure medication are currently lacking. Consequently, this study aimed to develop an artificial intelligence-based decision engine to provide guideline-based recommendations for disease-modifying medication in heart failure patients. Methods and Results We developed the decision engine by converting the ESC heart failure guidelines into Business Process Model and Notation, a visual modeling language suitable for developing complex decision engines. A safety evaluation, based on clinical parameters, was conducted to ascertain the system’s applicability to specific cases. The decision engine renders specific decisions concerning disease- modifying therapy for heart failure patients. We defined 72 virtual heart failure patient scenarios, encompassing a broad spectrum of baseline characteristics and background medication. All recommendations offered by the engine were evaluated by an independent heart failure specialist. All but three recommendations (94%) were identical to the treatment decisions by the heart failure specialist and all (100%) were in line with the 2021 ESC heart failure guidelines. Conclusion The decision engine offers guideline-based recommendations for disease-modifying therapy, positioning it as a tool to enhance self-care among heart failure patients. To validate our results, the decision engine is being prospectively tested in real-world patients in a multicenter clinical trial (NCT04699253).

HTA358 Value-Based Contracts Types Across Global Healthcare Systems: Comparing Perceptions Between Finance-Based and Outcomes-Based Agreements

HTA358 Value-Based Contracts Types Across Global Healthcare Systems: Comparing Perceptions Between Finance-Based and Outcomes-Based Agreements

Drivers of unprofessional behaviour between staff in acute care hospitals: a realist review

BackgroundUnprofessional behaviours (UB) between healthcare staff are rife in global healthcare systems, negatively impacting staff wellbeing, patient safety and care quality. Drivers of UBs include organisational, situational, team, and leadership issues which interact in complex ways. An improved understanding of these factors and their interactions would enable future interventions to better target these drivers of UB.MethodsA realist review following RAMESES guidelines was undertaken with stakeholder input. Initial theories were formulated drawing on reports known to the study team and scoping searches. A systematic search of databases including Embase, CINAHL, MEDLINE and HMIC was performed to identify literature for theory refinement. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories.ResultsWe included 81 reports (papers) from 2,977 deduplicated records of grey and academic reports, and 28 via Google, stakeholders, and team members, yielding a total of 109 reports. Five categories of contributor were formulated: (1) workplace disempowerment; (2) harmful workplace processes and cultures; (3) inhibited social cohesion; (4) reduced ability to speak up; and (5) lack of manager awareness and urgency. These resulted in direct increases to UB, reduced ability of staff to cope, and reduced ability to report, challenge or address UB. Twenty-three theories were developed to explain how these contributors work and interact, and how their outcomes differ across diverse staff groups. Staff most at risk of UB include women, new staff, staff with disabilities, and staff from minoritised groups. UB negatively impacted patient safety by impairing concentration, communication, ability to learn, confidence, and interpersonal trust.ConclusionExisting research has focused primarily on individual characteristics, but these are inconsistent, difficult to address, and can be used to deflect organisational responsibility. We present a comprehensive programme theory furthering understanding of contributors to UB, how they work and why, how they interact, whom they affect, and how patient safety is impacted. More research is needed to understand how and why minoritised staff are disproportionately affected by UB.Study registrationThis study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490.

COVID‐19 and cancer: Dichotomy of the menacing dilemma

AbstractThe coronavirus disease 2019 (COVID‐19) pandemic brought about unprecedented challenges to global healthcare systems. Among the most vulnerable populations are cancer patients, who face dilemmas due to their compromised immune systems and the intricate interplay with the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus. This comprehensive review delves into the multifaceted relationship between COVID‐19 and cancer. Through an analysis of existing literature and clinical data, this review unravels the structural intricacies of the virus and examines its profound implications for cancer patients, thereby bridging the knowledge gap between virology and oncology. The review commences with an introduction regarding the COVID‐19 pandemic and cancer. It then transitions into a detailed examination of the SARS‐CoV‐2 virus and its variants such as Alpha (PANGO lineage B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2), and Omicron (B.1.1.529 lineage). Subsequently, an insightful analysis of the impact of COVID‐19 on major cancer types (viz., Lung, Colon, Brain, and gastrointestinal cancer) is elaborated. Finally, the therapeutic avenues, oncological care, and management are discussed. The nexus between COVID‐19 and cancer adds a layer of complexity to patient care, emphasizing the importance of tailored approaches for those grappling with both conditions. Amid the landscape defined by the evolving viral strains, this review navigates through the multifaceted implications of COVID‐19 on cancer patients and underscores the significance of integrating virology and oncology.